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If Patients Are Flipped Out by Today's Physician Encounters, Why Not "Flip" The Clinic?

Mar 3, 2014, 5:34 PM, Posted by Susan Dentzer

“I am stressed.”

“I am feeling pressured.”

“I have been through all this before.”

“Why is it taking so long?”

If you’ve ever had any of these feelings while biding your time in a doctor’s office, you’re not alone.  There are a myriad ways in which the classic physician visit can often be sub-optimal: Spending a long time in a waiting room before a too-short doctor’s visit; barely understanding or absorbing what the physician says before he or she rushes off to see the next patient.

The experience could try the patience of the most self-confident of patients—and positively overwhelm the more nervous among us.  Small wonder that some patients experience “white coat syndrome,” or elevated blood pressure during a clinical encounter.  It’s believed to be brought on by some combination of apprehension about a potential disease or diagnosis, or even intimidation at the sight of the doctor in a white coat.

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How Do You Transform a Community After a Century of Neglect?

Nov 20, 2013, 1:00 PM


Bithlo, Fla. is a town of 8,000 that is just 30 minutes outside Orlando and not much farther from the “happiest place on Earth” — but is beset by poverty, illiteracy, unemployment and toxic dumps that have infiltrated the drinking water. The water is so bad that it has eroded many residents’ teeth, making it that much harder for them to find jobs. Streets filled with trash, frequent road deaths and injuries from a lack of transportation options and safe places to walk, and dropping out before 10th grade were all the norm.


In just a short time, a collection of partners and volunteers have begun to reverse some of the decades-old problems Bithlo has faced. And earlier this week, the town that had been forgotten for almost a century was the scene of a hubbub of activity as hundreds of volunteers descended on the town to continue work on “Transformation Village,” Bithlo’s future main street, which will sport a combination library/coffee shop, schools, shops and many other services, all long missing from Bithlo.

Over the last few months, NewPublicHealth has reported on initiatives of the participating members of Stakeholder Health, formerly known as the Health Systems Learning Group. Stakeholder Health is a learning collaborative made up of 43 organizations, including 36 nonprofit health systems, that share innovative practices aimed at improving health and economic viability of communities.

>>Read more on the Stakeholder Health effort to leverage health care systems to improve community health.

One of the Stakeholder Health members is the Adventist Health System, a not-for-profit health care system that has hospitals across the country. Recently, Adventist’s flagship health care provider, Florida Hospital in Orlando, began supporting United Global Outreach (UGO), a non-profit group aimed at building up communities in need, in their four-year-long effort to transform the town of Bithlo.

NewPublicHealth recently spoke with Tim McKinney, executive vice president of United Global Outreach, and Verbelee Neilsen-Swanson, vice president of community impact at Florida Hospital, about the partnerships and commitment that have gone into Bithlo’s transformation into a town that is looking forward to new housing stock, jobs, stores, better education and improved health outcomes for the its citizens.

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Preventing Gun Violence: How Laws Can Help

Dec 19, 2012, 3:33 PM

As the nation grapples with last week’s school shooting in Connecticut, discussions across the nation are focused on how we can reduce gun-related violence and the devastation it causes. NewPublicHealth joins that conversation today, beginning with an interview with Jeffrey Swanson, PhD, a professor of psychiatry and behavioral sciences at Duke University School of Medicine. Swanson is a member of the Methods Core of the Public Health Law Research (PHLR) program at Temple University, a project of the Robert Wood Johnson Foundation. The researchers analyze the intersection of public health and law, selecting studies for funding and providing technical assistance and support to strengthen research on law and health.

>> Read a blog post by Scott Burris, director of PHLR, on developing new laws to increase the safety of having guns in society.

An article published last year by Dr. Swanson following the shooting of Congresswoman Gabrielle Giffords and eighteen other people in Tucson, Arizona, argued that homicides committed with guns against strangers by individuals with mental disorders occur far too infrequently to allow for explanatory statistical modeling and predictability. However, improving treatment access, continuity and adherence for people with serious mental illnesses can help prevent some violent episodes, according to Swanson.

NewPublicHealth spoke with Swanson a few days after the shooting in Newtown, Conn.

NewPublicHealth: What is the role of law and public health in efforts to prevent gun and other forms of violence?

Swanson: We need to think about gun violence as a public health problem. Homicide and suicide are the second- and third-leading causes of mortality in the U.S. population ages 15-34, and firearms are involved in most violent fatalities. In theory, the law should be an effective public health tool in trying to address the problem. Law can regulate what kinds of guns are available, where they can used, by whom, and even how they are stored. But since the U.S. Constitution protects a citizen’s basic right to possess a gun, the law can’t go too far in limiting legal access to guns in the population. That means we have to focus more on trying to identify dangerous people who should not have guns. That’s very complicated, because violence is complicated and so are people. The law could be used even more effectively, though, if we had better research evidence about what features of gun laws and policies work best to protect safety while safeguarding civil rights. That’s what we’re trying to do.

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Ready or Not? Preparing for Public Health Emergencies

Dec 19, 2012, 11:11 AM

The Trust for America’s Health (TFAH) has released the 2012 edition of its Ready or Not? report. The annual report details and analyzes state and federal public health preparedness. This year’s entry focuses on emergency preparedness, looking at 10 indicators that help reveal the strengths and vulnerabilities in each state’s emergency preparedness status. TFAH’s hope is that policymakers, taxpayers and other groups can utilize the data to shore up their programs and policies—and help ensure they are ready to support public health in the event of a natural disaster or other emergency.

Among the key findings:

  • 29 states cut funding for public health from FY 2010-11 to FY 2011-12
  • 35 states and Washington, D.C. do not currently have climate change adaptation plans, which include planning for the health threats posed by extreme weather events
  • 21 states have not been accredited by the Emergency Management Accreditation Program (EMAP)
  • 13 state public health laboratories report they do not have sufficient capacity to work five, 12-hour days for six to eight weeks in response to an infectious disease outbreak, such as novel influenza A H1N1

This emphasis on analyzing emergency preparedness is especially meaningful now, with many in the Northeast still working to recover from the devastation of Hurricane Sandy. NewPublicHealth had been closely following public health’s role in responding to and recovering from Hurricane Sandy, and will continue to take an in-depth look at how this disaster continues to affect public health.

Here’s a look at some of the many ways NewPublicHealth has covered the intersection of public health and emergency preparedness:

Hurricane Sandy Recovery: New Jersey’s Health Commissioner Helms Response Roundtable
Just two weeks after Hurricane Sandy hit, the State of New Jersey held a Response Roundtable at the Jersey Shore University Medical Center in Neptune Township, N.J., to begin a review of the health department’s response to the storm. The site was an appropriate one: in the first few days of the Sandy, the medical center’s emergency room treated close to 2,000 patients with storm-related medical and mental health emergencies. A key roundtable participant was Nicole Lurie, the U.S. Department of Health and Human Services Assistant Secretary for Preparedness and Response. Leading the discussion was New Jersey’s Health Commissioner Mary E. O'Dowd.

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Upcoming Webinar: Gun Violence, Mental Illness and Firearms

Jan 24, 2012, 3:36 PM, Posted by NewPublicHealth

Swanson Jeffrey Swanson, Duke University School of Medicine

The Public Health Law Research Program as well as the American Society of Law Medicine and Ethics, the Network for Public Health Law and the Public Health Law Association and will be hosting a webinar on Thursday, January 26 at one p.m., looking at laws related to mental illness and firearms. The webinar will focus on what is known about the contribution of mental illness to violence and will consider the implications of research literature for law and policy that seek to limit firearms access for people with mental disorders who may pose a danger to themselves or others. The presentation will discuss research findings on whether current federal and state firearms restrictions reduce gun violence, and will lay out an agenda for needed future research.

>>UPDATE: Check out the recording of Thursday's webinar on the Network for Public Health Law website, here.

NewPublicHealth spoke with Jeffrey Swanson, PhD, Professor of Psychiatry and Behavioral Sciences at Duke University School of Medicine, and a presenter for the webinar.

NewPublicHealth: What’s the scope of the problem?

Jeffrey Swanson: Firearm violence is a major public health problem in the U.S. More than 300,000 people died from gunshot injuries from 1998 to 2007—a death toll five times greater than the number of U.S. military casualties in the Vietnam War. Very public acts of gun violence by persons with mental illness—such as the mass shootings at Virginia Tech in 2007 and in Tucson in 2011—suggest that the current patchwork of state and federal firearms laws may be ineffective at protecting the public from dangerous individuals. But, in fact, research shows that the large majority of people with mental illness are not violent, and that most violent acts are not caused by mental illness.

Two consequences can result from the varying state laws—mentally ill people can be kept from their constitutional right to own a firearm, and some laws can put firearms into the hands of mentally ill people who may use them not to kill others, but to commit suicide.

NPH: What’s the status of your research on the topic?

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Scott Burris With an Update on Public Health Law: A NewPublicHealth Q&A

Oct 28, 2011, 5:04 PM, Posted by NewPublicHealth

Scott Burris Scott Burris, Public Health Law Research

Update on 10/31: Scott Burris is at APHA and gave an overview this morning at the 2011 APHA annual meeting on how far the initiative has come since its inception two years ago.

The program has funded somewhere between $8 and 9 million dollars in public health law research so far, said Burris, many of which are starting to bear results. Researchers from Boston University School of Law and Harvard Medical School showed that companies that make antibiotics are encouraging the (over)use of those antibiotics by clinicians, a practice which is known to lead to antibiotic resistance.

PHLR is now focused on creating an online research community called SciVal for sharing methods, best practices and advances in the field. (PHLR staff is showcasing this new app at their booth #2060, so stop by to check it out if you’re here in Washington attending APHA). Burris also encouraged the audience to visit the PHLR website to take advantage of a wealth of resources on methods, all meant to guide this burgeoning field.


Public Health Law Research (PHLR), a Robert Wood Johnson Foundation program based at Temple University, represents an initiative to promote effective regulatory, legal and policy solutions to improve public health. The program will have a strong presence at the American Public Health Association Annual Meeting this year both during meeting sessions and at the Program’s booth on the exhibit floor. NewPublicHealth spoke with Scott Burris, JD, director of the program, about some of the upcoming presentations and booth demonstrations.

NewPublicHealth: Will you have many research results to show at this year’s APHA Annual Meeting?

Scott Burris: This is now Public Health Law Research at age 2.4 years. We are just starting to get results from our grantees, the people we funded in the first round and a few in the second and we have a number of them appearing at APHA this year. Our booth will have a complete guide to PHLR related events at APHA. Our Methods Core Member, Jeffrey Swanson, a professor at Duke University, is getting the 2011 Carl Taube Award for distinguished contributions to mental health services research. At our the booth, #2060, we’ve got a beta version of our Public Health Law Research Community application, which will eventually capture everybody who’s written in Public Health Law Research and all the papers that have been published. We’ll be demonstrating the app at our booth. We’ll also be showing our brand new seven-minute animated video about PHLR—popcorn included.

NPH: Can you point to some key PHLR research projects that will be presented at the APHA meeting?

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Laws, Policy, and Mental Health

May 18, 2011, 9:00 PM, Posted by NewPublicHealth

This month is Mental Health Month, a good time to note that while the mental health landscape has shifted over the last half a century -- legal reforms and new treatments have led to improvements in mental health care in the U.S. -- we still have a long way to go.

In a recent report in Mental Illness, Law, and a Public Health Law Research Agenda (pdf) for the National Public Health Law Research Program — an initiative of the Robert Wood Johnson Foundation and the Temple University Beasley School of Law — John Petrila, J.D., LL.M, a professor at the University of South Florida, and Jeffrey Swanson, a professor at the Duke University School of Medicine, talk about using laws to help solve the public health crisis of mental illness.

“In the last decade,” say the authors in their report, “numerous policymakers have concluded that the integration of mental health within public health is essential to improving care for people with or at risk for mental illnesses.”

And in an op-ed published today on the Health Care Blog, Swanson and Petrila note that "Public health laws and policies have an important role to play in keeping people safe and healthy; indeed, innovative laws may be the best approach to the daunting challenge of ensuring access to community-based mental health care for those who need it the most."

Read the full op-ed here. You can also watch "Violence, Mental Illness, and Gun Control," a lecture by Jeffrey Swanson, PhD, Professor in Psychiatry & Behavioral Sciences, Duke University School of Medicine, here.


This commentary originally appeared on the RWJF New Public Health blog.

Mental Health: Research and the Role of Law

May 3, 2011, 2:28 PM

May is Mental Health Month. While that observance is more than sixty years old, mental health has only recently started to take its place as a critical public health action item.

Why the gap between observance and action?

In a recent report in Mental Illness, Law, and a Public Health Law Research Agenda (pdf) for the National Public Health Law Research Program — an initiative of the Robert Wood Johnson Foundation and the Temple University Beasley School of Law — John Petrila, J.D., LL.M, a professor at the University of South Florida, and Jeffrey Swanson, a professor at the Duke University School of Medicine, say a variety of reasons have fueled the disconnect. They tick off stigma about mental illness; previous doubts about whether mental illness was a “real” illness; and the fact that mental health patients were often kept away from the community, limiting the public health focus on their needs.

“In the last decade, however,” say the authors, “numerous policymakers have concluded that the integration of mental health within public health is essential to improving care for people with or at risk for mental illnesses.”

Law has already played a role in shaping mental health policy and practice:

  • Constitutional principles have been used to challenge institutional confinement
  • Legislation has provided parity in insurance coverage for physical and mental illnesses
  • Legislation has reduced the impact of mental disabilities on access to employment and public accommodations.
  • State and federal laws also have expanded the use of coercion and denied people with mental illnesses access to products, such as guns, available to most citizens


The authors say the research agenda going forward should include items such as the legal infrastructure for dealing with mental illness; mapping state statutes on public health laws; studies on interventional law; and studies on implementing law that could improve care for people with mental illness.

Additional resources for helping improve care for people with mental illness are available from the American Public Health Association. Their resource site includes journals, research centers, government sites and community referral information.

Weigh in: Has your community increased its efforts on mental health issues?

This commentary originally appeared on the RWJF New Public Health blog.