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Dragonfly, Winter 1999 The Environment of Local Public Health: What Does Population-based Focus Really Mean? Neil Rambo

So you want to work with your local public health department? Maybe they've contacted you for copies of articles. Or you see good reasons to establish a mutually beneficial relationship with them. As with reaching out to serve and collaborate with any group, it pays to know something about who they are and what they do.

What do you know about your local public health department? Who are their "customers?" Who funds them? To whom do they report? Typically, a local health department is part of county government, although in urban areas it may be a combined county-city entity, and in more rural areas several counties may form a single health district. This has implications for how an agency is organized and whom it reports to. All good things to know.

What does a local health department do? Some think that public health is about minimal medical care to poor people. That used to be truer than it is now in an era of managed care and an expanding domain of what constitutes public health concerns. Many health departments do provide some patient care (e.g., immunizations, STD clinics, prenatal screening, and nutrition counseling). But local public health has become much more than that. It is a mix of services designed to meet the needs of communities in preventing the spread of disease, protecting people from unsafe drinking water, air, and hazardous waste, and ensuring that people have the information and resources needed to live healthy lives. These are known as population-based services.

Who are the health professionals on staff? You may find every type represented, and then some. You may find physicians and nurses who also care for patients at the hospital or clinic. There are public health nurses who work in a variety of roles with child care centers and school districts, mental health and drug and alcohol treatment programs, and law enforcement agencies. There are environmental health specialists who inspect drinking water for bacterial or chemical contamination; who work with solid waste programs to insure safe disposal; who inspect restaurants and train food workers to prevent foodborne illness. In larger jurisdictions there will be epidemiologists and others trained in tracking infectious disease outbreaks. There are those who monitor the health status of a community. There are social workers and data analysts. The list is a long one and it depends on local needs and programs.

In a nutshell: Local public health is very broad. To those used to the clinical care environment it is also somewhat messy. Public health is the application of health science in a community context. It's science, but it's also politics. It follows that the information needs are very broad and overlap with subject areas that we don't usually think of as being health-related.

Clearly, MEDLINE isn't always the answer in this uncertain territory. Like their clinical counterparts, though, most public health workers will find PubMed to be an enormously useful tool and a great boon to their practice. But not all will. Environmental health is a good example of an information challenge encountered in public health. Much of it, of course, is directly concerned with human health (e.g., vector-borne pathogens and toxicology). But it also gets into other areas such as surface and ground water use, sewer and septic system inspection and permitting, sanitation codes and practices, -- you get the idea.

The point is not to be discouraging. A librarian trained in working with health professional information needs has a tremendous amount to offer public health workers. Just be aware that many needs, and the resources to meet them, go beyond those that most of us are familiar with. No need to be daunted by that. As a librarian, you have information retrieval and evaluation skills that are of great value to this audience. Show them PubMed and other NLM resources, but also demonstrate how to do a smart and effective Web search. Show how to efficiently separate useful items from the other stuff and their time will have been well spent.

Other than providing brief and basic introductions to PubMed, what can you offer? Copies of articles and Loansome Doc service are sure to be popular. The public health nurses may be your most enthusiastic customers, but they probably aren't used to obtaining articles (or paying for them). This could be a good opportunity to let staff know what services you offer. Many of them won't know what's available.

Other thoughts on the local public health environment:

1. Public health practice is much more data-based than knowledge-based. This is part of the nature of the enterprise. When tracking an outbreak of E. coli O157, you are more concerned about numbers of victims, where they are, and how they were exposed, than you are about research on the organism and its effects on its host. (If you were treating a victim, though, -- a clinical rather than a population focus -- the opposite would be true.)

2. But the practice of public health is developing as a discipline. Its own body of knowledge -- one that is distinct from medicine or, say, public administration -- is growing. Similar to other fields in this process, public health practice will become more knowledge-based as the knowledge base about it grows.

   A related factor is the pressure for accountability. The focus on program evaluation and outcomes is encouraging a look at best practices in designing community interventions, for example. Increasingly, local public health is an information service: It gathers, compiles, analyzes, synthesizes, interprets, and disseminates population-based information about the health of the community.

3. Local health departments are strongly oriented toward the state health department. Although independent entities, the locals look to the state for leadership, coordination, and funding. It's a good idea to spend some time combing through the state department's Web site to get an idea of what resources and data are there. This will be a limited view because it's only what is publicly available. Much of the traffic between the local and state levels is sensitive data, increasingly available to authorized users over a secure intranet. Nevertheless, the state health department's Web site will give you a glimpse of what's happening and some of that will be reflected at the local level too.
4. At the top of the public health hierarchy is CDC. CDC sets much of the public health agenda that other levels of the hierarchy then carry out. Learn its Web site (warning: it's not always easy to get around) and you've taken a step toward anticipating what questions you may be asked by your local public health workers. You will look good if you know where immunization guidelines can be found: you might try Travelers Health, and the Prevention Guidelines Database, but don't forget to use the Search tool to find other important documents. Know how to retrieve a recent issue of the Morbidity and Mortality Weekly Report (MMWR): in PDF format from the MMWR pages and in HTML from the MMWR dataset in the CDC WONDER search system.

Public health professionals, like all practitioners, need one-stop-shopping. This is never truer than for information resources that are notoriously scattered. Two Web sites that attempt to answer some of that need are the Northwest Center for Public Health Practice and the Washington INPHO sites:

http://healthlinks.washington.edu/nwcphp/ and http://healthlinks.washington.edu/inpho/

These sites attempt to organize relevant and authoritative resources. From the NWCPHP page, note in particular the Tools and Calendar features (buttons on the control panel). From the INPHO page, follow the links for Diseases, Injuries & Disabilities => Infectious Diseases => Disease Specific Resources. These specific disease pages are examples of a practitioner's "information toolkit." They are categorized templates for the kinds of information a public health professional might need. They are pre-packaged and ready to serve.

The focus of both sites is Washington State but much is applicable beyond state borders. Feel free to refer to these resources if they would be useful in your setting. I welcome any comments or suggestions on how to improve them: Neil Rambo, nrambo@u.washington.ed, 206-616-3472.

URL: http://nnlm.gov/pnr/news/199901/local.html