Nearly six million people worldwide die from tobacco-attributable causes every year, making tobacco the leading cause of preventable disease and death. If current trends continue, tobacco use is expected to result in one billion deaths by the end of the century, most of these in low- and middle-income countries. Cigarette smoking is the most common form of tobacco use in most countries, and the majority of adult smokers try their first cigarette before the age of 18...
The US public health system is in crisis as a result of chronic underfunding and a fragmented approach to policy making and service delivery at the federal, state, Tribal, local, and territorial levels. In short, we do not have a national public health system. Rather, we have thousands of individual public health departments that offer no guarantee that, regardless of where we live, all people will receive certain basic public health services and protection. Furthermore, the COVID-19 pandemic has highlighted the many chronic stressors resulting in a rising level of distrust among many people living in the United States. A critical component of regaining trust will be public health's ability to deliver on its promise of protecting and promoting health in the postpandemic period. As the United States continues to grapple with response, recovery, and resilience from the COVID-19 pandemic, jurisdictions across the country are seeking ways to build and strengthen public health infrastructure in systematic ways. As Courogen et al1 describe in "Resetting the Course for Foundational Public Health Services (FPHS) During COVID-19," there is a dire need for sustainable funding for public health infrastructure and intentional approaches to transforming public health through frameworks such as the Foundational Public Health Services (FPHS).2 Their article describes how 3 states have worked, before and during the COVID-19 pandemic, to build the Foundational Capabilities and Foundational Areas so that every jurisdiction is not without these responsibilities to support both the daily work of public health and the work in times of crises. Public health is not alone in this challenge. The COVID-19 pandemic has severely stressed every major sector across all US communities. This includes not only the health care and public health systems but also the systems that support education, transportation, and employment, resulting in disruption at best and, in far too many instances, disintegration. Full-scale modernization of public health in a postpandemic environment requires a commitment to transforming a fragmented public health system to one that, like the interstate highway system, complies with and meets minimum standards that are consistent and in service to all people, in every community. In the same way that when traveling from one state to another, the size of the roads, the signage and "standards" do not change, public health standards should not change based on where you are. We are at a crucial moment in American public health. In response to the pandemic, Congress and the Biden Administration have allocated major new resources needed to modernize and transform public health in the United States—with a particular focus on workforce and data. We must leverage this investment to address the structural inadequacies that the pandemic magnified and exacerbated, caused in no small part by the well-documented chronic underfunding of the US public health system. To sustain policy maker support for modernization, the public health community must be accountable for quality improvement within a framework that ensures that all communities will be equitably served by the public health system. Congress frequently references Foundational Capabilities and accreditation as necessary to achieve public health transformation and modernization. The Public Health National Center for Innovations (PHNCI), a division of the Public Health Accreditation Board (PHAB), is home to the FPHS framework, which represents a minimum set of capabilities and areas that must be available in every community.1 Recently, PHNCI, in partnership with the Funders Forum on Accountable Health, revised the FPHS framework to ensure it continues to be a modern and robust framework. PHAB has also recently updated its accreditation Standards and Measures (version 2022), making more explicit the relationship between accreditation and the FPHS framework, particularly the Foundational Capabilities.3 The FPHS reinforces the fact that no individual's health status should be determined by where he or she lives. The Foundational Capabilities and Foundational Areas represent the infrastructure, services, and protections that "must be available by health departments everywhere for the public health system to work anywhere."1 The 2022 revision of the FPHS was timely and critically relevant to the reality and needs of the currently disjointed US public health system. It provides clarity and reinforces the urgent need for a rational and inspired approach to public health reform. The framework recognizes that health protection and improvement across all US communities require a commitment and intentional efforts to advance equity and address social determinants of health. Notably, equity was added as a stand-alone Foundational Capability in the 2022 revision. The definitions for Foundational Capabilities and Foundational Areas were refined providing greater clarity and topics critical to public health modernization and transformation, such as equity and social determinants of health, data, technology, and the public health workforce—which are now emphasized within the definitions. In addition, Community-specific Services previously included as "local protections and services unique but critical to a given community" remains, acknowledging the need to accommodate "local" contextual factors unique but critical to a given community. The revised framework graphic fully captures the connectivity among components of the FPHS. The Foundational Capabilities form the base, recognizing the importance of building a strong infrastructure. Foundational Areas and Community-specific Services are supported by the infrastructure, and equity, in addition to being a Foundational Capability, also encircles the Foundational Capabilities and Foundational Areas, emphasizing that public health must be a leader in ensuring opportunity for equitable health for every community and person (Figure).FIGURE: Foundational Public Health Services. Used with permission. This figure is available in color online (www.JPHMP.com).The FPHS update provides clarity for the reform needed within our US public health system. The framework defines the minimum standards to be achieved through modernization and transformation. Meaningful, sustainable system transformation must include the following: Sustainable support for atruepublic health system. Federal, state, Tribal, local, and territorial leadership, authority, and funding must be increased and sustained over the long term to leverage the role and functions of governmental public health within a broader public health system. Policy and authorities must be leveraged to fund and support sustainable workforce, systems, data, and laboratory functions vital to ensuring equitable health across all communities. Leadership for integrated capacities. Public health leaders must be recognized as the health strategists in their communities, supporting an integrated/networked ecosystem that builds upon, supports, and complements governmental public health capacities. In short, public health should build the partnerships, coalitions, and collaboration needed across governmental and nongovernmental sectors to meaningfully address social determinants of health that are so closely linked to improved health outcomes. Metrics and accountability. Public health must be willing to be held more accountable for visible quality improvement. Translating the FPHS framework into measurable benchmarks of progress as the public health system transforms and agencies modernize will be critical. This translation can then ultimately be linked to accreditation, a step some in Congress have suggested be required of all public health agencies that receive federal funds.4 And pathways toward accreditation are being developed, focused on the Foundational Capabilities that are central to the public health system's response to emergencies and to the ongoing public health needs of all people in all communities.5 We are at a crucial moment in the history of US public health. The pandemic has demonstrated the critical need for and importance of a strong public health system and infrastructure. We have the rare opportunity to harness policy maker interest and federal funding to transform and modernize public health in the United States. The revised FPHS framework provides the necessary roadmap for that transformation.
Preventing Chronic Disease (PCD) is a peer-reviewed electronic journal established by the National Center for Chronic Disease Prevention and Health Promotion. PCD provides an open exchange of information and knowledge among researchers, practitioners, policy makers, and others who strive to improve the health of the public through chronic disease prevention.
ABSTRACT Objective: This report provides an overview and assessment of the School Dismissal Monitoring System (SDMS) that was developed by the Centers for Disease Control and Prevention (CDC) and the US Department of Education (ED) to monitor influenza-like illness (ILI)-related school dismissals during the 2009-2010 school year in the United States. Methods: SDMS was developed with considerable consultation with CDC's and ED's partners. Further, each state appointed a single school dismissal monitoring contact, even if that state also had its own school-dismissal monitoring system in place. The SDMS received data from three sources: (1) direct reports submitted through CDC's Web site, (2) state monitoring systems, and (3) media scans and online searches. All cases identified through any of the three data sources were verified. Results: Between August 3, 2009, and December 18, 2009, a total of 812 dismissal events (ie, a single school dismissal or dismissal of all schools in a district) were reported in the United States. These dismissal events had an impact on 1947 schools, approximately 623 616 students, and 40 521 teachers. Conclusions: The SDMS yielded real-time, national summary data that were used widely throughout the US government for situational awareness to assess the impact of CDC guidance and community mitigation efforts and to inform the development of guidance, resources, and tools for schools. ( Disaster Med Public Health Preparedness . 2012;6:104-112)
In Brief Objectives: We assessed local health departments' (LHDs') ability to provide data on nonpharmaceutical interventions (NPIs) for the mitigation of 2009 H1N1 influenza during the pandemic response. Design: Local health departments voluntarily participated weekly in a National Association of County and City Health Officials Web-based survey designed to provide situational awareness to federal partners about NPI recommendations and implementation during the response and to provide insight into the epidemiologic context in which recommendations were made. Setting: Local health departments during the fall 2009 H1N1 pandemic response. Participants: Local health departments that voluntarily participated in the National Association of County and City Health Officials Sentinel Surveillance Network. Main Outcome Measures: Local health departments were asked to report data on recommendations for and the implementation of NPIs from 7 community sectors. Data were also collected on influenza outbreaks; closures, whether recommended by the local health department or not; absenteeism of students in grades K-12; the type(s) of influenza viruses circulating in the jurisdiction; and the health care system capacity. Results: One hundred thirty-nine LHDs participated. Most LHDs issued NPI recommendations to their community over the 10-week survey period with 70% to 97% of LHDs recommending hand hygiene and cough etiquette and 51% to 78% voluntary isolation of ill patients. However, 21% to 48% of LHDs lacked information of closure, absenteeism, or outbreaks in schools, and 28% to 50% lacked information on outpatient clinic capacity. Conclusions: Many LHDs were unable to monitor implementation of NPI (recommended by LHD or not) within their community during the 2009 H1N1 influenza pandemic. This gap makes it difficult to adjust recommendations or messaging during a public health emergency response. Public health preparedness could be improved by strengthening NPI monitoring capacity. This study assessed local health departments ability to provide data on nonpharmaceutical interventions for the mitigation of 2009 H1N1 influenza during the pandemic response.
AffiliationsAt the time of the study, Rear Admiral Boris D. Lushniak was the Acting Surgeon General, Washington, DC, and was with the National Prevention Council, Washington, DC. At the time of the study, Dawn E. Alley was with the Office of the Surgeon General, Washington, DC. Brigette Ulin is with the Office of the National Prevention Strategy, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Corinne Graffunder is with the CDC, Atlanta.
An overarching goal of Healthy People 2020 is to achieve health equity, eliminate disparities, and improve health among all groups.*Although significant progress has been made in reducing overall commercial tobacco product use, † disparities persist, with American Indians or Alaska Natives (AI/ANs) having one of the highest prevalences of cigarette smoking among all racial/ethnic groups (1,2).Variations in cigarette smoking among AI/ANs have been documented by sex and geographic location (3), but not by other sociodemographic characteristics.Furthermore, few data exist on use of tobacco products other than cigarettes among AI/ANs (4).CDC analyzed self-reported current (past 30-day) use of five tobacco product types among AI/AN adults from the 2010-2015 National Survey on Drug Use and Health (NSDUH); results were compared with six other racial/ethnic groups (Hispanic; non-Hispanic white [white]; non-Hispanic black [black]; non-Hispanic Native Hawaiian or other Pacific Islander [NHOPI]; non-Hispanic Asian [Asian]; and non-Hispanic multirace [multirace]).Prevalence of current tobacco product use was significantly higher among AI/ANs than among non-AI/ANs combined for any tobacco product, cigarettes, roll-your-own tobacco, pipes, and smokeless tobacco.Among AI/ANs, prevalence of current use of any tobacco product was higher among males, persons aged 18-25 years, those with less than a high school diploma, those with annual family income <$20,000, those who lived below the federal poverty level, and those who were never married.Addressing the social determinants of health and providing evidence-based, population-level, and culturally appropriate tobacco control interventions could help reduce tobacco product use and eliminate disparities in tobacco product use among AI/ANs (1).NSDUH is an annual, national survey of the civilian, noninstitutionalized U.S. population aged ≥12 years (4).The analyses in this report were restricted to persons aged ≥18 years.Because of the limited sample size of AI/ANs, data were pooled across six NSDUH waves (2010)(2011)(2012)(2013)(2014)(2015) to increase precision of estimates; pooled sample sizes were 3,655 for AI/AN adults and 235,262 for non-AI/AN adults.§ Annual response rates * https://www.healthypeople.gov/.† Commercial tobacco is defined as tobacco that is manufactured by the tobacco industry for recreational use.http://keepitsacred.itcmi.org/tobacco-andtradition/traditional-v-commercial/.§ The survey weights were recalibrated by dividing by 6 (number of years pooled) to ensure that estimates were nationally representative.
Skin cancer is one of the most common forms of cancer and has rapidly increased during the past three decades in the United States. More than 1 million new cases of skin cancer are estimated to be diagnosed in the United States each year. The National Skin Cancer Prevention Education Program (NSCPEP) was launched by the Centers for Disease Control and Prevention (CDC) in 1994 as a national effort to address the Healthy People 2000 objectives for skin cancer prevention. The NSCPEP is a comprehensive, multidimensional public health approach that includes (1) primary prevention interventions; (2) coalition and partnership development; (3) health communications and education; and (4) surveillance, research, and evaluation. In 1994, through support from the CDC, state health departments in Arizona, California, Georgia, Hawaii, and Massachusetts initiated primary prevention intervention projects to conduct and evaluate skin cancer prevention education. This article discusses the comprehensive, multidimensional public health approach highlighting examples from the state demonstration projects.
