Category Archives: Prevention
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.
As we learn more about the long-term effects of traumatic brain injuries (TBI), the public health focus is increasingly on prevention in youth sports. A recent study funded by the Robert Wood Johnson Foundation and published in the American Journal of Public Health found that while 44 states and Washington, D.C., have enacted youth sport TBI laws, they all deal with identifying and responding to the injuries—not preventing them.
NewPublicHealth recently spoke with Robert Faherty, VP and Commissioner of the Babe Ruth League Inc., about what the baseball league in particular—and youth sports in general—are doing to improve the prevention of and response to traumatic brain injuries. The league includes about 1 million players across its Cal Ripken and Babe Ruth divisions.
>>Read more in a related Q&A with the author of the youth sports TBI law study.
NewPublicHealth: How is the Babe Ruth League working to prevent primary traumatic brain injuries in youth baseball?
Robert Faherty: One of the things that we really pride ourselves on— and, first of all, our organizations are entirely made up of volunteers, from the league administration level right down to the coach—is providing that league with the best insurance program we possibly can. Through Babe Ruth League, you have the opportunity to buy accident, or liability insurance. That's because we wanted to make sure that there would be no reason that a player wouldn’t go get checked out or a league wouldn’t send a player to a doctor or to an emergency room. We weren’t worried about the parents having insurance, we weren’t worried about somebody’s liability being in question—you can go to the doctor and have it covered.
The second part of that would be our ongoing attempt to educate and prevent injuries right down to the simplest practices. In our coaching certification and coaching education courses, which are mandated, not only are there safety issues that we include that in our score books that we provide to the teams, but it’s also the smallest things about how to run a practice. One of the most common injuries is being hit by a baseball, but it’s not the batter being hit by a baseball or a fielder being hit by a baseball—it’s an overthrow by kids warming up improperly, and not throwing all in the same direction.
Yesterday, New York State Health Commissioner Nirav R. Shah, MD, MPH, released the 2013-17 Prevention Agenda: New York State’s Health Improvement Plan—a statewide, five-year plan to improve the health and quality of life for everyone who lives in New York State. The plan is a blueprint for local community action to improve health and address health disparities.
Dr. Shah was joined by New York City Health Commissioner Thomas Farley, MD, MPH, and representatives from leading health care and community organizations at the Charles B. Wang Community Health Center in Manhattan. Among the other speakers were Jo Ivey Boufford, MD, president of The New York Academy of Medicine, and Daniel Sisto, president of the Healthcare Association of New York State.
>>Read a related Q&A with Commissioner Nirav Shah.
“We’ve all heard the adage—an ounce of prevention is worth a pound of cure,” said Commissioner Shah. “We need to fundamentally change the way we think about achieving better health in our society.”
That fundamental shift toward prevention, said Dr. Shah, requires setting clear goals, promoting active collaborations, and identifying policies and strategies that create opportunities for everyone to live a healthy life.
The Prevention Agenda identifies five priority areas:
- Prevent chronic disease
- Promote healthy and safe environments
- Promote healthy women, infants and children
- Promote mental health and prevent substance abuse
- Prevent HIV, STDs, vaccine-preventable diseases, and healthcare-associated infections
A health improvement plan like the one released by the New York Department of Health is a critical prerequisite for public health department accreditation. Recently, the Public Health Accreditation Board awarded five-year accreditation to 11 public health departments. Those 11 are the first of hundreds currently preparing to become accredited, including New York state.
"Completing the accreditation application, which includes our Prevention Agenda 2013-17, provides the Department of Health a valuable opportunity to engage partners and community stakeholders in our ongoing efforts to improve public health, evaluate the effectiveness of our services and showcase our successes," Commissioner Shah said.
Today, New York State Health Commissioner Nirav R. Shah, MD, MPH, released the 2013-17 Prevention Agenda: New York State’s Health Improvement Plan—a statewide, five-year plan to improve the health and quality of life for everyone who lives in New York State. The plan is a blueprint for local community action to improve health and address health disparities, and is the result of a collaboration with 140 organizations, including hospitals, local health departments, health providers, health plans, employers and schools that identified key priorities.
Dr. Shah, the architect behind today’s prevention agenda, was confirmed as New York State’s youngest Commissioner of Health two years ago. The state’s governor, Andrew Cuomo, had three critical goals: reduce the state’s annual Medicaid growth rate of 13 percent, increase access to care and improve health care outcomes.
Shah, a former Robert Wood Johnson Foundation Physician Faculty Scholar and Clinical Scholar, has already made important inroads in all three goals and the prevention agenda builds on that. NewPublicHealth spoke with Dr. Shah about prevention efforts already underway in the state, and what it takes to partner health and health care to achieve needed changes in population health.
NewPublicHealth: How does improving the social determinants of health help you achieve your goals in New York State?
Dr. Shah: New York’s Medicaid program covers 40 percent of the health care dollars spent in the state. We were growing at an unsustainable rate, and we needed a rapid, but effective solution. So, we engaged the health care community, including advocates, physician representatives, the legislature, unions, management, and launched a process that enables continuous, incremental, but real change toward the Triple Aim—improved individual health care, improved population health and lower costs.
Collectively, these efforts resulted in a $4 billion savings last year in the State’s Medicaid program, increased the Medicaid rolls by 154,000 people, and resulted in demonstrable improvements in quality throughout the system.
NPH: What opportunities do you see for public health and health care to work together in New York State?
While this is the first year that the American Public Health Association has used “return on investment” as the theme for National Public Health Week, which runs through April 7, it’s far from the first time that public health practitioners have made the case to policymakers that the work of public health can save lives and money.
Research on the impact of public health services includes the critical fact that spending just $10 per person in programs aimed at smoking cessation, improved nutrition and better physical fitness could save the nation more than $16 billion a year, according to the Trust for America’s Health. That’s a nearly $6 return for every $1 spent.
Over the last two years, NewPublicHealth has reported frequently on the value of investing in public health. Some of our favorite ROI articles, reports and other resources include:
- >>UPDATE: Trust for America's Health released Investing in America's Health: A State-by-State Look at Public Health Funding and Key Health Facts today. The report examine public health funding and key health facts in states around the country, finding inadequate and cut funding and wide variation in health outcomes by state and county.
- Making the Case for Prevention: A Q&A with James S. Marks, Senior Vice President, Robert Wood Johnson Foundation, about the great potential for investing in prevention.
- National Prevention Resources Starter Guide:
A collection of resources that showcase how different fields can work together and take action to prioritize prevention.
- Strategies to Move from Sick Care to Health Care: The Trust for America's Health identifies high-impact steps that the nation can take to prioritize prevention and improve Americans' health.
- Workplace Wellness Perspectives: A Q&A with two very different businesses—one big, one small; one academic, one industrial—on creating healthier workplaces.
- Employers Join Community Health Movement: A Q&A with Trust for America’s Health and the National Business Coalition on Health about the critical role of employers in community prevention efforts.
- Stories of the value of investing in prevention from Wyandotte County, Kan., and Hernando, Miss.
>>Read more on the value of prevention from RWJF.org.
It’s that time of year when public health enthusiasts rejoice and remind the rest of the world why this field is so critical—this is National Public Health Week, a yearly observance since 1995. For 2013, the theme is "Public Health is ROI: Save Lives, Save Money." According to the American Public Health Association, (APHA), a key organizer of the yearly observance, this year’s theme was developed to highlight the value of prevention and the importance of well-supported public health systems in preventing disease, saving lives and curbing health care spending.
In honor of National Public Health Week, NewPublicHealth spoke with Georges C. Benjamin, MD, executive director of the APHA.
NewPublicHealth: Is this the first time that National Public Health Week has focused on the return on investment in public health?
Dr. Benjamin: I think it’s the first time we’ve done so directly. There’s no question that we have always talked about the value of public health and we’ve often talked about savings, but this is the first time we’ve really focused like a laser on that investment.
NPH: What reaction have you seen in states and local communities to this year’s theme?
“Death is an inevitable part of life. But death from preventable causes like cervical cancer, early heart disease, or gun violence is a tragedy. Whether expressed in dry, cold numbers or by the images of first graders smiling at the camera for their school picture, these tragedies will continue to motivate us to use both left-brain science and right-brain passion to improve human health and prevent unnecessary death.”
That paragraph is from the foreword by Michael Klag, MD, MPH, dean of the Johns Hopkins Bloomberg School of Public Health (JHSPH) in the current issue of the school’s magazine. The issue is devoted to how public health researchers and practitioners probe, investigate, understand and fight death.
The full issue is well worth reading. A few notable pieces include:
- An interview with Vladimir Canuda Romo, PhD, a demographer and assistant professor at the school who says his research shows American life expectancy is on the rise.
- A critical article on making palliative care a public health issue.
- A summary of a recent forum at the school on dealing with gun violence.
- A piece on prescription drug abuse, which the author calls the “biggest public health issue you’ve never heard of."
Perhaps most poignant are a collection of essays by JHSPH alumni including a thoughtful look at the last minutes of a deer.
>>Bonus Link: In a new book, Happier Endings , Erica Brown, PhD, the scholar in residence at the Jewish Federation of Greater Washington, tells her readers: “we are all going to die, but some of us will die better.” The book, which Dr. Brown calls “a meditation on life and death,” looks at the deaths of several people and shares intimate details of last months, last weeks, last seconds—sometimes peaceful, sometimes not. It’s an important reminder that communities and populations, the building blocks of public health, are made up of individuals who are loved, and missed when they pass away, and that death is indeed a public health issue worth attention.
As the year draws to a close, the most recent installment of the NewPublicHealth series on the National Prevention Strategy is especially appropriate. We spoke with Wendy Spencer, the CEO of the Corporation for National and Community Service (CNCS), a federal agency that engages more than 5 million Americans in volunteer community service. The mission of CNCS is to improve lives, strengthen communities, and foster civic engagement through service and volunteering.
Guiding principles of CNCS that help promote the National Prevention Strategy include:
- Put the needs of local communities first
- Strengthen public-private partnerships
- Use programs to build stronger, more efficient, and more sustainable community networks capable of mobilizing volunteers to address local needs, including disaster preparedness and response
- Build collaborations wherever possible across programs and with other federal programs
- Help rural and economically distressed communities obtain access to public and private resources
- Support diverse organizations, including faith-based and other community organizations
During Hurricane Sandy, which struck the East Coast in late October, close to 900 national service members were deployed to states affected by the storm, and nearly 900 more were on standby. National service members assisted with shelter operations, call centers, debris removal, and mass care. “Before the recovery is complete,” said Wendy Spencer, “we expect thousands of national service members from AmeriCorps and Senior Corps programs to help families and local and state officials rebuild these communities.”
For its Hurricane Sandy response effort, CNCS coordinated with the Federal Management Agency (FEMA), National Voluntary Organizations Active in Disaster, the American Red Cross and state and local authorities.
NewPublicHealth recently spoke with Wendy Spencer, the CEO of CNCS, Asim Mishra, the agency’s chief of staff and Erwin Tan, MD, the CNCS designee on the National Prevention Council and Director of Senior Corps and Strategic Advisor for Veterans and Military Families.
NewPublicHealth: What is the mission of the Corporation for National and Community Service (CNCS)?
This summer the National Prevention Council, made up of 17 federal departments that are incorporating prevention into their activities, released its first annual report detailing successes in implementing the National Prevention Strategy and laying out next steps to help achieve its goals.
At the release, Surgeon General Regina Benjamin, MD, MBA, who is also chair of the Council said, “This Action Plan highlights how the National Prevention Council departments are working together—in conjunction with state, tribal, local, territorial, public, and private partners—to begin to move our health system from one based on sickness and disease to one based on wellness and prevention.”
As part of our conversation series on the National Prevention Strategy, with key leaders in federal agencies who are shaping the Strategy, NewPublicHealth spoke with Dr. Benjamn about the regional meetings she is spearheading across the country to implement the strategy and her vision for healthier lives for all Americans.
Listen to a short podcast with Dr. Benjamin, and read the full interview below.
GUEST POST by Lisa Junker, CAE, director of communications for the Association of State and Territorial Health Officials (ASTHO)
At the opening session of the ASTHO Annual Meeting in Austin, Paul Wallace, vice president of The Lewin Group, pointed toward the need for collaboration and partnership between the health care and public health sectors to overcome key challenges and trends facing the United States at the federal, state and local level.
>>Read our earlier interview with Paul Wallace on public health and primary care integration.
“What are the opportunities to create a shared conversation around prevention?” asked Wallace, who chaired the Institute of Medicine (IOM) Committee on the Integration of Primary Care and Public Health.
He gave attendees an overview of the process his IOM committee underwent to develop the recently-released report “Primary Care and Public Health: Exploring Integration to Improve Population Health.” The committee was charged with identifying the best examples of effective integration and the factors that promote and sustain those efforts, examining the ways federal agencies can use the provisions of the Affordable Care Act to promote integration, and discussing how Health Resources and Services Agency (HRSA) supported primary care systems and state and local public health can promote those efforts moving forward.