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Chapter 1 provides an introduction to the history and background to a general desire to try to find ways to improve population health through primary care and public health. The first Practical Playbook derived from an internet-based initiative that sought to find, assemble, assess, and share stories of how communities and agencies across the United States were working together to improve health. This text is the second development from that, after the realization that a completely new text was needed that would build on the experiences of the broadening array of sites and sectors and provide a concise set of tools, methods, and examples that support multi-sector partnerships to improve population health. The chapter then outlines the coverage of the rest of the chapters.

This chapter introduces the next section of this book which is about policy and how to achieve sustained impact. There has recently been a growing recognition of the role that policy plays in the pursuit of community health goals. Public health leaders have articulated the importance of policy as a public health approach. Similarly, wide experimentation is taking place regarding the use of policies on health care reimbursement to reshape the contribution that delivery systems can make to community health objectives. Also, policy provides a prime example of the importance of cross-sector collaboration. Policy can affect all sectors, and it is rarely developed, implemented, and sustained without the active engagement of a broad coalition of interests. Public policy, the primary focus of this section of the book, is responsible for many of the most important advances in health in the last century.

This chapter looks forward to the next set of chapters in this book which broadly speaking cover the topic of innovation in public health collaborations. This section of the book provides a concise overview of the types and forms of innovation, the factors driving it, guidance on some of the more successful innovations that are under way, and how to engage in those changes. Innovation does not need to be new as such. It also can be facilitated by new partners, from new perspectives, and using new tools. Not all innovation is effective. The chapter gives an overview of future directions for innovation, which will be covered in one of the chapters in this section.

This chapter concludes the book and looks to the future. The teams and partnerships for health are clearly underway across the United States. From this point on, health care professionals and other agencies will all need to incorporate lessons learned and practices adopted into training programs, for all the health and related disciplines. Rather than learn what makes a difference in health, the aim should be to discover and then teach what makes a difference for some, and what works better for others. Training would be best carried out in teams, so the skills of teamwork and partnership are not just ideas, but practiced skills. The chapter concludes with this thought: health is something we can achieve together, but that no person or group can achieve alone.

Among professionals in public health, the political system is commonly viewed as a subway's third rail: avoid touching it, lest you get burned. Yet it is this third rail that provides power to the train, and achieving public health goals depends on a sustained, constructive engagement between public health and political systems. This commentary outlines the importance of such engagement, and suggests ground rules that can help bridge the current divide. Many of the top public health achievements have been achieved through such engagement, yet mutual suspicion and historically complex working relationships have led to immeasurable lost opportunities. Public health champions are quick to point to examples where “politics trumps science,” and politicians point to “overreach” by public health agencies and advocates. Both sides would benefit from a new working relationship that puts suspicion and old habits in the past to generate opportunities to save lives and money... Fundamental philosophical differences over the role of government provide an important backdrop to many public health policy debates. Many interventions employ the powers of government to ensure safety and improve health: these range across a continuum that spans the deployment of credible information, establishment of financial incentives, regulation of products or markets, and mandates or prohibitions of behaviors or commerce. However, for those favoring limited government, many interventions are viewed as government overreach—and therefore antithetical to personal or market-driven decision making... Public health champions value the prevention of premature death and disability, and achievement of measurable improvements in health status and resulting quality of life. Consequently, public health training emphasizes these imperatives over other factors that impact public decision making. For example, public health officials may advocate interventions that demonstrate positive outcomes on mortality, but are less likely to assess the broader economic and social impacts of interventions. Public health advocates also fear that the voice of public health scientists will be suppressed or discounted in the political process, particularly when evidence conflicts with positions that are grounded in nonscientific considerations. They also fear that the science will be discounted when businesses or other “special interests” influence the political process. They often view these interests as working against the public good... To achieve success, political figures must often consider elements that go beyond the science—and to the disappointment of public health advocates, may sometimes value these factors over scientific considerations. Scientific evidence is important, but decision making in the political arena also incorporates a complex set of economic, ideological, and personal factors. The art of politics involves tradeoffs across competing values and influences, and political figures may not always place a higher value on objective or scientific evidence than on other inputs. For example, elected officials have strong incentives to incorporate business and other perspectives in their decision making, and also respond to evidence on economic impact, relationships, maintaining coalitions beyond an immediate issue, and other factors in addition to public health evidence. Political decision makers are puzzled when advocates dismiss the role of these other factors in decision making, and resent being portrayed as ideologues or uninformed when they take positions outside a scientific consensus... Language: en

This article describes a nationally representative survey of central office employees at state health agencies to characterize key components of the public health workforce., Context: Public health practitioners, policy makers, and researchers alike have called for more data on individual worker's perceptions about workplace environment, job satisfaction, and training needs for a quarter of a century. The Public Health Workforce Interests and Needs Survey (PH WINS) was created to answer that call. Objective: Characterize key components of the public health workforce, including demographics, workplace environment, perceptions about national trends, and perceived training needs. Design: A nationally representative survey of central office employees at state health agencies (SHAs) was conducted in 2014. Approximately 25 000 e-mail invitations to a Web-based survey were sent out to public health staff in 37 states, based on a stratified sampling approach. Balanced repeated replication weights were used to account for the complex sampling design. Setting and Participants: A total of 10 246 permanently employed SHA central office employees participated in PH WINS (46% response rate). Main Outcome Measures: Perceptions about training needs; workplace environment and job satisfaction; national initiatives and trends; and demographics. Results: Although the majority of staff said they were somewhat or very satisfied with their job (79%; 95% confidence interval [CI], 78-80), as well as their organization (65%; 95% CI, 64-66), more than 42% (95% CI, 41-43) were considering leaving their organization in the next year or retiring before 2020; 4% of those were considering leaving for another job elsewhere in governmental public health. The majority of public health staff at SHA central offices are female (72%; 95% CI, 71-73), non-Hispanic white (70%; 95% CI, 69-71), and older than 40 years (73%; 95% CI, 72-74). The greatest training needs include influencing policy development, preparing a budget, and training related to the social determinants of health. Conclusions: PH WINS represents the first nationally representative survey of SHA employees. It holds significant potential to help answer previously unaddressed questions in public health workforce research and provides actionable findings for SHA leaders.

Background: Unnecessary intervention and overtreatment of indolent disease are common challenges in clinical management of prostate cancer. Improved tools to distinguish lethal from indolent disease are critical. Methods: We performed a genome-wide survival analysis of cause-specific death in 24,023 prostate cancer patients (3,513 disease-specific deaths) from the PRACTICAL and BPC3 consortia. Top findings were assessed for replication in a Norwegian cohort (CONOR). Results: We observed no significant association between genetic variants and prostate cancer survival. Conclusions: Common genetic variants with large impact on prostate cancer survival were not observed in this study. Impact: Future studies should be designed for identification of rare variants with large effect sizes or common variants with small effect sizes. (C) 2015 AACR.

The National Center for Health Statistics (NCHS) is the nation's principal health statistics agency, with a primary mission to collect, disseminate, and analyze health data. NCHS has a clear commitment to a wide range of improvements in surveillance and public health information systems. Building on its long history of conducting multipurpose surveys where the needs and interests of a variety of programmatic interests have to be accommodated, NCHS is working on a number of fronts to improve and better integrate data systems so that they will be more useful for public health surveillance. Examples include the redesign of the National Health Interview Survey, the integration of the Department of Health and Human Services' health surveys, the retooling of the vital statistics system, and the movement to subnational data collection.