Allison Larr, 25, graduated from Columbia University’s Mailman School of Public Health a few weeks ago as a member of the 2014 Master’s in Public Health class and will soon start working at Citigroup in New York City as an analyst in the bank’s public finance division, which finances infrastructure projects.
“Infrastructure is central to maintaining a healthy population,” according to Larr. “If you don’t have a sewer system, public transportation and roads, you won’t have a healthy population.”
NewPublicHealth recently spoke with Larr about the path she took to her new career.
NewPublicHealth: How did you end up at Citigroup?
Allison Larr: As an undergraduate I studied neuroscience, and I was considering pursuing a career in academia or medicine. After my college graduation, I worked for a psychiatric research organization where I realized that I didn’t want to perform the traditional academic roles of creating and distributing knowledge or devote my life to being a physician, but I still wanted to work in a field related to health. By that time, I had developed quite an interest in the environment and in climate change, and so I thought why not connect these two by studying environmental health sciences and figuring out some sort of way that I could work in that field on large-scale problems related to health from upstream processes.
When I started my Master’s in Public Health at Mailman, I didn’t really have a clear vision of exactly what I wanted to do after graduation. I did know that I wanted to work on some bigger-picture environmental issues related to health, so I chose environmental health policy. I worked on a funding opportunity for electric vehicle infrastructure, and that was really the first time that I considered anything related to finance as related to health, because electric vehicle infrastructure would certainly increase electric vehicle uptake, which would have a positive impact on public health through reduced emissions. And in order to make that happen, you need to be able to pay for it.
That’s when the seed was planted that finance could be health related. Following that I worked at the New York City Department of Environmental Protection in the energy office, and when we were evaluating potential projects, part of my role was to evaluate how much greenhouse gas savings the projects would produce, as well as the payback period—investigating really whether it was a worthwhile investment from a financial point of view.
Widely Used HIV Drug Linked to Higher Suicide Risk
People infected with HIV whose treatment includes the widely used antiretroviral drug efavirenz appear to have double the risk of suicidal thoughts, attempts and completion compared to HIV patients not taking the medication, according to a study by several researchers at the Harvard School of Public Health and the University of North Carolina at Chapel Hill. The study was published in the Annals of Internal Medicine.
“When efavirenz is used as a component of antiretroviral therapy, patients should be monitored carefully for exacerbation of depression or evidence of suicidal thoughts or behavior,” according to the study.
The drug has been previously linked to central nervous system side effects and suicide, but until now a clear link to suicidal thinking, attempted suicide, or completed suicide was not clear. The effects persist for the time patients are on the drug. The researchers recommend that patients with HIV use alternative drugs, if possible, if they are at risk for depression. Read more on HIV.
Nutrition Screenings Should Be Regular Part of Geriatric Health Assessment
Most older adults typically have one or more chronic health conditions that can affect their food intake and should be asked about their food intake during health exams, according to a new study in Nutrition in Clinical Practice. The researchers said that health care providers should also look for signs of malnutrition, such as loss of subcutaneous fat, muscle loss and fluid accumulation. Read more on aging.
Many American Teens Follow Pro-Marijuana Twitter Feeds and Receive Pro-Marijuana Tweets
Hundreds of thousands of American teens are following marijuana-related Twitter accounts and getting pro-marijuana tweets several times each day, according to researchers at the Washington University School of Medicine in St. Louis. The researchers say the tweets are cause for concern because young people are especially responsive to social media influences and because patterns of drug use tend to be established in a person’s late teens and early 20s. The study was published in the Journal of Medical Internet Research and relied on tweets sent and received between May 1 and Dec. 31, 2013, from a single popular pro-marijuana Twitter feed. During the study period, the feed posted an average of 11 pro-marijuana tweets per day. Read more on substance abuse.
Inappropriate and dangerous prescription practices for painkillers are driving high addiction and overdose rates—46 people die of a prescription painkiller overdose every day—according to a new Vital Signs report from the U.S. Centers for Disease Control and Prevention (CDC).
The CDC has also found wide variation in prescription practices across the country:
- Southern states had the most prescriptions per person for painkillers, especially Alabama and Tennessee.
- The Northeast, especially Maine and New Hampshire, had the most prescriptions per person for long-acting and high-dose painkillers.
- Nearly 22 times as many prescriptions were written for oxymorphone (a specific type of painkiller) in Tennessee than were written in Minnesota.
In total, doctors wrote 259 million prescriptions for painkillers in 2012—or enough for a bottle of prescription pain pills for every American adult in the country.
“Prescription drug overdose is epidemic in the United States. All too often, and in far too many communities, the treatment is becoming the problem,” said CDC Director Tom Frieden, MD, MPH. “Overdose rates are higher where these drugs are prescribed more frequently. States and [medical] practices where prescribing rates are highest need to take a particularly hard look at ways to reduce the inappropriate prescription of these dangerous drugs.”
According to the CDC, deaths from drug overdoses have been rising steadily over the past two decades and have become the leading cause of injury death in the United States—linked strongly to the overuse of prescription painkillers. In 2011, of the 41,340 drug overdose deaths in the United States, 55 percent were related to pharmaceuticals, and almost three quarters of those were from prescription painkillers.
Report: Food Sodium Levels at Many Top Chains Continue to Be Unhealthily High
From 2009 to 2013, the nation’s top restaurant chains reduced the sodium in their foods by an average of only 1.5 percent annually, according to a new report from the nonprofit Center for Science in the Public Interest (CSPI). In a review of 136 meals from 17 chains, researchers determined that approximately 79 percent of the 81 adult meals contained more than 1,500 milligrams (mg) of sodium—or one mg more than the U.S. Centers for Disease Control and Prevention recommends as a full day’s limit. The study also found efforts to reduce sodium to be inconsistent, with some chains actually increasing the amounts over the studied time period. CSPI Executive Director Michael F. Jacobson said the findings indicate that the U.S. Food and Drug Administration’s “wait-and-see” approach to sodium in packaged and restaurant food doesn’t work and that a new approach is needed. Read more on nutrition.
CDC: Antibiotic-resistant Foodborne Germs Remain a Serious Public Health Issue
New data from the U.S. Centers for Disease Control and Prevention (CDC) indicates both positive and negative trends in the ongoing public health fight against antibiotic-resistant foodborne germs, which contribute to an estimated 430,000 U.S. illnesses every year. According to the data, multi-drug resistant Salmonella—which causes approximately 100,000 U.S. illnesses annually—decreased over the past decade, but Salmonella typhi resistance to certain drugs increased by 68 percent in 2012, meaning one of the common treatments for typhoid fever may not be effective. “Our latest data show some progress in reducing resistance among some germs that make people sick but unfortunately we’re also seeing greater resistance in some pathogens, like certain types of Salmonella,” said Robert Tauxe, MD, MPH, deputy director of CDC’s Division of Foodborne, Waterborne, and Environmental Diseases. “Infections with antibiotic-resistant germs are often more severe. These data will help doctors prescribe treatments that work and to help CDC and our public health partners identify and stop outbreaks caused by resistant germs faster and protect people’s health.” Read more on food safety.
Four Communities to Share $120M in HUD Grants for Community Revitalization
Four U.S. communities will split nearly $120 million in U.S. Department of Housing and Urban Development (HUD) grants earmarked for the redevelopment of severely distressed public or HUD-assisted housing and their surrounding neighborhoods. "HUD's Choice Neighborhoods Initiative supports local visions for how to transform high-poverty, distressed communities into neighborhoods of opportunity," said HUD Secretary Shaun Donovan. "By working together, with local and state partners we will show why neighborhoods should always be defined by their potential—not their problems. Together, we will work to ensure that no child's future is determined by their zip code and expand opportunity for all."
The four communities are:
- Columbus (Ohio) Metropolitan Housing Authority — Columbus, Ohio
- Housing Authority of the City of Norwalk/Norwalk (Conn.) Redevelopment Agency
- City of Philadelphia, Office of Housing & Community Development/Philadelphia Housing Authority
- Housing Authority of the City of Pittsburgh/City of Pittsburgh
Read more on housing.
“Getting cigarettes out of our stores is a first step to making pharmacies a place where health happens,” said Troy Brennan, Executive Vice President and Chief Medical Officer of CVS Caremark Corporation, of the company’s decision earlier this year to stop selling tobacco products in its stores. In a Spotlight: Health session at the Aspen Ideas Festival last week, Brennan and other business CEOs discussed how making health a priority can lead to better business outcomes.
By decreasing the number of places that consumers are exposed to cigarettes and eliminating the convenience of tobacco, he said that CVS is actively trying to reduce smoking rates in the areas it serves. However, the healthy decision is also good for the company’s bottom line—already the decision has had positive business results that it didn’t anticipate, including an increase in the company’s stock price following the announcement.
“Companies that make health a priority—consumers gravitate toward that,” he said. “That’s the business incentive.”
Joining Brennan in the conversation, Vitality Institute Executive Director Derek Yach added that the private sector needs to complement public efforts when it comes to health and prevention. For example, taxes and increased prices must work in concert to discourage consumers from unhealthy products or behaviors.
“There may be an economic hit in the short term,” said Yach of companies that make healthy choices easier. “But in the long term, businesses are going to get an inflow of customers who know that their values are aligned.”
Yach also encouraged using County Health Rankings data to understand the underlying risks in each local area, as businesses are uniquely positioned to tailor their interventions to what the surrounding community needs.
Study: New Requirements Needed for Hand Hygiene for Anesthesia Providers
Anesthesia providers frequently miss identified opportunities to clean their hands during surgical procedures, with the points immediately before patient contact and immediately after contact with the patient’s environment the times when they are least likely to practice proper hand hygiene, according to a new study in the American Journal of Infection Control. However, the findings also point to a larger problem: Complete compliance with all hand hygiene guidelines would take so much time that there would be no time to actually perform any procedures. The findings indicate “a need to create more practical—but still effective—methods of controlling bacterial transmission in anesthesia work environments.” Read more on prevention.
HHS: $840M to Help State, Local Agencies Improve Disaster Preparedness
The U.S. Department of Health and Human Services (HHS) has awarded approximately $840 million in grants to help state and local public health and health care systems improve their emergency response preparedness. Distributed through the Hospital Preparedness Program (HPP) and the Public Health Emergency Preparedness (PHEP) program, the funds will ensure that communities are prepared to respond to an array of emergencies, including infectious disease outbreaks, natural disasters, or chemical, biological, or radiological nuclear events. “Community and state preparedness is essential to the health security of all Americans,” said Nicole Lurie, MD, assistant secretary for preparedness and response (ASPR), in a release. “Events in the last few years have demonstrated how critical it is for health systems across the country to be ready and able to respond quickly and effectively.” Read more on disasters.
ACP: Annual Pelvic Exams Not Needed for Asymptomatic Women
Annual pelvic exams for women do more harm than good and should not be a routine part of health care for women who are not pregnant or who show no other signs of pelvic problems, according to new guidelines from the American College of Physicians (ACP). In a review, researchers found no studies on the effectiveness of pelvic exams in identifying cancers, infections and other health issues that they are commonly used to find. Researchers stressed that their findings only apply to pelvic exams and that women should still undergo recommended cervical cancer screening. Read more on prevention.
A new climate change report, Risky Business: The Economic Risks of Climate Change in the United States, suggests that the American economy could face significant and widespread disruptions from climate change unless U.S. businesses and policymakers take immediate action to reduce climate risk. The report was released by former New York City Mayor Michael Bloomberg and former Treasury Secretary Henry Paulson.
The assessment of the committee that wrote and reviewed the report is that communities, industries and properties across the country face profound risks from climate change, but that the most severe risks can be avoided through early investments in resilience, as well as through immediate action to reduce the pollution that causes global warming.
The public health findings of the report were reviewed by Al Sommer, MD, Dean Emeritus of the Bloomberg School of Public Health at Johns Hopkins University. NewPublicHealth spoke with Sommer about the report.
NewPublicHealth: How did the report come about?
Al Sommer: The report came about because of the primary interest of the three co-chairs—Hank Paulson, investor Tom Styra and Mike Bloomberg—who felt that there was a need to better understand and better describe the possible public health impacts of climate change on businesses and labor productivity. Their goal is to engage the interest of business leaders so that they begin to think about the ramifications and perhaps see the problems of climate change from a totally different perspective than we usually talk about it.
I think from my own personal perspective that one of the great advantages of this report is that the group that did the analyses stuck with the data and the assumptions, and used sophisticated modeling and statistical analyses to give a range of outcomes. The most important part of the report from my perspective is that it has a granularity that most of the [climate change] reports don’t have, so it looks at likely outcomes in different regions of the country simultaneously.
In some instances, it looks like there is no change. There is reduced mortality in the northern part of the country because there is less freezing. But at the same time in the southern part of the country there’s dramatically increased mortality because of increased heat and humidity.
AHA to Fund Research Network for the Prevention of Heart Disease, Stroke
With a $15 million grant from the American Heart Association (AHA), four major medical institutions are coming together to form a research network with the goal of preventing heart disease and stroke. The Strategically Focused Prevention Research Network Centers will include investigators at Northwestern University in Chicago, Vanderbilt University in Nashville, the Icahn School of Medicine at Mount Sinai in New York City and the University of Texas-Southwestern Medical Center in Dallas. “Heart attack and stroke can strike suddenly, and frequently without warning. The best way to reduce premature mortality from cardiovascular diseases and stroke is to prevent the development of the risk factors that lead to these conditions,” said AHA President Elliott Antman, MD, professor of medicine at Harvard Medical School and a senior physician in the cardiovascular division of the Brigham and Women’s Hospital in Boston, in a release. “Scientists working in these research centers are helping to discover the mechanisms that will allow all Americans to live healthier lives, helping lead us to a culture of health.” Read more on heart health.
Study: One-Third of U.S. Total Knee Replacements ‘Inappropriate’
Approximately one-third of all total knee replacements in the United States are unnecessary and “inappropriate” under a patient classification system used in Spain, according to a new study in the journal Arthritis & Rheumatology. Researchers said the findings demonstrate a need for the United States to develop similar patient selection criteria so as to limit the unneeded surgeries. There are more than 600,000 total U.S. knee replacements annually—meaning that approximately 200,000 are unnecessary, according to the study—and from 1991 to 2010 the number of Medicare-covered replacements climbed by approximately 162 percent annually. Read more on aging.
Kids’ ADHD Medications Not Linked to Increase Risk of Substance Abuse
While children with attention-deficit/hyperactivity disorder (ADHD) are twice as likely to abuse drugs, the medications prescribed to treat ADHD do not play a role in the increased risk, according to a new study in the journal Pediatrics. In fact, researchers determined that the combination of behavioral techniques and ADHD medications actually lowers the risk of substance abuse. "Obviously, the medications that are used to treat ADHD have the potential for abuse, but the vast majority of children with ADHD do not develop a substance abuse problem," said Michael Duchowny, MD, a pediatric neurologist at Miami Children's Hospital. "More research has to be done to find out why some children are more susceptible than others." Common ADHD medications include amphetamines such as Adderall or Dexedrine, and methylphenidates such as Concerta, Metadate CD or Ritalin. Read more on substance abuse.
At this week’s Spotlight: Health conference at the Aspen Ideas Festival, Michael Murphy of the MASS Design Group will be part of a panel called “Buildings that Heal.” Murphy is a recent recipient of a grant from the Robert Wood Johnson Foundation (RWJF) for a two-year year research initiative to investigate effective and innovative models of health care facilities in Rwanda and other Sub-Saharan African countries. The goal is to gauge the implications for community health and economic development and then disseminate the findings in order to help improve facilities in the United States.
NewPublicHealth spoke with Murphy ahead of the Spotlight: Health conference.
NewPublicHealth: Tell us about the scope of your work.
Michael Murphy: I’m an architect and designer by training, and I launched MASS Design with my partner, Alan Ricks, around designing built environments to improve health outcomes. We have been working with a number of NGOs in the global south, thinking about the way that hospitals are designed and the built environment, and seeing very specific and direct links between our built environment and the health of our individual selves and our communities. We were struck by the direct links between the two, and how un-designed those environments are when they could be so easily shifted to improve people’s health.
NPH: Where have you done your work?
Murphy: We have an office in Rwanda where we built the Butaro Hospital in Northern Rwanda, together with the healthcare nonprofit Partners in Health. That first opportunity came about after meeting with the group and seeing that they were doing a lot of their work without the help of designers and architects. We were given the opportunity to assist their infrastructure team to help them rethink hospitals. We finished Butaro Hospital in 2011 and since then have brought this model to other countries, eight of which are in Africa: Tanzania, Uganda, Gabon, Liberia, Zambia, Malawi, the Democratic Republic of the Congo, Burundi and Haiti.
So, we have quite a bit of experience thinking about the health care environments that are affecting some of the more vulnerable communities in the world, and we encountered some real insights that could actually vastly improve the way in which we think about our health care environments back at home in the United States.
This Thursday at Spotlight: Health, the two-and-a-half day extension of the Aspen Ideas Festival, a number of speakers discussed the many facets that are integral to building a community that thrives. Speakers included Kennedy Odede, the Co-Founder, President and CEO of Shining Hope for Communities; Belinda Reininger, Associate Professor of Health Promotion and Behavioral Science and the University of Texas School of Public Health; Gabe Klein, Senior Visiting Fellow at the Urban Land Institute; and Gina Murdock, Founder and Director of the Aspen Yoga Society.
Although the communities they serve and the work they do vary greatly, all four presenters agreed on four key themes:
- The importance of listening to the community
- Working with the residents, rather than over their heads, to create what they believe will be a thriving place to live
- Measuring outcomes
- Setting goals
To the first theme, Odede explained that “people in the community must be ready for change and we can’t import it.” Growing up in Kenya’s Kiberia Slum, Odede went on to found Shining Hope For Communities—an organization that combats gender inequality and extreme poverty in urban slums by linking free schools for girls to holistic community services for all. By connecting these services with a school for girls, Odede and Shining Hope for Communities show that benefiting women has a positive impact on the entire community. The organization’s model relies on community input and solutions.
In Brownsville, Texas, a family-oriented town requires a family-oriented approach to improving health. Sitting in one of the poorest metro areas in the nation, the town is known for its low graduation rates and high prevalence of obesity and diabetes. However, the community had a goal of being one of the healthiest areas in the state and began chipping away at the obstacles by including all residents.
“Everything we do is driven by families,” said Reininger. “We wanted to be the healthiest area in the state, and to get there we all had to be part of it.”
Brownsville is beginning to see improvements across the community in physical activity and food choice. In fact, the thriving and changing community has been selected by the Robert Wood Johnson Foundation (RWJF) as one of this year’s Culture of Health prize winners.
Gabe Klein, who in addition to his work with the Urban Land Institute is a former Vice President of Zipcar, spoke about the importance of communication in affecting community change. “In Chicago, we never talked about bike lanes for the sake of bike lanes, we talked about opportunities for better health and ways to get where you’re going,” said Klein. “You have to communicate the larger vision.”
The session moderator, RWJF President and CEO Risa Lavizzo-Mourey, stressed the importance of goal setting and metrics. According to Lavizzo-Mourey, defining a vision is critical to success and measurements lead you to the outcomes you are trying to reach.