Category Archives: Prevention
While it has been decades since polio was a critical threat for much of the developed world, the disease—a virus that can spread from person to person and affect the brain and spinal cord with the potential for paralysis—still causes disease and death in the developing world. Earlier this year cases were reported in Syria, while in Israel the polio virus was found in soil likely from human waste infected with the disease, prompting a revaccination campaign among children age 5 and under. Polio has continued to spread in Afghanistan, Nigeria and Pakistan, and has been reintroduced and continues to spread in Chad and in the Horn of Africa after the spread of the virus was previously stopped. Other countries have seen small numbers of cases recently after no cases for decades.
Because even a small spread of the disease could reach the United States if infected individuals carry the virus here, the U.S. Centers for Disease Control and Prevention (CDC) several years ago made polio one focus of their Emergency Operations Center. CDC staff work with the World Health Organization and foreign health departments on vaccination campaigns aimed at fully eradicating the disease.
>>Bonus Content: View the CDC's infographic, "The Time to Eradicate Polio is Now."
NewPublicHealth spoke recently with Sona Bari, senior communications officer at the World Health Organization about the efforts underway to eradicate polio globally.
NPH: How are you able to detect polio outbreaks?
Sona Bari: We have a global surveillance system for polio and know from it that since 1988 the reduction of the disease has been over 99 percent. Polio is now endemic, which means indigenous polio virus transmission has never been stopped in parts of three countries: Nigeria, Afghanistan and Pakistan. So the surveillance is important because you can get polio down to very low levels like you do now, but it can reemerge. To completely eradicate polio you have to have an effective intervention, which is largely by vaccination. And you can be bring polio under very tight control by massive vaccination, but the virus is very good at finding children who are unvaccinated or under-vaccinated, and in Nigeria, Afghanistan and Pakistan we still have large groups of unvaccinated children. So the reason that polio transmission has not been stopped in these areas is that not enough children are vaccinated.
NPH: Why is there insufficient vaccination in those countries?
Bari: The basic reason is the quality of vaccination activities. Do these countries have decent health systems—strong routine immunization systems where children are regularly taken to a medical facility for their immunizations? When there are mass vaccination campaigns, are we reaching all children? Then there are, on top of that, layers of political complexities. In one part of Pakistan, for example, there is a ban on polio vaccinations by the local warlords. So there are access and security issues, layered on top of the difficultly of reaching all who need vaccines in countries such as Nigeria or Pakistan. That said, we know that these circumstances are not unique. They may differ from country to country, and each country does have a unique combination of the obstacles, but polio has been eradicated in countries that are far poorer than Nigeria or Pakistan, that have had worse conflict and that have perhaps much worse health systems. So it can be done.
New reports from the U.S. Centers for Disease Control and Prevention (CDC) show that 39 percent of adults and 41 percent of children six months and older got their flu shots for the 2013-2014 season by early November—a rate similar to flu vaccination coverage last season at the same time.
Other flu shot statistics of note this year include:
- Vaccination among pregnant women (41 percent) and health care providers (63 percent) is about the same as it was this time last year
- High rates were seen again this year among health care providers including pharmacists (90 percent), physicians (84 percent) and nurses (79 percent), but the CDC reported much lower vaccination rates among assistants or aides (49 percent) and health care providers working in long-term care facilities (53 percent)
“We are happy that annual flu vaccination is becoming a habit for many people, but there is still much room for improvement,” says Anne Schuchat, MD, director of the National Center for Immunization and Respiratory Diseases at CDC. “The bottom line is that influenza can cause a tremendous amount of illness and can be severe. Even when our flu vaccines are not as effective as we want them to be, they can reduce flu illnesses, doctors' visits, and flu-related hospitalizations and deaths.”
Seasonal influenza activity is increasing in parts of the United States. Further increases in influenza activity across the country are expected in the coming weeks. “If you have not gotten your flu vaccine yet this season, you should get one now,” said Schuchat.
The CDC’s report comes just ahead of the observance next week of National Influenza Vaccination Week (NIVW), which is scheduled each year for the second week in December because vaccination rates tend to fall off toward the end of November. It’s hardly too late to get the flu vaccine: flu season usually peaks January through March, and the virus—and the potential to catch it—often lasts as late as May.
People who haven’t had the flu shot should make it a priority to do so as soon as possible for at least two reasons. One, providers tend to return their unused vaccines toward the end of the year, which can make it hard to find a vaccine if you still need the shot (check this flu vaccine finder for providers in your area, and call ahead to be sure they have supplies on hand). Two, it takes two weeks for the flu vaccine to take full effect, so the sooner you get it the more protected you are against people harboring the flu during the upcoming holiday party season.
Still on the sidelines about getting the shot? The CDC has some impressive numbers from last year’s flu season: flu vaccination prevented an estimated 6.6 million influenza-associated illnesses and 79,000 hospitalizations during the 2012-2013 flu season.
>>Bonus Links: Learn more about preventing and treating influenza on NewPublicHealth.
>>Bonus Content: CDC's infographic on the benefits of the flu vaccine (full size PDF).
In the face of health care reform, funding challenges, and increased collaboration, public health faces a promising yet unclear future in terms of both financial support and program reach. On Saturday, the Robert Wood Johnson Foundation co-hosted a forum with the American Public Health Association (APHA) in advance of the APHA 2013 Annual Meeting to discuss these issues – and more. Leading minds from the fields of public health, government and business met to get to the bottom of a crucial question: how do we move public health forward?
In the opening session, Paul Kuehnert, Director of the Public Health Team at the Robert Wood Johnson Foundation, explained that the field’s challenge lies in “skating where the puck is going to be.” APHA Executive Director Georges Benjamin echoed that sentiment, nothing that the forum was “an opportunity to figure out where the public is going and then, when the wave comes, be right there to catch it.” The ensuing breakout sessions furthered this overarching theme with panels that discussed both the challenges they’ve faced -- and the opportunities they’ve found for success.
>>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.
Re-Thinking How We Pay for Public Health and Prevention
One panel discussed funding challenges that public health departments face and solutions that have been reached across the country. John Auerbach of Northeastern University’s Institute on Urban Health Research, and former health commissioner of Massachusetts, touched on health care reform as a vehicle for preventive care. “Nearly 75 percent of those insured in Massachusetts have had a preventive care visit in the last 12 months,” he explained. In other words, people who are insured are twice as likely to get care that could actually prevent them from getting sick, instead of having a treat a more serious illness. Auerbach also discussed development of the state’s Prevention and Wellness Trust Fund — a four-year, $60 million public health trust supported by a one-time assessment on health insurers and largest clinical providers. Auerbach stressed that this source of funding was important, particularly because it’s insulated from the variability of public funding and political tides.
By focusing on the critical services and programs that are truly necessary for the public health system to work, the Seattle and King County Health Department has developed a minimum package of public health services needed for all projects to success. David Fleming, Director and Health Officer in the Seattle/King County Health Department, and his staff determined the money needed to fund such a package in both per capita and overall costs. Washington State is now working with RWJF and other stakeholders to determine the feasibility of defining and costing these foundational services at the national level.
In honor of World Polio Day, the U.S. Centers for Disease Control and Prevention (CDC) will highlight polio eradication work around the globe on Twitter and Facebook. Development of the polio vaccine has reduced the disease worldwide by 99 percent, with only Afghanistan, Nigeria and Pakistan as the remaining polio endemic countries in 2012.
But both in endemic countries and in countries where polio was thought to have been vanquished, cases persist. According to the Global Polio Eradication Initiative, just this week eleven new wild poliovirus (WPV) cases were reported, including one from Afghanistan, two from Ethiopia, four from Pakistan and four from Somalia. The total number of WPV cases for 2013 is now 296, with 99 from countries that have not yet been able to eradicate the disease and 197 from countries that have seen outbreaks. In Israel, for example, while no cases of paralytic polio have been reported, environmental surveillance suggests that virus transmission (first detected in February 2013) continues in parts of the country’s southern and central regions. A vaccination campaign for children under age ten is ongoing.
On December 2, 2011, CDC Director Thomas R. Frieden, MD, MPH, activated CDC’s Emergency Operations Center (EOC) to strengthen the agency’s partnership engagement through the Global Polio Eradication Initiative (GPEI). Activation of the EOC has provided enhanced capacity for CDC’s polio eradication support program, which trains public health volunteers in the United States and globally to improve polio surveillance and help plan, implement and evaluate vaccination campaigns.
Additional EOC activities include:
- Publication of several joint World Health Organization Weekly Epidemiologic Record/CDC Morbidity and Mortality Weekly Reports (MMWR) highlighting polio eradication progress.
- Collaboration with GPEI partners on detailed country-plans for expanded technical and management support, including assistance with outbreak responses, surveillance reviews, vaccination campaign planning and monitoring, and data management.
- Provision of operational support to Nigeria for the country’s FY 2012 Polio Eradication Emergency Response Plan. The plan focuses on enhancing management and leadership skills to improve program performance.
- The development of indicators for monitoring polio vaccination campaign performance in the areas of planning, implementation and evaluation.
- Review of WHO-proposed outbreak response protocols for all polio-affected countries.
“If we fail to get over the finish line [to fully eradicate polio],” says Frieden, “we will need to continue expensive control measures for the indefinite future…More importantly, without eradication, a resurgence of polio could paralyze more than 200,000 children worldwide every year within a decade.”
Have you heard the story about the Prevention and Public Health Fund? A “no” wouldn’t be surprising.
Have you heard the story about the almost 200,000 preventable deaths in the United States each year due to heart disease and stroke? Probably so.
The latter was big news last week, inspiring headlines and handwringing across the country. Men are twice as likely as women to die of preventable cardiovascular disease. Blacks are twice as likely as whites. Southerners are at far greater risk.
Most of the stories emphasized how all this unhealthy living is the result of unhealthy lifestyle choices. But is that the whole story?
“Largely absent from most of the stories covering the study was context—a hard look at the social and environmental conditions that help explain the findings—as well as some explanation of what it might take to really change things and prevent large numbers of needless deaths.” They also tended to suggest “that poor health is essentially a personal moral failing, while ignoring the vastly different realities that exist in different communities in this country.”
That’s the thesis of a recent Forbes opinion piece, which looks past the round number of “200,000” and other statistics detailed by the U.S. Centers for Disease Control and Prevention (CDC), and points attention to the very real obstacles to healthy living that far too many people face.
The CDC study also discussed the importance of addressing the economic and social determinants that influence the health of individuals and communities (though this went largely unacknowledged in most media accounts, according to the Forbes piece). The CDC pointed out strategies that help create conditions for healthier living, including policy changes that increase access to health care, that give people healthy local food options and that build walkable communities—changes that can only be made by communities, not individuals.
That brings us back to the Prevention and Public Health Fund. Created by the Affordable Care Act, the Fund’s grantees have spent the past three years doing all these things—helping states, cities and tribes create safer, healthier communities.
“That’s a story that needs to be told, with context.”
>>Read the full piece, “200,000 Preventable Deaths A Year: Numbers That Cry Out For Action -- And Better Reporting.”
The United Nations Foundation believes that, for the biggest public health obstacles facing the world, it will take all nations and all sectors working toward solutions to succeed. So the Foundation works to make that a reality, bringing together partnerships, growing constituencies, mobilizing resources and advocating policies that can help everyone—in both the developing and developed world.
NewPublicHealth recently spoke with Kathy Calvin, President and Chief Executive Officer of the United Nations Foundation, about the organization’s many efforts to improve health both globally and locally—and how these two goals can support each other.
NewPublicHealth: What changes have you seen in global health during your time in the field?
Kathy Calvin: The number of nonprofits dedicated to health issues has quadrupled it seems, and real progress has been made, which is the most important point—that we’re actually seeing a reduction in maternal deaths and newborn deaths and preventable diseases such as measles and diarrhea and pneumonia. I mean, there’s just been enormous progress, with still much more to happen. But it’s been an exciting time after what I think has been a pretty discouraging period where no amounts of foreign aid seemed to be making a difference. I attribute that partly to some innovations in research and financing, but also to the fact that a lot of governments in Africa actually have prioritized women and prioritized health in some pretty significant ways. And I think we’ve had a very enlightened government in the last five years here, too, in terms of what we’re doing overseas.
So, it’s been exciting to see it. Health is not my background. I’ve really been privileged to see both how serious and significant the challenges are, but also how much good can be done with just a little bit of organized effort.
NPH: When you talk about enlightened government, what are some examples? What is making the difference now?
Calvin: Well ironically it isn’t all that political. In fact, some of the biggest shifts took place under President George W. Bush’s administration with his creation of the President’s Malaria Initiative—until then, there had been zero real depth of interest and progress on malaria—as well as PEPFAR, which some people criticized because it was so bilateral, but it had a huge impact in allowing the current administration to really set some ambitious goals for reducing and eliminating parent-to-child transmission and setting that audacious goal of an AIDS-free generation.
Who better to offer up advice on summer sun protection than the Los Angeles County Health Department? Recently the department warned its residents to “practice summer sun smarts” to protect themselves from skin cancer, which, at 1 million diagnoses per year according to the Environmental Protection Agency, is now the most common form of cancer among Americans.
July is recognized as "UV Safety Month" to encourage everyone—not just those in Los Angeles—to protect themselves from ultraviolet (UV) rays, a major risk factor for most skin cancers, by using sunscreen and avoiding prolonged sun exposure during peak hours. “Simple sun safeguards can go a long way in protecting the health of you and your family this summer,” says Jonathan E. Fielding, MD, MPH, the departments’ director of public health.
In other summer sun safety news, this week the National Highway Traffic Safety Administration (NHTSA) and SAFE KIDS Worldwide partnered up to promote National Heatstroke Prevention Day this past Wednesday, July 31. NHTSA and their partners used this opportunity to educate parents on the dangers of leaving children in unattended vehicles in the summer heat, as there have already been over 20 heat-related deaths of children in cars this summer. Children’s body temperatures can spike three to five times faster than an adult’s, and even cool temperatures in the 60s can cause the temperature in the car to rise well above 110 degrees Fahrenheit—so safety steps are critical at all times.
Cardiovascular disease is the focus of the 2013 annual report to Congress of the Community Preventive Services Task Force, an independent and unpaid panel of public health and preventive services experts. The report was discussed at a recent Congressional briefing that included health experts, Congressional staff, community health promotion partners and policy-makers.
Each year the Task Force reviews and updates the Guide to Community Preventive Services, a free resource that provides examples of evidence-based strategies to help communities choose programs and policies to improve health and prevent disease.
It’s not hard to understand why cardiovascular disease was the focus topic this year. According to John Clymer, executive director of the National Forum for Heart Disease & Stroke Prevention, almost half of all Americans have at least one of three modifiable risk factors for heart disease: tobacco use, high blood pressure or uncontrolled high cholesterol.
The Task Force has identified effective approaches to address most of the risk factors for heart disease, which include integrated community and health system practices. Some examples of such practices are a team approach to preventive care that includes doctors, nurses and community pharmacists; tobacco quitline interventions at no cost including follow-up counseling calls; and behavioral counseling and support for heart disease risk factor behaviors.
Jonathan Fielding, MD, MPH, co-chair of the Task Force and health director of Los Angeles County in California, says his county used evidence in the Guide that found that mass media efforts aimed at getting people to stop smoking only work in conjunction with other efforts.
Several community and health leaders of San Bernardino, Calif., the largest geographic county in the U.S., spoke at the recent briefing on use of the Community Guide to help improve population health in their county. San Bernardino ranked 44th out of 57 counties in the 2013 County Health Rankings. “The [Community] Guide has been instrumental in our work looking at population health,” says Dora Barilla, DrPH, Asst. Vice President for Strategy and Innovation at Loma Linda University Health, at the recent briefing. Loma Linda was part of a community initiative begun several years ago to improve population health in San Bernardino, which has 4.2 million residents in San Bernardino, “many with significant disparities,” said Barilla.
“We needed to identify the highest impact initiatives and without the community guide, we could not have done that,” said Barilla. “We used it to move forward fast. We needed science and evidence. Using the guide we were able to galvanize 20 of 24 cities. We were able to use what worked and not waste time on practices that were ineffective and outdated.”
Critical features of the Guide, said Barilla, is that it has targeted approaches for different populations “and does not take a one size fits all approach.” One key outcome, according to Barilla, was that hospitals engaged in community benefit efforts—a requirement for nonprofit hospitals under the Affordable Care Act. “We now had science and metrics to invest in upstream initiatives.”
>>Bonus Link: Watch a County Health Rankings and Roadmaps video on initiatives now in place to help improve population health in San Bernardino.
As we learn more about the long-term effects of traumatic brain injuries (TBI), the public health focus is increasingly on prevention in youth sports. A recent study funded by the Robert Wood Johnson Foundation and published in the American Journal of Public Health found that while 44 states and Washington, D.C., have enacted youth sport TBI laws, they all deal with identifying and responding to the injuries—not preventing them.
NewPublicHealth recently spoke with Robert Faherty, VP and Commissioner of the Babe Ruth League Inc., about what the baseball league in particular—and youth sports in general—are doing to improve the prevention of and response to traumatic brain injuries. The league includes about 1 million players across its Cal Ripken and Babe Ruth divisions.
>>Read more in a related Q&A with the author of the youth sports TBI law study.
NewPublicHealth: How is the Babe Ruth League working to prevent primary traumatic brain injuries in youth baseball?
Robert Faherty: One of the things that we really pride ourselves on— and, first of all, our organizations are entirely made up of volunteers, from the league administration level right down to the coach—is providing that league with the best insurance program we possibly can. Through Babe Ruth League, you have the opportunity to buy accident, or liability insurance. That's because we wanted to make sure that there would be no reason that a player wouldn’t go get checked out or a league wouldn’t send a player to a doctor or to an emergency room. We weren’t worried about the parents having insurance, we weren’t worried about somebody’s liability being in question—you can go to the doctor and have it covered.
The second part of that would be our ongoing attempt to educate and prevent injuries right down to the simplest practices. In our coaching certification and coaching education courses, which are mandated, not only are there safety issues that we include that in our score books that we provide to the teams, but it’s also the smallest things about how to run a practice. One of the most common injuries is being hit by a baseball, but it’s not the batter being hit by a baseball or a fielder being hit by a baseball—it’s an overthrow by kids warming up improperly, and not throwing all in the same direction.
Yesterday, 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.
Dr. Shah was joined by New York City Health Commissioner Thomas Farley, MD, MPH, and representatives from leading health care and community organizations at the Charles B. Wang Community Health Center in Manhattan. Among the other speakers were Jo Ivey Boufford, MD, president of The New York Academy of Medicine, and Daniel Sisto, president of the Healthcare Association of New York State.
>>Read a related Q&A with Commissioner Nirav Shah.
“We’ve all heard the adage—an ounce of prevention is worth a pound of cure,” said Commissioner Shah. “We need to fundamentally change the way we think about achieving better health in our society.”
That fundamental shift toward prevention, said Dr. Shah, requires setting clear goals, promoting active collaborations, and identifying policies and strategies that create opportunities for everyone to live a healthy life.
The Prevention Agenda identifies five priority areas:
- Prevent chronic disease
- Promote healthy and safe environments
- Promote healthy women, infants and children
- Promote mental health and prevent substance abuse
- Prevent HIV, STDs, vaccine-preventable diseases, and healthcare-associated infections
A health improvement plan like the one released by the New York Department of Health is a critical prerequisite for public health department accreditation. Recently, the Public Health Accreditation Board awarded five-year accreditation to 11 public health departments. Those 11 are the first of hundreds currently preparing to become accredited, including New York state.
"Completing the accreditation application, which includes our Prevention Agenda 2013-17, provides the Department of Health a valuable opportunity to engage partners and community stakeholders in our ongoing efforts to improve public health, evaluate the effectiveness of our services and showcase our successes," Commissioner Shah said.