Essential Public Health Operations Research Articles

Analysing local public health action plans: development of a tool for the French CLoterreS Study

Abstract Background The potential contribution of local authorities to prevention and health promotion is well recognized. In France, since 2009, Local Health Contracts (LHCs) are mobilising Regional Health Agencies, local elected officials and stakeholders to intervene in 4 areas: health promotion, prevention, health care and social care. LHCs remain poorly documented policy instruments. Methods As part of the CLoterreS study, a multidimensional coding tool was developed and tested by two coders to explore the place of prevention and health promotion in LHCs. Its development was based on the WHO conceptual framework for action on the social determinants of health and the Self-assessment tool for the evaluation of essential public health operations in the WHO European Region. Preliminary results concern a random sample of 17 LHCs from as many French regions selected among the 165 LHCs signed between 2015 and March 2018. Results On average, the LHCs featured 26 action forms (AF) (min: 5; max: 56). In a LHC, the average proportion of AF addressing either the social determinants of health, living circumstances or other determinants targeted by health protection, promotion or primary prevention interventions (SDoH-HPP-P1) was 79% while 44% of the AF address secondary/tertiary prevention, social care or the organization of health care and services. Among the SDoH-HPP-P1 themes (double coding permitted): psychosocial life circumstances were addressed in the 17 LHCs and concerned, on average, 31% of their AF; material living circumstances were addressed to a lesser extent (16 LHCs, 13%); other key themes include environmental health (12, 14%), mental health (16, 12%), alcohol abuse (15, 11%), drug use (14, 11%), smoking (13, 9%), physical activity (13, 12%), healthy eating (12, 12%). Conclusions This work confirms that LHCs are instruments with prevention and health promotion at their core. Explanation of the differing investments in this area across our sample will be further explored. Key messages Local Health Contracts are promising instruments to address locally a broad range of health determinants. The CLoterreS analytical tool has proven effective in capturing multiple themes and shedding light on differences between Local Health Contracts’ action plans.

Is there a golden recipe? A scoping review of public health workforce development

This study intended to design a suitable and comprehensive approach for a public health workforce development plan with the ultimate goal of meeting the health objectives in different European Region countries. We performed a scoping review, including an accurate and exhaustive country-specific hand-search process, mapping the key concepts and practices used in public health workforce development based on the available evidence worldwide. We identified nine comparative measures, based on common features from a scoping literature review, for the assessment of public health workforce development plans available in selected countries. This list of nine comparative measures includes: (i) Alignment between the 10 Essential Public Health Operations (EPHOs) or core public health functions and organizational resources and public health priority areas; (ii) Regulations and Norms; (iii) Capacity Assessment; (iv) Datasets and Databases; (v) Workforce Development Strategies, Planning and Management; (vi) Education, Training, Core Competencies and Models; (vii) Licensing, Accreditation and Credentialing; (viii) Forecasting Strategies for Enumerating and Quotas and (ix) Ethical and Professional Codes of Conduct. These measures are essential to develop, sustain and modernize the public health workforce effectively. We propose a well-balanced set of measures for countries aiming to improve or develop their public health workforce based on instruments that are successfully used and applied in a wide range of countries with different public health systems. However, the implementation should be tailored and adopted according to the specific country context and available recourses.

Developing the public health workforce: training and recognizing specialists in public health from backgrounds other than medicine: experience in the UK

BackgroundThere is increasing recognition that improving health and tackling inequalities requires a strong public health workforce capable of delivering key public health functions across systems. The World Health Organization in Europe has identified securing the delivery of the Essential Public Health Operations and strengthening public health capacities within this as a priority.It is acknowledged that current public health capacities and arrangements of public health services vary considerably across the World Health Organization in European Region, and investment in multidisciplinary workforce with new skills is essential if public health services are to be delivered.Case presentationThis paper describes the current situation in the UK where there are nationally funded multidisciplinary programmes for training senior public health specialists. Uniquely, the UK provides public health registration for multidisciplinary as well as medical public health specialists. Conclusion The transition from a predominantly medical to a multidisciplinary public health specialist workforce over a relatively short timescale is unprecedented globally and was the product of a sustained period of grass roots activism aligned with national policy innovation. the UK experience might provide a model for other countries seeking to develop public health specialist workforce capacity in line with the Essential Public Health Operations.

The Delivery of Health Promotion and Environmental Health Services; Public Health or Primary Care Settings?

The WHO Regional Office for Europe developed a set of public health functions resulting in the ten Essential Public Health Operations (EPHO). Public health or primary care settings seem to be favorable to embrace all actions included into EPHOs. The presented paper aims to guide readers on how to assign individual health promotion and environmental health services to public health or primary care settings. Survey tools were developed based on EPHO 2, 3 and 4; there were six key informant surveys out of 18 contacted completed via e-mails by informants working in Denmark on health promotion and five face-to-face interviews were conducted in Australia (Melbourne and Victoria state) with experts from environmental health, public health and a physician. Based on interviews, we developed a set of indicators to support the assignment process. Population or individual focus, a system approach or one-to-one approach, dealing with hazards or dealing with effects, being proactive or reactive were identified as main element of the decision tool. Assignment of public health services to one of two settings proved to be possible in some cases, whereas in many there is no clear distinction between the two settings. National context might be the one which guides delivery of public health services.

Sustaining success: aligning the public health workforce in South-Eastern Europe with strategic public health priorities.

To map out the Public Health Workforce (PHW) involved in successful public health interventions. We did a pilot assessment of human resources involved in successful interventions addressing public health challenges in the countries of South-Eastern Europe (SEE). High-level representatives of eight countries reported about success stories through the coaching by experts. During synthesizing qualitative data, experts applied triangulation by contacting additional sources of evidence and used the framework method in data analysis. SEE countries tailored public health priorities towards social determinants, health equalities, and prevention of non-communicable diseases. A variety of organizations participated in achieving public health success. The same applies to the wide array of professions involved in the delivery of Essential Public Health Operations (EPHOs). Key enablers of the successful work of PHW were staff capacities, competences, interdisciplinary networking, productivity, and funding. Despite diversity across countries, successful public health interventions have similar ingredients. Although PHW is aligned with the specific public health success, a productive interface between health and other sectors is crucial for rolling-out successful interventions.

Preparation of European Public Health Professionals in the Twenty-first Century.

The public health profession in Europe has a leadership role for ensuring European’s health in the twenty-first century and therefore must assume responsibility for advancing education for research and practice. Three fundamental questions are explored: (1) What are the main public health problems facing public health professionals; (2) What are their existing competencies after training; and (3) What competencies do European employers expect? The European Schools of Public Health assessed their best success to be in the field of health promotion, followed by disease prevention including identification of priority health problems, and elimination of health hazards in the community. Conversely, they see the least success in dealing with preparedness and planning for public health emergencies. From an employer’s perspective, significant gaps between current and desired levels of performance at the job exist for all Essential Public Health Operations of World Health Organization. Based on prior research and recent European surveys of Schools and Departments of Public Health, the following recommendations are made, which emphasize the leadership role of the European public health community: (1) the preparation of public health professionals requires an interface between public health functions, competencies, and performance; (2) competence-based education is important and allows debates on the scope of the required education; (3) governments have to realize that the present lack of infrastructure and capacity is detrimental to the people’s health; (4) as public health challenges are increasingly global, educational institutions have to look beyond the national boundaries and participate in European and global networks for education, research, and practice.

Trends in the results of self-assessments of Essential Public Health Operations (EPHOs) in WHO Member States

Trends in the results of self-assessments of Essential Public Health Operations (EPHOs) in WHO Member States

Main competences and skills to perform Essential Public Health Operations, offered by Schools of Public Health in four European countries: a short pilot report.

To consider the stage of implementation of main competences and EPHO skills in selected schools of public health in four European countries-France, Poland, Portugal, and the UK. By use of visual analogue scales (VAS) ranging 1-5, the leads of three schools of public health (SPH) in each of the four countries, France, Poland, Portugal and theUK, reported the strength of intellectual and practical competences as well as skills to perform essential public health operations (EPHOs), offered by their education and training programmes. The self-reports indicated substantial coverage of the multidimensional public health discipline. Each country representation had its overall characteristic profile, and there was found noteworthy within-country as well as between-country variation. The schools should meet the challenge of establishing collaborative networks, which will be important for public health strategy making and implementation, for shaping a coherent public health profession, and thus ultimately for population health. This pilot report should be followed up by more systematically penetrating and comprehensive analyses to identify met and unmet needs in public health education and training.

Defining and Assessing Public Health Functions: A Global Analysis.

Given the broad scope and intersectoral nature of public health structures and practices, there are inherent difficulties in defining which services fall under the public health remit and in assessing their capacity and performance. The aim of this study is to analyze how public health functions and practice have been defined and operationalized in different countries and regions around the world, with a specific focus on assessment tools that have been developed to evaluate the performance of essential public health functions, services, and operations. Our review has identified nearly 100 countries that have carried out assessments, using diverse analytical and methodological approaches. The assessment processes have evolved quite differently according to administrative arrangements and resource availability, but some key contextual factors emerge that seem to favor policy-oriented follow-up. These include local ownership of the assessment process, policymakers' commitment to reform, and expert technical advice for implementation.

Implications of health as ‘the ability to adapt and self-manage’ for public health policy: a qualitative study

To explore the implications for public health policy of a new conceptualisation of health as 'The ability to adapt and to self-manage, in the face of social, physical and emotional challenges'. Secondary qualitative data analysis of 28 focus group interviews, with 277 participants involved in public health and healthcare, on the future of the Dutch healthcare system. WHO's essential public health operations (EPHOs) were used as a framework for analysis. Starting from the new concept of health, participants perceived health as an individual asset, requiring an active approach in the Dutch population towards health promotion and adaptation to a healthy lifestyle. Sectors outside healthcare and public health were considered as resources to support individual lifestyle improvement. Integrating prevention and health promotion in healthcare is also expected to stimulate individuals to comply with a healthy lifestyle. Attention should be paid to persons less skilled to self-manage their own health, as this group may require a healthcare safety net. The relationship between individual and population health was not addressed, resulting in little focus on collective prevention to achieve health. The new concept of health as a basis for changes in the healthcare system offers opportunities to create a health-promoting societal context. However, inequalities in health within the general population may increase when using the new concept as an operationalisation of health. For public health, the main challenge is to maintain focus on the collective socioeconomic and environmental determinants of health and disease and, thereby, preserve collective prevention.

Enumerating the preventive youth health care workforce: Size, composition and regional variation in the Netherlands

The progress in workforce planning in preventive youth health care (YHC) is hampered by a lack of data on the current workforce. This study aimed to enumerate the Dutch YHC workforce. To understand regional variations in workforce capacity we compared these with the workforce capacity and the number of children and indicators of YHC need per region.A national survey was conducted using online questionnaires based on WHO essential public health operations among all YHC workers. Respondents (n=3220) were recruited through organisations involved in YHC (participation: 88%).The YHC workforce is multi-disciplinary, 62% had >10 years working experience within YHC and only small regional variations in composition existed. The number of children per YHC professional varied between regions (range 688–1007). All essential public health operations were provided and could be clustered in an operational or policy profile. The operational profile prevailed in all regions. Regional differences in the number of children per YHC professional were unrelated to the indicators of YHC need.The essential public health operations provided by the YHC workforce and the regional variations in children per YHC professional were not in line with indicators of YHC needs, indicating room for improvement of YHC workforce planning. The methodology applied in this study is probably relevant for use in other countries.

How to characterize the public health workforce based on essential public health operations? environmental public health workers in the Netherlands as an example.

BackgroundPublic health workforce planning and policy development require adequate data on the public health workforce and the services provided. If existing data sources do not contain the necessary information, or apply to part of the workforce only, primary data collection is required. The aim of this study was to develop a strategy to enumerate and characterize the public health workforce and the provision of essential public health operations (EPHOs), and apply this to the environmental public health workforce in the Netherlands as an example.MethodsWe specified WHO’s EPHOs for environmental public health and developed an online questionnaire to assess individual involvement in these. Recruitment was a two-layered process. Through organisations with potential involvement in environmental public health, we invited environmental public health workers (n = 472) to participate in a national survey. Existing benchmark data and a group of national environmental public health experts provided opportunities for partial validity checks.ResultsThe questionnaire was well accepted and available benchmark data on physicians supported the results of this study regarding the medical part of the workforce. Experts on environmental public health recognized the present results on the provision of EPHOs as a reasonable reflection of the actual situation in practice.All EPHOs were provided by an experienced, highly educated and multidisciplinary workforce. 27 % of the total full-time equivalents (FTEs) was spent on EPHO ‘assuring governance for health’. Only 4 % was spent on ‘health protection’. The total FTEs were estimated as 0.66 /100,000 inhabitants.ConclusionsCharacterisation of the public health workforce is feasible by identification of relevant organisations and individual workers on the basis of EPHOs, and obtaining information from those individuals by questionnaire. Critical factors include the operationalization of the EPHOS into the field of study, the selection and recruitment of eligible organisations and the response rate within organisations.. When existing professional registries are incomplete or do not exist, this strategy may provide a start to enumerate the quantity and quality of the public health within or across countries.

Towards a public health profession: the roles of essential public health operations and lists of competences

Today, public health is characterized by an increasingly Babylonian number of kingdoms with each their language and indispensable self-identity and sets of concepts. The numbers of partial educational programmes and vocations are high.1 So, who are we—and to whom shall then decision makers turn for advice? To traverse this question, it is necessary to acknowledge the two fundamental challenges, which European public health is up to in its own organization. The first challenge is the need for the creation and authorization of a public health professional as a central person in public health2—the focus of this editorial. The second challenge is the need to develop coherent and comprehensive national, regional and local public health organizational structures, able to shape the appropriate, cost-effective framework for public health professionals and their staff. I will leave that for now. In my view, it is easy to prophecy that if these two challenges are not met, public health will …

A new concept of health—implications for public health policy and practice: a qualitative analysis

BackgroundIn many developed countries ageing populations, growing health-care costs, and the rising burden of chronic diseases pose challenges for health systems and require innovations to improve and maintain population health. “Health as the ability to adapt and to self manage, in the face of social, physical and emotional challenges” was introduced as a new concept of health at an invitational conference in 2011, in reaction to the static nature and lack of realism of the 1948 WHO definition. Since this concept is one of the pillars of the innovation of the Dutch health-care professions and educational structure, we analysed the implications of this new concept for public health policy and practice. MethodsWe conducted focus group interviews (n=28) with stakeholders (n=277) in Dutch public health and health care (eg, physicians, nurses, policy makers, and patient organisations) on the pros and cons of this new concept in the light of a changing health-care system. We developed a framework of key themes within the interviews starting from WHO's essential public health operations and used a deductive approach to qualitative data analysis (Framework method) to analyse the interviews. FindingsIn reaction to the conceptualisation of adaptation and self-management, the participants perceived health as an individual asset and did not seem aware of the collective dimension, resulting in less attention paid to primary prevention programmes. Prevention was mainly mentioned in relation to primary and secondary care; health promotion was primarily regarded as an instrument to support individuals in adapting to a healthy lifestyle. However, adaptation and self-management could be supported by assuring governance for health and wellbeing through other sectors. InterpretationThe new concept fits with the changing burden of disease and the contribution of individual behaviour to health outcomes. The main challenge of this concept for public health policy and practice will be to preserve primary prevention through the collective efforts of society. The main task will be to incorporate essential public health operations in the different sectors (health, housing, education, social policy) and to integrate public health in community care programmes. FundingThe focus group interviews were funded by the National Health Care Institute, Netherlands. There was no external funding for the present analysis.

Monitoring the health of the population

Background Health monitoring is the first of the ten essential public health operations identified for the WHO European Region and a prerequisite for evidence-informed policy-making. This abstract aims to describe the current state of affairs in the WHO European Region. Methods We used our expertise that is based on extensive national experience with data integration, health reporting and forecasting. Next, we have drawn from the outcomes of …

Global health in the 21st century

Introduction Since the end of the 1990s, globalization has become a common term, facilitated by the social media of today and the growing public awareness of life-threatening problems common to all people, such as global warming, global security and global divides. Review For the main parameters of health like the burden of disease, life expectancy and healthy life expectancy, extreme discrepancies are observed across the world. Infant mortality, malnutrition and high fertility go hand in hand. Civil society, as an indispensable activator of public health development, mainly represented by non-governmental organisations (NGOs), is characterised by a high degree of fragmentation and lack of public accountability. The World Federation of Public Health Associations is used as an example of an NGO with a global mission and fostering regional cooperation as an indispensable intermediate level. The lack of a globally valid terminology of basic public health functions is prohibitive for coordinated global and regional efforts. Attempts to harmonise essential public health functions, services and operations are under way to facilitate communication and mutual understanding. Recommendations 1) Given the limited effects of the Millennium Development Goal agenda, the Post-2015 Development Goals should focus on integrated regional development. 2) A code of conduct for NGOs should be urgently developed for the health sector, and NGOs should be registered and accredited. 3) The harmonisation of the basic terminology for global public health essentials should be enhanced.

L.1. Round table: European Health Information System: Steps from idea to realityOrganised by: EUPHA Sections on Public Health Monitoring and Reporting and Urban Health

Health monitoring has been defined as essential public health function number one. Indeed it is the first of the 10 essential public health operations identified for the European region of WHO (WHO-EUR). Health monitoring is a prerequisite for good governance; the effective provision of public health and health care and the evaluation of (health) policies requires information on the population’s health and disease burden, as well as on the underlying determinants. More specifically, monitoring population health provides insights into the magnitude and distribution of health inequalities, and the magnitude, impact and distribution of health determinants, which can then be used to inform the …

The Future of public health services in Europe: Strategic intersection with healthcare services

This paper outlines some of the major challenges on strengthening public health, including consideration of public health services (PHS) and infrastructure, as well as some of the public health aspects of health care services. The purpose of the paper is to articulate the roles and functions of PHS and health care services. Such integrated health systems that combine individual and community approaches have an important potential to improve health outcomes. In line with the broad scope of PHS, where it spans the health-generating activities of both the health system and other sectors of society, it analyses its role and links towards health outcomes. The paper further presents the 10 horizontal ‘essential public health operations’ (EPHOs), describing the core PHS within each of them, as the unifying and guiding basis to set up, monitor and evaluate actions and strategies for development of public health. It concludes that strengthening PHS calls for implementation of the EPHOs while recognising strategic linkages with health care services and other sectors of society. Within this context, opportunities for intersection emerge towards improvement of health care quality, health promotion, disease prevention, and health surveillance.

The evaluation of public health in South Eastern Europe: from transition to progress

Background: The public health services project of the South-eastern Europe health network has undertaken an evaluation of public health services in its nine member countries. The purpose of the evaluation of public health services provision in the South-eastern European (SEE) countries is to understand where these countries now stand in public health, the institutional, organisational, legislative and service delivery developments that are taking place and to identify strengths and weaknesses in their public health systems and services in order to inform decision making about investment and future reform. Methods: The evaluation was orientated around “essential public health operations” that are deemed to form the core of public health activities and services and to be indispensable to the delivery of modern public health services in any country. The evaluation analysed these activities and services within the structure of the health system functions of stewardship, resource generation, financing and service delivery, as developed by WHO. Results: The results demonstrate a mixed picture of strengths and weaknesses within the context of significant social, economic and political challenges in the region. Among the many visible and significant strengths in public health services in the region are well developed networks of public health institutes with well defined surveillance systems, highly experienced and well educated public health professionals as well as many positive examples of service delivery. But there are also many concerns and challenges, not the least of which is political focus, direction and support for modern public health services, as well as funding. Collaboration and partnership among sectors is weak and information and communication systems are inadequate and not sufficiently integrated. Conclusions: Having emphasized the main weak and challengeable points in the Public Health systems and services in the SEE countries, the evaluation is also a first step to defining a way forward in the SEE countries to ensure that the turmoil of ‘transition’ is only a prelude to the comprehensive modernisation of public health services.