Council on Linkages Between Academia and Public Health Practice

Meeting Minutes

Friday, March 6, 1998
Alexandria, Virginia

I. Opening Business

Dr. Joshua Lipsman, chair, opened the meeting and welcomed all participants.  The minutes from the last Council meeting on October 27, 1997 were unanimously approved without comment.

II. Public Health Functions Work Group and Healthy People 2010 Update

Dr. Rika Maeshiro, of the Office of Disease Prevention and Health Promotion, presented an update on the Public Health Functions Working Group activities and progress made toward developing the Healthy People 2010 objectives.

The Working Group is moving forward in identifying federal dollars to channel to state and local health departments to train the public health workforce.  In addition, epidemiologists and health educators have been added to the list of standard occupational classifications.  It is hoped that the new descriptive job titles will diffuse to the state and local levels. The new Surgeon General and Assistant Secretary of Health, Dr. David Satcher, is very supportive of the effort.

Much progress has been made in developing and implementing the Healthy People 2010 initiative.  The electronic bulletin board for comments of the draft Healthy People 2010 objectives produced more than 1,500 pages of comments from both organizations and individuals. The final draft of objectives is currently being circulated within the department and will be discussed during an open meeting on April 30.  Additional opportunities for public comments will be facilitated through regional meetings to be held throughout Fall 1998.

Dr. Maeshiro also circulated a copy of the new edition of The Clinician’s Handbook of Preventive Services.  In addition to new sections on notifiable disease and occupational health, this edition is designed to complement the 2^nd Report of the U.S. Preventive Services Task Force.

III. Helping Frame the NIH Research Agenda

Mr. Mike Gemmell, executive director of ASPH, provided the Council an overview of the recent push to double the National Institutes of Health (NIH) budget in the next five years.  In general, the public health community supports this initiative as long as funding available to public health agencies does not suffer as a result.

During recent testimony before a House Appropriations Subcommittee, Dr. Susan Scrimshaw, on behalf of ASPH, conveyed the need for population-based prevention research at NIH.  Such research would be aimed at promoting health through investigations of the determinants of health and risk factors for disease and developing and implementing population-based interventions to minimize disease and injury, promote health and establish policy, and maintain cost-effective and efficient management systems.

Council discussion focused on the positive implications of developing a national prevention research agenda and the opportunity for collaboration among public health organizations.  Work has already begun in pursuing support and involvement of non-traditional organizations as well — building synergy is a key component for achieving a comprehensive plan.  The point was raised that it is vital to ensure that results of the work be disseminated within the communities the research is intended to benefit.  Discussion also highlighted the need to include the entire scope of public health, particularly social and behavioral sciences.  Emphasis was placed not only on advocating basic research, but also bringing back the training and knowledge to education.  Training students should be built into any research dollars that are proposed.

Ms. Elaine Auld, executive director of SOPHE, advocated that the current coalition, Research America, expand its message and activities to prevention research.  The Lasker Foundation was also named as a key player in the process; the organization should be involved in the public effort since it is actively involved in current private sector initiatives. Dr. Rebecca Parkin, of APHA, suggested that the study and report design from the EPA’s, "Research Priorities for Airborne Particulate Matter," be used as a model for developing a national research agenda.  The study was exemplary in developing a comprehensive inventory of public/private research initiatives and involving all the relevant parties. "Meeting the Challenge," a national research agenda for health, safety, and food, from the Executive Office of the President, Office of Science and Technology Policy, was also suggested as a good example to follow.

At the conclusion of the discussion, the Council proposed drafting a letter to Dr. Satcher that summarized the discussion and requested that developing a national research agenda be added to the agenda of the next Public Health Functions Steering Committee meeting.  Mr. Ron Bialek also suggested that discussing the topic at the next Public Health Functions Work Group meeting on March 26 would be an important starting point.  The window of opportunity is limited, so it is vital to develop an action plan for carrying through development of a national research agenda quickly.  As work continues in this area, the Council agreed that it should stay involved by contributing to the efforts, raising awareness, and helping ensure that all relevant parties are involved in the process.

Competencies
Mr. Bialek provided an update from the most recent conference call of the Council subcommittee on competencies.  The ideas derived from this meeting have been developed into the following proposed steps:

1. Compile and analyze information on other efforts to develop public health competencies.
2. Convene forums to develop and validate a set of organizational competencies necessary/desirable for the effective provision of the essential public health services (EPHS) at the community level. Involve approximately 50 people in these forums from public health agencies, managed care organizations, community-based organizations, other community health care providers, and institutions providing graduate-level education and training in public health
3. Involve other organizations and individuals in the refinement and validation processes through the sharing of the draft and the solicitation of comments.
4. Explore with the initial individuals involved in the forums where gaps may exist in organizational competence.
5. Determine strategies and recommendations for education and training that will help individuals achieve competence in areas where gaps may exist in organizational competence.
6. Develop and conduct dissemination activities for promoting the implementation of strategies and recommendations.
7. Evaluate the impact of dissemination activities.

Dr. Hugh Tilson presented a progress report on a current competencies-related project with which he is involved. The Robert Wood Johnson Foundation recently funded Kristine Gebbie, a faculty member with the Columbia University School of Nursing to survey the educational and professional needs of public health professionals.  The next step will be to convene a synthesis workshop in early May 1998 to formulate what questions still need to be answered and develop next steps.

Ms. Auld reported that SOPHE received a subcontract with Johns Hopkins University to look at education-based competencies.  The resulting white paper laid out four priorities and examined the relatively recent (1989) credentialing system.  The panel noted that the level of knowledge was very uneven and more attention is needed in leadership development, and accreditation and certification beyond the Council for Education in Public Health.  The four major needs identified include:

1. data needs: numbers of practicing health educators, national survey of students being trained, more rigorous data collection, information on numbers of health educators used by managed care organizations
2. training: health education faculty and how to obtain training
3. accreditation needs: relatively new set of competencies on graduate level, moving toward implementation, promote internships as part of training, accreditation needs
4. advocacy needs: how health educators function, cultural diversity of workforce

It was reported that the Macy Foundation is another organization looking at where there are synergies in training – e.g. between clinical and practice, health promotion and prevention, focusing on health rather than focusing on diseases.  Their work has shown that those professionals operating on the clinical side do have some responsibilities to public health.  A possible future project may be to help professionals, particularly subspecialists, to see how they fit in this context and to promote further understanding of the place of health promotion and disease prevention.

Council discussion emphasized that competencies are at the core of public health practitioners and academicians.  According to Dr. Tony Moulton, CDC thinks the issue is very important and future work of the Council would help clarify the process and provide a mechanism to continue focus on this issue and maintain continuity.  It was stressed that collaboration and mutual support among the individual initiatives will lead to better evaluation and impact of activities.  Some meeting participants expressed concern that the issue continues to be revisited but no solutions have been proposed yet.  There is also interest in further relating the current lists of competencies to performance standards and the essential public health services.

V. PHP Guidelines

Ms. Marie Flake presented a brief review of the history and the Council’s involvement in the public health guidelines development project.  One portion of the project, which focused on tuberculosis (TB) control guidelines, was recently completed.  Dr. Patrick Chaulk, of The Annie E. Casey Foundation, presented a summary of the research process.  The process began with forming a research team that represented a cross-section of practitioners.  The team initially focused on narrowing the topic and conducting an extensive literature review of existing documentation.  It was found that very few of the existing TB control guidelines were backed up with scientific or practice-based evidence and that the majority of documents were opinions not studies.  The list of documents was reduced to 27 studies on treatment completion and the research team developed a consensus statement from these guidelines.  A summary of the study was accepted for publication in the March 25 issue of the Journal of the American Medical Association (JAMA).

The Council discussion focused on the current CDC initiative to develop the Guide for Community Preventive Services. During the past year, the Council was solicited to submit a proposal for field testing the first two draft chapters, whose subjects are vaccine-preventable diseases and motor vehicle injury, which will be ready for dissemination and comment later in 1998.  The Council was considered an ideal body for convening representatives across public health and as a collective is highly knowledgeable in this area.

However, the direction of the project has recently changed and CDC is considering outsourcing the field testing to a professional organization with experience in running general focus groups.  The main goals of the field testing process are to determine from public health professionals whether the guidelines in these first two draft chapters meet their needs, are presented in a practical format, and can be effectively used in public health practice.  The development task force feels there is a need to put out timely, quality guidelines and would like to see the remaining chapters ready for field testing on a regular basis beginning in 1999.

Some Council members expressed concern that, under the current plan, the field testing will not be designed and conducted by an organization with as much practitioner representation as the Council.  If the Council is not directly responsible, many felt that it would be important for a representative to serve on the advisory committee in developing the field testing plan.  There was no consensus reached regarding the specific involvement of the Council as a body in the process.

VI. Linkage Activities

• Organizational Update
  Dr. William Barker presented an overview of several activities sponsored by ATPM.  In particular, a study to develop and evaluate case-based curricular materials on immunizations that promote preventive medicine skills, exemplified linking practice to academia.  An overview of this project was published in the September 3, 1997 issue of JAMA.

• The Link
  The Spring issue of The Link will include the annual organizational updates on linkage activities.  All organizations submitted an article with the exception of ATPM, AAHP, and AUPHA.  The newsletter mailing list has grown to approximately 2,500 individuals.  During the coming year, Council staff plans to update the current list and ensure that members from all Council organizations are included on the list.  Future issues will be designed around specific themes — the Summer and Fall issues will focus on innovative partnerships and competencies, respectively.  The publication schedule and deadlines for 1998 were distributed at the meeting.

• Council Web Site
  A draft of the Council web site was distributed to meeting participants.  The site will be updated regularly and will include general information about the Council, list of members with links to the organizations they represent, on-line editions of The Link, past and future meeting information, and a summary of Council projects and activities.  The address will be www.phf.org/Link.htm and will be publicly announced in the Spring issue of The Link.

• Linkages Award
  The call for abstracts for the annual Linkages Award was distributed to meeting participants.  The announcement will also appear in upcoming ASTHO and NACCHO newsletters as well as on the Council web page.  This year’s award will be available to both state and local health departments exhibiting exemplary activities that link the work of a public health agency with an academic institution.  The cash award will be presented during the annual joint ASTHO-NACCHO meeting in September.

VII. Council Direction

• Review of Goals and Objectives
  In the discussion of the Council direction in the coming year, Council members reviewed the current set of objectives and action steps.  Although the objectives are currently appropriate, it was decided that the Council should revisit the list at every meeting to ensure that the Council is on track and allow revisions as necessary.

• 1998 Report Card
  The Council also reviewed the utility of continuing an assessment of how the Faculty/Agency forum recommendations have been incorporated into public health training.  The last Council Report Card, completed in 1994, showed that progress has been made, but more work still needs to be done in assimilating the recommendations into curricula. Dr. Barker advocated that the Council should include non-accredited programs in its review.  It was decided to complete another evaluation by the end of 1998 to assess more recent progress.  The workplan will be presented at the next Council meeting.

• Participation Agreement
  A proposal to review the Council Participation Agreement was approved and seconded.  The draft document includes minimal requirements and obligations of the Council members and the organizations they represent.  The concept will be further discussed at the next Council meeting.

• Membership
  It was agreed that the Council would like to expand its membership to include SOPHE and an environmental health organization.  As more funds become available, the Council agreed to advocate expanding the Council and finding appropriate organizations to include.

VIII. Administrative Business

• Funding and Travel Policy
  Beginning October 1, 1997, the Council began operations with funding made available through the ASPH/HRSA cooperative agreement.  Mr. Bialek remains the project director and under the new contract, the Council will be staffed and operated from the Public Health Foundation (PHF).  The Johns Hopkins University Health Program Alliance will continue to be involved as a subcontractor of PHF.  Travel and other reimbursement requests should now be directed to PHF.

• Future Meetings
  The remaining meetings in 1998 have been scheduled:
  • Monday, June 8, Alexandria, Virginia
  • Friday, September 25 (in conjunction with the joint annual ASTHO-NACCHO meeting), St. Louis, Missouri
  • Thursday, November 19, (in conjunction with the annual APHA meeting), Washington, DC

Dr. Tilson proposed that the Council should strategize and plan for the NACHHO-ASTHO meeting.  Holding a focus group on competencies was one idea proposed.  Other ideas for sharing information will be further developed before the next Council meeting.

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