The Influence of the 1988 and 2003 IOM Future of Public Health Reports on the CDC.

The landmark 1988 Institute of Medicine report The Future of Public Health served the public health community well by pointing to what needed to be done, fostering a sense of urgency, and offering concrete directions to be pursued. In this article, the impact of the 1988 report, and of the subsequent 2003 report on the Centers for Disease Control and Prevention (CDC), is considered by tracing the course of the ideas that influenced the consciousness of the public health community and subsequently catalyzed concrete action. Among these ideas was that "public health is in disarray." This assessment led to an awareness that something needed to be done. Further, by stating that the public health enterprise had 3 core functions (assessment, policy development, and assurance), the 1988 report set in motion policy development to address the "disarray." At a more fundamental level, both reports championed the need for governmental public health (particularly at the CDC) to take action to strengthen the capacity of local and state public health agencies to address a growing range of public health threats and emergencies. (Am J Public Health. 2024;114(5):489-494. https://doi.org/10.2105/AJPH.2024.307598).

Analysis of problems and potentials for increasing pandemic resilience in public health administrations in Saxony-Anhalt, Germany-a mixed-methods approach.

INTRODUCTION: The COVID-19 pandemic has shown the importance of resilient, modern, and well-equipped public health administrations from national to communal levels. In Germany, the surveillance, contact tracing, and local adaptions went through local health offices, revealing both their important role and also their lack of equipment and general preparation for health crises. Research on the mode of operation of the public health service (PHS), especially in a time of crisis, is rare. The present study aims to qualitatively and quantitatively assess problem areas, conflict potentials, and challenges that have become apparent for the PHS of Saxony-Anhalt during the pandemic. It focuses on the individual insight of employees of the PHS of Saxony-Anhalt and its 14 health offices to derive concrete needs and fields of action for increasing pandemic preparedness. Furthermore, the prospective personnel and resource-based requirements as well as the necessary structural and organisational changes of the public health departments are to be considered. METHODS AND ANALYSIS: The study will follow a sequential mixed-methods approach. Introductory expert interviews (n=12) with leading staff of Saxony-Anhalt's PHS will be conducted, followed by focus group interviews (n=4) with personnel from all departments involved in the pandemic response. Thereafter, a quantitative survey will be carried out to validate and complement the results of the qualitative phase. ETHICS AND DISSEMINATION: Ethical approval was obtained by the Martin-Luther-Universität Halle-Wittenberg ethics commission (Ref number 2023-102). The authors will submit the results of the study to relevant peer-reviewed journals and give national and international oral presentations to researchers, members of the PHS, and policymakers.

Assessment of needs and gaps in public health cadre in India - a situational analysis.

BACKGROUND: A structured and organized public health set up with systematically trained personnel to manage and deliver public health services from grassroot levels to higher administrative levels with separate public health directorate is the need of the hour. The objective of this study was to conduct a situational analysis of public health cadre in select states in India to gain an in-depth understanding of the progress and explore the gaps and challenges in its implementation. METHODS: Four states from the country were selected based on stages of implementation of the cadre. The WHO health systems framework was the basis of assessment. In-depth interviews of 78 stakeholders from public health system across various categories and levels were conducted. RESULTS: Every state has a dedicated cadre for public health in the form of a separate hierarchical structure and Directorate. There are deficits in human resources skilled enough to manage and implement public health across all levels. Its penetration below districts level is limited. There are limited opportunities available for contractual staffs in terms of remuneration and job progression. The respondents strongly emphasized on having personnel with training in public health, especially at leadership positions. Funding was not reported to be a problem although some challenges in the timeliness of release of funds were reported. Under the existing Health Management Information System, duplication of data exists and there is underutilization of data for policy making. CONCLUSION: A dedicated public health cadre is under evolution in India. The main challenge is inadequate workforce skilled in public health management. States are committed to finding solutions to overcome these barriers.

Interpretable spatial identity neural network-based epidemic prediction.

Epidemic spatial-temporal risk analysis, e.g., infectious number forecasting, is a mainstream task in the multivariate time series research field, which plays a crucial role in the public health management process. With the rise of deep learning methods, many studies have focused on the epidemic prediction problem. However, recent primary prediction techniques face two challenges: the overcomplicated model and unsatisfactory interpretability. Therefore, this paper proposes an Interpretable Spatial IDentity (ISID) neural network to predict infectious numbers at the regional weekly level, which employs a light model structure and provides post-hoc explanations. First, this paper streamlines the classical spatio-temporal identity model (STID) and retains the optional spatial identity matrix for learning the contagion relationship between regions. Second, the well-known SHapley Additive explanations (SHAP) method was adopted to interpret how the ISID model predicts with multivariate sliding-window time series input data. The prediction accuracy of ISID is compared with several models in the experimental study, and the results show that the proposed ISID model achieves satisfactory epidemic prediction performance. Furthermore, the SHAP result demonstrates that the ISID pays particular attention to the most proximate and remote data in the input sequence (typically 20 steps long) while paying little attention to the intermediate steps. This study contributes to reliable and interpretable epidemic prediction through a more coherent approach for public health experts.

Factors related to the resignation and migration of physicians in public health administration agencies using nationwide survey data in Japan.

BACKGROUND: Physicians in public health administration agencies (public health physicians: PHP) play important roles in public health; however, there are not enough such physicians in Japan. This study aimed to elucidate the factors related to the resignation and migration of PHPs using nationwide survey data. METHODS: Data from the Survey of Physicians, Dentists, and Pharmacists (2010, 2012, 2014, and 2016) were analyzed. The outcome was the resignation of PHPs or migration to public health administration agencies. The explanatory variables in the resignation analysis were age, sex, workplace, and board certification status. The type of work was added as an explanatory variable in the migration analysis, and clinical specialty was added to the clinical doctor-restricted analysis. The odds ratios (ORs) of the explanatory variables were calculated using generalized estimation equations. RESULTS: In the resignation analysis among PHPs, women had a significantly lower OR, whereas younger PHPs and those with board certifications had significantly higher ORs. In the migration to public health administration agencies analysis among medical doctors, women and those aged between 35 and 39 years had significantly higher ORs, but those with board certifications had significantly lower ORs. Hospital/clinic founders or directors had significantly lower ORs, but the clinic staff and 'others/not working' had significantly higher ORs. In the migration to public health administration agencies analysis among clinical physicians, those aged between 35 and 39 years had significantly higher ORs. Still, those with two or more board certifications had significantly lower ORs. Hospital/clinic founders or directors had significantly lower ORs, but the clinic staff had significantly higher ORs. Clinical doctors specializing in surgery and other specialties had significantly lower ORs, but those specializing in pediatrics and psychiatry/psychosomatic medicine had significantly higher ORs. CONCLUSIONS: Having board certifications were significantly related to the resignation of PHPs and migration to public health administration agencies. Women migrated to public health administration agencies more than men and younger PHPs were more likely to resign. However, medical doctors aged between 35 and 39 years were more likely to migrate to public health administration agencies. Similarly, clinic staff, non-clinical physicians, and those whose specialties were pediatrics and psychiatry/psychosomatic medicine were more likely to migrate to public health administration agencies.

Health managers and community representatives' views of a system-wide intervention to strengthen public healthcare in the Free State, South Africa.

Background: A system-wide health system strengthening (HSS) initiative, the Health Systems Governance and Accountability (HSGA) intervention, was developed, translated to policy, and implemented in the Free State province. This study assessed health managers (HMs) and community representatives' (CRs) views of the intervention and whether it improved integration and performance. Method: A questionnaire survey among 147 HMs and 78 CRs and 14 focus group discussions (FGDs) with a mean of 10.3 participants and a total of 102 HMs and 42 CRs, were conducted. The questionnaire and FGD data were descriptively and thematically analysed to triangulate findings. Results: Many HMs (44%) mostly positioned at the operational levels indicated that implementation of the HSGA intervention did contribute to integration of health services. Most CRs (54%) believed that communities were actively involved in the intervention. However, both the self-administered questionnaire and the FGD data evidenced lack of policy awareness among, especially, operational-level HMs. Conclusion: From the perspectives of HMs and CRs, the implementation of the intervention was viewed as a step forward in strengthening public healthcare to respond to system deficiencies in the Free State province. Earlier engagement of especially operational-level HMs during reforms may be beneficial in successfully implementing HSS interventions.

Implementing an intervention to improve leadership/management of public healthcare services in the Free State Province, South Africa: lessons learned.

Background: Based on the World Health Organization's health systems strengthening framework, the Health Systems Governance and Accountability (HSGA) intervention to strengthen public health leadership/management, service integration and outcomes was developed in the Free State. Objectives: This study describes the process to implement and measure the effects of the HSGA intervention for system-wide improvement of leadership/management under routine conditions in a resource-constrained setting. Methods: Based on normalisation process theory, participatory discussions were held with health managers, staff and local stakeholders to attain buy-in. Evaluation of the implementation process considered progress in improving leadership/management through application of the Balanced Scorecard (BSC). All provincial reporting units were assessed during 2014/15 and again during 2015/16. Results: The mean scores on three BSC perspectives improved statistically significantly from 2014/15 to 2015/16: customer (p=0.0085), internal business processes (p=0.0008) and finance (p=0.0001). Overall leadership/management also improved significantly (p=0.0007). Conclusion: Improvement in leadership/management resulting from implementation of the HSGA intervention was observed during the two years under study. From this experience, successful implementation of a health systems strengthening intervention hinges on a participatory design, appropriate use of theory, as well as application of an evaluation approach to assess the success of implementation.

Olikoye O. Ransome-Kuti: A testimony of his achievements in health reforms and public health governance.

The late Professor Olikoye Ransome-Kuti, Nigeria's longest-serving Health Minister since independence to date, has been variedly referred to as a distinguished academic, professional, public servant, technocrat, reformer, change agent, and mentor. His name is widely known not only within Nigeria but in Africa and, indeed, globally. Based on my knowledge of him as a result of working and interacting very closely with him in various capacities during the last twenty-seven (27) years of his life (1976-2003), I have highlighted in this paper some of his efforts and achievements for which he will forever be remembered.

Barriers and Enablers to Using an Emergency Operations Center in Public Health Emergency Management: A Scoping Review.

OBJECTIVES: The aim of this study was to review the role of public health emergency operations centers in recent public health emergencies and to identify the barriers and enablers influencing the effective use of a public health emergency operations center (PHEOC) in public health emergency management. METHODS: A systematic search was conducted in 5 databases and selected grey literature websites. RESULTS: Forty-two articles, consisting of 28 peer-reviewed studies and 14 grey literature sources matched the inclusion criteria. Results suggest that PHEOCs are used to prepare and respond to a range of public health emergencies, including coronavirus disease (COVID-19). Factors found to influence the use of a PHEOC include the adoption of an incident management system, internal and external communications, data management, workforce capacity, and physical infrastructure. CONCLUSIONS: PHEOCs play an important role in public health emergency management. This review identified several barriers and enablers to using a PHEOC in public health emergency management. Future research should focus on addressing the barriers to using a PHEOC and looking at ways to evaluate the impact of using a PHEOC on public health emergency outcomes.

Gestión de personal en el Servicio Navarro de Salud-Osasunbidea durante la pandemia de COVID-19 / Personnel management in the Navarro Service of Health-Osasunbidea during the pandemic of COVID-19

Afrontar la pandemia por COVID-19 en el ámbito de la gestión de personal del Servicio Navarrode Salud-Osasunbidea, ha supuesto hacer frente a un empeoramiento de la falta de personalsanitario, derivado tanto del aumento de la carga de trabajo que genera la pandemia, como dela disminución del personal sanitario disponible como consecuencia del impacto que la propiaenfermedad produce en dicho personal. Las herramientas utilizadas para garantizar la adecuada asistencia sanitaria han consistidoen cambios legislativos que han permitido a los servicios de personal adoptar medidas paragarantizar el normal funcionamiento del sistema sanitario y además hacerlo compatible conlas nuevas medidas de salud pública adoptadas para evitar la propagación de la pandemia.Las medidas adoptadas se pueden agrupar, por una parte, en medidas para reforzar el personal sanitario mediante la contratación excepcional de residentes sin plaza, especialistas depaíses no miembros de la Unión Europea con titulación sin homologar, estudiantes de medicina y enfermería y por último reincorporación de profesionales sanitarios ya jubilados, asícomo puesta a disposición del personal sanitario de las mutuas. Por otro lado, en medidasextraordinarias por su duración o naturaleza a imponer al personal sanitario como: encomien-das de funciones distintas al puesto de trabajo, cambios geográficos entre distintos centros odepartamentos, y medidas en materia de jornada y descanso con revocación o denegación depermisos, licencias, vacaciones y reducciones de jornada. Junto a estas medidas orientadas a reforzar y garantizar el funcionamiento del sistema sanitario, también se adoptaron otras de tipo organizativo relacionadas con la protección de la saludpública, como son el teletrabajo, la cancelación de cursos, viajes y actividades formativas y lahabilitación para alojamiento del personal sanitario de hoteles para uso sanitario.(AU)

The Future of Public Health: Ensuring An Adequate Infrastructure.

Policy Points The US public heath infrastructure is in disrepair and building a sustainable system is the central challenge for the nation. Doing so in a highly patrician environment is the mission for the next ten years.

Fix the backlash against public health.

Societies generally have reacted to deadly epidemics by strengthening health systems, including laws. Under American federalism (the constitutional division of power between states and the federal government), individual states hold primary public health powers. State legislatures have historically granted health officials wide-ranging authority. After the anthrax attacks in the United States in 2001, the US Centers for Disease Control and Prevention (CDC) supported the Model State Emergency Health Powers Act, which granted public health officials even more expansive powers to declare a health emergency and respond swiftly. But all that ended with COVID-19, as state legislatures and courts gutted this authority. The next pandemic could be far deadlier than COVID-19, but when the public looks to federal and state governments to protect them, they may find that health officials have their hands tied behind their backs.