A host of sessions focused on health equity at this year’s American Public Health Association meeting. Panel topics varied greatly, from the effects of health inequity on education outcomes to creative marketing strategies for reaching vulnerable populations; but overall, a few key themes emerged:

• Health inequities must be addressed as locally as possible
• Prevention is crucial
• Organizations must strive for greater diversity, especially in leadership
• In fiscal crunches, health equity requires creativity and commitment

Read more about these themes below.

Inequities in health must be assessed and addressed on a local level, whether by region, city, neighborhood or even block-by-block.

The California Endowment started the conversation by covering the conference halls with images from their Health Happens Here campaign, which draws attention to the vast differences in life expectancy that can exist from one zip code to the next. [Read more in a Q&A with California Endowment president Robert Ross.]

Last week at the American Public Health Association (APHA) annual meeting, a number of presenters took on an important, but often overlooked topic in the public health world: violence. Violence is often primarily considered a criminal justice or public safety issue, but there is a growing movement of public health practitioners that recognize that the health of vulnerable communities cannot be improved without first stopping shootings and killings.

When violence is present in a community, it impacts the physical, mental and emotional health of all residents. Violence also often prevents other positive changes from taking place. According to Greta Massetti from the Centers for Disease Control and Prevention, the current economic impact of youth violence is an estimated $14.1 billion in combined costs from medical care and work loss.

During the APHA meeting, speakers from organizations such as Cure Violence, UNITY and the Centers for Disease Control and Prevention discussed the latest research and strategies to prevent disease.

Treating violence as a disease

For many vulnerable communities, violence is the most pressing health issue. For children growing up in violent communities, the health impact is more than just the physical threat. As Benita Tsao from Urban Networks to Increase Thriving Youth (UNITY) pointed out, growing up in a community plagued by violence can often feel like being in a war zone.  That constant fear results in real health consequences, as evidenced by the increasing number of children who have grown up surrounded by violence and are now showing signs of chronic traumatic stress disorder. Experiencing ongoing trauma impacts young people’s physical, mental and emotional development, and has the ripple effect of making it harder to focus and succeed in school. 

Several sessions at this week’s American Public Health Association meeting in San Francisco urged nonprofit hospitals and public health departments seeking national accreditation to join forces on community assessment reports that both are required to file.

Assessments can reveal critical needs in a community, such as asthma trends that could point to poor housing conditions. In a growing number of cities, such reports are providing the evidence needed to marshal resources and action such as dispatching case workers to make home visits to help prevent and reduce asthma emergencies. Such expenditures can reduce the cost burden of paying for emergency care and prevent more health crises in the first place.

In San Francisco, the health department and the city’s non-profit hospitals have been collaborating on community benefit and needs assessments reports since 1994 and have achieved much more than “just a sheaf of papers that sits on a shelf,” says Jim Soos, Assistant Director of Policy & Planning at San Francisco Department of Public Health. The collaboration has resulted in a number of critical efforts to improve health here, including San Francisco’s Community Health Improvement Plan (CHIP), which will be launched by early in 2013. 

Inspired by the American Public Health Association Annual Meeting, all week we've been talking with national health leaders and highlighting promising strategies to improve our nation's health and health care.

>>View the full package of thought leader interviews, video conversations  with leaders from across sectors, and more at RWJF.org/futureofhealth.

Now we want to hear from you on what’s needed—and what works—to achieve better health. Share your stories from the field, ideas or even the critical questions we need to be asking to achieve a healthier future. 

To join the conversation, add your thoughts in the comments section below.

To get your ideas flowing around the future of health and health care, read more on:

Reversing the Trend of Childhood Obesity. Read a Q&A with Jessica Donze Black of the Kids’ Safe & Healthful Foods Project on a new report looking at snacks sold in secondary schools. Also find updates on a new Yale Rudd Center for Food Policy & Obesity study on parents’ attitudes about food marketing to children, and more.

Reducing Violence in Communities. Read a Q&A with Debbie Lee from Start Strong on preventing teen dating violence and a discussion with Sheila Regan of Cure Violence on partnering with hospitals for violence prevention.

Preparing and Responding to Disasters. Read discussions spurred by Hurricane Sandy, including about the role of public health as well as legal issues around orders to evacuate in an emergency.

Harnessing the Potential of Big Data. Read updates on how Big Data can change the landscape of public health, including a conversation with Farzad Mostashari, National Coordinator for Health IT, as well as Q&As and video interviews with other innovators and thought leaders.

Improving Health Equity. Read stories from the field and interviews with leaders on efforts to ensure everyone—regardless of race, ethnicity, income or zip code—has access to the resources they need to be healthy, including a diverse and representative health public health workforce.

Working Across Sectors to Improve Health. Read stories from the field and big ideas for bridging across sectors from thought leaders, including conversations with The California Endowment President Robert Ross and new APHA president Adewale Troutman. 

Don't forget to share what YOU think will make for a healthier future in the comments below!

Economic constraints cause many Latinos to settle in low-income neighborhoods that have limited access to affordable healthy food options, playgrounds and parks, and pedestrian and bike-friendly streets. Instead, these neighborhoods have fast food restaurants that offer primarily nutrient poor food and, limited resources for rec­reation which limit physical activity options.

“Latinos will tell you it’s too hard to get fruits and vegetables,” Said Dr. George R. Flores, MD, MPH, Board of Directors, Latino Coalition for a Healthy California at APHA 2012. “Inequality in the social and physical environments in Latino communities contributes to the obesity epidemic by failing to provide opportunities for healthy eating and physical activity.”

Latino populations on average have some of the highest rates of obesity, which can have the severe consequence of type 2 diabetes. The diets of Latino children are higher in fat and lower in fruits and vegetables.

The use of school-based health services has gained momentum and recognition across the United States as a unique tool in the fight to prevent poor outcomes in both health and education, especially among vulnerable populations. When last surveyed in 2008, the number of school-based or school-linked health clinics in the U.S. had surpassed 1,900. Recently, the federal government has acknowledged their potential, too, creating a distinct grant program for school-based health centers as part of ACA and recognizing them as providers in the Children’s Health Insurance Program Reauthorization Act. [Read more on school-based health center policy developments.]

The typical school-based health center (SBHC) provides free or low-cost basic physical and mental health services, and sometimes oral and vision care. They’ve been shown to reduce asthma-related ER visits and hospitalization costs; reach greater numbers of racial minorities, especially young men; and increase the likelihood by 10 to 20 times that a student uses mental health services. But, the conversation at the American Public Health Association annual meetings was focused on the unique effects these centers are having on students and communities beyond the clinic walls.

Youth Successfully Influencing Their Peers

One session on youth as public health champions covered how receiving services directly on campus involves youth in their own health and the health of their peers in a powerful way. Kathleen Gutierrez from the California School Health Centers Association highlighted innovative ways in which California’s SBHCs are utilizing youth as messengers. 

The city of Philadelphia and the Pennsylvania Horticulture Society are seeing positive results as they continue to grow their Philadelphia Green program. The program has taken on the vacant lots in Philadelphia neighborhoods and transformed them from embarrassing eye sores to points of pride – and made the community safer in the process.

“The city owned the problem even if we did not own the land” said Robert Grossmann, Director, Philadelphia Green. “We decided to use horticulture to build community and improve the quality of life in Philadelphia’s neighborhoods and downtown public spaces.”

The goal was to help build equity for the people living in the neighborhoods so they felt a sense of pride – the result was crime prevention through environmental design.

With the help of community activists and landscape contractors the program has “cleaned and greened” more than 7,000 lots. The impact is a reduction in gun crimes, lower rates of vandalism and residents even report experiencing lower stress rates and an increased urge to get out and exercise.

>>EDITOR'S NOTE: On 9/13/2012 CeaseFire changed its name to Cure Violence.

Sheila Regan manages hospital partnerships for Cure Violence, formerly CeaseFire, an organization based in Chicago that has pioneered a public health approach to stopping shootings and killings. A grantee of the Robert Wood Johnson Foundation, Cure Violence has been successful at reducing violence in cities across America.

This week at APHA, Cure Violence shared how violence presents all the same characteristics of an infectious disease. Like tuberculosis or cholera, violence appears in clusters; it spreads and can be transmitted. By changing the frame on violence, Cure Violence is able to use proven public health strategies from other epidemics to stop shootings and killings. Hospital partnerships are a key part in stopping the spread and transmission of violence.

NewPublicHealth: Can you explain how Cure Violence’s hospital partnerships work?

Sheila Regan: We have a number of partnerships with level I trauma centers that are committed to the public health approach to violence prevention. We serve patients who are violently injured, typically shootings, stabbings or beatings and work to prevent further violence, retaliation or re-injury, which are seen as normal in our culture. There are the doctors, police, nurses, social workers, and everybody you’d expect to see in the hospital. What we’re trying to do is introduce a third party—our workers—who can impact behavior and mindset around violence at an opportune moment.

NPH: When someone has been injured, what is the goal of Cure Violence working with them in the hospital?

“The time is right for community health workers to be even more [integrated] into the community health system to help achieve the triple aim of better care, better outcomes and lower cost,” said Eduardo Sanchez, MD, MPH, vice president for medical affairs at Blue Cross Blue Shield of Texas ,who previously served as health commissioner of Texas. Sanchez made his remarks via a recorded presentation at a standing room only session on community health workers this week at the American Public Health Association annual meeting. The session was hosted by the APHA section on community health workers established just two years ago.

The section defines community health workers, who number in the thousands across the U.S., as a frontline public health worker who is a trusted member of or has an unusually close understanding of the community served. At the session yesterday, speakers said that this trusting relationship enables a community health worker to serve as a liaison between health and social services and the community. They can also facilitate access to services and improve the quality and cultural competence of service delivery. Dr. Sanchez said that community health workers are also often able to build individual and community capacity by increasing health knowledge and self-sufficiency through activities such as outreach, community education, informal counseling, social support and advocacy. 

A new report released today examines state standards for the types of snacks that can be sold in secondary schools. The report was developed by the Kids’ Safe & Healthful Foods Project, a joint initiative of RWJF and The Pew Charitable Trusts that is focused on ensuring all foods and beverages in school are healthy and safe. 

Some of the findings were discussed earlier this week at a session at the American Public Health Association annual meeting, and the full report is now available online. NewPublicHealth caught up with Jessica Donze Black, the project’s director, to learn more about the report.

NewPublicHealth: You’ve just released a new report about school snacks – what did you find?

Jessica Donze Black: We found that the majority of our nation’s students live in states where less healthy snacks like full-fat chips and candy are readily available in snack bars, school stores and vending machines – but there is limited access to healthy snacks. What students are able to buy varies widely from state to state, with some offering healthy snacks and others primarily providing less-healthy snack options.

The report recommends that the U.S. Department of Agriculture issue consistent, science-based standards to ensure all students have access to healthy snacks at school, regardless of where they live. The standards will establish a baseline that will help local communities make healthy choices when choosing what snacks to offer.

NPH: Have any states had success with offering healthy snack foods in schools?