NewPublicHealth is partnering with Grassroots Change: Connecting for Better Health to share interviews, tools, and other resources on grassroots public health. The project of the Robert Wood Johnson Foundation Health Group supports grassroots leaders as they build and sustain public health movements at the local, state and national levels.

In this Q&A, conducted by Grassroots Change, Shannon Frattaroli, PhD, Associate Professor at the Johns Hopkins Bloomberg School of Public Health, Center for Injury Research and Policy, shares her perspective on grassroots power and the future of public health. Her research helps answer two critical questions: Why are grassroots movements so important; and what is a public health movement, anyway?

>> Frattaroli’s interview has been edited for NewPublicHealth. View the full interview at GrassrootsChange.net.

Grassroots Change: What do you see as the role of grassroots movements in public health?

Shannon Frattaroli: There’s tremendous potential. Public health at its core is about the public. The public should have a voice in public health, and grassroots movements are one way for that to happen. The public has been very engaged in policy issues or problems throughout the history of public health. When people get engaged and are strategic with regard to policy change, things can happen quickly. And change can happen in a way that feels more legitimate. I think it’s where we should be moving in the future.

GC: What does “grassroots movement” mean? How are grassroots health movements different from other types of advocacy?

While laws to help make it easier for everyone to get their veggies are cropping up all over, some would-be planters get stopped in their carrot tracks by regulations that prohibit use of public spaces for planting, or even limit what can be grown on private property, according to a recent article in the Wall Street Journal [note: subscription required]. In some jurisdictions, according to the article, sidewalk gardeners have been fined and may lack the clout to advocate for changing the laws.

>>Bonus Link: Read about Urban Farming, a nonprofit group with high-profile corporate sponsors that supports gardens on unused land.

Doctors’ Knowledge of Lab Test Costs Reduces Unnecessary Testing
Knowing the cost of a laboratory tests makes doctors less inclined to order them for hospitalized patients, according to a new study in JAMA Internal Medicine. About $226 billion was wasted on unnecessary tests in 2011, according to the study from researchers at The Johns Hopkins University School of Medicine in Baltimore. Unnecessary tests also increase the risk of patient harm and false positives. "The rational approach to ordering tests is something we should all be interested in, and something—if we did better—that would save the system money and save the patients the horror of causing harm," said Leonard Feldman, MD, of Johns Hopkins. Read more on access to health care.

Mass. Study Shows Importance of Simplifying Health Insurance Benefits Options
Just six months before open enrollment for the Affordable Care Act’s health insurance marketplaces begins, a new study in the journal Health Affairs shows that some Massachusetts families who enrolled in unsubsidized Commonwealth Health Insurance Connector Authority plans experienced higher financial burdens due to health care costs. The study found that 38 percent saw financial burdens and 45 percent saw higher-than-expected out-of-pocket costs—indicating that lower-income families with increased health care needs and multiple children are at particular risk for higher costs. “Given the complexity of health insurance choices and consumers’ limited understanding of health insurance benefits, policy makers need to reach out and simplify information to promote optimal plan choices for the people,” wrote the study’s authors. Read more on community health.

CSPI Classifies Ginkgo Biloba as ‘Avoid’
The Center for Science in the Public Interest (CSPI) is now recommending people avoid Ginkgo biloba after a National Toxicology Program study linked it to liver cancer in mice and thyroid cancer in rats. The substance can be found in many dietary supplements, herbal teas and energy drinks. "Ginkgo has been used in recent years to let companies pretend that supplements or energy drinks with it confer some sort of benefit for memory or concentration," said CSPI executive director Michael F. Jacobson. "The evidence for those claims has been dubious, at best. The pretend benefits are now outweighed by the real risk of harm." The U.S. Food and Drug Administration has previously sent warning to drink manufacturers stating that the ingredient is not generally considered safe for food. Read more on nutrition.

Recently, The Atlantic and GlaxoSmithKline hosted “A Conversation on Community Health”—a series of events in three U.S. cities to explore what it takes to create a healthy community. The series brought together leaders from across different sectors to forge a dialogue across different perspectives.

NewPublicHealth recently spoke with Robert Simmons, DrPH, MPH, head of the Master’s Program in Public Health at Thomas Jefferson University who was part of a recent panel. Other speakers on that panel included entertainer and activist Dr. Bill Cosby; Dr. Alvin Poussaint, professor of psychiatry at Harvard Medical School; Dr. Irwin Redlener, Clinical Professor of Population and Family Health at the Columbia University School of Public Health; Diane Cornman-Levy, executive director of the Federation of Neighborhood Centers and Sarah Martinez-Helfman, executive director of the Eagles Youth Partnership.

NewPublicHealth: Tell us a bit about your background.

Dr. Simmons: I’ve worked in public health for 40 years including at the County Health Department in San Diego, the State Health Department in California, and the American Lung Association, where I was program director on issues of asthma and tobacco and cardiopulmonary disease. In the last five and a half years, I’ve been directing the public health program at Thomas Jefferson University in Philadelphia.

NPH: What do you think have been key improvements in addressing population health?

The U.S. Department of Health and Human Services (HHS) Center for Faith-based and Neighborhood Partnerships (known as the Partnership Center) engages with community organizations to:

• Strengthen the role of community organizations in health initiatives
• Reduce unintended pregnancies and support maternal and child health
• Promote responsible fatherhood and healthy families
• Foster interfaith dialogue and collaboration with leaders and scholars around the world, and at home

As part of HHS, the Partnership Center is a member agency of the National Prevention Council—a collaboration of 17 federal departments, agencies and offices to help promote prevention and wellness for individuals, families, and communities. The Council members are guided by the National Prevention Strategy, released two years ago by Surgeon General Regina Benjamin, which envisions a prevention-oriented society where all sectors recognize the value of health for individuals, families, and society and work together to achieve better health for all Americans.

>>Read more in our series exploring the National Prevention Strategy, and how each and every sector impacts public health.

NewPublicHealth recently spoke with Acacia Salatti, acting director of the Partnership Center, about their prevention efforts in U.S. communities.

NewPublicHealth: What is the role of the Center for Faith-based and Neighborhood Partnerships?

Acacia Salatti: Our office as is an open door for faith and community stakeholders. We see it as a two-way partnership—our center is able to provide information on health and human services programs, and we are able to gain a deeper understanding about what other types of best practices are happening in the community. We are one of 13 faith and neighborhood partnership offices in federal agencies and we all work to together to help faith and community stakeholders create a positive impact in their communities.

NPH: Why is prevention important to the office and how does the office align with the National Prevention Strategy?

The sixth annual Keeneland Conference begins today in Lexington, Kentucky. Each year hundreds of public health researchers and practitioners meet to share research and translation strategies at the annual conference, is sponsored by the National Coordinating Center for Public Health Services and Systems Research, which is based at the University of Kentucky. This year’s keynote speakers include Paul Kuehnert, MS, RN, senior program officer and director for the Public Health team at the Robert Wood Johnson Foundation; Lisa Simpson, president and CEO of AcademyHealth; and Joe V. Selby, MD, MPH, the first executive director of the Patient-Centered Outcomes Research Institute authorized by Congress.

In advance of the conference, NewPublicHealth spoke with Glen Mays, PHD, MPH, F. Douglas Scutchfield Endowed Professor of Health Services and Systems Research at the University of Kentucky College of Public Health. Mays is also the co-PI of the National Coordinating Center for PHSSR at the University of Kentucky, which is funded by the Robert Wood Johnson Foundation.

NewPublicHealth: What will be some of the key issues at the Keeneland conference this year, both from the plenary podiums and in hallway conversations?

Glen Mays: One area involves looking at the changing roles and responsibilities of health care organizations in the public health enterprise, especially the changing roles of hospitals in helping to deliver public health activities, in part because of new tax incentives for hospitals to be involved and to play a larger role in delivering community benefit services. We have a number of studies taking a look at that issue, as well as other elements of health care reform such as the accountable care organizations that hospitals are playing an important role in and that are part of new health delivery systems. The hospitals are playing roles and engaging public health activities as part of their health care delivery strategy. So there will be a number of studies looking at various angles of hospital and health care system involvement in public health delivery and the larger issue of integration of public health into new health care delivery strategies under health reform, which is a big area.

NPH: How much discussion do you expect about the Affordable Care Act?

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?

While this is the first year that the American Public Health Association has used “return on investment” as the theme for National Public Health Week, which runs through April 7, it’s far from the first time that public health practitioners have made the case to policymakers that the work of public health can save lives and money.

Research on the impact of public health services includes the critical fact that spending just $10 per person in programs aimed at smoking cessation, improved nutrition and better physical fitness could save the nation more than $16 billion a year, according to the Trust for America’s Health. That’s a nearly $6 return for every $1 spent.

Over the last two years, NewPublicHealth has reported frequently on the value of investing in public health. Some of our favorite ROI articles, reports and other resources include:

• >>UPDATE: Trust for America's Health released Investing in America's Health: A State-by-State Look at Public Health Funding and Key Health Facts today. The report examine public health funding and key health facts in states around the country, finding inadequate and cut funding and wide variation in health outcomes by state and county.
  
• Making the Case for Prevention: A Q&A with James S. Marks, Senior Vice President, Robert Wood Johnson Foundation, about the great potential for investing in prevention.
  
• National Prevention Resources Starter Guide:
  A collection of resources that showcase how different fields can work together and take action to prioritize prevention.
  
• Strategies to Move from Sick Care to Health Care: The  Trust for America's Health identifies high-impact steps that the nation can take to prioritize prevention and improve Americans' health.
• Workplace Wellness Perspectives: A Q&A with two very different businesses—one big, one small; one academic, one industrial—on creating healthier workplaces.
• Employers Join Community Health Movement: A Q&A with Trust for America’s Health and the National Business Coalition on Health about the critical role of employers in community prevention efforts.
• Stories of the value of investing in prevention from Wyandotte County, Kan., and Hernando, Miss.

>>Read more on the value of prevention from RWJF.org.

As research builds showing that where you live has a big impact on how healthy you are, organizations and businesses across the country are joining the dialogue on how to create healthier communities. Recently, The Atlantic and GlaxoSmithKline hosted “A Conversation on Community Health”—a series of events in U.S. cities across the country to explore what it takes, to create a healthy community. The series brought together leaders from across different sectors to forge a dialogue across different perspectives.

Jason Q. Purnell, PhD, MPH, Assistant Professor at the Brown School of Social Work and Public Health at Washington University in St. Louis, was a panelist at the St. Louis Conversation on Community Health, along with Jackie Joyner-Kersee and others. Recently, Dr. Purnell shared his vision for community health, and the critical role of broad collaboration across sectors, with NewPublicHealth.

NewPublicHealth: What's your vision of a healthy community? 

Jason Purnell: My vision for a healthy community includes the elimination of health disparities by race and ethnicity and socioeconomic status.  It involves everyone, regardless of zip code or net worth, having the resources to lead full, productive lives.  I follow the World Health Organization in its holistic focus on social, emotional, and physical well-being rather than a more narrow focus on disease prevention.  A healthy community allows everyone in its boundaries to express their full potential; it allows them to participate in the life of the community, in life itself, to the fullest extent possible.   

NPH: Your efforts have included collaboration across psychology, public health, oncology, and primary care. Similarly, the Conversation on Community Health series includes participants from across sectors. Why does public health require such broad collaboration?

Organization and business leaders across the country are realizing that every sector needs to join the fight—or at least the conversation—to create healthier places to live. While altruistic motivations play an important role in this movement, a growing body of research also points to the idea that better health is a major driver for a healthier economy.

Recently, GlaxoSmithKline (GSK) partnered with The Atlantic to host “A Conversation on Community Health”—a series of events in U.S. cities across the country to explore what it means, and what it takes, to create a healthy community. NewPublicHealth checked in with GSK’s Senior Vice President and Corporate Medical Director, Robert Carr, MD, MPH, FACPM, to get his take on why businesses should care about community health, and why a broad, cross-sector dialogue is a critical next step.

>>Read more on communities that were recognized for innovations that are improving the health and lives of their residents, with the 2013 RWJF Roadmaps to Health Prize.

NewPublicHealth: What prompted you and GSK to start thinking about community health?

Dr. Carr: As an HR executive and medical director of a global business, I’m acutely aware that employees are—first and foremost—members of families and communities. The places where they live and the choices made by the people around them profoundly influence the health of our employees. We regularly hear that our employees want to know not only what they can do to lead healthier lives but also what we can do as a company to improve the health of their own community. They want us to dig in and find out what’s needed. Similarly, we recently conducted some research about what Americans are looking for more broadly, and we learned that they want the same thing from GSK.  They want us to do more in their communities.

We heard them loud and clear, and we are digging in, starting with understanding what it means and what it takes to be a healthy community.  Last year we kicked off a program we call “Healthy Communities.”  As part of this attempt to learn more, directly from those on the ground in different American cities, we partnered with The Atlantic for “A Conversation on Community Health.”

NPH: What’s the focus of the “Conversation on Community Health” series?