Category Archives: Q&A
Today at the American Public Health Association annual meeting in New Orleans, Shirley Orr, MHS, APRN, a Robert Wood Johnson Foundation Executive Nurse Fellow and public health consultant, and Doris Brown of the Louisiana Department of Health, will be talking about opportunities for nursing leaders to implement the recommendations of a 2010 Institute of Medicine Report entitled “The Future of Nursing.” This report looks at ways that the nursing profession can transform itself in order to better align with population health and more effectively collaborate to create a healthier overall population.
NewPublicHealth recently spoke with Orr about how nurses can help improve community and population health. This interview has been lightly edited for clarity and length.
NewPublicHealth: What does the nursing profession need to do in order to align itself with a focus on population health?
Shirley Orr: A couple of things in particular that stand out are education and diversity. We recently did a public health nursing enumeration that was funded by the Robert Wood Johnson Foundation, and we found two things in particular relating to the recommendations. First, that overall, public health nurses need new skills and they need higher levels of education to be able to function more collaboratively and within collaborations—both within health care and with other community partners.
Second, we found that nationwide, the demographic profile of public health nurses does not look like the population that we serve. Ethnic minorities are very much underrepresented among public health nursing—particularly in leadership roles.
We have a very urgent need to recruit more nurses of color into the ranks of public health nursing leadership.
NPH: Why is that necessary?
Orr: A core component of nursing curriculum today is culture competency. That being said, we also know that having nurses who understand populations very, very deeply by having a frame of reference for that population and being a member of that population really are able to help to get the highest level of engagement from the population. They’re also best prepared to understand the culture, the needs, the motivations about populations, so they’re really best positioned to be able to carry out in partnership strategies that are going to make a difference long-term in the health of populations.
Beverage companies spent $866 million to advertise unhealthy drinks in 2013, and children and teens remained key target audiences for that advertising, according to a new report released today at APHA by the Yale Rudd Center for Food Policy & Obesity. The report “Sugary Drink FACTS 2014” highlights some progress regarding beverage marketing to young people, but also shows that companies still have a long way to go to improve their marketing practices and the nutritional quality of their products to support young people’s health.
“Despite promises by major beverage companies to be part of the solution in addressing childhood obesity, our report shows that companies continue to market their unhealthy products directly to children and teens,” said Jennifer Harris, PhD, Rudd Center’s director of marketing initiatives and lead author of the report. “They have also rapidly expanded marketing in social and mobile media that are popular with young people, but much more difficult for parents to monitor.”
Harris and her team examined changes in the nutritional content of sugar-sweetened drinks including sodas, energy drinks, fruit drinks, and others. They also analyzed marketing tactics for 23 companies that advertised these products, including changes in advertising to children and teens on TV, the internet, and newer media like mobile apps and social media. Researchers also examined changes in the nutrition and marketing of diet beverages, 100% juice, and water. The report was funded by the Robert Wood Johnson Foundation.
Learn more about the key findings of the report in the following exclusive interview with Harris. The interview has been lightly edited for clarity and length.
NPH: You issued the first version of this new report in 2011. What are the changes since then?
Jennifer Harris: The biggest change that we saw was a very significant decline in advertising on television. Preschoolers are seeing 33% fewer TV ads for sugary drinks in 2013 than they saw in 2010. Children are seeing 39% fewer, and teens are seeing 30% fewer. So, that was really some great news to see, but some categories had bigger declines than others. Fruit drinks went down by about 50%, but advertising for energy drinks that kids see actually increased. So, there was some good news and some bad news.
Looking at Health Departments’ Ever-Changing Future: A Discussion of the Recent Findings of the Public Health 2030 Project
From the dramatic impact of extreme weather events such as Hurricanes Katrina and Sandy, to the rapidly changing policy landscape of health care providers, the functions, missions and futures of public health agencies continue to change.
To help health departments plan for an uncertain future, the Institute for Alternative Futures—with support from the Robert Wood Johnson Foundation and the Kresge Foundation—recently worked with state and local health departments, leaders and experts in the field to look forward to the year 2030 and analyze public health scenarios in order to offer pathways to expectable, challenging and visionary futures for public health.
On Tuesday afternoon at APHA, Clement Bezold, PhD, the Founder and Chairman of the Institute for Alternative Futures, and Terry Allan MPH, will discuss theses scenarios and findings and insights gained.
Prior to their presentation, NewPublicHealth sat down with Bezold for an exclusive preview of his presentation.
NewPublicHealth: How did your APHA presentation come about?
Clement Bezold: The presentation is based on the Public Health 2030 project, and that project came about following scenario reports on primary care, on vulnerability, social and economic vulnerability in the United States and on health and health care.
NPH: What are some of the key points about the Public Health 2030 project?
CB: With Public Health 2030, there are a host of challenges and opportunities facing health departments. There are the ongoing fiscal issues at the state and local governmental levels, there’s increased infectious disease, there are climate-change-related changes that communities are facing.
The American Public Health Association (APHA) annual meeting begins next week in New Orleans, the first return to the area for the 15,000-strong meeting since Hurricane Katrina nine years ago. This year’s theme is Healthography, or, as APHA Executive Director Georges Benjamin, MD, recently said, “where you live matters.”
Earlier this week, Benjamin spoke with NewPublicHealth about key issues and presentations for this year’s meeting. The following interview has been lightly edited for clarity and length.
NewPublicHealth: “Healthography”—what is it and why is important especially right now?
Georges Benjamin: We know for sure that place matters, and I think New Orleans is an excellent example of that truth. It’s a wonderful city, but certainly has had huge health challenges. In our annual America’s Health Rankings survey that we do with the United Health Foundation and Partnership for Prevention, Louisiana consistently ranks as one of the lowest states in the nation for health. When you also consider the environmental tragedies that the state had—two storms in short succession and then the Gulf oil spill—the challenges of place and health become especially clear.
So the concept of the geography in which you live and your health is taking center stage as we head to New Orleans. As just one example, our opening session speaker, Isabel Wilkerson, wrote the book “The Warmth of Other Suns,” which deals with the great migration of Americans who moved from one place to another to try to achieve a better life.
NPH: What are some of the other highlights of this year’s meeting?
Benjamin: We’ve got the acting U.S. Surgeon General coming, Dr.Boris Lushniak, and he is going to talk a great deal about health and place. He’s an amazing speaker around the issues of place-based health, how we build our communities and things that we can do to make the healthy choice the easy choice.
In addition, Risa Lavizzo-Mourey, the president and CEO of the Robert Wood Johnson Foundation, will be the keynote speaker for the closing session on Wednesday, where she will talk about the foundation’s new Culture of Health and how they are playing a leading role in building a future where every American has the opportunity to live the healthiest life possible, regardless of where they live.
As RWJF clearly knows, when you design things, you get exactly what you design, and we’ve designed an environment and a culture around health that creates an unhealthy environment. So, if we redesign that culture to improve our health, we can make a big difference.
NPH: Why is building a Culture of Health so important?
Benjamin: Most people living in the United States are not as healthy as they can be, and so APHA believes that we need to build a movement to be the healthiest nation, and we think we can do that in a generation. So, this meeting is the first component of our new strategic direction which aligns very closely with RWJF’s strategic direction.
Our goal is for the United States to be number one and not be number 36 in terms of quality of our health. We think there’s an opportunity to do that through the kind of things that APHA does with education, policy development, legislative advocacy, and building grass roots and grass tops movements to get us there.
Last week the March of Dimes releases its annual Premature Birth report card and gave a “C” grade to the United States. While the U.S. rate has seen improvement in recent years and rates of premature birth—which can cause death and lifelong disability—have dropped, the organization says there is still much room for improvement. With World Prematurity Day next week, NewPublicHealth recently spoke with Jennifer L. Howse, PhD, president of the March of Dimes, about the new report card and new efforts by the organization to study premature birth and vastly reduce the U.S. rates further.
NewPublicHealth: What’s most significant about the 2014 report card?
Jennifer Howse: The 2014 report card on premature birth in the United States shows continued improvement. In fact, rates of pre-term birth in the United States have improved. That is they’ve lowered every year for the last seven years and that means that the United States currently has a pre-term birth rate of 11.4 percent, and that rate of pre-term birth is the lowest that it’s been in the in the last 17 years. So we’re very pleased. Having said that, the United States is still short of the target set by the March of Dimes of 9.6 percent or less. Our state-by-state report card assigns a letter grade to the U.S. composite and then to each state up against that goal of 9.6 percent. So, the United States has a “C” overall, but we continue to see progress and improvements—incremental, but progress in far and away the majority of states. So it’s very important around this critical child health issue to set a target, measure the target, and to hold states and the nation accountable.
NPH: What are the things that March of Dimes is doing, has done and will continue to do that are helping that rate?
Howse: The March of Dimes has mobilized a very strong group of partners in this campaign to end premature birth. We have assembled very strong partnerships with clinicians, with state health officials, with hospital leadership, with governmental leaders—particularly in the area of Medicaid programs—and those partnerships have been activated and expanded over the last decade. Specifically, the March of Dimes has led the charge on a quality improvement program across the nation to reduce and eliminate elective induction and C-section before 39 weeks of completed gestation. That’s the QI 39 program, and now two-thirds of hospitals are showing positive results in that arena.
In recent years, the state of New Jersey has found itself at the center of high-profile emergencies and public health scares—from the disaster wrought by Superstorm Sandy in 2012 to a controversial plan in recent weeks to quarantine individuals identified as at risk for contracting Ebola. As the 11th-most populous state—and a major hub of international travel and commerce—New Jersey’s public health leadership serves as a case study for the nation.
NewPublicHealth recently spoke with New Jersey Health Commissioner Mary O’Dowd. She has been sharing New Jersey’s preparedness and recovery lessons nationally as a member of the preparedness policy committee of the Association of State and Territorial Health Officials and implementing them as the state addresses potential exposure to Ebola in returning volunteers.
NewPublicHealth: Looking back, what worked well in the health department’s response before, during and after Sandy?
Mary O’Dowd: I think one of the things that really worked well in that immediate response phase was that we employed our lessons learned from Hurricane Irene the year before, in 2011. For example, we used the Emergency Management Assistance Compact, which is an agreement among states to assist each other in times of crisis or emergency, and we specifically used it to bring additional ambulances into New Jersey for our EMS system to enhance our capability, but we didn’t make the request until after the storm. So for the first day or two, we didn’t have the resources on hand.
We learned from that shortfall. The next year, before Sandy made its way to New Jersey, we had already put out the request via the EMAC system and had ambulances from Indiana on the ground before the storm hit. And that was really critical in our ability to immediately respond in particular with Sandy, because with the flooding we had several areas of the state where ambulances actually were flooded out and were no longer available for us. We were very lucky that we had learned that lesson from the year before.
Flu season in the United States typically runs from November through March, with the peak coming in January and February. But people can catch the flu both earlier than the usual start time and after the usual end of the season. In addition, the severity of the flu season can vary with from 3,000 to 49,000 U.S. deaths in a given year, an average of more than 200,000 hospitalizations and millions of illnesses, according to the U.S. Centers for Disease Control and Prevention (CDC).
Flu shot season has a shorter time table, so many pharmacies and doctors’ office that are well stocked at the moment can run out before Christmas, making it difficult for people who put off their vaccinations to find a vaccine location and protect themselves.
And despite a yearly campaign to get people to roll their arms up, less fewer than half of adults and less than 60 percent of kids received a flu shot last year. NewPublicHealth recently spoke with Carolyn Bridges, MD, the CDC’s associate director for adult immunizations about what keeps people from getting the flu shot and how more people can be encouraged to get the vaccine.
NewPublicHealth: What is it that keeps people from getting the shot?
Carolyn Bridges: I think there are a number of things. Certainly, we have pretty good awareness about the recommendations for the influenza vaccine, although some people may just not realize that they are potentially at risk. The current recommendations call for all persons six months of age and older to get an annual flu vaccine, with rare exceptions. But the vaccine recommendations have changed over time and in the last few years have been broadened to include [just about] everyone. For some people the message hasn’t gotten to them that in fact they are now included in the group recommended for a yearly flu vaccine
NPH: What common misconceptions do people still have about the flu vaccine?
Bridges: In terms of the safety, some people question or are worried about getting the flu from the flu vaccine. That’s still a common comment that we receive. Sometimes people will certainly have body aches or some tenderness in the arm where they get their flu vaccine, but that’s certainly not the same as getting influenza, and those symptoms generally are very self-limited and go away within two to three days. But the flu vaccine cannot cause the flu.
Ebola and U.S. Quarantines: Q&A with James Hodge and Kim Weidenaar of the Network for Public Health Law
On Monday, the U.S. Centers for Disease Control and Prevention (CDC) released new guidelines for people who have been exposed to the Ebola virus, either returning home from affected West African countries or looking after patients in the United States.
The guidelines establish four levels of risk -- "high" risk, "some" risk, "low" risk and "no" risk -- and recommend restrictions and health monitoring for each category.
Under the guidelines, people at high risk of Ebola exposure would be confined to their homes in voluntary isolation, while people carrying some risk would have their health and movements monitored by local officials. Those at high risk or with some risk would have daily in-person check-ups from state and local health departments for 21 days.
Immediately after yesterday’s CDC press conference, NewPublicHealth spoke with James Hodge and Kim Weidenaar, attorneys with the Network for Public Health Law, responded to questions from NewPublicHealth about laws and regulations that impact quarantines.
NewPublicHealth: Is there any legal support under United States law for possible quarantines for returning health workers and travelers from West Africa?
James Hodge and Kim Weidenaar: Yes, provided quarantine is limited in duration, consistent with due process, and based on known or suspected exposures.
Public health authorities must be prepared to demonstrate that 1) the subject of quarantine is actually or reasonably suspected of being exposed to an infectious condition, 2) that the infectious condition (like Ebola) poses a specific threat to the public’s health, 3) that the terms of quarantine are warranted, safe, and habitable, and 4) that procedural due process including fair notice, right to hearing, and right to counsel are provided.
News today that a fourth case of Ebola has been diagnosed in the United States underscores the urgent need to have health workers not just ready, but also willing to treat patients with the illness. Next Wednesday, the National Coordinating Center on Public Health Systems and Services Research (PHSSR) will be hosting a webinar on legal protections to help facilitate health worker willingness. Daniel Barnett, MD, an Associate Professor in the Department of Environmental Health Sciences at the Johns Hopkins Bloomberg School of Public Health, will be the main presenter. Barnett and three Bloomberg colleagues, Leonie Ratko, JD, PhD, MPH, Jon S. Enrick, JD, MPH Carol B. Thompson, MS, MBA received funding from the Robert Wood Johnson Foundation and PHSSR to study the issue. PHSSR's Center is funded by RWJF and based at the University of Kentucky.
NewPublicHealth recently spoke with Barnett.
NewPublicHealth: What are the concerns with respect to health workers being prepared to take some risks in order to protect the public?
Daniel Barnett: There’s been a longstanding tacit dysfunction about preparedness trainings: That if you train someone in knowledge and skills in terms of how to respond, that will necessarily translate into a willingness to do so. But our work has shown that “training to knowledge equals training to willingness” is a false assumption. In other words, I can teach someone how to recognize anthrax or some other infectious disease agent under a microscope, but that in no way ensures that that individual will be willing to come to work to look at anthrax or another infectious disease agent under a microscope, and by analogy, any other type of frontline public health or health care response.
That’s been, frankly, a missing piece in public health preparedness training nationally and internationally, and I think that we need to really rethink paradigms of preparedness training and education to take a more holistic approach. In other words, an approach that recognizes that frontline healthcare workers and public health workers have fears and concerns attached to a whole variety of aspects of the events at hand.
Recent data out of California has shown that close to 90,000 children go to the emergency room for dental care each year. Although the cost of those visits is tens of millions of dollars, often little more is done than prescribing antibiotics to control infections. While that is important, after such a visit a child’s teeth remain decayed, posing significant risks for adult dental health problems, which can lead to illnesses, deaths, huge out of pocket costs and reduced job opportunities if teeth are noticeably missing.
But California is now also the first state in the nation to permit dentists to take care of underserved kids and adults virtually. A law passed at the end of September vastly expands the Virtual Dental Home, a demonstration project that uses telehealth technology to bring dental services directly to patients in community settings, such as preschools, elementary schools and nursing homes.
Under the program, dental hygienists and assistants perform preventive care and provide patient information electronically for review by an off-site dentist. Under the direction of the dentist, the providers can also place temporary fillings—no drilling required—which can last for years, according to Jenny Kattlove, an oral health policy analyst for The Children’s Partnership, a children’s advocacy group. Patients who need more advanced care are referred to a dentist, and often they’re the dentist who worked with their technician.
A recent Pew study examined how the Virtual Dental Home worked at an elementary school in Sacramento, where the program provided cost-effective services to low-income children who did not have a regular source of dental care. Care under the Virtual Dental Home is paid for under California’s Medicaid program.
According to research by the University of the Pacific Arthur A. Dugoni School of Dentistry, which operates the Virtual Dental Home pilot program, more than 30 percent of Californians are unable to meet their oral health needs through the traditional dental care system. More than half of California’s Medicaid-enrolled children received no dental care in 2012 and even fewer received preventive care services.
NewPublicHealth recently spoke with Kattlove about the new law and its potential as a model for dental care for low income individuals across the country.
NewPublicHealth: What is the most significant advantage of the Virtual Dental Home?
Jenny Kattlove: The Virtual Dental Home is a way to diversify or disperse the workforce so that all the professionals are working at the top of their skills and expertise. By putting dental hygienists in a community setting and having them take care of the majority of the care that the child needs, the dentist can be in the clinic or in their dental office taking care of the more complex needs and supervising the hygienist.