1. Novick, Lloyd F. MD, MPH
  2. Editor

Article Content

This new book presents contemporary public health practice through the lens of the Los Angeles County Health Department. Edited by 2 experts in organizing and implementing public health services, Jonathan Fielding and Steven Teutsch, the volume is a seamless well-written exposition of the latest innovations of the delivery of public health functions, tempered by the experience of the nation's most populous county, Los Angeles. Los Angeles County has a population of more than 9.8 million, a greater number of residents than in 42 states. Similar to other jurisdictions, the county encounters problems associated with an aging population and chronic disease. It includes a diverse population, with causes of death that vary by racial and ethnic groups. Homicide is the second leading cause of premature death.


The editors point out "the approach in Los Angeles County is not unique." They correctly do not buy into the myth that "if you have seen one health department, you have seen one health department." But the editors and chapter authors are also too modest. The beauty of this volume is how far Los Angeles County is pushing the frontiers of public health practice. Examples, rather than abstract concepts, are expressed throughout in a carefully edited, harmonious voice, leading to an enjoyable and easy read for practitioners and students alike.


Particular sections of note include the chapter "Measuring Population Health," including the administration of the Los Angeles County Health Survey that includes mobile phone users, as opposed to the Behavioral Risk Factor Survey (BRFSS), which is oriented to those with landlines. Other innovative aspects include specific questions of emergency preparedness and use of soft money from grant initiatives to fund much of this data collection. The realization, expressed here, is that as response rates for telephone surveys decline, new methodologies, including those Web-based, will be needed.


Both Fielding and Teutsch, as well as this reviewer, have played major roles in the development of the US Community Preventive Services Task Force. It follows that they emphasize the role of evidence in public health approaches in Los Angeles County. They note a common finding that many staff are not conversant with the use of evidence base in public health. A strategy of training sessions has been employed in Los Angeles to emphasize the importance of using proven strategies. "Staff now understand the importance of doing 'what works' rather than what we have always done."


I was particularly impressed by the content on credentialing physicians in the chapter "Assuring Competence," authored by Jeffrey D. Gunzenhauser and Kathleen N. Smith. Developing a system to accomplish this should serve as an example for other public health agencies at the local, federal, and state levels. As the authors point out, this should be a standard practice within public health departments.


The chapter on communication is also outstanding, replete with illustrations and formats used for messages related to pandemic influenza and other health hazards.


This text is compact yet comprehensive, covering a wide range of public health issues and conveying a systematic approach as expressed in the introduction of the necessity for public health to address the full range of factors that contribute to the health and health disparities of communities. This is a must read for all of those with an interest in population health improvement.


-Lloyd F. Novick, MD, MPH