Recommendations for a national agenda to substantially reduce cervical cancer.

PURPOSE: Prophylactic human papillomavirus (HPV) vaccines and new HPV screening tests, combined with traditional Pap test screening, provide an unprecedented opportunity to greatly reduce cervical cancer in the USA. Despite these advances, thousands of women continue to be diagnosed with and die of this highly preventable disease each year. This paper describes the initiatives and recommendations of national cervical cancer experts toward preventing and possibly eliminating this disease. METHODS: In May 2011, Cervical Cancer-Free America, a national initiative, convened a cervical cancer summit in Washington, DC. Over 120 experts from the public and private sector met to develop a national agenda for reducing cervical cancer morbidity and mortality in the USA. RESULTS: Summit participants evaluated four broad challenges to reducing cervical cancer: (1) low use of HPV vaccines, (2) low use of cervical cancer screening, (3) screening errors, and (4) lack of continuity of care for women diagnosed with cervical cancer. The summit offered 12 concrete recommendations to guide future national and local efforts toward this goal. CONCLUSIONS: Cervical cancer incidence and mortality can be greatly reduced by better deploying existing methods and systems. The challenge lies in ensuring that the array of available prevention options are accessible and utilized by all age-appropriate women-particularly minority and underserved women who are disproportionately affected by this disease. The consensus was that cervical cancer can be greatly reduced and that prevention efforts can lead the way towards a dramatic reduction in this preventable disease in our country.

Reducing North Carolina's health care costs through environmental disease prevention.

At a time of unprecedented pressure on the North Carolina state budget, reducing environmental risks to health may provide opportunities for substantial savings in the proportion of the state budget (24%) that is allocated for medical assistance. Recently, the Research Triangle Environmental Health Collaborative held a summit to identify options for increasing attention to environmental impacts on health in the ongoing health care and budget debates. Summit participants included not only public health and environmental experts, but also individuals (such as transportation planners, developers, and industry representatives) whose decisions can have a significant impact on environmental quality. This article summarizes key recommendations from the summit, as well as commentaries in the policy forum of this issue that further elaborate on why environmental quality matters for public health in North Carolina. Key recommendations from the summit include requiring formal health impact assessments (similar to environmental impact assessments but with an emphasis on health) in state and local transportation and land use planning processes, quantifying the total disease burden attributable to environmental hazards in North Carolina, prioritizing environmental risks to health in North Carolina, providing state technical assistance for communities disproportionately affected by poor environmental quality, establishing a new database system to link existing environmental and public health data by geographic location, undertaking North Carolina case studies to test the hypothesis that improving environmental quality also reduces medical care costs, and developing "environment matters to your health" public awareness campaigns.

Piloting a state health department accreditation model: the North Carolina experience.

Accreditation of state and local public health agencies is a major national priority. North Carolina, a national leader in the accreditation of local public health agencies, undertook a pilot project to evaluate a process for accreditation of the state health agency, the North Carolina divisions of public and environmental health. This pilot project evaluated the instrument and process of a state public health agency accreditation effort and provided information on agency performance. The pilot project used a modified national public health performance standards state instrument to assess state health agency capacity and performance. A site visit followed a self-assessment process conducted internally within the state health department. The pilot project revealed that public health performance standards are a useful framework for state-level standards, but that measurement should focus on stem questions to ensure measurement at an appropriate, not overly detailed, level and reduce the level of work needed to complete the self-assessment process. The project also identified major strengths within the North Carolina Division of Public Health and laid the foundation for ongoing performance improvement under the leadership of the state health director and senior staff. As a result of this experience, accreditation of state health agencies is feasible and provides immediate benefit to state health agency leadership with respect to performance and quality improvement.

The NC accreditation learning collaborative: partners enhancing local health department accreditation.

North Carolina (NC) is one of several states that have developed an accreditation system for local public health agencies. The NC Collaborative, composed of the NC Association of Local Health Directors, the NC Division of Public Health, and the NC Institute of Public Health, conducted several initiatives to enhance the NC accreditation system and contribute to the Multi-state Learning Collaborative. Two of these projects, benefits of accreditation and the Accreditation Road Map, are of potential national interest and can inform the proposed national, voluntary accreditation model. Benefits of accreditation from the perspectives of various system participants were explored through the ongoing evaluation of the NC accreditation system. The development of the Accreditation Road Map and its intended uses are described. Implications for the proposed national model and public health systems research are discussed.