What are the benefits and risks of using return on investment to defend public health programs?

Return on investment (ROI) is an economic measure used to indicate how much economic benefit is derived from a program in relation to its costs. Interest in the use of ROI in public health has grown substantially over recent years. Given its potential influence on resource allocation, it is crucial to understand the benefits and the risks of using ROI to defend public health programs. In this paper, we explore those benefits and risks. We present two recent examples of ROI use in public health in the United States and Canada and conclude with a series of proposals to minimize the risks associated with using ROI to defend public health interventions

Teaching Health Impact and Behavior with Infographics

The use of Infographics can be a tool that not only allows for the communication of empirical health data in an understandable format, but encourages the health administration student to present evidence-based research in a creative manner. The purpose of this paper is to describe a learning exercise that implements Infographics to demonstrate an impact of a health issue and/or encourage a health behavior change. This learning exercise is developed to increase student knowledge and visual literacy skills with respect to presenting, in a concise format, a well-researched and referenced health issue and/or a health behavior change. Specifically, the exercise was designed to: (a) curate health statistics and reference information for the selected health issue; (b) identify media resources and apply copyright and fair use in a proper manner; (c) evaluate internet resources for credibility and accuracy; and (d) utilize Infographic tools to communicate one\u27s visual viewpoint. At the conclusion of the course, students reflected on the effective visual aspects of their Infographics and the points that were challenging to communicate using this medium. The benefits of this applied learning approach for students and the faculty instructor are discussed

Gender and the Burden of Disease Attributable to Obesity

Objectives. We estimated the burden of disease in the United States attributable to obesity by gender, with life expectancy, quality-adjusted life expectancy, years of life lost annually, and quality-adjusted life years lost annually as outcome measures. Methods. We obtained burden of disease estimates for adults falling into the following body-mass index categories: normal weight (23 to <25), overweight (25 to <30), and obese (≥ 30). We analyzed the 2000 Medical Expenditure Panel Survey to obtain health-related quality-of-life scores and the 1990–1992 National Health Interview Survey linked to National Death Index data through the end of 1995 for mortality. Results. Overweight men and women lost 270 000 and 1.8 million quality-adjusted life years, respectively, relative to their normal-weight counterparts. Obese men and women lost 1.9 million and 3.4 million quality-adjusted life years, respectively, per year. Much of the burden of disease among overweight and obese women arose from lower health-related quality of life and late life mortality. Conclusions. Relative to men, women suffer a disproportionate burden of disease attributable to overweight and obesity, mostly because of differences in health-related quality of life

What Directions for Public Health Under the Affordable Care Act?

Outlines opportunities for public health efforts under the 2010 healthcare reform law, such as building prevention into insurance expansion and boosting innovation in population health, as well as challenges, such as budget constraints

Does Long-Term Macrophyte Management in Lakes Affect Biotic Richness and Diversity?

We hypothesize that the richness and diversity of the biota in Lake Moraine (42°50’47”N, 75°31’39”W) in New York have been negatively impacted by 60 years of macrophyte and algae management to control Eurasian watermilfoil ( Myriophyllum spicatum L.) and associated noxious plants. To test this hypothesis we compare water quality characteristics, richness and selected indicators of plant diversity, zooplankton, benthic macroinvertebrates and fish in Lake Moraine with those in nearby Hatch Lake (42°50’06”N, 75°40’67”W). The latter is of similar size and would be expected to have similar biota, but has not been subjected to management. Measurements of temperature, pH, oxygen, conductivity, Secchi transparency, calcium, total phosphorus and nitrites + nitrates are comparable. Taxa richness and the diversity indices applied to the aquatic macrophytes are similar in both lakes. (PDF has 8 pages.

Considerations on the monitoring of water quality in urban streams: a case study in Portugal

Monitoring water quality in urban stream is of utmost importance for water resources managers, who are pressured to optimize monitoring schemes in order to reduce costs. The present study aims to use the results of a 2-year-long water quality monitoring pro- gram of an urban stream in Portugal to identify improve- ment opportunities. The urban stream under study was subjected to wastewater treatment plants effluent dis- charges, leachates from a major sealed landfill, low- class housing effluents, and nonpoint sources of pollu- tion. Contributing watersheds are mostly artificial sur- faces and agricultural land, which irrigate directly from the river. River water quality was evaluated on 11 sam- pling locations for 24 months from October 2013 to September 2015. The present paper describes statistical analysis of the results obtained for 12 physicochemical parameters in order to optimize the monitoring scheme. Cluster analysis detected a seasonal variation in the water quality and a spatial pattern based on the major point sources of pollution. A factor analysis showed that the parameters that mostly contribute to water quality assessment in this urban river are alkalinity, ammonia, electrical conductivity, pH, temperature, and dissolved oxygen. Results suggest that the monitoring efforts— and associated costs—may be reduced by decreasing monitoring frequency, sampling points, and monitored parameters. The statistical analysis described in this study may be replicated in other water quality monitor- ing programs, providing useful and important informa- tion for the systematic and iterative assessment of the adequacy of water quality sampling programs towards a sustainable management of water quality surveillance.info:eu-repo/semantics/publishedVersio

Equivalency of risk for a modified health endpoint: a case from recreational water epidemiology studies

BACKGROUND: The United States Environmental Protection Agency (USEPA) and its predecessors have conducted three distinct series of epidemiological studies beginning in 1948 on the relationship between bathing water quality and swimmers’ illnesses. Keeping pace with advances in microbial technologies, these studies differed in their respective microbial indicators of water quality. Another difference, however, has been their specific health endpoints. The latest round of studies, the National Epidemiological Assessment of Recreational (NEEAR) Water studies initiated in 2002, used a case definition, termed “NEEAR GI illness” (NGI), for gastrointestinal illness corresponding closely to classifications employed by contemporary researchers, and to that proposed by the World Health Organization. NGI differed from the previous definition of “highly credible gastrointestinal illness” (HCGI) upon which the USEPA’s 1986 bathing water criteria had been based, primarily by excluding fever as a prerequisite. METHODS: Incidence of NGI from the NEEAR studies was compared to that of HCGI from earlier studies. Markov chain Monte Carlo method was used to estimate the respective beta binomial probability densities for NGI and HCGI establish credible intervals for the risk ratio of NGI to HCGI. RESULTS: The ratio of NGI risk to that of HCGI is estimated to be 4.5 with a credible interval 3.2 to 7.7. CONCLUSIONS: A risk level of 8 HCGI illnesses per 1000 swimmers, as in the 1986 freshwater criteria, would correspond to 36 NGI illnesses per 1000 swimmers. Given a microbial DNA-based (qPCR) water quality vs. risk relationship developed from the NEEAR studies, 36 NGI per 1000 corresponds to a geometric mean of 475 qPCR cell-equivalents per 100 ml

Association Between High Perceived Stress Over Time and Incident Hypertension in Black Adults: Findings From the Jackson Heart Study.

Background Chronic psychological stress has been associated with hypertension, but few studies have examined this relationship in blacks. We examined the association between perceived stress levels assessed annually for up to 13 years and incident hypertension in the Jackson Heart Study, a community-based cohort of blacks. Methods and Results Analyses included 1829 participants without hypertension at baseline (Exam 1, 2000-2004). Incident hypertension was defined as blood pressure≥140/90 mm Hg or antihypertensive medication use at Exam 2 (2005-2008) or Exam 3 (2009-2012). Each follow-up interval at risk of hypertension was categorized as low, moderate, or high perceived stress based on the number of annual assessments between exams in which participants reported "a lot" or "extreme" stress over the previous year (low, 0 high stress ratings; moderate, 1 high stress rating; high, ≥2 high stress ratings). During follow-up (median, 7.0 years), hypertension incidence was 48.5%. Hypertension developed in 30.6% of intervals with low perceived stress, 34.6% of intervals with moderate perceived stress, and 38.2% of intervals with high perceived stress. Age-, sex-, and time-adjusted risk ratios (95% CI) associated with moderate and high perceived stress versus low perceived stress were 1.19 (1.04-1.37) and 1.37 (1.20-1.57), respectively (P trend&lt;0.001). The association was present after adjustment for demographic, clinical, and behavioral factors and baseline stress (P trend=0.001). Conclusions In a community-based cohort of blacks, higher perceived stress over time was associated with an increased risk of developing hypertension. Evaluating stress levels over time and intervening when high perceived stress is persistent may reduce hypertension risk

The biking & walking benchmarking report website : an online tool to support health equity

THE AMERICAN PUBLIC HEALTH ASSOCIATION and the Institute of Transportation Engineers, in partnership with the League of American Bicyclists, with support from the Centers for Disease Control and Prevention and the Federal Highway Administration, have unveiled an online tool that makes active transportation data more accessible.The Benchmarking Report Website (bikingandwalkingbenchmarks.org) was developed to share data and findings from the biennial Bicycling and Walking in the United States: Benchmarking Report.As public health professionals work to advance health equity in their communities, the Benchmarking Report Website is a valuable resource to help inform decision makers, illustrate data and inspire advocates to action.The online tool has been developed with public health practitioners, researchers, planners, engineers, students, and bicycle/pedestrian coordinators and advocates in mind, offering opportunities to explore the data in several ways. Ready-made graphics and data tables make it easy to find and present key data points, such as bicyclist and pedestrian fatality rates, active commuting levels and state funding provisions for bicycle and pedestrian infrastructure projects. Users can select up to four states or cities included in the report to compare the data provided by the tool.For researchers and advocates who want to dig deeper into the data, spreadsheets with all data collected for the Benchmarking Report are available to download from the website. Hundreds of rows of data have been compiled into two spreadsheets \u2014 one for states and one for cities included in the Benchmarking Report. Each data set is identified with its source, helping analysts find more detailed information about the methodologies for data collection.This white paper was made possible through a contract between the American Public Health Association and Dovetail Projects funded through cooperative agreement 5U38OT000131-03 between the Centers for Disease Control and Prevention and APHA. The contents of this document are solely the responsibility of the authors and do not necessarily represent the official views of APHA or CDC.Biking_Walking_Report.ashx2018cooperative agreement 5U38OT000131-031138