Protect Community Health Research Articles

A web-based screening tool for near-port air quality assessments

The Community model for near-PORT applications (C-PORT) is a screening tool with an intended purpose of calculating differences in annual averaged concentration patterns and relative contributions of various source categories over the spatial domain within about 10 km of the port. C-PORT can inform decision-makers and concerned citizens about local air quality due to mobile source emissions related to commercial port activities. It allows users to visualize and evaluate different planning scenarios, helping them identify the best alternatives for making long-term decisions that protect community health and sustainability. The web-based, easy-to-use interface currently includes data from 21 seaports primarily in the Southeastern U.S., and has a map-based interface based on Google Maps. The tool was developed to visualize and assess changes in air quality due to changes in emissions and/or meteorology in order to analyze development scenarios, and is not intended to support or replace any regulatory models or programs.

Application of landscape epidemiology to assess potential public health risk due to poor sanitation

Clear identification of areas vulnerable to waterborne diseases is essential for protecting community health. This is particularly important in developing countries where unsafe disposal of domestic wastewater and limited potable water supply pose potential public health risks. However, data paucity can be a compounding issue. Under these circumstances, landscape epidemiology can be applied as a resource efficient approach for mapping potential disease risk areas associated with poor sanitation. However, in order to realise the full potential offered by this approach, an in-depth understanding of the impact of different classes of an explanatory variable on a target disease and the validity of hotspot analysis using limited datasets is needed. Accordingly, this research study focused on typhoid and diarrhoea incidence with respect to different classes of elevation, flood inundation, land use, soil permeability, population density and rainfall as explanatory variables. An integrated methodology consisting of hot spot analysis and Poisson regression was employed to map potential disease risk areas. The study findings confirmed the significant differences in the influence exerted by the various classes of an explanatory variable in relation to a target disease. The results also confirmed the feasibility of the hotspot analysis for identifying areas vulnerable to the target diseases using a limited dataset. The study outcomes are expected to contribute to creating an in-depth understanding of the relationship between disease prevalence and associated landscape factors for the delineation of disease risk zones in the context of data paucity.

Community engagement in development of a community air monitoring network in Imperial County, California

INTRODUCTION: Imperial County, California, is a low-income, primarily Latino community that faces disproportionate impacts from a range of environmental hazards. With consistently high rates of emergency room visits and hospitalizations for asthma among schoolchildren, the community identified air pollution as a priority concern. Community members collaborated with researchers to build a community air monitoring network to provide local data on air quality that can be used to protect community health. METHODS: A community-based organization responsive to local concerns participated in research planning from the outset, and a Community Steering Committee guided the project. Community members selected priority neighborhoods within the county for air monitoring, and over 40 local residents identified vulnerable population groups. Key informant interviews informed data display decisions. Data was visualized using an environmental health web platform developed by the community. RESULTS: Community participation increased the usefulness of the monitoring network to the community. Community members identified schools throughout the county as priorities for siting the first 20 monitors. Local schools and businesses facilitated monitor deployment, promoting local capacity for maintenance. Training on air monitoring established a common knowledge base. Selection of monitor sites and hosting of monitors by local residents promoted community ownership of the monitoring network. Community input determined priority data display needs. Conclusions: Substantial engagement of and leadership by community members at every stage of planning and implementation of an air monitoring network (1) enhances responsiveness of research to community priorities, (2) fosters community ownership of the project and builds local capacity, (3) ensures accessibility, usability and usefulness of data displayed, and (4) promotes potential for network sustainability beyond the research period.

Commentary Introducing the Issue

In an era of diminished resources, public health agencies are being asked to do more with less. Evidence suggests that while revenues at the state and local levels have been flat or increased slightly since 2010, a large number of governmental public health agencies in the United States have been forced to cut programs and/or staff to compensate for the relative paucity of funds at their disposal. At the same time, these agencies have been challenged to effectively deploy diminished resources to develop and implement multi-level interventions in their communities and to address the many determinants of complex chronic diseases, such as diabetes mellitus and heart disease. Infectious diseases like influenza still pose significant threats to public health, placing an additional strain on departmental resources. One way many health departments are addressing the challenge posed by diminished resources is through collaborating with other partners in the public health system to protect community health. This commentary introducing the issue is available in Frontiers in Public Health Services and Systems Research: http://uknowledge.uky.edu/frontiersinphssr/vol3/iss5/7 n an era of diminished resources, public health agencies are being asked to do more with less. Evidence suggests that while revenues at the state and local levels have been flat or increased slightly since 2010, a large number of governmental public health agencies in the United States have been forced to cut programs and/or staff to compensate for the relative paucity of funds at their disposal. At the same time, these agencies have been challenged to effectively deploy diminished resources to develop and implement multi-level interventions in their communities and to address the many determinants of complex chronic diseases, such as diabetes mellitus and heart disease. Infectious diseases like influenza still pose significant threats to public health, placing an additional strain on departmental resources. One way many health departments are addressing the challenge posed by diminished resources is through collaborating with other partners in the public health system to protect community health. The articles in this issue of Frontiers in PHSSR provide insight into the diversity of opportunities for collaboration between public health agencies and other system partners, but also remind us that collaborative activities may have some drawbacks. Opportunities for collaboration highlighted in this issue range from activities with other healthcare providers, such as those related to the IRS Form 990, Schedule H requirements examined in “What ‘Community Building’ Activities Are Nonprofit Hospitals Reporting As Community Benefit?” to sharing services with other governmental public health agencies, as highlighted in “A Case Study of Cross-Jurisdiction Resource Sharing: The Merger of Two Tuberculosis Clinics in East Tennessee.” Whatever their type and form, public health agencies always run the risk that, the Kershenbaum et al. article reminds us, partnerships may yield some benefits, but also may come with some risks. Thus, it becomes important that, as “Exploring the Process, Models, and Outcomes of Hospital-Public Health Partnerships” and “Public Health System Partnerships and the Scope of Maternal and Child Services: a Longitudinal Study” both suggest, that public health agencies be conscious of the types of partnerships they have with other system members, and remember that some partnership attributes may be associated with more desirable outcomes. Whatever type of partnerships public health agencies enjoy, communication is a critical aspect of engaging other system members. As suggested in “Health Communication as a Public Health Training and Workforce Development Issue,” while many public health agencies may have a staff member tasked with activities related to communication, the background and qualifications of these staff vary. Given the critical role communication plays in engaging other system partners, agencies may wish to examine the qualifications of their communications staff. Partnerships and collaboration can be a double-edged sword: They may allow public health agencies to better serve their communities, through focusing less on the direct provision of services and more on assuring the provision of services through many system partners. However, with assurance comes the need for oversight and for ensuring that the most vulnerable among us don’t fall through the cracks of the public health system.

Informal alcohol in Malawi: Stakeholder perceptions and policy recommendations

Through the eyes of those involved in the alcohol policy-making process in Malawi, we explored the role of informal (non-commercial) alcohol in rural communities, its harmful effects, and implications for appropriate national policy. Harms included early drinking initiation, violence, and sexual risk exposure. Informants suggested that policy should address informal alcohol's content, selling times, and easy access. Because most informal alcohol producers are women who rely upon sales for subsistence, policies must avoid limiting women's economic opportunities while protecting community health.

Access, monitoring and intervention challenges in the provision of safe drinking water in rural Bihar, India

This practical paper addresses the vital gap in water quality monitoring in Bihar. The study addresses an institutional weakness in the area of water quality management in rural Bihar, India. The study focuses on the role of access as a vital component in addressing water quality monitoring and interventions that has a huge impact on protecting community health in areas severely contaminated with arsenic and fluoride. The study calls for a drastic shift in the monitoring and intervention strategy to address safe water provision for rural Bihar.

Social vaccines to resist and change unhealthy social and economic structures: a useful metaphor for health promotion

The term 'social vaccine' is designed to encourage the biomedically orientated health sector to recognize the legitimacy of action on the distal social and economic determinants of health. It is proposed as a term to assist the health promotion movement in arguing for a social view of health which is so often counter to medical and popular conceptions of health. The idea of a social vaccine builds on a long tradition in social medicine as well as on a biomedical tradition of preventing illness through vaccines that protect against disease. Social vaccines would be promoted as a means to encourage popular mobilization and advocacy to change the social and economic structural conditions that render people and communities vulnerable to disease. They would facilitate social and political processes that develop popular and political will to protect and promote health through action (especially governments prepared to intervene and regulate to protect community health) on the social and economic determinants. Examples provided for the effects of social vaccines are: restoring land ownership to Indigenous peoples, regulating the advertising of harmful products and progressive taxation for universal social protection. Social vaccines require more research to improve understanding of social and political processes that are likely to improve health equity worldwide. The vaccine metaphor should be helpful in arguing for increased action on the social determinants of health.

Senator Obama and the environment

With political reporting being what it is, one fears that Americans know more about Senator Barack Obama's three-point shooting ability than his stance on the environment. However, it may be that former Vice President Al Gore's summer challenge – on behalf of renewable energy – struck a chord with the American people, and that this message has stuck with Obama, who has said that he would support investing $150 billion over 10 years in alternative energy research. He believes that “we cannot drill our way to energy independence, but must fast-track investments in renewable sources of energy like solar power, wind power, and advanced biofuels”. Unlike his Republican counterpart, Senator John McCain, and his running mate, Alaska Governor Sarah Palin, a conservative on environmental issues, Senator Obama has condemned calls for drilling offshore and in the Arctic National Wildlife Refuge, although he conceded that some offshore drilling might be acceptable. He has boldly called for energy efficiency to be doubled within 18 years. The League of Conservation Voters' “0%” rating for McCain (although his lifetime record stands at “26%”) is in sharp contrast to their “86%” rating (down from “96%” only because of missed votes) for Obama over his 3 years in the US Senate, a rating that is largely based on Obama's introduction or co-sponsoring of nearly 100 environmentally friendly bills, including proposed legislation on reducing mercury emissions, raising fuel-economy standards for automobiles, and promoting biofuels production. (If a “below zero” rating were recognized, Palin would qualify. The day she stated that “the jury was out” regarding global warming, the Markham Ice Shelf separated from Canada's Ellesmere Island. Why would the governor of the state closest to the North Pole not be concerned about predictions that the Pole will be ice-free in a few years?) On the other hand, some environmental groups are skeptical of Obama's support for coal-to-liquids technology, and his apparent enthusiasm for ethanol-based fuels. Both candidates understand the need to cut carbon emissions, but disagree on how to accomplish this. Both support measures to maintain/enhance US energy security, but in somewhat different ways; Obama has supported corn-based ethanol and cellulosic-based fuels as fuel additives, whereas McCain has objected to ethanol and ethanol subsidies. Obama has strongly advocated new regulation of animal feeding operations for pollution mitigation. McCain has been mostly silent on this issue. The candidates differ on the nuclear power option. Obama is cautious about nuclear power, would end the development of the Yucca Mountain nuclear storage facility, and promotes the need for stronger scientific analyses. McCain is a dedicated supporter of nuclear power and the Yucca Mountain facility. Obama has fairly consistently supported development of green technologies, reductions in fossil-fuel consumption, and increases in fuel-efficiency standards. McCain has spoken out in favor of tougher emissions standards, the creation of nuclear and “clean coal” power plants, the use of alternative energy sources, and electric cars. Obama has promoted inner-city recycling programs, advanced environmental justice, and has fought environmental racism, a subject that McCain has largely avoided. Obama has called for reductions in both mercury and lead emissions to protect community health, a position with which McCain has basically agreed. Obama emphasizes the protection of the Great Lakes and our National Parks and Forests, while NRA member Palin supports aerial wolf hunting and has refused to take action to protect polar bears in Alaska. Neither candidate is entirely clear on how these critical issues would be funded. Obama would probably push for tax incentives and a tax on carbon emissions. McCain's position is not very different. So, will McCain's maverick image and his public divorce (or perhaps it's a trial separation) from the Bush Administration's environmental policies bode well for the environment, or will Obama's activist image portend better solutions to pressing problems? Most pundits believe that a McCain Administration will at least be a “step forward” from the Bush Administration when it comes to the environment, whereas an Obama Administration will eventually result in a nearly complete reversal of the current Administration's stance on environmental policy. Stay tuned during the fall and, of course, for the 4 years thereafter – Act One will open in Copenhagen, at the UN Climate Conference in early 2009.

Hacia una nueva organización de los dispositivos de salud pública en España. Informe SESPAS 2008

Public health in Spain shows significant weaknesses. Spanish public health services respond reasonably well in crisis situations but tend to be invisible and occupy a marginal position in political agendas and in relation to health services. The organization of the public health subsystem is clearly out of date in terms of its ability to promote and protect community health, to prevent diseases, and to cope effectively with the new public health threats and challenges related to the physical and social environment in today's globalized world. Consequently, there is broad consensus on the need to rethink functions, strategies and the organization of public health in Spain, in line with European and international trends. Thus, public health reform is currently a pending challenge and a strategic priority. Indeed, some Autonomous Communities have initiated a process of modernization and change. Empowerment of public health in the political agendas and in relation to the health services is strongly recommended by promoting intersectorial approaches, the Health in All Policies strategy and Health Impact Assessment. There is also a need for a specific law that would update public health functions, organization and structures, allocate competencies by facilitating alliances and partnership, and regulate coordination and intersectorial intervention. The following key elements related to this reform are described: 1) a participatory leadership in public health; 2) the generation of intelligence and evidence in public health; 3) improvement of professional education and development; 4) the importance of transparent, independent and competent performance and communication, and 5) new and flexible organization coherent with the new strategies and close to the local level and primary health care services. Coordination between the State and the Autonomous Communities should involved a functional and intelligent relationship by building up common spaces, alliances, networks and shared initiatives for public health.

Políticas de salud (actuaciones poblacionales) en los servicios asistenciales. Informe SESPAS 2008

Health interventions addressed to the population as a whole from health care services are scarce and only exceptionally involve coordination among public health services (vaccinations and, in some autonomous communities, secondary breast cancer prevention). Health education programs addressed to schools are one of the most frequent interventions but their outcomes are not systematically evaluated. However, primary health care services carry out many clinical preventive activities. While the aims of these activities are laudable, the interventions themselves have substantial limitations, because they are an important source of dependency, a powerful incentive to consume drugs, and are also inefficient and inequitable ways of spending health resources. These limitations justify the testing of combined approaches between public health services and citizens’ collectives to improve and protect community health. Developing community health programs based on cooperation between primary health care services and public health services requires strategies that produce appreciable results in the short term to both health sectors, as well as to the population, so that these programs stimulate the process and encourage further development. The settings in which collaboration is most promising are population health surveillance and monitoring in basic health areas, control of communicable diseases and epidemic outbreaks, health promotion and health protection programs through simultaneous clinical and community-based interventions, and improved management of all health services in local communities through joint evaluation. The resources needed to carry out these activities should be drawn from a reduction of clinical preventive activities that reduce workload and from an increase in the number and quality of the public health workforce.

Microbiological studies of an anaerobic baffled reactor: microbial community characterisation and deactivation of health-related indicator bacteria

This WRC funded project has studied the appropriateness of the ABR (anaerobic baffled reactor) for on-site primary sanitation in low-income communities. A 3,000 L pilot reactor was located at the Kingsburgh wastewater treatment plant south of Durban, South Africa. Feed to the reactor was raw domestic wastewater containing a significant proportion of particulate organic matter. The compartments of the ABR were routinely monitored for pH, COD, and gas production, among other physical-chemical determinants. The microbial population in each compartment was analysed by fluorescent in situ hybridisation, using general oligonucleotide probes for eubacteria and archeae and a suite of 10 genera or family specific probes. Scanning electron microscopy was conducted on the sludge fraction of each compartment. Mixed fractions from each compartment were also analysed for health-related indicator bacteria (total coliforms and E. coli). Results indicated that methanogenesis was not occurring to the expected extent in the latter compartments, and that this was probably due to a hydraulic load limitation. This contrasted with earlier studies on industrial effluent, for which the organic load was exclusively in soluble form. Inactivation of health-related indicator bacteria was less than 1 log, indicating the need for an additional post-treatment of the effluent to protect community health.

Strengthening the nation's public health infrastructure: historic challenge, unprecedented opportunity.

The nation's attention has been focused on the vital need for a strong public health infrastructure to protect community health. In this paper we provide an overview of progress during the past decade and point to immediate challenges and opportunities that resulted from recent events. Further, we highlight the need for continued vigilance and broad partnership development if we are to maintain public support for public health. Finally, we point to the need for better language, compelling case reports, and quantitative capacity assessment to guide policymakers and program leaders and to ensure long-term support.