Category Archives: APHA

Nov 5 2013
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Gaining Traction on Childhood Obesity in New England

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Harvard Pilgrim Health Care Foundation’s work on childhood obesity is driven by one startling fact: one in three Massachusetts children are overweight or obese. To find out why, Executive Director Karen Voci and her colleagues went to the places where children learn and play—schools, after school programs and child care centers— and found that children were sitting for most of the day and foods were heavy on starch and sugar. With a limited budget, Voci and her team found opportunities and partners in Massachusetts, New Hampshire and Maine to improve childhood obesity rates.

“It’s hard to measure what you’re accomplishing,” said Voci at one session during the American Public Health Association (APHA) 2013 meeting. “These environments look and feel different, but it’s hard to capture this feeling in a meaningful statistic that can be used further down the road.”

As a result, most of the results shared focused on process and intermediate outcomes rather than actual health outcomes—for now—but the communities are optimistic that they’re moving in the right direction.

Voci underscored the importance of staying committed, noting that Harvard Pilgrim and its partners had been at this for years and they were in fact moving the needle. Session presenters shared successes from Massachusetts, New Hampshire and Maine.

Massachusetts

Harvard Pilgrim partnered with the Massachusetts Department of Public Health and other foundations and businesses on the Mass in Motion initiative to combat childhood obesity in its home state. Led by their elected officials, 14 communities developed health improvement plans and received technical assistance to improve local food sources and increase physical activity. The multifaceted initiative included a “call to action” report, as well as a Governor’s Executive order establishing a nutrition standard for the food procured for the state of Massachusetts. In addition, the program implemented a body mass index (BMI) regulation that required schools to screen children’s BMI in order to identify potential issues early. The Department of Public Health worked within these communities to share information on physical activity and nutrition, all culminating in growth of the program to 52 communities in the state.

Communities in Eastern Massachusetts are showing concrete signs of progress on the childhood obesity front. Reports from this summer have shown that the obesity rate for the region’s children under six years of age has decreased by 21.4 percent—likely due in part to initiatives such as Mass in Motion, the Cambridge Healthy Children Task force and Shape Up Somerville.

New Hampshire

CATCH Kids Club is an evidence-based, after-school environment that has been adopted by 117 sites in nine of New Hampshire’s ten counties. The CATCH program promotes exercise and healthy eating in elementary school children with a four-phased approach:

  • Curriculum development
  • Staff and booster training
  • Staff support
  • Environment and policy assessment

In the environment and policy assessment phase, CATCH found that 93 percent of participating after-school programs made four or more changes to improve children’s physical activity and healthy eating. In addition, most sites now offer programs that promote these goals between three and five times a week.

Maine

In Maine, the Let’s Go! 5210 Goes to School program offers resources to help schools create a culture of health. It aims to take the focus off of the highly charged weight management issue and shift it toward four simple and embraceable goals for each day:

  • Eat 5 fruits and vegetables
  • Limit screen time to 2 hours or less
  • Get at least 1 hour of exercise
  • Drink 0 sugary drinks

While each school decides which of these four goals it would like to adopt, they often end up promoting all four points of the program as time goes on. In fact, the 5210 initiative reaches children in all 16 Maine counties in schools, after school programs, early childhood education, doctors’ offices and more locations.

One of the key lessons learned was to engage busy school representatives at a level that made sense for them. “Don’t ask them to do something unrealistic,” said Torey Rogers of the Let’s Go! 5210 Goes to School Program and The Barbara Bush Children’s Hospital at Maine Medical Center.

Representatives from each of these programs offered insights and lessons learned when it comes to working with schools. When speaking with school representatives, organizations are often successful when they relate the goal back to the mission of schools: education. By highlighting the secondary benefits to attendance and active participation of students, organizations can engage teachers as partners in public health initiatives.

>>For more information on the successes of state and community efforts to reduce childhood obesity, view an interactive map on the signs of progress on childhood obesity.

>>NewPublicHealth will be on the ground throughout the APHA conference speaking to public health leaders and presenters, hearing from attendees on the ground and providing updates from sessions, with a focus on how we can build a culture of health. Follow the coverage here.

Nov 5 2013
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‘Fast Food Facts’: Q&A with the Yale Rudd Center for Food Policy & Obesity

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In 2012 alone, the fast food industry spent $4.6 billion to advertise mostly unhealthy products, with many of those ads specifically targeting children and teens. A new report, Fast Food FACTS 2013, examined 18 of the nation’s top fast-food restaurants, following up on a 2010 report to see how the food selection and advertising landscapes have changed. And while there have been some positive developments—healthier sides and beverages are available in most kids’ meals—the findings indicate there is still a very long way to go.

Detailed findings from the report, which was supported by a grant from the Robert Wood Johnson Foundation, will be presented today at the American Public Health Association’s (APHA) annual meeting in Boston.

>>Read more on the Fast Food FACTS 2013 report.

>>NewPublicHealth will be on the ground throughout the APHA conference speaking to public health leaders, hearing from attendees on the ground and providing updates from sessions, with a focus on building a culture of health. Follow the coverage here.

NewPublicHealth spoke with Jennifer Harris, the Yale Rudd Center for Food Policy & Obesity’s director of marketing initiatives and lead author of the report, and Marlene Schwartz, the Center’s director, about their findings and how fast food advertising continues to impact our nation’s youth.

NewPublicHealth: Has any progress been made in the nutritional quality of fast food kids' meals?

Jennifer Harris: There have been a lot of changes in kids’ meals over the past three years and a lot of it has been good. Most of the restaurants have added healthy sides and healthy beverages to their kids’ meals. Now it’s possible to get a fairly healthy kids’ meal at most of the restaurants we looked at. But the problem is it’s kind of like finding a needle in a haystack. Almost all of the meals they offer are high in fat, sugar or sodium.

Marlene Schwartz: The odds of you getting the healthy combination when you go are extraordinarily low. For every healthy combination, there are roughly 250 unhealthy combinations.

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Nov 5 2013
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Investing in Public Health: Q&A with Glen Mays

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New research presented at the American Public Health Association (APHA) annual meeting in Boston today finds that when public health funding increases in a community, its rates of infant mortality and deaths due to preventable diseases decrease over time, with low-income communities experiencing the largest health and economic gains.

According to the research, conducted by Glen Mays, PhD, MPH, director of the University of Kentucky’s National Coordinating Center for Public Health Services and Systems Research, each ten percent increase in public health spending over 17 years led to a 4.3 percent reduction in infant mortality, as well as reductions of 0.5 to 3.9 percent in non-infant deaths from cardiovascular disease, diabetes, cancer and influenza.

However, these health gains were 20-44 percent larger when funding was targeted to lower-income communities. Increases in public health spending also correlated with lower medical care costs per person, especially in low-income areas. The study, which analyzed data compiled by the National Association of County and City Health Officials from 3,000 local public health agencies over a 17-year period, also found that lower death rates and health care costs were seen especially in communities that allocated their public health funding across a broader mix of preventive services.

“The results clearly show that better health and lower health care costs are possible if we simply change how and where we allocate public health funding, even if new money isn’t available, said Mays. “And it also shows that new resources, such as funding from the Affordable Care Act’s Prevention Fund, can have a larger impact if targeted to lower-resource, higher-need communities and if spread across a range of prevention strategies.”

>>NewPublicHealth will be on the ground throughout the APHA conference speaking to public health leaders and presenters, hearing from attendees on the ground and providing updates from sessions, with a focus on how we can build a culture of health. Follow the coverage here.

NewPublicHealth spoke with Mays about the new study just before the APHA annual meeting began.

Glen Mays, PhD, MPH, Director of the University of Kentucky’s National Coordinating Center for Public Health Services and Systems Research Glen Mays, PhD, MPH, Director of the University of Kentucky’s National Coordinating Center for Public Health Services and Systems Research

NewPublicHealth: What are the key findings of the study?

Glen Mays: We’ve done prior studies that show communities that invest more on public health realize gains in health status and, over time, those communities see slower growth in medical care costs. So the goal of the study is to look at who benefits most from investments in public health.

What we found was that, not all that surprisingly, communities that are more economically constrained, that have lower income communities with higher poverty rates and lower socioeconomic status, tend to benefit the most from investments in public health activities over time. These low-resource communities see larger reductions in their preventable mortality, and they also see larger reductions in their medical care costs over time from investments in public health spending compared to more affluent communities. We expected to find that, but this is the first time we’ve been able to document the size of that effect. Those communities see about twenty percent higher rates of health and economic gain from their spending compared to more affluent communities.

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Nov 4 2013
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APHA 2013: The Role of Housing in Public Health

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When thinking about ways to improve the public's health, housing may not leap to mind at first. Reducing obesity, increasing access to healthy food and promoting tobacco control are all more popular and more obvious public health strategies. But in the past several years, leaders in the field are realizing the vital role that housing can also play in health.

So why is housing so important for health? And how can we create "healthy housing" for the public? That was the focus of Monday's American Public Health Association (APHA) panel, "Landscape of Healthy Housing: Strategies, Policies, and Initiatives."

Panelists from the U.S. Department of Housing and Urban Development (HUD) to Maryland's Green and Healthy Homes Initiative to the U.S. Environmental Protection Agency (EPA) discussed issues ranging from lead-based paint hazards, to smoke-free housing, to infrastructure problems—and how all of these impact health.

Chris Trent, who's worked on HUD's Advancing Healthy Housing a Strategy for Action, asked: "Do we really have to be concerned about our homes? Yes, we do. There are 23 million housing units with one or more lead-based paint hazards. Six million housing units in the U.S. have moderate-to-severe physical infrastructure problems."

She also re-emphasized why housing is so important to health for everybody, even if we don't think about it: 69 percent of our time is spent in a residence, and therefore housing automatically impacts how healthy people are.

Trent also pointed out the return on investment (ROI) in creating healthy housing for people. "We know these [healthy housing strategies] are working. There is a return on your investment that is beneficial to everybody."

For example, she noted, spending $1 on preventing lead hazards lead to a $17-$221 savings in health costs.

Ruth Ann Norton, Executive Director of Green & Healthy Homes Initiative, noted the impact that unhealthy housing can have on people— especially children and their education.

"The largest reason kids don't come to school is asthma," she pointed out. "And this asthma is often coming from their home environment. We need to break the link between unhealthy housing and unhealthy children."

"All of these housing issues are health issues," Norton said.

>>NewPublicHealth will be on the ground throughout the APHA conference speaking to public health leaders and presenters, hearing from attendees on the ground and providing updates from sessions, with a focus on how we can build a culture of health. Follow the coverage here.

Nov 4 2013
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APHA 2013: The Boston Marathon and Preparing for the Unexpected

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How do you prepare for the safety and health of 27,000 runners and 500,000 spectators? And how do you prepare for the unexpected—such as a terrorist attack—so that the public health response can be as swift and effective as possible?

That was the first topic of Monday's American Public Health Association (APHA) session, "Late Breaking Developments in Public Health." Mary E. Clark, Director of Emergency Preparedness Bureau at the Massachusetts Department of Public Health, presented on "Public Health and Medical Response to the Boston Marathon Bombing."

Discussing the particular difficulties of staffing an event such as the Boston Marathon, Clark noted that the route goes through 26.2 miles, crosses through eight different communities in Massachusetts and then goes straight into the city of Boston. Along the way, there are thousands of runners and hundreds of thousands of spectators.

"This presents us with medical and health challenges, as well as security challenges," Clark explained.

"This year was the 117th running of the Boston Marathon, and each year we plan this as a planned mass casualty event," Clark said. "We have to build on the work that has gone on in the 116 years before."

To do this, Clark said, the department takes at least four months of preparedness planning, with the assumption that at least 1,000 runners or spectators will need some sort of medical care.

But how did they deal effectively with the unexpected?

"We had a remarkably quick response to bombings," Clark said. She noted that less than a minute after the bombs went off, gurneys were heading to the victims. And in just 18 minutes, they were able to remove 30 critically injured spectators off the scene into ambulances. Massachusetts General Hospital received their first patient 14 minutes after the explosions.

Since the marathon bombings, though, Clark said, they have identified further needs—particularly in the areas of mental health.

"One of the key things that's happened since the Marathon is the recognition of the need for a robust mental health response,” she said. “We have created more mental health support systems for volunteers and staff.”

But her biggest takeaway from the tragedy and the response? "Lessons learned were the benefit of preparedness activities," Clark said.

"People did what they were trained to do and they did it very well."

>>NewPublicHealth will be on the ground throughout the APHA conference speaking to public health leaders and presenters, hearing from attendees on the ground and providing updates from sessions, with a focus on how we can build a culture of health. Follow the coverage here.

Nov 4 2013
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Start of APHA 141st Annual Meeting is Also a Fresh Start for the Organization

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The American Public Health Association (APHA) launched its 141st annual meeting in Boston on Sunday by re-launching itself, its logo and its tagline which is now: For science. For action. For health.

”We’re deeply excited to share our new look and feel with our members and partners,” said Georges Benjamin, MD, executive director of APHA to the nearly 11,000 public health students, academics and practitioners attending the meeting. “With the challenges and opportunities presented by our rapidly changing health landscape, now is the time to better position APHA for success as the collective voice for the health of the public.”

>>NewPublicHealth will be on the ground throughout the APHA conference speaking to public health leaders and presenters, hearing from attendees on the ground and providing updates from sessions, with a focus on how we can build a culture of health. Follow the coverage here.

Benjamin also shared the five core values that APHA’s next phase will emphasize:

  • Community
  • Science and evidence-based decision-making
  • Health equity
  • Prevention and wellness
  • Real progress in improving health

Those themes were in abundance at Sunday’s opening session. ‘Social injustice is killing on a grand scale,” said Professor Sir Michael Marmot, chair of the World Health Organization’s Commission on Social Determinants of Health and Director of the International Institute for Society and Health at University College/London. At the request of the British Government, Marmot led a review of health inequalities in England, and published a report, ”Fair Society, Healthy Lives” in February 2010. He has also recently been asked by the World Health Organization to conduct a European review of health inequalities

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Nov 4 2013
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Public Health News Roundup: November 4

Firearm Injuries Cost $16B in U.S. Health Care in Less than a Decade
Firearm injuries cost more than $16 billion in hospital care between from 2000 to 2008, according to new research to be presented today at the American Public Health Association’s 141st Annual Meeting in Boston. The 275,939 victims spent approximately 1.7 million days in the hospital, for an average stay of 6.7 days and an average cost of medical treatment of $59,620. About one in three patients did not have insurance. “The impact is probably much higher than $16 billion since the years of life lost, disability, lack of productivity, societal well-being and emotional turmoil associated with such injuries is far-reaching,” said Min Kyeong Lee, DMD, Annual Meeting presenter. “This is one of the foremost reasons why health care costs in this country have gotten out of control and underlies the need for better preventive policies.” Read more on violence.

Study: Secondhand Smoke in the Workplace Down Overall, But Certain Groups Still at Risk
While recent policies and regulations have helped reduce the overall exposure rates of secondhand smoke in the workplace, certain professions continue to experience high rates, according to new findings to be presented today at the American Public Health Association’s 141st Annual Meeting. The study looked at exposure rates in Massachusetts since 2004, when its Smoke-Free Workplace Law was enacted to require all enclosed workplaces to be smoke free. However, that means that workers in installation, repair and maintenance still experience an overall secondhand smoke exposure rate of 37.4 percent; the national rate in 2010 was 5.4 percent. “We’re seeing a steady decline in prevalence of exposure, but it’s clear that there are still specific groups of workers that deserve our attention,” said Kathleen Fitzsimmons, MPH, lead researcher of the study. “Findings like these that combine information about occupation and environmental tobacco smoke provide helpful information for evaluating comprehensive statewide smoke-free workplace laws and for targeting interventions to reduce risks.” Read more on tobacco.

Study: HPV Screenings Better than Pap Tests at Protecting Against Invasive Cervical Cancer
Human papillomavirus (HPV) screenings are both more effective than Pap tests when it comes to screening against invasive cervical cancer, according to a new study in the journal The Lancet. Researchers analyzed the results of four clinical trials in Europe covering more than 175,000 women ages 20 to 64. The studies tracked them women for an average of 6.5 years after one of the screening types, finding that they were about equal in protection levels for the first 2.5 years, but that following that short time frame HPV screening provided as much as 70 percent greater protection. The findings were particularly significant in women ages 30 to 35. Read more on cancer.

Nov 3 2013
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Innovating, Leading and Moving Public Health Forward at APHA

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In the face of health care reform, funding challenges, and increased collaboration, public health faces a promising yet unclear future in terms of both financial support and program reach. On Saturday, the Robert Wood Johnson Foundation co-hosted a forum with the American Public Health Association (APHA) in advance of the APHA 2013 Annual Meeting to discuss these issues – and more. Leading minds from the fields of public health, government and business met to get to the bottom of a crucial question: how do we move public health forward?

In the opening session, Paul Kuehnert, Director of the Public Health Team at the Robert Wood Johnson Foundation, explained that the field’s challenge lies in “skating where the puck is going to be.” APHA Executive Director Georges Benjamin echoed that sentiment, nothing that the forum was “an opportunity to figure out where the public is going and then, when the wave comes, be right there to catch it.” The ensuing breakout sessions furthered this overarching theme with panels that discussed both the challenges they’ve faced -- and the opportunities they’ve found for success.

>>NewPublicHealth will be on the ground throughout the APHA conference speaking to public health leaders and presenters, hearing from attendees on the ground and providing updates from sessions, with a focus on how we can build a culture of health. Follow the coverage here.

Re-Thinking How We Pay for Public Health and Prevention

One panel discussed funding challenges that public health departments face and solutions that have been reached across the country. John Auerbach of Northeastern University’s Institute on Urban Health Research, and former health commissioner of Massachusetts, touched on health care reform as a vehicle for preventive care. “Nearly 75 percent of those insured in Massachusetts have had a preventive care visit in the last 12 months,” he explained.  In other words, people who are insured are twice as likely to get care that could actually prevent them from getting sick, instead of having a treat a more serious illness. Auerbach also discussed development of the state’s Prevention and Wellness Trust Fund — a four-year, $60 million public health trust supported by a one-time assessment on health insurers and largest clinical providers. Auerbach stressed that this source of funding was important, particularly because it’s insulated from the variability of public funding and political tides.

By focusing on the critical services and programs that are truly necessary for the public health system to work, the Seattle and King County Health Department has developed a minimum package of public health services needed for all projects to success. David Fleming, Director and Health Officer in the Seattle/King County Health Department, and his staff determined the money needed to fund such a package in both per capita and overall costs. Washington State is now working with RWJF and other stakeholders to determine the feasibility of defining and costing these foundational services at the national level.

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Oct 28 2013
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APHA Annual Meeting 2013: Q&A with Georges Benjamin, APHA Executive Director

Georges Benjamin MD, APHA Executive Director Georges Benjamin MD, APHA Executive Director

More than 10,000 public health officials, academics and students will gather in Boston next week for the 2013 American Public Health Association Meeting in Boston. This year’s theme is “Think Global, Act Local,” drawing critical attention to the increasingly global world of health where events across the globe—from food safety, to infectious disease outbreaks, to innovative public health solutions—can impact every local neighborhood.

>>NewPublicHealth will be on the ground at the APHA Annual Meeting, with speaker and thought-leader interviews, video perspective pieces and updates from sessions, with a focus on what it takes to build a culture of health. Follow our coverage here.

Ahead of the annual meeting, NewPublicHealth spoke with Georges Benjamin MD, APHA executive director.

NewPublicHealth: Why is the theme “Think Global, Act Local” so important?

Georges Benjamin: We’re in a world in which everything is global. There are no boundaries anymore. Rapid transit through planes, the fact that our borders are so porous...public health has always been a global enterprise, but even more so today. Our food comes no longer from a single farm but from multiple farms and sometimes multiple countries, so foodborne risks for disease and illness are global. We’ve seen that terrorism disasters are global. We’ve seen that obesity, particularly with corporations that sell certain products globally, is a big issue, and tobacco has always been a global issue. So, public health is global, and the idea is that if we can learn from people around the world and then utilize those learnings within our local communities, we’ll be stronger

NPH: What are some of the meeting sessions you’d highlight?

Benjamin: Our opening session will feature Professor Sir Michael Marmot, Director of the International Institute for Society and Health and Research Professor of Epidemiology and Public Health at University College, London, who spoke at our meeting five years ago on the social determinants of health and is going to give us an update. In the closing session, we’ll hear from actor/physician/public health doctor, Evan Adams, MD, the deputy provincial health officer for British Columbia, who will speak about improving the health of native people. So in both our opening and closing sessions we’re looking globally, as well as emphasizing what happens locally. We’ll also hear from the minister of health of Taiwan, who will talk about universal health care as well as violence prevention. And we’ll also be holding sessions that track the many public crises that we’ve already had this year.

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Oct 24 2013
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World Polio Day: Toward Total Eradication

In honor of World Polio Day, the U.S. Centers for Disease Control and Prevention (CDC) will highlight polio eradication work around the globe on Twitter and Facebook. Development of the polio vaccine has reduced the disease worldwide by 99 percent, with only Afghanistan, Nigeria and Pakistan as the remaining polio endemic countries in 2012.

But both in endemic countries and in countries where polio was thought to have been vanquished, cases persist. According to the Global Polio Eradication Initiative, just this week eleven new wild poliovirus (WPV) cases were reported, including one from Afghanistan, two from Ethiopia, four from Pakistan and four from Somalia. The total number of WPV cases for 2013 is now 296, with 99 from countries that have not yet been able to eradicate the disease and 197 from countries that have seen outbreaks. In Israel, for example, while no cases of paralytic polio have been reported, environmental surveillance suggests that virus transmission (first detected in February 2013) continues in parts of the country’s southern and central regions. A vaccination campaign for children under age ten is ongoing.

On December 2, 2011, CDC Director Thomas R. Frieden, MD, MPH, activated CDC’s Emergency Operations Center (EOC) to strengthen the agency’s partnership engagement through the Global Polio Eradication Initiative (GPEI). Activation of the EOC has provided enhanced capacity for CDC’s polio eradication support program, which trains public health volunteers in the United States and globally to improve polio surveillance and help plan, implement and evaluate vaccination campaigns.

Additional EOC activities include:

  • Publication of several joint World Health Organization Weekly Epidemiologic Record/CDC Morbidity and Mortality Weekly Reports (MMWR) highlighting polio eradication progress.
  • Collaboration with GPEI partners on detailed country-plans for expanded technical and management support, including assistance with outbreak responses, surveillance reviews, vaccination campaign planning and monitoring, and data management.
  • Provision of operational support to Nigeria for the country’s FY 2012 Polio Eradication Emergency Response Plan. The plan focuses on enhancing management and leadership skills to improve program performance.
  • The development of indicators for monitoring polio vaccination campaign performance in the areas of planning, implementation and evaluation.
  • Review of WHO-proposed outbreak response protocols for all polio-affected countries.

“If we fail to get over the finish line [to fully eradicate polio],” says Frieden, “we will need to continue expensive control measures for the indefinite future…More importantly, without eradication, a resurgence of polio could paralyze more than 200,000 children worldwide every year within a decade.”