Category Archives: Community Health
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.
Study: The Longer People Are Obese, the Greater Their Risk for Heart Disease
At a time when obesity rates for both U.S. adults and children are rising, new research indicates that the longer someone is obese, the greater their risk for heart disease. The study appeared in the Journal of the American Medical Association. "Each year of obesity was associated with about a 2 to 4 percent higher risk of subclinical coronary heart disease," said study lead author Jared Reis, an epidemiologist with the U.S. National Heart, Lung, and Blood Institute. "Those with longest duration of both overall obesity and abdominal obesity tended to have the highest risk [for subclinical disease].” Subclinical heart disease includes arterial damage indicated by markers such as calcium buildup on arterial walls, but which “has not yet developed into symptomatic illness,” according to HealthDay. The study is yet more evidence of the need to focus on the prevention and treatment of childhood obesity, according to the researchers. Read more on heart health.
EHRs Would Help Doctors’ Offices Cut Costs Slightly
Doctors’ offices that utilize electronic health records (EHRs) will spend less per patient than offices that use traditional paper records, according to a new study in the journal Annals of Internal Medicine. While the savings is expected to be small—about $5 per patient per month—they will add up over time. With a government commitment of about $30 billion for the widespread adoption of EHRs, the hope is the decrease in inefficiencies, incorrect care and errors will lead to better, cheaper health care. Previous studies have shown conflicting results. Rainu Kaushal, MD, who wrote an editorial that accompanied the study, said that while she does not expected the EHRs to contribute significantly to cost savings, their adoption is still vital. "EHRs may or may not directly contribute to those savings… but without investing in them you cannot achieve new models of healthcare delivery," said Kaushal, director of the Center for Healthcare Informatics and Policy at Weill Cornell Medical College in New York. Read more on technology.
No Evidence of Benefits of Community-wide Dementia Screening
New research has found no proof that there are any clinical, economic or emotional benefits to programs that use community-wide screening to identify people with dementia. "We found no evidence that population screening would lead to better clinical or psychosocial outcomes, no evidence furthering our understanding of the risks it entails and no indication of its added value compared to current practice," said author Carol Brayne, a professor of public health medicine from Cambridge Institute of Public Health, in the United Kingdom. The debate over the strategy’s efficacy has been going on for quite some time, with one side noting that there isn’t even a cure for Alzheimer’s disease, and the other noting that as many as half of the people with dementia remain undiagnosed. The researchers, however, did emphasize that family and friends should be aware of the warning signs of dementia so they can help loved ones get treatment. Read more on community health.
“Public health will always be local. But we will always need to adapt and evolve to continue to be relevant and effective,” said Thomas Frieden, MD, MPH, Director of the Centers for Disease Control and Prevention (CDC) to the packed crowd of local health department leaders at the opening session of this year’s National Association of County and City Health Officials (NACCHO) Annual Meeting. That means leveraging what’s working well, and keeping a finger on the pulse of what will work even better in the future, according to panelists at yesterday’s session, which was moderated by Dr. Swannie Jett, DrPH, MSc, Health Officer for the Florida Department of Health in Seminole County and included presentations by a number of federal-level public health officials.
>>Follow ongoing NewPublicHealth coverage of NACCHO Annual, including session recaps, interviews with speakers and more.
Jett alluded to a rapid transformation in public health that will change what it means to ensure the health of a nation or a county.
“Public health needs to be at the forefront,” said Jett. “We need to take the lead in our communities. We need to reach out to community partners, and to health officers in other counties and states. We need to bring everyone into the fold in this conversation.”
These kinds of cross-cutting partnerships, with public health playing a central role, were also the subject of a recent op-ed by Frieden on the Huffington Post, sharing success stories from the 2013 Annual Status Report of the National Prevention Strategy. The Strategy envisions a prevention-oriented society where all sectors recognize the value of health for individuals, families, and society, working together to achieve better health for all Americans. Frieden shared some examples of efforts to create healthier places to live happening across the country:
Cardiovascular disease is the focus of the 2013 annual report to Congress of the Community Preventive Services Task Force, an independent and unpaid panel of public health and preventive services experts. The report was discussed at a recent Congressional briefing that included health experts, Congressional staff, community health promotion partners and policy-makers.
Each year the Task Force reviews and updates the Guide to Community Preventive Services, a free resource that provides examples of evidence-based strategies to help communities choose programs and policies to improve health and prevent disease.
It’s not hard to understand why cardiovascular disease was the focus topic this year. According to John Clymer, executive director of the National Forum for Heart Disease & Stroke Prevention, almost half of all Americans have at least one of three modifiable risk factors for heart disease: tobacco use, high blood pressure or uncontrolled high cholesterol.
The Task Force has identified effective approaches to address most of the risk factors for heart disease, which include integrated community and health system practices. Some examples of such practices are a team approach to preventive care that includes doctors, nurses and community pharmacists; tobacco quitline interventions at no cost including follow-up counseling calls; and behavioral counseling and support for heart disease risk factor behaviors.
Jonathan Fielding, MD, MPH, co-chair of the Task Force and health director of Los Angeles County in California, says his county used evidence in the Guide that found that mass media efforts aimed at getting people to stop smoking only work in conjunction with other efforts.
Several community and health leaders of San Bernardino, Calif., the largest geographic county in the U.S., spoke at the recent briefing on use of the Community Guide to help improve population health in their county. San Bernardino ranked 44th out of 57 counties in the 2013 County Health Rankings. “The [Community] Guide has been instrumental in our work looking at population health,” says Dora Barilla, DrPH, Asst. Vice President for Strategy and Innovation at Loma Linda University Health, at the recent briefing. Loma Linda was part of a community initiative begun several years ago to improve population health in San Bernardino, which has 4.2 million residents in San Bernardino, “many with significant disparities,” said Barilla.
“We needed to identify the highest impact initiatives and without the community guide, we could not have done that,” said Barilla. “We used it to move forward fast. We needed science and evidence. Using the guide we were able to galvanize 20 of 24 cities. We were able to use what worked and not waste time on practices that were ineffective and outdated.”
Critical features of the Guide, said Barilla, is that it has targeted approaches for different populations “and does not take a one size fits all approach.” One key outcome, according to Barilla, was that hospitals engaged in community benefit efforts—a requirement for nonprofit hospitals under the Affordable Care Act. “We now had science and metrics to invest in upstream initiatives.”
>>Bonus Link: Watch a County Health Rankings and Roadmaps video on initiatives now in place to help improve population health in San Bernardino.
Just a few metro stops can mean the difference between an extra five to ten years added to your lifespan. Using new city maps, the Commission to Build a Healthier America, which reconvened recently after a four year hiatus, is illustrating the dramatic disparity between the life expectancies of communities mere miles away from each other. Where we live, learn, work and play can have a greater impact on our health than we realize.
For too many people, making healthy choices can be difficult because the barriers in their communities are too high—poor access to affordable healthy foods and limited opportunities for exercise, for example. The focus for the Commission’s 2013 deliberations will be on how to increase opportunities for low-income populations to make healthier choices.
The two maps of the Washington, D.C. area and New Orleans help to quantify the differences between living in certain parts of the region versus others.
Living in Northern Virginia’s Fairfax and Arlington Counties instead of the nearby District of Columbia, a distance of no more than 14 miles, can mean about six or seven more years in life expectancy. The same disparity exists between babies born at the end of the Washington Metropolitan Transit Authority’s (known as the Metro) Red Line in Montgomery County—ranked second out of 24 counties in the County Health Rankings, metrics developed by the Robert Wood Johnson Foundation and the University of Wisconsin to show the health of different counties—and those born and living at the end of the Metro’s Blue Line in Prince George’s County, which ranked 17th in the County Health Rankings.
Under the Affordable Care Act, tax-exempt hospitals are now required to conduct a community health needs assessment at least every three years and develop an implementation strategy to tackle the needs identified by the assessment.
At this week’s AcademyHealth meeting in Baltimore, experts moved from the “guess what you have to do” approach to community benefit heard at some public health meetings to some practical strategies hospitals can follow not only to fulfill the letter of the law, but to actually improve community health.
Peter Sartorius, community benefit director of the Muskegon (Michigan) Community Health Project, which brings together several Mercy hospitals in the region, told the audience that costs of the requirement can range from about $12,000 for a staff person to conduct the needs assessment to about $65,000 if a consultancy, such as a public health institute, does the work. Mercy requires that the County Health Rankings, developed through a collaboration of the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, be used by the hospitals in its network as the baseline measures of community health.
Sartorius urged hospitals to choose “collaborative partners” such as community health clinics, United Way agencies and universities, who can help develop the assessment and report and also share in the cost. Others have said that community benefit also offers a ripe opportunity for collaboration between hospitals and public health departments, which already house a lot of data and have similar community needs assessment requirements for voluntary accreditation.
RWJF ‘Commission to Build a Healthier America’ Reconvenes to Focus on Early Childhood and Improving Community Health
What do the needs of children in early childhood and improving community health have to do with each other? Everything, according to a group of panelists who addressed the Robert Wood Johnson Foundation (RWJF) Commission to Build a Healthier America at a public meeting in Washington, D.C. yesterday.
Early childhood education and other interventions early in life, particularly for low-income children, can set kids on a path to better jobs, increased income and less toxic stressors such as violence and food insecurity, according to testimony at the today’s meeting. And that in turn creates more stable and healthier communities. Those two issues are the focus of the Commission, which plans to release actionable recommendations in September.
Yesterday’s event marks the first time the Commission is reconvening since it issued recommendations for improving health for all Americans in 2009. It will be co-chaired again by Mark McClellan, MD, PhD, director of the Engelberg Center for Health Care Reform at The Brookings Institution and former Administrator of the Centers for Medicare & Medicaid Services, and Alice M. Rivlin, PhD, senior economist at The Brookings Institution and former director of the Office of Management and Budget.
“Although we have seen progress since the Commission issued its recommendations in 2009, we still have a long way to go before America achieves its full health potential,” said RWJF President and CEO Risa Lavizzo-Mourey, MD, MBA at the Commission’s public meeting in Washington. “We know what works: giving children a healthy start with quality child care and early childhood development programs, and building healthy communities where everyone has an opportunity to make healthy choices. That is why RWJF is reconvening the Commission, to concentrate on these two critical areas.”
Prepared for a Disaster and Building Back Better: Terry Cline on Public Health’s Response to Oklahoma Tornados
Tornadoes that struck Oklahoma just a few weeks ago have left more than 40 people dead, scores injured and billions in losses, including whole neighborhoods wiped out. The devastating weather of the past year—including superstorm Sandy, which wreaked havoc on the Northeast, especially New Jersey and New York City—has called even greater attention to the critical need for public health departments to be ready to respond at all times. Health departments in the communities and states where disasters happen have to be nimble enough to respond to the expected and the unexpected—as you’ll see from three interviews NewPublicHealth recently conducted with the health commissioners of New Jersey and Oklahoma, as well as with the health director of Oklahoma City, the most recent area to be rocked by severe weather.
And because disasters don’t honor state lines and devastated areas may not have the capacity on their own to handle the myriad of disaster health issues, the manpower and equipment of even far-flung health departments can be critical—making preparedness a year-round, 24/7 responsibility for everyone in public health.
Read the first installment in the series, a conversation with Terry Cline, PhD, the Commissioner of Health in Oklahoma.
NPH: With the recent tornadoes, what were you able to prepare for and what was unexpected?
Terry Cline: Unfortunately, in Oklahoma we have a lot of experience in dealing with disasters and we have what I consider to be a well-oiled machine in place. So overall, I think the response to this tragic situation went very well. The multiple tornados were a bit of a surprise though. It’s not unusual to have several tornados in the same area, but it’s unusual to have two significant tornados and then have one of those go through an urban area. I think a critical impact that was not anticipated was the flooding during the most recent tornado. The bottom line is that you need to have a strong infrastructure in place because Mother Nature has a way of always having the upper hand.
Jane Brody is the Personal Health columnist for The New York Times. She joined the newspaper in 1965 as a specialist in medicine and biology after receiving degrees in biochemistry and writing for multiple college newspapers, as well as for the Minneapolis Tribune. With her column she has seen and reported on almost 50 years in the evolution of personal and community health.
NewPublicHealth recently spoke with Brody about her take on the state of community health—and what we can all do to improve it.
NewPublicHealth: Over the years, what efforts have you seen that you think have been most effective at improving community health?
Jane Brody: Well, I think one of the most exciting things that’s happened in New York City, and possibly in other cities as well, is getting better food to people who live in food deserts. For example, collecting food that would otherwise be wasted and bringing it to communities where people get free food that is healthy, fresh, and they even have demonstrations of recipes. In fact, I got one of my favorite recipes—it’s a green bean frittata—from one of their demonstrations that I attended just to see how it all worked out.
We’ve also, as you’ve no doubt heard, been putting in all of these bike lanes and we now have introduced the Bike Share Program, which is not inexpensive, but it does at least give more people an opportunity to get off their butts and get out of their cars and maybe even not even use public transportation in some cases, but to get some exercise to and from work, which is wonderful. I remember during one of the transit strikes that we had in New York City, I rode my bicycle from Brooklyn to Times Square where I work, over the bridges and stuff, and it was just wonderful because I got my exercise in at the same time as I got to work and I didn’t have to spend an extra hour exercising. There have been improvements. We have, of course, public pools that are only open in the summer, but in summer is better than no public pools and nobody has to pay anything for a public pool, which is really great.