An Orientation to the Public Health System for Participants and Spectators

Transcription

1 An Orientation to te Public Healt System for Participants and Spectators Presented by TEAM ORANGE CRUSH Pallisa Curtis, Illinois Department of Public Healt Lynn Galloway, Vermillion County Healt Department Glynis Gilbert, Ford-Iroquois Public Healt Department Yolanda Jones, Illinois Department of Public Healt Judy McDonald, Will County Healt Department Board Member Jerry Nordstrom, Lake County Healt Department Uce Onwuta, Mentor, Kane County Healt Department

2 Wat is Public Healt? : An Orientation to te Public Healt System for Participants and Spectators Te field of public ealt includes a variety of responsibilities and professional disciplines. Most public ealt disciplines fulfill programmatic responsibilities by focusing on a specific set of issues like immunizations, food safety, communicable disease investigation or any number of oter programs. At te same time, tese people pursue te larger goal of preserving, promoting, and protecting te public s ealt. Over te last several years, te landscape as canged dramatically for staff at all levels of public ealt agencies. As te world as gotten smaller, te treats of disease and terrorism ave greatly increased. Public ealt professionals serving te public find it increasingly difficult to understand were tey fit in te daily accomplisments and needs of teir agencies. Similarly, boards of ealt members, elected officials, fellow ealtcare professionals and oters in te community find it difficult to understand wat public ealt does. Tey need to learn ow public ealt fits into te framework of meeting te needs of today's callenges. All parties sould ave a toroug understanding of bot te capabilities and limitations of public ealt systems. Tese capabilities and limitations are dictated by many factors tat include; size funding, oter community resources, political climate, geograpic location, staff competencies, and strengt of leadersip. Public ealt faces te callenge of operating in relative obscurity. Staff in te public ealt arena needs to actively pursue metods of communicating wic elp overcome callenges. Tere are tree Core Functions of Public Healt recognized by people in te field. Tese functions include Assessment, Policy Development, and Assurance. Toug tere are various sets of core functions one migt coose, te trio mentioned above is certainly among te most defensible. (Rowitz, 2001) Tese functions ave been furter defined by ten essential services, wic categorize te ongoing activities of public ealt professionals. We intend to provide a clear description of te tree core functions and ten essential services. Tis orientation packet is intended to provide brief, understandable information to elp orient a wide range of people to te core functions and essential services provided by all public ealt agencies. Weter you are an employee of a public ealt agency, an elected official, a community leader, or a member of te general public, tis packet is intended to elp you better understand te mission, responsibilities, services, and opportunities provided by public ealt. Hopefully, tis packet will provide a resource tat will elp you interact wit te public ealt system wit a greater understanding of te Core Functions and Essential Services. 2

3 Wat is Public Healt? : An Orientation to te Public Healt System for Participants and Spectators Table of Contents Section I Core Function: Assessment Page 4-5 Essential Service 1 Monitor ealt status. Page 6 Essential Service 2 Diagnose and investigate Page 7 Section II Core Function: Policy Development. Page 8-9 Essential Service 3 Inform, educate and empower... Page 10 Essential Service 4 Mobilize community partnersips Page 11 Essential Service 5 Develop policies Page Section III Core Function: Assurance Page Essential Service 6 Enforce laws... Page 16 Essential Service 7 Link to and provide care. Page 17 Essential Service 8 Assure competent workers. Page 18 Essential Service 9 Evaluate effectiveness Page Section IV Essential Service 10 Researc for new insigts.. Page Conclusion Page 23 References Page 24 3

4 Section I - Core Function: Assessment Assessment involves all te activities related to community diagnosis. Tese activities include surveillance, identification of needs, analysis of te causes of problems, collection and interpretation of data, case-finding, monitoring and forecasting trends, researc and te evaluation of outcomes. Tis Core Function addresses Essential Services 1 and 2 listed below: 1) Monitor ealt status to identify community ealt problems - Population-based community ealt profiles - Access to and utilization of current tecnology to manage, display, analyze and communicate population ealt data - Maintenance of population ealt registries 2) Diagnose and investigate ealt problems and ealt azards in te community - Identification and surveillance of ealt treats - Plan for public ealt emergencies - Investigation and responds to public ealt emergencies - Laboratory support for investigation of ealt treats Professionals wo generally ave responsibilities in at least one of tese service areas include: - Nurse (2) - Epidemiologist (1 & 2) - Healt Data Analyst (1 & 2) - Healt Statistician (1 & 2) - Laboratory Tecnician (2) - Environmental Healt Inspector (2) - Food Program Coordinator (2) - Food Sanitarian (2) - Infectious / Communicable Disease Coordinator (1 & 2) - Medical Advisor (1 & 2) - Emergency Response Coordinator (2) - Bio-terrorism Coordinator (1 & 2) - Agency liaison to IDPH, CDC, DHHS, EPA, USDA (1 & 2) - Public Healt Information Officer (1) Questions to elp someone determine ow tey support te public ealt system s efforts in tis area or wat te public ealt system asks itself wen it provides service in tis area: Do I provide data and analysis tat elps communities answer tese two key questions: How ealty are our residents? and Wat does te ealt status of our community looks like? 4

5 Do I compile and update community ealt profile using community ealt assessment data? Do I use new tecnologies to collect, manage, integrate, and display ealt profile data? Do I use information from one or more population ealt registries? Do I collect reportable disease information from community ealt providers on possible disease outbreaks? Do I ave a skill set tat allows me to assess, investigate and analyze ealt treats and azards? Do I perform functions tat ave a role in te development and testing of te plan tat defines te organization s responsibilities, establis communication and information networks, and clearly outlines alert and evacuation protocols in te event of a public ealt emergency? Do I perform functions tat ave a role in maintaining access to laboratory facilities capable of investigating public ealt problems, azards and emergencies; and meeting routine diagnostic and surveillance needs? 5

6 Essential Service # 1: Monitor ealt status to identify community ealt problems Tis service includes accurate diagnosis of te community s ealt status; identification of treats to ealt and assessment of ealt service needs; timely collection, analysis, and publication of information on access, utilization, costs, and outcomes of personal ealt services; attention to te vital statistics and ealt status of specific-groups tat are at iger risk tan te total population; and collaboration to manage integrated information systems wit private providers and ealt benefit plans. Te following provides a sample of te activities performed under tis service tat impact te public s ealt: Develops and maintains population-based programs tat collect ealt related data to measure ealt status Tracks ealt-related data and compares tem to national ealt objectives and oter bencmarks. Compiles and analyzes data for local, state and national ealt surveillance efforts. Offers training in te interpretation and use of ealt-related data to all levels of te public ealt system (federal, state and local). Allocates resources for monitoring ealt status and identifying ealt problems to areas of igest need and plans for te development of new resources. Professionals wo provide tese services: Epidemiologist Healt Data Analyst Healt Statistician Healt Planner Public Healt Information Officer Questions to ask yourself to elp determine if you perform functions tat contribute to Essential Service #1: Do I conduct regular community ealt assessments to monitor progress towards ealt related objectives? Do I promote community-wide use of community ealt profile and/or assessment data to assure tat tis information can be easily accessed and used by te community? Do I maintain and contribute to population ealt registries using establised criteria to report identified ealt events? 6

7 Essential Service #2: Diagnose and investigate ealt problems and ealt azards in te community Tis service includes te epidemiologic identification of emerging ealt treats; public ealt laboratory capability using modern tecnology to conduct rapid screening and ig volume testing; active infectious disease epidemiology programs; and tecnical capacity for epidemiologic investigation of disease outbreaks and patterns of cronic disease and injury. Te following provides a sample of te activities performed under tis service tat impact te public s ealt: Operates surveillance systems tat integrate all levels of te public ealt system to identify and analyze treats to te public ealt. Operates a reporting system for receiving and transmitting information regarding reportable diseases and oter potential public ealt treats. Assists in epidemiologic analysis at all levels of te public ealt system. Drafts, monitors and reviews periodically te public ealt treat investigation and response plans. Professionals wo provide tese services: Epidemiologist Infectious / Communicable Disease Coordinator Emergency Response Coordinator Bio-terrorism Coordinator Questions to ask yourself to elp determine if you perform functions tat contribute to Essential Service #2: Do I use new tecnologies and communication systems to support surveillance and investigation activities? Do I perform functions tat allow me to implement procedures tat alert te community of possible ealt treats and azards? Do I perform functions tat ave a role in te development of written epidemiologic case investigation protocols for immediate investigation of communicable disease outbreaks, environmental ealt azards, cemical and biological agent treats, radiological treats, and large scale disasters? Do I perform functions tat ave a role in maintaining guidelines or protocols to address te andling of lab samples tat define procedures for storing, collecting, labeling, transporting, and delivering lab samples and for determining te cain of custody regarding te andling of samples? 7

8 Section II - Core Function: Policy Development Policy Development is a complex process tat results from te interaction and consensus development of a wide range of public and private organizations and individuals. It is troug policy tat society makes decisions about problems, cooses goals and te proper means to reac tem, andles conflicting points of view about ways to address problems and finally, ow resources sould be andled. Government provides guidance in tis process. Tis Core Function addresses Essential Services 3, 4, and 5 listed below: 3) Inform, educate, and empower people about ealt issues Social marketing and targeted media public communication Providing accessible ealt information resources at community levels Joint ealt education programs wit scools, curces, and worksites 4) Mobilize community partnersips and action to identify and solve ealt problems Convening and facilitating community groups in undertaking defined preventive, screening, reabilitation, and support programs Skilled coalition building ability 5) Develop policies and plans tat support individual and community ealt efforts Systematic community level and state level planning for ealt improvement Tracking of measurable ealt objectives as a part of continuous quality improvement strategies Development of codes, regulations and legislation to guide te practice of public ealt Professionals wo generally ave responsibilities in at least one of tese service areas include: - Nurses (3) - Healt educators (3 & 4) - Communications manager (to te public troug te media and direct distribution of information) (3 & 4) - Substance abuse prevention specialists (3) - Public Healt Assistants (more tan a clerk, but not as involved as a nursing assistant) (3) - Liaisons working in scools, wit oter government agencies in a collaborative, and tose working wit oter community social service providers (3 & 4) - Clerical staff providing information troug an intake interview and screening process (3) - Public Healt Administrator (3, 4, & 5) 8

9 Board of Healt As a part of te local public ealt system; tey are key contributors to te agency s strategic plan and in carrying tat message to te community Questions to elp someone determine ow tey support te public ealt system s efforts in tis area or wat te public ealt system ask itself wen it provides service in tis area: Do I provide information in any form to individuals, groups, or te community at large in te course of my normal work activities? Tis migt include mailing out literature, directing people to programs or oter resources to assist tem wit teir issue or concern, conducting counseling or informational sessions, Do I interact wit groups wo form policies, implement legal requirements, or influence funding? Do I work as part of te public ealt system s efforts to encourage and develop partnersips in te community tat seek to address a public ealt need? 9

10 Essential Service # 3: Inform, educate, and empower people about ealt issues Tis service involves social marketing and targeted media public communication; providing accessible ealt information resources at community levels; active collaboration wit personal ealt care providers to reinforce ealt promotion messages and programs; and joint ealt education programs wit scools, curces, and worksites. Te following provides a sample of te activities performed under tis service tat impact te public s ealt: Provides ealt promotion and education programs Communicates via all aspects of media Conducts social marketing campaigns Provides accessible ealt information on ealt risks, ealt status and ealt needs Identifies and provides resources to facilitate ealty living Sponsors educational programs to develop knowledge, skills, and beavior to improve individual and community ealt Develops collaborative networks for ealt promotion Evaluates appropriateness, quality, and effectiveness of public ealt education Professionals wo provide tese services: Public Healt Nurses Healt Educators Community Relations Director Environmental Director/Inspectors Social Workers Questions to ask yourself to elp determine if you perform functions tat contribute to Essential Service #3: Do I provide information in any form to individuals, groups, or te community at large in te course of my normal work activities? Do I work wit a collaborative network to provide ealt promotion activities? Do I assist in te training, evaluation, credentialing, or monitoring of staff performance and quality of work outcomes? Do I work in a program wic elps enforce te local laws and regulations to protect te public s ealt and ensure safety? 10

11 Essential Service # 4: Mobilize community partnersips to identify and solve ealt problems Tis service involves convening and facilitating community groups and associations, including tose not typically considered to be ealt-related, in undertaking defined preventive, screening, reabilitation, and support programs; and skilled coalition-building ability in order to draw upon te full range of potential uman and material resources in te cause of community ealt. Te following provides a sample of te activities performed under tis service tat impact te public s ealt: Identifies potential stakeolders wo contribute to or benefit from public ealt, and increase teir awareness of te value of public ealt Builds coalitions to draw upon te full range of potential uman and material resources to improve community ealt Convenes and facilitates partnersips among groups and associations wic include tose typically not ealt related in understanding defined ealt improvement projects, including preventative, screening, reabilitation, and support programs Establises and maintains a compreensive directory of community organizations Directs and evaluates resolution to ealt problems Professionals wo provide tese services: Healt Educators Community Relations Director All Our Kids (A-OK) Network Coordinators Program Specific Coordinators/Supervisors, i.e. identified teen pregnancy problem will ave te Family Planning Coordinator at te table Public Healt Nurses Board of Healt Members Administrator and/or designated administrative staff Questions to ask yourself to elp determine if you perform functions tat contribute to Essential Service # 4: Do I work wit te Illinois Project for Local Assessment of Needs (IPLAN)? Do I design and/or deliver communication to te community relating to Public Healt s role in a particular incidence, i.e. Bioterrorism? Does my job description old me responsible for community networking and collaboration? 11

12 Essential Service #5: Develop policies and plans tat support individual and community ealt efforts Tis service requires leadersip development at all levels of public ealt; systematic community-level and state-level planning for ealt improvement in all jurisdictions; development and tracking of measurable ealt objectives as a part of continuous quality improvement strategies; joint evaluation wit te medical ealt care system to define consistent policy regarding prevention and treatment services; and development of codes, regulations and legislation to guide te practice of public ealt. Te following provides a sample of te activities performed under tis service tat impact te public s ealt: Deliver essential public ealt services to te entire community Establis and maintain effective community partnersips and appropriate working relationsips wit governing entities Establis and implement a strategic community ealt improvement plan and assess and evaluate it on an ongoing basis Educate te community about ealt goals and objectives tat ave been establised Coordinate services wit te state public ealt system and community ealt care partners Professional wo provide tese services: Agency Administrator Local Board of Healt members Director of Nursing/Community Services and Medical Director All program Coordinators/Supervisors Epidemiologist Public Healt Nurses Public Healt Educator Community Relations Director Quality Improvement and Safety Committee members Questions to ask yourself to elp determine if you perform functions tat contribute to Essential Service #5: Do I develop and/or implement policies and plans tat will improve te ealt of te community? Do I interact wit and promote positive working relationsips wit area community ealt care providers? Do I establis or participate in community partnersips? 12

13 Do I establis and track measurable ealt objectives as a part of te continuous quality improvement process? 13

14 Section III - Core Function: Assurance Assurance is related to te implementation of legislative mandates and te maintenance of statutory responsibility. It is critical tat mecanisms are in place to guarantee tat necessary services are provided to meet agreed upon goals. Assurance include regulation of services and products provided bot in te public and private sectors, accountability to people setting ealt objectives and providing reports on progress, and developing adequate responses to ealt crisis. Te assurance function requires te exercise of autority. It also provides te guarantees for certain ealt services. Tis Core Function addresses Essential Services 6, 7, 8, and 9 listed below: 6) Enforce laws and regulations tat protect ealt and ensure safety Full enforcement of sanitary codes and clean air standards Full protection of drinking water supplies Timely follow-up of azards, preventable injuries, and exposure-related diseases Monitoring of quality medical services 7) Link people to needed personal ealt services and assure te provision of ealt care wen oterwise unavailable Assuring effective entry for disadvantaged people into a coordinated system of care Culturally and linguistically appropriate materials, ongoing care management, transportation services Tecnical assistance for effective worksite ealt promotion/disease prevention programs 8) Assure a competent public and personal ealt care workforce Continuing education and training for personnel Efficient processes for licensure of professionals and certification of facilities Adoption of continuous quality improvement and life-long learning 9) Evaluate effectiveness, accessibility, and quality of personal and populationbased ealt services Ongoing evaluation of ealt programs, based on analysis of ealt status and service utilization data Professionals wo generally ave responsibilities in at least one of tese service areas include: Environmental Healt Inspectors (6) Animal Control Wardens/Officers (6) Rabies Registration staff (6) Epidemiologists (9) Risk Managers (9) Continuous Quality Improvement Coordinators (9) Nurses (7) Paraprofessional program support staff (7) 14

15 Case Managers (7) Translators (7) Programmatic intake/clerical staff (7) Human resource staff (8) All managers and supervisors (8) Questions to elp someone determine ow tey support te public ealt system s efforts in tis area or wat te public ealt system asks itself wen it provides service in tis area: Do I work in a program wic elps enforce te local laws and regulations to protect te public s ealt and ensure safety? Do I actively participate in te process tat works to ensure individuals or groups gain access to te public ealt resources provided by my agency or elsewere in te community? Do I assist in te training, evaluation, credentialing, or monitoring of staff performance and quality of work outcomes? 15

16 Essential Service #6: Enforce laws and regulations tat protect ealt and ensure safety Tis service involves full enforcement of sanitary codes, especially in te food industry; full protection of drinking water supplies; enforcement of clean air standards; timely follow-up of azards, preventable injuries, and exposure-related diseases identified in occupational and community settings; monitoring quality of medical services (e.g. laboratory, nursing omes, and ome ealt care); and timely review of new drug, biologic, and medical device applications. Te following provides a sample of te activities performed under tis service tat impact te public s ealt: Establises a solid working knowledge of federal, state, and local laws and regulations tat protect ealt and ensure safety and assure tey are enforced Assists wit modifying existing laws, or formulating new ones Educates ealt care staff and te community on public ealt laws tey are required to comply wit, and te meaning and purpose of tem Evaluates te compliance of regulated organizations and entities and assure enforcement activities are performed by te proper autorities Professionals wo provide tese services: Agency Administrator Local Board of Healt members Director of Nursing/Community Services Coordinator of Community Relations/Director of Public Relations Healt Educator Environmental, Communicable Disease, Immunization, Home Healt, and MCH program staff (including coordinators/supervisors, nurses, nurse assistants, sanitarians) Public Healt Information Officer Questions to ask yourself to elp determine if you perform functions tat contribute to Essential Service #6: Do I assess and enforce laws to assure regulated entities are in compliance wit public ealt laws/regulations? Do I identify ealt issues tat are not adequately addressed? Do I participate in modifying existing or formulating new laws to improve te public s ealt? Do I educate te community? Do I assure te community s environment is clean, safe, and its members ave access to quality medical services? 16

17 Essential Service #7: Link people to needed personal ealt services and assure te provision of ealt care wen oterwise unavailable Tis service (often referred to as "outreac" or "enabling" services) includes assuring effective entry for socially disadvantaged people into a coordinated system of clinical care; culturally and linguistically appropriate materials and staff to assure linkage to services for special population groups; ongoing "care management"; transportation services; targeted ealt information to ig risk population groups; and tecnical assistance for effective worksite ealt promotion/disease prevention programs. Te following provides a sample of te activities performed under tis service tat impact te public s ealt: Performs self-assessment and develops plans to identify and address priority ealt needs Ensures funding is available to provide access to and services for identified priority ealt risk communities Provides targeted outreac and education for special populations Develops continuous care management systems Professionals wo provide tese services: Public Healt Administrator Public Healt Educator Nurse (inclusive but not limited to Supervising Nurse, Staff Nurse, Registered Nurse, Nurse Practitioner, Case Manager, Licensed Practical Nurse) Home Healt Aide Social Worker Epidemiologist Financial Manager Board of Healt Environmental Engineer Questions to ask yourself to elp determine if you perform functions tat contribute to Essential Service #7: Do I provide information or service to individuals or communities in te course of my day to assure conditions in wic people can be ealty? Do I actively participate in activities tat organize communities aimed at te prevention of disease and promotion of ealt? Do I monitor ealt status to identify at-risk communities or ealt disparity? 17

18 Essential Service #8: Assure a competent public and personal ealt care workforce Tis service includes education and training for personnel to meet te needs for public and personal ealt service; efficient processes for licensure of professionals and certification of facilities wit regular verification and inspection follow-up; adoption of continuous quality improvement and life-long learning witin all licensure and certification programs; active partnersips wit professional training programs to assure community-relevant learning experiences for all students; and continuing education in management and leadersip development programs for tose carged wit administrative/executive roles. Te following provides a sample of te activities performed under tis service tat impact te public s ealt: Tracks of continuing education for management and leadersip development to guide te competency of a trained workforce Assures tat priority ealt needs are being addressed troug education, training and assessment of license and/or professional personnel Provides lifelong learning programs and partnersips wit professional training programs Professionals wo provide tese services: Public Healt Administrator Public Healt Educator Public Healt Trainer Public Healt Associations (IPHA, APHA) Public Healt Credentialing Associations Scools of Public Healt Board of Healt Questions to ask yourself to elp determine if you perform functions tat contribute to Essential Service #8: Do I assist in educating, training, licensing, monitoring or evaluating public and personal ealt care workers to guarantee skills necessary to fulfill daily responsibilities of meeting ealt needs? Do I elp staff develop goals and evaluate responsibilities? 18

19 Essential Service #9: Evaluate effectiveness, accessibility, and quality of personal and population-based ealt services. Tis service calls for ongoing evaluation of ealt programs, based on analysis of ealt status and service utilization data, to assess program effectiveness and to provide information necessary for allocating resources and resaping programs. Once a ealt service as been instituted, an evaluation strategy must be in place to track performance related to outcome objectives. Tis evaluation strategy sould address issues of effectiveness of process, as well as quality of personal and population-based programs. (Kouzes and Posner, 2002) Te following provides a sample of te activities performed under tis service tat impact te public s ealt: Demonstrate analytic abilities directed to program planning and function. Establis procedures to analyze systems for funding local ealt services Evaluate quality improvement initiatives Develop a process to ensure appropriate communication between individuals and departments Analyze ealt agency ability to obtain credentialing and accreditation Determination of te commitment and entusiasm of members of te ealt team. Professionals wo provide tese services: Cief Operating Officer/Executive Director/Public Healt Administrator Director of ealt services Senior level managers Human resource directors Healt planners Director of budget/financial officers Epidemiologists Environmental ealt director Questions to ask yourself to elp determine if you perform functions tat contribute to Essential Service #9: Do I understand te importance of evaluating te quality of ealt services provided by my agency? Do I conduct regular community ealt assessments to monitor progress towards ealt related objectives? Do I analyze data obtained from community ealt evaluations? Do I disseminate evaluation data to appropriate parties? Do I meet regularly wit departments to evaluate progress of quality delivery of ealt care? 19

20 Do I keep current on data related to accessibility and quality of ealt services? Do I understand te relationsip of Federal, State and Local ealt services related to access to ealt services? 20

21 Section IV - Essential Service #10: Researc for new insigts and innovative solutions to ealt problems Tis service includes continuous linkage wit appropriate institutions of iger learning and researc and an internal capacity to mount timely epidemiologic and economic analyses and conduct needed ealt services researc. "Leaders need information for making decisions. Ongoing program evaluation creates an atmospere in wic effective leadersip and organizational learning can flouris." Researc sould elp to identify broad forces affecting te community ealt system, suc as epidemiology, tecnology and legislation. "Te actual process of identifying ealt problems of importance to te community is one tat must titrate information derived from data sets wit information derived from te community's perceptions of problems wic are most important. (Turnock, 2001) Te following provides a sample of te activities performed under tis service tat impact te public s ealt: Identify problems for wic researc may be needed Evaluate te usefulness of researc on identified ealt problems Assess te priority of te ealt problem Ceck current knowledge on targeted ealt problems Identify tentative researc questions Identify potential researc partners and collaborate in designing researc Carry out researc Use and disseminate researc findings Professionals wo provide tese services: Agency administrator Researc staff members Funding/grant-writing staff Program coordinators/supervisors Epidemiologist Public ealt nurses Quality improvement and Safety Committee members Questions to ask yourself to elp determine if you perform functions tat contribute to Essential Service #10: Do I identify problems to be researced? Do I describe tecnical assistance needed for researc? Do I specify te resources needed for researc? 21

22 Do I prioritize te importance of researc problems? Do I gater information using reliable metods of study? Do I confer wit team members to analyze data? Do I disseminate researc findings to appropriate individuals? 22

23 Wat is Public Healt? : An Orientation to te Public Healt System for Participants and Spectators Conclusion Te goal of tis orientation packet is to educate te public and public ealt professionals on te tree Core Functions and ten Essential Services of public ealt. Tis orientation packet is a useful tool tat will assist in providing a basic working knowledge of te mission of public ealt and ow we as public ealt professionals work to fulfill tat mission in te daily performance of our duties and responsibilites. 23

24 Wat is Public Healt? : An Orientation to te Public Healt System for Participants and Spectators References 1. Institute for te Future. (2003) Healt and ealt care 2010: Te forecast, te callenge. (2 nd ed.) Princeton, N.J.: Jossey-Bass. 2. Institute of Medicine (1988), Te Future of Public Healt, Wasington, D.C.: National Academy Press. 3. Kouzes, M. & Posner, B. (2002) Leadersip te Callenge. San Francisco: Jossey-Bass. 4. National Public Healt Performance Standards Program: Performance Improvement Resource Guide for Local Public Healt Systems; Public Healt Foundation, June National Public Healt Performance Standards Program: State Public Healt System Performance Standards; Public Healt Foundation, June Rowitz, L. (2001) Public ealt leadersip: Putting principles into practice. Gaitersburg, Maryland: Aspen Publisers, Inc. 7. Turnock, B. J. (2001) Public ealt: Wat it is and ow it works. (2 nd ed.) Gaitersburg, Maryland: Aspen Publisers, Inc. Websites National Public Healt Performance Standards Program 24