Category Archives: Public policy
A 2012 report from the Robert Wood Johnson Foundation (RWJF) and Trust for America’s Health concluded that if the adult and childhood obesity rates in 2011 continued to increase at their steady paces, then by 2030 nearly two-thirds of U.S. adults would be obese and every single state would have obesity rates above 44 percent.
Data now show that childhood obesity rates have stabilized. In fact, for the first time in a decade the obesity rates among young children from low-income families in many states is trending down.
Helping lead the way in this important public health issue has been the city of Philadelphia, Penn., which has worked to improve access to healthy foods and opportunities for physical activity.
“We were very fortunate in Philadelphia to have colleagues...who have developed a better understanding of childhood obesity,” said Don Schwarz, former Health Commissioner and Deputy Mayor for Health and Opportunity, City of Philadelphia, and will also soon take on the role of director for RWJF’s Demand Team. “What that has meant is that Philadelphia was able to take a body of knowledge and bring it to scale. The partnership in Philadelphia that has allowed that to happen goes across government and between government and the private sector and community organizations—just everyday Philadelphians. So that kind of partnership, that wonderful knowledge base, has I believed turned the corner on childhood obesity, particularly for children who are of disadvantaged communities.”
Schwarz’s comments came during the Tuesday, July 22 Google Hangout TEDMED Great Challenges: A Candid Conversation About Childhood Obesity. The panel was moderated by Richard Besser, Chief Health and Medical Editor for ABC News.
Every member of the panel echoed the importance of partnerships, and Besser succinctly explained their critical role in not just obesity prevention but all public health efforts.
“The more creatively you can think and the wider variety of partners you can pull in, the more likely you are to be successful,” he said.
At the heart of Philadelphia’s success has been the important role that schools play in that community partnership. According to Schwarz, for the past decade the city’s schools have worked to reshape how they approach children’s health and wellbeing, including comprehensive nutrition policies, a new food environment that emphasizes healthy choices and more opportunities for kids to be physically active. One can’t be successful without the other.
A new climate change report, Risky Business: The Economic Risks of Climate Change in the United States, suggests that the American economy could face significant and widespread disruptions from climate change unless U.S. businesses and policymakers take immediate action to reduce climate risk. The report was released by former New York City Mayor Michael Bloomberg and former Treasury Secretary Henry Paulson.
The assessment of the committee that wrote and reviewed the report is that communities, industries and properties across the country face profound risks from climate change, but that the most severe risks can be avoided through early investments in resilience, as well as through immediate action to reduce the pollution that causes global warming.
The public health findings of the report were reviewed by Al Sommer, MD, Dean Emeritus of the Bloomberg School of Public Health at Johns Hopkins University. NewPublicHealth spoke with Sommer about the report.
NewPublicHealth: How did the report come about?
Al Sommer: The report came about because of the primary interest of the three co-chairs—Hank Paulson, investor Tom Styra and Mike Bloomberg—who felt that there was a need to better understand and better describe the possible public health impacts of climate change on businesses and labor productivity. Their goal is to engage the interest of business leaders so that they begin to think about the ramifications and perhaps see the problems of climate change from a totally different perspective than we usually talk about it.
I think from my own personal perspective that one of the great advantages of this report is that the group that did the analyses stuck with the data and the assumptions, and used sophisticated modeling and statistical analyses to give a range of outcomes. The most important part of the report from my perspective is that it has a granularity that most of the [climate change] reports don’t have, so it looks at likely outcomes in different regions of the country simultaneously.
In some instances, it looks like there is no change. There is reduced mortality in the northern part of the country because there is less freezing. But at the same time in the southern part of the country there’s dramatically increased mortality because of increased heat and humidity.
Far too many older people in generally good health find themselves without purpose—which is itself at cross purposes with the natural makeup of humans, according to Linda P. Fried, MD, MPH, an expert on aging and the dean of the Mailman School of Public Health at Columbia University.
“We are a species wired to feel needed, respected, and purposeful,” she wrote in the latest issue of The Atlantic. “The absence of those qualities is actually harmful to our health.”
The new article discusses the current research on the benefits of older people engaging in work that they are good at and enjoy. One example, Experience Corps—which Fried cofounded and which is now hosted by the AARP—seeks to leverage “the investments in one age group in order to benefit many stakeholders.”
Another example is the World Health Organization’s Global Network of Age-Friendly Cities and Communities, which provides a model for developing public-private partnerships. In New York City, the Age-Friendly NYC Commission was established in 2010 in partnership with the New York City Council and The New York Academy of Medicine. The underlying premise, according to Fried, was that the active participation of older residents in all aspects of city life is essential to the growth and health of the city, and that creating the conditions to achieve this is an important investment in public health.
Read the full story from The Atlantic, “Making Aging Positive.”
>>Bonus Link: Read a previous NewPublicHealth post on the Age-Friendly NYC Commission.
Hurricane season began yesterday and runs through the end of November. New this year for the season are storm surge maps from the National Weather Service (NWS) to underscore the danger that a surge poses during a severe storm. Storm surge is an abnormal rise of water generated by a storm, over and above the predicted tide levels, according to the NWS. “Most people see wind as the key threat in a tropical storm or hurricane, but surge can be far more deadly,” said Dennis Feltgen, a spokesman for the NWS.
The new, color-coded maps will be updated every six hours during storms that pose a surge risk along the Gulf and Atlantic Coasts. The maps highlight:
- Geographical areas where inundation from storm surge could occur
- How high above ground the water could reach in those areas
- Inundation levels that have a 10 percent chance of being exceeded
Maps will be available 45 minutes to an hour after each new advisory, to give cartographers time to plot their points.
The new maps are experimental for two years. The NWS will be collecting and reviewing public comments, and then afterward decide whether the maps will become a permanent product. Even if they don’t, say public health experts, the model maps are important right now in order to educate the public about the threat posed by a surge—even at fairly low heights.
For example, six inches of water can knock over an adult and two feet of water is all that’s needed to carry an SUV, according to the data from the NWS.
The NWS’ Feltgen said Hurricane Sandy is an important example to share when explaining storm surge because of the damage that storm’s surge did to inland communities. For instance, the surge knocked out power to many financial firms on Wall Street, which were then powered by generators as repairs went on for months after the storm. And many residents of high rise apartment buildings in Manhattan and other parts of New York City were stranded or limited to stairs until the electricity was fixed and elevators could run.
Other storm surge facts:
- More than half of the nation's economic productivity is located within coastal zones
- 72 percent of ports, 27 percent of major roads and 9 percent of rail lines within the Gulf Coast region are at or below 4 ft. elevation.
- A storm surge of 23 feet has the ability to inundate 67 percent of interstates, 57 percent of arterials, almost half of rail miles, 29 airports and virtually all ports in the Gulf Coast area.
>>Bonus Link: The National Weather Service has a fact site on storm surge, including photos of the havoc wreaked by surge episodes.
May is Foster Care Awareness Month, an observance aimed at focusing attention on the 400,000 children in foster care, many of whom often are bounced from home to home only to age out of the system at 18 without community or family ties. A report from the General Accounting Office (GAO) released yesterday found that 42 states reported that they face major challenges placing large sibling groups in foster care, 38 states face challenges placing foster students near their most recent school and 31 reported they face challenges providing appropriate housing after a child in foster care ages out of the system.
A second GAO report released this week found that children in foster care group homes were twice as likely to be given psychotropic drugs than children in foster homes, and children in foster care were more likely to be given the drugs than children in the general community. Many of the drugs have serious side effects—including suicidal thoughts—and require oversight by guardians and doctors. However, but often children in foster care—particularly in group homes—who are taking psychotropic drugs are not well monitored. The GAO recommended that the U.S. Department of Health and Human Services (HHS) provide improved guidance to state Medicaid, child-welfare and mental-health officials regarding prescription-drug monitoring and oversight for children in foster care receiving psychotropic medications through Managed Care Organizations.
Child advocates say much more needs to be done to effectively place foster children in safe, nurturing homes, as well as to support foster families in adopting children and creating permanent homes and families. NewPublicHealth recently spoke with Dave Roberts, a county supervisor in San Diego, who together with his husband is raising five adopted children, ages 5 to 18, who started their lives with the family as foster children. Roberts has been a health policy advisor to Presidents Bush and Obama and played a key role in developing Tricare, the health insurance system of the U.S. Department of Defense.
NewPublicHealth: What drew you and your husband to consider having foster children grow up in your home?
Dave Roberts: We left Washington, D.C., where we had been living, and moved to San Diego where my husband is from and the first year we were here we went to the Del Mar Fair and the county had a booth there advertising their foster to adopt program. And so we signed up for the program and went through the process, and Robert [almost 19 and planning to enter the U.S. Air Force in the fall] was our first child. He was four going on five when he came to live with us.
Recent decisions by a number of states to legalize, or consider legalizing, marijuana has prompted the National Institute on Drug Abuse (NIDA) to update two guides: Marijuana Facts for Teens and Marijuana: Facts Parents Need to Know.
According to NIDA, marijuana remains the most abused illegal substance among young adults. By the time they graduate high school, about 46 percent of U.S. teens will have tried marijuana at least once. And although marijuana use among teens dropped dramatically in the last ten years, use of the drug is on the upswing again. Approximately 12.4 percent of students reported use in the month before being surveyed in 2007; in 2013, nearly 23 percent of high school seniors reported current marijuana use and 6.5 percent used marijuana daily.
NIDA’s annual Monitoring the Future survey, which has been tracking teen attitudes and drug use since 1975, shows that use of marijuana over time is directly related to how safe teens perceive the drug to be. The most recent survey shows that the number of teens who think marijuana users risk harming themselves is declining, even though studies have shown that the impacts of marijuana use can include a permanently lower IQ, poor school performance, psychosis, panic and impaired driving. A study earlier this month in JAMA Pediatrics found that college-age men dispute the idea that marijuana can impact their driving.
“The subject of marijuana use has become increasingly difficult to talk about—in part, because of the mixed messages being conveyed by the passage of medical marijuana laws and legalization of marijuana in some states,” said NIDA director Nora Volk. “In addition, many parents of today’s teens may have used marijuana when they were younger, which could make talking openly and setting definitive rules about its use more difficult.”
“Sometimes,” he added, “just beginning the conversation is the hardest part. I hope these booklets can help.”
The updated booklets include new data on marijuana use; new evidence-based information on the potential harms of marijuana; and information on the highly dangerous and even lethal K2/Spice, also referred to as synthetic marijuana.
Marijuana Facts for Teens is also available in print; Marijuana: Facts Parents Need to Know will be available in print soon.
>>Bonus Link: Read an interview with Alexander Wagenaar, PhD, a Professor in the Institute for Child Health Policy at the University of Florida, who recently moderated a webinar on the public health perspectives of legalizing marijuana.
“Five years after the Great Recession officially came to an end, the United States has yet to fully recover from the economic devastation sparked by the collapse of an $8 trillion housing bubble and the ensuing turmoil that saw global financial systems teetering on the brink of collapse. But while the economic costs of the downturn have drawn the lion’s share of attention, the damage to our bodies could end up far surpassing the damage to our bank accounts.”
Those are the opening lines of a new special report from the Harvard School of Public Health (HSPH), “Failing Economy, Failing Health: The Great Recession’s Toll on Body and Mind,” detailing how poverty and inequality resulting from the economic maelstrom pulled down so many—and what that will mean for public health in the long term.
“Health is a long-run thing, but the methods we use to analyze current data only estimate short-term effects,” says SV Subramanian, HSPH professor of population health and geography. “It may take awhile for the health impact of the Great Recession to kick in, but once it does, it could be dramatic.”
The data is strong on the links between employment and health—people who are unemployed, underemployed or laid off are less healthy and don’t live as long.
A 2009 study found that in the 12 months after men lost their jobs in mass layoffs, they saw their chances of dying nearly double. While over time the risk lessened it was still significant two decades later. Another study that same year found that losing a job when a business shuts its doors increases the odds of fair or poor health by 54 percent among workers with no preexisting health conditions while also increasing the risk of new health conditions by 83 percent. The stress of the situation, according to the researchers, heightens the odds of stress-related conditions such as stroke, hypertension, heart disease, arthritis, diabetes and psychiatric problems.
Yet another study, this one in 2010, found that about 4 in 10 Americans with heart disease or diabetes and 1 in 5 with cancer said the stress of the Great Recession made it more difficult to manage their illnesses.
What’s more complex is unearthing the pathways behind why this is the case. The HSPH article outlines some of the mechanisms by which unemployment affects health.
On Thursday, April 17, from 1-2 p.m. (ET), the Network for Public Health Law, Public Health Law Research and the American Society of Law Medicine and Ethics (ASLME) will be holding a free webinar around public health perspectives on regulating non-medical marijuana in states where it has been made legal or decriminalized. Whatever course a state may take, public health’s expertise and experience in public policy means it should be a major voice in the discussion surrounding legislation from the very start. The issue is a critical one now as Colorado and Washington State have legalized the commercial production, distribution and sale of marijuana for non-medical use and a number of other states are considering similar legislation.
“Policy-makers, advocates and others are grappling with how to process licenses, develop regulations and manage production in an industry that is still largely illegal both in the U.S. and around the world,” said Alexander Wagenaar, PhD, Professor in the Institute for Child Health Policy at the University of Florida who will be the moderator for the webinar.
The webinar’s aim is to provide an overview of issues related to non-medical marijuana regulation through, among other things, the lessons learned from decades of alcohol and tobacco regulation and through insights from Washington State’s recent implementation of a marijuana law with participant Laura Hitchcock, JD, Policy, Research & Development Specialist in the public health department of Seattle & King County in Washington State. Additional speakers include Beau Kilmer, PhD, Co-Director of the RAND Drug Policy Research Center and Amanda Reiman, PhD, the Policy Manager of the Drug Policy Alliance of California.
>>Register for the webinar Regulating Non-Medical Marijuana: Lessons Learned and Paths Forward.
Ahead of the webinar, NewPublicHealth spoke with Wagenaar about who in public health will find the webinar important, as well as public health’s role both before and after a jurisdiction considers legalizing non-medical marijuana.
NewPublicHealth: Who is the webinar primarily geared toward?
Alexander Wagenaar: There are lots of different audiences that are interested in this, including the public health research community such as academics, scientists, health department and agency staff who are looking at the issue or will be looking at it in the future.
With just seven days to go until the announced deadline for its first round of funding, the front runner to reach its goal on UCLA Spark—a new crowdfunding platform hosted by the university—is a public health initiative, the UCLA Sex Squad School Tour 2014. The Squad is a multimedia theatre troupe made up of University of California, Los Angeles students and graduates who talk to high school students about sex and sexual health.
Crowdfunding uses social media to encourage contributions from strangers for projects of all kinds. Sites such as Kickstarter have raised millions of dollars for multiple projects, including one by three U.S. State Department officials who raised enough capital to start their own dress sock business.
UCLA Spark’s projects are way loftier. The four other projects in the first round of funding on the site, which debuted last month, include a program to connect ninth-grade girls with technology, a bus to transport campus volunteers to community service projects, funds to help preserve the Watts Towers, (an iconic Los Angeles monument) and expansion of cancer treatment in Ethiopia.
Nancy Katano, Executive Director of Corporate Foundation and Research Relations at UCLA, says the idea for a crowdfunding platform at the university came about because two things converged: The university began getting faculty and student requests for help funding some very small niche projects—beyond the scope for most grants—and Katano began receiving calls from crowdfunding platforms looking to contract with the university. Katano says using an outside platform would have lost too much money for the projects since the platforms take a fee as well as a percentage of funds raised, so instead the university launched its own platform.
To become a UCLA Spark project, faculty and official student organizations propose projects for funding through an online application and a UCLA vetting committee makes the final decision.
“We’ve set up a whole series of guidelines and then we have a face-to-face meeting for applicants to help them think through how the platform can be effective for them—what’s realistic and what their responsibility is going to be,” said Katano. “With most crowdfunding platforms engagement is key. We ask them about their social media reach, do they use Twitter? Do they use Facebook? Are they comfortable shooting video?"
The Network for Public Health Law and the U.S. Centers for Disease Control and Prevention (CDC) Public Health Law Program will host a webinar on Wednesday, March 26, 2:00-3:30 p.m. (ET), on cooperation between hospitals and local health departments on community health assessments, a new requirement for non-profit hospitals under the Affordable Care Act (ACA).
The ACA creates several new requirements for nonprofit hospitals to maintain tax-exempt status. One is that each hospital must conduct a community health needs assessment every three years, report on the needs identified and develop a strategy for responding to them.
In conducting the community health assessments, the law requires hospitals to get input from individuals with special knowledge of, or expertise in, public health. The goal of the assessment and follow up is to “reorient hospitals away from a primary focus on providing charity care and toward greater attention to community and population health issues,” says Mary Crossley, Professor of Law and former Dean at the University of Pittsburgh School of Law, who served as a scholar in residence at the San Francisco Department of Health and worked on the community health assessment issue there.
Crossley will be a presenter during the upcoming webinar, together with Corey Davis, JD, MSPH, Staff Attorney at the National Health Law Program and the Network for Public Health Law Southeastern Region, and Molly Berkery, JD, MPH a Senior Attorney with the CDC Public Health Law Program.
The webinar topics include:
- The new community health needs assessment (CHNA) requirements for charitable 501(c)(3) hospitals
- CDC resources for implementing the CHNA process
- Strategies for moving from the assessment stage to broader population health initiatives, with an emphasis on health department and hospital collaboration
- CHNA case studies
Register for the webinar.
>>Bonus Link: Read a NewPublicHealth interview with Mary Crossley.
>>Bonus Links: Read a selection of previous NewPublicHealth posts on community benefit: