At the Center for Public Health Practice, colleagues Jane Nelson (left) and Joyce Essien are part of a multidisciplinary team that creates partnerships with public health agencies. For a recent study, Emory researchers gathered the perspectives of employees at all levels of the DeKalb County Board of Health, from the custodial staff to the director to this employee, who offers a demonstration on breast self-examinat ion. Paul Wiesner, who directs the DeKalb County Board of Health, believes in a partnering approach to public health.

fter 20 years of working for the Centers for Disease Control and Prevention, including a stint as director of the Public Health Practice Office, Dr. Paul Wiesner decided to, as he puts it, "get a job in the r eal world." Now as the executive director of the DeKalb County Board of Health, Dr. Wiesner oversees 500 employees, a $20-million budget, personal health programs used by more than 20% of the county's population, and environmental and health education pro grams serving the whole county. His agency offers a broad array of public health services, including health planning, disease surveillance, and enforcement of health regulations, in addition to mobilizing community prevention services and operating health clinics used by some 116,000 people. In the health reform debate, agencies such as the DeKalb County Board of Health have been excluded, says Dr. Joyce Essien. As director of the Center for Public Health Practice at the Rollins School of Public Health, Dr. Essien has a goal "to strengthen those agencies so they can become flagships for reform." The Center seeks to improve the design and implementation of preventive health systems through a multidisciplinary effort from seven faculty members and additional adjunct faculty, whose fields inc lude economics, epidemiology, behavioral and social sciences, and organizational development. "When you design a health care system, you need the expertise of many disciplines," Dr. Essien says. "You also need practitioners of public health to be a part o f the process." The Center encourages participatory research through partnerships between academic and public health communities and public and private organizations. The exchange flows in two directions, from the academic to the practitioner setting and also from the agency or business environment back to the School. Currently, for example, Joe Latoff joins the Center's faculty as a visiting instructor, bringing his expertise as a health officer at the Mid-Michigan District Health Department to a position that Dr. Es sien calls "our practitioner in residence." By contrast, Professor Stephen Margolis is the Center's "academic-in-residence," working on-site in the Division of Public Health in Georgia's Department of Human Resources. "By promoting and facilitating applied research in the practice setting, we accelerate the transfer and translation of state-of-the-art knowledge," Dr. Essien says. "This approach builds bridges between the academic world and real-world settings and gi ves us an opportunity to translate theory into practice." Dr. Wiesner shares this partnering approach to public health. "Public health is not what the health department does," he says. "It is what we all do to create the conditions so that all can be healthy." The new mission of public health, Dr. Wiesner exp lains, is to shift the paradigm from fixed organizations that provide services to partnerships and collaborations that work together to diagnose problems, combine resources, and assist groups in attaining health goals. The partnering approach also enriches the graduate curricula by creating opportunities for students to do practice-based, interdisciplinary research. For example, in a recent study carried out at the DeKalb Board of Health, students prepared questionna ires with faculty supervision and assisted in conducting interviews. The study, designed by Dr. Jane Nelson, assistant professor, gathered the internal perspectives of 116 employees at all levels of the organization, from the managerial positions to the custodial staff. The 90-minute interviews sought to discover what e mployees thought about the mission and roles of the agency. While upper-level management seemed to embrace the vision of public health articulated by Dr. Wiesner, mid-level managers in the agency resisted that view. "We were able to use that knowledge in a practical sense," Dr. Wiesner says. In light of the research, the DeKalb County Board has begun a strategic planning process, which will include the addition of new divisions and the addition and renovation of n ew and existing health centers with five locations throughout the county. At each center, the Board will establish a partnership with primary care providers so that community residents can receive treatment for minor ailments. Dr. Nelson's study at the DeKalb Board of Health is just one component of a larger strategic planning and organizational change research model she has developed with funding from the Association of Schools of Public Health and the CDC Cooperative Agree ment. "The model," Dr. Nelson emphasizes, "provides a way to conceptually link theoretical constructs from multiple disciplines and to systematically test their relevance in the practice setting. Such research requires a big investment of time from both r esearchers and agency staff, but it can create an environment where agencies can learn from the dialogue they help create." As Dr. Wiesner puts it: "Public health reform is a two-way street. Faculty and students need an experience base, and agency people need to stay in touch with specific research findings. Collaboration is the key."