SESSION 2:  Public Health Systems (Section B)

Discussion leader: Kristine Gebbie (Columbia University)
Reporters:  Linda Meyers and Andrea Pernack (IOM)
Attendance:  About 20 participants

A number of themes emerged relating to needs that IOM should address. 

Intersectoral Public Health System

>A follow-up study or other activity focused on each of the components in the intersectoral public health system described in The Future of the Public's Health in the 21st Century (p. 30).  The components include employers and business, the media, academia, governmental public health infrastructure, communities, and the health care delivery system.

Economics

>High priority was given to an IOM study on the economics of public health that would examine how public health is funded, the stability of public health funding, guidelines for public health spending as a percentage of national health care spending, and how the focus on bioterrorism is affecting funding for more traditional public health activities.

Public Health Workforce

>Much of the discussion focused on the need for additional studies/activities by IOM related to the public health workforce.  Many attendees felt that there should be follow-up studies from the "Who Will Keep the Public Healthy?" report, examining particular issues in more depth.  A study examining the public health workforce in California is underway.

>There is also need for an examination of gaps in the public health workforce and the design of incentives to encourage public health school graduates to take jobs in those areas.  Lack of competitive pay has been cited often as the reason why most public health school graduates take jobs in the private sector rather than the public sector.  It would be helpful to examine how pay and other incentives could be improved.  In this regard, a central question that needs to be answered is how to improve the capture rate of graduates who go into the public sector.  What is the strategy that will create public awareness and public demand for the intersectoral public health system we envision?

>Also identified was the need to train emergency response personnel, including law enforcement, in public health.

>Preparation of a (generic) municipal manual for any cities meta-catastrophe; cities would then need to adapt this manual for their own specific situations.

>A number of attendees mentioned the need for an in-depth examination of the curriculum in public health schools and identification of new approaches to teaching public health. There should also be a specific focus on whether public health schools are teaching students about the latest public health data system technologies and techniques.

Data/Metrics

>There was also interest in more IOM study of data systems and data analysis methodologies related to public health.  One attendee noted that the public health community is good at identifying new problems, but there is often less focus on information/data for the ongoing management of public health problems (e.g., management of asthma).  Biostatistics should have an increasing focus on using statistical methods for data that are collected on an ongoing basis.

>A unified data base is needed of all health care information, with ongoing computer-based data mining to see if there are any outliers that seem like they should be investigated. 

>Like the public health preparedness metrics currently being developed by CDC, metrics could be developed for other areas of public health.

Integration/interface of Public Health and Clinical Medicine

>A number of attendees suggested the need to integrate the public health system with clinical medicine to a greater extent, so some of the work of public health can be done in the clinical medicine sector (e.g., disease reporting, laboratory testing).  As one attendee noted, especially with respect to public health system funding, "If we can't beat 'em, join 'em." The study would look at clinical systems and individual practitioners and how to draw them into public health.

Chronic Disease Prevention and Health Promotion

>A study/activity looking at characteristics of and lessons learned from successful public health efforts (e.g., reduction in tobacco use) was suggested as a valuable activity for the IOM.

>There was also a suggestion to have IOM do a study on the magnitude of insulin-resistant syndrome since it is becoming a global public health burden.