Areas Of Public Health Practice Research Articles

Gaining influence: Developing a Healthy Public Policy Unit at Vancouver Coastal Health.

Regional Public Health Unit (Office of the Chief MHO, Vancouver Coastal Health Authority, BC, Canada). Recognizing the need to invest resources that strategically move public health work "upstream" where policies and investments can shape the determinants of health, the Office of the Chief MHO for Vancouver Coastal Health embarked on a process in 2019 to develop a population health team designed to engage in Healthy Public Policy (HPP) and Health in All Policies (HiAP) approaches to health promotion. The mission and design of this unit was informed by internal and external research and engagement which continued even through the COVID-19 pandemic. Inthe fall of 2022, this new unit, the first of its kind in British Columbia, was launched. In 2023, it embarked on strategic planning, engaged in key public policy processes, and implemented priority areas of work to help advance healthy public policy in the region, including the development of processes, tools, and practices to support a more systematic and rigorous approach to this emerging area of public health practice. The creation of this new Healthy Public Policy Unit invites discussion within Canada's public health community on the issue of resource allocation to support upstream interventions seeking to build the capacity and effectiveness of HPP and HiAP approaches.

Readying the Applied Epidemiology Workforce for Emerging Areas of Public Health Practice.

Epidemiologists are key professionals within the public health workforce. As the role of public health agencies changes over time, epidemiologists will need to adapt and develop new skill sets to work in emerging areas of (public health) practice (EAoPs), which are areas of practice that are new or are growing in interest and use. This mixed-methods research study sought to explore the role and readiness of state health department epidemiologists in the United States to work in EAoPs. Three phases of data collection and analysis were conducted including secondary analysis of the Public Health Workforce Interests and Needs Survey, a survey of the designated state epidemiologist in all 50 states and the District of Columbia, and focus groups with early-, mid-, and senior-career epidemiologists working in state health departments. Fifty state health departments and the District of Columbia. Epidemiologists working in state health departments. Identification of EAoPs relevant to epidemiologists, the role of epidemiologists in these EAoPs, and readiness of epidemiologists to work in EAoPs. Participant state health department epidemiologists indicated that the studied EAoPs were important to their work and that epidemiologists have some role in them. Key facilitators identified to working in EAoPs included supportive organizational strategy and leadership, dedicated time for training and work, cross-training across programs, and the development of crosscutting skills. There is much opportunity for epidemiologists to be more engaged in current EAoPs. Not only can epidemiologists supply relevant data but they can also bring skills and expertise to help improve the overall success of population health improvement work. Workforce development strategies should be implemented to ensure a nimble epidemiology workforce that can readily adapt to the needs of future public health practice.

Health Educators in State/Local Public Health Departments: Training Needs and Awareness of Emerging Areas of Public Health Practice.

Although great progress has been made to define the field of health education and provide a voluntary certification system for professionals, research about the governmental health educator and health education specialist workforce is limited. The 2017 PH WINS (Public Health Workforce Interests and Needs Survey) provides valuable data on understanding the workforce demographics, attitudes, and training needs of governmental public health workers, including health educators, and informs future investments in workforce development efforts nationally. The purpose of this article is to examine demographics, job engagement and satisfaction, training needs, certification, and other characteristics of health educators and certified health education specialists (CHES) from PH WINS. We analyzed the data to describe the health educator workforce and compared it with the national governmental workforce across a range of variables. Compared with the national 2017 PH WINS sample, health educators were relatively younger, more ethnically diverse, more likely to be educated with an advanced degree, and were predominately employed in local versus state public health agencies. Health educators sampled were significantly more knowledgeable of all public health concepts compared with the national 2017 PH WINS respondent workforce. Comparison of CHES versus non-CHES professionals is also provided, along with practice and policy implications based on the data. This is the first detailed analyses of health educators in state and local health departments, with important findings and implications related to workforce composition, satisfaction, retention, and training. Further cross-sectional workforce research is needed to understand the current strengths and gaps in the health education workforce.

Training Needs and Awareness of Emerging Areas of Public Health Practice Among Epidemiologists Working in State Health Agency Central Offices in the United States, 2017.

Epidemiologists working in state health agency central offices (SHA-CO) are key professionals working to monitor population health indicators. Assessing training needs to identify gaps is critical to ensuring a competent public health workforce. The objective of this research was to identify training needs of SHA-CO epidemiologists and their awareness of emerging areas of public health practice (EAoP) using data from the 2017 Public Health Workforce Interests and Needs Survey (PH WINS). SHA-CO epidemiologists were surveyed in fall 2017 using a Web-based tool. Balanced repeated replication weights were used to account for complex sample design. Differences in responses by tenure, education level, and supervisory status were assessed using multinomial logistic regression. Forty-seven state health agencies. Permanently employed SHA-CO epidemiologists. Training needs were identified by classifying skill gaps as those skills that participants self-reported as high relevance to day-to-day work but self-rated as having low proficiency. Awareness of EAoP was self-reported. Systems and strategic thinking and budget and financial management were the areas with the greatest training needs. For most skill domains, fewer participants reported skill gaps with increasing years of public health work experience. Participants with 16 or more years of work experience were less likely to be motivated by most training motivators listed by epidemiologists with 5 or fewer years of experience. The EAoP participants reported greatest awareness of evidence-based public health practice (67%), and the EAoP they reported hearing least about was Health in All Policies (14%). Stratified analyses by tenure identified important differences in training needs and motivators that employers can use to customize workforce development strategies. SHA-CO epidemiologists reported varying amounts of awareness of EAoP. Specialized training approaches may contribute to improved employee engagement and reduce skill gaps among SHA-CO epidemiologists.

Generating the evidence for risk reduction: a contribution to the future of food-based dietary guidelines.

A major advantage of analyses on the food group level is that the results are better interpretable compared with nutrients or complex dietary patterns. Such results are also easier to transfer into recommendations on primary prevention of non-communicable diseases. As a consequence, food-based dietary guidelines (FBDG) are now the preferred approach to guide the population regarding their dietary habits. However, such guidelines should be based on a high grade of evidence as requested in many other areas of public health practice. The most straightforward approach to generate evidence is meta-analysing published data based on a careful definition of the research question. Explicit definitions of study questions should include participants, interventions/exposure, comparisons, outcomes and study design. Such type of meta-analyses should not only focus on categorical comparisons, but also on linear and non-linear dose-response associations. Risk of bias of the individual studies of the meta-analysis should be assessed, rated and the overall credibility of the results scored (e.g. using NutriGrade). Tools such as a measurement tool to assess systematic reviews or ROBIS are available to evaluate the methodological quality/risk of bias of meta-analyses. To further evaluate the complete picture of evidence, we propose conducting network meta-analyses (NMA) of intervention trials, mostly on intermediate disease markers. To rank food groups according to their impact, disability-adjusted life years can be used for the various clinical outcomes and the overall results can be compared across the food groups. For future FBDG, we recommend to implement evidence from pairwise and NMA and to quantify the health impact of diet-disease relationships.

Swimming against the tide: A Canadian qualitative study examining the implementation of a province-wide public health initiative to address health equity.

BackgroundEffectively addressing the social determinants of health and health equity are critical yet still-emerging areas of public health practice. This is significant for contemporary practice as the egregious impacts of health inequities on health outcomes continue to be revealed. More public health organizations seek to augment internal organizational capacity to address health equity while the evidence base to inform such leadership is in its infancy. The purpose of this paper is to report on findings of a study examining key factors influencing the development and implementation of the social determinants of health public health nurse (SDH-PHN) role in Ontario, Canada.MethodsA descriptive qualitative case study approach examined the first Canadian province-wide initiative to add SDH-PHNs to each public health unit. Data sources were documents and staff from public health units (i.e., SDH-PHNs, Managers, Directors, Chief Nursing Officers, Medical Officers of Health) as well as external stakeholders. Data were collected through 42 individual interviews and 226 documents. Interview data were analyzed using framework analysis methods; Prior’s approach guided document analysis.ResultsThree themes related to the SDH-PHN role implementation were identified: (1) ‘Swimming against the tide’ to lead change as staff navigated ideological tensions, competency development, and novel collaborations; (2) Shifting organizational practice environments impacted by initial role placement and action to structurally embed health equity priorities; and (3) Bridging policy implementation gaps related to local-provincial implementation and reporting expectations.ConclusionsThis study extends our understanding of the dynamic interplay among leadership, change management, ideological tensions, and local-provincial public health policy impacting health equity agendas. Given that the social determinants of health lie outside public health, collaboration with communities, health partners and non-health partners is essential to public health practice for health equity. The study findings have implications for increasing our knowledge and capacity for effective system-wide intervention towards health equity as a critical strategic priority for public health and for broader public policy and community engagement. Appropriate and effective public health leadership at multiple levels and by multiple actors is tantamount to adequately making inroads for health equity.Electronic supplementary materialThe online version of this article (doi:10.1186/s12939-016-0419-4) contains supplementary material, which is available to authorized users.

Integrating Public Health and Deliberative Public Bioethics: Lessons from the Human Genome Project Ethical, Legal, and Social Implications Program.

Public health policy works best when grounded in firm public health standards of evidence and widely shared social values. In this article, we argue for incorporating a specific method of ethical deliberation--deliberative public bioethics--into public health. We describe how deliberative public bioethics is a method of engagement that can be helpful in public health. Although medical, research, and public health ethics can be considered some of what bioethics addresses, deliberative public bioethics offers both a how and where. Using the Human Genome Project Ethical, Legal, and Social Implications program as an example of effective incorporation of deliberative processes to integrate ethics into public health policy, we examine how deliberative public bioethics can integrate both public health and bioethics perspectives into three areas of public health practice: research, education, and health policy. We then offer recommendations for future collaborations that integrate deliberative methods into public health policy and practice.

Tracking uptake of innovations from the European Union Public Health Programme

The European Commission developed the Public Health Programme to enable cross-national innovation and transfer in fields of health information, health threats and health promotion. PHIRE (Public Health Innovation and Research in Europe), a collaboration of the European Public Health Association (EUPHA) with seven partners, addressed the uptake of these public health innovation projects at country level. EUPHA thematic sections lead on areas of public health practice and research and experts can choose to be section members. The section presidents of seven sections chose eight European public health projects, starting in the EU Public Health Programme in 2003-05, that provided new knowledge for practice and covered a majority of the EU countries. A web-based questionnaire recorded country informants' (CIs) perceptions of uptake, assessed as relevance and dissemination to a range of public and non-governmental organizations. 108 CIs individually described the eight innovations in an average of 14 (46%) of the 30 European countries. Three of the eight innovations were considered of high relevance by >60% of respondents and at least 70% of informants considered seven of the eight innovation projects as of high or moderate relevance. Dissemination was noted across governmental, professional and academic settings, with high impact on knowledge/awareness for at least 30% of CIs. Some projects had uptake within the policy cycle in particular countries and connected strongly with academics and professionals. Projects working at local level had less visibility nationally and some projects were unknown to national respondents. European Union funding for public health can contribute to cross-national knowledge transfer and uptake of innovations. More attention is needed to classify, characterize and identify public health innovations and to demonstrate their direct contribution to European health and well-being.

Characteristics of health impact assessments reported in Australia and New Zealand 2005-2009.

Objective: To describe the use and reporting of Health Impact Assessment (HIA) in Australia and New Zealand between 2005 and 2009.Methods: We identified 115 HIAs undertaken in Australia and New Zealand between 2005 and 2009. We reviewed 55 HIAs meeting the study's inclusion criteria to identify characteristics and appraise the quality of the reports.Results: Of the 55 HIAs, 31 were undertaken in Australia and 24 in New Zealand. The HIAs were undertaken on plans (31), projects (12), programs (6) and policies (6). Compared to Australia, a higher proportion of New Zealand HIAs were on policies and plans and were rapid assessments done voluntarily to support decision-making. In both countries, most HIAs were on land use planning proposals. Overall, 65% of HIA reports were judged to be adequate.Conclusion: This study is the first attempt to empirically investigate the nature of the broad range of HIAs done in Australia and New Zealand and has highlighted the emergence of HIA as a growing area of public health practice. It identifies areas where current practice could be improved and provides a baseline against which future HIA developments can be assessed.Implications:There is evidence that HIA is becoming a part of public health practice in Australia and New Zealand across a wide range of policies, plans and projects. The assessment of quality of reports allows the development of practical suggestions on ways current practice may be improved. The growth of HIA will depend on ongoing organisation and workforce development in both countries.

Wishful thinking will not do it! Practitioners and decision-makers need tools to implement evidence-informed public health

In this issue of IJPH, we feature a paper which reports on the development and implementation of a registry of methods and tools to support evidence-informed public health practice (Peirson et al. 2013). Most discussions about evidence-based public health practice focus on the ‘‘what’’, discussing the type of evidence practitioners and decision-makers need in their practice. Consequently, most registries and resources available for practitioners to develop evidence-informed programs and interventions are made of research syntheses and knowledge products that provide scientific answers to practical public health questions. Examples of such questions are: ‘‘What are the most efficient interventions to increase influenza immunization coverage in a community?’’ or ‘‘What are the effective policy options to address youth obesity in a rural community?’’ The integration of such tools and products into public health practice is often taken for granted or, at best, not problematized as a legitimate research question in— and of itself. The registry presented in this issue is unique in two ways: it addresses the ‘‘how’’ in implementing evidence-informed public health practice and decisionmaking (Larsen et al. 2012), and it tackles the root causes of the problems of translating and using research evidence in public health. Its development started with the question ‘‘What is the scientific evidence about what works for increasing and improving knowledge translation and exchange practices in public health?’’ The registry identifies, sorts and indexes relevant and evidence-informed, as well as methods and tools that support the dissemination and integration of evidence-based practice in public health organizations. The registry was developed by the National Collaborating Center on Methods and Tools, one of the six constituents of the National Collaborating Centres for Public Health supported by the Public Health Agency of Canada to enhance the use of research results in public health decision-making and practice (http://www.ncchp.ca). Collectively, these six centres identify knowledge gaps, produce knowledge syntheses, develop knowledge products and facilitate exchanges among public health practitioners and decision-makers to support the integration of research evidence into public health (Frank et al. 2007). Individually, each centre focuses on a specific area of public health practice: Aboriginal Health, Environmental Health, Infectious Diseases, Methods and Tools, Healthy Public Policy, and Social Determinants of Health. Because their products (including web-based forums, webcasts and webinars) are mostly available through the web, their outreach is potentially global. We believe that the registry presented by Peirson et al. (2013) fills an important gap for public health practitioners who are often caught between imperatives of founding their practice on research results and the complexity and messiness of the scientific literature that makes it almost impossible to find clear and positive answers to common practical questions. The National Collaborating Centre for Methods and Tools has tackled head on the thorny issue of providing useful resources to enable public health This editorial is part of the section ‘‘Knowledge synthesis, translation and exchange’’.

The Public Health Specialist and Access to Public Health Advice

Public health specialists can be described as leaders of the ‘upstream health workforce’, concerned with preventing unnecessary and ‘revolving door’ contact with health services. Achieving this requires working to promote good health, improve health services and protect populations from infectious disease and environmental risks. Public health work is based upon the recognition that populations are complex constructions of groups of individuals, who may or may not seek help for health problems or be able effectively to take action to improve their own health. This article will define key areas of public health practice giving specific examples of the role of the public health specialist in the UK, as well as how and why primary care professionals might access specialist advice. The examples demonstrate the great potential for improving population health through the complementary efforts of primary care and public health professionals.

An example of the use of Public Health Grid (PHGrid) technology during the 2009 H1N1 influenza pandemic

Historically, public health surveillance systems in the USA have been designed as registries targeting specific public health issues that collect data from certain population groups to answer particular questions. This resulted in disparate public health information systems that can rarely address new needs without extensive redesign. Such a design limits the ability of public health professionals to address emerging public health threats when data need to be collected from different areas of public health practice; the 2009 H1N1 influenza pandemic posed such a challenge. The US Centers for Disease Control and Prevention's Public Health Informatics and Technology Program Office (CDC/PHITPO) and its partners explored a decentralised information architecture using the Public Health Grid (PHGrid). Through the exploration of PHGrid capabilities, CDC/PHITPO developed a pilot project to demonstrate a method for secure and timely data exchange using simulated data in aggregate format.

Applied (and appealing…) Epidemiology

Giuseppe La Torre has, in his manual “Applied Epidemiology and Biostatistics”, drawn upon his experience (long and intense despite his young age) as applied epidemiology expert in the Catholic University of Sacred Heart. For some years, in fact, he has offered valuable advice to many researchers who had failed to publish in international journals because of an inappropriate use of epidemiological methods and biostatistics, and has helped many of them present the results of their research. After numerous rejected papers, researchers would turn to his expertise and knowhow of the most modern epidemiological tools. The results were flattering: the papers which Professor La Torre and his staff had dealt with the epidemiological issues, as if by magic, were accepted for publication. It is therefore justified and understandable that the author has decided to propose, to a wider public, his epidemiological expertise about applied epidemiology. But there is no magic. The author simply focuses on the need to apply epidemiological methods to areas of public health practice for determining disease etiology and the “real-life” applications to public health and health services research.

Building a future in disability and public health

The Disability Section is one of the newest sections in the American Public Health Association (APHA) and represents people with disabilities as an underserved population in all areas of public health practice. Issues involving people with disabilities cut across the overarching domains of education, training, research, and service. Therefore, every constituency group, interest area, or section in the APHA must recognize the importance of addressing disability-related issues in any initiative that focuses on improving the health of our nation. While achieving section status within APHA has given “disability” increased visibility in the largest and most prominent public health organization in the world, focusing our future on infusing disability content and perspectives on issues that impact people with disabilities in other areas of public health (e.g., environment, gerontological health, medical care, public health education and health promotion, etc.) requires an understanding of the other side’s perspective. For this to occur, the Disability Section must be used as a base for recruiting and deploying health professionals who have an interest in a dyadic area of public health (e.g., medical care and disability, gerontological health and aging with a disability), and who can begin serving in leadership positions in other sections in APHA. Building capacity within and across the other sections in APHA will be our greatest challenge over these next few years. Our journey has just begun.

Elevating Physical Activity as a Public Health Priority: Creation of the National Society of Physical Activity Practitioners in Public Health

Physical activity has emerged as a distinct area of public health practice. As this field evolved, the need for a professional organization for physical activity practitioners in public health became evident. A collaboration of several existing public health professional organizations formed to address this new area of public health practice. The collaboration laid the foundation to establish a professional organization. National Association of Physical Activity Practitioners in Public Health (NSPAPPH) was launched in April 2006. NSPAPPH accomplishments to date include convening a national meeting of physical activity practitioners, conducting strategic planning, adopting bylaws and core competencies for professional practice, developing a website and electronic newsletter, and establishing training opportunities for practitioners. Future plans for NSPAPPH include development of a professional certification for physical activity practitioners in public health; enhancement of training and professional development opportunities; recruitment of members from national, tribal, state, and local organizations working in public and private sectors; publications of journal articles, reports, and issue briefs; and development of a policy agenda. Implementing these plans will serve to strengthen public health infrastructure for physical activity, thus improving the physical activity behaviors of Americans and the health of the nation.

Elevating Physical Activity as a Public Health Priority: Establishing Core Competencies for Physical Activity Practitioners in Public Health

Physical activity has emerged as a vital area of public health. This emerging area of public health practice has created a need to develop practitioners who can address physical activity promotion using population-based approaches. Variations in physical activity practitioners' educations and backgrounds warranted the creation of minimal standards to establish the competencies needed to address physical activity as a public health priority. The content knowledge of physical activity practitioners tends to fall into 2 separate areas--population-based community health education and individually focused exercise physiology. Competencies reflect the importance of a comprehensive approach to physical activity promotion, including areas of community health while also understanding the physiologic responses occurring at the individual level. Competencies are organized under the Center for Disease Control and Prevention's 5 benchmarks for physical activity and public health practice. The greatest impact on physical activity levels may be realized from a well-trained workforce of practitioners. Utilization of the competencies will enable the physical activity practitioner to provide technical assistance and leadership to promote, implement, and oversee evaluation of physical activity interventions.

Public Health Certification

In 2003, the Institute of Medicine (IOM) recommended voluntary certification of graduates achieving the Master of Public Health degree. The Association of Schools of Public Health (ASPH), the American Public Health Association, the Association of State and Territorial Health Officials, the National Association of County and City Health Officials, and the Association for Prevention Teaching and Research joined together to establish the National Board of Public Health Examiners (5). This new body will certify graduates of accredited schools and programs of public health who successfully pass their examination. If this certification becomes common, the debate will move to other questions such as (a) can those who lack a degree from a school of public health be certified through the same examination, or a similar one; (b) how will this general certificate relate to specialized areas of public health practice which are also learned elsewhere; and (c) how will we assess the public health competence of public health workers who do not have a professional education?

Partnership for Preparedness

The New York City Department of Health and Mental Hygiene and the Columbia University Mailman School of Public Health's National Center for Disaster Preparedness undertook a collaborative project to establish a model academic health department. The goals were to increase student participation at the health department, increase faculty participation in health department activities, and facilitate health department faculty appointments at the school. As a result, 17 students were placed in full-time summer research projects designed by health department staff specifically for the project, 154 health department staff attended a series of six lectures presented by faculty, and five health department professionals applied for academic appointments at the school. The benefits of the efforts toward establishing an academic health department extend to all areas of public health practice, including those of preparedness.

AIDS and the American Health Polity: The History and Prospects of a Crisis of Authority

In 1981, a profound crisis of authority was transforming the American health polity. Changing priorities between infectious and chronic diseases, communal and individual responsibilities for health, and comprehensive services and cost control created a fragmented health polity, leaderless and ill-equipped to address the AIDS epidemic. The American health polity may best serve the public interest when institutions within it do not accept fragmentation as the goal and the norm of health affairs.

Specialist public health capacity in England: working in the new primary care organizations

To determine the capacity and development needs, in relation to key areas of competency and skills, of the specialist public health workforce based in primary care organizations following the 2001 restructuring of the UK National Health Service. Questionnaire survey to all consultants and specialists in public health (including directors of public health) based in primary care trusts (PCTs) and strategic health authorities (SHAs) in England. Participants reported a high degree of competency. However, skill gaps were evident in some areas of public health practice, most notably "developing quality and risk management" and in relation to media communication, computing, management and leadership. In general, medically qualified individuals were weaker on community development than non-medically qualified specialists, and non-medically qualified specialists were less able to perform tasks that require epidemiological or clinical expertise than medically qualified specialists. Less than 50% of specialists felt that their links to external organizations, including public health networks, were strong. Twenty-nine percent of respondents felt professionally isolated and 22% reported inadequate team working within their PCT or SHA. Approximately 21% of respondents expressed concerns that they did not have access to enough expertise to fulfil their tasks and that their skills were not being adequately utilized. Some important skill gaps are evident among the specialist public health workforce although, in general, a high degree of competency was reported. This suggests that the capacity deficit is a problem of numbers of specialists rather than an overall lack of appropriate skills. Professional isolation must be addressed by encouraging greater partnership working across teams.