Category Archives: ASTHO
Last month at the Association of State and Territorial Health Officials Annual Meeting (ASTHO), attendees focused during one session on the progress made in reducing tobacco death and disease—and the significant room for improvement, as tobacco remains the leading cause of preventable death in the United States.
We caught up with Lawrence Deyton, MSPH, MD, director of the Food and Drug Administration’s (FDA) Center for Tobacco Products at the ASTHO meeting to get his take on the value of tobacco control as a prevention strategy, as well as the role of state and local public health officials.
NewPublicHealth: What did you go to ASTHO to learn, and what did you share?
Dr. Deyton: State health officers are on the front lines of tobacco control. They see the impact in their communities. I went to the ASTHO meeting to both hear from them, and to explain where we are in tobacco regulation at the FDA and to invite the public health community to get more involved in the regulatory process by commenting.
The depth and breadth of my respect for the work state health officers do—and the budgets they have to do it with—is great. We’ll want to see comments from all stakeholders, including folks from ASTHO, on our proposed regulations, because public health officials all have a very important view we’ll want to hear about. They may have the data that could be important to support their recommendations.
NPH: What is the FDA Center for Tobacco Products doing to help prevent tobacco-related death in the U.S., and what do you want public health leaders to know about this work?
Incidents of Smoking Up In Top American Films
For the first time in five years cases of smoking were up in top box office movies in America, according to a new study in Preventing Chronic Disease Journal. The study found approximately 1,900 tobacco “incidents” in 134 films, including movies aimed at the youth market, such as “Cowboys & Aliens,” “Green Hornet” and “The Twilight Saga: Breaking Dawn – Part 1.” “Hollywood has still not fixed this problem,” said lead author Stanton A. Glantz, PhD, a professor of medicine at UCSF and director of the Center for Tobacco Control Research and Education, in a release. “The result of the increase in onscreen smoking in youth-rated films will be more kids starting to smoke and developing tobacco-induced disease.” Read more on tobacco.
ASTHO Report: $2.4 Billion Could Be Cut From FY 2013 Federal Public Health Budget
The Association of State and Territorial Health Officials (ASTHO) released a new report on how the federal sequester scheduled for Jan. 2, 2013, will affect public health. Sequestration is the process of making automatic budget cuts to federal government programs. The sequester was included as a budget reduction enforcement mechanism in the Budget Control Act of 2011. It will take effect in 2013 unless Congress passes legislation to postpone it or finds other ways to reduce the federal deficit. According to the ASTHO report, these cuts could have a significant impact on public health efforts across the country:
- Between 210,000 and 840,000 children and adults would not get vaccines to help prevent hepatitis B, influenza, measles and pertussis outbreaks.
- Approximately 659,000 individuals in the United States would not be tested for HIV due to reductions in the availability of HIV tests.
- More than 750,000 mothers and infants would be cut from WIC.
- Outbreaks of foodborne disease, meningitis, pneumonia, and other conditions would be investigated more slowly or not at all.
Read more news from ASTHO.
Multifaceted Care a Big Help for At-risk HIV Patients
A new study in the journal Clinical Infectious Diseases finds that multifaceted treatment—such as substance abuse treatment, case management and transportation—can improve the health and extend the lives of people with HIV. The 15-year study followed primarily poor, black patients in Baltimore and shows how multifaceted care can help patients get the most out of advanced treatments, according to the study’s authors. "Just like over time we have developed medications that are easier to take, have fewer toxicities and are more effective, I think we've done exactly the same things in our ability to deliver quality care to this particular population," said lead author Richard Moore, MD, to Reuters. Read more on HIV.
Survey Can Help Identify Early Signs of Ovarian Cancer
A two-minute, three-question survey could help physicians and patients identify early signs of ovarian cancer, according to a new study in Open Journal of Obstetrics and Gynecology. The study looked for six symptoms in 1,200 women ages 40 to 87, finding 5 percent had symptoms, of which 60 percent where later diagnosed with ovarian cancer. "Recent research indicates that approximately one in 140 women with symptoms may have ovarian cancer,” said lead author M. Robyn Andersen. “Aggressive follow-up of these symptoms can lead to diagnosis when ovarian cancer can be caught earlier and more effectively treated.” Read more on cancer.
Ruth Ann Shepherd, MD, division director for maternal and child health in the Kentucky Department for Public Health, was an early pioneer in recognizing the critical public health problem of preterm births in Kentucky, and that the troubling trend was common to most states in the country. Dr. Shepherd’s research revealed that babies born at 37 or 38 weeks had far worse health outcomes than babies born at 39 or 40 weeks. With support from the leadership at the Kentucky Department of Health, and many other organizations who have since taken up the cause of helping to create conditions for healthier babies, many states are beginning to make strides in preventing early births. Last week, Dr. David Lakey acknowledged her leadership in preventing preterm birth and infant mortality by awarding her the Association of State and Territorial Health Officials (ASTHO) Presidential Meritorious Service Award.
Charles Kendell, MPA, chief of staff at the Kentucky Health Department, accepted the award on behalf of Dr. Shepherd, who was unable to attend the ASTHO meeting. NewPublicHealth caught up with Kendall to get his take on Kentucky’s role in catalyzing a national movement around healthier babies.
NewPublicHealth: Tell us about the award Dr. Shepherd received and what it was for.
Kendell: The award today was given by David Lakey as President of ASTHO for the last year. The Presidential Meritorious Service Award is given at the ASTHO president’s discretion for those he feels have contributed the most to the President’s Challenge that he or she has championed for the year. This year, he awarded it Dr. Ruth Shepherd, who was one of the early advocates for doing something about the prematurity birth rates in the country.
Dr. Shepherd has long championed that concern, and it was through her efforts that much of the initial data and advocacy and publicity about the issue became apparent to a lot of people. Through the connection of Dr. Shepherd to David Lakey, he was able to put a voice and a voice to the issue through his presidency. It’s really taken off from there, and connected with an awful lot of people.
NPH: What did the data Dr. Shepherd uncovered show?
GUEST POST by Virgie Townsend, JD, associate editor at the Association of State and Territorial Health Officials (ASTHO)
United States Department of Agriculture (USDA) Under Secretary for Food, Nutrition, and Consumer Services Kevin Concannon was recently eating lunch with elementary school students in Louisiana when a first-grader leaned over to him and said, “Sir, if you don’t finish your broccoli, I’ll finish it for you.”
In a session at the recent ASTHO Annual Meeting, Concannon cited this as one example of the progress being made in the fight against the obesity epidemic, applauding schools for creatively modifying their healthy recipes to appeal to kids. USDA aims to ensure that children receive fruits and vegetables at every meal, while still reducing trans fats and sodium in the food, said Concannon. Another school he visited adds a bit of green gelatin to their cups of applesauce—just enough to give the applesauce a hint of color, which makes it a popular lunch choice for the students, a large majority of whom come from impoverished backgrounds.
“Our goal is to ensure that Americans routinely have access to sound nutrition,” Concannon said. “We’re in the midst of an obesity crisis.”
Concannon discussed how USDA’s school lunch and breakfast programs, the Supplemental Nutrition Assistance Program, and WIC are working to create healthier environments by providing children with nutritious food options in schools and at home. He also called the Healthy Hunger-Free Kids Act of 2010 “one of the most significant” recent advances for child nutrition, and said, “We are on the verge of the first major changes to school meals in 15 years.”
>>Read up on a first-of-its-kind health impact assessment on a federal rule that would require updating school nutrition standards for snacks and beverages to meet the most recent Dietary Guidelines for Americans.
Although great strides have been made toward improving Americans’ access to healthy food, Concannon said USDA is seeking a greater partnership with public health leaders to promote wellness in schools.
“We would love to connect even more with [with public health officials] on wellness programs in schools,” he said. “We have huge challenges around obesity.”
He urged state health agencies to engage with schools on the entire wellness message, including promoting fitness at all levels of schooling.
In addition to reaching out to public health leaders at the ASTHO annual meeting, Concannon announced that USDA has begun working on dietary guidelines for children from birth to 2 years of age, which will be the first USDA guidelines to cover that age span. The new dietary guidelines will be released in 2015.
Following Concannon’s presentation, Hawaii Department of Health Director Loretta Deliana Fuddy described her agency’s partnership with the Hawaii Department of Education. She also gave examples of how Hawaii is enacting USDA’s recommendations on child nutrition, including training school cafeteria staff to be more creative in their healthy recipes, promoting breastfeeding, and forging strong relationships with community centers to address health inequities.
Crowds of public health officials thronged Mary Selecky, Secretary of the Washington State Department of Health since 1999 and a former ASTHO president, at the ASTHO annual meeting, likely for her wisdom as a long time health director grappling with some of the most critical problems facing public health.
NewPublicHealth caught up with Mary Selecky at the recent ASTHO meeting.
NewPublicHealth: What is the rest of the country learning from the recent pertussis (whooping cough) outbreak in Washington State?
Mary Selecky: We have more than 4,000 cases confirmed. Sixty percent of cases are in school age kids, 20 percent in adults and 20 percent in kids under age five. The most worrisome statistics are the numbers of babies hospitalized. [Editor’s Note: Babies get whooping cough vaccines at ages two, four and six months and don’t have full immunity until after the last vaccine.] Most adults get a mild case—they don’t know they have it, they have a dry hacky cough and they’re spreading pertussis germs. One of our very fundamental pieces of information is to make sure your kids are vaccinated and up to date, and that teens and adults have gotten a booster shot. We know we’re reaching the public because our insurance companies are telling us that double the amount of people have gotten the booster from last year. We know we’re getting some penetration there, but clearly not enough.
It has not really gone away. We’re still seeing about 100 new cases every week. We are slowing down—it’s a little bit less every week. Nevertheless, 100 cases per week is still ten times more than it was a year ago. We reached out to the CDC to have their epidemiology investigators to come in and look at our data and see what is happening. They were able to show us that our 13- and 14-year-olds are getting hit hardest and many were vaccinated, so we are evaluating when the booster shot was given and how soon after they got pertussis and what we can learn.
We’re seeing more whooping cough in the U.S. than we have seen in multiple decades. Our own numbers are more than we’ve seen since 1941. It’s a bug, easily passed person to person. We do have an effective vaccine but what the CDC is able to glean may indicate that we need to give a booster more often.
NPH: While the CDC investigates, what’s your recommendation as a state health director?
Jose T. Montero, MD, director of the Division of Public Health Services at the New Hampshire Department of Health and Human Services, was elected president of the Association of State and Territorial Health Officials (ASTHO) during the association’s recent annual meeting in Austin, Texas.
Dr. Montero began his medical career in Putumayo, Colombia, where he served as a local, county and state health official. He then went to teach family and preventive medicine and later became Colombia’s public health director. Dr. Montero began his service in New Hampshire in 1999 as chief of the New Hampshire Communicable Disease Section in the Division of Public Health. Before becoming director of the New Hampshire Division of Public Health Services, Dr. Montero was the state epidemiologist. He is an adjunct professor of family medicine and a member of the preventive medicine residency advisory committee at Dartmouth Geisel School of Medicine.
NewPublicHealth spoke with Dr. Montero about the new ASTHO President's Challenge, which will focus this year on the integration of public health and health care.
NewPublicHealth: Why is so critical now to work toward the improved integration of public health and health care?
Dr. Montero: We keep talking about the health system but there is not much that is health-focused—it’s currently mostly about providing care after people becomes ill. From a public health perspective we’re trying to improve outcomes and quality, without spending the amount of money on health that we’re currently spending because we can’t sustain that. The system needs to continue changing and evolving, but we don’t yet know what exactly how it will look or how it should look. We need to create a new system. Based on the experiences of some states, such as Massachusetts and Oregon, we know gaining access to health insurance has expanded use, but we don’t know if they’ve achieved improved health outcomes yet. We’re working toward that. But we need to work on the right indicators that allow us to consistently measure total population health.
When you look across the country, you see that public health entities provide the continuum of care throughout the life cycle. We are already integrating health care and the public health system at several different places and levels, but it’s not consistent. To prepare ourselves for the future, we need to be able to look at public health and health delivery systems and integrate them philosophically. We need to capture examples, decode them, and see what works and what doesn’t and how to use which in different parts of the country. We have different cultures, different investment levels, and different expectations. We can’t just copy and paste.
NPH: What are the critical issues you’re looking at?
What can happen when local partners collaborate to improve community health? In Austin, Texas, one such collaboration between the local YMCA, child safety advocacy group SafeKids Austin, Dell Children’s Medical Center of Central Texas and local elementary schools, has resulted in Project SAFE (Swimming, Aquatics, Fitness Education). The project, a free, two-week water safety and physical activity program for over 3,000 first-graders, includes an introduction to the Y, and its sliding scale fees for the kids and their families, many of whom are from underserved neighborhoods. About 20 percent of the families of kids in the project program returned to the Y facilities after their kids completed the class.We took a detour while in Austin for the ASTHO Annual Meeting to learn more about the Austin YMCA’s programs.
Not all the kids are swimmers by the end of the sessions, but most are comfortable in the water, can float on their back, know the importance of life jackets, recognize a swimmer in trouble and know “it’s not safe to run at the pool,” chime a group that has just finished up a morning lesson. That knowledge can be lifesaving, says Bret Kiester, executive director of the Hays Communities YMCA, one of the participating Y’s hosting the classes.
“Drowning is the leading cause of death in the U.S. for kids under fourteen, and many of these kids have no regular access to pools or the beach,” Kiester. On vacation, Kiester says, families may visit lakes, rivers and pools—and having no familiarity with water is often how accidents happen.
Health promoting hospitals—it sounds like an obvious concept, but a reimbursement-driven focus on treatment rather than prevention actually makes this a somewhat novel idea. Now, the World Health Organization health promoting hospitals initiative incorporates health promotion concepts, values and standards into the organizational culture and daily routines of hospitals around the world. The concept also allows all hospital employees and their families, patients and their families, and community residents to participate in health promotion together.
Taiwan has the largest network of health promoting hospitals in the world, Shu-Ti Chiou, MD, director-general of Taiwan’s Bureau of Health, told state health officers attending the ASTHO meeting. In Taiwan, one-quarter of all hospitals have received status as a health promoting hospital and many more have signed on to cancer screening initiatives that give reminders to patients about certain cancer screenings no matter the primary reason for their hospital or clinic visit.
Examples in Taiwan include a tobacco awareness campaign by the Pingtung Christian Hospital for community residents. Participants who smoked were provided with referrals for counseling services, and the outpatient smoking reminder system kicked into gear every three months to create contact with the smoker and discuss their smoking status or quit plans.
At the Cardinal Tien Hospital in Yung Ho, through the health promoting program of hospital, the rate of women hospital employees aged 30 and above who have had a Pap smear has increased from 30 percent to 80 percent, while those aged 50 and above who received mammography screening has reached 82 percent, thanks to a reminder system in place at the hospital.
In an interview with NewPublicHealth, Dr. Chiou says she has seen individual examples of health promotion at a number of hospitals in the United States, and two health promoting hospital networks are now in place—with three hospitals each—in Connecticut and Pennsylvania, both at early stages of their work.
“No matter the reason for a hospital visit, health promotion is an opportunity during an outpatient or inpatient stay,” says Dr. Chiou.
While so far only 25 percent of beds are in health promoting hospitals in Taiwan, the national cancer screening initiative is in place in 232 hospitals that have installed automatic reminder systems for cancer screening in outpatient services. The hospitals provide screening reminders for four types of cancer: oral, cervical, breast and colorectal. When an oral cancer screening reminder is prompted, health professionals also ask about smoking status “and the next step is to invite smokers to join cessation services,” says Dr. Chiou.
“We have found that many hospitals see the concept as a win/win and are applying for [health promoting hospital] status, and we look forward to meeting more hospital leaders in the U.S. to share the concept,” says Dr. Chiou.
The Office for State, Tribal, Local and Territorial Support (OSTLTS) at the Centers for Disease Control and Prevention (CDC), was launched in 2009 as a central office dedicated to advancing public health at the state and local levels and identifying both gaps and opportunities for collaboration. Judith Monroe, the office's director, spoke to us last year about challenges facing health departments in a tough time. Recently, at the ASTHO Annual Meeting, we had a chance to catch up with Dr. Monroe to hear what she and her office have been up to since we last spoke in the summer of 2011.
>>Read our earlier Q&A with Dr. Monroe.
NewPublicHealth: The focus of the ASTHO annual meeting this year is on the intersection of health care and public health. What efforts is CDC engaged in right now in that intersection?
Dr. Monroe: We’ve been involved in a number of areas. The IOM report on the integration of primary care and public health, was co-funded by the Health Resources and Services Administration and CDC. And CDC had a seat at the table when ASTHO and the IOM came together to develop the strategic map for the integration. We’re excited about that and we continue to be on those calls.
We have an office here at CDC recently created called the Office of Prevention Through Healthcare that is looking at this intersection and where the gains might be, working with the Centers for Medicare and Medicaid Services very closely. And, in addition, our office—the Office of State, Tribal, Local and Territorial Support—has forged a relationship with all of the primary care residency programs across the nation. That’s dear to my heart because I was a residency program director in family medicine for a number of years. We’ve had a number of educational venues taking the science from CDC and packaging it in a way that the residency programs can use. We’re looking toward some quality improvement projects with the residency programs as well as “playing matchmaker” in many ways, between health departments and residency programs. And, I am the point person here at CDC for our relationships between the American Academy of Family Physicians and the American College of Physicians so we have a lot going on. Those are the biggies, but there are many daily activities taking place as well.
NPH: Thank you for that overview. Since you’ve been at OSTLTS, what are some successes that you’d point to?
GUEST POST by Lisa Junker, CAE, director of communications for the Association of State and Territorial Health Officials (ASTHO)
At the opening session of the ASTHO Annual Meeting in Austin, Paul Wallace, vice president of The Lewin Group, pointed toward the need for collaboration and partnership between the health care and public health sectors to overcome key challenges and trends facing the United States at the federal, state and local level.
>>Read our earlier interview with Paul Wallace on public health and primary care integration.
“What are the opportunities to create a shared conversation around prevention?” asked Wallace, who chaired the Institute of Medicine (IOM) Committee on the Integration of Primary Care and Public Health.
He gave attendees an overview of the process his IOM committee underwent to develop the recently-released report “Primary Care and Public Health: Exploring Integration to Improve Population Health.” The committee was charged with identifying the best examples of effective integration and the factors that promote and sustain those efforts, examining the ways federal agencies can use the provisions of the Affordable Care Act to promote integration, and discussing how Health Resources and Services Agency (HRSA) supported primary care systems and state and local public health can promote those efforts moving forward.