The following reports have been published recently by the National Academy
of Sciences (ordering information at end). They will be presented at a
special session at the American Public Health Association, Wednesday, Nov.
12 at 8:30 am. The session will be sponsored by the community health
section, and co-sponsored by the APHA Program Development Board. The
published reports themselves could be useful in health professions training
programs with the same learning objectives as those shown for each of the
APHA presentations.
SHARING RESPONSIBILITY FOR THE COMMUNITY'S HEALTH: A SYNTHESIS OF NEW
REPORTS FROM THE INSTITUTE OF MEDICINE
Michael A. Stoto, Ph.D.
A syntheses of recently completed reports from the Institute of Medicine
dealing with current some of the leading themes in public health today
concludes that (1) the publics health depends on the interaction of many
factors; thus, the health of a community is a shared responsibility of
many entities, organizations, and interests in the community, including
health service delivery organizations, public health agencies, other
public and private entities, and the people of a community; (2) within
this context of shared responsibility, specific entities should identify,
and be held accountable for, the actions they can take to contribute
toward the communitys health; (3) communities can use performance
monitoring to promote collaboration and accountability in achieving
health improvement goals, (4) partnerships between public health
agencies and managed care organizations for the delivery of personal and
population-based health services and with public and private community
organizations to deal with broader concerns to advance the health of the
community will be critical for advancing the health of the public and of
communities in the future; (5) society must reinvest in governmental
public health agencies, with resources, commitments, and contributions
from government, private, and non-profit sectors, and substantial legal
authorities, if the publics health is to improve, (6) improved
community-based data systems and tools for performance monitoring are
needed, and (7) more community-based, practice oriented research is
needed to identify strategies for communities to use to improve the
health of their members.
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Learning Objectives
1. Participants will improve their understanding of the importance of
community factors on health and the many entities that can influence
a communitys health.
2. Participants will learn about new models for cooperation between
public health agencies and other entities that can contribute to a
communitys health.
3. Participants will learn about new tools such as performance
monitoring applied to community health improvement.
HEALTHY COMMUNITIES: NEW PARTNERSHIPS FOR THE FUTURE OF PUBLIC HEALTH
Stuart Bondurant, M.D, Hugh H. Tilson, M.D, Dr.PH, Michael A. Stoto,
Ph.D.
Representing the work of the IOM Public Health Roundtable, this report
reviews progress that has been made since the release of the IOMs The
Future of Public Health and two critical areas: (1) the relationship
between public health agencies and the publics health and managed care
and (2) the role of the public health agency in the community. Healthy
Communities concludes that the concepts in The Future of Public Health
remain vital to efforts to energize and focus the efforts of the public
health community, and that society must reinvest in governmental public
health agencies, with resources, commitments, and contributions from
government, private, and non-profit sectors, and substantial legal
authorities, if the publics health is to improve. The report reaffirms
the understanding of public health professionals and health scientists
that the publics health depends on the interaction of many factors; thus,
the health of a community is a shared responsibility of many entities,
organizations, and interests in the community, including health service
delivery organizations, public health agencies, other public and private
entities, and the people of a community. Within this context of shared
responsibility, specific entities should identify, and be held
accountable for, the actions they can take to contribute toward the
communitys health. As a result of this understanding, the report
focuses on how governmental public health agencies, especially at the
state and local level, can develop partnerships with managed care
organizations for the delivery of personal and population-based health
services and with public and private community organizations to deal with
broader concerns to advance the health of the community. Developing
these partnerships, the report says, will be critical for advancing the
health of the public and of communities in the future.
______________________
Learning Objectives
1. Participants will learn about new developments in public health
since the publication of The Future of Public Health, especially
with regard to (1) the relationship between public health agencies
and the publics health and managed care and (2) the role of the
public health agency in the community.
2. Participants will learn about new models for cooperation between
public health agencies, managed care organizations, and other
entities that can contribute to a communitys health.
3. Participants will learn about partnerships between public health and
other community agencies and their importance for community health
improvement.
IMPROVING HEALTH IN THE COMMUNITY: A ROLE FOR PERFORMANCE MONITORING
Bobbie Berkowitz, Ph.D., R.N., Thomas Inui, M.D., Alan Cross, M.D., Jane
Durch, M.A., Michael A. Stoto, Ph.D.
This report from the IOM Committee on Using Performance Monitoring to
Improve Community Health recommends that communities adopt a
comprehensive approach to health improvement that forges new coalitions
and systematically monitors the performance of the diverse elements that
affect health. Performance monitoring emerges as a tool that communities
can use to promote collaboration and accountability in achieving health
improvement goals. Improving Health in the Community draws on lessons
from a variety of current activities to outline the elements of a
continuing, community-based health improvement process intended to be
adapted locally to meet an individual community's circumstances,
discusses the role that performance monitoring can play in this process,
and proposes tools to help communities develop performance indicators.
The report calls for the development of community health coalitions to
oversee broad health assessment and priority-setting activities,
including the creation of a community health profile that includes
relevant information about local demographic and socioeconomic
characteristics, health status, and health risks. For addressing
specific health concerns, performance monitoring is an important tool.
Communities should carefully select indicators to measure the process and
outcomes of health improvement efforts. Data for these indicators should
be made available to the public to gauge the effectiveness of the health
improvement efforts and the contributions made by the many parties in the
community--public health agencies, managed care organizations, schools,
employers, and others--that could be expected to contribute.
______________________
Learning Objectives
1. Participants will learn about new models for cooperation between
public health agencies, managed care organizations, and other
entities that can contribute to a communitys health.
2. Participants will learn about the use of performance monitoring for
community health improvement.
3. Participants will learn about data systems and coalitions needed for
community-based performance monitoring for health improvement.
LINKING RESEARCH AND PUBLIC HEALTH PRACTICE: A REVIEW OF CDCS PROGRAM OF
CENTERS FOR RESEARCH AND DEMONSTRATION OF HEALTH PROMOTION AND DISEASE
PREVENTION.
Lawrence W. Green, Dr.P.H., Michael A. Stoto, Ph.D.
This report by an IOM committee reviews a CDC program CDC as well as the
community-based, practice oriented research that is needed to identify
strategies for communities to use to improve the health of their members.
The report concludes that the prevention research centers program has
made substantial progress and commends the participants and the programs
management for their contributions to health promotion and disease
prevention, and proposes a set of recommendations intended to strengthen
the quality and management of the program as it begins its second decade
of work. By strengthening the program, the prevention research centers
can contribute even more to local, state, and national efforts to improve
the health of Americans. The report also presents a vision for public
health and prevention research which may be of interest to academics in
public health and preventive medicine. In particular, the report
suggests that researchers in health promotion and disease prevention to
expand their activities to include (1) a focus on risk conditions and
social determinants of health; (2) an orientation toward the community;
(3) interdisciplinarity; (4) dissemination research in public health; (5)
an interactive process for establishing research priorities; and (6) a
role in setting national research priorities.
______________________
Learning Objectives
1. Participants will understand the importance of community-based,
practice oriented research for community health improvement.
2. Participants will understand the ways in which university-based
research centers can collaborate as full partners in research and
dissemination activities with the communities in which they are
located.
3. Participants will learn about new community-based approaches to
dissemination and dissemination research.
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The following additional report is not part of the APHA session, but
pertains to the same issues of community partnerships for health:
SCHOOLS AND HEALTH: OUR NATIONS INVESTMENT Diane Allensworth et al.
A new report from the Institute of Medicine (IOM), Schools and Health:
Our Nations Investment, proposes comprehensive school health programs
(CSHP) as a means to address many health-related problems of our nation's
children and youth. CSHPs can take advantage of the pivotal position of
to health-related services at the school site.
The final report relates the history and background of school health
programming in the United States and provides the committees findings and
14 policy recommendations. The recommendations are in the areas of
health education; health services; research; and the local, state, and
national infrastructure.
SYNOPSIS OF RECOMMENDATIONS
Education. Health education in elementary and middle school and
requirements for health education in high school are needed Preparation
of teachers in health education content and methodology also is
recommended.
Services. Planning and monitoring of school health services and all
aspects of research on school-based services is needed. Issues related to
confidentiality of student records and continuation of funding for
schools in reaching children and families by combiningin an integrated,
systematic mannerhealth education, health promotion and disease
prevention, and access school health services are addressed.
Infrastructure. National policy coordination and the site for this
coordination focus and relevant partnerships that need to be developed
are presented. Needs for state and local coordination of efforts and
training for personnel to provide this coordination and integration of
efforts are recommended.
Research and evaluation. Recommendations include the need to pursue
critical knowledge gaps about comprehensive school health programs, and
the need to launch and study model comprehensive school health programs
in whole and in part.
Overall the committee concluded that CSHPs must be locally tailored to
meet each communitys unique needs, resources, perspectives, and
standards. The first step in establishing a CSHP is for the community to
involve a wide range of stakeholdersparents, students, educators, health
and social service personnel, insurers, business and political leadersin
assessing community needs and resources and in establishing program
goals.
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Copies of LINKING RESEARCH AND PUBLIC HEALTH PRACTICE: A REVIEW OF CDC'S
PROGRAM OF CENTERS FOR RESEARCH AND DEMONSTRATION OF HEALTH PROMOTION AND
DISEASE PREVENTION, or any of the other reports abstracted above, can be
ordered by calling the toll-free number of the National Academy Press
(1-800-624-6242) between 8:30 a.m. and 5:00 p.m. EST, or 202-334-3313 in the
Washington, D.C. area, or through their Internet address: http://www.nap.edu
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