Public health and the economy could be served by reallocating medical expenditures to social programs.

As much as 30% of US health care spending in the United States does not improve individual or population health. To a large extent this excess spending results from prices that are too high and from administrative waste. In the public sector, and particularly at the state level, where budget constraints are severe and reluctance to raise taxes high, this spending crowds out social, educational, and public-health investments. Over time, as spending on medical care increases, spending on improvements to the social determinants of health are starved. In California the fraction of General Fund expenditures spent on public health and social programs fell from 34.8% in fiscal year 1990 to 21.4% in fiscal year 2014, while health care increased from 14.1% to 21.3%. In spending more on healthcare and less on other efforts to improve health and health determinants, the state is missing important opportunities for health-promoting interventions with a strong financial return. Reallocating ineffective medical expenditures to proven and cost-effective public health and social programs would not be easy, but recognizing its potential for improving the public's health while saving taxpayers billions of dollars might provide political cover to those willing to engage in genuine reform. National estimates of the percent of medical spending that does not improve health suggest that approximately $5 billion of California's public budget for medical spending has no positive effect on health. Up to 10,500 premature deaths could be prevented annually by reallocating this portion of medical spending to public health. Alternatively, the same expenditure could help an additional 418,000 high school students to graduate

Building capacity for evidence-based public health: Reconciling the pulls of practice and the push of research

Timely implementation of principles of evidence-based public health (EBPH) is critical for bridging the gap between discovery of new knowledge and its application. Public health organizations need sufficient capacity (the availability of resources, structures, and workforce to plan, deliver, and evaluate the preventive dose of an evidence-based intervention) to move science to practice. We review principles of EBPH, the importance of capacity building to advance evidence-based approaches, promising approaches for capacity building, and future areas for research and practice. Although there is general agreement among practitioners and scientists on the importance of EBPH, there is less clarity on the definition of evidence, how to find it, and how, when, and where to use it. Capacity for EBPH is needed among both individuals and organizations. Capacity can be strengthened via training, use of tools, technical assistance, assessment and feedback, peer networking, and incentives. Modest investments in EBPH capacity building will foster more effective public health practice

Estimating the costs and benefits of providing free public transit passes to students in Los Angeles County: lessons learned in applying a health lens to decision-making.

In spite of increased focus by public health to engage and work with non-health sector partners to improve the health of the general as well as special populations, only a paucity of studies have described and disseminated emerging lessons and promising practices that can be used to undertake this work. This article describes the process used to conduct a Health Impact Assessment of a proposal to provide free public transportation passes to students in Los Angeles County. This illustrative case example describes opportunities and challenges encountered in working with an array of cross-sector partners and highlights four important lessons learned: (1) the benefits and challenges associated with broad conceptualization of public issues; (2) the need for more comprehensive, longitudinal data systems and dynamic simulation models to inform decision-making; (3) the importance of having a comprehensive policy assessment strategy that considers health impacts as well as costs and feasibility; and (4) the need for additional efforts to delineate the interconnectivity between health and other agency priorities. As public health advances cross-sector work in the community, further development of these priorities will help advance meaningful collaboration among all partners

Rediscovering the Core of Public Health

The success of public health has been its ability to understand contemporary health problems, to communicate the needs successfully, to identify solutions, and to implement them through programs and policies. In the past 50 years, those successes can be attributed largely to control of infectious disease, improved maternal and child health, delivery of other personal health care services, and changes in behaviors, particularly smoking. Yet health is primarily a product of our social, cultural, and physical environments. To continue to improve the nation’s health and reduce disparities, public health needs to return to its historical roots and engage with other sectors to create healthier communities. To do so requires expanding public health skills in areas such as quantitative policy analysis, communication, and community engagement

Evidence-based Decision Making to Improve Public Health Practice

Despite the many accomplishments of public health, greater attention on evidence-based approaches is warranted. This article reviews the concepts of evidence-based public health (EBPH), on which formal discourse originated about 15 years ago. Key components of EBPH include: making decisions based on the best available scientific evidence, using data and information systems systematically, applying program planning frameworks, engaging the community in decision making, conducting sound evaluation, and disseminating what is learned. Core competencies for EBPH are emerging, including not only technical skills but also attention to administrative practices in public health agencies. To better bridge evidence and practice, the concepts of EBPH outlined in this article should be carried out in their entirety

Restricted regions of enhanced growth of Antarctic krill in the circumpolar Southern Ocean

Food webs in high-latitude oceans are dominated by relatively few species. Future ocean and sea-ice changes affecting the distribution of such species will impact the structure and functioning of whole ecosystems. Antarctic krill (Euphausia superba) is a key species in Southern Ocean food webs, but there is little understanding of the factors influencing its success throughout much of the ocean. The capacity of a habitat to maintain growth will be crucial and here we use an empirical relationship of growth rate to assess seasonal spatial variability. Over much of the ocean, potential for growth is limited, with three restricted oceanic regions where seasonal conditions permit high growth rates, and only a few areas around the Scotia Sea and Antarctic Peninsula suitable for growth of the largest krill (>60 mm). Our study demonstrates that projections of impacts of future change need to account for spatial and seasonal variability of key ecological processes within ocean ecosystems

Population-based Interventions Engaging Communities of Color in Healthy Eating and Active Living: A Review

INTRODUCTION: The U.S. obesity epidemic is escalating, particularly among communities of color. Obesity control efforts have shifted away from individual-level approaches toward population-based approaches that address socio-cultural, political, economic, and physical environmental factors. Few data exist for ethnic minority groups. This article reviews studies of population-based interventions targeting communities of color or including sufficient samples to permit ethnic-specific analyses. METHODS: Inclusion criteria were established, an electronic database search conducted, and non-electronically catalogued studies retrieved. Findings were aggregated for earlier (early 1970s to early 1990s) and later (mid-1990s to present) interventions. RESULTS: The search yielded 23 ethnically inclusive intervention studies published between January 1970 and May 2003. Several characteristics of inclusive interventions were consistent with characteristics of community-level interventions among predominantly white European-American samples: use of non-interpersonal channels for information dissemination directed at broad spheres of influence (e.g., mass media), promotion of physical activity, and incorporation of social marketing principles. Ethnically inclusive studies, however, also placed greater emphasis on involving communities and building coalitions from study inception; targeting captive audiences; mobilizing social networks; and tailoring culturally specific messages and messengers. Inclusive studies also focused more on community than individual norms. Later studies used "upstream" approaches more than earlier studies. Fewer than half of the inclusive studies presented outcome evaluation data. Statistically significant effects were few and modest, but several studies demonstrated better outcomes among ethnic minority than white participants sampled. CONCLUSION: The best data available speak more about how to engage and retain people of color in these interventions than about how to create and sustain weight loss, regular engagement in physical activity, or improved diet. Advocacy should be directed at increasing the visibility and budget priority of interventions, particularly at the state and local levels

A Midpoint Process Evaluation of the Los Angeles Basin Racial and Ethnic Approaches to Community Health Across the US (REACH US) Disparities Center, 2007-2009

BACKGROUND: Racial/ethnic minority groups have higher risks for disease resulting from obesity. COMMUNITY CONTEXT: The University of California, Los Angeles, and the Los Angeles County Department of Public Health partnered with community organizations to disseminate culturally targeted physical activity and nutrition-based interventions in worksites. METHODS: We conducted community dialogues with people from 59 government and nonprofit health and social service agencies to develop wellness strategies for implementation in worksites. Strategies included structured group exercise breaks and serving healthy refreshments at organizational functions. During the first 2 years, we subcontracted with 6 community-based organizations (primary partners) who disseminated these wellness strategies to 29 organizations within their own professional networks (secondary worksites) through peer modeling and social support. We analyzed data from the first 2 years of the project to evaluate our dissemination approach. OUTCOME: Primary partners had difficulty recruiting organizations in their professional network as secondary partners to adopt wellness strategies. Within their own organizations, primary partners reported significant increases in implementation in 2 of the 6 core organizational strategies for promoting physical activity and healthy eating. Twelve secondary worksites that completed organizational assessments on 2 occasions reported significant increases in implementation in 4 of the 6 core organizational strategies. INTERPRETATION: Dissemination of organizational wellness strategies by trained community organizations through their existing networks (train-the-trainer) was only marginally successful. Therefore, we discontinued this dissemination approach and focused on recruiting leaders of organizational networks

The Guide to Community Preventive Services Review of Interventions to Promote Health Equity in the United States

The optimal approach to eliminating health inequities is through evidence-based interventions. In 2009, the non-federal Community Preventive Services Task Force launched a series of systematic reviews of interventions to promote health equity. Topics to be considered include education, employment, housing, and transportation. Thus far, reviews have focused on educational interventions: center-based early childhood education, full-day kindergarten programs, out-of-school time academic programs, high school completion programs, and school-based health centers. These reviews demonstrate the benefits of diverse educational interventions in advancing health equity. Here, we summarize the strategy of Community Guide health equity reviews, first findings and challenges