Category Archives: Faces of Public Health
In the last decade or so, leaders in the field of architecture have begun to look at not just the aesthetics of building and community design, but also their own impact on the health of communities. In New York City, for example, the local chapter of the American Institute of Architecture’s New York chapter partnered with several agencies in New York City, including the departments of Health and Mental Hygiene, Design and Construction, Transportation, City Planning, and Office of Management and Budget, as well as research architects and city planners to create the city’s Active Design Guidelines. These provide architects and urban designers with a manual of strategies for creating healthier buildings, streets, and urban spaces, based on the latest academic research and best practices in the field. The Guidelines include:
- Urban design strategies for creating neighborhoods, streets, and outdoor spaces that encourage walking, bicycling, and active transportation and recreation.
- Building design strategies for promoting active living where we work and live and play, through the placement and design of stairs, elevators, and indoor and outdoor spaces.
NewPublicHealth recently spoke with Rick Bell, policy director of AIA New York, who was instrumental in the creation of the guidelines, about the burgeoning intersection between design and healthier communities.
>>Read more on architecture and design for a fit nation.
NewPublicHealth: How did AIA New York become involved in healthy design with the city of New York?
This week’s International Making Cities Livable Conference brings together city officials, practitioners and scholars in architecture, urban design, planning, urban affairs, health, social sciences and the arts from around the world to share experience and ideas. We spoke with some of those diverse attendees to find out: what do they want the public health community to know about working across sectors to make communities healthier and more livable?
Alain Miguelez, City of Ottawa, Program Manager for Zoning, Neighbourhoods and Intensification
NewPublicHealth: What do you want public health to know about making communities more livable?
Miguelez: I want public health to know they’re at the heart of what we do. Usually urban planning is a pretty arcane thing. We’ve done a good job of making it tough for people to understand and relate to. They don’t have the patience. Public health brings it home. As we heard in a session this week, it’s not necessarily people who are disabled—it's the built environment that’s disabling.
It comes down to how you see yourself functioning in your daily life. We've made it impossible to function any way other than with a car. For some people that’s okay, but for those who’ve had a taste of something different, there’s no going back. As planners people don't trust us anymore. We’ve done a lot of things in the name of progress. We’ve disconnected people from the built environment and forced them into places that make people fat and depressed and disconnected and not well-functioning. People coo about Portland and its trams and light rail and walkability. That’s how cities are supposed to be. Everywhere else has got to come up to that standard.
When you see statistics on obesity or depression, it becomes critical, especially with kids. I have two kids and I see very clearly how the environment we build around us impacts how they grow up. It gives kids the tools to function as independent human beings. The right type of city building and suburban repair [with an eye toward public health] can do that.
During opening remarks at this year’s Keeneland Conference, hosted by the National Coordinating Center for Public Health Systems and Services Research (PHSSR) based at the University of Kentucky in Lexington, Professor Douglas Scutchfield, director of the Center, proudly announced that three of the first health departments to be accredited by the Public Health Accreditation Board (PHAB) earlier this year were in Kentucky. Accreditation had its own track during the conference scientific sessions, including a presentation from Jessica Kronstadt, MPP, PHAB’s director of research and evaluation.
NewPublicHealth caught up with Kronstadt to talk about her presentation on some very early findings from an internal evaluation of the accreditation process.
>>Read more on national public health department accreditation.
NewPublicHealth: What information is PHAB seeking to gain from an evaluation of the accreditation process?
Jessica Kronstadt: Just as we’re asking health departments to engage in quality improvement, PHAB is very much committed to engaging in quality improvement of the accreditation program. So these evaluation efforts will really help us understand what is working well in our accreditation program, and what the experience was like from the perspective of the health departments and the site visitors. This evaluation will allow us to continue to improve the accreditation process.
The American Public Health Association (APHA) is currently accepting applications through April 8 for the association’s one-year Public Health Fellowship in Government. Fellows work in a congressional office on legislative and policy health issues. The position gives Fellows the opportunity to learn about the legislative process in Washington, DC, which can be a critical skill once they return to their positions in public health, since policies are an important tool that can be used to protect Americans and their communities from preventable, serious health threats. And it also allows Fellows to provide critical input, drawing on their knowledge and experience, on the decisions that impact public health at the national policy level.
To get some background on the role of a Fellow and the impact that public health practitioners can have when working in the national policy arena, NewPublicHealth recently spoke with Fern Goodhart, current legislative assistant to Senator Tom Udall (D-New Mexico), who spent the tenure of her fellowship working in the office of Senator Robert Menendez (D-New Jersey). Ms. Goodhart was the first person awarded the APHA policy fellowship and served in 2007-2008.
NewPublicHealth: What was your background before you took the fellowship?
Fern Goodhart: I have worked in public health for 30 years including at a state health department; as director of health education at an ambulatory center; as a medical school instructor; as a member of an autonomous board of health; and as a member of my city council. So I’ve had the opportunity to see how policy was made on the local level and the state level. What brought me to the APHA Fellowship was the desire to see firsthand how policy was made at the federal level.
NPH: What kind of work did that involve?
Today, New York State Health Commissioner Nirav R. Shah, MD, MPH, released the 2013-17 Prevention Agenda: New York State’s Health Improvement Plan—a statewide, five-year plan to improve the health and quality of life for everyone who lives in New York State. The plan is a blueprint for local community action to improve health and address health disparities, and is the result of a collaboration with 140 organizations, including hospitals, local health departments, health providers, health plans, employers and schools that identified key priorities.
Dr. Shah, the architect behind today’s prevention agenda, was confirmed as New York State’s youngest Commissioner of Health two years ago. The state’s governor, Andrew Cuomo, had three critical goals: reduce the state’s annual Medicaid growth rate of 13 percent, increase access to care and improve health care outcomes.
Shah, a former Robert Wood Johnson Foundation Physician Faculty Scholar and Clinical Scholar, has already made important inroads in all three goals and the prevention agenda builds on that. NewPublicHealth spoke with Dr. Shah about prevention efforts already underway in the state, and what it takes to partner health and health care to achieve needed changes in population health.
NewPublicHealth: How does improving the social determinants of health help you achieve your goals in New York State?
Dr. Shah: New York’s Medicaid program covers 40 percent of the health care dollars spent in the state. We were growing at an unsustainable rate, and we needed a rapid, but effective solution. So, we engaged the health care community, including advocates, physician representatives, the legislature, unions, management, and launched a process that enables continuous, incremental, but real change toward the Triple Aim—improved individual health care, improved population health and lower costs.
Collectively, these efforts resulted in a $4 billion savings last year in the State’s Medicaid program, increased the Medicaid rolls by 154,000 people, and resulted in demonstrable improvements in quality throughout the system.
NPH: What opportunities do you see for public health and health care to work together in New York State?
Washington State Secretary of Health Mary Selecky has announced her retirement from state service. Selecky has served under three governors since her initial appointment as acting secretary in October 1998. She also served two terms as president of the Association of State and Territorial Health Officials, served on the board of the National Association of County and City Health Officials and is a past president of the Washington State Association of Local Public Health Officials. In 2010, Selecky received the American Medical Association's Nathan Davis Award for Outstanding Government Service.
NewPublicHealth Health spoke with Mary Selecky about her public health career and accomplishments.
NewPublicHealth: Your tenure has spanned many public health game changers. What stands out to you as the greatest triumphs and greatest threats in Washington State?
Mary Selecky: In terms of greatest triumphs, a key one is that we took on the issue of tobacco use in Washington State. Tobacco would be at the top of my list because of the health impact it has had and because it really is something that can be prevented by getting the right information out to people. It has taken us decades for the public to get it that smoking kills.
We had an announcement about tobacco yesterday, in fact. Among our 10th-graders, 9.5 percent used a cigarette in the last 30 days, and our rate has dropped from two years ago, even though across the nation the rate has flattened. So we’re doing something right. We’re a smoke-free state—not just tobacco-free but smoke free. And that really has the most profound influence on people’s health.
On the other hand, tobacco is also our greatest threat, because the tobacco companies continue to spend more than $140 million in this state to get you to use their product or to switch products, and we know they’ve moved to point-of-sale marketing. If you go into the smaller stores particularly, you’re greeted by all these tobaccos posters on the windows, inside the shop and on the counter. Those kinds of things are going on every single day—and every year there’s a new crop of 10th-graders. So it disturbs me that so many of our states have reduced tobacco prevention programs and that, as a result, nationally we’re not making much headway.
Three months have passed since Hurricane Sandy hit the East Coast. And while the number of people displaced by the storm has gone down from tens of thousands to the hundreds in different communities, some people are still without power or a permanent place to live. Others face the daunting task of rebuilding businesses and homes while protecting against mold and dust, which can cause or exacerbate respiratory problems. For many, the stress has rekindled mental health issues that might have been at bay, or created new ones or just made tough times even worse.
NewPublicHealth spoke with Patricia Yang, DrPH, Chief Operating Officer and Executive Deputy Commissioner at the New York City Department of Health and Mental Hygiene.
NewPublicHealth: Hurricane Sandy hit just over two months ago. How’s the city doing now?
Dr. Yang: There are people in parts of the city for whom the storm is a distant memory, and their daily lives are virtually unaffected apart from what they might hear on the news or read in the papers. But in the areas that were most directly affected by the hurricane, life for many is far from normal and may never return to what it was pre-storm. Those areas in particular are parts of the Rockaways and Coney Island and Staten Island. So there are still thousands of people who don’t have basic utilities and for whom grid power and heat have not returned. And we’re heading into the coldest winter months.
NPH: What’s the role of the public health department both now to help people deal with the aftermath, and looking ahead to prepare for the next disaster?
The Robert Wood Johnson Foundation (RWJF) has announced a second round of grant winners for the Roadmaps to Health Community Grants. The grants support two-year state and local collaborative efforts among policymakers, business, education, health care, public health and community organizations, and are managed by Community Catalyst, a national consumer health advocacy organization. The goal of the grants is to create positive policy or systems changes that address the social and economic factors that impact the health of people in their community.
The grants build on the model of the County Health Rankings & Roadmaps program, which highlights the critical role that factors such as education, jobs, income and the environment play in influencing how healthy people are and how long they live. County Health Rankings & Roadmaps is a collaboration of RWJF and the University of Wisconsin Population Health Institute.
Four of the new grants have been awarded to projects spearheaded by United Way organizations in several states.
The Roadmaps to Health Community Grants are:
- Demonstrating how a range of partners from multiple sectors in a community can work together to take actionable data such as the County Health Rankings and begin addressing the multiple social or economic determinants of health in a community.
- Focusing on collaboration and action at the policy or system-change level.
- Getting grant partners in fields such as education, employment or community safety to think of themselves as part of the work of the public health community.
As we end the year and head into 2013, NewPublicHealth spoke with U.S. Centers for Disease Control and Prevention director Thomas Frieden, MD, MPH, about public health in 2012—and what’s ahead for 2013.
Dr. Thomas Frieden: Two really stand out. First, public health got even better at finding outbreaks quickly and stopping them. We saw that with Listeria, E. Coli, Salmonella and with the fungal meningitis outbreak. That is important because we are seeing that there are an ever-increasing number of ways that outbreaks can start and spread and we need to be on our guard. The second highlight that comes to mind immediately was the Tips from Former Smokers Campaign. This is the first-ever federally funded national anti-tobacco campaign and it was a stunning success. We had very ambitious goals for it. We hoped that half a million people would try to quit and at least 50,000 people would succeed for good. Based on calls to quitlines—and we will know more in the next few months—it looks like the campaign probably had at least twice that impact. This is a campaign that will have saved tens of thousands of lives and probably paid for itself in pretty short order in terms of reduced medical and societal expenses. It shows that when you invest in tobacco control you can make a big difference and save a lot of lives.
NPH: And your hopes for public health in 2013?
Frieden: There are a lot of things that are important and we can make progress on in the coming year. First is to be safer from threats whether they are from this country or abroad, and public health works 24/7 to keep us safe both at the federal level as well as the state and local level. We do have challenges, though, in terms of the fiscal climate that we are in, and we need to ensure that we have the resources needed to keep Americans safe from threats.
Last year, a new center to help promote physical activity among individuals with disabilities opened at the University of Alabama at Birmingham. NewPublicHealth spoke with James Rimmer, PhD, the center’s director, who has spent decades promoting the importance of people who are disabled engaging in physical activity for both their health and for fun.
NewPublicHealth: Tell us about the new center.
Rimmer: When I moved here from the University of Illinois/Chicago, there was a large donation made to support the needs of people with disabilities in all areas of physical activity, sport and recreation, by the Lakeshore Foundation, a non-profit organization that provides health and fitness services to people with disabilities. They brought me in to build an enterprise between the University of Alabama at Birmingham and the foundation, which is called the UAB Lakeshore Research Collaborative. Subsumed under that are two national centers that have been funded by the Centers for Disease Control and Prevention and the National Institute on Disability and Rehabilitation Research. The first center is the National Center Health, Physical Activity and Disability. The second center is the Rehabilitation Engineering Research Center.
NPH: You have been working in this field for decades. What will be new about your initiatives and efforts in 2013?