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Since its inception in 2010, the Network for Public Health Law (Network) has aligned with federal, state, tribal, and local public health practitioners to assess how law can promote and protect the public’s health. In 2013, Network authors illustrated major trends in public health laws and policies emanating from an internal assessment of thousands of requests for technical assistance nationally. More recently, the Robert Wood Johnson Foundation (RWJF) has invited the Network and other partners to consider new ideas and strategies toward building a “culture of health.” Per Figure 1, RWJF’s conception of a culture of health emphasizes key action areas essential to the promotion of health across all sectors and diverse populations.
Error climate refers to shared perceptions of organisational practices regarding errors. Error management climate (EMC), which acknowledges the inevitability of error, and error avoidance climate (EAC), characterised by fear of error and reluctance to discuss error, were explored in relation to supervision, stress, fatigue, psychological ill-health and violations. Errors are of particular concern in the aviation industry, particularly aviation maintenance. The focus of the present study was on perceptions of error climate among Technical Trade personnel in the Royal New Zealand Air Force. Participants were 189 personnel below the rank of Flight Sergeant, all in practical maintenance roles. Perceptions of EMC were associated with better perceived supervision and psychological health, and less EAC, fewer violations and errors. Perceptions of EAC were associated with more violations and errors, and worse psychological health and perceived supervision. Two types of violations were identified. Situational violations were predicted by routine violations, errors, stress and seniority. Routine violations were predicted by situational violations, errors and fatigue. Violations partially mediated the effect of error climate on errors. These findings suggest that error climate is an important organisational factor in safety and aviation maintenance.
Public health law research reveals significant complexities underlying the use of law as an effective tool to improve health outcomes across populations. The challenges of applying public health law in practice are no easier. Attorneys, public health officials, and diverse partners in the public and private sectors collaborate on the front lines to forge pathways to advance population health through law. Meeting this objective amidst competing interests requires strong practice skills to shift through sensitive and sometimes urgent calls for action to address known threats to the health of individuals and the community. It also necessitates objective, timely information and national and regional legal support.
Similar to the triaging of patients by health care workers, legal and public health professionals must prioritize and respond to issues of law and ethics in declared public health emergencies. As revealed by the 2009-2010 H1N1 influenza outbreak and other events, there are considerable inconsistencies among professionals regarding how to best approach these issues during a public health emergency. Our project explores these inconsistencies by attempting to assess how practitioners make legal and ethical decisions in real-time emergencies to further critical public health objectives. Using a fictitious scenario and interactive visualization environment, we observed real-time decision-making processes among knowledgeable participants. Although participants' decisions and perspectives varied, the exercise demonstrated an increase in the perception of the relevance of legal preparedness in multiple aspects of the decision-making process and some key lessons learned for consideration in future repetitions of the exercise and actual, real-time emergency events.
(Disaster Med Public Health Preparedness. 2011;5:S242-S251)