Earlier this year, Durham County, N.C., was chosen by the Robert Wood Johnson Foundation (RWJF) as a Culture of Health Prize winner for its efforts to ensure that its most vulnerable residents have access to the county’s repository of world-class health resources, high-skilled jobs and places to exercise. As part of an ongoing series, Health Affairs blog has featured a piece by local Durham leader Erika Samoff on the community’s health successes.
While Durham is home to a wealth of health care resources—so much so that it’s been dubbed “The City of Medicine”—a 2004 health assessment found high rates of cardiovascular disease and other chronic conditions; HIV/AIDS and other sexually transmitted diseases; and infant mortality. In addition, a 2007 evaluation found that nearly one in three of Durham’s adults were obese, with the rate especially high in its African-American population, at 42 percent. Half of the adults surveyed pointed to a lack of opportunities for physical activity as a contributing factor to their condition.
County leaders responded to these findings by creating the Partnership for a Healthy Durham. It is an alliance of more than 150 nonprofits, hospitals, faith-based organizations and businesses. The partnership’s efforts include:
- Turning an empty, run-down junior high school into the Holton Career & Resource Center, which offers mentoring programs, internships and hands-on career training to high school students
- Creating new bike lanes, bike racks and sidewalks to encourage physical activity and help combat chronic obesity
- Creating Project Access of Durham County to provide access to specialty care for uninsured residents
- Passing smoke-free legislation
To learn more about Durham’s prize-winning efforts to improve health, read the Health Affairs blog post.
- Learn more about the 2014 RWJF Culture of Health Prize winners and read NewPublicHealth coverage of the prize announcement.
- Read Everyday Health’s post, “How Healthy Is Your Hometown?: What you can do to create a culture of health in your community – and win a prize for it.”
>>Bonus Content: Watch a NewPublicHealth video on Durham’s efforts to build a Culture of Health.
Last June, the Washington Post held a live event, Health Beyond Health Care, which brought together doctors, bankers, architects, teachers and others to focus on health beyond the doctor’s office. The goal of the Washington, D.C., event—which was co-sponsored by the Robert Wood Johnson Foundation others—was to showcase examples of communities working with partners to create cultures of health.
Healthy Detroit is a shining example. The project is a 501(c)(3) public health organization dedicated to building a culture of healthy, active living in the city of Detroit. It was formed less than a year ago in response to the U.S. Surgeon General’s National Prevention Strategy (NPS.) The NPS offers guidance on choosing the most effective and actionable methods of improving health and well-being, and envisions a prevention-oriented society where all sectors recognize the value of health.
NewPublicHealth recently spoke with Nicholas Mukhtar, founder and CEO of Healthy Detroit.
NewPublicHealth: How did Healthy Detroit get its start?
Nicholas Mukhtar: I was just about to the MPH part of a joint MPH/MD degree and had always wanted to be a surgeon. But as I started living in the city and getting more involved in the community, I really saw a different side of health care, and to me it just became more rewarding to focus on the systemic issues in the health care system, more so than treating people once they already got sick. I’ve now finished the MPH part of my degree, and am starting on my MD degree.
So I started sending out a number of emails to different people and reached out to Dr. Regina Benjamin, then the U.S. Surgeon General, as well as local individuals. And then we established our mission, which was really to build a culture of prevention in the city while implementing the National Prevention Strategy.
EBOLA UPDATE: Third U.S. Aid Workers Arrives for Treatment
(NewPublicHealth is monitoring the public health crisis in West Africa.)
A third U.S. medical missionary has arrived at the Nebraska Medical Center in Omaha for treatment for Ebola. Rick Sacra, MD, is a SIM USA missionary, as were Kent Brantly, MD, and Nancy Writebol, who were both treated successfully for Ebola at Emory Hospital. Approximately 1,900 people have died and 3,500 have been sickened in the ongoing outbreak. Approximately 400 deaths came in the past week alone. Read more on Ebola.
CDC Report Explores the Extent and Impact of Intimate Partner and Sexual Violence
The U.S. Centers for Disease Control and Prevention (CDC) has released a new report examining the extent and impact of intimate partner and sexual violence. According to the report, almost 20 people per minute are victims of physical violence by an intimate partner; almost 2 million women are raped each year; and more than 7 million women and men are victims of stalking each year. The report determined that since a “substantial portion” of this violence and stalking comes at a young age, primary prevention must also focus on people at young ages, accounting for the differences in victims, addressing risk factors and emphasizing health relationships. Read more on violence.
Study Links Breastfeeding, Lower Weight for Mothers
Mothers who were obese before pregnancy and who then go on to breastfeed may have an easier time losing their pregnancy weight and then keeping it off, according to a new study in journal Pediatrics. Researchers determined that previously obese mothers who breastfed weighed almost 18 pounds less than those who didn’t. "Breast-feeding not only burns extra calories but it also changes the metabolism through a series of hormonal effects required to lactate," said Lori Feldman-Winter, MD, a pediatrician and a professor of pediatrics at Children's Regional Hospital at Cooper University Health Care in Camden, N.J. "The full understanding of how breast-feeding leads to improvements in metabolism for both mother and her baby is incomplete, but there are multiple epidemiological studies showing the association." She also said that the healthier eating habits many mothers who breastfeed take up may also contribute to the lower weights. Read more on maternal and infant health.
Recently NewPublicHealth shared an interview from AlleyWatch, a Silicon Valley technology blog about SenseHealth, a new medical technology firm that has created a text message platform that health care providers can use to communicate with patients. In May, SenseHealth was picked to be part of the New York Digital Health Accelerator, which gives up to $100,000 in funding to companies developing digital health solutions for patients and providers. The accelerator is run by the Partnership Fund for New York City and the New York eHealth Collaborative. SenseHealth engaged in a clinical trial last year that used the technology to help providers engage with patients who are Medicaid beneficiaries.
Health conditions supported by the SenseHealth platform range from diabetes to mental health diagnoses, while the messaging options include more than 20 customizable care plans, such as medicine or blood pressure monitoring reminders. There are also more than 1,000 supportive messages, such as a congratulatory text when a patient lets the provider know they’ve filled a prescription or completed lab work. The platform couples the content with a built-in algorithm that can sense when a user has logged information or responded to a provider, and providers are able to set specific messages for specific patients. Early assessments show that the technology has helped patient manage their conditions, with data showing more SenseHealth patients adhered to treatment plans and showed up for appointments than patients who didn’t receive the text program.
We received strong feedback on the post, including a question from a reader about whether Medicaid beneficiaries lose contact with their providers if they disconnect their cell phones or change their numbers, a common occurrence among low-income individuals who often have to prioritize monthly bills. To learn more about SenseHealth and its texting platform, NewPublicHealth recently spoke with the company’s CEO and founder, Stan Berkow.
NewPublicHealth: How did SenseHealth get its start?
Stan Berkow: We got started about two to two-and-a-half years ago. I met one of the other founders while I was working at the Columbia University Medical Center in New York City. We were both clinical trial coordinators and were seeing—first hand—the difficulties in getting participants in our studies to actually follow through on all the exercise and nutritional changes they needed to make in order to complete the research project. That led us to step back and look at the bigger health care picture and recognize the challenges for providers to help patients manage chronic conditions, and recognizing that there’s a huge time limitation on the providers. That pushed us toward finding a way through technology to help those providers help the patients they work with more effectively to prevent and manage chronic conditions.
EBOLA UPDATE: WHO Says More than $600M Needed to Combat the Ebola Outbreak
(NewPublicHealth is monitoring the public health crisis in West Africa.)
Approximately $600 million in supplies is needed to combat the ongoing Ebola outbreak in West Africa, according to the World Health Organization (WHO), while Canadian health officials continue to work on a way to transport an experimental treatment to the affected area. "We are now working with the WHO to address complex regulatory, logistical and ethical issues so that the vaccine can be safely and ethically deployed as rapidly as possible," said Health Canada spokesman Sean Upton, in a statement. "For example, the logistics surrounding the safe delivery of the vaccine are complicated." More than 1,900 people have died in the outbreak. Read more on Ebola.
RWJF, TFAH Report Finds State Obesity Rates Continue to Remain High
Adult obesity rates continue to be high across the country, with rates increasing in six states and decreasing in none over the past year, according to a new report from the Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF). The report, The State of Obesity: Better Policies for a Healthier America, found that rates climbed in Alaska, Delaware, Idaho, New Jersey, Tennessee and Wyoming. Mississippi and West Virginia have the highest rates, at 35.1 percent, and no state has a rate below 21 percent. “Obesity in America is at a critical juncture. Obesity rates are unacceptably high, and the disparities in rates are profoundly troubling,” said Jeffrey Levi, PhD, executive director of TFAH, in a release. “We need to intensify prevention efforts starting in early childhood, and do a better job of implementing effective policies and programs in all communities—so every American has the greatest opportunity to have a healthy weight and live a healthy life.” Read more on obesity.
Study: Women Are Underrepresented in Surgical Research
A review of more than 600 studies in five major surgical journals found that males are vastly overrepresented, calling into question how the findings will translate for female patients. The journals— Annals of Surgery, American Journal of Surgery, JAMA Surgery, Journal of Surgical Research and Surgery—responded by announcing they will now require study authors to report the sex of animals and cells in their research, or to explain why only one sex was analyzed. "Women make up half the population, but in surgical literature, 80 percent of the studies only use males," study senior author Melina Kibbe, MD, professor of surgical research at Northwestern University Feinberg School of Medicine, said in a release. "We need to do better and provide basic research on both sexes to ultimately improve treatments for male and female patients.” The study appeared in the journal Surgery. Read more on health disparities.
In the last few days, the U.S. Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO) and the medical aid group Doctors Without Borders have sounded alarms on the growing needs of several countries in West Africa fighting the Ebola outbreak. The groups have called for increased funding, equipment and expert health personnel to help stem the rapidly increasing numbers of infections.
As of last week, there have been more than 3,000 cases and more than 1,500 deaths, making it by far the largest outbreak since Ebola was discovered during the 1970s, according to the WHO. CDC Director Tom Frieden, MD, MPH, who last week visited the main West African countries dealing with the Ebola outbreak, said the number of cases could spike to 20,000 if more isn’t done to stem spread of the disease in those countries.
In addition, a recent post on ForeignPolicy.com said that the epidemic must be controlled before it also poses a security threat. Liberia, which has seen the highest number of Ebola cases and deaths in the region so far, has been under the watch of an international United Nations (U.N.) peacekeeping force since a civil war ended in 2003. While the U.N. had planned to begin drawing down the force next year, U.N. Secretary General Ban Ki-moon said he’d like to delay any drawdown for at least three months because of the virus outbreak, which has needed troops to help secure order.
However, several countries want to pull out troops now in order to reduce the risk to their personnel and to citizens at home who they worry could be infected by returning soldiers. Ban has said that the nature of the illness poses little risk to the troops, who are unlikely to have contact with the bodily fluids of people who are ill—which is the way the virus spreads—and some of the countries involved are considering sending their own experts to assess the risks.
EBOLA UPDATE: HHS Partners with Mapp Biopharmaceutical on Development of Ebola Treatments
(NewPublicHealth is monitoring the public health crisis in West Africa.)
The U.S. Department of Health and Human Services has contracted with Mapp Biopharmaceutical Inc. for the development of an Ebola treatment. The funding will come through the Assistant Secretary for Preparedness and Response’s Biomedical Advanced Research and Development Authority. Under the 18-month, $24.9 million contract, Mapp will also continue the development and manufacture of its existing Ebola drug, ZMapp, which was used to successfully treat two Americans who were infected in the outbreak in West Africa. “While ZMapp has received a lot of attention, it is one of several treatments under development for Ebola, and we still have very limited data on its safety and efficacy,” said Nicole Lurie, MD, assistant secretary for preparedness and response, in a release. “Developing drugs and vaccines to protect against Ebola as a biological threat has been a long-term goal of the U.S. government, and today’s agreement represents an important step forward.” Read more on Ebola.
CVS Announces All Stores are Now Tobacco Free
Tobacco products are no longer sold at any of the approximately 7,700 CVS/pharmacy locations, the company announced today, almost a month ahead of its planned tobacco-free schedule. The company also announced that is has changed its corporate name to CVS Health. "Every day, all across the country, customers and patients place their trust in our 26,000 pharmacists and nurse practitioners to serve their health care needs," said Helena B. Foulkes, President of CVS/pharmacy, in a release. "The removal of cigarette and other tobacco products from our stores is an important step in helping Americans to quit smoking and get healthy." Read more on tobacco.
Study: Double Mastectomies and Lumpectomies Carry Similar Survival Rates
Double mastectomies for early stage breast cancer are no more effective than lumpectomies at improving survival rates, according to a new study in the Journal of the American Medical Association. Analyzing data on more than 189,000 patients in California, researchers found that while the percentage of women who opted for double mastectomies climbed from 2 percent in 1998 to 12.3 percent in 2011—and that in 2011 approximately one-third of patients younger than 40 chose to have a double mastectomy rather than the potentially breast-conserving lumpectomy—the death rates for the two treatments were similar. The researchers said their findings are especially significant for women at average risk. Read more on cancer.
NewPublicHealth continues a new series to highlight some of the best public health education and outreach campaigns every month. Submit your ideas for Public Health Campaign of the Month to firstname.lastname@example.org.
The Federal Emergency Management Agency (FEMA) is starting off National Preparedness Month with a series of stark, dark and attention-getting public service advertisements (PSAs) developed in cooperation with the Ad Council. They are set in what looks to be a dark, crowded school auditorium and showcase an intact family sheltering from the storm, and another family unable to locate their son. The obvious focus is on making a plan to know where all family members are when disaster strikes, but the auditorium—with too few chairs, no apparent cots and little room to move or stretch—gives a rare glimpse into what a public shelter looks like during an emergency and adds to the urgency of making that plan.
“The first step to preparing for disasters is simple and it’s free—talk to your family and make a plan,” said Craig Fugate, FEMA administrator. “Do you know how you’ll reunite and communicate with your family during an emergency? Through our continued partnership with the Ad Council, this year’s campaign illustrates how making a plan can keep families together and safe during a disaster.”
According to a recently released FEMA survey, 50 percent of Americans have not discussed or developed an emergency plan for family members about where to go and what to do in the event of a local disaster.
EBOLA UPDATE: NIH to Begin Human Trials of Experimental Vaccine
(NewPublicHealth is monitoring the public health crisis in West Africa.)
Following an expedited review by the U.S. Food and Drug Administration, the National Institutes of Health will this week begin human testing of an experimental Ebola vaccine. This will be the first safety trial for this type of vaccine, which was developed by GlaxoSmithKline and the National Institute of Allergy and Infectious Diseases (NIAID). The vaccine will first be given to three people to determine its safety, and then to 20 volunteers ages 18 to 50. “Today we know the best way to prevent the spread of Ebola infection is through public health measures, including good infection control practices, isolation, contact tracing, quarantine, and provision of personal protective equipment,” said NIAID Director Anthony Fauci, MD. “However, a vaccine will ultimately be an important tool in the prevention effort. The launch of Phase 1 Ebola vaccine studies is the first step in a long process.” Read more on Ebola.
Study: Low-Carb Diets May Be Better than Low-Fat Diets for Losing Weight, Reducing Heart Disease Risk
Low-carbohydrate diets may be more effective than low-fat diets for both losing weight and reducing the risk of heart disease, according to a new study in the Annals of Internal Medicine. Researchers assigned 148 patients either a low-carbohydrate or a low-fat diet, collected data at the start of the study, then again at three, six and 12 months. Of the people who completed the study—59 in the low-carbohydrate group and 60 in the low-fat group—researchers determined that the low-carbohydrate diet was the more effective of the two, concluding that “[r]estricting carbohydrate may be an option for persons seeking to lose weight and reduce cardiovascular risk factors.” Read more on obesity.
Study: Many People Have Difficulty Understanding their Electronic Health Records
While electronic lab results are increasingly used to keep patients up to date on their health, a new study out of the University of Michigan’s schools of Public Health and Medicine found that many people have difficulty understanding the information. The researchers pointed to people with low comprehension of numerical concepts and low literacy skills as the most likely to have difficulty understand their results, make them less likely to use the data to decide whether a physician follow-up might be needed. "If we can design ways of presenting test results that make them intuitively meaningful, even for people with low numeracy and/or literacy skills, such data can help patients take active roles in managing their health care," said Brian Zikmund-Fisher, associate professor of health behavior and health education at the university’s School of Public Health, in a release. "In fact, improving how we show people their health data may be a simple but powerful way to improve health outcomes." Read more on access to health care.
It’s no secret that kids perform better in school when they are healthy and feel motivated to learn. But not all kids have access to the quality health care that can help them get healthy, stay healthy or treat any chronic health conditions they have. That’s where school-based health centers come in.
School-based health centers are partnerships between schools and community health organizations. They help students get the preventive care they need—including flu shots, annual physicals, dental exams, vision exams and mental health counseling—right where they spend most of their daytime hours: On school grounds. There are currently more than 2,000 school-based health centers across the country. Besides removing barriers to health care that many families face, school-based health centers help reduce inappropriate visits to emergency departments by up to 57 percent, research has found. They also help lower Medicaid expenditures, decrease student absences from school and do a better job of getting students with mental health issues the services they need.
Moreover, with growing recognition that health disparities affect academic achievement, school-based health clinics help close the gap by providing crucial access to health care for students who might not otherwise get it. A study by researchers at the University of Washington, Seattle, found that high school students who used school-based health centers experienced greater academic improvements over the course of five semesters than students who didn’t use these centers; the effect was especially pronounced among those who took advantage of mental-health services. Another study found that high school students who were moderate users of school-based health centers had a 33 percent lower dropout rate in an urban setting that has a high dropout rate.
The exact services offered by these centers vary by community. At Santa Maria High School in Santa Maria, Calif., the health center’s offerings include crisis intervention sessions; a grief group for students dealing with loss; and ongoing opportunities for students to build important social skills and skills that will help them maintain a healthy lifestyle. In Oakland, Calif., the Native American Health Center offered at a middle school and a high school provides medical care, dental care, mental health services and a peer health education program in one setting. At the Maranacook Health Center in central Maine, kids can get support for chronic health problems (such as asthma, diabetes, or seizures), medications they need, counseling or other mental-health evaluations and services.
The ultimate goal behind these centers is for all children to enjoy and benefit from good health and school success.
“Children and adolescents are at the heart of the mission,” said John Schlitt, president of the School-Based Health Alliance, based in Washington, D.C. But the “scope of the health center’s influence extends beyond the clinic walls to the entire school, its inhabitants, climate, curriculum, and policies. The school is transformed as a hub for community health improvement.”