Governance review demonstrates a need to refine the process for identifying and nominating candidates for the Advanced Mediterranean Environmental Health Leadership Competency Assessment. This scenario is professionally challenging because it requires balancing the imperative to foster leadership development with the need to ensure fair and equitable access, while strictly adhering to the assessment’s stated purpose and eligibility criteria. Misinterpreting these criteria can lead to the exclusion of deserving individuals or the inclusion of those who do not meet the foundational requirements, undermining the integrity and effectiveness of the assessment. The best approach involves a systematic review of existing nomination processes against the stated purpose and eligibility criteria of the Advanced Mediterranean Environmental Health Leadership Competency Assessment. This entails clearly defining what constitutes “advanced” leadership in Mediterranean environmental health, identifying the specific professional backgrounds and experience levels that align with this definition, and establishing transparent mechanisms for self-nomination and organizational nomination. Eligibility should be assessed based on demonstrable experience in leading environmental health initiatives within the Mediterranean region, a proven track record of impact, and a commitment to advancing environmental health leadership. This aligns with the assessment’s goal of identifying and nurturing high-potential leaders who can address the unique environmental health challenges of the region. The ethical justification lies in ensuring that the assessment serves its intended purpose of developing specialized leadership capacity and that all eligible candidates have a fair opportunity to be considered, promoting meritocracy and inclusivity. An incorrect approach would be to prioritize nominations based solely on seniority or the number of years in a particular role, without a thorough evaluation of leadership competencies and regional impact. This fails to align with the “advanced” nature of the assessment and may overlook individuals with less tenure but significant leadership achievements. Another incorrect approach is to interpret eligibility too narrowly, focusing only on specific job titles or organizational affiliations, thereby excluding qualified individuals from diverse sectors or non-traditional leadership roles who possess the requisite experience and potential. This contravenes the principle of broad access and may stifle innovation by limiting the pool of potential leaders. Furthermore, an approach that relies on informal networks or subjective recommendations without a structured evaluation against defined criteria is ethically problematic, as it introduces bias and lacks transparency, undermining the credibility of the assessment process. Professionals should adopt a decision-making framework that begins with a clear understanding of the assessment’s objectives and eligibility requirements. This involves consulting the official documentation for the Advanced Mediterranean Environmental Health Leadership Competency Assessment, seeking clarification from the administering body if necessary, and developing a nomination process that is objective, transparent, and inclusive. Regular review and refinement of the nomination process, based on feedback and outcomes, are crucial for continuous improvement and ensuring that the assessment effectively identifies and develops the most promising environmental health leaders in the Mediterranean region.

Scenario Analysis: This scenario is professionally challenging because it requires balancing the immediate need for comprehensive candidate preparation with the practical constraints of time and resource allocation. Leaders in environmental health must demonstrate foresight and strategic planning in developing effective assessment processes. The challenge lies in creating a framework that is both rigorous enough to ensure competency and accessible enough to be realistically achievable for candidates, all while adhering to the principles of fair and equitable assessment. Careful judgment is required to avoid overburdening candidates or, conversely, providing insufficient preparation, which could compromise the integrity of the assessment and the future effectiveness of environmental health leaders. Correct Approach Analysis: The best approach involves a structured, phased timeline that integrates diverse preparation resources. This method acknowledges that competency development is a process, not a single event. It begins with a foundational understanding of the assessment’s scope and objectives, followed by targeted resource engagement. This includes recommending a mix of self-study materials (e.g., relevant policy documents, scientific literature, case studies), interactive workshops or webinars focusing on leadership competencies and Mediterranean environmental health challenges, and opportunities for peer-to-peer learning or mentorship. The timeline should be realistic, allowing sufficient time for absorption and application of knowledge, with clear milestones and checkpoints. This approach aligns with ethical principles of fair assessment by providing candidates with the tools and time necessary to succeed, and it is supported by best practices in adult learning and professional development, which emphasize a multi-modal and spaced learning approach. Incorrect Approaches Analysis: One incorrect approach is to provide a single, comprehensive study guide with a short, intensive preparation period. This fails to acknowledge the complexity of leadership competencies and the diverse learning styles of individuals. It can lead to superficial understanding rather than deep competency development and may disadvantage candidates who require more time or different learning modalities. Ethically, it risks creating an uneven playing field. Another incorrect approach is to recommend a broad, unstructured list of resources with no defined timeline or guidance on prioritization. This places an undue burden on candidates to self-direct their preparation, potentially leading to confusion, inefficiency, and a lack of focus on critical leadership competencies. It can also result in candidates missing key areas due to a lack of structured guidance, which is professionally irresponsible. A third incorrect approach is to rely solely on on-demand, self-paced online modules without any live interaction or opportunities for discussion. While flexible, this can lack the depth of engagement needed for leadership development, particularly in a complex field like Mediterranean environmental health where collaborative problem-solving and nuanced understanding are crucial. It may not adequately prepare candidates for the practical application of leadership skills in real-world scenarios. Professional Reasoning: Professionals should approach candidate preparation resource and timeline recommendations by first clearly defining the competencies being assessed. This should be followed by a thorough review of available and relevant preparation materials, considering their accessibility, quality, and alignment with the assessment objectives. A phased timeline should then be developed, incorporating a variety of learning methods and allowing for progressive skill development. Regular communication with candidates about expectations and available support is also paramount. This systematic process ensures fairness, promotes effective learning, and upholds the integrity of the assessment.

Scenario Analysis: This scenario presents a professional challenge due to the inherent tension between rapid public health intervention and the need for robust, evidence-based decision-making within a regulated framework. Leaders must balance the urgency of addressing a potential environmental health threat with the procedural requirements of environmental impact assessment and public consultation, all while navigating resource constraints. The complexity arises from the need to protect public health without unduly hindering necessary development or causing economic disruption, requiring careful judgment and adherence to established protocols. Correct Approach Analysis: The best approach involves initiating a preliminary environmental health risk assessment to identify potential immediate threats while simultaneously commencing the formal environmental impact assessment process. This strategy is correct because it prioritizes public safety by acknowledging and investigating potential risks without prematurely halting all activity. It aligns with the principles of precautionary action in public health, where potential harm warrants investigation, while respecting the procedural integrity of environmental regulations. This dual approach ensures that immediate public health concerns are addressed promptly, and the broader environmental implications are thoroughly evaluated according to established legal and ethical standards for environmental protection and public health. Incorrect Approaches Analysis: Proceeding with the development without any environmental assessment or public health consultation is ethically and regulatorily unacceptable. This approach disregards fundamental principles of environmental stewardship and public health protection, potentially leading to irreversible environmental damage and significant health risks to the population. It violates the spirit and letter of environmental protection laws that mandate impact assessments before significant development. Delaying the development indefinitely until a comprehensive, multi-year environmental study is completed, without any interim risk assessment, is also professionally unsound. While thoroughness is important, this approach fails to acknowledge the potential for immediate environmental health risks that may require prompt action. It can lead to unnecessary economic hardship and may not be the most efficient use of resources if the initial concerns are minor or manageable. This approach neglects the principle of proportionality in risk management. Focusing solely on the economic benefits of the development and downplaying potential environmental and health risks is a clear ethical and regulatory failure. This approach prioritizes financial gain over the well-being of the community and the environment, directly contravening the mandate of public health and environmental leadership roles. It demonstrates a lack of integrity and a disregard for legal obligations. Professional Reasoning: Professionals in this situation should employ a risk-based, phased approach. First, conduct a rapid initial assessment to identify any immediate public health threats. Second, initiate the formal environmental impact assessment process as mandated by regulations. Third, engage in transparent public consultation throughout the process. Fourth, ensure that any mitigation measures are proportionate to the identified risks and are implemented effectively. This structured decision-making framework balances urgency, regulatory compliance, ethical responsibility, and stakeholder engagement.

Scenario Analysis: This scenario is professionally challenging because it requires balancing the immediate need for information with the ethical and legal obligations to protect sensitive data and ensure informed consent. The pressure to demonstrate progress in an assessment context can lead to shortcuts that compromise these principles. Careful judgment is required to navigate the competing demands of transparency, data privacy, and assessment integrity. Correct Approach Analysis: The best professional practice involves proactively communicating the purpose and scope of the assessment to all participants, clearly outlining what data will be collected, how it will be used, and who will have access to it. This communication should occur before any data collection begins, allowing individuals to make an informed decision about their participation. This approach aligns with principles of transparency and respect for individual autonomy, which are foundational to ethical leadership and data handling practices in environmental health. It ensures that participants understand the context of the evaluation and can consent to their involvement, thereby upholding their rights and fostering trust. Incorrect Approaches Analysis: One incorrect approach involves proceeding with data collection without explicit consent, assuming that participation in a leadership competency assessment implies agreement to all data usage. This fails to uphold the principle of informed consent, a cornerstone of ethical research and data management. It disregards the individual’s right to know and control how their information is used, potentially leading to breaches of trust and privacy. Another unacceptable approach is to collect data broadly and then decide later how to use it, or to share it with unspecified stakeholders without prior agreement. This demonstrates a lack of foresight and respect for data governance. It violates principles of data minimization and purpose limitation, which dictate that data should only be collected for specified, explicit, and legitimate purposes and not further processed in a manner that is incompatible with those purposes. Such actions can lead to unauthorized disclosure and misuse of sensitive information. A further flawed approach is to only provide a vague overview of the assessment’s goals without detailing the specific data points being gathered or the intended audience for the results. While some level of overview is necessary, omitting specific details about data collection and usage prevents participants from making a truly informed decision. This lack of specificity can lead to misunderstandings and a feeling of being misled, undermining the ethical foundation of the assessment process. Professional Reasoning: Professionals should adopt a framework that prioritizes transparency, informed consent, and data protection. This involves: 1. Clearly defining the assessment’s objectives and scope. 2. Identifying all data points to be collected and their specific purpose. 3. Determining who will have access to the data and for what duration. 4. Developing a clear, accessible communication plan to inform all participants about these details. 5. Obtaining explicit, informed consent from all individuals whose data will be collected or used. 6. Establishing robust data security and privacy protocols. 7. Regularly reviewing and updating these processes to ensure ongoing compliance with ethical standards and any relevant regulatory requirements.

Scenario Analysis: This scenario presents a professional challenge in managing the Advanced Mediterranean Environmental Health Leadership Competency Assessment’s blueprint weighting, scoring, and retake policies. The core difficulty lies in balancing the need for rigorous assessment and competency validation with fairness, accessibility, and adherence to the established assessment framework. Misinterpreting or misapplying these policies can lead to invalid assessments, candidate dissatisfaction, and potential reputational damage to the assessment body. Careful judgment is required to ensure that policy decisions are transparent, equitable, and aligned with the overarching goals of leadership competency development in Mediterranean environmental health. Correct Approach Analysis: The best professional practice involves a thorough review of the existing assessment blueprint, including its weighting and scoring mechanisms, to identify any areas that may be outdated, inequitable, or no longer reflect current leadership competencies. This review should be conducted in consultation with subject matter experts and stakeholders. Any proposed changes to weighting or scoring must be formally documented, justified based on evidence of improved assessment validity or relevance, and approved by the relevant governing body. Retake policies should be clearly defined, consistently applied, and communicated transparently to candidates, outlining the conditions under which retakes are permitted, the process involved, and any associated implications. This approach ensures that the assessment remains a valid and reliable measure of leadership competency while upholding principles of fairness and due process. Incorrect Approaches Analysis: One incorrect approach involves unilaterally adjusting the weighting or scoring of assessment components based on anecdotal feedback or perceived difficulty without a formal review process or documented justification. This undermines the integrity of the assessment blueprint and can lead to biased evaluations. Another incorrect approach is to implement ad-hoc retake policies that are applied inconsistently across candidates, creating an environment of perceived unfairness and potentially allowing individuals to pass without demonstrating the required level of competency. Furthermore, failing to communicate retake policies clearly and in advance to candidates is ethically problematic, as it deprives them of the opportunity to prepare adequately and understand the assessment process. Professional Reasoning: Professionals tasked with managing assessment policies should adopt a systematic and evidence-based approach. This involves: 1) Understanding the foundational principles of the assessment framework and its objectives. 2) Engaging in regular reviews of assessment components, including weighting and scoring, to ensure continued relevance and validity. 3) Developing clear, consistent, and transparent policies for all aspects of the assessment, including retakes. 4) Seeking stakeholder input and expert consultation during policy development and revision. 5) Ensuring all policy changes are formally approved and documented. 6) Communicating policies effectively and proactively to all participants. This structured decision-making process promotes fairness, maintains assessment integrity, and fosters confidence in the leadership competency assessment.

This scenario is professionally challenging because it requires balancing competing interests and navigating complex stakeholder dynamics within the framework of environmental health leadership. The core challenge lies in effectively integrating diverse perspectives to achieve optimal process improvements for public health outcomes, while adhering to established environmental health principles and leadership competencies. Careful judgment is required to ensure that proposed changes are not only efficient but also equitable, evidence-based, and compliant with relevant regulations. The best approach involves a systematic and inclusive process optimization strategy that prioritizes data-driven decision-making and collaborative engagement. This entails clearly defining the scope of the process improvement, identifying key performance indicators aligned with environmental health goals, and actively soliciting and analyzing feedback from all relevant stakeholders. By establishing a transparent feedback loop and using this input to refine proposed changes, this method ensures that solutions are practical, sustainable, and address the root causes of identified issues. This aligns with leadership competencies that emphasize strategic thinking, stakeholder management, and evidence-based practice, all crucial for effective environmental health governance. An approach that focuses solely on immediate cost savings without a thorough assessment of potential public health impacts is professionally unacceptable. This failure to consider the broader environmental health implications can lead to unintended negative consequences, such as increased pollution or exposure risks, which directly contravene the fundamental objectives of environmental health leadership. Such an approach also risks alienating stakeholders who may be disproportionately affected by the changes, undermining trust and collaboration. Another unacceptable approach is one that dismisses or minimizes stakeholder concerns without adequate investigation. Environmental health leadership demands a commitment to understanding and addressing the diverse needs and perspectives of the community. Ignoring valid concerns, even if they appear to complicate the optimization process, represents a failure in ethical leadership and can lead to the implementation of suboptimal or even harmful solutions. This also neglects the importance of community engagement in fostering buy-in and ensuring the long-term success of any environmental health initiative. Finally, an approach that relies on anecdotal evidence or personal opinions rather than robust data and scientific principles is professionally unsound. Environmental health decisions must be grounded in evidence to ensure their effectiveness and to maintain public confidence. Relying on less rigorous forms of information can lead to ineffective interventions, misallocation of resources, and potential risks to public health, all of which are antithetical to the principles of environmental health leadership. Professionals should employ a decision-making process that begins with a clear understanding of the problem and the desired environmental health outcomes. This should be followed by a comprehensive stakeholder analysis to identify all relevant parties and their interests. Data collection and analysis, including the systematic gathering and evaluation of feedback, are critical steps. Proposed solutions should then be developed and evaluated against established environmental health standards, ethical principles, and leadership competencies, with a strong emphasis on transparency and collaborative refinement.

Scenario Analysis: This scenario presents a common challenge in environmental health leadership: translating broad stakeholder concerns into actionable, data-informed program planning and evaluation. The difficulty lies in moving beyond anecdotal evidence or general sentiment to a systematic, evidence-based approach that can demonstrate impact and secure continued support. Professionals must navigate diverse stakeholder priorities, limited resources, and the need for measurable outcomes, all while adhering to principles of good governance and public health practice. Correct Approach Analysis: The most effective approach involves systematically collecting and analyzing relevant data to identify specific environmental health risks and community needs. This data then informs the development of targeted program objectives and the selection of appropriate evaluation metrics. By establishing baseline data and setting measurable targets, leaders can objectively assess program effectiveness, demonstrate accountability to stakeholders, and make evidence-based adjustments to optimize resource allocation and program design. This aligns with principles of evidence-based public health practice, which emphasize the use of the best available evidence to inform decision-making, and promotes transparency and accountability in program management. Incorrect Approaches Analysis: Focusing solely on stakeholder anecdotes without rigorous data collection risks developing programs that are misaligned with actual environmental health priorities or that cannot demonstrate tangible impact. This can lead to inefficient use of resources and a failure to address the most pressing issues, potentially violating ethical obligations to serve the public interest effectively. Prioritizing the implementation of pre-existing, generic program templates without tailoring them to the specific context and data of the region can result in programs that are irrelevant or ineffective. This approach neglects the critical step of needs assessment and data-driven adaptation, undermining the core principles of responsive and effective public health interventions. Relying exclusively on qualitative feedback without quantitative data can provide valuable insights into community perceptions but may not offer the objective evidence needed to prioritize interventions or measure program success. While qualitative data is important, its limitations in establishing causality and quantifying impact make it insufficient as the sole basis for program planning and evaluation in a data-driven framework. Professional Reasoning: Professionals should adopt a cyclical, data-driven approach to program planning and evaluation. This begins with a thorough assessment of the environmental health landscape, incorporating both quantitative and qualitative data to identify key issues and stakeholder concerns. This information then guides the formulation of specific, measurable, achievable, relevant, and time-bound (SMART) program objectives. Program activities should be designed to directly address these objectives, and robust evaluation frameworks, including appropriate metrics and data collection methods, must be established from the outset. Regular analysis of evaluation data should inform ongoing program adjustments and future planning cycles, ensuring continuous improvement and alignment with community needs and evidence-based best practices.

Scenario Analysis: This scenario is professionally challenging because it requires balancing the immediate need for operational efficiency with the long-term imperative of protecting public and worker health from environmental and occupational hazards. The pressure to meet production targets can create a conflict of interest, potentially leading to shortcuts that compromise safety protocols. Effective leadership in environmental and occupational health demands a proactive, evidence-based approach that prioritizes risk mitigation and stakeholder well-being over short-term gains. Careful judgment is required to navigate these competing demands ethically and legally. Correct Approach Analysis: The best approach involves a comprehensive, multi-stakeholder risk assessment and management plan, integrated into the facility’s operational framework. This entails systematically identifying potential environmental and occupational health hazards associated with the new production process, evaluating their risks, and developing robust control measures. Crucially, this process must involve active consultation with workers, environmental regulators, and community representatives to ensure all perspectives are considered and to foster transparency and buy-in. This aligns with the principles of responsible environmental stewardship and occupational safety, often mandated by regulatory frameworks that require proactive hazard identification and control, and promote stakeholder engagement in decision-making processes affecting health and safety. Incorrect Approaches Analysis: One incorrect approach focuses solely on immediate cost-effectiveness and production output, deferring comprehensive environmental and occupational health assessments until after the process is implemented. This approach fails to meet regulatory requirements that often mandate pre-implementation risk assessments and the integration of health and safety considerations into process design. Ethically, it prioritizes profit over people, creating potential for significant harm to workers and the surrounding environment, and exposing the organization to legal liabilities and reputational damage. Another incorrect approach relies on outdated or incomplete hazard data and generic industry best practices without specific site- or process-level analysis. While industry best practices are valuable, they are not a substitute for a tailored risk assessment that accounts for the unique characteristics of the new production process and its specific environmental and occupational health implications. This can lead to the overlooking of critical, context-specific risks, violating the principle of due diligence in hazard management and potentially contravening regulations that require specific, evidence-based risk assessments. A third incorrect approach involves implementing control measures based on anecdotal evidence or the opinions of a limited group of internal personnel, without formal validation or regulatory consultation. This bypasses the scientific rigor required for effective environmental and occupational health management and neglects the importance of independent verification and regulatory compliance. It risks implementing ineffective controls or failing to address significant hazards, which is a direct contravention of the principles of evidence-based practice and regulatory oversight in health and safety. Professional Reasoning: Professionals should adopt a structured, risk-based decision-making process. This begins with a thorough understanding of the relevant regulatory framework and ethical obligations. The process should involve systematic hazard identification, risk assessment, and the development of appropriate control strategies, prioritizing the hierarchy of controls. Crucially, stakeholder engagement and transparent communication are vital throughout the process. When faced with competing priorities, professionals must advocate for approaches that uphold health, safety, and environmental protection, grounding their recommendations in scientific evidence and regulatory compliance.

Scenario Analysis: This scenario is professionally challenging because it requires balancing competing interests and ensuring that environmental health policies do not inadvertently exacerbate existing societal inequalities. The leadership role demands a proactive approach to identify and mitigate potential disparities in policy outcomes, particularly concerning vulnerable populations within the Mediterranean region. Careful judgment is required to move beyond superficial analysis and delve into the systemic factors that contribute to inequity. Correct Approach Analysis: The best professional practice involves a comprehensive equity-centered policy analysis that systematically assesses the differential impacts of proposed environmental health policies on various population subgroups, with a specific focus on marginalized and vulnerable communities. This approach prioritizes identifying potential barriers to equitable access to environmental health benefits and burdens, and proactively designing mitigation strategies. This aligns with the ethical imperative to promote social justice and public health for all, as enshrined in international health frameworks and principles of good governance that emphasize inclusivity and non-discrimination. It also reflects a commitment to the core tenets of environmental justice, which demand that no group bears a disproportionate share of negative environmental consequences. Incorrect Approaches Analysis: One incorrect approach would be to focus solely on the aggregate health outcomes of a policy without disaggregating data by socioeconomic status, geographic location, or other relevant demographic factors. This failure to disaggregate data can mask significant disparities, leading to policies that benefit the majority while leaving vulnerable groups behind, thus violating the principle of equitable distribution of public health resources and protections. Another incorrect approach would be to assume that a policy designed to improve general environmental health will automatically benefit all populations equally. This overlooks the complex interplay of social determinants of health, such as access to resources, education, and political power, which can significantly influence how individuals and communities experience and respond to environmental health interventions. This approach risks perpetuating existing inequities by failing to address the root causes of differential vulnerability. A further incorrect approach would be to prioritize cost-effectiveness above all other considerations, even if it means disproportionately burdening certain communities with environmental risks or limiting their access to essential environmental health services. While fiscal responsibility is important, it must not supersede the fundamental ethical obligation to protect the health and well-being of all individuals, particularly those most at risk. This approach can lead to policies that are economically efficient in the short term but socially unjust and ultimately detrimental to public health equity. Professional Reasoning: Professionals should adopt a structured, iterative approach to policy analysis that explicitly incorporates equity considerations from the outset. This involves: 1) defining the scope of the policy and identifying all relevant stakeholders, paying particular attention to marginalized groups; 2) conducting a thorough impact assessment that disaggregates data and analyzes potential differential effects; 3) engaging with affected communities to understand their perspectives and needs; 4) developing and evaluating policy alternatives that actively promote equity; and 5) establishing mechanisms for ongoing monitoring and evaluation to ensure that policies remain equitable in their implementation and outcomes. This process-oriented framework ensures that equity is not an afterthought but a central guiding principle in environmental health leadership.

This scenario is professionally challenging because it requires balancing the urgent need for public health intervention with the imperative of respecting community autonomy and ensuring equitable access to information and resources. Effective community engagement, health promotion, and communication are not merely about disseminating information but about building trust, fostering collaboration, and empowering individuals and groups to participate in decisions that affect their health. The Mediterranean region, with its diverse cultural contexts and varying levels of infrastructure, necessitates a nuanced and context-specific approach. The best approach involves a multi-faceted strategy that prioritizes building trust and understanding through culturally sensitive engagement. This includes actively listening to community concerns, involving local leaders and trusted intermediaries, and co-designing communication materials and interventions that are accessible and relevant to the specific population. This aligns with ethical principles of respect for persons, beneficence, and justice, and is often mandated by public health frameworks that emphasize community participation and empowerment in health initiatives. Such an approach ensures that interventions are not only effective but also sustainable and culturally appropriate, fostering long-term health improvements. An approach that focuses solely on top-down dissemination of information, without prior community consultation or consideration of local communication channels, fails to acknowledge the importance of community buy-in and can lead to mistrust and resistance. This neglects the ethical principle of respect for autonomy and can be seen as a failure to engage in genuine partnership, potentially violating guidelines that promote participatory public health. Another inadequate approach would be to rely on a single communication channel, such as mass media, without considering the digital divide or literacy levels within the community. This can lead to inequitable access to vital health information, violating principles of distributive justice and potentially contravening regulations that mandate accessible public health messaging. Finally, an approach that assumes a uniform understanding of health concepts across diverse communities, without tailoring messages to specific cultural beliefs and practices, is likely to be ineffective and could even be counterproductive. This demonstrates a lack of cultural humility and can undermine the credibility of health promotion efforts, failing to meet the ethical obligation to communicate in a way that is understood and respected by all members of the community. Professionals should employ a decision-making process that begins with a thorough needs assessment that includes understanding the community’s existing knowledge, beliefs, and communication preferences. This should be followed by stakeholder mapping to identify key influencers and potential partners. The development of communication strategies and health promotion interventions should be iterative, involving continuous feedback and co-creation with community members. Regular evaluation of the effectiveness and reach of these efforts, with a willingness to adapt strategies based on community input, is crucial for successful and ethical public health practice.