NN/LM PNR DRAGONFLY: The Environment of Local Public Health: What Does Population-based Focus Really Mean?

[NNLM PNR]

by 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.)

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.

2. 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.

3. 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 at u.washington.ed,
206-616-3472.


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Dragonfly is the newsletter of the National Network of Libraries of     
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