Council
on Linkages Between Academia and Public Health Practice
Meeting Minutes
Thursday, July 17, 1997
| Members Present: | Ron Brown, Diane Downing, Henry Fernandez, Bill Keck, Joshua Lipsman (chair), Charles Mahan, Thomas Novotny, Neil Sampson, Hugh Tilson, Marty Wasserman, and Bill Wiese |
| Other Participants Present: | Deane Johnson, Doug Lloyd, Mo Mullet, Lloyd Novick, and Alison Wojciak |
| Staff Present: | Michon Béchamps, Ron Bialek, and Marie Flake |
I. Opening Business
Dr. Joshua Lipsman, chair, opened the meeting and welcomed all participants. Dr. Mo Mullet, chair of the Public Health Foundation Board of Directors, voiced his support on behalf of the PHF board for the important work of the Council and their efforts to link with NACCHO members. Congratulations were extended to Dr. Bill Wiese, who was recently named the Public Health Division Director for the State of New Mexico. Dr. Lipsman announced that Dr. Charles Mahan, dean of the University of South Florida, College of Public Health, has been named the new ASPH representative and welcomed Dr. Mahan to the Council.
The minutes from the April 18 meeting were unanimously approved.
II. Debriefing on Thursday Sessions
The Council co-sponsored two sessions during the NACCHO annual conference. The roundtable, "Can We Talk? How Do Practitioners and Academics REALLY Communicate for Effective Partnerships" was moderated by Drs. Lipsman, Bill Keck, Tom Novotny, and Hugh Tilson. The panel, "Public Health Practice and Academia: Linking the Two Worlds in Print," was moderated by Dr. Lloyd Novick. Council members Drs. Hugh Tilson and Tom Novotny, along with Dr. Hardy Loe from the University of Texas Houston School of Public Health, served as panelists.
As reported by Council members who attended the roundtable on the first day, the discussion was very interactive. The relationships and experiences discussed produced good examples of ways to link local agencies and schools. It was noted that some participants in the practice world felt angry about seeming abandonment by schools. However, there was general agreement by participants that it is vital to move from operating with distinct divisions between practice and academia to forming common goals and objectives. A broad, open approach seems imminent and it is important to keep in mind that linkages looks brighter now than they did five years ago. The Council agreed that publishing a summary of the roundtable in The Link and NACCHO News would be a valuable means of disseminating the work of the Council.
The presentations and discussions of the panel on publishing were also productive. Council members who attended reported that they themselves learned a lot about the process of publication, especially work based on linkages activities and partnerships. The panel took a nuts and bolt approach and was helpful in identifying some common problems and tensions with linking practice and academia. During the panel presentation, Dr. Lloyd Novick gave the suggestion of writing in teams – a good approach for those who don’t like to work in isolation and very constructive for effective communications between practice and academia. Dr. Novick volunteered to publish a write-up of this session in The Journal of Public Health Management and Practice.
Many participants from both of the sessions expressed interest in getting involved in the Council and its work. Members agreed that working with public health practice school coordinators and ASPH might be the best approach for informing interested public health practitioners and academics. Another possibility for facilitating links would be a world wide web page on the Internet. In continuing operation of the Council, a web site would be useful to make information available to public health professionals in the practice world (for example, PHP coordinators) and to be able to respond on-line
III. Council Funding
As reported during the last meeting, Mr. Ron Bialek and Council staff have been working with HRSA to secure continued funding for the Council. Carry-over funding from past years will be depleted by the end of September 1997.
Mr. Sampson acknowledged that there is much public health activity in HRSA that could involve the Council. HRSA is committed to continuing the Council, but needs to make sure that funds are directed via the correct mechanism. HRSA provided current funds to the Council through the Johns Hopkins University School of Hygiene and Public Health. Granting future monies through the Public Health Foundation will require accessing a different source of funds. At the current time, HRSA would like to support the Council through a 3-year or longer term for approximately $150,000 per year.
The acting administrator for HRSA, Dr. Claude Earl Fox, has expressed strong interest in pushing workforce analysis and possibly expanding the role of the Council. The Council could also provide a discussion forum and explore other issues in environmental health, essential public health services, public health workforces and look towards fulfilling tasks identified by the Joint Council and the Public Health Functions Workgroup.
IV. PHP Guidelines Update
As reviewed by the Council, exploration of public health practice guidelines has been one of the most successful efforts of the group. The Council work helped further define public health and has led to institutionalization of the initiative with formation of the CDC Community Preventive Services Task Force.
Over the last few months, CDC has been looking at ways to transition their task force into a new level of activity or perspective. At the present time, the Epidemiology Program Office is focusing on the scientific aspect while the Public Health Practice Program Office is involved in exploring field testing and focus groups. The task force hopes to produce three to five chapters, each showing sample formats for guidelines and actual guidelines. Mr. Deane Johnson expressed interest in the Council serving in an advisory role as well as continuing to assist in the implementation of task force plans.
As a consultant to the Public Health Practice Guidelines Project funded by the Kellogg Foundation, Dr. Novick reported that the project is making progress. Current activities include examining causal pathways and reviewing the literature on motor vehicular accidents, immunization, and cardiovascular disease. After the literature review is completed, the panel plans to evaluate the best options for further work and involvement of local health officers. Several individuals, including Caswell Evans with the CDC task force and Bobbie Berkowitz with the University of Washington, have expressed support and interest in pilot testing the guidelines. Thus, the next possible step would be developing guidelines for testing the practice guidelines.
The Kellogg Foundation has expressed interest in continued Council involvement – possibly a testing role with practitioners input. A suggested avenue for focus groups and testing could be Turning Point projects. The local and state health departments, who would form the audience for focus groups and testing, will not be identified until December 1997. Council involvement could begin in Spring 1998. In the mean time, it is vital to maintain the momentum and to incorporate guidelines into currently funded initiatives.
Mr. Johnson expressed that PHPPO sees a strong need for surveys, focus groups or some type of review of content — can content be supported? does it make sense? is it a logical model? functional, relevant, or useful? CDC would like reviews in enough settings to validate what has been drafted. Development of a methodology for effectively evaluating the content of every chapter remains on the agenda. Ideally, a "cookbook" approach should be avoided; after field testing guidelines, a useful format should be possible. Council involvement can be instrumental since its body represents a tremendous cross-section. The Council can also offer linkages to practitioners so guidelines can be substantively and technically evaluated so they can be useful in the field.
The Council reached a consensus to submit a proposal to PHPPO that focused on activities to complement the Kellogg-funded initiative. Coordinating and focusing resources in an efficient manner would provide appropriate follow through and bolster the research agenda in public health. The next window of opportunity to send something forward will be early 1998. Thus, the Council would need to submit a proposal, reflecting the meeting discussion and focus of the Council itself, before the middle of September.
As unanimously approved, Dr. Lipsman proposed that Council staff draft a proposal (2-3 pages letter of intent) before the middle of September. A committee of Council members — Dr. Mahan; Dr. Ron Brown, Dr. Wiese, and Ms. Diane Downing — will review the draft before full Council review. The first piece of the process will be to convene all interested parties — CDC, Caswell Evans, HRSA, Kellogg, Council, taskforce — to discuss key issues and coordinate resources. The second piece will be a proposal for funding, directed to CDC, for activities such as focus groups testing concepts and then pilot testing models.
At next meeting, the Council plans to revisit and discuss appropriate roles for the Council in these initiatives.
V. GPHE Funding
Dr. Tilson provided an update on ACPM and ATPM activities in pursuing redirection of Medicare-related GME funds to include non-hospital based residencies for primary care physicians-in-training.
As presented at the last Council meeting, ASPH has been pursuing general public health education funding. However, the deans of the schools and residency program directors realized that focusing on training preventive medicine physicians was the optimal means of moving forward. Of the 500 residents in 87 programs, only 100 are currently supported. ACPM has taken the lead in pursuing Medicare as a reasonable source of future funding to attempt to "de-institutionalize" Medicare. The organization has hired an outside consultant, Ellen Riker, to work with the ACPM Director of Public Affairs, Ms. Suzy Leous, to help inform major external contacts such as Congress and the Administration. ACPM has made considerable progress in increasing access, promoting the message, receiving favorable responses, and educating political leaders. The topic has been discussed in both the House and Senate. Through working with committees and Senator Mack’s staff , it is hoped that a bill will be introduced to specify preventive medicine funding.
The Council members agreed that the first logical expansion outside hospital-based medicine should be preventive medicine. As more skills and functions are addressed in managed care, more board-certified preventive medicine physicians will fulfill needs in the field. The Council will continue to support ACPM’s effort and maintain the topic as a standing item on the agenda.
VI. ASPH Survey of Tenure and Promotion
Ms. Alison Wojciak shared the preliminary results of the practice/tenure survey with Council members (Attachment A). The responses were not surprising and showed that the issue of promotion and tenure as it relates to public health practice is an important topic to pursue. During the last several meetings of the public health practice coordinators, participants have discussed the topic and shared criteria that seem to incorporate public health practice. Survey results have also been shared with ATPM. However, more work is needed to move beyond just sharing model criteria.
The next step will be to build a consensus definition of public health practice through valid examples and models of scholarship and rigor. An ASPH-sponsored subcommittee is in the process of drafting a position paper to further explore potential activities and ideas. The survey committee has discovered that the tenure/practice relationship is not just relevant to public health but also to higher education in general. Research is often valued more than practice and incentives are needed to encourage faculty to pursue other avenues besides traditional ones. ASPH would like to pursue a more in-depth analysis, particularly looking at schools with strength.
The Council discussed the issue of external validation and possible reference groups in academia. Accreditation issues were also examined, particularly in relation to the role of academic and market-driven forces. It also may be useful to consult with other organizations that have good track records in higher education, such as the Carnegie Institution, to collect a list of past activities and explore pursuing collaborative future initiatives with the Council. Council members agreed to share the draft position paper with their organizations.
Council staff will also contact other leads as possible funding sources for future activities related to this topic. During the next Council meeting, members suggested a presentation about CDC’s position on accreditation. ASPH will present the final survey results at the next meeting as well. These presentations will hopefully serve as a springboard for a longer discussion of the issues at hand and potential projects, partners, and approaches.
VII. Public Health Competencies
As discussed at the last Council meeting, the Public Health Functions Steering Committee has specifically cited the Council as body for pursuing competencies-related activities. Specifically, the group is looking for the Council to take on a leadership role. Council members agreed to revisit this topic as more information is available.
VIII. Membership Issues
During the past few months, the Council has received requests on behalf of environmental health and the Society of Public Health Educators (SOPHE) for future involvement or representation on the Council. Council discussion led to the conclusion that it may be worthwhile to bring in environmental health and health education workforce representatives — their connections in community health and other programs outside the traditional Council scope could be valuable connections. Representatives will be invited initially to attend Council meetings as observers in order to determine the focus and scope of participation.
IX. Administrative Issues
Organizational Updates: The Council approved the draft guidelines for organizational updates on linkages activities. The next update will be due in October.
Next Council meeting: October 27 in Alexandria, Virginia.
Future meetings: Given continued funding, the Council will set meeting dates for the coming year in October. The April meeting may be scheduled in conjunction with Prevention ’98 in San Francisco, California.
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