I. Opening Business

Dr. Joshua Lipsman, chair, opened the meeting and welcomed all participants.   The minutes from the last Council meeting on September 25, 1998 were unanimously approved without comment.

 

II. APHA Meeting

The opening discussion reviewed the meetings and sessions attended by Council members and staff during the APHA annual meeting.  In particular, discussion focused on the special session, led by Dr. C. William Keck, on academic public health agencies.

A. Discussion of Academic Public Health Agencies Meeting
Dr. Keck summarized the special session, which is included as Attachment A of these minutes.  The most pressing needs for moving forward the concept of academic public health agencies is to define the need, define the concept, build an inventory of existing sites, and develop a "how-to" compendium.

The discussion that followed the summary focused on ways in which to act on these needs.  Several steps were suggested for the Council to help create a supportive environment:

• Develop description of special session to advocate benefits.
• Develop articles for The Link and other relevant newsletters.
• Initiate discussions with NIH, CDC, and HRSA.
• Advocate for graduate medical education resources (ATPM has already done work in this area).
• Present information at national meetings. Prevention 2000 in Atlanta was suggested as a specific venue.
• Develop an informal survey to build the inventory and collect information for "how-to" compendium.

It was agreed by participants that this topic is worthwhile for the Council to pursue.  Council members discussed ways in which to implement the survey to discover and catalog those community health agencies that consider themselves to be academically oriented.  The survey would create an understanding of what is currently happening and to discover existing models that work and the corollary lessons learned.  Particular examples noted were the Tulane and Pittsburgh Universities projects linking state and local health departments with academe.  It was agreed that the survey should target national professional association newsletters (NACCHO, NALBOH, SOPHE, NACHC, AHEC, etc.).  In addition, a similar survey for state public health agencies could be distributed through ASTHO.  The idea to include appropriate questions in the NACCHO local health department profile survey was also discussed.   Mr. Tom Milne agreed to work with Dr. Keck on developing some possible questions to include.

Ensuing discussion brought forth the need to clearly delineate and recognize the benefits to the university, department, and community.   Another way to promote development of academic public health agencies would be to establish awards for excellence in public health.  It was also mentioned that beginning in 1999, GME funding will be available for non-hospital sites such as Federally Qualified Health Centers and other public health centers.  This highlighted the need to look beyond public health departments and to look at public health agencies broadly.

A motion was made to support the efforts to promote and develop academic public health agencies through collecting information and developing a position paper.  The motion was unanimously approved.

B. Discussion of Other APHA Sessions and Meetings Attended
The Council also discussed other issues raised at APHA sessions attended such as the need to promote behavioral health skills in the public health workforce and questions about current and future trends in training requirements.  Other sessions highlighted the need for work toward development of community and population-based interventions.
Other activities brought forward included the Public Health Leadership Society’s renewed attention to training and learning.  SOPHE has started a new practice journal to provide another opportunity to publish about practice. HRSA has established the Northeast Center to examine capacity, need, and inventory of learning.  ASPH continues to maintain its Public Health Practice Council Excellence in Public Health program.  It was also mentioned that the Academic Public Health Caucus (sponsored by ASPH) is planning 12 sessions focusing on distance learning, accreditation, and managed care.  A call for abstracts will be circulated shortly.

 

III. Initiatives in Public Health

A. Accreditation of Graduate Programs
Dr. Keck reported that over the past 10 years, the work of the Council on Education for Public Health (CEPH) has nearly doubled.  Within the next 10 years or sooner, the number of schools and programs is expected to double again.  Ten programs are currently involved in the accreditation process and 45 others are interested in beginning the process.  Many of these are new MPH programs and CEPH is looking to increase its staff to meet this need.  At next year’s APHA annual meeting, CEPH will celebrate its 25th anniversary.  The focus of the celebration will be to highlight the increasing value of MPH degrees.  There are also between 200 and 300 other institutions and/or programs that are not accredited through CEPH.  Unfortunately, few employers ask if degrees are from accredited institutions.  Dr. Keck noted that CEPH is interested in continuing to bring these issues to the Council for discussion and to raise awareness of available information.  Council staff will follow up by obtaining the current list of programs and forwarding to the Council members.  The staff will also circulate copies of the current accreditation criteria.

The discussion focused on the value of accreditation and what information is currently available about graduates of accredited graduate programs in public health.  The McGee Study (1986) is the most recent known study that examined where graduates are employed.  It was agreed that there is a need for newer data.  One participant raised the idea that it is dangerous to assume that accreditation means a program is better than one not accredited.  Although there was no agreement on this point, it was noted that non-accreditation usually means that there is not enough information known about the program or school.

B. Public Health Competencies
This discussion lead directly to discussion of public health competencies.  The common threads between accreditation and competencies are quality and quality assurance.  The main question is how to enhance the quality of workers and agencies to better serve the public.

The issues of credentialing public health professionals and accrediting public health agencies were also discussed.  An accurate picture of the demand for masters-trained public health professionals needs to be created.  This will help better understand whether or not credentialing makes a difference.  Approximately 10 years ago, APHA attempted to study this, but the profession was split and the issue was not carried forward. ASTHO, NACCHO, and NALBOH are currently developing performance standards aligned with the essential public health services as part of CDC’s National Public Health Performance Standards Program cooperative agreement.

Some of this work is relevant to competencies for public health professionals and can be helpful in evaluating the current lists of competencies.  One can begin by looking at what is common and what is specialized and if there is a way to shift what is examined.  A process of evaluation can be created, but there are lots of potential issues.  One such issue is that there is not agreement about the vision of public health.  How do you measure performance without a common vision?   There also is the problem of categorical funding, which works for funding, but not for implementing overall goals or competencies.  It is also important to look at credentialing bodies that already exist to examine how certification has worked and what has been the outcome for assuring quality professionals.  Mr. Ron Merrill mentioned that $50-75,000 has been appropriated in HRSA's Year 2000 budget for beginning the process of evaluating public health competencies. HRSA would also like to see CDC contribute some dollars to this project.  It is likely that the Council will receive this project money as part of a general cooperative agreement with HRSA to fund the Council.

C. Public Health Professionals Report
Related to the discussion of competencies was follow-up to the presentation made by Dr. Kristine Gebbie on "Preparing Currently Employed Public Health Professionals for Changes in the Health System" at the previous meeting.

In review, Dr. Gebbie suggested several action steps for the Council to take in follow-up to the report:

• Remain attentive to education programs for new and returning public health professionals.
• Validate the current list of public health competencies so they can be more useful for job descriptions and curriculum development.
• Identify ways of developing more effective educational teaching models in public health.
• Actively develop strategies to meet needs identified in the report.

Dr. Ron Brown advocated linking specialty and primary care physicians to promote population-based health care.  This idea is supported by AAHP.   Dr. Brown suggested the possible approach of managed care and public health jointly advocating for interdisciplinary education of physicians.  Although identified as a roadblock in the report, this issue presents an opportunity and challenge to get involved.

At this time, there were no specific actions proposed for the Council. However, Council members agreed that it is important to keep up-to-date about activities spurred by this report and to keep Dr. Gebbie's recommendations in the forefront of discussions.

 

IV. Council Objectives and Strategies

The following change was requested for the Council Objectives and Strategies:

• Objective 5, include all member organizations (not just ASTHO and NACCHO) as possible sources of information for articles in The Link.

This was an acceptable to change to all present. Updated copies of the Council Objectives and Strategies will continue to be distributed with each set of meeting materials.

 

V. National Public Health Research and Applications Agenda

Mr. Bialek presented the Council with the most recent concept paper on developing a national public health research and applications agenda.  This iteration resulted from the recent meeting of the research agenda subcommittee.  As a reminder, the subcommittee is composed of Mr. Bialek, Dr. Lipsman, Dr. Hugh Tilson, Ms. Michon Béchamps, Ms. Ione Austen from the National Library of Medicine, and Ms. Kathleen Stratton from the Institute of Medicine.

Crossing the Healthy People focus areas with the essential public health services shapes the potential framework (see Attachment B).  The matrix formed by these two axes would create areas in which to categorize existing public health research and applications and to identify where research is lacking and/or needed.   What is being proposed would involve conducting a pilot to test the framework/approach and to determine its utility and feasibility for use on a larger, national scale.  The Council needs to continue to assess the level of support for moving this effort forward.

Council discussion brought forth several issues to address before moving forward with implementation of the proposed pilot.  Although there was general support for refining the focus, there was concern about too much reduction in scope of the project.  There was also concern that this project might duplicate the efforts already in process.  However, further discussion brought agreement that this approach is unique because it crosscuts and provides an umbrella for many separate initiatives, such as CDC developing its own detailed research agenda.  The broad approach proposed would provide a framework for identifying areas across the field that need attention.

Another concern raised was that the list of research questions might limit creativity and potential scope of activities in the field.   Members of the research agenda subcommittee emphasized that the agenda would be a guiding document to serve as a catalyst for new research, not a rigid constraint.  The issue of how to prioritize research needs was discussed extensively but not resolved.  Two mechanisms suggested were the nominal group process (used by NIH) and the consensus development process.  Ways to test prioritization methods and criteria may be incorporated into the pilot project.  More investigation into existing models of prioritization techniques is needed.

Overall, there was strong support for the Council taking the lead in piloting the proposed approach.  If the Council stays involved, it will be important to integrate this effort with other activities such as the analysis of public health competencies and workforce issues.  The next important step will be to secure the necessary resources to implement the pilot.

A motion was made to Apresent the modified concept paper to the Public Health Functions Working Group and Steering Committee."  The motion was unanimously approved.

A second motion was made to incorporate this activity as a strategy for achieving Council Objective 1. The motion was unanimously approved.

 

VI. Update on Other Council Activities

A. 1998 Report Card
Ms. Béchamps reported that some work on the 1998 Report Card has been completed thus far.  The working outline of the report includes: 1) what the Council has accomplished; 2) case studies on three Council projects; and 3) case studies of successful linkages activities.  The project is scheduled for completion by Spring 1999.

B. Council Membership and Participation Agreement
As the conclusion of the probationary year, Dr. Lipsman recommended the Society for Public Health Education (SOPHE) for full membership.  A motion to accept SOPHE as a Council member was made and unanimously approved, with one abstention.  Prior to the next meeting, SOPHE will appoint a representative to serve on the Council. 

Dr. Lipsman also advocated moving forward with bringing an environmental health organization to the Council. Since formation of the Council, environmental health has always been an identified area that should be represented.  However, until recently, there has not been enough interest to pursue this.  The National Environmental Health Association (NEHA) has recently come forward and expressed interest in probationary membership. Council members agreed that Council staff should continue efforts to add an environmental health group as a member and identify an appropriate representative from NEHA to attend Council meetings for the probationary year.  Full membership will be addressed at the last 1999 meeting of the Council.

At the conclusion of the discussion, Dr. Lipsman requested that members keep Council staff apprised of changes in leadership and/or Council representatives to keep the Participation Agreements up-to-date.

C. Council Brochure
The Council unanimously approved the revised design of the Council brochure.  This brochure will be displayed at appropriate public health meetings as well as be available for members to distribute to interested individuals.

D. The Link
The Link issue under development is focused on developing a public health research and applications agenda.  This issue will be published in early 1999.  The completed report card will form the content of the following issue. Ms. Bechamps encouraged Council members to continue submitting names to be added to the mailing list.

E. Council Web Site
The address of the Council web site continues to be: www.phf.org/Link.htm.  Expected updates have been delayed, but the site should be current by the next Council meeting.

 

VII. Update on Healthy People 2010

Ms. Debbie Maiese, of the DHHS Office of Disease Prevention and Health Promotion (ODPHP), provided the Council a summary of progress made toward development of the Healthy People 2010 document.  The development process has been very comprehensive and inclusive. Most recently, regional meetings have allowed public health professionals from the field to come together to talk about the national document as well as address ways to develop state health objectives plans.  After more than a year of public comment and revisions, the draft document will be closed for internal revisions on December 15.  The final objectives plan is scheduled to be released January 26, 2000.

The comments received will hopefully provide feedback about whether the document works, including such aspects as the schemata, format, and general information provided.  The final document, as currently planned, will be divided into three volumes.  The first volume will be a slim document that describes the history, purpose and intended uses of Healthy People 2010.  The actual objectives and sources will comprise the second volume.  The third volume will be a compendium of data.

Although time limited the discussion, there was general interest in developing strategies for measuring developmental objectives (objectives with no data source) at a future meeting.  In light of the previous discussion, more discussion is needed about the link between Healthy People and developing the public health research and applications agenda.  In the meanwhile, the Council agreed to examine the draft document and to submit official comments on the infrastructure chapter.  Council staff will collect the comments from individual members for submission to ODPHP via its Healthy People web site.

 

VIII. Administrative Business

A. Council Logo
The four different standards of the Council logo were unanimously adopted.  Council staff will move forward with the process of obtaining an official copyright.

B. Future Meetings
Council members agreed that at least one of the 1999 meetings should be held in conjunction with a national public health meeting.  Prevention '99 and the NACCHO annual meeting were suggested as two possibilities.  The former would target academicians and the latter, practitioners.  Council staff will circulate calendars to finalize the dates.

C. Selection of New Chair
Dr. Lipsman announced that he was resigning as Director of the Alexandria Health Department.  Thus, he was also resigning as chair of the Council and NACCHO's representative to the Council.  Mr. Bialek expressed appreciation on behalf of the Council staff and members for exemplary leadership, vision, and distinctive service."

Dr. Hugh Tilson nominated Dr. Keck as the new chair.  The members present unanimously approved Dr. Keck as the new Council chair.

D. Staffing
With the departure of Marie Flake from Johns Hopkins University, all staffing of the Council will now come from the Public Health Foundation.  Linda Wilburn from the Public Health Foundation will now provide the administrative support for Council meetings and logistical arrangements.  She can be reached at (202) 898-5600, x3033 or by e-mail: lwilburn@phf.org.

The meeting was adjourned at noon.