Patrick W. O'Carroll

Public health informatics: improving and transforming public health in the information age.

Development of effective public health information systems requires understanding public health informatics (PHI), the systematic application of information and computer science and technology to public health practice, research, and learning. PHI is distinguished from other informatics specialties by its focus on prevention in populations, use of a wide range of interventions to achieve its goals, and the constraints of operating in a governmental context. The current need for PHI arises from dramatic improvements in information technology, new pressures on the public health system, and changes in medical care delivery. Application of PHI principles provides unprecedented opportunities to build healthier communities.

Suicide clusters: an examination of age-specific effects.

The age specificity of time-space clusters of suicide was examined using National Center for Health Statistics data for 1978-84. Significant clustering of suicide occurred primarily among teenagers and young adults, with minimal effect beyond 24 years of age. Clustering was two to four times more common among adolescents and young adults than among other age groups.

New directions in violence prediction: the public health arena.

Injury resulting from interpersonal violence is now recognized as an important public health problem. Consequently, the public health community is applying its perspectives and strategies to the goal of preventing violence. The public health approach emphasizes preventing injuries due to interpersonal violence from occurring or recurring, rather than treating the health consequences of these injuries. Four interrelated steps are used to develop information to guide the development of prevention strategies: public health surveillance, risk group identification, risk factor exploration, and program implementation/evaluation. The ability to predict which people are at greatest risk of injury (or producing injury) and the relative effectiveness and costs of alternative prevention strategies are central to decisions influencing the nature and focus of public health prevention strategies. In order to improve the information base on which decisions concerning violence prevention strategies are founded, the following activities should be given priority: (a) developing surveillance systems for morbidity associated with interpersonal violence; (b) precisely identifying risk groups for nonfatal violent events; (c) applying case-control methods to the exploration of potentially modifiable risk factors for injuries and violent behaviors; and (d) rigorously evaluating extant programs that are intended to prevent interpersonal violence or modify a suspected risk factor for violence.

Information needs in public health and health policy: results of recent studies.

ConclusionClearly, much work needs to be done to address the diverse and sometimes unique on-line information needs of public health professionals and health policy analysts. In some cases, there are needs for complex new knowledge bases created via linkages among multiple databases (e.g., public health-relevant geographic information systems).However, in many other cases, what is needed is a more systematic way of capturing the so-called grey literature: policy documents, government reports, legislative summaries, industry group publications, descriptions of best practices, and so on. In general, very little of this grey literature is formally peer reviewed, most is not available on-line, and almost none of it is accessible through such trusted databases as MEDLINE. Yet, it is frequently this practice-oriented literature that is of most importance to public health professionals and health policy analysts. New systems are needed to make this large and growing body of information accessible electronically in a well-indexed, timely, reasonably comprehensive, yet meaningfully filtered, manner. The development of such systems presents new and difficult challenges to those interested in ensuring on-line access to such information for health policy analysts and public health professionals.Clearly, much work needs to be done to address the diverse and sometimes unique on-line information needs of public health professionals and health policy analysts. In some cases, there are needs for complex new knowledge bases created via linkages among multiple databases (e.g., public health-relevant geographic information systems). However, in many other cases, what is needed is a more systematic way of capturing the so-called grey literature: policy documents, government reports, legislative summaries, industry group publications, descriptions of best practices, and so on. In general, very little of this grey literature is formally peer reviewed, most is not available on-line, and almost none of it is accessible through such trusted databases as MEDLINE. Yet, it is frequently this practice-oriented literature that is of most importance to public health professionals and health policy analysts. New systems are needed to make this large and growing body of information accessible electronically in a well-indexed, timely, reasonably comprehensive, yet meaningfully filtered, manner. The development of such systems presents new and difficult challenges to those interested in ensuring on-line access to such information for health policy analysts and public health professionals.

Public Health 101 for Informaticians

Public health is a complex discipline that has contributed substantially to improving the health of the population. Public health action involves a variety of interventions and methods, many of which are now taken for granted by the general public. The specific focus and nature of public health interventions continue to evolve, but the fundamental principles of public health remain stable. These principles include a focus on the health of the population rather than of individuals; an emphasis on disease prevention rather than treatment; a goal of intervention at all vulnerable points in the causal pathway of disease, injury, or disability; and operation in a governmental rather than a private context. Public health practice occurs at local, state, and federal levels and involves various professional disciplines. Public health principles and practice are illustrated by a case study example of neural tube defects and folic acid. The application of information science and technology in public health practice provides previously unfathomed opportunities to improve the health of the population. Clinical informaticians and others in the health care system are crucial partners in addressing the challenges and opportunities offered by public health informatics. � J Am Med Inform Assoc. 2001;8:585-597.

Regional Variation in Homicide Rates: Why Is the West So Violent?

Scientists have long been interested in the fact that the South has consistently had the highest crude homicide rates in the United States. Past investigations, however, have generally been predicated on the assumption that this geographic pattern was not attributable to or substantially altered by the age or race structures of the populations being compared. In this study, we calculated age-adjusted homicide rates for each of three race categories—white, black, and other—for each state and region in the United States in 1980. We found that for each race group, homicide rates were highest, not in the South, but in the West. Moreover, homicide rates for blacks were lower in the South than in any other region of the country. We infer that, for 1980 at least, the high crude homicide rate in the South results from the mutual effect of two factors: (1) blacks have very high homicide rates compared with whites, and (2) blacks make up a larger proportion of the population in the South than in other regions of the country. It remains to be determined whether the age-adjusted, race-stratified rates of past decades also show this pattern.

Using problem-based learning as a strategy for cross-discipline emergency preparedness training.

The rapid and effective response to a bioterrorist event requires the coordinated efforts of trained personnel from different agencies. This article describes the design and implementation of a 1-week cross-disciplinary course employing problem-based learning (PBL) for professionals with backgrounds in public health, fire/emergency medical services (EMS), law enforcement, emergency management, and hospital administration. The curriculum provided opportunities for professionals from different disciplines to meet and learn the priorities and resources of partner agencies. In course evaluations, participants rated the training highly and found it applicable to their work and a good use of time and training resources. PBL techniques were successful in fostering cross-agency communication, thereby showing promise as an effective training method for meeting local and national emergency preparedness objectives.

Issues and opportunities in public health informatics: a panel discussion.

A panel was convened at the American Medical Informatics Association Spring Congress to discuss issues and opportunities that arise when informatics methods, theories, and applications are applied to public health functions. Panelists provided examples of applications that connect efforts between public health and clinical care, emphasizing the need for integration of clinical data with public health data and the analysis of those data to support surveillance and informed decision making. Benefits to be gained by both medical informatics and public health at the interface were evident; both encounter the same major issues including privacy, systems integration, standards, and many more.

Assessing regional public health preparedness: a new tool for considering cross-border issues.

OBJECTIVE To provide regional, state, and local public health officials a conceptual framework and checklist for assessing regional public health emergency preparedness, specifically in regard to cross-border public health preparedness needs. METHODS The project had four phases that are as follows: defining the scope, conducting a literature review, soliciting expert opinion, and creating the assessment framework and checklist. A conceptual framework was developed to define the scope of the project on the basis of the kinds of resources likely to be shared across borders in a public health response (eg, data, supplies, staff), in support of the public health functions likely to be important in a health emergency (eg, epidemiology, laboratory). A literature review was then conducted to identify key articles and tools addressing regional preparedness. Key informant interviews (n = 23) were conducted with public health and emergency management professionals in the Pacific Northwest to identify a set of systems, agreements, and protocols that should be systematically considered in assessing regional public health preparedness. Using the literature review and themes from interviews, a checklist was developed. RESULTS A checklist was developed for use by public health leaders, which recommends 24 specific agreements, protocols, systems, and management structures that should be considered to foster cross-border public health preparedness. CONCLUSIONS Regional public health preparedness represents not only the sum of state-level preparedness of the states in a region but also the capacity of those states to collaborate across state and international borders during a public health emergency. This checklist provides a tool to systematically consider cross-border preparedness issues.

The rapid implementation of a statewide emergency health information system during the 1993 Iowa flood.

In the face of disastrous flooding, the Iowa Department of Public Health established the statewide Emergency Computer Communications Network to establish rapid electronic reporting of disaster-related health data, provide e-mail communications among all county health departments, monitor the long-range public health effects of the disaster, and institute a general purpose public health information system in Iowa. Based on software (CDC WONDER/PC) provided by the Centers for Disease Control and Prevention and using standard personal computers and modems, this system has resulted in a 10- to 20-fold increase in surveillance efficiency at the health department, not including time saved by county network participants. It provides a critical disaster assessment capability to the health department but also facilitates the general practice of public health.