Category Archives: NACCHO
Aaron Wernham, director of the Health Impact Project, a joint project of the Pew Charitable Trusts and the Robert Wood Johnson Foundation, is leading a health impact assessment training and two sessions on the health impact assessments during the annual meeting of the American Public Health Association.
Health impact assessments have only become more widely used in the last few years but are growing in their use by cities, states and community based organizations to identify and address health risks and benefits of decision made outside the health sector.
HIAs, as they are known, are showing great promise as a means to factor health into a wide range of decisions that do not normally focus on health, such as transportation and land use planning, permitting of natural resource development and energy production projects housing projects and policies, and social policies and programs such as living wage and paid sick days legislation, energy assistance, and rental voucher programs. Currently, based on tracking by the Health Impact Project and the Centers for Disease Control and Prevention, over 130 HIAs have been completed or are being conducted right now.
NewPublicHealth spoke with Aaron Wernham about the state of HIAs, successes in the field and strategies that will be driving greater use of the tool in the future.
NewPublicHealth: Do you think that many attendees at the APHA meeting will have greater familiarity with the concept of an HIA than they might have a year or two ago?
Dr. Wernham: Absolutely. I think I’ve been giving talks on HIA at the APHA annual meeting since 2007 where I think there was just one session on HIAs at the whole meeting and this year I believe we’re up closer to six or seven groups from around the country coming to talk about HIA. I really think this reflects a lot of the developments that have been going on in the field in the last year.
We had a National Research Council committee that just finished a report on the field in the US and developed a framework and guidance for the practice. I think one of the most important findings of the committee is simply that HIA is a very valuable and promising tool for addressing the health consequences of non-health decision making, decisions made in other sectors like transportation and agriculture and education.
NPH: What sessions are you involved in during the APHA meeting?
Dr. Wernham: I gave a training session on Sunday with our colleagues at Human Impact Partners. One of my sessions is looking at health impact assessment as a tool to help incorporate health into what’s commonly being called nowadays a health in all policies framework. The idea is looking at HIA as a tool to help decision makers outside the health sector factor health in. And I’m giving another talk with a group of HIA practitioners from around the country about the National Research Council’s findings, defining HIA, the steps of HIA, how it’s done, and then they’ll all be providing some examples.
NPH: One interesting session involves the built environment and older adults. Have you seen the issue addressed before?
Update on 10/31: Scott Burris is at APHA and gave an overview this morning at the 2011 APHA annual meeting on how far the initiative has come since its inception two years ago.
The program has funded somewhere between $8 and 9 million dollars in public health law research so far, said Burris, many of which are starting to bear results. Researchers from Boston University School of Law and Harvard Medical School showed that companies that make antibiotics are encouraging the (over)use of those antibiotics by clinicians, a practice which is known to lead to antibiotic resistance.
PHLR is now focused on creating an online research community called SciVal for sharing methods, best practices and advances in the field. (PHLR staff is showcasing this new app at their booth #2060, so stop by to check it out if you’re here in Washington attending APHA). Burris also encouraged the audience to visit the PHLR website to take advantage of a wealth of resources on methods, all meant to guide this burgeoning field.
Public Health Law Research (PHLR), a Robert Wood Johnson Foundation program based at Temple University, represents an initiative to promote effective regulatory, legal and policy solutions to improve public health. The program will have a strong presence at the American Public Health Association Annual Meeting this year both during meeting sessions and at the Program’s booth on the exhibit floor. NewPublicHealth spoke with Scott Burris, JD, director of the program, about some of the upcoming presentations and booth demonstrations.
NewPublicHealth: Will you have many research results to show at this year’s APHA Annual Meeting?
Scott Burris: This is now Public Health Law Research at age 2.4 years. We are just starting to get results from our grantees, the people we funded in the first round and a few in the second and we have a number of them appearing at APHA this year. Our booth will have a complete guide to PHLR related events at APHA. Our Methods Core Member, Jeffrey Swanson, a professor at Duke University, is getting the 2011 Carl Taube Award for distinguished contributions to mental health services research. At our the booth, #2060, we’ve got a beta version of our Public Health Law Research Community application, which will eventually capture everybody who’s written in Public Health Law Research and all the papers that have been published. We’ll be demonstrating the app at our booth. We’ll also be showing our brand new seven-minute animated video about PHLR—popcorn included.
NPH: Can you point to some key PHLR research projects that will be presented at the APHA meeting?
William Schaffner, MD, professor and chair of the preventive medicine department at Vanderbilt University, responded to an article on the effectiveness of the flu vaccine with a quote from Voltaire—“perfection is the enemy of the good." The article, published yesterday in Lancet Infectious Diseases, detailed an analysis of previous studies and found that the most commonly used vaccine in the U.S. is about 60 percent effective—somewhat less than had been thought—and that there are no trials on children ages two through 17 and on adults age 65 and older.
Schaffner, who is also a spokesman for the Infectious Diseases Society of America says that while the current flu vaccine isn’t fully effective for everyone who gets it, everyone eligible should get the shot because even in cases where it doesn’t prevent the flu, it can minimize serious flu effects including hospitalizations and deaths. “That’s crucial,” says Schaffner. “A healthy person with the flu can go from feeling fine to very ill in the hospital in just 48 hours.”
People have a tendency to disrespect the seriousness of the risk posed by the flu, but they make a mistake, says Paul Etkind, DrPH, senior director for infectious diseases at the National Association of County and City Health Offiicals. From 3,000 to 48,000 people die each year from the flu, depending on how active the season is, says Etkind, and about a quarter of a million people are hospitalized each year.
Today, public health leaders from across the country are gathered in Portland, Ore., for the start of the Association of State and Territorial Health Officials (ASTHO) Annual Meeting. This year’s meeting, and today’s Opening Session, focuses on the vision for the “new” public health. The Opening Session features perspectives on this vision from the federal, state and local levels.
John Auerbach, MBA, president of ASTHO and commissioner of the Massachusetts Department of Public Health, said this has been a challenging year for public health with budget and staff cuts, but this year has also represented a number of new opportunities, including the Patient Protection and Affordable Care Act and Community Transformation Grants.
Lillian Shirley, MPH, MPA, president of the National Association of County and City Health Officials and director of Multnomah County Health Department talked about what state and local public health can do together – and why that collaboration is so important. Shirley reflected on the lesson in collaboration learned during the H1N1 outbreak.
Job losses and program cuts continue to impact local health departments according to a newly released survey from the National Association of County and City Health Officials (NACCHO). Survey results show that in the last year, more than half of all local health departments reduced or eliminated at least one program. Services for mothers and children were among the hardest hit. Other areas that faced the axe: emergency preparedness, immunizations, chronic disease screening, and personal health services.
“Fewer staff means a loss of key protections for you and me,” said Robert M. Pestronk, M.P.H., NACCHO’s executive director.
But Pestronk says that with the loss comes resourcefulness. Case in point: in response to losing millions in their budget and eliminating 20 staff positions, Coconino Public Health Services District in Arizona became its own tax district in 2010 and now has a dedicated, stable funding source that lets health officials assign funding to local priorities.
NewPublicHealth spoke with Robert Pestronk about the NACCHO 2011 survey.
NewPublicHealth: What’s new this year that you haven’t seen before in job losses at local health departments?
Robert Pestronk: I think what we’re seeing new is the impact on programs and services that local health departments have been delivering. There is more impact in more places than we’ve seen before.
NPH: Are there any bright signs ahead? New creative ideas from local health departments to help deal with the funding cuts?
Trust for America’s Health and the Robert Wood Johnson Foundation recently issued a new report, Remembering 9/11 and Anthrax: Public Health’s Vital Role in National Defense. NewPublicHealth will continue to run excerpts from the report throughout the months of September and October.
The following is an excerpt of the piece from Jack Herrmann, MSEd, NCC, LMHC, Senior Advisor for Public Health Preparedness at the National Association of County and City Health Officials.
It is hard to believe that 10 years have gone by since September 11, 2001. In my memory, it feels like yesterday because I can recall the events vividly. That day and the work I did in the days, weeks and months afterward shaped my life in many ways.
When you think about public health and responses to natural or manmade tragedies, you think about the physical destruction these events leave on communities. However, the mental health impact from disasters is also incredibly important to consider. I began my disaster relief response work in 1993 with the American Red Cross and was deployed to my first large scale disaster in 1994, the Northridge, CA earthquake. I had seven years of disaster response under my belt before 9/11 and knew firsthand the importance of an integrated behavioral health response.
What I wasn’t ready for was how the events of September 11th would transform my own understanding of terrorism as well as those of most everyone in our country.
At the time of the attacks, I was the New York State Disaster Mental Health Volunteer Lead for the Red Cross and in that leadership role responsible for working with Red Cross chapters across the state recruiting and training disaster mental health responders. I immediately called the NY State Red Cross Disaster Lead and received instructions to deploy to New York City. I rented a van, went to the local Red Cross chapter to gather supplies, packed a few personal items and began my drive downstate.
Eventually I had the city in sight. I was struck by the absence of two of New York City’s most well-known landmarks replaced by a landscape of billowing gray-black smoke.
At one point I passed close enough to see the rubble from the buildings and the continuing fire and smoke. At that moment I thought to myself: “what could I possibly do, as one volunteer, in response to this massive event?”
The National Association of County and City Health Officials (NACCHO), with support from the Centers for Disease Control and Prevention, conducted needs assessments to find out how informatics has fared at the local level, and to identify any needs and gaps in current informatics capacity at local health departments.
Gulzar H. Shah, Ph.D., M.Stat, M.S.S., Lead Research Scientist at NACCHO, presented the results of two needs assessment surveys and accompanying focus groups from the last two years at this week's Public Health Informatics Conference. The 2010 survey looked at overall informatics capacity, while the 2011 survey honed in on use of meaningful use-certified electronic health record (EHR) systems. Shah noted that the response rate was down in 2011, likely due to budget cuts and staff resources, however preliminary results were promising.
Among the 134 local health departments that responded, 62% were able or planning to receive data from meaningful use-certified EHR systems, with more large health departments responding positively (89%) than small ones (45%). Fewer than half of respondents were already receiving and processing data for immunization registries, electronic lab reporting and syndromic surveillance – the three public health requirements under meaningful use of EHRs.
Not surprisingly, among those not yet receiving meaningful use data from EHRs, top reasons included a lack of funding and not having an EHR system in place locally from which to receive data. However, a significant number also said they needed more technical assistance to be able to receive the data. More than three-quarters of these respondents were not aware that they could be receiving technical assistance from the state level.
When it came to general informatics, in focus groups some discussed the merits of the terminology used by the field. "Colleagues think it's just a nonsensical buzz word," said one participant. Some even suggested changing the term "public health informatics" to something simpler, like "e-public health" (though one session attendee noted that public health informatics is an ingrained term, and is really just one slice of the broader topic of e-public health).
Whatever we call it, most of the 309 survey respondents said that their staff have an adequate level of physical infrastructure needed to do their jobs. That said, very basic barriers emerged in informatics capabilities, with budget and staff time and training again topping the list. One of the biggest challenges is that in order to work on public health informatics efforts, resources would have to be diverted from on-the-ground programs.
“It was a choice: use the people to give vaccines, or use the people to put the information in computers,” said one focus group attendee.
The Public Health Informatics 2011 Conference has come to a close in Atlanta, where over 1,000 people attended in person, and 1,600 more joined the conversation online through the Virtual Conference. One theme throughout the conference was making new connections – connections from EHRs to public health surveillance systems, from public health departments to health care and social services, and more. Different technical systems need to be able to work together, which requires standards and ways to bridge different terminologies.
That goes for making IT systems interoperable, but the same is also true for making connections between different fields, which often seem to speak a different language. Coming together at a conference like Public Health Informatics is certainly a step in the right direction.
Here are some highlights from NewPublicHealth coverage of the conference this week:
- Dr. Farzad Mostashari, Director of the National Coordinator of Health Information Technology in the U.S. Department of Health and Human Services comments on the enormous potential for meaningful use to impact public health.
- Local health departments share how they put the “public” back in public health by collaborating directly with folks from their communities to plan for emergencies and tell public health stories through social media.
- Health departments find ways to integrate health and social services on very little budget, so there can be “no wrong door” to access a multitude of services, from food stamps to flu shots.
- Conference attendees tell their stories on using technology to support public health – from monitoring pregnancy risks across the country to bringing disease surveillance systems to former Soviet countries
All of the content captured during the live event that was not made available during the conference will be be re-released September 7, 2011 at the Virtual Conference site, thanks to conference co-sponsors the Centers for Disease Control and Prevention and the National Association of County and City Health Officials. When posted, many of the sessions will then feature a live chat with the speakers. All of the plenaries, sessions, videos, downloads and other materials will be available on this site for 3 months.
Catch up on the rest of the NewPublicHealth coverage of the Public Health Informatics Conference here.
Today the Public Health Informatics Conference 2011, co-sponsored by the Centers for Disease Control and Prevention (CDC) and the National Association of County and City Health Officials (NACCHO), kicks off in Atlanta, GA. NewPublicHealth will be on the ground with live conference coverage. This morning the opening plenary session featured an energized, inspiring group of speakers, who emphasized that collaboration – with support from (but not driven by) health information technology – is the key to moving public health forward.
Seth Foldy, M.D., M.P.H., Director of the Public Health Informatics and Technology Program Office at Centers for Disease Control and Prevention (CDC), urged the crowd to think first about, “what exactly are we trying to do with our technology – instead of what is the coolest technology we can do it with?”
Dr. Foldy acknowledged the challenges public health informatics is up against, including a shrinking and aging workforce that must tackle a bigger job than ever before. "We’ll need to do more with less – in our ability to train, to reach the public with direct services, and deliver the environmental services needed to protect the public from disease," said Dr. Foldy.
Despite the challenges, the 2011 conference comes at a time when opportunity is great. The opportunities Dr. Foldy espoused are to enable a far more close, real-time relationship (driven by data and decision support) between public health and clinical care. Dr. Foldy said, "We can create a health system that for the first time is incentivized by preventing disease and injury rather than just treating it."
In the summer of 2011, nearly 800 public health and informatics professionals from across the country convened in Atlanta for the Public Health Informatics 2011 conference.
Around the conference, NewPublicHealth spoke with Farzad Mostashari, M.D., S.c.M., Director of the Office of the National Coordinator for Health Information Technology in the U.S. Department of Health and Human Services, to get his perspective on how health information technology can impact public health, and how the public health informatics field is evolving.
NewPublicHealth: The Public Health Informatics Conference is coming up this month. For those who aren't familiar with the field, what exactly is public health informatics?
Dr. Mostashari: I think that I’m a little bit of a student of public health informatics myself, and an avid follower. In the early days it was about building better systems – disease surveillance and outbreak detection systems. The second phase was building the connection between those systems and clinical systems, and using clinical information systems as primary data sources for public health. The third stage is about how public health informatics systems can embed within them a public health consciousness. I think about having a Tom Frieden [Director of the Centers for Disease Control and Prevention (CDC)] on the left shoulder of every physician to help inform clinical decisions from a public health perspective, as enabled by health information technology.
NPH: What is the role of the Office of the National Coordinator (ONC) in advancing public health informatics?