Category Archives: APHA
A full house of American Public Health Association (APHA) annual meeting attendees got an update on health department accreditation this week from Public Health Accreditation Board (PHAB) president and CEO Kaye Bender, RN, PHD, FAAN; board chair Carol Moehrle; and vice chair Leslie Beitsch, MD, JD. Right now, Moehrle told the crowd, 19 health departments—local, state and tribal—have been granted the credential and more than 200 departments are in various stages of their applications.
Moehrle gave some “heads–ups” on what’s upcoming for accreditation in 2014, including revised application standards and measures—called version 1.5—as well as the establishment of several additional PHAB think tanks to help expand the issues health departments are asked about when they apply for accreditation. Information from the previous think tanks informed the development of the Guide to Public Health Department Accreditation Version 1.0 and the PHAB Standards and Measures Version 1.0. New topics for PHAB think tanks will include the U.S. Army.
Moehrle also announced that the new version will be released on the PHAB website in January 2014, and those new standards and measures become effective for health departments' seeking accreditation beginning on July 1, 2014. To apply under the 1.0 version, health departments must submit their application by 11:59 PM Eastern Time on June 2, 2014.
Moehrle said that PHAB is recommending that health departments review the proposed changes to the standards and measures before they automatically decide that they will apply under Version 1.0, because version 1.5 is designed to “enhance, strengthen, expand, and clarify the Standards and Measures document,” including the following:
- Number of examples needed and timeframes for required documentation
- Edits to version 1.0 for clarity and consistency, based on frequently asked questions from applying health departments
- New measures and revised content to advance public health practice based on suggestions from PHAB Think Tanks conducted on special topics, including health equity, communication science, public health informatics, public health ethics, public health workforce and emergency preparedness
It’s no secret that public health department budgets have been shrinking in the past few years. In the face of the recession, public health professionals must seek new and diverse partnerships in order to achieve greater impact despite the lack of funding. The topic of one session at the American Public Health Association (APHA) Annual Meeting held in Boston was just that—how to increase impact through strategic partnerships with unlikely partners.
“The need for austerity and efficiency opens up the conversation for collective impact,” said Joseph Schuchter of the University of California-Berkeley School of Public Health. Partnerships can include a wide array of non-public health entities, including non-profit organizations, businesses and schools. The APHA panel discussed different approaches to successful partnerships that advance public health programs.
The Center for Health Leadership and Practice provides group leadership training for cross-sector teams that are working together to advance public health. “We may all be talking about the same thing, we’re just using different vocabulary and styles,” says VP of External Relations and Director Carmen Rita Nevarez. The Center provides existing partnerships with the tools and training needed to move forward in the same direction, while understanding that individual efforts may differ. More than 90 percent of program participants agree that the approach is effective in supporting intersectoral leadership development and most teams report regularly engaging other sectors as a result.
Networked and Entrepreneurial Approaches
Networked and entrepreneurial approaches to partnerships offer public health professionals with resources and allow them to reduce the negative externalities of the economy. The impact investment market constitutes an $8 billion industry that is eager to fund novel solutions to social problems. In order to succeed in these partnerships, the field of public health must work with social entrepreneurs and investors to highlight the potential return on investment for prevention programs and produce irrefutable outcomes.
The Community Health Improvement Partners (CHIP) serves as a backbone organization for a larger, cross-sector childhood obesity initiative. Cheryl Moder of CHIP shared her insights into the role of such an organization and how to successfully grow a diverse partnership. A backbone organization must serve as mission leaders by recruiting and retaining partners and support aligned activities so that they connect to one another. In addition, backbone organizations must navigate the challenges of larger partnerships—such as developing and retaining trust, encouraging equal partner recognition and shared measurement and evaluation—in a way that suits the needs of partners from different sectors.
>>NewPublicHealth was on the ground throughout the APHA conference speaking to public health leaders and presenters, hearing from attendees on the ground and providing updates from sessions, with a focus on how we can build a culture of health. Find the complete coverage here.
Tobacco featured prominently as a public health issue at the American Public Health Association (APHA) meeting this week, including a regulatory update from Mitch Zeller, JD, who became director of the U.S. Food and Drug Administration’s (FDA) Center for Tobacco Products earlier this year. Zeller previously worked on tobacco issues in government as associate commissioner and director of FDA’s first Office of Tobacco Programs, and also as a U.S. delegate to the World Health Organization (WHO) Working Group for the Framework Convention on Tobacco Control.
NewPublicHealth spoke with Zeller ahead of the APHA meeting.
Mitch Zeller: I think most broadly my goals are to help give the center and the agency the greatest chance of fulfilling the public health mission behind the law passed in 2009 giving the Food and Drug Administration authority over tobacco. This really is an important piece of legislation. It’s really stunning that in 2013—with everything that we know about the harms associated with tobacco use—that it remains the leading cause of preventable death and disease both in this country and globally.
There are some very powerful tools that Congress has given FDA to use wisely and supported by evidence. That’s where I think, the greatest opportunity lies: to use the tools relying on regulatory science to try to protect consumers and reduce the death and disease toll from tobacco.
There are two areas where I think these tools can make a profound positive impact on public health. The first is something called product standards, which is basically the power to ban, restrict or limit the allowable levels of ingredients in tobacco or tobacco smoke. We are exploring potential product standards in three areas: toxicity, addiction and appeal. And we are funding research in all three areas and working very hard behind the scenes to find out what our options are for potential product standards in those three areas.
“For too long, we’ve thought of health as something that happens to you in a doctor’s office,” explained Howard Koh, U.S. Department of Health and Human Services Assistant Secretary for Health on Monday at the American Public Health Association (APHA) 2013 meeting. “We have about 20 leading health indicators that we look at closely, one of them is high school graduation.”
Koh went on to describe social efforts such as boosting graduation rates as among the most important things we can do to improve health for the future. He also discussed the important role that learning plays in being healthy—and that being healthy can also free kids up to focus and get a better education. The assistant secretary’s sentiments kicked off a panel on the indelible connection between the nation’s drop-out crisis and public health, and the ways in which we can achieve success in both.
Robert Balfanz of the Johns Hopkins School of Education began by describing the drop out epidemic: the overall graduation rate in the United States is as low as 78 percent and is far lower in some communities with the greatest inequities. In fact, one third of all schools produce 85 percent of the country’s drop outs. Chronic absenteeism, often related to student health, is the leading cause of the issue. For example, 25 percent of students in one city missed a year or more of schooling over a five-year period.
Health factors have a significant impact on academic success and graduation rates. According to Charles Basch of Teachers College at Columbia University, health issues such as poor vision, asthma and teen pregnancy inhibit student success, disproportionately so in children of urban, minority communities. Left unaddressed, these issues can form causal pathways to the increased likelihood of dropping out.
Stakeholder Health, formerly known as the Health Systems Learning Group, is a learning collaborative made up of 43 organizations, including 36 nonprofit health systems, that have met for close to two years to share innovative practices aimed at improving health and economic viability of communities.
The idea for the learning collaborative came from a series of meetings at the White House Office and U.S. Department of Health & Human Services Centers for Faith-Based & Neighborhood Partnerships. The Stakeholder Health administrative team is based at Methodist Le Bonheur Healthcare Center for Excellence in Faith and Health in Memphis, Tenn., and at Wake Forest Baptist Health System in Winston-Salem, N.C. The Robert Wood Johnson Foundation provided a grant to share the group’s findings and lessons learned.
Earlier this year, Stakeholder Health released a monograph to help identify proven community health practices and partnerships. Kimberlydawn Wisdom, MD, MS, Senior Vice President of Community Health & Equity and Chief Wellness Officer at the Henry Ford Health System was a key contributor to the monograph.
NewPublicHealth recently spoke to Wisdom about Stakeholder Health’s objectives, goals and emerging successes, which she also presented on at the American Public Health Association’s annual meeting in Boston.
NewPublicHealth: What are examples of implementation of the Stakeholder Health recommendations at the Henry Ford Health System?
Kimberlydawn Wisdom: There are several. Stakeholder Health talks quite a bit about transformative partnerships and the importance of those transformative partnerships. And we have some stellar examples here in southeast Michigan of transformative partnerships, and one that I’d like to point to in particular is an effort we established called Sew Up the Safety Net, which addresses decreasing the infant mortality rate in our region, which is appallingly high.
We’ve developed a partnership with three other competing health systems within the Detroit region. So while on one level we are very strong competitors, on another level, we’ve actually joined our strategies and resources together in order to address the infant mortality challenge that we have in our communities. We also have private partners and public partners that are involved with us at various levels, but I think having that unprecedented partnership with competing health systems and getting real work done is something that we’re very proud of and work very hard to maintain.
David Satcher, MD, PhD, was a four-star admiral in the U.S. Public Health Service Commissioned Corps and served as the 10th Assistant Secretary for Health and the 16th Surgeon General of the United States—at the same time. He was Surgeon General from 1998 through 2001, and under his tenure he tackled disparities in tobacco use and overall health equity, sexual health and—critically—youth violence.
Satcher was a key speaker in a recent American Public Health Association (APHA) Annual Meeting Town Hall Meeting on a global approach to preventing violence. NewPublicHealth spoke with Satcher about approaches to preventing violence as a public health issue.
NewPublicHealth: How do you take a public health approach to preventing violence?
David Satcher: When you take a public health approach, public health experts pose four questions:
- First, what is the problem and what is the magnitude, the nature and distribution of the problem?
- The second question is: what is the cause of the problem or the major risk factors for the problem?
- The third question is: what can we do to reduce the risk of the problem?
- And finally, how can we then implement that more broadly throughout society?
So, when we say we’re taking a public health approach, that’s what we’re talking about.
What we’ve tried to do and what we need more of is to really study the different causes of violence and violent episodes. They’re not all the same. I’ve dealt with a lot of the mass murders; I was Surgeon General when Columbine took place and the Surgeon General’s Report on Youth Violence in part evolved from that. And obviously there, as in most mass murders, we’re dealing with, among other things, mental health problems and easy access to weapons combined. I don’t think the same is necessarily true for gang violence, which causes thousands of deaths each year. With youth violence and gangs, I think there you’re dealing with a culture of insecurity where young people feel that in order to protect themselves they need to be members of gangs and they need to be armed.
“We live in a culture of violence,” said Larry Cohen, MSW, founder and executive director of the Prevention Institute, in a morning session on violence prevention at the American Public Health Association (APHA) Annual Meeting, held this year in Boston, Mass.
“Just as air, water and soil affect our health, the social environment affects the spread of violence through our communities,” said Cohen.
One of the most important factors in the environment that influences the perpetration of violence is actually more violence. Basically, violence begets violence. It spreads like a disease.
“It’s like the flu,” said Gary Slutkin, MD, PhD, Founder and Executive Director of Cure Violence. “The greatest predictor of a case of the flu is a preceding case of the flu. It’s the same thing with violence. Violence is an infectious disease.”
Slutkin shared a study of one community that found that exposure to community violence in one form or another was associated with a 30 times increased risk of committing violence—but what was most striking is that statistic held true, even controlling for poverty, race, crowded housing and other factors that could have an impact on violence. The effect is also “dose dependent,” according to Dr. Slutkin. That is, the more violence you witness or experience, the more likely you are to perpetrate violence.
The good news is that “we know how to prevent epidemics,” said Slutkin. “We need to recognize that this is a preventable problem. We need to build a movement,” agreed Cohen.
Cure Violence focuses on the very same steps used to prevent the spread of infectious disease in their work to help prevent the spread of violence:
- Detect and interrupt the transmission of violence, by anticipating where violence might occur.
- Change the behavior of those most at risk for spreading violence.
- Change community norms to discourage the use of violence as an acceptable and even encouraged way to handle conflict.
Just over a year ago, Hurricane Sandy made landfall in the United States. Estimated damage came to $65 billion, at least 181 people in the United States died and power outages left tens of millions of people without electricity for weeks.
In the aftermath of this devastating event, the public health community continued efforts to make Americans aware that public health needs to play a much larger role in emergency response and recovery.
And in an American Public Health Association (APHA)-sponsored session on Wednesday, panelists discussed how they can draw on disaster response incidents to analyze policy implications for preparedness and response efforts to protect the health of workers, communities and the environment—with particular emphasis on promoting health equity.
"Addressing health disparities and environmental justice concerns are a key component of Sandy impacted communities," said the moderator of the panel, Jim Hughes of the National Institute of Environmental Health Sciences (NIEHS).
Kim Knowlton of the Natural Resources Defense Council and Columbia Mailman School of Public Health stressed that public health needs to advance environmental health policies post-Sandy, especially in regards to helping vulnerable populations.
"Climate change is a matter of health. It's such a deep matter of public health," she said. "We have to make a bridge between public health and emergency response preparedness communities," adding that "This is also an opportunity for FEMA to put climate change into their process for hazard mitigation planning and risk assessment.”
The changing environment for health departments under the Affordable Care Act (ACA) was the focus of a very well attended early morning session at the American Public Health Association (APHA) annual meeting in Boston today, moderated by APHA public health policy analyst Vanessa Forsberg, MPP.
Hospitals and private health care providers will soon be competing with health departments for clinical services such as immunizations for a newly insured population, according to Forsberg. However collaboration may help departments keep and grow clinical services, as well as collaborate with new partners under other new ACA rules, such as community benefit requirements for hospitals to improve population and individual health.
“There’s a lot of innovation, a lot of people moving into that space and this is a clarion call to say public health had a head start and don’t let the space be taken from you, learn the finance side,” said James Corbett, M.Div, JD, an ethics fellow at the Harvard Medical School and vice president of charity care and ethics at the Steward Health Care System in Boston.
Opportunities for health departments, says Corbett, include focusing on addressing disparities, preventive health, innovative programs and partnerships that improve care and reduce costs.
A key example Corbett shared was a decision by Steward to hire community health workers whose services can be billed for under the ACA beginning January 1. Corbett says he looked at the hospital’s bad debt documentation by language and found trends, then convinced the hospital’s CEO to allow him to hire community workers who got iPads and then went out into the community to visit patients who hadn’t paid bills. They were able to use the devices to record identification and other information, then help the patients sign up for Medicaid and other assistance that allowed them to be covered and the health system to be paid.