Public Health in the Media. Public Health has been in the national spotlight since the terrorists events of 2001. This ongoing assignment is to find one of the various course topics in the media. The media submissions may include: television, movies, magazines, songs, anywhere people get information or entertainment. The actual videos and / or audio file for these findings is preferred, but not required. If the file is not available a detailed description and file locations is acceptable. A one paragraph (50 word minimum for each chapter) description summarizing the submission and the submission’s relevance to the chapter is required and must accompany the submission. 

You are expected to read and provide relevant discussion (25 word minimum, each comment for each chapter) for at least 2 of your classmates’ media submissions on the appropriate discussion board thread. All media submissions are due by the date provided in the course schedule. 

Chapter 2

Organizations that Help Shape Community and Public Health

Chapter Objectives (1 of 2)
After studying this chapter, you will be able to:
Explain the need for organizing to improve community and public health.
Explain what a governmental health organization is and give an example of one at each of the following levels—international, national, state, and local.
Explain the role the World Health Organization (WHO) plays in community and public health.
Briefly describe the structure and function of the United States Department of Health and Human Services (HHS).
State the three core functions of public health.
List the 10 essential public health services.
Explain the relationship between a state and local health department.

Chapter Objectives (2 of 2)
Explain what is meant by the term Whole School, Whole Community, Whole Child (WSCC).
Define the term quasi-governmental and explain why some health organizations are classified under this term.
List the four primary activities of most voluntary health organizations.
Explain the purpose of a professional health organization/association.
Explain how philanthropic foundations contribute to community and public health.
Discuss the role that service, social, and religious organizations play in community and public health.
Identify the major reason why corporations are involved in community and public health, and describe some corporate activities that contribute to community and public health.

Introduction
Only in past ~100 years have communities taken explicit actions to deal aggressively with health issues continuously
Community response to own problems hindered by various issues
Three classifications based on funding sources, responsibilities, and organizational structure
Governmental
Quasi-governmental
Nongovernmental

Governmental Health Agencies
Part of governmental structure
Federal, state, or local
Funded primarily by tax dollars
Managed by government officials
Authority over some geographic area
Exist at four levels
International, national, state, local

International Health Agencies
World Health Organization (WHO) most widely recognized international governmental health organization
Headquartered in Geneva, Switzerland
Six regional offices around the world
Not oldest world health-related international agency, but largest

History of WHO
1945: charter of the United Nations; article calling for establishment of health agency with wide powers
1946: UN representatives created and ratified the constitution of WHO
1948: constitution went into force and WHO began work

Organization of WHO
Membership open to any nation that has ratified constitution and receives majority vote of World Health Assembly
World Health Assembly – delegates of member nations
Approves WHO programs and budget
194 member countries
WHO administered by different levels of staff

Purpose and Work of WHO
Primary objective: attainment of the highest possible level of health by all peoples
Six core functions to achieve objective
Work financed by member nations
Most notable work: helping to eradicate smallpox
Work guided by 12th General Programme of Work and the UN’s Millennium Declaration
2003 Millennium Summit established Millennium Development Goals
Sustainable Development Goals established in 2015 to build on the MDGs

National Health Agencies
Each nation has department or agency within its government responsible for protection of health and welfare of its citizens
U.S. primary national health agency: Department of Health and Human Services (HHS)
Other federal agencies contribute to health – Dept. of Agriculture, EPA, OSHA, DHS

Department of Health and Human Services
Headed by Secretary of Health and Human Services
appointed by president; member of cabinet
~25% of federal budget; largest department in federal government
New healthcare reform law provides series of new duties and responsibilities for HHS
Organized into 11 operating agencies; 10 regional offices

Operating Agencies of the DHHS (1 of 2)
Administration for Community Living (ACL)
Administration for Children and Families (ACF)
Agency for Healthcare Research and Quality (AHRQ)
Agency for Toxic Substances and Disease Registry (ATSDR)
Centers for Disease Control and Prevention (CDC)

Operating Agencies of the DHHS (2 of 2)
Food and Drug Administration (FDA)
Centers for Medicare and Medicaid Services (CMS)
Health Resources and Services Administration (HRSA)
Indian Health Services (IHS)
National Institutes of Health (NIH)
Substance Abuse and Mental Health Services Administration (SAMHSA)

State Health Agencies
All 50 states have their own state health departments
Purpose: to promote, protect, and maintain the health and welfare of their citizens
Usually headed by a medical director who is appointed by the governor
Purposes represented in “Core Functions of Public Health” (assessment, policy development, assurance)

Core Functions of Public Health
and 10 Essential Services
Reproduced from: Centers for Disease Control and Prevention (2014). The Public Health System and the 10 Essential Public Health Services. Available at http://www.cdc.gov/nphpsp/essentialservices.html

State Health Departments
Most organized into divisions or bureaus
Play many different roles
Can establish health regulations
Provide link between federal and local health agencies
Serve as conduits for federal funds aimed at local health departments
Have laboratory services available for local health departments

Local Health Departments
Responsibility of city or county governments
Jurisdiction often depends on size of population
State mandated services provided locally
Restaurants, public buildings, and public transportation inspections; detection and reporting of certain diseases; collection of vital statistics
Approximately 2,800 in the United States

Organization of Local Health Departments

Whole School, Whole Community, Whole Child (WSCC) Model
Schools under category of governmental health agency – funded by tax dollars
Schools have great potential for impacting community health
Ecological approach directed at the whole school
Expands on the 8 elements of the coordinated school health (CSH) approach
Expanded components – social and emotional climate, physical environment, community involvement, and family engagement

Quasi-Governmental Health Organizations
Some official health responsibilities; operate more like voluntary health organizations
Operate independently of government supervision
Derive some funding and work from government
Examples: American Red Cross, National Academy of Sciences, National Science Foundation

The American Red Cross
Official duties
Provide relief to victims of natural disasters
Serve as liaison between members of armed forces and their families during emergencies
Nongovernmental services
Blood drives, safety services, community volunteer services, international services
Part of international movements

Nongovernmental Health Agencies
Funded by private donations or membership dues
Arose due to unmet health need
Operate free from governmental interference
Meet specific IRS guidelines with tax status
Many types
Voluntary, professional, religious, social, philanthropic, corporate, service

Voluntary Health Agencies
Created by one or more concerned citizens that felt a specific health need was not being met by governmental agencies
Most exist at national, state, and local levels
National often focused on research, state links national with local offices, local often carry out programming
Usually combination of paid staff and volunteers

Purpose of Voluntary Health Agencies
Four basic objectives
Raise money to fund programs and/or research
Provide education to professionals and the public
Provide services to those afflicted
Advocacy
Fundraising is a primary activity
Examples, ACS, AHA, March of Dimes, MDA

Professional Health Organizations
Made up of health professionals who have completed specialized training and have met standards of registration/certification or licensure for their fields
Mission: to promote high standards of professional practice
Funded primarily by membership dues
Examples: American Medical Association, American Public Health Association

Philanthropic Foundations
Endowed institutions that donate money for the good of humankind
Fund programs and research on prevention, control, and treatment of many diseases
Some have broad support, others very specific
Examples: Bill and Melinda Gates Foundation, Commonwealth Fund, Robert Wood Johnson Foundation, local Community Foundations

Service, Social, and Religious Organizations
Many do not have health as primary mission, but make significant health-related contributions
Examples: Kiwanis, Elks, Shriners, Lions, FOP
Contributions of religious groups to community health are substantial
History of volunteerism, influence on families, donation of space, sponsorship of programs (food banks, shelters)

Corporate Involvement in Community Health
Biggest role is provision of healthcare benefits
Worksite health promotion programs aimed at lowering healthcare costs and reducing absenteeism
Safety, counseling, education courses, physical fitness centers

Discussion Questions
How have voluntary health organizations impacted health outcomes?
How does the Department of Health and Human Services impact individuals?
How can the World Health Organization overcome the obstacles they face?

Chapter 5

Community Organizing/Building and Health Promotion Programming

Chapter Objectives (1 of 2)
After studying this chapter, you will be able to:
Explain the terms evidence, evidence-based practice, and socio-ecological perspective.
Define community organizing, community capacity, community participation, and empowered community.
Identify the assumptions that underlie the process of community organization.
Briefly explain the differences among planning and policy practice, community capacity development, and social advocacy strategies to community organization.
Explain the difference between needs-based and strengths-based community organizing models.
List the steps for a generalized model for community organizing/building.

Chapter Objectives (2 of 2)
Explain what community building means.
Explain the difference between health education and health promotion.
State and summarize the steps involved in creating a health promotion program.
Define the term needs assessment.
Briefly explain the six steps used in assessing needs.
Explain the difference between goals and objectives.
List the different types of intervention strategies.
Explain the differences among best practices, best experiences, and best processes.
Explain the purposes of pilot testing in program development.
State the difference between formative and summative evaluation.

Introduction (1 of 2)
Evidence-based Practice
Systematically finding, appraising, and using evidence as the basis for decision making
Evidence – the body of data that can be used to make decisions

Introduction (2 of 2)
Socio-ecological approach to behavior change
Interaction between and interdependence of factors within and across all levels of a health problem
Behavior has multiple levels of influence
Behavior change usually a combination of individual and environmental/policy-level interventions

Community Organizing/Building
Community health problems range from small to complex
Community organizing
Process through which communities are helped to identify common problems or goals, mobilize resources, and develop and implement strategies for reaching the goals they have collectively set
Not a science, but an art of consensus building

Community Organizing/Building Terms
Community capacity
Empowerment
Grassroots participation
Macro practice
Participation and relevance
Social capital

Need for Organizing Communities
Changes in community social structure have lead to loss of a sense of community
Advances in electronics
Communications
Increased mobility
Community organizing skills extend beyond community health

Assumptions of Community Organizing
Those who organize communities do so while making certain assumptions

Community Organizing Methods (1 of 2)
No single preferred method
Planning and policy practice, community capacity development, and social advocacy
All incorporate fundamental principles
Start where the people are
Participation
Create environments in which people and communities can become empowered as they increase problem-solving abilities

Community Organizing Methods (2 of 2)
Reproduced from Minkler, M., and N. Wallerstein (2012). “Improving Health through Community Organization and Community Building: Perspectives from Health Education and Social Work.” In M. Minkler, ed., Community Organizing and Community Building for Health and Welfare, 3rd ed. New Brunswick, NJ: Rutgers University Press, 44. Reprinted with permission.
Community organization and community building typology

Recognizing the Issue
Initial organizer
Recognizes that a problem exists and decides to do something about it
Gets things started
Can be from within or outside of the community
Grass-roots, citizen initiated, bottom-up
Top-down, outside-in

Gaining Entry into the Community
Organizers need:
Cultural sensitivity, cultural competence, cultural humility
Organizers need to know:
Who is causing problem and why; how problem has been addressed in past; who supports and opposes idea of addressing problem; who could provide more insight
Gatekeepers

Organizing the People
Executive participants
Leadership identification
Recruitment
Expanding constituencies
Task force
Coalition

Assessing the Community
Community building
Needs assessment vs. mapping community capacity
Community assets
Primary building blocks
Secondary building blocks
Potential building blocks

Determining the Priorities and Setting Goals
Criteria to consider when selecting priority issue
Problem must be winnable
Must be simple and specific
Must unite members of organizing group
Should affect many people
Should be part of larger plan
Goals written to serve as guide for problem solving

Arriving at a Solution and Selecting Intervention Strategies
Alternate solutions exist for every problem
Probable outcomes
Acceptability to the community
Probable long- and short-term effects
Costs of resources

Final Steps
Implementing
Evaluating
Maintaining
Looping Back

Health Promotion Programming
Important tool for community health professionals
Health education – part of health promotion
Health promotion – more encompassing than health education
Program planning
May or may not be associated with community organizing/building
Process by which an intervention is planned

Creating a Health Promotion Program
Involves a series of steps
Success depends on many factors
Experienced planners use models to guide work
Before process begins, important to understand and engage priority population (audience)
Priority population – those whom the program is intended to serve

Assessing Needs of the Priority Population
Determining purpose and scope of needs assessment
Gathering data
Analyzing data
Identifying risk factors linked to health problem
Identifying program focus
Validating prioritized need

Setting Appropriate Goals and Objectives
Foundation of the program
Portions of the programming process are designed to achieve the goals by meeting the objectives

Goals
Provide overall direction for the program
Are more general in nature
Do not have a specific deadline
Usually take longer to complete
Are often not measured in exact terms

Objectives (1 of 2)
More precise than goals
Steps to achieve the program goals
The more complex a program, the more objectives needed
Composed of who, what, when, and how much

Objectives (2 of 2)
Data from Deeds, S. G. (1992). The Health Education Specialist: Self-Data from Study for Professional Competence. Los Alamitos, CA: Loose Cannon Publications; Cleary, M. J., and B. L. Neiger (1998). The Certified Health Education Specialist: A Self-Study Guide for Professional Competence, 3rd ed. Allentown, PA: National Commission for Health Education Credentialing; and McKenzie, J. F., B. L. Neiger, and R. Thackeray (2017). Planning, Implementing, and Evaluating Health Promotion Programs: A Primer, 7th ed. Boston: Pearson Education, Inc.

Creating an Intervention that Considers the Peculiarities of the Setting
Intervention
Activities that will help the priority population meet the objectives and achieve the program goals
The program that the priority population will experience
May be several or a few activities

Intervention Considerations
Multiplicity
Dose
Best practices
Best experience
Best processes

Implementing the Intervention
Implementation
Putting a planned program into action
Pilot test
Trial run‒implementation to a small group
Determine problems and fix before full implementation
Phasing in
Step-by-step implementation; implementation with small groups

Evaluating the Results
Determine the value or worth of an object of interest
Evaluation should occur during first steps of program development
Formative evaluation
Summative evaluation
Impact evaluation
Outcome evaluation

Steps to Evaluation
Engage stakeholders
Describe the program
Focus on the evaluation design
Gather credible data
Justify conclusions
Ensure use and share lessons learned

Discussion Questions
How would you explain the difference between health education and health promotion?
How can community members work together to solve health problems?

Chapter 6

The School Health Program: A Component of Community Health

Chapter Objectives (1 of 2)
After studying this chapter, you will be able to:
Describe the Whole School, Whole Community, Whole Child model.
List the ideal members of a school health advisory council.
Explain why a school health program is important.
Define written school health policies and explain their importance to the school health program.
Explain processes for developing and implementing school health policies.
List the ten components of the Whole School, Whole Community, Whole Child model.
Describe the role of the school health coordinator.

Chapter Objectives (2 of 2)
Identify those services offered as part of school health services and explain why schools are logical places to offer such services.
Explain what is meant by a healthy school environment and discuss the two major environments.
Define school health education.
Identify the eight National Health Education Standards.
Explain how a health education specialist could locate credible health education curricula.
Identify and briefly explain four issues that are faced by school health advocates.

Introduction
The school health program has great potential for affecting the health of the community

Whole School, Whole Community, Whole Child (WSCC) Model
A model focused on addressing the educational and health needs of children within the context of the school setting
Community strengths can boost the role of the school in addressing child health and learning needs, but also can be a reflection of areas of need in the community
Provides a shared framework and approach for schools and the community to work together to provide a systematic, integrated, and collaborative approach to health and learning

The School Health Advisory Council
Individuals from a school or school district and its community who work together to provide advice and aspects of the school health program
Should include diverse representation
Primary role – provide coordination of the WSCC components

The School Nurse
Can provide great leadership for the school health program
Has medical knowledge and formal training
Has multiple responsibilities
Often districts do not have resources to hire full-time nurses

The Teacher’s Role
Heavy responsibility in making sure the WSCC model works
Often spend more waking hours with children than parents do

The Need for School Health
An unhealthy child has a difficult time learning
Health and success in schools are interrelated
A school health program provides the integration of education and health

Foundations of the School Health Program
School administration that supports the effort
A well-organized school health advisory council
Written school health policies

School Health Policies
Steps for creating local health-related policies include
Build a policy development team
Assess the environment
Draft the policy
Adopt the policy
Implement the policy
Measure and evaluate
Communicate the results

Policy Development
Should be executed by the school health council
Should cover all facets of the school health program
Gain approval from key stakeholders

Policy Implementation
Policies only effective if implemented
Distribute policies to those affected
Distribute with a memorandum of explanation
Place in faculty, staff, and student handbooks
Present them at group meetings (PTO)
Hold a special meeting for explaining policies
Place them in the school district newsletter

Policy Development Resources
Action for Healthy Kids
School Health Index (via CDC)

Monitoring Status of School Health Policy in the U.S.
CDC has periodically conducted a national survey to assess school health policies and practices
School Health Policy and Practices Study (SHPPS)
Assesses
School health policies
School health practices at the state, district, school, and classroom levels

Components of a WSCC Model
Administration and organization
School health services
Healthy school environment
School health education
Counseling, psychological, and social services
Physical education and physical activity
Nutrition environment and services
Community involvement
Family engagement
Employee wellness

Administration and Organization
A WSCC model should be administered by a school health coordinator
Trained professional at the state, district, or school level who is responsible for managing, coordinating, planning, implementing, and evaluating school health policies, programs, and resources
Often not a position required by states

School Health Services
Health services provided by school health workers to appraise, protect, and promote health
The Framework for the 21st Century School Nursing Practice calls for student-centered nursing care focused on the key principles of care coordination, leadership, quality improvement, and community/public health with standards of practice as the foundation

Healthy School Environment
By law, school districts are required to provide a safe school environment
Physical environment
School building and its contents, the land on which the school is located, and the area surrounding it
Psychosocial environment
Attitudes, values, feelings of students and staff

School Health Education
The development, delivery, and evaluation of a planned curriculum
Priority health content:
Alcohol and other drugs, healthy eating, mental and emotional health, personal health and wellness, physical activity, safety/unintentional injury prevention, sexual health (abstinence and risk avoidance), tobacco, violence prevention

Development of and Sources of Health Education Curricula
Sources
Many available from national specialists
Approved curricula from state departments of education or health
Health agencies and associations
Commercially produced curricula
National Health Education Standards

Other WSCC Components
Counseling, psychological, and social services
Physical education and physical activity
Nutrition environment and services
Community involvement
Family engagement
Employee wellness

Issues and Concerns of the School Health Program
Lack of support for WSCC
School health curriculum challenges
School-based health centers
Violence in schools

Lack of Support for WSCC
Limited success in getting WSCC implemented across the country
Need supportive legislation

School Health Curriculum Challenges
Controversy
Strong opinions on various topics
Improper implementation
Often provided by individuals other than health education specialists
Barriers to school health education

School-Based Health Centers
Provided in different ways; most common on school property
Seven core competencies used to guide the delivery of health care in a school setting
“Cultural wars”
Funding challenges

Violence in Schools
High-profile incidents of violence in schools
Bullying
Electronic aggression
Recommendations for improving school climate as it relates to violence

Discussion Questions
Why is a WSCC model so challenging to implement in every school district?
How can schools have more effective health programs with limited funding?