Study: Graphic Warning Labels on Tobacco Effective on At-risk Populations
The U.S. Food and Drug Administration’s graphic warning labels on tobacco products may be more effective than written labels at convincing less-educated, lower-income populations of the dangers of tobacco use, according to a new study in the American Journal of Preventive Medicine. This population is also linked to higher smoking rates and high rates of death and disease related to tobacco. The labels show graphic images of the results of tobacco use—from the effects of cancer to death. "Research on cigarette warnings in the United States and other countries has repeatedly shown that pictures work better than text," said James Thrasher, MD, an associate professor in the department of health promotion, education and behavior at the University of South Carolina in Columbia. "Our research supports this finding while also showing what tobacco researchers have assumed for a while—that warnings with pictures work particularly well among smokers with low levels of literacy." Read more on tobacco.

Clinton Foundation to Combat Health Disparities, Preventable Illness
The William J. Clinton Foundation’s Clinton Health Matters Initiative is partnering with major corporations in an effort to combat health disparities and preventable illness. Beginning with Verizon, General Electric Co., Tenet Healthcare Corp. and NBC/Universal, the program will implement and support workplace and community wellness programs. The efforts will include free exercise classes, walking groups in poor neighborhoods, farmers' markets in underserved areas and smoking-cessation programs, according to Reuters. Read more on health disparities.

Cost a Factor When Doctors Choose Heart Disease Treatments
Doctors are increasingly considering the financial costs when deciding exactly how to treat heart disease, according to attendees at an annual scientific meeting of the American Heart Association (AHA). The AHA believes the annual cost of treating heart disease—the number one cause of death in the United States—will rise to $800 billion by 2030. Factors include rising costs of drugs and equipment; to insurance reimbursements; and changes anticipated under the Patient Protection and Affordable Care Act. "We have an unsustainable economic model in healthcare delivery in the U.S.," said Elliott Antman, MD, professor of medicine at Harvard Medical School and chairman of the AHA Scientific Sessions Committee, according to Reuters. "We all have to be conscious of ways we can be more cost efficient, and that includes understanding what the big breakthroughs mean in terms of cost." Multiple studies presented at the meeting covered the overlap between quality patient care and cost. Read more on heart health.

Inspired by the 2012 American Public Health Association (APHA) Annual Meeting, the Robert Wood Johnson Foundation recently talked with a range of national thought leaders to discuss what’s needed—and what works—to achieve better health.

Today, we're featuring video interviews with Ron Chapman, MD, MPH, Director of the California Department of Public Health.

Chapman spoke with us about the current national opportunity to transform public health by making quality improvement and performance management “a way of life.”

He also discussed how collaborating with city planners, the business community, transportation officials and others can enable us to build healthier communities from the ground up.

Deadline Extended: National Leadership Academy for the Public’s Health Accepting Applications

Update: The deadline to submit applications to participate in the NLAPH program has been extended to November 30th at 5:00pm PST to align with the extended deadline for those who were impacted by Hurricane Sandy.

The National Leadership Academy for the Public’s Health (NLAPH), which is funded by the Centers for Disease Control and Prevention, is accepting applications through November 14, 2012, for its yearlong leadership academy. The Academy brings together teams of leaders from multiple sectors to actively engage their communities to achieve health equity. Application is open to teams of four people in current leadership roles. Teams must be multi-sector including representatives from the public, private and non-profit sectors and each team must have one member from the public health department. NLAPH is free for all selected teams including the cost of round-trip transportation and lodging at the national retreat, access to all program material and archived webinars, and enrollment in the Leadership Learning Network after completion of the program year. Read on for more information.

USDA Mobilizes Resources to Help Feed Many Impacted by Hurricane Sandy
The U.S. Department of Agriculture (USDA) is coordinating with states and organizations to provide food in 13 states affected by Hurricane Sandy. In New York State, for example, the USDA is working with the state, the Food Bank of New York City, and partner agencies to distribute approximately 1.1 million pounds of food. That will be distributed through nearly 1,000 designated emergency feeding outlets to affected households in New York City, Long Island, and Westchester and Rockland counties, which were hit very hard by the storm. 

In certain areas USDA has granted a waiver to allow SNAP (formerly known as food stamp) recipients to purchase hot foods using their benefits, an option not usually allowed under the program. And the USDA and the Department of Education are reminding states and schools that they are permitted to use USDA provisions purchased for the National School Lunch Program to help prepare meals at schools, shelters or other feeding sites to help feed local residents who need food assistance. Read more on the public health role in emergency preparedness and response.

New JAMA study finds Latinos and Blacks Face Heart Disease Risks Far Greater than Whites
Studies funded by the National Institutes of Health and published recently in the Journal of the American Medical Association (JAMA) have found that Latinos and Blacks living in the U.S. have far higher risks for heart disease than Whites. The multi-state Latino study of over 16,000 men and women found that 80 percent of the men and 71 percent of the women have at least one risk factor such as high blood pressure, high cholesterol, obesity, diabetes, and smoking. The second study, which included close to 25,000 people, found that Black men and women were about twice as likely to die from heart disease compared with age-matched whites. Black women had a higher incidence of fatal and nonfatal heart disease than white women. “This research shows clearly that there is much work to be done in addressing racial health disparities. We haven’t been able to move the needle in this important population that is disproportionately affected by coronary heart disease and stroke,” said Walter J. Koroshetz, M.D., deputy director of the National Institute of Neurological Disorders and Stroke. “It highlights the need for a campaign to control known vascular risk factors that lead to premature death and loss of quality of life.” Read more on heart health.

Hospitalized Smokers Often Still Light Up
A study of smokers admitted to a large urban teaching hospital in Massachusetts found that 18.4 percent reported smoking during their hospitalization, according to a study published in the Archives of Internal Medicine. The Joint Commission, a hospital accrediting body in the U.S., requires accredited U.S. hospitals to have a policy prohibiting smoking in hospital buildings, but that requirement does not extend to the hospital campus. In most hospitals where a campus-wide smoking ban is not in place, hospitalized smokers can go outside the hospital to smoke. The hospital in the study, Massachusetts General, bans smoking in all indoor areas and on the outdoor campus except in two outdoor shelters, which patients may use. According to the authors, patients were more likely to report having smoked while hospitalized if they were younger, had more severe cigarette cravings, did not report planning to quit, had longer stays and were not admitted to a cardiac unit. When tobacco counselors ordered nicotine replacement therapy for a patient on the day of admission, patients smoked less before the counselors’ visit, but continued to smoke during the stay. Read more on tobacco.

Inspired by the 2012 American Public Health Association (APHA) Annual Meeting, the Robert Wood Johnson Foundation recently talked with a range of national thought leaders to discuss what’s needed—and what works—to achieve better health.

Today, we're featuring video interviews Alex Briscoe, director of the Alameda County Health Care Services Agency.

In the first video, Briscoe talks about the connection between health, wealth, race and class. Briscoe says, "it's now harder to get out of poverty than in the history of our civilization." Watch the video:

Briscoe also talked about how we can shift the power dynamic that exists between consumer and physician. How can we empower patients to realize that they are their own best clinician? Briscoe shares his ideas:

Finally, Briscoe talks about "the trump card" in achieving better health outcomes: the resilience of communities and individuals. Watch the video:

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.]

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.

To follow is an excerpt of a blog post by Myra Parker, JD, PhD, is acting instructor at the Center for the Study of Health and Risk Behaviors at the University of Washington and a Robert Wood Johnson Foundation (RWJF) New Connections grantee, about her experiences at the APHA Annual Meeting.

I took my seven-year-old daughter to help me pick up my registration materials at the Moscone Center. I was thrilled to map the American Indian, Alaska Native and Native Hawaiian (AI/AN/NH) sessions and discover they are located in one of the central buildings this year! It’s terrific to be able to attend the general sessions AND those specific to my community, which has not always been the case with AI/AN/NH sessions held in off-site hotels last year in Washington, D.C.

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I was excited to see the diversity of attendees across many different professional backgrounds and ethnic/cultural communities.

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My first session, since I am working on an evaluation of a tribal home visitation grant funded under the Affordable Care Act through the Administration for Children and Families, was Protecting the Health of Our Children and Families – Examples of Maternal and Child Health in Indigenous Communities. It was standing room only!! The first presenter focused on a national campaign to raise awareness about Sudden Infant Death Syndrome within AI/AN communities, entitled: Lessons from designing a campaign to address infant mortality among urban American Indians and Alaska Natives, by Shira P. Rutman, MPH and Crystal Tetrick, MPH. Being in Seattle and being Native, of course I am aware of the groundbreaking work done at the Urban Indian Health Institute based at the Seattle Indian Heallth Center. It was a treat to hear about one of their efforts and you can learn more here: http://www.uihi.org.

>>Read the full post over on RWJF's Human Capital blog.

As thousands of people who are striving to improve health and health care convene in San Francisco, Calif., for the American Public Health Association Annual Meeting, RWJF is hosting brief interviews with thought leaders from across sectors. Brian Gallagher, President and CEO of United Way Worldwide, provided his thoughts on partnerships.

NewPublicHealth also spoke with Stacey Stewart, who was recently named to the new position of president of United Way USA. She was previously the executive Vice President, Community Impact Leadership and Learning at United Way Worldwide. Stewart shared her goals for UnitedWay USA, as well as what she's learned about the integral connections between education, income and health.

To follow is an excerpt of a conversation with Monica Peek, a Robert Wood Johnson Foundation scholar and grantee, who presented at the American Public Health Association Annual Meeting about new research exploring the value of high quality doctor-patient relationships on health outcomes and cost of care.

As a little girl, Monica Peek often went to the doctor with her grandmother, Mae Reather Long. On those visits to the clinic, she recalls, “my grandmother, who had diabetes, hypertension and high cholesterol, would listen patiently to her doctor’s advice. He would advise her to ‘eat healthy.’  She would politely answer that she had been doing so, and that was that.” Her grandmother’s physician didn’t realize that “yes, I’m eating healthy” most likely meant vegetables prepared southern style—with smoked ham.  Or that Peek’s grandmother really wanted more time to discuss her medications and how to take them, but she was afraid to ask.

At a presentation at the October 2012 American Public Health Association (APHA) meeting, Peek, who is now an MD, MPH, and diabetes specialist, taught other health care providers how to avoid this type of disconnect with their patients and harness the tremendous power of culturally appropriate communication.  Peek’s research, along with her award-winning film on shared decision making between physician and patient and her ongoing work at the South Side diabetes project in Chicago, grew, in part, out of those early lessons learned by her grandmother’s side.

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Peek and her colleagues have been investigating the behaviors that encourage share decision making since 2008, with a focus on African Americans, though Peek suggests her findings are also applicable to other ethnic or cultural groups struggling with diabetes. She found that while African American patients wanted to participate in SDM, they were much less likely to be asked by their physicians to engage in it than non-Hispanic Whites.  

>>Read the full interview with Monica Peek.
>>Read reflections on APHA 2012 from an RWJF scholar.
>>Watch the award-winning film: Shared Decision Making: The Importance of being Actively Involved in Your Health Care.