Category Archives: Faces of Public Health
People tuning into news coverage of the Dallas Ebola cases have come to recognize David Lakey, the Texas state health officer. Every state has a similar position and those officials are charged with improving population health—from holding immunization clinics to responding to potentially fatal illnesses. The Association of State and Territorial Health Officers (ASTHO) is the professional association of the 50 state health officers. Jim Blumenstock is the chief program officer of ASTHO’s public health practice division. NewPublicHealth spoke to Blumenstock this week about state and federal coordination on Ebola detection and case treatment.
NewPublicHealth: What is ASTHO’s role in dealing with preparedness for Ebola in the United States and with the current cases?
Jim Blumenstock: In a crisis or a public health emergency like we’re experiencing with Ebola, ASTHO’s role principally is to do two things. Number one is to sort of be the glue or the hub that helps pull together the 50 states, the nine territories and the District of Columbia as an integrated, harmonious component of our public health infrastructure. The second feature is to provide a solid interface between federal efforts and state efforts. So, that’s our role with any significant public health issue.
During the H1N1 outbreak several years ago, both ASTHO and the National Association of County and City Health Officials (NACCHO) had key staff embedded in the U.S. Centers for Disease Control and Prevention’s (CDC) Emergency Operation Center because it was recognized that the value of the insight of a national organization that represents all the states and locals was so critical to the federal planning and response process. That was the first time it was done.
We’re on standby to do it and we’re sort of functioning in that capacity right now, but sort of in a virtual or remote area. For example, I’m not today embedded in CDC’s Emergency Operation Center. However, I would say I’m on the phone with them at least six to eight times a day—including last evening—and have had email exchanges already this morning, not only to get information, but also to be part of some planning and problem solving efforts they’ve requested our help on, or a request for our help on state consensus around a strategy or a tactic or an approach on a particular matter.
And our other critical roles are to help our members; to talk to federal public health officials; and to educate and inform the public.
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.
Faces of Public Health: Q&A with Andrea Gielen, the Johns Hopkins Center for Injury Research and Policy
The U.S. Centers for Disease Control and Prevention (CDC) recently awarded $4 million to the Johns Hopkins Center for Injury Research and Policy at the Bloomberg School of Public Health to further fund its work on injury prevention research and policy development. According to the CDC, injuries are the leading cause of death in the United States among people ages 1 to 44, costing the country $406 billion each year. And across the globe, 16,000 people die from largely preventable injuries every day.
“This funding will allow us to advance our work in closing the gap between research and practice in new and innovative ways,” said Andrea Gielen, ScD, ScM, the center’s director. “Whether fatal or non-fatal, injuries take an enormous toll on communities. Our faculty, staff and students are dedicated to preventing injuries and ameliorating their effects through better design of products and environments, more effective policies, increased education and improved treatment.”
The five-year grant will support several innovative research projects on key issues, including evaluating motor vehicle ignition interlock laws, studying universal bicycle helmet policies, testing m-Health tools to reduce prescription drug overdose and evaluating programs to prevent falls among older adults. The center will also continue to offer training and education to public health students and practitioners, as well as to new audiences that can contribute to injury prevention.
NewPublicHealth recently spoke with Gielen about the CDC grant
NewPublicHealth: What are the goals for each of the four research areas for which you’ve received funding?
Andrea Gielen: Each of the four is a full research projects with specific aims. For example, with ignition interlock laws—which are car ignitions that can’t start unless a breathalyzer confirms that a driver is sober—there’s been a little bit of evidence that they reduce alcohol-related motor vehicle crash injuries and deaths, but there are two gaps. There has never been a national study of the impact of these laws, and we don’t know a whole lot about how they’re implemented. What is it about ignition interlock policies and how they’re implemented that’s really related to their impact on reducing fatal crashes?
We want to look at all four projects in the same way: We’ll be looking at barriers and facilitators to how policies that we think are effective are adopted and implemented, and what it is about that adoption and implementation of the processes that make these policies effective.
Last June, the Washington Post held a live event, Health Beyond Health Care, which brought together doctors, bankers, architects, teachers and others to focus on health beyond the doctor’s office. The goal of the Washington, D.C., event—which was co-sponsored by the Robert Wood Johnson Foundation others—was to showcase examples of communities working with partners to create cultures of health.
Healthy Detroit is a shining example. The project is a 501(c)(3) public health organization dedicated to building a culture of healthy, active living in the city of Detroit. It was formed less than a year ago in response to the U.S. Surgeon General’s National Prevention Strategy (NPS.) The NPS offers guidance on choosing the most effective and actionable methods of improving health and well-being, and envisions a prevention-oriented society where all sectors recognize the value of health.
NewPublicHealth recently spoke with Nicholas Mukhtar, founder and CEO of Healthy Detroit.
NewPublicHealth: How did Healthy Detroit get its start?
Nicholas Mukhtar: I was just about to the MPH part of a joint MPH/MD degree and had always wanted to be a surgeon. But as I started living in the city and getting more involved in the community, I really saw a different side of health care, and to me it just became more rewarding to focus on the systemic issues in the health care system, more so than treating people once they already got sick. I’ve now finished the MPH part of my degree, and am starting on my MD degree.
So I started sending out a number of emails to different people and reached out to Dr. Regina Benjamin, then the U.S. Surgeon General, as well as local individuals. And then we established our mission, which was really to build a culture of prevention in the city while implementing the National Prevention Strategy.
Harold W. “Bill” Kohl, PhD, a professor of epidemiology at the University of Texas School of Public Health is in the midst of a three-year appointment to the President’s Council on Fitness, Sports & Nutrition (PCFSN) Science Board. Kohl’s role is to provide recommendations in the areas of program development and evaluation, which is critical to the Council’s mission to engage, educate and empower all Americans across to adopt a healthy lifestyle that includes regular physical activity and good nutrition. During his time at the School of Public Health, Kohl has been researching effective uses of social networking to create demand for healthy lifestyles among youth and working with organizations to promote disease prevention, physical activity and exercise as a health priority.
NewPublicHealth recently spoke with Kohl about the work of the President’s Council.
NewPublicHealth: Is the current mission of the President’s Council different than it was in the past?
Bill Kohl: There has been a shift. The President’s Council started in the 1950s as the result of a small study that suggested that American kids are not as fit as kids in Eastern bloc countries—Russia, primarily. The President’s Council started under President Eisenhower and then President Kennedy’s administrating sought to increase kids’ fitness by doing fitness testing in schools and promoting physical activity and physical education.
That wound its way through the ‘60s and ‘70s. Then in the ‘80s there was a much bigger rush to health-related physical fitness rather than skill-related fitness activities—things that you can actually change and that are related to health outcomes compared to fitness skills you might be born with, such as the ability to run a 50-yard dash.
Then, most recently, the Council has included nutrition in his mission and been renamed.
NPH: How does your background inform your new role?
Kohl: As chair of the science board, my job is to make sure that the President’s Council has the most up-to-date science that’s relevant to its mission and advancing initiatives that are evidence-based.
Late last month, the Bipartisan Policy Center, a think tank based in Washington, D.C., released a new white paper, Teaching Nutrition and Physical Activity in Medical School: Training Doctors for Prevention-Oriented Care, that strongly recommends providing greater training in nutrition and physical activity for medical students and physicians in order to help reduce U.S. obesity rates. The report was jointly published with the American College of Sports Medicine and the Alliance for a Healthier Generation, a nonprofit founded by the American Heart Association and the Clinton Foundation as a response to the growing rate of childhood obesity. The report found that current training for medical professionals and students in nutrition and exercise is inadequate to cope with the nation’s obesity epidemic.
A survey conducted for the new report found that more than 75 percent of physicians felt they had received inadequate training to be able to counsel their patients on changing diet and increasing activity levels. It also found that while some schools have stepped up their performance, fewer than 30 percent of medical schools meet the minimum number of hours of education in nutrition and exercise science recommended by the National Academy of Sciences.
“The health care marketplace needs to place greater value on preventive care,” said Jim Whitehead, Chief Executive Officer and Executive Vice President of the American College of Sports Medicine. “Doing so will provide medical schools with the incentive to train their students accordingly. And it will give medical professionals the leverage they need to address healthy lifestyles with their patients.”
NewPublicHealth recently spoke with Lisel Loy, director of the Nutrition and Physical Activity Initiative at the Bipartisan Policy Center, about the report and about how to improve training for medical professionals on nutrition and exercise.
NPH: What was the idea that propelled you to look into making changing to medical school education?
Loy: Well, the technical launching pad was our June 2012 policy report called Lots to Lose: How America’s Health and Obesity Crisis Threatens our Economic Future. And in that, my four co-chairs recommended a suite of policy changes that would improve health outcomes and lower costs for families, communities, schools and work sites. Within that community context they called out the need to improve training for health professionals—not just physicians but health professionals much more broadly defined than that—in pursuit of the goal of reducing obesity and chronic disease and cutting costs.
So that’s sort of the technical answer to your question. The more philosophical answer is as we as a country shift toward more preventive care, they really saw a gap in the education and training of health professionals in terms of being able to best support improved health outcomes. So that’s how they determined that that belonged in our report as a policy recommendation, and since we put out that report we prioritized a handful of recommendations, one of which had to do with health professional training.
In 2012, a new campus was constructed for the Buckingham K-5 public school in rural Dillwyn, Va., replacing the original middle and high school buildings that had stood since 1954 and 1962.
The Charlottesville, Va., architectural firm VMDO Inc., which constructed the campus, says the sites were transformed into a modern learning campus with the aim of addressing the growing concerns of student health and wellbeing. New facilities include a teaching kitchen; innovative food and nutritional displays; an open servery to promote demonstration cooking; a food lab; a small group learning lounge; scratch bakery; dehydrating food composter; ample natural daylight; flexible seating arrangements; and outdoor student gardens.
The firm took advantage of the school’s natural setting surrounding a pine and oak forest and wove them into the design and construction to showcase the “active landscape.” The school’s project committee and design team worked collaboratively to create a total learning environment in order to support learning both inside and outside the traditional classroom. Each grade level enjoys age-appropriate outdoor gardens and play terraces, which encourage children to re-connect and spend time in their natural surroundings. Inside the schools, in addition to core classrooms, each grade level has small group learning spaces that transform pathways into child-centric “learning streets” that have soft seating and fun colors that communicate both collaborative and shared learning experiences.
To study the impact of the healthy design features, VMDO teamed with Matthew Trowbridge, MD, MPH, an associate professor at the University of Virginia School of Medicine, with a special interest in the impact of the built environment on public health to study how health-promoting educational design strategies can support active communities and reduce incidence rates of childhood obesity.
NewPublicHealth recently spoke with Trowbridge about the project.
NewPublicHealth: How did the project come about?
Matthew Trowbridge: Through a collaboration between me and Terry Huang, who was a program officer at the National Institute of Child Health and Human Development and a leader in that institute’s childhood obesity research portfolio. [Editor’s note: He is now a Professor and Chair of the Department of Health Promotion, Social & Behavioral Health University of Nebraska Medical Center College of Public Health.] Back in 2007, Terry had been thinking about how architecture, and particularly school architecture, could be utilized as a tool for obesity prevention. The thinking behind that is that schools have always been a particularly interesting environment for child health very broadly, but also obesity prevention in particular, partly because children spend so much time at school and because the school day provides an important opportunity to help children develop healthy lifelong attitudes and behaviors.
One of the insights that Terry had was that while public health had done a lot to develop programming for school-based obesity prevention, the actual school building itself had really not been looked at in terms of opportunities to help make school-based obesity prevention programs work most effectively. In 2007, Terry actually wrote a journal article outlining ideas for ways in which architecture could be used to augment school-based childhood obesity prevention programs that was published in one of the top obesity journals. When I met Terry at NIH, we realized we both shared an interest in moving beyond studying the association between built environment and health toward real world translation. In other words, providing tangible tools and guidelines to foster collaboration between public health and the design community to bring these ideas into action.
A new climate change report, Risky Business: The Economic Risks of Climate Change in the United States, suggests that the American economy could face significant and widespread disruptions from climate change unless U.S. businesses and policymakers take immediate action to reduce climate risk. The report was released by former New York City Mayor Michael Bloomberg and former Treasury Secretary Henry Paulson.
The assessment of the committee that wrote and reviewed the report is that communities, industries and properties across the country face profound risks from climate change, but that the most severe risks can be avoided through early investments in resilience, as well as through immediate action to reduce the pollution that causes global warming.
The public health findings of the report were reviewed by Al Sommer, MD, Dean Emeritus of the Bloomberg School of Public Health at Johns Hopkins University. NewPublicHealth spoke with Sommer about the report.
NewPublicHealth: How did the report come about?
Al Sommer: The report came about because of the primary interest of the three co-chairs—Hank Paulson, investor Tom Styra and Mike Bloomberg—who felt that there was a need to better understand and better describe the possible public health impacts of climate change on businesses and labor productivity. Their goal is to engage the interest of business leaders so that they begin to think about the ramifications and perhaps see the problems of climate change from a totally different perspective than we usually talk about it.
I think from my own personal perspective that one of the great advantages of this report is that the group that did the analyses stuck with the data and the assumptions, and used sophisticated modeling and statistical analyses to give a range of outcomes. The most important part of the report from my perspective is that it has a granularity that most of the [climate change] reports don’t have, so it looks at likely outcomes in different regions of the country simultaneously.
In some instances, it looks like there is no change. There is reduced mortality in the northern part of the country because there is less freezing. But at the same time in the southern part of the country there’s dramatically increased mortality because of increased heat and humidity.
Earlier this week the American Academy of Pediatrics (AAP) hosted a daylong Symposium on Child Health, Resilience & Toxic Stress in Washington, D.C. that brought together federal government officials, national thought leaders and medical professionals to discuss the emerging science of toxic stress.
According to the AAP, science shows that adversity experienced in childhood has long-lasting physical and emotional effects that have come be known as "toxic stress.” Toxic stress can occur when a child experiences chronic adversity without access to stable, supportive relationships with caring adults. These adverse childhood experiences can include physical and emotional abuse; neglect; exposure to violence; food insecurity; and economic hardship. An AAP 2011 policy statement found that toxic stress can affect a child's brain development and lead to the presence of many adult diseases, including heart disease, cancer, chronic lung disease and liver disease.
“[Currently], there are more randomized trials for leukemia than for effects of stress on children,” said James S. Marks, MD, MPH, senior vice president of the Robert Wood Johnson Foundation, at the symposium. “This is about more than our children—it’s about our future as a people and a society, and the earlier you invest in children the better the return to society and to those children and families.”
During the symposium, the AAP announced the formation of the Center on Healthy, Resilient Children to launch in the next year or so, which will be a national effort coordinated by the AAP and many partners to support healthy brain development and prevent toxic stress. In addition to prevention efforts to keep children healthy, the Center will focus on ways to help pediatricians and others identify children who have experienced adversity and toxic stress and ensure they have access to appropriate interventions and supports.
"Pediatricians envision a world in which every child has every opportunity to become a healthy, successful adult," said James M. Perrin, MD, president of the AAP. "Achieving this will require strong, sustained investments in the health of the whole child, brain and body. It will require building upon our existing work and forging new partnerships across sectors and fields of expertise.”
NewPublicHealth spoke with Perrin following the symposium
NewPublicHealth: How familiar are pediatricians with the evidence surrounding the burden and response to toxic stress in children and families?
James Perrin: I think there is increasing awareness of toxic stress in pediatric practice, not only in community practice, but in our specialty practices, too. I think people are recognizing how critically important toxic stress is to the developing child and developing brain. And the increasing science in this area has been incredibly helpful for us to understand the potential permanent effects of toxic stress. But we also want to focus on positive ways to affect brain development. Reading to children, for example, affects brain development and brain growth in positive ways.
A report from a White House Task Force on sexual assaults on campus several weeks ago found that one in five women have been attacked, but only about 12 percent of the attacks are ever reported, often because of a campus climate that places blame on women and sends messages to men that sexual attacks are manly. The task force is asking colleges and universities to survey their students about sexual assault and other “campus climate” issues, and to track assaults and enforcement of campus policies that govern such assaults.
One idea gaining traction for reducing sexual assaults is called bystander intervention, which not only trains individuals to find safe ways to help prevent assaults, but seeks to change the campus cultures that can condone attacks.
NewPublicHealth recently spoke with Dorothy Edwards, executive director of Green Dot etc., which provides training for high schools and colleges on bystander intervention.
NewPublicHealth: Where does the name Green Dot come from?
Dorothy Edwards: Well, two different ways. I started my career in the field in Texas and for whatever reason for Sexual Assault Awareness Month green was the color of the ribbons. What was more intentional was the “dots” piece. That came out of one of the challenges in mobilizing bystanders to prevention, which is that this issue feels so big. People have been hearing about it for decades and I think there’s a kind of resignation that has settled in. Because when you hear the same number over and over and programs come and programs go and it’s an issue this big, people can just feel that there’s nothing they can do about it. “I’m one person, I can’t change this.”
So, one of the original challenges when we were playing with this idea of bystander intervention and highlighting more the integral role of this kind of third character—apart from victim and perpetrator—was that we knew in order for it to be effective it wasn’t just about skill and knowledge, it was about giving people a sense of possibility, giving people a sense of manageability. And when you say the word dot, a dot is small. So instead of saying we’ve got to change the whole culture, we’ve got to change all college campuses, we’ve got to change sexual assault—which feels so big—we can say to people, gosh, all we need you to actually deal with is a single green dot, a single moment, a single choice. And suddenly something very big feels very small and manageable