As the demand for walkable communities keeps growing, experts are moving from asking “If they build it, will they come?” to questioning how to fund the new developments, as well as keeping our eyes on issues such as transit, affordability and improving population health. As of January sharing best practices for those and many other issues is the job of Chris Zimmerman, who recently joined the staff of Smart Growth America as Vice President for Economic Development, following a very long stint as a member of the Arlington County Board in Virginia. Before his post in Arlington, Zimmerman was Chief Economist and Committee Director for Federal Budget and Taxation at the National Conference of State Legislatures. In his new role, Zimmerman will focus on the relationships between smart growth strategies and the economic and fiscal health of communities.
NewPublicHealth spoke with Zimmerman soon after he landed in his new office.
NewPublicHealth: What did you do before joining Smart Growth America?
Chris Zimmerman: For the last 18 years I’ve been a member of the Arlington County Board, the governing body of Arlington County, Virginia, an urban county of about 220,000 people right next to Washington D.C. The county functions as a comprehensive local government, with functions from school funding to land use and development to standard municipal functions such as parks and recreation, public safety, waste removal and managing public infrastructure. We don’t run the schools, but the funds for the schools are part of the county budget, at a cost of a little more than $1 billion annually.
Arlington County has become a model for transit-oriented development that is studied by folks around the country and even around the world, particularly because of the way the county has chosen to develop around the Metro system. That includes the initial commitment to be involved in Metro Rail, to fund underground Metro stations and then to focus development around them, beginning even before the ideas of the vocabulary of Smart Growth and urbanism had really gotten started, decades ago.
Prior to serving on the county board, I served on the county’s planning commission and a number of other commissions. So I’ve had about 20 to 25 years of involvement in the development of every aspect of the community, including housing, planning development and economic development, and even agencies such as the Washington Metropolitan Area Transit Authority, which runs Metro Rail and Metro Bus and every other regional transportation planning body there is here in Washington. I was involved in a lot of regional transportation issues that obviously were fundamental to our county because of the way we chose to develop and because of where we’re located. There are seven crossings of the Potomac River and five of them go through Arlington, so although there are a couple hundred thousand people in Arlington, there’s a million and a half or so in northern Virginia and large numbers of them go through Arlington every day.
WIC Expands to Offer More Options to 9 Million Poor Women and Children
Newly announced changes to the U.S. Department of Agriculture’s Special Supplemental Nutrition Program for Women, Infants and Children—also known as WIC—will expand access to fruits, vegetables and whole grains for approximately 9 million poor women and young children. The changes include an increase over 30 percent, or $2 per month, in the allowance for each child's fruit and vegetable purchases. They also allow fresh produce instead of jarred infant food for babies. The changes, which were recommended by the Institute of Medicine, mark the first comprehensive revisions to the voucher program allowances since 1980. Read more on nutrition.
Survey Finds Majority of Hispanic Adults Are Not Confident in Their Understanding of Key Insurance Terms
While the majority of white, non-Hispanic adults feel confident in their understanding of key insurance terms, the same cannot be said for Hispanics. According to the Urban Institute’s Health Reform Monitoring Survey (HRMS), only one in four Hispanic adults express confidence in their understanding of terms such as “premium,” “copayment” and “deductible.” This disparity is an impediment to Affordable Care Act marketplace and Medicaid enrollment. The findings demonstrate the need for culturally appropriate education campaigns and bilingual navigators to provide assistance in target communities. The quarterly HRMS is funded by the Robert Wood Johnson Foundation and the Ford Foundation. Read more on health disparities.
New Program to Train Police Officers in Bleeding Control for Mass Casualty Victims
As part of ongoing efforts to increase the number of survivors of active shooter or mass casualty incidents, more than 36,000 police officers across the country will receive bleeding control kits and training this year. The goal is to train officers to slow or stop bleeding at the scene before other first responders arrive. The five-step “THREAT” approach:
- T - Threat suppression
- H – Hemorrhage control
- RE – Rapid Extrication to safety
- A – Assessment by medical providers
- T – Transport to definitive care.
The initiative is led by the Hartford Consensus, a collaborative group of trauma surgeons, federal law enforcement and emergency responders, and driven by the American College of Surgeons, the Federal Bureau of Investigation, the Major Cities Chiefs Association and the Prehospital Trauma Life Support program. “Controlling hemorrhage has to be a core law enforcement tactic,” said Alexander Eastman, MD, MPH, FACS, chief of trauma at UT Southwestern/Parkland Memorial Hospital and Dallas Police Department lieutenant, in a release. “We saw the dramatic impact of this tactic in the Tucson, Ariz. shooting in 2011. With training and tourniquets, law enforcement officers will save lives – many lives.” Read more on violence.
Future of Public Health is an ongoing series focused on the emerging faces in the world of public health. We spoke with Azmina Lakhani, MD, MPH, about what helped lead her to the field and where she hopes to go from here.
NPH: What’s your educational background in public health?
Azmina Lakhani: I went to the Illinois Mathematics and Science Academy for high school, and then I did medical school, undergraduate and public health all at Northwestern University in Chicago. I received a BA in psychology and global health as an undergrad and then for the next five years I attended medical school and earned a Master’s in Public Health, as well.
NPH: This seems like something that you went into knowing full well that this is what you’re interested in. What was it that encouraged you to pursue a degree and a career in public health?
Lakhani: I had sort of been interested in health care in general in high school, and I wasn’t really sure whether I was going to do research or clinical work or public health work, but in college I really started becoming interested in public health. First through global health, I started learning about different health care systems abroad and doing some volunteer work in Ecuador and Mexico City. That’s really when I got interested in health care delivery systems and also how one can have a greater influence on health.
I appreciate the clinical side. I’m a family medicine resident in training currently, so I love working one-on-one with patients. I also see a lot of value in making an impact on a larger scale—whether that’s how someone gets their health care, what insurance systems we have in place, or the traditional public health things that you think of such as vaccines—that have a really large impact on people. But I think for a shorter answer to your question, I really got interested in college and then built on that in medical school while I was getting my MPH.
NPH: Within the field of public health, what’s your primary interest? What really speaks to you? The global approach?
Lakhani: I think public health is just so awesome because it has so many different facets, and to be honest, I don’t have one particular interest in terms of public health. During my year at the Chicago Department of Public Health (CDPH) I worked on a project called PlayStreets. It’s a very simple idea where we close down streets in the city—neighborhood streets—to allow children with little access to public spaces to have a place to play. The whole intent is to get people out there, meeting their community members, and, in the long term, trying to reduce childhood obesity. It’s kind of a lofty goal, but I am interested in making resources available to people so they can take control of their own health on a broader scale and PlayStreets was one example of that.
Much of the country is still facing at least a few more weeks of winter weather, so harbingers of spring are especially welcome. In Washington, D.C., one of those signs is an increase in the number of “TapIt” posters on the city’s metro system letting city dwellers and visitors know where they can get clean drinking water throughout the area for their reusable water bottles. TapIt is a six-year-old national network of cafes, coffee shops and some retail stores that offer free drinking water to anyone who asks and brings their own vessel to fill and drink from. Partners that have helped with costs often include local water utility companies.
"This network protects the environment, as well as people’s wallets," said TapIt Campaign Director Will Schwartz in a recent release. "In fact, users could save up to $700 per year if they were to use TapIt instead of buying a bottle of water each day."
Other reasons to actively look for easy access to water in the community include:
- A 2012 study in the American Journal of Clinical Nutrition found that replacing sugary drinks with water resulted in a 2 to 2.5 percent weight loss for study participants during a six month clinical trial.
- In 2011, the American Academy of Pediatrics issued a parents advisory urging them to make water the primary form of hydration for kids.
- A 2013 survey published in the U.S. Centers for Disease and Control and Prevention’s journal Preventing Chronic Disease found that low drinking water intake is common and associated with known unhealthful behaviors such as insufficient physical activity and unhealthy eating.
Local TapIt apps, available via the internet or on Android and iPhone smartphone platforms, fix on a user’s location and display a map of nearby outlets that offer water. Users click on map markers for names of locations, addresses and distances. Information includes beverage specifics such as whether the offered water is filtered, chilled, self-serve, or needs to be requested. For example, at the Birchwood Café in Minneapolis, Minn. consumers help themselves to chilled, filtered tap water from the soda dispenser, while at the Village Bean Co. in Des Moines, Iowa, water drinkers must ask wait staff for water and will be offered room-temperature, non-filtered tap water.
National outlets welcoming TapIt users include REI outdoor clothing retail stores and Whole Food supermarkets.
Also, if you don’t have a computer or smartphone at the ready, many of the water partners post TapIt stickers on storefront windows or doors to let people know they’re invited in for a drink.
>>Bonus Link: Read an FAQ on the TapIt program.
FDA Proposes New ‘Nutrition Facts’ Food Labels
The U.S. Food and Drug Administration (FDA) has put forth a new proposed Nutrition Facts label for packaged foods. The updated design would reflect scientific information not available when the current label was designed two decades ago. For example, it would replace out-of-date serving sizes and feature a design that highlights key parts of the label, such as calories and serving sizes. “For 20 years consumers have come to rely on the iconic nutrition label to help them make healthier food choices,” said FDA Commissioner Margaret A. Hamburg, MD. “To remain relevant, the FDA’s newly proposed Nutrition Facts label incorporates the latest in nutrition science as more has been learned about the connection between what we eat and the development of serious chronic diseases impacting millions of Americans.” Read more on nutrition.
Study: One in Five U.S. Health Facilities Don’t Provide Hand Sanitizer Everywhere Needed
One in five U.S. health facilities don’t make hand sanitizer available everywhere necessary, needlessly increasing the risk for health-care associated infections, according to a new study in the American Journal of Infection Control. In addition, approximately half of the hospitals, ambulatory care facilities and long-term care facilities included in their budgets funds for proper hand hygiene training. The study examine compliance with the World Health Organization’s hand hygiene guidelines at 168 facilities in 42 states and Puerto Rico. "When hospitals don't focus heavily on hand hygiene, that puts patients at unnecessary risk for preventable health care-associated infections," said by Laurie Conway, RN, MS, CIC, PhD student at Columbia Nursing, in a release. "The tone for compliance with infection control guidelines is set at the highest levels of management, and our study also found that executives aren't always doing all that they can to send a clear message that preventing infections is a priority." Read more on infectious disease.
CDC Foundation Expands Safe Injection Campaign
The CDC Foundation and Eli Lilly are partnering to expand the U.S. Centers for Disease Control and Prevention’s (CDC) Safe Injection Practices Coalition—a safety awareness campaign that provides information for health providers and patients. According to CDC data, more than 150,000 patients have been notified of potential exposure to hepatitis and HIV because of unsafe injection practices in U.S. health care settings since 2001, and CDC researchers have found that medical injections are an overlooked source of infections and outbreaks. Planned actives of the partnership include:
- Expand the One & Only Campaign to new audiences such as individual and group-owned physician practices
- Educate health care providers through new and enhanced training and communication materials to address emerging issues
- Improve the Safe Injection Practices Coalition website and social media platforms to share resources and toolkits with new audiences
- Engage new and existing Safe Injection Practices Coalition partners
Read more on prevention.
With the passage of the Mental Health Parity Act and the implementation of the Affordable Care Act (ACA), behavioral health experts are pushing to improve the quality of that care so that people seeking help—some for the first time—receive evidence-based care that best suits their individual needs. As part of that conversation, the U.S. Senate Health, Education, Labor and Pension committee held a hearing this week on mental health treatment trends in the United States.
Sen. Tom Harkin (D-Iowa) the committee chair opened the hearing by “pointing to disturbing new trends [including]...significant increases in the prescribing of psychotropic medications, while the use of behavioral and psychological treatments among children and youth has increased only slightly, and has actually decreased among adults.”
According to committee research on recent use of psychotropic drugs, use of antipsychotic medications has increased eight-fold among children and five-fold among adolescents, and has doubled among adults between 1993 and 2009.
The key witness at the hearing was William Cooper, MD, MPH, a professor of pediatrics and health policy at the Vanderbilt University School of Medicine who conducts population-based studies of medication use in children. Cooper told the committee about a nine-year-old boy he treated for weight gain—which turned out to be a side effect of a psychotropic drug the child had been prescribed by a primary care provider given for disturbing the classroom. No mental illness diagnosis had been made for the child, and no mental illness was detected after evaluation at Vanderbilt.
Cooper said that in recent years the United States has seen a tremendous increase in the numbers of children diagnosed with mental health disorders.
“Whether this is a result of increased awareness, improved diagnosis, or other factors is not clearly understood,” said Cooper, who added that “while we must acknowledge that a part of the increase could be due to over-diagnosis, there is no disputing the fact that a large number of children and their families suffer significantly because of mental illness.”
Furthermore, added Cooper, given the fact that suicide is the second leading cause of death for children ages 12-17, “tragic consequences of childhood mental health disorders highlight our sense of urgency in addressing this important problem.”
Cooper added that treating mental health disorders can be challenging and that 50-75 percent of the care for children with mental health disorders occurs in primary care settings “making it critical that consultation and communication between primary care professionals and experts in mental health be enhanced.”
Significantly, Cooper told the panel that despite guidelines, much of the mental health care for children occurs in a manner “inconsistent with optimal practice,” including:
- Use of medications for diagnoses for which there is little evidence of benefit.
- Use of multiple medications at the same time, especially among particularly vulnerable children such as children in foster care, where a recent study found multiple psychiatric medications in up to 75 percent of children being treated.
- Use of medications alone without proven psychotherapies.
Cooper attributed the problems to several factors, among them:
- Many general practice doctors are unaware of current mental health treatment guidelines.
- Inadequate mental health resources to provide best treatments.
- Too few professionals with training in providing mental health care to children.
- Barriers to treatment, including cost or the need to travel long distances.
- Stigma associated with mental illness, which may reduce families’ willingness to acknowledge a mental health disorder and seek treatment.
The HELP committee plans to hold additional hearings to address mental health issues. Other attention to the issues addressed at the hearing include a recent meeting in Washington, D.C. among professionals who conduct psychiatric clinical trials. They stressed the need to involve patients and families more in trial design and access, as well as to work with trial designers on mental health needs not currently being met.
The Substance Abuse and Mental Health Services Administration, a federal agency, recently announced several new funding grants to help individual groups facing mental health concerns including:
- A grant program for residential treatment of pregnant and postpartum women.
- A grant program to expand and sustain comprehensive community mental health services for children and their families, in order to improve behavioral health outcomes for children and youth with serious emotional disturbances, as well as improve the health and well-being of their families.
- A grant program to provide tribal and urban American Indian and Alaskan Native communities with tools and resources to plan and design a holistic, community-based coordinated system of care approach to support mental health and wellness for children, youth and families.
Read more about mental health on NewPublicHealth.
New Study Shows Latinos of Different Origins Can Have Different Diseases, Risk Factors
A review of a recent study, the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) that enrolled about 16,415 Hispanic/Latino adults, finds diversity among Latinos not only in ancestry, culture and economic status, but also in prevalence of certain diseases, risk factors and lifestyle habits. The study was done among Latinos living in San Diego, Chicago, Miami, and the Bronx, N.Y., who self-identified with Central American, Cuban, Dominican, Mexican, Puerto Rican, or South American origins.
- The percentage of people who reported having asthma ranged from 7.4 (among those of Mexican ancestry) to 35.8 (among those of Puerto Rican ancestry).
- The percentage of individuals with hypertension ranged from 20.3 (South American) to 32.2 (Cuban).
- The percentage of people eating five or more servings of fruits/vegetables daily ranged from 19.2 (Puerto Rican origin) to 55.0 (Cuban origin). Also, men reported consuming more fruit and vegetables than women.
- Women reported a much lower consumption of sodium than men among all Hispanic groups represented in the study.
- About 1 in 3 individuals had pre-diabetes, also fairly evenly distributed among Hispanic groups.
- Only about half of individuals with diabetes among all Hispanic groups had it under control.
A second study among the same population will start in October 2014 to reassess certain health measurements and understand the relationship between the identified risk factors during the first visit and future disease in Hispanic populations. Read more on health disparities.
Study: Acetaminophen During Pregnancy Tied to Increased Risk for ADHD, HKDs in Kids
Children whose mothers used acetaminophen during pregnancy are at higher risk for developing attention-deficit/hyperactivity disorder (ADHD)–like behavioral problems or hyperkinetic disorders (HKDs), according to a new study in JAMA Pediatrics. Researchers analyzed data on 64,322 children and mothers enrolled in the Danish National Birth Cohort from 1996 to 2002, finding that approximately 56 percent of the mothers reported acetaminophen use during pregnancy. Their children were 37 percent more likely to be diagnosed with an HKD, 29 percent more likely to be prescribed ADHD medications and 13 percent more likely to exhibit ADHD-like behaviors at age 7. Approximately five to six percent of babies born today will develop ADHD symptoms at some point in their lives. Jorn Olsen, MD, one of the study's authors and a professor of epidemiology at UCLA and at Aarhus University in Denmark, noted that the risk was relatively modest, but that “for women who are pregnant and who have not taken these drugs, I think that the take-home message would be a lot of the use of these particular drugs during pregnancy is not really necessary," according to Reuters. Read more on maternal and infant health.
Stigma Remains Powerful Barrier Impeding Mental Health Care for Many
The stigma surrounding mental health continues to remain a very real and very serious barrier keeping many people from seeking the health care they need, according to a new study in the journal Psychological Medicine. The analysis, from researchers at King’s College London and funded in part by the U.S. National Institutes of Health, combined the results of 144 studies including more than 90,000 people from around the world. Approximately 25 percent of people are estimated to have mental health problems, but only 75 percent of those in the United States and Europe seek treatment; delays in treatment are linked to worse outcomes for many mental health disorders, such as psychosis, bipolar disorder, major depression and anxiety disorders. The study pointed specifically to “treatment stigma” (the stigma associated with using mental health services or receiving mental health treatment) and “internalized stigma” (shame, embarrassment) as the most significant barriers, as well as concerns about confidentiality, wanting to handle the problem by themselves and not believing they needed help. "We now have clear evidence that stigma has a toxic effect by preventing people seeking help for mental health problems,” said Professor Graham Thornicroft, from the college’s Institute of Psychiatry and the study’s lead author. “The profound reluctance to be ‘a mental health patient’ means people will put off seeing a doctor for months, years, or even at all, which in turn delays their recovery." Read more on mental health.
A new infographic from the Office of the U.S. Surgeon General highlights collaborations within the federal government and between the health and healthcare sectors to help improve prevention outreach. These efforts are part of the cross sector National Prevention Strategy launched by the office several years ago.
Current examples of collaboration include Million Hearts, an initiative of the U.S. Department of Health and Human Services to prevent one million heart attacks by 2017. The initiative includes a commitment by close to 150 large private medical practices in the United States to get hypertension control rates above 80 percent in their communities.
You can also view the fully interactive infographic here.
>>Bonus Link: Read interviews and listen to podcasts about the National Prevention Strategy conducted with former and current U.S. Cabinet Secretaries and agency heads.
Cold Winter Raises Concerns about Energy Insecurity
A new brief by researchers at the Mailman School of Public Health at Columbia University looks at energy insecurity (EI), which is measured by the proportion of household energy expenditures relative to household income. EI tends to impact low-income families in part because they often live in older homes and apartments that haven’t been constructed to conserve heat.
Key findings of the brief include:
- More than half of families affected by economic EI are living in poverty (below 100 percent of the federal poverty level) and about one third are extremely poor.
- Approximately half of all households facing economic EI are black/African-American and about one-third are white.
- Geographically, the largest proportion (46 percent) of children in households with economic EI resides in the South.
- Over half of families with economic EI are renters; 41 percent are homeowners.
According to the Mailman researchers, the main safety net program for EI, the Low-Income Home Energy Assistance Program (LIHEAP), covers only a fraction of the overall need. Of the estimated 10-15 million homes eligible for benefits in 2012, 5.5 million received assistance for reasons such as lack of awareness by people who could benefit and program budget cuts. Read more on poverty.
Many Adults with Depression Symptoms Have Not Consulted a Professional
A new report by the Substance Abuse and Mental Health Services Administration (SAMHSA) finds that close to 40 percent of the 15 million American adults who experienced a major depressive episode in the past year did not talk to a counselor or health provider. A major depressive episode is defined as a period of at least two weeks when a person experienced a depressed mood or loss of interest or pleasure in daily activities and had at least four of seven additional symptoms reflecting the criteria as described in the fourth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of the Mental Disorders (DSM-IV). “This report shows that too many Americans still needlessly suffer in silence instead of reaching out to providers for help in getting them on the road to recovery through effective treatment and supports,” said Paolo del Vecchio, the director of SAMHSA’s Center for Mental Health Services. “We are raising awareness about the hope for recovery from these conditions, helping communities identify their behavioral health needs, and increasing education about access to treatment for all Americans through the Affordable Care Act and the new parity protections for insurance coverage.” Read more about mental health.
EPA Proposes New Safety Measures to Protect Farm Workers from Pesticide Exposure
The U.S. Environmental Protection Agency (EPA) has announced proposed revisions to the Worker Protection Standard to protect the nation’s two million farm workers and their families from pesticide exposure. The EPA is proposing significant improvements to worker training regarding the safe usage of pesticides, including how to prevent and effectively treat pesticide exposure. Increased training and signage will inform farm workers about their protections under the law. The EPA has also proposed that children under 16 be legally barred from handling all pesticides, with an exemption for family farms. The revisions are based on more than a decade of extensive stakeholder input by federal and state partners and from across the agricultural community including farm workers, farmers and industry. Read more on the Environmental Protection Agency.
IOM Report: More Evidence-Based Practices Needed to Help Treat and Prevent Psychological Disorders among Service Members and Families
Between 2000 and 2011, almost 1 million service members or former service members were diagnosed with at least one psychological disorder either during or after deployment, according to recent research by the Institute of Medicine (IOM). As a follow up, the U.S. Department of Defense (DOD) asked the IOM to evaluate the department’s efforts to prevent psychological disorders among active-duty service members and their families. That report was recently released.
The report includes recommendations on how the DOD can improve care.
Finding 1: DOD has implemented numerous resilience and prevention programs for service members and their families, but it faces a number of challenges, including an insufficient evidence base to support its interventions and a lack of systematic evaluation and performance measures.
Recommendation 1: By targeting resources to develop the evidence base and disseminate that evidence, DOD’s prevention efforts can be both more effective and cost effective.
Finding 2: There is a need for DOD to improve approaches for identifying and intervening with service members and their members who may already have or may be at risk for developing a psychological disorder.
Recommendation 2: DOD should dedicate funding, staffing and logistical support for data analysis and evaluation to support performance monitoring of programs for accountability and continuous improvement.
Finding 3: Screening, assessment and treatment approaches for psychological health problems are not always implemented between and within the DOD and the U.S. Department of Veterans Affairs (VA) in a consistent manner or aligned with the evidence base, which threatens the delivery of high-quality care and hampers evaluation efforts.
- There are opportunities to improve processes of training and evaluating clinicians, including the incorporation of continuing education and supervision; standardized periodic evaluation; and a greater emphasis on coordination and interdisciplinarity.
- The DOD and VA should invest in research to determine the efficacy of treatments that do not have a strong evidence base.
- Both departments should conduct systematic assessments to determine whether screening and treatment interventions are being implemented according to clinical guidelines and departmental policy.
- Accessible inter-department data systems should be developed to assess treatment outcomes, variations among treatment facilities and barriers to the use of evidence-based treatment.
- Read the complete report.
- Read a NewPublicHealth interview with Jonathan Woodson, MD, Assistant Secretary of Defense for Health Affairs about the National Prevention Strategy.
- Learn more about the state of mental health in the military from this infographic from the American Psychiatric Association embedded below.