Category Archives: Public health agencies
Just about every think tank, school of public health and infectious disease association has held a conference on Ebola in the last few weeks, but two coming up are still absolutely worth tracking.
Now that New York City has seen is first diagnosis of Ebola, an already scheduled conference next week at Columbia University’s Mailman School of Public Health has taken on added importance. Presenters include ABC News Chief Health and Medical editor and former acting U.S. Centers for Disease Control and Prevention director Richard Besser, MD, as well as Irwin Redlener, MD, director of the National Center for Disaster Preparedness at Columbia University's Earth Institute. While the conversation surrounding the Ebola cases in Dallas focused on the need for health care workers to receive better guidance and training, hours into the first case in New York City the focus is on the challenge of containing the disease in a huge urban setting—a topic the presenters will discuss at length.
And on November 7, the White House Office of Science and Technology Policy will host a simulcast workshop together with Texas A&M, the Worcester Polytechnic Institute and the University of California, Berkeley to discuss proposals to dispatch robots to aid in the care of Ebola patients and people who have succumbed to the disease. The idea is to augment — and not replace — health workers. Robots could spray disinfectant, respond to commands given by health workers in a remote location and even help bury the dead.
The conference will include not just engineers, but also public health officials and health care personnel who can speak to the human needs that need to be considered when design the robots. For example, Texas A&M engineering students are working on a robotic attachment that would pick up a dead body in movements that mimic compassion, rather than in another way that may be efficient but does not show sensitivity for the dead and their families.
>>Bonus Link: Read an interview with the conference conveners.
In the wake of the Ebola outbreak in West Africa and cases diagnosed in the United States, NewPublicHealth has been looking at the toll of other infectious diseases in need of new prevention and treatment efforts. Earlier this week, the Kaiser Family Foundation released a series of infographics that compare Ebola to twelve other infectious diseases, including SARS, malaria and HIV, which are all current public health challenges.
The infographics are an important teaching tool for explaining how Ebola is spread and for reminding public health professionals about the need for vigilance when it comes to other diseases.
The series of infographics touch on topics including:
- Transmission routes
- Vaccines, treatments and cures
- Fatality rates
- Key characteristics such as immunity after infection and number of cases worldwide each year
Below is one of the Kaiser Family Foundation’s infographics. Click through to view the additional educational tools.
Over the weekend, NewPublicHealth conducted an email interview with Tarik Jasarevic, a spokesperson for the World Health Organization (WHO), on Ebola efforts on the ground in West Africa and the impact on the global effort of the cases recently diagnosed in the United States.
NewPublicHealth: Is there concern among global health leaders that the attention on a handful of cases is taking away attention from the thousands of cases in West Africa?
Tarik Jasarevic: While countries need to be vigilant and prepared for a possible case of Ebola, we need to focus on getting all possible resources—trained health workers, medical facilities with beds and money—to the affected countries in West Africa.
NPH: Several weeks ago global health leaders had a checklist of things, including money and personnel, needed to stem the outbreaks in the various countries. Where do things stand now, and what is still needed?
Jasarevic: We need a lot of resources if we’re going to get the virus under control. WHO and partners constructed 12 Ebola Treatment Centers in Liberia, 15 in Sierra Leone and 3 in Guinea—30 out of the 50 that are needed. These facilities contain more than 1,100 beds for patients, out of the more than 4,000 needed. There are more than 2,500 beds becoming available in the next few weeks, but we still need more. We also need international health workers to come work alongside national health workers to manage and run the health facilities. WHO has set up “training academies” in each of the affected countries to train more local health workers, but more are needed.
NPH: What is the current fatality rate?
Jasarevic: The fatality rate for this particular outbreak has always been approximately 70 percent. We are seeing higher numbers of cases and deaths because of the geographic spread of the disease, from urban city centers to rural, hard to reach villages. There is also significant under reporting of cases in the three countries, especially Liberia.
Earlier this year, Brownsville, Tex., was chosen by the Robert Wood Johnson Foundation as a Culture of Health Prize winner for its efforts to improve community health. As part of a new ongoing series, Health Affairs blog has featured a piece by local Brownsville leader Belinda Reininger on the community’s health successes.
Brownsville is a mostly Spanish-speaking town on the Texas border. The community, which is home to approximately 180,000 people, is also among the poorest metropolitan areas in the country. Approximately 48 percent of its children live in poverty, 80 percent of its population is obese or overweight, 30 percent have diabetes and about 67 percent have no health insurance.
However, over the last decade it has also become a “robust, bike-friendly city” that also promotes health through community gardens and the world’s largest Zumba class, according to Reininger. This is thanks in large part to the University of Texas’ decision to open its School of Public Health in Brownsville and the formation of Community Advisory Board that brings together 200 people and organizations, from private citizens and elected officials to business executives and nonprofits.
The board’s members “carry the message of wellness into their homes and businesses, and they’re able to affect policy and environmental changes by voting and leadership—and that’s how we have been able to include the community, by engaging them every single step of the way,” said Reininger, DrPh, to NewPublicHealth earlier this year.
Brownsville’s efforts include:
- Using data to assess the community’s health issues and then to engage with community members in a way that is both informative and beneficial to their health.
- Creating diverse programs — from Brownsville in Motion to promote physical activity through safe access to trails and bike lanes, to the Brownsville Farmers’ Market and Community Garden—to address the relationships between health, poverty, education and the economy.
To learn more about Brownsville’s prize-winning efforts to improve public health, read the Health Affairs blog post.
>>Bonus Content: Watch a NewPublicHealth video on Brownsville's efforts to build a Culture of Health.
People tuning into news coverage of the Dallas Ebola cases have come to recognize David Lakey, the Texas state health officer. Every state has a similar position and those officials are charged with improving population health—from holding immunization clinics to responding to potentially fatal illnesses. The Association of State and Territorial Health Officers (ASTHO) is the professional association of the 50 state health officers. Jim Blumenstock is the chief program officer of ASTHO’s public health practice division. NewPublicHealth spoke to Blumenstock this week about state and federal coordination on Ebola detection and case treatment.
NewPublicHealth: What is ASTHO’s role in dealing with preparedness for Ebola in the United States and with the current cases?
Jim Blumenstock: In a crisis or a public health emergency like we’re experiencing with Ebola, ASTHO’s role principally is to do two things. Number one is to sort of be the glue or the hub that helps pull together the 50 states, the nine territories and the District of Columbia as an integrated, harmonious component of our public health infrastructure. The second feature is to provide a solid interface between federal efforts and state efforts. So, that’s our role with any significant public health issue.
During the H1N1 outbreak several years ago, both ASTHO and the National Association of County and City Health Officials (NACCHO) had key staff embedded in the U.S. Centers for Disease Control and Prevention’s (CDC) Emergency Operation Center because it was recognized that the value of the insight of a national organization that represents all the states and locals was so critical to the federal planning and response process. That was the first time it was done.
We’re on standby to do it and we’re sort of functioning in that capacity right now, but sort of in a virtual or remote area. For example, I’m not today embedded in CDC’s Emergency Operation Center. However, I would say I’m on the phone with them at least six to eight times a day—including last evening—and have had email exchanges already this morning, not only to get information, but also to be part of some planning and problem solving efforts they’ve requested our help on, or a request for our help on state consensus around a strategy or a tactic or an approach on a particular matter.
And our other critical roles are to help our members; to talk to federal public health officials; and to educate and inform the public.
In light of the ongoing Ebola outbreak, NewPublicHealth recently launched an in-depth look at the current state of several infectious diseases and efforts to stem Ebola and other outbreaks. Tomorrow night the PBS documentary series Frontline will air “The Trouble with Antibiotics” (10 p.m. EST), taking a look at antibiotic use on American farms and the death of a patient being treated at the National Institutes of Health (NIH) three years ago who succumbed to a superbug the NIH was unable to treat.
According to the program’s correspondent, David Hoffman, a former journalist with the Washington Post, 70 percent of U.S. antibiotics are used on farms and are linked to at least some of the two million people who become ill and the more than twenty thousand people who die of antibiotic resistance each year.
NewPublicHealth recently spoke with Hoffman about the project.
NewPublicHealth: What made you interested in the topic of antibiotic resistance?
David Hoffman: In 2012, the Clinical Center at the National Institutes of Health disclosed the details of an outbreak of resistant bacteria in the hospital during 2011. It was a remarkable story in which advanced genomics from an NIH institute were used to unravel the mystery of how the organism had spread, and the hospital took extraordinary measures to combat it. This led to a 2013 Frontline film about the growing problem of resistance in human health, “Hunting the Nightmare Bacteria.” While working on “Hunting.”’ we heard a lot about antibiotics in animal agriculture. But the issues were complex and needed time for serious examination. We decided to devote our next film to answering some of the questions and that process took about a year.
U.S. public health officials have continually said that it is highly unlikely that the Ebola virus will spread in the United States, even if infected travelers land here. Officials at the U.S. Centers for Disease Control and Prevention (CDC) say that the disease is most contagious when people come into contact with the bodily fluids of someone who is ill—and someone that ill would be very likely be identified by border and airline personnel quickly. If hospital admission became necessary, U.S. infection control procedures could stem an outbreak, according to Tom Frieden, MD, the CDC’s director and the point person for the U.S. government on the current Ebola outbreak. Frieden has discussed the issue repeatedly during several news conferences in the last few weeks.
Of course, that changes if the virus becomes transmissible through the air, rather than just via bodily fluids, as Michael T. Osterholm, PhD, MPH, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, suggested in the New York Times last week. While Osterholm often addresses the direst potential outcomes of infectious disease outbreaks, it’s prudent to at least know what to do, which is why agencies such as the CDC and the Network for Public Health Law say what’s needed is information and procedures...but not panic.
Last month, the Network held an online webinar on preparedness measures and Ebola which was watched by more than 1,200 public health officials. Following the webinar, Network experts posted answers to follow-up questions, including one about the right of public health or hospital workers to refuse to care for/help with someone suspected of having Ebola.
The Network also recently created an online primer on preparedness and legal issues surrounding the Ebola outbreak, both for public health officials engaged in the response overseas and for those with current or future responsibility for handling Ebola-related issues in the United States.
>>Bonus Link: Richard Besser, MD, now the chief health editor for ABC News, was formerly the CDC’s head of disaster response and led the early response to the H1N1 outbreak in the United States several years ago. In a recent opinion piece for the Washington Post, Besser laid out what’s being accomplished and what still needs to be done to stem the Ebola outbreak in West Africa.
In the last few months, several prominent national and state public health leaders have announced plans to move on to new things, including David Fleming, MD, MPH, the former Public Health Director in Seattle & King County Washington, who NewPublicHealth spoke with last month. We also recently spoke with Joshua Sharfstein, MD, secretary of Maryland’s Department of Health and Mental Hygiene, who will leave his post at the end of the year to teach at the Bloomberg School of Public Health at Johns Hopkins University as part of the faculty of the School of Health Policy and Management.
Earlier this year, Sharfstein gave the commencement address at the graduation ceremony of the University of Maryland School of Public Health, and had this to say about the importance of ensuring the public’s health:
“The premise of public health is that the wellbeing of individuals, families and communities has fundamental moral value. When people are healthy, they are productive, creative and caring. They enjoy life and have fun with their friends and families. They strengthen their neighborhoods and they help others in need. In short, they get to live their lives.”
NewPublicHealth: What prompted you to move to academia at this point in your career?
Joshua Sharfstein: It's a chance to help train hundreds of new public health leaders as well as work in depth on issues that are important to me. I am especially looking forward to getting to work closely with so many talented faculty at the Johns Hopkins Bloomberg School.
NPH: How have your research and teaching skills benefitted from your time as deputy director of the U.S. Food and Drug Administration (FDA) and your position with the state of Maryland?
Sharfstein: I've seen a lot of public health in action at the local, state and federal level. My goal will be to show students how important, interesting, engaging and—at times—strange public health can be. I have a research interest in why certain policies are pursued and others are not—and how public health can be successful in a difficult political and economic climate.
The worst Ebola outbreak in history has now claimed 1,145 lives, according to the World Health Organization (WHO). In the two days to August 13, 76 people died and there were 152 confirmed, probable and suspected new cases in Guinea, Liberia, Nigeria and Sierra Leone. NewPublicHealth has been following the outbreak in West Africa closely. You can read our ongoing coverage of the Ebola epidemic here. Below is a look at the latest news on the outbreak:
- While stating its belief that the magnitude of the outbreak has been “vastly” underestimated, WHO continues to partner with individual countries, disease control agencies, agencies within the United Nations system and other organizations to combat the Ebola epidemic. “Practical on-the-ground intelligence is the backbone of a coordinated response,” the global health organization said in an update, noting that the U.S. Centers for Disease Control and Prevention (CDC) is providing computer hardware and software that should enable real-time reporting and analysis. The World Food Programme is also delivering food to the more than one million people living in quarantine zones; the food shortage has been compared to a “wartime” situation.
- The medical charity Médecins Sans Frontières (MSF) estimates that it will take public health officials at least six months to bring the Ebola outbreak under control. "In terms of timeline, we're not talking in terms of weeks, we're talking in terms of months,” said MSF President Joanne Lui, according to the BBC. “We need a commitment for months, at least I would say six months, and I'm being, I would say, very optimistic."
- Kent Brantly, MD, one of two U.S. aid workers infected in Liberia who received an experimental Ebola treatment, continues to improve and hopes to be “released sometime in the near future.” He is being treated at Emory University Hospital in Atlanta, Ga. The family of Nancy Writebol, a missionary from Charlotte, N.C., said she also continues to improve and doctors remain optimistic.
- The U.S. Department of State has ordered family members of staff members at the U.S. embassy in Freetown, Sierra Leone, to evacuate the country, announcing the order as part of reconfiguring of resources to better respond to the Ebola outbreak. The order stated: “We remain deeply committed to supporting Sierra Leone and regional and international efforts to strengthen the capacity of the country’s health care infrastructure and system—specifically, the capacity to contain and control the transmission of the Ebola virus, and deliver health care.”
This week, David Fleming, MD, MPH, stepped down as public health director of Seattle and King County in Washington State after seven years leading the public health agency. Over that period, among many other accomplishments, he led the department’s efforts to sign up more than 165,000 residents under the Affordable Care Act and oversaw a 17 percent drop in obesity rates in partnering schools.
NewPublicHealth spoke with Fleming about his views on the mission of public health.
NPH: How has public health changed since you began your career?
David Fleming: The mission of public health has not changed—and that's to prevent unnecessary illness and death—but what has been changing is what the nature of that prevention is. Increasingly, it is in chronic diseases, injuries and, importantly, the driving force of underlying social determinants of health. So public health has changed from being more of a direct service agency where we have frontline public health workers who are out there providing treatment to people and preventing infectious diseases, to really more of a collaborative kind of agency where we need to be working with a wide range of partners outside of the traditional domains of public health to help them implement the changes that need to happen. It's a fundamental shift, I think, in the business model of public health that we're in the process of witnessing today.
NPH: When you point to some of the achievements that you've had, whether they're specific changes in the state or specific models of examples that you've given to other states, what would you point to?
Fleming: First off, I think it's important to say that public health is a team sport, and so when I talk about accomplishments, I'm talking about accomplishments of the department in which I work on this and the staff that work here. I think that we have been successful at pivoting to that future that we were talking about a moment ago, at looking at how health departments can attack the underlying social determinants of health.
Increasingly, it is health disparities that are driving poor health in this country. We have been successful here in beginning to figure out how to partner with other sectors—the education sector to reduce obesity in our poorest school districts, for example. We’ve also worked with the community development sector to begin making investments in our poorest neighborhoods to increase the healthiness of our communities, so that people who live in them can be healthy, as well. At the end of the day, I think that we have been trying to lead this new path where public health is a partner in communities with all of the other entities that are capable of influencing health and figuring out how to make that happen.