Journal of Public Health Management and Practice最新文献

Background: Mental or emotional health (MEH) among public health employees is crucial for their well-being, organizational performance, workforce retention, and effective delivery of public health activities. This study examines the relationship between domains of workplace environment and self-rated MEH among governmental public health employees, drawing on data from the 2021 Public Health Workforce Interests and Needs Survey.

Methods: Perceptions of workplace environment domains were examined using exploratory factor analysis. The dependent variable, self-rated MEH, was assessed on a 5-point scale from poor to excellent. Logistic regression was used to examine the association of workplace environment domains-organizational support & satisfaction, supervisor relationships, and work values & commitment-on the likelihood of predicting fair or poor (suboptimal) MEH.

Results: More than 20% of public health employees rated their MEH as suboptimal. Employees who reported an intention to leave their positions in the next year were significantly more likely to report suboptimal MEH (OR: 2.17, P < .001). Individuals who were satisfied with organizational factors, such as training needs being met, and perceived impact through their work were significantly less likely to report suboptimal MEH. Employees in supervisory roles, especially managers (OR: 1.28) and executives (OR: 1.37), were significantly more likely to report suboptimal MEH.

Conclusion: Workplace dissatisfaction was significantly associated with suboptimal MEH and increased the probability of employees leaving public health roles. These findings underscore the need for strategies that strengthen organizational factors and workplace values, thereby promoting workforce stability within governmental public health agencies.

Context: Declarations of racism as a public health crisis and increased awareness of racial injustice in health disparities were prominent in 2020, and 72% of 2021 Public Health Workforce Interests and Needs Survey (PH WINS) respondents agreed that addressing racism should be part of their work.

Program: The Public Health Training Center Network and National Network of Public Health Institutes developed the Racial Justice Competency Model for Public Health Professionals (RJCM) and conducted a pilot test to assess its application at the organizational level across a range of public health settings.

Implementation: Sixteen public health organizations participated, with funding used to develop or update competency-based training, strategic plans, organizational policies, or for novel projects addressing racism.

Evaluation: Most pilot respondents (85%) reported increased confidence in applying racial justice principles, with the development of practical tools enhancing organizational capacity and partnerships. All pilot respondents affirmed changing practices to better promote racial justice as a result of implementing their funded projects.

Discussion: The RJCM has potential for continued use as a framework to continue advancing racial justice within public health organizations and to empower collective action in support of health equity.

Context: Precarious employment is a social determinant of health, impacting an increasing number of workers. Cross-sectoral, multilevel initiatives (eg organizational, community, and systems) that address upstream policy, systems, and environmental changes have demonstrated impact for improving worker health and wellness through addressing social determinants of health-like precarious employment. The Cook County Department of Public Health (CCDPH), such as other health departments, had not historically focused on prioritizing healthy work despite acknowledging it as an important social determinant of health.

Program: Through the Healthy Work Collaborative (HWC), a capacity building initiative launched by the University of Illinois Chicago (UIC) Center for Healthy Work in 2017, CCDPH partnered with Centro de Trabajadores Unidos (CTU) and Arise Chicago, and later with Chicago Workers Collaborative (CWC). These are worker centers who organize and advocate for policy changes to increase standards for all workers. The purpose of this evaluation is to describe the lessons learned about facilitating successful collaboration for policy, systems, and environmental change.

Implementation: These organizations worked together from the time of the HWC's first phase of in-person planning and training sessions through later phases of HWC funding and beyond.

Evaluation: Interview and focus group data were examined to identify lessons learned for the partnership, yielding the following: (1) Commitments to equity and justice provided the foundation for a common agenda and complementary roles; (2) Creativity and openness facilitated novel ways to engage and expand areas of work; (3) Strong relationships, supported by humility, provided a foundation for collaboration; (4) Having clearly defined goals, objectives, and a work plan facilitated focused progress and flexibility; and (5) Systems thinking and strategic planning supported implementation and sustainability.

Discussion: The CCDPH-CTU-Arise-CWC-UIC partnership can serve as a powerful illustration of how public health, together with partners, can position itself to address precarious employment through policy, systems, and environmental change.

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.