Category Archives: Public policy
Public Health Presentations Cap First Class of Network for Public Health Law Mentorship Program for Young Attorneys
Laws and policies that impact public health can create healthier conditions for entire communities—a more cost-effective approach than treating one person at a time, and then only after they’re sick. Last week, five inaugural Visiting Attorneys in Public Health Law presented on their efforts over the past year as part of a program hosted by the Network for Public Health Law and the Robert Wood Johnson Foundation (RWJF). The attorneys focused on public health law around:
- The legality of tobacco “power walls” that put colored cigarettes boxes directly in the line of vision of children
- The impact of environmental noise on heart disease
- Displacement of residents through gentrification
- The challenges and promise of “health in all policies”
- Legal avenues toward reducing sodium intake by the public
The post-JD program is designed to help develop exceptional skills in practice-based public health law than can help lawyers to advance their public health law careers. During the program, the five attorneys were each located at a host site under the mentorship of a renowned public health legal expert. This year’s mentors included Doug Blanke, founder and director of the Public Health Law Center at the William Mitchell College of Law in Minnesota, and Clifford Rees, practice director of the western region of the Network for Public Health Law.
“This fellowship is one that we developed in conjunction with the Network for Public Health Law to help to build the field of public health law and to allow bright, new attorneys with an interest in public health, to be able to experience working in [that] setting while being mentored and coached by leaders in the field,” says Angela McGowan, JD, MPH, RWJF’s senior program officer.
McGowan says RWJF hopes this type of experience will highlight that public health law is an exciting career option, as well as show the value of engaging new professionals in this practice as a way of making meaningful impacts at the local, state and federal levels of public health. McGowan added that the Visiting Attorneys were able to really be engaged with the real work that public health and law practitioners face daily, and to apply their legal knowledge to solving public health problems.
CDC’s Ali Khan: “By Every Measure Our Nation Is Dramatically Better Prepared for Public Health Threats”
Today is the eighth anniversary of Hurricane Katrina, one of the deadliest and most expensive natural disasters in U.S. history. Close to 2,000 people died during the worst of the storm and in the flooding that followed.
Since then, local, state, national and private disaster preparedness efforts have been increasingly improved. States reeling from the impact of last year’s Super Storm Sandy on the East Coast, for example, were able to rely on some of those improvements. They included more and better trained disaster management assistance teams from other states, as well as both commercial and government social media tools that helped professionals communicate among themselves and with the public to share safety and recovery instructions.
“By every measure our nation is dramatically better prepared for public health threats than they were,” said Ali Khan, MD, MPH, Director, Office of Public Health Preparedness and Response at the U.S. Centers for Disease Control and Prevention (CDC), at a Congressional briefing last week on the topic. It was hosted by the Alliance for Health Reform and the Robert Wood Johnson Foundation. In a conversation with NewPublicHealth this week, Khan ticked off some recent advances in disaster preparedness:
Congressionally appropriated funds for the U.S. Department of Health and Human Services to allow all states to improve their public health and health care preparedness and response capabilities.
- Response activities now coordinated through state-of-the-art emergency operations center at CDC and centers at almost all state public health departments.
- Health departments use the National Incident Management System, allowing for structured collaboration across responding agencies.
- More than 150 laboratories in the United States now belong to CDC’s Laboratory Response Network and can test for biological agents with the addition of regional chemical laboratories.
- The National Disaster Medical System now includes 49 Disaster Medical Assistance Teams, ten Disaster Mortuary Response Teams and five National Veterinary Response Teams, as well as other specialized units to provide medical-response surge during disasters and emergencies through on-scene medical care, patient transport and definitive care in participating hospitals.
- The Strategic National Stockpile was authorized and expanded, ensuring the availability of key medical supplies. All states have plans to receive, distribute and dispense these assets. Development of new medical countermeasures under the Biomedical Advanced Research and Development Authority (BARDA) includes new drugs and diagnostics. BARDA has delivered nine new medical countermeasures to the Strategic National Stockpile (SNS) in the last six years.
The United Nations Foundation believes that, for the biggest public health obstacles facing the world, it will take all nations and all sectors working toward solutions to succeed. So the Foundation works to make that a reality, bringing together partnerships, growing constituencies, mobilizing resources and advocating policies that can help everyone—in both the developing and developed world.
NewPublicHealth recently spoke with Kathy Calvin, President and Chief Executive Officer of the United Nations Foundation, about the organization’s many efforts to improve health both globally and locally—and how these two goals can support each other.
NewPublicHealth: What changes have you seen in global health during your time in the field?
Kathy Calvin: The number of nonprofits dedicated to health issues has quadrupled it seems, and real progress has been made, which is the most important point—that we’re actually seeing a reduction in maternal deaths and newborn deaths and preventable diseases such as measles and diarrhea and pneumonia. I mean, there’s just been enormous progress, with still much more to happen. But it’s been an exciting time after what I think has been a pretty discouraging period where no amounts of foreign aid seemed to be making a difference. I attribute that partly to some innovations in research and financing, but also to the fact that a lot of governments in Africa actually have prioritized women and prioritized health in some pretty significant ways. And I think we’ve had a very enlightened government in the last five years here, too, in terms of what we’re doing overseas.
So, it’s been exciting to see it. Health is not my background. I’ve really been privileged to see both how serious and significant the challenges are, but also how much good can be done with just a little bit of organized effort.
NPH: When you talk about enlightened government, what are some examples? What is making the difference now?
Calvin: Well ironically it isn’t all that political. In fact, some of the biggest shifts took place under President George W. Bush’s administration with his creation of the President’s Malaria Initiative—until then, there had been zero real depth of interest and progress on malaria—as well as PEPFAR, which some people criticized because it was so bilateral, but it had a huge impact in allowing the current administration to really set some ambitious goals for reducing and eliminating parent-to-child transmission and setting that audacious goal of an AIDS-free generation.
About 40 million U.S. workers don’t receive even a single paid sick day and millions of others can’t utilize sick leave to take care of a sick child. The result is sick kids in school—where they make others sick—and a dramatically increased likelihood of ending up in an emergency room rather than a doctor’s office.
About $1.1 billion in emergency department costs could be saved each year if every U.S. worker had access to paid sick days, according to Vicki Shabo, the Director of Work and Family Programs at the National Partnership for Women & Families. Shabo recently spoke with Grassroots Change about the importance of paid sick leave and the on-the-ground efforts to enact the essential public health initiative at the local level—while also battling government preemption efforts that would take away local ability to improve sick leave policies.
“Unfortunately, we’re seeing a trend,” she said. “It’s sobering and undeniable. There are preemption bills this year that have been introduced in 13 or so states, and several of them have passed. Last year we saw Louisiana pass preemption, and until we alerted some of the local groups on the ground, no one was paying attention to it.”
This and other examples illustrate the critical importance of grassroots efforts to combat preemption and promote improved sick leave policies, which Shabo says benefits workers and their families while having no negative economic impact. With the number of these grassroots advocates growing every day, the next step is improving training and providing more resources to improve policies statewide.
“The takeaway message is that progress is possible, it’s happening, and local grassroots activity is instrumental in the progress that’s been made. As we work federally, grassroots activity will continue to play a central role in future progress. We know that this is not something that we can do from Washington—it has to come from the ground up.”
NewPublicHealth is on the ground this week in Dallas at NACCHO Annual, the yearly meeting of the National Association of County and City Health Officials (NACCHO). The meeting theme this year is “Public Health by the Numbers” as city and county health departments face increased pressure for limited resources; an increased focus on both new and traditional public health roles; and government accountability and effectiveness.
NewPublicHealth spoke with Robert Pestronk, NACCHO’s executive director, in advance of the conference.
>> Be sure to follow our NACCHO conference coverage all week long, including stories from key sessions and interviews with speakers and thought leaders.
NewPublicHealth: What are the key issues at this year’s NACCHO conference?
Robert Pestronk: We’re focused on a conference theme of public health by the numbers because the availability and use of data is integral to the performance and operations of local health departments. The use of data and metrics is important for quality improvement in health departments, and for the development and communication of messages about health status and disease status within local communities.
A couple of other things that are new for this year’s annual meeting is that we’re recognizing the role that large cities and metropolitan areas play in modeling and demonstrating public health policy and governmental public health practice work. We have a couple of sessions with presenters from big cities to talk about the work they’re doing. And because the Affordable Care Act is influencing the work and funding and future for local health departments, there are sessions to help local health departments consider the effects from the law. We’ve also got a plenary session on reducing health disparities, which is a line of work that is very important to NACCHO. In fact, NACCHO’s work in this area has stimulated work in other parts of the governmental public health structure at the state and federal level.
NPH: What is the role that local health departments will play when it comes to implementing the Affordable Care Act?
Pestronk: I think that the specific role that local health departments play, like in most situations, will depend upon the kinds of assets that are available in a local community and the extent to which their state is implementing provisions of the law. Local health departments can be helpful informing people about the start of enrollment and helping people understand where they can go to enroll. Part of what NACCHO has been doing over the past year is to share with local health departments the kinds of opportunities that are available for implementing and educating about the health law.
An anniversary session at the AcademyHealth Annual Resarch Meeting yesterday looked back at the organization’s thirty years of translating research into policy. It’s an important topic. A number of recent meetings focusing on public health, including last week’s public meeting of the Commission to Build a Healthier American, stressed the need for evidence in order to consider planning and community improvement decisions. The Affordable Care Act has a number of new initiatives that call on clinical and public health practitioners to seek and rely on an evidence base, including the Patient-Centered Outcomes Research Institute (PCORI), which is authorized by Congress to evaluate the best available evidence to help patients and their health care providers make more informed decisions.
Decades of research is beginning to pay off, according to the panelists. For example, according to Sherry Glied, PhD, professor of health policy and management at the Columbia University Mailman School of Public Health, the experts involved in crafting the Affordable Care Act drew on a body of research to inform the expected cost of implementing the law.
Gail Wilensky, senior fellow at Project HOPE, an international health foundation, who directed the Medicare and Medicaid programs from 1990 to 1992, pointed out that sometimes evidence has limitations. “Getting legislation passed also has to do with, among other things, the political mood of the country,” said Wilensky, who added that sometimes policy passes and sometimes it doesn’t, which is important for younger researchers to realize. “Important legislation has passed with minimal analysis including Medicaid and Medicare,” Wilensky pointed out.
Jane Brody is the Personal Health columnist for The New York Times. She joined the newspaper in 1965 as a specialist in medicine and biology after receiving degrees in biochemistry and writing for multiple college newspapers, as well as for the Minneapolis Tribune. With her column she has seen and reported on almost 50 years in the evolution of personal and community health.
NewPublicHealth recently spoke with Brody about her take on the state of community health—and what we can all do to improve it.
NewPublicHealth: Over the years, what efforts have you seen that you think have been most effective at improving community health?
Jane Brody: Well, I think one of the most exciting things that’s happened in New York City, and possibly in other cities as well, is getting better food to people who live in food deserts. For example, collecting food that would otherwise be wasted and bringing it to communities where people get free food that is healthy, fresh, and they even have demonstrations of recipes. In fact, I got one of my favorite recipes—it’s a green bean frittata—from one of their demonstrations that I attended just to see how it all worked out.
We’ve also, as you’ve no doubt heard, been putting in all of these bike lanes and we now have introduced the Bike Share Program, which is not inexpensive, but it does at least give more people an opportunity to get off their butts and get out of their cars and maybe even not even use public transportation in some cases, but to get some exercise to and from work, which is wonderful. I remember during one of the transit strikes that we had in New York City, I rode my bicycle from Brooklyn to Times Square where I work, over the bridges and stuff, and it was just wonderful because I got my exercise in at the same time as I got to work and I didn’t have to spend an extra hour exercising. There have been improvements. We have, of course, public pools that are only open in the summer, but in summer is better than no public pools and nobody has to pay anything for a public pool, which is really great.
The Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts, recently announced eight new grant recipients that will receive funding to conduct health impact assessments (HIAs). The projects will bring health considerations into upcoming decisions on topics including education, sanitation infrastructure, and energy.
“Our new grantees will use health impact assessments to uncover opportunities to improve health in a wide range of policy decisions, as well as to identify and avoid potential unintended consequences,” said Aaron Wernham, MD, director of the Health Impact Project. “These eight HIAs are the latest in a fast-growing field, as more cities and states find them a useful way to bring health into decisions in other sectors.”
By the end of 2007, there were 27 completed HIAs in the United States. There are now more than 225 completed or in progress, according to the Health Impact Project map of HIA activity in the United States.
Funding for some of the new proposals was also provided by the Blue Cross and Blue Shield of Minnesota Foundation and The California Endowment.
Some of the new HIAs that have received funding include:
- Partners for a Healthier Community, Inc. will undertake an HIA to inform decisions about a proposed casino in western Massachusetts. Decision-makers—including the state gaming commission, local government officials, and voters—will consider siting options as well as licensing, regulation, design and development of the casino. The HIA will examine health risks that might be linked to gambling—including substance abuse, mental health, and injury—and potential health benefits related to employment opportunity, access to health insurance, and community revenues.
- The University of Texas at El Paso, will conduct an HIA on the impacts of proposed water and sanitation improvement projects on the town of Vinton, Texas. Vinton primarily relies on failing septic tanks and cesspools for wastewater removal and domestic wells with poor water quality. Poor water and sanitation are associated with gastrointestinal illnesses and other serious health conditions such as hepatitis, dysentery, and dehydration. Improved systems could not only improve public health but also support economic development and long-term sustainability of local businesses and industry.
- An HIA by the Kentucky Environmental Foundation, in collaboration with the Purchase District Health Department, will examine the potential health benefits and risks of the retrofit or retirement of the Shawnee coal plant in Paducah, KY, operated by the Tennessee Valley Authority. The HIA will analyze environmental health concerns associated with air and water pollution from the plant and the effects of its closure on the community including employment, individual income, and revenue for local services important to health.
NewPublicHealth recently spoke with two of the researchers conducting the Shawnee coal plant HIA, Elizabeth Crowe, executive director of the Kentucky Environmental Foundation, and Deborah Payne, energy and health coordinator for the Foundation.
NewPublicHealth: What is the scope of the HIA you’re conducting?
The U.S. Food and Drug Administration (FDA) has announced that it will investigate the safety of caffeine in food products, especially the effects of caffeine on children and teens. The FDA’s announcement comes as an increasing number of food companies have introduced food products that contain caffeine—including gum, jelly beans, hot sauce, marshmallows and Cracker Jacks.
Caffeine can be addictive, and can lead to high blood pressure and insomnia, according to the American Academy of Pediatrics (AAP). AAP discourages the use of caffeine by kids and teens. Caffeine levels vary in the new foods on the market. According to the FDA, a caffeinated version of Wrigley’s gum contains as much caffeine as four ounces of coffee, per piece. The new caffeinated gum packs each contain eight pieces of gum.
Jill Birnbaum is an advocate for nutrition policy, tobacco control, and health care reform who has worked at the federal, state, and local levels. Her work began in Minnesota, and she now oversees state advocacy for the American Heart Association. Her grassroots experience, combined with her national role, gives her unique insights into public health policy at all levels of government.
This is the first in a two-part interview conducted by Grassroots Change: Connecting for Better Health, a project of the Robert Wood Johnson Foundation Health Group. In part one, Jill shares her perspective on grassroots movements and the threat of preemption in the obesity prevention arena. Preemption can take away the ability of states and local communities to adopt innovative solutions to their own public health problems in a way that responds to each community’s unique needs.
Grassroots Change: What do you see as the impact of preemption in public health, especially in obesity prevention?
Jill Birnbaum: [Preemption] slows or even ends grassroots movements before they begin. It also drains our resources for future advocacy efforts. We leave it to the next generation of public health advocates to undo policy compromises that we make today. We’re still seeing that in a few states with tobacco, and anticipating the fights both at the federal and state levels that we might have to undo someday [in obesity prevention].
Preemption stifles innovation, and it also makes some assumptions that can be wrong. It assumes that we know everything today and that there’s nothing more that we have to learn tomorrow. That’s especially true in nutrition policy where science continues to evolve and policy needs to evolve along with the science.
Preemption also has the effect of dividing the [public health] community when a small group of people, in some cases even a single individual or organization, negotiates away something that other people really want.
GC: Are the concerns about preemption in obesity prevention mostly about nutrition policy? There doesn’t seem to be a major effort to preempt local physical activity policies.