Public Health Commons^™

The Association Between Insurance Status And Cervical Cancer Screening In Community Health Centers: Exploring The Potential Of Electronic Health Records For Population-Level Surveillance, 2008-2010, Stuart Cowburn, Matthew J. Carlson, Jodi A. Lapidus, Jennifer E. Devoe

Sociology Faculty Publications and Presentations

Introduction: Cervical cancer incidence and mortality rates in the United States have decreased 67% over the past 3 decades, a reduction mainly attributed to widespread use of the Papanicolaou (Pap) test for cervical cancer screening. In the general population, receipt of cervical cancer screening is positively associated with having health insurance. Less is known about the role insurance plays among women seeking care in community health centers, where screening services are available regardless of insurance status. The objective of our study was to assess the association between cervical cancer screening and insurance status in Oregon and California community health centers …

Towards A Framework Convention On Global Health, Lawrence O. Gostin, Eric A. Friedman, Kent Buse, Attiya Waris, Moses Mulumba, Mayowa Joel, Lola Dare, Ames Dhai, Devi Sridhar

Georgetown Law Faculty Publications and Other Works

A global health treaty, a Framework Convention on Global Health (FCGH)–grounded in the right to health, with the central goal of reducing immense domestic and global health inequities–could serve as a robust global governance instrument to underpin the United Nations post-2015 Millennium Development Goals (MDGs). It would ensure for all people the three essential conditions for a healthy life–public health, health care, and the positive social determinants of health–while advancing good governance, responding to drivers of health disadvantages for marginalized populations, elevating health in other legal regimes, and enhancing people's ability to claim their rights.

The legally binding nature of …

Providing Outreach And Enrollment Assistance: Lessons Learned From Community Health Centers In Massachusetts, Julia Paradise, Sara J. Rosenbaum, Peter Shin, Jessica Sharac, Carmen Alvarez, Julia Zur, Leighton Ku

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

In 2006, major health care reform legislation was enacted in Massachusetts. In many ways a prototype for the Affordable Care Act (ACA), the Massachusetts law required nearly all state residents to obtain health insurance, and made insurance accessible and affordable by reforming the health insurance market and providing subsidies for coverage through expansions of Medicaid and CHIP and a new program for low-income adults who are not eligible for Medicaid, known as Commonwealth Care. The law also created the “Connector,” which, like the ACA’s health insurance Marketplaces, is designed to facilitate and simplify access to insurance for individuals, families, and …

Overcoming Shortage Of Pharmacists To Provide Pharmaceutical Services In Public Health Centers In Indonesia, Yuyun Yuniar, Max Joseph Herman

Kesmas

Indonesia masih menghadapi keterbatasan jumlah apoteker di puskesmas, sehingga pihak pemerintah daerah dan puskesmas harus berupaya mengatasi permasalahan tersebut. Penelitian ini bertujuan untuk menggambarkan ketersediaan dan distribusi tenaga pelayanan kefarmasian di puskesmas serta permasalahan dan alternatif pemecahannya. Data diambil dari hasil Riset Fasilitas Kesehatan (Rifaskes) tahun 2011I. Data kuantitatif tentang tenaga pelayanan kefarmasian di puskesmas dianalisis secara deskriptif berdasarkan regional. Data kualitatif sebagai pendukung diperoleh melalui wawancara mendalam dengan bagian kepegawaian dinas kesehatan dan apoteker empat puskesmas di Kota Bogor dan Bekasi, 3 kemudian dianalisis dengan metode analisis tema. Hasil analisis menunjukkan bahwa Sulawesi memiliki persentase puskesmas dengan tenaga apoteker …

Diffusion Of Innovation Across A National Local Health Department Network: A Simulation Approach To Policy Development Using Agent-Based Modeling, Mark Orr, Jacqueline Merrill

Frontiers in Public Health Services and Systems Research

The network that local health officials use to communicate about professional issues is sparsely connected, which may limit the spread of innovative practices. We used agent-based simulation modeling to find out if a policy to promote more connections improved the network’s capability to diffuse innovation. We found that unanticipated effects could result, depending on the requirements of the policy and the proportion of health officials involved. With carefully crafted assumptions and reliable data it is possible to untangle complex processes using simulation modeling. The results represent how the world might actually work which may provide useful decision support for policymakers …

Community Health Assessment By Local Health Departments: Presence Of Epidemiologist, Governance, And Federal And State Funds Are Critical, Gulzar H. Shah, Barbara Laymon, Julia Joh Elligers, Carolyn Leep, Christine B. Bhutta

Frontiers in Public Health Services and Systems Research

Using the data from the National Association of County and City Health Officials’ (NACCHO) 2010 Profile of Local Health Departments (LHDs) our study investigates whether or not infrastructural characteristics of LHDs were associated with completion of community health assessment (CHA). Our results show that local and shared LHD governance, greater share of revenue from federal and state sources, smaller population size in LHD jurisdiction, and having an epidemiologist significantly increased the odds of CHA completion in the past, after controlling for community characteristics and other independent variables. These findings have important implications for LHDs, PHAB and its partners.

Jefferson Hosts American Public Health Association Student Assembly's Strategic Planning Meeting, Alex Bryan

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Factors Influencing Access To Healthcare Services, Melissa Delia

Independent Study Project (ISP) Collection

Following several political upheavals, the country of Madagascar has become one of the poorest countries in the world. This level of poverty affects many aspects of life, especially access to healthcare services. The availability of both allopathic and traditional healthcare to the impoverished citizens of Madagascar was examined through discussions, interviews, and journal articles. It was found that although both the allopathic and traditional medicinal systems do not charge their patients for general consultations and care, there is a high cost for pharmaceutical medications in the allopathic system. These medications are sometimes too expensive for many Malagasy patients to afford. …

Racial Disparities In The Use Of Cardiac Revascularization: Does Local Hospital Capacity Matter?, Suhui Li, Arnold Chen, Katherine H. Mead

Health Policy and Management Faculty Publications

Objective: To assess the extent to which the observed racial disparities in cardiac revascularization use can be explained by the variation across counties where patients live, and how the within-county racial disparities is associated with the local hospital capacity.

Data Sources: Administrative data from Pennsylvania Health Care Cost Containment Council (PHC4) between 1995 and 2006.

Study Design: The study sample included 207,570 Medicare patients admitted to hospital for acute myocardial infarction (AMI). We identified the use of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) procedures within three months after the patient’s initial admission for AMI. Multi-level hierarchical …

The Stigmatization Of Disabilities In Africa And The Developmental Effects, Kelsey Koszela

Independent Study Project (ISP) Collection

Stigmatization still exists in large scale and leads to exclusion and continued poverty and poor standard of life for persons with disabilities, especially for those living in Africa. The main cause of stigmatization in Africa is a lack of education about disabilities and the needs of persons with disabilities. The unknown creates fear in society and exclusion for persons with disabilities, prohibiting them from obtaining decent education, proper health care and having access to jobs and financial support. Since the Convention for the Rights of Disabled Persons (CRPD) in 2006 societal education has been supplemented by implementation of development programs …

Local Public Health In Financial Crises: Common Decision Drivers For Changes In Services Due To Economic Downturn, Gulzar H. Shah

Health Policy & Management: Faculty Presentations (2008-2022)

We measured the impact of the 2008-2010 economic recession on local health departments (LHDs) across the United States. Between 2008 and 2010, we conducted 3 Web-based, cross-sectional surveys of a nationally representative sample of LHDs to assess cuts to budgets, workforce, and programs. By early 2010, more than half of the LHDs (53%) were experiencing cuts to their core funding. In excess of 23 000 LHDs jobs were lost in 2008-2009. All programmatic areas were affected by cuts, and more than half of protecting the health of the public, such as monitoring health status to identify and solve community health …

Community Health Assessment Activity By Lhds: The Influence Of Local Health Agency And Community Characteristics, Gulzar H. Shah, Barbara Laymon, Carolyn Leep, Julia Elligers

Health Policy & Management: Faculty Presentations (2008-2022)

Research Objective: This study investigates organizational and community characteristics associated with the likelihood of local health departments to conduct community health assessments (CHAs).

Study Design: For this observational study, we used data from the 2010 National Profile of Local Health Departments Study (Profile). Using the FIPS codes for the county and place, additional data were merged with Profile data to capture community characteristics. To compute estimates of community characteristics for LHDs involving multiple cities/counties, we computed population weighted averages. In order to estimate unbiased population parameters, we used appropriate statistical weights in all analyses, to account for disproportionate non-responses …

The Resilient Local Health Department: Surviving The 2008 Economic Crisis, Paul C. Erwin, Gulzar H. Shah, Glen P. Mays

Health Policy & Management: Faculty Presentations (2008-2022)

Research Objective: The purpose of this study was to identify potential modifiable factors that can protect local health departments from job losses and budget cuts during periods of economic stress.

Study Design: This was a retrospective cohort study which used data from census surveys of local health departments (LHDs) which were conducted in 2005 and 2010 by the National Association of County and City Health Officials. The 2005 survey data served as the source of independent variables, which were grouped around domains of organization, revenue, and services. The outcome of interest - resiliency of the LHD - represented financial resiliency …

Rural Children Experience Different Rates Of Mental Health Diagnosis And Treatment, David Hartley Phd, Mph, Jennifer D. Lenardson Mhs, Nathaniel J. Anderson Ms, Mph, Samantha J. Neuwirth Md

Mental Health / Substance Use Disorders

Research indicates that privately insured, rural adults have lower use of office-based mental health services, but higher use of prescription medicines than their urban counterparts. Patterns for rural children may be different from urban children because of the limited supply of pediatric mental health providers in rural areas, which may lead to reduced access and lower use of mental health services in rural areas versus urban. Using data on children ages 5-17 from the 2002-2008 of the Medical Expenditure Panel Survey, researchers from the Maine Rural Health Research Center find that rural children are significantly less likely to be diagnosed …

From The Frontier: Translating Research To Practice…Qi As The Hinge Point, Paul C. Erwin

Frontiers in Public Health Services and Systems Research

This article is number three in the series From the Frontier: Translating Research to Practice. The narrative describes the work of a practice-academic network in Minnesota which explored the degree to which having a culture of quality at the local health department level influenced the capacity to implement a new statewide initiative. The network conducted a mixed-methods study of grantees funded to develop and implement local policy, systems, and environmental change strategies to promote nutrition, increase activity, and reduce tobacco use and exposure. The results of their study indicated that grantees with higher performance levels in Quality Improvement (QI) …

Addressing Health Inequalities In The United States: Key Data Trends And Policy Action, Sara N. Bleich, Marian P. Jarlenski, Caryn N. Bell, Thomas A. Laveist

Frontiers in Public Health Services and Systems Research

Health inequalities, which have been well documented for decades, have recently become policy targets in the United States. This report summarizes current patterns and trends in health inequalities, commitments to reduce health inequalities, and progress made to eliminate health inequalities. Time trend data indicate improvements in health status and major risk factors but increases in morbidity, with black and lower-education individuals experiencing a disproportionate burden of disease. A common policy response has been priority setting in the form of national objectives or goals to address health inequalities. More research and better methods are needed to precisely measure relationships between stated …

Quality Of Care In Community Health Centers And Factors Associated With Performance, Peter Shin, Jessica Sharac, Sara J. Rosenbaum, Julia Paradise

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Federally funded community health centers are a key source of comprehensive primary care for medically underserved communities, serving more than 20 million patients in 2011. The Affordable Care Act (ACA) expanded the health center program significantly to help meet the increased demand for health care that is expected as millions of the uninsured gain health coverage, beginning in 2014. Especially given health centers’ growing role, evidence of the quality of care they provide is of keen interest. Most research shows high performance by health centers relative to various standards, but some gaps have also been found, and suitable benchmarks for …

Principles To Consider For The Implementation Of A Community Health Needs Assessment Process, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

No abstract provided.

Advancing The Right To Health Through Global Organizations: The Potential Role Of A Framework Convention On Global Health, Eric A. Friedman, Lawrence O. Gostin, Kent Buse

Georgetown Law Faculty Publications and Other Works

Organizations, partnerships, and alliances form the building blocks of global governance. Global health organizations thus have the potential to play a formative role in determining the extent to which people are able to realize their right to health.

This article examines how major global health organizations, such as WHO, the Global Fund to Fight AIDS, TB and Malaria, UNAIDS, and GAVI approach human rights concerns, including equality, accountability, and inclusive participation. We argue that organizational support for the right to health must transition from ad hoc and partial to permanent and comprehensive.

Drawing on the literature and our knowledge of …

Realizing The Right To Health Through A Framework Convention On Global Health?, Eric A. Friedman, Jashodhara Dasgupta, Alicia E. Yamin, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

This article introduces a special issue of Health and Human Rights (volume 15, issue 1) that features articles exploring potential elements of and key questions and issues surrounding the Framework Convention on Global Health (FCGH). The FCGH is a proposed global health treaty that would be grounded in the right to health, with the aim of closing domestic and global health inequities. It would set standards and ensure financing for health care and public health services, while also addressing social determinants of health. The FCGH would raise the priority of health in other sectors, ensure effective private sector regulation, and …

The Presence Of Coups D'État Within Revolutions: Effects On Population Health, Rose E. Facchini

Master's Theses

The present study is a comparative approach to revolutions and their effect on population health during the post-conflict period. Specifically, it attempts to determine whether revolutions that are accompanied by a coup d'état have a significant negative impact on post-revolution population health. Degree of revolutionary violence, governmental structures, and pre-revolution health systems is of particular interest as relevant variables. The study focuses on the Latin American countries of Nicaragua and Chile due to their similar region and timeframe. The revolutions and accompanying coup d'état in both of these countries do not demonstrate different patterns on public health in the post-conflict …

Improving Health Outcomes For Children (Ihoc): Summary Of Pediatric Quality Measures For Children Enrolled In Mainecare Ffy 2009 - Ffy 2012, Nathaniel J. Anderson Ms, Mph, Tracey Meagher

Population Health & Health Policy

his report, authored by USM Muskie School research staff, presents the results of the 16 CHIPRA Core Measures that were collected using MaineCare claims or Vital Statistics data and reported in the State of Maine’s FFY 2012 CHIP Annual Report to the Centers for Medicare and Medicaid Services (CMS). Also included in this report are an additional three measures from the Improving Health Outcomes for Children (IHOC) project’s Master List of Pediatric Measures. In addition to presenting results in graphs and narrative, this report also provides measure definitions and background information about each measure topic.

The goal of this document …

The Value Of Public Health Financial Data, Glen P. Mays

Health Management and Policy Presentations

Effective policy and administrative decision-making in public health requires reliable information on the amount of resources invested in governmental public health programs and how these resouces are allocated and used across the U.S. public health system. This session examines current and potential uses of public health financial data in the U.S., and considers expanded roles for research in informing policy and administrative decisions.

Gokids Boston Youth Fitness, Training, And Research Center, Gokids Boston, University Of Massachusetts Boston

Office of Community Partnerships Posters

GoKids Boston embodies innovation and leadership in youth health through life-changing programs, groundbreaking research, exceptional training opportunities, and dedication to the community with a focus on eliminating health disparities.

Clarifying And Expanding Concepts Of Cross-Jurisdictional Sharing: Early Lessons Learned From Conducting Qi With Georgia’S Health Districts, William C. Livingood, Nandi A. Marshall, Angela Peden, Ketty Gonzales, Gulzar H. Shah, Dayna S. Alexander, Alesha Wright, Russell B. Toal, Lynn S. Woodhouse, Deanna Keene

Health Policy & Management: Faculty Presentations (2008-2022)

Research Objective: Assess the legal and organization cultural foundations for Cross-Jurisdictional Sharing (CJS) in support of local public health accreditation and QI in Georgia.

Data Sets and Sources: Archival data (primarily state statutes), secondary data from previous qualitative comparative research on Deep South public health organization, secondary data from previous surveys, and oral interviews and written communication.

Study Design: Primarily Qualitative design combining ethnographic and participatory research methods.

Analysis: Qualitative Content analysis based on predetermined and emergent themes.

Principal Findings: Georgia’s Health Districts have emerged as major CJS entities that support delivery of essential services and local public health (LPH) …

Predictors Of Evidence-Based Decision Making And Population Health Practice In Lhds, Kay Lovelace, Robert Aronson, Kelly Rulison, Gulzar H. Shah, Mark Smith

Health Policy & Management: Faculty Presentations (2008-2022)

Research Objective: To identify the frequency with which LHDs carry out Evidence-Based Decision Making (EBDM) and population health strategies in LHDs and state-, LHD-, and community-levels predictors of LHDs' use of these strategies.

Data Sets and Sources: Harmonized PHSSR dataset consisting of 2010 NACCHO Profile of Local Health Departments Survey, Module 2 respondents, 2010 ASTHO Profile of State Health Departments, US Census data, and Area Resource File data.

Study Design: The study used multivariate analysis to identify predictors of EBDM and population health. We identified items in the 2010 NACCHO Profile Survey representing EBDM and population health strategies and …

There Is No “I” In Team: Players, Leaders, And Team Performance In Public Health Emergency Response, William Riley, Paige Anderson Bowen, Micky Scullard, Cheryl Petersen-Kroeber, Gulzar H. Shah

Health Policy & Management: Faculty Presentations (2008-2022)

Research Objective: Research objectives are to: 1) assess effect of controller-led in situ simulation on emergency response capacity of state health department; 2) study effects of training on team function, dynamics, and communications among staff responsible for emergency operations at state health department; and 3) train public health teams for high reliability.

Data Sets and Sources: Thirty trials (one-hour functional exercises) conducted in the state department operations center over a 16-month period (May 2010 to September 2011). Data gathered using in situ simulation methodology (recording, live viewing, playback analysis). Behavioral markers data collected using event set observational tool …

The Gastón Institute’S Partnership With The Puerto Rican Cultural Center In Springfield, Ma, Gaston Institute, University Of Massachusetts Boston

Office of Community Partnerships Posters

No abstract provided.

Cruza: The Alliance For Latino Health Through Faith And Action, A Umass Boston - Dana-Farber/Harvard Cancer Center Partnership For Community-Based Research, Gaston Institute, University Of Massachusetts Boston, Dana-Farber/Harvard Cancer Center

Office of Community Partnerships Posters

CRUZA is a community-based participatory research partnership aimed at shifting the focus from intervention delivery on an individual level to a focus on enhancing the capacity of community organizations. CRUZA intends to activate collective resources to translate scientific evidence into strategies that increase cancer screening among Latinos in Massachusetts.

Lift Up Your Voice! Health Care Advocacy Training Program: Empowering Older Adults, Nina M. Silverstein, Alison Gottlieb, Kelli Barton, Gerontology Institute, University Of Massachusetts Boston

Office of Community Partnerships Posters

Lift Up Your Voice! (LUYV) is a health care advocacy training program developed by Community Catalyst and funded through Atlantic Philanthropies. LUYV directly engages older adults with chronic disease in state-based Campaign for Better Care initiatives to achieve changes in the health care delivery system.