Category Archives: Faces of Public Health
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
May is Foster Care Awareness Month, an observance aimed at focusing attention on the 400,000 children in foster care, many of whom often are bounced from home to home only to age out of the system at 18 without community or family ties. A report from the General Accounting Office (GAO) released yesterday found that 42 states reported that they face major challenges placing large sibling groups in foster care, 38 states face challenges placing foster students near their most recent school and 31 reported they face challenges providing appropriate housing after a child in foster care ages out of the system.
A second GAO report released this week found that children in foster care group homes were twice as likely to be given psychotropic drugs than children in foster homes, and children in foster care were more likely to be given the drugs than children in the general community. Many of the drugs have serious side effects—including suicidal thoughts—and require oversight by guardians and doctors. However, but often children in foster care—particularly in group homes—who are taking psychotropic drugs are not well monitored. The GAO recommended that the U.S. Department of Health and Human Services (HHS) provide improved guidance to state Medicaid, child-welfare and mental-health officials regarding prescription-drug monitoring and oversight for children in foster care receiving psychotropic medications through Managed Care Organizations.
Child advocates say much more needs to be done to effectively place foster children in safe, nurturing homes, as well as to support foster families in adopting children and creating permanent homes and families. NewPublicHealth recently spoke with Dave Roberts, a county supervisor in San Diego, who together with his husband is raising five adopted children, ages 5 to 18, who started their lives with the family as foster children. Roberts has been a health policy advisor to Presidents Bush and Obama and played a key role in developing Tricare, the health insurance system of the U.S. Department of Defense.
NewPublicHealth: What drew you and your husband to consider having foster children grow up in your home?
Dave Roberts: We left Washington, D.C., where we had been living, and moved to San Diego where my husband is from and the first year we were here we went to the Del Mar Fair and the county had a booth there advertising their foster to adopt program. And so we signed up for the program and went through the process, and Robert [almost 19 and planning to enter the U.S. Air Force in the fall] was our first child. He was four going on five when he came to live with us.
Earlier this week the White House honored eleven transportation “Champions of Change” for their roles in ensuring that transportation facilities, services and jobs help individuals and their communities.
- Wanda Vazquez, a mentor and trainer in Chicago who helps Hispanic advocates in the Chicago area become certified child passenger safety technicians, and help families understand the importance of safe transportation for their children.
- Daphne Izer, head of the twenty-year-old Parents Against Tired Truckers.
- Marilyn Golden, a senior policy analyst with the Disability Rights Education & Defense Fund, based in Berkeley, California, where she has advocated for greater access to public and private transportation for people with disabilities.
Research from the U.S. Department of Transportation has found that poor transportation access is a factor preventing lower income Americans from gaining higher income levels than their parents. “Transportation plays a critical role in connecting Americans and communities to economic opportunity through connectivity, job creation, and economic growth,” said U.S. Secretary of Transpiration Anthony Foxx at the event recognizing the Champions. “Recognizing social mobility as a defining trait of America’s promise, access to reliable, safe and affordable transportation is critical.”
Following the awards ceremony, NewPublicHealth spoke with Marilyn Golden about her work.
NewPublicHealth: How much more is there to be done to help people with disabilities to get easier access to transportation to take them where they need to go, whether it’s recreational, medical, or work?
Marilyn Golden: We should acknowledge that a lot has been done under the Americans with Disabilities Act (ADA) by transit agencies, with a lot of thank you to the U.S. Department of Transportation, particularly the Federal Transit Administration for enforcing the ADA in a sufficiently robust manner that transit agencies do respond.
I shouldn’t suggest that every transit agency only acts because of an enforcement action. It’s much more diverse than that, and some are very proactive on their own and really leaders in the industry, and then there are transit agencies that trail behind. We do have many challenges that remain.
The American Red Cross recently announced the opening of its second Digital Operations Center—the first one outside of its national headquarters in Washington, D.C.—in the organization’s North Texas Region. Both centers are funded by the Dell Computer Corporation. The new center, along with others to be opened in the next few years, expands the ability of the American Red Cross to engage in social media, especially during regional disasters.
The Center will “allow us to build a center of expertise through our digital volunteers who help provide social data for regional responses,” said Laura Howe, vice president of public relations at the American Red Cross. NewPublicHealth recently spoke with Howe about the impact of using social media to respond during disasters.
NewPublicHealth: How did the Red Cross social listening program begin?
Laura Howe: We started a social listening program for emergencies and disaster in a fulsome way after the Haiti earthquake. I walked out of my office and I had a bunch of staff members who were in tears. They were getting Twitter and Facebook messages from members of the Haitian diaspora community here in the United States giving them the exact locations of where people were trapped under rubble and where people needed help in Port au Prince. We were able to move that information to the U.S. Department of State and the U.S. Department of Defense to hopefully get people help on the ground. But, it showed us two things. It showed us the power of individuals to provide information that can help responders, but it also showed that there was a tremendous gap in the response system for being able to take in information and respond specifically to people who had an urgent emergency rescue need, and there really is no infrastructure to be able to do that.
But I do want to make clear that the Red Cross as an organization and Red Cross disaster workers are not going to be able to take in information off of social media and then send one of our people to come get you out of the rubble or to come rescue you. We are not acting as a 911 dispatch here. We are using social media platforms to provide people with preparedness information, emotional support and information that they can take action on. We’re also listening for information that can help us in our disaster response generally and help us better hone where we’re putting our resources during a disaster.
NPH: What are the criteria for an optimal American Red Cross digital volunteer?
Laura Howe: We want someone who is comfortable in a social space; understands social media platforms and how social communities work; and is comfortable engaging with the public, having done that previously. Volunteers don’t necessarily have to have professional experience with social media, but do have to have a personal comfort level. Our training follows up on those prior skills about how to engage on behalf of the Red Cross. We train the digital volunteers about how we take in the information and then move it to our decision makers in order to make operational decisions.
The Network provides assistance and resources to public health lawyers and officials on legal issues related to public health, including health reform, emergency preparedness, drug overdose prevention, health information privacy and food safety. More than 3,500 public health practitioners, attorneys, researchers, policy makers and others have joined the Network since it was formed in 2010 as a national initiative of the Robert Wood Johnson Foundation (RWJF).
“We are delighted that Ms. Levin, an experienced leader in public health law, will be joining a stellar Network team,” said Michelle Larkin, JD, assistant vice president for RWJF. “Laws and policies that help people lead healthier lives are among the cornerstones for building a culture of health. Through Ms. Levin’s leadership, we look forward to continued growth in the Network—a strategic resource for state and local public health officials.”
NewPublicHealth recently spoke with Levin about her new position with the Network.
NewPublicHealth: How does your previous work as the general counsel for a state health department help inform your goals for the Network for Public Health Law?
Donna Levin: During my decades at the Massachusetts Department of Health I saw the responsibility of the state health department grow exponentially. We were trusted by the legislature and given many new initiatives. So public health grew and grew and public health law has grown alongside it. So what informs my view is that the range of issues is so incredibly broad. And so I really know firsthand how the availability of technical assistance from the Network is so valuable both to lawyers working in the field and to practitioners.
The Center for Public Health Readiness and Communication (CPHRC) at the Drexel University School of Public Health in Philadelphia recently re-launched DiversityPreparedness.org, a clearinghouse of resources and an information exchange portal to facilitate communication, networking and collaboration to improve preparedness, build resilience and eliminate disparities for culturally diverse communities across all phases of an emergency. The site had originally been developed by Dennis Andrulis, now at the Texas Health Institute, and Jonathan Purtle, who co-writes a blog on public health for the Philadelphia Inquirer.
- Read a previous NewPublicHealth interview with Dennis Andrulis
- Read a previous NewPublicHealth interview with Jonathan Purtle
NewPublicHealth recently spoke with Esther Chernak, MD, MPH, the head of CPHRC, about the re-launched site and her work in preparedness.
NewPublicHealth: Tell us a little bit about your background and how you came to lead the Center for Public Health Readiness and Communication.
Esther Chernak: I’m an infectious disease physician by training and pretty much have been working in public health since I finished my infectious disease fellowship in 1991 at the University of Pennsylvania. I started working in the Philadelphia Department of Public Health in its city clinic system doing HIV/AIDS care, and then became the Clinical Director of HIV Clinical Programs for the health centers back in the early ’90s when the epidemic was obviously very different. I then moved to working in infectious disease epidemiology as a staff doctor in the acute communicable disease control program and was involved in infectious disease surveillance and outbreak investigations for a number of years.
Then in 1999, I took a job with the City Health Department in what was then called bioterrorism preparedness. That was the time when major cities in the country were just beginning to be funded to do bioterrorism response plans. Groups that were involved in bioterrorism preparedness recognized relatively quickly that despite the fact that we were dealing with planning for novel strains of influenza and pandemic preparedness and SARS and smallpox, we were also dealing with many, many really significant infectious disease outbreaks, and then ultimately non-infectious disease related issues that had huge impacts on public health, such as earthquakes and hurricanes. Those links helped prepare me for my role at the Center.
Last month The George Washington University in Washington, D.C. announced three gifts totaling $80 million for the university’s School of Public Health and public health initiatives from the Milken Institute, the Sumner M. Redstone Charitable Foundation and the Milken Family Foundation. The public health graduate school is now called the Milken Institute School of Public Health and the university has also established the Sumner M. Redstone Global Center for Prevention and Wellness. Redstone is the executive chairman of Viacom and CBS Corp., while Michael Milken is an entrepreneur.
The gifts include:
- $40 million from the Milken Institute to support new and ongoing research and scholarships
- $30 million from the Sumner M. Redstone Charitable Foundation to develop and advance innovative strategies to expand wellness and the prevention of disease
- $10 million from the Milken Family Foundation to support the Milken Institute School dean’s office, including a newly created public health scholarship program
NewPublicHealth recently spoke with Lynn Goldman, MD, MS, MPH, and dean of the School of Public Health, about the impact of the gifts for the school and the public’s health both globally and in the United States.
NewPublicHealth: What changes will the recent gifts bring to the school?
Lynn Goldman: It’s no exaggeration to say the gift is transformational for our school. We have the opportunity to recruit the best talent in the country to work with our school, whether that might be students through the increase that we’ve received in scholarship funding or faculty members, and we have the opportunity to support our current faculty to be able to take their work to the next level.
It also allows us to establish the Sumner M. Redstone Global Center for Prevention and Wellness, which is a very exciting enterprise. We recently announced that William Dietz, MD, MPH, formerly the director of the Division of Nutrition, Physical Activity and Obesity at the U.S. Centers for Disease Control and Prevention (CDC), will be the first director of the Redstone Center. The initial focus of the Center will be childhood obesity. That is so exciting because Dietz was doing research on childhood obesity well before that became the flavor of the month. It has been his lifelong mission to prevent childhood obesity, and what we are charged to do with this center is to very directly engage in efforts that will result in reducing the rates of obesity in the United States and globally. The way we are going to be doing that is by bringing together the evidence that people are generating about efforts that are working and also efforts that are not working, and be able to sift through that research. I think Bill is the perfect person to be the leader of an effort such as this because he is very collaborative, and we want to do this in a collaborative fashion.
Behavioral health was a frequent topic at this year’s Preparedness Summit in Atlanta for both presenters and attendees, who focus on helping people cope with stress during a disaster as well as on mental health conditions which can be exacerbated by the stress of an emergency. Thomas Bornemann, EdD, has been the director of mental health programs at the Carter Center in Atlanta since 2002. The Carter Center is the philanthropic foundation of former president Jimmy Carter and his wife, and focuses primarily on peace and health initiatives globally and in the United States.
NewPublicHealth spoke with Bornemann about the Center’s mental health programs and challenges that lie ahead. We spoke with Bornemann several days before the shooting this week at Fort Hood.
NewPublicHealth: What are the key mental health projects underway at the Carter Center?
Thomas Bornemann: We’re involved in a number of issues at the local level, national level and globally. One of our major global programs is a program in Liberia, West Africa, where we’ve been working on scaling up services in this post-conflict, low-income country. We are in our fourth year of five, and we’re providing three services: We’re training mental health workers because their mental health system was decimated after the war; we have helped them develop a national mental health policy plan and a national mental health law that will go to the legislature for approval this year we hope; and we’ve been working on the issues of stigma and discrimination against people with mental illnesses and helping to develop support for family caregivers who provide the lion’s share of the care.
In the United States we’ve been working for years on Mrs. Carter’s number one healthy policy priority, which has been the implementation of mental health parity legislation which passed in 2008. The U.S. Department of Health and Human Services has been working on final regulations since then which spell out the terms and conditions of parity. We’ve been working on monitoring that through the years, and we were very proud that in November Secretary Kathleen Sebelius came here to announce the release of the regulations out of respect for Mrs. Carter’s long commitment to parity legislation. We’ll continue to monitor the parity efforts as they become implemented through the Affordable Care Act.
NewPublicHealth will be on the ground in Atlanta next week for the 2014 Preparedness Summit, an annual event since 2006 convened by the National Association of County and City Health Officials (NACCHO) and other partners including the U.S. Centers for Disease Control and Prevention (CDC) and the American Red Cross. Summit attendees include preparedness professionals working in local, state and federal government, emergency management, volunteer organizations and health care coalitions.
Goals of the summit include opportunities to connect with colleagues, share new research and learn to implement model practices that enhance capabilities to prepare for, respond to and recover from disasters and emergencies.
Additional partners include the American Hospital Association; the Association of State and Territorial Health Officials (ASTHO); the Association of Schools and Programs of Public Health (ASPPH); the Council of State and Territorial Epidemiologists (CSTE); the Association of Public Health Laboratories (APHL); the Office of the Assistant Secretary for Preparedness and Response (ASPR); the U.S. Food and Drug Administration (FDA); the Medical Reserve Corps (MRC); the U.S. Department of Homeland Security (DHS); the National Association of Community Health Centers (NACHC); and the Veterans Emergency Management Evaluation Center (VEMEC).
In advance of the summit, NewPublicHealth spoke with Jack Herrmann, Senior Adviser and Chief of Public Health Preparedness at NACCHO.
NewPublicHealth: What are some important issues going on in disaster preparedness in the United States right now that make the Summit especially important this year?
Jack Herrmann: There have been significant budget cuts to the ASPR Hospital Preparedness Program, and that is going to impact local and state public health departments and health care facilities pretty significantly across the country. Hopefully the summit will provide a venue to better understand what those impacts might be and allow us as a community to voice our concerns to our political leaders around the impacts of those budget cuts. It will also provide some very substantive evidence for organizations such as NACCHO , ASTHO and others to advocate on behalf of our constituents.
NPH: What are some of the key plenary talks?
Herrmann: Sheri Fink, a correspondent at The New York Times, who is also the author of the Pulitzer Prize-winning book “Five Days at Memorial” about her experience during Hurricane Katrina, will be a keynote speaker. What we’re having her do during the session is look back to her experience during Hurricane Katrina and researching what happened during that time from a health care preparedness perspective—and the lives that were lost and the issues and challenges that health care facilities faced in the aftermath of that disaster—and looking at where we are now.