Category Archives: Q&A
Paul Biddinger, MD, FACEP, director of the Emergency Preparedness and Response Exercise Program at the Harvard School of Public Health, was a member of this morning’s opening panel on disaster preparedness at the 2014 Preparedness Summit. NewPublicHealth spoke with Biddinger ahead of the conference on what students and communities need to know and do to be best prepared for a disaster.
NewPublicHealth: Is it a requirement for students in graduate school for public health degrees to take at least one class in disaster preparedness?
Paul Biddinger: It is not. They have the option, but it is not a required element of what they have to take.
NPH: How do you think recent disasters have informed what students and public health staff members need to know about response?
Paul Biddinger: I think some of what students need to know has always been the case—but maybe has been underscored by recent events—which is that no matter what you do in public health you may be needed as part of the response, and whether you're working in maternal and child health or smoking cessation or HIV/AIDS, when a disaster happens it’s all hands on deck. And I think the hurricanes, the pandemic and other events have showed that often we need to reach well outside the traditional emergency response or preparedness work staff in public health, and so everyone has to be flexible, has to be able to participate in the response. I think in order to participate in the response you have to know that there is an emergency operations plan, what your role in it would be, how you would get information, to whom you would be responsible or to whom you would report. And those are things that you should know ahead of time.
I think the other thing we see when we see these wide-area disasters like we saw in Sandy, like we saw in Katrina, is the central role that public health can play in coordinating the health response—that multiple hospitals, long-term care facilities, out-patient facilities such as dialysis centers all need to be coordinated in their response to achieve the best possible health outcomes for the community. And public health is in a particularly strong place in the community to be able to help make sure that each of those individual participants is pointed in the same direction and is leveraging the community resources as best they can.
Rockingham County, N.C., is one of several counties profiled in videos produced for the 2014 report of the County Health Rankings, a joint project of the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, and released yesterday. The Rankings shows how communities across the country are doing and how they can improve on their health.
Rockingham evolved from a wealthy county to a poor one very quickly after losing two major industries only a couple of decades ago. The community suffers from high general smoking rates, high obesity rates and high rates of smoking during pregnancy. When the 2010 County Health Rankings were released, Rockingham was ranked at 71 out of 100 counties on health measures. The community's poor standing served as a wake-up call.
One new program set to begin this spring is the Nurse-Family Partnership, a decades-old, evidence-based community health program that serves low-income women pregnant with their first child.
Nurse-Family Partnership is based on the work of David Olds, MD, a professor of pediatrics, psychiatry and preventive medicine at the University of Colorado Denver. While working in an inner-city day care center in the early 1970s, Olds was struck by the risks and difficulties in the lives of low-income children and over the next decades tested nurse home visitation for low income families in randomized controlled trials in Elmira, New York, Memphis, Tennessee and Denver. Results have shown that the program improved pregnancy outcomes; improved the health and development of children; and helped parents create a positive life course for themselves. There are now Nurse-Family Partnership programs in 43 states, the U.S. Virgin Islands and six Indian tribal communities.
In the Nurse-Family Partnership programs, the mothers receive ongoing visits from the nurses in their homes from the first trimester until the baby is two years old. Program goals include:
- Improve pregnancy outcomes by helping the new mothers engage in good preventive health practices, including comprehensive prenatal care from their healthcare providers, improving their diets and reducing their use of cigarettes, alcohol and illegal substances.
- Improve child health and development by helping parents provide responsible and competent care.
- Improve the economic self-sufficiency of the family by helping parents develop a vision for their own future, plan future pregnancies, continue their education and find work.
According to Heather Adams, executive director of the Rockingham County Partnership for Children, there are about 5,000 children under the age of five in Rockingham County. Over half live in poverty and are born to mothers under the age of 20 and many of the children are in single parent households.
“The County Health Rankings really gave us some concrete data to show us what we knew anecdotally was really true,” said Adams. “Nurse-Family Partnership really rose to the top as a really strong program that could help meet some of our needs.”
As part of its County Health Rankings coverage, NewPublicHealth recently spoke with Elly Yost, MSN, PNP, director of nursing practice at the Nurse-Family Partnership national office in Denver, Co. Yost is a pediatric nurse practitioner who previously worked in hospitals and community practice settings.
Tomorrow, March 25, the day after World Tuberculosis Day, the Public Broadcasting Program Frontline will present TB Silent Killer a new documentary that looks at tuberculosis in Swaziland, the country with the highest incidence of the disease.
While many people, especially in the United States, think tuberculosis has long since been eradicated, there are in fact more than 8 million new infections every year, many of them virulent new drug-resistant strains that are passed—throughout the world—through a cough or a sneeze. According to the World Health Organization, tuberculosis has become the second-leading cause of death from an infectious disease on the planet.
Jezza Neumann, the filmmaker who created TB Silent Killer, tells the story of several people in Swaziland suffering daily from the disease, including ten-year-old Nokubegha, whose mother recently died of a multidrug resistant strain of tuberculosis and whose 17-year-old brother cares for her.
“In Swaziland, a quarter of all adults are HIV-positive, which means their immune systems are compromised and especially susceptible to TB infection,” said Neumann, “But globalization and international travel mean that these infections have the potential to spread all over the world.”
NewPublicHealth spoke by phone with Jezza Neumann a few days before the documentary was scheduled to air on Frontline (Check local PBS schedules here.)
NewPublicHealth: Why did you choose tuberculosis as your topic?
Jezza Neumann: The idea being to make films that make a difference and give voice to the voiceless. In doing so, we’ve made and kept relationships with nonprofits and NGOs and other organizations and look to find the issue that’s hidden in the background that no one is hearing about, that’s not getting the platform that it needs.
One of the organizations we’d worked a lot with is MSF, Medecins Sans Frontieres, or Doctors Without Borders as it’s known over here. The press officer at the U.K. office knew that Doctors Without Borders had been struggling to get the issue of tuberculosis out on the mainstream. People had done small reports but she knew there was a big impact possible with a documentary because the reality is if you combine the facts, stats and figures in documents with a film that has a human face and a human cost of those facts, stats and figures, it becomes something so much bigger. The documentary becomes a platform that has a life far further reaching than just the transmission.
Louis W. Sullivan, MD, former U.S. Secretary of Health and Human Services under President George H.W. Bush, recently wrote a memoir, Breaking Ground: My Life in Medicine, that offers a wide view of Sullivan’s experiences as a medical student in Boston, the founding dean of the Morehouse School of Medicine in Atlanta and as the country’s chief health officer. NewPublicHealth recently sat down with Sullivan to discuss the book and his thoughts on the history and future of improving the nation’s health.
NewPublicHealth: Looking back, what can you share about the highlights of your career in medicine and health promotion?
Louis Sullivan: Highlights would certainly include my time at the Boston University School of Medicine. That had many significant points. It was my first time living in an integrated environment because up until that time I spent all of my life in the South. Working in an environment without concerns about discrimination and bias, that was a great experience; my classmates and the faculty at Boston University were all welcoming.
Another highlight was later when I was a research fellow in hematology in the Harvard unit at Boston City Hospital. I had a paper accepted for presentation at a major research conference in Atlantic City. It was a paper showing that heavy drinking suppressed the production of red blood cells by the bone marrow.
And of course a tremendous highlight was going back to Morehouse College, my alma mater, to start the Morehouse School of Medicine. I was returning home in a sense. I had gained experience as a faculty member at Boston University, had been steeped in medicine and now I was in the process of establishing a new institution to train young people for the future.
NewPublicHealth: What changes have you created and supported to improve population health.
Sullivan: Well, certainly becoming Secretary of Health and Human Services was indeed an honor and a great opportunity for me, and it was also a very challenging experience.
In the late ‘80s, when I became Secretary, AIDS was a new disease. There were many demonstrations by various advocacy groups, groups that didn’t trust the government, and we had to work to develop a relationship with them. I convinced President Bush to put $1.6 billion in his budget to be used for research on this new disease, to develop mechanisms for treating the disease and to educate the public. And as a result of that initial investment and ones that followed, this disease has been transformed from a virtual death sentence to a chronic disease which is controlled by medication. And people, rather than living a few months, which was the case once the diagnosis was made in 1989, are now living for decades with the virus suppressed on medication, raising their families, working, earning wages, paying taxes. So that has been really a very satisfying outcome from that experience. And we hopefully are close to finding a cure for this disease as well.
County Health Rankings & Roadmaps — Transforming Public Schools in Baltimore: Q&A with Robert English
Years of research shows that school facilities in poor condition—including faulty heating and cooling systems, poor indoor air quality, and deficient science labs—significantly reduce academic achievement and graduation rates. On the other hand, new and renovated school buildings that are equipped with modern science labs; art and music resources; and other amenities lead to improved educational outcomes. Research has also shown that when students attend high-quality schools they are more likely to be engaged in school and have higher attendance, test scores and graduation rates.
The public schools in Baltimore, Md., have the lowest graduation rates and oldest facilities in the state. A recent report described 85 percent of Baltimore’s 162 public school buildings as being in either poor or very poor condition.
While graduation rates in Baltimore public schools have increased significantly in recent years, thanks to better funding and other academic-focused efforts, Baltimoreans United in Leadership Development (BUILD) aims to further improve the graduation rate, educational outcomes, overall health and economic prosperity of Baltimore residents. The goal is to integrate the rebuilding and renovation of every city school into the district’s education reform efforts. BUILD and its partners, ACLU of Maryland and Child First, want to change state and city policies to support school construction and renovation.
BUILD is the recipient of a County Health Rankings & Roadmaps community health grant to educate and engage parents, school leaders, and leaders from other sectors such as business, the community and faith leaders about the need for updated schools to get the best education outcomes for Baltimore’s students. NewPublicHealth recently spoke with Robert English, BUILD’s lead organizer, about the group’s recent successful efforts.
>>How healthy is your county? Join the live webcast event on March 26 to celebrate the launch of the 2014 County Health Rankings and to spotlight communities taking action to build a culture of health across America.
NPH: What’s the link between improving the school infrastructure and improving the graduation rates?
English: A leading indicator of students graduating from high school is that they feel safe and challenged in their schools. We’ve talked to thousands of students and families in Baltimore City and by the time students here in Baltimore get into the 9th grade and 10th grade, they have often lost interest in high school and many of them have said that it’s because of the facilities. We didn’t have science labs in many cases or other core components of a quality education to send kids to college.
This campaign is about building the 21st century learning environments that can prepare young people not only to graduate, but to go to college. For BUILD this is not a bricks-and-mortar campaign—this is about providing the educational space where every child has an opportunity to learn, and then secondly this is about bringing people together around creating high expectations for students. We’ve continued to organize in the schools that are in year one through year three of school construction, and the constituency we are building will be here to hold our schools accountable to providing real results.
Community Health Centers serve more than 22 million people at more than 9,000 sites located throughout all 50 states and U.S. territories, and have become needed health centers in particular for people newly insured under the Affordable Care Act (ACA) who have not previously had relationships with healthcare providers.
The National Association of Community Health Centers (NACHC) was organized in 1971 and works with a network of state health center and primary care organizations to serve health centers in several ways, including to:
- Provide research-based advocacy for health centers and their clients.
- Educate the public about the mission and value of health centers.
- Train and provide technical assistance to health center staff and boards.
- Develop alliances with private partners and key stakeholders to foster the delivery of primary health care services to communities in need.
Ronald A. Yee, MD, became chief medical officer of the NACHC last year. NewPublicHealth recently spoke with Yee about the mission of health centers and their new roles under the Affordable Care Act.
NewPublicHealth: What field of medicine did you practice before taking on your new role?
Ronald A. Yee: I am a family physician. I worked for 20 years at a community migrant health center in Fresno County. I basically practiced full-scope family medicine including obstetrics, so I was delivering babies up until October of last year when I came to NACHC. So I was on the frontlines doing patient care and I was also the chief medical officer for our health center. I got involved earlier in my career with NACHC on a state and then national level, was on the board and then became chief medical officer.
NPH: Who is most likely to use the services of a community health center?
Yee: Health centers provide about one quarter of all the primary care visits for low-income populations, which include about one in seven people who are uninsured, or one out of every 15 Americans. With the roll out of the Affordable Care Act we’re seeing a big surge in demand among the newly insured, whether that’s through Medicaid expansions or the health insurance exchanges. Many of our patients who previously paid on a sliding scale basis are now covered through the ACA, which is helping us extend the funding we have.
In Shasta County, Calif., the Shasta County Health and Human Services Agency is using a County Rankings & Roadmaps grant to realize the “Shasta Promise,” which helps young people in the community prepare for success in any post-secondary school option so that they can obtain high-skill, high-income jobs that will yield long-term health benefits.
High poverty rates, low educational attainment and lack of employment opportunities are among the factors that make Shasta one of the least healthy counties in California. Only 19.7 percent of Shasta County’s adult population age 25 or older has a bachelor’s degree or higher, compared to 30.2 percent statewide. The goal of Shasta Promise is to increase awareness of and preparedness for post-secondary education. The program provides students in middle school, high school and college with the guidance and support they need to overcome barriers to pursuing higher education, and encourages a culture of college attendance among county residents.
To accomplish this, the county is implementing a newly-established College and Career Readiness Strategic Plan:
- School leaders and counselors are being provided with a training curriculum and sessions to help them get students ready for college.
- Parent focus groups are being convened to inform the development of an engagement plan between the schools and families.
- Written policies are being developed for local colleges to accept all county students who meet enrollment requirement.
- An agreement is being secured from Southern Oregon University to charge in-state tuition for Shasta County students who are admitted.
NewPublicHealth recently spoke with Charlene Ramont, a public health policy and program analyst with the Shasta County Health and Human Services Agency, and Tom Armelino, Shasta County’s Superintendent of Schools, about the Shasta Promise.
NewPublicHealth: What is the mission of the project?
Charlene Ramont: Our aim is to give every student, every option. We want all students, when they graduate from high school, to be prepared for all options post high school. When they graduate, they need to be prepared to join the military if they so choose, they need to be prepared to go to college if they so choose, they need to be prepared to go to a trade school or a certificate program.
Several leading cancer organizations recently formed a think tank to address health disparities in cancer research with the goal of improving treatment access and outcomes for underserved populations. “Closing the inequality gap will not happen easily, and won’t get done if any of us goes it alone," said Otis W. Brawley, MD, chief medical officer of the American Cancer Society (ACS), one of four groups involved, in addition to the American Association for Cancer Research (AACR); the American Society of Clinical Oncology (ASCO); and the National Cancer Institute (NCI), a branch of the National Institutes of Health (NIH).
“Cancer mortality rates are decreasing for most minorities, but absolute death rates continue to be higher," said NCI Deputy Director Doug Lowy, MD. Lowy adds that it’s important to understand the sources of the disparities in order to reduce them.
The goal of the collaboration is to address the fact that that some racial and ethnic minorities in the United States are more likely to develop cancer, less likely to access high-quality cancer care and more likely to die from cancer when compared to others and to whites. For example, the death rate for cancer among African-American males is 33 percent higher than among white males, and the rate for African-American females is 16 percent higher than it is for white females.
“We must move from describing the problems to more quickly identifying and implementing solutions to address the racial and economic-based disparities that continue to affect many cancer patients and families in the United States,” said ASCO president Clifford A. Hudis, MD.
NewPublicHealth recently spoke with Hudis about the new collaboration.
NewPublicHealth: What key issues help explain—and then overcome—differences in cancer incidence and severity among different populations?
Clifford A. Hudis: We can’t completely disentangle environmental factors, which include nutrition, access to care, general health behaviors, exercise and education, which relates to behaviors such as tobacco use. And of course underlying that is the socioeconomic status. But there also is a burgeoning understanding of the role of genetic variations that may be clustered in various populations and may influence things such as drug metabolism and diseases.
As the demand for walkable communities keeps growing, experts are moving from asking “If they build it, will they come?” to questioning how to fund the new developments, as well as keeping our eyes on issues such as transit, affordability and improving population health. As of January sharing best practices for those and many other issues is the job of Chris Zimmerman, who recently joined the staff of Smart Growth America as Vice President for Economic Development, following a very long stint as a member of the Arlington County Board in Virginia. Before his post in Arlington, Zimmerman was Chief Economist and Committee Director for Federal Budget and Taxation at the National Conference of State Legislatures. In his new role, Zimmerman will focus on the relationships between smart growth strategies and the economic and fiscal health of communities.
NewPublicHealth spoke with Zimmerman soon after he landed in his new office.
NewPublicHealth: What did you do before joining Smart Growth America?
Chris Zimmerman: For the last 18 years I’ve been a member of the Arlington County Board, the governing body of Arlington County, Virginia, an urban county of about 220,000 people right next to Washington D.C. The county functions as a comprehensive local government, with functions from school funding to land use and development to standard municipal functions such as parks and recreation, public safety, waste removal and managing public infrastructure. We don’t run the schools, but the funds for the schools are part of the county budget, at a cost of a little more than $1 billion annually.
Arlington County has become a model for transit-oriented development that is studied by folks around the country and even around the world, particularly because of the way the county has chosen to develop around the Metro system. That includes the initial commitment to be involved in Metro Rail, to fund underground Metro stations and then to focus development around them, beginning even before the ideas of the vocabulary of Smart Growth and urbanism had really gotten started, decades ago.
Prior to serving on the county board, I served on the county’s planning commission and a number of other commissions. So I’ve had about 20 to 25 years of involvement in the development of every aspect of the community, including housing, planning development and economic development, and even agencies such as the Washington Metropolitan Area Transit Authority, which runs Metro Rail and Metro Bus and every other regional transportation planning body there is here in Washington. I was involved in a lot of regional transportation issues that obviously were fundamental to our county because of the way we chose to develop and because of where we’re located. There are seven crossings of the Potomac River and five of them go through Arlington, so although there are a couple hundred thousand people in Arlington, there’s a million and a half or so in northern Virginia and large numbers of them go through Arlington every day.
Future of Public Health is an ongoing series focused on the emerging faces in the world of public health. We spoke with Azmina Lakhani, MD, MPH, about what helped lead her to the field and where she hopes to go from here.
NPH: What’s your educational background in public health?
Azmina Lakhani: I went to the Illinois Mathematics and Science Academy for high school, and then I did medical school, undergraduate and public health all at Northwestern University in Chicago. I received a BA in psychology and global health as an undergrad and then for the next five years I attended medical school and earned a Master’s in Public Health, as well.
NPH: This seems like something that you went into knowing full well that this is what you’re interested in. What was it that encouraged you to pursue a degree and a career in public health?
Lakhani: I had sort of been interested in health care in general in high school, and I wasn’t really sure whether I was going to do research or clinical work or public health work, but in college I really started becoming interested in public health. First through global health, I started learning about different health care systems abroad and doing some volunteer work in Ecuador and Mexico City. That’s really when I got interested in health care delivery systems and also how one can have a greater influence on health.
I appreciate the clinical side. I’m a family medicine resident in training currently, so I love working one-on-one with patients. I also see a lot of value in making an impact on a larger scale—whether that’s how someone gets their health care, what insurance systems we have in place, or the traditional public health things that you think of such as vaccines—that have a really large impact on people. But I think for a shorter answer to your question, I really got interested in college and then built on that in medical school while I was getting my MPH.
NPH: Within the field of public health, what’s your primary interest? What really speaks to you? The global approach?
Lakhani: I think public health is just so awesome because it has so many different facets, and to be honest, I don’t have one particular interest in terms of public health. During my year at the Chicago Department of Public Health (CDPH) I worked on a project called PlayStreets. It’s a very simple idea where we close down streets in the city—neighborhood streets—to allow children with little access to public spaces to have a place to play. The whole intent is to get people out there, meeting their community members, and, in the long term, trying to reduce childhood obesity. It’s kind of a lofty goal, but I am interested in making resources available to people so they can take control of their own health on a broader scale and PlayStreets was one example of that.