Using Public Health Legal Counsel Effectively: Beliefs, Barriers and Opportunities for Training

2013 ◽  
Vol 41 (S1) ◽  
pp. 61-64 ◽  
Author(s):  
Nancy Kaufman ◽  
Susan Allan ◽  
Jennifer Ibrahim

Laws, ordinances, regulations, and executive orders create the powers and duties of public health agencies and modify the complex community conditions that affect health. Appropriately trained legal counsel serving as legal advisors on the health officer's team facilitate clear understanding of the legal basis for public health interventions and access to legal tools for carrying them out.Legal counsel serve public health agencies via different organizational arrangements — e.g., internal staff counsel, external counsel from the state attorney general's (AG) office, state health department, county or city, or private counsel under contract, or in combination. As of 2011, most state health departments (63%) employ their own counsel, and 56% use AG counsel, while 17% contract with independent attorneys; most local health departments (66%) work with attorneys and legal staff assigned by local government, by the state health agency (23%), or contract with outside attorneys and legal staff (15%).

2009 ◽  
Vol 124 (6) ◽  
pp. 875-882 ◽  
Author(s):  
Carlyn Orians ◽  
Shyanika Rose ◽  
Brian Hubbard ◽  
John Sarisky ◽  
Letitia Reason ◽  
...  

Objectives. We evaluated the effectiveness of the Protocol for Assessing Community Excellence in Environmental Health (PACE EH) in building competency in essential environmental health services and renewing efforts to engage the community in problem solving. Competency and community engagement have been identified by environmental health practitioners as important to meet new threats to public health. Methods. We conducted a national survey and 24 case studies of public health agencies. We invited 917 organizations to participate in the national survey because they had requested a copy of the protocol. Results. We received 656 total responses: 354 had not considered implementation, 302 had considered implementation, and 66 had implemented PACE EH. For the 24 case studies, we interviewed 206 individuals in communities implementing PACE EH. We found that PACE EH has had a positive effect on building community and professional networks, enhancing leadership, developing workforce competence, and expanding definitions of environmental health practice. Conclusions. With appropriate investments, PACE EH can be an effective tool to meet the environmental health challenges identified by local environmental health practitioners and state, tribal, and federal agencies.


2020 ◽  
Vol 110 (3) ◽  
pp. 288-294 ◽  
Author(s):  
Justin A. Gerding ◽  
Bryan W. Brooks ◽  
Elizabeth Landeen ◽  
Sandra Whitehead ◽  
Kaitlyn R. Kelly ◽  
...  

An ever-changing landscape for environmental health (EH) requires in-depth assessment and analysis of the current challenges and emerging issues faced by EH professionals. The Understanding the Needs, Challenges, Opportunities, Vision, and Emerging Roles in Environmental Health initiative addressed this need. After receiving responses from more than 1700 practitioners, during an in-person workshop, focus groups identified and described priority problems and supplied context on addressing the significant challenges facing EH professionals with state health agencies and local health departments. The focus groups developed specific problem statements detailing the EH profession and workforce’s prevailing challenges and needs according to 6 themes, including effective leadership, workforce development, equipment and technology, information systems and data, garnering support, and partnerships and collaboration. We describe the identified priority problems and needs and provide recommendations for ensuring a strong and robust EH profession and workforce ready to address tomorrow’s challenges.


2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S28-S28
Author(s):  
Janice Kim ◽  
Kyle Rizzo ◽  
Sean O’Malley ◽  
Monise Magro ◽  
Jon Rosenberg

Abstract Background Legionnaires’ disease (LD) causes significant morbidity and mortality to hospital patients and residents of skilled nursing facilities (SNF). In California, LD is reportable to local health departments via the California Reportable Disease Information Exchange (CalREDIE) surveillance system. Cases are classified as suspected or confirmed using Centers for Disease Control and Prevention (CDC) definitions. The California Department of Public Health (CDPH) Healthcare-Associated Infections (HAI) Program maintains a database of healthcare-associated LD (HA-LD) and consults with local public health departments for single cases and outbreaks. Methods We described characteristics of confirmed HA-LD cases in 2015–2017. We classified HA-LD as definite if patient had continuous exposure in a facility for 2–10 days prior to symptom onset and possible if patient had overnight exposure in a facility for a portion of 2–10 days prior to symptom onset. Results From 2015 to 2017, 125 (8%) of 1,554 confirmed LD cases were HA-LD. Of these, 73 (58%) were definite HA-LD and 52 (42%) were possible HA-LD. The majority of HA-LD cases (N = 99, 79%) occurred in southern California. SNF were associated with 57 cases (46%) and hospitals with 44 cases (35%); 23 cases (18%) had exposures in both SNF and hospitals during the incubation period. Among the definite HA-LD cases, 50 cases (68%) had exposures in a single SNF. The median age of patients with HA-LD was 77 years. The HAI Program consulted with 15 local public health agencies on 33 HA-LD investigations, including 7 outbreaks and 26 single-case investigations. Conclusion HA-LD represented a small but important percentage of LD in California; the majority occurred in SNF. To prevent HA-LD, California hospitals and skilled nursing facilities should implement water management programs, as recommended by CDC and required by the Centers for Medicare and Medicaid Services (CMS) since June 2017. Public health agencies should respond rapidly to investigate HA-LD cases and control outbreaks. Disclosures All authors: No reported disclosures.


2019 ◽  
Vol 83 (4) ◽  
pp. 715-721
Author(s):  
MELANIE J. FIRESTONE ◽  
CRAIG W. HEDBERG

ABSTRACT In recent years, numerous state and local health departments have developed systems to disclose restaurant inspection results to consumers. Public disclosure of restaurant inspection results can reduce transmission of foodborne illness by driving improvements in sanitary conditions. In Minnesota, restaurant inspection results are not readily accessible for consumers to use to make decisions about where to eat. The objective of this study was to assess the consumer interest among Minnesota adults in having better access to restaurant inspection results and to identify preferred formats for disseminating this information. We conducted a survey among 1,188 Minnesota residents aged 18 years or older at the 2019 Minnesota State Fair. Overall, 94.4% of respondents wanted better access to restaurants' inspection information. More than three-quarters (77.1%) of respondents stated that they would use this information to decide where to eat. Respondents wanted to see inspection results online (71.6%) and at restaurants (62.1%). Increasing public access to inspection results could reinforce efforts by public health agencies and food service operators to improve the safety of foods prepared away from home. HIGHLIGHTS


1952 ◽  
Vol 15 (5) ◽  
pp. 233-237
Author(s):  
Ralph L. Tarbett

The California Conference of Local Health Officers of a 1950 meeting requested the State Health Department to make a study of the effect of food handler training in a restaurant sanitation program. The Conference had previously gone on record as favoring education and inspection as desirable parts of a food sanitation program. This request, coupled with the questions passed by several sanitation directors of local health departments, “Will food handler training schools substantially improve sanitation in our restaurants?” caused the State Department of Public Health to enter upon these studies. Previous to the start of these studies, institutes on promoting and conducting food handler training programs had been held throughout the State. Guides which outlined the food handler courses had been distributed and widely accepted by local departments interested in food handler training. Consultants from the A.P.H.A., U.S.P.H.S., University of California School of Public Health, and Department of Public Health planned the methods, forms, and technique to be used in making this study. Field surveys of restaurants would be used as a base for measurements, State restaurant inspection personnel were used on the survey team. Each restaurant is given a numerical grade based on 100: 37 points for physical plant and 63 points for operational items. A rating is given the community using the U.S.P.H.S. method of scoring. Several types of communities were surveyed: (1) Those not having and not anticipating a food handler training program, (2) those not having, but developing a food handler training program, and (3) those having had a stable program for several years. This is developing a picture of the various types of communities. It is impossible to draw positive conclusions as to the value of food handler training on the basis of our studies up to the present time. However, it does appear, from the information thus far accumulated in a number of communities in the State of California, that food handler training does pay substantial dividends. These dividends appear to be in improved restaurant sanitation, better working relations between the restaurant industry and the local health department, and an increased public interest in and support for the program. Much of the criticism thrown at Health Departments regarding Food Sanitation is the lack of uniformity in recommended practices and legal interpretations of laws. These studies, we believe, in addition to measuring the value of food handler training courses, are also tending to standardize practices and legal interpretations and develop closer relationships between the State and local health departments.


2022 ◽  
Vol 3 (1) ◽  
Author(s):  
Stephanie Mazzucca ◽  
Louise Farah Saliba ◽  
Romario Smith ◽  
Emily Rodriguez Weno ◽  
Peg Allen ◽  
...  

Abstract Background Mis-implementation, the inappropriate continuation of programs or policies that are not evidence-based or the inappropriate termination of evidence-based programs and policies, can lead to the inefficient use of scarce resources in public health agencies and decrease the ability of these agencies to deliver effective programs and improve population health. Little is known about why mis-implementation occurs, which is needed to understand how to address it. This study sought to understand the state health department practitioners’ perspectives about what makes programs ineffective and the reasons why ineffective programs continue. Methods Eight state health departments (SHDs) were selected to participate in telephone-administered qualitative interviews about decision-making around ending or continuing programs. States were selected based on geographic representation and on their level of mis-implementation (low and high) categorized from our previous national survey. Forty-four SHD chronic disease staff participated in interviews, which were audio-recorded and transcribed verbatim. Transcripts were consensus coded, and themes were identified and summarized. This paper presents two sets of themes, related to (1) what makes a program ineffective and (2) why ineffective programs continue to be implemented according to SHD staff. Results Participants considered programs ineffective if they were not evidence-based or if they did not fit well within the population; could not be implemented well due to program restraints or a lack of staff time and resources; did not reach those who could most benefit from the program; or did not show the expected program outcomes through evaluation. Practitioners described several reasons why ineffective programs continued to be implemented, including concerns about damaging the relationships with partner organizations, the presence of program champions, agency capacity, and funding restrictions. Conclusions The continued implementation of ineffective programs occurs due to a number of interrelated organizational, relational, human resources, and economic factors. Efforts should focus on preventing mis-implementation since it limits public health agencies’ ability to conduct evidence-based public health, implement evidence-based programs effectively, and reduce the high burden of chronic diseases. The use of evidence-based decision-making in public health agencies and supporting adaptation of programs to improve their fit may prevent mis-implementation. Future work should identify effective strategies to reduce mis-implementation, which can optimize public health practice and improve population health.


2020 ◽  
Vol 41 (S1) ◽  
pp. s233-s233
Author(s):  
Muzna Mirza ◽  
Lauren Wattenmaker ◽  
Odion Clunis ◽  
Wendy Vance ◽  
Shunte Moon ◽  
...  

Background: The CDC National Healthcare Safety Network (NHSN) is the nation’s most widely used healthcare-associated infection (HAI) and antibiotic use and resistance (AUR) surveillance system. More than 22,000 healthcare facilities report data to the NHSN. The NHSN data are used by facilities, the CDC, health departments, the CMS, among other organizations and agencies. In 2017, the CDC updated the NHSN Agreement to Participate and Consent (Agreement), completed by facilities, broadening health department access to NHSN data and extending eligibility for data use agreements (DUAs) to local and territorial health departments. DUAs enable access to NHSN data reported by facilities in the health department’s jurisdiction and have been available to state health departments since 2011. The updated agreement also enables the CDC to provide NHSN data to health departments for targeted prevention projects outbreak investigations and responses. Methods: We reviewed the current NHSN DUA inventory to assess the extent to which health departments use the NHSN’s new data access provisions and used semistructured interviews with health department staff, conducted via emails, phone, and in person conversations, to identify and describe their NHSN data uses. Results: As of late 2019, the NHSN has DUAs with health departments in 17 states, 7 local health departments (including municipalities and counties), and 1 US territory. The NHSN also has received requests from 2 state health departments for data supporting HAI prevention projects. Health departments with DUAs described improved relationships with facilities in their jurisdictions because of new opportunities to offer NHSN data analysis assistance to facilities. One local health department analyzed their NHSN carbapenem-resistant Enterobacteriaceae (CRE) data to identify (1) facilities in its jurisdiction with comparatively high CRE infection burden and (2) geographic areas to target for a CRE isolate submission program. Outreach to facilities with high CRE burden led to enrollment of 15 clinical laboratories into a voluntary isolate submission program to analyze CRE isolates for additional characterization. Examples of health departments’ use of data for action include: notifying facilities with high standardized infection ratios (SIRs) and sharing Targeted Assessment for Prevention (TAP) reports. Conclusions: The NHSN’s role as a shared surveillance resource has expanded in multiple public health jurisdictions as a result of new data access provisions. Health departments are using NHSN data in their programmatic responses to HAI and AR challenges. New access to NHSN data is enabling public health jurisdictions to assess problems and opportunities, provide guidance for prevention projects, and support program evaluations.Funding: NoneDisclosures: None


Author(s):  
Jonathan H. Marks

Collaboration with industry has become the paradigm in public health. Governments commonly develop close relationships with companies that are creating or exacerbating the very problems public health agencies are trying to solve. Nowhere is this more evident than in partnerships with food and soda companies to address obesity and diet-related noncommunicable diseases. The author argues that public-private partnerships and multistakeholder initiatives create webs of influence that undermine the integrity of public health agencies; distort public health research and policy; and reinforce the framing of public health problems and their solutions in ways that are least threatening to the commercial interests of corporate “partners.” We should expect multinational corporations to develop strategies of influence. But public bodies need to develop counter-strategies to insulate themselves from corporate influence in all its forms. The author reviews the ways in which we regulate public-public interactions (separation of powers) and private-private interactions (antitrust and competition laws), and argues for an analogous set of norms to govern public-private interactions. The book also offers a novel framework that is designed to help public bodies identify the systemic ethical implications of their existing or proposed relationships with industry actors. The book makes a compelling case that, in public health, the paradigm public-private interaction should be at arm’s length: separation, not collaboration. The author calls for a new paradigm to protect and promote public health while avoiding the ethical perils of partnership with industry.


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