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Summarize the article’s main points.

Question

Summarize the article’s main points. Identify 5 key points of this article. You may want to come back to this

question once you have answered the three questions below.

Describe the three (3) main changes in public health prompting public health to collaborate with the public sector. In other words, what are the BIG, transformative changes in the field of public health causing public health’s need to partner with business? (Note: DO NOT get the forces driving these changes confused with the changes the need to partner.)

What are the trends underscoring public health’s need to partner with the business sector? There are three (3) trends that highlight the need for public health to partner with the business sector. These 3 reasons are different from the “changes” identified in the answer to question two (2). Read extremely carefully!

Give three examples of public health-business partnerships that have been established in the past 15 years and discuss their purpose. The article mentions some and points you to others. DO NOT provide a vague, general statement identifying “sectors” of business and public health as partnerships! I want to know the name of the partnership, the entities involved in the partnerships, and the focus of the partnership’s specific goals.

The article review is to be written as a paper. DO NOT PROVIDE BULLETED ANSWERS! One source (not your text) should be given to support your response in addition to citing the assigned article and it should be on a reference page. Please remember to place the word count at the end of the document.

These are the instructions: no bulleted answers, 450-500 words. Here is the article

Public Health’s Inconvenient Truth: The
Need to Create Partnerships With the
Business Sector
EDITORIAL
Suggested citation for this article: Majestic E. Public
health’s inconvenient truth: the need to create partnerships
with the business sector. Prev Chronic Dis 2009;6(2):
A39. http://www.cdc.gov/pcd/issues/2009/apr/08_0236.htm.
Accessed [date].
The corporate community and public health agencies
[must] initiate and enhance joint efforts to
strengthen health promotion and disease and injury
prevention programs for employees and their
communities.
— IOM Report on the Future of Public Health in
the 21st Century, 2003
Why should public health agencies work with companies
or trade associations that represent the business sector?
Why should public health entities with altruistic goals
work with companies that are primarily motivated by the
desire for profit? The differences in mission, perspectives,
and priorities create skepticism for public health officials
about the motives of the private sector and the benefits
of engaging in partnerships, even when the efforts might
have substantial public health benefits. Because we face
skyrocketing health care costs, a growing chronic disease
burden, and shrinking resources for public health programs
at local, state, and national levels, health professionals
may reluctantly collaborate on specific projects with the
business sector. These collaborations rarely establish the
types of partnerships that promote the mutual exchange
of ideas, resources, expertise, or access to specific populations,
nor do they result in political advocacy that would
benefit public health.
The interviews and articles in this theme issue of
Preventing Chronic Disease (PCD) present a particular
point of view in favor of working with the business sector
that has not yet been fully embraced by the public health
profession. Public health professionals have 2 compelling
reasons to more actively and strategically seek partnerships
with the business sector. The first reason is using
the workplace to improve health. The second reason is
based on changes in our society and their potential impact
on public health partnerships.
Using the Workplace to Improve the Health
of Working Adults
Workplace health programs appeal to both the public
health community and the business sector. Perhaps the
most obvious reason is the opportunity to improve the
health of millions of workers and their families. Because
workers in America spend more than one-third of their day
on the job, employers are in a unique position to protect
their health and safety.
In the United States, the Centers for Disease Control and
Prevention (CDC) has conducted research with employers
to build the evidence needed to promote workplace health
programs. This collaborative work with such organizations
as the National Business Group on Health and
the National Business Coalition on Health has produced
guidelines and tool kits to help employers implement programs
(www.cdc.gov/business).
Unhealthy workers are a major concern for the private
sector. Escalating health care costs threaten the competitiveness
of American business, even to the point of
bankruptcy, and are a factor in the transfer of jobs overseas
where it is cheaper to produce goods and services (1).
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the US Department of Health and Human Services,
the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. Use of trade names is for identification only
and does not imply endorsement by any of the groups named above.
www.cdc.gov/pcd/issues/2009/apr/08_0236.htm • Centers for Disease Control and Prevention
Elizabeth Majestic, MS, MPH
VOLUME 6: NO. 2
APRIL 2009
Centers for Disease Control and Prevention • www.cdc.gov/pcd/issues/2009/apr/08_0236.htm
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the US Department of Health and Human Services,
the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. Use of trade names is for identification only
and does not imply endorsement by any of the groups named above.
Rising health care costs have contributed to the decline of
American automakers. In 2007, General Motors, Ford, and
Chrysler spent nearly $100 billion on health care for active
workers, retirees, and their families, which added $1,500
to the cost of building each car. This clearly puts US automakers
at a disadvantage with other countries where the
government is responsible for workers’ health care.
Healthy workers are good for business: they miss less
work, are more productive, and have lower health care
costs. In Disease Prevention: A Job for Employers, Lichiello
and Harris note that more businesses are realizing that
they need the expertise, tools, and resources offered by public
health agencies to effectively promote worker health.
Employment-based health promotion offers employers,
insurers, and government an opportunity to
work together. . . . Recent research indicates that
employers sorely need accurate, evidence-based
information on health promotion activities from
reliable, objective sources. They specifically want
information on both the health impact and costeffectiveness
of health (2).
In fact, the private, for-profit sector is willing to pay
our profession for its expertise, making the opportunity
for partnership a win-win situation. Examples of these
types of partnerships are the American Cancer Society’s
consulting program called Workplace Solutions (3), and
CDC’s collaboration with Cargill, Inc, on a research project
that assessed worksite polices, programs, and practices.
This last project was funded by Cargill and is described by
Jason Lang and colleagues in this issue of PCD (4).
The Changing Landscape
Public health professionals operate in a continually
changing society. Our role includes anticipating these
changes, identifying the shifting needs of the public, and
preparing to meet these needs.
At times, rapid changes in political and social forces
drive these changes. No one can underestimate the impact
of the World Trade Center terrorist attacks on the US
model of public health. The event challenged us to think
about protecting the public’s health in different ways. It
showed us the importance of working with diverse agencies
and organizations. And it expanded the range of
partnerships in which we engaged — not just state and
local health departments but advocacy groups, the business
sector, and the public at large.
Substantial shifts in demographics and economic profiles
also drive these changes. For example, because of
the growing number of uninsured Americans and spiraling
health care costs, health care has become a preeminent
issue on state and federal public policy agendas.
Reforming our health system will require a reexamination
of the strengths, weaknesses, and boundaries of the sectors
presently grappling with these issues: governmental
public health, the health care industry, the private sector,
and civil society institutions such as education agencies
and national nonprofit organizations.
The following trends underscore the need to partner
with the business sector: 1) the public’s health has become
big business; 2) there will be less money for public health
programs; and 3) there is an increasing need for public
health professionals but a shortage of workers.
Since 1960, when the National Health Expenditure
Accounts (NHEA) began tracking medical expenditures
by private insurance, public programs, and out-of-pocket
spending, health care spending per capita has increased
each year. In the past 3 decades, the total national spending
on health care has more than doubled to 16% percent
of the gross domestic product (GDP). In 2006 alone,
national health expenditures grew 6.7% to $2.1 trillion, or
$7,026 per person (5).
The Congressional Budget Office’s (CBO’s) 2008 projections
in its Long-Term Outlook for Health Care Spending
offered 2 possible scenarios, both of which reinforce the
amount of money that could go into health care spending:
Under both scenarios total primary spending [for
health] . . . would grow sharply in coming decades,
CBO estimates, rising from its current level of 18%
of GDP to more than 30% by 2082, the end of the
75-year period that CBO’s long-term projections
span.’
The public’s health has become big business
Clearly health and health care are big business, and the
private sector is responding enthusiastically. According to
the Bureau of Labor Statistics:
VOLUME 6: NO. 2
APRIL 2009
www.cdc.gov/pcd/issues/2009/apr/08_0236.htm • Centers for Disease Control and Prevention
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the US Department of Health and Human Services,
the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. Use of trade names is for identification only
and does not imply endorsement by any of the groups named above.
As the largest industry in 2006, health care provided
14 million jobs with 7 of the 20 fastest growing
occupations being in health care related fields.
Health care will generate 3 million new wage and
salary jobs between 2006 and 2016, more than any
other industry (7).
As the business sector takes advantage of these new
opportunities, health officials must recognize their related
roles and responsibilities. In this issue of PCD, Eileen
Salinsky notes the emergence of retail health clinics,
demonstrating that health care is big business with public
health responsibility:
As the nature of medical practice evolves, public
health must continue to seek ways to harness the
reach and creativity of new corporate stakeholders
(8).
Working with the business sector can also be a responsibility
taken on by national nongovernmental organizations.
In his article about AARP’s partnerships with the
private sector, CEO Bill Novelli describes how his organization
has formed a coalition of business associations
and labor unions to ensure access to health care for all
Americans (9). The Business Roundtable, the National
Federation of Independent Business, and the Service
Employees International Union have joined with AARP to
form the Divided We Fail campaign to highlight the key
issues of health care and financial security (www.aarp.
org/aarp/presscenter/pressrelease/articles/DWF_Post_
Election_Ads.html).
There will be less money for public health programs
Public health revenues for programs at the national,
state, and local levels will decline as a result of the economic
downturn, growing budget deficits, and a shrinking
workforce. As we experience the worst economic crisis since
the Great Depression (10), tax revenues for local, state,
and national governments will be reduced. Furthermore,
while the US GDP is almost $14 trillion (11), in 2008, the
US debt passed the $10 trillion mark (12), or more than
half of our nation’s GDP.
Similar budget troubles can also be seen at the state
level. According to the Center on Budget Priorities:
At least 39 states faced or are facing shortfalls in
their budgets for this and/or next year. Over half
the states had already cut spending, used reserves,
or raised revenues in order to adopt a balanced
budget for the current fiscal year — which started
July 1 in most states. New gaps have opened up in
the budgets of at least 27 states plus the District
of Columbia just 3 months after they struggled to
close the largest budget shortfalls seen since the
recession of 2001 (12).
The number of workers contributing to the economy will
also decline in the foreseeable future. Today, there are 3.3
workers for every beneficiary. By 2030, the proportion of
the US population aged 65 years or older will double to
about 71 million, and the ratio of workers to beneficiaries
is expected to decline even more, to 2.2 workers per
beneficiary (13). (For more information, visit www.ssa.
gov/OACT/ProgData/fundFAQ.html.)
The urgency of the current economic crisis requires that
we forge partnerships with new stakeholders, especially
the business sector. Without strong and effective programs,
public health agencies run the risk of becoming
irrelevant in addressing our nation’s leading causes of
death and disability. Public health agencies rarely have
the resources needed to fully and comprehensively implement
programs to address chronic diseases. With further
reductions in funding, many public health programs will
fail because they have insufficient resources to improve
the public’s health.
By combining the knowledge and expertise of public
health with the resources of the business sector, health
goals can be reached. In this issue of PCD, Easton, Davis
and colleagues, and Hawkins and colleagues share experiences
from the Steps Program, a part of CDC’s Healthy
Communities Program (www.cdc.gov/HealthyCommuniti
esProgram/), to demonstrate that collaborations with the
private sector represent not only the possibilities but the
realization of successful approaches to improving health
(14-16).
There is an increasing need for public health professionals
but a shortage of workers
Chronic diseases such as asthma, cancer, diabetes,
obesity, and heart disease affect the quality of life for 133
million Americans and are responsible for 7 of every 10
deaths in the United States, killing more than 1.7 million
VOLUME 6: NO. 2
APRIL 2009
Centers for Disease Control and Prevention • www.cdc.gov/pcd/issues/2009/apr/08_0236.htm
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the US Department of Health and Human Services,
the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. Use of trade names is for identification only
and does not imply endorsement by any of the groups named above.
Americans every year. As the primary reason for escalating
health care costs, chronic diseases account for more
than 75 cents of every dollar we spend on health care in
this country (17). Increases in foreclosures, joblessness,
and people without health insurance will escalate the
demands on public health programs. Advances in medical
technology will extend the lives of the aging baby boomers
and will place unparalleled demands on the nation’s public
health and health care systems.
As the need for public health increases, the number
of public health workers is declining (17). The average
number of public health workers varies greatly across the
United States as measured by the 10 US Department of
Health and Human Services regions, from 76 per 100,000
population in Region V to 200 per 100,000 population in
Region 10.
Without concerted action, the situation will worsen.
According to a 2004 joint report of the Council of State
Governments, Association of State and Territorial Health
Officials, and National Association of State Personnel
Executives, “State governments could lose more than 30%
of their workforce to retirement, private-sector employers,
and alternative careers by 2006, and health agencies
would be the hardest hit” (18). To address the growing
labor shortage, Indiana University President Michael
McRobbie discusses why he appointed a task force to
assess the feasibility of establishing a school of public
health and how his institution is pursuing partnerships
with the private sector to improve the health of the people
of Indiana (19).
Building the Public Health Community’s
Capacity for Collaborating With the
Business Sector
Creating and managing these partnerships requires
that health officials develop a different set of competencies
and capabilities. In his interview, CDC’s former general
counsel Gene Matthews encourages health officials
to move beyond the absolutist approach concerning the
business sector and find sophisticated partnership models
that preserve institutional integrity while improving public
health impact (20).
Although our profession should be seeking new and creative
ways of responding to these trends by building partnerships
with businesses, these collaborations must begin
carefully. To be sure, some of the barriers to partnerships,
such as those with the tobacco industry, have been erected
by the public health community for legitimate reasons.
Other partnerships, such as working with food companies
that are owned by the tobacco industry to address the obesity
epidemic, have in hindsight been questionable. In an
interview in this issue of PCD, Michael Eriksen, Director of
the Institute of Public Health at Georgia State University,
shares his views about whether partnerships with the
tobacco industry are possible and what lessons can be
learned from the tobacco control experience that might be
relevant for addressing the obesity epidemic (21).
Effective partnerships include a contractual agreement
between a public health entity and 1 or more for-profit
business organizations or trade associations. Through
such agreements, the skills and assets of the public health
entity and the business organization are shared to improve
public health. In addition to sharing resources, each party
also shares in the risks and rewards that result from the
partnership.
To learn from our successes and share our failures,
partnerships between public health and business must be
systematically evaluated and reported in the scientific literature.
In this issue’s Tools and Techniques section, Fran
Butterfoss provides useful information about evaluating
these partnerships and offers a window into the diverse
views held by the public and business sectors concerning
evaluation and how to measure success (22).
In his article, Bob McKinnon suggests that the public
and business sectors confront each other with antagonism
and suspicion because they fail to understand and accept
their differences. McKinnon explains that many problems
stem from lack of a common language, a problem that
could be ameliorated if both sectors worked to understand
and address these communication barriers (23).
The Prevention Research Centers, as Sharon McDonnell
describes, are building public health research capacity
through partnerships with the business sector. Several
centers have implemented innovative projects, which exemplify
not only the creative potential but the recognition of
winning approaches to improving public health (24).
To help its employees develop effective partnerships,
CDC developed an agency policy that contains criteria for
VOLUME 6: NO. 2
APRIL 2009
www.cdc.gov/pcd/issues/2009/apr/08_0236.htm • Centers for Disease Control and Prevention
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the US Department of Health and Human Services,
the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. Use of trade names is for identification only
and does not imply endorsement by any of the groups named above.
assessing the appropriateness of a partnership with an outside
agency, organization, business, or trade association.
To implement the agency’s policy, CDC’s National Center
for Chronic Disease Prevention and Health Promotion
(NCCDPHP) developed additional guidance for its divisions
(Appendix.) The purpose of this guidance is to 1)
provide specific criteria against which all public-private
partnerships will be measured and approved to ensure
the best interest of NCCDPHP; 2) provide a consistent,
fair, and transparent review process for all public-private
initiatives; and 3) provide a high level of confidence that
the public’s interests are fully assured through provisions
in agreements and contracts for ongoing monitoring and
oversight of the agreement.
As Goldsmith and Eggers observe:
Government agencies, bureaus, divisions, and offices
are becoming less important as direct service
providers, but more important as generators of
public value within the web of multiorganizational,
multigovernmental, and multisectoral relationships
that increasingly characterize modern government
(25).
For this reason and other reasons outlined above, public
health needs to collaborate with the business sector to
protect and improve the health, economic prosperity, and
quality of life of the American people. Although public
health and the business sector each bear a responsibility
to assure the health of our nation, only by exercising those
responsibilities together will we be able to contribute fully
to that goal.
Author Information
Elizabeth Majestic, Centers for Disease Control and
Prevention, 4770 Buford Hwy, NE, MS K40, Atlanta,
GA 30341. Telephone: 770-771-3451. E-mail: E..c@
cdc.gov.
References
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employers? Seattle (WA): University of Washington.
http://depts.washington.edu/rchpol/docs/st0511/
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3. Harris JR, Cross J, Hannon PA, Mahoney E, RossViles
S, Kuniyuki A. Employer adoption of evidencebased
chronic disease prevention practices: a pilot
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gov/pcd/issues/2008/jul/07_0070.htm.
4. Lang JE, Hersey JC, Isenberg KL, Lynch CM, Majestic
E. Building company health promotion capacity: a
unique collaboration between Cargill and the Centers
for Disease Control and Prevention. Prev Chronic Dis
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natio

 
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