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2.
PLoS One ; 16(1): e0245135, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33513146

RESUMO

Why have the effects of COVID-19 been so unevenly geographically distributed in the United States? This paper investigates the role of social capital as a mediating factor for the spread of the virus. Because social capital is associated with greater trust and relationships within a community, it could endow individuals with a greater concern for others, thereby leading to more hygienic practices and social distancing. Using data for over 2,700 US counties, we investigate how social capital explains the level and growth rate of infections. We find that moving a county from the 25th to the 75th percentile of the distribution of social capital would lead to a 18% and 5.7% decline in the cumulative number of infections and deaths, as well as suggestive evidence of a lower spread of the virus. Our results are robust to many demographic characteristics, controls, and alternative measures of social capital.


Assuntos
/prevenção & controle , Controle de Doenças Transmissíveis , /epidemiologia , Participação da Comunidade , Humanos , Governo Local , Confiança , Estados Unidos/epidemiologia
3.
J Public Health Manag Pract ; 27 Suppl 1, COVID-19 and Public Health: Looking Back, Moving Forward: S43-S56, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32956299

RESUMO

OBJECTIVE: To overcome the absence of national, state, and local public health data on the unequal economic and social burden of COVID-19 in the United States. DESIGN: We analyze US county COVID-19 deaths and confirmed COVID-19 cases and positive COVID-19 tests in Illinois and New York City zip codes by area percent poverty, percent crowding, percent population of color, and the Index of Concentration at the Extremes. SETTING: US counties and zip codes in Illinois and New York City, as of May 5, 2020. MAIN OUTCOME MEASURES: Rates, rate differences, and rate ratios of COVID-19 mortality, confirmed cases, and positive tests by category of county and zip code-level area-based socioeconomic measures. RESULTS: As of May 5, 2020, the COVID-19 death rate per 100 000 person-years equaled the following: 143.2 (95% confidence interval [CI]: 140.9, 145.5) vs 83.3 (95% CI: 78.3, 88.4) in high versus low poverty counties (≥20% vs <5% of persons below poverty); 124.4 (95% CI: 122.7, 126.0) versus 48.2 (95% CI: 47.2, 49.2) in counties in the top versus bottom quintile for household crowding; and 127.7 (95% CI: 126.0, 129.4) versus 25.9 (95% CI: 25.1, 26.6) for counties in the top versus bottom quintile for the percentage of persons who are people of color. Socioeconomic gradients in Illinois confirmed cases and New York City positive tests by zip code-level area-based socioeconomic measures were also observed. CONCLUSIONS: Stark social inequities exist in the United States for COVID-19 outcomes. We recommend that public health departments use these straightforward cost-effective methods to report on social inequities in COVID-19 outcomes to provide an evidence base for policy and resource allocation.


Assuntos
/epidemiologia , Efeitos Psicossociais da Doença , Grupos Étnicos/estatística & dados numéricos , Renda/estatística & dados numéricos , Governo Local , Pandemias/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Fatores Socioeconômicos , Estudos Transversais , Humanos , Illinois/epidemiologia , Cidade de Nova Iorque/epidemiologia , Fatores Raciais , Estados Unidos/epidemiologia
4.
J Environ Manage ; 279: 111764, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33360650

RESUMO

Municipalities around the globe are increasingly adopting and integrating sustainability goals into their service functions. As with many public programs, local sustainability initiatives benefit from regular and systematic assessment aimed at determining the extent to which efforts are achieving their performance goals. However, there currently is little understanding of how local governments are collecting and tracking data on their sustainability-related performance and to what extent they integrate its lessons into their sustainability management practice. This study helps fill this gap by investigating U.S. local governments' sustainability performance management systems and provides empirical evidence on some of their key institutional and system characteristics. Our findings indicate that a significant number of U.S. local governments are engaged in sustainability performance assessment, but they vary in their ability to establish appropriate indicators as well as supporting mechanisms, indicating significant room for improvement in local sustainability performance management.


Assuntos
Governo Local , Cidades
5.
Am J Public Health ; 111(2): 301-308, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33351657

RESUMO

Objectives. To examine correlates of applying for accreditation among small local health departments (LHDs) in the United States through 2019.Methods. We used administrative data from the Public Health Accreditation Board (PHAB) and 2013, 2016, and 2019 Profile data from the National Association of County and City Health Officials to examine correlates of applying for PHAB accreditation. We fit a latent class analysis (LCA) to characterize LHDs by service mix and size. We made bivariate comparisons using the t test and Pearson χ2.Results. By the end of 2019, 126 small LHDs had applied for accreditation (8%). When we compared reasons for not pursuing accreditation, we observed a difference by size for perceptions that standards exceeded LHD capacity (47% for small vs 22% for midsized [P < .001] and 0% for large [P < .001]).Conclusions. Greater funding support, considering differing standards by LHD size, and recognition that service mix might affect practicality of accreditation are all relevant considerations in attempting to increase uptake of accreditation for small LHDs.Public Health Implications. Overall, small LHDs represented about 60% of all LHDs that had not yet applied to PHAB.


Assuntos
Acreditação/estatística & dados numéricos , Centros Comunitários de Saúde/estatística & dados numéricos , Governo Local , Administração em Saúde Pública/estatística & dados numéricos , Centros Comunitários de Saúde/normas , Humanos , Estados Unidos
6.
Am J Public Health ; 111(2): 259-264, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33351659

RESUMO

States have enacted a wave of statutes over the past several years preempting local government law and policies that potentially promote public health in various ways. Among these local preemption measures are statutes in at least 9 states that outlaw municipal policies providing some form of "sanctuary" to immigrants. Such policies, and their preemption, have importance both for direct access to health services and for broader social determinants of health.This article gauges the coverage and potential impact of these state preemption laws based on key informant interviews nationally and a close legal analysis of relevant laws and policy documents. It distinguishes between preemption laws focused on law enforcement cooperation and those that also encompass a wider array of "welcoming" policies and initiatives. It also distinguishes between more passive forms of preemption that prohibit barring cooperation with federal immigration enforcement, and those statutes that more affirmatively require active measures to assist federal enforcement.Drawing these distinctions can help municipalities determine which immigrant-supportive measures are still permitted, and how best to mitigate the adverse public health effects of these preemption laws.


Assuntos
Emigração e Imigração/legislação & jurisprudência , Governo Local , Saúde Pública/legislação & jurisprudência , Governo Estadual , Acesso aos Serviços de Saúde/legislação & jurisprudência , Humanos , Estados Unidos
7.
Artigo em Inglês | MEDLINE | ID: mdl-33375307

RESUMO

During times of public crises (such as COVID-19), governments must act swiftly to release crisis information effectively and efficiently to the public. This paper provides a general overview of the way that the Wuhan local government use Weibo as a channel to engage with their citizens during the COVID-19 pandemic. Based on the media richness, dialogic loop, and a series of theoretically relevant factors, such as content type, text length, and information source, we try to examine how citizen engage with their local government. By analyzing the data mining samples from Wuhan Release, the official Sina Weibo account of Wuhan's local government, results show that, despite the unstable situation COVID-19 over the crisis, there exist three stages of a crisis on the whole. Combining the behavior of the government and the public, duration from 31 December 2019 to 19 January 2020 could be seen as the development period, then the outbreak period (30 January 2020 to 28 February 2020), and a grace period (29 February 2020 to19 April 2020). Public attention to different types of information changes over time, but curbing rumors has always been a priority. Media richness features partially influent citizen engagement. Text length is significantly positively associated with citizen engagement through government social media. However, posts containing information sources have a negative impact on citizen engagement.


Assuntos
Disseminação de Informação/métodos , Governo Local , Pandemias , Mídias Sociais , China , Humanos
8.
Sci Data ; 7(1): 438, 2020 12 17.
Artigo em Inglês | MEDLINE | ID: mdl-33335102

RESUMO

A cross-sectional survey of adolescents and heads of households was done in six urban and rural local government areas in Ebonyi state, Nigeria in August 2018. Modified cluster sampling technique was used to select households from which eligible adolescent boys and girls were recruited. This data article describes two datasets that, for the first time, expansively describe adolescents' sexual and reproductive behaviors in Nigeria. The datasets include variables on adolescents' demographic and socioeconomic characteristics; family relationships; sexual behaviors; awareness and use of contraceptives; access to sexual and reproductive health information and services; gender norms and ideology about adolescent sexuality; and potential strategies for reducing unwanted teenage pregnancies and unsafe abortions. This dataset would be useful to public health researchers and social scientists investigating drivers of adolescent sexual and reproductive behaviour, as well as programme managers seeking potential strategies for improving adolescent health outcomes. The datasets also provide a template that could be replicated for national or regional surveys on adolescent sexual and reproductive behaviours.


Assuntos
Saúde Reprodutiva , Saúde Sexual , Adolescente , Anticoncepcionais , Família , Humanos , Governo Local , Nigéria , População Rural , Comportamento Sexual , População Urbana
9.
PLoS One ; 15(12): e0240260, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33362224

RESUMO

The growing importance of maturity smart cities is currently observed worldwide. The vast majority of smart city models focus on hard domains such as communication and technology infrastructure. Scientists emphasize the need to take into account social capital and the knowledge of residents. The smart cities invest in enhanced openness and transparency data. Mature smart cities use real-time evidences and information to citizens, businesses and visitors. The smart cities are characterized by bottom-down management and civil government. The paper aims to assess the urban smartness of selected European cities based on the ISO 37120 standard. Several research methods including the Multidimensional Statistical Analysis (MSA) were applied. Using the statistical analysis of European smart cities with the implemented ISO 37120 standard, the author tried to fill gaps in the knowledge and to evaluate maturity smart cities. The results of the research have shown that the smart city concept is a viable strategy which contributes to the urban sustainability. The author also found out that urban sustainability frameworks contain a large number of indicators measuring environmental sustainability, the smart city frameworks lack environmental indicators while highlighting social and economic aspects.


Assuntos
/estatística & dados numéricos , Governo Local , Desenvolvimento Sustentável , Cidades/estatística & dados numéricos , Europa (Continente) , Disseminação de Informação/métodos , Análise Multivariada
10.
Artigo em Inglês | MEDLINE | ID: mdl-33379266

RESUMO

This article selects the listed companies in China's A-share heavy pollution industry from 2014 to 2018 as samples, uses a random effect model to empirically test the relationship between media attention and corporate environmental performance and examines the impacts of local government environmental protection and property nature on that relationship. Results are as follow: (1) Media attention can significantly affect a company's environmental performance. The higher the media attention, the greater the company's supervision and the better its environmental performance. (2) In areas where the government pays less attention to environmental protection, the impact of media on corporate environmental performance is more obvious, but in other areas, the impact of media on environmental performance cannot be reflected; (3) The media attention is very significant for the environmental performance improvement of state-owned enterprises, and it is not obvious in non-state-owned enterprises. (4) A further breakdown of the study found that the role of media attention in corporate environmental performance is only significant in the sample of local governments that have low environmental protection and are state-owned enterprises. This research incorporates the local government's emphasis on environmental protection into the research field of vision, expands the research scope of media and corporate environmental performance, and also provides new clues and evidence for promoting the active fulfillment of environmental protection responsibilities by companies and local governments.


Assuntos
Poluição Ambiental , Indústrias , Governo Local , Meios de Comunicação de Massa , China , Conservação dos Recursos Naturais
11.
Artigo em Inglês | MEDLINE | ID: mdl-33379354

RESUMO

Policy is a lever for initiating the structural and environmental changes that foster health-enhancing physical activity (HEPA) promotion. However, little is known about the evidence in support of local governments regarding their HEPA-promoting policies. The aim of this study was to collect comprehensive information on municipal HEPA policies on the French Riviera (Alpes-Maritimes and Var counties) to provide an overview of the development of these policies in this territory. Mid-sized cities from the two counties constituting the French Riviera were targeted (n = 17). In each city, a local tool for HEPA policy analysis, CAPLA-Santé, was used to gain information from key informants heading the departments of sports, health services, and social services. Data were collected through semi-structured interviews and document analysis. Ten mid-sized cities volunteered to participate. Key informants from the sports (n = 10), health services (n = 5), and social services (n = 6) departments were interviewed. Written HEPA policy documents were formalized in six cities. These documents (n = 14) were mainly from the sports (n = 8) and health services (n = 4) sectors. The key informants reported that support from national policy, the commitment of elected officials, and large local stakeholder networks facilitated HEPA promotion, whereas the lack of intersectoral collaboration and limited resources were limitations. The results provide insight into the development of municipal HEPA policies, highlighting some of the barriers, facilitators, and perspectives. These findings could be valuable to scale up HEPA promotion at the local level.


Assuntos
Exercício Físico , Política de Saúde , Promoção da Saúde , Governo Local , Cidades , França , Humanos
12.
Artigo em Inglês | MEDLINE | ID: mdl-33142755

RESUMO

Systemic inequity concerning the social determinants of health has been known to affect morbidity and mortality for decades. Significant attention has focused on the individual-level demographic and co-morbid factors associated with rates and mortality of COVID-19. However, less attention has been given to the county-level social determinants of health that are the main drivers of health inequities. To identify the degree to which social determinants of health predict COVID-19 cumulative case rates at the county-level in Georgia, we performed a sequential, cross-sectional ecologic analysis using a diverse set of socioeconomic and demographic variables. Lasso regression was used to identify variables from collinear groups. Twelve variables correlated to cumulative case rates (for cases reported by 1 August 2020) with an adjusted r squared of 0.4525. As time progressed in the pandemic, correlation of demographic and socioeconomic factors to cumulative case rates increased, as did number of variables selected. Findings indicate the social determinants of health and demographic factors continue to predict case rates of COVID-19 at the county-level as the pandemic evolves. This research contributes to the growing body of evidence that health disparities continue to widen, disproportionality affecting vulnerable populations.


Assuntos
Infecções por Coronavirus/epidemiologia , Disparidades nos Níveis de Saúde , Pandemias , Pneumonia Viral/epidemiologia , Saúde da População/estatística & dados numéricos , Determinantes Sociais da Saúde , Betacoronavirus , Infecções por Coronavirus/diagnóstico , Estudos Transversais , Demografia , Georgia/epidemiologia , Humanos , Governo Local , Pneumonia Viral/diagnóstico , Pobreza , Qualidade de Vida , Fatores Socioeconômicos
13.
N C Med J ; 81(6): 389-393, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33139472

RESUMO

The Patient Protection and Affordable Care Act has resulted in benefits for North Carolina hospitals and the patients they serve. The impact of the ACA is not as great as it might have been due to lack of Medicaid expansion and exigent challenges at the state and local level.


Assuntos
Hospitais , Patient Protection and Affordable Care Act , Humanos , Governo Local , Medicaid/organização & administração , North Carolina , Governo Estadual , Estados Unidos
14.
Pediatrics ; 146(5)2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33082284

RESUMO

BACKGROUND AND OBJECTIVES: Road traffic accidents are a leading cause of child deaths in the United States. Although this has been examined at the national and state levels, there is more value in acquiring information at the county level to guide local policies. We aimed to estimate county-specific child mortality from road traffic accidents in the United States. METHODS: We queried the Fatality Analysis Reporting System database, 2010-2017, for road traffic accidents that resulted in a death within 30 days of the auto crash. We included all children <15 years old who were fatally injured. We estimated county-specific age- and sex-standardized mortality. We evaluated the impact of the availability of trauma centers and urban-rural classification of counties on mortality. RESULTS: We included 9271 child deaths. Among those, 45% died at the scene. The median age was 7 years. The overall mortality was 1.87 deaths per 100 000 children. County-specific mortality ranged between 0.25 and 21.91 deaths per 100 000 children. The availability of a trauma center in a county was associated with decreased mortality (adult trauma center [odds ratio (OR): 0.59; 95% credibility interval (CI), 0.52-0.66]; pediatric trauma center [OR: 0.56; 95% CI, 0.46-0.67]). Less urbanized counties were associated with higher mortality, compared with large central metropolitan counties (noncore counties [OR: 2.33; 95% CI, 1.85-2.91]). CONCLUSIONS: There are marked differences in child mortality from road traffic accidents among US counties. Our findings can guide targeted public health interventions in high-risk counties with excessive child mortality and limited access to trauma care.


Assuntos
Acidentes de Trânsito/mortalidade , Mortalidade da Criança , Centros de Traumatologia/provisão & distribução , Adolescente , Teorema de Bayes , Criança , Pré-Escolar , Bases de Dados Factuais/estatística & dados numéricos , Escolaridade , Feminino , Humanos , Renda , Governo Local , Masculino , Razão de Chances , Distribuição de Poisson , População Rural/estatística & dados numéricos , Distribuição por Sexo , Análise de Pequenas Áreas , Centros de Traumatologia/classificação , Estados Unidos/epidemiologia , População Urbana/estatística & dados numéricos
15.
Rev Bras Epidemiol ; 23: e200091, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-33027433

RESUMO

OBJECTIVE: To analyze the association between the transmission potential of SARS-CoV-2 and the decisions made by the municipal government of Florianópolis (Brazil) regarding social distancing. METHODS: We analyzed new cases of COVID-19 identified in Florianópolis residents between February 1 and July 14, 2020, using a nowcasting approach. Decrees related to COVID-19 published in the Official Gazette of the Municipality between February 1 and July 14, 2020 were also analyzed. Based on the actions proposed in the decrees, whether they loosened social distancing measures, or increased or maintained existing restrictions, was analyzed, thus creating a Social Distancing Index. Time-dependent reproduction numbers (Rt) for a period of 14 days prior to each decree were calculated. A matrix was constructed associating the classification of each decree and the Rt values, analyzing the consonance or dissonance between the potential dissemination of SARS-CoV-2 and the actions of the decrees. RESULTS: A total of 5,374 cases of COVID-19 and 26 decrees were analyzed. Nine decrees increased social distancing measures, nine maintained them, and eight loosened them. Of the 26 actions, 9 were consonant and 17 dissonant with the tendency indicated by the Rt. Dissonance was observed in all of the decrees that maintained the distance measures or loosened them. The fastest expansion in the number of new cases and the greatest amount of dissonant decrees was found in the last two months analyzed. CONCLUSION: There was an important divergence between municipal measures of social distancing with epidemiological indicators at the time of each political decision.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Tomada de Decisões , Governo Local , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Brasil/epidemiologia , Humanos , Estudos Retrospectivos
16.
MMWR Morb Mortal Wkly Rep ; 69(39): 1398-1403, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33001876

RESUMO

Coronavirus disease 2019 (COVID-19) is a viral respiratory illness caused by SARS-CoV-2. During January 21-July 25, 2020, in response to official requests for assistance with COVID-19 emergency public health response activities, CDC deployed 208 teams to assist 55 state, tribal, local, and territorial health departments. CDC deployment data were analyzed to summarize activities by deployed CDC teams in assisting state, tribal, local, and territorial health departments to identify and implement measures to contain SARS-CoV-2 transmission (1). Deployed teams assisted with the investigation of transmission in high-risk congregate settings, such as long-term care facilities (53 deployments; 26% of total), food processing facilities (24; 12%), correctional facilities (12; 6%), and settings that provide services to persons experiencing homelessness (10; 5%). Among the 208 deployed teams, 178 (85%) provided assistance to state health departments, 12 (6%) to tribal health departments, 10 (5%) to local health departments, and eight (4%) to territorial health departments. CDC collaborations with health departments have strengthened local capacity and provided outbreak response support. Collaborations focused attention on health equity issues among disproportionately affected populations (e.g., racial and ethnic minority populations, essential frontline workers, and persons experiencing homelessness) and through a place-based focus (e.g., persons living in rural or frontier areas). These collaborations also facilitated enhanced characterization of COVID-19 epidemiology, directly contributing to CDC data-informed guidance, including guidance for serial testing as a containment strategy in high-risk congregate settings, targeted interventions and prevention efforts among workers at food processing facilities, and social distancing.


Assuntos
Centers for Disease Control and Prevention, U.S./organização & administração , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Administração em Saúde Pública , Prática de Saúde Pública , Infecções por Coronavirus/epidemiologia , Humanos , Governo Local , Pneumonia Viral/epidemiologia , Governo Estadual , Estados Unidos/epidemiologia
18.
J Allied Health ; 49(3): 228-229, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32877482

RESUMO

Local governments, especially in rural settings, may look to collaborate with neighboring communities to maintain public health services and efficiencies in face of restrictive local budgets. Cross-jurisdictional partnerships of rural health departments have allowed offering an increased range of prevention programs and community health initiatives. Genesee and Orleans counties, in rural Western New York, developed a cross-jurisdictional partnership 7 years ago which has been integral for the coronavirus disease 2019 (COVID-19) response for both county health departments. Using a cross-jurisdictional partnership and a joint incident command structure has allowed a coordinated approach towards contact tracing of COVID-19 confirmed cases.


Assuntos
Busca de Comunicante/métodos , Infecções por Coronavirus/epidemiologia , Governo Local , Pneumonia Viral/epidemiologia , Administração em Saúde Pública/métodos , Betacoronavirus , Comportamento Cooperativo , Humanos , Pandemias , Estados Unidos
19.
PLoS One ; 15(9): e0239572, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32960932

RESUMO

Social distancing, a non-pharmaceutical tactic aimed at reducing the spread of COVID-19, can arise because individuals voluntarily distance from others to avoid contracting the disease. Alternatively, it can arise because of jurisdictional restrictions imposed by local authorities. We run reduced form models of social distancing as a function of county-level exogenous demographic variables and jurisdictional fixed effects for 49 states to assess the relative contributions of demographic and jurisdictional effects in explaining social distancing behavior. To allow for possible spatial aspects of a contagious disease, we also model the spillovers associated with demographic variables in surrounding counties as well as allow for disturbances that depend upon those in surrounding counties. We run our models weekly and examine the evolution of the estimated coefficients over time since the onset of the COVID-19 pandemic in the United States. These estimated coefficients express the revealed preferences of individuals who were able to and chose to stay at home to avoid the disease. Stay-at-home behavior measured using cell phone tracking data exhibits considerable cross-sectional variation, increasing over nine-fold from the end of January 2020 to the end of March 2020, and then decreasing by about 50% through mid-June 2020. Our estimation results show that demographic exogenous variables explain substantially more of this variation than predictions from jurisdictional fixed effects. Moreover, the explanations from demographic exogenous variables and jurisdictional fixed effects show an evolving correlation over the sample period, initially partially offsetting, and eventually reinforcing each other. Furthermore, the predicted social distance from demographic exogenous variables shows substantial spatial autoregressive dependence, indicating clustering in social distancing behavior. The increased variance of stay-at-home behavior coupled with the high level of spatial dependence can result in relatively intense hotspots and coldspots of social distance, which has implications for disease spread and mitigation.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Modelos Teóricos , Pneumonia Viral/epidemiologia , Análise por Conglomerados , Infecções por Coronavirus/prevenção & controle , Estudos Transversais , Demografia , Humanos , Governo Local , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Isolamento Social , Estados Unidos
20.
PLoS One ; 15(9): e0237380, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32986698

RESUMO

OBJECTIVE: The objective of this study was to develop a measurement tool to capture local public health department (LHD) organizational characteristics that align with implementation of equity-oriented practice, which may be used to gauge progress in building public health structures and functions that address the needs of vulnerable populations and reduce health inequities. METHODS: We developed and tested a measurement tool, with practitioner input, based on an implementation science framework and informed by previous work defining public health essential services and practice recommendations for health equity. Measures assessed types of vulnerable populations served by the LHD, organizational climate, and four equity-oriented practice areas, including: assessment and planning, monitoring and analysis, leadership support, and obesity prevention. We also assessed opportunities for capacity building by identifying training needs of practitioners. Primary data were collected from Missouri local health department practitioners (n = 92, 80% response rate) via an online questionnaire, with a subset of the sample providing data for test-retest reliability. RESULTS: Measures of equity-oriented implementation climate indicated areas of variability with respect to strengths and gaps across LHDs. While implementation climate was strong with respect to perceived importance (86%), a substantial proportion of LHDs cited concern over other priorities conflicting with equity-oriented implementation (32%). Likewise, a strong internal push (67%) was often accompanied by limited external political (25%) and community support (40%). Implementation climate measures generally had good to excellent reliability and were significantly associated with areas of equity-oriented practice. Frequently identified (>70%) training needs included improving skills in applying frameworks, assessment methods, and evaluating collaborations around equity. CONCLUSION: We developed a theory-based, practitioner-informed questionnaire to assess capacity for equity-oriented practice and identify opportunities for capacity building in local public health departments to engage in effective change toward health equity.


Assuntos
Fortalecimento Institucional , Equidade em Saúde , Governo Local , Obesidade/prevenção & controle , Administração em Saúde Pública/métodos , Saúde Pública/métodos , Feminino , Humanos , Masculino , Missouri , Inquéritos e Questionários
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