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?

In recent years many bacteria have become resistant to drugs that commonly vanquished them, depleting a natural resource—antibiotics—that has saved millions of lives around the globe. Using these drugs only when necessary, and using the right drug for the right infection will help ensure that the medications are available and effective when they’re needed.

>>Watch a new, three-minute animated video that tells the story of how antibiotic-resistant “superbug” bacteria have become a serious public health threat that affects everyone. The video frames the problem uniquely: We must treat antibiotics as a natural resource that can be depleted with overuse, just like water, trees, and other resources on which we all depend. The video lays out specific steps that everyone – including doctors, hospitals, and consumers – can take to tackle the problem.

Extending the Cure (ETC), a project of the Center for Disease Dynamics, Economics & Policy based in Washington, D.C., and New Delhi, released the Superbugs video this week, along with a new report on trends in antibiotic resistance.

Last year, the organization also released research showing that certain types of bacteria responsible for causing urinary tract infections (UTIs) are becoming more difficult to treat with current antibiotics. ETC released the research via its online ResistanceMap, an online tool created to track changes in antibiotic drug use and resistance. A new, added feature of the ResistanceMap is ETC’s Drug Resistance Index, a way for non-experts to track changes in antibiotic effectiveness.

This research was funded by the Robert Wood Johnson Foundation. Urinary tract infections account for about 8.6 million visits to health care providers each year, according to the Centers for Disease Control and Prevention. More than half of U.S. women will get a UTI in their lifetime.

“Without proper antibiotic treatment, UTIs can turn into bloodstream infections, which are much more serious and can be life-threatening,” said Ramanan Laxminarayan, director of Extending the Cure (ETC). “These findings are especially disturbing because there are few new antibiotics to replace the ones that are becoming less effective,” says Laxminarayan. 

Read a previous NewPublicHealth interview with Ramanan Laxminarayan about ETC’s research and Drug Resistance Index.

It’s that time of year when public health enthusiasts rejoice and remind the rest of the world why this field is so critical—this is National Public Health Week, a yearly observance since 1995. For 2013, the theme is "Public Health is ROI: Save Lives, Save Money." According to the American Public Health Association, (APHA), a key organizer of the yearly observance, this year’s theme was developed to highlight the value of prevention and the importance of well-supported public health systems in preventing disease, saving lives and curbing health care spending.

In honor of National Public Health Week, NewPublicHealth spoke with Georges C. Benjamin, MD, executive director of the APHA.

NewPublicHealth: Is this the first time that National Public Health Week has focused on the return on investment in public health?

Dr. Benjamin: I think it’s the first time we’ve done so directly. There’s no question that we have always talked about the value of public health and we’ve often talked about savings, but this is the first time we’ve really focused like a laser on that investment.

NPH: What reaction have you seen in states and local communities to this year’s theme?

At this month’s Public Health Preparedness Summit, John Lumpkin, MD, MPH, senior vice president and the director of the Health Care Group at the Robert Wood Johnson Foundation, presented about the National Health Security Preparedness Index. The Index, when completed, will be a single annual measure of health security and preparedness at the national and state levels. The Index will help inform decisions about how to prioritize investments and continual quality improvement of public health preparedness, and will also identify and highlight strengths and novel approaches. With input from many stakeholders, the Association of State and Territorial Health Officials, in partnership with the Centers for Disease Control and Prevention, is coordinating development of the Index.

Prior to joining the Foundation in 2003, Dr. Lumpkin served as director of the Illinois Department of Public Health for 12 years. In an interview at the Summit, Dr. Lumpkin described how the Index will help improve the quality of public health preparedness. He also shared his insights from his first-hand experience in coordinating a sustained response to public health emergencies that extends well beyond the initial response.

NPH: In the aftermath of a disaster such as Hurricane Sandy, how can public health agencies balance their focus on immediate needs such as shelter, food and emergency services, with longer-term challenges such as mental health, housing solutions and resilience?

Dr. John Lumpkin: While the immediate impact of homes being destroyed, people being forced to relocate and lives being lost, is devastating—there is also an ongoing public health impact of a disaster such as Hurricane Sandy, which is tremendous.

>>Watch a video on the ongoing public health response to Hurricane Sandy.

The Aspen Institute’s Justice and Society Program, with funding from the Robert Wood Johnson Foundation, is accepting applications for a new project, the Excellence in State Public Health Law program. 

The one-year program will bring together and provide resources to teams in eight states to work together to address their respective public health priorities, such as tobacco control and disaster preparedness. At the program’s conclusion, each team member will be recognized as a Fellow in the Excellence in State Public Health Law Program.

>>Apply here for the Excellence in State Public Health Law program, and join a web conference the program hosted by the Aspen Institute on Wednesday February 20 from 1-2 pm EST.

As the application process begins, NewPublicHealth spoke with Meryl Chertoff, JD, Director of The Aspen Institute’s Justice and Society Program, and program director of the Excellence in State Public Health Law Program, and Leah Devlin, DDS, MPH, former health official of North Carolina and a past president of the Association of State and Territorial Health Officials, who is a consultant to this program.

NewPublicHealth: Tell us about the program.

Meryl Chertoff: The post-Affordable Care Act period is an excellent opportunity to focus on public health innovation through state legislative and regulatory activities. The goal of the program is to provide key people working in public health law with additional tools, networks and opportunities to share best practices and innovations in their state.  Especially in a time of economic shortfalls, we have to do more with less. We have to support legislators, advisors to governors and relevant agency officials in their ongoing efforts to use public funds in the smartest way and to build the partnerships that they need in order to effectively leverage the assets that are available to them. We are very much hoping that the initiatives that are undertaken will utilize evidenced-based research in order to improve public health

Leah Devlin: And it’s about building partnerships, which is important in this environment because there are so many new governors, new legislators, and new state health officials. We have our biggest health gains when we develop a sound health policy. So bringing together these high level leaders within a state who may be working together on a public health issue for the first time will be a very powerful approach.  It is important to note that the teams can also include local health directors who are also critical players for successful health policy development in states.

NPH: Who will be part of the teams?

Creating a healthier community takes partners from all different sectors—transportation, planning, social services and more. But public health isn’t always top of mind for those with so many different competing priorities. Effectively combating obesity, diabetes and other critical issues requires showing potential partners that while they might see issues differently, their goals overlap. That means listening to their needs and reshaping the message.

NewPublicHealth spoke with Eliza Lawson, MPH, Program Manager for the Initiative for a Healthy Weight in the Rhode Island Department of Health, about the Healthy Communities Plan and her efforts to bring diverse partners to the table.

NewPublicHealth: Tell us a little about how you approached the obesity conversation so you could help to get other sectors on board in creating a healthier community in Rhode Island.

Eliza Lawson: We definitely started by talking to other people from our own perspective around obesity. We knew we had to work with some more nontraditional partners, people in transportation and planning, people working in environmental stuff. I feel like people were receptive to what we were saying, but never really thought there was a mutual benefit in working together. It was more “that sounds good, that is something we support”—but never any clear link on how the two are tied together.

Over a couple years we started to realize that obesity was our issue—it wasn’t their issue—so we said we were going to try to re-approach this. So we picked a couple partners and did some research to see what they were working on—and we started to morph. We still talked about obesity, but we tried to reframe it a little. Finally I was asked to present at a Smart Growth conference and when I saw all the other presentations, I figured I would just frame it around Smart Growth as everyone else was doing. I remember doing a chart that showed “what you say and what we do” kind of things. You are working on an initiative to get people out of their cars for environmental reasons, and we are doing an initiative to get children to walk to school because it burns calories and it is physical activity that’s good for their health. We are both kind of working on the same thing here and here is a way that we can work together on this.

NPH: Tell us about the healthy communities plan. What were the main goals and strategies, and how does health play a role throughout the whole plan and not just in a specific health section?

During American Heart Month in February 2013, the Heart Truth campaign of the National Heart, Lung, and Blood Institute (NHLBI) will share stories of women taking action to protect their heart.

Today is National Wear Red Day, an observance established in 2003 by the American Heart Association (AHA) and the National Heart Lung and Blood Institute [of the National Institutes of Health], to encourage women to take preventive actions against heart disease, the number one killer of women in the U.S. Why the focus on women? Until then, and still today, the myth persists than heart disease is a problem strictly for older men.

Successes since the first National Wear Red Day include:

• 21% fewer women dying from heart disease
• 23% more women aware that it's their No. 1 health threat
• Education on gender-specific differences in symptoms and responses to medications and guidelines for prevention and treatment
• Legislation to help end gender disparities

The most recent update on flu activity in the U.S. from the Centers for Disease Control and Prevention finds 47 states showing widespread activity, down from 48 states the week before. “Widespread” means that more than half of the counties in a state are reporting flu activity. While the Western part of the country will likely see more cases, flu seems to be slowing some in the South, Southeast, New England and the Midwest—though still packing a punch in terms of illness, deaths, emergency room visits and hospital admissions.

NewPublicHealth spoke with Paul Etkind, MPH, DrPH, MPH, DrPH, Senior Director of Infectious Diseases at the National Association of County and City Health Officials about the role local health departments play in educating communities about flu prevention and helping to facilitate treatment.

NewPublicHealth: What, if anything, is different about the flu this year?

Paul Etkind: The flu severity that’s being experienced, which we haven’t seen for several years now, has gotten the public’s attention and they’re really heeding the public health urgings, communication and education that’s been going on all along saying hey, get your flu shots, protect yourself. So now, within a relatively short period of time, there’s a very large demand for flu shots.

During the H1N1 outbreak of a few years ago, there was much greater funding for what the health departments were doing. I saw some magic happening then. They had the funds to hold clinics in very unusual places, such as local baseball stadiums and airports. They went to places where people are most comfortable.

Two new studies published this week in the New England Journal of Medicine found that smoking remains a very serious public health problem in the United States, but smokers who quit between the ages of 25 and 34 regained nearly the same life expectancy as people who had never smoked.

The study on life expectancy (21st-Century Hazards of Smoking and Benefits of Cessation in the United States) found that, on average, smoking reduces a person's life expectancy by at least 10 years. But smokers can significantly extend their life expectancy by quitting. Those who quit between the ages of 25 and 34 lived about ten years longer than people who didn’t quit. Those who quit between 35 to 44, 45 to 54, and 55 to 64 gained 9, 6 and 4 years of life, respectively.

A second study, on smoking and mortality rates in the United States (50-Year Trends in Smoking-Related Mortality in the United States), found that death rates among female smokers — previously shown to be lower than those of male smokers — have increased and are looking similar to those of men for lung cancer, chronic obstructive pulmonary disease (COPD) and other tobacco-related diseases. The study authors say research has shown a rise in similar smoking patterns among men and women since the 1960s. The second study also found that the death rate from COPD continues to rise among both male and female smokers, while there has been a significant decrease in COPD risk among men who never smoked.

"A plausible explanation for the continuing increase in deaths from COPD among male smokers is that cigarettes marketed since the late 1950s have undergone design changes that promote deeper inhalation of smoke,” according to the researchers, who also note that cigarette design changes may have contributed to an increase in one form of lung cancer (called peripheral adenocarcinomas).

According to the Campaign for Tobacco-Free Kids, tobacco use kills more than 400,000 Americans and results in health care costs for the United States of $96 billion in health each year.

NewPublicHealth spoke with Danny McGoldrick, Vice President for Research at the Campaign for Tobacco-Free Kids, about the new studies.

NewPublicHealth: What’s most important about these two new studies?

Danny McGoldrick: I think they really point out, once again, just how devastating smoking is to smokers. The average smoker loses more than ten years from their lifetime and we know that it causes all of these horrible diseases, so the studies quantify, yet again, just how devastating smoking is to health.

The keynote address at last week’s 2013 Public Health Law Research (PHLR) annual meeting was from Pamela Hyde, JD, administrator of the federal Substance Abuse and Mental Health Services Administration.

“People are just beginning to wake up to the knowledge that behavioral health [issues are] so common and that half of all Americans have a mental health issue at sometime in their lives,” Hyde told meeting attendees. Depression, according to the World Health Organization, is the most common medical disorder worldwide. And among the eight million people in the past year who had a mental illness or a substance abuse disorder, only 6.9 percent received treatment.

“The country has to spend as much time helping children develop their emotional skills as they do their soccer skills,” said Hyde.

Just prior to the PHLR meeting, NewPublicHealth spoke with Administrator Hyde about public health law research and some new initiatives aimed at helping address behavioral health in the United States.

NewPublicHealth: What research is critically needed on mental health issues to help improve awareness and treatment?

Pamela Hyde: Often people don’t think of behavioral health as part of the larger public health message or initiatives or infrastructure in the country and so they don’t think about mental health research when they think about other kinds of public health research. But you can think about behavioral health needs in the same way. It is just important to protect people from lost hope as it is to protect them from bacteria in the water.