State-level Public Health Research Articles

Teleconferences for national surveillance of infectious diseases and public health events in Germany. Evaluation after three quarters in 2009

ZusammenfassungUm adäquat auf neue Bedrohungen reagieren zu können, kann sich der Öffentliche Gesundheitsdienst (ÖGD) nicht mehr ausschließlich auf traditionelle Surveillance-Strukturen verlassen. Im Januar 2009 wurde von der Abteilung für Infektionsepidemiologie am Robert Koch-Institut (RKI) eine wöchentliche telefonische infektionsepidemiologische Bund-Länder-Lagekonferenz etabliert. Die Konferenz schafft eine Plattform, auf der die Teilnehmer (zuständige Landesgesundheitsbehörden, Referenten für Infektionsschutz der Bundesländer, Bundeswehr, RKI) regelmäßig, strukturiert und zeitnah infektionsepidemiologische Ereignisse diskutieren können. In den ersten drei Quartalen 2009 wurden Ereignisse, die 46 Infektionskrankheiten betrafen, diskutiert; darunter auch Ausbrüche nicht-meldepflichtiger Erkrankungen, wie zum Beispiel Kuhpocken. Masern und Meningokokken-Meningitis gehörten zu den am häufigsten diskutierten Infektionskrankheiten. Die Ergebnisse einer Evaluation und die konstant hohe Teilnehmerzahl zeigen, dass mit der Telefonkonferenz dem Bedarf nach zusätzlichem Informationsaustausch entsprochen wurde. Die Telefonkonferenz ermöglicht direkte Kommunikation; Informationen zu Ereignissen können schneller weitergegeben und evaluiert werden. Somit können auch Public-Health-Maßnahmen rascher eingeleitet werden.

Effects of state‐level public spending on health on the mortality probability in India

This study uses the second National Family Health Survey of India to estimate the effect of state-level public health spending on mortality across all age groups, controlling for individual, household, and state-level covariates. We use a state's gross fiscal deficit as an instrument for its health spending. Our study shows a 10% increase in public spending on health in India decreases the average probability of death by about 2%, with effects mainly on the young, the elderly, and women. Other major factors affecting mortality are rural residence, household poverty, and access to toilet facilities.

Household Use of Inpatient Healthcare Services in India

Improving household use of healthcare facilities is a vital public health strategy to reduce burden of disease in India. Our study set out to understand the importance of the interplay of household characteristics and state-level public health covariates in accessing inpatient healthcare services. The study is based on morbidity and healthcare data from the 60th round of the Indian National Sample Survey Organisation, 2004. We used multilevel logistic regression to disentangle dependence among the observations. We observed that the education level of household heads and the household's economic well-being had a significant positive influence on accessing inpatient healthcare services. Distance from the household to the health facility showed a significant inverse association with use of health facilities for inpatient treatment. Further, we found a significant variation across the states. Variability in accessing inpatient services at the household and state levels are 1.7% and 21% respectively.

Do Geographic Regions with Higher Suicide Rates also have Higher Rates of Nonfatal Intentional Self‐Harm?

Fatal and nonfatal intentional self-harm events in eight U.S. states were compared using emergency department, hospital, and vital statistics data. Nonfatal event rates increased by an estimated 24.20% over 6 years. Case fatality ratios varied widely, but two northeastern states' total event rates (fatal plus nonfatal) were very high (New Hampshire 206.5/100,000 person years; Massachusetts 166.7/100,000). Geographic context did not uniformly impact the likelihood of self-harm across event types. The state-level public health burden posed by such acts cannot, therefore, be accurately estimated from either mortality or morbidity data alone.

Federal civil rights policy and mental health treatment access for persons with limited english proficiency.

As noted in the supplement to the U.S. Surgeon General's report on mental health (U.S. Department of Health and Human Services, 2001), overcoming language access barriers associated with limited English proficiency (LEP) should help to eliminate racial and ethnic disparities in mental health care access and quality. Federal policy requires remedial action to overcome language barriers: Under Title VI of the Civil Rights Act of 1964, Medicaid and other federally funded programs must provide assistance to LEP persons. Some state-level public and mental health authorities have responded by instituting "threshold language" policies. The history and terms of federal civil rights policy, and of threshold-language-policy-inspired initiatives, should be understood by everyone concerned with overcoming ethnic disparities in mental health services use. Concerned parties should promote implementation of required measures for language assistance and help to evaluate their implementation and effectiveness.

Using Information Technology to Improve the Public Health System

Information technology can be both a vital tool and critical link in the modern public health system. This article discusses the role of information technology in public health and the activities of the Information Technology Collaborative, one of the collaboratives that comprise the national Turning Point initiative. Data are presented from a nationwide survey investigating local health department information technology needs and information technology use. This data, and data from an investigation of state-level public health information technology, will be presented in a more complete format on the Information Technology Collaborative's online Public Health Information Systems Catalog, a free resource for individuals interested in public health informatics. Recommendations for future initiatives, policy changes, and information technology standards are discussed.

Collaborative partnerships at the state level: promoting systems changes in public health infrastructure.

Reforms in the public health infrastructure such as those called for in recent Institute of Medicine reports require stakeholder engagement on different levels than traditional grass-roots community work. The Turning Point Initiative, funded by The Robert Wood Johnson Foundation, involves 21 state-wide partnerships established for systems change and focused in specific areas of public health innovation and policy development. These partnerships represent a different model of strategic alliances and relationship-building than has been previously described in the literature on community-level and health-promotion collaborations. This article utilizes qualitative data to illustrate the ways in which state-level partnerships for systems change both confirm and extend previous models. Findings indicate that state-level public health partnerships share many of the challenges and opportunities of locally-based and health-promotion-oriented partnerships. Collaboration at the state level, however, involves more attention to organizational alliances, coordination of institutional change, and strategic responses to political changes. These partnerships depend on a combination of interpersonal skills, material resources, and organizational savvy to manage complex planning and implementation processes. Influencing policy development and organizational redesign in public health systems requires nuanced understanding of the opportunities provided by various kinds of organizational partners.

Analytical resources for assessment of clinical genetics services in public health: current status and future prospects.

Genetics services are not well integrated into the public health programs of most states, nor has there been effective use of clinical and program databases in the design, evaluation, and monitoring of public health genetics services at the state level. To evaluate the availability and current use of population-based clinical genetics databases, including birth defects surveillance programs, in state-level public health genetics programs. Mail survey to state genetics coordinators in 50 states and 3 territories during 1996 with an update in 1997. Thirty states had birth defects surveillance programs; data from these resources were used in public health genetics program planning and management in only 15 states. Thirty states or territories had clinical genetics services databases. Most states had newborn screening program databases; few linked these records to vital statistics for programmatic purposes. Only 24 states had individual record databases for the Children with Special Health Care Needs program; 8 states had databases for maternal serum alpha-fetoprotein screening, and 7 had statewide cytogenetics registries. Population-based databases concerning aspects of public health genetics are largely unavailable at the state level. Where these databases exist, they are poorly integrated into state public health genetics program activities. More attention should be paid to the development and use of clinical data programs for the assessment, monitoring, and assurance of genetics issues with relevance to population health.

Governmental planning and budgeting with multiple objective models

This paper presents a goal programming model development and application for a state level public health care agency. Only limited applications of macro planning processes related to health care have been presented in the literature. In that regard, this paper describes briefly the goal programming model, the background of the agency involved and the specific models developed. Three formulations of the model are presented involving (1) the resources required to achieve all goals, (2) the goal attainment status utilizing a likely budget and (3) a proposal for resolving the goal desire-resource limitation dilemma.