Category Archives: Q&A
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
Future of Public Health: Q&A with Stephanie Lucas, MPH Candidate at Columbia University Mailman School of Public Health
Future of Public Health is an ongoing series focused on the emerging faces in the world of public health. We spoke with Stephanie Lucas, a Masters of Public Health candidate in epidemiology and global health at Columbia University Mailman School of Public Health. Lucas spoke about what helped lead her to the field of public health; her work in migrant health and reproductive health in the Philippines; and where she hopes to go from here.
NewPublicHealth: What encouraged you to pursue a degree and a career in public health?
Stephanie Lucas: I came from a wide variety of backgrounds. I taught English for a while and I did lab work because I was a biology major in my undergraduate studies. I also came from a small college that was really oriented in social justice and there were a number of study and volunteer abroad programs. One year, I decided to go to Belize for spring break and help teach a class. I also went abroad to South Africa and worked with an NGO there that helped street children. I think that’s where my interest in public health began because it was so blatant to see what needed to be done. When I was teaching English and doing lab work, I didn’t feel like I was connected to that enough. I felt like public health allowed me to take all of my background information—like biology and education—and intertwine them in a way that I can put them to good use to improve population health.
NPH: Is there a field within public health that’s of primary interest to you?
Lucas: I actually want to take on a broad range of public health topics. When I went to the Philippines, I did two practica there; one in the field of reproductive health and another in the field of migrant health. I didn’t know anything about migrant health, but that was OK because I just wanted to learn about the spectrum of the different issues in an effort to understand that all of those issues are interrelated.
Recovery after a disaster can take years or even decades—but what most people don’t realize is that recovery starts even before the disaster occurs. Resilience is about how quickly a community bounces back to where they were before a public health emergency—and only a healthy community can do that effectively.
NewPublicHealth recently spoke with Alonzo Plough, PhD, MPH, Vice President, Research-Evaluation-Learning and Chief Science Officer at the Robert Wood Johnson Foundation, about taking steps toward recovery even before a disaster occurs.
NewPublicHealth: What are some important aspects of preparedness that help prepare responders and the community for recovery from a disaster?
Alonzo Plough: Connectivity between organizations, between neighbors, between communities and formal responder organizations is absolutely critical to building community disaster resilience. This allows recovery to go more smoothly because the partners who have to work together in recovery have been working together and connecting to communities prior to a disaster event. Managing the long tail of recovery is easier if there has been recovery thinking in the preparedness phase.
NPH: One of the issues for the panel at the recent Preparedness Summit is the impact of the news spotlight when a disaster occurs, and then the impact of that spotlight turning off. How does that focus impact recovery?
Plough: Often the initial media frames are to wonder why there weren’t preventive mechanisms. In the case of the mudslides in Washington State, for example, why weren’t there zoning restrictions or regulatory restrictions? That initial media frame often will point a finger to ask why houses were allowed to be built in an at-risk location. Why were building permits given at all?
But none of that really addresses the long-term issues of communities working toward recovery, regardless of the specific event. There is a disruption of life as people know it in a disaster that goes on for a long, long period of time. The media doesn’t really capture the complexity of that while they’re focused on the short-term outcomes. When the media focus goes away, the appropriate agencies and organizations who need to be engaged continue their engagement.
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.
Future of Public Health: Q&A with Chinedum Ojinnaka, Doctoral Candidate at the Texas A&M Health Science Center School of Public Health
Future of Public Health is an ongoing series focused on the emerging faces in the world of public health. We spoke with Chinedum Ojinnaka, a Doctoral Candidate at the Texas A&M Health Science Center School of Public Health and graduate research assistant at the Southwest Rural Health Research Center. Ojinnaka spoke about what helped lead her to the field of public health; her work with the Texas Colon Cancer Screening, Training and Education Program; and where she hopes to go from here.
NewPublicHealth: What encouraged you to pursue a degree and a career in public health?
Chinedum Ojinnaka: I actually trained as a physician in Nigeria and had the opportunity to practice in a rural health center. During my year at the rural health center, I was astounded by some of the problems that could be solved if health professionals knew how to get across to people culturally and to better organize the health system to improve patient navigation.
As a medical student, I had been intrigued by public health and the fact that it was prevention-based. During medical school, it was sad to see patients having to wait for a long time before they could see a doctor. By the time they were examined, the diseases were at a late stage. The frustration was that had the patients been seen earlier, associated complications might have been prevented. This led me to start considering a career path in preventive medicine. After my experience working at the rural health center, I became even more convinced that public health was the path for me.
NPH: Within the field of public health what are your primary interests? It seems like you’re doing a lot of work in rural health and preventative measures, but is there something specifically within those fields that really interests you in your field of study?
Ojinnaka: My particular interest is health disparities, especially with regards to cancer care and women’s health. That’s currently what I’m working on. I’ve been privileged to work as a research assistant on a colorectal cancer prevention program, and we recently received a women’s health grant for a breast and cervical cancer prevention program. My interest is in ensuring that underserved women or women who don’t have adequate access to health care are not left behind in the fight against cancer.
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.
Center for Community Health and Evaluation Releases First National Evaluation of HIAs: Q&A with Tatiana Lin
Health impact assessments (HIAs) are evidence-based analyses that estimate future health benefits and risks of proposed laws, regulations, programs and projects. They provide decision makers with an opportunity to minimize health risks and enhance health benefits. HIA practitioners say the tool allows for more informed—and potentially healthier—decisions related to land use, transportation, housing, education, energy and agriculture.
The Center for Community Health and Evaluation, a division of Group Health Research Institute, a nonprofit based in Seattle, recently published a national study on HIAs that looked at their utility and potential improvements.
The new study outlines how HIAs change decision making and highlights evidence that HIAs can also lead to stronger cross-sector relationships, greater attention to community voices and longer-term changes beyond the initial decision the HIA is focused on.
Key findings of the Center’s evaluation include:
- HIAs can contribute directly to the decision-making process and help achieve policy outcomes that are better for health.
- There are opportunities to advance the HIA field in the areas of stakeholder and decision-maker engagement, dissemination and follow-up.
- Attention to specific elements can increase likelihood of HIA success.
A past HIA funded by a grant from the Health Impact Project, a program of the Robert Wood Johnson Foundation and the Pew Charitable Trusts, was conducted in 2012 by the Kansas Health Institute (KHI) and looked at the health impacts of building a casino in Southeast Kansas (a law that would move such a project forward was enacted last month).
NewPublicHealth recently spoke with Tatiana Lin, the author of the HIA and a senior analyst at KHI, about the recent HIA evaluation and lessons learned from the HIAs KHI has worked on so far.
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.