Turnock Home Page

TURNOCK READING ROOM

Commentaries/Editorials/Letters
Articles/Books/Chapters/Reports
Working Papers/Unpublished Studies

Note: PDF versions of most publications are available by request.

COMMENTARIES/EDITORIALS/LETTERS

Public Health workforce trends since 1980: myth or reality (2009 forthcoming)
Public health management: out of the shadows (2006)
Binghamton by way of Elmira (2006)
Public health funding: one hand giveth while the other taketh away (2004)
Accrediting public health organizations: the ducks is on the pond (1998)
Public health practice: back to the future (1998)
Public health expenditures: the good news and bad news for public health (1997)
Evaluating the performance of local health agencies: the 10 public health practices vs. the 10 public health services--a clarification (1995, letter)
Mandatory Premarital HIV Testing: The Illinois Experience (1990, letter)

ARTICLES/BOOKS/CHAPTERS/REPORTS

Public Health: What It Is and How It Works, Fourth Edition. (2008, preface)
Sustaining leadership in public health improvement in Illinois over five decades (2007)
History will be kind (2007)
Essentials of Public Health (2007, preface)
Performance management: the evolution of standards, measurement and quality improvement in public health (2007)
Public health workforce, 2006: new challenges (2006)
Public Health: Career Choices That Make a Difference (2006, preface)
MAPP in the classroom: oxymoron or opportunity (2005)
Public Health Preparedness at a Price: Illinois (2004)
Public Health: What It Is and How It Works, Third Edition (2004, preface)
Roadmap for public health workforce preparedness (2003)
Governmental public health in the U.S.: implications of federalism (2002)
Public health workforce development (2002)
Assessing capacity and measuring performance in maternal and child health (2002)
Competency based credentialing of public health administrators in Illinois (2001)
A conceptual framework to measure performance in the public health system (2001) , HTML
Public Health: What It Is and How It Works, Second Edition (2001, preface)
Public health practice (2000)
Performance measurement and improvement (2000)
Can public health performance standards improve the quality of public health practice? (2000)
The local public health workforce in Illinois: size, distribution, composition, and influence on core function performance, 1998-1999 (2000)
Guidebook for Performance Measurement (1999)
Public health practice linkages between schools of public health and state health agencies: 1992-1996 (1999)
Impact of Medicaid resources on core public health responsibilities of local health departments in Illinois (1998)
Core function-related local public health practice effectiveness (1998)
Public health practice linkages between schools of public health and state health agencies: results from a three-year survey (1997)
Quality assessment of perinatal regionalization by multivariate analysis: Illinois, 1991-1993 (1997)
From measuring to improving public health practice (1997)
Public Health: What It Is and How It Works (1997, preface)
Local health department effectiveness in addressing the core functions of public health: essential ingredients (1996)
Is public health ready for reform? The case for accrediting local health departments (1996)
Roles for state-level local health liaison officials in local public health surveillance and capacity building (1995)
A strategy for measuring local public health practice (1995)
Capacity-building influences on Illinois local health departments (1995)
Local health department effectiveness in addressing the core functions of public health (1994)
Implementing and assessing organizational practices in local health departments (1994)
Building bridges between schools of public health and public health practice (1994)
Mandatory premarital testing for human immunodeficiency virus: The Illinois experience (1989)
Incorporating outcome standards into perinatal regulations (1986) , HTML
The decline in perinatal and infant mortality in Chicago during the 1980's (1985)
Approaches to reducing infant mortality in Illinois, part 2:targeting approaches (1983)
Approaches to reducing infant mortality in Illinois, part 1: strategies to reduce infant mortality (1983)
Patterns of utilization of special care nurseries in New York City (1982)
Evaluation of an EMS regional referral system using a tracer methodology (1980)
Family-centered care activities by size of maternity service (1979)

WORKING PAPERS/UNPUBLISHED REPORTS

Public Health Performance Management Curriculum (2004) (complete curriculum materials available from Turning Point National Program Office or from authors upon request; PowerPoint file available here)
Assessing the Reliability of Measures Used in the National Public Health Performance Standards Local Instrument (2001)
Feasibility of linking core function-related performance measures and community health outcomes (1999)
Mandatory Premarital Testing for the Human Immunodeficiency Virus in the State of Illinois (1994)

Public health workforce development since 1980: myth or reality?

Turnock BJ---Division of Community Health Sciences, University of Illinois at Chicago School of Public Health.

Journal of Public Health Management and Practice 2009 (forthcoming)

Increasingly, the national spotlight is focusing on the needs of the public health workforce fueled, in part, by assertions that the number of public health workers has declined since 1980. A closer examination suggests that there is little evidence to support the claim of a shrinking workforce and that the number of public health workers has actually been increasing at a rate greater than that that of the general population. These findings suggest that the evidence base for public health workforce preparedness efforts must be strengthened.

Sustaining leadership in public health improvement in Illinois over five decades

Bassler EJ, Landrum LB, and Turnock BJ---Illinois Public Health Institute and Division of Community Health Sciences, University of Illinois at Chicago School of Public Health

Leadership in Public Health 2007;7(4):2-5.

After nearly five decades of experience with state standards for local health departments (LHDs), Illinois is poised to enhance its current LHD certification program with key elements of the national voluntary accreditation initiative. Leadership was essential in the initial establishment of standards for LHDs in 1961 (a process that actually began in 1957) and in efforts in the 1970s and 1980s to recognize and reward LHDs meeting established standards through a LHD certification program. Leadership was equally critical in refocusing LHD certification away from program-based standards in the early 1990s. Blending the lessons and best elements of this long standing effort with the opportunities of a new national effort presents yet another leadership challenge for the public health community in Illinois .

History will be kind

Turnock BJ and Barnes PA---Division of Community Health Sciences, University of Illinois at Chicago School of Public Health and U.S. Air Force Health Education Program.

Journal of Public Health Management and Practice 2007;13(4):337-341.

Current initiatives to accredit public health agencies can trace their roots to efforts initiated more than 150 years ago and owe much to a succession of leading public health figures and landmark documents over that period. The influence of public health leaders and national professional organizations is apparent in the progress made in the shift from measuring to improving public health practice. More recent developments derive from consensus as the importance of an accountable governmental presence in health and initiatives that have operationalized important concepts of public health’s mission and functions.

Performance management: the evolution of standards, measurement, and quality improvement in public health

Landrum LB, Beitsch LM, Turnock BJ, and Handler AS---Division of Community Health Sciences, University of Illinois at Chicago School of Public Health and Chicago Department of Public Health.

Chapter 17 in Public Health Administration: Principles for Population-Based Management, 2nd edition. Novick L, Morrow CP, and Mays GP (eds). Sudbury MA; Jones & Bartlett Publishers, 2007.

Public health workforce 2006: new challenges

Gebbie KM and Turnock BJ---Division of Community Health Sciences, University of Illinois at Chicago School of Public Health and Chicago Department of Public Health.

Health Affairs 2006;25:923-933.

Public health workforce development efforts since 2001 have benefited from increased funding resulting form concerns over terrorism and other public health threats. Greater attention has also been accompanied by the need for greater accountability for results. The size, composition, and distribution of the public health workforce have long been policy concerns. Production and retention of public health workers remain important issues, although new dimensions of readiness are also taking center stage. Policy recommendations are made in areas of assessing the public health workforce and its needs, organizing development efforts around essential competencies for public health practice, credentialing individual workers, and accrediting agencies.

MAPP in the classroom: oxymoron or opportunity?

Turnock BJ and Long A---Division of Community Health Sciences, University of Illinois at Chicago School of Public Health and Chicago Department of Public Health.

Journal of Public Health Management and Practice 2005;11(5):442-447.

As MAPP becomes increasingly important for community public health practice, it is critical to examine what learning MAPP entails as well as its barriers and benefits. Competency-based education and training interventions that prepare public health workers to effectively contribute to the implementation of MAPP in their communities face significant obstacles. Current public health education and training programs are poorly positioned to enhance MAPP-related competencies among significant numbers of public health students and workers. Establishing the community as the classroom for learning MAPP and forging links with professional education and life-long professional development strategies are necessary for MAPP to be successful in promoting healthy communities.

Public Health Preparedness at a Price: Illinois

Turnock BJ---Division of Community Health Sciences, University of Illinois at Chicago School of Public Health

Century Foundation Monograph. New York NY; Century Foundation, 2004.

The infusion of federal bioterrorism preparedness funding, beginning in earnest in mid-2002, offered state and local governments an unprecedented opportunity to retool their public health systems in synch with national needs. By mid-2003, the early experience in sentinel states like Illinois shed light on whether the national bioterrorism preparedness imitative will achieve its desired effect on states and localities, and whether the implementation of this federal public health program is benefiting from the lessons of history.

Roadmap for public health workforce preparedness

Turnock BJ---Division of Community Health Sciences, University of Illinois at Chicago School of Public Health

Journal of Public Health Management & Practice 2003;9(6):471-480.

Major developments to improve the public health workforce have occurred since 1997, driven by increasing financial support from federal health agencies, technologies to access public health workers, and an emerging national priority to prepare for and respond to bioterrorism and other urgent threats. This paper examines the current status of the national public health workforce development agenda, including its major strategies and emphases, and suggests strategies for remediation.

Governmental public health in the U.S.: implications of federalism

Turnock BJ and Atchison C. University of Illinois at Chicago School of Public Health and University of Iowa College of Public Health.

Health Affairs 2002;21(6):68-78.

Governmental public health activities in the U.S. have evolved over time as a result of two forces: the nature and perceived importance of threats to the population’s health and safety, and changing relationships among the various levels of government. Shifts toward a more state-centered form of federalism in the second half of the 20^th century weakened key aspects of the governmental public health enterprise, including its leadership and coordination, by the century’s end. These developments challenge governmental public health responses to the new threats and increased societal expectations of the early 21^st century.

Public health workforce development

Turnock BJ---Division of Community Health Sciences, University of Illinois at Chicago School of Public Health

Health and Human Rights: the Educational Challenge SP Marks (ed). Boston MA; Francois-Xavier Bagnoud Center for Health and Human Rights, 2002 (Chapter 3, pp 43-57)

Emerging interest in improving the public health infrastructure has focused a spotlight on the preparedness of public health workers to address both routine and emergent threats. While this interest traces much of its origin to the often-cited 1988 report of the Institute on Medicine, The Future of Public Health, meaningful developments to improve the public health workforce accelerated since 1997 driven by increased financial support from federal health agencies, promising technologies to reach public health workers, and an urgent need to prepare for and respond to bioterrorism and other urgent threats. These developments were layered over long-standing, but largely fragmented, approaches to addressing the continuing education needs of the public health workforce. The result has been an amorphous patchwork of activity moving in unclear directions. This report describes the current status of the national public health workforce development agenda, including its strategies and activities. The intent is to provide a context that can assist future efforts to promote enhanced competency of public health workers, especially those focusing on newly identified competency needs and curricula.

Assessing capacity and measuring performance in maternal and child health

Handler A, Grason, H, Ruderman M, Issel M, Turnock BJ. University of Illinois at Chicago and University of North Carolina at Chapel Hill Schools of Public Health.

Maternal and Child Health Journal 2002;6(2):115-123.

This study was undertaken to understand the similarities, differences, and relationships between three tools for performance and capacity assessment currently available for Maternal and Child Health (MCH) programs and for state and local health agencies. Three tools for performance and capacity assessment currently available for Maternal and Child Health (MCH) programs and for state and local health agencies, the Title V MCH Block Grant Performance and Outcome Measures (Title V "24"), CAST-5, and the National Public Health Performance Standards Program (NPHPSP) were compared using two metrics, a conceptual model of the public health system, and a set of attributes related to the use of the instruments. The results indicated that both CAST-5 and the NPHPSP are focused on the capacity and key processes (10 Essential Public Health Services) of the public health system, although CAST-5 is intended for capacity assessment and the NPHPSP is intended for performance measurement. The Title V "24" tool is also intended for performance measurement; however, its focus is on the outputs and outcomes of the health system. The Title V "24" tool is the only one of the three that is mandatory, and the only one whose results at the current time can be used to compare across entities. In addition, both the Title V "24" and the NPHPSP include explicit standards, while CAST-5 does not specify explicit standards against which to compare findings. The authors conclude that, while there are various tools available to MCH practitioners for capacity assessment and performance measurement, knowing how the tools relate to each other, and their defining characteristics, should lead to more effective and productive use.

Competency-based credentialing of public health administrators in Illinois

Turnock BJ---Division of Community Health Sciences, University of Illinois at Chicago School of Public Health

Journal of Public Health Management & Practice 2001;7(4):74-82.

This article describes an initiative to develop and implement a competency-based credentialing program for public health managers and administrators that is linked with practice performance standards for local public heath systems. The Illinois Public Health Administration Certification Board represents an innovative model for credentialing public health workers, placing equal value on competencies secured through education and training and those demonstrated in practice. Competency-based credentialing of public health administrators may have applicability for other segments of the public health workforce.

A conceptual framework to measure performance of the public health system

Handler AS, Issel LM, Turnock BJ---Division of Community Health Sciences, University of Illinois at Chicago School of Public Health

American Journal of Public Health 2001;91:1`235-1239.

This article describes a unifying conceptual framework for the public health system as a way to facilitate the measurement of public health system performance. A conceptual framework for the public health system was developed on the basis of the work of Donabedian and a conceptual model developed by Turnock and Handler. The conceptual framework consists of 5 components that can be considered in relationship to each other: macro context, mission, structural capacity, processes, and otucomes. Although the availability of measures for each of these components varies, the framework can be used to examine the performance of public health systems as well as that of agencies and programs. A conceptual framework that explicates the relationships among the various components of the public health system is an essential step toward providing a science base for the study of public health system performance.

Performance measurement and improvement

Turnock BJ and Handler AS---Division of Community Health Sciences, University of Illinois at Chicago School of Public Health

Chapter 18 in Public Health Administration: Principles for Population Based Management. Novick L and Mays GP (eds). Gaithersburg MD; Aspen Publishers; 2000; pp 431-456.

Public health organizations use performance measurement activities to track the work produced and results achieved through their internal and inter-organizational efforts. Increasingly, organizations rely on performance measurement activities both to achieve internal quality improvement goals and to demonstrate accountability to external stakeholders. A growing array of management tools and processes is available to assist organizations in carrying out performance measurement activities on a routine basis. Organizations should adapt measurement approaches to their specific institutional capacities and priorities, and to address the needs and concerns of the communities they serve.

Can public health performance standards improve the quality of public health practice?

Turnock BJ---Division of Community Health Sciences, University of Illinois at Chicago School of Public Health

Journal Public Health Management & Practice 2000;6(5):19-25.

Recent developments suggest that the national public health performance standards program could succeed in improving the quality of public health practice. Public health standards also may be useful for enhancing accountability and strengthening the science base of public health practice. For national public health performance standards to have a substantial influence on the quality of public health practice, several important issues must be addressed. These include agreement as to the ultimate purpose and appropriate unit of measurement, delineation of the specific qualities to be measured, and expansion of strategies to promote widespread us of public health practice standards.

The Local Public Health Workforce in Illinois: Size, Distribution, Composition, and Influence on Core Function Performance, 1998-1999

Turnock BJ and Hutchison KS---Division of Community Health Sciences, University of Illinois at Chicago School of Public Health and Illinois Health Workforce Studies Center.

Illinois Health Workforce Studies Center: Chicago IL, 2000.

Guidebook for Performance Measurement

Lichiello P and Turnock BJ---Turning Point National Program Office and Division of Community Health Sciences, University of Illinois at Chicago School of Public Health

Turning Point National Program Office: Seattle WA, 1999.

A guidebook and primer on the fundamentals of performance measurement and its use in public health.

Public health practice linkages between schools of public health and state health agencies: 1992-1996

Gordon AK, Chung K, Handler A, Turnock BJ, Schieve LA, Ippoliti P---Division of Community Health Sciences, University of Illinois at Chicago School of Public Health

Journal Public Health Management & Practice 1999;5(3):25-34.

Since 1988, there has been an increased call for enhanced linkages between schools of public health agencies and public health agencies, which has prompted schools of public health with support from the federal government to develop public health practice initiatives. Surveys of schools of public health and of state public health agencies were conducted in 1992 by the University of Illinois at Chicago, School of Public Health (UIC-SPH) to collect baseline data on practice initiatives undertaken by academe and governmental public health agencies to enhance collaboration; follow-up surveys were undertaken in 1993, 1994, and 1996. Initial responses revealed that a substantial amount of interaction between schools of public health and public health agencies had been occurring for some time, with much of the interaction informal and between individuals or departments, rather than institution-wide. In the follow-up surveys, both frequency and formalization of such collaborations increased, reflecting a growing emphasis on public health practice activities at schools of public health. One of the most important trends by 1996 was the significant increase of public health professionals appointed to faculty positions at schools of public health and involved in the academic life of the school. This bodes well for one of the primary goals of public health practice which is to bring "the real world of public health" into the educational milieu of the student. Another goal of public health practice is to familiarize public health agencies with faculty expertise and research at SPHs which is also now being realized as public health professionals become more active in the academic setting. However, agencies and schools have discordant perceptions about the amount and kind of collaborative activities they have with each other.

Impact of Medicaid resources on core public health responsibilities of local health department in Illinois

Lumpkin JR, Landrum LB, Oldfield A, Kimmel P, Jones MC, Moody CM, Turnock BJ---Illinois Department of Public Health and University of Illinois at Chicago School of Public Health

Journal Public Health Management & Practice 1998;4(6):69-78.

With Illinois' plan to embark on a statewide Medicaid managed care program, the impact of Medicaid resources on core public health responsibilities of local health departments (LHDs) was assessed and found to be substantial. A reduction of $330,000 in core public health activities would likely accompany each $1 million in Medicaid resources lost by these LHDs. Only by actively participating in the planning and implementation of these conversions can public health agencies maintain high productivity and efficiency in addressing core public health responsibilities in their communities.

Core function-related local public health practice effectiveness

Turnock BJ, Handler AS, Miller CA---Division of Community Health Sciences, University of Illinois at Chicago School of Public Health and University of North Carolina at Chapel Hill, School of Public Health

Journal Public Health Management & Practice 1998;4(5):26-32.

This study assesses the extent to which the U.S. population in 1995 was being effectively served by public health's three core functions (assessment, policy development, and assurance). A random sample of local health departments (LHDs) stratified by population size and type of jurisdiction was asked to provide their opinion of, as well as indicate performance on 20 core function-related measures of local public health practice. The authors conclude that, in 1995, the nation fell far short of its year 2000 national objective, which called for 90 percent of the population to be served by an LHD effectively carrying out public health's core functions. Considerable capacity building and performance improvement is needed within the public health system.

Public health practice linkages between schools of public health and state health agencies: results from a three-year survey

Schieve LA, Handler A, Gordon AK, Ippoliti P, Turnock BJ---Division of Community Health Sciences, University of Illinois at Chicago School of Public Health

Journal Public Health Management & Practice 1997;3(3):29-36.

Several recent examinations of the state of public health have called for enhanced linkages between schools of public health and public health agencies, prompting federal health agencies and schools of public health to develop practice initiatives. Surveys of schools of public health and of state public health agencies were conducted in 1992 to collect baseline data on practice links between the two organizations; follow-up surveys were undertaken in 1993 and 1994. Responses reveal that a substantial amount of interaction between schools and agencies has been occurring for some time, but that until recently much of the interaction has been informal and between individuals or departments rather than institution-wide. Both frequency and formalization of such collaborations have increased, reflecting a growing emphasis on public health practice activities at schools of public health together with public health agencies.

Quality assessment of perinatal regionalization by multivariate analysis: Illinois, 1991-1993

Dooley SL, Freels SA, Turnock BJ---Divisions of Epidemiology and Community Health Sciences, University of Illinois at Chicago School of Public Health

Obstetrics & Gynecology 1997;89(2):193-198.

OBJECTIVE: To identify (1) those elements in the infrastructure of a regionalized perinatal network that have independent effects on the variation in perinatal mortality among nontertiary units (member level I and II hospitals) and (2) shortcomings, if any, in a traditional perinatal data base that impede quality assessment of contemporary regionalized care.

METHODS: We analyzed perinatal surveillance data for 3 years, from 1991 to 1993, in the state of Illinois, representing more than 190,000 annual births. Fetal death and neonatal mortality rates for the 97 nontertiary hospitals studied were the dependent variables of interest. Two sets of independent variables were studied, those assessing the maternal sociobehavioral risk of populations served and those assessing the network infrastructure (defined as the facilities of member hospitals and their function within the regionalized network). We used multivariate analysis to partition the variation in hospital rates of perinatal mortality into two components, one attributable to maternal sociobehavioral risk and the other to the network infrastructure.

RESULTS: Maternal sociobehavioral risk alone explained 73 percent of the variation in hospital fetal death rates and 38 percent of that in hospital neonatal mortality rates. When controlling for maternal sociobehavioral risk, rates of inborn very low birth weight (VLBW) deliveries (P < .001) and neonatal transport (P = .01) had independent effects on the variation in hospital fetal death rate; rates of inborn VLBW deliveries (P < .001), neonatal transport (P < .001), and proportion of VLBW infants transported out (P = .029) had independent effects on the variation in hospital neonatal mortality rate.

CONCLUSIONS: In this mature statewide network, the rate of inborn VLBW deliveries exerted the strongest independent effect on variation in level I and II hospital rates of both fetal death and neonatal mortality. However, that there was such a large effect from maternal sociobehavioral risk alone has important public health implications. Additions and modifications to traditional perinatal surveillance are suggested to better assess the quality of regionalization in a contemporary health care environment.

From measuring to improving public health practice

Turnock BJ, Handler AS---Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago

Annual Review Public Health 1997;18:261-282.

Efforts to measure public health practice have taken on various forms and focused on different aspects of the system of public health practice over the past century. Before 1990, measurement was primarily based on a series of self-assessment instruments initiated under the auspices of the Committee on Administrative Practice of the American Public Health Association. These instruments emphasized measurement of immediate results of local public health services although they also provided information on local resources and capacity to perform. Following the Institute of Medicine's report in 1988, efforts began to focus on performance related to public health's core functions. These more recent assessments suggest that the system of public health practice must be improved to achieve the targets of effectiveness established for the year 2000. Ultimately, a comprehensive national surveillance system for public health practice will need to both measure and examine the relationships among inputs (resources, capacity, etc), core function-related processes, and outputs (services), as well as outcomes.

Local health department effectiveness in addressing the core functions of public health: essential ingredients

Handler AS, Turnock BJ---Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago

Journal Public Health Policy 1996;17(4):460-483.

OBJECTIVES: Objective 8.14 of the U.S. Healthy People 2000 objectives calls for 90 percent of the population to be served by a local health department (LHD) which is effectively carrying out the core functions of public health (assessment, policy development, assurance). This study seeks to describe the structural and service characteristics of an effective LHD.

METHODS: Data from a 1993 national random sample survey of LHD practice were merged with data from the 1992-1993 National Association of Country and City Health Officials (NACCHO) profile of local health agencies. Using a definition of effectiveness related to the core functions of public health, the correlates of effectiveness were examined for 264 health departments in the matched sample.

RESULTS: Effectiveness of local health agencies was not related to jurisdiction size or type. Inputs (structural factors) associated with effectiveness included having a full-time agency head, a larger budget derived from a greater number of funding sources, and a larger number of staff. With respect to outputs (services), effective health departments were also more likely to provide a greater number of services directly, particularly personal preventive and treatment services.

CONCLUSIONS: Only a few inputs are correlated with core-function related effectiveness. However, a profile of an effective health department emerges. Effective LHDs appear more likely to have full-time leadership which is able to tap diverse funding sources to provide the mix and match of community and personal prevention and treatment services needed to address community needs and improve the public's health.

Is public health ready for reform? The case for accrediting local health departments

Turnock BJ and Handler AS---Division of Community Health Sciences, University of Illinois at Chicago School of Public Health.

Journal Public Health Management & Practice 1996;2(3):41-45.

Reform of the governmental public health system in the U.S. has been stymied by changes in political, economic and medical care landscapes since public health was called to action by the Institute of Medicine report in 1988. Despite a new national health objective calling for 90 percent of the population to be served by a local health department effectively addressing public health's three core functions by the year 2000, capacity building initiatives have not been deployed extensively, and there is little likelihood of reaching the year 2000 objective. A national program of accrediting local and state health departments could energize public health capacity building. Accreditation would build on recent initiatives in states like Washington and Illinois, promote wider use of the Assessment Protocol for Excellence in Public Health (APEXPH), and facilitate reform of the public health system around public health's core functions. Key questions addressing the why, how and who of such an initiative set the stage for consideration of a national accreditation program.

Roles for state-level local health liaison officials in local public health surveillance and capacity building

Turnock BJ, Handler AS, Hall W, Potsic S, Munson J, Vaughn EH---Division of Community Health Services, University of Illinois at Chicago School of Public Health.

American Journal Preventive Medicine 1995;11(6 Suppl):41-44.

In 27 state health agencies, local health liaison units or officials (LHLOs) are formally assigned responsibility for fostering a close working relationship between the state health agency and local health departments (LHDs). Yet in most other states, other agency staff carry out these responsibilities informally. Even where formal LHLOs exist, the assigned functions and specific activities vary, with little consistency across states other than serving as a potential or, in most cases, a real and vital linkage between LHDs and the state agency. This linkage places the LHLO in a unique position to develop extensive knowledge, data, and information on LHD activities and to play an important role in assessing and improving local public health practice. This report examines aspects of the LHLO-LHD relationship in terms of potential LHLO roles in LHD practice surveillance and capacity building. Surveys of LHLOs and LHDs indicate that both support the development of surveillance tools to measure LHD effectiveness as a means to enhance capacity building efforts. Although LHLOs may not know or have the specific information immediately available to assess local public health practice for LHDs in their state, they report being able to obtain the information if necessary and with sufficient time. Further, LHDs are willing to share information concerning local public health practice with their state health department, particularly with their state LHLO. These findings suggest that LHLOs could be extensively involved in surveillance strategies beyond merely collecting and aggregating information provided by LHDs.

A strategy for measuring local public health practice

Handler AS, Turnock BJ, Hall W, Potsic S, Munson J, Nalluri R, Vaughn EH---Department of Community Health Sciences, University of Illinois at Chicago, Illinois 60612, USA.

American Journal Preventive Medicine 1995;11(6 Suppl):29-35.

The national health objectives for the year 2000 call for 90 percent of the population to be served by a local health department (LHD) that is effectively addressing the core functions of public health. Achieving this objective requires consensus definitions for effectiveness as well as a system for ascertainment. In 1990 when this objective was established, no baseline data were available, and no accepted methods of measuring health department effectiveness were in use. Our approach to the development of a surveillance system to measure the effectiveness of LHDs has been to translate the three core public health functions characterized by the Institute of Medicine and the 10 practices delineated by the Centers for Disease Control and Prevention (CDC) and the national public health practice organizations into practice performance measures that could be judged as met or not met at the level of a jurisdiction served by a LHD. As part of our effort to develop a surveillance system to measure local public health practice, performance measures that characterize the 10 public health practices and their related core functions were developed and field-tested with state local health liaison officials and local health departments over a two-year period. Obtaining input from these sources is essential to establishing their validity and is a critical aspect of building nationwide consensus for appropriate measures of effective local public health practice. The results of these efforts led to the establishment of a proposed surveillance instrument comprising 10 performance standards and 29 associated indicators. We describe two approaches to its use.

Capacity-building influences on Illinois local health departments

Turnock BJ, Handler A, Hall W, Lenihan DP, Vaughn E---Division of Community Health Sciences, University of Illinois at Chicago School of Public Health

Journal Public Health Management & Practice 1995;1(3):50-58.

Illinois local health departments (LHDs) were surveyed in 1992 and again in 1994 in order to assess changes in, influences on, and results of practice performance during this two-year period. Illinois LHDs serving both small and large populations were found to have greatly increased the extent to which they carry out practice measures related to public health's core functions. The Assessment Protocol of Excellence in Public Health (APEXPH) and its Illinois adaptation were cited as the most positive influences on practice performance. LHDs viewed the most significant consequences of participation in needs assessment and planning processes as increased understanding of internal strengths and weaknesses and of community health problems. These findings suggest that significant improvements in LHD practice performance can result from widespread implementation of APEXPH and its derivatives.

Local health department effectiveness in addressing the core functions of public health

Turnock BJ, Handler A, Hall W, Potsic S, Nalluri R, Vaughn EH---University of Illinois at Chicago School of Public Health 60612.

Public Health Reports 1994;109(5):653-658.

Objective 8.14 of the Year 2000 National Health Objectives calls for 90 percent of the population to be served by a local health department effectively carrying out the three core functions of public health--assessment, policy development, and assurance. To provide a benchmark of local health department effectiveness in addressing the core functions and to assess implications for achieving the year 2000 target, a random national sample (stratified by jurisdiction and population base) of local health departments was surveyed to determine self-reported compliance with 10 public health practice performance measures that operationalize the core functions. Overall compliance with the 10 performance measures was 50 percent, based on weighted responses of 208 responding health departments. Compliance was highest for the practices related to the assurance function and lowest for practices related to the policy development function. Compliance was also high for departments serving a population of 50,000 or more and those smaller departments organized at the city and city-county levels. Using two different definitions developed by the investigators, 19 and 31 percent of the health departments were judged to be effective in addressing the core functions of public health. These data suggest that less than one third of the U.S. population was served by a health department effectively addressing the core functions of public health in 1993. It appears that considerable capacity building within the public health system will be needed to achieve the year 2000 target of 90 percent.

Implementing and assessing organizational practices in local health departments

Turnock BJ, Handler A, Dyal WW, Christenson G, Vaughn EH, Rowitz L, Munson JW, Balderson T, Richards TB---School of Public Health, University of Illinois at Chicago.

Public Health Reports 1994;109(4):478-484.

One of the most difficult forms of public health practice to characterize involves governmental public health agencies, especially at the local level. A lack of consensus within the public health community as to the purpose and content of organizational public health practice inhibits efforts to increase the capability of public health to address effectively its core functions of assessment, policy development, and assurance. Meaningful capacity building efforts must establish both benchmarks and expectations for the organizational practice of public health. Those markers must be established so that the impact of practice on outcomes and health status can be examined. A model identifying 10 organizational practices was established through the work of the Centers for Disease Control and Prevention (CDC) in collaboration with national practice organizations. Early applications of the model to public health capacity building activities have been successful. Among the applications have been approaches to surveillance of health department practice, certification of local health departments using practice guidelines, and development of leadership within the public health enterprise. Although results are promising, use of the model requires additional external examination and validation, as well as acceptance and consensus within the public health community. The development of organizational practice guidelines for public health agencies may be useful in further efforts to characterize and measure public health practice and its impact on the public's health.

Building bridges between schools of public health and public health practice

Handler A, Schieve LA, Ippoliti P, Gordon AK, Turnock BJ---Center for the Development of Public Health Practice, School of Public Health, University of Illinois at Chicago 60612.

American Journal Public Health 1994;84(7):1077-1080.

A 1988 Institute of Medicine report, The Future of Public Health, characterized the current public health system as fragmented, particularly with regard to relationships between public health agencies and academic institutions. As one response to the report, the Health Resources and Services Administration established the Center for the Development of Public Health Practice at the University of Illinois to advance linkages between schools of public health and public health agencies. Surveys of schools of public health and of state health agencies were conducted in 1992 to collect baseline data on the practice links between the two. Responses reveal that there is a substantial amount of informal collaboration between them. Formalization of collaborative activities between schools and agencies is beginning to occur and is expected to expand owing to increased focus on public health practice at schools of public health.

Mandatory premarital testing for human immunodeficiency virus: the Illinois experience

Turnock BJ, Kelly CJ---Illinois Department of Public Health

JAMA 1989;261(23):3415-3418.

During the first 6 months of legislatively mandated premarital testing for human immunodeficiency virus in Illinois, 8 of 70,846 applicants for marriage licenses were found to be seropositive, yielding a seroprevalence of 0.011 percent. The total cost of the testing program for 6 months is estimated at $2.5 million or $312,000 per seropositive individual identified. Half of the reported seropositive individuals reported a history of risk behavior. During the same period, the number of marriage licenses issued in Illinois decreased by 22.5 percent, while the number of licenses issued to Illinois residents in surrounding states increased significantly. We conclude that mandatory premarital testing is not a cost-effective method for the control of human immunodeficiency virus infection.

Incorporating outcome standards into perinatal regulations

Turnock BJ, Masterson JW---Chicago Department of Health

Public Health Reports 1986;101(1):59-67.

State and local governments license and monitor hospitals to ensure that a minimum acceptable level of care is present as one means of improving the outcomes and health status of patients served. Standards developed to achieve these purposes, however, have focused almost exclusively on the inputs and processes believed to be necessary for quality care and optimal services. Even when the overwhelming consensus of professionals and providers is that such standards impact positively on outcomes, direct evidence of such causal relationships is often lacking. In 1983, the Chicago Department of Health began incorporating direct measurement of outcomes into its mandated regulatory functions for one operating unit of hospitals--the maternity and newborn services. Crude perinatal and neonatal mortality rates for Chicago hospitals are adjusted using an indirect standardization process that controls for both race and birthweight. This process allows for the calculation of adjusted mortality rates and standardized mortality ratios (SMRs) that are used as an initial screening instrument. Additional evaluation and investigation activities are then directed to hospitals identified through the initial screening process as meriting further study. Hospitals are also evaluated for compliance with the traditional standards and requirements. Information derived from both outcome and compliance evaluations is used to determine monitoring and regulatory activities such as penalties, waivers, and periodicity of future inspections. Use of this Outcome-Oriented Perinatal Surveillance System appears to be an objective, understandable, and acceptable basis for establishing monitoring, evaluation, and regulatory strategies for hospitals with maternity and newborn units.

The decline in perinatal and infant mortality in Chicago during the 1980s

Turnock BJ, Masterson J, Green LA, Edwards LC---Chicago Department of Health

Chicago Medicine 1985;88:246-250.

1983 marked a significant turning point in Chicago's efforts to reduce perinatal and infant mortality within the nation's third largest city. For the first time since vital events have been recorded in the city, fewer than 1,000 Chicago infants died before reaching their first birthday. Even more importantly, the city experienced a continuation of its reduction in infant mortality rates of more than 5 percent, with perinatal mortality declining by 10 percent and the neonatal mortality rate falling nearly 7 percent. Postneonatal mortality fell 3 percent, while the fetal death rate was nearly 13 percent lower. This report summarizes the progress that has been made, describes factors that have contributed to these successes, and highlights some emerging trends that may actually impede further progress in this area.

Approaches to reducing infant mortality in Illinois: part 1, strategies to reduce infant mortality

Approaches to reducing infant mortality in Illinois: part 2, targeting approaches

Turnock BJ and McGill L---Illinois Department of Public Health

Illinois Medical Journal 1983;163:415-418 and 1983;164:29-32.

Although the infant mortality rate for Illinois decreased by one-third between 1970 and 1980, the Illinois rate remains 18 percent higher than the comparable national figure. Three public health strategies seek to address infant mortality through their impact on either the neonatal or postneonatal components of infant mortality. The provision of preconceptional and prenatal health care acts to lower neonatal mortality by reducing the proportion of low birthweight infants among all births. Perinatal health care services also serve to reduce neonatal mortality, but act through improving birthweight-specific survival rates. On the other hand, infant follow-up services and health supervision during the first year of life exert their impact on postneonatal mortality. Selective application of one or more of these approaches can be facilitated by analysis of the relative contribution of the birthweight distribution, birthweight-adjusted mortality rates, and postneonatal deaths to the total level of excess infant deaths occurring in a service area. A broader perspective of perinatal health care systems encompasses all three strategies, and represents the most promising approach for maximizing perinatal outcomes in the future.

Patterns of utilization of special care nurseries in New York City

Turnock BJ and Pakter J---New York City Department of Health

Perinatology-Neonatology 1982;6(1):63-69.

How many special care beds for neonates will be needed in the future? In a survey of these specialized units in New York City hospitals, both individual hospitals and groups of hospitals showed unequal patterns of utilization, Under-utilization and unnecessary utilization may well be symptoms of a perinatal care system suffering from excess capacity.

Evaluation of an EMS regional referral system using a tracer methodology

Egges J, Turnock BJ---Illinois Department of Public Health

Annals Emergency Medicine 1980;9(10):518-523.

To improve patient care, cost effectiveness, and resource utilization, the Illinois EMS Program attempted to regionalize emergency medical care services by identifying referral centers for critically ill and injured patients. The performance of one referral region was evaluated applying a tracer method designed to track patients whose clinical conditions, as determined by a clinical panel, required treatment at a designated regional center. The proportion of patients reaching the appropriate centers suggests that the regional referral system under study appropriately moved only about one half the patients with the tracer conditions to the designated referral center. Additional patients were transferred to hospitals with greater emergency department capabilities, although these hospitals were not formally designated centers. Except for low birth weight, factors that might be associated with referral patterns indicate no significant differences between those patients at the regional center and those treated elsewhere.

Family-centered care activities by size of maternity service

Turnock B, Pakter J---New York City Department of Health

Women & Health 1979;4(4):373-384.

Fifty-four of the 55 New York City maternity services in operation as of January 1, 1978 responded to a questionnaire eliciting information as to the availability of certain family-centered care practices. The larger maternity units, especially those in which more than 2,000 live births occur annually, were noted to have a higher prevalence and greater extent of family-centered care activities than the smaller units. Although size alone cannot be isolated as the critical factor in this analysis, its association with other factors helps explain the differences observed.

Turnock Reading Room last revised October 29, 2008

Turnock Home

Turnock CV

Reading Room

Courses

CHSC 400

Prepare Center