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Opportunities for public relations research in public health.

Kurt Wise (*)

Abstract

While communication researchers have developed a solid body of knowledge in the health field, we know little about the activities of public relations practitioners in public health bodies. This is unfortunate, because public health bodies at the federal, state, and local level have faced considerable criticism for what amounts to poor public relations. Public relations scholarship and practice have much to offer the field of public health in helping public health bodies meet their challenges. In order for public relations scholars to assist public health bodies, however, scholars first must fill a void in the research by investigating the public relations functions of public health bodies. The author suggests six avenues of public relations research in the field of public health. [C] 2001 Elsevier Science Inc. All rights reserved.

1. Introduction

Health is a common topic of discussion in our society. One can hardly pick up a metropolitan newspaper, a national news magazine, or watch a network news broadcast without being exposed to a health-related story. The story may concern information about a new treatment for a specific form of cancer, another hospital merger, a proposal from a legislator concerning the future of Medicare, or a horror story from a patient who was denied treatment by his/her HMO. But the work of public health bodies such as state health agencies, with the exception of crisis situations, takes place in relative obscurity.

It is understandable, then, why we know little about the activities of public relations practitioners in public health bodies. Public relations scholarship has focused on other areas in the health communication field, while virtually ignoring practitioners working in settings providing population-based services. This is unfortunate, because bodies such as state health agencies are involved in tasks important to everyone.

Although public health bodies such as the U. S. Public Health Service (PHS), state health agencies, and local health departments carry out critical functions, there is evidence to suggest these bodies are not as effective as necessary. In a highly critical review of the nation's public health efforts, the Institute of Medicine (IOM) (1) said that public health vigilance nationally had slackened and that the health of the public was "unnecessarily threatened as a result." (2) The IOM said public health professionals had been "slow in developing strategies to demonstrate the worth of their efforts to legislators and the public." (3) The LOM said it saw "much evidence of isolation and little evidence of constituency building, citizen participation, or continuing (as opposed to crisis-driven) communications with elected officials or with the community at large." (4) Although progress has been made at some national, state, and local health bodies, "there is little evidence of significant improvement in core functi on-related performance since the appearance of the IOM report...."(5)

The problems cited by critics of the public health system--difficulty in demonstrating worth to key constituencies and little evidence of constituency building, for example--indicate weaknesses in the public relations efforts of public health bodies. Public relations personnel with the proper training and support would seem to be ideally suited to helping public health bodies address some of their most important challenges. Yet we know very little about the activities of practitioners in public health settings. Communication-related research in the health arena has focused primarily on the ways interpersonal and group communication influence health care delivery and/or persuasive health communication campaigns. (6) Such research is certainly valuable, but a gap exists in the public relations literature concerning practitioners in public health bodies.

This paper suggests directions for future research by public relations scholars in the field of public health. The author first addresses the mission and state of public health in this country, noting the need for improved communication practices. The paper then explores opportunities for public relations research that has the potential to improve the effectiveness of public health bodies, and thus, the health of the nation's population.

2. Public health

Total national health expenditures in 1997 in the United States were four times more than 1980 and almost 40 times more than total spending in l960. (7) The United States spends more of its total gross domestic product on health care services than any industrialized nation. (8) But, probably less than 1% of all national health expenditures are earmarked for population based services carried out by PHS agencies, state, and local health bodies. (9) Expenditures for population-based services will always make up a small portion of health care sector spending given the structure of the U. S. health care system, but part of the reason for the disparity is the partial failure of public health bodies to practice quality public relations. Before addressing this issue, however, a discussion of the nature of public health in this country is in order.

The mission of public health has been defined by the IOM as "fulfilling society's interest in assuring conditions in which people can be healthy."(10) Its core functions have been identified as assessment, policy development, and assurance. In 1994 a group was assembled by the PHS to develop a statement that would describe what public health is and what public health does. (11) Public health, the committee said:

* Prevents epidemics and the spread of disease

* Protects against environmental hazards

* Prevents injuries

* Promotes and encourages healthy behaviors

* Responds to disasters and assists communities in recovery

* Assures the quality and accessibility of health services

Essential public health services, the committee said:

* Monitor health status to identify health problems

* Diagnose and investigate health problems and health hazards in the community

* Inform, educate, and empower people about health issues

* Mobilize community partnerships to identify and solve health problems

* Develop policies and plans that support individual and community health efforts

* Enforce laws and regulations that protect health and ensure safety

* Link people with needed personal health services

* Assure a competent public health and personal care workforce

* Evaluate effectiveness, accessibility, and quality of personal and population-level health services

* Research for new insights and innovative solutions to health problems

Public health bodies, then, have been charged with some of the most important tasks in our society. Public relations practitioners, with the necessary training and support, could play vital roles in helping public health bodies achieve their organizational goals with respect to providing essential health services. Two of the services mentioned above, for example, speak directly to the need for public health bodies to have individuals carry out boundary-spanning functions. White and Dozier (12) defined boundary spanners as "individuals within the organization who frequently interact with the organization's environment and who gather, select, and relay information to decision makers." (13) Boundary spanners could, and should, assist public health bodies in mobilizing community partnerships to identify and solve health problems and in developing policies and plans that support individual and community health efforts.

Public relations personnel, at least in a normative sense, should be assisting public health managers achieve their goals in a challenging environment. Glueck and Jauch (14) suggest that managers in the public sector "must be able to deal with more complex internal and external environments than private- and third-sector managers." (15) Public managers, they said, have responsibilities to the executive branch of government, the legislative branch, out-of-office politicians, and the press (among others). Many public administrators may come to their jobs unprepared in the basics of public relations practice to meet their multiple responsibilities, given that public relations has virtually disappeared from public administration education textbooks. (16)

The task of public health agencies is made more difficult by the fact that trust in such bodies among an organization's publics or the general public may not be at high levels, as pointed out by the IOM (17): "With trust in public institutions at risk or at low levels in many communities, governmental public health agencies must find ways to improve their openness and their communication with the public to maintain and increase their trustworthiness." (18) Health officials, the IOM said, "have not yet found the correct formula for informing the public about the importance of public health. Finding better ways to inform the public and elected officials of the substance and importance of public health clearly deserves more attention." (19)

The communication-related challenges noted by the IOM illustrate a failure of public health bodies to optimally carry out core public relations functions. Nearly 20 years ago, J. E. Grunig and Hune (20) defined public relations as the "management of communication between an organization and its publics." (21) Public health bodies have experienced difficulties in managing their communication functions. These difficulties exist at all levels of the public health system, but none more important than the difficulties faced by state health bodies.

Federal, state, and local governments all play roles in the three core functions of public health. The IOM concluded, however, that "states are and must be the central force in public health." (22) State governments--not federal or local governments-bear the primary responsibility for health. Although state health departments retain ultimate responsibility for protecting the health of the citizenry, Dandoy (23) said their roles, significance, and visibility are often overlooked: "The state health department is viewed as just a pass-through agency, passing funds and regulations from the federal and state to the local level, but not contributing significantly to the planning, development, and implementation of health services." (24) The IOM said many state health departments do not have the influence necessary to acquire adequate resources. (25)

Dandoy said the role of state health departments is often ignored because there is no lobbying group that effectively represents the departments. (26) Citizens served by health departments "are not organized, vocal, or powerful. Governors... have not gone on record that public health is important to their states and cities." (27) When health departments are successful, nothing happens. There are "no outbreaks, no contaminated food or water... Therefore, health departments are invisible to most citizens, except when a disease outbreak or community crisis occurs." (28) Policy makers, Addiss said, need to know the resources invested in population-based care are worthwhile. (29) Public health objectives can be achieved only if the public health "message" is communicated to the public and elected officials.

To complicate the matter further, state health department responsibilities are likely to grow. Pickett and Hanlon (30) noted a growing disenchantment with local health departments caused by "rising expectations, increasing costs, tougher competition for local tax revenues, the growing complexity of public health problems ... and a growing frustration at the local level at the inability to establish control over forces that are affecting the public's health." (31) Moreover, it is easier to complain about the state health department than "your" health department. (32) And while state health responsibilities grow, resources remain limited.

One of the reasons state health departments may not have adequate resources is that public health is a difficult "sell." Larry Gordon, (33) who spent more than four decades in public health leadership positions at the city, county, district, state, and national levels, perhaps best captured this idea:

Public health continues to be a difficult sell, whereas health care continues to be demanded and better funded. Public health programs, unlike health care issues, lack an effective constituency. Public health has always been a rocky road, as it provides no immediate gratification or feedback. It requires the ability to look into the future, which is not a commonplace trait of our political leaders who are looking to the next election rather than the status of their constituents' health in coming decades. Public health, thus far, lacks the glamour associated with hospitals, organ transplants, emergency medicine, diagnosis, treatment, and rehabilitation and does not compete well with crisis health care. (34)

Public health may well lack the glamour of other health fields, but it is the job of those in boundary-spanner roles--including public relations personnel--to make certain those making funding decisions understand the value of public health in their respective states. This is difficult in part because of the wide array of health programs administered by state governments. Because of the breadth of their responsibilities, state health agencies are often "viewed as fragmented, complex, inflexible, and uncoordinated." (35) State health agencies can often seem like a giant maze to those outside the organization, making the task of managing the organization's relationships more difficult. The Florida Department of Health, for example, has responsibilities in the areas of disability determination, health in correctional facilities, emergency medical services, licensing of health professionals, disease control, epidemiology, immunization, environmental health, family health, child nutrition, dental health, chronic d isease, maternal health, and laboratory administration. The above list is incomplete and, to some degree, some areas overlap others. It is no wonder those unfamiliar with state health agencies may find agency structures and operations overwhelming.

In its 1988 report, the IOM called on leaders of public health agencies to develop relationships with legislators, other public officials, physicians, private sector representatives, professional groups, and citizen groups. (36) Although the IOM's recommendations were general rather than specific, it is clear the IOM viewed relationships as an important factor in the effectiveness of a public health agency, including agencies at the state level. Lipson (37) said the challenge before state public health agencies during this century will be "one of seeking partnerships with the private sector and with local governments." (38) State governments, according to the National Research Council (NRC), have "found it important to involve a broad range of stakeholders in the strategic planning process to achieve consensus on program goals and measures." (39) Yet public health bodies, including state health departments, have been criticized for being slow to develop the types of relationships key to maximizing effectivene ss.

3. Suggestions for future research

Despite the fact that public relations scholarship has much to offer the field of public health in meeting its relationship challenges, health-related communication scholarship has focused on other areas. Both textbooks and journals (such as Health Communication and Journal of Health Communication) have centered around two major interdependent branches of inquiry: the health care delivery branch and the health promotion branch. (40) Communication scholars in the health care delivery branch have focused on interpersonal and group communication influence on health care delivery including the study of "the provider/consumer relationship, therapeutic communication, health care teams, health care decision making, and the provision of social support." (41) Many mass communication scholars work in the health promotion branch studying the "development, implementation, and evaluation of persuasive health communication campaigns designed to prevent major health risks and promote public health." (42)

While both branches of research are certainly valuable, there are considerable gaps in the communication literature addressing public relations matters pertaining to public health bodies. The only significant book on public relations in health care (43) is a general work and does not address public health settings in any detail. The field of hospital public relations (44) has drawn some attention, while other authors have suggested media advocacy (45) is key to the success of public health efforts. But, for the most part, public relations research in the public health field is sparse. The following sections outline important avenues for future public relations research in the field of public health:

3.1. Models, roles, and departmental expertise

Perhaps the first type of public relations research to be conducted in the public health arena should be basic model and role research. Public relations models research is well developed. It has been nearly two decades since J. E. Grunig and Hunt proposed four models of public relations practice now familiar to scholars and students: press agentry, public information, two-way asymmetrical, and two-way symmetrical. (46) Those practicing press agentry are concerned with publicity. The public information model often involves "journalists-in-residence" disseminating fairly objective information. Both are one-way models. Research is used to develop messages in the two-way asymmetrical model with information gained through research used to persuade publics to behave as organizations desire. The two-way symmetrical model stresses win-win situations. J. E. Grunig and L. A. Grunig (47) contended two-way symmetrical public relations "epitomizes professional public relations and reflects the growing body of knowledge in the field. This ethical approach also contributes to organizational effectiveness more than other models of public relations." (48) If symmetrical practice contributes to organizational effectiveness more than other types of practice, an examination of the models practiced by public health bodies would provide us with information concerning the level to which public relations is contributing to the effectiveness of bodies such as state health departments.

Similarly, no research has focused on the roles of public relations practitioners in public health bodies. Roles research pioneered by Broom and Dozier (49) is equally well developed. Scholars, and some practitioners, are familiar with the major role categories of technician and manager. J. E. Grunig (50) said managers "conceptualize and direct public relations programs" (51) while technicians provide services such as "writing, editing, photography, media contacts, or production of publications." (52) To practice what has come to be called "excellent" public relations, the presence of management skills in a public relations department is a must. As measured by researchers in the Excellence Study managerial role expertise included organizational response to issues, use of research to segment publics, development of departmental goals and objectives, use of evaluation research and preparation of budgets. (53)

Are public relations practitioners in public health settings mainly technicians carrying out basic functions, or do they possess a great deal of managerial expertise? We could learn much from conducting an investigation similar to the work of Gordon and Kelly (54) concerning practitioners in hospitals. The results of their survey of nearly 200 leaders of public relations departments in hospitals indicated departments that "have the expertise or knowledge to practice two-way models, especially the symmetrical model, enact the manager role, and participate in strategic planning are more likely to contribute to organizational effectiveness" (55) than departments lacking sufficient knowledge or expertise. By conducting similar research on public relations departments in public health settings we would learn valuable information on the ability of such departments to contribute to organizational effectiveness of public health bodies.

3.2. Perceptions of effectiveness

Hon (56) argued the "long-term viability of the public relations function is directly linked to a better understanding of public relations' value-added contribution." (57) She conducted interviews with practitioners and other executives in addressing three research questions: (1) What do practitioners and other managers consider the main goals and objectives for public relations at their organizations? (2) What do they think is the link between goals and objectives for public relations and goals and objectives for their organization? (3) How do they evaluate public relations?

Although data gathered on any one of the three questions would add to our knowledge of public relations in the public health arena, information on the second question would perhaps be the most valuable. Do leaders in public health bodies see any link between the goals and objectives of their public relations efforts and organizational goals and objectives? The question is especially important now, because the emphasis on measuring effectiveness in public health bodies has never been greater. Performance monitoring, the IOM (58) said, has "gained increasing attention as a tool for managing processes and improving their outcomes." (59) The IOM defines performance monitoring as a continuing and evolving process for: (1) selecting and using a limited number of indicators that can track critical processes and outcomes over time and among accountable stakeholders, (2) collecting and analyzing data on those indicators, and (3) making the results available to inform assessments of the effectiveness of an intervention and the contributions of accountable entities.

Hon (60) said most of her interviewees did "not see public relations as an isolated function" (61) and could "articulate clearly how the ultimate success of the organization is inextricably linked to effective communication." (62) Can the same be said for practitioners in the public health field and/or public health administrators? Do they believe public relations makes a clear contribution to public health that would "register" on performance monitoring systems used by public health bodies? Research is necessary to answer these questions. No interviews in Hon's study measured any relationship indicators, but such efforts certainly could be applied to public health.

3.3. Relational research

One of the more exciting developments in public relations research in the past few years has been the growth of what might be called relational approaches to the study of public relations. Ferguson (63) called focus on relationships more than 16 years ago, but the first model for building theory about public-organizational relationships was not offered until 1997. Broom, Casey, and Ritchey (64) proposed a three-stage model that consisted of antecedents to relationships (perceptions, motives, needs, behaviors, etc., that are causes in the formation of relationships), relational concepts that define the nature of relationships (properties of exchanges, transactions, communications, and other interconnected activities), and consequences of relationships (outputs that have the effect of changing the environment). J. E. Grunig and Huang (65) suggested a model similar to Broom et al.'s model of organization public relationships. The three stages of the model offered by J. E. Grunig and Huang are situational anteced ents of relationships, maintenance strategies, and relational outcomes.

Building on research from Canary and Spitzberg, (66) J. E. Grunig and Huang (67) suggested that four features--control mutuality, trust, relational satisfaction, and relational commitment--seem to represent the essence of organization-public relationships. Control mutuality concerns power distribution in relationships. Trust, relational satisfaction, and relational commitment are common constructs in interpersonal literature. Although Broom et al. noted "researchers and practitioners can study relationships as phenomena distinct from the perceptions held by parties in the relationships," (68) J. E. Grunig and Huang (69) suggested the "best starting point for developing measures" (70) of relationship outcomes is to ask the parties about the four features above.

The suggestion of J. E. Grunig and Huang (71) also seems to be a good starting point for relationship research in the field of public health. How would local health departments, for example, rate the satisfaction of their relationship with their respective state health agencies? How much do members of the legislative committees responsible for oversight and/or funding trust state health agencies? Research designed to answer these and other similar questions could, at the very least, provide practitioners and others at state health bodies valuable information on "where they stand" with each of their strategic constituencies. Given that public health agencies are often not at the top of legislators' lists when funding is discussed, relational research (especially research involving legislators who control funding) could provide public health bodies with information valuable to their efforts to achieve funding goals.

3.4.Crisis-related research--opportunities for case studies

Public health bodies are not involved in crisis situations as frequently as they once were. According to the U.S. Centers for Disease Control and Prevention (CDC) (72) contaminated food and water resulted in many instances of foodborne infections decades ago including outbreaks of typhoid fever, botulism, and scarlet fever. Outbreaks, however, have not been eliminated. During 1997-1998, 13 states reported 17 outbreaks of disease associated with drinking water supplies causing more than 2,000 people to become ill. (73) Some of the outbreaks were caused by parasites such as Giardia and Cryptosporidium, while bacteria such as E. coli caused others. The most serious Cryptosporidium outbreak occurred in Milwaukee in 1993 resulting in the deaths of more than 60 people and the hospitalization of approximately 4,000. (74) An E. coli outbreak in Milwaukee in the summer of 2000 killed a young girl and sickened more than 500. (75) The number of states reporting cases of illness caused by Giardia has nearly doubled over the last several years. (76) Each year, an estimated 76 million people experience foodborne illnesses. (77) Some of the more common pathogens identified as causes are Salmonella, Listeria, and E coli O157.

Often, cases of foodborne and waterborne illness result in significant media attention, as did the Milwaukee Cryptosporidium outbreak. These cases thrust public health bodies into the limelight and offer public relations researchers excellent opportunities for case study research of crisis situations.

During and after an outbreak of illness caused by contaminated drinking water, for example, the public may blame a local or state health body for not providing adequate oversight to protect the water supply. Crises, Coombs (78) said, "threaten an organization's impression (image) or public legitimacy, and impression management strategies are used in attempts to reestablish public legitimacy (repair the image)." (79) Certainly, the "image" of a state or local health body could suffer if, in the eyes of strategic publics, the body was negligent in its water monitoring or slow to respond to an outbreak. By establishing positive relationships with practitioners in health bodies before an outbreak, researchers may be able to negotiate access to a public health body in the event of a crisis. First-hand observations noted by researchers during a public health crisis could provide valuable additions to case study literature in the field. In addition, public health practitioners may be able to improve their crisis pre paration by reading such case study accounts. Crisis response techniques could be analyzed and compared to emerging standards in crisis management to assist public health managers in improving crisis response in their organizations.

3.5. Issues management

Another area of research that has not been applied to public relations practitioners in public health management is issues management. Research has suggested public relations practitioners involved in issues management hold more power in their organizations than practitioners who are not involved in issues management, and that involvement in issues management is strongly related to practitioner involvement in decision making by an organization's dominant coalition. (80) There is also evidence that the type of issues management practiced in an organization is related to the type of public relations activities practiced. (81) We know little about the activities of public relations practitioners in public health settings concerning what Chase and Jones (82) outlined as the five steps of the issues management process: issue identification, issue analysis, issues change strategy options, issue action programs, and evaluation of results.

This is particularly troubling in the field of public health, given the range and importance of public health agency responsibility. The core functions of public health (as noted in a previous section) are assessment, policy development, and assurance. Identification of threats to health is a part of public health's assessment function (83) -- clearly related to the concept of issue identification in the issues management process. Systematic community-level and state-level planning for health departments is part of public health's policy development function--clearly related to the strategic portion of the issues management process. Evaluating effectiveness is part of public health's assurance function--clearly related to the evaluation step in the issues management process. Issues management research in the public health field, then, is a potentially rich avenue of investigation for public relations scholars.

3.6. Technology

Technology is a fairly common topic in both scholar-oriented and practitioner-oriented public relations literature. Public Relations Review, for example, devoted a special issue (84) to technology a few years ago. As noted by Hill and White (85) technology-related articles appear in the public relations trade press regularly. Both Johnson (86) and Hill and White (87) conducted interviews with practitioners concerning the use of and opinions about new technology. Johnson argued "new media have the capability of shifting more public relations practitioners from technician roles to manager roles." (88) Hill and White reported practitioners "perceived [a Web site] as a way to strengthen relationships that already existed, mainly because of the e-mail function." (89)

While new media may have the capability of helping public relations practitioners move from technical roles to managerial roles, it appears practitioners may not be taking full advantage of the opportunities offered by advances in technology. In a recent article in The Public Relations Strategist, Ha and Pratt (90) contended "not many organizations employ their sites effectively as part of their public relations program." (91) They sampled Web sites from a membership list of the Public Relations Society of America. The authors said the "low use of some common public relations tools such as newsletters, FAQs, and customer case histories reflects a low interest among organizations in truly communicating with their publics in cyberspace." (92)

How would the Web sites of public health bodies fare in a similar analysis? If the Web sites are the responsibility of the public relations personnel in state health bodies, time and staff considerations may limit the ability of such bodies to take full advantage of the new technology.

Technology-related research, such as investigating public health body practitioner perceptions and use of new technologies and/or examining the content of public health body Web sites, would at least provide us with a better overall picture of public relations practice at public health bodies. Such research may also, as Johnson (93) suggested, provide us with an indication of whether new technology is helping to shift practitioners from technical to managerial roles.

4. Conclusion

Public health bodies make vital contributions to our nation's health and public relations has a significant role to play in helping such bodies achieve their goals. Yet we know little about public relations practice in public health settings. The author is hopeful the suggestions offered in this article will spur additional interest and research in the field.

Kurt Wise is completing his doctorate at the University of Florida and is now on the Faculty of the School of Communication, Quinnipiac University, Hamden, CT.

(*.) Tel.: +1-203-582-8441; fax: +1-203-582-5310.

E-mail address: kurt.wise@quinnipiac.edu (K. Wise).

References

(1.) Institute of Medicine (IOM), The Future of Public Health (Washington, DC: National Academy Press, 1988).

(2.) Ibid, p. 2.

(3.) Ibid, p. 5.

(4.) Ibid, p. 5.

(5.) Bernard J. Turnock, Public Health: What it is and How it Works, 2nd ed., (Gnithersburg, MD: Aspen, 2001), p. 202.

(6.) Gary L. Kreps, Ellen W. Bonaguro, and Jim L. Query, Jr., "The History and Development of the Field of Health Communication," in Lorraine D. Jackson and Bernard K. Duffy (eds.), Health Communication Research (Westport, CT: Greenwood Press, 1998), pp. 1-15.

(7.) Bernard J. Turnock, op. cit., p. 99.

(8.) Ibid, p. 99.

(9.) Ibid, p. 101.

(10.) IOM, op. cit., p. 8.

(11.) Public Health Functions Steering Committee, "Public Health in America," (Washington, DC: U.S. Public Health Service, 1994).

(12.) Jon White and David M. Dozier, "Public Relations and Management Decision Making," in James E. Grunig (ed.), Excellence in Public Relations and Communications Management (Hillsdale, NJ: Lawrence Erlbaum Associates, 1992) pp. 91-108.

(13.) Ibid, p. 93.

(14.) William F. Glueck and Lawrence R. Jauch, Strategic Management and Business Policy, 2nd ed., (New York: McGraw-Hill, 1984).

(15.) Ibid, p. 25.

(16.) Mordecai Lee, "Public Relations in Public Administration: A Disappearing Act in Public Administration Education," Public Relations Review 24 (Winter 1998) pp. 509-520.

(17.) IOM, Healthy Communities: New Partnerships for the Future of Public Health (Washington, DC: National Academy Press, 1996).

(18.) Ibid, p. 5.

(19.) Ibid, p. 45.

(20.) James E. Grunig and Todd Hunt, Managing Public Relations (New York: Holt, Rinehart & Winston, 1984).

(21.) Ibid, p. 6.

(22.) IOM (1988), op. cit., p. 143.

(23.) Susan Dandoy, "The State Public Health Department," in F. Douglas Scutchfield and C. William Keck (eds.) Principles of Public Health Practice (Albany, NY: Delmar, 1997), pp. 68-86.

(24.) Ibid, p. 84.

(25.) IOM (1988), op. cit., p. 143.

(26.) Susan Dandoy, "Filling the Gaps: The Role of Public Health Departments Under Health Care Reform," Journal of American Health Policy (May-June, 1994), pp. 6-13.

(27.) Ibid, p. 7.

(28.) Ibid, p. 7.

(29.) Susan Addiss, "Communicating the Public Health Message," Journal of Public Health Management Practice 1 (1995), pp. 105-106.

(30.) George Pickett and John J. Hanlon, Public Health: Administration and Practice (St Louis: Times Mirror/Mosby, 1990), p. 130.

(31.) Ibid, p. 130.

(32.) Ibid, p. 130.

(33.) Larry Gordon, "Public Health is More Important Than Health Care," Journal of Public Health Policy (Autumn 1993) pp. 261-264.

(34.) Ibid, p. 263.

(35.) National Governor's Association, Transforming State Health Agencies to Meet Current and Future Challenges (Washington, DC: Author, 1997), p. 1.

(36.) IOM (1988), op. cit., p. 154.

(37.) Debra J. Lipson, "State Roles in Health Care Policy: Past as Prologue?" in Theodor J. Litman and Leonard S. Robins (eds.), Health Politics and Policy, 3rd ed., (Albany, NY: Delmar, 1997), pp. 176-197.

(38.) Ibid, p. 188.

(39.) National Research Council (NRC), Measuring Health Performance in the Public Sector (Washington, DC: National Academy Press, 1999), p. 47.

(40.) Gary L. Kreps, Ellen W. Bonaguro, and Jim L. Query, Jr., op. cit., p. 4.

(41.) Ibid, p. 5.

(42.) Ibid, p. 5.

(43.) Kathleen Larey Lewton, Public Relations in Health Care (Chicago: American Hospital Publishing, 1995).

(44.) Keith A. Dines and Eugene S. Schneller, Public Relations and the American Hospital (Tempe, AZ: Arizona State University Press, 1992); Chandra Grosse Gordon and Kathleen S. Kelly, "Public Relations Expertise and Organizational Effectiveness: A Study of U.S. Hospitals," Journal of Public Relations Research 11 (1999), pp. 143-165.

(45.) Lawrence Wallack, Lori Dorfman, David Jernigan, and Makani Themba, Media Advocacy and Public Health (Newbury Park, CA: Sage, 1993).

(46.) James E. Grunig and Todd Hunt, op. cit., p. 13.

(47.) James E. Grunig and Larissa Grunig, "Models of Public Relations and Communication," in James E. Grunig (ed.), Excellence in Public Relations and Communication Management (Hillsdale, NJ: Lawrence Erlbaum Associates, 1992), pp. 285-325.

(48.) Ibid, p. 320.

(49.) Glen M. Broom and David M. Dozier, "Advancement for public relations role models," Public Relations Review 12 (1984), pp. 37-56.

(50.) James E. Grunig, "An Overview of the Book," in James E. Grunig (ed.), Excellence in Public Relations and Communication Management (Hillsdale, NJ: Lawrence Erlbaum Associates, 1992), pp. 1-28.

(51.) Ibid, p. 19.

(52.) Ibid, p. 19.

(53.) David M. Dozier, Larissa A. Grunig and James E. Grunig, Manager's Guide to Excellence in Public Relations and Communications Management (Mahwah, NJ: Lawrence Erlbaum Associates, 1995), p. 24.

(54.) Chandra Grosse Gordon and Kathleen S. Kelly, op. cit.

(55.) Ibid, p. 161.

(56.) Linda Childers Hon, "Demonstrating Effectiveness in Public Relations: Goals, Objectives, and Evaluation," Journal of Public Relations Research 10 (1998), pp. 103-135.

(57.) Ibid, p. 104.

(58.) Institute of Medicine (IOM), Improving Health in the Community: A Role for Performance Monitoring (Washington, DC: National Academy Press, 1997).

(59.) Ibid, p. 26.

(60.) Linda Childers Hon, op. cit., p. 129.

(61.) Ibid, p. 129.

(62.) Ibid, p. 129.

(63.) Mary Ann Ferguson, "Building Theory in Public Relations: Interorganizational Relationships," paper presented at the convention of the Association for Education in Journalism and Mass Communication, Gainesville, Florida, 1984.

(64.) Glen M. Broom, Shawna Casey, and James Ritchey, "Toward a Concept and Theory of Organization-Public Relationships," Journal of Public Relations Research 9 (1997), pp. 83-98.

(65.) James E. Grunig and Yi-Hui Huang, "From Organizational Effectiveness to Relationship Indicators: Antecedents of Relationships, Public Relations Strategies, and Relationship Outcomes," in John A. Ledingham and Stephen D. Bruning (eds.), Public Relations as Relationship Management: A Relational Approach to the Study and Practice of Public Relations (Mahwah, NJ: Lawrence Erlbaum Associates, 2000), pp. 23-53.

(66.) Daniel J. Canary and Brian H. Spitzberg, "A Model of the Perceived Competence of Conflict Strategies," Human Communication Research 19 (1989), pp. 630-649.

(67.) James E. Grunig and Yi-Hui Huang, op. cit., p. 42.

(68.) Glen M. Broom, Shawna Casey, and James Ritchey, op. cit., p. 17.

(69.) James E. Grunig and Yi-Hui Huang, op. cit., p. 47.

(70.) Ibid, p. 47.

(71.) Ibid, p. 47.

(72.) Centers for Disease Control and Prevention (CDC), "Achievements in Public Health, 1900-1999: Safer and Healthier Foods," Morbidity and Mortality Weekly Report 48 (1999), pp. 905-913.

(73.) CDC, "Surveillance for waterborne-disease outbreaks--United States, 1997-1998," Morbidity and Mortality Weekly Report 48 SS-4 (2000), pp. 1-34.

(74.) Helena Solo-Gabriele and Shondra Neumeister, "U.S. Outbreaks of Cryptosporidiosis," Journal of the American Water Works Association 88 (1996), pp. 76-86.

(75.) Joby Warrick, "An Outbreak Waiting to Happen," The Washington Post (April 9, 2001), p. A01.

(76.) CDC, "Giardiasis Surveillance--United States, 1992-1997," Morbidity and Mortality Weekly Report 49 SS-07 (2000), pp. 1-13.

(77.) CDC, "Preliminary FoodNet Data on the Incidence of Foodborne illnesses--Selected Sites, United States, 1999," Morbidity and Mortality Weekly Report 49 (2000), pp. 201-205.

(78.) W. Timothy Coombs, "An Analytic Framework for Crisis Situations: Better Responses From a Better Understanding of the Situation," Journal of Public Relations Research 10 (1998), pp. 177-191.

(79.) Ibid, p. 179.

(80.) Martha M. Lauzen and David M. Dozier, "Issues Management Mediation of Linkages Between Environmental Complexity and Management of the Public Relations Function," Journal of Public Relations Research 6 (1994), pp. 163-184.

(81.) Martha M. Lauzen, "Understanding the Relation Between Public Relations and Issues Management," Journal of Public Relations Research 9 (1997), pp. 65-82.

(82.) W. Howard Chase and Barrie L. Jones, "Managing Public Issues," Public Relations Review 5 (1979), pp. 3-23.

(83.) Bernard J. Turnock, op. cit., p. 175.

(84.) Claire Hoertz Badaracco (ed.), "Technology and the Corporate Citizen," Public Relations Review 24 (1998-Special Issue), pp. 265-412.

(85.) Laura Newland Hill and Candace White, "Public Relations Practitioners' Perception of the World Wide Web as a Communications Tool," Public Relations Review 26 (2000), pp. 31-51.

(86.) Melissa A. Johnson, "Public Relations and Technology," Journal of Public Relations Research 9 (1997), pp. 213-236.

(87.) Laura Newland Hill and Candace White, op. cit., p. 31.

(88.) Melissa A. Johnson, op. cit., p. 234.

(89.) Laura Newland Hill and Candace White, op. cit., p. 42.

(90.) Louisa Ha and Cornelius Pratt, "The Real State of Public Relations on the World Wide Web," The Public Relations Strategist 6 (2000, Fall) 30-33.

(91.) Ibid, p. 33.

(92.) Ibid, p. 33.

(93.) Melissa A. Johnson, op. cit., p. 234.
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Title Annotation:Public relations professionals in public health sector
Comment:Opportunities for public relations research in public health.(Public relations professionals in public health sector)
Author:Wise, Kurt
Publication:Public Relations Review
Geographic Code:1USA
Date:Dec 22, 2001
Words:6276
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