Such breadth is usually required of professionals who assume positions of leadership in public health. The campus program is available to students in joint degree programs on the campus, working professionals who return to campus to study, and medical and other health professional residents in Gainesville and Jacksonville. The online program is available to individuals who have experience in the field, or a prior degree in a health-related field.
Students begin their programs with the MPH core courses required of all students. Instead of a specified set of concentration core courses, however, these students choose 2 to 3 courses from concentration core course options in of the other concentrations. Students complete their degrees with a credit internship. The concentration is offered in the traditional credit format or in an accelerated credit format.
If you are interested in the Public Health Practice concentration, please contact Katherine Pizarro at katypiz phhp. The examples discussed below may also aid those doing non-communicable disease planning, as many risk factors for cancer are shared with other non-communicable diseases [ 12 ]. Global strategies for controlling cancer by income level of country. Reprinted with permission from authors and the American Society of Clinical Oncology . Articles were limited to those published from U. Article abstracts were scanned in order to determine whether the content was related to the NCCCP specifically, or to other general or broad efforts not pertaining to this CDC-funded program.
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All articles found to be NCCCP-specific were read for content and those that contained analyses of cancer plans or activities implemented as part of cancer planning were chosen for inclusion as an example of activities in this book chapter see Section 3 below. Many NCCCP participants have their own websites with further information that may be useful for cancer and non-communicable disease planners. These areas already had existing cancer plans and were in different stages of implementation [ 14 ]. The new CDC funding allowed for expansion into certain areas such as survivorship, pediatric cancers, genomics, and blood cancers [ 15 ].
It also established an avenue for providing coordinated, technical assistance from the national perspective and exchange of ideas and practices among the participants. The program quickly grew over the next few years to include 63 participants in all 50 U. As of , more than half of the 63 NCCCP participants were receiving funding solely to build capacity and infrastructure, while the more advanced participants were receiving funding to implement specific cancer control activities [ 14 ].
Also in , CDC began offering additional funding on a competitive basis to NCCCP participants to implement specific activities related to ovarian, prostate, skin, colorectal cancer. There is a great deal of diversity among each of these funded entities in terms of cancer burden, racial and ethnic structure, levels of income inequality and poverty, and access to cancer care and services. All these factors influence the level of funding each participant receives from CDC. Evaluation efforts at the national level in the early years of the program, including the development and fielding of a performance measurement system and cancer plan assessment tool, provided valuable information regarding technical assistance needs and improvements that could be made across all participants [ 16 , 17 , 18 ].
Results from surveys in and showed that a majority of programs had successfully implemented at least one community- or organization-level change strategy; however, not all programs were using only evidence-based interventions, and there were few participants linking their activities to cancer impact [ 19 ]. Recognizing that participants needed assistance in these areas, as well as in communicating their efforts, CDC developed an overarching set of strategic priorities to guide the cancer public health practice of all NCCCP participants, regardless of their unique nature and cancer burden [ 20 ].
At the national level, the priorities allow for provision of standardized technical assistance and tools, a more objective and consistent way to assess participant performance, and a more uniform and systematic way to disseminate information and successes regarding programmatic activities. The priorities span the cancer continuum primary prevention, early detection, and survivorship , and place special emphasis on addressing health disparities and inequities in each of these continuum areas [ 20 ]. The priorities also define the methodology participants are encouraged to use to address these areas, specifically the implementation of systems and environmental change approaches, and emphasize participant-level evaluation as critical part of programmatic success [ 20 ].
The priorities were released in and were readily incorporated into planning by NCCCP participants.
Publishing with a Purpose
Soon after the release of the priorities, informal assessments showed programs tended to focus on implementation activities in one priority area for example, some participants were implementing only primary prevention strategies listed. As of , all 66 NCCCP participants have demonstrated the capability to implement activities in all priority areas. Current funding agreements require that all NCCCP participants at least three interventions in each of the cancer continuum areas and at least one strategy in these areas has to be aimed at reducing cancer disparities [ 21 ].
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Additionally, participants use a specific library of interventions and data indicators, compiled by CDC, as a tool to plan and implement their interventions [ 21 ]. Place emphasis on the primary prevention of cancer during planning and implementation to reduce risk and environmental exposures. Promote the early detection of cancers for which population-based screening is recommended. Use systems and environmental change approaches resulting in sustainable cancer control. All NCCCP participants, regardless of their unique cancer burden, are required to implement evidence-based initiatives and interventions EBIs to prevent and control cancer in their population [ 20 ].
Several U. Brief descriptions and specific examples of the types of activities are described below, categorized by each cancer continuum-related NCCCP priority area. These implementation examples are from a variety of NCCCP participants in different settings and with different resources. More detailed information on these implementation activities can be found in the cited reference or by contacting the individual NCCCP participant [ 8 ]. Primary prevention for cancer includes reducing exposure to cancer-promoting environmental influences, reduction of genetic and behavioral risk factors, and vaccination against viruses that can cause cancer [ 25 ].
Many cancer risk factors and viruses also cause other diseases, and therefore emphasizing primary prevention in NCCCP plans has a broader impact on improving health [ 4 ]. Many of the strategies and interventions in these areas are specifically recommended to reduce the global burden of cancer [ 9 , 12 ]. Implementation of activities that address behavioral risk factors is a key approach most NCCCP plans address the primary prevention of cancer. Lung cancer is the leading cause of death in the U. A assessment of NCCCP cancer plans showed that all plans incorporated at least one evidence-based tobacco control strategy [ 26 ].
The Cherokee Nation Comprehensive Cancer Control Program implemented the Tobacco Tour , which educated young members of their tribe about the dangers of tobacco use, using culturally appropriate story-telling methods [ 28 ]. The education program also included a presentation from a six-time cancer survivor and former smokeless tobacco user, who shared intimate details about his experience with tobacco-associated cancer which strongly resonated with the students [ 28 ]. Radon is the second leading cause of lung cancer, and the leading cause of lung cancer among non-smokers [ 29 ].
Many NCCCP participants are increasingly incorporating activities to reduce exposure to radon, a radioactive gas ubiquitously present in the lower levels of U. An updated review in , showed that the number of NCCCP participants addressing radon had increased; nearly two-thirds of all NCCCP cancer plans contained radon-related strategies [ 30 ]. Specific examples of radon activities implemented included increasing education, promoting radon testing and remediation of houses, partnering with other national agencies that address radon, and promoting adherence to existing local statewide radon policies [ 29 , 30 ].
Iowa has the highest average radon concentrations in the U. There are several evidence-based nutrition and physical activity strategies for reducing cancer risk due to obesity. They provided coordinated education to the public and decision makers about the importance of planned environments, and partnered with the state transportation department, street design and engineering, pedestrian, and bicycle interest groups to facilitate its implementation. The intervention increased opportunities for Indiana residents to be physically active and reduce their cancer risk [ 34 ].
The Iowa Comprehensive Cancer Control Program designed a local initiative to reduce cancers that are disproportionately higher among African-Americans in Iowa [ 34 ]. In the first year, Iowa worked with 2 churches to support health awareness among its members [ 34 ].
More than 1, African-American residents across Iowa participated in the program in one year alone, and it is currently estimated that the program has now reached approximately African-American Iowans [ 34 ]. Intense, intermittent exposure to ultraviolet UV light from the sun is strongly linked with melanoma, which is one of the deadliest forms of skin cancer in the U.
New Mexico, Florida, and Arizona used systems and environmental change strategies and the establishment of partnerships adapted for their individual needs within schools and educational community to control sun exposure among school children [ 36 ]. New Mexico provided two or more presentations per year in schools delivering specific messages to avoid the sun between 10 am and 4 pm, wear sun-protective clothing when exposed to sunlight, and use sunscreen with a sun-protection factor of 15 or higher [ 36 ].
More than students demonstrated positive behavior changes following educational presentations, including playing in the shade, wearing a hat, using sunscreen, and wearing sunglasses. Additionally, many teachers, who serve as important role models for school children, reported positive changes in their own behavior related to sun safety [ 36 ].
New Mexico also implemented 55 systems and environmental changes including modifying recess times to avoid peak UV exposure, allowing students to wear hats outside, and providing shade structures or planting trees [ 36 ]. It is estimated that a total of 56, school-age children, school staff and community members have been reached through these efforts in New Mexico [ 27 ].
South Dakota worked with two worksites who hired seasonal workers to work outdoors to limit UV exposure in the workplace [ 34 ]. These worksites adopted local policies to provide employees with sunscreen and lip balm, and employees were also encouraged to wear wide-brimmed hats, long sleeve shirts, lightweight full-length pants, and sunglasses, as well as work in shaded areas and avoiding peak sun hours when possible [ 34 ].
For example, a worldwide analysis based on DHS data revealed that a substantial proportion of people access the private sector for key child health services in many developing countries, arguing for more programmatic effort to engage private-sector providers. Additional epidemiologic methods. These include cohort and case-control studies to help assess factors predicting health, disease, and adverse outcomes, as well as phylogenetic studies to assess patterns of disease transmission. While modeling doesn't actually generate new data, this exploration of the implications of data can provide insights into whether, when, and how interventions may work.
The greater the situational complexity, the more variability can arise from the assumptions and model mechanics. Modeling can definitely be misleading. Human functionality, culture, and biology.
Public health practice what works
This approach, which includes both experimental and observational methods, is somewhat reductionist and far-ranging. It can comprise task analysis issues, such as how many clients a provider can effectively see daily, how many tasks a community health worker can effectively provide, and what training approaches result in competence; how medical culture influences programs; how social networks influence behavior; and what neuroimaging changes correlate with approval or disapproval when individuals see an anti-smoking ad. Summative evaluations that assess program effectiveness can be designed in advance as well as conducted post hoc.
They can make use of a variety of methods as described above. Here also, it is important not only to assess whether something worked or how well it worked but also to uncover the details of the many factors that caused it to work or not. There are well-established criteria for assessing the quality of RCTs.
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However, addressing quality of evidence in the complex and variable terrain of public health, with its diverse and more complex questions when, how, how cost-effective, and how sustainable and with its heterogeneous forms of evidence, is far less cut-and-dried. Nevertheless, quality criteria for methodologies such as qualitative approaches do exist. We need to build on such concepts to further refine and assess the quality of public health evidence.
A starting point for assessing the quality of EBPH evidence is how well the studies contribute to other evidence. A key value-added of EBPH is identifying and synthesizing patterns of findings across multiple experiences, less than perfect though they may be, in enough detail to meaningfully inform similar efforts across a variety of situations. Simple examples I personally have observed include:.
Referrals from one place in the health system to another risk a high loss to follow up. Important population-level behavior change, such as reducing tobacco use, most often results not from any one single campaign or intervention but from a sustained combination of interventions, including structural interventions such as increasing taxation, individual persuasion, and changing social norms.
Public Health Practice
Another example of synthesis is a systematic review of strategies to increase health services in mountainous locations. It found benefit from: task shifting, strengthened roles of community health workers, mobile teams, and inclusive structured planning forums. Synthesizing common patterns across multiple methodologies and helping program managers apply that knowledge are key goals for EBPH. Evidence arising within a specific program can help with better implementation in that setting.
But beyond locally relevant learning, a major objective is identifying systematic patterns for wider application.
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Triangulating and otherwise bringing together evidence arising from different methodologies with sufficient detail to illuminate causal relationships is essential to applying such knowledge to real-world public health problems across diverse situations. Some may question the rigor of these approaches. But we are not advancing mere anecdote. Rather, our mandate is an even greater and more difficult standard of rigor: of investigation, observation, accumulation, systemization, and appropriate application. Narrow internal rigor elegance is not an end in itself.
The overriding virtue of EBPH is real-world relevance. Cite this article as: Shelton JD. Evidence-based public health: not only whether it works, but how it can be made to work practicably at scale. Glob Health Sci Pact. National Center for Biotechnology Information , U. Glob Health Sci Pract. Published online Aug James D Shelton a. Find articles by James D Shelton. Author information Copyright and License information Disclaimer. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited.
This article has been cited by other articles in PMC. Complex Interventions in Complex Environments Consider the challenges of designing and implementing public health programs at scale. Some examples: Variability and failure to assess the causal pathway fully. Simple examples I personally have observed include: Referrals from one place in the health system to another risk a high loss to follow up.
Notes Competing Interests : None declared.