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Population-based health principles in medical and public health practice.

Traditionally, medical education, research, and practice have focused on the care of the individual but an increasing emphasis on the care of populations has raised awareness among academic medical centers, integrated delivery systems, and managed care organizations of the value of embracing population-based health principles. Five principles are relevant in this regard: a community perspective, a clinical epidemiology perspective, evidence-based practice, an emphasis on outcomes, and an emphasis on prevention. This article describes these interrelated concepts together with specific strategies to effect implementation. Widespread awareness and adoption of these principles will have a profound impact on medical and public health education, practice, and ultimately the public's health.

Community Health Planning↗

Fat-related dietary behaviour: behavioural science concepts for public health practice.

Despite being central to Canadian health objectives, reduction in fat consumption remains a difficult health target to reach. Strong epidemiological data associate high dietary fat intake with cardiovascular disease (CVD). There has been considerable interest in applying concepts from psychosocial models of behaviour change to enhance the effectiveness of CVD prevention programs. This review suggests that the determinants of fat-related dietary behaviours can be integrated within a comprehensive model useful to public health practice. The Transtheoretical Model (TTM) is suggested as an organizing framework for variables empirically related to diet. The TTM holds that dietary change occurs through successive stages, defined according to people's readiness to adopt new behaviours. Furthermore, readiness to change can be explained by variables that are amenable to public health interventions. The integration of important variables within the TTM framework may prove helpful in designing, implementing and evaluating effective dietary change intervention programs in the community.

Cardiovascular Diseases↗

Exploring the role of complementary and alternative medicine in public health practice and training.

OBJECTIVES: Consumer use of complementary and alternative medicine (CAM) in the United States continues to expand. Although conventional medicine has responded actively, the response from public health has been far less pronounced. To examine the potential for integrating CAM into public health contexts, an exploratory survey was conducted. DESIGN: A 19-item, self-administered survey instrument was used to collect participant data. SETTINGS/LOCATION: Participants were surveyed at the 2003 American Public Health Association (APHA) annual meeting while attending CAM-related talks sponsored by the Alternative and Complementary Health Practices Special Interest Group (ACHP SPIG). SUBJECTS: A convenience sample of 153 individuals was surveyed, which was predominantly female (81%) and Caucasian (68%), with an average age of 42 years. OUTCOME MEASURES: The survey instrument included items about participant and client demographics, participant use of CAM (personal and professional), perceived client interest in CAM, and several attitude measures. RESULTS: The majority of participants (64%) were currently employed as public health professionals working in a wide variety of settings with highly diverse populations. Personal use of CAM was high (66% using four or more modalities). The majority also reported integrating CAM into work settings. There was a significant relationship between personal and professional use of CAM. Participants overwhelmingly agreed that more professional training in this area was needed. CONCLUSIONS: This exploratory study provides insight into the potential role of CAM as an important resource in public health settings. Additional funding and research in this area is urgently needed.

Adult↗

Analysis of the current status of public health practice in local health departments.

This article describes the performance by local health departments of core public health functions. A post hoc analysis based on these essential functions was implemented using the 1994 dataset from a cooperative project with the Centers for Disease Control and Prevention (CDC) and National Association of County and City Health Officials, which involved a survey of the nation's 2,888 local health departments. Applying guidelines for each functional area drafted by the Office of Disease Prevention and Health Promotion/Office of the Assistant Secretary for Health, CDC, and the Public Health Foundation in conjunction with the health officers in five states, a score was created for each core public health function: (1) health-related data collection, surveillance, and outcomes monitoring, (2) protection of environment, housing, food, and water, (3) investigation and control of diseases and injuries, (4) public information and education, (5) accountability and quality assurance, (6) laboratory services, (7) training and education, and (8) leadership, policy development, and administration. The individual and summary scores provide a mechanism to measure and describe the 2,079 local health departments' performance of these core functions and to examine their relationship to several characteristics and practices--planning, administrative units, annual total expenditures, and jurisdiction population size. This article shows that the core performance index is highest for the data function and for local health departments serving a population of 50,000 or more people. In addition, the performance index increases as budget increases and is greater for all eight functions in those local health departments using health planning models such as Assessment Protocol for Excellence in Public Health (APEX-PH), Planned Approach to Community Health (PATCH), Healthy People 2000, or Healthy Communities 2000. These results may be used to facilitate cooperation between local, state, and federal health agencies and the communities they serve; strengthen the core functions at the local, state, and federal levels; and improve public health practice.

Health Expenditures↗