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At least 91 records · Page 5Linked to original sources

The importance of public health for twenty-first-century health care: lessons from tuberculosis.

Once epidemic, tuberculosis has re-emerged, often in newly drug-resistant forms. This public health threat calls for strong public action as well as improved private care. Action has been hampered by failures in public health infrastructure and legal-philosophical support for government intervention. Josephine Gittler's accompanying article usefully suggests rebuilding public-health agencies and adapting traditional authority and controls from the age of epidemics to take account of today's circumstances and sensibilities.

Acquired Immunodeficiency Syndrome↗

The reinvigoration of public health nursing: methods and innovations.

Los Angeles County (LAC) restructured and reinvigorated public health in response to nationwide concern over the adequacy of all public health infrastructures and functions. LAC's reorganization into geographically defined service planning areas (SPAs) has facilitated the integration of core public health functions into local practice. Public health nurses practicing as generalists within their SPA identified three initial objectives to address in population-based care: (1) expanding practice beyond disease control to a more holistic approach, (2) providing consultation using the Ask-the-Nurse innovation, and (3) developing a community assessment database for interdisciplinary SPA health planning. Additional innovative objectives are planned for the future.

Community Health Planning↗

Neonatal screening program in Thailand.

The Neonatal Screening Program for congenital hypothyroidism (CHT) and phenylketonuria (PKU) commenced in 1996 with the objective of bringing better quality of life to people throughout the country, especially in the remote areas. This involved the implementation of routine services to the public health infrastructure all over the country. The plan of action has been designed so that by the year 2000 all public health service units throughout the country may provide screening services which can cover 1.2 million babies/ annum. Implementation of the screening program has been performed through public health sectors all over the country. These involved: education of the health personnel and communities, implementation of routine specimens collection and delivery systems to the central laboratories, establishment of central laboratory screening services, routine follow up and case management. Local in-house reagents using ELISA and IRMA techniques have been developed and utilized as screening and confirmation tests for CHT. In addition, Guthrie's test has been used for PKU screening and the automated Fluorometry has been selected for PKU confirmation. All 724 community hospitals have provided newborn screening services as one of the basic requirements for newborns according to public health policy. Of 1,425,025 babies screened, 3,450 (0.24%) were above the first screening cut off for CHT (TSH > 25 mU/l) and 321 (0.02%) for PKU (PKU > 4mg/dl). With a 63.10% follow up rate, the incidences were 1:3,314 for CHT and 1:237,504 for PKU. Newborn screening has been implemented as routine practice for all public health sectors of the country for CHT and PKU. It is expected that by the year 2003, all Thai newborns will be provided with screening services resulting in a better quality of life for the next generation.

Congenital Hypothyroidism↗

Use of corporate sponsorship as a tobacco marketing tool: a review of tobacco industry sponsorship in the USA, 1995-99.

OBJECTIVE: To describe the nature and extent of tobacco company sponsorship in the USA during the period 1995-99 and analyse this sponsorship in a marketing context. DESIGN: A cross-sectional study of tobacco company sponsorships identified through a customised research report from IEG Inc, and from internet web site searches. METHODS: First, a customised report was received from IEG Inc, which identified sponsorship activities for Philip Morris, RJ Reynolds, Brown & Williamson, Lorillard, and US Tobacco for the years 1997 and 1998. Second, the internet was systematically searched for tobacco industry sponsorships during the period 1995-99 by the same parent companies and their respective brands. RESULTS: During the period 1995-99, tobacco companies sponsored at least 2733 events, programmes, and organisations in the USA. Sponsorships involved all 50 states and the District of Columbia, and the minimum total funding amount of these sponsorships was $365.4 million. Tobacco corporate sponsorships involved numerous small, community based organisations, both through direct funding and through grants to larger umbrella organisations, and many of these organisations were part of the public health infrastructure. CONCLUSIONS: Tobacco corporate sponsorship serves as an important marketing tool for tobacco companies, serving both a sales promotion and public relations function. Public health practitioners need to develop better surveillance systems for monitoring tobacco sponsorship, to seek out alternative funding sources for tobacco company sponsored events and organisations, and to consider promoting a ban on tobacco sponsorship, possibly linking such regulation to the creation of alternative funding sources.

Advertising↗

Local variation in public health preparedness: lessons from California.

Since September 2001 Congress has allocated approximately dollars 3 billion to strengthen the public health infrastructure. To achieve this goal, the U.S. Centers for Disease Control and Prevention (CDC) allocates funding to states, which distribute funds to local jurisdictions. Evidence-based measures to assess public health preparedness are lacking. We used an expert-panel process to develop performance measures, based on the ten essential public health services. We developed and conducted tabletop exercises in California to evaluate preparedness to detect and respond to a hypothetical smallpox outbreak based on those measures. There was wide variation of readiness in California. While the sources of variation are often different, common infrastructure gaps need to be addressed.

California↗

Local health department applies incident management system for successful mass influenza clinics.

Faced with a national influenza vaccine shortage in fall 2004, the Anne Arundel County (Maryland) Department of Health was forced to alter plans for influenza vaccine distribution to reach County residents most at risk. While approximately 37,000 doses of vaccine had been ordered and were to be administered through 17 large flu clinics, only 8,000 doses of flu vaccine were now available for distribution. This year's vaccine shortage provided an opportunity to test the Department's capacity to mobilize mass clinics in the event of a natural emergency or bioterrorism. Implementation of Incident Management System and utilization of partnerships with County and State agencies and media proved that the community's readiness relies on the quality and training of the local public health infrastructure.

Disaster Planning↗

Powerful connections for public health: the National Library of Medicine and the National Network of Libraries of Medicine.

As incorporated in Healthy People 2010 objectives, data and information systems and a skilled workforce are 2 of the critical components of the public health infrastructure. The National Library of Medicine (NLM) and the National Network of Libraries of Medicine (NN/LM) are important resources for improving Internet access and providing related training to the public health workforce and to those in training for public health careers. The NLM and the NN/LM have joined forces with the Centers for Disease Control and Prevention, the Health Resources and Services Administration, the Association of State and Territorial Health Officials, the National Association of County and City Health Officials, and the Public Health Foundation. The goal of this collaboration is to improve electronic resources useful in public health practice and increase awareness of them, to train public health professionals to use electronic information services, and to help public health agencies obtain the equipment and Internet connections needed to use these services effectively. The databases, outreach programs, and connection grants available to public health professionals from the NLM, and the training and ongoing support available from the NN/LM for accessing these programs and services, are described.

Centers for Disease Control and Prevention, U.S.↗

Law and ethics in population health.

This paper proposes an action agenda to assure healthier and safer populations. First, create a strong public health infrastructure with sustainable funding and secure foundations--a well-trained workforce, modern data systems, rapid disease surveillance, and laboratory capacity. Second, use law as a tool for the public's health - tax and spend to create incentives for health, alter the informational and built environments to reduce risk behaviours, lower socio-economic disparities to improve health, regulate for the public's welfare, pursue tort litigation to innovate for safety, and deregulate to reduce harm. Third, create a new public health ethic in society that truly values human health--advocate for a renewed commitment to the ideals of community and partnership, and stress citizens' duties to help and protect their fellow human beings.

Government Regulation↗

Public health's response to a changed world: September 11, biological terrorism, and the development of an environmental health tracking network.

Historically, the importance of public health has often been recognized during or as a result of major tragedy. The attacks that occurred in the United States in 2001 are no exception. These events have raised awareness of our vulnerability and the need for emergency preparedness, the need for a flexible and sustainable public health infrastructure, and the importance of linkages between environmental exposures and health outcomes. The authors encourage the public health community, along with policymakers, to develop a national environmental health tracking system that can improve our overall public health capacity and prepare us to investigate the critical issues of the day, whether they be emerging infectious diseases, terrorist attacks, or chronic illnesses.

Anthrax↗

A prescription for change: the need for qualified physician leadership in public health.

A key element missing in the federal bioterrorism preparedness plan is qualified physician leadership at the local level. Physicians now lead fewer than one-fourth of local health departments. When appointed leaders are not physicians, leadership falls on elected officials or non-medical administrators who become managers of outbreaks. As illustrated in recent case examples, these leaders may find themselves in medical emergencies that they are not qualified to handle. In serious disease outbreaks, unprepared leadership could contribute to unnecessary illness and death. Here I propose strategies to increase qualified physician leadership in state and local public health infrastructures.

Bioterrorism↗

Quebec's approach to population health: an overview of policy content and organization.

While Canada's international leadership in the area of health promotion has been widely acknowledged in the past, Quebec's approach could be better known. Canada's second largest province has indeed developed a comprehensive public health infrastructure and adopted a population health approach which features an integrated set of legislative, organizational and programmatic policy instruments. These instruments not only ensure the core functions of public health, but also foster public intervention on the social determinants of health. In addition, Quebec's policy is supported by a solid research infrastructure, networked expertise and a mobilized workforce among health professionals. In spite of the interest it represents for the larger public health community in Canada and elsewhere, this largely French-speaking province's approach remains little known because of language and cultural barriers between Quebec and Anglo-Saxon countries, and it has yet to be systematically discussed in the English-language literature. This article provides an overview of policies and administrative structures in Quebec to support public health and address socially determined inequalities in health. It analyzes the development of these policies over the past decade and offers insight to their core content.

Health Policy↗

Infectious diseases. China awakens to fight projected AIDS crisis.

Official tallies count only 670 confirmed AIDS cases and 18,143 confirmed HIV-infected people among China's 1.2 billion population. Now changing social mores, including an increase in drug use and a boom in commercial sex, combined with a tainted blood supply, have led China to the brink of an AIDS explosion. But its historic isolation also gives the country an advantage in testing the latest vaccines, as the different strains of HIV have not yet commingled there; China's well-developed public health infrastructure could also help facilitate clinical trials.

AIDS Vaccines↗

Improving cardiovascular disease prevention and management in Africa: issues to consider for the 21st century.

There is substantial evidence that cardiovascular diseases, and their associated risk factors, are becoming an increasing threat to the health of a large portion of the populace in many areas of Africa, particularly sub-Saharan Africa. If not adequately addressed, this epidemic will place an even greater burden on the poor economies and weak public health infrastructures of this continent. Important strategies for curtailing this epidemic will include primordial, primary, and secondary prevention, population-based prevention programs, improved research and surveillance, and increased governmental accountability for the adequate appropriation of public health.

Africa↗

Building sustainable public health systems change at the state level.

Reforming the public health infrastructure requires substantial system changes at the state level, including the reorganization of state agencies' plans, roles, and relationships with other sectors and communities. Beyond the limited time period of pilot programs and grants, how are these public health system changes to be sustained? Turning Point is an initiative of The Robert Wood Johnson Foundation to transform and strengthen the public health system. The 21 states participating in this initiative developed multisector partnerships to produce public health improvement plans and from these, chose one or more priorities for implementation. Reform efforts to strengthen the public health system occur within complex fiscal and political environments, however, and must cope with both uncertainty and turbulence in the process of implementing change. Turning Point state partners have developed a variety of approaches to the challenge of incorporating effective community collaborations as a permanent strategy for transforming public health systems. A qualitative, descriptive study design was used to analyze the strategies used by Turning Point state partnerships to meet the challenges of sustaining their system improvements. These strategies included: institutionalization within government, establishing "third sector" institutions, cultivating relationships with significant allies, and enhancing communication and visibility among multiple communities.

Community Health Planning↗

Public health nurses and the prevention of and intervention in family violence.

This article seeks to describe the current efforts of public health nurses involved in family violence prevention while on home visits, participating in community groups, working on special projects, and developing innovative policies. Despite a dearth of outcomes research and data regarding public health nursing practice in this area, both strengths and weakness in public health nursing practice are evident. Improvements in nursing education related to family violence, an increase in multidisciplinary collaboration by public health nurses, and improvements in the utilization of public health nurses in the public health infrastructure and in primary prevention efforts would remove many barriers to effective family violence prevention strategies.

Crisis Intervention↗

The global emergence/resurgence of arboviral diseases as public health problems.

During the past 20 years there has been a dramatic resurgence or emergence of epidemic arboviral diseases affecting both humans and domestic animals. These epidemics have been caused primarily by viruses thought to be under control such as dengue, Japanese encephalitis, yellow fever, and Venezuelan equine encephalitis, or viruses that have expanded their geographic distribution such as West Nile and Rift Valley fever. Several of these viruses are presented as case studies to illustrate the changing epidemiology. The factors responsible for the dramatic resurgence of arboviral diseases in the waning years of the 20th century are discussed, as is the need for rebuilding the public health infrastructure to deal with epidemic vector-borne diseases in the 21st century.

Animals↗

The challenges of emerging illness in urban environments: an overview.

The New York City West Nile outbreak is an important case study for examining several medical and public health issues raised by the specter of emerging illnesses in urban areas. Five specific issues are addressed in this issue of the Journal of Urban Health: ecosystem health, vector (e.g., mosquito) control, risk communication, public health infrastructure, and parallels between this outbreak and bioterrorism.

Animals↗

Quantitative evaluation of "Can It Happen in Kansas: Response to Terrorism and Emerging Infections".

PURPOSE: This study describes the evaluation of a 2-year plan to train 10 percent of Kansas' multidisciplinary health professionals for response to terrorism and emerging infections. This project was part of a national effort covering 19 states funded by the Health Resources and Services Administration in 2003. METHODS: The initial training occurred in six 2-day workshops. A terrorism preparedness questionnaire was developed to assess Health Resources and Services Administration terrorism response competencies/learning objectives. These were measured before, after, and 3 months after training in a hybrid cross-sectional and cohort follow-up design. RESULTS: Health professionals' mean scores significantly improved on all four Health Resources and Services Administration terrorism self-reported competencies from pretest to posttest. Three months posttraining, health professionals' mean scores decreased slightly but remained significantly higher than their pretest scores. CONCLUSIONS: This project prepared healthcare professionals to respond to the medical consequences of terrorism. The integration of core competencies into the evaluation plan allowed for trainees to evaluate their confidence and abilities. The evaluation plan and curriculum may serve as useful tools for preparation of healthcare workers nationwide, with the potential to rebuild the public health infrastructure to assume preparedness responsibilities.

Adult↗