Journal of Public Health Management and Practice最新文献

Context: Rural populations face greater barriers to care and worse health outcomes than urban populations. Local health departments (LHDs) serving rural populations may play a key role in bridging the clinical care gap within their communities.

Objective: To assess and describe the differences in services provided by rural and urban LHDs, as well as the contextual factors contributing to those differences.

Methods: Data from the 2022 National Profile of Local Health Departments was used to estimate the provision of various clinical and population-based services and types of occupations employed, across urban and rural LHDs. Analyses were descriptive in nature but weighted by jurisdiction size to provide nationally representative estimates.

Results: Rural LHDs were more likely to provide many clinical services, offering care that is often more limited from other providers in the jurisdiction than urban LHDs. Conversely, fewer rural LHDs tend to provide population-based services or programs related to emergent public health issues, such as substance use. While 88% of rural LHDs reported that clinical substance use care was available through other community organizations, this is less than the proportion of urban LHDs (94%). Fewer rural LHDs also provide population-based primary prevention in this area than urban LHDs. Fewer rural LHDs employ occupations that support the provision of population-based services than urban LHDs.

Conclusions: Rural LHDs are a key clinical service provider in their communities. However, they may have challenges prioritizing population-based services and those addressing emergent public health issues. Implications include supporting rural LHDs through formula-based funding, workforce capacity, and partnerships to continue and bolster both clinical and population-based services available for their communities.

Context: Prevalence of insurance coverage in NYC varies by race and ethnicity: one-quarter (26%) of Latino New Yorkers lack health insurance, compared to 11% of Asian and Pacific Islanders, 11% of non-Latino Blacks, and 8% of non-Latino whites.

Program: The Office of Health Insurance Services at the NYC Health Department implemented a tailored racial equity engagement project to identify barriers and opportunities in accessing health care and health insurance among adult Latino and Chinese New Yorkers.

Implementation: We conducted 12 community stakeholder interviews and 9 consumer focus groups and used the results to develop a tailored, multilingual, data-driven media campaign in NYC neighborhoods with the highest proportions of uninsured Latino and Chinese New Yorkers. We conducted a social media post-survey to evaluate the campaign's effectiveness.

Evaluation: Stakeholder interviews indicated that cultural beliefs about medicine, insufficient access to services in appropriate languages, and limited awareness of enrollment opportunities impacted health insurance enrollment among Chinese and Latino New Yorkers. Consumer focus groups emphasized that health insurance enrollment media campaigns should focus on culturally salient themes and incorporate community input. Most post-campaign survey respondents (84%) agreed that they and their communities were represented by the implemented campaigns. Survey respondents reacted most positively to images of multigenerational families used in the campaigns.

Discussion: Community input is important for public health campaigns focused on specific racial or ethnic groups. Community engagement can help local health departments effectively reach priority populations, ensure that messaging is culturally and linguistically appropriate, and align public health messaging with health equity goals.

Objective: This systematized review aimed to identify the most common methods used to prioritize health needs among 501(c)(3) nonprofit hospital systems in the US since the implementation of the Affordable Care Act.

Introduction: Of the approximately 6000 hospitals in the US, 50% are 501(c)(3) nonprofits. These 501(c)(3)s are tax-exempt with surplus revenue serving their communities and must meet the community benefit standard provided by Internal Revenue Code (IRC) section 501(c)(3) and Revenue Ruling 69-545. Additionally, the Patient Protection and Affordable Care Act (ACA) (2010) requires all 501(c)(3) nonprofit hospitals to conduct a Community Health Needs Assessment (CHNA) every 3 taxable years. The Internal Revenue Service (IRS) provides broad guidelines for these needs assessments, but no guidance on prioritizing the needs identified.

Methods: A systematized review was utilized to review commonly used methods in CHNAs. The PubMed database was utilized to find recent, peer-reviewed articles. A librarian was consulted for the generation of Boolean search terms. Filters included articles in English, peer-reviewed, and time-bound from 2010 to 2025. Data extracted focused on the type of prioritization method used by CHNAs.

Results: Out of 1076 records initially identified, 37 peer-reviewed studies met the final inclusion criteria. Three broad categorical approaches of prioritizing needs were identified: community-driven approaches, structured prioritization frameworks, and a combination of approaches. Prioritization methods include the nominal grouping technique, multivoting technique, community-based participatory research, concept mapping, the Delphi technique, descriptive statistics & regressions, and the Hanlon method.

Discussion: There are many evidence-based methods for prioritizing health needs. Some are better suited to specific situations and communities than others. Aggregating the examples of prioritization methods in CHNAs will aid hospitals and communities in selecting the right method to best serve their community. Ultimately, this research provides guidance to communities creating a useful CHNA and a healthier equitable community. Future research should investigate the effect of these prioritization methods on health outcomes and quantifying subsequent community benefit.

Objectives: Given the historic cannabis-related injustices in the US, several states with legalized nonmedical cannabis have initiatives to promote industry participation among disproportionately impacted communities and areas (DICAs). This study assessed these initiatives and relevant outcomes across states.

Design: This was a mixed-methods study using publicly available data.

Setting: Evaluation was attempted among 17 states with non-medical cannabis retail (as of May 2025) and state-level social equity (SE) entrepreneurship initiatives.

Main outcome measures: Data were collected regarding: (1) characteristics of state SE entrepreneurship initiatives, including: (a) licenses available and/or reserved, (b) selection process, (c) eligibility criteria, and (d) training and financial support; and (2) relevant outcomes, including: (a) number of SE applications and SE licenses issued; and (b) percent of: SE applications licensed, total licenses issued to SE entrepreneurs, and total licenses held by each sex, race, and ethnicity.

Results: Eleven states reserved a number/percentage of licenses, and certain states reserved specific licenses (n = 2) or specified licenses available (n = 3) for SE entrepreneurs. Each state required majority ownership, and most considered DICA as possible (n = 12) or required criteria (n = 3), required state residency (n = 2) or included other criteria (eg, DICA, farming-related) integrating residency (n = 13), and considered cannabis-related convictions as possible (n = 12) or required criteria (n = 2). Most provided support (training n = 14, financial n = 12, reduced fees n = 10). Percentages ranged for SE applications licensed (Arizona: 2.0% to Massachusetts/Michigan: 100%), licenses issued to SE entrepreneurs (Washington: 2.4% to Maryland: 100%), female-held licenses (Illinois: 22.0% to New Jersey: 44.0%), and minority-held licenses (Vermont: 11.3% to New Jersey: 60.3%).

Conclusions: This multistate assessment marks a key step in evaluating SE entrepreneurship initiatives. However, outcomes (eg, licenses issued to SE entrepreneurs or DICA subgroups) were not clearly associated with characteristics of these initiatives, suggesting the need to consider different outcomes or allow greater time for SE initiatives to mature and have an impact.

Context: Epidemiologists in local health departments are central to ensuring healthy, thriving communities and responding to public health threats, particularly in big cities where diseases often emerge and spread quickly due to their landscape.

Program: In Spring 2024, the Council of State and Territorial Epidemiologists and the Big Cities Health Coalition (BCHC) collaborated to field the third Epidemiology Capacity Assessment in 35 large, urban health departments, who were BCHC members at the time. The assessment aimed to track workforce capacity by understanding the number of epidemiologists currently in departments, the number of epidemiologists needed, current funding status and other key metrics of capacity.

Implementation: The 30-question assessment was distributed electronically to the 35 BCHC member jurisdictions, and data collection took place from March to June 2024.

Evaluation: Quantitative results were analyzed in R Studio software and Excel 2008 through a combination of descriptive statistics, cross-tabulations, and tests of significance. Qualitative results were coded and grouped thematically.

Discussion: There is a need for additional epidemiologists at the local level, even in the nation's largest cities, to effectively deliver the Essential Public Health Services, and many existing staff will be lost with the end of pandemic funding. Flexible, sustained funding would allow epidemiologists to prioritize the unique needs of their communities, retain current staff and institutional knowledge, and proactively build a workforce prepared to respond to future public health emergencies.

Objective: To assess cross-sector preparedness and response capacity for a hypothetical Highly Pathogenic Avian Influenza (HPAI) H5N1 outbreak in Alabama using a statewide tabletop exercise (TTX) and to identify strengths, gaps, and corrective actions to inform future planning.

Design: Basic qualitative design using inductive data analysis of multi-source qualitative data, including participant discussion notes, hotwash debrief, feedback forms, and an After-Action Report/Improvement Plan (AAR/IP).

Setting: A 6-hour, in-person statewide TTX held in August 2025, facilitated by the Alabama Department of Public Health (ADPH), Alabama Department of Agriculture and Industries (ADAI), and the University of Alabama at Birmingham (UAB).

Participants: Eighty-three representatives from federal, state, and local agencies; and professional associations.

Intervention: A multi-phase TTX simulating escalating zoonotic threats, from avian cases to human infections and sector-wide disruptions. Scenarios incorporated stakeholder-recorded audio vignettes to enhance realism and foster cross-sector discussion grounded in One Health principles.

Main outcome measures: Identification of key strengths, areas for improvement, and corrective actions mapped to 6 exercise objectives focused on roles and responsibilities, priority-setting, procedural gaps, communication, resource needs, and interagency coordination.

Results: Participants demonstrated strong interagency relationships, robust surveillance systems, and shared understanding of zoonotic response roles. Key gaps included inconsistent communication and data-sharing protocols, insufficient engagement of local partners, procedural ambiguities (eg, specimen transport), and concerns regarding availability of critical resources, including Strategic National Stockpile assets. Workforce turnover and limited institutional knowledge were recurring barriers. The AAR/IP outlined 6 priority corrective actions, including development of a Multi-Agency Coordination Zoonotic Disease Workgroup.

Conclusions: The Alabama HPAI H5N1 TTX revealed strong existing partnerships and surveillance capacity but highlighted vulnerabilities in communication, coordination, and resource readiness. Implementing corrective actions, strengthening workforce capacity, and expanding stakeholder engagement will enhance statewide preparedness for H5N1 and future zoonotic threats. The exercise materials and findings offer a model for other jurisdictions seeking to refine preparedness plans.

This study examined the relationship between the comprehensiveness of nonprofit hospitals' health equity strategies and their community benefit spending. Health equity strategies were measured using data from the American Hospital Association's Annual Survey and included indicators of equitable and inclusive organizational policies; systematic and shared accountability for health equity; diverse representation in hospital leadership and governance; community engagement; collection and use of segmented data to drive action; and culturally appropriate patient care. Community benefit spending was measured using data from Internal Revenue Service (IRS) Form 990 Schedule H. Among 984 hospitals with complete data for the year 2022, those with the most comprehensive health equity strategies dedicated more resources to traditional clinical community benefits-including charity care and Medicaid payment shortfalls-while spending less on subsidized health services. These hospitals also consistently invested more in population health-related community benefits, such as community health improvement programs, community building activities, and cash or in-kind contributions. These findings suggest that robust health equity strategies are linked to greater investment in both clinical needs and broader determinants of community health.

From 2005 to 2024, the Centers for Disease Control and Prevention's port health stations (PHSs) received 37 reports of travelers with suspected or confirmed cholera. Most reports (29/37, 78%) occurred before 2012, with the majority linked to the 2010 Haiti outbreak. The median age of travelers was 34 years (interquartile range: 21-59 years), and nearly all (35/37, 95%) arrived by air. Seventeen (46%) cases were laboratory-confirmed as toxigenic Vibrio cholerae O1, serotype Ogawa; 16 (94%) patients with confirmed cholera were hospitalized. No deaths were reported. Following the publication in 2011 of notification criteria for communicable diseases in travelers, health department notifications to PHSs of cholera cases declined. Continued coordination with public health partners is important to ensure timely evaluation and follow-up of travelers with suspected cholera. Clinicians should obtain travel histories and consider cholera in recent travelers with severe watery diarrhea who have been in outbreak or endemic areas.

Context: The public health (PH) workforce shortage poses a significant threat to the US population. Despite an increase in PH programs attracting students, there is a need to enhance diversity within local and state PH departments. While internships are recognized as valuable entry points into the PH field, research on the effectiveness of such pathway programs for recruiting diverse candidates is limited.

Program: Sponsored by the Connecticut (CT) Department of Public Health and supported by the CDC Crisis Response Cooperative Agreement: COVID-19 Public Health Workforce Supplemental Funding, the CT Public Health Fellowship Program (PHFP) aims to generate interest in PH careers by placing students in high-quality fellowship positions in CT. Third- or fourth-year undergraduates and graduate students enrolled in PH programs receive administrative support, one-on-one coaching, orientation, and a $3500 stipend to facilitate their internships.

Implementation: From January 2023 to May 2024, 97 out of 205 applicants were admitted to the PHFP. Acceptance was on a rolling basis, accommodating academic schedules, personal limitations such as work/family obligation or transportation access, and host agency capacities.

Evaluation: We analyzed program data from PHFP applications. Chi-square tests and t-tests were conducted to assess differences between PHFP fellows and non-fellows. The results were not statistically significant. Additionally, fellows were compared to a representative sample of PH students from the US, New England, and CT.

Discussion: The PHFP has a strong potential to help replenish and diversify the PH workforce and enhance health equity. Future research should examine the long-term impacts of such PH experiential learning initiatives on a large scale.

Context: The 2024 Public Health Workforce Interests and Needs Survey (PH WINS) offers important data on the composition, well-being, and training needs of the public health workforce in the post-COVID-19 era.

Objective: To characterize the state governmental public health workforce in 2024 and provide a comparison to the 2021 survey.

Design: State health agency leaders were invited to have their workforce participate in PH WINS 2024. Participating agencies provided staff lists used to send e-mail invitations to employees to participate in this electronic survey.

Setting: State health agencies.

Participants: State health agency central office staff.

Main outcome measure: PH WINS 2024 maintains the domains from previous fieldings (ie, workplace engagement, training needs assessment, emerging public health concepts, well-being, and demographics).

Results: The proportion of staff aged 35 and under increased approximately 4% from 20% in 2021 (95% CI: 20%-21%) to 24% in 2024 (95% CI: 23%-24%). State health agency central office staff with 5 or fewer years in their current agency increased from 49% (95% CI: 48%-50%) in 2021 to 55% (95% CI:54%-56%) in 2024. Self-reported mental health improved with the proportion of those rating their mental and emotional health as poor or fair in 2021, 5% (95% CI:4%-5%) and 18% (95% CI: 17%-19%), respectively, decreasing to 3% (95% CI: 3%-3%) and 15% (95% CI: 14%-15%), respectively, in 2024. The top 3 strategic skill training needs in 2024 were budget and financial management (48%; 95% CI: 47%-49%), policy engagement (38%; 95% CI: 37%-39%), and systems and strategic thinking (34%; 95% CI: 33%-34%).

Conclusion: The 2024 PH WINS results indicate demographic shifts toward a state health agency central office workforce that is younger in age and tenure and positive improvements in key workforce well-being indicators that can inform future public health infrastructure investments and field practices to ensure a robust public health system.