Public Health Practice: What Works

399 Pages·2012·3.185 MB·English

by  Jonathan E. Fielding, Steven M. Teutsch

■ Public Health Practice: What Works
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Public Health Practice
What Works
EDITED BY
Jonathan E. Fielding, MD, MPH
Steven M. Teutsch , MD, MPH
MANAGING EDITOR
Stephanie N. Caldwell, MPH
3
3
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Library of Congress Cataloging-in-Publication Data
Public health practice: what works / edited by Jonathan Fielding, Steven Teutsch;
managing editor, Stephanie Caldwell.
p.; cm.
Includes bibliographical references.
ISBN 978–0–19–989276–1 (hardcover: alk. paper)
I. Fielding, Jonathan E. II. Teutsch, Steven M. III. Caldwell, Stephanie N.
[DNLM: 1. Public Health Practice—Los Angeles. 2. Health Services—Los Angeles.
3. Local Government—Los Angeles. WA 100]
362.109794(cid:99)94—dc23
2012019464

Use of trade names and commercial sources is for identifi cation only and does not imply
endorsement by the Los Angeles County Department of Public Health (LAC DPH). References to
non-LAC DPH sites on the Internet are provided as a service to readers and do not constitute or
imply endorsement of thes organizations or their programs by LAC DPH.
9 8 7 6 5 4 3 2 1
Printed in the United States of America
on acid-free paper
■
F O R E W O R D
GEORGES C. BENJAMIN, MD
Executive Director, American Public Health Association
If we want to look at how well we have done as a society to improve health, we can take
heart from the unprecedented gains in the twentieth century. Life expectancy grew by
30 years, due in large measure to public health actions at the community level across
the country. It didn’t happen by accident, but was the result of concerted action by
people who created a shared vision of what was possible and used an evidence-based
approach to implement programs through strategic partnerships to translate that
vision into reality.
While the principles and science of public health are well taught in schools of public
health and presented in many excellent textbooks and journals, they do not fully convey the
complexity and challenges of public health practice in states and local health departments.
As a fi eld, eff ective public health requires the practical application of a wide variety of skills
from careful assessment, analysis, and reevaluation; to policy development, program pla-
nning, and implementation; to eff ective assurance strategies such as community organiza-
tion and mobilization, risk communication, and quality improvement. Combining these
skills together into eff ective public health action requires leadership, good management,
scientifi c expertise, and political competency.
Until now, it has been diffi cult for students, academics, and policy makers to learn
about on-the-ground public health practice without actually working extensively in
a state or local public health department. Th is book fi lls that need. Th e case studies in
Public Health Practice: What Works portray the richness of real-world public health
practice and are fi lled with the array of health problems, resource constraints, partner-
ships, and solutions that can be brought to bear on many of the most serious health
problems in the nation. From substance abuse to maternal and child health; from envi-
ronmental health to the social determinants; and from control of infectious disease to
responding to chronic conditions like the obesity epidemic, these case studies deliver
insights from one of the country’s most innovative public health departments.
While not an academic treatise, these case studies deliver insights into how to assess
problems, plan and implement solutions, build partnerships, craft informational and
policy infrastructure, and assess impacts. Th ese real life examples are valuable insights
to students, public health professionals, and policy makers.
In my career as the Health Commissioner for our nation’s capital, as the Secretary
of Health for the State of Maryland, and in my current role as Executive Director of
the American Public Health Association, I have learned fi rsthand that the real work
of improving the public’s health occurs on the ground in our states and localities.
Finding meaningful ways to share these experiences is an important eff ort that this
text does very well. It is a valuable resource for all those who aspire to improve the
public’s health.
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■
P R E FA C E
Th e health of the public is central to our well-being and prosperity as individuals,
as communities, and as a nation. Our health is determined more by our social and
physical environments, our communities and families, than by the health care system.
Public health has the primary responsibility for assuring these conditions—the condi-
tions that together keep people healthy. Despite the importance of the mission, the
public and even many public health and public policy professionals who have never
worked in a local or state public health jurisdiction may have little sense of what grass-
roots public health entails. Hence this book.
Public health practitioners receive extensive training. Many have clinical train-
ing and even more have advanced degrees in public health. Th ey have solid academic
grounding in public health science, theory, and management. Yet missing from much
of public health training is exposure to the day-to-day challenges of public health prac-
tice. Th is book seeks to fi ll that gap by providing real-world examples of public health
challenges, the context in which those challenges occur and the results of each eff ort.
Th ese short stories of actual experiences are intended for practitioners, students, and
others interested in understanding how to translate public health theory and experi-
ence into eff ective action at the local, regional, and state level. We see the book being
used to inject reality for those without local public health experience and to provide
examples that can help practitioners working on similar health problems. It should
have similar value for public policy students and professionals.
Why case studies from Los Angeles County? Los Angeles is a microcosm of the
diverse settings where public health is practiced in the United States. It has an urban
core, yet large areas of the county are rural. Th e population is among the most diverse
in the nation. In many ways, Los Angeles County—the most populous county in the
country with its 88 cities—is as complex as a state. In sum, the public health issues
found in almost any local, regional, or state jurisdiction can be found here.
Th e chapters in this volume illustrate innovative and conventional ways that we
have addressed a wide range of population health problems facing local and state
health departments. Th ey have been selected to convey the scope of a local or state
health department while providing practical lessons from real-world situations. Th e
chapters that follow illustrate the core functions of public health and the essential pub-
lic health services, including the value of planning, the necessity of careful program
and policy development, the importance of evidence-based practice, and the need for
eff ective partnerships to improve population health outcomes and reduce health dis-
parities. Th e chapters also cover major common challenges, and why we are not always
completely successful in meeting them.
Of necessity, case studies refl ect past activities. Yet permeating the chapters is a
vision for the future. Th e health equity and the social and physical environmental
determinants are addressed in many chapters and are the focal point of several. In
the current fi scal environment, resources are becoming scarcer while public health
challenges are not. Th is demands greater attention to effi ciency, organizational energy,
vii
viii ■ Preface
policy, and innovation. Lessons from the case studies should be applicable to new
challenges.
Th e book is organized into fi ve main sections. Th e fi rst provides historical context
for the evolution of public health in Los Angeles as well as information about the pub-
lic health department itself. It also covers many of the cross-cutting core capacities that
every public health department needs. Th e second focuses on health promotion—how
to aff ect the underlying determinants of health and the individual behaviors that largely
determine our overall health and well-being. Th e third section is about health protec-
tion, the activities that reduce exposures to deleterious harms from infectious and toxic
agents. Th e fourth section concerns emergency response, the capacity to address natu-
ral and other emergencies. Th e fi nal section addresses the delivery of clinical and other
services to prevent and control disease and injury over both the short term and over the
entire life cycle. Since many case studies do not fall neatly into a single category, pertinent
examples for a topic may be found in more than one section. Each case study begins with
a description of the problem and the relevant contextual information, followed by the
approach to the problem, how the solution was implemented, the qualitative or quantita-
tive evaluation, and lessons learned.
Th is book would not have been possible without the help of many people. First and
foremost, we must recognize the Los Angeles County Board of Supervisors (Michael D.
Antonovich, Don Knabe, Gloria Molina, Mark Ridley-Th omas, and Zev Yaroslavsky)
and their health deputies (Richard Espinosa, Phillip Chen, Elan Shultz, Yolanda Vera,
and Amy Luft ig Viste) for their commitment to the health of the people of Los Angeles
County. We see that commitment every day in the strength of our Department and the
Board’s leadership. Th is book would not have been possible without their unwavering
support for which we are most grateful. Th e County’s Chief Executive Offi cer William
Fujioka and Deputy Chief Executive Offi cer Sheila Shima have always encouraged
departmental innovation and leadership. Robert Ragland, Principal Deputy County
Counsel, provided wise guidance and reviewed content at every step of the process.
Th e breadth and depth of this book are due to the diversity and skills of our colleagues
in the Department. We express our appreciation to all the authors, and the staff who
helped with manuscript preparation, graphics, and organization. Elizabeth Bancroft
and Mark Malak made important contributions. Elishia Nelson, Filip Bartnik, Aisha
Carter, Ligia Galvan, James Teng, Beverly Ware, Boyd Jackson, Summer Nagano, Maria
Agosta, Patricia Gibson, Chris Foster, Carolyn Brown, Aura Wong, Wayne Sugita, Tim
Duenas, Lana Skylar, Donna Sze, and Angelo Bellomo all played important support-
ing roles. Many other Los Angeles County departments and organizations contribute
enormously to the work of the Department of Public Health and to this volume. We are
grateful to them all. Financial support for initial editing of the book was provided by
the Centers for Disease Control and Prevention (CDC) cooperative agreement number
CD001274–02, though the contents are solely the responsibility of the authors and the
Los Angeles County Department of Public Health and do not necessarily represent the
offi cial views of the CDC. Lastly, we want to thank the team of editors at Oxford for their
encouragement and guidance.
S.M.T.
J.E.F.
Los Angeles, California
January 2012
■
C O N T E N T S
Acronyms xiii
Contributors xix
1 Introduction and History of Public Health in
Los Angeles County 1
JONATHAN E. FIELDING, JONATHAN FREEDMAN,
AND STEPHANIE N. CALDWELL
PART ONE ■ Core Capacities
2 Measuring Population Health: Th e Los Angeles
County Health Survey 15
SUSIE B. BALDWIN AND AMY S. LIGHTSTONE
3 Strategic Planning: Visioning the New Public Health Agency 25
WENDY K. SCHIFFER, VIRGINIA HUANG RICHMAN,
JOSHUA M. BOBROWSKY, AND MAXANNE HATCH
4 Programs and Policies Th at Work: How Evidence Can Drive Action 33
STEVEN M. TEUTSCH
5 From Direct Service to Community Orientation:
Transformation of Nursing Practice 41
DAVID CALEY AND DEBORAH DAVENPORT
6 Assuring Competence: Credentialing and
Privileging of Public Health Physicians 48
JEFFREY D. GUNZENHAUSER AND KATHLEEN N. SMITH
7 Performance Improvement: Using Rapid-Cycle Improvement
Techniques to Improve Public Health Services 55
DAWN MARIE JACOBSON AND DEBRA LOTSTEIN
8 Th e Medium and the Message: Strategies for
Eff ective Communication 66
ROSE ANNE RODRIGUEZ AND SARAH M. KISSELL
9 Understanding Birth Outcomes and Adverse Birth Events:
LAMB and LA HOPE 76
SHIN MARGARET CHAO, GIANNINA DONATONI,
CHANDRA HIGGINS, MARIAN ELDAHABY,
AND CYNTHIA A. HARDING
PART TWO ■ Health Promotion
10 Underlying Determinants of Health: Putting Local
Data to Work 87
MARGARET SHIH
ix