The American Public Health Association (APHA) is currently accepting applications through April 8 for the association’s one-year Public Health Fellowship in Government. Fellows work in a congressional office on legislative and policy health issues. The position gives Fellows the opportunity to learn about the legislative process in Washington, DC, which can be a critical skill once they return to their positions in public health, since policies are an important tool that can be used to protect Americans and their communities from preventable, serious health threats.  And it also allows Fellows to provide critical input, drawing on their knowledge and experience, on the decisions that impact public health at the national policy level.

To get some background on the role of a Fellow and the impact that public health practitioners can have when working in the national policy arena, NewPublicHealth recently spoke with Fern Goodhart, current legislative assistant to Senator Tom Udall (D-New Mexico), who spent the tenure of her fellowship working in the office of Senator Robert Menendez (D-New Jersey). Ms. Goodhart was the first person awarded the APHA policy fellowship and served in 2007-2008.

NewPublicHealth: What was your background before you took the fellowship?

Fern Goodhart: I have worked in public health for 30 years including at a state health department; as director of health education at an ambulatory center; as a medical school instructor; as a member of an autonomous board of health; and as a member of my city council. So I’ve had the opportunity to see how policy was made on the local level and the state level. What brought me to the APHA Fellowship was the desire to see firsthand how policy was made at the federal level.

NPH: What kind of work did that involve?

CDC Vital Signs: 1 in 5 Teen Births is a Repeat Birth
Although teen births have fallen over the past 20 years, nearly one in five is a repeat birth, according to a Vital Signs report from the U.S. Centers for Disease Control and Prevention (CDC). More than 365,000 teenage girls ages 15-19 years gave birth in 2010, and almost 67,000 (18.3 percent) of those were repeat births. A repeat birth is a second (or more) pregnancy resulting in a live birth before the mother turns 20. “Teen birth rates in the United States have declined to a record low, which is good news,” said CDC Director Tom Frieden, MD, MPH. “But rates are still far too high. Repeat births can negatively impact the mother’s education and job opportunities as well as the health of the next generation. Teens, parents, health care providers, and others need to do much more to reduce unintended pregnancies.” Data from CDC’s National Vital Statistics System show that repeat teen births in the United States decreased by more than 6 percent between 2007 and 2010. Despite this decline, the number of repeat births remains high and there are substantial racial/ethnic and geographic differences. Repeat teen births were highest among American Indian/Alaska Natives (21.6 percent), Hispanics (20.9 percent), and non-Hispanic blacks (20.4 percent), and lowest among non-Hispanic whites (14.8 percent). Read more on maternal and child health.

Health Impact Project Announces Eight New Funded Projects
The Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts, has recently added eight more grantees who will receive funding to conduct health impact assessments, or HIAs. The projects will bring health considerations into upcoming decisions on topics including education, sanitation infrastructure, and energy. “Our new grantees will use health impact assessments to uncover opportunities to improve health in a wide range of policy decisions, as well as to identify and avoid potential unintended consequences,” said Aaron Wernham, MD, director of the Health Impact Project. “These eight HIAs are the latest in a fast-growing field, as more cities and states find them a useful way to bring health into decisions in other sectors.” By the end of 2007, there were 27 completed HIAs in the United States. There are now more than 225 completed or in progress, according to the Health Impact Project map of HIA activity in the United States. Read more on health impact assessment.

Post-ER Visit for Chest Pain Reduces Heart Attack Risk
Seeing a doctor within a month of an emergency room visit for chest pain significantly reduced the risk of a heart attack or death among high risk patients, according to a recent study in the journal Circulation. Researchers analyzed data on 56,767 adults (average age 66, 53 percent men) in Ontario, Canada, who were diagnosed with chest pain in an emergency room between April 2004 and March 2010 and had been previously diagnosed with heart disease or diabetes. They tracked data for a median 3.7 years and accounted for differences in key patient characteristics such as age, gender, health status and location. According to the study, only 17 percent of high risk chest pain patients seen in the emergency room were evaluated by cardiologists within a month; 58 percent saw a primary care physician and 25 percent had no physician follow-up within a month. Patients who followed up with a cardiologist within 30 days were 21 percent less likely to have a heart attack or die within one year, compared with patients who failed to seek additional care within that time. Patients seen by a primary care physician were 7 percent less likely to have a heart attack or die compared to those patients who sought no follow up care. Read more on heart health.

An article in the  New York Times this week looks at the role of health impact assessments (HIAs), a tool that helps policymakers at all levels of government more fully understand the health effects of proposed laws, regulations, programs and projects—from big infrastructure projects to school curriculum development—and craft recommendations that capitalize on opportunities to improve health.

HIAs are a fast growing tool: nearly 225 of the assessments have been completed or are in process across the U.S., according to the Health Impact Project, a national initiative designed to promote the use of health impact assessments as a decision-making tool for policymakers. The Health Impact Project is a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts.

 “People in the public health world and in the business and development world are waking up to the need to get at health care problems and bring down health care costs,” says Aaron Wernham, MD, MPH, director of the Health Impact Project, in the New York Times article. “So we see a fair amount of uptake in certain sectors — the health impact assessment is out there and growing.”

Growth of the tool is also well indicated by last year’s sold out Inaugural National Health Impact Assessment Meeting. Registration has just opened for the second National Health Impact Assessment Meeting, to be held in Washington, D.C., September 24 and 25, 2013.

The meeting will bring together policymakers, public health professionals,  HIA practitioners; community-based organizations; researchers and decision makers from non-health agencies all who may use  or rely on the results of  HIAs in the fields of planning, transportation, housing, agriculture, energy, environment, and education.

The health upside to a new casino can be the increased quality of life and life expectancy associated with new jobs. But, it can bring health downsides too, including the fallout associated with gambling addiction. Those are some of the key findings in a new health impact assessment (HIA) from the Kansas Health Institute (KHI), released this week. The HIA was funded by a grant from the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and the Pew Charitable Trusts, and conducted by KHI together with the University of Kansas School of Medicine-Wichita.

“Our first HIA intended to inform the discussion of potential casino development…” says Robert F. St. Peter, MD, who is KHI’s chief executive officer. “In many cases,” says St. Peter, issues like these may not seem to have direct connections to health, making them a good fit for [a] health impact assessment.”

The results of the new HIA suggest that there may be positive impacts of casino development related to new jobs; the negative impacts would be related to increases in pathological gambling, which is also associated with nicotine dependence, substance abuse, depression, insomnia, and domestic violence. The HIA offered recommendations including:

• Train physicians to screen for problem gambling behaviors
• Eliminate smoking within and around casino buildings
• Strengthen local services to treat and prevent gambling addictions and related conditions
• Operate a “safe ride” program for patrons and residents
• Use a “loss limit” strategy to prevent substantial financial losses among casino visitors

Read a recent NewPublicHealth interview with Tatiana Lin, KIH senior analyst and strategy team leader, who was the director of the Casino HIA. 

The Network for Public Health Law will sponsor the 2012 Public Health Law Conference, with the theme “Practical Approaches to Critical Challenges,” from October 10 through 12, 2012, in Atlanta. Follow NewPublicHealth during the conference for interviews and session updates. Goals of the conference include:

• Examining practical legal approaches to address priority public health issues
• Learning about helpful public health law resources and evidence-based research
• Discussing public health legal questions and answers
• Building partnerships to accomplish public health objectives and foster innovation

 According to the Network, target audiences for the conference include attorneys, local, state, tribal and federal public health officials and practitioners, policy-makers, advocates and academics and researchers.

NewPublicHealth spoke with Dan Stier, director of the Network for Public Health Law about the Network’s accomplishments since its founding two years ago, and upcoming goals.

>>BONUS: Read our earlier Q&A with Dan Stier, offering a sneak preview of what's to come at the 2012 Public Health Law Conference.

NewPublicHealth:  How much has awareness of the Network grown since you launched in 2010?

Dan Stier: The volume of the requests has grown greatly, as have the complexity and timeliness of the requests. The fact that people are becoming increasingly aware of us means that we really are addressing issues in real time. Dramatic current examples include legal questions on public health services related to West Nile virus and Hurricane Isaac in real time.

>>Read an interview with James Hodge of the Network on legal questions on these and other recent public health crises.

Other requests include longer-term issues like shared services among local health departments. State and local health departments face budget cuts and so they are figuring out ways to do things more efficiently and economically, and oftentimes, that involves shared service agreements between local health departments. We’ve seen much more activity along those lines. More recently we’ve gotten an increasing number of questions on maternal and child health, particularly with respect to the provisions relating to children in the Affordable Care Act, so we now advertise that as another area of specialty.

NPH: How have people become aware of what the Network offers? 

Quebec will be the host city of the 12th HIA International Conference this week, the first time the meeting will be held in North America.

Quebec is a strong choice as host city. In 2001, the province of Quebec institutionalized health impact assessments (HIAs) by requiring that all laws and by-laws that could have an effect on health be evaluated for their impact. To help develop effective strategy, internal procedures were created at the Ministry of Health and Social Services to respond to requests, as well as HIA guidelines, a research program, and communication tools to help disseminate the HIA outcomes. Over 500 requests for advice have been generated since the requirement was put in place.

NewPublicHealth recently spoke with Alain Poirier, MD, chairman of the HIA meeting’s local organizing committee and the former National Public Health Director and Assistant Deputy Minister in Quebec’s Ministry of Health and Social Services.

NewPublicHealth: How did the 2001 law come about?

Dr. Poirier: The Health Minister at the time had been an official with the World Health Organization and so was well acquainted with the work being done in some European countries on evaluation the impact of laws on health. Our Public Health Act said the health minister “shall” be consulted, not “should” be consulted on any measures resulting from a new law or by-law that could have an impact on health.

And just saying that is not enough. I was made the person in charge in the Ministry of Health and Social Services of taking responsibility for the evaluations with the help of different groups, including academia. We also have a public health institute, the Institute National de Santé Publique du Quebec, which also has a mandate to help evaluate public policies and counsel the health minister about the impact of public policy.

We’ve had a lot of demand to evaluate new proposals, in part because every five years all the ministers in Quebec are required to issue a report on strategic planning. So when we screen the strategic planning we could foresee in advance what is going to be worked on in other ministries.

NPH: What is an example in Quebec of an HIA that was done that has resulted in a change in policy?

The twelfth HIA International Conference held this week in Quebec will be the first to take place in North America. Health impact assessments (HIAs) bring together scientific data, health expertise and public input to identify potential health effects of proposed laws, regulations, projects and programs, providing decision-makers with the information they need to advance smarter policies for safe, healthy, thriving communities.

Alain Poirier, MD, chair of the conference local organizing committee and former minister of health and social services in Quebec says the location provides an excellent opportunity for Americans and Canadians, who have not attended this HIA conference in large numbers previously, to learn what is going on in the field across the world, particularly now that HIA is a burgeoning field in the United States. An updated map from the Health Impact Project, a joint program of the Pew Charitable Trusts and the Robert Wood Johnson Foundation, offers an updated look at HIAs completed or underway in the United States. According to the Health Impact Project, in 2007, there were only 27 completed HIAs in the U.S. but the map now counts 100 completed and more than 200 total HIAs. The built environment is the most popular field for HIAs in the country right now, with over 70 completed or in process, followed by transportation, agriculture and food, natural resources, and food and housing.

The map details some recent critical examples of HIAs in the United States:

Economic Policy: New Hampshire State Budget. An HIA will inform lawmakers on how funding changes in parts of the state budget might affect the health of residents.

Built Environment: San Pablo (CA) Corridor. This HIA addressed the health implications of placing affordable housing units along the San Pablo Corridor, a high traffic transit and retail corridor in Richmond and El Cerrito, Calif.

Housing: Trinity Plaza Housing Redevelopment. This HIA examined a proposed redevelopment project in San Francisco that would demolish an older apartment building with over 360 rent-controlled units, and replace them with 1,400 market-rate condominiums.

>>Recommended Reading: NewPublicHealth frequently covers emerging HIA projects across the country. Read about HIAs that examined the potential health impacts of:

• USDA nutrition standards; regarding impact on both student health and school budgets
• High energy costs and smart metering policies
• Low-income rental housing inspections
• Increased public transportation use
• Casino development

Updating nutrition standards for snacks and beverages sold in school so that they meet the most recent Dietary Guidelines for Americans could help students maintain a healthy weight and support school food service revenue, according to a first-of-its-kind health impact assessment (HIA) released today by the Kids’ Safe & Healthful Foods Project and the Health Impact Project. This is the first HIA completed to inform a new federal rule. The Kids’ Safe & Healthful Foods Project and Health Impact Project are both collaborations of The Pew Charitable Trusts and the Robert Wood Johnson Foundation.

NewPublicHealth spoke with Jessica Donze Black, RD, MPH, project director of the Kids' Safe & Healthful Foods Project, about the HIA findings.

>>Read more on the implications of the HIA for the field in an interview with Aaron Wernham, director of the Health Impact Project.

The snacks and drinks sold in school vending machines, stores and à la carte lines are sometimes called “competitive foods” because they compete with school meals for students’ spending. The U.S. Department of Agriculture (USDA) last issued nutrition standards for competitive foods in 1979, but they mostly covered foods sold in cafeterias at meal times. Since then, says Black, the nutrition environment has changed dramatically, and now there is food sold all over the school throughout the school day. In December of 2010, Congress directed USDA to update those standards, and the proposal is due soon.

The HIA was designed to assess the health impact of the updated nutrition standards, as well as their impact on school and district budgets. According to Black, the HIA found that changing the school environment to make healthier foods more available would change students’ eating patterns, increasing their consumption of fruits, vegetables and low-fat dairy. That change, says Black, could ultimately to lead to less chronic disease.

A first-of-its-kind health impact assessment (HIA) released today by the Kids’ Safe & Healthful Foods Project and the Health Impact Project looked at updating nutrition standards for snacks and beverages sold in school from a perspective of both student health and school budgets. This is the first HIA completed to inform a new federal rule.

NewPublicHealth spoke with Aaron Wernham, MD, MPH, director of the Health Impact Project, about what this HIA represents for the field.

>>Read more on the HIA findings in a Q&A with Jessica Donze Black, project director of the Kids’ Safe & Healthful Foods Project.

NewPublicHealth: Isthis is the first time an HIA has been done on a federal rule?

Aaron Wernham: This is a somewhat new topic for HIA. There have been a number of HIAs of federal agency decisions. So, for example, developing permits for mines and oil and gas activities, but this is the first time that we’re aware of that an HIA has addressed a federal rule-making process.

NPH: Why was HIA the right tool to use in this circumstance?

Aaron Wernham: We advocate for doing an HIA on a decision where it absolutely adds value. There are some decisions for which the health implications may be obvious and are already being addressed, and other decisions where there really aren’t such important health implications. In this case we felt as if some of the health implications were known, or at least suspected as far as the potential nutritional benefits, but there were a lot of questions, such as just what are those benefits and how strong is the evidence for them? So I think that was one reason why we thought the HIA would be very valuable was really to put all of that evidence together into a clear picture to help USDA think through the nutritional benefits for children in setting these standards.

The second question, which really sealed the deal, was the realization that setting nutritional standards is great, but what about the practical challenges that schools may face implementing them? So, HIA was the right tool for this job because it really is a good way to bring the perspectives of the different stakeholders into the picture as well as the best available evidence. The HIA serves to make sure that you’re considering not just what might appear best for health on the face of it, but really a deeper look at the tradeoffs and how to make sure that that ultimate decision is a win/win.

NPH: What implications does this HIA have for the practice of HIAs as a tool to enforce important policy?

Aaron Wernham: I hope and believe that the information in this HIA is going to be useful to USDA as they make their decisions on this rule. But I also think that it’s a pilot to help us understand how do you do HIA well to inform a high level federal regulatory decision? What are the data needs? How do you put together a solid team to do the analysis? What sorts of information are most useful? How do you make sure that all of the stakeholders are collaborating effectively through the process? So I think we’ve learned a lot about that through the process of doing this HIA, and I think that will strengthen the field going forward into doing more HIA work at this level. As the first HIA on federal rule making, we wanted to make sure that it was adequately resourced and done very rigorously.

As a field, we also recognize that there’s really a downside to not considering health when we make many decisions—both small or local decisions and larger federal decisions. The National Research Council, in its review of HIA, said that HIA is valuable because it seeks to correct the fundamental problem of failing to consider health at all in decision making, and even with a lack of perfect data it’s still a valuable tool because it’s better to identify potential health risks and benefits than to ignore them. HIA can really be fit for different purposes and different levels of resources.

The American Public Health Association (APHA) will host a free webinar series this summer on transportation and public health, focusing on key issues including active (non-motorized) transportation and how pediatricians can play critical roles in keeping their patients safe during transport and travel. The first webinar will be held on Wednesday June 13 from 2:00 pm to 3:00 pm EST. Register for the webinars here.

NewPublicHealth spoke with Susan Polan, PhD, associate executive director of APHA, about the upcoming series.

NewPublicHealth: What is the focus of the webinars?

Susan Polan: They are designed to bring real-life, on the ground stories and the most current data on public health and transportation to both public health and transportation professionals. Our research around the country has shown that when a community focuses on these issues and creates an approach to transportation that is not based just on individual car, but is based on the big picture, you have more access for formerly under-served communities, and you’re on a step toward building healthier communities overall.

NPH: What’s your goal with the webinars?

Susan Polan: The goal is for participants to understand how to take some of the beginning steps toward necessary changes in transportation for communities. It's also for them to understand what some of the benefits, seen and unseen, might be. We’ll show data, challenges, obstacles and opportunities so that stakeholders who have an interest in making changes in their own communities are better prepared when they start the planning process.

NPH: The second webinar focuses on the role of pediatricians. Why pediatricians?

Susan Polan: Whenever doctors engage in something which is a little bit outside the normal “how are you feeling?” and “what treatment can we offer?” it does have an impact, and that's true for pediatricians probably most of all. And so, engaging those kinds of opinion leaders and opinion shapers in this debate is critical. This is about helping pediatricians engage in education and policy-making for transportation systems, to help make travel for children and teens, whether they’re the passengers or drivers, much safer. Twenty years ago there were a handful of doctors who were engaged in this and were leading the way, and we are hoping to move this towards the norm rather than the exception.

NPH: And the third webinar looks at health impact assessments (HIAs)?

Susan Polan: Yes, the focus of several health impact assessments recently has been on transportation initiatives, whether it be public transit or safe routes to school or a complete streets approach. The webinar leaders will talk about what we seen in the evaluation when these policies have been put forward, and what the HIAs have shown us are the best practices in potential areas of challenge can make a difference on transportation access inequity.

NPH: Is there a registration deadline for the webinars or can participants sign up until the last minute?

Susan Polan: Depending on where we are in terms of registration, participants can sign in until we no longer have room. And if people are not able to participate in the live webinar, they can access the webinars later on; they will be archived on the APHA site.