Commentary Introducing the Issue

Regional Public Health Training Centers: An Essential Partner in Workforce Development.

Health Systems Need to Transform Data Collection to Advance Health Equity.

Background During the past decades, the growth of knowledge to prevent disease on the one hand and the growth of public acceptance to prevent disease on the other hand led to form public health systems. Soon after, health was no longer considered as an individual responsibility only, and more effective interventions against health threats and communicable diseases were developed. As a result, public agencies and authorities were established to implement newly discovered interventions against health threats and to prevent non-communicable diseases. Though, the orientation of public health agencies and authorities shifted from prevention of disease to promotion of health in almost all countries, their public health systems are developed widely differently. While some countries look back to traditionally established public health systems, others are pursuing different approaches to achieve Health in All Policies through policy and legislation in Wales or are now evaluating their public health policies after a ten-years-strategy, like Sweden and still others have only recently (2015) introduced a new Preventive Health Care Act and follow a bottom up approach called “Future Forum Public Health”, like Germany. Objectives This workshop aims at presenting the very different perspectives on the achievement of public health and different systems around Europe. Both, the disparity of the approaches and their different forms, and different stages of their development will be addressed by each presentation. Despite differences of the public health systems in each context, the workshop will focus on identifying shared features and common challenges of the countries with the goal of identifying inspiring examples and discussing criteria of transferability. During the discussion that will follow, different possibilities of cooperation and exchange will be assessed and debated. In particular, the workshop will encompass a presentation from Wales on “the future generation’s act” and will include information on the requirements to turn the legislation into practice. The Swedish input will focus on the Swedish national public health policy and its achievements after ten years. France will give an overview of the structural developments during the last ten years. The presentation from Germany will consist of contrasting a top-down and a bottom-up approach, namely the act to strengthen health promotion and prevention in Germany on the one hand and the future forum public health on the other hand. And last but not least, we will hear about the particular success of the Slovenian example with a newly shaped and largely developed public health system. Key messages Acquiring insight into different approaches to achieve improvements in public health based on alternative systems is important to identify inspiring examples, shared features and common challenges. Identification of criteria of transferability of public health strategies, legislation and policies between countries, and requirements for implementation are crucial for learning from best practice.

Strategies for Enhancing Governmental Public Health Workforce Well-being and Retention.

Governmental public health (GPH) agencies need a diverse, skilled, and motivated workforce to advance health and well-being, but they face a number of recruitment challenges. While there has been massive growth in public health degree programs and graduates, those with a degree in public health are underrepresented in the GPH workforce. This study evaluates potential reasons undergraduate and graduate public health degree holders are underrepresented in the GPH workforce, assesses student awareness of and interest in GPH jobs, and identifies strategies for improved recruitment. We conducted pilot focus groups to explore public health students' interest in working for GPH agencies, obstacles to employment, and how this career path could be better promoted. Eight focus groups were conducted with a total of 33 participants at 3 universities and at the Annual Meeting of the American Public Health Association. Participants were enrolled full-time in or graduated within the last year from a public health bachelor's degree program or a public health master's degree program. Undergraduates had declared a public health major and were in their senior year; graduate students were in their second year and actively job seeking; or participants graduated within the past 12 months. The focus groups sought to capture students' perspectives of GPH agencies and how they believe recruitment can be improved. Participants described attractive job attributes including fulfilling, meaningful work; a position at a mission-driven organization; and the opportunity to make an impact on their community. Governmental public health agencies were viewed as bureaucratic, lacking innovation, and underresourced. Participants reported difficulties accessing and finding relevant job postings. Key to effectively recruiting and retaining new graduates is understanding their perceptions about/experiences with GPH agencies. While GPH jobs have desired attributes, participants reported that health departments are not effectively recruiting them.

Heterogeneity and Interoperability in Local Public Health Information Systems.

A PRIMARY CARE PHYSICIAN SITS IN HER OFFICE WITH her patient, an overweight 57-year-old man with diabetes and hypertension. She knows that in addition to treating his chronic medical conditions, she also should encourage him to quit smoking, modify his diet, and increase his level of activity to reduce the risk of developing disabling or fatal heart disease or stroke. At the same time, a public health officer in another part of town focuses on overcoming the challenges presented by lack of access to healthy foods and open space for exercise and by the easy availability of cigarettes in the community in which this patient lives—all of which likely have contributed to the development of the patient’s chronic medical conditions. Both the primary care physician and the public health officer are aware of and encouraged by the Million Hearts Initiative recently launched by the Department of Health and Human Services to prevent 1 million myocardial infarctions and strokes in the next 5 years through clinic and community interventions. Although they strive for the same goal—improved health for those whom they serve— the primary care physician and public health officer work in silos, independent of one another. They may wonder how to bridge the worlds of the clinic and community to more effectively serve this patient and those like him. Would the primary care physician be able to do a better job of preventing and treating cardiovascular disease if her local public health department shared information with her about affordable community resources that could help her patients exercise or gain access to healthy foods or if the public health department collaborated with local primary care practices to offer educational programs aimed at improving self-management of blood pressure or diabetes? Would the public health officer be better able to target community interventions if he had information on the adequacy of blood pressure control in different neighborhoods and among specific populations of underserved minorities or on the frequency of emergency department visits for cardiovascular conditions? The Institute of Medicine (IOM) recently issued a report, “Primary Care and Public Health: Exploring Integration to Improve Population Health,” that addresses these questions. The authors of this Viewpoint were members of the IOM committee that produced this report on strategies to promote the integration of public health and primary care. The report is not the first to explore how these 2 sectors might align and coordinate efforts to improve population health. Integration of primary care and public health has always been logical. Both sectors share an emphasis on prevention and population health that requires understanding individuals in the context of their communities and environment. However, many factors have stymied repeated calls in the United States during the past several decades for integration of these sectors. Not the least of these factors is a cultural and organizational separation between primary care and public health that dates back to the early 20th century and the advent of public health schools distinct from medical schools. Both sectors tend to view themselves as underappreciated and underresourced. Payment systems reward primary care physicians for delivering office visits rather than improving population health. Models such as communityoriented primary care that integrate primary care and public health have proved to be impractical to implement broadly in the absence of payment models that support these activities. The United States has not made the same investment in public health infrastructure that it has in biomedical research. Even the calls in the last decade for strengthening the US public health system have focused more on bioterrorism preparedness than on health promotion. Could things be different this time? There are several reasons why there is potential for meaningful progress on in-

Is Africa prepared for tackling the COVID-19 (SARS-CoV-2) epidemic. Lessons from past outbreaks, ongoing pan-African public health efforts, and implications for the future

Health care systems in countries around the world are focused on improving the health of their populations. Many countries face common challenges related to capturing, structuring, sharing and acting upon various sources of information in service of this goal. Information science, in combination with information and communications technologies (ICT) such as online communities and cloud-based services, can be used to address many of the challenges encountered when developing initiatives to improve population health. This presentation by RTI International will focus on the development of the Public Health Quality Improvement Exchange (www.phqix.org), where informatics and ICT have been used to develop new approaches to public health quality improvement; a challenge common to many nations. The presentation will also identify lessons learned from this effort and the implications for Gulf Cooperation Council (GCC) countries. This presentation addresses two of Qatar's Cross-cutting Research Grand Challenges; "Managing the Transition to a Diversified, Knowledge-based Society," and "Developed modernized Integrated Health Management." The first grand challenged is addressed by our research on the use of social networks and their relationship to public health practice environments. The second is addressed through our research in the development of taxonomies that align with the expectations of public health practitioners to facilitate information sharing [1]. Health care systems aim to have the most effective practices for detecting, monitoring, and responding to communicable and chronic conditions. However, national systems may fail to identify and share lessons gained through the practices of local and regional health authorities. Challenges include having appropriate mechanisms for capturing, structuring, and sharing these lessons in uniform, cost-effective ways. The presentation will explore how a public health quality improvement exchange, where practitioners submit and share best practices through an online portal, help address these challenges. This work also demonstrates the advantages of a user-centered design process to create an online resource that can successfully accelerate learning and application of quality improvement (QI) by governmental public health agencies and their partners. Public health practitioners, at the federal, state, local and tribal levels, are actively seeking to promote the use of quality improvement to improve efficiency and effectiveness. The Public Health Quality Improvement Exchange (PHQIX) was developed to assist public health agencies and their partners in sharing their experiences with QI and to facilitate increased use of QI in public health practice. Successful online exchanges must provide compelling incentives for participation, site design that aligns with user expectations, information that is relevant to the online community and presentation that encourages use. Target audience members (beneficiaries) include public health practitioners, informatics professionals, and officials within health authorities. This discussion aims to help audience members understand how new approaches and Web-based technologies can create highly reliable and widely accessible services for critical public health capabilities including quality improvement and data sharing. 1. Pina, J., et al., Synonym-based Word Frequency Analysis to Support the Development and Presentation of a Public Health Quality Improvement Taxonomy in an Online Exchange. Stud Health Technol Inform, 2013. 192: p. 1128.

A National Research Agenda for Public Health Services and Systems

Barriers to Recovery and Recommendations for Change: The Pennsylvania Consensus Conference on Psychiatry's Role

Public Health Finance

By providing affordable healthcare to many Americans for the first time, the Affordable Care Act increases demand for public mental health services. It is, however, unclear if states’ provision standards for supply of mental health services will be able to accommodate this demand increase. Both the demand and supply of public mental health services vary within states; it is necessary to measure both locally. In this paper, we estimate the prevalence of mental illness within 30 geographical regions in the state of Virginia, a representative example of how many states organize their public mental health systems and how mental illness prevalence can be measured locally. Our methodology extends the analysis in Stern (Health Serv. Outcomes Res. Methods 14:109–155, 2014) by covering an entire state and accounting for peoples’ insurance status. The latter allows us to compare estimates of demand for public mental health services among those 30 geographical regions. We find that over 66,000 uninsured and Medicaid-insured individuals in Virginia are not provided with public mental health services. The deficit varies locally, with several regions having no deficit and others having 5000 or more untreated people. We also estimate that a large portion of the unserved people with mental illness are uninsured but would be insured for mental health services through Medicaid if Virginia were to accept the Medicaid expansion associated with the Affordable Care Act. These results provide evidence that there is significant variation in the demand for and public health systems’ ability to supply mental health services within states. This implies states can better serve populations relying on mental health care by allocating scarce public mental health dollars to localities reflecting their need.

Given challenges to recruiting nurses to public health and the growth in national policies focused on population health, it is crucial that public health agencies develop strategies to sustain this important group of employees. The objective of this study was to examine factors that influence nurses' decisions to work in public health agencies. This cross-sectional study examined perspectives of nurses who worked in state and local public health departments and responded to the 2010 Council on Linkages Between Academia and Public Health Practice's survey of public health workers. We calculated the mean rating of each recruitment and retention factor for nurses and non-nurses separately and compared differences by using t tests. We then used multivariate regression analysis to examine differences in ratings by role (ie, nurse or non-nurse). After controlling for personal and organizational characteristics, the influence of 5 recruitment factors was significantly stronger among nurses than among non-nurses: flexibility of work schedule ( P < .001), autonomy/employee empowerment ( P < .001), ability to innovate ( P = .002), specific duties and responsibilities ( P = .005), and identifying with the mission of the organization ( P = .02). The influence of 5 retention factors was stronger among nurses than among non-nurses : autonomy/employee empowerment ( P < .001), flexibility of work schedule ( P < .001), specific duties and responsibilities ( P < .001), opportunities for training/continuing education ( P = .03), and ability to innovate ( P = .008). Some factors that influence nurses to begin and remain working in local governmental public health agencies, such as flexible schedules and employee autonomy, are factors that governmental public health agencies can design into positions and highlight when recruiting from health care organizations, private industry, and academia.

The public health system has a specialized body of knowledge and expertise in bioterrorism and public health emergency management that can assist in the development and delivery of continuing medical education programs to meet the needs of emergency medical service providers. A nationally representative sample of the basic and paramedic emergency medical service providers in the United States was surveyed to assess whether they had received training in weapons of mass destruction, bioterrorism, chemical terrorism, radiological terrorism, and/or public health emergencies, and how the training was provided. Local health departments provided little in the way of training in biologic, chemical, or radiological terrorism to responders (7.4%-14.9%). State health departments provided even less training (6.3%-17.3%) on all topics to emergency medical services providers. Training that was provided by the health department in bioterrorism and public health emergency response was associated with responder comfort in responding to a bioterrorism event (OR = 2.74, 95% CI = 2.68, 2.81). Local and state public health agencies should work with the emergency medical services systems to develop and deliver training with an all-hazards approach to disasters and other public health emergencies.