Category Archives: Public policy
A session on health in all policies at the American Public Health Association (APHA) meeting in Boston gave prominent attention to a newly released publication on the topic: An Introduction to Health in All Policies: A Guide for State and Local Governments. The guide was issued collaboratively by APHA, the California Endowment, the California Department of Health and the Public Health Institute.
It was released last month and is geared, according to its authors, “toward state and local government leaders who want to use intersectoral collaboration to promote healthy environments.”
The guide includes a history of health in all policies, case studies, a glossary, messaging, resources and a list of critical thinking questions. It draws heavily on the experiences of the California Health in All Policies Task Force, which was created in 2010 by an executive order of the governor and grew out of a common interest among several California agencies in climate change, health and childhood obesity. The task force brings together non-government stakeholders and local government representatives in its “health-in-all-policies” work through workshops, meetings and opportunities for public comment and testimony.
The Guide emphasizes that there is no one “right” way to implement a health-in-all-policies approach, but puts forward five key elements:
- Promote health, equity and sustainability
- Support for Intersectoral collaboration
- Benefit multiple partners
- Engage stakeholders
- Create structural or procedural change
- Health Impact Assessments (HIA) are one of the key tools addressed in the new Guide. See a regularly updated map on HIAs in the United States created by the Health Impact Project, a collaboration of the Pew Charitable Trusts and the Robert Wood Johnson Foundation.
- HIA was front and center at the American Public Health Association meeting, with more than thirty presentations this week. Read a summary of the HIAs discussed at the meeting, prepared by the Health Impact Project.
>>NewPublicHealth was on the ground throughout the APHA conference speaking to public health leaders and presenters, hearing from attendees on the ground and providing updates from sessions, with a focus on how we can build a culture of health. Find the complete coverage here.
David Satcher, MD, PhD, was a four-star admiral in the U.S. Public Health Service Commissioned Corps and served as the 10th Assistant Secretary for Health and the 16th Surgeon General of the United States—at the same time. He was Surgeon General from 1998 through 2001, and under his tenure he tackled disparities in tobacco use and overall health equity, sexual health and—critically—youth violence.
Satcher was a key speaker in a recent American Public Health Association (APHA) Annual Meeting Town Hall Meeting on a global approach to preventing violence. NewPublicHealth spoke with Satcher about approaches to preventing violence as a public health issue.
NewPublicHealth: How do you take a public health approach to preventing violence?
David Satcher: When you take a public health approach, public health experts pose four questions:
- First, what is the problem and what is the magnitude, the nature and distribution of the problem?
- The second question is: what is the cause of the problem or the major risk factors for the problem?
- The third question is: what can we do to reduce the risk of the problem?
- And finally, how can we then implement that more broadly throughout society?
So, when we say we’re taking a public health approach, that’s what we’re talking about.
What we’ve tried to do and what we need more of is to really study the different causes of violence and violent episodes. They’re not all the same. I’ve dealt with a lot of the mass murders; I was Surgeon General when Columbine took place and the Surgeon General’s Report on Youth Violence in part evolved from that. And obviously there, as in most mass murders, we’re dealing with, among other things, mental health problems and easy access to weapons combined. I don’t think the same is necessarily true for gang violence, which causes thousands of deaths each year. With youth violence and gangs, I think there you’re dealing with a culture of insecurity where young people feel that in order to protect themselves they need to be members of gangs and they need to be armed.
“We live in a culture of violence,” said Larry Cohen, MSW, founder and executive director of the Prevention Institute, in a morning session on violence prevention at the American Public Health Association (APHA) Annual Meeting, held this year in Boston, Mass.
“Just as air, water and soil affect our health, the social environment affects the spread of violence through our communities,” said Cohen.
One of the most important factors in the environment that influences the perpetration of violence is actually more violence. Basically, violence begets violence. It spreads like a disease.
“It’s like the flu,” said Gary Slutkin, MD, PhD, Founder and Executive Director of Cure Violence. “The greatest predictor of a case of the flu is a preceding case of the flu. It’s the same thing with violence. Violence is an infectious disease.”
Slutkin shared a study of one community that found that exposure to community violence in one form or another was associated with a 30 times increased risk of committing violence—but what was most striking is that statistic held true, even controlling for poverty, race, crowded housing and other factors that could have an impact on violence. The effect is also “dose dependent,” according to Dr. Slutkin. That is, the more violence you witness or experience, the more likely you are to perpetrate violence.
The good news is that “we know how to prevent epidemics,” said Slutkin. “We need to recognize that this is a preventable problem. We need to build a movement,” agreed Cohen.
Cure Violence focuses on the very same steps used to prevent the spread of infectious disease in their work to help prevent the spread of violence:
- Detect and interrupt the transmission of violence, by anticipating where violence might occur.
- Change the behavior of those most at risk for spreading violence.
- Change community norms to discourage the use of violence as an acceptable and even encouraged way to handle conflict.
Just over a year ago, Hurricane Sandy made landfall in the United States. Estimated damage came to $65 billion, at least 181 people in the United States died and power outages left tens of millions of people without electricity for weeks.
In the aftermath of this devastating event, the public health community continued efforts to make Americans aware that public health needs to play a much larger role in emergency response and recovery.
And in an American Public Health Association (APHA)-sponsored session on Wednesday, panelists discussed how they can draw on disaster response incidents to analyze policy implications for preparedness and response efforts to protect the health of workers, communities and the environment—with particular emphasis on promoting health equity.
"Addressing health disparities and environmental justice concerns are a key component of Sandy impacted communities," said the moderator of the panel, Jim Hughes of the National Institute of Environmental Health Sciences (NIEHS).
Kim Knowlton of the Natural Resources Defense Council and Columbia Mailman School of Public Health stressed that public health needs to advance environmental health policies post-Sandy, especially in regards to helping vulnerable populations.
"Climate change is a matter of health. It's such a deep matter of public health," she said. "We have to make a bridge between public health and emergency response preparedness communities," adding that "This is also an opportunity for FEMA to put climate change into their process for hazard mitigation planning and risk assessment.”
The American Public Health Association (APHA) launched its 141st annual meeting in Boston on Sunday by re-launching itself, its logo and its tagline which is now: For science. For action. For health.
”We’re deeply excited to share our new look and feel with our members and partners,” said Georges Benjamin, MD, executive director of APHA to the nearly 11,000 public health students, academics and practitioners attending the meeting. “With the challenges and opportunities presented by our rapidly changing health landscape, now is the time to better position APHA for success as the collective voice for the health of the public.”
>>NewPublicHealth will be on the ground throughout the APHA conference speaking to public health leaders and presenters, hearing from attendees on the ground and providing updates from sessions, with a focus on how we can build a culture of health. Follow the coverage here.
Benjamin also shared the five core values that APHA’s next phase will emphasize:
- Science and evidence-based decision-making
- Health equity
- Prevention and wellness
- Real progress in improving health
Those themes were in abundance at Sunday’s opening session. ‘Social injustice is killing on a grand scale,” said Professor Sir Michael Marmot, chair of the World Health Organization’s Commission on Social Determinants of Health and Director of the International Institute for Society and Health at University College/London. At the request of the British Government, Marmot led a review of health inequalities in England, and published a report, ”Fair Society, Healthy Lives” in February 2010. He has also recently been asked by the World Health Organization to conduct a European review of health inequalities
More than 10,000 public health officials, academics and students will gather in Boston next week for the 2013 American Public Health Association Meeting in Boston. This year’s theme is “Think Global, Act Local,” drawing critical attention to the increasingly global world of health where events across the globe—from food safety, to infectious disease outbreaks, to innovative public health solutions—can impact every local neighborhood.
>>NewPublicHealth will be on the ground at the APHA Annual Meeting, with speaker and thought-leader interviews, video perspective pieces and updates from sessions, with a focus on what it takes to build a culture of health. Follow our coverage here.
Ahead of the annual meeting, NewPublicHealth spoke with Georges Benjamin MD, APHA executive director.
NewPublicHealth: Why is the theme “Think Global, Act Local” so important?
Georges Benjamin: We’re in a world in which everything is global. There are no boundaries anymore. Rapid transit through planes, the fact that our borders are so porous...public health has always been a global enterprise, but even more so today. Our food comes no longer from a single farm but from multiple farms and sometimes multiple countries, so foodborne risks for disease and illness are global. We’ve seen that terrorism disasters are global. We’ve seen that obesity, particularly with corporations that sell certain products globally, is a big issue, and tobacco has always been a global issue. So, public health is global, and the idea is that if we can learn from people around the world and then utilize those learnings within our local communities, we’ll be stronger
NPH: What are some of the meeting sessions you’d highlight?
Benjamin: Our opening session will feature Professor Sir Michael Marmot, Director of the International Institute for Society and Health and Research Professor of Epidemiology and Public Health at University College, London, who spoke at our meeting five years ago on the social determinants of health and is going to give us an update. In the closing session, we’ll hear from actor/physician/public health doctor, Evan Adams, MD, the deputy provincial health officer for British Columbia, who will speak about improving the health of native people. So in both our opening and closing sessions we’re looking globally, as well as emphasizing what happens locally. We’ll also hear from the minister of health of Taiwan, who will talk about universal health care as well as violence prevention. And we’ll also be holding sessions that track the many public crises that we’ve already had this year.
Use of tourniquets—a piece of tightly tied cloth used to keep a victim with an arm or leg wound from bleeding to death—has been discouraged over the last few decades out of concern that the method can save the life, but lose the limb. But a new article in The Wall Street Journal finds that multiple examples of successful use of tourniquets on battle fields in Iraq and Afghanistan, as well as after the bombing at the Boson Marathon earlier this year, has reopened the debate. The pros and cons of tourniquet use is on the agendas of several upcoming medical meetings and preparedness conferences.
Read the full story here.
>>Bonus Link: Read a NewPublicHealth post on new approaches to teaching more people CPR.
At the recent 2nd Annual National Heath Impact Assessment Meeting held in Washington, D.C.,Paul Anderson, MD, MPH, manager of the HIA Program at the Alaska Department of Health, spoke about his state’s HIA efforts and successes. NewPublicHealth caught up with Anderson following the meeting to ask about lessons learned that can benefit other public health officials considering and conducting health impact assessments.
NewPublicHealth: Tell us about the HIA program in Alaska and how the health department has made HIA a routine part of decision making.
Paul Anderson: HIA in Alaska started with a couple of health impact assessments done in conjunction with natural resource development permitting and environmental impact statements (EISs) in the north of the state. These studies generated increased interest in the human health concerns that arise during project permitting. The Department of Natural Resources (DNR) contacted the Alaska Division of Public Health, asking us if we could get involved with this new idea—called health impact assessment—as it related to natural resource development permitting.
After some deliberation, we realized the importance of being involved with this work, and so we developed an HIA working group. That working group met for about three years and developed an HIA Toolkit, which is our guidance document for performing HIA in Alaska. Out of that working group came a realization that Alaska needed an institutionalized HIA program in order to lead this process forward effectively. So the group eventually decided to create an HIA Program in the Division of Public Health under the Section of Epidemiology.
NPH: Have you worked collaboratively in Alaska on HIAs?
Anderson: When our program was new, we wanted to conduct field work because we needed additional health information regarding a specific region of rural Alaska. This field work involved utilizing surveys, which can be very tiring for rural communities because they are surveyed frequently. There are several agencies in Alaska that already do surveys as a routine part of their work, and one of those is the Alaska Department of Fish and Game. They go house-to-house and community-to-community and use a very well-designed survey tool to learn about subsistence foods. They worked with us to integrate some important questions about food consumption onto their survey form. This turned out to be an effective cooperative relationship that benefitted both agencies and reduced the strain on rural communities.
At the recent Place Matters conference in Washington, D.C., David Williams, PhD, the Norman Professor of Public Health at the Harvard School of Public Health and staff director of the reconvened Robert Wood Johnson Foundation Commission to Build a Healthier America, talked about the need for cooperation between the community development industry and health leaders.
“Community development and health are working side by side in the same neighborhoods and often with the same residents but often don’t know each other or coordinate efforts.”
NewPublicHealth recently asked Dr. Williams about how synergies between the two fields can help improve population health.
>>View David Williams' PowerPoint presentation from the conference:
NewPublicHealth: Is there progress on the community development and health fields working together to help improve the health of communities?
David Williams: I would say there is increasing recognition by individuals both in health and in community development that they are two groups working in many ways on the same challenges and often in the same communities and in many ways there can be there could be synergy from working together. But I would also say that this is all so new, and I don’t think the field has matured in terms of our full understanding of where the potential is. To me, one of the greatest hungers out there is for people to see examples of success and progress and initiatives that in fact have worked well together, and we’re still in the beginnings of seeing that—such as the Federal Reserve healthy communities conferences, which have raised awareness levels and have begun to help similar initiatives. But we’re still in the infancy of really capitalizing on the potential.
One of the key challenges is that this area of healthy communities is a broader issue. And that includes the need to recognize the importance of a health in all policies approach—that policies in many sectors far removed from health have health consequences. A good example is the education sector—and having teachers recognize that they are themselves are health workers in a certain sense because the work they do can have such an important impact on health.
Building on the success of the Inaugural Health Impact Assessment (HIA) meeting held in April 2012, leading HIA stakeholders including the Health Impact Project—a collaboration of the Robert Wood Johnson Foundation and the Pew Charitable Trusts—and the U.S. Centers for Disease Control and Prevention (CDC) convened the second national HIA meeting today, in Washington D.C.
>> Follow the real-time Twitter conversation about the conference with the hashtag #NatHIA13.
An HIA is a tool that helps evaluate the potential health effects of a plan, project or policy before it is built or implemented. It can provide recommendations to increase positive health outcomes and minimize adverse health outcomes. It can also bring potential public health impacts and considerations to the decision-making process for plans, projects and policies that fall outside the traditional public health arenas, such as transportation and land use.
While HIAs have been conducted for decades, their wider use has become more common in just the last few years. According to the Health Impact Project, more than 200 HIAs have been conducted in the United States on issues as diverse as transportation, economic policy and climate change.
NewPublicHealth has created a short HIA resource list with links to background information on health impact assessments.
- Health Impact Assessment posts on NewPublicHealth
- HIA Issue Brief from the Robert Wood Johnson Foundation
- HIA in the United States, a map from the Health Impact Project
- An HIA Infographic from the Health Impact Project
- CDC’s Healthy Places collection of HIA information
- CDC Resource on HIAs and Public Policy Development
- The World Health Organization HIA site