If we want more evidence-based practice, we need more practice-based evidence.*
Table of Contents
Community health agencies assume a significant responsibility for the provision of health services which benefit and protect the public. The material presented in this chapter is designed to increase awareness of the array of community health agencies and the diverse programs and services provided by these agencies.
After an initial review and discussion of community health agencies, the focus is broadened to include a survey of sources of public health law, examples of federal support for community health and an inventory of major voluntary health agencies.
Internet Is a Valued Source for Health Seekers. July 16, 2003
'Video Doctor,' Personalized Feedback Device, Is Always In. July 15, 2003
Mandate on Smallpox to Cut Local Health Services. (New York Times, January 5, 2003) - Many local health agencies across the country say they will have to cut a number of services including cancer, children's dental exams, and tuberculosis screening in order to meet the needs of President Bush's federal smallpox vaccination program.
Budget Fight Challenges Indian Health Services. (Nation's Health February 1996).IHS that serves 1.2 million American Indians and Alaska Natives relies on Federal money not only to provide direct health care, but to pay service contractors.
When Sweden Stopped Paying Workers for Their First Day of Illness, Absenteeism Dipped 25 per cent. (Globe and Mail 1996).
Getting Better Value for Our Health-Care Dollar. (Financial Post January 21, 1995).It is estimated that $7 billion a year could be saved in Canada without any deterioration in the quality of care.
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Diehr, P., Yanez, D., Ash, A., Hornbrook, M., & Lin, D.Y. (1999). Methods for Analyzing Health Care Utilization and Costs. ANNUAL REVIEW OF PUBLIC HEALTH 20: 125-158.
Fisher, L. D. (1999). Advances in Clinical Trails in the Twentieth Century. ANNUAL REVIEW OF PUBLIC HEALTH 20: 109-124.
Ginzberg, E. (1999). US Health Care: A Look Ahead to 2025. ANNUAL REVIEW OF PUBLIC HEALTH 20: 55-66.
Books and Reviews
Shah, C. P. (1998). Public Health and Preventive Medicine in Canada, 4th edition. Toronto: University of Toronto Press. ISBN 0-9694044-3-3.
McCraig, L. F. (1999). National Hospital Ambulatory Medical Care Survey: 1997 Outpatient Department Summary. Advance data from vital and health statistics; no. 307. Hyattsville, MD: National Center for Health Statistics.
Local Data for Local Decision Making -- Selected Counties, Connecticut, Massachusetts, and New York, 1997.Morbidity and Mortality Weekly Report 47 (38), October 1, 1998.
Although the delivery of clinical preventive services to adults, such as adult vaccinations and cancer and cardiovascular screening, reduces premature morbidity and mortality (1), such services are underused (1-3). Performance monitoring at the population level plays a critical role in supporting efforts to increase the use of clinical preventive services. However, many communities do not have the capacity to measure prevention activities. Without such information, efforts aimed at improving the county-wide or regional use of clinical preventive services must rely on state or national data. To examine the use of seven clinical preventive services among adults at the county level and to demonstrate how a population-based survey can be used to guide local prevention efforts, a community-based coalition (the Sickness Prevention Achieved through Regional Collaboration [SPARC]), in collaboration with state health departments, peer review organizations, and CDC, conducted a survey in the four-county SPARC region. This report summarizes the results of this analysis, which indicate that clinical preventive services in this region were underused despite high levels of access to medical care.
Editorial Note: The findings in this report indicate that despite high levels of health-care coverage and access to physicians, adult clinical preventive services in the region are not fully used. These findings are consistent with studies in other populations that indicate patients are often not aware of the need for these services and that clinicians frequently do not recommend preventive services to their patients (4-6). Performance monitoring is an important tool for establishing shared responsibility among community-level health-care providers (7). A major reason preventive services are not fully used in the United States may be that no defined public or private organization takes responsibility for assuring that all residents in a community are presented with an informed choice and reasonable access to these services. References
1. Public health nuisances. The important concept here is the use of regulation to maintain order. The regulation of nuisances, even those of minor health significance, enables corrective measures which have been legitimized by the community. Community health regulations work to protect the safety of the community and attempt to insure the compliance of individuals in violation of the law. Identify a private nuisance, a public nuisance and a mixed nuisance in the community. (Do not use those already defined in the text.) After identification, cite the regulation or statute which declares such a nuisance illegal. Is the regulation a local, state or federal code? Is it really designed to protect public health?
2. Community health services. Select a service division within a city or county health department. Visit the health department and list services provided by the division. How are the services delivered to the community (home care, clinics, media)? Who delivers these services (physicians, nurses, lay professionals)? Consider the impact on the community if one of the services within the division ceased to exist. How do these services compare with those identified in Figure 20-10?
3. Health education. Health education is a critical element of health promotion. Identify and discuss a health education program currently in progress within a specified health agency. The discussion should include the focus of the educational campaign, the intended audience and the method of delivery. A long-term project might involve an evaluation of the educational campaign.
4. Inter-agency cooperation. A number of the annotated readings illustrate the fact that community health agencies do not operate as isolated entities. Meet with a representative of the local health department. Identify other agencies with which the health department interacts. In what way is this interaction beneficial? What sources of conflict arise from this inter-agency contact?
5. Brochures. Select an issue that is of interest to a city or county health department. Prepare an educational brochure for individuals at risk. Identify the health concern, preventive measures or care referral sources.