APPENDIX A
Recommendations from The Future of the Public’s Health in the 21st Century

  1. The Secretary of the Department of Health and Human Services (DHHS), in consultation with states, should appoint a national commission to develop a framework and recommendations for state public health law reform. In particular, the national commission would review all existing public health law as well as the Turning Point1 Model State Public Health Act and the Model State Emergency Health Powers Act;2 provide guidance and technical assistance to help states reform their laws to meet modern scientific and legal standards; and help foster greater consistency within and among states, especially in their approach to different health threats (Chapter 3).

  2. All federal, state, and local governmental public health agencies should develop strategies to ensure that public health workers who are involved in the provision of essential public health services demonstrate mastery of the core public health competencies appropriate to their jobs. The Council on Linkages between Academia and Public

1

Turning Point, a program funded by the Robert Wood Johnson and the W. K. Kellogg foundations, works to strengthen the public health infrastructure at the local and state levels across the United States and spearheads the Turning Point National Collaborative on Public Health Statute Modernization.

2

The Model State Emergency Health Powers Act (MSEHPA) provides states with the powers needed “to detect and contain bioterrorism or a naturally occurring disease outbreak. Legislative bills based on the MSEHPA have been introduced in 34 states” (Gostin et al., 2002).



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Training Physicians For Public Health Careers APPENDIX A Recommendations from The Future of the Public’s Health in the 21st Century The Secretary of the Department of Health and Human Services (DHHS), in consultation with states, should appoint a national commission to develop a framework and recommendations for state public health law reform. In particular, the national commission would review all existing public health law as well as the Turning Point1 Model State Public Health Act and the Model State Emergency Health Powers Act;2 provide guidance and technical assistance to help states reform their laws to meet modern scientific and legal standards; and help foster greater consistency within and among states, especially in their approach to different health threats (Chapter 3). All federal, state, and local governmental public health agencies should develop strategies to ensure that public health workers who are involved in the provision of essential public health services demonstrate mastery of the core public health competencies appropriate to their jobs. The Council on Linkages between Academia and Public 1 Turning Point, a program funded by the Robert Wood Johnson and the W. K. Kellogg foundations, works to strengthen the public health infrastructure at the local and state levels across the United States and spearheads the Turning Point National Collaborative on Public Health Statute Modernization. 2 The Model State Emergency Health Powers Act (MSEHPA) provides states with the powers needed “to detect and contain bioterrorism or a naturally occurring disease outbreak. Legislative bills based on the MSEHPA have been introduced in 34 states” (Gostin et al., 2002).

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Training Physicians For Public Health Careers Health Practice3 should also encourage the competency development of public health professionals working in public health system roles in for-profit and nongovernmental entities (Chapter 3). Congress should designate funds for the Centers for Disease Control and Prevention (CDC) and the Health Resources and Services Administration (HRSA) to periodically assess the preparedness of the public health workforce, to document the training necessary to meet basic competency expectations, and to advise on the funding necessary to provide such training (Chapter 3). Leadership training, support, and development should be a high priority for governmental public health agencies and other organizations in the public health system and for schools of public health that supply the public health infrastructure with its professionals and leaders (Chapter 3). A formal national dialogue should be initiated to address the issue of public health workforce credentialing. The Secretary of DHHS should appoint a national commission on public health workforce credentialing to lead this dialogue. The commission should be charged to determine if a credentialing system would further the goal of creating a competent workforce and, if applicable, the manner and time frame for implementation by governmental public health agencies at all levels. The dialogue should include representatives from federal, state, and local public health agencies, academia, and public health professional organizations who can represent and discuss the various perspectives on the workforce credentialing debate (Chapter 3). All partners within the public health system should place special emphasis on communication as a critical core competency of public health practice. Governmental public health agencies at all levels should use existing and emerging tools (including information technologies) for effective management of public health information and for internal and external communication. To be effective, such communication must be culturally appropriate and suitable to the literacy levels of the individuals in the communities they serve (Chapter 3). The Secretary of DHHS should provide leadership to facilitate the development and implementation of the National Health Information Infrastructure (NHII). Implementation of NHII should take into account, where possible, the findings and recommendations of the 3 The Council on Linkages between Academia and Public Health Practice is comprised of leaders from national organizations representing the public health practice and academic communities. The Council grew out of the Public Health Faculty/Agency Forum, which developed recommendations for improving the relevance of public health education to the demands of public health in the practice sector. The Council and its partners have focused attention on the need for a public health practice research agenda.

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Training Physicians For Public Health Careers National Committee on Vital and Health Statistics (NCVHS) working group on NHII. Congress should consider options for funding the development and deployment of NHII (e.g., in support of clinical care, health information for the public, and public health practice and research) through payment changes, tax credits, subsidized loans, or grants (Chapter 3). DHHS should be accountable for assessing the state of the nation’s governmental public health infrastructure and its capacity to provide the essential public health services to every community and for reporting that assessment annually to Congress and the nation. The assessment should include a thorough evaluation of federal, state, and local funding for the nation’s governmental public health infrastructure and should be conducted in collaboration with state and local officials. The assessment should identify strengths and gaps and serve as the basis for plans to develop a funding and technical assistance plan to assure sustainability. The public availability of these reports will enable state and local public health agencies to use them for continual self-assessment and evaluation (Chapter 3). DHHS should evaluate the status of the nation’s public health laboratory system, including an assessment of the impact of recent increased funding. The evaluation should identify remaining gaps, and funding should be allocated to close them. Working with the states, DHHS should agree on a base funding level that will maintain the enhanced laboratory system and allow the rapid deployment of newly developed technologies (Chapter 3). DHHS should develop a comprehensive investment plan for a strong national governmental public health infrastructure with a timetable, clear performance measures, and regular progress reports to the public. State and local governments should also provide adequate, consistent, and sustainable funding for the governmental public health infrastructure (Chapter 3). The federal government and states should renew efforts to experiment with clustering or consolidation of categorical grants for the purpose of increasing local flexibility to address priority health concerns and enhance the efficient use of limited resources (Chapter 3). The Secretary of DHHS should appoint a national commission to consider if an accreditation system would be useful for improving and building state and local public health agency capacities. If such a system is deemed useful, the commission should make recommendations on how it would be governed and develop mechanisms (e.g., incentives) to gain state and local government participation in the accreditation effort. Membership on this commission should include representatives from CDC, the Association of State and Territorial

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Training Physicians For Public Health Careers Health Officials, the National Association of County and City Health Officials, and nongovernmental organizations (Chapter 3). CDC, in collaboration with the Council on Linkages between Academia and Public Health Practice and other public health system partners, should develop a research agenda and estimate the funding needed to build the evidence base that will guide policy making for public health practice (Chapter 3). The Secretary of DHHS should review the regulatory authorities of DHHS agencies with health-related responsibilities to reduce overlap and inconsistencies, ensure that the department’s management structure is best suited to coordinate among agencies within DHHS with health-related responsibilities, and, to the extent possible, simplify relationships with state and local governmental public health agencies. Similar efforts should be made to improve coordination with other federal cabinet agencies performing important public health services, such as the Department of Agriculture and the Environmental Protection Agency (Chapter 3). Congress should mandate the establishment of a National Public Health Council. This National Public Health Council would bring together the Secretary of DHHS and state health commissioners at least annually to Provide a forum for communication and collaboration on action to achieve national health goals as articulated in Healthy People 2010; Advise the Secretary of DHHS on public health issues; Advise the Secretary of DHHS on financing and regulations that affect governmental public health capacity at the state and local levels; Provide a forum for overseeing the development of an incentive-based federal–state-funded system to sustain a governmental public health infrastructure that can assure the availability of essential public health services to every American community and can monitor progress toward this goal (e.g., through report cards); Review and evaluate the domestic policies of other cabinet agencies for their impact on national health outcomes (e.g., through health impact reports) and on the reduction and elimination of health disparities; and Submit an annual report on their deliberations and recommendations to Congress. The Council should be chaired by the Secretary of DHHS and cochaired by a state health director on a rotating basis. An appropriately resourced secretariat should be established in the Office of the

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Training Physicians For Public Health Careers Secretary to ensure that the Council has access to the information and expertise of all DHHS agencies during its deliberations (Chapter 3). Local governmental public health agencies should support community-led efforts to inventory resources, assess needs, formulate collaborative responses, and evaluate outcomes for community health improvement and the elimination of health disparities. Governmental public health agencies should provide community organizations and coalitions with technical assistance and support in identifying and securing resources as needed and at all phases of the process (Chapter 4). Governmental and private-sector funders of community health initiatives should plan their investments with a focus on long-lasting change. Such a focus would include realistic time lines, an emphasis on ongoing community engagement and leadership, and a final goal of institutionalizing effective project components in the local community or public health system as appropriate (Chapter 4). Adequate population health cannot be achieved without making comprehensive and affordable health care available to every person residing in the United States. It is the responsibility of the federal government to lead a national effort to examine the options available to achieve stable health care coverage of individuals and families and to assure the implementation of plans to achieve that result (Chapter 5). All public and privately funded insurance plans should include age-appropriate preventive services as recommended by the U.S. Preventive Services Task Force and provide evidence-based coverage of oral health, mental health, and substance abuse treatment services (Chapter 5). Bold, large-scale demonstrations should be funded by the federal government and other major investors in health care to test radical new approaches to increase the efficiency and effectiveness of health care financing and delivery systems. The experiments should effectively link delivery systems with other components of the public health system and focus on improving population health while eliminating disparities. The demonstrations should be supported by adequate resources to enable innovative ideas to be fairly tested (Chapter 5). The federal government should develop programs to assist small employers and employers with low-wage workers to purchase health insurance at reasonable rates (Chapter 6). The corporate community and public health agencies should initiate and enhance joint efforts to strengthen health promotion and disease and injury prevention programs for employees and their communi-

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Training Physicians For Public Health Careers ties. As an early step, the corporate and governmental public health community should: Strengthen partnership and collaboration by Developing direct linkages between local public health agencies and business leaders to forge a common language and understanding of employee and community health problems and to participate in setting community health goals and strategies for achieving them, and Developing innovative ways for the corporate and governmental public health communities to gather, interpret, and exchange mutually meaningful data and information, such as the translation of health information to support corporate health promotion and health care purchasing activities. Enhance communication by Developing effective employer and community communication and education programs focused on the benefits of and options for health promotion and disease and injury prevention, and Using proven marketing and social marketing techniques to promote individual behavioral and community change. Develop the evidence base for workplace and community interventions through greater public, private, and philanthropic investments in research to extend the science and improve the effectiveness of workplace and community interventions to promote health and prevent disease and injury. Recognize business leadership in employee and community health by elevating the level of recognition given to corporate investment in employee and community health. The Secretaries of DHHS and the Department of Commerce, along with business leaders (e.g., chambers of commerce and business roundtables), should jointly sponsor a Corporate Investment in Health Award. The award would recognize private-sector entities that have demonstrated exemplary civic and social responsibility for improving the health of their workers and the community (Chapter 6). An ongoing dialogue should be maintained between medical and public health officials and editors and journalists at the local level and their representative associations nationally. Furthermore, foundations and governmental health agencies should provide opportunities to develop and evaluate educational and training programs that provide journalists with experiences that will deepen their knowledge of public health subject matter and provide public health workers with a foundation in communication theory, messaging, and application (Chapter 7).

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Training Physicians For Public Health Careers The television networks, television stations, and cable providers should increase the amount of time they donate to public service announcements (PSAs) as partial fulfillment of the public service requirement in their Federal Communications Commission (FCC) licensing agreements (Chapter 7). The FCC should review its regulations for PSA broadcasting on television and radio to ensure a more balanced broadcasting schedule that will reach a greater proportion of the viewing and listening audiences (Chapter 7). Public health officials and local and national entertainment media should work together to facilitate the communication of accurate information about disease and about medical and health issues in the entertainment media (Chapter 7). Public health and communication researchers should develop an evidence base on media influences on health knowledge and behavior, as well as on the promotion of healthy public policy (Chapter 7). Academic institutions should increase integrated interdisciplinary learning opportunities for students in public health and other related health science professions. Such efforts should include not only multidisciplinary education but also interdisciplinary education and appropriate incentives for faculty to undertake such activities (Chapter 8). Congress should increase funding for HRSA programs that provide financial support for students enrolled in public health degree programs through mechanisms such as training grants, loan repayments, and service obligation grants. Funding should also be provided to strengthen the Public Health Training Center program to effectively meet the educational needs of the existing public health workforce and to facilitate public health worker access to the centers. Support for leadership training of state and local health department directors and local community leaders should continue through funding of the National and Regional Public Health Leadership Institutes and distance-learning materials developed by HRSA and CDC (Chapter 8). Federal funders of research and academic institutions should recognize and reward faculty scholarship related to public health practice research (Chapter 8). The committee recommends that Congress provide funds for CDC to enhance its investigator-initiated program for prevention research while maintaining a strong Centers, Institutes, and Offices (CIO)-generated research program. CDC should take steps that include Expanding the external peer review mechanism for review of investigator-initiated research; Allowing research to be conducted over the more generous time lines often required by prevention research; and

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Training Physicians For Public Health Careers Establishing a central mechanism for coordination of investigator-initiated proposal submissions (Chapter 8). CDC should authorize an analysis of the funding levels necessary for effective Prevention Research Center functioning, taking into account the levels authorized by P.L. 98–551 as well as the amount of prevention research occurring in other institutions and organizations (Chapter 8). NIH should increase the portion of its budget allocated to population-and community-based prevention research that Addresses population-level health problems; Involves a definable population and operates at the level of the whole person; Evaluates the application and impacts of new discoveries on the actual health of the population; and Focuses on the behavioral and environmental (social, economic, cultural, physical) factors associated with primary and secondary prevention of disease and disability in populations. Furthermore, the committee recommends that the Director of NIH report annually to the Secretary of DHHS on the scope of population and community-based prevention research activities undertaken by the NIH centers and institutes (Chapter 8). Academic institutions should develop criteria for recognizing and rewarding faculty scholarship related to service activities that strengthen public health practice (Chapter 8).