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Bishai D, Saleh BM, Huda M, Aly EM, Hafiz M, Ardalan A, Mataria A. Practical strategies to achieve resilient health systems: results from a scoping review. BMC Health Serv Res 2024; 24:297. [PMID: 38449026 PMCID: PMC10918906 DOI: 10.1186/s12913-024-10650-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 01/28/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND This paper presents the results of a systematic review to identify practical strategies to create the institutions, skills, values, and norms that will improve health systems resilience. METHODS A PRISMA 2020 compliant systematic review identified peer-reviewed and gray literature on practical strategies to make health systems more resilient. Investigators screened 970 papers to identify 65 English language papers published since 2015. RESULTS Practical strategies focus efforts on system changes to improve a health system's resilience components of collective knowing, collective thinking, and collaborative doing. The most helpful studies identified potential lead organizations to serve as the stewards of resilience improvement, and these were commonly in national and local departments of public health. Papers on practical strategies suggested possible measurement tools to benchmark resilience components in efforts to focus on performance improvement and ways to sustain their use. Essential Public Health Function (EPHF) measurement and improvement tools are well-aligned to the resilience agenda. The field of health systems resilience lacks empirical trials linking resilience improvement interventions to outcomes. CONCLUSIONS The rigorous assessment of practical strategies to improve resilience based on cycles of measurement should be a high priority.
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Affiliation(s)
- David Bishai
- University of Hong Kong School of Public Health, Hong Kong, China.
| | - Basma M Saleh
- Institute of Global Health and Human Ecology, American University of Cairo, Cairo, Egypt
| | - Maryam Huda
- Department of Community Medicine, Aga Khan University, Karachi, Pakistan
| | - Eman Mohammed Aly
- Institute of Global Health and Human Ecology, American University of Cairo, Cairo, Egypt
| | - Marwa Hafiz
- Institute of Global Health and Human Ecology, American University of Cairo, Cairo, Egypt
| | - Ali Ardalan
- World Health Organization Eastern Mediterranean Regional Office, Cairo, Egypt
| | - Awad Mataria
- World Health Organization Eastern Mediterranean Regional Office, Cairo, Egypt
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McCullough JM, Narain K, Rhoads N, Fielding JE, Teutsch SM, Zimmerman FJ. Quantifying the Value of Prevention: A Survey of Public Health Departments' Quantitative and Economic Modeling Capacity. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2020; 25:E18-E26. [PMID: 31136521 DOI: 10.1097/phh.0000000000000988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To improve the understanding of local health departments' (LHDs') capacity for and perceived barriers to using quantitative/economic modeling information to inform policy and program decisions. DESIGN We developed, tested, and deployed a novel survey to examine this topic. SETTING The study's sample frame included the 200 largest LHDs in terms of size of population served plus all other accredited LHDs (n = 67). The survey was e-mailed to 267 LHDs; respondents completed the survey online using SurveyMonkey. PARTICIPANTS Survey instructions requested that the survey be completed from the perspective of the entire health department by LHD's top executive or designate. A total of 63 unique LHDs responded (response rate: 39%). MAIN OUTCOME MEASURE(S) Capacity for quantitative and economic modeling was measured in 5 categories (routinely use information from models we create ourselves; routinely use information from models created by others; sometimes use information from models we create ourselves; sometimes use information from models created by others; never use information from modeling). Experience with modeling was measured in 4 categories (very, somewhat, not so, not at all). RESULTS Few (9.5%) respondents reported routinely using information from models, and most who did used information from models created by others. By contrast, respondents reported high levels of interest in using models and in gaining training in their use and the communication of model results. The most commonly reported barriers to modeling were funding and technical skills. Nearly all types of training topics listed were of interest. CONCLUSIONS Across a sample of large and/or accredited LHDs, we found modest levels of use of modeling coupled with strong interest in capacity for modeling and therefore highlight an opportunity for LHD growth and support. Both funding constraints and a lack of knowledge of how to develop and/or use modeling are barriers to desired progress around modeling. Educational or funding opportunities to promote capacity for and use of quantitative and economic modeling may catalyze use of modeling by public health practitioners.
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Affiliation(s)
- J Mac McCullough
- College of Health Solutions, Arizona State University, Phoenix, Arizona (Dr McCullough); Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine UCLA, Los Angeles, California (Dr Narain); UCLA Center for Health Advancement, Los Angeles, California (Drs Narain, Fielding, Teutsch, and Zimmerman and Ms Rhoads); UCLA Geffen School of Medicine, Los Angeles, California (Dr Fielding); and UCLA Fielding School of Public Health Department of Health Policy and Management, Los Angeles, California (Drs Fielding, Teutsch, and Zimmerman)
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Ballard A. Framing Bias in the Interpretation of Quality Improvement Data: Evidence From an Experiment. Int J Health Policy Manag 2019; 8:307-314. [PMID: 31204447 PMCID: PMC6571496 DOI: 10.15171/ijhpm.2019.08] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 02/16/2019] [Indexed: 12/02/2022] Open
Abstract
Background: A growing body of public management literature sheds light on potential shortcomings to quality improvement (QI) and performance management efforts. These challenges stem from heuristics individuals use when interpreting data. Evidence from studies of citizens suggests that individuals’ evaluation of data is influenced by the linguistic framing or context of that information and may bias the way they use such information for decision-making. This study extends prospect theory into the field of public health QI by utilizing an experimental design to test for equivalency framing effects on how public health professionals interpret common QI indicators.
Methods: An experimental design utilizing randomly assigned survey vignettes is used to test for the influence of framing effects in the interpretation of QI data. The web-based survey assigned a national sample of 286 city and county health officers to a "positive frame" group or a "negative frame" group and measured perceptions of organizational performance. The majority of respondents self-report as organizational leadership.
Results: Public health managers are indeed susceptible to these framing effects and to a similar degree as citizens. Specifically, they tend to interpret QI information presented in a "positive frame" as indicating a higher level of performance as the same underlying data presenting in a "negative frame." These results are statistically significant and pass robustness checks when regressed against control variables and alternative sources of information.
Conclusion: This study helps identify potential areas of reform within the reporting aspects of QI systems. Specifically, there is a need to fully contextualize data when presenting even to subject matter experts to reduce the existence of bias when making decisions and introduce training in data presentation and basic numeracy prior to fully engaging in QI initiatives.
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Affiliation(s)
- Andrew Ballard
- School of Public Affairs and Administration, Rutgers University, Newark, NJ, USA
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Local Boards of Health as Linkages Between Local Health Departments and Health Care and Other Community Organizations. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2018; 26:E17-E23. [DOI: 10.1097/phh.0000000000000858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Development and Usefulness of a District Health Systems Tool for Performance Improvement in Essential Public Health Functions in Botswana and Mozambique. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2018; 22:586-96. [PMID: 27682727 DOI: 10.1097/phh.0000000000000407] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION This study describes the development of a self-audit tool for public health and the associated methodology for implementing a district health system self-audit tool that can provide quantitative data on how district governments perceive their performance of the essential public health functions. METHODS Development began with a consensus-building process to engage Ministry of Health and provincial health officers in Mozambique and Botswana. We then worked with lists of relevant public health functions as determined by these stakeholders to adapt a self-audit tool describing essential public health functions to each country's health system. We then piloted the tool across districts in both countries and conducted interviews with district health personnel to determine health workers' perception of the usefulness of the approach. RESULTS Country stakeholders were able to develop consensus around 11 essential public health functions that were relevant in each country. Pilots of the self-audit tool enabled the tool to be effectively shortened. Pilots also disclosed a tendency to upcode during self-audits that was checked by group deliberation. Convening sessions at the district enabled better attendance and representative deliberation. Instant feedback from the audit was a feature that 100% of pilot respondents found most useful. CONCLUSION The development of metrics that provide feedback on public health performance can be used as an aid in the self-assessment of health system performance at the district level. Measurements of practice can open the door to future applications for practice improvement and research into the determinants and consequences of better public health practice. The current tool can be assessed for its usefulness to district health managers in improving their public health practice. The tool can also be used by the Ministry of Health or external donors in the African region for monitoring the district-level performance of the essential public health functions.
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Fitter DL, Delson DB, Guillaume FD, Schaad AW, Moffett DB, Poncelet JL, Lowrance D, Gelting R. Applying a New Framework for Public Health Systems Recovery following Emergencies and Disasters: The Example of Haiti following a Major Earthquake and Cholera Outbreak. Am J Trop Med Hyg 2017; 97:4-11. [PMID: 29064359 PMCID: PMC5676637 DOI: 10.4269/ajtmh.16-0862] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 06/09/2017] [Indexed: 11/25/2022] Open
Abstract
Emergencies can often directly impact health systems of an affected region or country, especially in resource-constrained areas. Health system recovery following an emergency is a complex and dynamic process. Health system recovery efforts have often been structured around the World Health Organization's health systems building blocks as demonstrated by the Post-Disaster Needs Assessment. Although this structure is valuable and well known, it can overlook the intricacies of public health systems. We retrospectively examine public health systems recovery, a subset of the larger health system, following the 2010 Haiti earthquake and cholera outbreak, through the lens of the 10 essential public health services. This framework illustrates the comprehensive nature of and helps categorize the activities necessary for a well-functioning public health system and can complement other assessments. Outlining the features of a public health system for recovery in structured manner can also help lay the foundation for sustainable long-term development leading to a more robust and resilient health system.
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Affiliation(s)
- David L. Fitter
- Centers for Disease Control and Prevention, Port-au-Prince, Haiti
| | | | | | | | | | | | - David Lowrance
- Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
| | - Richard Gelting
- Centers for Disease Control and Prevention, Atlanta, Georgia
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State and Local Health Department Activities Related to Abortion: A Web Site Content Analysis. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2017; 24:255-262. [PMID: 28857971 PMCID: PMC5895165 DOI: 10.1097/phh.0000000000000647] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Context: Recent legislation in states across the United States has required governmental health agencies to take on new and different roles in relation to abortion. While there has been media attention to health department roles in regulating abortion providers, there has been no systematic investigation of the range of activities in which state and local health departments are engaged. Objective: To systematically investigate health department activities related to abortion. Methods: We searched state health department Web sites of the 50 states and District of Columbia using key words such as “abortion” and “pregnancy termination”. Two trained coders categorized 6093 documents using the 10 Essential Public Health Services (EPHS) framework. We then applied these methods to 671 local health department documents. Setting: State and local health department Web sites. Participants: N/A. Results: On average, states engaged in 5.1 of 10 Essential Services related to abortion. Most (76%-98%) state health departments engaged in activities to Monitor Health Status (EPHS1), Enforce Laws (EPHS6), and Evaluate Effectiveness, Accessibility, and Quality (EPHS9). Many (47%-69%) engaged in activities to Inform and Educate (EPHS3), Develop Policies (EPHS5), and Link to Services (EPHS7). A minority (4%-29%) engaged in activities to Diagnose and Investigate Health Problems (EPHS2), Mobilize Community Partnerships (EPHS4), and Assure Competent Workforce (EPHS8). No state engaged in Innovative Research (EPHS10). Few local health departments engaged in abortion-related activities. Conclusions: While most state health departments engage in abortion-related activities, they appear to reflect what the law requires rather than the range of core public health activities. Additional research is needed to assess whether these services meet quality standards for public health services and determine how best to support governmental health agencies in their growing tasks. These findings raise important questions about the role of public health agencies and professionals in defining how health departments should be engaging with abortion.
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The Tobacco Control Network's Policy Readiness and Stage of Change Assessment: What the Results Suggest for Moving Tobacco Control Efforts Forward at the State and Territorial Levels. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2017; 22:9-19. [PMID: 25822902 DOI: 10.1097/phh.0000000000000247] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT The Tobacco Control Network (TCN) is comprised of the tobacco control programs in the health departments of states, territories, and the District of Columbia. During the assessment period, the TCN was managed by the Tobacco Technical Assistance Consortium at Emory University. OBJECTIVE To assess the readiness of state and territory tobacco control programs to work on evidence-based, promising policy and system change strategies aimed at preventing and reducing tobacco use and secondhand smoke exposure. DESIGN The Policy Readiness and Stage of Change Assessment was a Web-based survey fielded in September 2013, which was based on the Community Readiness Model. SETTING Fifty-nine comprehensive tobacco control programs. PARTICIPANTS State and territory tobacco control program managers and their internal and external partners. INTERVENTION The TCN's 2012 Policy Platform recommendations were used as the basis to assess state/territory readiness to adopt and implement evidence-based and promising tobacco control policy/system change strategies. MAIN OUTCOME MEASURES Sixteen tobacco control strategies were rated on: (1) implementation status, (2) readiness, (3) stage of change, and (4) the appropriate level of action for work on the strategy. RESULTS The 3 strategies with the highest readiness scores were as follows: (1) 100% smoke-free air in workplaces (64%), (2) tobacco-free schools (61%), and (3) $1.50 or less cigarette tax with funds to tobacco control (53%). The 3 strategies with lowest readiness scores were: 1) coupon redemption (17%), 2) tobacco mitigation fee (14%), and 3) disclosure or sunshine laws (8%). CONCLUSION Readiness to work on tobacco control strategies varied by region and strategy. Many states/territories are ready to work on strategies for which there is less evidence of a population-level impact for reducing tobacco use, but which contribute to denormalizing tobacco use. Working toward less impactful policies may build support, capacity, and policy success, laying an important foundation to achieve more impactful strategies.
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Leider JP, Bharthapudi K, Pineau V, Liu L, Harper E. The Methods Behind PH WINS. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2017; 21 Suppl 6:S28-35. [PMID: 26422490 PMCID: PMC4590521 DOI: 10.1097/phh.0000000000000285] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Supplemental Digital Content is Available in the Text. This article outlines the conceptualization, development, and implementation of the Public Health Workforce Interests and Needs Survey, as well as considerations and limitations. The Public Health Workforce Interests and Needs Survey (PH WINS) has yielded the first-ever nationally representative sample of state health agency central office employees. The survey represents a step forward in rigorous, systematic data collection to inform the public health workforce development agenda in the United States. PH WINS is a Web-based survey and was developed with guidance from a panel of public health workforce experts including practitioners and researchers. It draws heavily from existing and validated items and focuses on 4 main areas: workforce perceptions about training needs, workplace environment and job satisfaction, perceptions about national trends, and demographics. This article outlines the conceptualization, development, and implementation of PH WINS, as well as considerations and limitations. It also describes the creation of 2 new data sets that will be available in public use for public health officials and researchers—a nationally representative data set for permanently employed state health agency central office employees comprising over 10 000 responses, and a pilot data set with approximately 12 000 local and regional health department staff responses.
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Affiliation(s)
- Jonathon P Leider
- de Beaumont Foundation, Bethesda, Maryland (Dr Leider); Association of State and Territorial Health Officials, Arlington, Virginia (Drs Bharthapudi and Harper); and NORC at the University of Chicago, Bethesda, Maryland (Mss Pineau and Liu)
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Abstract
Supplemental Digital Content is Available in the Text. This article examines the attitudes, perceptions, and practices of public health practitioners with respect to the concept of foundational capabilities. Context: National efforts are underway to classify a minimum set of public health services that all jurisdictions throughout the United States should provide regardless of location. Such a set of basic programs would be supported by crosscutting services, known as the “foundational capabilities” (FCs). These FCs are assessment services, preparedness and disaster response, policy development, communications, community partnership, and organizational support activities. Objective: To ascertain familiarity with the term and concept of FCs and gather related perspectives from state and local public health practitioners. Design: In fall 2013, we interviewed 50 leaders from state and local health departments. We asked about familiarity with the term “foundational capabilities,” as well as the broader concept of FCs. We attempted to triangulate the utility of the FC concept by asking respondents about priority programs and services, about perceived unique contributions made by public health, and about prevalence and funding for the FCs. Setting: Telephone-based interviews. Participants: Fifty leaders of state and local health departments. Main Outcome Measures: Practitioner familiarity with and perspectives on the FCs, information about current funding streams for public health, and the likelihood of creating nationwide FCs that would be recognized and accepted by all jurisdictions. Results: Slightly more than half of the leaders interviewed said that they were familiar with the concept of FCs. In most cases, health departments had all of the capabilities to some degree, although operationalization varied. Few indicated that current funding levels were sufficient to support implementing a minimum level of FCs nationally. Conclusions: Respondents were not able to articulate the current or optimal levels of services for the various capabilities, nor the costs associated with them. Further research is needed to understand the role of FCs as part of the foundational public health services.
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State Public Health Enabling Authorities: Results of a Fundamental Activities Assessment Examining Core and Essential Services. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2016; 22:529-36. [PMID: 27682724 DOI: 10.1097/phh.0000000000000347] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Public health enabling authorities establish the legal foundation for financing, organizing, and delivering public health services. State laws vary in terms of the content, depth, and breadth of these fundamental public health activities. Given this variance, the Institute of Medicine has identified state public health laws as an area that requires further examination. To respond to this call for further examination, the Centers for Disease Control and Prevention's Public Health Law Program conducted a fundamental activities legal assessment on state public health laws. OBJECTIVE The goal of the legal assessment was to examine state laws referencing frameworks representing public health department fundamental activities (ie, core and essential services) in an effort to identify, catalog, and describe enabling authorities of state governmental public health systems. DESIGN In 2013, Public Health Law Program staff compiled a list of state statutes and regulations referencing different commonly-recognized public health frameworks of fundamental activities. The legal assessment included state fundamental activities laws available on WestlawNext as of July 2013. The results related to the 10 essential public health services and the 3 core public health functions were confirmed and updated in June 2016. RESULTS Eighteen states reference commonly-recognized frameworks of fundamental activities in their laws. Thirteen states have listed the 10 essential public health services in their laws. Eight of these states have also referenced the 3 core public health functions in their laws. Five states reference only the core public health functions. CONCLUSIONS Several states reference fundamental activities in their state laws, particularly through use of the essential services framework. Further work is needed to capture the public health laws and practices of states that may be performing fundamental activities but without reference to a common framework.
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Harris JK, Beatty K, Leider JP, Knudson A, Anderson BL, Meit M. The Double Disparity Facing Rural Local Health Departments. Annu Rev Public Health 2016; 37:167-84. [PMID: 26735428 DOI: 10.1146/annurev-publhealth-031914-122755] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Residents of rural jurisdictions face significant health challenges, including some of the highest rates of risky health behaviors and worst health outcomes of any group in the country. Rural communities are served by smaller local health departments (LHDs) that are more understaffed and underfunded than their suburban and urban peers. As a result of history and current need, rural LHDs are more likely than their urban peers to be providers of direct health services, leading to relatively lower levels of population-focused activities. This review examines the double disparity faced by rural LHDs and their constituents: pervasively poorer health behaviors and outcomes and a historical lack of investment by local, state, and federal public health entities.
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Affiliation(s)
- Jenine K Harris
- Brown School, Washington University in St. Louis, St. Louis, Missouri 63130;
| | - Kate Beatty
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee 37614;
| | - J P Leider
- Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland 21205;
| | - Alana Knudson
- Public Health Department.,NORC Walsh Center for Rural Health Analysis, University of Chicago, Chicago, Illinois 60637; , ,
| | - Britta L Anderson
- NORC Walsh Center for Rural Health Analysis, University of Chicago, Chicago, Illinois 60637; , ,
| | - Michael Meit
- Public Health Department.,NORC Walsh Center for Rural Health Analysis, University of Chicago, Chicago, Illinois 60637; , ,
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Leider JP, Castrucci BC, Harris JK, Hearne S. The Relationship of Policymaking and Networking Characteristics among Leaders of Large Urban Health Departments. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:9169-80. [PMID: 26258784 PMCID: PMC4555272 DOI: 10.3390/ijerph120809169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 07/27/2015] [Accepted: 07/29/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND The relationship between policy networks and policy development among local health departments (LHDs) is a growing area of interest to public health practitioners and researchers alike. In this study, we examine policy activity and ties between public health leadership across large urban health departments. METHODS This study uses data from a national profile of local health departments as well as responses from a survey sent to three staff members (local health official, chief of policy, chief science officer) in each of 16 urban health departments in the United States. Network questions related to frequency of contact with health department personnel in other cities. Using exponential random graph models, network density and centrality were examined, as were patterns of communication among those working on several policy areas using exponential random graph models. RESULTS All 16 LHDs were active in communicating about chronic disease as well as about use of alcohol, tobacco, and other drugs (ATOD). Connectedness was highest among local health officials (density = .55), and slightly lower for chief science officers (d = .33) and chiefs of policy (d = .29). After accounting for organizational characteristics, policy homophily (i.e., when two network members match on a single characteristic) and tenure were the most significant predictors of formation of network ties. CONCLUSION Networking across health departments has the potential for accelerating the adoption of public health policies. This study suggests similar policy interests and formation of connections among senior leadership can potentially drive greater connectedness among other staff.
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Affiliation(s)
- Jonathon P Leider
- Beaumont Foundation, 7501 Wisconsin Avenue, Suite 1310E Bethesda, Maryland, MD 20814, USA.
| | - Brian C Castrucci
- Beaumont Foundation, 7501 Wisconsin Avenue, Suite 1310E Bethesda, Maryland, MD 20814, USA.
| | - Jenine K Harris
- Brown School, Center for Public Health Systems Science, Washington University in St. Louis, Missouri, MO 63130, USA.
| | - Shelley Hearne
- Director, Big Cities Health Coalition, National Association of County and City Health Officials, 1100 17th Street, NW, Seventh Floor, Washington, DC 20036, USA.
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Thomas CW, Corso L, Monroe JA. The value of the "system" in public health services and systems research. Am J Public Health 2015; 105 Suppl 2:S147-9. [PMID: 25689189 PMCID: PMC4355686 DOI: 10.2105/ajph.2015.302625] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2015] [Indexed: 11/04/2022]
Affiliation(s)
- Craig W Thomas
- All authors are with Office for State, Tribal, Local and Territorial Support, Centers for Disease Control and Prevention, Atlanta, GA
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Use of fees to fund local public health services in Western Massachusetts. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2014; 21:167-75. [PMID: 24717556 DOI: 10.1097/phh.0000000000000082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Recent budget cuts have forced many local health departments (LHDs) to cut staff and services. Setting fees that cover the cost of service provision is one option for continuing to fund certain activities. OBJECTIVE To describe the use of fees by LHDs in Western Massachusetts and determine whether fees charged cover the cost of providing selected services. DESIGN A cross-sectional descriptive analysis was used to identify the types of services for which fees are charged and the fee amounts charged. A comparative cost analysis was conducted to compare fees charged with estimated costs of service provision. SETTING AND PARTICIPANTS Fifty-nine LHDs in Western Massachusetts. MAIN OUTCOME MEASURES Number of towns charging fees for selected types of services; minimum, maximum, and mean fee amounts; estimated cost of service provision; number of towns experiencing a surplus or deficit for each service; and average size of deficits experienced. RESULTS Enormous variation exists both in the types of services for which fees are charged and fee amounts charged. Fees set by most health departments did not cover the cost of service provision. Some fees were set as much as $600 below estimated costs. CONCLUSIONS These results suggest that considerations other than costs of service provision factor into the setting of fees by LHDs in Western Massachusetts. Given their limited and often uncertain funding, LHDs could benefit from examining their fee schedules to ensure that the fee amounts charged cover the costs of providing the services. Cost estimates should include at least the health agent's wage and time spent performing inspections and completing paperwork, travel expenses, and cost of necessary materials.
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Leveraging the Revised National Public Health Performance Standards to Meet Today's Ever-Changing Public Health System Landscape. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2014; 20:135-7. [DOI: 10.1097/phh.0b013e3182a7bdae] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mays GP, Hogg RA, Castellanos-Cruz DM, Hoover AG, Fowler LC. Public health research implementation and translation: evidence from practice-based research networks. Am J Prev Med 2013; 45:752-62. [PMID: 24237919 PMCID: PMC4366056 DOI: 10.1016/j.amepre.2013.08.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 07/23/2013] [Accepted: 08/13/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Research on how best to deliver efficacious public health strategies in heterogeneous community and organizational contexts remains limited. Such studies require the active engagement of public health practice settings in the design, implementation, and translation of research. Practice-based research networks (PBRNs) provide mechanisms for research engagement, but until now they have not been tested in public health settings. PURPOSE This study uses data from participants in 14 public health PBRNs and a national comparison group of public health agencies to study processes influencing the engagement of public health settings in research implementation and translation activities. METHODS A cross-sectional network analysis survey was fielded with participants in public health PBRNs approximately 1 year after network formation (n=357) and with a nationally representative comparison group of U.S. local health departments not participating in PBRNs (n=625). Hierarchic regression models were used to estimate how organizational attributes and PBRN network structures influence engagement in research implementation and translation activities. Data were collected in 2010-2012 and analyzed in 2012. RESULTS Among PBRN participants, both researchers and practice agencies reported high levels of engagement in research activities. Local public health agencies participating in PBRNs were two to three times more likely than nonparticipating agencies to engage in research implementation and translation activities (p<0.05). Participants in less densely connected PBRN networks and in more peripheral locations within these networks reported higher levels of research engagement, greater perceived benefits from engagement, and greater likelihood of continued participation. CONCLUSIONS PBRN networks can serve as effective mechanisms for facilitating research implementation and translation among public health practice settings.
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Affiliation(s)
- Glen P Mays
- Department of Health Services Management, College of Public Health, University of Kentucky, Lexington, Kentucky
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Scutchfield DF, Miron E, Ingram RC. From service provision to function based performance - perspectives on public health systems from the USA and Israel. Isr J Health Policy Res 2012; 1:46. [PMID: 23181452 PMCID: PMC3560218 DOI: 10.1186/2045-4015-1-46] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 10/15/2012] [Indexed: 11/10/2022] Open
Abstract
If public health agencies are to fulfill their overall mission, they need to have defined measurable targets and should structure services to reach these targets, rather than offer a combination of ill-targeted programs. In order to do this, it is essential that there be a clear definition of what public health should do- a definition that does not ebb and flow based upon the prevailing political winds, but rather is based upon professional standards and measurements.The establishment of the Essential Public Health Services framework in the U.S.A. was a major move in that direction, and the model, or revisions of the model, have been adopted beyond the borders of the U.S.This article reviews the U.S. public health system, the needs and processes which brought about the development of the 10 Essential Public Health Services (EPHS), and historical and contemporary applications of the model. It highlights the value of establishing a common delineation of public health activities such as those contained in the EPHS, and explores the validity of using the same process in other countries through a discussion of the development in Israel of a similar model, the 10 Public Health Essential Functions (PHEF), that describes the activities of Israel's public health system. The use of the same process and framework to develop similar yet distinct frameworks suggests that the process has wide applicability, and may be beneficial to any public health system.Once a model is developed, it can be used to measure public health performance and improve the quality of services delivered through the development of standards and measures based upon the model, which could, ultimately, improve the health of the communities that depend upon public health agencies to protect their well-being.
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Affiliation(s)
- Douglas F Scutchfield
- University of Kentucky College of Public Health, 111 Washington Avenue, Lexington, KY, 40509, U.S.A
| | - Ehud Miron
- Israel Association of Public Health Physicians, Nissenboim 4/23, Haifa, 32807, Israel
| | - Richard C Ingram
- University of Kentucky College of Public Health, 111 Washington Avenue, Lexington, KY, 40509, U.S.A
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Mobley J, Zuniga MA. Training primary care physicians for local health authority duties in Texas. Am J Public Health 2012; 102:e21-6. [PMID: 22594741 DOI: 10.2105/ajph.2012.300688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Only one fourth of Texas counties have a local health authority (LHA) or health district. Primary care physicians in the remaining counties could be trained in public health basics by providing an online LHA training course and courses at annual meetings of the Texas Medical Association and the Texas Academy of Family Physicians. The Texas Department of State Health Services should develop a web portal for LHAs. The Texas Association of Local Health Officials should also provide automatic limited membership for LHAs. These initiatives would provide public health training to primary care physicians and would greatly improve availability of public health services for the citizens of Texas.
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Affiliation(s)
- James Mobley
- San Patricio County Department of Public Health, Sinton, TX, USA.
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Ingram RC, Scutchfield FD, Charnigo R, Riddell MC. Local public health system performance and community health outcomes. Am J Prev Med 2012; 42:214-20. [PMID: 22341157 DOI: 10.1016/j.amepre.2011.10.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 10/07/2011] [Accepted: 10/28/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND Public health systems are charged with protecting the health and well-being of the communities they serve. Higher-performing public health systems should be associated with improved community health status. Currently, little research examines the impact of variations in public health system performance on community health outcomes. PURPOSE The current study seeks to provide local public health system partners with evidence regarding the impact of their efforts. It does so through examining the relationship between variations in local public health system performance in providing the core functions of public health (assessment, assurance, and policy development) and community health outcomes. METHODS Measures of community health status (dependent variables) and community demographic characteristics, collected from 1994 to 2003, were merged with measures of public health system performance collected from 2002 to 2007 (independent variables). For each dependent variable, Pearson correlations were calculated with all of the independent variables. Multivariate linear regression models were developed for each health outcome. Analysis was completed in 2010. RESULTS Bivariate analysis found nine associations between local public health system performance and health outcomes. Linear regression models found associations between performance and three of the six outcomes measured. The outcomes associated with performance are those that would seem to be most sensitive to variations in practice. Poverty is significantly associated with all the health outcomes measured. CONCLUSIONS These associations between performance and health outcomes suggest that improving performance of the core functions of public health may improve health.
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Affiliation(s)
- Richard C Ingram
- Department of Health Services Management, University of Kentucky College of Public Health, Lexington, Kentucky, USA.
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Phillips VL, Teweldemedhin B, Ahmedov S, Cobb J, McNabb SJN. Evaluation of program performance and expenditures in a report of performance measures (RPM) via a case study of two Florida county tuberculosis programs. EVALUATION AND PROGRAM PLANNING 2010; 33:373-378. [PMID: 20138366 DOI: 10.1016/j.evalprogplan.2010.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Revised: 11/09/2009] [Accepted: 01/08/2010] [Indexed: 05/28/2023]
Abstract
Health Department (HD) managers at both state and local levels are in desperate need of tools to assist in monitoring and evaluating programs. The purpose of this study is to assess the feasibility and utility of linking program performance scores and expenditures into a Report of Performance Measures (RPM). We analyzed secondary data on performance indicators, selected by HD staff, and expenditures, related to six surveillance activities, from two, similar, high-incidence, tuberculosis (TB) programs in Florida from 2002 to 2003. We compared the findings between the county HDs as an illustration of basic cost-effectiveness benchmarking, based on the cost-effectiveness grid. Data included here provide examples of: (1) two instances in which one county was operating relatively inefficiently compared to the other; (2) two instances in which performance and expenditures were similar for the counties; and (3) two instances in which one county spent more for higher performance scores than the other. These data illustrate how the RPM can be used to facilitate benchmarking, a basic evaluation tool. They also demonstrate ways to identify potential operational inefficiencies in a single time period and ultimately over time. It is thus likely to be a feasible and useful management tool.
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Affiliation(s)
- V L Phillips
- Department of Health Policy and Management, Rollins School of Public Health of Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA.
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Wholey DR, White KM, Kader H. Accreditation and accountability: is the cart before the horse? Am J Public Health 2010; 100:4-5; author reply 5-6. [PMID: 19910339 DOI: 10.2105/ajph.2009.181123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Supporting Public Health Departments' Quality Improvement Initiatives. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2010; 16:14-8. [DOI: 10.1097/phh.0b013e3181ce96df] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Quality Improvement in Local Health Departments. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2009; 15:494-502. [DOI: 10.1097/phh.0b013e3181aab5ca] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Felix HC, Bronstein J, Bursac Z, Stewart MK, Foushee HR, Klapow J. Family planning provider referral, facilitation behavior, and patient follow-up for abnormal Pap smears. Public Health Rep 2009; 124:733-44. [PMID: 19753952 DOI: 10.1177/003335490912400516] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Family planning (FP) clinics are important access points for cervical cancer screening and referrals for follow-up care for abnormal Papanicolaou (Pap) smears for a substantial number of U.S. women. Because little is known about referral and facilitation practices in these clinics or client action based on referrals, we sought to determine FP provider referral and facilitation practices when seeing FP clients with abnormal Pap smear results, and FP client follow-up for abnormal Pap smears due to FP provider referrals. METHODS We conducted a mail survey of Medicaid-enrolled FP providers in Arkansas and Alabama, and conducted a telephone survey with a sample of FP clients of those providers responding to the provider survey. RESULTS Major provider factors associated with referral included rural location, health department and clinic institutional setting, large Title X practice/clinic size, and high FP clinic focus. Major factors associated with facilitation included rural location, non-physician specialty, health department and clinic institutional setting, and small Title X clinic size. Of women reporting abnormal results, 62.4% reported follow-up care. Of those who received follow-up care, 40.0% received some care and a referral from their FP provider. A major factor associated with clients seeking follow-up care was being told by their FP provider where to go for follow-up care. Age was a major factor associated with clients actually obtaining follow-up care. CONCLUSIONS Where follow-up care is not available at the FP site, referrals are critical and are a major factor associated with whether women seek care for the condition. Interventions to increase follow-up rates should focus on provider and system features, rather than clients.
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Affiliation(s)
- Holly C Felix
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham St., Slot 820, Little Rock, AR 72205, USA.
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Scutchfield FD, Mays GP, Lurie N. Applying health services research to public health practice: an emerging priority. Health Serv Res 2009; 44:1775-87. [PMID: 19686256 DOI: 10.1111/j.1475-6773.2009.01007.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Wholey DR, Gregg W, Moscovice I. Public health systems: a social networks perspective. Health Serv Res 2009; 44:1842-62. [PMID: 19686252 DOI: 10.1111/j.1475-6773.2009.01011.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To examine the relationship between public health system network density and organizational centrality in public health systems and public health governance, community size, and health status in three public health domains. DATA SOURCES/STUDY SETTING During the fall and the winter of 2007-2008, primary data were collected on the organization and composition of eight rural public health systems. STUDY DESIGN Multivariate analysis and network graphical tools are used in a case comparative design to examine public health system network density and organizational centrality in the domains of adolescent health, senior health, and preparedness. Differences associated with public health governance (centralized, decentralized), urbanization (micropolitan, noncore), health status, public health domain, and collaboration area are described. DATA COLLECTION/EXTRACTION METHODS Site visit interviews with key informants from local organizations and a web-based survey administered to local stakeholders. PRINCIPAL FINDINGS Governance, urbanization, public health domain, and health status are associated with public health system network structures. The centrality of local health departments (LHDs) varies across public health domains and urbanization. Collaboration is greater in assessment, assurance, and advocacy than in seeking funding. CONCLUSIONS If public health system organization is causally related to improved health status, studying individual system components such as LHDs will prove insufficient for studying the impact of public health systems.
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Affiliation(s)
- Douglas R Wholey
- Division of Health Policy & Management, University of Minnesota, School of Public Health, Minneapolis, MN 55455-0392, USA.
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Aqil A, Lippeveld T, Hozumi D. PRISM framework: a paradigm shift for designing, strengthening and evaluating routine health information systems. Health Policy Plan 2009; 24:217-28. [PMID: 19304786 PMCID: PMC2670976 DOI: 10.1093/heapol/czp010] [Citation(s) in RCA: 199] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2009] [Indexed: 11/22/2022] Open
Abstract
The utility and effectiveness of routine health information systems (RHIS) in improving health system performance in developing countries has been questioned. This paper argues that the health system needs internal mechanisms to develop performance targets, track progress, and create and manage knowledge for continuous improvement. Based on documented RHIS weaknesses, we have developed the Performance of Routine Information System Management (PRISM) framework, an innovative approach to design, strengthen and evaluate RHIS. The PRISM framework offers a paradigm shift by putting emphasis on RHIS performance and incorporating the organizational, technical and behavioural determinants of performance. By describing causal pathways of these determinants, the PRISM framework encourages and guides the development of interventions for strengthening or reforming RHIS. Furthermore, it conceptualizes and proposes a methodology for measuring the impact of RHIS on health system performance. Ultimately, the PRISM framework, in spite of its challenges and competing paradigms, proposes a new agenda for building and sustaining information systems, for the promotion of an information culture, and for encouraging accountability in health systems.
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Affiliation(s)
- Anwer Aqil
- MEASURE Evaluation, 1616 N. Fort Mayer Drive, Arlington, VA 22209, USA.
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Scutchfield FD, Bhandari MW, Lawhorn NA, Lamberth CD, Ingram RC. Public health performance. Am J Prev Med 2009; 36:266-72. [PMID: 19215852 DOI: 10.1016/j.amepre.2008.11.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2007] [Revised: 08/26/2008] [Accepted: 11/07/2008] [Indexed: 11/18/2022]
Abstract
This review examines past, current, and future issues in developing and using public health performance data for improving the public health system. Issues are explored relating to public health performance data collection and analysis, and inferences made from those data, largely by examining public health performance data collected since the Year 2000. More research is needed to improve understanding of the context in which public health systems operate and how that context affects performance and its relationship to health outcomes. There are major areas of concern that must be addressed by the public health practice organizations, governmental public health entities, and the public health systems research communities, such as ensuring that data are collected on public health infrastructure, practice, and performance and that data from various sources are collected in a harmonious fashion. At issue also is the examination of the impact of new arrivals to the public health system, such as accreditation and credentialing of the public health workforce, on public health system performance.
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Olson D, Hoeppner M, Larson S, Ehrenberg A, Leitheiser AT. Lifelong learning for public health practice education: a model curriculum for bioterrorism and emergency readiness. Public Health Rep 2008; 123 Suppl 2:53-64. [PMID: 18773523 PMCID: PMC2430942 DOI: 10.1177/00333549081230s208] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
In 2002, the University of Minnesota School of Public Health (UMNSPH) adopted an approach that supports basic, advanced, and continuing education curricula to train current and future public health workers. This model for lifelong learning for public health practice education allows for the integration of competency domains from the Council on Linkages Between Academia and Public Health Practice's core public health workforce competency levels and the Centers for Disease Control and Prevention's Bioterrorism and Emergency Readiness Competencies. This article describes how UMNSPH has implemented the model through coordination with state planning efforts and needs assessments in the tristate region of Minnesota, North Dakota, and Wisconsin. In addition, we discuss methods used for credentialing practitioners who have achieved competency at various levels of performance to enhance the capacity of the public health preparedness systems.
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Affiliation(s)
- Debra Olson
- University of Minnesota School of Public Health, Minneapolis, MN 55455, USA.
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Bagley P, Lin V, Sainsbury P, Wise M, Keating T, Roger K. In what ways does the mandatory nature of Victoria's municipal public health planning framework impact on the planning process and outcomes? AUSTRALIA AND NEW ZEALAND HEALTH POLICY 2007; 4:4. [PMID: 17376248 PMCID: PMC1851012 DOI: 10.1186/1743-8462-4-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2006] [Accepted: 03/22/2007] [Indexed: 11/27/2022]
Abstract
Background Systems for planning are a critical component of the infrastructure for public health. Both in Australia and internationally there is growing interest in how planning processes might best be strengthened to improve health outcomes for communities. In Australia the delivery of public health varies across states, and mandated municipal public health planning is being introduced or considered in a number of jurisdictions. In 1988 the Victorian State government enacted legislation that made it mandatory for each local government to produce a Municipal Public Health Plan, offering us a 20-year experience to consider. Results In-depth interviews were undertaken with those involved in public health planning at the local government level, as part of a larger study on local public health infrastructure and capacity. From these interviews four significant themes emerge. Firstly, there is general agreement that the Victorian framework of mandatory public health planning has led to improvements in systems for planning. However, there is some debate about the degree of that improvement. Secondly, there is considerable variation in the way in which councils approach planning and the priority they attach to the process. Thirdly, there is concern that the focus is on producing a plan rather than on implementing the plan. Finally, some tension over priorities is evident. Those responsible for developing Municipal Public Health Plans express frustration over the difficulty of having issues they believe are important addressed through the MPHP process. Conclusion There are criticisms of Victoria's system for public health planning at the local government level. Some of these issues may be specific to the arrangement in Victoria, others are problems encountered in public health planning generally. In Victoria where the delivery structure for public health is diverse, a system of mandatory planning has created a minimum standard. The implementation of the framework was slow and factors in the broader political environment had a significant impact. Work done in recent years to support the process appears to have led to improvements. There are lessons for other states as they embark upon mandated public health plans.
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Affiliation(s)
| | - Vivian Lin
- La Trobe University, Melbourne, Australia
| | | | | | | | - Karen Roger
- National Public Health Partnership, Melbourne, Australia
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Joly BM, O'Rourke K, Tilson HH, Leonard JF. Use of national public health performance standards to assess Maine's diabetes system. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2007; 13:68-71. [PMID: 17149102 DOI: 10.1097/00124784-200701000-00011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In the fall of 2003, Maine underwent a rigorous assessment of the diabetes public health system using a modified version of the State Public Health System Performance Instrument developed by the Centers for Disease Control and Prevention's National Public Health Performance Standards Program and other national partners. The assessment was intended to serve as the impetus for the development of a statewide improvement plan. This article details the assessment process and provides a case study highlighting the successful application of systems-based model standards for a categorical issue.
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Affiliation(s)
- Brenda M Joly
- Department of Health Policy and Management, Muskie School of Public Service, University of Southern Maine, Augusta, Maine 04330, USA.
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Mays GP, McHugh MC, Shim K, Perry N, Lenaway D, Halverson PK, Moonesinghe R. Institutional and economic determinants of public health system performance. Am J Public Health 2006; 96:523-31. [PMID: 16449584 PMCID: PMC1470518 DOI: 10.2105/ajph.2005.064253] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Although a growing body of evidence demonstrates that availability and quality of essential public health services vary widely across communities, relatively little is known about the factors that give rise to these variations. We examined the association of institutional, financial, and community characteristics of local public health delivery systems and the performance of essential services. METHODS Performance measures were collected from local public health systems in 7 states and combined with secondary data sources. Multivariate, linear, and nonlinear regression models were used to estimate associations between system characteristics and the performance of essential services. RESULTS Performance varied significantly with the size, financial resources, and organizational structure of local public health systems, with some public health services appearing more sensitive to these characteristics than others. Staffing levels and community characteristics also appeared to be related to the performance of selected services. CONCLUSIONS Reconfiguring the organization and financing of public health systems in some communities-such as through consolidation and enhanced intergovernmental coordination-may hold promise for improving the performance of essential services.
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Affiliation(s)
- Glen P Mays
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR 72205, USA.
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Pearson D, Thompson J, Finkbonner J, Williams C, D'Ambrosio L. Assessment of public health workforce bioterrorism and emergency preparedness readiness among tribes in Washington State: a collaborative approach among the Northwest Center for Public Health Practice, the Northwest Portland Area Indian Health Board, and the Washington State Department of Health. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2005; Suppl:S113-8. [PMID: 16205529 DOI: 10.1097/00124784-200511001-00019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article examines the collaboration, methodology, results, and lessons learned stemming from the experience of a unique university, state, and tribal collaborative model for public health emergency preparedness assessment activities. This collaborative model may be applicable to other public health preparedness efforts, as well as the broader range of general public health or workforce development partnerships between state, local, and tribal health departments and academic institutions.
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Affiliation(s)
- Dave Pearson
- Group Health Community Foundation, 1730 Minor Avenue, Ste. 1500, Seattle, WA 98101, USA.
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Corso LC, Wiesner PJ, Lenihan P. Developing the MAPP community health improvement tool. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2005; 11:387-92. [PMID: 16103811 DOI: 10.1097/00124784-200509000-00003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
From 1997 to 2001, the National Association of County and City Health Officials, in collaboration with the Centers for Disease Control and Prevention's Public Health Practice Program Office, developed a new community strategic planning tool, titled Mobilizing for Action through Planning and Partnerships (MAPP). This article provides a chronological description of the development of MAPP, devoting significant attention to pivotal decisions, development milestones, and distinguishing features of this new public health planning tool. All phases of the development ensured a practice-driven process, ongoing substantive input from the field, careful attention to research and literature, and intentional linkage with related efforts. This deliberate process laid the foundation for a tool that is not only well grounded in research and concepts but also relevant for practical use in communities. The process also demonstrates how practice-based research can be conducted in a way that effectively balances the need for applied relevance with intellectual integrity.
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Affiliation(s)
- Liza C Corso
- Office of the Chief of Public Health Practice, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
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Abstract
Based on the concepts of quality and public health and of public health organizations as service organizations, the advisability of establishing a reference model for quality in public health, incorporating objective criteria, indicators and standards, is discussed. The 2 main models of quality management in the field of service organizations, ISO 9001-2000 and EFQM, are reviewed and their advantages and disadvantages with respect to their application in public health services are contrasted. Based on the Institute of Medicine's definition of the functions of public health, we followed the approach of the Delphi study of the World Health Organization and the Assessment Protocol for Excellence in Public Health (APEX PH) model. The NPHPSP of the Centers for Disease Control is described in detail. We propose the use of this model as the reference model for quality management and improvement in public health organizations. Finally, we conclude that the approval of the Law of Cohesion and Quality of the National Health System by the Spanish parliament, which lays out the eight main health services that the National Health System should provide, would allow the NPHSPS to be adapted to our environment as a tool for quality management of Spanish public health services.
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Affiliation(s)
- Joan Guix Oliver
- Unidad de Medicina Preventiva y Salud Pública, Universidad Rovira i Virgili, Reus, Tarragona, Spain.
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Baker EL, Potter MA, Jones DL, Mercer SL, Cioffi JP, Green LW, Halverson PK, Lichtveld MY, Fleming DW. The public health infrastructure and our nation's health. Annu Rev Public Health 2005; 26:303-18. [PMID: 15760291 DOI: 10.1146/annurev.publhealth.26.021304.144647] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Threats to Americans' health-including chronic disease, emerging infectious disease, and bioterrorism-are present and growing, and the public health system is responsible for addressing these challenges. Public health systems in the United States are built on an infrastructure of workforce, information systems, and organizational capacity; in each of these areas, however, serious deficits have been well documented. Here we draw on two 2003 Institute of Medicine reports and present evidence for current threats and the weakness of our public health infrastructure. We describe major initiatives to systematically assess, invest in, rebuild, and evaluate workforce competency, information systems, and organizational capacity through public policy making, practical initiatives, and practice-oriented research. These initiatives are based on applied science and a shared federal-state approach to public accountability. We conclude that a newly strengthened public health infrastructure must be sustained in the future through a balancing of the values inherent in the federal system.
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Affiliation(s)
- Edward L Baker
- The North Carolina Institute for Public Health, Chapel Hill, 27599-8165, USA.
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Lower T, Durham G, Bow D, Larson A. Implementation of the Australian core public health functions in rural Western Australia. Aust N Z J Public Health 2005; 28:418-25. [PMID: 15707183 DOI: 10.1111/j.1467-842x.2004.tb00023.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To assess the implementation of the Australian core functions of public health in rural Western Australia. METHODS Cross-sectional surveys (n=26) and semi-structured key informant interviews (n=64) with public health practitioners throughout each of the eight rural health regions in Western Australia. A scoring system was utilised to categorise responses that were frequently part of current practice (score=2), sometimes undertaken (score=1) and rare or not undertaken at all (score=0). RESULTS Functions with reasonably good coverage (mean score 1.0) included: preventing and controlling communicable and non-communicable diseases; promoting and supporting healthy lifestyles; planning, funding, managing and evaluating health gain; ensuring safe and healthy environments; and contributing to healthy growth and development through all life stages. Lower levels of coverage were found for: assessing health needs; developing healthy public policy and fiscal measures; strengthening communities; and improving health for Aboriginal people and other vulnerable groups. CONCLUSIONS There are limitations in the capacity of the rural public health workforce in Western Australia to implement the core public health functions. While some areas were defined as being adequately addressed, gaps in implementation appeared across all nine functions. IMPLICATIONS The Australian core functions can be utilised to broadly assess current public health practice, however further development of the functions and their measurement, plus methods to align accountability measures for current public health practice with the core functions, are required.
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Affiliation(s)
- T Lower
- Combined Universities Centre for Rural Health, Western Australia.
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Lower T, Durham G, Bow D, Larson A. Implementation of the Australian core public health functions in rural Western Australia. Aust N Z J Public Health 2004. [DOI: 10.1111/j.1467-842x.2004.tb00940.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Mays GP, McHugh MC, Shim K, Lenaway D, Halverson PK, Moonesinghe R, Honoré P. Getting What You Pay For. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2004; 10:435-43. [PMID: 15552769 DOI: 10.1097/00124784-200409000-00011] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Governmental spending in public health varies widely across communities, raising questions about how these differences may affect the availability of essential services and infrastructure. This study used data from local public health systems that participated in the National Public Health Performance Standards Program pilot tests between 1999 and 2001 to examine the association between public health spending and the performance of essential public health services. Results indicated that performance varies significantly with both local and federal spending levels, even after controlling for other system and community characteristics. Some public health services appear more sensitive to these expenditures than others, and all services appear more sensitive to local spending than to state or federal spending. These findings can assist public health decision makers in identifying public health financing priorities during periods of change in the resources available to support local public health infrastructure.
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Affiliation(s)
- Glen P Mays
- Department of Health Policy and Management, College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham, #820, Little Rock, AR 72205, USA.
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Mays GP, Halverson PK, Baker EL, Stevens R, Vann JJ. Availability and perceived effectiveness of public health activities in the nation's most populous communities. Am J Public Health 2004; 94:1019-26. [PMID: 15249309 PMCID: PMC1448383 DOI: 10.2105/ajph.94.6.1019] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the availability and perceived effectiveness of 20 basic public health activities in the communities where most Americans reside. METHODS A self-administered questionnaire was mailed to the 497 directors of US local health departments serving at least 100 000 residents. RESULTS On average, two thirds of the 20 public health activities were performed in the local jurisdictions surveyed, and the perceived effectiveness rating averaged 35% of the maximum possible. In multivariate models, availability of public health activities varied significantly according to population size, socioeconomic measures, local health department spending, and presence of local boards of health. CONCLUSIONS Local public health capacity varies widely across the nation's most populous communities, highlighting the need for targeted improvement efforts.
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Affiliation(s)
- Glen P Mays
- Mathematica Policy Research, Washington, DC, USA.
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Mays GP, McHugh MC, Shim K, Perry N, Halverson PK, Lenaway D, Moonesinge R. Identifying Dimensions of Performance in Local Public Health Systems. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2004; 10:193-203. [PMID: 15253515 DOI: 10.1097/00124784-200405000-00003] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article uses data from the National Public Health Performance Standards Program to explore how the performance of essential public health services varies across communities and to identify underlying domains of activity that appear to drive variation in performance. Cross-sectional data were used from 315 local public health jurisdictions located within seven states that participated in the Performance Standards Program pilot tests between 1999 and 2001. Results demonstrate that local public health systems vary considerably in the extent to which they perform essential services and meet established performance standards. Factor analysis results indicate that four underlying domains of activity explain much of the variation observed in the individual performance measures, and that achieving performance standards for a single essential public health service often involves more than one underlying domain of activity. The findings suggest that composite measures constructed from the Performance Standards Program can assist public health decision makers in monitoring the performance of public health systems and identifying promising pathways for improving performance.
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Affiliation(s)
- Glen P Mays
- Mathematica Policy Research, Inc., Washington, DC 20024, USA.
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Potter MA, Ley CE, Fertman CI, Eggleston MM, Duman S. Evaluating workforce development: perspectives, processes, and lessons learned. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2004; 9:489-95. [PMID: 14606187 DOI: 10.1097/00124784-200311000-00008] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Evaluating workforce development for public health is a high priority for federal funders, public health agencies, trainees, trainers, and academic researchers. But each of these stakeholders has a different set of interests. Thus, the evolving science of training evaluation in the public health sector is being pulled simultaneously in a number of different directions, each emphasizing different methods, indicators, data-collection instruments, and reporting priorities. We pilot-tested the evaluation of a 30-hour, competency-based training course in a large urban health department. The evaluation processes included strategic, baseline assessment of organizational capacity by the agency; demographic data on trainees as required by the funder; a pre- and posttraining inventory of beliefs and attitudes followed by a posttraining trainee satisfaction survey as required by the trainers and the agency; and a 9-month posttraining follow-up survey and discussion of learning usefulness and organizational impact as desired by the academic researchers and the trainers. Routinely requiring all of these processes in training programs would be overly burdensome, time-consuming, and expensive. This pilot experience offers some important practical lessons for training evaluations in the future.
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Affiliation(s)
- Margaret A Potter
- Center for Public Health Practice, University of Pittsburgh, Graduate School of Public Health, 3109 Forbes Avenue, Suite 210, Pittsburgh, PA 15260, USA
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Potter MA, Barron G, Cioffi JP. A model for public health workforce development using the National Public Health Performance Standards Program. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2003; 9:199-207. [PMID: 12747316 DOI: 10.1097/00124784-200305000-00004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Workforce development programs in public health should link improvements in workers' performance with improvements in their agencies' performance. The "ten essential services" of public health provide criteria for measuring both individual worker training (as in workforce competency standards) and agency performance (as in the Centers for Disease Control and Prevention's National Public Health Performance Standards Program). This shared foundation was the basis for a model strategic training program developed for use in a 500-employee urban county health department. Full implementation of this model as a foundation for assessment, curriculum development, and evaluation requires careful attention to management issues, confidentiality of employee records, and evaluation methodologies.
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Affiliation(s)
- Margaret A Potter
- Center for Public Health Practice, University of Pittsburgh, Pennsylvania, USA
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Malone RE. Tobacco industry surveillance of public health groups: the case of STAT (Stop Teenage Addiction to Tobacco) and INFACT (Infant Formula Action Coalition). Am J Public Health 2002; 92:955-60. [PMID: 12036789 PMCID: PMC1447494 DOI: 10.2105/ajph.92.6.955] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The goal of this study was to describe how the tobacco industry collects information about public health groups. METHODS Publicly available internal tobacco industry documents were reviewed and analyzed using a chronological case study approach. RESULTS The industry engaged in aggressive intelligence gathering, used intermediaries to obtain materials under false pretenses, sent public relations spies to the organizations' meetings, and covertly taped strategy sessions. Other industry strategies included publicly minimizing the effects of boycotts, painting health advocates as "extreme," identifying and exploiting disagreements, and planning to "redirect the funding" of tobacco control organizations to other purposes. CONCLUSIONS Public health advocates often make light of tobacco industry observers, but industry surveillance may be real, intense, and covert and may obstruct public health initiatives.
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Affiliation(s)
- Ruth E Malone
- Department of Social and Behavioral Sciences, School of Nursing, and Institute for Health Policy Studies, University of California, San Francisco, 94143-0936, USA.
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