Category Archives: Recommended Reading
Implementation of the Affordable Care Act—and keeping future generations of Americans healthy or even healthy enough—will rely on an adequate supply of primary care physicians. That includes family physicians, pediatricians and internists who can help steer patients toward healthier lifestyles and effective treatments for chronic illnesses to help avoid both unnecessary complications and costs. However, the Association of American Medical Colleges predicts a shortfall of about 45,000 primary care doctors in the next decade, according to The Wall Street Journal. Many medical students have traditionally avoided primary care training in favor of specializing in fields such as dermatology and radiology because the pay is generally far higher. That matters especially these days, when many medical students leave school owing more than $150,000 for their training.
According to the article, in an effort to increase the number of doctors specializing in primary care, a number of medical schools have strengthened their primary care programs and at least 17 new medical schools have opened since 2005—some that have only primary care training programs. And some of the schools have been able to recruit effectively by building loan repayment programs into the program, especially if students commit to practicing in underserved areas following their training.
Colleen Christmas, director of the internal residency program at Johns Hopkins Bayview Medical Center, who is interviewed in the article, points out that a strategy of increasing the number of primary care doctors makes economic as well as population health sense. According to Christmas, a recent study by Johns Hopkins researchers showed that with each 1 percent increase in the proportion of primary-care physicians, an average city will have 503 fewer hospital admissions, almost 3,000 fewer emergency-room visits and 512 fewer surgeries annually.
Read the full story in The Wall Street Journal.
>>Bonus Link: Four months after Surgeon General Regina Benjamin left her post to return to academia and a medical practice, the White House has nominated Vivek Hallegere Murthy, co-founder and president of Doctors for America and a Boston-area physician, to take up that post.
Atlantic Cities recently reported on a ride sharing program called Lyft, which requires riders to join up and input credit card information to be eligible for the carpool-like rides. Lyft’s licensed drivers are pinged to pick up passengers whom the system tracks as headed in the same direction as other riders already in the car.
The article focuses on the "cool" factor, and the potential for building social relationships, making it a great solution for college kids or young adults looking for a safe way to get home on nights out—a critical public health service, particularly when research released earlier this year found that more than one-third of designated drivers end up drinking.
But another potential future use could be to help alleviate massive transportation challenges in rural areas, particularly for those with limited income or no access to a car for other reasons. One Department of Transportation study found, "Close to 40 percent of all rural counties are not served by rural transit, while another 28 percent have limited service. And, nearly 57 percent of the rural poor do not own a car, while 1 in every 14 households in rural America has no vehicle." In the future, perhaps ride sharing programs could catch on as a viable transportation option in rural towns far away from the neon lights.
>>Bonus Link: A second transportation article in Atlantic Cities this week finds that despite the growth in ridership of bike share programs across the country, PBSC, a Montreal-based major supplier of city bikeshare equipment and software faces major transportation woes. PBSC bike share customers include London, D.C. and Chicago, the city with the largest bike-share program in the nation.
A presentation at the recent American Public Health Association (APHA) annual meeting, held last week in Boston, reported on the Gun Shop Project. The program of the New Hampshire Firearm Safety Coalition shares guidelines on how to avoid selling or renting a firearm to a suicidal customer with gun advocates, gun shop owners, mental health professionals and public health professionals. The Gun Shop Project also encourages gun stores and firing ranges to display and distribute suicide prevention materials tailored to their customers
“The science shows us that not only is suicide the leading type of death from a firearm, but having a gun in the home increases the incidence of suicide, femicide [shooting a woman], and the likelihood that people in the community will be shot. Many mass shootings, like those at Sandy Hook Elementary School in Newtown, involve the suicide of the shooter,” said David Hemenway, who spoke about the Gun Shop Project at the APHA meeting. “One way to prevent the shootings may be to prevent the suicide.”
He is a member of the Project’s team as director of the Injury Control Center at the Harvard School of Public Health, as well as a recipient of a Robert Wood Johnson Foundation Investigator Award in Health Policy Research.
The ultimate goal of the coalition is to change social norms around gun use and to see the Gun Shop Project achieve results similar to the national effort to stop drunk driving.
“We want to work with the gun-owning community to create reasonable norms about when to get the guns out of the house,” Hemenway said. “If a neighbor is also a gun owner, for example, that neighbor could be asked to hold the firearms until another neighbor’s difficult period has passed. It’s the same idea as the ‘don’t let a friend drive drunk’ campaign. This can make a difference…”
Hemenway says the efforts of the Gun Shop Project are a growing national effort and partners include the U.S. Army, the American Foundation for Suicide Prevention and other groups working to reduce suicides by limiting access to lethal means at critical periods.
Read more about the Gun Shop Project.
In 2008, the U.S. Department of Veterans Affairs (VA) sent Army paratrooper Jeffrey Waggoner to an Oregon hospital to recover from an addiction to painkillers. However, once there they instead gave him a steady stream of medications, eventually releasing him for a weekend with 19 prescription drugs in hand. He was found dead of an overdose three hours later.
“As a parent, you’d want to know how this happened to your child,” said his father, Greg Waggoner, according to a new report from The Center for Investigative Reporting (CIR). “You send your child to a hospital to get well, not to die.”
In its investigation, CIR found that, post 9/11, the VA has increasingly been treating addictions with a variety of drugs, “feeding addictions and contributing to a fatal overdose rate among VA patients that is nearly double the national average.” Over the past dozen years, prescriptions for the four opiates hydrocodone, oxycodone, methadone and morphine have increased by 270 percent.
Waggoner’s weekend leave medications included 12 oxycodone pills.
As part of its investigation, CIR has created a comprehensive interactive tool that shows the VA systems with the highest prescription rates and allows users to search for information by region and system. The data is culled from CIR’s own research, as well as information from the VA and the U.S. Census Bureau.
Trust for America’s Health also recently released an interactive tool on the growing public health issue of prescription drug abuse—about 6.1 million Americans use or abuse prescription drugs. The tool allows users to search state-by-state prescription drug overdose death rates and find out how each scores on 10 key steps to curb abuse.
>>Read The Center for Investigative Reporting’s “VA’s opiate overload feeds veterans’ addictions, overdose deaths”
>>Read NewPublicHealth’s story, “New Report: Most States Not Implementing Enough Proven Strategies to Prevent Prescription Drug Abuse”
A story on the urbanwonk blog of The Atlantic Cities website finds that in Vienna, Austria, pilot projects are taking women’s home, work and elder care responsibilities into account in design planning. For example, surveys found that women—often with strollers in in tow—were more likely than men to use public transportation and needed some accommodating. They also found that after age nine boys were more likely than girls to use park space, perhaps because the girls felt fearful or outnumbered. A reengineering soon followed that brought girls into the parks. Austrian city planners have worked a lot of that data into other city construction, including a pilot apartment complex that includes onsite parks, doctor’s office, a pharmacy and a preschool.
A key concept? Assess needs first…and then plan the design.
>>Read the full article at The Atlantic Cities
>>Bonus Link: Read a NewPublicHealth post on creating safer urban biking opportunities for women
Have you heard the story about the Prevention and Public Health Fund? A “no” wouldn’t be surprising.
Have you heard the story about the almost 200,000 preventable deaths in the United States each year due to heart disease and stroke? Probably so.
The latter was big news last week, inspiring headlines and handwringing across the country. Men are twice as likely as women to die of preventable cardiovascular disease. Blacks are twice as likely as whites. Southerners are at far greater risk.
Most of the stories emphasized how all this unhealthy living is the result of unhealthy lifestyle choices. But is that the whole story?
“Largely absent from most of the stories covering the study was context—a hard look at the social and environmental conditions that help explain the findings—as well as some explanation of what it might take to really change things and prevent large numbers of needless deaths.” They also tended to suggest “that poor health is essentially a personal moral failing, while ignoring the vastly different realities that exist in different communities in this country.”
That’s the thesis of a recent Forbes opinion piece, which looks past the round number of “200,000” and other statistics detailed by the U.S. Centers for Disease Control and Prevention (CDC), and points attention to the very real obstacles to healthy living that far too many people face.
The CDC study also discussed the importance of addressing the economic and social determinants that influence the health of individuals and communities (though this went largely unacknowledged in most media accounts, according to the Forbes piece). The CDC pointed out strategies that help create conditions for healthier living, including policy changes that increase access to health care, that give people healthy local food options and that build walkable communities—changes that can only be made by communities, not individuals.
That brings us back to the Prevention and Public Health Fund. Created by the Affordable Care Act, the Fund’s grantees have spent the past three years doing all these things—helping states, cities and tribes create safer, healthier communities.
“That’s a story that needs to be told, with context.”
>>Read the full piece, “200,000 Preventable Deaths A Year: Numbers That Cry Out For Action -- And Better Reporting.”
DoSomething.org, a service and information website aimed at getting teens involved in their communities, has some startling statistics on bullying:
- About 160,000 teens skip school each year because of bullying
- More than 3.2 million students are victims of bullying each year
- 1 in 7 students in grades K-12 are either a bully or a victim of bullying
- 71 percent of students report incidents of bullying as a problem at their school
Which is why a new book on bullying prevention, "A Public Health Approach to Bullying Prevention" from the American Public Health Association (APHA), is a welcome addition as the school year starts back up. The new book is intended as a resource for both parents and educators to help stem the problem of bullying at school.
“With its public health perspective and approach, this book can lead us steps closer to eliminating the physical and mental anguish that bullying has on our nation’s children and communities,” said Georges Benjamin, MD, executive director of the APHA. “The book’s collection of various perspectives offers a comprehensive tool for parents and professionals to ensure healthy and safe schools.”
The book includes successful bullying prevention efforts implemented in southwestern Pennsylvania schools and essays by professionals working to develop approaches that might implement similar success in other U.S. school communities. Authors include psychologists, educators, social workers and public health program workers—and all have experience addressing bullying in the school environment.
“The goal ultimately, is to enable and empower students, teachers, school administration and parents to take on the work and responsibility of providing a safer and healthier environment for children,” explained Matthew Masiello, MD, MPH, Center for Health Promotion, Disease Prevention Director at the Windber Research Institute in Windber, Pennsylvania and co-editor of the book.
“A public health approach to bullying prevention…may be our best approach to providing legitimate and sustainable hope to our children at a time when it is becoming increasingly more difficult to do so,” says Masiello.
The cost of book is $30 for APHA members and $50 for non members. It can be ordered through the APHA bookstore.
Ahead of the annual pilgrimage of Muslims to Mecca and Medina in Saudi Arabia this October, the Saudi health ministry is limiting the number of foreign and local pilgrims in order to lower the risk of the spread of H7N9, a new form of avian flu identified several months ago in China, and MERS, or Middle East respiratory syndrome corona virus (MERS/MERS-CoV), a potentially fatal virus that emerged last year. The largest numbers of cases of the virus—and deaths—have been in Saudi Arabia. According to a recent post on the Network for Public Health Law’s (NPHL) blog by Daniel G. Orenstein, JD, deputy director of NPHL’s Western Region, so far neither the U.S. Centers for Disease Control and Prevention nor the World Health Organization have issued travel restrictions about the Hajj.
However, the post does note that the emergence of the two viruses has prompted the U.S. Food and Drug Administration (FDA) to take action under its legal authority to increase U.S. readiness to treat potential outbreaks of H7N9 and MERS. Under the Pandemic and All Hazards Preparedness Reauthorization Act of 2013 (PAHPRA), the FDA recently issued Emergency Use Authorizations (EUAs) for diagnostic tests for both viruses. EUAs enable the FDA to temporarily allow use of unapproved medical products such as antibiotics, vaccines and diagnostic tests needed during emergencies.
Orenstein says that “issuing the EUAs illustrates the flexibility and adaptability of FDA authority as clarified under PAHPRA. As epidemiologic research develops further on these viruses, FDA will be able to respond quickly, hopefully mitigating the impact on population health.”
>>Read more: Read the full post on the Network for Public Health Law’s blog.
“I’ll pack the dead batteries.”
“I’ll only put what I don’t need into a duffle bag.”
“I’ll try to get the generator going without any gas.”
Not exactly smart moves in the event of a natural disaster or other emergency…but maybe not far from reality for many families. Six out of 10 Americans don't have a disaster plan and only 19 percent said they were very prepared for a disaster. A new PSA campaign from the U.S. Department of Homeland Security’s Federal Emergency Management Agency (FEMA) and the Ad Council hopes to change that.
The campaign is designed to educate and empower families with children in the household to take steps to get everyone prepared for emergencies. That means giving everyone a role and ensuring everyone knows the plan. Unfortunately, because the subject matter is difficult and weighty, some parents hesitate to even bring it up.
By showing exactly how not to approach the discussion of preparedness—the above quotes are from family members sitting around a table—the new campaign encourages parents to have honest conversations with their kids about disaster preparedness, which can inspire a sense of confidence, control and calm when an actual emergency strikes.
“Humor is important because people get their guard down when they’re engaged in message,” said Priscilla Natkins, Ad Council’s executive vice president and director of client services. “They’re laughing, they’re smiling—yet they’re listening to the content. They’re listening to what these people are saying.”
>>Read More: Go to CNN.com to read the full story and watch a video on the new PSA campaign.
>>Bonus Link: Learn more about how families can prepare for disasters at Ready.gov/kids.
Almost everything touches public health. From understanding care options to access to nutritious food to being able to breathe clean air—it all works together to prevent disease and promote healthy living. That includes the types of available transportation.
>>View NewPublicHealth’s infographic exploring the role of transportation in the health of our communities, “Better Transportation Options = Healthier Lives.”
The Transportation Research Board Subcommittee on Health and Transportation (H+T) was formed in the Summer of 2011 to provide a variety of disciplines the opportunity to share and compare transportation-related health research in an academic environment. It’s a place where engineers, public health professionals, planners, epidemiologists, advocates and others can identify, advance and publish research that advances our understanding of transportation infrastructure and policies affect public health. [Editor’s Note: Read NewPublicHealth’s coverage of last year’s Transportation Research Board conference.]
The H+T Subcommittee’s areas of interest and study include sustainable and active transportation modes (e.g., walking, biking, transit); mobility and accessibility; safety; transportation-related air pollution and noise impacts; and social cohesion and other social, physical and mental health impacts.
State and local government across the country are already utilizing engineering and design solutions to improve public health in their communities, according to The Network for Public Health Law, which provides information and technical assistance on issues related to public health and is funded by the Robert Wood Johnson Foundation.
“In Massachusetts and Minnesota, transportation officials are exploring infrastructures that allow for ‘active transportation’—like walking and bicycling—which can help prevent weight gain and lower the risks of obesity, diabetes and heart disease. In Washington and California, programs are incorporating transit-oriented development strategies to improve environmental health and access to healthy foods.”
>>Read more on how transportation can impact health.