Changes in the association of low birth weight with socioeconomic status in Hawaii: 1970-1990.

This study examines rates of low birth weight (LBW) in the state of Hawaii and changes in the association of LBW with socioeconomic status from 1970 to 1990. The analysis is based on aggregate data for census tracts. Rates of low birth weight were calculated for each census tract. Relative socioeconomic scores were calculated from average household income and years of education. The results show that (1) there was a decrease in the rate of low birth weight infants in Hawaii; and (2) that the correlation between socioeconomic status and low birth weight was substantially reduced, though a significant correlation remains. The paper suggests likely ceiling effects, but that the progressive public health policies and expansion of access to primary health care in Hawaii during this period played a major role in reducing the rate of low birth weight infants and in decreasing socioeconomic inequality on this important health indicator.

Use of foldback analysis to foster consolidation between academic and public health practice.

INTRODUCTION: Departments of health can provide applied settings for students from academic public health programs to explore the connection of course work to real-life circumstances. Barriers exist for public health practitioners, however, that restrict their willingness to engage in joint efforts with academe. To address these barriers, they must be identified and characterized. That is, it is important for academics in public health to respect both barrier-issues and to understand underlying value constructs, if they hope to employ public health practice settings to advance their students' training. METHODS: A 100% sample of all midmanagers was surveyed at the Hawaii Department of Health by the School of Public Health. Nine clusters of "key issues for continued collaboration" were identified and rank-ordered in importance. Further analysis of the rank-orders, using multidimensional scaling, distinguished important underlying value constructs crucial to improving joint activities between the school and department. RESULTS: Working together, representatives from the Department and School identified the first three value dimensions as cooperation, implying the need for true reciprocal and equal interaction; obligation, signifying mutual responsibility and parallel investment; and, professional practice, suggesting the balanced interdigitation of research with practice. These value dimensions account for three fifths (58%) of the variance in opinion. CONCLUSIONS: Detailed analysis of these dimensions suggests that low-cost strategies improve collaboration, and foster possible consolidation, between academic and clinical public health settings. A stronger partnership between the school and the department is likely, provided the two agencies can address these issues satisfactorily. Insights from the Hawaii experience may prove useful to other academic public health practice settings. Recommendations that may improve collaboration include holding joint semi-annual meetings, a school bulletin board listing practica at the department, a public health leadership course, improved electronic communications between the school and the department, joint appointments to the two agencies, faculty release time to conduct research to improve practices at the department, and the establishment of a steering committee for the collaboration.

Minimum competencies for public health personnel.

The public health discipline is receiving increased attention in the United States under initiatives for health care reforms. It is realized that community-wide interventions to prevent disease and promote health are more cost-effective than medical interventions to cure injury and illness. Internationally, these same realizations were embedded in the Alma Ata movement for increased primary care. To improve respect for public health professionalism, a national effort is now underway in the United States to establish minimum competencies for public health practice, and to assure that these competencies are addressed as part of professional graduate studies. Using nationally recommended competencies detailed across nine public health and a separate cross-cutting list of universal competencies, the University of Hawaii School of Public Health assessed all their courses to determine the degree each competency is addressed by each course. A four-point scale was used. Lead faculty for each course assessed the depth of coverage. For the Hawaii School of Public Health, this study identified important gaps in instruction, and possible areas of over-instruction. This information will assist the School to revise course offerings and academic/clinical posts. This approach to curriculum reform and the establishment of minimum competencies for academic public health should also prove useful to other schools in the US and elsewhere. By standardizing professional competencies, the public health profession with increase in stature and impact.

Development of an Asia-Pacific regional network for public health.

As public health by its very nature is multi-disciplinary, it may benefit individual programs to formulate a regional network, joining researchers and academics across programs. This approach may afford extended benefits, such as the establishment of regional health surveillance systems and collaborative funding initiatives. To explore this potential, member institutions comprising the Asia-Pacific Academic Consortium for Public Health provided data to form an aggregate profile of cross-institutional expertise and resources, which was presented to Health Specialists at the Asian Development Bank. The study provided a foundation for a planned regional network. A four-pronged approach was proffered detailing concurrent aspects of development: 1) network formation and expansion, 2) research coordination, 3) cross-institutional communication and instruction, and 4) promotion of self-sufficiency. The proposed plan affords the groundwork for an improved approach to public health research and practice that builds upon the established Consortium, and encourages new horizons. Regionalization is an increasing phenomenon world wide, and should be furthered as a concept for improved public health intervention and control.

Establishment of an International Information Network for International Health Development: a survey of public health administration and management courses.

The purpose of the present study was to examine the content emphasis of courses of public health administration and management (A & M) among member institutions of the Asia-Pacific Academic Consortium for Public Health (APACPH), to determine comparability of curricula across campuses. A survey of course syllabi from APACPH schools was conducted by three separate reviewers to identify topical subject matter presented in general and specialty A & M courses delivered to graduate students at each campus. Based on this review, three synthetic general content A & M courses, and one specialty A & M course (i.e. Hospital Administration) were created as a basis for intercampus cross-institutional comparisons conducted by the author. Despite the number of courses provided by the different APACPH institutions, specific content areas consistently appeared across institutions, suggesting possible foundational A & M content for public health students. In general, there was much better coverage of similar topics at the introductory level of instruction, and much greater consistency was observed across institutions that provided course work addressing the administration of hospitals. Several recommendations are made for further studies of other content areas, and for the development of minimum training content areas as a basis for cross-institutional studies.

Probable future funding priorities in maternal and child health: a modified Delphi National Survey.

Recent enactment of program consolidation block grants proposed by the Reagan administration has left many observers of public health services wondering about the impact of such a change on categorical programs in maternal and child health (MCH). This study first presents predictions about the future of 23 specific MCH services, derived from a modified Delphi Survey of MCH experts, and then examines the implications of these predictions for future public health.

PIP: Recent enactment of program consolidation block grants proposed by the Reagan administration has left many observers of public health services wondering about the impact. This study 1st presents predictions about the future of 23 specific Maternal-Child Health (MCH) services, and then examines the implications of these predictions for future public health. The predictions were gathered in 1981-2 by means of a Delphi National Survey, a method of seeking consensus among homogeneous groups of experts by aggregating the judgments of individuals and then feeding back the results to a participating panel of experts. 5-year forecasts for 23 categorical MCH services were established through 3 Rounds of questions administered to a panel of 83 nationally recognized experts in MCH from across the US. Information was obtained regarding the survival potential of the 23 services, including expected and projected financial support from government and private sources. Given current economic and sociopolitical indications, several potential future gaps in services for parents and children were indicated. Main areas of concern include declining health care for youth, specifically school programs and adolescent health services, and the lack of commitment to preventive health in the MCH field. If born out by future events, severe gaps in preventive services to mothers and children will occur. A need for state level consideration of private funding sources in their fiscal planning of preventive programs is strongly suggested. Such planning would include close examination of the question of cost-effective primary prevention programs versus less cost-effective secondary and tertiary treatment programs in the long run.