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Book review
  1. Christian T K-H Stadtländer
  1. Correspondence to Dr Christian T K-H Stadtländer, 3828 Fairway Terrace, St. Paul, MN 55125-5021, USA; ctkstadtlander{at}

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Public Health Practice – What Works by Jonathan E. Fielding and Steven M. Teutsch (Eds.). New York, NY: Oxford University Press, 2013. (400 pages), hardcover, $59.99, ISBN: 978-0-19-989276-1.

There are numerous excellent books in the market that deal with issues related to the broad field called ‘public health.’ However, most of these books focus primarily on definitions, concepts and research methods. These books are valuable in that they describe in detail the many different ways public health can be practiced, typically using examples from national and/or international research studies. The book by Fielding and Teutsch is unique in that it provides readers with important information about the development and successful implementation of public health programmes by demonstrating the on-the-ground public health practice of the US Los Angeles County Health Department.

Public Health Practice—What Works is multi-authored and organised into five main sections containing a total of 37 chapters. The foreword is written by Georges C Benjamin, the executive director of the American Public Health Association. He points out that effective public health action requires a wide range of skills, such as assessment, analysis and re-evaluation, policy development, programme planning and implementation, as well as several effective assurance strategies including community organisation and mobilisation, risk communication and quality improvement. In order to be successful in combining these skills, good leadership and management are as important as scientific expertise and political competency. Benjamin emphasises that ‘the real work of improving the public's health occurs on the ground in our states and localities.’

The introduction (Chapter 1) provides an interesting description of the role of a public health department, in general, and of the history of public health in the Los Angeles County Health Department (LACHD). The authors mention that a health department has to deal with a wide range of threats such as communicable diseases, food-borne diseases, natural and man-made disasters, toxic exposures and preventable illnesses and injuries. Its focus is also on preventing the occurrence and progression of chronic diseases. In other words, in the LACHD, like in all other public health institutions, the overall goal is disease prevention, health protection and health promotion. An important factor in reaching this goal is to be aware of limited financial resources and strictures, and to be able to decide how money from various sources can best be spent. According to the authors, the LACHD was established in 1903 and initially focused on rural health issues. Later, with population growth, the department had to learn how to deal with the increasing complexity of the health system, recognise new public health problems, set priorities, implement evidence-based practices and seek opportunities for improvements.

Part 1 contains eight chapters that describe core capacities, such as measuring population health through well-designed, multi-language population health surveys and understanding birth outcomes and adverse birth events by looking, for example, at maternal risk behaviour and prenatal and infant healthcare. Another topic relates to making the switch from direct service to a community orientation; the authors use here the transformation of the nursing practice as an example. Furthermore, valuable information is provided about issues related to strategic planning, programme and policy development and effective communication. They also describe issues and techniques for the assurance of competence of health professionals by discussing credentialing and privileging of physicians, and improvements of public health services performance with an emphasis on two areas: high-level infrastructure development (eg, disease surveillance systems, emergency response capabilities and a department strategic plan) and the selection of priority setting and output measures linked to population-level health outcomes. What makes these chapters powerful is that the authors use a combination of theoretical instruction to the topics followed by a detailed description of public health practice implementation.

The following two parts are about health promotion (Part 2, Chapters 10–15) and health protection (Part 3, Chapters 16–22). Health promotion has to do with identifying underlying determinants of health in the social environment (eg, education, employment and social cohesion) and in the physical environment (eg, transportation systems, environmental toxins and pollution), and the associated individual behaviours that determine overall health and well-being. Since Los Angeles is racially and ethnically diverse and has significant socioeconomic and health disparities, the main focus was on developing city/community-level health indicator reports, then prioritising issues and encouraging partnerships with local stakeholders (Chapter 10). The authors of the remaining chapters in this section discuss various health promotion targets, including attempts to reduce the obesity epidemic in the USA by tackling the ‘toxic food environments,’ and programmes aimed at promoting an active living style, for example, by encouraging walking and biking and less driving. They also look at advanced local policies aimed at eliminating gaps of previous tobacco control efforts. Increased influenza vaccination coverage in the African American community (an underserved population) as well as effective prevention and control mechanisms to address asthma are additional topics that the authors review. In the third part (health protection), the focus is on infectious disease programmes and their implementation by addressing issues related to food supply and contamination. Discussions include Listeria monocytogenes infection in Mexican-style cheese, the outreach to hospitals with regard to infection control and the control of animal importation with the goal to reduce zoonoses. Other chapters deal with attempts to re-establish public confidence by ensuring safe food facilities, the search for effective local responses to food product recalls, the reforms implemented at the LACHD for reporting and public notification of sewage discharges and the programmes designed to protect communities against contaminated fish through outreach, education and cooperative agreements.

The adequate response to emergencies is another very important issue in public health. Part 4 lays out in six chapters what policies and improvements are currently used at the LACHD. Specific topics include, for example, how to build an effective structure for emergency management for local public health. The authors point out that today the emphasis is on an ‘all-hazards’ perspective that goes beyond fire and law enforcement, and now also includes biological, chemical and radiological events, as well as earthquakes, wildfires and natural disasters. Another important chapter reviews the framework for emergency readiness by training employees as first responders. Furthermore, the authors discuss the role of the Threat Assessment Unit in response to potential emergencies (eg, bioterrorism) as well as the radiation risk and the multi-agency response. Also very crucial in emergencies is the distribution of medications. Two chapters are devoted to this topic: Chapter 27 deals with the determination of the points of dispensing emergency medications and supplies, and Chapter 28 with the provision of real-time information by automating medication data collection systems.

The final part (Part 5) is titled ‘Service Delivery.’ The authors start out by looking at the Drug Court Program, which is aimed at reducing drug use among non-violent offenders. They then turn their attention to the legal challenges and effectiveness of suitable performance measurement systems developed for preventing drug overdose deaths and increasing the accountability among substance abuse treatment providers. Maternal and Child Health are discussed in the following four chapters. More specifically, the authors describe programme design and implementation for preconception health for mother and child, data tools and strategies for improved birth outcomes and programmes that are used at LACHD to assure medical coverage for children and families. A new service delivery model for paediatric physical and occupational therapy is discussed in Chapter 35. The remaining two chapters in this section are about the implementation of postexposure prophylaxis to reduce HIV cases (Chapter 36) and public health issues (sexually transmitted diseases/HIV) in the adult film industry (Chapter 37).

In conclusion, Fielding and Teutsch developed a well-organised and excellently written book. Its strength lies in the description of a broad array of topics and in how public health is practiced on the ground at the LACHD. The authors reached this by describing the problems, approaches, challenges and opportunities, and the solutions and impact on public health, as well as the key lessons learnt. What struck me as one of the many important take-home lessons in this book is what the authors of Chapter 19 emphasised: ‘Never let a good crisis go to waste. A crisis may present an opportune political climate to implement sweeping changes to an outdated system.’ What I also like in this book is that the chapters are self-contained and encapsulate their topics in a concise manner without overwhelming detail, but with sufficient illustration (eg, excellent flow charts) and suitable references. The five-page list of acronyms used in the book is helpful, but a glossary of selected terms and an index are missing. I believe the inclusion of non-US public health data in relevant sections (eg, health protection and emergency response) adds another dimension and stimulates the reader to look beyond the local and national boundaries by comparing the challenges of the LACHD to other systems. Overall, I believe this text is useful for a large audience, which includes public health professionals, practitioner trainees, administrators and policy makers, as well as many other people working in the public health field. This book can also serve well as a resource for academic researchers and as a text book for faculty and students. I consider Public Health Practice—What Works a one-of-a-kind book that fills a major gap in the public health literature. I highly recommend it to the reader.


  • Competing interests None.

  • Provenance and peer review Not commissioned; internally peer reviewed.