Local Health Department Leadership Strategies for Healthy Built Environments
Local Health Department Leadership Strategies for Healthy Built Environments
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DOI：
10.1097/phh.0b013e31822d4c7f
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发表时间：
2012-03-01
影响因子：
3.3
通讯作者：
Satariano, William A.
中科院分区：
文献类型：
--
作者：
Kuiper, Heather;Jackson, Richard J.;Satariano, William A.
内容：建筑环境是一个重要但较少被认识到的健康决定因素，地方卫生部门需要更多的指导来解决这个问题，在这种情况下，领导力尤为重要。目的：评估当地公共和环境卫生领导人是否以及如何增加其部门对建筑环境设计的健康促进影响，以及他们应该避免哪些陷阱。设计：采用横断面调查和比较案例研究的混合方法。设置：当地公共和环境卫生部门。参与者调查：来自加州所有62个地方司法管辖区的159名（89%）卫生官员、卫生主任和环境卫生主任。案例研究：三个部门，12个案例，36名卫生和土地使用专业人员，30名关键信息提供者。主要结局指标：该研究测量了领导实践对卫生部门与建筑环境相关的合作、土地使用活动、政策制定以及对物理变化的贡献的影响。采用定量多变量线性回归和Logistic回归分析。还采用了案例研究内容分析和模式匹配，将强领导和弱领导做法与成果联系起来。结果如下：部门具有高度创新的领导者与积极的态度有更大的几率实现物理变化的建成环境（OR：4.5，3.4，分别）。领导层最准备他们的部门为建筑环境工作（通过更新人员配置，结构和战略）增加了三倍机构间和跨部门合作（OR：3.4）。成功部门的领导层一贯（1）建立和管理健康的建筑环境愿景，（2）培养创新，（3）支持，授权和保护员工，（4）直接参与土地使用和运输过程，（5）与其他部门的主管建立直接联系，（6）利用他们的专业声誉。在这些实践中，失败案例的不一致性是成功案例的两倍（80%，43%）。结论：地方卫生领导是公共和环境卫生部门社区设计工作的基础，应得到技术支持和有针对性的资源，以便有效地开展工作。
Context: The built environment is an important but less-recognized health determinant, and local health departments need expanded guidance to address it. In such situations, leadership is particularly relevant. Objective: To assess whether and how local public and environmental health leaders increase their departments' health-promoting impact on built environment design, and what pitfalls they should avoid. Design: Mixed-methods employing cross-sectional surveys and a comparative case study. Setting: Local public and environmental health departments. Participants Survey: A total of 159 (89%) health officers, health directors, and environmental health directors from all 62 local jurisdictions in California. Case-Study: Three departments, 12 cases, 36 health and land-use professionals, and 30 key informants. Main Outcome Measures: The study measured the influence of leadership practices on health departments' built environment-related collaborations, land use activities, policy developments, and contributions to physical changes. Quantitative multivariate linear and logistic regression were used. Case-study content analysis and pattern-matching, which related strong and weak leadership practices to outcomes, were also employed. Results: Departments having highly innovative leaders with positive attitudes had greater odds of achieving physical changes to the built environment (OR: 4.5, 3.4, respectively). Leadership that most prepared their departments for built environment work (by updating staffing, structure, and strategy) tripled interagency and cross-sector collaboration (OR: 3.4). Leadership of successful departments consistently (1) established and managed a healthy built environment vision, (2) cultivated innovation, (3) supported, empowered and protected staff, (4) directly engaged in land use and transportation processes, (5) established direct contacts with directors in other departments, and (6) leveraged their professional reputation. Inconsistency in these practices was twice as common among failure as success cases (80%, 43%). Conclusions: Local health leadership underlies public and environmental health departments' community design efforts and should receive technical support and targeted resources to do so effectively.