Category Archives: Public policy
As the demand for walkable communities keeps growing, experts are moving from asking “If they build it, will they come?” to questioning how to fund the new developments, as well as keeping our eyes on issues such as transit, affordability and improving population health. As of January sharing best practices for those and many other issues is the job of Chris Zimmerman, who recently joined the staff of Smart Growth America as Vice President for Economic Development, following a very long stint as a member of the Arlington County Board in Virginia. Before his post in Arlington, Zimmerman was Chief Economist and Committee Director for Federal Budget and Taxation at the National Conference of State Legislatures. In his new role, Zimmerman will focus on the relationships between smart growth strategies and the economic and fiscal health of communities.
NewPublicHealth spoke with Zimmerman soon after he landed in his new office.
NewPublicHealth: What did you do before joining Smart Growth America?
Chris Zimmerman: For the last 18 years I’ve been a member of the Arlington County Board, the governing body of Arlington County, Virginia, an urban county of about 220,000 people right next to Washington D.C. The county functions as a comprehensive local government, with functions from school funding to land use and development to standard municipal functions such as parks and recreation, public safety, waste removal and managing public infrastructure. We don’t run the schools, but the funds for the schools are part of the county budget, at a cost of a little more than $1 billion annually.
Arlington County has become a model for transit-oriented development that is studied by folks around the country and even around the world, particularly because of the way the county has chosen to develop around the Metro system. That includes the initial commitment to be involved in Metro Rail, to fund underground Metro stations and then to focus development around them, beginning even before the ideas of the vocabulary of Smart Growth and urbanism had really gotten started, decades ago.
Prior to serving on the county board, I served on the county’s planning commission and a number of other commissions. So I’ve had about 20 to 25 years of involvement in the development of every aspect of the community, including housing, planning development and economic development, and even agencies such as the Washington Metropolitan Area Transit Authority, which runs Metro Rail and Metro Bus and every other regional transportation planning body there is here in Washington. I was involved in a lot of regional transportation issues that obviously were fundamental to our county because of the way we chose to develop and because of where we’re located. There are seven crossings of the Potomac River and five of them go through Arlington, so although there are a couple hundred thousand people in Arlington, there’s a million and a half or so in northern Virginia and large numbers of them go through Arlington every day.
“Building a culture of health means recognizing that while Americans’ economic, geographic, or social circumstances may differ, we all aspire to lead the best lives that we can,” wrote Robert Wood Johnson Foundation president and CEO Risa Lavizzo-Mourrey, MD, MBA in her 2014 President’s Message, released earlier this week. Laying out the plans for achieving those goals, Lavizzo-Mourrey added: “for the Foundation, it also means informing the dialogue and building demand for health by pursuing new partnerships, creating new networks to build momentum, and standing on the shoulders of others also striving to make America a healthier nation.”
The Foundation’s wide-ranging plans to “inform the dialogue” included a plenary talk by Mark McClellan, co-chair of the RWJF Commission to Build a Healthier America, and a former head of both the Food and Drug Administration and the Centers for Medicare and Medicaid Services. McClellan spoke at the AcademyHealth National Health Policy Conference in Washington, D.C., last week — less than a month after the release of the Commission’s 2014 report.
“To become healthier and reduce the growth of public and private spending on medical care, we must create a seismic shift in how we approach health and the actions we take,” said McClellan, “As a country, we need to expand our focus to address how to stay healthy in the first place.”
McClellan told a very attentive audience that critical needed changes include:
- Improve opportunities [for people] to make healthy decisions where we live, learn, work and play
- Improve access to a good education, jobs and health care
- Work across sectors, collaborating to improve the health of all Americans
- Make investing in America’s youngest children a high priority
- Fundamentally change how we revitalize neighborhoods, fully integrating health into community development
- Adopt new health “vital signs” to assess non-medical indicators for health such as jobs, income, housing, transportation and access to healthy food.
- Create incentives tied to reimbursement for health professionals and health care institutions to address non-medical factors that affect health.
McClellan cited two examples of organizations that are addressing issues beyond healthcare in order to improve health:
- Health Leads, a national health care organization, enables physicians and other health professionals to systematically screen patients for food, heat, and other basic resources that patients need to be healthy and “prescribe” these resources for patients.
- The Medical-Legal Partnership program removes legal barriers that impede health for low-income populations by integrating legal professionals into the care team. These volunteers intervene with landlords, social service agencies, and others to address health-harming conditions ranging from lack of utilities to bedbugs to mold in rental properties.
- Read Risa Lavizzo-Mourrey’s President’s Message
- Read the report of the 2014 Commission to Build a Healthier America
The fallout from this week’s snowstorm in Atlanta was a hot topic among many of the county officials attending the National Association of Counties (NACo) Health Initiative Forum in San Diego. Many have had to make tough decisions on crises in their communities—from flu to flooding to snow to shootings—and the consensus was that the snarled traffic, kids left to stay overnight in schools and thousands of cars abandoned marked a failure not of adequate preparation, but of communication and preparedness.
“You can’t know what disaster might hit, so you have to be prepared for everything,” said Linda Langston, NACo’s president and the supervisor of Linn County, Iowa, who has chosen resilient counties as her President’s initiative.
Langston said several steps can help reduce the trauma from disasters, including designating someone in each community to coordinate response, to stay up to date on dealing with emergencies, to building relationships among intersecting communities so that people trust each other in a disaster and to convening meetings with all sectors at the table. Langston pointed out that while schools and businesses don’t typically plan together, in the case of Atlanta’s snow storm most students and workers left the city for the suburbs at the same time of day, increasing traffic at the height of icy conditions. That might have been avoided by having a large pool of participants at the planning table.
“By inviting a member of the chamber of commerce, for example, to preparedness meetings and exercises, decisions can be made on traffic flow and other crowd control issues in the event of an emergency,” she said.
Langston, whose community saw devastating flooding in 2008, said recent preparations for possible flooding (that thankfully never happened) made city managers and the sheriff’s department—which controls the jail—realize they needed to coordinate on evacuation plans in the event of an emergency.
“And if the emergency never occurs, all those planning exercises create a more cohesive community, able to deal with run of the mill disasters like budget cuts, “ said Langston.
From antibiotic-resistant superbugs to the seasonal flu to Salmonella, infectious diseases are a serious health threat that also cost individuals and the health care industry billions. A new report from Trust for America’s Health and the Robert Wood Johnson Foundation, Outbreaks: Protecting Americans from Infectious Diseases, assesses gaps in our public health system that could severely limit our ability to effectively respond to an outbreak.
NewPublicHealth created an infographic that illustrates many of the key findings of the new report.
A new report from Trust for America’s Health finds that despite recommendations by medical experts about the effectiveness and safety of vaccines, an estimated 45,000 adults and 1,000 children die from vaccine-preventable diseases each year in the United States.
NewPublicHealth spoke with Litjen (L.J) Tan, MS, PhD, chief strategy officer of the Immunization Action Coalition, to ask about ongoing efforts to improve immunization rates among all age groups across the nation. The Coalition works to increase immunization rates and prevent disease by creating and distributing educational materials for health professionals and the public and facilitates communication about the safety, efficacy, and use of vaccines within the broad immunization community of patients, parents, health care organizations, and government health agencies. The Coalition is supported by the U.S. Department of Health and Human Services.
NewPublicHealth: What are the critical gaps in immunization in the United States—for children and adults?
Litjen Tan: Immunization rates are really high in our childhood population, but generally not at all high in the adult population, though for some vaccines the rates are improving. We are also not doing very well for adolescents. On the broader level I think what the immunization rates reflect is the state of preventive care in the United States when you come out of childhood, which is why I think the Affordable Care Act really is a great boon. We’ve got this wonderful preventive care model for our kids; we take our kids in, we get them their shots, they get protected and we’ve got high coverage rates generally over 90 percent for all major vaccines. We have almost no vaccine-preventable disease in the United States except for instances linked to pockets of populations that haven’t been vaccinated—as we’ve seen recently with measles.
But then we get to adolescence we have this breakdown. Rates for HPV vaccination are not so good. Our meningococcal vaccination rates are not where they should be and neither are the tetanus, diphtheria and pertussis booster rates in adolescents. What happens with the adolescents is parents don’t necessarily bring them in for prevention checkups anymore. We bring them in when there’s a problem or when they need a school sports visit, and so we plant in adolescents this idea that care is no longer about prevention but care is now about acute care, and that persists into adulthood. This is the thinking that stops us from saying, “hey, do I need my vaccines? When should I get them?”
We need to make sure that our adolescents get the idea that vaccines prevent disease and that they actually do have vaccines that are recommended for them and then I think we’ll begin to see an appreciation of immunizations for adults as well.
NPH: Do we need to target both parents and the adolescents themselves?
Tan: Absolutely, but there’s a lot of discussion about how we do that. It gets a little tricky because we push autonomy of the adolescent, and we have a precedent in public health—discussions between providers and adolescents about sexually transmitted infections—but there are a lot of legislative and regulatory barriers against directly talking to an adolescent in the absence of a parent.
A session on health in all policies at the American Public Health Association (APHA) meeting in Boston gave prominent attention to a newly released publication on the topic: An Introduction to Health in All Policies: A Guide for State and Local Governments. The guide was issued collaboratively by APHA, the California Endowment, the California Department of Health and the Public Health Institute.
It was released last month and is geared, according to its authors, “toward state and local government leaders who want to use intersectoral collaboration to promote healthy environments.”
The guide includes a history of health in all policies, case studies, a glossary, messaging, resources and a list of critical thinking questions. It draws heavily on the experiences of the California Health in All Policies Task Force, which was created in 2010 by an executive order of the governor and grew out of a common interest among several California agencies in climate change, health and childhood obesity. The task force brings together non-government stakeholders and local government representatives in its “health-in-all-policies” work through workshops, meetings and opportunities for public comment and testimony.
The Guide emphasizes that there is no one “right” way to implement a health-in-all-policies approach, but puts forward five key elements:
- Promote health, equity and sustainability
- Support for Intersectoral collaboration
- Benefit multiple partners
- Engage stakeholders
- Create structural or procedural change
- Health Impact Assessments (HIA) are one of the key tools addressed in the new Guide. See a regularly updated map on HIAs in the United States created by the Health Impact Project, a collaboration of the Pew Charitable Trusts and the Robert Wood Johnson Foundation.
- HIA was front and center at the American Public Health Association meeting, with more than thirty presentations this week. Read a summary of the HIAs discussed at the meeting, prepared by the Health Impact Project.
>>NewPublicHealth was 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. Find the complete coverage here.
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.
“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:
- Detect and interrupt the transmission of violence, by anticipating where violence might occur.
- Change the behavior of those most at risk for spreading violence.
- Change community norms to discourage the use of violence as an acceptable and even encouraged way to handle conflict.
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.”
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:
- 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