Category Archives: Prevention
NewPublicHealth Q&A: John Auerbach and Cheryl Bartlett on the Massachusetts Prevention and Wellness Trust
The Massachusetts Prevention and Wellness Trust is a four-year, $60 million project designed to support prevention and health-promotion activities in the state. The first project of its kind in the United States will fund six to 12 collaborative initiatives, and partners on the initiative will include municipalities, community-based organizations, health care providers, regional agencies and health plans. Information on the Trust is detailed in a new report prepared by the Institute on Urban Health Research and Practice at Northeastern University and funded by the Robert Wood Johnson Foundation.
The vision behind the creation of the project is to give all Massachusetts residents the opportunity to live in communities that promote health, as well as seamless access to all community and clinical services needed to prevent and control chronic diseases. It was created because while there is access to health insurance and health care in Massachusetts, health costs continue to rise. The goals of the project include:
- Reducing the rate of the state’s most costly preventable health conditions
- Reducing health disparities
- Increasing healthy behaviors
- Increasing the adoption of workplace wellness programs
- Developing a strong evidence base of effective prevention programs
In order to implement these goals, the Massachusetts Department of Public Health identified four priority areas: tobacco use, childhood asthma, hypertension and elder falls prevention—all of which should be considered closely when working to reduce health disparities and co-occurring mental health conditions in these areas.
A new infographic created for the Prevention and Wellness Trust’s inauguration perfectly illustrates how community links work together to improve health under the principles of the Trust. For example, a diagnosis of hypertension would need a provider to prescribe medications, but the obesity and exercise needs that would also improve the condition for many patients requires input from other community entities, including:
- Classes in exercise, medication and stress reduction by community agencies
- Chronic disease self management classes and home visits for medication use instruction by a community agency
- A neighborhood policy that provides support for transportation changes to encourage walking or biking and zoning for healthy food stores
- A neighborhood policy that provides support for more accessible recreation options in parks and city centers for increased stress reduction
- Workplace policies that provide support for workplace wellness programs that help provide and encourage exercise, healthy foods and stress reduction
NewPublicHealth recently spoke with John Auerbach, a Professor at Northeastern University and the primary author of a report on the Trust, and Cheryl Bartlett, public health commissioner of Massachusetts and the lead person charged with its implementation.
Improved Prevention and Treatment Decrease U.S. Stroke Deaths
Stroke deaths in the United States have declined dramatically in the last few decades because of improved prevention and treatment, according to a scientific statement published in Stroke, published by the American Heart Association. “The decline in stroke deaths is one of the greatest public health achievements of the 20th and 21st centuries,” said Daniel T. Lackland, DrPH, chair of the statement writing committee and professor of epidemiology at the Medical University of South Carolina, in Charleston, S.C. “The decline is real, not a statistical fluke or the result of more people dying of lung disease, the third leading cause of death,” said Lackland, who added that “although all groups showed improvement, there are still great racial and geographic disparities with stroke risks as well many people having strokes at young ages [and] we need to keep doing what works and to better target these programs to groups at higher risk.” Public health efforts that have helped lower stroke rates include hypertension control that started in the 1970s; smoking cessation programs; improved control of diabetes and high cholesterol levels; and improved stroke treatment options. Read more on prevention.
NHTSA Announces New Safety Efforts for Older Drivers
The National Highway Traffic Safety Administration (NHTSA) has announced a new strategic plan to help ensure the safety of older drivers and passengers. In 2012, according to NHTSA, more than 5,560 people over the age of 65 died, and 214,000 were injured in motor vehicle crashes. That’s a three percent increase in the number of fatalities and a 16 percent increase in the number of injuries from the previous year. In addition, since 2003 the population of older adults—defined as age 65 and older—has increased by 20 percent and the number of licensed older drivers increased by 21 percent, to 35 million licensed older drivers in 2012.
NHTSA has several new efforts in place to reduce these deaths and injuries:
- The agency is researching advanced vehicle technologies, including vehicle-to-vehicle communications, collision avoidance and crashworthiness that could help reduce the risk of death or injury to older occupants in the event of a crash. It is also considering adding a “silver” rating system, meaning cars with certain technologies might be preferable for older drivers.
- NHTSA will conduct studies to better understand the effects of age-related medical conditions, including dementia.
- NHTSA will continue public education efforts on functional changes that can impact driving, including vision, strength, flexibility and cognition.
Read more on transportation.
Poll: Parents Concerned Over Lack of Physical Activity During School Day
A recent poll conducted by the Harvard School of Public Health, National Public Radio and the Robert Wood Johnson Foundation found that many parents are concerned about inadequate levels of physical education at schools. More than 1,300 parents of public school students were polled on a range of issues concerning education and health in the their child’s school, and one in four parents (25 percent) said their child’s school gives too little emphasis to physical education, compared with one in seven who say the same thing about reading and writing (14 percent) or math (15 percent). About three in 10 parents (28 percent) give a low grade (C, D or F) to their child’s school on providing enough time for physical education, while almost seven in 10 parents (68 percent) report that their child’s school does not provide daily physical education classes, a recommendation included in U.S. Centers for Disease Control and Prevention guidelines for schools. “In a period with a significant public debate about the content of educational reform, it is significant that many parents feel that more physical education is needed in the schools,” said Robert Blendon, ScD, Richard L. Menschel professor of Health Policy and Political Analysis at Harvard. Read more on education.
Construction Workers Frequently Impacted by Pain and Stress
Construction workers are frequently stressed about work-related injuries and pain, but often fail to get help for either, putting themselves at risk for additional injuries and mental health issues, according to a new study in the Journal of Occupational and Environmental Medicine. The researchers, based at the Harvard School of Public Health, reviewed data compiled by the School’s Center for Work, Health and Wellbeing and found that the construction industry has one of the highest rates of work-related injuries and suicides in the U.S. workplace, as well as a high prevalence of musculoskeletal pain among its workers. The researchers also conducted a mental health survey of 172 New England construction workers at four construction sites. Sixteen percent of the workers reported being distressed, 75 percent had experienced musculoskeletal pain over the previous three months and 42 percent reported one or more work injuries in the preceding month. A follow-up survey found that more than half of those who previously said they felt distressed had not sought professional help—likely, say the researchers, because of fear of stigmatization or job loss. Read more on injury prevention and mental health.
USPSTF: Cannot Recommend For, or Against, Vitamin Supplements to Help Prevent Cancer, Heart Disease
Citing the fact that there is simply too little evidence to make a conclusion either way, the U.S. Preventive Services Task Force (USPSTF) has concluded at this time that it can’t recommend for or against taking vitamin and mineral supplements to help prevent cancer and heart problems. In a draft statement, the panel also ruled that neither beta-carotene nor vitamin E should be taken to prevent heart disease or cancer; beta-carotene was previously found to exacerbate the risk of lung cancer for people who were already at high risk. The researchers analyzed data from 26 studies between January 2005 and January 2013, which included people across an array of demographics, finding no difference between those who took the supplements and those who took placebos. Vitamin supplements are a $12 billion per year industry in the United States. Read more on prevention.
Study: Simple Urine Test Could Identify Young Type 1 Diabetes Patients with Highest Risk of Heart, Kidney Disease
A basic urine test could help doctors prevent heart and kidney disease in kids who are at higher risk due to their type 1 diabetes, according to a new study in the journal Diabetes Care. As many as 40 percent of youth with type 1 diabetes may be at increased risk for the health problems. Researchers at the University of Cambridge, in England, analyzed data on more than 3,300 diabetes patients between the ages of 10 and 16; an estimated 490,000 kids worldwide have type 1 diabetes. "Managing type 1 diabetes is difficult enough without having to deal with other health problems," study lead author David Dunger. "By using early screening, we can now identify young people at risk of heart and kidney disease. The next step will be to see if drugs used to treat heart and kidney disease—such as statins and blood-pressure-lowering drugs—can help prevent kidney and heart complications in this young, potentially vulnerable population.” Read more on pediatrics.
In the face of health care reform, funding challenges, and increased collaboration, public health faces a promising yet unclear future in terms of both financial support and program reach. On Saturday, the Robert Wood Johnson Foundation co-hosted a forum with the American Public Health Association (APHA) in advance of the APHA 2013 Annual Meeting to discuss these issues – and more. Leading minds from the fields of public health, government and business met to get to the bottom of a crucial question: how do we move public health forward?
In the opening session, Paul Kuehnert, Director of the Public Health Team at the Robert Wood Johnson Foundation, explained that the field’s challenge lies in “skating where the puck is going to be.” APHA Executive Director Georges Benjamin echoed that sentiment, nothing that the forum was “an opportunity to figure out where the public is going and then, when the wave comes, be right there to catch it.” The ensuing breakout sessions furthered this overarching theme with panels that discussed both the challenges they’ve faced -- and the opportunities they’ve found for success.
>>NewPublicHealth will be 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. Follow the coverage here.
Re-Thinking How We Pay for Public Health and Prevention
One panel discussed funding challenges that public health departments face and solutions that have been reached across the country. John Auerbach of Northeastern University’s Institute on Urban Health Research, and former health commissioner of Massachusetts, touched on health care reform as a vehicle for preventive care. “Nearly 75 percent of those insured in Massachusetts have had a preventive care visit in the last 12 months,” he explained. In other words, people who are insured are twice as likely to get care that could actually prevent them from getting sick, instead of having a treat a more serious illness. Auerbach also discussed development of the state’s Prevention and Wellness Trust Fund — a four-year, $60 million public health trust supported by a one-time assessment on health insurers and largest clinical providers. Auerbach stressed that this source of funding was important, particularly because it’s insulated from the variability of public funding and political tides.
By focusing on the critical services and programs that are truly necessary for the public health system to work, the Seattle and King County Health Department has developed a minimum package of public health services needed for all projects to success. David Fleming, Director and Health Officer in the Seattle/King County Health Department, and his staff determined the money needed to fund such a package in both per capita and overall costs. Washington State is now working with RWJF and other stakeholders to determine the feasibility of defining and costing these foundational services at the national level.
Study: Improved Layperson CPR Education Increases Bystander Intervention, Saves Lives
As many as 80 percent of cardiac arrests occur outside of a hospital, meaning that improving the layperson’s knowledge of cardiopulmonary resuscitation (CPR) could improve the odds of effective bystander intervention—and along with it the chances of survival, according to a new study in the Journal of the American Medical Association. "In many cases, time from recognition of cardiac arrest to the arrival of emergency medical services is long, leaving bystanders in a critical position to potentially influence patient prognosis through intervention before EMS arrival," according to the study. "However, only a minority of cardiac arrests receive bystander CPR." The study authors looked at a 10-year period of about 19,400 out-of-hospital cardiac arrests in Denmark, finding that as the percentage who received bystander CPR rose from about 21 percent to 45 percent, the rate of people who arrived alive to the hospital also rose from about 8 percent to 22 percent. Read more on heart health.
Post-menopausal Hormone Therapy Ineffective at Long-term Disease Prevention
Post-menopausal hormone therapy is not effective at the long-term prevention of heart disease and other chronic conditions, according to a new study in the Journal of the American Medical Association. The study a review of the Women's Health Initiative (WHI), which is a collection of U.S. trials established to assess the role of hormone therapy in preventing chronic diseases in more than 27,000 healthy, older women. They found that the benefits were minimal and were offset by concerns over complications such as elevated rates of blood clots and strokes. However, the findings do support the continued use of hormone therapy for the short-term treatment of hot flashes, as well as for “relatively younger women who use it for a finite time,” according to HealthDay. Read more on prevention.
Study: Exercise as Effective as Drugs at Treating Heart Disease
When it comes to treating heart disease, exercise may be just as effective as medication, according to a new study in the British Medical Journal. The researchers from Britain's London School of Economics and Harvard and Stanford universities said this means physical activity should also be included as a comparison during the development and testing of new medications, as the lack of its inclusion "prevents prescribers and their patients from understanding the clinical circumstances where drugs might provide only modest improvement but exercise could yield more profound or sustainable gains." Cardiovascular disease accounts for 17 million global deaths each year. Another recent study also reinforced the ability of exercise to help prevent high blood pressure. Read more on physical activity.
Public Health Accreditation Board Awards National Accreditation to Five High-Performing Health Departments
The Public Health Accreditation Board (PHAB) this week awarded five-year national accreditation status to five more public health departments. The decisions bring the number of public health agencies now recognized by PHAB as high-performing health departments to 19. PHAB is the independent organization that administers the national public health accreditation program, which aims to improve and protect the health of the public by advancing the quality and performance of the nation’s Tribal, state, local and territorial health departments.
Accreditation status was awarded Aug. 20 to:
- Central Michigan District Health Department, Mount Pleasant, Mich.
- Chicago Department of Public Health, Chicago, Ill.
- El Paso County Public Health, Colorado Springs, Colo.
- Kansas City Missouri Health Department, Kansas City, Mo.
- Tulsa Health Department, Tulsa, Okla.
Read more on accreditation.
Needlestick, Sharps-related Injuries Cost Health Care Industry $1B Every Year
Improved safety-engineered devices, combined with better education and techniques, could save the health care industry more than $1 billion in preventable costs every year, according to a Safe in Common review of U.S. healthcare industry statistics. With approximately 1,000 skin puncture injuries per day in U.S. hospitals, needlestick and sharps-related injuries affect more than half a million health care personnel every year—both physically and emotionally. "The desperate need for attention to the risk of needlestick injuries and their dangerous implications for both patients and personnel are startling when you look directly at the impact to healthcare costs," said Safe in Common chairperson Mary Foley, PhD, RN. "Learning how to permanently prevent these types of injuries—with more education and the introduction of advanced safety devices—will ultimately reduce a significant cost burden and, most importantly, the pain and emotional trauma that the needlestick victims and their families are enduring." Read more on prevention.
Study: Volunteering Linked to Greater Happiness, Longer Lives
Volunteering is not only linked to greater happiness and improved mental health, but could also help people live longer, according to a new study in the journal BMC Public Health. The analysis of 40 published studies found that volunteers had a 20 percent lower risk of death, as well as lower levels depression and increased satisfaction with their lives. "It is still unclear whether biological and cultural factors and social resources that are often associated with better health and survival are also associated with a willingness to volunteer in the first place,” said leader Suzanne Richards, PhD, of the University of Exeter Medical School in England. "The challenge now is to encourage people from more diverse backgrounds to take up volunteering, and then to measure whether improvements arise for them," she explained. People often cite a desire to give back to their community as a reason for volunteering; gaining work experience and meeting new people are also popular reasons. Approximately 27 percent of U.S. adults and 23 percent of European adults actively volunteer. Read more on aging.
The United Nations Foundation believes that, for the biggest public health obstacles facing the world, it will take all nations and all sectors working toward solutions to succeed. So the Foundation works to make that a reality, bringing together partnerships, growing constituencies, mobilizing resources and advocating policies that can help everyone—in both the developing and developed world.
NewPublicHealth recently spoke with Kathy Calvin, President and Chief Executive Officer of the United Nations Foundation, about the organization’s many efforts to improve health both globally and locally—and how these two goals can support each other.
NewPublicHealth: What changes have you seen in global health during your time in the field?
Kathy Calvin: The number of nonprofits dedicated to health issues has quadrupled it seems, and real progress has been made, which is the most important point—that we’re actually seeing a reduction in maternal deaths and newborn deaths and preventable diseases such as measles and diarrhea and pneumonia. I mean, there’s just been enormous progress, with still much more to happen. But it’s been an exciting time after what I think has been a pretty discouraging period where no amounts of foreign aid seemed to be making a difference. I attribute that partly to some innovations in research and financing, but also to the fact that a lot of governments in Africa actually have prioritized women and prioritized health in some pretty significant ways. And I think we’ve had a very enlightened government in the last five years here, too, in terms of what we’re doing overseas.
So, it’s been exciting to see it. Health is not my background. I’ve really been privileged to see both how serious and significant the challenges are, but also how much good can be done with just a little bit of organized effort.
NPH: When you talk about enlightened government, what are some examples? What is making the difference now?
Calvin: Well ironically it isn’t all that political. In fact, some of the biggest shifts took place under President George W. Bush’s administration with his creation of the President’s Malaria Initiative—until then, there had been zero real depth of interest and progress on malaria—as well as PEPFAR, which some people criticized because it was so bilateral, but it had a huge impact in allowing the current administration to really set some ambitious goals for reducing and eliminating parent-to-child transmission and setting that audacious goal of an AIDS-free generation.
Who better to offer up advice on summer sun protection than the Los Angeles County Health Department? Recently the department warned its residents to “practice summer sun smarts” to protect themselves from skin cancer, which, at 1 million diagnoses per year according to the Environmental Protection Agency, is now the most common form of cancer among Americans.
July is recognized as "UV Safety Month" to encourage everyone—not just those in Los Angeles—to protect themselves from ultraviolet (UV) rays, a major risk factor for most skin cancers, by using sunscreen and avoiding prolonged sun exposure during peak hours. “Simple sun safeguards can go a long way in protecting the health of you and your family this summer,” says Jonathan E. Fielding, MD, MPH, the departments’ director of public health.
In other summer sun safety news, this week the National Highway Traffic Safety Administration (NHTSA) and SAFE KIDS Worldwide partnered up to promote National Heatstroke Prevention Day this past Wednesday, July 31. NHTSA and their partners used this opportunity to educate parents on the dangers of leaving children in unattended vehicles in the summer heat, as there have already been over 20 heat-related deaths of children in cars this summer. Children’s body temperatures can spike three to five times faster than an adult’s, and even cool temperatures in the 60s can cause the temperature in the car to rise well above 110 degrees Fahrenheit—so safety steps are critical at all times.
Task Force Calls for Regular Lung Cancer Screening for Older, High-risk Patients
New recommendations from the U.S. Preventive Services Task Force call for annual lung cancer screenings for people ages 55-79 who smoked at least a pack of cigarettes a day for 30 years, or the equivalent (e.g., two packs a day for 15 years). Low-dose computed tomography (CT) scans utilize an X-ray machine to take a series of detailed pictures that can help identify smaller tumors earlier, allowing for earlier treatment and improved health outcomes. “Lung cancer is the leading cause of cancer death in the United States and a devastating diagnosis for more than two hundred thousand people each year,” says Task Force chair Virginia Moyer, MD, MPH. “Sadly, nearly 90 percent of people who develop lung cancer die from the disease, in part because it often is not found until it is at an advanced stage. By screening those at high risk, we can find lung cancer at earlier stages when it is more likely to be treatable.” Lung cancer kills about 160,000 Americans each year. Read more on tobacco.
Study Links Breastfeeding, Higher Intelligence in Kids
Children who breastfeed score higher on intelligence tests later in life, according to a new study in JAMA Pediatrics. Researchers found that for each month spent breastfeeding there were slightly higher results on the intelligence tests at ages three and seven, though not on tests of motor skills or memory. Mandy Belfort, MD, who led the study at Boston Children's Hospital, said the study accounted for parental intelligence and other home factors and provides parents with one more piece of important information when making a decision on the complex question of whether to breastfeed. "Given the size of the benefit, I think this should be helpful for women who are trying to make decisions about how long to breastfeed… because there are many factors that go into that decision," said Belfort. "You have to weigh that against the time that it takes, maybe the time that it takes away from work and your other family duties." Previous studies have linked breastfeeding to lower risk of ear and stomach infections, as well as eczema. Read more on infant and maternal health.
NCI: ‘Cancer’ May Need to Be Redefined
The dramatic increase in cancer screenings over the past few decades has resulted in overdiagnosis and overtreatment, in part because of confusion—by both patients and physicians—over which types of cancer are actually lethal and require immediate treatment. As a result, a panel of experts commissioned by the U.S. National Cancer Institute has recommended that the word “cancer” may need to be redefined to differentiate between lethal and indolent cancers. The recommendations were published in the Journal of the American Medical Association. "We're still having trouble convincing people that the things that get found as a consequence of mammography and PSA testing and other screening devices are not always malignancies in the classical sense that will kill you," said Harold Varmus, MD, director of the National Cancer Institute, to The New York Times. "Just as the general public is catching up to this idea, there are scientists who are catching up, too." Over the past several years the U.S. Preventive Services Task Force has also called for an end to regular mammography screening for women under 50, as well as the widespread use of PSA tests to identify prostate cancer. Read more on cancer.
This week’s International Making Cities Livable Conference brings together city officials, practitioners and scholars in architecture, urban design, planning, urban affairs, health, social sciences and the arts from around the world to share experience and ideas. We spoke with some of those diverse attendees to find out: what do they want the public health community to know about working across sectors to make communities healthier and more livable?
Alain Miguelez, City of Ottawa, Program Manager for Zoning, Neighbourhoods and Intensification
NewPublicHealth: What do you want public health to know about making communities more livable?
Miguelez: I want public health to know they’re at the heart of what we do. Usually urban planning is a pretty arcane thing. We’ve done a good job of making it tough for people to understand and relate to. They don’t have the patience. Public health brings it home. As we heard in a session this week, it’s not necessarily people who are disabled—it's the built environment that’s disabling.
It comes down to how you see yourself functioning in your daily life. We've made it impossible to function any way other than with a car. For some people that’s okay, but for those who’ve had a taste of something different, there’s no going back. As planners people don't trust us anymore. We’ve done a lot of things in the name of progress. We’ve disconnected people from the built environment and forced them into places that make people fat and depressed and disconnected and not well-functioning. People coo about Portland and its trams and light rail and walkability. That’s how cities are supposed to be. Everywhere else has got to come up to that standard.
When you see statistics on obesity or depression, it becomes critical, especially with kids. I have two kids and I see very clearly how the environment we build around us impacts how they grow up. It gives kids the tools to function as independent human beings. The right type of city building and suburban repair [with an eye toward public health] can do that.