Feb 1, 2000 - als in their own fields, they should be respected as ... are currently working in the field? ... Requests for reprints should be sent to Betty C. Jung ...
Letters to the Editor
Re McKinlay and Marceau’s “Tale of 3 Tails” Although it would be difficult to refute McKinlay and Marceau’s statement that “much of our well-intentioned hard work in public health appears to yield disappointing results”1(p295) in relation to the research effort, why is it, then, that the totality of the public health effort, at least in developed countries, has registered some pretty impressive gains over the greater part of this century? The fact that there has been such a reduction in cardiovascular disease mortality in a number of countries like Finland, Australia, and the United States over the past 30 years suggests that some other forces have been at work. More particularly, the underpinning biomedical and epidemiologic research effort, and the steady but increased involvement of health professionals in the secondary and tertiary prevention of cardiovascular disease, have provided the very platform for much of the more substantial health promotion and public health effort directed at tobacco control and the other, broader community-wide efforts that have made such significant contributions. This has been made possible, not only by a developing evidence base, but also by the role of health professionals as opinion leaders and agents for social and legislative change. Similar comments can also be made regarding the authors’ discussion of the “Tail End of Causality.” Although there has been a significant increase in public health actions and research efforts that have incorporated multilevel strategies addressing a broader range of causal factors, surely it is important that the evaluation effort address the impact on not only the immediate outcomes but also on more downstream health outcomes. For example, the effect of bicycle helmet laws should be evaluated not only in terms of helmet wearing rates but also in terms of the 294
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effect of such laws on the rate of head injuries to bicyclists. While there is always a need to improve the linkage between public research and practice, we question the extent to which we are really “Chasing Our Tails” in a downward spiral. There has surely been substantial development and refinement of our research methods, particularly in the application of social and behavioral science methods to public health. Moreover, considering the fact that most developed countries spend less than 6% of their national health expenditure on public health and health promotion, the number of lives saved as a result of this small investment is arguably quite impressive! Finally—coming back to McKinlay and Marceau’s professed disappointment with large community intervention studies—there is a major inconsistency in the authors’ argument. They make their assessment of change in terms of those very outcomes that they criticize as being inadequate and inappropriate measures of change. Lawrence Green and colleagues made the point many years ago that there is probably much more evidence of change at the community and societal level than is apparent in intervention trials per se, and they cite various reasons for this.2 In summary, while we agree with the need to study “the reasons why our large community interventions have fallen far short of expectations,”1(p297) we argue that we should also understand more about the reasons for our successes over the past two generations. Brian Oldenburg, PhD, MPsychol Paul Scuffham, PhD
The authors are with the School of Public Health, Queensland University of Technology, Brisbane, Australia.
Requests for reprints should be sent to Brian Oldenburg, PhD, School of Public Health, Queensland University of Technology, Kelvin Grove, 4059, Australia.
Acknowledgment Paul Scuffham is on an overseas postdoctoral fellowship funded by the Health Research Council of New Zealand.
References 1. McKinlay JB, Marceau LD. A tale of 3 tails. Am J Public Health. 1999;89:295–298. 2. Green LW, Wilson AL, Lovato CY. What changes can health promotion achieve and how long do these changes last? The tradeoffs between expediency and durability. Prev Med. 1986;15:508–521.
Educating Public Health Professionals I found Gebbie’s editorial “The Public Health Workforce: Key to Public Health Infrastructure”1 thought-provoking. Indeed,
Letters to the Editor will be reviewed and are published as space permits. By submitting a Letter to the Editor, the author gives permission for its publication in the Journal. Letters should not duplicate material being published or submitted elsewhere. Those referring to a recent Journal article should be received within 3 months of the article’s appearance. The editors reserve the right to edit and abridge and to publish responses. Submit 3 copies. Both text and references must be typed double-spaced. Text is limited to 400 words and fewer than 10 references. Reprints can be ordered through the author whose address is listed at the end of the letter. February 2000, Vol. 90, No. 2
Letters to the Editor
those of us who work in public health should share a common philosophical background. Such a common foundation would help us understand how our work fits into the greater scheme of things (accomplishing public health’s many goals). The core curriculum suggested by Gebbie is a start. However, I found it somewhat demeaning, although this may not have been the author’s intention, to be lumped together with others under the term “public health workers.” A more appropriate term would be “public health professionals,” which would automatically imply an educated workforce of individuals who make it their personal responsibility to maintain the skills necessary to perform their tasks competently. Public health thrives on the diversity of the many disciplines that have become a part of public health practice over the years. Professionals from these disciplines provide perspectives that are needed in addressing the many issues that affect the health of the public. And, as administrators, environmental scientists, health educators, nurses, and physicians are already professionals in their own f ields, they should be
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respected as professionals, rather than viewed as simply workers, when they are contributing their expertise. Second, rather than pontificate on what skills “public health workers” should ideally possess, on the basis of selected input that may not necessarily reflect the activities of the rank and file, why not survey those who are currently working in the field? Why not find out what they are doing and what skills they feel they need to improve their approach to their work? Did they find their education useful in preparing them to work in public health? What courses did they find most useful in the workplace? In what areas would they have liked more preparation? Such a survey could be the basis for developing the meaningful outcome measures that eluded the Charleston Charter meeting. Any professional should be able to tell you what they feel they need to do a good job. Finally, a suggestion: Why not survey the members of the American Public Health Association? These are the individuals who are most interested in public health and in their careers as public health professionals.
When developing the survey, put together a focus group of public health professionals working in the private, public, and voluntary sectors, at the federal, state, and local levels. Find out what would be the most suitable questions to ask about educational preparation, continuing education needs, and what the work of public health professionals entails. Does this sound like a lot of work? It does. But findings from such a survey would be more relevant to those of us who have chosen public health as our profession and to decision makers who are interested in a flexible and reliable infrastructure that would guarantee the public’s health. Betty C. Jung, RN, MPH, CHES Requests for reprints should be sent to Betty C. Jung, RN, MPH, CHES, 25 Driftwood Ln, Guilford, CT 06437-1929.
Reference 1. Gebbie KM. The public health workforce: key to public health infrastructure. Am J Public Health. 1999;89:660–661.
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