Chapter 1: Overview of Public Health Administration PDF

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Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC OT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIB C HAPT E R 1 © littlenySTOCK/Shutterstock Overview of Public Health © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Administration Jones & Bartlett Learning, LLC and Leiyu Shi James A. Johnson © Jones & Bartlett Learning, LLC OT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION LEARNING OBJECTIVES ToTo bedescribe able to define public health and population health To understand © Jones & Bartlett Learning, LLC public health functions and essential services © Jones & Bartlett Learning To understand the NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIB systems perspective in public health and the utility of systems thinking To be familiar withthe roles and responsibilities of public health administrators To identify the purposecoreandcompetencies for public health managers and leaders goals of Healthy People 2020/2030 and how this relates to public health administration © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Chapter SALE OROverview NOTThe populations. operative SALEcomponents of this 1 NOT FOR DISTRIBUTION FOR OR DISTRIBUTION definition are that public health efforts are directed Since the beginning of public health activities in to populations rather than to individuals. Public the Ancient World there has been a need for orga- health practice does not rely on a specific body nization and management. Coordination of effort of knowledge and expertise, but rather relies on to accomplish LLC Jones & Bartlett Learning, goals necessitates certain skills©and Jones & Bartlett a dynamic, Learning,approach multidisciplinary LLC that often abilities. This chapter defines public health and combines the natural and social sciences. The OT FOR SALE ORpopulation DISTRIBUTION NOT FOR SALE OR DISTRIBUTION health to establish the context in which definition of public health reflects its central goal, public health administration takes place. It also the reduction of disease and the improvement of addresses important perspectives and needed com- health in a population. In 1920, famed American petencies, along with future goals and challenges. ­bacteriologist and public health expert Charles-­ © Jones & Bartlett Learning, LLC Edward Amory Winslow provided© Jones the& Bartlett Learning following Public Health and NOT FOR SALE OR DISTRIBUTION seminal definition of publicNOT healthFOR SALE OR DISTRIB practice: Population Health Public health is the science and art of Definitions preventing disease, prolonging life, and promoting physical health and efficiency © Jones As & Bartlett described Learning, by Novick, Morrow,LLC and Mays in the © Jones through & Bartlett organized communityLearning, efforts LLC NOT FOR SALE OR DISTRIBUTION previous edition of this book, public health con- for NOT FOR SALE OR DISTRIBUTION the sanitation of the environment, sists of organized efforts to improve the health of the control of community ­infections, the 1 Jones & Bartlett Learning, LLC © Jones © Jones & Bartlett Learning LLC, an Ascend Learning &NOT Company. Bartlett FOR SALELearning, LLC OR DISTRIBUTION. OT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC OT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 2 Chapter 1 Overview of Public Health Administration education of the individual in principles health outcomes, public health approaches of personal©hygiene, the organization of Jones & Bartlett Learning, involve LLCmultilevel interventions © thatJones address &theBartlett Learning medical and nursing services for the individual, the community, and public policy. NOT FOR SALE OR DISTRIBUTION early diagnosis and preventive treat- NOT FOR SALE OR DISTRIB The importance of public health and ment of disease, and the development population-based interventions is underscored ­ of social machinery which will ensure by achievements in the twentieth century, during to every individual in the community which individuals living in developed countries a standard of living © Jones & Bartlett Learning, adequate for LLCthe increased life expectancy © Jonesfrom 45 to 75Learning, & Bartlett years. LLC maintenance of health.2 Now in the twenty-first century, we have seen NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION this increase to 78 years in the United States and Since Winslow’s definition, the Institute of Medi- 82 years in Japan.5 The majority of this gain, 25 of cine (IOM) published its classic 1988 report, The the 30-plus years, can be attributed to public health Future of Public Health, which similarly defined measures such as better nutrition, improved air public health as an “organized community effort Jones & Bartlett Learning, LLC © quality, Jonessanitation, and clean & Bartlett drinking water. Learning, LLCMed- to address the public interest in health by apply- ical care focusing on individual patients, although OT FOR SALEingOR DISTRIBUTION scientific and technical knowledge to prevent NOT FOR SALE OR DISTRIBUTION important, is estimated to have contributed about disease and promote health.” Thus, the mission of 3 5 years to the gain in life expectancy. public health, both historically and ­contemporarily, Both science and social factors form the is to ensure the necessary conditions that promote basis for an effective public health intervention. the health of the©population. Jones & Bartlett Learning, ForLLC example, successfully eradicating a vaccine-­ © Jones & Bartlett Learning Richard Riegelman, founding dean of the preventable disease from a community requires NOT FOR SALE OR School of Public Health and Health Services at DISTRIBUTION NOT FOR SALE OR DISTRIB more than the development of an effective ­vaccine. George Washington University, states, “Public Acceptance and widespread use of the vaccine in health is about what makes us sick, what keeps us the community depends on a successful public healthy, and what we can do TOGETHER about health initiative that provides public information it. When we think about © Jones & Bartlett Learning, LLChealth, what comes to and facilitates delivery. © Jones Policies to support Learning, & Bartlett the ini- LLC mind first is individual health and wellness. In tiative, such as vaccines for children and school/ NOT FOR SALE OR DISTRIBUTION public health, what should come to mind first is NOT FOR SALE OR DISTRIBUTION daycare requirements for vaccinations, further the health of communities and society as a whole. increase the likelihood of success. Too often, Thus, in public health the focus shifts from the scientific advances are not fully translated into individual to the population, from me to us.”4 improved health outcomes. For example, in the Population-based strategies for improving Jones & Bartlett Learning, LLC © United JonesStates, perinatal Learning, & Bartlett transmission of HIV has LLC health include, but are not limited to, efforts to declined because of aggressive approaches to OT FOR SALE OR DISTRIBUTION control epidemics, ensure safe drinking water NOT testingFOR and SALE treatmentORof DISTRIBUTION HIV during pregnancy and food, reduce vaccine-preventable diseases, and delivery. On the other hand, congenital improve maternal and child health, and conduct syphilis, although decreased, has not achieved surveillance of health problems. In a­ ddition to the same level of success despite the fact that long-standing efforts to protect p ­opulations theLLC scientific means (penicillin)©toJones eradicate&itBartlett Learning © Jones & Bartlett Learning, from infectious disease and environmental was discovered in 1928. A comprehensive pub- health hazards,NOT FOR health the public SALEmission OR DISTRIBUTION has NOT FOR SALE OR DISTRIB lic health approach, combining s­cience with expanded to address contemporary health risks practical approaches to address cultural and such as obesity, injury, violence, substance ­socioeconomic factors affecting health, is essen- abuse, sexually transmitted infections (STIs), tial for the reduction and ultimately the elimina- human immunodeficiency © Jones & Bartlett Learning, LLC virus (HIV) infec- tion of preventable diseases.& Bartlett Learning, LLC © Jones tion, acquired immunodeficiency syndrome The focus on the health of populations as the NOT FOR SALE OR DISTRIBUTION (AIDS), natural disasters, and bioterrorism. To NOT FOR SALE OR DISTRIBUTION most contemporary way of expanding the defi- effectively address both historical and contem- nition of public health is further underscored by porary health concerns and sustain improved Kindig, with his perspective on population health Jones & Bartlett Learning, LLC © Jones © Jones & Bartlett Learning LLC, an Ascend Learning &NOT Company. Bartlett FOR SALELearning, LLC OR DISTRIBUTION. OT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC OT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Public Health Functions 3 Population health Assessment involves obtaining data to define © Jones & Bartlett Learning, LLC the health of populations© Jonesand the&nature of Bartlett Learning health problems NOT FOR SALE OR DISTRIBUTIONAssurance includes NOT FOR SALE OR DISTRIB Healthcare Traditional Social the oversight responsi- systems public health policy bility for ensuring that essential components of an effective health system are in place Figure 1.1 A full spectrum of population health. Policy development includes developing © Jones Reproduced from Riegelman R. Public Health 101: Healthy People—Healthy Populations. Burlington, MA: Jones & evidence-based © Jones recommendations and anal- LLC Bartlett& Bartlett Learning; Learning, 2012. www.jblearning.com. Reprinted with permission. LLC & Bartlett Learning, ysis to guide public policy as it pertains to NOT FOR SALE OR DISTRIBUTION health NOT FOR SALE OR DISTRIBUTION as “the distribution of health outcomes within a population, the health determinants that influ- Building on the IOM recommendations, the ence distribution and the policies and interven- U.S. Public Health Service put forth the “­Public tions that impact those determinants.” Further 6 Health in America Statement” in 1994. This Jones & Bartlett Learning, LLC along this line of thinking, Nash adds, “It spans © Jones & Bartlett statement Learning, was supported and LLCpromoted by the OT FOR SALE ORwellness DISTRIBUTION and health promotion, chronic disease NOT FOR SALE OR DISTRIBUTION A ­ merican Public Health Association (APHA) and management, care of the frail and elderly, and most other groups advocating for a consistent and palliative and end-of-life care. In essence, broad unified approach to public health. The 10 essential population health approaches are designed to public health services are presented in Table 1.1. preserve wellness and minimize the physical and To better visualize how the core functions © Jones & financial impact of illness.” The concept of popu- Bartlett 7 Learning, LLC and essential © Jones services for public &together health fit Bartlett Learning NOT FOR lation health can be seen as a comprehensive way SALE OR DISTRIBUTION it helps to look at Figure NOT 1.2. FOR SALE OR DISTRIB of thinking about the current and future scope of public health. It utilizes an evidence-based approach to analyze the determinants of health Table 1.1 Essential Public Health Services and disease, along with options for intervention 1. Monitor health status to identify community © Jones and&prevention BartletttoLearning, preserve andLLC improve health. © problems. health Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION The interconnection of public health, public 2. NOT Diagnose FOR and SALE investigate ORproblems health DISTRIBUTION and policy, and health systems is demonstrated by health hazards in the community. 3. Inform, educate, and empower people about ­Reigelman in Figure 1.1.4 health issues. 4. Mobilize community partnerships to identify and solve health problems. Jones & Bartlett Learning, LLC Public Health Functions © Jones5.&Develop Bartlett Learning, policies LLC and plans that support OT FOR SALE ORThe DISTRIBUTION NOT 1988 Institute of Medicine report mentioned FOR SALE individual OR and DISTRIBUTION community health efforts. 6. Enforce laws and regulations that protect earlier, The Future of Public Health, defined three health and ensure safety. core functions that public health agencies need to 7. Link people to needed personal health services perform. These functions remain the responsibility and assure the provision of health care when of governments and should not be delegated to otherwise unavailable. © Jones & Bartlett Learning, LLC 8. Assure a competent public © Jones health and& Bartlett Learning nongovernmental organizations. While popu- NOT FOR SALE OR DISTRIBUTIONpersonal healthcare workforce. lation health does engage the full spectrum of NOT FOR SALE OR DISTRIB 9. Evaluate effectiveness, accessibility, and quality of stakeholders, public health at the local, state, and personal and population-based health services. federal levels is responsible for accomplishing the 10. Research for new insights and innovative essential health services. While much work may solutions to health problems. be & © Jones contracted BartlettoutLearning, to other sectors, LLCthe responsi- © Jones &Essential Bartlett Learning, The Public Health System & the 10 Public Health Services. Atlanta, LLC bility remains with the government public health NOT FOR SALE OR DISTRIBUTION agencies. The core functions defined by the IOM GA: Centers NOT for Disease FOR Control and SALE OR DISTRIBUTION Prevention. https://www.cdc.gov /publichealthgateway/publichealthservices/essentialhealthservices.html. are (1) assessment, (2) policy development, and Accessed March 26, 2020. (3) assurance.8 Jones & Bartlett Learning, LLC © Jones © Jones & Bartlett Learning LLC, an Ascend Learning &NOT Company. Bartlett FOR SALELearning, LLC OR DISTRIBUTION. OT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC OT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 4 Chapter 1 Overview of Public Health Administration © Jones & Bartlett Learning, LLC As © Jones & Bartlett Learning se NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIB ss m Evaluate Monitor health en t © Jones & Bartlett Learning, LLC Assure competent © Jones Diagnose & Bartlett Learning, LLC and Assurance investigate NOT FOR SALE OR DISTRIBUTION workforce NOT FOR SALE OR DISTRIBUTION Research Link to/provide Inform, educate, care Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC and empower OT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Mobilize community Enforce laws Po partnerships lic y Develop © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning de policies ve NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIB lo pm en t Figure 1.2 Core functions and essential public health services. © Core Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Functions of Public Health and How They Relate to the 10 Essential Services. Atlanta, GA: Centers for Disease Control and Prevention. http://www.cdc.gov/nceh/ehs/ephli/core_ess.htm. Accessed March 26, 2020. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION This framework is used by local, state, and society, including the global community. Using federal agencies throughout the country (discussed the language of systems theory, public health is a further in Chapter 4, “Systems Thinking for Pub- complex adaptive system. It is complex in that it lic and Global Health”). It serves as a guide and is composed of multiple, diverse, interconnected Jones & Bartlett Learning, framework for publicLLC health organization design © elements, Jones & andBartlett Learning, it is adaptive in that theLLC system is OT FOR SALEandOR DISTRIBUTION development, workforce planning and staffing, NOT FOR capable SALE and of changing ORlearning DISTRIBUTION from experience strategic management, resource allocation, infor- and its environment.”9 Johnson further explains mation systems design, and staff training. that the systems approach in public health is more than just the relationships that support and facili- tate the organization and actions of public health, Systems© PerspectiveJones & Bartlett Learning, butLLCalso includes “the mindset of © public Jones & Bartlett Learning health in Public NOTHealth FOR SALE OR DISTRIBUTION professionals.” This is often referredNOTtoFOR SALE OR DISTRIB as sys- 9 tems thinking, and it is especially salient in pub- As can be seen so far in this chapter and will be lic health management, practice, and research. further emphasized throughout this text, public The National Cancer Institute (NCI) sums up its health is best understood from a systems perspec- understanding and embrace of systems think- © tive. Jones & Bartlett Described Learning, by Johnson LLC book ing as presented in the recent © inJones Box 1.1.&The Bartlett NCI wasLearning, one of LLC NOT HealthFOR SALE Systems OR “Public Thinking, DISTRIBUTION health is highly the first publicNOThealthFOR agenciesSALE OR to fully DISTRIBUTION embrace interconnected and interdependent in its relation- ­systems thinking and has found it a most useful ship to individuals, communities, and the larger paradigm in its Tobacco Control Research Branch. Jones & Bartlett Learning, LLC © Jones © Jones & Bartlett Learning LLC, an Ascend Learning &NOT Company. Bartlett FOR SALELearning, LLC OR DISTRIBUTION. OT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC OT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Role of the Public Health Administrator and Manager 5 ­ anagement skills on the job or take course- m Box 1.1 ©N Jones ational Cancer Institute (NCI) & Bartlett Learning, work in other related fields©ofJones LLC management such & Bartlett Learning Statement on Public Health as business and health services administration. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIB Burke and Friedman define management in the Public health researchers and practitioners often work to solve complex population and health following ways: 11 issues, such as obesity and chronic disease, which It is first and foremost an interdisciplinary, are deeply embedded within the fabric of society. rigorous, and valid endeavor that is integral © JonesAs&such, the solutions often require intervention Bartlett Learning, LLC to all© Jones & Bartlett human enterprise, Learning, including public LLC and engagement with key stakeholders and NOT FOR SALE OR organizations DISTRIBUTION across many levels ranging from NOT FOR SALE OR DISTRIBUTION health. local entities (schools, churches, and work It is both a necessary and sufficient condition environments) to regional systems (health to ensure the goals of public health programs departments and hospital networks) to entire are met. countries (national agencies). This multilevel, multiparticipant Johnson and Davey identify the following seven view is at the heart of systems © Jones Jones & Bartlett Learning, LLC & Bartlett Learning, LLC thinking, a process of understanding how parts interconnected processes and responsibilities com- OT FOR SALE OR DISTRIBUTION influence one another within a whole. NOT FOR monly SALE ORwith associated DISTRIBUTION the administrative role:12 1. Planning is the process of specifying goals, Implementation Science at a Glance. Washington, DC: National Cancer establishing priorities, and otherwise identi- Institute. https://researchtoreality.cancer.gov/cyber-seminars/using fying and sequencing action steps to accom- -systems-thinking-and-tools-solve-public-health-problems. © Jones & Bartlett Learning, LLC plish goals. © Jones & Bartlett Learning NOT FOR SALE OR DISTRIBUTION 2. Organizing involves establishing NOT FOR a structure SALE OR DISTRIB Other systems thinking applications and or set of relationships so plans can be imple- efforts in public health will be discussed in mented and goals accomplished. Chapter 4, “Systems Thinking for Public and 3. Staffing is the assignment of personnel to spe- Global Health.” However, the importance of this cific roles or functions so the organization © Jones & Bartlett is f­ urther Learning, underscored LLCHealth Orga- by the World works© as Jones designed.& Bartlett Learning, LLC NOT FOR nizationSALE in itsOR DISTRIBUTION report titled Systems Thinking for 4. Directing NOTinvolves FOR making SALEdecisions and com- OR DISTRIBUTION Health Systems Strengthening, which asserts that municating them so they can be i­ mplemented. systems thinking is a “paradigm shift” for pub- 5. Coordinating is the task of assuring effective lic health. The report states: “Systems thinking interrelationships. offers a more comprehensive way of antici­pating 6. Reporting is the transfer of information and Jones & Bartlett Learning, synergies andLLC mitigating negative emergent © Jones &assurance Bartlett of accountability. Learning, LLC b ­ ehaviors, OT FOR SALE OR DISTRIBUTION 10 with direct relevance for creating more 7. Budgeting is fiscal NOT FOR SALE OR DISTRIBUTION planning, accounting, and system-ready policies.” control. The Council on Education for Public Health Role of the Public (CEPH) places considerable importance on management and administration by identifying Health Administrator © Jones & Bartlett Learning, LLC “management competencies” © Jones & Bartlett for public health Learning NOT FOR SALE OR DISTRIBUTION and Manager education and practice. NOT The FOR SALE Association of OR DISTRIB Schools and Programs of Public Health provides The work of public health could not be done or a list of core competencies in the managerial and its goals accomplished without managers and leadership domains, as shown in Table 1.2 and administrators. These individuals often obtain a Table 1.3. © Jones & Bartlett graduate degree, Learning, either masterLLC of public health © Jones Johnson defines & Bartlett as management Learning, “the processLLC NOT FOR (MPH)SALE OR DISTRIBUTION or master of public administration of workingNOT withFORand SALE through OR DISTRIBUTION others to achieve (MPA), during which time they study manage- organizational or program objectives in an efficient ment, administration, and policy. Others learn and ethical manner.”13 In subsequent ­chapters of Jones & Bartlett Learning, LLC © Jones © Jones & Bartlett Learning LLC, an Ascend Learning &NOT Company. Bartlett FOR SALELearning, LLC OR DISTRIBUTION. OT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC OT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 6 Chapter 1 Overview of Public Health Administration Table 1.2 Management Competencies, Health Policy and Management © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning D. Health Policy and Management* NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIB Health policy and management is a multidisciplinary field of inquiry and practice concerned with the delivery, quality, and costs of health care for individuals and populations. This definition assumes both a managerial and a policy concern with the structure, process, and outcomes of health services including the costs, financing, organization, outcomes, and accessibility of care. Competencies: Upon graduation, a student with an MPH should be able to… © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC D.1 Identify the main components and issues of the organization, financing, and delivery of health services NOT FOR SALE and public OR health DISTRIBUTION systems in the United States. NOT FOR SALE OR DISTRIBUTION D.2 Describe the legal and ethical bases for public health and health services. D.3 Explain methods of ensuring community health safety and preparedness. D.4 Discuss the policy process for improving the health status of populations. D.5 Apply the principles of program planning, development, budgeting, management, and evaluation in Jones & Bartlett organizational Learning,and LLC community initiatives. © Jones & Bartlett Learning, LLC D.6 Apply principles of strategic planning and marketing to public health. OT FOR SALED.7  ORApply DISTRIBUTION NOT FOR SALE OR DISTRIBUTION quality and performance improvement concepts to address organizational performance issues. D.8 Apply “systems thinking” for resolving organizational problems. D.9 Communicate health policy and management issues using appropriate channels and technologies. D.10 Demonstrate leadership skills for building partnerships. © isJones *In this series, health policy & Bartlett treated as a separate text and area ofLearning, LLC inquiry. As such, this text © Jones addresses only the health management competencies. & Bartlett Learning NOT Reproduced from Master’s Degree inFOR SALE Public Health ORDevelopment Core Competency DISTRIBUTION NOT Project, version 2.3. Association of Schools of Public Health; August 2006.FOR https://s3 SALE OR DISTRIB.amazonaws.com/aspph-wp-production/app/uploads/2014/04/Version2.31_FINAL.pdf. Table 1.3 Management Competencies, Leadership © Jones & Bartlett Learning, LLC H. Leadership © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT The ability to create and communicate a shared vision for a changing future, FORsolutions champion SALEtoOR DISTRIBUTION organizational and community challenges, and energize commitment to goals. Competencies: Upon graduation, it is increasingly important that a student with an MPH be able to... H.1 Describe the attributes of leadership in public health. H.2 Describe alternative strategies for collaboration and partnership among organizations, focused on Jones & Bartlett public Learning, LLC health goals. © Jones & Bartlett Learning, LLC OT FOR SALEH.3  ORArticulate DISTRIBUTION NOT an achievable mission, set of core values, and FOR vision. SALE OR DISTRIBUTION H.4 Engage in dialogue and learning from others to advance public health goals. H.5 Demonstrate team building, negotiation, and conflict management skills. H.6 Demonstrate transparency, integrity, and honesty in all actions. H.7 Use collaborative methods for achieving organizational and community health goals. H.8 Apply social justice and human rights principles when addressing community needs. © Jones & Bartlett Learning, LLC © Jones & H.9 Develop strategies to motivate others for collaborative problem solving, decision making, and evaluation. Bartlett Learning NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIB Reproduced from Master’s Degree in Public Health Core Competency Development Project, version 2.3. Association of Schools of Public Health; August 2006. https://s3.amazonaws.com/aspph-wp-production/app/uploads/2014/04/Version2.31_FINAL.pdf. this text every element of this definition and all Johnson and Kim Davey provide the following © of Jones & Bartlett the competencies Learning, listed LLC in these tables will be © Jones & Bartlett Learning, LLC commentary on the role of public health managers: NOT FOR and addressed SALE OR DISTRIBUTION elaborated on. NOT FOR SALE OR DISTRIBUTION As described in their book, Managing Public Public health managers and leaders are Health Organizations, published in 2021, James needed to help their organizations, Jones & Bartlett Learning, LLC © Jones © Jones & Bartlett Learning LLC, an Ascend Learning &NOT Company. Bartlett FOR SALELearning, LLC OR DISTRIBUTION. OT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC OT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Role of the Public Health Administrator and Manager 7 a­ gencies, and departments navigate com- leaders in their communities and in the world. plex©systems and constantly evolving Jones & Bartlett Learning, LLC In fact, public health, with©itsJones public service mis- & Bartlett Learning culture and subcultures to enact change sion and global reach, is an ideal environment for NOT FOR SALE OR DISTRIBUTION and influence health. Within the public NOT FOR SALE OR DISTRIB managers who desire to have a positive and last- health context, escalating costs, pro- ing impact. It is also a changing and sometimes vider shortages, health disparities, obe- demanding environment that offers many chal- sity and diet-related diseases, the opioid lenges and opportunities to grow professionally epidemic, climate © Jones & Bartlett Learning, LLC change, resurgence of and personally, © Jones and &to Bartlett help othersLearning, in large and LLC infectious diseases, demographic shifts, small ways. Table 1.4 identifies some of the ways NOT FOR shrinking SALE OR DISTRIBUTION budgets, and numerous other NOT FOR SALE OR DISTRIBUTION public health managers make a difference. challenges are threatening the health and well-being of individuals and commu- Table 1.4 Public Health Practice Profile for nities. These challenges require public Public Health Administration health professionals Jones & Bartlett Learning, LLC who possess strong© Jones & Bartlett Learning, LLC management knowledge, skills, and abil- Public Health Administrators Make a Difference by OT FOR SALE OR DISTRIBUTION ities. Public health professionals must be NOT FOR SALE OR DISTRIBUTION Public Health Purposes able to manage an evolving and expand- Preventing epidemics and the spread of disease ing number of public health priorities, Protecting against environmental hazards programs, professionals, organizations, Preventing injuries © Jones & Bartlett Learning, LLC Promoting and encouraging inter-­ o rganizational and multi-sector healthy behaviors © Jones & Bartlett Learning ­collaborations, population health activ- Responding to disasters and assisting NOT FOR SALE OR DISTRIBUTIONcommunities in recoveryNOT FOR SALE OR DISTRIB ities, policy initiatives, and much more. Ensuring the quality and accessibility of health Countries and communities around the services world are looking to public health pro- fessionals and organizations for answers Essential Public Health Services and innovative © Jones & Bartlett Learning, LLC approaches to address © Jones Monitoring & Bartlett health status Learning, LLC to identify community health disparities and priorities. Fur- health problems NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Diagnosing and investigating health problems and thermore, public health organizations and practice must evolve to redefine and health hazards in the community Informing, educating, and empowering people reinvent itself in response to environ- about health issues mental forces. Managers have a primary Mobilizing community partnerships to identify and responsibility for enabling, implementing, Jones & Bartlett Learning, LLC © Jones solve health problems & Bartlett Learning, LLC and overseeing this evolution in public Developing policies and plans that support OT FOR SALE OR DISTRIBUTION health organizations.12 NOT FOR individual SALE OR DISTRIBUTION and community health efforts Enforcing laws and regulations that protect All organizations require managers, who are health and ensure safety essential for their maintenance, effectiveness, Linking people with needed personal health and sustainability. Whether it be the manage- services and ensuring the provision of health © Jones & Bartlett Learning, ment of resources (people, finances, buildings, LLC care when otherwise unavailable © Jones & Bartlett Learning Ensuring a competent public health and personal technology) ­ NOT or FOR strategySALE (vision,OR DISTRIBUTION mission, goals, healthcare workforce NOT FOR SALE OR DISTRIB objectives) or behavior dynamics (motivation, Evaluating effectiveness, accessibility, and conflict, change, decision making), or values quality of personal and population-based (fairness, diversity, responsiveness, accountability, health services social responsibility), the manager’s role and effec- Researching new insights and innovative solutions © Jones & Bartlett tiveness Learning, in that role are centralLLC to the organiza- to health © Jones problems & Bartlett Learning, LLC NOT FOR tion’sSALE ability toOR existDISTRIBUTION and perform its mission and NOT FOR SALE OR DISTRIBUTION Reproduced from Turnock B. Essentials of Public Health. Burlington, MA: Jones & purpose. Public health managers are often lead- Bartlett Learning; 2016. ers within their own professions, and many are Jones & Bartlett Learning, LLC © Jones © Jones & Bartlett Learning LLC, an Ascend Learning &NOT Company. Bartlett FOR SALELearning, LLC OR DISTRIBUTION. OT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC OT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 8 Chapter 1 Overview of Public Health Administration Exhibit 1.1 © WHO Perspective on Public Health Management Jones & Bartlett Learning, LLC © Jones & Bartlett Learning NOTand Effective leadership FOR SALE are management ORessential to scaling up the quantity and quality ofNOT DISTRIBUTION healthFOR SALE OR DISTRIB services and to improving population health. Good leadership and management are about: providing direction to, and gaining commitment from, partners and staff; facilitating change; and © Jones & Bartlett achieving Learning, better health LLCefficient, creative, and responsible services through © Jones & Bartlett deployment Learning, LLC of people and other resources. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Strengthening leadership and management requires the fulfillment of four main conditions: adequate numbers of managers deployed, managers with appropriate competencies, functioning management support systems, and a work environment that expects, supports, and rewards good management performance. While leaders set Jones & Bartlett Learning, LLCthe strategic vision and mobilize the efforts&toward © Jones its realization, Bartlett Learning, good managers LLC ensure effective organization and utilization of resources to achieve results and meet the aims. OT FOR SALE ORThe DISTRIBUTION WHO management framework proposes that NOTgoodFOR SALE leadership andOR DISTRIBUTION management at the opera- tional level need to have a balance between four areas: 1. ensuring an adequate number of managers at all levels of the health system; 2. ensuring managers have appropriate competences; 3. creating better critical management support systems; and 4. creating and©enabling Jones the & Bartlett working Learning, LLC environment. © Jones & Bartlett Learning NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIB The WHO is a strident advocate of systems thinking. These four conditions are closely interrelated. Strengthening one without the others is not likely to work. Reproduced from World Health Organization. Management for health services delivery. https://www.who.int/management/en. Accessed March 26, 2020. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE ORtheDISTRIBUTION NOT FOR SALE OR DISTRIBUTION In public health, need for skilled and highly effective managers and leaders is great. Looking to the Future APHA, ASPPH, and the WHO have all recog- Public health administrators and practitioners nized the importance of management in public will face many challenges in the twenty-first cen- health systems, organizations, and programs. tury, while also having an opportunity to shape Jones & Bartlett Learning, Furthermore, these LLC groups have called for bet- © public Joneshealth & Bartlett Learning, practice and LLC policy. One way of OT FOR SALEterOR DISTRIBUTION management development and leadership NOT FOR gaining SALE insight ORkinds into the DISTRIBUTION of issues to be faced if public health is to meet its greatest potential is to look at the Healthy People 2020 initiative. and achieve the goal of health for all. This is Going beyond that, we will have the Healthy captured in the WHO perspective presented in People 2030 initiative to consider. Since 1980, Exhibit 1.1. the United States has undertaken 10-year plans © Jones As public health & Bartlett continues Learning, to advance, the LLC certain key national objectives outlining © Jonesto &beBartlett Learning NOThealth role of the public FORmanager SALE will OR likely DISTRIBUTION accomplished during each subsequent NOT FOR SALE OR DISTRIB decade. expand. One such vision, as described by the The process and achievements of these plans Centers for Disease Control and Prevention ­ are explored further in ­subsequent chapters of (CDC), has public health leaders serving as chief this text. However, in our discussion of the role health strategists in their communities, partner- of public health administrators, it is important © ing Jones across&­mBartlett Learning, ultiple sectors LLC data and leveraging to realize how © Jones these objects&forBartlett the comingLearning, years LLC NOT and FOR SALE resources OR DISTRIBUTION to address social, environmental, NOTefforts will help galvanize FORand SALE guide OR p DISTRIBUTION ­ olicy. The and economic conditions that affect health and mission is as follows: Healthy People 2020 strives health equity.14 to (1) identify nationwide health i­mprovement Jones & Bartlett Learning, LLC © Jones © Jones & Bartlett Learning LLC, an Ascend Learning &NOT Company. Bartlett FOR SALELearning, LLC OR DISTRIBUTION. OT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC OT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Looking to the Future 9 Determinants of Health © Jones & Bartlett Learning, econ omic, cuLLCltura l, h © Jones & Bartlett Learning ial, NOT FOR SALE OR d s DISTRIBUTION o c and w or k in g c on d ea lth NOT FOR SALE OR DISTRIB n g itio ivi n oa ,a and communi li y, Br nd L Interventions ty Outcomes s am env a l be hav Policies du Behavioral outcomes ne ivi ,f i ironm t ial wo Programs Specific risk factors, In d or Soc rks locate individual Information diseases, and conditions levels ental cond © Jones & Bartlett Learning, LLC traits: age, sex, race, and © Jones Injuries & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION biological NOT FOR SALEand Well-being OR DISTRIBUTION l loca factors health-related itio Across life course nd quality of life n ,a sa Health equity e n at t d po l, s lic ti o na ies the global, na of Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC OT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Assessment, monitoring, evaluation, and dissemination Figure 1.3 Action model to achieve U.S. Healthy People 2020 overarching goals. Reproduced from U.S. Department of Health and Human Services. About Healthy People. https://www.healthypeople.gov/2020/About-Healthy-People. Updated May 26, 2020. Accessed April 1, 2020. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIB ­riorities; (2) increase public awareness and p quality of life and well-­being, determinants of understanding of the determinants of health, health, and disparities. disease, and disability and the opportunities for The next 10-year period of national health progress; (3) provide measurable objectives and planning is being addressed in Healthy People © Jones & that goals Bartlett Learning, can be used LLC at national, state, and local © Jones 2030. Although much& Bartlett progress hasLearning, been made LLC NOT FOR SALE OR DISTRIBUTION levels; (4) engage multiple sectors to take actions NOT FOR SALE OR DISTRIBUTION since the Healthy People initiatives began, the that are driven by the best available evidence and United States is still behind other developed on knowledge; and (5) identify critical research and key measures of health and well-being, including data collection needs. Figure 1.3 presents an life expectancy, infant mortality, and ­obesity. A action model that may be used by public health challenge for Healthy People 2030 is to guide the Jones & Bartlett Learning, LLC planners, administrators, and policymakers © to Jones & Bartlett country Learning, in achieving LLC for health its full potential OT FOR SALE ORbetter DISTRIBUTION achieve overarching goals. NOT FOR SALE OR and well-being. SeeDISTRIBUTION Box 1.2 for an overview. As described by Shi and Johnson, Healthy The remaining chapters of this text address People 2020 is differentiated from previous a wide