The Public Health Workforce

Today our Nation faces a widening gap between challenges to improve the health of Americans and the capacity of the public health workforce to meet those challenges.  The public health community is actively engaged in a wide range of activities to keep the current workforce up to date and to anticipate future needs.  As a leadership forum for action on public health infrastructure issues, the Steering Committee of the Public Health Functions Project (see Appendix A) in September 1994 commissioned the Subcommittee on Public Health

Workforce, Training, and Education to review factors related to workforce challenges and to make recommendations for an action plan.    Their charge was as follows: To further an understanding of the public health workforce, a Subcommittee  . . . is charged with providing a profile of the current public health workforce and making projections regarding the workforce of the 21^st century.  As a part of this effort, the Subcommittee should examine the current and future shortfalls in the public health workforce, looking broadly at Federal, State and local levels, in public health departments as well as mental health, substance abuse, and environmental health agencies and at the emerging need for public health competencies in managed care systems, health plans, and in other governmental agencies such as departments of agriculture, education, and justice.  The

Subcommittee should also address training and education issues including curriculum development for graduate training in public health and ongoing training and development activities to ensure a competent workforce to perform the essential functions of public health now and in the future.  Minority representation in public health disciplines should be analyzed and the programs to increase representation should be reviewed and evaluated.  Distance learning and other advanced technology training methods should be explored to ensure that training and education activities are carried out in the most efficient and cost-effective manner. Therefore, the Subcommittee shall examine the financing mechanisms for curriculum development and for strengthening the training  and education infrastructure, as well as explore the feasibility of establishing a Council on Graduate Public Health Education.

The Public Health Functions Steering Committee also developed a consensus statement, entitled Public Health in America, in 1994. Building further upon the core functions of public health (assessment, policy development, and assurance) identified by the Institute of Medicine (IOM) in its 1988 study The Future of Public Health, the consensus statement describes what public health does and what services are essential to achieving healthy people in healthy communities. Successful provision of these essential services requires collaboration among public and private partners  within a given community and across various levels of government.  The Subcommittee used these essential services as a framework for their respective activities.

Human Health Risk Assessment Studies in Asbestos Based Industries In India

According to Pooley (1972), Piney was the first author to use the word “asbestos” referring to a fibrous mineral of Greek derivation which means “inextinguishable” or “unquenchable”. The word “asbestos” is defined in Webster’s Medical Dictionary as “a mineral that readily separates into long flexible fibres suitable for use as noncombustible, non-conducting, chemically resistant material”.

Asbestos is a naturally occurring hydrated mineral silicate that crystallizes in fibrous form (Mossman et al., 1990b). Mineralogically asbestos can be classified into two major groups; the Serpentine, which includes the most abundant variety of asbestos i.e. Chrysotile and the Amphibole which includes Actinolite, Amosite, Anthophyllite, Crocidolite and Tremolite (Mossman et al., 1996, ATSDR, 2001). Both groups have different physico–chemical nature. Chrysotile is curly and stranded structure whereas amphiboles are straight and rod like structures (ATSDR). Amphiboles are generally more brittle and appear to be dustier and more fibrogenic than chrysotile (Mossman et al., 1990 ; Mossman and Gee, 1989).   Asbestos fibres bear unique properties of a high tensile strength, resistance to heat and many chemicals without having any detectable odor. Mineralogists some times refer that the minerals crystallize into bundles of thousands of flexible fibrils that look like organic fibres. Terms that are sometimes used to describe asbestos or similar minerals include fiber, fibrous, asbestiform and acicular. The term fibrous is used to describe a crystallization habit in which the fibres have a high tensile strength and flexibility than crystals in other parts of the same mineral; asbestiform is generally synonymous with fibrous or sometimes it means “like asbestos”; and acicular” refer to a crystal that has a needle-like form. Even though the use of asbestos was known to medieval India, it was commercially exploited only since the beginning of this century. Asbestos is attractive in a broad variety of industrial applications because of its resistance to heat and chemicals, high tensile strength, and lower cost compared to man-made minerals. At the peak of its demand, about 3,000 applications or types of products were of asbestos-based (Ramanathan and Subramaniam, 2001). Asbestos is used for the manufacture of a variety of asbestos-based products mainly as asbestos-cement (AC) sheets, AC pipes, brake shoes, brake linings, clothes and ropes. AC industry is by far the largest user of asbestos fibre worldwide accounting for about 85% of all uses. Asbestos is also incorporated into cement construction materials (roofing, shingles, and cement pipes), friction materials (brake linings and clutch pads), jointing and gaskets, asphalt coats and sealants, and other similar products.  As a result of these applications, an estimated 20% buildings  including hospitals, schools and other public and private structures contain asbestos containing materials (ACM). Asbestos in building does not spontaneously releases fibres, but physical damage to ACM by decay, renovation or demolition can cause release of airborne fibres. Asbestos in air at work environment is a major cause of adverse effects on health of industrial workers. Industrialization and modernization  with recent developments enhanced the demand and consumption of asbestos thus increasing the risk of exposure to asbestos.

Physical working conditions and risk of injury and illness.

 The type of work and the tasks involved influence a worker’s risk of physical injury and illness.

·         Workers in particular sectors of the work force are at increased risk of work-related injuries and illness.  Eight sectors—air transportation, nursing facilities, work with motorized vehicles and equipment, trucking services, hospitals, grocery and department stores, and food services—account for nearly 30 percent of nonfatal occupational injuries.

·         Certain jobs are also associated with higher risks.  For example, operators, fabricators and laborers suffered nearly 40 percent of all reported occupational illnesses and injuries in 2001, while representing only 15 percent of workers.Physically demanding daily tasks and uncomfortable working positions can lead to physical strain and injury, increasing the risk of long-term absence.

·         Jobs requiring repetitive movements and those with high physical workload including lifting, pushing or pulling heavy loads put workers at higher risk for musculoskeletal injuries and disorders, overextension and repetitive strain injuries.

·         Carpal tunnel syndrome, caused by repetitive motion, accounted for the highest median days (25 days) away from work among all occupational illness or injuries in 2001. The ergonomics of equipment and work space are important contributors to occupational health.  For example, poorly designed tools, keyboards and chairs have been linked with arm, back and shoulder pain, as well as other musculoskeletal disorders.

·         Sedentary jobs allow few opportunities for movement or exercise, and physical inactivity contributes to risk of obesity and chronic diseases such as diabetes and heart disease.

Hazardous exposures in the workplace. 

In addition to workplace conditions like inadequate ventilation or temperature control that can aggravate allergies or asthma, the physical environment of a workplace can expose workers to a variety of potentially hazardous chemicals. Lead, pesticides, aerosols, ammonia and other cleaning products, and asbestos are just a few of the many workplace-related chemicals for which long-term exposure have been related to poisoning and serious illnesses. Hearing loss from noisy work environments is one of the most common occupational injuries worldwide, and workplace noise also creates a higher risk of accidents.

The psychosocial aspects of work and how work is organized also can affect health. The experience of work itself—how time is organized, and the social and psychological aspects of working conditions—affect both physical and mental health.  Differences in the degree of control that workers feel they have over their working conditions are thought to be a major factor accounting for steep social gradients in health among employed civil servants in the United Kingdom. For many Americans, work is a major source of opportunities for personal development and building stable social networks.  These opportunities are shaped by many characteristics of the work environment, including workplace culture, job demands and latitude in making decisions about one’s work.

Work Matters for Health

On average, American adults spend nearly half of their waking hours at work

Where we work influences our health, not only by exposing us to physical conditions  that have health effects, but also by providing a setting where healthy activities and  behaviors can be promoted.  In addition to features of worksites, the nature of the  work we do and how it is organized also can affect our physical and mental health.   Work can provide a sense of identity, social status and purpose in life, as well as  social support.  For most Americans, employment is the primary source of income,  giving them the means to live in homes and neighborhoods that promote health and to pursue health-promoting behaviors.  In addition, most Americans obtain their health care insurance through their jobs.  Not only does work affect health; health also affects work.  Good health is often needed for employment, particularly for lowskilled workers.  Lack of employment among those who are unable to work because of ill health can lead to further economic and social disadvantage and fewer resources and opportunities to improve health, perpetuating a vicious cycle

Employment-related health problems have significant human and economic costs for individuals and for society overall. In 2007, over 5,000 fatal and 4 million nonfatal work-related injuries and illnesses  were reported in private industry workplaces; about half of the non-fatal injuries  resulted in time away from work due to recuperation, job transfer or job restriction. Some reports have found that the total economic costs to the nation of occupational illness and injury match those of cancer and nearly those of heart disease.

Healthy workers and their families are likely to incur lower medical costs and be more productive, while those with chronic health conditions generate higher costs in terms of health care use, absenteeism, disability and overall reduced productivity. Workplace injuries and work-related illnesses have a major financial impact on both large and small employers.  In 2006, the cost to employers for workers’ compensation totaled $87.6 billion.This issue brief examines how work can affect health, exploring the health effects of  both physical and psychosocial aspects of work as well as of work-related opportunities and resources.  Examples of promising approaches to making work healthier also are provided.

THE MODERN SCIENCE OF MENTAL HEALTH

The creation of dianetics is a milestone for Man comparable to his discovery of fire and superior to his inventions of the wheel and arch. Dianetics (Gr., dianoua -- thought) is the science of mind. Far simpler than physics or chemistry, it compares with them in the exactness of its axioms and is on a considerably higher echelon of usefulness. The hidden source of all psycho-somatic ills and human aberration has been discovered and skills have been developed for their invariable cure. Dianetics is actually a family of sciences embracing the various humanities and translating them into usefully precise definitions. The present volume deals with Individual.

Dianetics and  is a handbook containing the necessary  skills  both  for   the  handling of interpersonal relations and the treatment of the mind. With the techniques presented in this handbook the psychiatrist, psycho-analyst and intelligent layman can successfully and invariably treat all psycho-somatic ills and inorganic aberrations. More importantly, the skills offered  in  this  handbook will produce the dianetic clear, an optimum individual with intelligence considerably greater than the current normal, or the dianetic release, an individual who has been freed from his major anxieties or illnesses.  The release can be done in less than twenty hours of work and is a state superior to any produced by several years of psychoanalysis, since the release will not release.

Dianetics is an exact science and its application is on the order of, but simpler than, engineering. Its axioms should not be confused with theories since they demonstrably exist as natural laws hitherto undiscovered. Man has known many portions of dianetics in the past thousands of years, but the data was not evaluated for importance, was not organized into a body of precise knowledge. In addition to things known, if not evaluated, dianetics includes a large number of new discoveries of its own about thought and the mind.

The axioms may be found on Page 42 of this volume. Understood and applied, they embrace the field of human endeavor and thought and yield precision results. The first contribution of dianetics is the discovery that the problems of thought and mental function can be resolved within the bounds of the finite universe, which is to say that all data needful to the solution of mental action and Man’s endeavor can be measured, sensed and experienced as scientific truths independent of mysticism or metaphysics. The various axioms are not assumptions or theories -- the case of past ideas about the mind -- but are laws which can be subjected to the most vigorous laboratory and clinical tests. The first law of dianetics is a statement of the dynamic principle of existence.  

Ethnicity and health

Black and minority ethnic (BME) groups generally have worse health than the overall population, although some BME groups fare much worse than others, and patterns vary from one health condition to the next. Evidence suggests that the poorer socio-economic position of BME groups is the main factor driving ethnic health inequalities. Several policies have aimed to tackle health inequalities in recent years, although to date, ethnicity has not been a consistent focus. This POSTnote reviews the evidence on ethnic health inequalities, the causes and policy options.

Ethnicity

Ethnicity results from many aspects of difference which  are socially and politically important in the UK.  These include race, culture, religion and nationality, which impact on a person’s identity and how they are seen by others. People identify with ethnic groups at many different levels. They may see themselves as British, Asian, Indian, Punjabi and Glaswegian at different times and in different circumstances. However, to allow data to be collected and analysed on a large scale, ethnicity is often treated as a fixed characteristic. BME groups are usually classified by the methods used in the UK census, which asks people to indicate to which of 16 ethnic groups they feel they belong.

Health inequalities

Health inequalities are differences in health status that are driven by inequalities in society. Health is shaped by many different factors, such as lifestyle, material wealth, educational attainment, job security, housing conditions, psycho-social stress, discrimination and the health services. Health inequalities represent the cumulative effect of these factors over the life-course; they can be passed on from one generation to the next through maternal influences on baby and child development. 

Ethnic health inequalities Large-scale surveys like the Health Survey for England show that BME groups as a whole are more likely to report ill-health, and that ill-health among BME people starts at a younger age than in the White British. There is more variation in the rates of some diseases by ethnicity than by other socio-economic factors. However, patterns of ethnic variation in health are extremely diverse, and inter-link with many overlapping factors: 

• Some BME groups experience worse health than others. For example, surveys commonly show that Pakistani, Bangladeshi and Black-Caribbean people report the poorest health, with Indian, East African Asian and Black African people reporting the same health as White British, and Chinese people reporting better health. 

• Patterns of ethnic inequalities in health vary from one health condition to the next. For example, BME groups tend to have higher rates of cardio-vascular disease than White British people, but lower rates of many cancers.

• Ethnic differences in health vary across age groups, so that the greatest variation by ethnicity is seen among the elderly.

• Ethnic differences in health vary between men and women, as well as between geographic areas. 

• Ethnic differences in health may vary between generations. For example, in some BME groups, rates of ill-health are worse among those born in the UK than in first generation migrants.  

Commission to Build a Healthier America

America is a country founded in the pursuit of a vision, the realization of an ideal. In words that are built into our national DNA, all of us are created equal, endowed with the inherent and inalienable right to life, liberty and the pursuit of happiness. None of that is possible without good health. Unfortunately, today, when it comes to health and health care, we are not all equal, are we?

The health of America depends on the health of all Americans. And when huge numbers of us are left behind, more of the nation’s future is left behind as well. What would the signers of the Declaration of Independence think of our country today if they knew that where you live predicts your life expectancy, your health is poorer if you are poorer, and your baby is much more likely to die if you haven’t finished high school? Life isn’t just better at the top, it’s longer and healthier. The problem is real. But in the United States, where disparities in health are enormous, the problem has been largely anonymous. America’s public debate on “health” has mostly centered on access to and affordability of care, even though a large body of evidence tells us that whether or not a person gets sick in the first place in most cases has little to do with seeing a doctor. A far greater determinant is the sometimes toxic relationship between how we live our lives and the economic, social and physical environments that surround us. Some of the factors affecting our health we certainly can influence on our own; many of the factors, however, are outside our individual control.For more than a generation, the Robert Wood Johnson Foundation has pioneered the research and knowledge that brings us to this understanding. Now it’s time to chart the way forward, identify workable solutions and motivate others to act.

  

Differences in health along social, economic and racial or ethnic lines are  known as “health disparities” or “social disparities in health.” New research presented in this report—and supported by previous studies—indicates that these differences are keeping America from reaching its potential. They represent preventable illness and loss of life and compromise Americans’ quality of life and our productivity as a nation.The conclusions of this report suggest that reducing America’s large and persistent health disparities requires taking a broader, deeper look at how health is shaped across lifetimes and generations. Finding solutions to avoidable differences in health requires looking beyond the medical care system to acknowledge and address the many other factors that also can determine a person’s health.

This report from the Robert Wood Johnson Foundation:

•           Examines the roles of personal and societal responsibilities for health within the contexts in which people live, work and learn which influence both the choices people have and their ability tomake healthy choices.

•           Reviews evidence of the lasting impact that physical and social environments have on a child’s health and on his or her chances of becoming a healthy adult.

•           Reveals new national evidence of differences in health across income and education groups, and how they relate to differences in health by race or ethnicity.

•           Provides new evidence of the economic and human costs of social differences in health, including the life stories of three American families who are trying to make healthy choices but face major obstacles.

•           Offers a framework for finding solutions by applying current knowledge about the underlying causes of social disparities in health.