Wanted: Academic Health Departments to Foster Evidence-Based Practice and Practice-Based Evidence

Bekemeier, Betty PhD, MPH, FAAN; Ensign, Karl MPP

Journal of Public Health Management & Practice: May/June 2017 - Volume 23 - Issue 3 - p 328–330
doi: 10.1097/PHH.0000000000000571
State of Public Health

Northwest Center for Public Health Practice, University of Washington School of Public Health, Seattle, Washington (Dr Bekemeier); and Association of State and Territorial Health Officials, Arlington, Virginia (Mr Ensign).

Correspondence: Karl Ensign, MPP, Association of State and Territorial Health Officials, 2231 Crystal Drive, Suite 450, Arlington, VA 22202 (kensign@astho.org).

The authors declare no conflicts of interest.

Article Outline

“The days of wild guesses are over and we need to get our act together.” This is what a national public health practice leader said to a few of us in December 2016. He was referring to the degree to which state and local public health systems clearly understand what we are currently investing across our states and communities on public health and prevention. A clearer understanding of the nature of these investments and the value of our public health systems, more generally, would provide the evidence desperately needed for informing policy and performance regarding systems of prevention and population health improvement. Public health leaders want such evidence to guide their practice and support crucial discussions with policy makers and the public, but much more relevant and practice-based evidence needs to be generated to fill the void of “wild guesses.”

Lawrence W. Green has famously suggested that “if we want more evidence-based practice, we need more practice-based evidence” to effectively improve the public's health.1,2 He laments that academics do not tend to conduct the research needed to guide prevention interventions in such a way as to provide relevant, actionable evidence for those in practice. Research, he states, should blend the “rigor and reality” of participatory approaches to generating evidence.3 Lessons can be learned from Green's leadership on the generation of practice-based evidence base that partners academia and practice to guide the delivery of more effective interventions related to tobacco, screening, and cancer prevention.

In 2012, the Institute of Medicine (now the National Academy of Medicine) described, in detail, the need for public health systems to demonstrate the value of what their focus on prevention contributes to health systems and the nation's health. It described value in terms of both return on a financial investment and effectively addressing the population-centered needs and values of a system's constituency. Now, 5 years after the report's publication, this need to demonstrate the value of these systems is more urgent than ever even as we know more now about how to demonstrate public health system value more effectively together and are generating meaningful evidence that can guide public health system improvements.2 For practice, ensuring highest value of our system efforts depends on utilizing evidence-based practices and having the evidence that ensures highest efficiency and effectiveness.

In 2008, the Robert Wood Johnson Foundation funded the first public health Practice-Based Research Networks. These networks have helped give us the experience, foundation, and initial structure and funding to bring academic and public health practice leaders together to generate practice-based evidence for ensuring effective, evidence-based public health systems. They provided the “co-learning” and capacity building needed to help practitioners gain a better understanding of research processes and help academics better understand the needs and dynamics of practice settings.4 Because of these formal partnerships, a great deal of public health system research was generated. Research that, when conducted in partnership, helps reveal the “difficult-to-detect” impact of public health systems on population health outcomes,5,6 the impact of and efficiencies gained through shared service delivery models, drivers of quality in public health practice, and much more.7,8 But today there is little structure for these fledgling networks and for their pursuit of the critical public health system research that is still needed.

Meanwhile, Academic Health Departments, also often without a formal structure, are increasingly forming around the United States to link the assets and needs of academic institutions and state and local health departments.9 While they are traditionally focused heavily on building workforce capacity and supporting program evaluation, these Academic Health Departments could be the key toward producing and supporting the ongoing critical need for practice-based evidence to improve and demonstrate the value of our public health systems while growing public health system capacity.10

Recent interviews with 3 state health officials on this topic underscored the value that academic partnerships bring to their agencies and the broader field of public health. Officials from Ohio, Rhode Island, and Washington State shared their experiences in partnering with academic institutions, the accomplishments these partnerships achieved, the value of these partnerships, and future directions. Two of the 3 (Rhode Island and Washington) have formalized their Academic Health Departments. Ohio has a strong tradition of this at the local level. Although strong partnerships with institutions of higher learning exist at the state level, the Ohio Department of Health has not yet taken the final step to becoming an Academic Health Department.

Although the 3 states vary in structure and process for agency and academic partnerships and are at different partnership stages, common interview themes emerged. First, the partnerships began with the exchange of people and expertise—a foundation that remains after the partnerships have matured. Institutions of higher learning supply interns and new state employees, whereas public health agencies supply visiting faculty. In Rhode Island, its Academic Center housed within the state's Department of Health supports interns and students coming to the agency—designating them as public health scholars. Similarly, a primary driver of Washington State's Department of Health formalization as an Academic Health Department was to provide interns and students, and those supervising them, with needed supports and direction. Second, through Washington State health official leadership, existing partnerships were first assessed and then formalized. The vision and leadership of Dr Nicole Alexander-Scott in Rhode Island and Dr John Wiesman in Washington are credited with those 2 states establishing Academic Health Departments. Third, all 3 state health officials started with the largest educational institution but found value in extending their reach to others within the state, including community colleges, or, in the case of Rhode Island, even extending outside the state.

Fourth was the bidirectional nature of their partnerships. Dr Nicole Alexander-Scott, Director, Rhode Island Department of Health, noted,

The academic world brings advanced research, clinical trials, and clinical advances, while the public health agency brings statewide data, direct engagement with communities, an understanding of the needs of the underserved, and the research questions we need help addressing. The value is in the bi-directional flow of data, analysis, and learning. (Personal communication, February 6, 2017)

Dr Wiesman, Secretary of Health, Washington State Department of Health, described academic institutions as something that “can help us better understand what we are struggling with.” He provided examples of investigating anencephaly clusters, potential cancer risks posed by artificial outdoor play surfaces, opioid misuse, and marijuana impacts on youth in the state (John Wiesman, DrPH, personal communication, February 8, 2017).

Fifth, these partnerships can be leveraged. Examples included helping the public health workforce stay current and recruiting faculty participation on advisory panels. These arrangements also help recruit and extend existing agency staff. In Washington State, groups of students have worked alongside agency staff on food-borne illness investigations, providing students with practical experiences. An added benefit was observing potential hires in practice, rather than only in interviews. In addition to “helping keep staff motivated, stimulated, and current,” Dr John Wiesman, noted, “It helps governmental public health become the ‘employer of choice’” (personal communication, February 8, 2017).

Sixth, Mr Richard Hodges, Director of Health at the Ohio Department of Health, considered partnerships and active engagement with higher education as “essential for supporting the health official at the state or local level as the chief public health strategist” (personal communication, February 13, 2017). His state's partnership with academia has been critical for assessing the status of accreditation and needed supports, as well as doing research to help define and cost out Foundational Public Health Services. The work of these important state projects is to ultimately inform the efficient allocation and use of resources.

In terms of future directions, Dr Nicole Alexander-Scott, describes the desire to “act as an ambassador of the Academic Health Department model with other state agencies that wish to undertake similar efforts. And on the national stage, we want to act as a role model for other states that wish to do this as well” (personal communication, February 6, 2017). She noted the vision, mission, and expected outcomes of her Academic Center:

* Vision: Excellence in public health practice while producing the next generation of multidisciplinary public health practitioners.

* Mission: Strengthen the integration of scholarly activities with public health practice, by instilling a culture of learning and problem solving along with continuous quality improvement.

* Outcomes: Improved public health capacity for assessment, policy development, and assurance; enhanced public health outcomes; and health equity.11

Dr Wiesman's vision was aspirational. He looks toward “co-funding a faculty position with a university that would produce a half-time position rotating faculty into the agency” (John Wiesman, DrPH, personal communication, February 8, 2017).

Exemplar state health departments are creating cultures of evidence-based practice and high-performing public health systems by growing the Academic Health Department movement. Academic institutions correspondingly can bring a culture of generating practice-based evidence. Academic Health Departments bring these cultures together and are key to providing the structure for practice-based research and similar partnerships that are crucial for ensuring evidence-based public health systems and an infrastructure that ensures high value for prevention-related investments in the public's health.

Back to Top | Article Outline

References

1. Green LW. Making research relevant: if it is an evidence-based practice, where's the practice-based evidence? Fam Pract. 2008;25(suppl 1):i20–i24.
2. Green LW, Glasgow RE, Atkins D, Stange K. Making evidence from research more relevant, useful, and actionable in policy, program planning, and practice slips “twixt cup and lip.” Am J Prev Med. 2009;37(6)(suppl 1):S187–S191.
3. Green LW. Closing the chasm between research and practice: evidence of and for change. Health Promot J Aust. 2014;25(1):25–29.
4. Winterbauer N, Bekemeier B, VanRaemdonck L, Hoover AG. Applying community-based participatory research partnership principles to public health practice-based research networks. SAGE Open. 2016;6(4):1–13.
5. Bekemeier B, Yip MP, Dunbar M, Whitman G, Kwan-Gett T. Local health department food safety and sanitation expenditures and reductions in enteric disease, 2000-2010. Am J Public Health. 2015;105(suppl 2):S345–S352.
6. Bekemeier B, Yang Y, Dunbar M, Pantazis A, Grembowski D. Targeted health department expenditures benefit birth outcomes at the county level. Am J Prev Med. 2014;46(6):569–577.
7. Mays GP, Hogg RA. Expanding delivery system research in public health settings: lessons from practice-based research networks. J Public Health Manag Pract. 2012;18(6):485–498.
8. Bekemeier B, Zahner SJ, Kulbok P, Merrill J, Kub J. Assuring a strong foundation for our nation's public health systems: a commentary. Nurs Outlook. 2016;64(6):557–565.
9. Erwin PC, Barlow P, Brownson R, Amos K, Keck CW. Characteristics of Academic Health Departments: initial findings from a cross-sectional survey. J Public Health Manag Pract. 2016;22(2):190–193.
10. Bekemeier B. The population health fashion mismatch with health departments and how Academic Health Departments can help. https://jphmpdirect.com/2017/01/31/the-population-health-fashion-mismatch-with-health-departments-and-how-academic-health-departments-can-help-by-betty-bekemeier-phd-mph-rn-faan. Published 2017. Accessed February 16, 2017
11. Alexander-Scott N. Rhode Island Department of Health Academic Center. Paper presented at: Unsure of the event, Dr. Alexander-Scott only shared with us the PowerPoint itself; February 2017; Providence, RI.
Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.