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1、Public Health:What It Is and How It Works, Fourth Edition Chapter-by-Chapter Power Point Slides Links to Internet-based resources1Chapter 6The Infrastructure of Public Health2Chapter 6 Will Help You To:identify the major components of public healths infrastructure and key dimensions of each componen
2、t identify strategies for assessing and enhancing the infrastructure of public health 3Capacity-Process-Outcome LinksCapacity-Process-Outcome LinksCapacityCapacityProcessProcess(Core Functions/Essential Public Health Services)(Core Functions/Essential Public Health Services)OutputsOutputsOutcomesOut
3、comesSystem InputsSystem InputsImproved Improved Improved organizational organizational organizational performance +performance +performance +Improved Improved Improved program program program performanceperformanceperformanceAssessAssessAddressAddressAssureAssurePrograms and Programs and Programs a
4、nd Services Services Services consistent consistent consistent with with with mandates and mandates and mandates and community community community prioritiesprioritiesprioritiesKey Processes Key Processes Improved OutcomesImproved Outcomes& Customer Satisfaction& Customer SatisfactionIncreased Value
5、& Public Support4 4WWWo oor rrk kkf ffo oor rrc cce eeI IIn nnf ffo oor rrmmma aat tti iio oon nnO OOr rrg gga aan nni iiz zza aat tti iio oon nn & & R RRe eel lla aat tti iio oon nns ssh hhi iip pps ssF FFa aac cci iil lli iit tti iie ees ssF FFu uun nnd ddi iin nng ggInfrastructure, Ingredients,an
6、d InputsPublic health infrastructure: the resources and relationships necessary to carry out public healths core functions and essential services in the communityIn Capacity-Process-Outcomes model, inputs are the structural components of the public health infrastructure while processes represent wha
7、t those inputs do5Human Resources in Public HealthKey element of public healths infrastructureSize of the public health workforce unclear because of lack of consensus as to meaning of term “public health worker”Best guess as to size = 600,000Beyond size, distribution, composition, skills/competencie
8、s, and impact are key considerations 6Full Time Equivalent (FTE) Workers of Governmental Health Agencies, 1995-2005Source: Data from U.S. Bureau of the Census, Public Employment and Payroll Data.YearFedFTEStateFTELocalFTES+LFTEF+S+LFTE1995125,048160,031208,588368,619493,6671998119,846166,930219,6553
9、86,585506,4312001122,999172,414251,399423,813546,8122002124,979176,345252,326428,671553,6502003124,828176,868253,888430,756555,5842004127,933174,301249,857424,128552,0612005125,163178,465246,300424,765549,9187Full Time Equivalent (FTE) Workers for State and Local Health* Agencies per 10,000 Populati
10、on, Selected Years 1994-2005, U.S.Source: Data from U.S. Bureau of the Census, Public Employment and Payroll Data.8Public Health Work-Doing System9Mean Salary for Full Time Equivalent Workers of State and Local Health* Agencies, Selected Years, 1994-2005, U.S. Source: Data from Bureau of the Census,
11、 Public Employment and Payroll Data. 1011Conventional Wisdom?Public Health Workforce is shrinkingAverage age is high (47)Public Health workers soon will be retiring in large numbers Recruitment and retention are major issues, especially in rural communitiesKey disciplines (such as public health nurs
12、es and epidemiologists) are increasingly scarceFew public health workers have received formal training in public healthPublic Health Workforce is not prepared for current and future threats12Approaches to Public Health Workforce Development: Pipeline vs. Willy SuttonConventional Wisdom approach to w
13、orkforce development: more schools, increase number of graduates, higher proportion of gradates into primary public health workforce through scholarships and loan repayment programs (Pipeline approach)Willie Sutton approach to workforce development: focus on the work organizations (thats where the w
14、orkers are).Which approach is likely to be most effective?13Organizational ResourcesLargely discussed in Chapter 4; includes governmental and non-governmental organizationsNon-governmental contributions estimated at one-fourth to one-third or more!LeadershipCoalitions and ConsortiaCommunity Health P
15、artnerships14The MAPP Model15Turning Points Performance Management CollaborativeFour components of a performance management systemSource: Turning Point Performance Management Collaborative, From Silos to Systems: Using Performance Management to Improve the Publics Health , March 2003. 1616Informatio
16、n ResourcesAssessment data and informationSurveillance systemsInformation for planningEvidence-based policy and decisions17Actual Causes of Death, 2000( (SourceSource: Mokdad et al, : Mokdad et al, JAMAJAMA 2004) 2004)TobaccoTobacco435,000435,000Poor diet & physical activityPoor diet & physical acti
17、vity400,000400,000AlcoholAlcohol85,00085,000Microbial agentsMicrobial agents75,00075,000Toxic agentsToxic agents55,00055,000Motor vehicleMotor vehicle43,00043,000FirearmsFirearms29,00029,000Sexual BehaviorSexual Behavior20,00020,000Illicit drug useIllicit drug use17,00017,0001818Fiscal ResourcesTota
18、l health expenditures = $2.0 trillionPublic health expenditures within total health expenditures = about $60-70 billion1/3 from federal sources2/3 from state and local sources19Healthy People 2010Infrastructure Objectives17 objectives Data and information systemsSkilled workforceEffective public hea
19、th organizationsResourcesPrevention researchProgress uncertain as of 200620DiscussionBecause of your interest in a public health career you have been asked to provide input into the development of a training package to orient new members of your local Board of Health to their duties.What themes or m
20、essages would you suggest for this video? How would you propose presenting or packaging these messages? 21DiscussionReview the progress of the past century related to safer and healthier foods (Safer and Healthier Foods in the Century of Progress in Public Health case study) and a recent report on p
21、ublic perceptions about food safety. Then follow the chronology of CDC and USDA reports regarding an outbreak of cases of listeriosis in the Mid-Atlantic States. Specifically, review CDCs press releases from mid-September through mid-October 2002,and USDAs press releases from 2001 dated October 2, O
22、ctober 9, October 13, and October 17. Finally, review the news article dated October 15 titled and Consumer Groups Accuse US of Negligence in Food Safety.“ Based on this information and the DHHS-USDA Listeria Action Plan, do you agree or disagree with accusations that USDA and CDC did not protect th
23、e public from this risk in a timely manner? 22DiscussionWhat characteristics distinguish a public health professional from a professional working in a public health agency? 23DiscussionAfter reviewing The Past and Future of Public Health Practice, identify the public health practitioner (past or pre
24、sent) that you most admire and the reasons or criteria that led you to this choice. 24Additional ResourcesCommunity Strategies for Health. American Public Health Association Healthy People 2010: Public Health Infrastructure Objectives; Washington DC; USDHHS-PHS; 2000 Principles of Community Engageme
25、nt. CDC Public Health Practice Program Office; Atlanta GA; 1997 Public Health Data Standards Tutorial (modules 4-9). Public Health Data Standards Consortium Public Health Infrastructure (report to Congress in PDF format) CDC;2001 Public Health Workforce: An Agenda for the 21st Century (PDF format). USDHHS-PHS; Washington DC; 1997 Public Health Workforce: Enumeration 2000 (PDF format). USDHHS-HRSA; Rockville MD; 2000 25
