Christopher G. Atchison

Demonstrating excellence in practice-based teaching for public health.

Demonstrating Excellence in Practice-based Teaching for Public Health is a report intended to provide a resource for practice-based teaching of public health and includes a brief explanation of terms and practices, as well as suggestions on methodologies for implementation. No comparable resource currently exists that assists faculty and practice partners to recognize, implement, and promote practice-based teaching. This article summarizes findings from the report, including an explanation of practice-based teaching, its guiding principles, practical approaches, and recommendations on sustaining and advancing partnerships for professional public health education and training.

The quest for an accurate accounting of public health expenditures.

This article describes one effort to develop management tools that will help public health administrators and policy makers implement comprehensive public health strategies. It recounts the ongoing development of a methodology through which the Essential Public Health Services can be related to public health budgets, appropriations, and expenditures. Through three pilot projects involving: (1) nine state health agencies, (2) three local health agencies, and (3) all local jurisdictions and the state health agency in one state, a workable methodology for identifying public expenditures for comprehensive public health programming has been identified.

After the Waters Receded: A Qualitative Study of University Official’s Disaster Experiences During the Great Iowa Flood of 2008

When the Great Flood of 2008 hit towns across Eastern Iowa, officials from the University of Iowa shut its operations for a week, relocated and evacuated students and community residents, and suffered damage to over a dozen buildings. This study is a qualitative assessment of the experiences and perceptions of twelve university officials involved in the response and management of the disaster. Major themes are presented according to phases of the Disaster Management Cycle. During the preparedness phase, an established all-hazards plan as well as specific annexes for flooding and pandemic influenza proved to enhance community response to the flood. However, training university clientele across a large organization to execute these plans and respond to future disasters is not an easy task. The content and effective means for delivering these trainings are areas for further research. During the response phase of the flood, officials swiftly expedited a business continuity plan to assure that personnel were paid during the university closure. However, enforcing a policy to avoid coming to work during the closure was challenging. Thus, future work must be done to determine and implement effective disaster communications that relay clear messages about roles and responsibilities. Now, in recovery, the university must rebuild its infrastructure and consider potential mental health issues. Lessons learned from the Great Flood of 2008 provide the opportunity to self-assess and prepare universities for disasters in the future.

Developing the academic institution's role in response to bioterrorism: the Iowa Center for Public Health Preparedness.

The terrorist acts during the fall of 2001 triggered renewed concern about the capacity of the nations public health system to deal with crisis. A critical element of the response ability of the public health system is a prepared workforce. Based on a pre-existing concern about emerging infectious disease, the Centers for Disease Control (CDC), working with the Association of Schools of Public Health, had established a network of university-based Centers for Public Health Preparedness. The events of September 11 accelerated, expanded, and focused this effort. This article discusses this national program, details the activities of the based Center for Public Health Preparedness located at the University of Iowa, and suggests preparedness issues deserving future development.

Public Health and Terrorism Preparedness: Cross-Border Issues

On December 15, 2003, the Centers for Public Health Preparedness at the University of Minnesota and the University of Iowa convened the “Public Health and Terrorism Preparedness: Cross-Border Issues Roundtable.” The purpose of the roundtable was to gather public health professionals and government agency representatives at the state, provincial, and local levels to identify unmet cross-border emergency preparedness and response needs and develop strategies for addressing these needs. Representatives from six state and local public health departments and three provincial governments were invited to identify cross-border needs and issues using a nominal group process. The result of the roundtable was identification of the needs considered most important and most doable across all the focus groups. The need to collaborate on and exchange plans and protocols among agencies was identified as most important and most doable across all groups. Development of contact protocols and creation and maintenance of a contact database was also considered important and doable for a majority of groups. Other needs ranked important across the majority of groups included specific isolation and quarantine protocols for multi-state responses; a system for rapid and secure exchange of information; specific protocols for sharing human resources across borders, including emergency credentials for physicians and health care workers; and a specific protocol to coordinate Strategic National Stockpile mechanisms across border communities.

Public Health Strategy and the Police Powers of the State

The preparedness of the U.S. public health system to respond to acts of terrorism has received a great deal of attention since September 11, 2001, and especially subsequent to the anthrax attacks later that year. The use of biologic agents as a weapon has served as a catalyst to better aligning public safety and health strategies through public health law reforms. Associated with this work is the renewal of the debate over the most appropriate means to both protect the public and asssure the rights of individuals when implementing readiness strategies. A key element of the debate focuses on what is a reasonable application of state-based police powers to ensure community public health standards. The doctrine of state “police power” was adopted in early colonial America from firmly established English common law principles mandating the limitation of private rights when needed for the preservation of the common good. It was one of the powers reserved by the states with the adoption of the federal Constitution and was limited only by the Constitutions Supremacy Clause—which mandates preeminence of federal law in matters delegated to the federal government—and the individual rights protected in the subsequent Amendments.1,2 The application of police power has traditionally implied a capacity to (1) promote the public health, morals, or safety, and the general well-being of the community; (2) enact and enforce laws for the promotion of the general welfare; (3) regulate private rights in the public interest; and (4) extend measures to all great public needs.3 The application of “police powers” is not synonymous with criminal enforcement procedures; rather, this authority establishes the means by which communities may enforce civil self-protection rules. More specifically, public health police power allows the states to pass and enforce isolation and quarantine, health, and inspection laws to interrupt or prevent the spread of disease. Historically, the exercise of public health police power was enforced with strong support of the courts and restraint of police power occurred only when there was open disregard for individual rights. The abilities of states to exercise their police powers has been constrained since the 1960s by the legal and social reexamination of the balance of power between the individual, the states, and the federal government, which affects contemporary efforts to reform public health law in the face of terrorism. Given the development of the criminally based threats to health marked by bioterrorism, the relatively recent emphasis on the personal rights side of the equation should be reassessed.4 A reexamination of the legal, ideological, and social limits of police power is appropriate since increased state capacity can be crucial for first responses to terrorist threats or actions. Effective first responses may be hampered in the absence of pragmatically designed realignments of the state-individual relationship and the redesign of state public health infrastructures.5 This article begins with an historical overview of the doctrine of state police power, addresses recent limitations imposed on the implementation of public health police powers, then uses the example of the imposition of quarantine orders to illustrate the states capability to impose such orders in exercise of its police power. Finally, it suggests changes in state public health agency governance, focus, and regulation to rebalance public and private interests.

Assessing public health performance in Iowa's counties.

Local health agencies in Iowa were surveyed to assess the performance of public health practices in their communities. Responses were received from 97 percent of counties. Less than 50 percent of counties were performing half of the indicators of the Assessment function. Policy Development functions also were frequently not performed. Performance was best in the Assurance function, with 86 percent of counties reporting that they inform and educate the public. However, the other three types of Assurance practices (Manage, Implement, and Evaluate) were performed less frequently. Comparison of the performance of Iowas rural counties reveals a profile nearly identical to that reported elsewhere for a group of six other states.

Matching Documented Training Needs With Practical Capacity: Lessons Learned From Project Public Health Ready

The Upper Midwest offers a distinct environment for identifying and addressing threat and preparedness scenarios. The population is often scattered, with residents using urban centers periodically. This has also led to the challenge of providing specific skills and cross-disciplinary awareness and coordination to the public health community. The Upper Midwest Center for Public Health Preparedness was established by a grant from the Centers for Disease Control and Prevention to assist in meeting the challenge of adding capacity to develop the preparedness workforce in the Upper Midwest. Project Public Health Ready (PPHR) provides an example of the role academic preparedness centers can play in partnering with local public health agencies to strengthen the public health workforce. The purpose of this article is to present the Iowa Systems Model for Workforce Development being utilized for workforce training and education, describe how the model has been applied in the example of PPHR, and discuss lessons learned from the PPHR experience.

Preparing and sustaining a comprehensive pandemic plan for an academic community.

Creating a public health emergency plan requires unprecedented cooperation and active participation across an academic institution and throughout the community in which that institution is located. Developing an effective plan at an academic institution to mitigate the consequences of a global event, such as an influenza pandemic, requires development of new understandings, relationships, and agreements in an environment traditionally governed by principles of academic freedom and shared governance. Established in 1847, the University of Iowa (UI) is a major research university located in Iowa City, Iowa, population 63,807, within Johnson County. In many respects, the UI represents a community of its own with more than 50,000 students, staff, and faculty carrying out a

Governmental Public Health In The United States: The Implications Of Federalism

2.1 billion budget. The international student population, which comprises approximately 7% of the student body, represents more than 100 countries. Housing is provided for the approximately 6,000 students who choose to live on campus in residence halls. The remaining 24,000 students live off campus, largely remaining in Iowa City. A campus bus system, Cambus, provides transportation among the 11 colleges, the UI Hospitals and Clinics (UIHC, a 680-bed, comprehensive academic medical center), the University Hygienic Laboratory (Iowa’s environmental and public health lab), various administration centers, parking facilities, libraries, museums, and athletic complexes. The UI’s all-hazards Critical Incident Management Plan, maintained by the UI Department of Public Safety, was crafted to respond to traditional public safety concerns such as weather-related crises or criminal activities. The threat of an influenza pandemic made apparent the need for UI to develop new plans and strategies to address the possibility of a public health emergency on campus.