Institutes in Action
Public health institutes maintain a portfolio of competencies, including: population-based health program delivery; health policy; training and technical assistance; research and evaluation; health informatics; health communications; social marketing; fiscal/administrative management; and collaborative leadership. "Institutes in Action" features examples of NNPHI members utilizing their competencies to achieve measurable improvements in population health.
LPHI: Building Coalitions to Clear the Air
Public health institutes (PHIs) are uniquely situated to engage a broad range of stakeholders—from grassroots non-profits to government agencies—in discussion and action to make communities healthier. The health expertise of their staffs—complemented by their capacity to devote extensive resources into cultivating relationships among diverse groups—makes PHIs ideal convening agencies.
Since 2002, the Louisiana Public Health Institute (LPHI) has implemented and evaluated the Louisiana Campaign for Tobacco-Free Living (TFL) and worked with the Coalition for a Tobacco-Free Louisiana in a statewide partnership to prevent and reduce tobacco use and exposure. These cross-sector partners, working in concert with community groups and other concerned interests, helped bring about the passage of the 2007 Louisiana Smoke-Free Air Act.
The Act, which prohibits smoking in most public places and workplaces, including all restaurants with or without attached bars, has been embraced by a majority of citizens and businesses—even the restaurants that have been most directly affected by it. The Louisiana Office of Alcohol and Tobacco Control has reported that 95 percent of the state’s restaurants are complying with the law, and TFL research shows that 81 percent of the state’s registered voters support smoking bans in restaurants.
Not just effective in improving indoor air quality, the Act and TFL’s other partnership efforts are also credited with encouraging greater numbers of smokers and tobacco users to stop using tobacco products. Since the law went into effect, more than 7,500 tobacco users across the state have sought counseling and information about quitting with calls to The Louisiana Tobacco Quitline (1-800-QUIT-NOW). Moreover, according to LPHI’s Behavioral Risk Factor Surveillance Survey (BRFSS), Louisiana experienced a six point decline in Adult Smoking Prevalence between 2003 (26.5) and 2008 (20.5).
LPHI continues to foster partnerships to promote sound health policies. During 2008, for example, TFL and the American Cancer Society defeated several efforts to undermine the Smoke-Free Air Act by visiting media and lawmakers to heighten awareness of the correlation between smoke-free air laws and their effect on tobacco consumption, quality and length of life, and cost savings to Louisiana.
LPHI also recently conducted a study, in collaboration with the Louisiana State University Health Sciences Center, which reveals that, on average, non-smoking bar and casino employees have five times more cotinine in their saliva after work shifts than employees who completed their shifts in non-smoking venues. Cotinine is created as the body breaks down nicotine. The study reinforces a growing body of evidence that bar and casino employees and performers involuntarily inhale enough secondhand smoke to suffer the same negative health effects of pack-a-day smokers. LPHI and its partners are using the study and related literature to seek expansion of the Smoke-Free Air Act’s coverage to bars and casinos.
LPHI has and continues to utilize its ability to generate and sustain partnerships across agencies and communities to improve the quality of life and health for all Louisianans.
Sound Policies Send California's Teen Pregnancy Rates Plummeting
One of the most important ways in which public health institutes (PHIs) help make communities healthier is through utilizing their staffs’ ample data collection and evaluation skills to inform policymakers. California's Public Health Institute (PHI) conducts the Adolescent Sexual Health Policy Project (ASHPP) through its Center for Research on Adolescent Health and Development.
To reach its goals, ASSHP focuses on achieving:
- Better-informed policymakers and influencers in regards to: adolescent sexual health trends, effective policies and programs to promote adolescent sexual health, and expected investment returns of these policies
- Improved quality of debate and media reporting on these issues
- Improved quality of research and evaluation related to these issues
Through investigating determinants of teen pregnancy and educating policymakers on how best to address root causes of teen birth rates, PHI has helped contribute to the state’s 50% reduction (to 35.2 teen births per 1,000 in 2008) in rates over the past 19 years—a 17% higher decrease than the national average of 33% (41.5 teen births per 1,000 in 2008) over the same period.
While a wide range of efforts deserve credit for California’s dramatic decline in teen birth rates between 1991 and 2008, the decrease can be attributed in large part to California’s adherence to policy recommendations by PHI and fellow advocates. Over the past decade—spanning three governors and both political parties— California’s leadership has implemented a number of PHI recommendations, including: (1) enactment of legislation that school-based and other state-funded sexuality education be comprehensive, age-appropriate, and medically accurate; (2) consistent refusal to participate in the federal Title V, Section 510 abstinence-only education program; (3) provision of state-funded teen pregnancy prevention programs; and (4) grant initiatives funded by philanthropic foundations throughout the state.
The impact of California’s implementation of progressive teen pregnancy prevention policies—especially when compared to the United States as a whole—is particularly impressive in light of its high percentage of Latinas, which have the highest teen birth rate of all population groups. Although Latinas still have a significantly higher teen birth rate than any other ethnic group in California, they sustained an 8.1 teen births per 1,000 decrease between 2006 and 2008.
In spite of California’s incredible success in reducing teen pregnancy, the state’s current fiscal crisis casts grave doubts on the survival of a number of vital prevention programs. To sustain and build on California’s progress to date, therefore, PHI has evaluated and published a number of long-term cost savings for the state, should it continue investing on the front-end in preventing teen pregnancy. PHI has found that, had California continued to experience its 1991 teen birth rate of 71 per 1,000, it would have experienced an additional 52,685 births in 2008. The state’s progress translates into a current annual savings to California taxpayers of $1.1 billion and total annual savings to society of $4.5 billion.
Through intensive, ongoing research into the myriad of factors that impact a teen’s likelihood of becoming pregnant—and effective dissemination of policy recommendations based on that research—PHI continues to impact California’s incredible progress in reducing teen pregnancy rates.
More than a Middleman: PHS Administers Millions to Combat HIV/AIDS
Among their many roles, public health institutes (PHIs) often act as fiscal intermediaries to hasten service delivery and manage educational campaigns. Many PHIs have years of experience collaborating with care providers, academia, and other stakeholders to tackle pressing health issues. Their knowledge—not only of which agencies are equipped to provide the most effective care, but also of how to spearhead initiatives to address complex health problems—makes PHIs ideal to entrust with the management of government funding.
As a fiscal intermediary of both the federal and New York City government, Public Health Solutions (PHS) implements and assesses effective HIV/AIDS prevention and care methods in New York City and beyond through administering millions in HIV/AIDS care and prevention funds. PHS’ HIV Care Services (HIVCS) project has furnished services for individuals living with HIV/AIDS under the federal Ryan White Treatment Modernization Act since 1991, currently managing over $100 million in funds for over 150 organizations providing care and support services. HIVCS’ 200+ Ryan White-funded contracts provide primary and specialty medical care, case management, nutrition and wellness promotion, and supportive counseling, among other vital services.
Since 2000, HIVCS has also managed over $22 million in federal Centers for Disease Control and New York City municipal funding for HIV/AIDS prevention, partnering with an array of organizations to develop groundbreaking media campaigns that are reducing risk behaviors among vulnerable populations.
One such partnership—between HIVCS and New York University’s Steinhardt School of Culture, Education, and Human Development—merges the respective institutions’ expertise in epidemiology and learning theory to reduce HIV transmission rates. The “HIV Is Still a Big Deal” online video series, first implemented in 2008, features reinactments of social and health-related dilemmas gay men face, as well as links to additional resources on discussing HIV with partners, getting tested, and seeking support. The videos are available on YouTube, MySpace, and a variety of other popular social media sites.
Baseline and follow-up surveys of 500 men who viewed the initial episode indicated that those men were three times more likely to disclose their HIV status and 1.5 times more likely to get tested for HIV three months after seeing the video. “We’ve found that online video can be a powerful new intervention tool in the fight against HIV,” says Dr. Mary Ann Chiasson, an epidemiologist and PHS’ Vice-President for Research and Evaluation. “We are seeing that it can be as effective as one-on-one outreach, but with the internet’s scope, it has the potential to reach and influence thousands of men.”
As a fiscal intermediary, PHS is driven to grow its network of collaborators and innovate its outreach strategies to help individuals with and at-risk of developing HIV/AIDS. From coordinating the efforts of hundreds of providers, to collaborating with cross-sector partners to develop and assess effective health education campaigns, PHS continuously leverages the impact of the government dollars entrusted to its management.
ACHI: Tackling Obesity Through Informing Policy
Governmental public health frequently relies on public health institutes (PHIs) to provide non-biased tracking and analysis of major health trends. The Arkansas Center for Health Improvement (ACHI) was tasked by the state’s General Assembly in 2003 with measuring and evaluating body mass indexes (BMIs) of all public school children. By the 2008-2009 school year, ACHI was assessing 98.7% (1,072 of 1,086) of Arkansas' public schools, reporting results and attendant health concerns for students in grades K-12. ACHI’s analysis of the data—eight years’ worth to date—has been instrumental in informing further policy decisions as well as monitoring the childhood obesity trends in the state.
In 2003, the Arkansas General Assembly passed Act 1220, a multi-pronged initiative to address skyrocketing obesity rates and improve the general health and wellbeing of children statewide. Act 1220 was the first law in the country with comprehensive, multi-branched approaches to bring families, schools, and communities together to combat the obesity crisis. The law mandates that parents shall be provided with an annual, confidential BMI reports for their child, as well as an explanation of what BMI means and the health effects associated with obesity. BMI reports are recommended by the American Academy of Pediatrics for all children 18 and under annually.
ACHI’s position as a politically unaffiliated non-profit—as well as its staff’s extensive expertise in collecting and analyzing population health data—made it an ideal choice to charge with developing and implementing standardized statewide BMI assessments and reporting. ACHI drew on its networking skills to accomplish the mammoth task of assessing Arkansas’ hundreds of thousands of public school students, forming a BMI Task Force in collaboration with local school districts, the Arkansas Children’s Hospital (ACH), and the University of Arkansas’ College of Public Health.
ACHI understood the value of establishing a set of guiding principles to inform its efforts and set the appropriate tone for engaging the general public. Those principles not only reflect ACHI’s competency in data management, but also its awareness of its responsibility as a PHI to provide accurate, comprehensive health information and recommendations on which policymakers and parents alike can rely:
- BMI Assessment is a health screening tool like vision, hearing, or scoliosis screenings routinely performed in public schools.
- Confidentiality and privacy should be maintained in measuring and reporting.
- Confidential Child Health Reports are a health advisory tool for parents, and should include an explanation of BMI and the child’s assessment; recommendations for a healthy lifestyle; and recommendations to discuss concerns with the child’s physician.
ACHI’s efforts and programs in the eight years following the bill’s passage have contributed to leveling Arkansas’ childhood obesity rates. However, in spite of curbing the rise of obesity, ACHI notes that nearly 38% of Arkansas children and adolescents remain overweight or obese. The task of reducing the numbers of Arkansas youth with weight problems is considerable, but it is achievable. ACHI is informing parents across the state of their children’s health status and guiding them in strategies to help their children achieve better health. Additionally, because of ACHI’s comprehensive, reliable gathering of BMI rates for nearly 100% of Arkansas public school students, policymakers are now able to monitor trends and alter weight reduction strategies—within schools and communities—accordingly.