public health partnerships

Cross Sector Collaborations Addressing Population Health Issues

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Cross sector collaborations can be a great way to address population health issues. There are myriad ways and types of cross sector collaborations as well as a variety of types of organizations involved in cross sector collaborations. Here are a few examples of current or recent collaborations.

Examples

Engaging Youth in Building a Culture of Health — Collaboration between the National 4-H Council, the Robert Wood Johnson Foundation, the national Cooperative Extension System, and Local Health Councils

The National 4-H Council is partnering with the Robert Wood Johnson Foundation, the national Cooperative Extension System and local Health Councils in 1,000 different communities in the U.S. with a focus on engaging youth in to promote a culture of health in their communities. (1).

The 4-H organization is a youth development organization that focuses on empowering youth to by providing youth with experiences that help to develop critical life skills. The Robert Wood Johnson Foundation works to improve health and health care, with an emphasis on creating a culture of health.

This new partnership will focus on involving youth in addressing top public health priorities in cross-sector collaborations between the youth and community members, local public health organizations, businesses, government entities, and non-profit agencies. Three main focus areas of this partnership will be designing a network to promote health and wellness in communities, creating and disseminating tools for healthier communities, and launching a training curriculum for local community advocates. The network, tools, and curriculum created from this partnership will be able to be applied to other communities in the U.S. (1)

Opioid Addiction Treatment through Telemedicine in Rural Communities– a Cross-Disciplinary Team

The opioid addiction epidemic is a serious and severe population health issues. Many different organizations are working to address this issue. One way is through cross sector collaboration. An example is a cross disciplinary team of psychiatrists, a nurse practitioner, and a social worker from the University of Maryland School of Medicine and health system working with a non-profit organization to develop and implement opioid telemedicine programs in rural communities as part of Robert Wood Johnson Foundation’s Clinical Scholars program.(2)

Collaborators:

  • Eric Weintraub, MD, director of substance abuse services at University of Maryland School of Medicine (UMSOM)
  • Seth Himelhoch, MD, professor of psychiatry at UMSOM
  • Jewell Benford, LCSW-C, a lead social worker at UMSOM,
  • Marian Currens, director of chemical dependency, University of Maryland Medical System
  • Wells House, a non-profit providing recovery services to community members battling drug and alcohol dependencies in Hagerstown, MD

NACCHO – FDA – Health Departments Collaboration to offer a Mentorship program to improve and standardize Retail Food Regulatory programs

Having robust, standardized retail food protection programs can improve food safety inspections and help to reduce the risk and occurrence of foodborne illness outbreaks in retail food establishments.

The National Association of City and County Health Officials (NACCHO) and the Food and Drug Administration (FDA) connect retail food regulatory programs (RFRP) that are looking to improve and standardize their retail food protection services with mentors from RFRP’s that are already experienced with implementing the FDA’s Retail Food Regulatory Program standards.(3) The FDA’s RFRP standards are a set of 9 standards that focus on the improving the design and management of existing RFRP’s so that they can better provide their services to reduce risk factors that contribute to foodborne illnesses in their jurisdiction. (4)

In addition to facilitating the mentorship experience NACCHO and the FDA provide funding for both the mentee and the mentor RFRP’s. Other assistance is also provided, such as sharing of policies, procedures, tools, and technical assistance to help RFRP’s implement the FDA’s RFRP standards to better be able to improve food safety in their community or jurisdiction.(5)

Conclusion

Learning about different cross sector collaborations has hopefully given you some ideas for how your organization or an organization you work with can collaborate with other organizations in different sectors to address a population health issue.

Organizations collaborating in cross sector collaborations can come from a variety of industries, ranging from the federal government, national non-profits focused on supporting local health officials or creating a culture of health, university hospitals, health departments, and more. Cross sector collaborations can be a great way to address population health issues.

Do you have any examples of cross sector collaborations working to improve community health issues, or have you or your organization been a part of a cross sector collaboration that you would like to share about? Then leave a comment below!

Jillian Regan, MPH is a consultant at Rillian. She enjoys providing technical assistance to organizations, so that the organization can better serve its clients, customers, patients, or other stakeholders. Connect with her by email at Jillian.Regan@RillianConsulting.com or Twitter (@JillianReganMPH) or LinkedIn.

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Sources:

  1. National 4-H Council and the Robert Wood Johnson Foundation Partner to Empower Youth in Creating Healthier Communities. Robert Wood Johnson Foundation. Retrieved 9/14/17 from https://www.rwjf.org/en/library/articles-and-news/2017/09/national-4-h-council-and-rwjf-partner-to-empower-youth-in-creating-healthier-communities.html
  2. Felix, K. New Leaders Use Telehealth—and Teamwork—to Tackle Opioid Use. Robert Wood Johnson Foundation. Retrieved 9/26/17 from https://www.rwjf.org/en/culture-of-health/2017/09/new-leaders-use-telehealth-to-tackle-opioid-use.html
  3. National Associated of City and County Health Officials (NACCHO). NACCHO Mentorship Program. Retrieved 11/5/17 from https://www.naccho.org/programs/environmental-health/hazards/food-safety/mentorship
  4. Food and Drug Administration (FDA). 2015. Voluntary National Retail Food Regulatory Program Standards – Introduction. Retrieved 11/5/17 from https://www.fda.gov/downloads/Food/GuidanceRegulation/RetailFoodProtection/ProgramStandards/UCM372399.pdf
  5. National Associated of City and County Health Officials (NACCHO). Retail Food Program Standards Flyer. Retrieved 11/5/17 from https://www.naccho.org/uploads/downloadable-resources/Retail-Program-Standards-Mentorship-Program-Flyer.pdf

Public Health Accreditation Board (PHAB) Accredited State and Local Health Departments

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Public Health Accreditation Board (PHAB) Accreditation is a set of nationally recognized standards in the U.S. that are intended to improve the quality and performance of all public health departments, whether they are Tribal, state, local, or territorial health departments.

As of this past August 2017, over half (51%) of state health departments are PHAB accredited, while another quarter (25%) of them are in the process of getting PHAB accredited. Less than a quarter (24%) of state health departments in the U.S. are not PHAB accredited nor in the process of getting PHAB accredited (Figure 1).

The percentage of state health departments that are PHAB accredited, in the process of getting PHAB accredited, or are neither PHAB accredited nor in the process of getting PHAB accredited as of August 2017. Data Source: Public Health Accreditation Board (PHAB). Accredited Health Departments as of June 2017. Graph: Rillian.

At the local level, only 21% of local health departments (LHD’s) are engaged in PHAB accreditation as of 2016. This percentage has increased greatly since 2013 when it was only 6% of LHD’s that were formally engaged in PHAB accreditation (Figure 2).

The percentage of local health departments (LHDs) that are formally engaged in PHAB accreditation between 2013 to 2016. Data Source: National Association of County and City Health Officials (NACCHO). 2016 National Profile of Local Health Departments. Graph: Rillian.

Only 4% of LHD’s are PHAB accredited as of 2016 with another 5% having just completed the application for PHAB accreditation, and 3% having registered in e-PHAB, the electronic system PHAB uses for document submission for PHAB accreditation application (Figure 3). Another 17% of LHD’s have plans to apply for PHAB accreditation in the future, but have not yet taken the first step of registering in ePHAB. Some LHD’s (31%) have not yet decided if they are going to apply for PHAB accreditation, while 20% of LHD’s have decided not to apply as of 2016 (Figure 3).

Local health departments (LHDs) level of engagement with PHAB accreditation as of 2016. Data Source: National Association of County and City Health Officials (NACCHO). 2016 National Profile of Local Health Departments. Graph: Rillian.

It should be noted that states vary in the structure of their public health department systems, so in some states, once the state health department is PHAB accredited, the accreditation may also apply to the LHD’s in states in which the local health department is essentially just an outpost of the state health department.

 

Summary

 

At the state health department level, most states (51%) are either PHAB accredited or in the process of becoming PHAB accredited (25%) while at the local level less than a quarter (21%) of local health departments are formally engaged in PHAB accreditation.

 

Check out PHAB’s list of PHAB accredited health departments to find out if your local, state, or tribal health department is accredited.

 

Sources:

 

  1. Public Health Accreditation Board (PHAB). What is Public Health Department accreditation?. Retrieved 9/4/17 from http://www.phaboard.org/accreditation-overview/what-is-accreditation/

 

  1. Public Health Accreditation Board (PHAB). Accredited Health Departments as of June 2017. Retrieved 8/15/17 from http://www.phaboard.org/news-room/accreditation-activity/


3. National Association of County and City Health Officials (NACCHO). 2016 National Profile of Local Health Departments. Retrieved 9/4/17 from http://nacchoprofilestudy.org/wp-content/uploads/2017/04/ProfileReport_Final3b.pdf

Rillian EPOCH Environmental Health Community Health Assessments

Ways to Include Environmental Health Data When Assessing Community Health–Using the Environmental Profile of a Community’s Health (EPOCH) Instrument

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Rillian EPOCH Environmental Health Community Health Assessments

The Environmental Profile of a Community’s Health (EPOCH)

One way in which to conduct a study specific to the community is by using the Environmental Profile of a Community’s Health (EPOCH), a measurement tool designed for collecting data on environmental factors that are associated with cardiovascular disease (CVD) risk factors. EPOCH measures both objective factors as well as subjective perceptions of the environment of community members.(1) EPOCH has two parts, EPOCH 1 that assesses the physical environment and EPOCH 2 is an survey of participants’ perceptions of environmental factors in their communities (2). This instrument has been tested in both urban and rural communities (n = 84) in 5 different countries on different continents  (Brazil, Canada, China, Columbia, and India) with a sample size of 2,360 individual respondents, or an average of 28 respondents per community surveyed, and found to be a reliable measure (reliability > 0.8) for all of the community-level measures.(1) 

 

EPOCH In Use in Recent Studies

The EPOCH instrument was used to collect data on these CVD risk factors in a large city in Southeast Asia (Karachi, Pakistan), an area in which there has not been a lot of research conducted on CVD environmental risk factors.(3)

  • This study focused on two different middle to high income communities in Karachi with a study population of young adults 18-25 years old (n = 120).
  • These communities were found to be exposed to CVD risk factors in their environment, such as a high proportion of tobacco shops and fast food restaurants compared to recreational parks and vendors or stores selling fresh fruits and/or vegetables, as well as perceive tobacco use by men as socially acceptable in their communities.

The EPOCH instrument was recently adapted for use with a photographic evaluation of the community built environment, and called the EPOCH Photo Neighbourhood Evaluation Tool (EP-NET). (4)

  • This method was found to be a reliable and reproducible way (intra-class correlation for most (87%) of the survey items  of > or = 0.70) to assess these specific built environment factors across a diverse, international range of communities. EP-NET involves a systematic method for taking and analyzing the photos.
  • Link to EPOCH EP-NET Survey Instrument. Source: Source: Corsi et al 2014. (4)
  • Link to EPOCH EP-NET Instruction Manual. Source: Source: Corsi et al 2014. (4)

Another study used EPOCH to specifically study one CVD environmental risk factor, tobacco advertising, across both urban (n = 235) and rural (n = 227) communities  in 16 different countries with 11,842 individual study participants. (5).

  • Lower-income countries were found to have higher levels of tobacco marketing than higher income countries.
  • However, even in countries that had ratified the (FCTC), there were still high levels of tobacco marketing.
  • Almost half (45%) of study participants reported seeing at least one type of tobacco ad, and 10% reported seeing at least 5 types of tobacco marketing in the 6 months prior to the survey.
  • Urban communities were found to have higher intensities of tobacco marketing than rural communities.
Cardia Disease Environmental Health

Hollow log shaped like a heart outside in the environment at Kemper Park, Charlottesville, VA. Photo © Jillian Regan 2017

Conclusion

EPOCH is an instrument that can be useful for measuring environmental CVD risk factors when assessing the community’s health. It has been found to be reliable in both urban and rural communities as well as across a diverse range of countries at various levels of development.

Links to the PDFs of the EPOCH survey instruments:

 

Sources:

  1. Corsi, DJ; Subramanian, SV; McKee, M; Swaminathan, S; Lopez-Jaramillo, P; Avezum, A; Lear, SA; Dagenais, G; Rangarajan, S; Teo, K; Yusuf, S; Chow, CK. (2012). Environmental Profile of a Community’s Health (EPOCH): an ecometric assessment of measures of the community environment based on individual perception. PLoS One;7(9):e44410. doi: 10.1371/journal.pone.0044410. Epub 2012 Sep 4.
  2. Chow, CK; Lock, K; Madhavan, M; Corsi DJ; Gilmore, AB; Subramanian, SV; Wei, L; Swaminathan, S; Lopez-Jaramillo, P; Avezum, A; Lear, S; Dagenais, G; Teo, K; McKee, M; and Yusuf, S. (2010). Environmental Profile of a Community’s Health (EPOCH): An Instrument to Measure Environmental Determinants of Cardiovascular Health in Five Countries. PLoS One. 2010; 5(12): e14294.Published online 2010 Dec 10. doi:  10.1371/journal.pone.0014294
  3. Hussain, MA; Noorani, S; Khan, A; Asad, H; Rehan, A; Kazi, A; Baig, MZ; Noor, A; Agil, A; Bham, NS; Khan, MA; Hassan, IN; and Kadir, MM. (2015). The Role of Neighborhood Environment in Promoting Risk Factors of Cardiovascular Disease among Young Adults: Data from Middle to High Income Population in an Asian Megacity. PLoS One. 2015 May 6;10(5):e0124827. doi: 10.1371/journal.pone.0124827. eCollection 2015.
  4. Chow, CK; Corsi, DJ; Lock, K; Madhavan, M; Mackie, P; Li, W; Yi, S; Wang, Y; Swaminathan, S; Lopez- Jaramillo, P; Gomez-Arbelaez; Avezum, A; Lear, SA; Dagenais, G; Teo, K; McKee, M; and Yusuf, S. (2014). A novel method to evaluate the community built environment using photographs–Environmental Profile of a Community Health (EPOCH) photo neighbourhood evaluation tool. PLoS One. 2014 Nov 4;9(11):e110042. doi: 10.1371/journal.pone.0110042. eCollection 2014.
  5. Savell, E; Gilmore, AB; Sims, M; Mony, PK; Koon, T; Yusoff, K; Lear, S; Seron, P; Ismail, N; Calik, KBT; Rosengren, A; Afridi, A; Rahman, O; Chifamba, J; zatonska, K; Mohan, V; Mohan, D; Lopez-Jaramillo; Avezum, A; Poirier, P; Orlandini, A; Wei, Li; McKee, M; Rangarajan, S; Yusuf, S; and Chow, C. (2015). The environmental profile of a community’s health: a cross-sectional study on tobacco marketing in 16 countries. Bulletin of the World Health Organization 2015;93:851-861G. doi: http://dx.doi.org/10.2471/BLT.15.155846