This morning Scott Rhodes, PhD, MPH, a professor in the department of Social Sciences & Health Policy at Wake Forest University Health Sciences, presented a study on the impact of immigration enforcement on access to care among Latinos. The presentation came at a session on social and legal factors that affect health at the Public Health Law Research Program annual meeting. NewPublicHealth spoke with Rhodes about the study.

NewPublicHealth: You’ve been looking at immigration and found significant health care access issues in North Carolina?

Scott Rhodes: Yes, we’ve been working on Latino immigration issues for about ten years, but we hadn’t really looked at the role of immigration policy enforcement on access to care, specifically access to public health services among Latino immigrants. What we looked at in the research we presented at the PHLR annual meeting this morning were the limits that some of the policies pose, such as policies that allow police officers to start deportation processes with the Immigration and Customs Enforcement agency if they stop someone and find they are in the United States illegally. We wanted to know if those policies impact whether Latinos access public health services that they may need and what kind of impact that has on their health.

So, we did two things. We analyzed statewide county-level vital records data to look at the use of prenatal care services by Latinos across the state of North Carolina—pre- and post-implementation of one of the immigration policies that link police to the immigration service. And we also conducted focus groups and in-depth interviews with Latinos living in three counties in North Carolina in which the policy has been implemented, and then three counties in North Carolina where the policy was publicly rejected, to see whether there were some differences in perceptions about eligibility and about accessing and utilizing services.

NPH: And what did you find?

Thomas Farley, MD, MPH, Health Commissioner of the New York City Department of Health and Mental Hygiene, is the keynote speaker at the opening session of the Public Health Law Research annual meeting that started yesterday afternoon in New Orleans. In advance of the meeting, NewPublicHealth spoke with Dr. Farley about the role of legal research in moving the public health agenda forward, how New York City is doing in the weeks following Hurricane Sandy, and the flu epidemic hitting the city that prompted New York State Governor Cuomo to declare a public health emergency earlier this week.

NewPublicHealth: What will you focus on during your address at the Public Health Law Research Program annual meeting?

Dr. Farley: I will be going through a number of policies that we have put in place here in New York City to promote health. Most of those will be around food, but some will be around tobacco. So that includes things such as our raising of tobacco taxes, our smoke-free air rule and around our prohibition on the use of trans fats in restaurants, our calorie labeling initiative and our portion rule [limits on beverage sizes at some food outlets]. And I will share some thoughts about the role researchers can play in policy development for an agency like ours.

NPH: How important has legal research been for some of the recent public health initiatives that have been introduced in New York City?

Citric acid-based drinks have been linked to devastating tooth erosion, especially in Central Appalachia where the drinks are widely consumed by people of all ages. The issue was selected for a five-minute “Critical Opportunities” presentation that garnered more votes than any other issue in the session at the most recent Public Health Law Conference. This year, the issue has moved to a general session on the main day of the Public Health Law Research (PHLR) Annual Meeting, as an emerging issue in public health law. Priscilla Harris, JD, an associate professor with the Appalachian School of Law in Grundy, Va., will present “Finding Legal Interventions to Impact Purchase and Consumption of Sugar-Sweetened Beverages and Citric Acid Drinks: Trying to undo the damage of the Dew.”

According to the American Dental Association, 65 percent of West Virginia's children ages three through seven suffer from tooth decay—and near-constant sipping of Mountain Dew and other citric acid-based drinks plays a role. Harris, together with Dana Singer, JD, a program developer and researcher at the Mid-Ohio Valley Health Department and Mary Beth Shea, a dental hygienist with the health department, spoke at an information session to the Mid-Ohio Valley Board of Health a few weeks ago to present the research they have worked on to show the damaging health effects of the beverages for the people of the region. NewPublicHealth spoke with the three public health professionals just before the PHLR annual meeting began.

NewPublicHealth: What research are you working on to look at the impact of citric acid on tooth health?

Priscilla Norwood Harris: We conducted surveys to determine purchase and consumption patterns for sugar-sweetened beverages and citric acid drinks. We also interviewed and sent surveys to dentists in Central Appalachia about their perceptions of oral health problems in the region. We also went to five clinics that offer medical, dental and vision care to low-income people, and asked patients about these drinks. In addition, have almost 2,000 surveys of students in grades K through 12. We have also reviewed journal articles, many from Europe, that examine the issue of dental erosion. While it’s under the radar here in America, the studies we’ve reviewed are making the connection between dental erosion and the citric acid in drinks.

A lot of the attention in the U.S. has been focused on the sugar in these drinks and their contribution to obesity as well as the sugar with regard to oral health and cavities. Unfortunately, the acids in these drinks and the connection to dental erosion have been almost ignored. “Mountain Dew Mouth,” a term used in Central Appalachia for severely damaged teeth, involves the acids in these drinks, which can take away the tooth’s enamel.

Mary Beth Shea: From a dental health professionals’ perspective, we see a high number of adults who have said they didn’t have a clue that the beverages they’re consuming are causing the damage in their mouth and they haven’t had money for dental care.

Public Health Law Research (PHLR), a program of the Robert Wood Johnson Foundation, will hold its annual meeting in New Orleans this week. NewPublicHealth will be on the ground covering sessions on research in public health law as well as posting interviews with conference speakers including Thomas Farley, MD, MPH, Health Commissioner of New York City and Pamela Hyde, JD, administrator of the federal Substance Abuse and Mental Health Services Administration.

In advance of the conference, NewPublicHealth spoke with Diana Silver, PhD, MPH, assistant professor of public health at the Steinhardt School of Culture, Education and Human Development at New York University. Silver’s research looks at the impact of public and private services on health and well-being for children and families, especially in urban America. Her presentation at the PHLR annual meeting is called “Are More Laws Better?” with a specific  look at what has happened to traffic fatalities between 1980 and 2009 as new laws have been implemented in some parts of the country.

NewPublicHealth: Tell us about your research on laws and traffic fatalities.

Diana Silver: The motivating idea here was that there are multiple laws at the state level that govern traffic safety. Some deal with alcohol, some deal with restraining children one way or another in the car, some are about the vehicle itself such as seatbelts or speed limits. The laws vary at the state level, and they create, in some sense, really different environments that people are exposed to. We have now categorized across 30 years 25 different laws in all 50 states. 

What we found is that there are some laws that virtually all states have adopted, mostly because there’s been a federal mandate to do so, like a minimum legal drinking age. But many laws vary across states, and so we were interested to find out what factors predicted whether a state would pick up new laws and how quickly they would do that. Then, how do these different packages predict, or are they associated with reductions in motor vehicle fatalities?

NPH: How was your research different than other research that looks at this data?

The Transportation Research Board, a division of the National Research Council, is holding its annual meeting this week including a critical session later today that will bring together several subcommittees to talk about the intersection of transportation and health.

>>Read our coverage from last year’s Transportation Research Board meeting.

Ed Christopher, who is with the Federal Highway Administration Resource Center Planning Team and co-chair of the health subcommittee, says that over the last ten years people in the transportation sector have become more aware of the connections between health and transportation including physical activity, safety, air quality, equity, and access, but that collaboration is still in its early stages. “Health and transportation professionals often come from different scientific backgrounds and have separate institutional structures,” says Christopher. Today’s session bring together the health subcommittee along with several others including committees on policy, legal resources, safety and public transportation.

Christopher says the session will help “demystify” the connections between health and transportation, and identify promising opportunities for research and collaboration.

The keynote speaker at today’s session is Andrew Dannenberg, MD, MPH, an Affiliate Professor at the University of Washington’s School of Public Health Department of Environmental and Occupational Health Sciences and the Department of Urban Design and Planning in the College of Built Environments.

Dr. Dannenberg is also a consultant to and former team lead of the Healthy Community Design Initiative at the Center for Disease Control and Prevention, where he works on activities related to the health aspects of community design including land use, transportation, urban planning, and the built environment. In advance of today’s meeting, NewPublicHealth spoke with Dr. Dannenberg about synergies between transportation and health.

NewPublicHealth: What is the intersection of health and transportation and why does it matter?

Three months have passed since Hurricane Sandy hit the East Coast. And while the number of people displaced by the storm has gone down from tens of thousands to the hundreds in different communities, some people are still without power or a permanent place to live. Others face the daunting task of rebuilding businesses and homes while protecting against mold and dust, which can cause or exacerbate respiratory problems. For many, the stress has rekindled mental health issues that might have been at bay, or created new ones or just made tough times even worse.

NewPublicHealth spoke with Patricia Yang, DrPH, Chief Operating Officer and Executive Deputy Commissioner at the New York City Department of Health and Mental Hygiene.

NewPublicHealth: Hurricane Sandy hit just over two months ago. How’s the city doing now?

Dr. Yang: There are people in parts of the city for whom the storm is a distant memory, and their daily lives are virtually unaffected apart from what they might hear on the news or read in the papers. But in the areas that were most directly affected by the hurricane, life for many is far from normal and may never return to what it was pre-storm. Those areas in particular are parts of the Rockaways and Coney Island and Staten Island. So there are still thousands of people who don’t have basic utilities and for whom grid power and heat have not returned. And we’re heading into the coldest winter months.

NPH: What’s the role of the public health department both now to help people deal with the aftermath, and looking ahead to prepare for the next disaster?

Health disparities and social equity were key issues addressed at last month’s American Public Health Association (APHA) annual meeting. Angela Glover Blackwell, founder and CEO of PolicyLink, a national research and action institute whose goal is to advance economic and social equity, participated in the APHA president’s panel on the topic, where a key part of the discussion focused on the language used to discuss health disparities in the United States.

NewPublicHealth followed up with Angela Glover Blackwell to get her insights on the language of health disparities.

NewPublicHealth: During the panel at the APHA meeting, you talked about the need to be mindful of the language we use when talking about improving health for all Americans. How should we be characterizing the issues?

Angela Glover Blackwell: It is certainly good to see that the health world, public health and beyond, is talking about health disparities. Because for many years this was not anything that people talked about and it was not a topic at the American Public Health Association or any of the other big main stream meetings where health professionals gathered. So it’s a good thing that people have begun to talk about health disparities.

But, health disparities really talks about things being unequal. That’s what disparity means—unequal, different. But I don’t think that disparity captures what the condition is, nor does it suggest what the solution is. What I have heard others say and I have taken it on myself is the term health inequities, because the term “inequities” suggests unjust, unfair, and not just different. When you call them health inequities you focus on a societal problem that needs to be corrected, not just studied. The goal becomes achieving health equity, just and fair health outcomes.

It’s time that we recognize that we have unequal, unjust, unfair health outcomes and that they are related to race, and income, and place and we need to get sharp strategies that move us towards being able to help all people reach their full potential.

NPH: Where do we need to take the conversation from here?

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.

Among the impacts of the East Coast’s Hurricane Sandy have been tens of thousands of uprooted trees, contaminated water and tons of compromised food. A recent article in the Journal of Environmental Health Natural recommends that environmental health become an integral part of emergency preparedness and that community stakeholders take a role in merging the two.

David Dyjack, DrPH, associate executive director of the National Association of County and City Health Officials, and a co-author of the study, spoke with NewPublicHealth about building momentum to include environmental health in disaster emergency preparedness.

NewPublicHealth: What does the article address?

David Dyjack: The article is the first step in a series of research steps looking at how best to integrate environmental health and emergency preparedness so that communities are more resilient and take greater responsibility for their own health and safety in the event of an environmental disaster.

NPH: What is distinct about environmental health emergency preparedness? 

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.