On July 20, 2012, during a midnight showing at a local movie theatre in Aurora, Colorado, a gunman opened fire, killing and injuring unsuspecting moviegoers. Ultimately the massacre killed 12 and injured 57 — presenting an enormous challenge for local emergency dispatch, fire departments, police, hospitals, public health, and more, and requiring all to work together on an integrated response in the midst and the wake of a chaotic, unprecedented active shooter situation. Partners came together to share their lessons learned at the 2013 Public Health Preparedness Summit.

>>Read continued NewPublicHealth coverage from the Summit.

When the first 9-1-1 calls came in following the shooting, the University of Colorado Hospital, a level II trauma center, already had full emergency department — 49 out of 50 beds were filled.

“We’d been notified we were going to get three to five gun shot victims,” said Patrick Conroy, manager of support services and safety officer for the University of Colorado Hospital. “But we had this queasy feeling something was not quite right. We started notifying emergency services to get ready.”

The Aspen Institute’s Justice and Society Program, with funding from the Robert Wood Johnson Foundation, is accepting applications for a new project, the Excellence in State Public Health Law program. 

The one-year program will bring together and provide resources to teams in eight states to work together to address their respective public health priorities, such as tobacco control and disaster preparedness. At the program’s conclusion, each team member will be recognized as a Fellow in the Excellence in State Public Health Law Program.

>>Apply here for the Excellence in State Public Health Law program, and join a web conference the program hosted by the Aspen Institute on Wednesday February 20 from 1-2 pm EST.

As the application process begins, NewPublicHealth spoke with Meryl Chertoff, JD, Director of The Aspen Institute’s Justice and Society Program, and program director of the Excellence in State Public Health Law Program, and Leah Devlin, DDS, MPH, former health official of North Carolina and a past president of the Association of State and Territorial Health Officials, who is a consultant to this program.

NewPublicHealth: Tell us about the program.

Meryl Chertoff: The post-Affordable Care Act period is an excellent opportunity to focus on public health innovation through state legislative and regulatory activities. The goal of the program is to provide key people working in public health law with additional tools, networks and opportunities to share best practices and innovations in their state.  Especially in a time of economic shortfalls, we have to do more with less. We have to support legislators, advisors to governors and relevant agency officials in their ongoing efforts to use public funds in the smartest way and to build the partnerships that they need in order to effectively leverage the assets that are available to them. We are very much hoping that the initiatives that are undertaken will utilize evidenced-based research in order to improve public health

Leah Devlin: And it’s about building partnerships, which is important in this environment because there are so many new governors, new legislators, and new state health officials. We have our biggest health gains when we develop a sound health policy. So bringing together these high level leaders within a state who may be working together on a public health issue for the first time will be a very powerful approach.  It is important to note that the teams can also include local health directors who are also critical players for successful health policy development in states.

NPH: Who will be part of the teams?

Preparing for disasters like Hurricane Sandy is critical, even more so because of the massive devastation this storm has brought to Staten Island, New York, where hundreds are still without power, and thousands must rebuild their homes and businesses. Thanks to some critical partnerships that have developed among non-profits and businesses in Staten Island in the last few years, some vital relationships that help to facilitate rapid response were already in place when the super storm hit.

NewPublicHealth spoke with David Sorkin, executive director of the Jewish Community Center of Staten Island, who is a also a founding board member and past president of the Staten Island Not-For-Profit Association and former chairman of the Staten Island Economic Development Corporation Business Council.

NewPublicHealth: How did prior relationships help you serve the community when the hurricane hit?

David Sorkin: The Staten Island Not-For-Profit Association is a collective of about 150 not-for-profits on Staten Island who have been networking, training, and learning together over the past four or five years. We already had relationships and interconnections, which allowed us all to react very, very quickly to issues and concerns as well as emergencies because we have emergencies almost every day, though different from a super storm.

A “normal” emergency not related to a storm is when we have a family or an individual who’s in crisis and needs a variety of support such as economic, legal, financial, counseling or a combination of all of them. So, we work together on a regular basis. The other avenue we work through is the Staten Island Economic Development Corporation, which is a coalition of businesses on Staten Island. Because we’re a part of that, I was able to access quality services from businesses and corporations on Staten Island with good relationships already built in. So, I don’t have to worry about vetting these companies and organizations during an emergency and I know that they can come to our assistance very, very quickly.

Men More Likely than Women to Die of Cancer
Men are more likely than women to both be diagnosed with cancer and to die of the disease, according to a new study in The Journal of Urology. The researchers did not include mortality rates for sex-specific cancers. The gender gap could be due to men's higher rates of smoking and drinking, as well as they fact that men are on average less likely to have frequent doctor visits—meaning cancers are not caught as early. "That means going to screening programs, seeing a general practitioner or primary care provider on a regular basis and as soon as symptoms arise that are new, mentioning that to their primary care physicians," said Yang Yang, a sociologist and cancer researcher from the University of North Carolina at Chapel Hill, who was not part of the study. Read more on cancer.

Survey Finds Major Support for Worksite Wellness Initiatives
The States of Wellness national survey on worksite wellness has found that, more and more, businesses are understanding and embracing the business benefits of wellness initiatives. The poll found that 87 percent of organizations understand the importance of worksite wellness and 74 percent said they would utilize community-based collaborations to learn about and improve wellness initiatives. Read more on physical activity and partnerships.

Study: Simply Cutting Fat Intake Drops Weight, Keeps it Off
Simply switching high-fat foods with low-fat foods isn’t as effective as dieting, but it still lowers weight and the weight stays off, according to a new study in the journal BMJ. Researchers say the findings could have a major effect on dietary recommendations in the ongoing effort to prevent cancer, stroke and heart disease—all of which include excessive weight as a contributing factor. "This means having low-fat milk and yogurt, cutting down on butter and cheese and cutting the fat off meat," said study leader Lee Hooper, MD, of the University of East Anglia’s Norwich Medical School, in a release. "Most importantly, have fruit instead of fatty snacks like biscuits, cake and crisps. And remember, this isn't a diet, so don't take it to extremes, but work out a way of eating that you can stick to permanently." Read more on nutrition and obesity.

There is great promise in leveraging the strengths and resources of both the health care and public health systems to create healthier communities. Hospital community benefit is one critical area of opportunity for greater collaboration. Historically, nonprofit hospitals, as a condition of their tax-exempt status, have been required to enhance the health and welfare of their communities. Through the Affordable Care Act, nonprofit hospitals will have the opportunity to direct their community benefit efforts toward public health interventions and collaborate more effectively with local health departments.

>>Read more and join the conversation about working together across public health and health care.

Paul Kuehnert, MS, RN, senior program officer and director of the Public Health Team at the Robert Wood Johnson Foundation (RWJF), shared his insights on the opportunities and challenges that lie in integrating health and health care. Prior to joining the Foundation, he was county health officer and executive director for health for Kane County, Ill., where he led a partnership between the health department, hospitals and other partners to assess and address the community’s health needs. Paul is a Pediatric Nurse Practitioner and worked as a primary care provider in schools and other community settings in Missouri and Illinois.

NewPublicHealth: There has been lots of conversation across the public health field about the need for more strategic coordination or integration with health care. Why is there so much focus on this now?

Paul Kuehnert: There are a couple of reasons for that. One of the primary reasons is that we know that there are increasingly limited dollars for public health. We really have to be as efficient and effective as we can be in trying to improve health in our communities. There’s a common interest between public health and health care around controlling the overall cost of health care. At the same time, we’re not getting the kinds of health outcomes we need. There’s this dynamic of mutual interest in controlling cost and finding ways to improve health and get to the best health outcomes for the community.

What do you call a phone number that helps assess your needs—even if that need is for heat and food, after a hurricane has destroyed your home? In New Jersey and throughout the nation, you call that number 2-1-1.

A growing number of cities have established 2-1-1 call centers that connect people to essential services such as employment training, help for an older parent, addiction prevention and affordable housing options. During Hurricane Sandy, the call centers also directed people to shelters, food, government resources, and, if needed, a mental health counselor to listen and comfort. In the aftermath of the storm calls to the service have increased at least 400 percent, says Laura Zink Marx, director of operations for the NJ 2-1-1 Partnership and chair of the 2-1-1US Steering committee, a volunteer role. The New Jersey 2-1-1 Partnership is a subsidiary of the United Way of New Jersey.

“Probably the most common question,” says Marx, “is, ‘when will my power be back on?’ If you have internet access you can keep looking at interactive maps that show you how much progress utility companies have made, though millions are still without power. But if you have no electricity, and no way to access information, you just feel abandoned and scared. We’re getting those calls and sharing the information as it’s updated.”

Marx says the 2-1-1 line in New Jersey is also letting people know where the food pantries are in their neighborhood and, by tracking call origins, can also provide the aggregate data to the food bank to see where the need is the greatest. Volunteers have been loaned by Americorps and many are fielding rumors perpetuated by social media, says Marx. A common one: FEMA is not giving out $300 food vouchers but it is standing up mobile kitchens. Operators tell callers how to find the closest ones.

Just before Superstorm Sandy hit, NewPublicHealth spoke with Laura Marx about the impact the 2-1-1 line is having in New Jersey. Despite her recent sleepless days and nights, Marx also updated us on the call line’s response in the wake of the storm and the subsequent Storm Athena.

NewPublicHealth: What is the 2-1-1 project in New Jersey and how did United Way get involved?

Laura Marx:  The 2-1-1 concept began about 15 years ago, even before September 11th. United Ways have always had an information referral component within their organization for probably the last 35 years. That’s an important resource for us to help connect people with services in their local community.

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!

Adewale Troutman, MD, MPH, becomes president of the American Public Health Association today. Dr. Troutman is the former head of the Metro Louisville (Kentucky) Department of Health and Wellness, and is currently a professor of public health practice at the University of South Florida. NewPublicHealth spoke to him this week about his vision and mission.

NewPublicHealth: Are you hopeful about the future?

Dr. Troutman: I am always hopeful about the future, I have seen so much in the past. One of the sad stories that I often think about is as a kid seeing the cover of Jet Magazine and a picture of Emmett Till who was murdered in the South, accused of whistling at a white woman. That was a low point for me as a kid because I was a child and I was absolutely terrified that something like that might happen to me.  So much has happened since then. I mean I had a high school average of 69, my first semester at a community college was a .38. I didn’t know anything about school or college and yet here I stand today, many years later, with some five degrees, an emergency medicine physician, running health departments for the last 15 years now ascending to the presidency of this organization. You got to be hopeful with that kind of a background. So yes, I am very hopeful. 

NPH: What’s ahead for public health under your leadership?

Dr. Troutman: We are looking now and ahead at a definition of health that is much more than just going to the doctor’s office. Health is not health care.  Health care is a part of the spectrum of health and we need to look at it that way.

Together with non-traditional partners we are looking at social determinants -- the things that are responsible for the health of populations and you find things like housing, education, neighborhoods, urban blight, crime and punishment,  early childhood development, and social isolation. You have to be in partnership to address those issues because they are other people’s fields of specialization and we need to find a way to recognize that all of them act together synergistically to improve the health of a community. And a healthy community is a fair community. 

In my health department in Louisville for instance we reached out to Jobs for Justice.  Some asked if I was crazy, and I said no. Employment status is an integral part of the health of populations and communities. And there are people out there that have more of a history or more expertise in social justice, community organizing, policy development, than maybe we do. So why shouldn’t we be in an equal partnership with them? 

Back in 2003, officials from the city of Oakland approached the head of the Alameda County Public Health Department to figure out how to collaborate to tackle the growing problem of violence. They began working together, and with the community, to figure out what was going on. Through a series of rigorous, door-to-door community surveys and community forums, they discovered a complex web of interrelated community issues—as well as a number of powerful community assets and existing partnerships.

Alameda County public health officials presented at the APHA annual meeting on a session about the role of community partners in community-based public health.

Alameda is a county of opposites, according to Liz Maker, Evaluation Specialist at Alameda County Public Health Department—some very poor, some doing amazingly well and in some cases those sections are separated only by a block or a fence.

The City-County Neighborhood Initiative, a partnership between the Alameda County Public Health Department, the City of Oakland, neighborhood resident groups, community-based organizations, the Oakland Unified School District and the University of California, Berkeley, was created to empower residents and support grassroots efforts to create safer neighborhoods and reduce inequities. Partners include a homeowners association, a large community reform church, and local neighborhood committees.