Category Archives: APHA

Nov 6 2013
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Violence Prevention: Q&A with David Satcher

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David Satcher, MD, PhD, was a four-star admiral in the U.S. Public Health Service Commissioned Corps and served as the 10th Assistant Secretary for Health and the 16th Surgeon General of the United States—at the same time. He was Surgeon General from 1998 through 2001, and under his tenure he tackled disparities in tobacco use and overall health equity, sexual health and—critically—youth violence.

Satcher was a key speaker in a recent American Public Health Association (APHA) Annual Meeting Town Hall Meeting on a global approach to preventing violence. NewPublicHealth spoke with Satcher about approaches to preventing violence as a public health issue.

NewPublicHealth: How do you take a public health approach to preventing violence?

David Satcher: When you take a public health approach, public health experts pose four questions:

  • First, what is the problem and what is the magnitude, the nature and distribution of the problem?
  • The second question is: what is the cause of the problem or the major risk factors for the problem?
  • The third question is: what can we do to reduce the risk of the problem?
  • And finally, how can we then implement that more broadly throughout society?

So, when we say we’re taking a public health approach, that’s what we’re talking about.

What we’ve tried to do and what we need more of is to really study the different causes of violence and violent episodes. They’re not all the same. I’ve dealt with a lot of the mass murders; I was Surgeon General when Columbine took place and the Surgeon General’s Report on Youth Violence in part evolved from that. And obviously there, as in most mass murders, we’re dealing with, among other things, mental health problems and easy access to weapons combined. I don’t think the same is necessarily true for gang violence, which causes thousands of deaths each year. With youth violence and gangs, I think there you’re dealing with a culture of insecurity where young people feel that in order to protect themselves they need to be members of gangs and they need to be armed.

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Nov 6 2013
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Violence: Can We End the Epidemic?

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“We live in a culture of violence,” said Larry Cohen, MSW, founder and executive director of the Prevention Institute, in a morning session on violence prevention at the American Public Health Association (APHA) Annual Meeting, held this year in Boston, Mass.

“Just as air, water and soil affect our health, the social environment affects the spread of violence through our communities,” said Cohen.

One of the most important factors in the environment that influences the perpetration of violence is actually more violence. Basically, violence begets violence. It spreads like a disease.

“It’s like the flu,” said Gary Slutkin, MD, PhD, Founder and Executive Director of Cure Violence. “The greatest predictor of a case of the flu is a preceding case of the flu. It’s the same thing with violence. Violence is an infectious disease.”

Slutkin shared a study of one community that found that exposure to community violence in one form or another was associated with a 30 times increased risk of committing violence—but what was most striking is that statistic held true, even controlling for poverty, race, crowded housing and other factors that could have an impact on violence. The effect is also “dose dependent,” according to Dr. Slutkin. That is, the more violence you witness or experience, the more likely you are to perpetrate violence.

The good news is that “we know how to prevent epidemics,” said Slutkin. “We need to recognize that this is a preventable problem. We need to build a movement,” agreed Cohen.

Cure Violence focuses on the very same steps used to prevent the spread of infectious disease in their work to help prevent the spread of violence:

  1. Detect and interrupt the transmission of violence, by anticipating where violence might occur.
  2. Change the behavior of those most at risk for spreading violence.
  3. Change community norms to discourage the use of violence as an acceptable and even encouraged way to handle conflict.

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Nov 5 2013
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APHA 2013: Preparedness Lessons From Hurricane Sandy

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Just over a year ago, Hurricane Sandy made landfall in the United States. Estimated damage came to $65 billion, at least 181 people in the United States died and power outages left tens of millions of people without electricity for weeks.

In the aftermath of this devastating event, the public health community continued efforts to make Americans aware that public health needs to play a much larger role in emergency response and recovery.

And in an American Public Health Association (APHA)-sponsored session on Wednesday, panelists discussed how they can draw on disaster response incidents to analyze policy implications for preparedness and response efforts to protect the health of workers, communities and the environment—with particular emphasis on promoting health equity.

"Addressing health disparities and environmental justice concerns are a key component of Sandy impacted communities," said the moderator of the panel, Jim Hughes of the National Institute of Environmental Health Sciences (NIEHS).

Kim Knowlton of the Natural Resources Defense Council and Columbia Mailman School of Public Health stressed that public health needs to advance environmental health policies post-Sandy, especially in regards to helping vulnerable populations.

"Climate change is a matter of health. It's such a deep matter of public health," she said. "We have to make a bridge between public health and emergency response preparedness communities," adding that "This is also an opportunity for FEMA to put climate change into their process for hazard mitigation planning and risk assessment.”

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Nov 5 2013
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APHA 2013: Public Health System Transformation Under the Affordable Care Act

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The changing environment for health departments under the Affordable Care Act (ACA) was the focus of a very well attended early morning session at the American Public Health Association (APHA) annual meeting in Boston today, moderated by APHA public health policy analyst Vanessa Forsberg, MPP.

Hospitals and private health care providers will soon be competing with health departments for clinical services such as immunizations for a newly insured population, according to Forsberg. However collaboration may help departments keep and grow clinical services, as well as collaborate with new partners under other new ACA rules, such as community benefit requirements for hospitals to improve population and individual health.

“There’s a lot of innovation, a lot of people moving into that space and this is a clarion call to say public health had a head start and don’t let the space be taken from you, learn the finance side,” said James Corbett, M.Div, JD, an ethics fellow at the Harvard Medical School and vice president of charity care and ethics at the Steward Health Care System in Boston.

Opportunities for health departments, says Corbett, include focusing on addressing disparities, preventive health, innovative programs and partnerships that improve care and reduce costs.

A key example Corbett shared was a decision by Steward to hire community health workers whose services can be billed for under the ACA beginning January 1. Corbett says he looked at the hospital’s bad debt documentation by language and found trends, then convinced the hospital’s CEO to allow him to hire community workers who got iPads and then went out into the community to visit patients who hadn’t paid bills. They were able to use the devices to record identification and other information, then help the patients sign up for Medicaid and other assistance that allowed them to be covered and the health system to be paid.

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Nov 5 2013
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Gaining Traction on Childhood Obesity in New England

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Harvard Pilgrim Health Care Foundation’s work on childhood obesity is driven by one startling fact: one in three Massachusetts children are overweight or obese. To find out why, Executive Director Karen Voci and her colleagues went to the places where children learn and play—schools, after school programs and child care centers— and found that children were sitting for most of the day and foods were heavy on starch and sugar. With a limited budget, Voci and her team found opportunities and partners in Massachusetts, New Hampshire and Maine to improve childhood obesity rates.

“It’s hard to measure what you’re accomplishing,” said Voci at one session during the American Public Health Association (APHA) 2013 meeting. “These environments look and feel different, but it’s hard to capture this feeling in a meaningful statistic that can be used further down the road.”

As a result, most of the results shared focused on process and intermediate outcomes rather than actual health outcomes—for now—but the communities are optimistic that they’re moving in the right direction.

Voci underscored the importance of staying committed, noting that Harvard Pilgrim and its partners had been at this for years and they were in fact moving the needle. Session presenters shared successes from Massachusetts, New Hampshire and Maine.

Massachusetts

Harvard Pilgrim partnered with the Massachusetts Department of Public Health and other foundations and businesses on the Mass in Motion initiative to combat childhood obesity in its home state. Led by their elected officials, 14 communities developed health improvement plans and received technical assistance to improve local food sources and increase physical activity. The multifaceted initiative included a “call to action” report, as well as a Governor’s Executive order establishing a nutrition standard for the food procured for the state of Massachusetts. In addition, the program implemented a body mass index (BMI) regulation that required schools to screen children’s BMI in order to identify potential issues early. The Department of Public Health worked within these communities to share information on physical activity and nutrition, all culminating in growth of the program to 52 communities in the state.

Communities in Eastern Massachusetts are showing concrete signs of progress on the childhood obesity front. Reports from this summer have shown that the obesity rate for the region’s children under six years of age has decreased by 21.4 percent—likely due in part to initiatives such as Mass in Motion, the Cambridge Healthy Children Task force and Shape Up Somerville.

New Hampshire

CATCH Kids Club is an evidence-based, after-school environment that has been adopted by 117 sites in nine of New Hampshire’s ten counties. The CATCH program promotes exercise and healthy eating in elementary school children with a four-phased approach:

  • Curriculum development
  • Staff and booster training
  • Staff support
  • Environment and policy assessment

In the environment and policy assessment phase, CATCH found that 93 percent of participating after-school programs made four or more changes to improve children’s physical activity and healthy eating. In addition, most sites now offer programs that promote these goals between three and five times a week.

Maine

In Maine, the Let’s Go! 5210 Goes to School program offers resources to help schools create a culture of health. It aims to take the focus off of the highly charged weight management issue and shift it toward four simple and embraceable goals for each day:

  • Eat 5 fruits and vegetables
  • Limit screen time to 2 hours or less
  • Get at least 1 hour of exercise
  • Drink 0 sugary drinks

While each school decides which of these four goals it would like to adopt, they often end up promoting all four points of the program as time goes on. In fact, the 5210 initiative reaches children in all 16 Maine counties in schools, after school programs, early childhood education, doctors’ offices and more locations.

One of the key lessons learned was to engage busy school representatives at a level that made sense for them. “Don’t ask them to do something unrealistic,” said Torey Rogers of the Let’s Go! 5210 Goes to School Program and The Barbara Bush Children’s Hospital at Maine Medical Center.

Representatives from each of these programs offered insights and lessons learned when it comes to working with schools. When speaking with school representatives, organizations are often successful when they relate the goal back to the mission of schools: education. By highlighting the secondary benefits to attendance and active participation of students, organizations can engage teachers as partners in public health initiatives.

>>For more information on the successes of state and community efforts to reduce childhood obesity, view an interactive map on the signs of progress on childhood obesity.

>>NewPublicHealth will be on the ground throughout the APHA conference speaking to public health leaders and presenters, hearing from attendees on the ground and providing updates from sessions, with a focus on how we can build a culture of health. Follow the coverage here.

Nov 5 2013
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‘Fast Food Facts’: Q&A with the Yale Rudd Center for Food Policy & Obesity

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In 2012 alone, the fast food industry spent $4.6 billion to advertise mostly unhealthy products, with many of those ads specifically targeting children and teens. A new report, Fast Food FACTS 2013, examined 18 of the nation’s top fast-food restaurants, following up on a 2010 report to see how the food selection and advertising landscapes have changed. And while there have been some positive developments—healthier sides and beverages are available in most kids’ meals—the findings indicate there is still a very long way to go.

Detailed findings from the report, which was supported by a grant from the Robert Wood Johnson Foundation, will be presented today at the American Public Health Association’s (APHA) annual meeting in Boston.

>>Read more on the Fast Food FACTS 2013 report.

>>NewPublicHealth will be on the ground throughout the APHA conference speaking to public health leaders, hearing from attendees on the ground and providing updates from sessions, with a focus on building a culture of health. Follow the coverage here.

NewPublicHealth spoke with Jennifer Harris, the Yale Rudd Center for Food Policy & Obesity’s director of marketing initiatives and lead author of the report, and Marlene Schwartz, the Center’s director, about their findings and how fast food advertising continues to impact our nation’s youth.

NewPublicHealth: Has any progress been made in the nutritional quality of fast food kids' meals?

Jennifer Harris: There have been a lot of changes in kids’ meals over the past three years and a lot of it has been good. Most of the restaurants have added healthy sides and healthy beverages to their kids’ meals. Now it’s possible to get a fairly healthy kids’ meal at most of the restaurants we looked at. But the problem is it’s kind of like finding a needle in a haystack. Almost all of the meals they offer are high in fat, sugar or sodium.

Marlene Schwartz: The odds of you getting the healthy combination when you go are extraordinarily low. For every healthy combination, there are roughly 250 unhealthy combinations.

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Nov 5 2013
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Investing in Public Health: Q&A with Glen Mays

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New research presented at the American Public Health Association (APHA) annual meeting in Boston today finds that when public health funding increases in a community, its rates of infant mortality and deaths due to preventable diseases decrease over time, with low-income communities experiencing the largest health and economic gains.

According to the research, conducted by Glen Mays, PhD, MPH, director of the University of Kentucky’s National Coordinating Center for Public Health Services and Systems Research, each ten percent increase in public health spending over 17 years led to a 4.3 percent reduction in infant mortality, as well as reductions of 0.5 to 3.9 percent in non-infant deaths from cardiovascular disease, diabetes, cancer and influenza.

However, these health gains were 20-44 percent larger when funding was targeted to lower-income communities. Increases in public health spending also correlated with lower medical care costs per person, especially in low-income areas. The study, which analyzed data compiled by the National Association of County and City Health Officials from 3,000 local public health agencies over a 17-year period, also found that lower death rates and health care costs were seen especially in communities that allocated their public health funding across a broader mix of preventive services.

“The results clearly show that better health and lower health care costs are possible if we simply change how and where we allocate public health funding, even if new money isn’t available, said Mays. “And it also shows that new resources, such as funding from the Affordable Care Act’s Prevention Fund, can have a larger impact if targeted to lower-resource, higher-need communities and if spread across a range of prevention strategies.”

>>NewPublicHealth will be on the ground throughout the APHA conference speaking to public health leaders and presenters, hearing from attendees on the ground and providing updates from sessions, with a focus on how we can build a culture of health. Follow the coverage here.

NewPublicHealth spoke with Mays about the new study just before the APHA annual meeting began.

Glen Mays, PhD, MPH, Director of the University of Kentucky’s National Coordinating Center for Public Health Services and Systems Research Glen Mays, PhD, MPH, Director of the University of Kentucky’s National Coordinating Center for Public Health Services and Systems Research

NewPublicHealth: What are the key findings of the study?

Glen Mays: We’ve done prior studies that show communities that invest more on public health realize gains in health status and, over time, those communities see slower growth in medical care costs. So the goal of the study is to look at who benefits most from investments in public health.

What we found was that, not all that surprisingly, communities that are more economically constrained, that have lower income communities with higher poverty rates and lower socioeconomic status, tend to benefit the most from investments in public health activities over time. These low-resource communities see larger reductions in their preventable mortality, and they also see larger reductions in their medical care costs over time from investments in public health spending compared to more affluent communities. We expected to find that, but this is the first time we’ve been able to document the size of that effect. Those communities see about twenty percent higher rates of health and economic gain from their spending compared to more affluent communities.

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Nov 4 2013
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APHA 2013: The Role of Housing in Public Health

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When thinking about ways to improve the public's health, housing may not leap to mind at first. Reducing obesity, increasing access to healthy food and promoting tobacco control are all more popular and more obvious public health strategies. But in the past several years, leaders in the field are realizing the vital role that housing can also play in health.

So why is housing so important for health? And how can we create "healthy housing" for the public? That was the focus of Monday's American Public Health Association (APHA) panel, "Landscape of Healthy Housing: Strategies, Policies, and Initiatives."

Panelists from the U.S. Department of Housing and Urban Development (HUD) to Maryland's Green and Healthy Homes Initiative to the U.S. Environmental Protection Agency (EPA) discussed issues ranging from lead-based paint hazards, to smoke-free housing, to infrastructure problems—and how all of these impact health.

Chris Trent, who's worked on HUD's Advancing Healthy Housing a Strategy for Action, asked: "Do we really have to be concerned about our homes? Yes, we do. There are 23 million housing units with one or more lead-based paint hazards. Six million housing units in the U.S. have moderate-to-severe physical infrastructure problems."

She also re-emphasized why housing is so important to health for everybody, even if we don't think about it: 69 percent of our time is spent in a residence, and therefore housing automatically impacts how healthy people are.

Trent also pointed out the return on investment (ROI) in creating healthy housing for people. "We know these [healthy housing strategies] are working. There is a return on your investment that is beneficial to everybody."

For example, she noted, spending $1 on preventing lead hazards lead to a $17-$221 savings in health costs.

Ruth Ann Norton, Executive Director of Green & Healthy Homes Initiative, noted the impact that unhealthy housing can have on people— especially children and their education.

"The largest reason kids don't come to school is asthma," she pointed out. "And this asthma is often coming from their home environment. We need to break the link between unhealthy housing and unhealthy children."

"All of these housing issues are health issues," Norton said.

>>NewPublicHealth will be on the ground throughout the APHA conference speaking to public health leaders and presenters, hearing from attendees on the ground and providing updates from sessions, with a focus on how we can build a culture of health. Follow the coverage here.

Nov 4 2013
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APHA 2013: The Boston Marathon and Preparing for the Unexpected

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How do you prepare for the safety and health of 27,000 runners and 500,000 spectators? And how do you prepare for the unexpected—such as a terrorist attack—so that the public health response can be as swift and effective as possible?

That was the first topic of Monday's American Public Health Association (APHA) session, "Late Breaking Developments in Public Health." Mary E. Clark, Director of Emergency Preparedness Bureau at the Massachusetts Department of Public Health, presented on "Public Health and Medical Response to the Boston Marathon Bombing."

Discussing the particular difficulties of staffing an event such as the Boston Marathon, Clark noted that the route goes through 26.2 miles, crosses through eight different communities in Massachusetts and then goes straight into the city of Boston. Along the way, there are thousands of runners and hundreds of thousands of spectators.

"This presents us with medical and health challenges, as well as security challenges," Clark explained.

"This year was the 117th running of the Boston Marathon, and each year we plan this as a planned mass casualty event," Clark said. "We have to build on the work that has gone on in the 116 years before."

To do this, Clark said, the department takes at least four months of preparedness planning, with the assumption that at least 1,000 runners or spectators will need some sort of medical care.

But how did they deal effectively with the unexpected?

"We had a remarkably quick response to bombings," Clark said. She noted that less than a minute after the bombs went off, gurneys were heading to the victims. And in just 18 minutes, they were able to remove 30 critically injured spectators off the scene into ambulances. Massachusetts General Hospital received their first patient 14 minutes after the explosions.

Since the marathon bombings, though, Clark said, they have identified further needs—particularly in the areas of mental health.

"One of the key things that's happened since the Marathon is the recognition of the need for a robust mental health response,” she said. “We have created more mental health support systems for volunteers and staff.”

But her biggest takeaway from the tragedy and the response? "Lessons learned were the benefit of preparedness activities," Clark said.

"People did what they were trained to do and they did it very well."

>>NewPublicHealth will be on the ground throughout the APHA conference speaking to public health leaders and presenters, hearing from attendees on the ground and providing updates from sessions, with a focus on how we can build a culture of health. Follow the coverage here.

Nov 4 2013
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Start of APHA 141st Annual Meeting is Also a Fresh Start for the Organization

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The American Public Health Association (APHA) launched its 141st annual meeting in Boston on Sunday by re-launching itself, its logo and its tagline which is now: For science. For action. For health.

”We’re deeply excited to share our new look and feel with our members and partners,” said Georges Benjamin, MD, executive director of APHA to the nearly 11,000 public health students, academics and practitioners attending the meeting. “With the challenges and opportunities presented by our rapidly changing health landscape, now is the time to better position APHA for success as the collective voice for the health of the public.”

>>NewPublicHealth will be on the ground throughout the APHA conference speaking to public health leaders and presenters, hearing from attendees on the ground and providing updates from sessions, with a focus on how we can build a culture of health. Follow the coverage here.

Benjamin also shared the five core values that APHA’s next phase will emphasize:

  • Community
  • Science and evidence-based decision-making
  • Health equity
  • Prevention and wellness
  • Real progress in improving health

Those themes were in abundance at Sunday’s opening session. ‘Social injustice is killing on a grand scale,” said Professor Sir Michael Marmot, chair of the World Health Organization’s Commission on Social Determinants of Health and Director of the International Institute for Society and Health at University College/London. At the request of the British Government, Marmot led a review of health inequalities in England, and published a report, ”Fair Society, Healthy Lives” in February 2010. He has also recently been asked by the World Health Organization to conduct a European review of health inequalities

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