Scope Of Public Health Research Articles

Privatization and the scope of public health: a national survey of local health department directors.

This study sought to obtain and analyze nationally representative data on (1) privatization of local health department services, (2) local health department directors' beliefs and perspectives on the desirable role and focus of health departments, and (3) the influence of these views on privatization practices. A stratified representative national sample of 380 local health department directors was drawn, and 347 directors were interviewed by telephone. Logistic regression established the independent effects of various factors on decisions to privatize. Almost three quarters (73%) of the local health departments privatized public health services of some type. The 12% of the directors who believed that local health departments should be restricted to the core public health functions and move entirely out of direct provision of personal health care were more likely to privatize services. The 77% of the directors who believed that local health departments should be involved in an increasing array of social problems were more likely to privatize. Privatization has quietly and quickly become commonplace in public health, and privatization practices are intimately related to divergent conceptions of public health and the role of local health departments.

OPACIDADE E VISIBILIDADE DA PATERNIDADE NA REPRODUÇÃO ADOLESCENTE

O presente trabalho visa, através da análise de textos de divulgação científica, identificar as condições epistemológicos que propiciaram a emergência da questão da paternidade adolescente no âmbito das preocupações da Saúde Pública referentes à gravidez e à maternidade juvenis. Além disto, a investigação em pauta enseja promover uma reflexão destinada a elucidaro papel desempenhado pela ocultação do tema da paternidade nos textos científicos que têm, como objeto, o processo reprodutivo da mulher adolescente.

Public Health in Canada: A Comparative Study of Six Provinces

To describe the public health systems and their projected futures in six provinces in the context of two developments: 1) the emerging discourse on population health and 2) the trend toward regionalization of the health care system.Telephone interviews with key informants and key document review.Communicable disease control and health protection are currently the "core businesses" of public health; the population health discourse has not resulted in mandated programming. The reality is a retrenchment of public health scope during a time that should be considered conducive to expansion. Only Ontario has not regionalized its health care system, although public health is already delivered regionally. Alberta, Saskatchewan and Manitoba have either evolved or are evolving toward an integrated health system. There were concerns about the potential impact on public health identity and funding of this "vertical integration". Regionalization of public health may result in units that are too small to support adequate local expertise and may jeopardize development and enforcement of province-wide programs.

Perspectives on the place of environmental health and protection in public health and public health agencies.

The field of environmental health and protection and the entire field of public health have repeatedly found themselves isolated from one another, unable to articulate the definition, mission, and goals of public health and the essential role for environmental health and protection in the provision of a healthy ecological and human environment. Environmental agencies often forget that they, too, are public health agencies; public health agencies that have had environmental health functions have divided and abdicated their environmental responsibilities, considering these to be "regulatory" rather than public health. This article reviews the history of environmental health and protection, its involvement within the field of public health, its eventual separation from other public health programs with resulting benefits and consequences, and what the future may hold for environmental health and protection activities as well as for the broader scope of public health of which these activities are a part.

Public health reform.

Changes in funding and social and public policy will compel public health departments to reexamine their structure and values. Along with a reduction in providing health care services, public health will see a renewed emphasis on primary prevention. At the heart of primary prevention are marketing, communication, and community organizing. Unfortunately, these disciplines are all too often considered beyond the scope of public health and are contracted out or ignored. The commentary calls for a revitalized role for public health based on organizational adjustments consistent with anticipated changes in social policy and health care delivery.

Data management issues for emerging diseases and new tools for managing surveillance and laboratory data.

Data Management Issues for Emerging Diseases Since 1976, when Legionnaires’ disease affected attendees at the American Legion Convention in Philadelphia (1), the scope of public health has expanded. During the 1976 outbreak investigation, public attention was drawn to news accounts of the increasing numbers of cases and deaths as well as to speculations about diseases causes and prevention. After the outbreak, public health officials contended with volumes of information, including clinical data, epidemiologic survey results, and records of specimens collected from patients and the environment. This information was managed on mainframe computers. In 1980, a cluster of cases of unrecognized illness, primarily affecting young women, created a data management situation similar to that surrounding the Legionnaires’ disease outbreak. A major epidemiologic investigation, which included examining a multitude of laboratory specimens and analyzing volumes of data, was undertaken by a large team of federal, state, and local public health officials, as well as numerous academic institutions and private industries. The problems with establishing databases and implementing a data management system for toxic shock syndrome (2) were essentially the same as the data management problems of Legionnaires’ disease, except that computer technology had crept forward slightly in public health offices. During the spring of 1993, a cluster of cases of another unknown illness, eventually attributed to hantavirus (3), occurred in the southwestern United States. The reaction to this unknown disease by public health officials reflected a startling fact: even though the epidemiologic and laboratory methods for curtailing the outbreak were in place, a consistent data management strategy had not been established. Ad hoc databases built by outbreak investigators for a multitude of purposes began to bog down the investigation. Cases were recorded in multiple databases that did not recognize duplicate reports of cases. Updates of data about cases were done in some, but not all, databases. Laboratory data about specimens from patients were not linked to other clinical and epidemiologic data about a patient. No single database was available with well-edited, complete data about all the cases. Parallel, fragmented data management efforts evolved in at least 15 locations, with no coordinated mechanism to integrate them into one system. Introducing a single system for data management in the midst of the hantavirus outbreak involved more than the data management issues encountered in the earlier outbreaks. Previously, computer technology was viewed as a solution that, although somewhat cumbersome, enabled officials to move from data management by hand to electronic management. However, during the hantavirus outbreak, computer technology became part of the problem; it initially prevented good data management and may have hindered some of the laboratory and epidemiologic efforts to control the outbreak. Data were essentially being locked into various databases and could not be adequately analyzed or merged with data in other databases. In some instances, this peculiar circumstance caused investigators to perform analyses by hand using printouts from electronic databases or entering data again into other systems. In recent years, legal considerations, such as the Privacy Act enacted in 1974 and the Freedom of Information Act enacted in 1966 (4,5), have also complicated data management. These acts, in their efforts to protect individual privacy and ensure availability of data, have in some cases, constrained public health responses to emergency situations and subsequent surveillance efforts by enforcing strict database design and handling requirements.

Could you starve to death in England in 1839? The Chadwick-Farr controversy and the loss of the "social" in public health.

The public health field has long been pulled in two directions, either toward a narrower biomedical mission to control infectious disease or toward a broader mission to address the social and economic factors that adversely affect health and wellbeing. This paper explores as an instance of this tension an 1839 controversy between the statistician William Farr and the pioneering sanitary reformer Edwin Chadwick on the role of starvation as a cause of death. Farr thought hunger contribution significantly to many deaths; Chadwick wanted Farr to concentrate on the diseases from which people actually died. The paper then considers what the "constitutional" disease theories, which underlay Farr's concerns, implied for public health using medical testimony on child labor in industrial revolution factories as an illustration. An exploration of this constitutional medicine may help provide a "useable past" for modern public health workers interested in broadening the scope of public health.

The Sanitarians: A History of American Public Health by John Duffy

826 Book Reviews TECHNOLOGY AND CULTURE ropeans and Japanese took over this market, and with the imported cars came imported tires. The heavy debt incurred by the OE firms to finance the switch to radials was intensified by poor sales years during the stagflation of the 1980s and caused them to restructure to raise funds. Strengthened by the actions of raiding financiers, firms sold off parts of the tire industry. The buyers were often foreign tire companies. Today, Goodyear is the only American-owned OE manufacturer. The U.S. tire oligopoly has become one of the transnational portions of the developing global economy. The role of technology in the migration of the tire industry is another vivid illustration for a theme of severing local ties. The previous existence of the rubber industry made Akron, Ohio, a hub of the tire industry. Given the technology, tire building was a skilled craft, and mistakes caused costly losses from throwaways. The tire builders earned high wages, and many rubber workers migrated to the tire plants. The trade also required muscle; tires weigh a lot. For these reasons the rise of unions rested on issues like the speedup and the length of the work week. Then, in the postwar era, new technology, especially for the assembly of the radial tire, made the tire builder a semiskilled worker. Among other factors, this made possible the relocation of plants in such traditionally antiunion areas as the South. The plants were taken to the workers; there are none in Akron today. This is a book for all interested in economic history: it is tightly organized, succinct, and well researched and contains an excellent annotated bibliography and a fine index. It speaks well of publisher Twayne’s “Evolution of American Business Series: Industries, Insti­ tutions, and Entrepreneurs.” It is too bad the publishing format did not permit the author to delve into the tire in popular culture. Ernest B. Fricke Dr. Fricke, professor of history at Indiana University of Pennsylvania, has published articles dealing with Allentown, Pennsylvania, during the Depression and an article on the smallest tire company: “The New Deal and the Modernization of Small Business: The McCreary Tire and Rubber Company, 1930— 1940,” Business History Review, vol. 56 (Winter 1982). The Sanitarians: A History of American Public Health. By John Duffy. Champaign: University of Illinois Press, 1990. Pp. ix + 330; notes, bibliography, index. $32.50. The Sanitarians is a needed synthesis of several decades’ worth of case studies, focusing on response to epidemics and the establishment of public health agencies by various cities and states and, more rarely, by the federal government. Scattered among dissertations, articles in TECHNOLOGY AND CULTURE Book Reviews 827 the trade press, or in state and local historicaljournals, this literature has been difficult to access. John Duffy’s first three chapters cover efforts of English colonists to cope with the familiar smallpox and the unfamiliar yellow fever in their new port cities. The dominant image of the 19th century (the next eight chapters) is one of periodic reform efforts invariably undermined by apathy, corruption, ignorance, or prejudice. The final eight chapters on the 20th century show efforts to expand the scope of public health from a narrow focus on communicable disease into occupational medicine, nutrition, health education, and even national health insurance. Readers should be aware that the book does not deal systematically with demographic or epidemiological matters; also that the experience of New York City, focus of Duffy’s own research, looms large. Synthesis is certainly needed, yet a synthesizer is constrained by the sources: some of the literature Duffy uses is little more than professional self-congratulation, much of it is dominated by some conception of what “public health” ought to be or to have been in particular circumstances. Duffy shows that what public health is has varied greatly. Yet why particular problems appeared and faded remains unclear, for the book does little to integrate public health into larger themes in American history and culture and provides little explanation of why the domain of public health shifted over the years. For many early-20th-century Americans, public health would have been bound up with eugenics; many of their grandparents would...

Need for job-related health counseling in small workplaces.

Health counseling aimed at maintaining health and safety on the job is required in most small workplaces. From a labor protection point of view, the most important advice deals with environmental hazards such as protection against physical and chemical factors, ergonomic problems, and safety risks. Information provided by the employers was considered insufficient in three-fourths of the 163 firms surveyed in this study. The staff providing local occupational health services could perform two broad types of counseling. First, they could educate management as to its responsibilities for the health and safety of employees; health personnel can instruct management during their workplace visits. Second, during health examinations and other personal contacts, the worker can be advised about ways to improve or maintain his health. Moreover, such occasions also provide an opportunity for more extensive health counseling about personal, social emotional, and other problems although, in municipal health centers, these subjects belong within the scope of public health rather than occupational health.

The Scope of Public Health in Venereal Disease Control

The Scope of Public Health in Venereal Disease Control

The Scope of Public Health After 1948, by F. A. E. CREW, T.D., F.R.S., M.D., F.R.C.P.E., D.SC., Professor of Public Health and Social Medicine, University of Edinburgh

The Scope of Public Health After 1948, by F. A. E. CREW, T.D., F.R.S., M.D., F.R.C.P.E., D.SC., Professor of Public Health and Social Medicine, University of Edinburgh