Friday 24 May 2019

Anavar: Advantages and Disadvantages


Anavar is a cutting steroid and it is almost as popular as winstrol. It is known for being a mild anabolic, which is why people tend to stay away from it when their goal is to bulk up. However, people take it when they want to retail muscle mass while losing weight. If you want to learn more about the pros and cons of this legal anabolic steroid, then read the rest of this article.

Anavar Pros

The main benefit of using the steroid is it helps burn fat. Once the drug hits your bloodstream, your body will be primed to lose weight quickly. There are not many steroids that work as good as Anavar, when it comes to burning fat.

Unlike many steroids, Anavar preserves muscle as you lose weight and burn fat. If you’ve worked hard to acquire muscle mass, then you want to keep it for as long as possible. This is nearly impossible to do when you go on a cutting cycle. However, Anavar allows you to retain gains while burning fat. See Cardarine also known as GW501516 or Endurobol

The other two main benefits is it enhances vascularity and increases energy. By the end of an Anavar cycle, you will be ripped and have more energy than you had before starting your cycle.

In short, the main benefits are as followed:

. Burn fat fast
. Preserve muscle
. Enhances vascularity
. Increases energy

Anavar Cons

First of all, the major con is Anavar is considered a controlled substance in the United States. This means it is illegal without a prescription. Not only that, but sports organizations have banned it from being used. If you compete in sports and you are caught using this steroid, then be prepared to deal with serious consequences. Rexadrene Before and After

This particular steroid is safer than other anabolics, but it does come with side effects. It suppresses your body’s ability to produce testosterone and your libido will suffer. It will make you feel tired, cause you to breakout with acne and you may start to lose your hair. Sure, you may become ripped, but you won’t look good with no hair and acne all over your face and body.

It’s toxic to your liver and can raise blood pressure and cholesterol levels. As you know, there are many negative consequences you can experience as a result of high cholesterol levels.

To sum up the above, the main cons of Anavar are:

. It’s illegal
. Suppresses testosterone products
. Makes you tired
. Acne
. Hair loss
. Toxic to your liver
. Increase cholesterol levels
. Raise blood pressure levels

Should You Use Anavar

You shouldn’t buy Anavar. Looking for real Anavar for sale is too risky because you have to turn to the black market to find it. If you want to use this steroid, then go Anavar online store and find a legal supplement designed to mimic its effects. see Sarms lgd 4033 Ligandrol

You can easily find legal Anavar online. They are available in pill form and they are easy to take. If you take legal Anavar for at least four weeks and you train hard and eat right, then you will achieve amazing results. If you want to use legal Anavar

Speed Drug Overview


How Does Speed Work?

Speed increases the levels of dopamine which stimulates the central nervous system. Dopamine is a neurotransmitter responsible for our good mood and the sensation of happiness.

Actually, methamphetamine is more potent than amphetamine, meaning that it can enter a person’s brain more easily. This characteristic is responsible for the euphoric state and the famous rush.

Long-term use of speed can lead to severe changes in the brain on the molecular level. According to some studies, the areas of the brain responsible for emotions and memory change structurally due to chronic speed use.

Orally taken speed has a half-life of around 4-5 hours, with approximately 62% of the drug being excreted within 24 hours.

Why Do People Take Speed?
Speed is one of the more commonly abused drugs, but why is it so popular?

Speed drug popularity has grown, especially with the younger generation because of itsability to energize the users and keep them awake. To students it appears as a perfect solution to all their problems, they can party for longer and they can stay awake to study for longer. When it comes to using speed during a night out it is also far cheaper than buying alcohol, although many do choose to mix the two, often with negative consequences.

After the initial speed use, many become addicted due to the traits of amphetamine and the other substances mixed in with it, such as caffeine.

People may also take speed for their mental health. Speed users are mainly the younger generation that is heavily engaged in nightlife. However, many will rely on speed to prevent anxiety setting in during social situations. In the long term, this tends to have the reverse effect, especially when using highly impure speed.

Facts and Statistics On Speed
Speed use is very common amongst college students. In fact, over 90% of students who use methamphetamine are binge drinkers. Meanwhile, a report from 1997 states that 2.5% of all Americans had used meth at least once in their life. In the same year, ADAM reported that 40% of San Diego arrested law offenders tested positive for methamphetamine use and in San Jose this percentage went up to 52%.

Nowadays, Meth is still a widely used illegal drug which causes thousands of deaths every year.

Speed is a Class B drug, meaning it is illegal to have, sell or offer. Furthermore, if speed is prepared so that you can inject it, the drug becomes Class A. Possession of the drug alone can get you up to five years in incarceration and supplying speed to others can carry a sentence of up to fourteen years. Like other drugs in the US, a conviction for speed can carry effects outside your sentence, such as affecting your employability by limiting the type of jobs you are allowed to apply for.

Speed Side Effects
Just as with any methamphetamine products, speed can have some serious side effects. Apart from death as a result of chronic meth use, the following side effects are quite common:

High blood pressure
Increased heart rate
Insomnia
Fast breathing
Confusion
Anxiety
Paranoia
Aggressive behavior
Blood vessel damage
Brain damage
Cardiovascular collapse
Hallucinations
Psychosis
Movement disorder
Dependence
Addiction
Death
The damage that excessive use of speed can cause is irreversible. As a result, psychiatric symptoms can last for years, even after a person has stopped using the drug. These symptoms consist of things like psychotic episodes in which the user suffers from delusions, severe agitation or uncontrollable panic attacks.

Symptoms of Speed Addiction
Those who struggle with speed addiction can experience many physical, psychological, and behavioral symptoms.s

Some of the Most Common Physical Symptoms of Speed Abuse Are:
Addiction
Tolerance
Dilated pupils
Arrhythmia
Fast breathing
Nausea
Vomiting
Headache
Seizures
Skin problems
High blood pressure
Most Common Psychological Issues of Speed Abuse Are:
Paranoia
Aggression
Psychosis
Hallucinations
Euphoria
Mood swings
Behavioral Symptoms of Speed Abuse Include:
Insomnia
Increased level of energy
Loss of appetite
Improved work performances
Memory improvement
Increased or decreased interest in sex
Increased physical performance

Speed Impurity
Speed is one of the least pure drugs around. Due to it being illegal it is only sold on the street, meaning dealers and suppliers have control over its ingredients. Speed tends to be cut with other amphetamines, caffeine, sugars or even paracetamol in order to increase their weight and therefore their value.

This means that the drug sold as speed is usually only around 5-15% amphetamine sulfate powder and is therefore even more dangerous.

The mixture of speed with other drugs increases the chance of overdose dramatically, due to people not really knowing what is in the drug they are taking. Therefore monitoring the quantity becomes more of a challenge.


Sometimes the people in the process of making speed do not even know the contents, due to adding them by mistake during the manufacturing process.
Many of the drugs mixed with speed are not only added to increase short-term value but to ensure the user gets addicted, thus increasing long-term profits. For example, caffeine is a highly addictive drug, so mixing it with speed will increase the likelihood of a repeat customer.

Speed and Pregnancy
Taking speed drug whilst pregnant can be dangerous to both you and your child even when used for weight loss. Although there is still limited knowledge on the subject it is already clear that it can cause premature delivery, heart and brain issues and disability. There is further research in the early stages currently highlighting that speed use may also affect the social and cognitive skills of your child.

Children born to a mother addicted to speed will also experience withdrawal symptoms, which may cause the child to be extremely nauseated, upset or in pain. Furthermore, amphetamines are excreted in human milk, so mothers taking speed should avoid nursing.

What are Withdrawal Symptoms of Speed Abuse
Speed withdrawal symptoms include both physical and psychological problems.

Some of the most dangerous physical withdrawal symptoms are:
Drug cravings
Seizures
Insomnia
Tremor
Fever
Sweating
Nausea
Vomiting
High blood pressure
High heart rate
Respiratory failure
Coma
Death
Psychological withdrawal symptoms include:
Paranoia
Hallucinations
Anxiety
Depression
What are Treatment Options For Speed Abuse
The treatment for speed abuse relies on detox and cognitive-behavioral therapy. Moreover, sometimes during the withdrawal period, medication is necessary to ease the unpleasant symptoms. If this happens, the drug of choice is Bupropion because it helps with depression.

The speed addict should conduct the detox in a specialized facility or a hospital supervised by trained medical personnel. They will monitor the patient’s vitals and the process of recovery. In addition, most inpatient rehab clinics provide their patients with 24-hour supervision and medical care while speed removes form the body.

After detox, the best treatment option is a combination of counseling, family therapy, cognitive-behavioral therapy, and a 12-step program.

Conclusion
Speed is one of the most addictive and most abused recreational drugs. In addition, it is a central nervous system stimulant that increases the levels of dopamine in one’s brain.

In many cases, the damage that frequent use of speed can cause is irreparable. Furthermore, psychiatric symptoms can persist for years, even after successful detoxification. According to some studies, it can take more than two years for dopamine to return to its normal level!

Finally, the treatments that have been proven to be most effective are ones combining the detox process and cognitive-behavioral therapy.

Garri Health Benefits


Garri is a good food and even has more nutritional benefits than eating rice. Soups made with palm oils and vegetables are the best to use with garri. Soaking and drinking garri may not give you the balanced diet that you require, so therefore, it is not advisable to drink gari alone. Soaking of gari in water is not a sufficient meal and too much of this can have a health effect on your vision.

Garri is best taken in the busy hour of the day like in the afternoon to replenish lost energy and to allow burning more energy. Diabetes sufferers should avoid taking garri because it is a rich source of sugar for the body, but if they still want to, they should just reduce the quantity of garri they consume. Drinking gari during pregnancy is also frowned upon. Below are the health effects of garri:

In West Africa, most especially Nigeria, one very indispensable food is garri. The food which is derived from cassava tubers is locally called “Garri” by many Nigerian tribes and is pronounced as ‘garry’. Other names that it is called are ‘African or cassava flakes, gari, garry, or gali’. There are many health benefits of cassava garri, and there are also effects of garri on health. The English name of garri is always referred to as “Cassava flakes.”

Importance of Garri

Because of its affordability, garri is enjoyed by all. The rich and the poor all consume garri. It is used to make “Eba” after mixing with hot water and taken with soups. And because of its flaky nature when soaked in cold water, it is popularly taken as a food drink in many households.

Though drinking of garri is common among poor and average families (because the rich could easily afford well-processed flakes made from corn), it is taken with milk, sugar, suya (roasted meat), groundnut, kulikuli (snacks made from groundnut), coconut, fried meat, fish (raw, cooked or fried), among others.

Garrihas plentiful benefits as and african food  it increases vitality in its consumers. However, taking too much of garri can have some serious health effects on health and vision. Before discussing the effects of garri on health, take a look at the many benefits.

Its Benefits:

As mentioned earlier, garri is a staple food, and mostly eaten in all of West Africa. It is a food that every common man craves for, and it is locally produced.

Garriis a grain-like food substance that is derived from drying and processing of starchyplant tuber, cassava. The major nutritional content of garri is carbohydrate. It is a cheap and indigenous source of energy. Unlike rice and other expensive food commodities that are eaten occasionally due to its price and availability, garri is easily produced in small quantities for home consumption by families most of whom engage in subsistence farming, or in larger quantities for sale.

Cassava is used to produce two popular local food types called Garri and Akpu (or Fufu). Akpu is a white food substance that has been prepared from cassava after allowing for fermentation and later boiled for eating with soup. For Garri, cassava is soaked and fermentation is allowed. Then it grounded, fried and dried for storage purposes. Garri can be in yellow or white colour depending on what type of palm oil was used to fry it. Yellow garri is said to be more nutritious than white garri, since it is fried with palm oil which contains vitamins like A and C.

Garri can be taken on its own by soaking in water and drinking, but it could also be mixed with hot water, and be eaten with soup to give a balanced diet, since it is mostly an energy giving food and can help give energy to farm workers, busy professionals, people recovering from malaria, and even used for recovery from alcohol hangover.

Its Effects:

1. Eye Defects: Garri is made from cassava which is known to contain hydrocyanic acid. Cyanide in garri, if contained in large quantity can lead to serious eye defects. However, proper, safe, and thorough processing of the garri should reduce the concentration of the acid to a considerate level.

2. Where in excess, another drastic effect of Cyanide which is an organic acid in nature is that it can lead to intestinal issues, and can worsen the situation of an ulcer patient.

3. Cassava which is the crop from which garri is derived from is rich in carbohydrate. A cup of garri contains about 360 calories, out of which 99 per cent is carbohydrate. Hence, consuming too much of garri can lead to excess storage of carbs in the body and this can lead to unnecessary weight gain. So, you know, garri is not good for weight loss.

With these stated side effects of garri, you may be having a second thought on consuming it. The major key here is the need to take caution so as to prevent any negative health effects. As stated above, proper processing of the garri can dramatically reduce the level of cyanide.

Hence, it is advisable that you purchase your garri from trusted. Now that you know the calories in drinking garri, moderate your overall consumption of garri.

Health Benefits Of Irish Moss

Irish moss is a red algae species, which is also known as carrageen moss. It is found along the coastal regions of North America and Europe. This seaweed is usually soaked and used as a gel. It does not have any taste or color that helps it to blend well with all types of dishes. The ancient Irish folklore medicine used this moss for treating people from several medical conditions like tuberculosis and pneumonia. It is also rich in antiviral properties that help in treating viral infections and illnesses.
 
 
Top 10 Health Benefits Of Irish Moss
Find below the best health benefits offered by Irish moss.
 
1. Cures Anemia
When the oxygen circulated in your body becomes very low, it results in low hemoglobin levels and a decrease of red blood cells. Irish moss combats anemia by preventing iron deficiency and maintaining the red blood cells as well as the hemoglobin count. It, in turn, promotes the immunity level and improves the functions of the brain.
 
2. Source of Energy
The iron content of Irish moss helps in quick transportation of oxygen to your body cells. It also aids in promoting the metabolic enzyme process, which is important for absorbing the nutrients and promotes the digestion of proteins in the foods. This weed also helps in improving the concentration and improves the muscle strength by offering instant energy to your body.
 
3. Treats Thyroid Disorders
This sea moss has an abundant amount of DI-Iodothyronine, which gets broken down by T3 that makes it an apt choice for treating the thyroid gland. The brown colored seaweed contains T3 and T4 in the form of iodine compounds that are organically present.
 
Plus, it also has iodine in the concentrated form, which fuels the functions of the thyroid gland. The sea moss also has a tremendous amount of selenium that helps in producing the thyroid hormone. It also promotes the role of the thyroid and improves your metabolism and aids in quick weight loss.
 
4. Relieves Respiratory Problems
Irish moss can relieve all the symptoms associated with flu and colds, which makes it a good choice for your winter soups. Being a potent source of potassium chloride, this sea moss dissolves the catarrhs or the phlegm and inflammation of the mucous membrane to prevent congestion.
 
It also has antiviral agents and antimicrobial properties that help in getting rid of all kinds of infections. It improves the immunity system of the body. It also prevents several infections like flu, sore throat, chest coughs, bronchitis, tuberculosis, pneumonia, and much more.
 
5. Boosts Mental Health
Sea moss has a high amount of potassium, which is essential for the smooth functioning of your body cells. As your body cannot conserve potassium, it is important for you to add sea moss in your diet to promote your mental functions and behavior. It also helps you to get good relief from anxiety disorders, depression, fibromyalgia, agitation, moodiness, and agitation.
 
Irish moss also has Algin, which is a phytonutrient with an extraordinary therapeutic value that helps it to perform like a metal detoxifying agent. This ingredient in the sea moss helps in removing the heavy metal residue from your body tissues.
 
6. Promotes Recovery
Irish moss can strengthen the connective tissues. It helps it to recover faster after a strenuous workout session or from surgeries, invasive procedures, and serious injuries. It has several minerals and vitamins to help you recover from illnesses and diseases quickly by replenishing and supporting the immune system.
 
The Irish moss also helps in quick recovery from debilitating medical issues like pneumonia and tuberculosis. As it maintains a nutrition rich profile, it helps people suffering from hypertension and arteriosclerosis recover much faster.
 
7. Improves Skin Health
The cosmetic industry considers the Irish moss as a wonder ingredient. It can help in preventing skin inflammation, varicose veins, dysentery, and halitosis. It is also known as a skin protector and softer, which works by nourishing the skin by maintaining its hydration level. The sea moss also repairs the skin from various issues like rashes, psoriasis, and eczema.
 
Using Irish moss as a beverage or as a topical application will provide an excellent hydration effect in the long term. This seaweed also protects the moisture inside the cellular walls to prevent it from drying. It is rich in sodium and can give you a facelift when you apply the gel on your facial skin. Irish moss is also beneficial for hair growth 
 
8. Aids In Quick Digestion
Irish moss has rich fiber that makes it a mild and useful laxative. It can also soothe the tissues that are inflamed in the intestinal walls to offer good relied for all kinds of disorders. The demulcent properties that the sea moss has helped in soothing the digestive tract mucous membranes. It also eases vomiting, gastritis, indigestion, dyspepsia, heartburn, and nausea.
 
9. Helps in Weight Loss
Regular consumption of Irish moss would help in keeping obesity at bay. Being a low-calorie food item and rich in nutrients, it can make a great choice for all weight loss programs. Its prowess to absorb the moisture, improving its volume and fills the intestinal tract with its bulk material, thereby offering a fuller feeling to prevent you from binge eating and snacking.
 
It also helps in eliminating the waste by passing it along the gastrointestinal tract. The rich iodine content in it accelerates the thyroid function, energy, and promotes weight loss.
 
10. Prevents Radiation Poisoning
The iodine content found in Irish moss helps in curbing the side effects of radiation therapy. It can be used in the diet of cancer patients to provide better relief. It also aids in the recovery from cancer and poisoning caused by radiation.
 
This seaweed can absorb the toxic substances from bowel and make sure the radiation poisoning is flushed out from your system.
 
The health benefits offered by Irish moss explained above would help understand why one needs to incorporate it in a regular diet. Enjoy the goodness of this sea moss in the form of smoothies, desserts, gravies, and soups!
 
Nutritional Value Of Irish Moss
This sea moss has been used in Ireland for many centuries in soups, broths, and gravies. It is primarily used for healing people suffering from undernourishment to strengthen and fortify their health. When you use 10 gram or 2 tablespoons of Irish moss, it has only five calories and fat of 0.02 grams. This makes it a suitable choice for replacing fatty ingredients in dishes like nuts and avocados to lower its fat content.
 
It also has 0.06 grams of sugar, 3.33% of magnesium, dietary fiber of 0.1 grams, 11.13% of iron. Further, it has 3.62% of Vitamin B2, Vitamin B9 of 4.5%, and magnesium of 3.33%. This makes it ideal for everyday use. Irish moss is loaded with 15 essential minerals to help the human body get a good dose of potassium, calcium, iodine, and sulphur. It is also rich in Vitamins K, F, D, E and A that helps in improving the overall health of a person.
 
As the seaweed has lots of nutrients, minerals, and vitamins, it is capable of curing various health issues like lung disorders, thyroid malfunctions, less immunity level, ulcers, bladder issues, intestinal disorders, tumors, and glandular issues.
 

Quest diagnostics is 45105N SAP 5-50+/6AM/T.


45105N SAP 5-50+/6AM/T this a five panel test which checks for the following things,

Marijuana
Opiates
AMphetamines
Phencyclidine
Cocaine
It looks for these things with a GC/MS test and the threshold is 50 ng/ml. This is what the 5-50 stands for in the name. The 5 is for 5 panel and 50 is the threshold. The SAP stands for substance abuse panel. The MDMA means it also i checks for ectasy high and 6 AM stands for 6 acetyl morphine which is a byproduct for heroin. The T is the confirmatory test part done by the lab to prove the validity of the sample. IT is a closely guarded secret of Quest Diagnostics and it not available to the public or employers. It does not include anything not on this panel. Not hydrocodone, no oxycodone, not benzos. 

Employment. Employers may test you before hiring and/or after hiring to check for on-the-job drug use.
Sports organizations. Professional and collegiate athletes usually need to take a test for performance-enhancing drugs or other substances.
Legal or forensic purposes. Testing may be part of a criminal or motor vehicle accident investigation. Drug screening may also be ordered as part of a court case.
Monitoring opioid use. If you've been prescribed an opioid for chronic pain, your health care provider may order a drug test to make sure you are taking the right amount of your medicine.
Why do I need a drug test?
You may have to take a drug test as a condition of your employment, in order to participate in organized sports, or as part of a police investigation or court case. Your health care provider may order drug screening if you have symptoms of drug abuse. These symptoms include:

Slowed or slurred speech
Dilated or small pupils
Agitation
Panic
Paranoia
Delirium
Difficulty breathing
Nausea
Changes in blood pressure or heart rhythm
What happens during a drug test?
A drug test generally requires that you give a urine sample in a lab. You will be given instructions to provide a "clean catch" sample. The clean catch method includes the following steps:

Wash your hands
Clean your genital area with a cleansing pad given to you by your provider. Men should wipe the tip of their penis. Women should open their labia and clean from front to back.
Start to urinate into the toilet.
Move the collection container under your urine stream.
Collect at least an ounce or two of urine into the container, which should have markings to indicate the amounts.
Finish urinating into the toilet.
Return the sample container to the lab technician or health care provider.
In certain instances, a medical technician or other staff member may need to be present while you provide your sample.

For a blood test for drugs, you will go to a lab to provide your sample. During the test, a health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.

Will I need to do anything to prepare for the test?
Be sure to tell the testing provider or your health care provider if you are taking any prescription drugs, over-the-counter medicines, or supplements because they may give you a positive result for certain illegal drugs. Also, you should avoid foods with poppy seeds, which can cause a positive result for opioids.

Are there any risks to the test?
There are no known physical risks to having a drug test, but a positive result may affect other aspects of your life, including your job, your eligibility to play sports, and the outcome of a court case.

What do the results mean?
If your results are negative, it means no drugs were found in your body, or the level of drugs was below an established level, which differs depending on the drug. If your results are positive, it means one or more drugs were found in your body above an established level. However, false positives can happen. So if your first test shows that you have drugs in your system, you will have further testing to figure out whether or not you are actually taking a certain drug or drugs.

Is there anything else I need to know about a drug test?
Before you take a drug test, you should be told what you are being tested for, why you are being tested, and how the results will be used. If you have questions or concerns about your test, talk to your health care provider or contact the individual or organization that ordered the test.

Public Health Agencies: Their Roles in Educating Public Health Professionals



The previous two chapters have reviewed the role of schools of public health and of other programs and schools in educating public health professionals. While the committee is aware that public health professionals work in a variety of settings, there is a special relationship with the governmental public health agencies at the local, state, and federal level. These agencies have a major responsibility for educating and training the current public health workforce and future public health workers who have not received training elsewhere.

The following sections discuss activities and roles of local, state, and federal public health agencies. These discussions are followed by a series of recommendations targeted at what official public health agencies can do toward better educating public health professionals.

LOCAL PUBLIC HEALTH AGENCIES
Activities and Responsibilities
Local health departments (LHDs) have a fundamental and complex role as the front line for delivery of basic public health services to most of the communities in this country. There are nearly 3,000 local health departments in the United States, varying dramatically in geographic size, size and nature of population, urban and rural mix, economic circumstances, governmental structure within which they work, and governing organization to which they are accountable. The majority of local health departments provide a wide variety of services to very diverse communi-

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Suggested Citation:"6. Public Health Agencies: Their Roles in Educating Public Health Professionals." Institute of Medicine. 2003. Who Will Keep the Public Healthy?: Educating Public Health Professionals for the 21st Century. Washington, DC: The National Academies Press. doi: 10.17226/10542. ×
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ties with limited resources and too few staff (the median size is 14 full-time equivalents). Although local public health services are often discussed within the framework of the 10 Essential Public Health Services, the services actually provided vary widely from state to state, from urban to rural areas, and are especially adapted to address local priorities and concerns. Despite considerable variation, however, more than two-thirds of local health departments provide the following core services: adult and childhood immunizations; communicable disease control; community outreach and education; epidemiology and surveillance; environmental health regulation such as food safety services and restaurant inspections; and tuberculosis testing (NACCHO, 2001).

The past decade has been a period of significant challenges and transitions in local public health. For many LHDs, resources for some traditional services have been shrinking at the same time that challenges and demands have been increasing. More people lack health insurance and are looking to “safety net” providers for health care. Rapidly growing immigrant communities are creating a need for new services or for providing traditional services in a different way. Many LHDs are shifting from “personal health care” services to “population-based” services. In the aftermath of bioterrorism, health departments have greatly increased disease surveillance activities and are now at the center of many of the federal, state, and local emergency planning activities. With these challenges and changing circumstances, there is increasing urgency for an assessment of how new public health professionals are educated and how the current workforce can be trained for new skills. The education and training of the public health workers poses a difficult challenge to local health departments, one for which they will require the engagement and support of many partners, most notably the schools that educate health and public health professionals.

Training and Education in Local Health Departments
LHDs have serious and urgent needs for preparing new public health professionals and for upgrading the skills of current public health professionals (NACCHO, 2001). They face an on-going need to train new and current workforces in how to respond to emerging areas, changing diseases, new priorities, and new technologies. Because LHDs are experiencing significant changes in the types of services they provide and the roles they are expected to fulfill, education and training are needed to prepare new and current local public health staff to meet these changing expectations.

As discussed earlier, the vast majority of current public health workers do not have formal public health training. Many have training in a primary health profession, such as nursing or environmental health, and

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Suggested Citation:"6. Public Health Agencies: Their Roles in Educating Public Health Professionals." Institute of Medicine. 2003. Who Will Keep the Public Healthy?: Educating Public Health Professionals for the 21st Century. Washington, DC: The National Academies Press. doi: 10.17226/10542. ×
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continue to receive training updates from the schools and through their professional associations. One of the major training needs for LHDs is the capacity to support their professional staff in maintaining their professional credentials or licensure through on-going continuing education. Much of the training for local public health staff is obtained through the initiative of individual employees, seeking continuing education in areas of special interest to them or for the continuing medical education or continuing education units that are required to maintain their professional credentials.

LHDs provide a significant amount of direct staff training, primarily for focused technical skills specific to their services and programs. Most LHDs have very limited financial and staff resources for providing or obtaining training or for supporting education for their staff, and they rarely have staff who are professionally prepared to be trainers or educators. Linkages with schools of public health could enhance the capacity of LHDs to provide broader and higher quality training.

LHDs can play an important role in training and education by assessing the skills and training needs of their workforce. This assessment role is proposed in the National Public Health Performance Standards (NPHPS) (CDC, 1998), as part of Essential Service 8 (Assure a Competent Public and Personal Health Care Workforce) (Public Health Functions Steering Committee, 1994). The NPHPS also proposes that LHDs adopt “continuous quality improvement and life-long learning programs for all members of the public health workforce, including opportunities for formal and informal public health leadership development.” They further recommend that LHDs “[p]rovide opportunities for all personnel to develop core public health competencies.”

Many sources of education and training are currently available for local health department staff, including state government agencies, professional organizations, academic institutions, federal government agencies, consultants, other local government agencies, and in-house training (Bialek, 2001). However, there is little systematic information about the extent to which LHDs actually use various sources, which courses and topics are most frequently sought, or the effectiveness of the alternative sources of training. “Distance learning” has become increasingly available, but there has been no assessment of the level of use or value for local public health professionals.

Incentives for Public Health Training for LHD Professionals
Most LHD professionals do not have formal public health training. Few M.P.H. graduates work in LHDs, at least in part because pay scales of LHDs usually are not competitive. Also, most LHDs are unable to provide support or incentives for current staff to obtain the formal public

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Suggested Citation:"6. Public Health Agencies: Their Roles in Educating Public Health Professionals." Institute of Medicine. 2003. Who Will Keep the Public Healthy?: Educating Public Health Professionals for the 21st Century. Washington, DC: The National Academies Press. doi: 10.17226/10542. ×
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health training that would increase the quality of the workforce. For example, they have limited ability to provide tuition reimbursement or educational leave to current employees who might wish to obtain an M.P.H. Most LHDs cannot provide pay increases or other incentives to staff who obtain additional public health training or degrees.

The National Public Health Performance Standards recommend that LHDs “[p]rovide incentives (e.g., improvements in pay scale, release time, and tuition reimbursement) for the public health workforce to pursue education and training (Essential Service 8). This will become possible only if additional resources become available to LHDs. In many cases, significant changes would also be required in local government personnel rules and systems. Efforts should be directed toward engendering increased understanding and financial support from local governments as well as from other funders and policy makers, regarding the importance of on-going training and a higher level of initial education for staff working in public health.

LHDs as Partners with Programs and Schools of Public Health
Partnerships linking LHDs with programs and schools of public health would offer many potential benefits to both partners. The National Public Health Performance Standards recommends that LHDs “[p]rovide opportunities for public health workforce members, faculty and student interaction to mutually enrich practice-academic settings” (Essential Service 8).

Field Placements
Field placement programs are probably the most frequent collaborative activity that currently occurs between local health departments and academic institutions for health professions. Most of the students are at the baccalaureate level. Students participating in field placement programs rarely or never receive financial support from either the academic institution or the health department. The student field experience varies widely among the programs and schools of public health. Implementation of this committee’s recommendations related to improving the practice experiences of students in schools of public health (see Chapter 4) would greatly enhance the value of these experiences for both the students and LHDs.

Staff and Faculty Exchanges
Local health department staff offer practical experience that could be of value in the education of public health and other health professionals.

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Suggested Citation:"6. Public Health Agencies: Their Roles in Educating Public Health Professionals." Institute of Medicine. 2003. Who Will Keep the Public Healthy?: Educating Public Health Professionals for the 21st Century. Washington, DC: The National Academies Press. doi: 10.17226/10542. ×
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Available information suggests that staff and faculty exchanges are not currently a major collaborative activity between local health departments and academic institutions for health professions. LHD staff and academic faculty might benefit substantially from programs allowing them to spend significant time in such activities. Many LHDs have indicated that they would be interested in having department staff placed in faculty appointments (Bialek, 2001). Such interest corresponds well with the committee recommendation (see Chapter 4) that there be enhanced participation of practitioners in the education of students in schools of public health. Other activities offering the potential for collaboration include special projects, seminar courses in the academic setting, and practical training in LHDs. Few LHD staff serve on academic institution steering or advisory committees.

Research Opportunities
Because LHDs are intimately involved with their communities, they have an immediate and detailed knowledge about local public health issues that need to be investigated. They also have the types of credibility with those communities that would facilitate community-based research, providing another cornerstone for working collaboratively with faculty and the community to facilitate such research.

Local Public Health Leadership
Because persons in leadership positions in LHDs are responsible for setting the policies and priorities of their departments and also for coaching and training their subordinate staff, it would be desirable for these leaders to have formal education in the full range of public health principles and skills. However, a 1992–1993 survey of LHDs showed that 78 percent of LHD executives had no formal public health training, although executives of larger jurisdictions were more likely to have a public health degree (NACCHO, 2001). Many LHD leaders do not have access to the financial support nor the educational leave necessary to obtain a formal public health degree. Flexible and creative approaches, such as certificate programs and public health leadership institutes, are needed to provide substantial public health training to the majority of the current LHD leadership.

The many state, regional, and national public health leadership institutes that have arisen in recent years are of increasing prominence as sources of training for these upper-level LHD professionals. The leadership institutes are important sources of training in management and leadership skills for the current workforce. In some cases, they also provide training in public health theory to current managers who do not have

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Suggested Citation:"6. Public Health Agencies: Their Roles in Educating Public Health Professionals." Institute of Medicine. 2003. Who Will Keep the Public Healthy?: Educating Public Health Professionals for the 21st Century. Washington, DC: The National Academies Press. doi: 10.17226/10542. ×
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formal public health training. Many of these leadership institutes are linked with or located within academic institutions, in some cases schools of public health.

Many different organizations and professions contribute to the health of a community, but local governmental public health agencies have a special, fundamental role. They provide services that either cannot be provided or will not be provided by anyone else. In most cases, local health departments provide the most basic public health services in a community, while also establishing the framework for the network of population-based services provided in the community. As we write this report, local health departments are increasingly engaged in emergency and bioterrorism preparedness. A decade ago, LHDs faced the emerging epidemic of AIDS and HIV. To respond effectively to the current and to future challenges, LHD professionals need the ability and resources to rethink and refocus services and to adapt as each new problem arises, as the population changes, or as the community expectations evolve. To do this effectively, they need an ecological perspective and preparation that is grounded in the fundamental skills of public health.

Local public health officials welcome the diffusion of public health approaches and methods of analysis and approach into other components of the health services system and related fields. At the same time, there is a striking disconnect between the current focus of the academic institutions for the public health profession and persons actually practicing in the field. This results from a very complex set of demands and constraints, discussed earlier, including the limited funding available to provide meaningful practice experiences in both education and research. Although this quandary is not easily resolved, it must be confronted and addressed to ensure that the future leaders of state and local public health will have the professional skills and knowledge that they require to effectively address our public health needs.

Local public health agencies in Nigeria works closely with community health care providers, and all health professionals should function to some degree as part of their community’s system of public health. Therefore, public health at the local level would be greatly enhanced by including basic public health education in the training of all health professionals. It would be a great benefit to our public health services and to our communities if all physicians, nurses, and other health professionals had some education in basic public health concepts and systems. In particular, they need familiarity with legal context and responsibilities, the meaning and value of a “population health” approach, and epidemiologic techniques. This improves their ability to work appropriately with their local public health department. Associations representing LHDs have participated in national discussions urging that education of all health professionals should

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Suggested Citation:"6. Public Health Agencies: Their Roles in Educating Public Health Professionals." Institute of Medicine. 2003. Who Will Keep the Public Healthy?: Educating Public Health Professionals for the 21st Century. Washington, DC: The National Academies Press. doi: 10.17226/10542. ×
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be competency-based and should recognize the broad determinants of health, including social determinants.

STATE PUBLIC HEALTH AGENCIES
The 1988 Institute of Medicine report The Future of Public Health described the need for well-trained public health professionals who can address the needs of the public health system associated with technological advances, leadership and political will, and social justice. That report briefly described major barriers to meeting those needs: lack of public health training among the leadership of public health systems, lack of financial resources, and the general limitations of the governmental environment. Those observations were significant for the times, but that landmark report did not offer additional analysis regarding the issue of workforce development. Much has changed during the past decade and a half. Since 1989, new challenges for public health have emerged, with new emphases on surveillance of complex disease patterns and syndromes, emergency preparedness with regard to chemical and biological terrorism, and the increasing diversity of the population as a whole. These challenges have escalated at a time when most states are dealing with budget cuts, personnel hiring freezes, and difficulty in recruiting and hiring public health professionals. Since two-thirds to three-fourths of the state health departments’ budgets are personnel related, the cost of weak workforce development is magnified.

The Organizational Climate
All states and territories and the District of Columbia have a designated entity known formally as the state public health department. There are a total of 56 such designated units in the United States and its territories. The mission, authority, governance, and accountability of these agencies vary according to the state statutes that establish the public health departments. Some are located within a comprehensive health and human services umbrella agency; some are divisions within the governor’s organizational structure; and some are stand-alone state agencies. According to the Association of State and Territorial Health Officials (ASTHO), in 2001, 35 state health departments described themselves as free-standing agencies, while 21 listed themselves as being part of a larger umbrella agency.

The executive-level leadership of state health departments also varies. Most states have statutory requirements for the appointment of the state health official, but the legal requirements differ. Twenty-eight states require the official state health executive to hold a license to prac-

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Suggested Citation:"6. Public Health Agencies: Their Roles in Educating Public Health Professionals." Institute of Medicine. 2003. Who Will Keep the Public Healthy?: Educating Public Health Professionals for the 21st Century. Washington, DC: The National Academies Press. doi: 10.17226/10542. ×
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tice medicine in the state; others do not. The state health department’s organizational climate will often emulate the philosophy of the top executive, especially with regard to workforce development. Therefore, the educational background and previous experience of the state health official is important to the process of educating the public health workforce. See Food Poisoning in Nigeria 

Regarding the mission of the organization, the majority of state public health departments have published mission statement language that describes protecting and promoting the health of the public. Most states have a combination of state and local health departments; some states operate the local health departments; and a few states have no local health departments at all.

State level public health staffs are often health professionals without public health degrees. Regarding governance, 34 state public health agencies have a state level board of health, while 22 state public health agencies do not. Seven state public health departments are designated as the official environmental health agency. Four state public health departments are the official mental health agency. Four state public health departments are the official Medicaid agency.

Recent emphasis on the development of state-level public health system performance measures offers an exceptional opportunity to articulate the unique role of state health departments within the overall public health system. The process of developing measures has challenged ASTHO, the Centers for Disease control and Prevention (CDC) and other partner organizations to delineate the basic public health functions that all states have in common, regardless of variations in organizational structures. Based on the set of essential public health services (see Box 6-1), performance measures enable states to take an enterprise-level view of key functions that must be in place to improve population-based health. The 10 Essential Public Health Services, by their nature, cut across categorical distinctions and allow for a more universal perspective on the principal state public health capacities and functions. The state health department’s role in any given state is to facilitate the implementation of the Essential Public Health Services, either by carrying them out directly or by indirectly supporting the efforts of the local public health agencies, and to articulate the needs of the public health workforce to federal partners.

Responsibility of the State Health Department
One of the 10 Essential Public Health Services specifically focuses on assuring a competent public health and personal care workforce, and state health departments have specific responsibilities in this area. Continuous improvement in the quality of services delivered to the citizens of a state includes an ongoing and systematic assessment. Public health act 2014