One of the most sought-after experts at the second national Health Impact Assessment (HIA) meeting, currently underway in Washington, D.C., is Arthur Wendel, MD, MPH, team lead for the Healthy Community Design Initiative at the U.S. Centers for Disease Control and Prevention (CDC), which is a sponsor of the HIA meeting. Health impact assessments are decision-making tools that help identify the health consequences of policies in other sectors.

NewPublicHealth caught up with Dr. Wendel just after the first plenary session.

NewPublicHealth: How’s the meeting so far?

Arthur Wendel: The first plenary speaker, councilman Joseph Cimperman form Cuyahoga County in Cleveland, was just an outstanding speaker and made such a good impression for the whole conference. When you have a policymaker come in and provide a fresh perspective about how health impact assessments can make a difference, that sets the stage for attendees.

>>Editor’s Note: NewPublicHealth will be speaking with Councilman Cimperman later this week about his championing of HIA work in Cleveland, including a health impact assessment on the city’s budget, the first time the tool has been used that way.

NPH: How long has CDC been involved in health impact assessments?

Arthur Wendel: CDC has been involved with health impact assessments, through the Healthy Community Design Initiative, since 2003. The initiative is part of CDC’s National Center for Environmental Health, and initially we were just kind of trying to figure out the field of health impact assessments, learn a little bit about it from some domestic and international groups that conducted health impact assessments. Some of the initial steps were just trying to provide technical assistance for a few HIAs. That gave us a little bit of flavor for how health impact assessments were done, and from that initial effort we started to compile some research. One of the initial papers that came out of our group was identifying the first 27 HIAs that were conducted in the United States and some of the common characteristics among them.

>>Looking for examples of successful HIAs? Read stories from the field from CDC grantees.

State AGs Urge FDA to Adopt New Regulations Covering E-cigarettes
The Attorneys General of 41 states are urging the U.S. Food and Drug Administration (FDA) to follow through on a pledge to issue regulations that would expand its oversight to include e-cigarettes. In a letter to FDA Commissioner Margaret Hamburg, they asked “the FDA to move quickly to ensure that all tobacco products are tested and regulated to ensure that companies do not continue to sell or advertise to our nation's youth.” The FDA was given authority to regulate cigarettes, cigarette tobacco and roll-your-own tobacco in 2009, as well as the authority to expand its authority after it issued new regulations. Last week a similar plea related to FDA authority was made to President Obama by the American Academy of Pediatrics and 14 other public health organizations, including the American Lung Association and American Heart Association. E-cigarettes continue to increase in sales (a projected $1.7 million in 2013) even while dropping in price. At the same time, there are no advertising restrictions for e-cigarettes. "Consumers are led to believe that e-cigarettes are a safe alternative to cigarettes, despite the fact that they are addictive, and there is no regulatory oversight ensuring the safety of the ingredients in e-cigarettes,” according to the Attorneys General’s letter. Read more on tobacco.

Expert: People Should Get Now-available Flu Vaccine As Soon As Possible
This season’s influenza vaccine is now available and people shouldn’t hesitate to go ahead and get it, according to Stephen Russell, MD, associated professor in the general internal medicine division at the University of Alabama at Birmingham and a lead physician at the university’s Medicine Moody Clinic. This year’s vaccine protects against four types of flu viruses (as opposed to the three of previous vaccines) and comes as either a traditional shot or a nasal spray. "Contrary to some beliefs, getting the flu shot in September is a good thing and will offer protection for the entirety of the flu season," he said. The U.S. Centers for Disease Control and Prevention recommends the vaccine for people ages 6 months and older, particularly for seniors, pregnant women, caregivers and people with chronic medical conditions. "Many people will say they do not need the vaccine, as they have never had the flu before, but that is like saying you don't need to wear your seatbelt because you have never had a wreck," Russell said. "You may have been fine in the past, but that should not offer security or protection for future exposures to the flu." Read more on influenza.

Study: Losing 10 Percent of Weight Can Greatly Reduce Arthritic Knee Pain, Put Off Knee Replacement
Losing just 10 percent of their weight could go a long way toward easing the knee pain from osteoarthritis in overweight and obese people ages 55 and older, according to a new study in the Journal of the American Medical Association. That would mean better knee function, improved mobility, enhanced quality of life…and reducing the odds of needed a knee replacement. "We've had a 162 percent increase in knee replacements over the last 20 years in people 65 and over, at a cost of $5 billion a year," said lead author Stephen Messier. "From our standpoint, we think this would be at least a good way to delay knee replacements and possibly prevent some knee replacements." The study tracked 454 overweight and obese people in three groups—diet-only, exercise-only and a combination—finding that people who did the combination were the most successful at losing weight and thus reducing knee pain. "We're not talking about people getting down to ideal body weight," said Patience White, MD, the Arthritis Foundation’s vice president of public policy and advocacy. "They just have to lose 10 percent of their total weight. Someone who is 300 pounds only needs to lose 30 pounds. I think that's within reach for people." Read more on obesity.

A key panel discussion during the National Health Impact Assessment (HIA) meeting will be on perspectives on health impact assessments with policymakers. Ahead of the meeting, NewPublicHealth spoke with State Representative Denise Provost (D), of Somerville, Mass., who will be one of the panel members.

NewPublicHealth:  How does it value governing, communities and population health by factoring health into policies made in other sectors?

Denise Provost: Governance should always take consideration of health. Legislators should actually embrace the first principle of the Hippocratic Oath, which is “first do no harm.” Sometimes by action or inaction we, as a nation, have pursued policies which we’ve discovered are not so good for health. Some are market forces that end up being reinforced by the actions of government. Looking out for the health impact on the population needs to be part of the long-term view of what we do. The particular discipline of looking at health through a health impact assessment is valuable for government because policy makers are often disparaged by scientists for governing by anecdote and that’s a real danger in the absence of quantitative analysis based on peer reviewed studies. The HIAs I’ve seen employ that kind of methodology.

The value of HIAs to communities is that they will in the long term—and even in the short- or middle-term—enjoy better health and fewer negative health effects from government decisions or government failure to reign in market forces that result in conditions that cause bad health as part of their business model.

NPH: Can you give us examples of HIAs in your community that have been innovative and beneficial?

Provost: We’re still in early days with HIAs but one, as contemplated by our 2009 transportation reform bill, has some fairly groundbreaking language in it that requires our secretaries of transportation, health and the environment to convene regularly and look at healthy transportation projects very broadly. They’re also charged with developing tools such as HIAs for use in the evaluation of transportation projects.

Building on the success of the Inaugural Health Impact Assessment (HIA) meeting held in April 2012, leading HIA stakeholders including the Health Impact Project—a collaboration of the Robert Wood Johnson Foundation and the Pew Charitable Trusts—and the U.S. Centers for Disease Control and Prevention (CDC) convened the second national HIA meeting today, in Washington D.C.

>> Follow the real-time Twitter conversation about the conference with the hashtag #NatHIA13.

>>Follow NewPublicHealth’s coverage of the National Health Impact Assessment meeting on our blog and on Twitter with @RWJF_PubHealth.

An HIA is a tool that helps evaluate the potential health effects of a plan, project or policy before it is built or implemented. It can provide recommendations to increase positive health outcomes and minimize adverse health outcomes. It can also bring potential public health impacts and considerations to the decision-making process for plans, projects and policies that fall outside the traditional public health arenas, such as transportation and land use.

While HIAs have been conducted for decades, their wider use has become more common in just the last few years. According to the Health Impact Project, more than 200 HIAs have been conducted in the United States on issues as diverse as transportation, economic policy and climate change.

NewPublicHealth has created a short HIA resource list with links to background information on health impact assessments.

• Health Impact Assessment posts on NewPublicHealth
• HIA Issue Brief from the Robert Wood Johnson Foundation
• HIA in the United States, a map from the Health Impact Project
• An HIA Infographic from the Health Impact Project
• CDC’s Healthy Places collection of HIA information
• CDC Resource on HIAs and Public Policy Development
• The World Health Organization HIA site

GUEST POST by Virgie Townsend, JD, associate editor at the Association of State and Territorial Health Officials (ASTHO)

About 40 percent of the health care dollars spent in New York State come from Medicaid. Realizing that the rate was climbing far too fast, the state brought together health care advocates, physician representatives, elected officials, management and unions to solve the growing financial issue by addressing the social determinants.

And they were effective. Last year the state saved $4 billion while adding approximately 154,000 people to its Medicaid program.

One of the key figures behind the public health improvements was New York State Health Commissioner Nirav R. Shah, MD, MPH, who last week moderated the panel discussion “Medicaid and Public Health: Improving Partnerships” at the Association of State and Territorial Health Officials’ (ASTHO) 2013 Annual Meeting.

>>Read more in a NewPublicHealth Q&A with Shah.

>>Read more on New York State’s Health Improvement Plan.

>>Follow continued ASTHO Annual Meeting coverage on NewPublicHealth.org.

In addition to Shah, the panel included Vermont Department of Health Commissioner Harry Chen, MD; Executive Director of the National Association of Medicaid Directors Matt Salo; and Chief Medical Officer for Center for Medicaid and CHIP Services Stephen Cha, MD, MHS. Shah and Chen discussed how their states are improving population health through greater integration with Medicaid, while Cha and Salo presented their views from the Medicaid perspective.

Study: 40 Percent of Antibiotics Released from 1980-2009 Withdrawn from Market
Safety concerns, lack of effectiveness when compared to existing drugs and weak sales led more than 40 percent of the antibiotics released between 1980 and 2009 to be withdrawn from the market, according to a new study in the Journal of Law, Medicine and Ethics. The rate was three times as high as that for any other type of drug. “This study raises the question whether or not money would be better spent on higher quality antibiotics, rather than a larger quantity” and whether “approving a flood of new lower-quality antibiotics might actually trigger much higher levels of resistance,” said author Kevin Outterson, JD, LLM, professor at Boston University School of Law and co-director of the Boston University Health Law Program. Antibiotic use can lead to bacteria becoming resistant to a strain. A recent report from the U.S. Centers for Disease Control and Prevention found that as many as 50 percent of prescriptions for antibiotics are either not needed or prescribed inappropriately. Antibiotic-resistant infections sicken more than two million Americans each year, killing more than 23,000 in the process. Read more on prescription drugs.

Locations of Drinking Can Influence Types of Partner Violence
Where and when a person drinks can affect the type of partner violence that can follow, according to a new study from the journal Addiction. The study looked at six drinking locations: restaurants, bars, parties at someone else's home, quiet evenings at home, with friends in one's own home and in parks/other public places. Researchers from the Prevention Research Center in California and Arizona State University found that men drinking in bars and at partners away from home and women drinking in parks/other public places were linked with an increased rate of male-to-female violence. They also found that men drinking during quiet evenings at home was associated with increased female-to-male violence. The findings could help prevent partner violence by encouraging people in risky relationships not to drink in particular places/situations, which could prove more effective than counseling people simply to drink less. Read more on alcohol.

Multiple Myeloma Group Hopes Opening Records to Hundreds of Patients Will Advance Research
The Multiple Myeloma Research Foundation's (MMRF) Researcher Gateway is opening global online access to genetic and research data on hundreds of patients in an effort to help identify biological targets for future treatments, improve enrollment in studies by pairing them with the right patients and enhance researcher collaboration. The MMRF Research Gateway is a $40-million program funding by the foundation and drug company partners. The main component of the effort will be the Commpass study which will enroll 1,000 new multiple myeloma patients and monitor them throughout the course of the disease; cancer tissue banks typically include only one sample per patient. "There is going to be new information generated there that you would never get unless you followed patients through first relapse and second relapse and beyond," said George Mulligan, director of translational medicine for Millennium Pharmaceuticals, Japan's Takeda Pharmaceutical Co.’s oncology unit, which is one of the co-sponsors. "The size of it in patient numbers and the breadth and richness of it on a biological level, it's going to grow over time and mushroom into something that's going to be really special.” About 86,000 people are diagnosed with multiple myeloma each year, with about 20,000 of those from the United States. Read more on research.

GUEST POST by John Skendall, Manager, Web and New Media at the Association of State and Territorial Health Officials (ASTHO).

“How much are we really doing in the area of worksite wellness? Are we walking the talk and serving our employees the way we should?” This question was posed by Paul Jarris, executive director of the Association of State and Territorial Health Officials (ASTHO), in a session on workplace wellness at the organization’s annual meeting last Friday in Orlando.

Jarris said that health departments can do more to foster wellness among employees in the states and territories. “We in public health are not leading in this area,” he said. “We are the laggards.”

>>Follow continued ASTHO Annual Meeting coverage on NewPublicHealth.org.

Terry Dwelle, state health official for the North Dakota Department of Health and moderator of the session, agreed. “Health departments must have a worksite wellness program. We need to practice what we preach,” said Dwelle. He also said that the business case for worksite wellness needs to be made to convince employers of the value of investing in wellness.

UN: Improved Access to HIV/AIDS Treatment Reduces Number of AIDS-related Deaths
The United Nations’ annual report on HIV infections and AIDS related-deaths around the world concluded that increased access to treatment in poorer and middle-income countries has led to positive health outcomes. “AIDS-related deaths in 2012 fell to 1.6 million, down from 1.7 million in 2011 and a peak of 2.3 million in 2005. And the number of people newly infected with the disease dropped to 2.3 million in 2012 down from 2.5 million in 2011.” The executive director of UNAIDS, Michel Sidibé, said that the international community is well on its way to surpass the 2015 goals of expanding access to treatment. Read more on the public health impact of AIDS.

Racism Leads to Negative Effects on Mental Health of Children and Teens
A new report published in the journal Social Science & Medicine examines the link between the mental health and well-being of youth ages 12-18 and racism. The review shows that being a victim of racial discrimination can lead to low self-esteem, reduced resilience, and increased behavior problems. There was also evidence of increased risk of poorer birth outcomes for children when mother experienced racism while pregnant. These types of detriments to children and teen’s mental health and well-being can lead to larger problems in terms of engagement in education and employment later in life, according to study authors. Read more on health disparities.

Positive Relationships May Help Break the Cycle of Maltreatment
In a special supplement released by the Journal of Adolescent Health, investigations on the effects of safe, stable, nurturing relationships found that these types of relationships could help break the cycle of child maltreatment that is often passed along from parents to children. Findings also showed that supportive and nurturing relationships between adults can help protect children as well. This study can provide helpful prevention strategies for breaking the cycle of maltreatment and promoting improved health in the long term. Read more on violence prevention.

GUEST POST by Lisa Junker, CAE, Director of Communications at the Association of State and Territorial Health Officials (ASTHO).

The United States is facing a “perfect storm of vulnerability,” said U.S. Centers for Disease Control and Prevention (CDC) Director Tom Frieden, MD, MPH, yesterday at the 2013 Annual Meeting of the Association of State and Territorial Health Officials (ASTHO)—and state and local public health officials are on the front line of defense.

Frieden began his remarks by encouraging his listeners to “go back to first principles” and keep in mind the first priority of government, which is to keep people safe.

“If the government can’t keep people safe, whether it’s the police or us in public health, we are failing at our number-one responsibility to the public,” Frieden said.

And to keep the U.S. population safe today, public health officials have to keep their eyes open for threats arriving from outside our borders. Infectious diseases, drug resistance, new pathogens, intentional engineering of microbes, and globalization of travel, food and medicines: “If there’s a blind spot anywhere, we’re at risk everywhere,” Frieden emphasized.

He also focused on CDC’s partnership with state and local public health, even during the current tight fiscal atmosphere.

“Overall, our approach has been to double down on support for the front lines [state and local health agencies],” he said. “We all are in this together…We have lots of problems and lots of opportunities, and the more effectively we are connected, the more effectively we can address these opportunities.”

CDC: ‘Tips From Former Smokers’ Campaign Created Spikes in Quitline Calls, Website Visits
An additional 150,000 U.S. smokers called the tobacco cessation helpline 1-800-QUIT NOW as a direct result of the U.S. Centers for Disease Control and Prevention's (CDC) 2013 “Tips From Former Smokers” campaign, which ran for 16 weeks, according to CDC’s latest Morbidity and Mortality Weekly Report. That’s an increase of about 75 percent. It also generated approximately 2.8 million visits to the campaign website, or a nearly 38-fold increase. "The TIPS campaign continues to be a huge success, saving tens of thousands of lives and millions of dollars; I wish we had the resources to run it all year long," said CDC Director Tom Frieden, MD, MPH. "Most Americans who have ever smoked have already quit, and most people who still smoke want to quit. If you smoke, quitting is the single most important thing you can do for your health – and you can succeed!" A recent study in The Lancet concluded that the campaign helped as many as 100,000 people quit smoking permanently. Read more on tobacco.

FDA, NIH Award as Much as $53M for 14 Tobacco Regulation Research Centers
The U.S. Food and Drug Administration (FDA) and the National Institutes of Health (NIH) have joined together to award as much as $53 million in funding to create 14 Tobacco Centers of Regulatory Science (TCORS). The first-of-its-kind program will bring together a diverse array of scientists, public health experts, communications veterans and marketing experts to generate research to inform the regulation of tobacco products to protect public health. “While we’ve made tremendous strides in reducing the use of tobacco products in the U.S., smoking still accounts for one in five deaths each year, which is far too many,” said NIH Director Francis S. Collins, MD, PhD. “FDA/NIH partnerships like the Tobacco Centers of Regulatory Science keep us focused on reducing the burden and devastation of preventable disease caused by tobacco use.” Read more on research.

Overweight, Underweight Pregnant Women See More Complications and Longer Hospital Stays
Pregnant women who are either too thing or too heavy as measured by body-mass index (BMI) are at increased risk for complications and additional hospitalization, according to a new study in BJOG: An International Journal of Obstetrics and Gynaecology. Women with higher BMIs saw increased complications; severely obese women were three times as likely as normal weight women to have high blood pressure and gestational diabetes, as well as longer overall hospitalizations. Lower-weight women also had higher rates of additional hospitalization (8 percent) compared to normal-weight women, though not as high as the rates for overweight and obese women. The findings indicate the need to fine and implement new approaches to combating obesity. "Longer-term benefits of reducing maternal obesity will show improvements, not only in the health outcomes of mothers and their babies, but the workload and cost to current maternity services," said study co-author Fiona Denison, MD, of Queens's Medical Research Institute in Edinburgh. Read more on maternal and infant health.