Global Health Access Program, Oakland, CA 94618, USA.
J Public Health Manag Pract. 2012 Mar-Apr;18(2):E11-23. doi: 10.1097/PHH.0b013e31822d4c7f.
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.
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.
Mixed-methods employing cross-sectional surveys and a comparative case study.
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.
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.
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%).
Local health leadership underlies public and environmental health departments' community design efforts and should receive technical support and targeted resources to do so effectively.
建筑环境是一个重要但尚未得到充分认识的健康决定因素，地方卫生部门需要扩大指导，以解决这一问题。在这种情况下，领导力尤为重要。
评估地方公共卫生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促进健康的影响，以及他们应避免哪些陷阱。
采用横断面调查和比较案例研究的混合方法。
地方公共卫生和环境卫生部门。
加利福尼亚州所有 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。
三个部门，12 个案例，36 名卫生和土地使用专业人员以及 30 名主要信息提供者。
该研究衡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。使用了定量多变量线性和逻辑回归。还采用了案例研究内容分析和模式匹配，将强有力和薄弱的领导实践与结果联系起来。
具有积极态度的高度创新型领导者的部门更有可能实现对建筑环境的物理变化（OR：4.5，3.4）。使部门为建筑环境工作做好充分准备的领导（通过更新人员配备、结构和战略）使机构间和跨部门合作增加了两倍（OR：3.4）。成功部门的领导层始终如一地（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交通流程，（5）与其他部门的主任建立直接联系，以及（6）利用其专业声誉。在失败案例中，这些实践的不一致性是成功案例的两倍（80％，43％）。
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，应为此提供技术支持和有针对性的资源。
