Public Health Leaders Research Articles

Collaboration for Health Equity: A Qualitative Assessment of Local Leaders in Community-Based Organizations, Health Care, and Public Health in Michigan.

A qualitative study was conducted using semi-structured interviews leaders in community-based organizations, health care, and local public health to understand organizational perspectives of collaboration for health equity and identify opportunities to improve collaboration. Twelve leaders were interviewed from March through May 2023 in Kent County, Michigan. All leaders saw collaboration as valuable for advancing health equity. Key themes that affected collaboration and could be a facilitator or barrier to advancing health equity in the community were inclusion, power, relationships, resources, and organizational traits. Leaders articulated the following factors as those that support collaboration for health equity: authentic inclusion, shared decision-making, taking time to foster trusting relationships, adequate resources to support the infrastructure needed for collaborations, organizational flexibility, and individual commitment. Building partnerships with these facilitators in mind may result in more robust, sustainable, and resilient collaboratives.

Climate change and public health: An evaluation framework for local government

ObjectivesTo develop and pilot an evaluation framework for assessing the engagement of local government public health teams in England on climate change and sustainability. These teams are uniquely positioned to address local health impacts of climate change and promote health co-benefits of mitigation. No statutory framework currently exists to support their engagement in this agenda. Study designLiterature review and two cross sectional surveys. MethodsA group of public health professionals conducted a literature review and agreed on criteria based on statutory responsibilities and remit of these teams, available information, and opportunities for local government action. With the resulting framework, this group evaluated all 11 local governments in the East of England region, and then conducted a follow-up survey to assess the framework’s impact and acceptability. ResultsAn evaluation framework was developed with 21 criteria in two sections. The first assessed overall local government action and leadership in climate change and sustainability, to understand the context in which the public health team was situated. The second assessed the climate change related actions undertaken by the public health team.All 11 local governments in the East of England region completed the evaluation. Results indicated inconsistencies in local public health team action on and engagement with climate change and health. Ten local governments completed the follow-up survey on acceptability and impact, reporting that the evaluation was easy to complete. Seven out of ten respondents found that the evaluation had influenced change or reflection within their organisation, for example through identifying gaps and prompting more collaboration between teams. ConclusionsThis evaluation framework is a useful and acceptable tool to assess local government public health engagement and leadership on climate change and sustainability. If used more widely, it could help to support public health teams to advance much-needed action in this area.

A Scoping Review of Health Equity Interventions in Governmental Public Health.

Despite major efforts in research, practice, and policy, racial and ethnic disparities in health and health care persist in the United States. Interventions in collaboration with governmental public health may provide ways to address these persistent racial and ethnic health and health care disparities and improve health outcomes. To conduct a comprehensive review of health equity interventions performed in collaboration with public health agencies. This scoping review includes intervention studies from Ovid MEDLINE, PsycINFO, and Academic Search Premier, published between 2017 and 2023. The search strategy used terminology focused on 4 concepts: race/ethnicity, equity, health departments, and epidemiologic studies. The following inclusion criteria were determined a priori: (1) intervention tailored to reduce racial/ethnic health disparities, (2) public health department involvement, (3) health outcome measures, (4) use of epidemiologic study methods, (5) written in English, (6) implemented in the United States, (7) original data (not a commentary), and (8) published between January 2017 and January 2023. This review focused primarily on 4 dimensions of racial health equity interventions including intervention components, intervention settings, intervention delivery agents, and intervention outcomes. This review indicated that health equity interventions involving public health agencies focused on the following categories: (1) access to care, (2) health behavior, (3) infectious disease testing, (4) preventing transmission, and (5) cancer screening. Critical strategies included in interventions for reaching racial/ethnic minoritized people included using community settings, mobile clinics, social media/social networks, phone-based interventions, community-based workers, health education, active public health department involvement, and structural/policy change. This scoping review aims to provide an evidence map to inform public health agencies, researchers, and funding agencies on gaps in knowledge and priority areas for future research and to identify existing health equity interventions that could be considered for implementation by public health leaders.

Optimizing Professional Development for New York State Public Health Association Members: Findings From a Mixed Methods Assessment of Public Health Professionals

The COVID-19 pandemic placed significant burden on public health professionals, with many experiencing burnout and leaving the profession. The New York State Public Health Association (NYSPHA) recognized the impact of the pandemic on the state’s public health workforce and sought professional development opportunities to support current and future generations of public health professionals. To achieve this goal, NYSPHA solicited input from its members and potential members via survey and focus groups as part of its New Directions Initiative. Seventy individuals participated in listening sessions, and 850 responded to the survey. While more than half felt that NYSPHA is invested in the health and wellness of New Yorkers, fewer considered NYSPHA a leader in public health or a go-to source for public health information. Only about one-third felt connected to NYSPHA as a public health professional. Participants identified multiple professional development opportunities that would encourage them to join or renew their membership including sections or special interest groups (57.4%), opportunities to gain leadership experience (56.7%), volunteering (58.1%), a new committee that addresses public health in the community (55.9%), and mentorship (48.4%). NYSPHA used the results of the survey and focus groups to provide several professional development opportunities including a mentorship program, a new Public Health in Action Committee, and special interest groups in mental health and climate change that have already made a difference in local New York State communities. Similar organizations may use NYSPHA’s experience as an example for supporting their workforce to maximize impact on the communities they serve.

Lethal carbon monoxide generated from small internal combustion engines.

Fuel-burning small engines have the potential to emit dangerous and potentially lethal concentrations of carbon monoxide when used in poorly ventilated environments. The North Carolina Office of the Chief Medical Examiner investigated seven cases from 2013 to 2020 involving lethal carbon monoxide from small internal combustion engines. Evaluation of percent carboxyhemoglobin saturation was determined in these case studies as ratios of carboxyhemoglobin to reduced hemoglobin, using HP 8453 and Agilent 8454 UV-Visible Spectrophotometers (Agilent Technologies, Santa Clara, CA, USA). Sources of carbon monoxide included a pressure washer, a propane-powered forklift, an inboard engine boat, a motorcycle, propane and kerosene heaters, and home-use generators. It was demonstrated during a death investigation that the Dräger X-am 2000 electrochemical gas monitor often used by first responders, falsely reacted to acetylene gas, initially misleading investigators to the source of the carbon monoxide. Educating first responders about not only the hazards of these unexpected carbon monoxide sources, but the limitations of their equipment, is a valuable goal of disseminating complete medical examiner case information. The details of these cases will educate first responders, the forensic science community, and public health leaders on potential small engine sources of carbon monoxide in death investigations, responder safety, and the limitations of portable air quality monitoring equipment during death investigation.

Reimagining Public Health: Mapping A Path Forward.

The COVID-19 pandemic and other ongoing public health challenges have highlighted deficiencies in the US public health system. The United States is in a unique moment that calls for a transformation that builds on Public Health 3.0 and its focus on social determinants of health and partnerships with diverse sectors while also acknowledging how the pandemic altered the landscape for public health. Based on relevant literature, our experience, and interviews with public health leaders, we describe seven areas of focus within three broad categories to support transformational change. Contextual areas of focus include increasing accountability and addressing politicization and polarization. Topical areas of focus highlight prioritizing climate change and sharpening the focus on equity. Technical areas of focus include advancing data sciences, building the workforce, and enhancing communication capacity. A transformed public health system will depend highly on leadership, funding incentives, and both bottom-up and top-down approaches. A broad effort is needed by public health agencies, governments, and academia to accelerate the transition to a next phase for public health.

Oregon's Approach To Demonstrating The Value Of A Modern Public Health System Through Accountability Metrics.

Oregon's public health system uses accountability metrics to improve health, eliminate inequities, and practice stewardship. First enacted into law during the 2015 legislative session, with additions and clarifications made in the 2017 session, these metrics promote collective action across sectors, bring attention to the root causes of health inequities, and hold public health authorities accountable for performance improvement as they carry out core public health functions. This article describes the development of Oregon's accountability metrics and implications for future practice. In 2023, Oregon's public health leaders adopted a new set of health outcome indicators and process measures for communicable disease control and environmental health, with performance tied to financial incentives. Oregon's process is a model for other states developing an accountability framework in their pursuit of public health transformation. Oregon's work contributes to legislative and other policy decisions for measuring the success of approaches to eliminating health inequities and for applying performance-based incentives within the public health system.

Training the Next Generation of Local Public Health Leaders: A Case Study of Community Health Organizers in Pennsylvania.

Few short-term training programs exist for persons with limited experience or training in public health to support public health initiatives. We describe a public health training designed by the Pennsylvania (PA) Training Center for Health Equity for the PA Community Health Organizer (CHO) program. The CHO program was created to address the immediate needs of underserved communities and promote lasting health equity during the pandemic. CHOs are professionals who promote community action and align efforts with local organizations to build sustainable public health infrastructure and apply evidence-based practices to program policy, planning, and development. The training content, delivered by Project Extension for Community Healthcare Outcomes (ECHO) in 12 monthly sessions, focused upon foundational public health concepts in a novel community case study approach. The ECHO All Teach, All Learn training model was successful in providing relevant public health information to this new workforce, and the pre-/post-training evaluation demonstrated a positive increase in knowledge across all domains.

Emerging infodemic management strategies focus on technology: They can't forget trust.

Public health authorities around the world are planning to manage infodemics as part of their next public health emergency. But the experience of managing communications for Ontario's COVID-19 Science Advisory Table suggests that emerging infodemic management (IM) strategies should include three key principles, which appear to be missing from much of the existing literature: (1) emerging IM strategies should incorporate leadership from epidemiologists who can align infodemic response with underlying disease; (2) they should embrace journalists who mediate trust in crises; and (3) they should acknowledge the unique opportunity for public health leaders to build public trust rapidly in the first days of a crisis-a foundation for all subsequent IM. Standardizing infodemic response may help accelerate interventions during a public health emergency, especially when paired with technology. But over-standardizing the human work of building trust risks losing the infodemic fight before it starts.

Building a New Generation of Public Health Leaders Forged in a Public Health Crisis.

The COVID-19 pandemic presented wide-ranging leadership challenges to public health leaders and public health organizations. In its wake, as the necessity of reconstructing public health and modernizing the Centers for Disease Control and Prevention (CDC) is considered, we reviewed reports from the Commonwealth Fund and the CDC and other leadership-focused literature to identify common themes for a new generation of public health leaders. We posit that this new generation must have the ability to communicate (build and maintain trust and accountability); forge, facilitate, and promote partnerships; connect public health and health care systems; build information systems that provide accessible, actionable data; engage in systems and strategic thinking and action; center equity and inclusivity and understand structural racism as a fundamental driver and creator of health inequities; and achieve and maintain resilience and self-care. For each of the 7 abilities, we offer a description, assess what COVID-19 taught us about the necessity of the ability for public health leaders, and offer suggestions for developing (or honing) one's skill set, mindset, and tool set in this regard. (Am J Public Health. 2024;114(6):626-632. https://doi.org/10.2105/AJPH.2024.307633).

IJCM_379A: Inductive Thematic Analysis of responses obtained for SOAR Analysis of self by Community Medicine Professionals enrolled in Foundation Course on Leadership in public Health

Background: Foundation Course on Leadership in Public health is a newer initative of IAPSM association to generate Public Health Leaders. SOAR is an acronym for Strengths, Opportunities, Aspirations and Results. Tough SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis is a comprehensive approach and SOAR is a positivist approach still it was chosen as the task because aspirational goals are important in initial phase of an organizational or self-leadership. Risk Mitigation as facilitated by SWOT is required at a later stage. Also, SOAR is a proactive approach in interest of initiation of leadership. Also, SOAR is a less used and newer approach so it would have been a new learning for the participants and moderators as well. Objective: To qualiatatively understand responses obtained for self SOAR analysis by the participants. Methodology: The moderators obtained responses of the participants and analysed the exact verbatim as first order themes. further second order and higher order themes were generated by conseus of both the authors. these themes were further classified into SOAR categories. Results: The strengths of SOAR analysis were themed under categories of interpersonal skills, learning and adaptibility, leadership management, adapatbility and flexibilty. Major themes categorised under their aspirations were education, communication and leadership Conclusion: Young Public Health professional are seeking opportunities for career advancement, leadership anf public health research.

Solving poverty or tackling healthcare inequalities? Qualitative study exploring local interpretations of national policy on health inequalities under new NHS reforms in England

ObjectivesMajor reforms to the organisation of the National Health Service (NHS) in England established 42 integrated care systems (ICSs) to plan and coordinate local services. The changes are based on...

Role of Grassroots Public Health Leadership in Bedouin Society in Israel in Reducing Health Disparities.

Negev Bedouin settlements suffer from poor infrastructure, and the population's health status is low across all indicators. While it is difficult for Bedouin citizens of Israel to integrate into the Israeli employment market, integrating this population into the health system is far-reaching. The aim of this study is to analyze the barriers and motivational factors experienced by Bedouin doctors to promote public health in the Bedouin community in southern Israel and to examine the perceptions these doctors have around the concept of leadership in a public health setting. We conducted semi-structured interviews with Bedouin doctors from the Negev Bedouin community and analyzed them using thematic analysis. Most interviewees saw themselves as leaders whose role was to improve public health in their community. They stressed the need for health leadership in Negev Bedouin society, and their desire to lead change in the community from within. All interviewees had grown used to a different way of life and a higher standard of living, and as a result, had difficulty returning home. Interviewees presented that trust in the health system is a critical factor for the success of health promotion programs. However, they noted the evolving trends of general mistrust in the government and its institutions that form the infrastructure for mistrust in the health system. Lack of time and workload were barriers to exercising leadership. Interviewees reported their perception of how socioeconomic status, the standard of living, and lack of infrastructure, education, and training affect health outcomes and collaboration potential. This study presents a unique perspective on the views of doctors from the Negev Bedouin population on their involvement with grassroots leadership as a strategy to reduce health disparities in this community.

Co-designing strategies to implement long-acting injectable PrEP for sexual minority men in Chicago: a study protocol for an innovation tournament and implementation mapping

BackgroundParticipatory design approaches can improve successful selection and tailoring of implementation strategies by centering the voices of key constituents. To reduce incidence of the human immunodeficiency virus (HIV) in the USA, co-design of implementation strategies is needed for long-acting injectable cabotegravir (CAB-LA), a new form of HIV pre-exposure prophylaxis, among the disproportionately impacted population of sexual minority men (SMM). This manuscript describes the protocol for participatory design approaches (i.e., innovation tournament and implementation mapping) to inform implementation of CAB-LA among SMM (≥ 12 years), particularly Black and Latino populations, in Chicago.MethodsThis research incorporates innovative methods to accomplish two objectives: (1) to crowdsource ideas for the design of implementation strategies for CAB-LA through a virtual innovation tournament and (2) to leverage the ideas from the innovation tournament to operationalize implementation strategies for CAB-LA thorough the systematic process of implementation mapping. A committee of constituents with diverse expertise and perspectives (e.g., SMM, implementation scientists, HIV clinicians, public health leadership, and community partners) will provide input throughout the design process.DiscussionThis research will produce a menu of co-designed implementation strategies, which can guide plans for CAB-LA integration in Chicago and provide insights for other EHE regions. Further, as the first innovation tournament focused on HIV prevention, this research can provide a framework for participatory approaches across the care continuum. Given that the co-design of implementation strategies often does not involve the participation of individuals with lived experiences, this work will center the voices of those who will benefit most.

Q&A: Continuous Coverage Unwinding and Medicaid Expansion on the Ground in Two North Carolina Counties.

After three years of continuous Medicaid coverage as permitted by COVID-19-related waivers, in 2023 counties had to begin redeterminations of eligibility, "unwinding" this continuous coverage. As unwinding and eligibility determination continues, Medicaid expansion has begun, and county public health leaders are navigating uncertain but exciting waters. Lisa Macon Harrison, MPH, of Granville Vance Public Health, and Joshua Swift, MPH, of Forsyth County Department of Public Health, share their experiences, concerns, and hopes for the future.

Strategies for Preparing Future Public Health Leaders: Learning from Trailblazing Women in Health Education

Many female health education pioneers made seminal contributions to public health and social justice, yet these examples are not well documented in textbooks or integrated into public health curricula as pedagogical learning opportunities. Providing biographies and lessons learned from the past leaders within undergraduate health education curricula can help develop students’ skills as future leaders and address gender inequities in the field. Gender inequities in higher education as well as many public health practice settings result in lower salaries, slower career advancement opportunities, fewer supervisory positions, increased work-life conflicts, and heavier workloads. Developing women’s competencies in leadership and professionalism early in their careers is critical to meeting public health challenges such as COVID-19. We present four female health education trailblazers from different historical eras and various workforce sectors who exemplify leadership attributes (i.e., courage/risk taking, vision, advocacy, mentorship) and can be highlighted as a part of future health education curriculum. Innovative methods and approaches are provided for integrating these leadership lessons into undergraduate public health courses, in alignment with the HESPA II 2020 competencies. Learning from the past to inform the future is critical to inspiring and shaping the careers of emerging health educators.

Clinical research imperatives: principles and priorities from the perspective of Allied Health executives and managers.

Objective It is widely understood that a key means of improving health systems and patient outcomes is through research - accessing, understanding, generating and applying research evidence-based practice. To promote more targeted and strategic research in Allied Health practice, this study sought to establish the principles, areas and priorities for clinical research as perceived by Allied Health leaders in the South Australian public health system. Methods The study used a mixed-methods design (full, sequential and equal model). Participants were recruited from theSouth Australian Department of Health and Wellbeing employment lists for Allied Health senior leaders. Consenting participants attended face-to-face focus groups; after an overview presentation, they discussed the principles for Allied Health research, followed by areas and priorities for research. Summaries of the responses were themed descriptively and circulated electronically so participants could confirm the research areas and ascribe priority ratings, clinical populations and services. Results A total of 28 people attended the stakeholder forum (5 online); 20 responded to the second-round electronic summary. Nine principles of research action were agreed. Fourteen research areas were identified and prioritised. There was a relatively consistent prioritisation of measuring Allied Health value, Allied Health workforce, hospital avoidance and closing the gap for Aboriginal health outcomes - whether the individuals were thinking about their own service or the state as a whole. Conclusions Allied Health leadership identified key principles and priorities for research to improve service delivery and patient outcomes. These priorities should generate further discussion and interest for novice and experienced researchers and leaders and can be used to inform granting and project plans.

Background and Rationale - CDC Guidance for Communities Assessing, Investigating, and Responding to Suicide Clusters, United States, 2024.

To assist community leaders in public health, mental health, education, and other fields with developing a community response plan for suicide clusters or for situations that might develop into suicide clusters, in 1988, CDC published Recommendations for a Community Plan for the Prevention and Containment of Suicide Clusters (MMWR Suppl 1988;37[No. Suppl 6]:1-12). Since that time, the reporting and investigation of suicide cluster events has increased, and more is known about cluster risk factors, assessment, and identification. This supplement updates and expands CDC guidance for assessing, investigating, and responding to suicide clusters based on current science and public health practice. This report is the first of three in the MMWR supplement that describes an overview of suicide clusters, information about the other reports in this supplement, methods used to develop the supplement guidance, and the intended use of the supplement reports. The second report, CDC Guidance for Community Assessment and Investigation of Suspected Suicide Clusters - United States 2024, describes the potential methods, data sources and analysis that communities can use to identify and confirm suspected suicide clusters, and better understand the relevant issues. The final report, CDC Guidance for Community Response to Suicide Clusters - United States, 2024, describes how local public health and community leaders can develop a response plan for suicide clusters. The guidance in this supplement is intended as a conceptual framework that can be used by public health practitioners and state and local health departments to develop response plans for assessing and investigating suspected clusters that are tailored to the needs, resources, and cultural characteristics of their communities.

CDC Guidance for Community Assessment and Investigation of Suspected Suicide Clusters, United States, 2024.

This report is the second of three reports in the MMWR supplement updating CDC's guidance for investigating and responding to suicide clusters. The first report, Background and Rationale - CDC Guidance for Assessing, Investigating, and Responding to Suicide Clusters, United States, 2024, describes an overview of suicide clusters, methods used to develop the supplement guidance, and intended use of the supplement reports. The final report, CDC Guidance for Community Response to Suicide Clusters, United States, 2024, describes how local public health and community leaders can develop a response plan for suicide clusters. This report provides updated guidance for the approach to assessing and investigating suspected suicide clusters. Specifically, this approach will guide lead agencies in determining whether a confirmed suicide cluster exists, what concerns are in the community, and what the specific characteristics are of the suspected or confirmed suicide cluster. The guidance in this report is intended to support and assist lead agencies and their community prepare for, assess, and investigate suicide clusters. The steps provided in this report can be adapted to the local context, culture, capacity, circumstances, and needs for each suspected suicide cluster.

CDC Guidance for Community Response to Suicide Clusters, United States, 2024.

This is the third of three reports in the MMWR supplement that updates and expands CDC's guidance for assessing, investigating, and responding to suicide clusters based on current science and public health practice. The first report, Background and Rationale - CDC Guidance for Communities Assessing, Investigating, and Responding to Suicide Clusters, United States, 2024, describes an overview of suicide clusters, methods used to develop the supplement guidance, and intended use of the supplement reports. The second report, CDC Guidance for Community Assessment and Investigation of Suspected Suicide Clusters, United States, 2024, describes the potential methods, data sources, and analysis that communities can use to identify and confirm suspected suicide clusters and better understand the relevant issues. This report describes how local public health and community leaders can develop a response plan for suicide clusters. Specifically, the steps for responding to a suicide cluster include preparation, direct response, and action for prevention. These steps are not intended to be explicitly adopted but rather adapted into the local context, culture, capacity, circumstances, and needs for each suicide cluster.