Public Health Administration Research Papers (original) (raw)

European policymakers have recently become increasingly committed to using Impact Assessment (IA) to inform policy decisions. Welcoming this development, the public health community has not yet paid sufficient attention to conceptual concerns about IA or to corporate efforts to shape the way in which IA is used. This essay is a thematic analysis of literature concerning IA and associated tools and a related assessment of the European Union's (EU) new 'integrated'IA tool. Eight key concerns regarding IA are identified from ...

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- Human Geography, Epidemiology, Information Policy, European Union
- by Selena Gray
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- Health Promotion, Forecasting, Quality of Mental Health Care, Public Health

More than four years after September 11, 2001, bioterrorism preparedness remains a high priority for federal, state, and local governments. With reasonably flexible federal funding, communities have strengthened their ability to respond to public health emergencies, according to assessments by stakeholders and market observers. Collaborative relationships developed for bioterrorism preparedness have proved useful in addressing other threats, such as natural disasters and infectious disease outbreaks. Major ongoing challenges include funding constraints, inadequate surge capacity, public health workforce shortages, competing priorities, and jurisdictional issues. [Health Affairs 25, no. 4 (2006): 946-957; 10.1377/hlthaff.25.4.946] 9 4 6

- by Aaron Katz
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- Public Health, Applied Economics, Public Health Administration, United States

Regression to the mean (RTM) is a widespread statistical phenomenon. It is a group phenomenon that occurs whenever an extreme group is selected from a population based on the measurement of a particular variable. If a second measurement is then taken for the same group, the second mean will be closer to the population mean than the first measurement. This decrease (or increase) can be mistakenly attributed to a treatment effect; the conclusion can be drawn that an effect results from treatment when it in fact results from chance. Any intervention that is aimed at a group or characteristic that is very different from the average will appear to be successful because of RTM. It is therefore important that any genuine reductions because of the treatment are separated out from the effect of RTM. If the problem is ignored then this will lead to errors in the interpretation of results and, potentially, decisions made on the evidence of those results. This paper highlights the importance of the issue and its effects on many common clinical, public health and managerial decisions.

Recent public health literature contains calls for collaborative public health interventions and for leaders capable of guiding them. The National Public Health Leadership Institute aims to develop collaborative leaders and to strengthen networks of leaders who share knowledge and jointly address public health problems. Evaluation results show that completing the institute training increases collaborative leadership and builds knowledgesharing and problem-solving networks. These practices and networks strengthen interorganizational relationships, coalitions, services, programs, and policies. Intensive teamand project-based learning are key to the program's impact. (Am J Public Health. 2005;95:641-644.

- by Karl Umble
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- Program Evaluation, Leadership, Evaluation, Public Health
- by Celia Iriart
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- Human Rights, Politics, Social Justice, Capitalism
- by Samira Asma and +1
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- Data Management, Tobacco, Thailand, Peru
- by Jamie Chriqui
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- Program Evaluation, Law, Applied Ethics, Research Design

To determine the extent to which public health decision makers used five systematic reviews to make policy decisions, and to determine which characteristics predict their use. Methods: This cross-sectional follow-up study of public health decision makers in Ontario collected primary data using a telephone survey and a short, self-administered organizational demographics questionnaire completed by the administrative assistant for each Medical Officer of Health. Independent variables included characteristics of the innovation, organization, environment, and individual. Data were entered into a computerized database developed specifically for this study, and multiple logistic regression analysis was conducted. Results: The participation rate was very high, with 85% of public health units and 96% of available decision makers completing the survey. In addition, 63% of respondents stated they had used at least one of the systematic reviews in the previous 2 years to make a decision. The most important predictors of use were one's position, expecting to use a review in the future, and perceptions that the reviews were easy to use and that they overcame the barrier of limited critical appraisal skills. Conclusions: Utilization of the systematic reviews in Ontario was very high. The utilization rates found in this study were significantly higher than those reported in previous utilization studies. One's position was found to be the strongest predictor of use, identifying program managers and directors as the most appropriate audience for systematic reviews.

- by Maureen Dobbins
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- Evidence Based Medicine, Public Health, Applied Economics, Policy making
- by Marian Earls
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- Family Therapy, Leadership, Parenting, Family

This study, funded by the National Cancer Institute, assessed cancer awareness and service needs in the Republic of the Marshall Islands (RMI). Findings suggest that cancer is the second-leading cause of death in the RMI and is, in part, a consequence of 12 years of nuclear testing in this region of the Pacific. However, cancer-related services are lacking. Assistance is needed to establish a national cancer registry, to increase public awareness about cancer and related risk factors, and to develop and implement a cancer prevention and screening program.

- by Tin Soe and +1
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- Needs Assessment, Public Health Administration, Micronesia, Registries

In this paper we argue that a gender analysis is fundamental to health and health planning. We begin with a definition of gender and related concepts including equity and equality. We discuss why gender is key to understanding all dimensions of health including health care, health seeking behaviour and health status, and how a gender analysis can contribute to improved health policies and programming. Despite the many reasons for incorporating gender issues in health policies and programmes many obstacles remain, including the lack of attention to gender in the training of health professionals and the lack of awareness and sensitivity to gender concerns and disparities in the biomedical community. We argue that the key to placing gender values firmly in place in Health for All renewal is a change in philosophy at all levels of the health sector and suggest ways in which such a change can be implemented in the areas of policy, research, training and practical programmes and interventions. r

- by Claudia Garcia
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- Sociology, Anthropology, Health Care, Culture

Health department accreditation is one of the most important initiatives in the fıeld of public health today. The Public Health Accreditation Board (PHAB) is establishing a voluntary accreditation system for more than 3000 state, tribal, territorial, and local health departments using domains, standards, and measures with which to evaluate public health department performance. In addition, public health department accreditation has a focus on continuous quality improvement to enhance capacity and performance of health departments in order to advance the health of the population. In the accreditation effort, a practice-based research agenda is essential to build the scientifıc base and advance public health department accreditation as well as health department effectiveness. This paper provides an overview of public health accreditation and identifıes the research questions raised by this accreditation initiative, including how the research agenda will contribute to better understanding of processes underlying the delivery of services by public health departments and how voluntary accreditation may help improve performance of public health departments. (Am J Prev Med 2012;42(3):263-271)

- by F. Scutchfield and +2
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- Education, Accreditation, Research, Public Health Administration
- by Graham Colditz
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- Program Evaluation, Health Promotion, Evidence Based Practice, Obesity
- by Lawrence Gostin
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- Law, Civil Rights, Capitalism, Public Health
- by Lawrence Gostin
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- Law, Applied Ethics, International Law, Human Rights
- by Leslie Lenert
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- Engineering, Grid Computing, Medical Informatics, Public Health

Research projects demonstrating ways to improve health services often fail to have an impact on what national health programmes actually do. An approach to evidence-based policy development has been launched in Ghana which bridges the gap between research and programme implementation. After nearly two decades of national debate and investigation into appropriate strategies for service delivery at the periphery, the Community-based Health Planning and Services (CHPS) Initiative has employed strategies tested in the successful Navrongo experiment to guide national health reforms that mobilize volunteerism, resources and cultural institutions for supporting community-based primary health care. Over a 2-year period, 104 out of the 110 districts in Ghana started CHPS. This paper reviews the development of the CHPS initiative, describes the processes of implementation and relates the initiative to the principles of scaling up organizational change which it embraces. Evidence from the national monitoring and evaluation programme provides insights into CHPS' success and identifies constraints on future progress.

- by John Awoonor-williams
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- Geography, Director, Evidence Based Medicine, Politics
- by Agis Tsouros
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- Public Health, Health Policy, Russia, Health Care reform

A key challenge of preconception healthcare is identifying how it can best be delivered at a population level. To review current strategies of preconception healthcare, explore methods of preconception healthcare delivery, and develop public health models which reflect different preconception healthcare pathways. Preconception care strategies, programmes and evaluations were identified through a review of Medline and Embase databases. Search terms included: preconception, pre-pregnancy, intervention, primary care, healthcare, model, delivery, program, prevention, trial, effectiveness, congenital disorders OR abnormalities, evaluation, assessment, impact. Inclusion criteria for review articles were: (1) English, (2) human subjects, (3) women of childbearing age, (4) 1980-current data, (5) all countries, (6) both high risk and universal approaches, (7) guidelines or recommendations, (8) opinion articles, (9) experimental studies. Exclusion criteria were: (1) non-human subjects, (2) non-English, (3) outside of the specified timeframe, (4) articles on male healthcare. The results of the literature review were synthesised into public health models of care: (1) primary care; (2) hospital-based and inter-conception care; (3) specific preconception care clinics; and, (4) community outreach. Fifteen evaluations of preconception care were identified. Community programmes demonstrated a significant impact on substance use, folic acid supplementation, diabetes optimization, and hyperphenylalaninemia. An ideal preconception visits entail risk screening, education, and intervention if indicated. Subsequently, four public health models were developed synthesizing preconceptioncare delivery at a population level. Heterogeneity of risk factors, health systems and strategies of care reflect the lack of consensus about the best way to deliver preconception care. The proposed models aim to reflect differing aspects of preconception healthcare delivery.

- by Geordan Shannon
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- Medicine, Pregnancy, Public Health Administration, Maternal child health

The Tanzania Food and Drugs Authority piloted the use of Minilab kits, a thin-layer-chromatographic based drug quality testing technique, in a two-tier quality assurance program. The program is intended to improve testing capacity with timely screening of the quality of medicines as they enter the market. After 1 week training of inspectors on Minilab screening techniques, they were stationed at key Ports-of-Entry (POE) to screen the quality of imported medicines. In addition, three non-Ports-of-Entry centres were established to screen samples collected during Post-Marketing-Surveillance. Standard operating procedures (SOPs) were developed to structure and standardize the implementation process. Over 1200 samples were tested using the Minilab outside the central quality control laboratory (QCL), almost doubling the previous testing capacity. The program contributed to increased regulatory reach and visibility of the Authority throughout the country, serving as a deterrent against entry of substandard medicines into market. The use of Minilab for quality screening was inexpensive and provided a high sample throughput. However, it suffers from the limitation that it can reliably detect only grossly substandard or wrong drug samples and therefore, it should not be used as an independent testing resource but in conjunction with a full-service quality control laboratory capable of auditing reported substandard results.

- by Thomas Layloff
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- Program Evaluation, Service Quality, Health Policy, Tanzania

Funding agencies are increasingly requiring quantitative evaluations of the impact of public health programmes, to meet increased demands for accountability. The present paper addresses summative evaluations of established interventions, rather than formative evaluations whose purpose is to fine tune programme implementation. 1 The results of summative evaluations are to be used to make decisions about the programmes evaluated. Such 'instrumental' use of evaluation results is on the increase. 2 This is a distinct situation from what was observed in the past, when evaluations had limited 'instrumental' use but affected programmes and policies less directly, through changing perceptions. This difference in the uses of evaluations is important because one is more likely to reach decision makers when the use is 'instrumental', since the evaluators can ascertain what information is necessary for the decision-taking. It is generally understood that other factors weigh as much or even more than quantitative evaluation results in the final decisions about programmes. However, the inferences from quantitative evaluations should be pertinent to the decisions if

- by Patrick Vaughan
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- Program Evaluation, Statistics, Epidemiology, Research Design

Over the past two decades a variety of national and international efforts has sought to bring together health and social scientists to address complex health issues. This paper reviews how the notion of transdisciplinary research has emerged; discusses research programs that have successfully traversed discipline boundaries in sustained fashion; considers facilitating and constraining factors that have emerged from the analyses of this process; and suggests next steps for conceptualizing, organizing, and assessing transdisciplinary research based on the notion of heterarchy.

- by Frank Kessel
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- Education, Social Sciences, Developing Countries, Research

The paper examines health sector reforms in Kenya at the district level based on the Government of Kenya's Health Policy Framework of 1994. The authors present the context of and historical perspective to health sector reforms in Kenya and discuss the major reform policies including decentralization to the district level. The authors then review intended policy outcomes, investigating assumptions on which the implementation and effectiveness of the reform agenda at the local level are based. The authors argue that emphasis on outcomes rather than process have not supported sustainable reforms or achieved the government's goal of improving health and ensuring equity for the citizens of the country.

- by Charles Oyaya and +1
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- Politics, Social Justice, Health Policy, Kenya

By the close of the 19th century, there was a strong possibility that the Maori race might not survive, and the government was advised by a Dr Featherston: 'Our plain duty is to smooth down their dying pillow. Then history will have nothing to reproach us with' (Newman, 1881). Muskets, infectious diseases, alcohol and starvation contributed to the reduction of the population from an estimated 200 OOO (pre-European contact) to 42 OOO (1906 census). Dr Featherston's prediction may well have come true, had it not been for the energies and adaptability of a relatively small group of youthful Maori leaders who launched a revival movement that in 50 years turned the 'dying race' into a highly virile one. Today the Maori population is in excess of 390000, and makes up 12 per cent of the total population. It is youthful, over 65 per cent being under the age of 25 (non-Maori 40 per cent), but only 3.9 per cent over age 60 (non-Maori 14.9 per cent). Maori fertility is at a higher level (2.6) than that of non-Maori (1.9), and Maori babies make up over 13 per cent of all births.

- by Susan M Carr
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- Social Change, Epidemiology, Government, Traditional Medicine
- by frank hogan
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- Mental Health, Mental Health Policy, Health Policy, Applied Economics

Comparing the key determinants of health articulated by the Public Health Agency of Canada (the Agency) with the spiritual and cultural knowledge systems of First Nations peoples, as expressed by the Four Worlds International Institute for Human and Community Development (Four Worlds) and their 14 determinants of well-being and health, reveals differing philosophical perspectives. The key determinants of health can be interpreted as lacking a holistic and inclusive approach to public health services. As a result, many public health programs in Canada marginalize, ignore and suppress the needs of First Nations communities and people. Incorporating the Four Worlds guiding principles and its 14 health determinants model within the context of Canadian public health services geared towards First Nations populations provides the opportunity to develop a deeper understanding of social determinants of health. Therefore, when implementing public health initiatives to address the health statu...

- by Rose Roberts and +1
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- Philosophy, Social Determinants of Health, Canada, Public Health Administration

Disasters are fortunately rare occurrences. However, accurate and timely information and communication are vital to adequately prepare individual health organizations for such events. The current article investigates the health related communication and information systems for emergency management in Iran. A mixed qualitative and quantitative methodology was used in this study. A sample of 230 health service managers was surveyed using a questionnaire and 65 semi-structured interviews were also conducted with public health and therapeutic affairs managers who were responsible for emergency management. A range of problems were identified including fragmentation of information, lack of local databases, lack of clear information strategy and lack of a formal system for logging disaster related information at regional or local level. Recommendations were made for improving the national emergency management information and communication system. The findings have implications for health organizations in developing and developed countries especially in the Middle East. Creating disaster related information databases, creating protocols and standards, setting an information strategy, training staff and hosting a center for information system in the Ministry of Health to centrally manage and share the data could improve the current information system.

- by hesam seyedin
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- Information Systems, Communication, Developing Countries, Public Health

Network therapy flourished in the U.S. during the 1970s, but has since dwindled there and begun to find new applications in Europe, especially in the Nordic countries. State social and healthcare systems, in developing deep vertical expertise, seems to build up a need for complementary horizontal expertise. The latest theories of sociology are used to analyze the need for networking, with the focus on language and dialogue as specific form. Two approaches developed in crisis service for psychotic patients (Open Dialogue) and in consultation for stuck cases in social care (Anticipation Dialogues), are dealt with. What becomes essential seems no longer to be the therapeutic method itself but the ability to see the polyphonic nature of clients' reality. In this respect, language--and dialogue as a specific form of being in language--as the focus of treatment, makes the practical forms of different approaches secondary.

- by Jaakko Seikkula
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- Psychology, Family Therapy, Communication, Social Work
- by Richard Johnson
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- Public Health, Research, Aerosols, Disease Outbreaks
- by Vincent Covello
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- Communication, Health Communication, Public Relations, Risk Management

Stakeholder analysis has developed as a tool, or set of tools, with different purposes in its application in the fields of policy, management and project implementation. Being clear about the aim helps to identify the scope and time dimensions of most interest: past, present and/or future. In policy, its scope can range from broad with a strong retrospective dimension, with the aim of understanding the roles of stakeholders in the evolution of the policy context and processes, to prospectively outlining more long-term and also broadly-focused policy directions (see ). As a policy analysis research tool, stakeholder analysis is frequently applied by a researcher whose interest is in conducting a comprehensive analysis which produces new knowledge about policy-making processes; this requires a strong retrospective dimension. The scope is broad where a HEALTH POLICY AND PLANNING; 15(3): 338-345

- by Ruairí F Brugha
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- Health Planning, Systems Analysis, Stakeholder Analysis, Investments

Public health informatics is emerging as a new and distinct specialty area in the global scenario within the broader discipline of health informatics. The potential role of informatics in reducing health disparities in underserved populations has been identified by a number of reports from all over the world. The article discusses the scope, the limitations, and future perspective of this novice discipline in context to India. It also highlights information and technology related tools namely Geographical Information Systems, Telemedicine and Electronic Medical Record/Electronic Health Record. India needs to leverage its &amp;amp;amp;quot;technology&amp;amp;amp;quot; oriented growth until now (e.g., few satellite-based telemedicine projects, etc.) simultaneously toward development of &amp;amp;amp;quot;information&amp;amp;amp;quot;-based public health informatics systems in future. Under the rapidly evolving scenario of global public health, the future of the public health governance and population health in India would depend upon building and integrating the comprehensive and responsive domain of public health informatics.

- by Sanjay Zodpey
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- Medical Informatics, Public Health Informatics, Telemedicine, India

Recent EU and Greek Government legislation highlights the need for the modernisation of the public health management system and the improvement of the overall health of EU citizens. In addition the effusion of epidemics even in developed countries makes the need for the enhancement of public health services imperative. In order to best confront the above-described challenges, the National Technical University of Athens, in cooperation with the Greek Ministry of Health and Welfare and the European Commission (EC), designed and developed an integrated public health information network, named GEPIMI (Integrated Geographical System for EPIdemiological and other Medical Information), in the framework of a three-year pilot project. This pilot project, funded by Greek Ministry of Health and Welfare and the EC supported the Programme INTERREG II to establish an advanced and integrated web-based information system that can process and move information in real time, allowing public health authorities to monitor events at hundreds or thousands of public health facilities at once. The system is established among hospitals, primary healthcare authorities and health agents in Greece, Bulgaria, Albania, Fyrom, and Turkey. The project aims at demonstrating the best practices, prospects, applications and high potential of Telematics Healthcare Networks in Europe, with a view to promoting cooperation and interconnection between European communities in the field of Telematics Healthcare Applications. The GEPIMI System, implemented via an innovative web based system, constitutes a replication of a highly effective mechanism. It incorporates state-of-the-art technologies such as Geographic Information Systems (G.I.S.), web based databases, GPS, and Smart Card Technology and supports a variety of health-related web applications including early warning and response of epidemics, remote management of medical records, seamless healthcare coverage, comprehensive statistical analysis of data, decision-making procedures, inter-communication between international scientific fora and other.

Current electronic health record systems are primarily clinical in focus, designed to provide patient-level data and provider-level decision support. Adapting EHR systems to serve public health needs provides the possibility of enormous advances for public health practice and policy. In this review, we evaluate EHR functionality and map it to the three core functions of public health: assessment, policy development, and assurance. In doing so, we identify and discuss important design, implementation, and methodological issues with current systems. For example, in order to support public health's traditional focus on preventive health and socio-behavioral factors, EHR data models would need to be expanded to incorporate environmental, psychosocial, and other non-medical data elements, and workflow would have to be examined to determine the optimal way of collecting these data. We also argue that redesigning EHR systems to support public health offers benefits not only to the public health system but also to consumers, health-care institutions, and individual providers.

- by Connie Chan
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- Medical Informatics, Health Care, Policy Development, Biomedical informatics

Improving population health requires understanding and changing societal structures and functions, but countervailing forces sometimes undermine those changes, thus reflecting the adaptive complexity inherent in public health systems. The purpose of this paper is to propose systems thinking as a conceptual rubric for the practice of team science in public health, and transdisciplinary, translational research as a catalyst for promoting

- by William Trochim
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- Education, Systems Thinking, Science, Systems Theory
- by Peter Jahrling
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- Research, Aerosols, Disease Outbreaks, Infection Control
- by Traci Green
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- Virulence, Public Health Administration, Prisoners

TolayelAhned"" Peoplc ofBangladesh, mostly livins in rhc rurul a@s arc very hardworki B with pmven capacity to prcscrvc mcntal strcngth in the event ofunexpectcd extensive loss due to nalur0l cdlamitics (lloods, cyclones, eridcmic elc). But unro.tunntely their basic nccds ollivelihoods incldding hcrhh care havc r€mained largcly unm€t. Population explosion, trequent nntural disastcrs.

India, with a population of more than 1 billion people, has many challenges in improving the health and nutrition of its citizens. Steady declines have been noted in fertility, maternal, infant and child mortalities, and the prevalence of severe manifestations of nutritional deficiencies, but the pace has been slow and falls short of national and Millennium Development Goal targets. The likely explanations include social inequities, disparities in health systems between and within states, and consequences of urbanisation and demographic transition. In 2005, India embarked on the National Rural Health Mission, an extraordinary effort to strengthen the health systems. However, coverage of priority interventions remains insufficient, and the content and quality of existing interventions are suboptimum. Substantial unmet need for contraception remains, adolescent pregnancies are common, and access to safe abortion is inadequate. Increases in the numbers of deliveries in institutions have not been matched by improvements in the quality of intrapartum and neonatal care. Infants and young children do not get the health care they need; access to effective treatment for neonatal illness, diarrhoea, and pneumonia shows little improvement; and the coverage of nutrition programmes is inadequate. Absence of well functioning health systems is indicated by the inadequacies related to planning, financing, human resources, infrastructure, supply systems, governance, information, and monitoring. We provide a case for transformation of health systems through effective stewardship, decentralised planning in districts, a reasoned approach to financing that affects demand for health care, a campaign to Correspondence to:

- by Dileep Mavalankar
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- Child Welfare, Culture, Developing Countries, Health Services Research

To compare the level of availability and rational use of drugs in primary health care (PHC) facilities where the Bamako Initiative (BI) drug revolving fund programme has been operational, with PHC centres where the BI-type of drug... more

- by Obinna Onwujekwe
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- Primary Health Care, United Nations, Developing Countries, Health Policy

First responders, including military health care workers, public health service workers, and state, local, and volunteer first responders serve an important role in protecting our nation's citizenry in the aftermath of disaster. Protecting our nation's health is a vital part of preserving national security and the continuity of critical national functions. However, public health and public safety workers experience a broad range of health and mental health consequences as a result of work-related exposures to natural or man-made disasters. This chapter reviews recent epidemiologic studies that broaden our understanding of the range of health and mental health consequences for first responders. Evidence-based psychopharmacologic and psychotherapeutic interventions for posttraumatic distress reactions and psychiatric disorders are outlined. Finally, the application of public health intervention models for the assessment and management of distress responses and mental disorders in first-responder communities is discussed. 55 Annu. Rev. Public. Health. 2007.28:55-68. Downloaded from www.annualreviews.org by Uniformed Services University -HSC EBVC Account on 02/26/11. For personal use only.

- by Robert J Ursano and +1
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- Terrorism, Mental Health, Occupational Health, Public Health

This paper proposes an action agenda to assure healthier and safer populations . First, create a strong public health infrastructure with sustainable funding and secure foundations -a well-trained wor kforce, modern data systems , rapid disease surveillance, and laboratory capacity. Second, use law as a tool for the public' s health -tax and spend to create incentives for health, alter the informational and built environments to reduce risk behaviours, lower socio-economic disparities to improve health, regulate for the public's welfare , pursue tort litigation to innovate for safety, and deregulate to reduce harm. Third, create a new public health ethic in society that truly values human health -advocate for a renewed commitment to the ideals of community and partnership, and stress citizens' duties to help and protect their fellow human beings.

- by Lawrence Gostin
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- Health Promotion, Social Justice, Public Health, Health Policy

In 1987, district health care policies were officially adopted by a majority of developing countries. Many operational problems constraining implementation of such policies have subsequently been identified, most of which are attributable to well-known characteristics of less developed countries. However, the policy of operational and administrative decentralization has often been critically obstructed by inappropriate organizational structures in ministries of health. By applying Mintzberg's analytical framework to several ministries of health, we identify structural deficiencies that make systems unfit to match their policy environment and yield the expected outcomes of functional and decentralized services. We propose a typology likely to elicit strategies for decentralizing health care administration. Our analysis is based on the following steps:

- by Baruch Fischhoff and +2
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- Communication, Perception, Air Quality, Health Behavior
- by Martin Iguchi
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- Program Evaluation, Health Behavior, Health Services Research, Urban Health