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Perspectives in Disease Prevention and Health Promotion Implementing the 1990 Prevention Objectives: Summary of CDC's Seminar
In the publication, Promoting Health/Preventing Disease: Objectives for the Nation (1), the U.S. Public Health Service (PHS) established 226 measurable objectives in 15 priority areas to be achieved by 1990: high blood pressure control, family planning, pregnancy and infant health, immunization, sexually transmitted disease control, toxic agent control, occupational safety and health, injury control, fluoridation and dental health, infectious disease surveillance and control, smoking and health, alcohol and drug misuse, nutrition, physical fitness and exercise, and stress and violent behavior control. In developing these objectives, PHS drew on the expertise of over 500 individuals from the public and private sectors, representing federal agencies and departments, state and local health agencies, consumer groups, volunteer organizations, and academic and other health professionals.
CDC was given the lead responsibility within PHS for working with state and local health departments in developing comparable objectives tailored to the needs of their populations and in implementing prevention activities. As part of its effort to work with the states on the 1990 Objectives, CDC convened a seminar on September 23-24, 1982, in Atlanta, Georgia, with two major objectives: 1) to determine how PHS can assist state, county, and city health officials and health professionals in achieving the 1990 Objectives for the Nation; and 2) to consider methods of fostering collaboration among the academic community, non-governmental public health organizations, and governmental public health agencies directed toward achieving the national prevention goals.
The 200 seminar participants represented a cross-section of U.S. medical and public health organizations, including: the Association of State and Territorial Health Officials, the National Association of County Health Officials, and the U.S. Conference of City Health Officers; the academic community, including the Association of Schools of Public Health and the Association of Teachers of Preventive Medicine; and public health and professional associations, such as the American Public Health Association, the American Rural Health Association, the American Academy of Pediatrics, and the American Conference of Governmental Industrial Hygienists. Representatives from all PHS agencies and state and local participants from different geographic areas (e.g., California, Michigan, Pennsylvania, Texas, and Utah) also attended.
Presidents of state, city, and county health officers' associations described how their states and communities use the 1990 Objectives and how actions and resources needed by state and local health agencies can achieve these Objectives. A number of states--including California, Connecticut, Georgia, Minnesota, and Utah--have adopted the national Objectives as part of their process for setting state priorities. To develop performance standards for their local health programs, Seattle, Washington, and Birmingham, Alabama, have analyzed the 1990 Objectives and the Model Standards for Community Preventive Health Services (2).
Among the important needs identified by health officials were: information exchange among federal, state, and community agencies; improved state surveillance systems and data analyses to track progress toward the Objectives; scientific expertise and technical consultation; multi-city intervention trials; research on cost-effective prevention measures; professional training; stronger links between Medicaid and state public health programs; and support for extending health promotion programs to vulnerable populations in both urban and rural areas. After the health officers' panel, brief presentations by leaders of professional associations and the academic community opened the general discussion. The issues were examined in more detail during work group sessions.
The seven work groups were organized according to priority areas identified in Promoting Health/Preventing Disease: Objectives for the Nation: Fluoridation and Dental Health, Health Promotion, Immunization, Injury Control, Occupational Safety and Health/Toxic Agent Control, Sexually Transmitted Disease Control, and Surveillance and Control of Infectious Diseases. The work groups' recommendations can be summarized into seven categories:
strategies: PHS epidemiologic studies and demonstration and evaluation projects are needed to identify prevention opportunities, to test the feasibility of possible interventions, and to assess and compare the effectiveness of different prevention strategies. Such studies would identify: behavioral risk factors, illnesses related to toxic exposures in the community and workplace, injury-related risk factors and injury control strategies, and additional cost-effective methods for controlling sexually transmitted diseases. They would also evaluate new and existing vaccines and develop new technology for the control of hospital infection.
2. Technical assistance in the development of programmatic data: All work groups identified the need to develop improved surveillance methods and uniform data definitions (e.g., age groups, race). State and local health officials encouraged PHS to assist in developing data collection methods and in analyzing data assessing the extent of preventable health problems, identifying target populations, and determining the effectiveness of particular interventions. Results of these data analyses could then be applied to programs implemented at the state and local levels. Among the identified data needs were the development of state injury-surveillance systems, surveys to monitor serious dental health problems, surveillance of occupational injuries and health effects of exposure to toxic substances, and applications of the results of state surveys on the prevalence of behavioral risk factors.
3. Information interpretation and transfer: Seminar participants viewed PHS as a national repository for scientific information on prevention-related subjects. Work groups recommended that PHS facilitate information exchange on model programs and effective control methods among the various state and local governments and with the academic community and professional organizations. This role in technology transfer would include developing information on performance standards for prevention practices and programs. "Sexually Transmitted Diseases: Treatment Guidelines, 1982" is a recent example of a source of technical information on prevention (3). Participants identified a need for additional information transmission on injury-control methods and behavioral research findings.
4. Professional development and training programs: All work groups expressed concern about the need to incorporate prevention methods and concepts, including the 1990 Objectives, into clinical training for medical and other health professionals and into public health school curricula. Training programs were proposed in several areas, particularly health promotion and occupational safety and health. Special courses to train health agency epidemiologists and industrial hygienists in current environmental and occupational health approaches were suggested. Similarly, the Health Promotion work group recommended developing a training program in planning, implementing, and evaluating health promotion programs for state and local health department personnel.
5. Building coalitions at the state and local level: Participants identified a key role for state and local health agencies in influencing public decision-makers to implement programs and policies that promote health. As part of the effort to establish coalitions supporting prevention programs, health agencies would be responsible for building relationships with schools of public health and medicine and prevention-oriented private organizations. Public health leaders could convene meetings addressing the 1990 Objectives and initiate collaboration projects that might result in innovative methods of preventing illness and improving health. To facilitate cooperative efforts between health agencies and private groups, health officers could review and recommend to foundations their findings regarding support for prevention projects. State and local health departments could also co-sponsor health promotion campaigns organized by volunteer associations, such as the American Cancer Society's Great American Smoke-Out.
6. Building coalitions at the national level: Work groups emphasized a leadership role for PHS in building relationships between official health agencies, professional associations, and academic institutions, including working with schools of public health and medical school preventive medicine departments to integrate the 1990 Objectives into their academic curricula; promoting the importance of health department activities among academic leaders; encouraging schools of public health and medicine to initiate joint studies with state and local health departments; and assisting these institutions to form coalitions at the state and local levels. Participants were interested in using professional and public coalitions to translate concern for promoting health into active and effective prevention programs and policies.
7. Dissemination of information to the public: One concern emphasized by all work groups was the need for public information about actions that individuals and organizations can take to prevent disease and promote health. Specifically, the participants recommended that CDC provide leadership in educating the public about disease detection and prevention methods and that state and local health departments, federal health agencies, professional organizations, and private organizations work with the media to transmit prevention messages to the public. Future seminars should include journalists as active participants to further public education on prevention issues.
These findings will be disseminated to seminar participants and to other public health professionals through the co-sponsoring organizations. Furthermore, CDC is working with the other PHS agencies to begin implementing many of the recommendations through current program activities. For example, the Health Resources and Services Administration and CDC are sponsoring workshops with schools of medicine and public health to identify ways of incorporating prevention methods into training programs for health professionals. The Office of Disease Prevention and Health Promotion (in the Office of the Assistant Secretary for Health), the National Center for Health Statistics, and CDC are identifying existing sources of data and the additional data needed to track progress toward the 1990 Objectives. PHS will also consider and analyze the seminar's recommendations during the program-planning process for fiscal year 1985 and beyond.
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