Category Archives: Public health agencies
The U.S. Food and Drug Administration (FDA) was a partner agency for last week’s Preparedness Summit in Atlanta. NewPublicHealth spoke with Brooke Courtney, Senior Regulatory Counsel in the FDA Office of Counterterrorism and Emerging Threats, about how the agency plans for disasters it hopes never occur. Previously, Courtney was the Preparedness Director at the Baltimore City Health Department and in that role oversaw all of the public health preparedness and response activities for Baltimore City.
NewPublicHealth: What did you speak about at the Summit last week?
Brooke Courtney: FDA views the summit as an unparalleled opportunity each year to engage with stakeholders at the state, local and federal levels—to share with them updates from the federal side and also for us to get feedback from them about challenges and successes. We engage with stakeholders on a regular basis, but this is really the meeting where the largest number of people involved in preparedness come together, and it’s a great opportunity to see people face-to-face.
We feel really fortunate to have been able to take part in the summit for the past few years. For this year’s summit FDA served on the Planning Committee and also participated in the medical countermeasure policy town hall with federal colleagues from the Office of the Assistant Secretary for Preparedness and Response, the U.S. Department of Homeland Security and the national security staff, all of whom we work with closely.
Another thing that we like to do at the summit each year is to give a more in-depth update through a session with the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department for Health and Human Services (HHS) legal counsel on the authorities that we have that we use related to the emergency use of medical countermeasures during emergencies. This year’s session was especially exciting for us because it was an opportunity for us to discuss with stakeholders some new authorities that were established in 2013 to enhance preparedness and response flexibility.
For example, we can now clearly issue emergency use authorizations in advance of emergencies, which is really a critical medical countermeasure tool for preparedness purposes. Through these flexibilities, for example, we’ve issued three emergency use authorizations in the past year for three different in-vitro diagnostic tests to address the emerging threats of H7 and 9 influenza and MERS-CoV.
NPH: What are the key responsibilities the FDA has in helping to prepare the United States for possible disasters?
Courtney: As an agency of the U.S. Department of Health and Human Services, the FDA, at its core, is a public health agency. FDA’s mission is to protect and promote public health in a number of critical ways. We’re responsible for regulating more than $1 trillion in consumer goods annually, ranging from medical products such as drugs and vaccines to tobacco and food products.
On Friday, April 4, the Robert Wood Johnson Foundation held a First Friday Google+ Hangout to explore how the 2014 County Health Rankings can be used to move the needle toward healthy communities. Hosted by Susan Dentzer, RWJF senior policy advisor, the Hangout featured four panelists from various sectors working to improve the health of U.S. communities.
Marjorie Paloma, Senior Policy Advisor at the Foundation, provided viewers with an overview of the County Health Rankings and Roadmaps, explaining that the rankings continue to show that where we live matters to our health. The rankings allow each state to see how counties compare on a number of health factors, including housing, education, income and safety. The Rankings offer a look at health trends across the country in addition to county-level information. This year’s Rankings find that people who live in the least health communities are twice as likely to live shorter lives and that we are slowly seeing an uptick in the number of children living in poverty. However, there have been significant declines in smoking rates and violent crime.
“The Rankings really help us to see how we’re doing and also where we can improve on health,” said Paloma. “The Roadmaps are really a call to action. They are really helping to move communities from awareness to driving action.”
Paloma also highlighted the broad range of resources available through the County Health Rankings website for communities to find and develop health solutions.
According to Brian Smedley, Vice President and Director, Health Policy Institute, Joint Center for Political and Economic Studies, the County Health Rankings is critical in understanding the importance of place as an upstream driver of health. Transportation, housing, opportunities for experience, quality of greenspace and more can be critical in determining the health of a community and the individuals who call it home. He explained that successful Roadmaps communities are ones that have built coalitions across different sectors and have health policy strategies that are local.
“We need to look at smaller geographic areas to see how neighborhoods affect health,” said Smedley. “A lens on place can be powerful in helping us to understand how we can reduce risks at the individual level and the community level.” He also offered additional tools for acquiring even finer cuts of data, such as Community Commons, local health departments and the U.S. Census Bureau.
Mary Lou Goeke, Executive Director, United Way of Santa Cruz County, offered a look at how the County Health Rankings and Roadmaps are used to improve health in Santa Cruz by shining a light on areas that need improvement and mobilizing the community to action. In particular, Goeke highlighted Santa Cruz’s efforts to reconcile a correlation between drinking rates and violent crime with the city’s new entertainment district. By using the data, the community was able to mitigate the potential harm of the entertainment district by implementing evidence-based practices to decrease drinking and crime.
“The County Health Rankings hold us accountable for things that aren’t working and encourages us to find new approaches,” said Goeke.
Katie Loovis, Director of U.S. Partnerships and Stakeholder Engagement, GlaxoSmithKline, explained how her company uses the rankings to shape its philanthropic efforts across the country. In the past few years, GlaxoSmithKline employees have overwhelming expressed support for the company to improve health in communities.
“If you want to improve health in your community, you have to know where you’re starting,” said Loovis. “The rankings do just that.” GlaxoSmithKline relies on the roadmaps to help highlight which interventions have the science to back them up and to identify which nonprofits to partner with in their target communities.
In addition, Loovis encourages local health departments and non-profits to reach out to local businesses directly and invite them to get involved in the solutions.
Each year during the first week of April, the American Public Health Association (APHA) hosts National Public Health Week, an opportunity to help communities across the United States highlight issues that are critical to improving the health of the nation. This year’s theme is “Public Health: Start Here”—entry points for making us a healthier nation. Each day this week has its own theme and NewPublicHeatlth will have a post about each one:
- Monday, April 7: Be healthy from the start. From maternal health and school nutrition to emergency preparedness, public health starts at home. Let us show you around. (Read a previous NewPublicHealth post, County Health Rankings — Nurse-Family Partnership: Q&A with Elly Yost, about how Rockingham County, N.C. is working to improve maternal health.)
- Tuesday, April 8: Don't panic. Disaster preparedness starts with community-wide commitment and action. We're here to help you weather the unexpected.
- Wednesday, April 9: Get out ahead. Prevention is now a nationwide priority. Let us show you where you fit in.
- Thursday, April 10: Eat well. The system that keeps our nation's food safe and healthy is complex. We can guide you through the choices.
- Friday, April 11: Be the healthiest nation in one generation. Best practices for community health come from around the globe.
In observance of National Public Health Week, NewPublicHealth spoke with Georges Benjamin, MD, executive director of the American Public Health Association about National Public Health Week 2014.
NewPublicHealth: Tell us about the 2014 National Public Health Week.
Georges Benjamin: We have an overarching theme, and it’s “Public Health: Start Here.” The intent is to get people to “just do it.” Often all of us have a tendency to kind of ruminate over what we want to do to improve the public’s health, and what we’re trying to emphasize this year is that there is enormous opportunity for people just to get up and do it. The evidence base is there, the opportunity is there, and so we’re just getting people to start improving their health.
We have five themes for the week. Monday is around early health such as maternal and child health; school nutrition; and conversations at home about how to make every family healthier. Tuesday is focused on emergency preparedness and disaster preparedness. On Wednesday we’ll be on prevention, including clinical and community preventive health services. Thursday’s focus is on eating well with a focus on the nutritional aspects of health. And Friday we look at becoming the healthiest nation in just one generation. Like the Robert Wood Johnson Foundation, the American Public Health Association is focused on a creating a culture of health and creating a healthy environment for everyone.
Disaster experts at this week’s Preparedness Summit underscored the importance of meeting the specific needs of children and young adults in a disaster, who often react not only to their own response to a crisis but also to how adults around them are responding and dealing with the situation.
The Federal Emergency Management Agency (FEMA) has a program called Teen CERT (Community Emergency Response Team) which teaches readiness and response skills and includes practice and exercises. A California fourteen-year-old Teen CERT member, for example, has 17,000 Twitter followers for a weekly feed she updates with disaster preparedness tips.
Teen CERT Training takes 20-30 hours; more if teens are also certified in CPR, First Aid and the use of automatic defibrillators. Training includes:
- Keeping the teen volunteer safe while helping others
- Identifying and anticipate hazards
- Reducing fire hazards in the home and workplace
- Using fire extinguishers to put out small fires
- Assisting emergency responders
- Conducting light search and rescue
- Setting up medical treatment areas
- Applying basic first aid techniques and helping reduce survivor stress
Teen CERT members are also eligible for community credits which many high schools require for graduation.
And Columbia University’s National Center for Disaster Preparedness spearheads a program called SHOREline, which has a pilot program at five high schools in the Gulf Coast. Students work on organizational and leadership skills; meet and practice preparedness drills with local and national experts; and attend youth preparedness summits, said David Abramson, PHD, MPH, the deputy director of the Center who spoke about the SHOREline program at the Preparedness Summit this morning.
Abramson told attendees about the work of one group of SHOREline members at a Gulf Coast high school who took the lead on a disaster recently when a student at the school was killed by in a shooting. Seeing that the school had not planned a memorial service, the students raised $500 and bought all the helium balloons they could find for a service they planned and carried out that Abramson said was very critical for community recovery.
At the start of the 2014 Preparedness Summit meeting this week in Atlanta, Summit chair Jack Herrmann took a moment to remember the lives lost in the mudslide in Washington State last week and took note of the many public health workers who left their communities to help in the rescue and recovery. Since then, two more major disasters have occurred—the earthquake and tsunami waves in Chile and the shooting yesterday at Fort Hood. Conversations about those events, and other events back home that need the attention of public health staff even while they are on travel at a preparedness conference, can be heard in the hallways during breaks in the sessions as people who train for such disasters mourn the losses and offer their assistance.
Tom Hipper, Public Health Planner at the Center for Public Health Readiness and Communication at Drexel University in Philadelphia, had some advice for communications by public health departments not involved in a disaster earlier this week. Hipper advises delaying planned, non-urgent communication and sending out empathetic messages about the disasters which can help build community and resilience and give people a chance to become involved by expressing and sharing their sentiments. Hipper says empathetic communication can be a bonding experience and lets people know that others will be thinking about and trying to help them in the event of an emergency in their community.
In addition, says Hipper, while previously people outside a disaster area could often only help by donating money, they can now also be “digital volunteers” by posting and retweeting accurate information from credible sources about a disaster to let people impacted by an emergency know they’re not alone.
The Center maintains and updates a list of important preparedness resources.
>> Bonus Content: Read a previous NewPublicHealth Q&A with Jonathan Woodson on the U.S. Department of Defense’s overall approach to wellness and prevention for military, veterans and their families as part of our National Prevention Strategy series.
Last week the Robert Wood Johnson Foundation (RWJF) released its 2014 County Health Rankings, an annual assessment of how where we live, learn, work and play impacts our health. This coming Friday, April 4 from 12:00-1:00 p.m. ET, RWJF will be hosting a First Friday Google+ Hangout focused on the how the County Health Rankings can be used to help spur business, government, public health, education and other sectors to work together to create healthier communities.
>>Go here to register for Friday’s event.
Susan Dentzer, senior policy adviser to the Foundation, will lead the discussion exploring the Rankings’ key findings and how they have inspired communities to take meaningful action to improve health.
Panelists will include:
Katie Loovis, Director of U.S. Community Partnerships and Stakeholder Engagement, GlaxoSmithKline, will discuss how good health is good for business. When more people in a community are healthy, there are lower health costs, fewer sick days and increased productivity, according to Loovis. And when communities are healthier, everyone in the community benefits.
Mary Lou Goeke, Executive Director, United Way of Santa Cruz County, will discuss how the United Way uses the County Health Rankings’ framework to mobilize people and organizations to use good data and evidence to identify joint priorities; develop and implement collaborative solution; build public will; and engage in advocacy to improve education, financial stability and health. Santa Cruz County won an inaugural RWJF Roadmaps to Health Prize, which honors outstanding community partnerships helping people to live healthier lives.
Brian Smedley, Vice President and Director, Health Policy Institute, Joint Center for Political and Economic Studies, will discuss how where you live plays a significant factor in how healthy you are. The Joint Center runs a national initiative called PLACE MATTERS to build the capacity of local leaders around the country to improve social, economic, and environmental conditions that shape health. The learning community consists of 19 teams working in 27 jurisdictions.
Marjorie Paloma, Senior Policy Adviser, the Robert Wood Johnson Foundation (RWJF), who will discuss the foundation’s partnership with the University of Wisconsin Population Health Institute in producing the County Health Rankings, as well as the many online tools that can help communities compare rankings, delve more deeply into the data and learn more about particular interventions that can address community health issues.
>>Bonus Links: Read up on some of the panelists:
- United Way of Santa Cruz County won the RWJF Roadmaps to Health Prize for their efforts
- Brian Smedley shared why place matters to health in a recent interview with NewPublicHealth.
- Marjorie Paloma previously spoke with NewPublicHealth about the critical role of housing in better health. Housing is one of the new measures in the 2014 County Health Rankings and a national trend report found that almost 1 in 5 households are overcrowded, pose a severe cost burden, or lack adequate facilities to cook, clean, or bathe.
- Katie Loovis wrote about why living a healthy life is like a game of Shoots and Ladders, on the RWJF Culture of Health Blog. One of Katie Loovis' colleagues at GlaxoSmithKline, Robert Carr, also talked with NewPublicHealth about why businesses should care about community health.
“Disasters pose questions of who [is helped] first and who...last,” said Sheri Fink, MD, PhD, a correspondent for The New York Times and Pulitzer Prize-winning author, to more than 1,000 attendees of the 2014 Preparedness Summit in Atlanta this week. Fink is the author of Five Days at Memorial: Life and Death in a Storm Ravaged Hospital, about the response by health providers, first responders, volunteers, patients and family members who rode out the storm in a hospital that lost power in the early hours of the hurricane. Fink was the headline speaker for the first plenary session of the Summit.
Fink’s book—which Umair Shah, deputy director of Harris County Public Health and Environmental Health Services in Texas and a panelist for the plenary discussion, urged the audience to read even if they only had time to skim—takes a close up look at the response from what may have been mercy killings to heroics by family members who commandeered boats to help evacuate patients.
Questions posed during the emergency in New Orleans, said Fink, included whether the hospital should be taking in new patients during the storm at a time when it was trying to evacuate the patients there, and whether criteria for first evacuees should be maximizing numbers of lives saved or maximum number of years of life saved.
“And because there is no right answer, we need to develop better evidence to [rely on] when difficult decision are needed,” said Fink, who had been a disaster and conflict first responder.
In response to the deaths and delays of Katrina, Fink and other panelists including Shah, Paul Biddinger, MD, FACEP, director, emergency preparedness and response exercise program at the Harvard School of Public Health, and Nicole Lurie, MD, MSPH, Assistant Secretary for Preparedness and Response in the U.S. Department of Health and Human Services, ticked off disaster response improvements including the creation of Lurie’s office, and the development of new partnerships—in particular public and private ones such as with hospitals and health departments. One key change—mapped data from the Centers for Medicare and Medicaid Services—helps responders identify people in the community whose medical conditions require them to shelter in place.
Fink shared some recommendations for additional preparedness needs:
- A need to update infrastructure that is vulnerable to collapse or breakdown across the country
- Engage the public so that they will show their support for preparedness funding
- Face the fact that all power can be lost and respond in that way
- Promote research
- Maintain flexibility and creativity
Fink shared some examples of creativity at Memorial Hospital in New Orleans, including hospital workers who used a truck to transport patients to another side of the building and then carried them up rickety stairs to the helipad since it could not be reached by elevator; workers who hotwired boats to aid in evacuation; and workers who found that neonatal incubators would not fit on some of the evacuation helicopters and so kept babies warm by tucking their heads under their own clothing and continued to ventilate them manually.
>>Bonus Content: Read a NewPublicHealth interview with Paul Biddinger.
Leaders from the Robert Wood Johnson Foundation (RWJF) and the University of Wisconsin Population Health Institute, who collaborate each year on the County Health Rankings, held a webinar yesterday—the launch day for the 2014 report—to talk about the importance of the Rankings and what’s new this year, as well as to answer questions from a wide ranging Twitter audience.
The webcast is now available online and provides a broad and insightful overview of how the County Health Rankings are helping to improve health across the United States.
"Our vision is a nation where getting healthy, staying healthy and making sure our children grow up healthy are top priorities,” said Michelle Larkin, JD, RN, RWJF assistant vice president for portfolio programs, at the start of the webcast.
Six new measures were added to this year’s report, including housing and transportation.
“The Rankings are only as valuable as the actions they inspire,” said Julie Willems Van Dijk, RN, PhD, Deputy Director of the County Health Rankings & Roadmaps and a panelist on the webinar. She also directed viewers to the Action Center section of the Rankings website, which includes step-by-step guides for policies and activities counties can initiate to help improve health.
Videos shown during the webcast explained the health factors and outcomes that make up the rankings while showcasing efforts to improve health in Western New York, Kentucky and North Carolina. The webcast also highlighted the six 2013 Culture of Health Prize winners whose community efforts to improve health included tackling domestic violence and improving access to preschool education.
Questions poured in via Twitter during the webcast, including a query about how the Rankings have helped changed the conversation about community health.
“There has been an incredible change,” said Van Dijk. “People are starting to talk about the many factors that influence health. When we started people would say, ‘Why are issues such as employment and education in a health report?’” Added Van Dijk, “More and more, we’re seeing people understand that those factors are key determinants of health. And what that has done has increased the sense of awareness that it takes all of us to build a culture of health. We can’t just lay it at the door of hospitals and health departments.”
“We’ve seen mayors and other legislators stand up and take ownership of this report and action on changing policy, such as how people from all income levels have access to quality preschool education,” she added.
Webinar panelist Patrick Remington, MD, MPH, associate dean for public health at the University of Wisconsin School of Medicine and Public Health, encouraged participants to add to the utility of the Rankings report by also using local data to help them drill down on what is impacting local communities. “Differences we see in teenage pregnancies may be two times higher in blacks than whites, but can be fifteen times higher when comparing where people live,” he said.
>>Bonus Link: Read more about the 2014 County Health Rankings reports and featured communities on NewPublicHealth.
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.
Job loss at local health departments continues unabated, according to the 2013 edition of the National Association of County and City Health Officials (NACCHO) Profile of Local health Departments. The total number of employees in local health departments has fallen to 162,000 last year from 190,000 in 2008.
However, the report also highlights program gains:
- Nearly half of health departments not yet accredited plan to apply, have submitted a formal application or have submitted a statement of intent to apply for public health accreditation from the Public Health Accreditation Board.
- The percentage of local health departments who have completed the three key accreditation prerequisites — community health assessment, community health improvement plans and an agency-wide strategic plan — has grown from 20 percent in 2010 to 30 percent in 2013.
- Facebook use has grown from 20 percent in 2010 to 44 percent last year.
- Twitter use has grown from 13 percent in 2010 to 18 percent last year.
- YouTube use has grown from 6 percent in 2010 to 12 percent last year.
- In 2013, 56 percent of local health departments were engaged in some type of quality improvement (QI) activity, up from 45 percent in 2010.