Category Archives: Community Health
Public Health Presentations Cap First Class of Network for Public Health Law Mentorship Program for Young Attorneys
Laws and policies that impact public health can create healthier conditions for entire communities—a more cost-effective approach than treating one person at a time, and then only after they’re sick. Last week, five inaugural Visiting Attorneys in Public Health Law presented on their efforts over the past year as part of a program hosted by the Network for Public Health Law and the Robert Wood Johnson Foundation (RWJF). The attorneys focused on public health law around:
- The legality of tobacco “power walls” that put colored cigarettes boxes directly in the line of vision of children
- The impact of environmental noise on heart disease
- Displacement of residents through gentrification
- The challenges and promise of “health in all policies”
- Legal avenues toward reducing sodium intake by the public
The post-JD program is designed to help develop exceptional skills in practice-based public health law than can help lawyers to advance their public health law careers. During the program, the five attorneys were each located at a host site under the mentorship of a renowned public health legal expert. This year’s mentors included Doug Blanke, founder and director of the Public Health Law Center at the William Mitchell College of Law in Minnesota, and Clifford Rees, practice director of the western region of the Network for Public Health Law.
“This fellowship is one that we developed in conjunction with the Network for Public Health Law to help to build the field of public health law and to allow bright, new attorneys with an interest in public health, to be able to experience working in [that] setting while being mentored and coached by leaders in the field,” says Angela McGowan, JD, MPH, RWJF’s senior program officer.
McGowan says RWJF hopes this type of experience will highlight that public health law is an exciting career option, as well as show the value of engaging new professionals in this practice as a way of making meaningful impacts at the local, state and federal levels of public health. McGowan added that the Visiting Attorneys were able to really be engaged with the real work that public health and law practitioners face daily, and to apply their legal knowledge to solving public health problems.
New York City is currently developing a pilot public health program known as NYC Macroscope — the first domestic effort to aggregate electronic health record (EHR) data into a surveillance tool to inform public health decisions. The population health surveillance system will compile electronic health records from primary care practices to help city health officials monitor—and respond to—the real-time prevalence of conditions that impact public health. The project is the result of a partnership between the New York City Health Department and the CUNY School of Public Health, with support from the Robert Wood Johnson Foundation’s Pioneer Portfolio, and additional support from the de Beaumont Foundation, Robin Hood and the New York State Health Foundation.
NewPublicHealth spoke with Carolyn Greene, MD, Deputy Commissioner of the NYC Department of Health and Mental Hygiene’s Division of Epidemiology, about the plans and goals for the program.
NewPublicHealth: Tell us about NYC Macroscope and how it will work.
Carolyn Greene: NYC Macroscope is going to be New York City’s first electronic health record surveillance system. We have a program here at the health department called Primary Care Information Project (PCIP), and it’s one of the nation’s largest distributed electronic health record networks. PCIP began in 2005. It concentrated on primary care practices in high need areas where the Health Department really wanted to encourage providers to use electronic health records. The program has been extremely successful and they’ve completed many different activities to improve the quality of clinical care.
But in recent years, we’ve been asking the question: Can we use electronic health records for more than just patient care? Can we, in fact, use electronic health records to monitor the health of the population? Here at the Health Department, we have many different ways to conduct population health surveillance. We have surveys that we conduct by telephone, we have disease registries that we host, and we have our vital statistics registry on deaths and births. All these data are very important. But they are costly, resource-intensive and they often have a time lag from when the data are collected to when we can actually find the results from the data, so the advantages of an electronic health record surveillance system are many.
One advantage is that the architecture is already there. If you already have the electronic health records in place, you don’t have to find additional resources to collect the data because you’re already collecting the data through the EHR architecture. Other advantages are that potentially you can collect data in real time and potentially at low cost.
NPH: Do you see any potential disadvantages?
Greene: I think the first one is we always have to ask how representative the data will be in terms of representing the population as a whole. First of all, electronic health records only collect data on people who are in care and, because sicker patients go to the doctor more frequently, there’s a greater likelihood that we may be picking up more information on sicker patients. So we have questions about how representative are the data.
In the last decade or so, leaders in the field of architecture have begun to look at not just the aesthetics of building and community design, but also their own impact on the health of communities. In New York City, for example, the local chapter of the American Institute of Architecture’s New York chapter partnered with several agencies in New York City, including the departments of Health and Mental Hygiene, Design and Construction, Transportation, City Planning, and Office of Management and Budget, as well as research architects and city planners to create the city’s Active Design Guidelines. These provide architects and urban designers with a manual of strategies for creating healthier buildings, streets, and urban spaces, based on the latest academic research and best practices in the field. The Guidelines include:
- Urban design strategies for creating neighborhoods, streets, and outdoor spaces that encourage walking, bicycling, and active transportation and recreation.
- Building design strategies for promoting active living where we work and live and play, through the placement and design of stairs, elevators, and indoor and outdoor spaces.
NewPublicHealth recently spoke with Rick Bell, policy director of AIA New York, who was instrumental in the creation of the guidelines, about the burgeoning intersection between design and healthier communities.
>>Read more on architecture and design for a fit nation.
NewPublicHealth: How did AIA New York become involved in healthy design with the city of New York?
Public Health Law Research’s (PHLR) LawAtlas is a comprehensive content management tool that enables users to track and analyze key laws aimed at improving health and access to health care. From interactive law maps to policy surveillance reports to “reams” of digital data, it offers an expansive view of how health and the law are intersecting throughout the country. In fact, LawAtlas just today released two new data sets, one on Child Restraint Systems and one on Dental Hygienist Scope of Practice Laws.
NewPublicHealth spoke with Scott Burris, Director of PHLR’s National Program Office, and Damika Barr, Legal Analyst and LawAtlas Manager, about what LawAtlas means for the public health community—and their hopes for its future.
NewPublicHealth: What are you learning about the value of LawAtlas to the public health and law communities?
Scott Burris: I think there are two things that people really like about this. One is getting law as data. So, we take law and it’s a bunch of words that people in health often don’t want to cope with or don’t really appreciate. It’s not what they do. We turn it into data that they understand, that they can use, that fits right into their broader lifestyle, as it were. Meeting the needs of people doing epidemiology and science, that’s one part of it. The other part is just a great demand to see law laid out in this geographical way so that everyone can see what states have what laws and how any particular policy is progressing across the states.
Damika Barr: We’re finding that this is eye opening because you can finally see the dimensions of the law across jurisdictions over time with your own eyes, and it’s really easier for our researchers or the public health law communities and providers to see the dimensions as compared to looking at a long table with many columns. Researchers can start to ask more detailed questions or about more dimensions of the law than they would have if they were just limited to a table.
NPH: We’ve seen a couple of the ways that LawAtlas is being used already, including the study by Hosea Harvey that looked at youth sports concussion laws. What are some other innovative ways you’re seeing LawAtlas being used in research?
Burris: I think it’s not so much “innovative ways" as what important things can LawAtlas show us? LawAtlas in itself was an innovation in that it allows people to more efficiently code the characteristics of the law and more easily publicize it, but what we’ve learned in recent research is how you can answer important questions with it.
In the national conversation on the spreading epidemic of obesity and chronic diseases, and the ways in which public health initiatives can fight these issues, architecture and design are continuing to play a leading role in developing fit and healthy solutions. The way a community or a school or a store or a workplace is built can actually influence physical activity, access to healthier food and more to help create an overall fitter nation.
FitNation is an initiative that highlights innovative design strategies across the country to get people healthy and moving. These projects, which stretch across the realms of local and national policy and grassroots-driven action to urban improvements, are brought together in FitNation as inspired by New York City’s Active Design Guidelines and the annual Fit City Conference, which is a partnership between the American Institute of Architects New York and the New York City Department of Health and Mental Hygiene.
Here is a selection of some of the creative solutions featured in FitNation that were developed to help individuals and communities lead happier and healthier lives.
Red Swing Project
Design by Hatch Workshop and University of Texas at Austin Architecture Students
Starting in Austin, Texas, a group of architecture students seeking to make better use of public spaces started the Red Swing Project, an open source initiative to transform some unexpected places into playgrounds. The swings consist of a piece of scrap wood, painted red, and rock climbing rope and have popped up all over the world—transforming areas hit by natural disasters, lining a bicycle path from Paris to Barcelona, and below an interstate overpass. You can track the project online with a geo-tagged map or through #redswingproject on Instagram and Facebook.
Urban Farming Food Chain, Edible Wall
Design by Elmslie Osler, Architect
Los Angeles, CA
We all know that some of the healthiest foods grow on trees, but now in Los Angeles thanks to the Urban Farming Food Chain, they can grow on walls too. The Food Chain consists of “edible walls” that grow fresh fruits, vegetables, and herbs, intended to provide economically disadvantaged populations with healthier food options. The walls are installed on pre-existing structures and have storage for tools, seeds and soil. This project’s vertical angle on community gardens help provide social activities as well as the opportunity to share and develop skills and healthy habits.
Tackling the problem of obesity in the United States cannot be done with a single step solution. There are many factors that need to be addressed at the family, school and community levels in order for obesity rates to continue to decline across the country. Unfortunately, not everyone has equal access to the education and options that allow us to make healthier food choices. Higher prices and lack of accessibility to fresh produce serve as barriers for lower income communities in the battle against obesity and improving public health.
In urban areas across the country, groups focused on healthy living and eating are working to develop programs to create more healthy options for everyone. Programs in cities such as New York, Los Angeles and Philadelphia—to name just a few—have caught on with local food vendors, store owners, public health departments and the general public as we start to see rates of obesity drop in those targeted areas.
>>Read more about the fight against childhood obesity and the signs of progress in different areas across the country.
We have found some great examples of programs across the country that are proving successful in their attempts to increase the number of healthy options available to at-risk children and the greater community.
- In New York City, pediatricians at Lincoln Medical Center in the Bronx and Harlem Hospital have started prescribing fruits and vegetables for children. The prescriptions allow them to use coupons for produce at local farmers markets and city green carts. Medical professionals see this as a longer-term solution to the issues they are seeing children come in with, rather than simply prescribing them medicine.
- With Philadelphia weighing in as the most obese city in the nation, The Food Trust’s Brianna Almaguer Sandoval has enlisted the help of corner store owners to start providing healthier options on their shelves. The Healthy Corner Store Initiative provides store owners with free marketing materials such as labels and recipe cards; trainings on how to select, price and display the healthier offerings; and for some even funding for new shelves and refrigerator cases to help better stock fresh food.
- Groups in Athens, Ohio, are joining together to host an event called “Bounty on the Bricks,” to raise money to create a new grant program to enhance the capacity for local food pantries to provide more healthy options for their visitors in need. Those who bought tickets to the event will enjoy a meal celebrating local farmers and fresh produce along one of the main streets in Athens. The dinner will be held August 10 and organizers have already surpassed expected ticket sales.
The Supplemental Nutrition Assistance Program (SNAP) is the federal government’s principal program for helping low-income families purchase enough food. More than 47 million Americans currently receive SNAP benefits; approximately half of the beneficiaries are children. As part of the debate over the Farm Bill—legislation that authorizes SNAP and other federal nutrition programs—Congress is considering legislation that would cut SNAP benefits and limit who qualifies for the benefits.
Yesterday, the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts, released a white paper that provides a rigorous, objective and nonpartisan analysis of the potential health impacts of the proposed changes to SNAP.
NewPublicHealth spoke with Aaron Wernham, MD, director of the Health Impact Project, along with lead researcher Marjory Givens, to learn more about the study’s findings.
NewPublicHealth: What is the goal of the health impact assessment on the potential changes to the SNAP program?
Aaron Wernham: Congress is deliberating reauthorizing the U.S. Farm Bill, and one of the parts of that is the Supplemental Nutrition Assistance Program or SNAP, which was formerly known as food stamps. This is one of the federal government’s main programs for ensuring that people who have low incomes are able to get enough to eat. We did this health impact assessment because so far the public health effects of these proposed policy changes have not really been a part of the political debate. We wanted to make sure that the best available public health evidence was brought to bear to help ensure that everyone has complete information—those affected by the change, the general public and decision-makers in Congress.
NPH: What’s the big picture on what SNAP has to do with health in the first place?
Wernham: Not having enough to eat—or being what’s called “food insecure”—is attached to a higher risk of a lot of diseases. So, adults who are food insecure have a higher risk of heart disease, high blood pressure, diabetes and some other problems. Children who are food insecure are more likely to be reported by their parents as being in poor health, are more likely to be hospitalized and also have a higher risk for a number of health related problems from asthma, to depression and anxiety. We actually have a number of studies that have looked at the health benefits of receiving SNAP and found, for example, that adults who had access to SNAP when they were children are less likely to have problems in adulthood, such as obesity, high blood pressure and heart disease.
NPH: What did the health impact assessment find?
Wernham: We looked at ways in which the House and Senate have proposed to change how eligibility for SNAP benefits is determined and how the amount of benefits is determined. Both the House and Senate have proposed changes, and we found that as many as 5.1 million people could actually lose eligibility under changes proposed by the House. Under the changes in the Senate, about 500,000 people might receive lower benefit amounts. With the House changes, as many as 1.4 million children and nearly 900,000 older adults would be among those five million people who could be affected. So, for those people, they would lose upward of an average of 35 percent of their total income and would be at higher risk for the health problems that relate to food insecurity.
The Robert Wood Johnson Foundation Human Capital portfolio’s blog, a forum for discussion about the challenges of building a diverse, well-trained health care workforce, features a “Day in the Life” series this week featuring public health nurses. With their own words, these nurses talk not just about what they do, but why they do it—the importance and meaning of their efforts.
For Anneleen Severynen, RN, MN, PHN, of the South King County Mobile Medical Unit for Public Health Seattle and King County in Washington State, it’s about being able to help one person at a time. Anneleen wrote about Charlie, a 60-year-old Native American man who started drinking at the age of 12, bounced around foster homes, returned from service in Vietnam hurting even more, and now calls himself a “lost cause” who expects to drink himself to death.
“As I sat silently, I listened to him grieve the loss of his culture and detail the many kinds of discrimination he has suffered. Though he spoke with the slurred speech of a chronic alcoholic, his eloquence moved me. I noticed tears in his eyes as he described a few happy childhood memories with his father—memories not quite lost to him.”
By helping him to open up she was also able to get Charlie to agree to a few medical tests. He was given a prescription for high blood pressure. She doesn’t know whether he’ll follow through, but she knows that because she took the time to listen, he now has a better chance.
“Every day I get the chance to make a difference in people’s lives, and to help them know that they matter. I can help one person at a time make small choices that will improve their lives and health. As long as there is someone to hear their stories, there are no lost causes.”
In 2011, Sonoma County in California established the division of Health Policy, Planning and Evaluation (HPPE) in an effort to move the county up in the County Health Rankings, toward a goal of becoming the healthiest in the state by 2020. As the director of the division, Peter Rumble, MPA, has played a critical role in the development of numerous programs and policy efforts to help create opportunities for everyone in Sonoma County to be healthy. Rumble has worked on programs and policies that go beyond traditional public health activities and aim to address the root causes of poor health, including the local food system, education and poverty.
Following his presentation at the International Making Cities Livable Conference, NewPublicHealth was able to speak with Rumble about the ways in which his work with HPPE is pushing to achieve health equity in Sonoma County. Rumble will soon move into a position as Deputy County Administrator of Community and Government Affairs for the County of Sonoma, where he plans to continue his commitment to a vision of health and quality of life for the county.
NewPublicHealth: Sonoma is making a concerted effort to help address the root causes of poor health, like poverty and lack of education. Tell us about some of those efforts.
Peter Rumble: Health Action is our real heartbeat of addressing social determinants of health, and it’s a roadmap for our vision of being the healthiest county in California by 2020. Health Action is a community council that advises the Board of Supervisors. There are 45 seats on the council, including elected officials, individual community leaders, nonprofit leaders, and representative from the business, financial, labor, media, transportation and environmental sectors. If you pick a name out of the hat for all of the sectors in the community, we’ve got somebody who either directly or tangentially represents that sector. That group began talking about needing to do something around health in 2007.
If we’re going to be the healthiest county in California by 2020, what do we need to do to achieve our ten goals based on the best evidence available? We certainly have goals associated with the health system, but predominantly, we’re focused on influencing the determinants of health. Our first goal is related to education. We want all of our children to graduate from high school on time and ready to either enter a thriving workforce or go into college or a technical career academy.
We started with some grassroots initiatives. Being a real strong agricultural community, iGROW was a good place to start. It was a movement to develop community gardens—for people to tear up their front lawns and plant a garden there, and increasing access to healthy food. That was a huge hit. We set a goal of a few hundred community gardens, and we’re up to a thousand now—it’s just caught fire.
That was all great, but a community garden is not going to make us the healthiest county in California, right? You can see the beautiful posters out on shop windows, you can see your neighbor tore up their front lawn and is growing this beautiful zucchini and has an edible lawn now and all that’s wonderful, but we only have a graduation rate of 70 percent. We’ve got nearly one in four kids living in poverty by the federal poverty standards and if you look at what actually it takes to raise a family in Sonoma County, about half of all families can’t make ends meet.
NPH: Does that surprise people to hear about Sonoma?
Zachary Thompson, director of Dallas County Department of Health and Human Services, greeted the 1,000-plus attendees at last week’s annual conference of the National Association of County and City Health Officials (NACCHO) and expressed how honored he was to meet so many local health department leaders from across the country.
NewPublicHealth spoke with Thompson about Dallas’ particular health challenges and innovations the department has developed to help improve health in the community.
>>Read more NewPublicHealth coverage of the NACCHO Annual Meeting.
NewPublicHealth: Dallas ranks 67 out of 232 Texas counties in the County Health Rankings. What efforts are underway to help improve population health in the county?
Zachary Thompson: Dallas County is looking at various things, including adding more bike lanes and more parks where people can exercise. There’s a health assessment going on now to look at how all of the major stakeholders can come together to improve our health rankings. We have a great public health improvement work group that is working on ways to improve overall health in Dallas County.
NPH: West Nile virus was a major issue in Dallas last year. What are you doing this year to help keep the city safe?
Thompson: We had no deaths from West Nile virus in 2010 and 2011, then 20 deaths in 2012, which may have been a once-in-fifty-years event. Last year’s outbreak got everyone’s attention that West Nile virus is endemic in our community, and so we took the lessons learned and increased our resources.
We know what we improved on. We began to do year-round mosquito testing in 25 municipalities, and began meeting regularly with all the municipalities to assess their needs. Everyone has been on board with the overall integrated mosquito plan. So far this year we’ve had no human cases of West Nile virus. We definitely focused on preventive education—we started that earlier. We’ve also added additional ground-based truck spraying capabilities in the event that we needed to increase our spraying activity if we have a similar outbreak as last year. We have made insect repellent available for all senior citizens. Hopefully last year’s outbreak will have been a rare occurrence, but we’re prepared in any case.