Sep 19 2014
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Faces of Public Health: Q&A with Joshua Sharfstein, MD

Faces of Public Health Joshua Sharfstein

In the last few months, several prominent national and state public health leaders have announced plans to move on to new things, including David Fleming, MD, MPH, the former Public Health Director in Seattle & King County Washington, who NewPublicHealth spoke with last month. We also recently spoke with Joshua Sharfstein, MD, secretary of Maryland’s Department of Health and Mental Hygiene, who will leave his post at the end of the year to teach at the Bloomberg School of Public Health at Johns Hopkins University as part of the faculty of the School of Health Policy and Management.

Earlier this year, Sharfstein gave the commencement address at the graduation ceremony of the University of Maryland School of Public Health, and had this to say about the importance of ensuring the public’s health:

“The premise of public health is that the well­being of individuals, families and communities has fundamental moral value. When people are healthy, they are productive, creative and caring. They enjoy life and have fun with their friends and families. They strengthen their neighborhoods and they help others in need. In short, they get to live their lives.”

NewPublicHealth: What prompted you to move to academia at this point in your career?

Joshua Sharfstein: It's a chance to help train hundreds of new public health leaders as well as work in depth on issues that are important to me. I am especially looking forward to getting to work closely with so many talented faculty at the Johns Hopkins Bloomberg School.

NPH: How have your research and teaching skills benefitted from your time as deputy director of the U.S. Food and Drug Administration (FDA) and your position with the state of Maryland?

Sharfstein: I've seen a lot of public health in action at the local, state and federal level. My goal will be to show students how important, interesting, engaging and—at times—strange public health can be. I have a research interest in why certain policies are pursued and others are not—and how public health can be successful in a difficult political and economic climate.

Read more

Sep 19 2014
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Public Health News Roundup: September 19

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EBOLA UPDATE: Sierre Leone on Three-Day Lockdown
(NewPublicHealth is monitoring the public health crisis in West Africa.)
Today the nation of Sierra Leone began a three-day lockdown in an effort to slow the spread of the Ebola virus. "Today, the life of everyone is at stake, but we will get over this difficulty if all do what we have been asked to do," said President Ernest Bai Koroma. "These are extraordinary times and extraordinary times require extraordinary measures." The ongoing outbreak has so far killed at least 2,630 people and infected a total of 5,357 people. Read more on Ebola.

FDA Revises Proposed Rules to Prevent Foodborne Illnesses
Taking into account the public comments stemming from its extensive outreach, the U.S. Food and Drug Administration (FDA) has issued revisions to four proposed rules designed to promote food safety and help prevent foodborne illness. The rules include produce safety, preventive controls for human food, preventive controls for animal food and the foreign supplier verification program. “Ensuring a safe and high-quality food supply is one of the FDA’s highest priorities, and we have worked very hard to gather and respond to comments from farmers and other stakeholders regarding the major proposed FSMA regulations,” said FDA Commissioner Margaret A. Hamburg, MD, in a release. “The FDA believes these updated proposed rules will lead to a modern, science-based food safety system that will better protect American consumers from potentially hazardous food. We look forward to public comment on these proposals.” Read more on food safety.

CDC: Too Many Americans Don’t Receive a Flu Vaccination
At a news conference this morning, U.S. Centers for Disease Control and Prevention (CDC) Director Thomas Frieden, MD, stressed the need for all people ages 6 months and older to be vaccinated for the upcoming flu season. According to the CDC, fewer than half of eligible Americans get vaccinations resulting in unnecessary lost work days, hospitalizations and even death. "It's really unfortunate that half of Americans are not getting the protection from flu they could get," said Frieden, according to HealthDay. More than 100 children died from the flu-relate complications last year, and approximately 90 percent of them were unvaccinated. Read more on influenza.

Sep 18 2014
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New Survey: Americans like Mass Transit

A new report on public transit, Who’s on Board: The 2014 Mobility Attitudes Survey, has good news for developers and planners. The review of transit across the United States by TransitCenter, a New York City-based non-profit aimed at increasing and improving mass transit, finds that Americans across the country think about and use public transit in remarkably similar ways. That can result in communities adopting good ideas from other regions—reducing cost and speeding up new and improved transit systems.

“We commissioned this survey to take a deeper look at the public attitudes which are propelling recent increases in transit ridership,” said Rosemary Scanlon, Chair of TransitCenter and Divisional Dean of New York University’s Schack Institute of Real Estate. “As Millennials begin to take center stage in American life and the Baby Boom generation confronts retirement, both the transit industry and the real estate industry will need to adjust.”

The survey—the largest of its kind, according to TransitCenter—reviewed online survey responses from nearly 12,000 people from 46 metropolitan areas across the country, including a mix of what the group refers to as “transit progressive” cities (such as Miami, Denver, Seattle and Minneapolis) and “transit deficient” cities (such as Tampa, Dallas, Fresno and Detroit.)

Among the findings:

  • When choosing whether or not to take public transportation, riders of all ages and in all regions place the greatest value on factors such as travel time, proximity, cost and reliability, putting them above safety, frequency and perks such as Wi-Fi.
  • There is a high demand for quality public transportation nationwide, but such infrastructure is often missing in the places where people currently live.
  • Fifty-eight percent of survey respondents said their ideal neighborhood contained “a mix of houses, shops and businesses,” but only 39 percent currently live in that type of neighborhood.
  • Mass transit attracts the wealthy as well as the poor. In New York City, Philadelphia, Washington, D.C., and Chicago, people with a salary of $150,000 or greater are just as likely to ride public transportation as people with a $30,000 salary.

“There is a desire for reliable, quality transportation in communities across all regions of the U.S., and among riders of all ages, backgrounds and financial status,” said David Bragdon, Executive Director of TransitCenter. “Unfortunately, this desire is largely going unmet, to the detriment of many local economies. To serve and attract residents and workforces today and in the future, cities need to unite land use and transit planning to form comprehensive, innovative infrastructures that can support this demand.”

The report is based on an online survey that TransitCenter plans to update regularly. Bragdon said that one innovation is the increased number of transit options in suburban areas for people who don’t plan to move to the city, but who still want some of the conveniences of city life. Daybreak, Utah, a suburb of Salt Lake City, for example, now has a buses, light rail stations, sidewalks and bike lanes. Planners say Daybreak took a “transit first” approach to new community development rail stations.

According to Bragdon, the survey will be updated and conducted regularly to track changes in transit rider attitudes and regional trends over time.

Sep 18 2014
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Public Health News Roundup: September 18

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EBOLA UPDATE: Death Toll to at Least 2,622
(NewPublicHealth is monitoring the public health crisis in West Africa.)
The World Health Organization announced today that the Ebola outbreak in West Africa has now claimed at least 2,622 lives and infected at least 5,335 people. "The upward epidemic trend continues in the three countries that have widespread and intense transmission—Guinea, Liberia and Sierra Leone," the global health agency said in a statement, adding that the disease’s spread through Liberia is in large part due to an increasing number of cases in the capital of Monrovia. Read more on Ebola.

HHS to Sponsor the Development of a Portable Ventilator for Use in Public Health Emergencies
The U.S. Department of Health and Human Services (HHS) is sponsoring the development of a next-generation portable ventilator for use in pandemics and other public health emergencies. The low-cost, user-friendly device will be developed with Philips Respironics under a $13.8 million contract; the project will be overseen by the Biomedical Advanced Research and Development Authority (BARDA) within the HHS Office of the Assistant Secretary for Preparedness and Response. “In pandemics and other emergencies, doctors must have medicines, vaccines, diagnostics, and critical equipment such as mechanical ventilators at the ready in order to save lives,” said BARDA Director Robin Robinson, PhD, in a release. Read more on preparedness.

HUD Launches $1B National Disaster Resilience Competition
The U.S. Department of Housing and Urban Development (HUD) is launching a $1 billion National Disaster Resilience Competition to help state, local and tribal leaders prepare their communities for the impacts of climate change and other factors using federal funds. “The National Disaster Resilience Competition is going to help communities that have been devastated by natural disasters build back stronger and better prepared for the future,” said HUD Secretary Julián Castro, in a release. “This competition will help spur innovation, creatively distribute limited federal resources, and help communities across the country cope with the reality of severe weather that is being made worse by climate change.” Read more on disasters.

Sep 17 2014
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Can Idea Sharing Among CEOs Improve Health and Bring Down Health Care Costs?

The Bipartisan Policy Center (BPC) in Washington, D.C., and nine CEOs from leading U.S. companies issued a report yesterday that lays out their ideas for improving individual and community health while reducing health care costs. The report, Building Better Health: Innovative Strategies from America's Business Leaders, shares strategies from all the companies and makes several recommendations:

  • Implement and track the outcomes of corporate health and wellness programs
  • Collaborate on the implementation of community-based programs
  • Improve the health care system by supporting the movement toward transparency and payment and delivery models that are based on outcomes rather than on volume

The CEOs are members of the BPC’s CEO Council and collectively employ more than one million people and provide coverage for over 150 million people. Council participants include McKinsey & Company, Aetna, Johnson & Johnson, The Coca-Cola Company, Verizon Communications, Bank of America, Blue Cross Blue Shield Association and Walgreens Co.

In addition to the report, the council released an interactive website with examples of initiatives the companies have taken to improve individual and community health. Some examples also improve the corporations’ bottom lines, such as Verizon’s partnerships with university research centers to test wireless health monitors that individuals or companies can download and buy through the technology company. However, David Erickson, director of the Center for Community Development Investments at the Federal Reserve Bank of San Francisco, points out that no for-profit company can afford the investments required for improving public health without also being able to see an impact on their own bottom line. Examples include increased sales and greater efficiencies in delivering health care.

For example, Walgreens has increased its share of flu shots given from fewer than one million in 2009 to more than seven million in 2013. While that represents improved income for the company, Walgreens—which has stores within three miles of 63 percent of Americans, 75 percent of African-Americans and 78 percent of Latinos—has also worked with state and federal health officials to publicize and increase immunization initiatives. It has also worked with many third-party payers so that patients are often fully or largely covered for the vaccines, with little or no copayment required. Retail clinics such as those at many Walgreen stores also often improve on current health care delivery, such as being open 365 days a year, unlike most doctors’ offices.

Sep 17 2014
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Public Health News Roundup: September 17

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White House Announces Significant Increase in U.S. Ebola Response
Yesterday, NewPublicHealth reported President Obama’s initial planned response to the ongoing Ebola outbreak in West Africa. The White House has since expanded on the plans. They will include:

  • A military command center in Liberia.
  • A staging area in Senegal to help dispatch personnel and aid to affected communities more quickly
  • Personnel from the U.S. Public Health Service will deploy to a new field hospitals the U.S. is setting up in Liberia.
  • US AID will help distribute home kits with items such as gloves and masks to help reduce the number of Ebola cases.

Read more about Ebola.

Survey Finds Doctors are Overextended or At Capacity for Patients
A new survey of 20,000 doctors by the Physicians Foundation, a non-profit group that works with practicing physicians, finds that 81 percent of doctors say they are over-extended or at full capacity and only 19 percent indicate they have time to see more patients. Forty-four percent of doctors responding say they plan to take steps that would reduce patient access to their practices , including cutting back on patients seen, retiring, working part-time, closing their practice to new patients or seeking non-clinical jobs, leading to the potential loss of tens of thousands of physicians in the United States. The timing of the survey is significant because signup for health insurance coverage under the Affordable Care Act begins in just a few weeks. Read more about access to care.

Number of Smokers Increases in New York City
Earlier this week the New York City Health Department released new 2013 data showing that 16.1 percent of adult New Yorkers are smokers, a significant increase from the city’s lowest recorded adult smoking rate of 14 percent in 2010. For the first time since 2007, there are more than one million smokers in New York City who are at risk of developing a smoking-related illness, including heart disease, stroke, diabetes, emphysema, lung and other cancers, according to the health department. So far, the city does not have strong data to explain the uptick in smoking. Nationally, the U.S. Centers for Disease Control and Prevention estimates that 18 percent of U.S. adults are smokers, down from 20 percent several years ago. However, New York City is often a bellwether for public health issues, and the health experts across the country will be looking to see whether the city’s tobacco control efforts—including a new ad campaign that focuses on both daily and occasional smokers—have an impact on smoking rates. Read more on tobacco.

Sep 16 2014
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Reading, Writing and Hands-Free CPR: AHA Calls for More CPR Training in Schools

The American Heart Association (AHA) is working with dozens of state legislatures this year to develop laws that would add cardiopulmonary resuscitation (CPR) classes to middle or high school curricula. Nineteen states require in-school training for high school students, and more are expected to consider or implement the training in the next few years. In Virginia, for example, Gwyneth’s Law—named for a little girl who went into cardiac arrest and died waiting for an ambulance with no one with CPR training able to step forward to try to help—goes into effect in two years and makes CPR mandatory for high school graduation, unless students are specifically exempted.

The AHA says that by graduating young adults with the knowledge to perform CPR—now taught as a hands-only skill, with no mouth-to-mouth resuscitation so as to keep the emphasis on chest compressions—they can vastly reduce the number of Americans, currently 420,000, who die of cardiac arrest outside a hospital each year. The numbers are highest among Latinos and African-Americans, according to the AHA, largely because too many members of those communities have not been taught CPR. AHA surveys find that people who live in lower-income, African-American neighborhoods are 50 percent less likely to have CPR performed.

New AHA grants are helping fund the training in underserved areas. A 2013 study in Circulation: Cardiovascular Quality and Outcomes studied several underserved, high-risk neighborhoods to learn about CPR barriers. The researchers found that the biggest challenges for minorities in urban communities are cost (including child care and travel costs), fear and lack of information.

“Our continued research shows disparities exist in learning and performing CPR, and we are ready to move beyond documenting gaps to finding solutions to fix them,” said Dianne Atkins, MD, professor of Pediatrics at the University of Iowa. “School is a great equalizer, which is why CPR in schools is an integral part of the solution and will help increase bystander CPR across all communities and save more lives.”

The AHA has received funding from Ross, the national clothing store chain, for a program called CPR in Schools, which teaches hands-free CPR to seventh and eighth graders. As a way to increase training for minority students, AHA is partnering local Ross stores with nearby public schools where at least 50 percent of students receive free or reduced lunches.

>>Bonus Links:

  • Read a NewPublicHealth story about a pilot kiosk CPR trainer to teach hands-free CPR in the Dallas/Fort Worth Airport. The pilot program will expand to other locations in 2015.
  • Watch hands-only CPR training videos from the American Heart Association. Tip: First learn to hum “Staying Alive” by the Bee Gees. The beat is almost precisely the rhythm needed for effective CPR chest compressions. 
Sep 16 2014
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Public Health News Roundup: September 16

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EBOLA UPDATE: Obama to Commit as Many as 3,000 Troops to Epidemic Response
(NewPublicHealth is monitoring the public health crisis in West Africa.)
President Obama will today announce an expansion of military and medical resources that could send as many as 3,000 people to West Africa to help combat the ongoing Ebola outbreak. According to The New York Times, the United States will help train health workers and build as many as 17 Ebola treatment centers, which will house approximately 1,700 treatment beds. The U.S. Department of Defense will also open a joint command operation in Liberia in order to coordinate an international response to the outbreak. Read more on Ebola.

Report: 1 in 9 People Worldwide are Chronically Undernourished
An estimated 805 million people in the world are chronically undernourished, according to a new report, The State of Food Insecurity in the World 2014, from the Food and Agriculture Organization of the United Nations. While that means that approximately one in every nine people are undernourished, the number is down more than 100 million over the past decade and 209 million since 1990-1992. In the past two decades the prevalence of undernourishment has also dropped from 23.4 percent to 13.5 percent in developing countries. According to the health agency, the eradication of hunger requires a sustained political commitment that emphasizes food security and nutrition. Read more on global health.

SAMHSA: Percentage of Youth Using Illegal Drugs is Down Over the Past Decade
The percentage of U.S. teens using illegal drugs is down over the past decade, according to a new study from the Substance Abuse and Mental Health Services Administration’s (SAMHSA). The report, the 2013 National Survey on Drug Use and Health, found that the rate of illicit drug use in the past month for adolescents ages 12-17 was 8.8 percent, down from 9.5 percent in 2012 and 11.6 percent in 2002. From 2002 to 2013, the percentage of youth in that age group with a substance abuse or dependence problem dropped from 8.9 percent to 5.2 percent. “This report shows that we have made important progress in some key areas, but that we need to rejuvenate our efforts to promote prevention, treatment and recovery to reach all aspects of our community,” said SAMHSA Administrator Pamela S. Hyde, in a release. “The real lives represented by these statistics deserve our protection and help from the ravages of substance use disorders. Through a comprehensive, national effort we can help people avoid, or recover from substance use problems and lead, healthy, productive lives.” Read more on substance abuse.

Sep 15 2014
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Recommended Reading: Some Drugs—Especially Oncology Medicines—Have Been in Short Supply for Too Many Years

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Health Affairs and the Robert Wood Johnson Foundation recently released an issue brief on the continuing shortages of certain drugs, most frequently injectable drugs for cancer treatment. According to the issue brief, there have been fewer reports of newly unavailable drugs in the last few years, but problems remain, forcing many patients to skip some treatments or sometimes opt for a less-effective drug. U.S. Food and Drug Administration (FDA) updates on drug shortages in just the first two weeks of September found sixteen injectable drugs in short supply, two of them new to the list.

Recent Government Accountability Office reports have found several reasons for the shortages, including:

  • Difficulty acquiring raw materials
  • Manufacturing problems
  • A loss of drug products when factories are updated and modernized
  • Low reimbursement by Medicare and other government payment programs
  • FDA regulations that may slow down new drug approvals

The authors of the issue brief say that it is unlikely that Congress will act, and that the industry has and will make changes likely to help bolster some supplies. Also, thorough reviews such as the current issue brief help remind policymakers that some drug shortages remain.

Read the full issue brief.

Sep 15 2014
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Public Health News Roundup: September 15

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EBOLA UPDATE: Obama to Announce New Ebola Plan Tomorrow
(NewPublicHealth is monitoring the public health crisis in West Africa.)
President Obama is expected to make an announcement tomorrow detailing the United States’ increased involvement in combatting the Ebola outbreak in West Africa. The plan would likely involve an increased U.S. military presence; the government has already committed approximately $100 million related to protective equipment for health care workers; food; water; and medical and hygiene equipment. More than 2,400 people have so far died in the outbreak. Read more on Ebola.

HHS: $295M to Expand Health Services for 1.5M New Patients
Late last week, the U.S. Department of Health and Human Services (HHS) announced $295 million in funds to enable 1,195 health centers across the country to hire approximately 4,750 new staff, stay open later and expand their services to cover areas such as oral health, behavioral health, pharmacy and vision services. The funds are available through the Affordable Care Act. HHS estimates that this will help 1.5 million new patients. “These funds will enable health centers to provide high-quality primary health care to more people including the newly insured, many of whom may be accessing primary care for the first time,” said HHS Secretary Sylvia M. Burwell, in a release. Read more on the Affordable Care Act.

Study: 11 Million Unnecessary Antibiotic Prescriptions for Kids Annually
Physicians prescribe antibiotics for kids approximately twice as often than they are needed, contributing to the growing problem of antibiotic resistance, according to a new study in the journal Pediatrics. Researchers analyzed a selection of studies published between 2000 and 2011, as well as data on children examined at outpatient clinics, finding that an estimated 27 percent of U.S. children with infections of the ear, sinus area, throat or upper respiratory tract had illnesses caused by bacteria, yet antibiotics were prescribed for approximately 57 percent of these visits. They estimate that there are more than 11 million such unnecessary prescriptions for kids each year. Read more on prescription drugs.