Category Archives: Public health agencies
“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.
Many of the sessions at the National Association of Counties (NACo) Health Initiatives Forum meeting in San Diego this week have been moderated by Nick Macchione, director of San Diego’s Health and Human Services Agency and vice chair of the Healthy Counties Initiative Advisory Board. Macchione is a key architect of Live Well San Diego, a program voted in by the San Diego Board of Supervisors that is a long term, comprehensive and innovative strategy on wellness with a goal of helping all San Diego County residents become healthy, safe and thriving.
NewPublicHealth spoke with Nick Macchione ahead of the forum. Senior Policy Advisor Julie Howell and Dale Fleming, director of strategic planning and operational support, joined the conversation.
NewPublicHealth: The buzz about San Diego is that you’re working hard toward population health improvement.
Nick Macchione: I think the excitement about San Diego is that we have earned a reputation as a health innovation zone by having a collective impact on health and wellness. Our deeds demonstrate our words because over the past decade there have been five major broad-based population health improvements: reduction of heart disease and stroke; reduction of cancer rates; reduction of childhood obesity; reduction of infant mortality; and reduction of children in foster care. That reduction is extremely important to population health because we also look at the social determinants of health and not just pure health care.
We've taken an ecological approach to population health—working with partners across all sectors and coming together not just from traditional health care but beyond that to public health, social services, business, community, schools and the faith community.
And we’ve done that in the context of optimizing existing resources to improve outcomes. We’ve been blessed with a lot of competitive federal grants and philanthropy investments, but really the framework is how we leverage and optimize what we have first before we go and seek to augment with other resources. That has worked exceptionally well and that’s earned us that innovation zone reputation.
NPH: Tell us about Live Well San Diego.
Macchione: Live Well San Diego is a comprehensive public health initiative that involves widespread community partnerships to address the root causes of illness and rising health care costs. The tagline is healthy, safe and thriving. We think it’s a great template that communities can use, it’s transferable because San Diego has every imaginable bio-climate except a tropical rainforest. So we have desert towns, we have rural communities, we have mountain villages, we have beach towns and everything in between urban core. We also call it Project 1 Percent because 1 percent of San Diego represents the nation both in its diversity and its population. So, if we can achieve what we're achieving on advancing population based health in a broad scale it can be demonstrated throughout the country.
NewPublicHealth is on the ground at the NACo 2014 Healthy Counties Initiative Forum. The theme of the forum this year is “Improving Health in a Climate of Change.” Ahead of the meeting we spoke with James McDonough, county commissioner in Ramsey, Minn., and chair of the Healthy Counties initiative about the meeting and the health changes he is seeing at the county level.
NewPublicHealth: Can you tell us how the NACo Healthy Counties Initiative got its start?
James McDonough: Three years ago the president of NACo at that time, Lenny Eliason, from Athens County, Ohio, really was concerned about how the majority of health care dollars were being spent on treating preventable conditions and the whole issue of the wellbeing of our constituents and our employees. So he elevated the issue of wellness and health in counties as a presidential initiative. Typically those are short term and last for a year or two, but NACo has embraced this and has continued this on as a task force to really embed it in the work that we do—elevating how counties can have an impact on wellness in communities.
NPH: What are the current goals?
McDonough: To really elevate and get the county commissioners and county managers throughout the country to just pause and take a look at what they're doing and what they could be doing. We’ve been talking about how we can do a better job supporting counties that are already doing great work in this area and helping share those best practices, and then helping counties that haven’t really taken a look at what their role is. That can help us have a better impact on getting ahead of some of the major preventable diseases in our communities.
NPH: How important is county-level action when it comes to health?
McDonough: For the most part, counties really are responsible for the public health departments within their communities. Throughout the country we operate almost 1,000 county hospitals and close to 700 county nursing homes, so we have a lot of responsibility for public health and—just as important—we employ more than 30 million people throughout the country.
Action, responsibility and efforts vary county to county, but for example, in Ramsey County, Minnesota, where I’m the County Commissioner, we run the public health department working with our cities, the state and with the federal government. So for us it’s a really big opportunity to be the convener as well to lead the Healthy Cities Initiatives as well to a larger regional more focused and concentrated effort.
NPH: The focus of the forum includes some critical topics such as behavioral health and key health issues in jails. How much of a financial burden do these health issues place on counties?
When it comes to movies, sometimes the most realistic scenarios are also the scariest. The dramatic, often global and always fatal spread of infectious disease is now a well-worn movie trope—but because it could happen it remains scary every time. The good news (in addition to them just being movies, so no need to grip the theater armrest so hard!) is these silver screen attempts at showing the story behind the spread and containment of infectious disease help to highlight the importance of public health. Without the many integrated public health systems that touch our lives daily and protect us in emergency situations, we’d be much more susceptible to all the many types of outbreaks that plague Hollywood characters.
Well, maybe not all of them...
As part of Outbreak Week, we’ve compiled a list of some of the scariest outbreaks to terrify movie watchers. What do you think they got right? (And spoilers below...)
The scariest part of this outbreak is realizing how quickly disease can spread—and through interactions you may not even realize. It also highlights the wide range of reactions people can have to a disease spreading through a population. Several days pass before doctors and administrators at the U.S. Centers for Disease Control and Prevention realize the extent or gravity of this new infection. First they need to identify virus, then they can start working toward a means of combating it, a process that will likely take several months. As the contagion spreads to millions of people worldwide, people panic and society breaks down.
World War Z
A mysterious infection turns entire human populations into rampaging, mindless zombies. After barely escaping the chaos, United Nations Investigator Gerry Lane is persuaded to go on a mission to investigate the disease. What follows is a perilous global trek where Lane must brave horrific dangers and long odds to find answers before civilization falls. What at least the book gets right is the vast number of organizations and government groups that must come together to respond to an outbreak.
28 Days Later
How scary would it be to wake up after being in a month-long coma only to find your city completely deserted, with cars left empty and seemingly nothing but silence? One look at the film’s barren London streets will show you. Then think about how you’d feel if you found out that this emptiness was caused by rage virus-infected animals released by group of animal rights activists in protest of animals being used for medical research. And the virus was still out there...
An unknown virus wiped out five billion people in 1996. By 2035, only 1 percent of the population was still surviving, forced to live underground. A convict reluctantly volunteers to be sent back in time to 1996 to gather information about the origin of the epidemic (which he's told was spread by a mysterious "Army of the Twelve Monkeys") and locate the virus before it mutates, so that scientists from his time can study—and hopefully cure—the disease.
As a toxin begins to turn the residents of Ogden Marsh, Iowa into violent psychopaths, Sheriff David Dutton tries to make sense of the situation while he his wife, and two other unaffected townspeople band together in a fight for survival. Eventually military support is brought in to attempt to contain the outbreak.
(Image source: WikiCommons, Sailko)
Watch the live event right here starting at noon EST.
Today at 12 p.m. EST the Robert Wood Johnson Foundation will hold its very first Culture of Health Hangout. The goal of the new Hangout Series is to explore exactly what we all need to do to create a culture of health—and to shine a spotlight on communities that are already on their way. Panelists will talk through some of the complex ways public health is transforming, while also sharing innovative ways that public health departments are stepping up to the challenge.
This first Hangout will discuss the role of public health departments in transforming community health. Topics to be covered include:
- How the role of public health departments has evolved in recent years, and how it could continue to transform in the future
- How the scope of public health department partners is changing over time, and why that kind of broad partnership across sectors is critical for public health
- The particular public health challenges in rural settings
The panelists will include: Jewel Mullen, Connecticut Department of Public Health Commissioner; Muntu Davis, Public Health Director and County Health Officer of Alameda County; Karen DeSalvo, City of New Orleans Health Commissioner; and Michael Meit, Co-Director of the NORC Walsh Center for Rural Health Analysis. Our moderator is Paul Kuehnert, RWJF senior program officer and Public Health team director.
A full house of American Public Health Association (APHA) annual meeting attendees got an update on health department accreditation this week from Public Health Accreditation Board (PHAB) president and CEO Kaye Bender, RN, PHD, FAAN; board chair Carol Moehrle; and vice chair Leslie Beitsch, MD, JD. Right now, Moehrle told the crowd, 19 health departments—local, state and tribal—have been granted the credential and more than 200 departments are in various stages of their applications.
Moehrle gave some “heads–ups” on what’s upcoming for accreditation in 2014, including revised application standards and measures—called version 1.5—as well as the establishment of several additional PHAB think tanks to help expand the issues health departments are asked about when they apply for accreditation. Information from the previous think tanks informed the development of the Guide to Public Health Department Accreditation Version 1.0 and the PHAB Standards and Measures Version 1.0. New topics for PHAB think tanks will include the U.S. Army.
Moehrle also announced that the new version will be released on the PHAB website in January 2014, and those new standards and measures become effective for health departments' seeking accreditation beginning on July 1, 2014. To apply under the 1.0 version, health departments must submit their application by 11:59 PM Eastern Time on June 2, 2014.
Moehrle said that PHAB is recommending that health departments review the proposed changes to the standards and measures before they automatically decide that they will apply under Version 1.0, because version 1.5 is designed to “enhance, strengthen, expand, and clarify the Standards and Measures document,” including the following:
- Number of examples needed and timeframes for required documentation
- Edits to version 1.0 for clarity and consistency, based on frequently asked questions from applying health departments
- New measures and revised content to advance public health practice based on suggestions from PHAB Think Tanks conducted on special topics, including health equity, communication science, public health informatics, public health ethics, public health workforce and emergency preparedness