New Public Health RWJF's New Public Health forum is a vibrant online destination for news and discussion about public health. We connect the dots in public health and across other sectors to identify ways to prevent health crises where they begin—in our communities. Mon, 22 Sep 2014 14:28:00 -0400 en-us Copyright 2000- 2014 RWJF (RWJF) <![CDATA[Following the Announcement of New Antibiotic Resistance Initiative, Advocates Call for Increased Emphasis on Prevention in Livestock]]>

Despite growing awareness of the dangers, antibiotic resistance continues to sicken two million Americans and kill 23,000 each year, according to a 2013 report from the U.S. Centers for Disease Control and Prevention. Late last week the Obama administration announced a series of efforts targeting the public health issue. Among them:

  • A Cabinet-level task force to create a national action plan on  antibiotic resistance
  • Improved federal oversight of antibiotic use in the United States, including better tracking of outbreaks
  • Incentives for developing new generations of antibiotics aimed at treating currently resistant microbes
  • A $20-million prize for the development of a rapid diagnostic laboratory test that doctors can use to identify highly resistant bacterial infections

Many in the public health field are quick to note that more should be done to address a key source of antibiotic resistance—widespread use of antibiotics to prevent infection and promote growth in livestock. There have been concerns that, in addition to over-prescription by physicians overuse, of the antibiotics in farm animals has also contributed to the growing trend of antibiotic resistance. A recent study found that livestock workers can harbor resistant bacteria acquired on the job and introduce it into the community.

Ed Silverman, who writes the Pharmalot blog for the Wall Street Journal, said that an administration report calls for the U.S. Food and Drug Administration (FDA), the U.S. Department of Agriculture, the National Science Foundation and the U.S. Department of Homeland Security to work together to develop an analytic model to assess the relationship between antibiotic use in livestock and the development of antibiotic resistance. The FDA currently has voluntary guidelines for livestock producers on limiting antibiotic use that go into effect in 2016, but advocates had hoped for an actual ban.

APIC ABCs of Infections

>>Bonus Link: The Association for Professionals in Infection Control and Epidemiology (APIC) has released a useful infographic for public health professionals and physicians to share with consumers about their roles in preventing antibiotic resistance.

Mon, 22 Sep 2014 14:28:00 -0400 New Public Health Antibiotic resistance Food safety Food Safety Food and Drug Administration <![CDATA[Public Health News Roundup: September 22]]> NPH_Public_Health_News_Roundup_Header

UPDATE: Sierra Leone Ends Three-Day Lockdown, Reports 130 New Cases
(NewPublicHealth is monitoring the public health crisis in West Africa.)
Officials in Sierra Leone have ended a three-day curfew designed to help contain the continuing spread of the Ebola virus, calling the effort a success. Authorities reported 130 new cases during the lockdown and are waiting for tests on 39 more people. The West African country has been one of the hardest hit by the outbreak—more than 550 of the nearly 2,800 total deaths have been in Sierra Leone. In addition more than 100 tons of health-related supplies are being flown to Sierra Leone and Liberia. They include gloves, masks, gowns, goggles, saline, antibiotics, oral rehydration solution and painkillers. "We must do all we can to reduce further the human tragedy caused by this deadly outbreak and help communities avoid an even deeper setback than has occurred already," said Chief Executive Thomas Tighe of Direct Relief, according to USA Today. Read more on Ebola.

Study: Medicare Patients Less Likely to Receive Post-Stroke Surgery
Despite the fact that it can significantly help recovery and reduce the risk of long-term disability or even death, a common post-stroke surgical treatment is far less likely to be referred by physicians of patients with Medicare, according to a new study in the journal PLOS One. Researchers at the University of Florida (UF) analyzed data on more than 21,000 adult patients discharged from 2003 to 2008 with a diagnosis of subarachnoid hemorrhage, finding that—when compared to patients with private insurance—Medicare patients were almost 45 percent less likely to receive surgery and were more than twice as likely to die in the hospital. Azra Bihorac, MD, the study’s senior author and an associate professor of anesthesiology, medicine and surgery at the UF College of Medicine, said the results could indicate a conscious or unconscious bias. “Not every hospital has skilled neurosurgeons who specialize in subarachnoid hemorrhage,” he said in a release. “If these hospitals don’t have the necessary expertise, then they may actually overestimate the risk of a bad prognosis. They may assume that the patient won’t do well anyway, so they won’t proceed with surgery.” Read more on access to care.

Study: Weekly Text Reminders about Calories Help People Make Healthier Choices
Something as simple as a weekly text reminder may help U.S. adults develop a better understanding of basic nutrition and make healthier food choices, according to a new study in Health Promotion Practice. Researchers from the Johns Hopkins Bloomberg School of Public Health sent either a weekly text message reminder, a weekly email reminder, or no weekly reminder about the U.S. Food and Drug Administration’s recommendation of a reasonable daily caloric intake—2,000 calories—to 246 participants dining in the Johns Hopkins Hospital cafeteria. They found that at the beginning of the study approximately 58 percent knew the recommended benchmark, but after four weeks the participants who received texts were twice as likely to know the benchmark. “While daily energy needs vary, the 2,000-calorie value provides a general frame of reference that can make menu and product nutrition labels more meaningful,” said study leader Lawrence J. Cheskin, MD, director of the Johns Hopkins Weight Management Center, in a release. “When people know their calorie ‘budget’ for the day, they have context for making healthier meal and snack choices.” Read more on nutrition.

Mon, 22 Sep 2014 10:43:00 -0400 New Public Health Public health News roundups Access to Health Care Health disparities Ebola Nutrition <![CDATA[Faces of Public Health: Q&A with Joshua Sharfstein, MD]]> Faces of Public Health Joshua Sharfstein

In the last few months, several prominent national and state public health leaders have announced plans to move on to new things, including David Fleming, MD, MPH, the former Public Health Director in Seattle & King County Washington, who NewPublicHealth spoke with last month. We also recently spoke with Joshua Sharfstein, MD, secretary of Maryland’s Department of Health and Mental Hygiene, who will leave his post at the end of the year to teach at the Bloomberg School of Public Health at Johns Hopkins University as part of the faculty of the School of Health Policy and Management.

Earlier this year, Sharfstein gave the commencement address at the graduation ceremony of the University of Maryland School of Public Health, and had this to say about the importance of ensuring the public’s health:

“The premise of public health is that the well­being of individuals, families and communities has fundamental moral value. When people are healthy, they are productive, creative and caring. They enjoy life and have fun with their friends and families. They strengthen their neighborhoods and they help others in need. In short, they get to live their lives.”

NewPublicHealth: What prompted you to move to academia at this point in your career?

Joshua Sharfstein: It's a chance to help train hundreds of new public health leaders as well as work in depth on issues that are important to me. I am especially looking forward to getting to work closely with so many talented faculty at the Johns Hopkins Bloomberg School.

NPH: How have your research and teaching skills benefitted from your time as deputy director of the U.S. Food and Drug Administration (FDA) and your position with the state of Maryland?

Sharfstein: I've seen a lot of public health in action at the local, state and federal level. My goal will be to show students how important, interesting, engaging and—at times—strange public health can be. I have a research interest in why certain policies are pursued and others are not—and how public health can be successful in a difficult political and economic climate.

NPH: What accomplishments at FDA and in Maryland do you point to with respect to public health improvement?

Sharfstein: I've been fortunate to be part of great teams that have been able to make a huge difference for public health. At FDA, among other projects, we established the first tobacco regulatory program, won passage of a landmark food safety law, reorganized the medical device program and took caffeinated alcoholic beverages off of the market. In Maryland, we've seen progress in a broad range of health outcomes, including infant mortality, and are now focusing our energy on new threats, such as drug overdose.

NPH: How do you think the teaching of public health has changed from the time you were in medical school?

Sharfstein: When I went to medical school, public health and medicine were quite separate. Today, the term "population health" is used by both sides. The leaders of the health care system realize they have to care about whether communities are becoming healthier, and public health officials are understanding that resources for change will increasingly come by preventing unnecessary medical care.

NPH: Your training, like so many who go into public health, is in pediatrics. What was your road from pediatrics to public health?

Sharfstein: Pediatricians recognize the value of prevention, so it's an easy path to public health. After a fellowship in general academic pediatrics, I went to work for Congressman Henry Waxman in Washington, D.C. I applied for the position of Commissioner of Health in Baltimore simply out of interest and told the Congressman "I am applying for a job I don't want and won't get." He responded: "We'll see about that."

NPH: What reasons do you give when you encourage students to consider a career in public health?

Sharfstein: Public health is incredibly rewarding—both because of the nature of the work and its outcomes. The work itself uses data, values creativity and engages the public. And its outcome is healthier, longer lives for people in your city, county, or state. Recently, in our building's convenience store, one of the front line Medicaid staff pulled me aside to thank me and the department for our efforts to combat overdoses. She confided in me that her own son had lost his life, and I connected her to our outreach efforts to friends and family. It was a reminder that behind every project in public health is the goal of avoiding terrible pain and suffering.

NPH: How well is the United States doing in creating a culture of health?

Sharfstein: I think we have a considerable distance to travel. But in general, I think there is greater recognition of the opportunities for health all around us.

Fri, 19 Sep 2014 13:52:00 -0400 New Public Health Public health schools Public health agencies Faces of Public Health Q&A <![CDATA[Public Health News Roundup: September 19]]> NPH_Public_Health_News_Roundup_Header

EBOLA UPDATE: Sierre Leone on Three-Day Lockdown
(NewPublicHealth is monitoring the public health crisis in West Africa.)
Today the nation of Sierra Leone began a three-day lockdown in an effort to slow the spread of the Ebola virus. "Today, the life of everyone is at stake, but we will get over this difficulty if all do what we have been asked to do," said President Ernest Bai Koroma. "These are extraordinary times and extraordinary times require extraordinary measures." The ongoing outbreak has so far killed at least 2,630 people and infected a total of 5,357 people. Read more on Ebola.

FDA Revises Proposed Rules to Prevent Foodborne Illnesses
Taking into account the public comments stemming from its extensive outreach, the U.S. Food and Drug Administration (FDA) has issued revisions to four proposed rules designed to promote food safety and help prevent foodborne illness. The rules include produce safety, preventive controls for human food, preventive controls for animal food and the foreign supplier verification program. “Ensuring a safe and high-quality food supply is one of the FDA’s highest priorities, and we have worked very hard to gather and respond to comments from farmers and other stakeholders regarding the major proposed FSMA regulations,” said FDA Commissioner Margaret A. Hamburg, MD, in a release. “The FDA believes these updated proposed rules will lead to a modern, science-based food safety system that will better protect American consumers from potentially hazardous food. We look forward to public comment on these proposals.” Read more on food safety.

CDC: Too Many Americans Don’t Receive a Flu Vaccination
At a news conference this morning, U.S. Centers for Disease Control and Prevention (CDC) Director Thomas Frieden, MD, stressed the need for all people ages 6 months and older to be vaccinated for the upcoming flu season. According to the CDC, fewer than half of eligible Americans get vaccinations resulting in unnecessary lost work days, hospitalizations and even death. "It's really unfortunate that half of Americans are not getting the protection from flu they could get," said Frieden, according to HealthDay. More than 100 children died from the flu-relate complications last year, and approximately 90 percent of them were unvaccinated. Read more on influenza.

Fri, 19 Sep 2014 11:00:00 -0400 New Public Health Public health News roundups Ebola Flu Food Safety <![CDATA[New Survey: Americans like Mass Transit]]>

A new report on public transit, Who’s on Board: The 2014 Mobility Attitudes Survey, has good news for developers and planners. The review of transit across the United States by TransitCenter, a New York City-based non-profit aimed at increasing and improving mass transit, finds that Americans across the country think about and use public transit in remarkably similar ways. That can result in communities adopting good ideas from other regions—reducing cost and speeding up new and improved transit systems.

“We commissioned this survey to take a deeper look at the public attitudes which are propelling recent increases in transit ridership,” said Rosemary Scanlon, Chair of TransitCenter and Divisional Dean of New York University’s Schack Institute of Real Estate. “As Millennials begin to take center stage in American life and the Baby Boom generation confronts retirement, both the transit industry and the real estate industry will need to adjust.”

The survey—the largest of its kind, according to TransitCenter—reviewed online survey responses from nearly 12,000 people from 46 metropolitan areas across the country, including a mix of what the group refers to as “transit progressive” cities (such as Miami, Denver, Seattle and Minneapolis) and “transit deficient” cities (such as Tampa, Dallas, Fresno and Detroit.)

Among the findings:

  • When choosing whether or not to take public transportation, riders of all ages and in all regions place the greatest value on factors such as travel time, proximity, cost and reliability, putting them above safety, frequency and perks such as Wi-Fi.
  • There is a high demand for quality public transportation nationwide, but such infrastructure is often missing in the places where people currently live.
  • Fifty-eight percent of survey respondents said their ideal neighborhood contained “a mix of houses, shops and businesses,” but only 39 percent currently live in that type of neighborhood.
  • Mass transit attracts the wealthy as well as the poor. In New York City, Philadelphia, Washington, D.C., and Chicago, people with a salary of $150,000 or greater are just as likely to ride public transportation as people with a $30,000 salary.

“There is a desire for reliable, quality transportation in communities across all regions of the U.S., and among riders of all ages, backgrounds and financial status,” said David Bragdon, Executive Director of TransitCenter. “Unfortunately, this desire is largely going unmet, to the detriment of many local economies. To serve and attract residents and workforces today and in the future, cities need to unite land use and transit planning to form comprehensive, innovative infrastructures that can support this demand.”

The report is based on an online survey that TransitCenter plans to update regularly. Bragdon said that one innovation is the increased number of transit options in suburban areas for people who don’t plan to move to the city, but who still want some of the conveniences of city life. Daybreak, Utah, a suburb of Salt Lake City, for example, now has a buses, light rail stations, sidewalks and bike lanes. Planners say Daybreak took a “transit first” approach to new community development rail stations.

According to Bragdon, the survey will be updated and conducted regularly to track changes in transit rider attitudes and regional trends over time.

Thu, 18 Sep 2014 13:50:00 -0400 New Public Health Transportation Transportation policy Transportation <![CDATA[Public Health News Roundup: September 18]]> NPH_Public_Health_News_Roundup_Header

EBOLA UPDATE: Death Toll to at Least 2,622
(NewPublicHealth is monitoring the public health crisis in West Africa.)
The World Health Organization announced today that the Ebola outbreak in West Africa has now claimed at least 2,622 lives and infected at least 5,335 people. "The upward epidemic trend continues in the three countries that have widespread and intense transmission—Guinea, Liberia and Sierra Leone," the global health agency said in a statement, adding that the disease’s spread through Liberia is in large part due to an increasing number of cases in the capital of Monrovia. Read more on Ebola.

HHS to Sponsor the Development of a Portable Ventilator for Use in Public Health Emergencies
The U.S. Department of Health and Human Services (HHS) is sponsoring the development of a next-generation portable ventilator for use in pandemics and other public health emergencies. The low-cost, user-friendly device will be developed with Philips Respironics under a $13.8 million contract; the project will be overseen by the Biomedical Advanced Research and Development Authority (BARDA) within the HHS Office of the Assistant Secretary for Preparedness and Response. “In pandemics and other emergencies, doctors must have medicines, vaccines, diagnostics, and critical equipment such as mechanical ventilators at the ready in order to save lives,” said BARDA Director Robin Robinson, PhD, in a release. Read more on preparedness.

HUD Launches $1B National Disaster Resilience Competition
The U.S. Department of Housing and Urban Development (HUD) is launching a $1 billion National Disaster Resilience Competition to help state, local and tribal leaders prepare their communities for the impacts of climate change and other factors using federal funds. “The National Disaster Resilience Competition is going to help communities that have been devastated by natural disasters build back stronger and better prepared for the future,” said HUD Secretary Julián Castro, in a release. “This competition will help spur innovation, creatively distribute limited federal resources, and help communities across the country cope with the reality of severe weather that is being made worse by climate change.” Read more on disasters.

Thu, 18 Sep 2014 11:05:00 -0400 New Public Health Public health News roundups Ebola Preparedness Disasters <![CDATA[Can Idea Sharing Among CEOs Improve Health and Bring Down Health Care Costs?]]>

The Bipartisan Policy Center (BPC) in Washington, D.C., and nine CEOs from leading U.S. companies issued a report yesterday that lays out their ideas for improving individual and community health while reducing health care costs. The report, Building Better Health: Innovative Strategies from America's Business Leaders, shares strategies from all the companies and makes several recommendations:

  • Implement and track the outcomes of corporate health and wellness programs
  • Collaborate on the implementation of community-based programs
  • Improve the health care system by supporting the movement toward transparency and payment and delivery models that are based on outcomes rather than on volume

The CEOs are members of the BPC’s CEO Council and collectively employ more than one million people and provide coverage for over 150 million people. Council participants include McKinsey & Company, Aetna, Johnson & Johnson, The Coca-Cola Company, Verizon Communications, Bank of America, Blue Cross Blue Shield Association and Walgreens Co.

In addition to the report, the council released an interactive website with examples of initiatives the companies have taken to improve individual and community health. Some examples also improve the corporations’ bottom lines, such as Verizon’s partnerships with university research centers to test wireless health monitors that individuals or companies can download and buy through the technology company. However, David Erickson, director of the Center for Community Development Investments at the Federal Reserve Bank of San Francisco, points out that no for-profit company can afford the investments required for improving public health without also being able to see an impact on their own bottom line. Examples include increased sales and greater efficiencies in delivering health care.

For example, Walgreens has increased its share of flu shots given from fewer than one million in 2009 to more than seven million in 2013. While that represents improved income for the company, Walgreens—which has stores within three miles of 63 percent of Americans, 75 percent of African-Americans and 78 percent of Latinos—has also worked with state and federal health officials to publicize and increase immunization initiatives. It has also worked with many third-party payers so that patients are often fully or largely covered for the vaccines, with little or no copayment required. Retail clinics such as those at many Walgreen stores also often improve on current health care delivery, such as being open 365 days a year, unlike most doctors’ offices.

Wed, 17 Sep 2014 14:19:00 -0400 New Public Health Workforce issues Business Business <![CDATA[Public Health News Roundup: September 17]]> NPH_Public_Health_News_Roundup_Header

White House Announces Significant Increase in U.S. Ebola Response
Yesterday, NewPublicHealth reported President Obama’s initial planned response to the ongoing Ebola outbreak in West Africa. The White House has since expanded on the plans. They will include:

  • A military command center in Liberia.
  • A staging area in Senegal to help dispatch personnel and aid to affected communities more quickly
  • Personnel from the U.S. Public Health Service will deploy to a new field hospitals the U.S. is setting up in Liberia.
  • US AID will help distribute home kits with items such as gloves and masks to help reduce the number of Ebola cases.

Read more about Ebola.

Survey Finds Doctors are Overextended or At Capacity for Patients
A new survey of 20,000 doctors by the Physicians Foundation, a non-profit group that works with practicing physicians, finds that 81 percent of doctors say they are over-extended or at full capacity and only 19 percent indicate they have time to see more patients. Forty-four percent of doctors responding say they plan to take steps that would reduce patient access to their practices , including cutting back on patients seen, retiring, working part-time, closing their practice to new patients or seeking non-clinical jobs, leading to the potential loss of tens of thousands of physicians in the United States. The timing of the survey is significant because signup for health insurance coverage under the Affordable Care Act begins in just a few weeks. Read more about access to care.

Number of Smokers Increases in New York City
Earlier this week the New York City Health Department released new 2013 data showing that 16.1 percent of adult New Yorkers are smokers, a significant increase from the city’s lowest recorded adult smoking rate of 14 percent in 2010. For the first time since 2007, there are more than one million smokers in New York City who are at risk of developing a smoking-related illness, including heart disease, stroke, diabetes, emphysema, lung and other cancers, according to the health department. So far, the city does not have strong data to explain the uptick in smoking. Nationally, the U.S. Centers for Disease Control and Prevention estimates that 18 percent of U.S. adults are smokers, down from 20 percent several years ago. However, New York City is often a bellwether for public health issues, and the health experts across the country will be looking to see whether the city’s tobacco control efforts—including a new ad campaign that focuses on both daily and occasional smokers—have an impact on smoking rates. Read more on tobacco.

Wed, 17 Sep 2014 11:51:00 -0400 New Public Health Public health News roundups Ebola Access to Health Care Tobacco <![CDATA[Reading, Writing and Hands-Free CPR: AHA Calls for More CPR Training in Schools]]>

The American Heart Association (AHA) is working with dozens of state legislatures this year to develop laws that would add cardiopulmonary resuscitation (CPR) classes to middle or high school curricula. Nineteen states require in-school training for high school students, and more are expected to consider or implement the training in the next few years. In Virginia, for example, Gwyneth’s Law—named for a little girl who went into cardiac arrest and died waiting for an ambulance with no one with CPR training able to step forward to try to help—goes into effect in two years and makes CPR mandatory for high school graduation, unless students are specifically exempted.

The AHA says that by graduating young adults with the knowledge to perform CPR—now taught as a hands-only skill, with no mouth-to-mouth resuscitation so as to keep the emphasis on chest compressions—they can vastly reduce the number of Americans, currently 420,000, who die of cardiac arrest outside a hospital each year. The numbers are highest among Latinos and African-Americans, according to the AHA, largely because too many members of those communities have not been taught CPR. AHA surveys find that people who live in lower-income, African-American neighborhoods are 50 percent less likely to have CPR performed.

New AHA grants are helping fund the training in underserved areas. A 2013 study in Circulation: Cardiovascular Quality and Outcomes studied several underserved, high-risk neighborhoods to learn about CPR barriers. The researchers found that the biggest challenges for minorities in urban communities are cost (including child care and travel costs), fear and lack of information.

“Our continued research shows disparities exist in learning and performing CPR, and we are ready to move beyond documenting gaps to finding solutions to fix them,” said Dianne Atkins, MD, professor of Pediatrics at the University of Iowa. “School is a great equalizer, which is why CPR in schools is an integral part of the solution and will help increase bystander CPR across all communities and save more lives.”

The AHA has received funding from Ross, the national clothing store chain, for a program called CPR in Schools, which teaches hands-free CPR to seventh and eighth graders. As a way to increase training for minority students, AHA is partnering local Ross stores with nearby public schools where at least 50 percent of students receive free or reduced lunches.

>>Bonus Links:

  • Read a NewPublicHealth story about a pilot kiosk CPR trainer to teach hands-free CPR in the Dallas/Fort Worth Airport. The pilot program will expand to other locations in 2015.
  • Watch hands-only CPR training videos from the American Heart Association. Tip: First learn to hum “Staying Alive” by the Bee Gees. The beat is almost precisely the rhythm needed for effective CPR chest compressions. 
Tue, 16 Sep 2014 13:12:00 -0400 New Public Health Access and barriers to care Medically underserved areas Access to Health Care School Health <![CDATA[Public Health News Roundup: September 16]]> NPH_Public_Health_News_Roundup_Header

EBOLA UPDATE: Obama to Commit as Many as 3,000 Troops to Epidemic Response
(NewPublicHealth is monitoring the public health crisis in West Africa.)
President Obama will today announce an expansion of military and medical resources that could send as many as 3,000 people to West Africa to help combat the ongoing Ebola outbreak. According to The New York Times, the United States will help train health workers and build as many as 17 Ebola treatment centers, which will house approximately 1,700 treatment beds. The U.S. Department of Defense will also open a joint command operation in Liberia in order to coordinate an international response to the outbreak. Read more on Ebola.

Report: 1 in 9 People Worldwide are Chronically Undernourished
An estimated 805 million people in the world are chronically undernourished, according to a new report, The State of Food Insecurity in the World 2014, from the Food and Agriculture Organization of the United Nations. While that means that approximately one in every nine people are undernourished, the number is down more than 100 million over the past decade and 209 million since 1990-1992. In the past two decades the prevalence of undernourishment has also dropped from 23.4 percent to 13.5 percent in developing countries. According to the health agency, the eradication of hunger requires a sustained political commitment that emphasizes food security and nutrition. Read more on global health.

SAMHSA: Percentage of Youth Using Illegal Drugs is Down Over the Past Decade
The percentage of U.S. teens using illegal drugs is down over the past decade, according to a new study from the Substance Abuse and Mental Health Services Administration’s (SAMHSA). The report, the 2013 National Survey on Drug Use and Health, found that the rate of illicit drug use in the past month for adolescents ages 12-17 was 8.8 percent, down from 9.5 percent in 2012 and 11.6 percent in 2002. From 2002 to 2013, the percentage of youth in that age group with a substance abuse or dependence problem dropped from 8.9 percent to 5.2 percent. “This report shows that we have made important progress in some key areas, but that we need to rejuvenate our efforts to promote prevention, treatment and recovery to reach all aspects of our community,” said SAMHSA Administrator Pamela S. Hyde, in a release. “The real lives represented by these statistics deserve our protection and help from the ravages of substance use disorders. Through a comprehensive, national effort we can help people avoid, or recover from substance use problems and lead, healthy, productive lives.” Read more on substance abuse.

Tue, 16 Sep 2014 10:36:00 -0400 New Public Health Public health News roundups Ebola Global Health Substance Abuse <![CDATA[Recommended Reading: Some Drugs—Especially Oncology Medicines—Have Been in Short Supply for Too Many Years]]> NPH_RecommendedReadingHeader

Health Affairs and the Robert Wood Johnson Foundation recently released an issue brief on the continuing shortages of certain drugs, most frequently injectable drugs for cancer treatment. According to the issue brief, there have been fewer reports of newly unavailable drugs in the last few years, but problems remain, forcing many patients to skip some treatments or sometimes opt for a less-effective drug. U.S. Food and Drug Administration (FDA) updates on drug shortages in just the first two weeks of September found sixteen injectable drugs in short supply, two of them new to the list.

Recent Government Accountability Office reports have found several reasons for the shortages, including:

  • Difficulty acquiring raw materials
  • Manufacturing problems
  • A loss of drug products when factories are updated and modernized
  • Low reimbursement by Medicare and other government payment programs
  • FDA regulations that may slow down new drug approvals

The authors of the issue brief say that it is unlikely that Congress will act, and that the industry has and will make changes likely to help bolster some supplies. Also, thorough reviews such as the current issue brief help remind policymakers that some drug shortages remain.

Read the full issue brief.

Mon, 15 Sep 2014 11:39:00 -0400 New Public Health Prescription drugs Access and barriers to care Recommended Reading Prescription drugs <![CDATA[Public Health News Roundup: September 15]]> NPH_Public_Health_News_Roundup_Header

EBOLA UPDATE: Obama to Announce New Ebola Plan Tomorrow
(NewPublicHealth is monitoring the public health crisis in West Africa.)
President Obama is expected to make an announcement tomorrow detailing the United States’ increased involvement in combatting the Ebola outbreak in West Africa. The plan would likely involve an increased U.S. military presence; the government has already committed approximately $100 million related to protective equipment for health care workers; food; water; and medical and hygiene equipment. More than 2,400 people have so far died in the outbreak. Read more on Ebola.

HHS: $295M to Expand Health Services for 1.5M New Patients
Late last week, the U.S. Department of Health and Human Services (HHS) announced $295 million in funds to enable 1,195 health centers across the country to hire approximately 4,750 new staff, stay open later and expand their services to cover areas such as oral health, behavioral health, pharmacy and vision services. The funds are available through the Affordable Care Act. HHS estimates that this will help 1.5 million new patients. “These funds will enable health centers to provide high-quality primary health care to more people including the newly insured, many of whom may be accessing primary care for the first time,” said HHS Secretary Sylvia M. Burwell, in a release. Read more on the Affordable Care Act.

Study: 11 Million Unnecessary Antibiotic Prescriptions for Kids Annually
Physicians prescribe antibiotics for kids approximately twice as often than they are needed, contributing to the growing problem of antibiotic resistance, according to a new study in the journal Pediatrics. Researchers analyzed a selection of studies published between 2000 and 2011, as well as data on children examined at outpatient clinics, finding that an estimated 27 percent of U.S. children with infections of the ear, sinus area, throat or upper respiratory tract had illnesses caused by bacteria, yet antibiotics were prescribed for approximately 57 percent of these visits. They estimate that there are more than 11 million such unnecessary prescriptions for kids each year. Read more on prescription drugs.

Mon, 15 Sep 2014 10:49:00 -0400 New Public Health Public health Affordable Care Act Ebola News roundups Prescription drugs Pediatrics <![CDATA[Faces of Public Health: Q&A with Andrea Gielen, the Johns Hopkins Center for Injury Research and Policy]]> NPH_Faces_AndreaGielen

The U.S. Centers for Disease Control and Prevention (CDC) recently awarded $4 million to the Johns Hopkins Center for Injury Research and Policy at the Bloomberg School of Public Health to further fund its work on injury prevention research and policy development. According to the CDC, injuries are the leading cause of death in the United States among people ages 1 to 44, costing the country $406 billion each year. And across the globe, 16,000 people die from largely preventable injuries every day.

“This funding will allow us to advance our work in closing the gap between research and practice in new and innovative ways,” said Andrea Gielen, ScD, ScM, the center’s director. “Whether fatal or non-fatal, injuries take an enormous toll on communities. Our faculty, staff and students are dedicated to preventing injuries and ameliorating their effects through better design of products and environments, more effective policies, increased education and improved treatment.”

The five-year grant will support several innovative research projects on key issues, including evaluating motor vehicle ignition interlock laws, studying universal bicycle helmet policies, testing m-Health tools to reduce prescription drug overdose and evaluating programs to prevent falls among older adults. The center will also continue to offer training and education to public health students and practitioners, as well as to new audiences that can contribute to injury prevention.

NewPublicHealth recently spoke with Gielen about the CDC grant

NewPublicHealth: What are the goals for each of the four research areas for which you’ve received funding?

Andrea Gielen: Each of the four is a full research projects with specific aims. For example, with ignition interlock laws—which are car ignitions that can’t start unless a breathalyzer confirms that a driver is sober—there’s been a little bit of evidence that they reduce alcohol-related motor vehicle crash injuries and deaths, but there are two gaps. There has never been a national study of the impact of these laws, and we don’t know a whole lot about how they’re implemented. What is it about ignition interlock policies and how they’re implemented that’s really related to their impact on reducing fatal crashes?

We want to look at all four projects in the same way: We’ll be looking at barriers and facilitators to how policies that we think are effective are adopted and implemented, and what it is about that adoption and implementation of the processes that make these policies effective. 

I think that our center is uniquely positioned to do that kind of research and to say: we know these things have promise, how do we get them widely adopted so everyone is protected?

NPH: What makes this kind of research different from other kinds of medical research?

Gielen: That’s really one of the great things about injury as a public health problem. We know lots of things that work to reduce injuries. It’s not like we have to find a gene. We have a lot of evidence about what works, but what we don’t know is how we get these effective strategies widely disseminated across the population, and in particular to populations that are disproportionately affected by injuries.

NPH: How do you do that dissemination?

Gielen: We do that in a number of ways. We have a commitment to where we are geographically located to Baltimore, Md., and the region around our state, so we do a lot of work with local stakeholders by giving them the evidence they need for policies and programs that they can implement locally and regionally. We do that by providing technical assistance, getting them access to the best evidence that they need for a particular problem and testifying locally.

But we also have a real mission to do that nationally. We’re a national resource, and so we have partners. We often work with the National Conference of State Legislatures, for example, and with Trust for America’s Health (TFAH). With TFAH, we’ve worked on two reports, the top ten injury prevention policies that states should have, and then most recently on their prescription pain medication report.

With those reports I also did some of the media tours to answer questions on the evidence and policies. And our faculty writes op-eds and letters to the editor. We always try to do a lot more than just publish our results in our peer-reviewed journals, which of course we do a great deal of. But with this new funding, one of the things we’re really excited about being able to do is something that we’re calling a translation symposium and compendium. In the translation compendium our goal is to have one place that people in the practice community can go to for things like op-eds, press releases and policy briefs on the topics we’re investigating.

And then, building on that, we’re going to have a symposium. Initially, it will be a regional injury and violence prevention translation symposium that people can participate in on campus or access virtually online. We’re going to identify best-available research evidence and have conversations with practitioners about what is it that we know and ask participants what it is that we don’t know that, if we could find it out for you, would be helpful.

One of the key things that we say about our center is that we tried to close the gap between research and practice, and we try to do that not just by pushing out the research, but by trying to find ways to listen to practitioners in health departments and hospitals, as well as policymakers.

NPH: What is a good example of an area where research has been effective in preventing injury?

Gielen: Motorcycles is a great one because there is evidence that on an individual basis, motorcyclists have less of a chance of a head injury if they’re wearing a helmet. But also, research on a population level was clearly showing that having laws requiring motorcycle helmet use was associated with population-wide reductions in injuries and deaths to motorcyclists. And that has such an interesting history because there’s the evidence that it works. There are laws that are passed. There are people who don’t like those laws so the laws get rescinded, and what happened with the motorcycle helmet story is that because we knew individually and on a population basis that helmets and laws about helmets were effective, but even more dramatically, when those laws were rescinded in states, you could actually see the increase in motorcyclist injuries and deaths after the law was taken away.

That’s a clear example of the critical importance of research and surveillance in trying to, first, identify effective strategies and then to look at what happens when they’re applied to populations. That same is true of graduated driver licensing policies for new drivers, which has the same kind of history where we have solid evidence that it saves kids’ lives.

Motor vehicle safety is called one of the greatest public health achievements of the last century, and scholars who have looked at that repeatedly identify points along that way where research informed both how we communicated with the public and educated the public and, importantly, the policies that were put in place to reduce alcohol-related driving, to increase the use of seatbelts and to increase the use of child restraint devices. There’s a great story there about the need for, in addition to those things, improving the environment so that we made cars safer. We made roads safer. We educated the public and we passed laws, and through that whole process all of those things were evidence informed, and we were able to monitor and track what was working and what wasn’t working.

That’s injury research. That’s our history. That’s what we do.

NPH: What’s your next milestone?

Gielen: There are so many things that we’re focusing on. One of the key reasons it’s so important to have this center and the new funding is because it gives us the infrastructure to bring together faculty, students, and staff who cover everything from engineering to law and policy and behavior and communication, so we have this enormous breadth as well as depth of disciplines that are really needed to identify the next big hazards. So, for example, recently our portfolio has increased to include work on prescription drug overdose. And because we have the infrastructure and the wide range of different areas of expertise, we’re really able to be nimble and to stay on top of what is the new hazard because every time you turn around, there is a new hazard.

Another new thing that we’ve been working on is pedestrian safety. That sounds like an old topic, but the hazards have changed. We now have an enormous problem with distracted walking, and the rates of people getting injured while they’re on a cell phone crossing the street, have doubled in the past few years.

We’re able to make sure that we are positioned to respond to these emerging threats as they occur.

NPH: How does injury prevention help move us toward a culture of health?

Gielen: If you look at what largely preventable injuries cost us every year, it’s a staggering toll—not just for the pain and suffering of individuals and their families, but financially on the country. Injury is front and center in thinking about the population’s health. It’s an expensive, largely preventable health condition that everyone has a stake in. For example, the big push on reducing obesity and promoting physical activity is really important and something that obviously we have to be doing, but that’s a good example of how injury prevention can contribute to that because the last thing we want to do is turn couch potatoes into trauma patients.

And, if we don’t have a safe environment and if people don’t know how to be physically active in ways that also protect them that can happen. You need to make sure people have bike helmets if they’re going to go out and bicycle. You need to know that pedestrians who want to increase their walking have safe places to walk.

We have talked about the culture of safety in work places and protecting workers, so I think the culture of health is a great umbrella that covers health and safety. 

Fri, 12 Sep 2014 11:48:00 -0400 New Public Health Injury Public policy Injury Prevention Faces of Public Health Q&A <![CDATA[Public Health News Roundup: September 12]]> NPH_Public_Health_News_Roundup_Header

EBOLA OUTBREAK: WHO Says Ebola is Spreading at a Faster Rate than Health Workers Can Handle
(NewPublicHealth is monitoring the public health crisis in West Africa.)
Earlier this week, the World Health Organization (WHO) announced that the Ebola outbreak in West Africa—the largest in history—shows no signs of slowing down. Today the global health organization followed that by declaring that health officials are currently unable to handle the growing number of cases. "In the three hardest hit countries, Guinea, Liberia and Sierra Leone, the number of new cases is moving far faster than the capacity to manage them in the Ebola-specific treatment centers," said Margaret Chan, the WHO director-general, according to CNN. "Today, there is not one single bed available for the treatment of an Ebola patient in the entire country of Liberia." More than 2,400 people have died from Ebola since the start of the outbreak. Read more on Ebola.

Study: Majority of Nursing Home Residents with Advanced Dementia Receive Questionable Medications
The majority of nursing home residents dealing with advanced dementia receive medications that are both questionable—if not outright ineffective—and cost them needless amounts of money, according to a new study in JAMA Internal Medicine. In a review of 5,406 nursing home residents with advanced dementia, researchers determined that slightly more than half (53.9 percent) received at least one medication with questionable benefit; the medications constituted approximately 35.2 percent of the total cost of care for those patients. According to the researchers, the patients’ goals of care should dictate the treatment they receive when dealing with a terminal illness, and medications that don’t promote that primary goal should be minimized. Read more on aging.

Study: ‘Fat Shaming’ is Counterproductive
“Fat shaming” does not promote weight loss and in fact can be counterproductive, according to a new study in the journal Obesity. In an analysis of nearly 3,000 adults tracked over four years, researchers determined that weight discrimination was associated with a weight gain of approximately 2 pounds, while the participants who reported no fat shaming lost an average of 1.5 pounds. "Our study clearly shows that weight discrimination is part of the obesity problem and not the solution," said the study's senior author, Jane Wardle, director of the Cancer Research UK Health Behaviour Centre at University College London (UCL), in a release. "Weight bias has been documented not only among the general public but also among health professionals, and many obese patients report being treated disrespectfully by doctors because of their weight. Everyone, including doctors, should stop blaming and shaming people for their weight and offer support, and where appropriate, treatment.” Read more on obesity.

Fri, 12 Sep 2014 10:46:00 -0400 New Public Health Public health Ebola Aging Obesity News roundups <![CDATA[For the Homeless, a Place to Call Home After a Hospital Stay]]>

A comment period has just opened, through September 30, on proposed minimum standards for medical respite centers for the homeless. Medical respite centers provide an indoor, supported home where discharged homeless hospital patients can convalesce instead of immediately returning to the street.

Experts on homelessness says strong standards and compliance with them can result in not just reducing hospital readmission for discharged homeless patients, but also an increase in permanent housing solutions for people who entered the hospital without a place to call home. In fact, about 80 percent of homeless people who enter a respite facility move onto housing options instead of back to the street, according to Sabrina Eddington, director of special projects at the National Health Care for the Homeless Council (NHCHC).

Medical Respite Centers Location of medical respite centers in the United States

Eddington says that having the standards in place is critical. An estimated 150,000 people who have no permanent address are discharged from the hospital each year, based on state estimates. Going back to the street can mean reinfection, hospital readmission and an inability to keep up with care, such as daily medication that could improve, stabilize and even cure both physical and emotional health problems.

Medical respite care centers range from free-standing centers to sections of homeless shelters, and even vouchers for motels and hotels with home visits by medical and social support staff.

The proposed minimum standards were published on September 1 and a comment period runs through September 30. The NHCHC will hold a webinar tomorrow, September 12, from 1-2:30 EST. Click here to register.

The goals of the guidelines for the respite care centers are to:

  • Align with other health industry standards related to patient care
  • Represent the needs of the patients being served in the medical respite centers.
  • Promote quality care and improved health
  • Create standards for a range of respite center types with varying degrees of resources

NHCHC has dozens of stories about previously homeless patients who were discharged to medical respite care and are now living in stable housing, often with no need for hospital readmission. Take Ahmed. After losing his family and business, Ahmed moved to the street, where he struggled with alcoholism and depression. In 2005, Ahmed had a stroke and was hospitalized. Following discharge he was back on the street until an outreach team brought him to a medical respite program, where he was medically stabilized; received help for his depression; and referred to a program that specializes in treating co-occurring mental illness and addiction. Ahmed is now in supportive housing and participating in a recovery program. He continues to visit his primary care clinic and psychiatrist and has not been hospitalized since the stroke occurred.

There are now dozens of medical respite facilities throughout the community, and NHCHC is hopeful about expanding the models.

“We advocate that medical respite services be available in all communities serving homeless clients,” said Eddington.

Earlier this summer, NHCHC was one of 39 Health Care Innovation Award recipients announced by the U.S. Department of Health and Human Services. The $2.6 million award is administered by the Center for Medicare and Medicaid Innovation and will be used to demonstrate improved health outcomes and reduced spending when homeless patients have access to medical respite care following a hospital stay. The three-year project will test a model that will provide medical respite care for homeless Medicaid and Medicare beneficiaries, following discharge from a hospital, with the goal of improving health, reducing readmissions and reducing costs.

>>Bonus Links:

Thu, 11 Sep 2014 13:47:00 -0400 New Public Health Homeless Shelters Access to Health Care Housing Health disparities <![CDATA[Public Health News Roundup: September 11]]> NPH_Public_Health_News_Roundup_Header

EBOLA UPDATE: Gates Foundation Commits $50M to Fight Ebola Epidemic
(NewPublicHealth is monitoring the public health crisis in West Africa.)
The Bill & Melinda Gates Foundation will commit $50 million to combat the ongoing Ebola outbreak in West Africa. The flexible funds will enable United Nations agencies and international organizations to purchase supplies and scale up their operations; the funds will also go toward the development of Ebola treatments. The foundation has already committed $5 million to the World Health Organization for emergency operations and R&D assessments and $5 million to the U.S. Fund for UNICEF to support public health efforts in Liberia, Sierra Leone and Guinea. “We are working urgently with our partners to identify the most effective ways to help them save lives now and stop transmission of this deadly disease,” said Sue Desmond-Hellmann, CEO of the Gates Foundation, in a release. “We also want to accelerate the development of treatments, vaccines and diagnostics that can help end this epidemic and prevent future outbreaks.” Read more on Ebola.

CDC: Millions of U.S. Kids Don’t Receive Proper Preventive Care
Millions of U.S. infants, children and adolescents do not receive key clinical preventive services, according to the U.S. Centers for Disease Control and Prevention’s (CDC) latest Morbidity and Mortality Weekly Report (MMWR) Supplement. Preventive services from doctors, dentists, nurses and allied health providers help prevent and detect diseases in their earliest stages, when they are the most treatable. Among the report’s findings:

  • In 2007, parents of 79 percent of children aged 10-47 months reported that they were not asked by health care providers to complete a formal screen for developmental delays in the past year.
  • In 2009, 56 percent of children and adolescents did not visit the dentist in the past year and 86 percent of children and adolescents did not receive a dental sealant or a topical fluoride application in the past year.
  • 47 percent of females aged 13-17 years had not received their recommended first dose of HPV vaccine in 2011.
  • Approximately 31 percent of outpatient clinic visits made by 11-21 year-olds during 2004–2010 had no documentation of tobacco use status; 80 percent of those who screened positive for tobacco use did not receive any cessation assistance.
  • Approximately 24 percent of outpatient clinic visits for preventive care made by 3-17 year olds during 2009-2010 had no documentation of blood pressure measurement.

“We must protect the health of all children and ensure that they receive recommended screenings and services. Together, parents and the public health and healthcare communities can work to ensure that children have health insurance and receive vital preventive services,” said Stuart K. Shapira, MD, PhD, chief medical officer and associate director for science in CDC’s National Center on Birth Defects and Developmental Disabilities. “Increased use of clinical preventive services could improve the health of infants, children and teens and promote healthy lifestyles that will enable them to achieve their full potential.” Read more on pediatrics.

GAO: More Data Needed to Help Veterans Readjust to Civilian Life
More information is needed in order to best provide services to military veterans readjusting to civilian life, according to a new review by the U.S. Government Accountability Office (GAO). The review found that while many veterans readjust with little difficulty, others experience financial, employment, relationship, legal, housing and substance abuse difficulties. While the U.S. Department of Veterans Affairs is working to improve veteran wellness and economic security, “there is limited and incomplete data to assess the extent to which veterans experience readjustment difficulties,” according to the GAO. Read more on the military.

Thu, 11 Sep 2014 10:43:00 -0400 New Public Health Public health News roundups Ebola Pediatrics Military <![CDATA[With Classes Well Underway, It’s a Good Time for Colleges and Universities to Think about their Campus Tobacco Policies]]>

Just a few weeks ago the Bloomberg School of Public Health at Johns Hopkins University announced that it had launched the Tobacco-Free Campus Initiative, which prohibits the use of any tobacco product—not just cigarettes—in all buildings, facilities and vehicles. The initiative also forbids e-cigarettes and discourages the use of tobacco products on all outdoor campus grounds. Organizers of the initiative say that deterring the use of tobacco in all forms is crucial to protect the health of the students and workforce of the campus community.

“By keeping out all tobacco products, the initiative ensures that the School doesn’t unintentionally encourage or reinforce tobacco addiction among students, faculty and staff,” according to a statement released by the school.

However, the rest of the university won’t be taking the same steps, at least for now. In 1991, all Johns Hopkins campuses followed the example first set by the School of Public Health in becoming smoke-free, said Dennis O’Shea, a spokesman for the university, adding that the “school could follow the new initiative, but no decision has been made.”

Hopkins is not the only college deliberating. While there are a few states that require state campuses to adopt smoke-free policies most campuses voluntarily adopt them, according to Cynthia Hallett, the executive director of Americans for Non-Smokers Rights (ANR). According to ANR, there are a little more than 4,000 colleges and universities in the United States, and as of July 2014 there were 1,372 smoke-free campuses in the United States, of which 938 are 100 percent tobacco-free and 176 prohibit the use of e-cigarettes anywhere on campus. That’s up from 446 smoke-free campuses in 2010; reporting on tobacco-free campuses began in 2012, when there were 608.

Credit some of that change to the Tobacco-Free College Campus Initiative (TFCCI) of the U.S. Department of Health and Human Services (HHS), launched two years ago to promote and support the adoption and implementation of tobacco-free policies at colleges and universities. TFCCI is a partnership of HHS, the American College Health Association and the University of Michigan, with sponsorship from the American Legacy Foundation.

While support for making campuses smoke- and even tobacco-free is growing, it’s hardly a slam dunk, especially when the move requires students to vote. Universities say opposition can come from foreign students who are sometimes more likely to smoke than their U.S. counterparts or contract employees who don’t want to be barred from smoking on campus. It can even come from the media. Two years ago, when UCLA announced its campus-wide tobacco free policy, the Los Angeles Times published an editorial titled “A Smoke Free UC Goes too Far” which said that “[s]moking is a detestable, dangerous habit—but it's also a legal one, and there is plenty to say in defense of allowing adults to make bad decisions if they're not breaking the law or harming others.”

Hoping to get the initiatives to pick up steam, TFCCI has launched challenges aimed at getting more campuses—and their students, faculty and employees—to give up their smokes.

>>Bonus Links:

Wed, 10 Sep 2014 13:26:00 -0400 New Public Health Tobacco Tobacco control Tobacco School Health <![CDATA[Public Health News Roundup: September 10]]>

EBOLA UPDATE: Death Toll Now to at Least 2,296
(NewPublicHealth is monitoring the public health crisis in West Africa.)
The death toll from the ongoing Ebola outbreak in West Africa is now at least 2,296, according to the World Health Organization. However, the global health agency does not have the latest figures from Liberia—the country that has been hit hardest by the disease—making the true toll likely much higher. "It remains a very grave situation," said Liberian President Ellen Johnson Sirleaf on Tuesday, according to Reuters. "It is taking a long time to respond effectively .... We expect it to accelerate for at least another two or three weeks before we can look forward to a decline." As of Sept. 6 there were 4,293 recorded cases in five countries. Read more on Ebola.

Johns Hopkins Bloomberg School of Public Health, Clinton Foundation Announce Consensus Statement on Treating Prescription Drug Abuse and Misuse
The Johns Hopkins Bloomberg School of Public Health and the Clinton Foundation have released a consensus statement calling for a public health frame to analyze and disseminate proven, evidence-based intervention to combat prescription drug abuse and misuse. The statement is in response to President Clinton’s call-to-action on the subject in May of this year. “Prescription drug abuse and misuse, as well as widespread addiction and diversion of these products to the illicit market, represents one of the greatest challenges to our country’s public health in recent memory,” said Michael J. Klag, MD, MPH, dean of the Johns Hopkins Bloomberg School of Public Health, in a release. “This consensus statement marks a continuation of our school’s commitment, as well as that of the Clinton Foundation, to address epidemic rates of poisonings and deaths that are occurring due to prescription opioids and other prescription drugs that are highly prone to abuse and misuse.” According to the U.S. Centers for Disease Control and Prevention, drug overdoses killed 41,430 people in 2011, making it the leading cause of injury deaths. Read more on substance abuse.

CDC: 90% of Youth Ages 6-18 Consume Too Much Sodium
Approximately 9 in 10 U.S. children ages 6-18 consume more than the recommended amount of sodium, according to a new report from the U.S. Centers for Disease Control and Prevention (CDC). The report also found that approximately 43 percent of the sodium comes from the ten foods they eat the most often: pizza; bread and rolls; cold cuts/cured meats; savory snacks; sandwiches; cheese; chicken patties/nuggets/tenders; pasta mixed dishes; Mexican mixed dishes; and soups. “Too many children are consuming way too much sodium, and the result will be risks of high blood pressure and heart disease in the future,” said CDC Director Tom Frieden, MD, MPH, in a release. “Most sodium is from processed and restaurant food, not the salt shaker. Reducing sodium intake will help our children avoid tragic and expensive health problems.” Read more on nutrition.

Wed, 10 Sep 2014 10:27:00 -0400 New Public Health Public health News roundups Ebola Nutrition Prescription drugs Substance Abuse <![CDATA[The Ebola Response: Q&A with Laurie Garrett, Council on Foreign Relations]]> file

Almost every day brings reports of new cases of Ebola, the often-fatal virus now impacting multiple countries in West Africa. According to the U.S. Centers for Disease Control and Prevention (CDC), the 2014 Ebola outbreak is the largest Ebola outbreak in history. Spread of the disease to the United States is unlikely—although not impossible—and efforts are underway to find vaccines and cures, including scale-ups of drug development and manufacturing, as well as human trials for vaccines both in the United States and around the world. However, in West Africa the epidemic is impacting lives, economies, health care infrastructure and even security as countries try a variety of methods—including troop control—to get citizens to obey quarantines and other potentially life-saving instructions.

Late last week, NewPublicHealth spoke with Laurie Garrett, senior fellow for global health at the Council on Foreign Relations. Garrett has written extensively on global health issues and was on the ground as a reporter during the Ebola outbreak in Zaire in 1995.

NewPublicHealth: What are your key concerns with respect to the current Ebola outbreak?

Laurie Garrett: My main concern has been about the nature of the international response, which could be characterized as non-response until very recently. And now that the leadership of the international global health community has finally taken the epidemic seriously, it’s too late to easily stop it. We’ve gone through the whole list of all the usual ways that we stop Ebola and every single one of them was initiated far too late with far too few resources and far too few people—and now we’re in uncharted territory. We’re now trying to tackle a problem that has never reached this stage before and we don’t know what to do. The international response is pitiful, disgusting and woeful.

NPH: How do you account for such a poor response?

Garrett: First of all, the World Health Organization (WHO) is a mere shadow of its former self. When I was involved in the Ebola epidemic in 1995 in Kikwit, Zaire, the WHO was recognized worldwide as the leader of everything associated with outbreaks and infection, and it acted aggressively. It didn’t have a huge budget, but it still was able to take the problem very seriously and the resources that were needed were available, and more importantly a very talented leadership team combining the resources of the U.S. Centers for Disease Control and Prevention; WHO; Medicin San Frontiers (Doctors Without Borders); and the University of Kinshasa, Zaire, came together. They respected each other. They were on board together. They worked very closely with the local Red Cross, and they were able to conquer the problem pretty swiftly. 

In contrast, the current outbreak is, first of all, urban. We’ve never seen that before. It’s in at least five countries, three with really rampant spread. Though it seems to involve a familiar strain—the exact same strain as was responsible for the 1976 original epidemic—it’s mutating, and we really don’t know what the mutations signify or what changes may occur with the virus.

And I feel that WHO’s many major budget cuts are impacting the effort, including a 20 percent layoff of its staff, operating with a total annual epidemic and crisis response budget of only $114 million. It’s pathetic. If we don’t radically change everything immediately then we will lose. The virus will win.

NPH: Do you see a ramping up happening?

Garrett: Yes, things are starting, but they’re starting months too late. We don’t even have a designated bank account for deposits from donors. Such basic things have not been accomplished, and we only just got the announcement two days ago that one country, Ghana, is willing to serve as the air bridge for the transport of goods and material and personnel in and out of the epidemic, despite the fact that the outbreak begin last March. And this is an air bridge in principle. In practice, do we have personnel on the ground in Accra, Ghana? Do we have processing of supplies? Do we have warehouse facilities? Do we have a chain of command for decision making? Do we have a system for saying what is needed where in the field, sending that back up and responding at the warehouse level to get supplies, personnel and equipment in in a timely fashion? No. We don’t have any of that. We’re all the way out to September. We don’t have a single one of those pieces in place. It’s appalling.

For 14 years, the WHO struggled to get the nations of the world to agree to the new international health regulations (IHR) which finally passed in 2005 and went into effect in 2010. Among the things in the IHR is the stipulation that the WHO is in charge in a serious epidemic, but it also is a UN agency that never believes it can walk into any situation without the complete cooperation of the local government and that it only serves to support the local government in whatever it’s doing. So now we have three of the weakest governments on planet Earth—three of the poorest countries on planet Earth—two of which went through the bloodiest, most hideous civil wars in modern times, and we’re all waiting for them to take charge? We’re all waiting for them to have the capacity to do something that no country in the world has done: Fight Ebola on a scale that it now exists?

So, we have this contradictory international set up. We don’t have any agreed-upon global government structure outside of the rules of the United Nations. We don’t have any system whereby international responders can pour into a site and do what needs to be done. Everything is done with the careful, tedious permission mechanism country-by-country. No borders get crossed without the permission of the country, and no penalties are applied by anyone—even the Security Council—against governments that refuse to allow border crossings even for medical responders, and that is occurring at this time.

NPH: What recommendations do you have for the global response?      

Garrett: Inside Liberia, Sierra Leone and Guinea right now—and probably Nigeria—each of these countries has its own internal issues to deal with, many of which stem from the legacy of the civil war and the distrust that still is pervasive across all the different cultural, religious and ethnic groups inside the countries. No outside force can come in and solve that problem. That’s up to them. What outsiders can do is assist with the technology of communication. So, for example, if the president of Liberia wanted to be able to give rapid notification to all the people of Liberia on a daily or even multiple-times-a-day basis about the movements of the virus and where it might be—where cases might be appearing and so on—she might turn to outsiders to develop an appropriate cell phone app for distribution of that message. But the content of message—the cultural flavor of that message—is up to Liberians. Outsiders cannot make that determination.

Right now, there’s so much not done that you almost have to do everything at once. Within the next week we should have sorted out the following:

One, there should be an international acceptable, transparent and accountable central bank repository with a central control over the flow of financial resources dedicated to this epidemic. It is logical that it should be based at the World Bank. Representatives of all affected countries, as well as the largest donors, should sit on the board that oversees that account, and it should be an account that can accept not only government donations, but also private-sector donations so that corporations that do business in these countries can make donations. How that money gets meted out should be determined by a board to which everyone is a representative that oversees the decision process—not a day-by-day meeting to decide spending, but an oversight on the accountability and making sure that no country feels like some other country is getting too much money and they’re not getting enough. 

The second thing that should be in place immediately is a command and control structure. Included in that is centralization of information regarding human resources. One estimate put out last week is that we need 11,000 health care workers on the ground right now. Eleven thousand? Where the heck are these people going to come from and how do we manage the fatigue and exhaustion issues and rotate people out of danger for two-week R&Rs and then back in, the way MSF is doing? And who screens the volunteers? I’m sure there’re a lot of people out there that would raise their hand and say “I want to be a hero, send me to the epidemic.” But are they the type of people you really want to put on the ground? Do they know what they’re doing, or would they be more trouble than they’re worth? We don’t need to have any more infected health care workers and we need to be sure that people know the procedures and follow them and that they understand what the chain of command is and follow it.

You can’t recruit from 200 countries around the world for skilled personnel to get to where they’re needed in a hurry unless you have a centralized control and command structure of some sort. We need a staging area. Not just saying that Accra will allow planes to land and come and go from the epidemic. That’s great, but where are the warehouses and who is going to be overseeing the warehouses?

The scale of what we need right now is commensurate with the scale of the response in 2005 when the great tsunami overwhelmed Aceh, Indonesia and Southern Thailand, Malaysia and Sri Lanka. That involved almost the entire Pacific fleet of the U.S. Navy just to move supplies, and we don’t see anything akin to that now.

NPH: Who is taking the lead now?

Garrett: On August 12, U.N. Secretary General Ban Ki-moon appointed David Nabarro a special coordinator for the entire U.N. Ebola response. Nabarro played the same role in 2005 regarding H5N1 bird flu and the possibility of a giant pandemic coming of super deadly influenza. He knows how to do it. He knows all the players. He knows what the different problems are and foibles and weaknesses of the various agencies within the UN family.

The problem is that this is bigger than the UN family, and what we don’t have is any kind of coordinating mechanism and ability to kick butt that extends beyond the boundaries of what classically is considered under control of the United Nations. And Nabarro, he’s not a miracle worker. If, for example, MSF put out a call saying they wanted military medical response, then the single greatest rapid response force for medical disasters on the planet today is the U.S. Army and Marines, because we’ve now been fighting on multi-fronts in combats since 2001, and we have battle-hearty, danger-experienced medical teams in mobile units that can drop into a location and within less than 10 hours be treating patients. MSF wants them on the ground. But those are U.S. military personnel. Does Liberia want uniformed U.S. military personnel on its soil? Does Sierra Leone, does Guinea, does Nigeria? These sorts of things are very tough decisions. They have political layers that are very difficult to sort through on a rapid basis or even to anticipate repercussions down the line.

[Editor’s Note: On Sunday, the White House announced that the Pentagon will send a 25-bed field hospital to Liberia to help provide medical care for health worker. According to a Pentagon spokesman, the hospital will be set up by the U.S. military and then turned over to the Liberian government to operate. There are no current plans for the U.S. military to provide medical treatment.]

We have a kind of hodgepodge, ad hoc committee approach to solving these things. It’s not ideal. What we are now seeing, what the world is now witnessing, is the frailties of globalization—a system that was developed for globalized trade and economics, but has never functioned well for globalized governance in a crisis.

>>Bonus Links: FRONTLINE will air a documentary this evening—called “Ebola Outbreak”—filmed in Sierra Leone, one of the West African countries currently grappling with the epidemic. Read more from PBS about Ebola, then check local listings for the documentary air time and station.  

Tue, 9 Sep 2014 11:56:00 -0400 New Public Health Public health Barriers to care: logistics and transportation Ebola Global Health Q&A <![CDATA[Public Health News Roundup: September 9]]> file

EBOLA UPDATE: Liberia Experiencing an Exponential Increase in Infections
(NewPublicHealth is monitoring the public health crisis in West Africa.)
The World Health Organization (WHO) estimates that Liberia will see thousands of new Ebola cases over the next several weeks. "Transmission of the Ebola virus in Liberia is already intense and the number of new cases is increasing exponentially," according to a WHO statement. "The number of new cases is moving far faster than the capacity to manage them in Ebola-specific treatment centers." So far, 1,089 people have died of the disease in Liberia—the highest toll for any country. Approximately 2,100 people have been killed overall, and WHO estimates that as many as 20,000 people could be infected before public health workers are able to bring the epidemic under control. Read more on Ebola.

CDC Expands National Violent Death Reporting System to Cover 32 States
The U.S. Centers for Disease Control and Prevention (CDC) has awarded $7.5 million to expand the National Violent Death Reporting System (NVDRS) to cover 32 states. The NVDRS—which currently covers 18 states—links data from law enforcement, coroners, medical examiners, crime laboratories and other sources to help states understand when and how violent deaths occur. “More than 55,000 Americans died because of homicide or suicide in 2011. That’s an average of more than six people dying a violent death every hour,” said Daniel M. Sosin, MD, MPH, FACP, acting director of CDC’s National Center for Injury Prevention and Control, in a release. “This is disheartening and we know many of these deaths can be prevented. Participating states will be better able to use state-level data to develop, implement, and evaluate prevention and intervention efforts to stop violent deaths.” Read more on violence.

NIAAA to Conduct Trials on New Alcohol Use Disorder Treatment
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) is preparing to conduct clinical trials of a potential treatment for alcohol use disorders. “Current medications for alcohol dependence are effective for some, but not all, patients. New medications are needed to provide effective therapy to a broader spectrum of alcohol dependent individuals,” said George F. Koob, PhD, director of the NIAAA, a part of the National Institutes of Health (NIH), in a release. “Prior clinical studies of gabapentin, the active metabolite of the molecule called gabapentin enacarbil, have shown positive results in patients with AUD. We believe that the time is right to conduct a multi-site, well-controlled clinical trial.” The NIH estimates that approximately 17 million people in the United States are affected by an alcohol use disorder, with lost productivity, health care costs and property damage costs amounting to an estimated societal cost of $223.5 billion annually. Real more on alcohol.

Tue, 9 Sep 2014 11:08:00 -0400 New Public Health Public health News roundups Alcohol Violence Ebola <![CDATA[Recommended Reading: Helping First Timers Sign up for Health Insurance]]> Recommended Reading

A new Kaiser Health News (KHN) article describes the challenges of helping people who have never had health insurance sign up for coverage. The KHN profile looks at the Arab Community Center for Economic & Social Services (ACCESS) a nonprofit agency that is helping the large Arab-American population in Dearborn, Mich., sign up for coverage and access care.

 The group has found that many of the people they are helping are immigrants who know little to nothing about health insurance concepts such as enrollment, copays and deductibles—an issue that also applies to millions of other people new to health insurance across the country. Immigrant and uninsured populations all over the country face cultural and language barriers to understanding and adopting U.S. insurance practices.

Ten million non-citizens living legally in the U.S. are expected to gain health insurance under the Affordable Care Act, according to KHN. The navigators at ACCESS are also trained to teach immigrants about free public health screenings for conditions such as breast cancer, which requires specialized training and conversations because of cultural stigmas associated with cancer.. At the ACCESS center in Dearborn, for example, women coming for free mammograms enter through an unmarked door.

Read the Kaiser Health News article.

Bonus Links:

  • Kaiser Health News recently reported that, on average, premiums will decline in 16 major cities for the 2015 coverage year.
  • Advertising for health insurance plans has already started across the country. Sign up for the 2015 coverage year begins October 15, 2014 and ends February 15, 2015, a period that is roughly three months shorter than last year’s enrollment period. Find information at
Mon, 8 Sep 2014 13:20:00 -0400 New Public Health Public health Access and barriers to care Affordable Care Act Access to Health Care <![CDATA[Public Health News Roundup: September 8]]> file

Mandatory Policies Increase Flu Shot Rates for Health Care Workers
Hospitals can improve their flu vaccination rate among health care workers by using a mandatory employee vaccination policy, according to a study by researchers at the Henry Ford Health System in Detroit. At Henry Ford, getting the flu shot is a condition of employment and the health system now has a 99 percent compliance rate. Nationally, only 63 percent of health care workers were immunized against the flu in the past two years, according to the Centers for Disease Control and Prevention, which poses a risk to patients. The study was presented this weekend at the Interscience Conference on Antimicrobial Agents and Chemotherapy in Washington D.C.

Before making flu vaccination mandatory, the vaccination rate at Henry Ford was between 41 percent and 55 percent. An increasing number of health systems are making flu shots mandatory for employees. At Henry Ford, employees can opt out for religious or medical reasons so long as they have documentation from clergy or a physician and then must take other precautions against the flu, such as wearing a mask when caring for patients.

Many doctors’ offices, pharmacies and clinics already have the flu shot on hand for the upcoming flu season. The HealthMap flu shot locator has been updated for the 2014-2015 flu season.

Read more on the flu.

Study: Alcohol Ad Reminders to “Drink Responsibly” Promote Drinking
A new study by researchers at the Johns Hopkins School of Public Health finds that magazine ads from the alcohol industry that advise readers to “drink responsibly” or “enjoy in moderation” fail to convey important information about dangers associated with alcohol consumption.

The study, published in Drug and Alcohol Dependence, analyzed all alcohol ads that appeared in U.S. magazines from 2008 to 2010 to determine whether messages about responsibility define responsible drinking or provide clear warnings about the risks associated with alcohol consumption.

According to the study, 87 percent of the ads analyzed included a responsibility message, but none actually defined responsible drinking or promoted abstinence at particular times or in certain situations. When responsibility messages were accompanied by a product tagline or slogan, the messages were displayed in smaller font than the company’s tagline or slogan 95 percent of the time.

Responsibility statements are voluntary and are also frequently included in ads appearing in other media including radio and online ads. The researchers say more effective ads would have prominently placed tested warning messages that directly address behaviors and that do not reinforce marketing messages. “We know from experience with tobacco that warning messages on product containers and in advertising can affect consumption of potentially dangerous products,” say Katherine Clegg Smith, a professor at the Johns Hopkins Bloomberg School of Public Health and a lead author of the study. “We should apply that [tobacco ad] knowledge to alcohol ads and provide real warnings about the negative effects of excessive alcohol use.”

Read more on alcohol.

NYC Health Department Investigating Meningitis Outbreak among HIV Positive Men
The New York City Health Department is currently investigating a cluster of meningitis cases among HIV-positive men who have sex with men. Three cases of meningitis have occurred in Brooklyn and Queens since August 24, with the last two cases reported since early September.

Meningitis is a severe bacterial infection that has a high fatality rate. A previous outbreak of the disease among men who have sex with men ended in February 2013 after 22 cases were reported, including seven fatal cases.

The Health Department recommends meningitis vaccination for all HIV-positive men who have sex with men. Meningitis vaccinations are also recommended for men, regardless of HIV status, who regularly have intimate contact with other men met through a website, digital application (“app”), or at a bar or party.

People living with HIV are at a greater risk than the general population of acquiring meningitis and, if infected, dying from infection. This disease is spread by prolonged close contact with nose or throat discharges from an infected person.

Read more on sexual health.



Mon, 8 Sep 2014 10:03:00 -0400 New Public Health Public health Infectious diseases Flu Alcohol Sexual Health Infectious disease <![CDATA[Recommended Reading: Culture of Health Prize Winner Durham County on Health Affairs Blog]]>

Earlier this year, Durham County, N.C., was chosen by the Robert Wood Johnson Foundation (RWJF) as a Culture of Health Prize winner for its efforts to ensure that its most vulnerable residents have access to the county’s repository of world-class health resources, high-skilled jobs and places to exercise. As part of an ongoing series, Health Affairs blog has featured a piece by local Durham leader Erika Samoff on the community’s health successes.

While Durham is home to a wealth of health care resources—so much so that it’s been dubbed “The City of Medicine”—a 2004 health assessment found high rates of cardiovascular disease and other chronic conditions; HIV/AIDS and other sexually transmitted diseases; and infant mortality. In addition, a 2007 evaluation found that nearly one in three of Durham’s adults were obese, with the rate especially high in its African-American population, at 42 percent. Half of the adults surveyed pointed to a lack of opportunities for physical activity as a contributing factor to their condition.

County leaders responded to these findings by creating the Partnership for a Healthy Durham. It is an alliance of more than 150 nonprofits, hospitals, faith-based organizations and businesses. The partnership’s efforts include:

  • Turning an empty, run-down junior high school into the Holton Career & Resource Center, which offers mentoring programs, internships and hands-on career training to high school students
  • Creating new bike lanes, bike racks and sidewalks to encourage physical activity and help combat chronic obesity
  • Creating Project Access of Durham County to provide access to specialty care for uninsured residents
  • Passing smoke-free legislation

To learn more about Durham’s prize-winning efforts to improve health, read the Health Affairs blog post.

>>Bonus Links:

>>Bonus Content: Watch a NewPublicHealth video on Durham’s efforts to build a Culture of Health. 

Fri, 5 Sep 2014 15:37:00 -0400 New Public Health Social determinants of health Community benefit Culture of Health Community Benefit Community Health Video <![CDATA[Faces of Public Health: Nicholas Mukhtar, Healthy Detroit]]> file

Last June, the Washington Post held a live event, Health Beyond Health Care, which brought together doctors, bankers, architects, teachers and others to focus on health beyond the doctor’s office. The goal of the Washington, D.C., event—which was co-sponsored by the Robert Wood Johnson Foundation others—was to showcase examples of communities working with partners to create cultures of health.

Healthy Detroit is a shining example. The project is a 501(c)(3) public health organization dedicated to building a culture of healthy, active living in the city of Detroit. It was formed less than a year ago in response to the U.S. Surgeon General’s National Prevention Strategy (NPS.) The NPS offers guidance on choosing the most effective and actionable methods of improving health and well-being, and envisions a prevention-oriented society where all sectors recognize the value of health.

NewPublicHealth recently spoke with Nicholas Mukhtar, founder and CEO of Healthy Detroit.

NewPublicHealth: How did Healthy Detroit get its start?

Nicholas Mukhtar: I was just about to the MPH part of a joint MPH/MD degree and had  always wanted to be a surgeon. But as I started living in the city and getting more involved in the community, I really saw a different side of health care, and to me it just became more rewarding to focus on the systemic issues in the health care system, more so than treating people once they already got sick. I’ve now finished the MPH part of my degree, and am starting on my MD degree.

So I started sending out a number of emails to different people and reached out to Dr. Regina Benjamin, then the U.S. Surgeon General, as well as local individuals. And then we established our mission, which was really to build a culture of prevention in the city while implementing the National Prevention Strategy. 

NPH: Where does your funding come from?

Mukhtar: We have a lot of local partners. We’ve applied for a few federal and foundation grants and we’re waiting to hear back, but for now most of the funding comes from private sponsors and donation.

NPH: What are you proudest of so far?

Mukhtar: Bringing together people that for the last few decades have not worked together. Without a doubt, we have one of the most racially tense and segregated cities in the entire country, including the divide between the suburbs and the city, and now even between the downtown and midtown areas in the neighborhoods. We’ve been bringing together community organizations that have been doing great work in the neighborhoods for decades with larger health systems that are based outside the city and have felt left out of these conversations for a long time.

NPH: How are you creating a culture of health in Detroit?

Mukhtar: Our vision and our philosophy is that really the health care system should be expanded to encompass the places that people go every day and that includes parks, churches and schools. And, of course, it’s going to be different city to city—and even within a city, neighborhood to neighborhood. But for us the big thing is this concept that we created called “health parks,” which are really just taking parks and recreation centers and trying to turn them into community hubs of health that are one-stop shops for everything you need to be healthy—everything from a farmer’s market, to an urban garden, to all your typical park amenities, to an outdoor fitness center, an indoor fitness center and programming to go along with it.

We’ve built a collaboration of 40-plus different organizations that are offering a lot of these services in a park setting that normally wouldn’t be in a park setting. The idea is to get life in the neighborhoods of Detroit to revolve around these health parks, and to us that’s really how you instill this culture of health in a more natural way than saying do this or this. So, for us it’s just looking at where people are and what people are doing and making it easy for people to just be healthy in their everyday lives.

We’re working in three parks and recreation centers right now, and we have three health parks in different areas of the city. The public-private partnership that we formed with the city and the recreation department have just been incredibly supportive and it’s a testament to the mission that everyone in the city wants this and understands the importance of it.

NPH: Who are your partners?

Mukhtar: Our approach is that we partner with absolutely everyone and don’t take no for an answer because we really do believe it needs an interdisciplinary approach—which, again, is what the National Prevention Strategy is all about. Our main partner is the Detroit Wayne County Health Authority and we’ve also reached out to the health systems, insurance companies and a lot of the community-based organizations.

NPH: How are you sharing your work?

Mukhtar: Regionally we have something called the Wayne County Population Health Council, which is a collaboration of a number of organizations. Nationally, we were featured in the annual status report of the National Prevention Strategy that is delivered to the president and Congress. As a new organization we’re still trying to do things locally before we try to project ourselves out throughout the country. We have a huge following on social media. I think that’s how most people learn about us and reach out to us. 

Fri, 5 Sep 2014 11:39:00 -0400 New Public Health Health policy Community-based care Community Benefit Faces of Public Health Q&A <![CDATA[Public Health News Roundup: September 5]]> file

EBOLA UPDATE: Third U.S. Aid Workers Arrives for Treatment
(NewPublicHealth is monitoring the public health crisis in West Africa.)
A third U.S. medical missionary has arrived at the Nebraska Medical Center in Omaha for treatment for Ebola. Rick Sacra, MD, is a SIM USA missionary, as were Kent Brantly, MD, and Nancy Writebol, who were both treated successfully for Ebola at Emory Hospital. Approximately 1,900 people have died and 3,500 have been sickened in the ongoing outbreak. Approximately 400 deaths came in the past week alone. Read more on Ebola.

CDC Report Explores the Extent and Impact of Intimate Partner and Sexual Violence
The U.S. Centers for Disease Control and Prevention (CDC) has released a new report examining the extent and impact of intimate partner and sexual violence. According to the report, almost 20 people per minute are victims of physical violence by an intimate partner; almost 2 million women are raped each year; and more than 7 million women and men are victims of stalking each year. The report determined that since a “substantial portion” of this violence and stalking comes at a young age, primary prevention must also focus on people at young ages, accounting for the differences in victims, addressing risk factors and emphasizing health relationships. Read more on violence.

Study Links Breastfeeding, Lower Weight for Mothers
Mothers who were obese before pregnancy and who then go on to breastfeed may have an easier time losing their pregnancy weight and then keeping it off, according to a new study in journal Pediatrics. Researchers determined that previously obese mothers who breastfed weighed almost 18 pounds less than those who didn’t. "Breast-feeding not only burns extra calories but it also changes the metabolism through a series of hormonal effects required to lactate," said Lori Feldman-Winter, MD, a pediatrician and a professor of pediatrics at Children's Regional Hospital at Cooper University Health Care in Camden, N.J. "The full understanding of how breast-feeding leads to improvements in metabolism for both mother and her baby is incomplete, but there are multiple epidemiological studies showing the association." She also said that the healthier eating habits many mothers who breastfeed take up may also contribute to the lower weights. Read more on maternal and infant health.

Fri, 5 Sep 2014 10:38:00 -0400 New Public Health Public health News roundups Violence Ebola Maternal and Infant Health <![CDATA[Better Health, Delivered by Phone: Q&A with Stan Berkow]]>

Recently NewPublicHealth shared an interview from AlleyWatch, a Silicon Valley technology blog about SenseHealth, a new medical technology firm that has created a text message platform that health care providers can use to communicate with patients. In May, SenseHealth was picked to be part of the New York Digital Health Accelerator, which gives up to $100,000 in funding to companies developing digital health solutions for patients and providers. The accelerator is run by the Partnership Fund for New York City and the New York eHealth Collaborative. SenseHealth engaged in a clinical trial last year that used the technology to help providers engage with patients who are Medicaid beneficiaries.

Health conditions supported by the SenseHealth platform range from diabetes to mental health diagnoses, while the messaging options include more than 20 customizable care plans, such as medicine or blood pressure monitoring reminders. There are also more than 1,000 supportive messages, such as a congratulatory text when a patient lets the provider know they’ve filled a prescription or completed lab work. The platform couples the content with a built-in algorithm that can sense when a user has logged information or responded to a provider, and providers are able to set specific messages for specific patients. Early assessments show that the technology has helped patient manage their conditions, with data showing more SenseHealth patients adhered to treatment plans and showed up for appointments than patients who didn’t receive the text program.

We received strong feedback on the post, including a question from a reader about whether Medicaid beneficiaries lose contact with their providers if they disconnect their cell phones or change their numbers, a common occurrence among low-income individuals who often have to prioritize monthly bills. To learn more about SenseHealth and its texting platform, NewPublicHealth recently spoke with the company’s CEO and founder, Stan Berkow.

NewPublicHealth: How did SenseHealth get its start?

Stan Berkow: We got started about two to two-and-a-half years ago. I met one of the other founders while I was working at the Columbia University Medical Center in New York City. We were both clinical trial coordinators and were seeing—first hand—the difficulties in getting participants in our studies to actually follow through on all the exercise and nutritional changes they needed to make in order to complete the research project. That led us to step back and look at the bigger health care picture and recognize the challenges for providers to help patients manage chronic conditions, and recognizing that there’s a huge time limitation on the providers. That pushed us toward finding a way through technology to help those providers help the patients they work with more effectively to prevent and manage chronic conditions.

NPH: How much training do patients need to use the platform?

Berkow: None. What we’ve seen is that a lot of people using it already text with their health care providers, and we’re just inserting ourselves into that behavior to ensure that they’re getting more information on a more consistent basis and that their provider is involved in that dynamic.

We are starting to build in different channels to work with different populations through actual phone calls or interactive voice response, for example for Medicare beneficiaries, or apps for more tech-savvy users. As we do continue to do that, I think we’ll need to look at how much instruction people may need. We believe we need to design our technology to meet people where they are as opposed to kind of imposing new types of communication.

NPH: Many Medicaid patients don’t have cell phones or will have cell phones disconnected and then reconnected with new numbers. Has that been a problem for you?

Berkow: People getting new phones or disconnecting old phones and getting new numbers has definitely been an interesting challenge to tackle, and it’s certainly something that we don’t have the end solution to. But one thing that does help is that our technology automatically gets an alert when a number becomes disconnected. And that allows us to alert the providers sooner when someone changes their number, so that ideally they can find another way to get in touch with them before that person becomes too disconnected from the health engagement process that they started. It’s not a foolproof solution, but we have been able find ways to alert the providers who are then on alert to ask for new phone information at the next appointment.

NPH: What is next for the company?

Berkow: We’re continuing to really try and make a big push within the Medicaid space and extend that out to larger patient groups in need of this type of support and technology. And as we do that, it does actually require us to think about different ways to reach people including, as I mentioned, smart phone apps for people who have a Smartphone and voice prompts for older patients. We are constantly looking to partner with more healthcare organizations working with Medicaid and Medicare populations as well as ensuring that our technology has all of the kind of features and tools that’s in place to effectively speak to patients in the way that will resonate best.

We view the technology really as an intermediary between the provider and patient. We’re not looking to displace the providers with technology, but rather to help make their lives easier so that they can work more consistently across larger number of patients, and I think that’s an important framing for a technology like ours.

Thu, 4 Sep 2014 14:36:00 -0400 New Public Health Access and barriers to care Medicaid Access to Health Care Technology Q&A <![CDATA[Public Health News Roundup: September 4]]> file

EBOLA UPDATE: WHO Says More than $600M Needed to Combat the Ebola Outbreak
(NewPublicHealth is monitoring the public health crisis in West Africa.)
Approximately $600 million in supplies is needed to combat the ongoing Ebola outbreak in West Africa, according to the World Health Organization (WHO), while Canadian health officials continue to work on a way to transport an experimental treatment to the affected area. "We are now working with the WHO to address complex regulatory, logistical and ethical issues so that the vaccine can be safely and ethically deployed as rapidly as possible," said Health Canada spokesman Sean Upton, in a statement. "For example, the logistics surrounding the safe delivery of the vaccine are complicated." More than 1,900 people have died in the outbreak. Read more on Ebola.

RWJF, TFAH Report Finds State Obesity Rates Continue to Remain High
Adult obesity rates continue to be high across the country, with rates increasing in six states and decreasing in none over the past year, according to a new report from the Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF). The report, The State of Obesity: Better Policies for a Healthier America, found that rates climbed in Alaska, Delaware, Idaho, New Jersey, Tennessee and Wyoming. Mississippi and West Virginia have the highest rates, at 35.1 percent, and no state has a rate below 21 percent. “Obesity in America is at a critical juncture. Obesity rates are unacceptably high, and the disparities in rates are profoundly troubling,” said Jeffrey Levi, PhD, executive director of TFAH, in a release. “We need to intensify prevention efforts starting in early childhood, and do a better job of implementing effective policies and programs in all communities—so every American has the greatest opportunity to have a healthy weight and live a healthy life.” Read more on obesity.

Study: Women Are Underrepresented in Surgical Research
A review of more than 600 studies in five major surgical journals found that males are vastly overrepresented, calling into question how the findings will translate for female patients.  The journals— Annals of SurgeryAmerican Journal of Surgery, JAMA SurgeryJournal of Surgical Research and Surgery—responded by announcing they will now require study authors to report the sex of animals and cells in their research, or to explain why only one sex was analyzed. "Women make up half the population, but in surgical literature, 80 percent of the studies only use males," study senior author Melina Kibbe, MD, professor of surgical research at Northwestern University Feinberg School of Medicine, said in a release. "We need to do better and provide basic research on both sexes to ultimately improve treatments for male and female patients.” The study appeared in the journal Surgery. Read more on health disparities.

Thu, 4 Sep 2014 10:40:00 -0400 New Public Health Public health News roundups Obesity Ebola Health disparities <![CDATA[Recommended Reading: Ebola Is Also an International Security Threat]]> file

In the last few days, the U.S. Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO) and the medical aid group Doctors Without Borders have sounded alarms on the growing needs of several countries in West Africa fighting the Ebola outbreak. The groups have called for increased funding, equipment and expert health personnel to help stem the rapidly increasing numbers of infections.

As of last week, there have been more than 3,000 cases and more than 1,500 deaths, making it by far the largest outbreak since Ebola was discovered during the 1970s, according to the WHO. CDC Director Tom Frieden, MD, MPH, who last week visited the main West African countries dealing with the Ebola outbreak, said the number of cases could spike to 20,000 if more isn’t done to stem spread of the disease in those countries.

In addition, a recent post on said that the epidemic must be controlled before it also poses a security threat. Liberia, which has seen the highest number of Ebola cases and deaths in the region so far, has been under the watch of an international United Nations (U.N.) peacekeeping force since a civil war ended in 2003. While the U.N. had planned to begin drawing down the force next year, U.N. Secretary General Ban Ki-moon said he’d like to delay any drawdown for at least three months because of the virus outbreak, which has needed troops to help secure order.

However, several countries want to pull out troops now in order to reduce the risk to their personnel and to citizens at home who they worry could be infected by returning soldiers. Ban has said that the nature of the illness poses little risk to the troops, who are unlikely to have contact with the bodily fluids of people who are ill—which is the way the virus spreads—and some of the countries involved are considering sending their own experts to assess the risks.

"While the Ebola outbreak began primarily as a medical emergency, it has become more complex, with political, security and humanitarian implications that are significant and dynamic,” Ban told the Security Council in a letter.

Ban has also expressed his concerns about airlines stopping flights to and within the region over concerns about carrying infected travelers. During a press conference yesterday about his trip to West Africa, Frieden said he had to take a return flight one one day earlier than planned because his originally scheduled flight was cancelled.

Frieden and other health leaders are calling on countries around the world to meet the WHO’s request for close to $500 million in funding, in addition to equipment and medial personell trained to treat infectious diseases. Frieden is in Washington, D.C. this week for talks on the Ebola outbreak.

“What I saw was a continuing need to strengthen the health care system by increasing the number of treatment centers, providers, access to supplies; as well as a need to improve clinical management by hand washing, infection control, and other methods,” said Frieden. “There is a need for data to better trace where Ebola is beginning to spread. And there is a basic need for infrastructure like trucks, jeeps and motorcycles. Perhaps most importantly, there is need for a functional emergency operations center at either the national or the district levels directing an efficient response.”

Frieden added that he fears the window of opportunity to stop Ebola from spreading widely throughout Africa and becoming a global threat for years to come is nearing a close.

“But it is not yet closed,” he said. “If the world takes the immediate steps—which are direct requests from the front lines of the outbreak and the Presidents of each country—we can still turn this around.”

Read the blog post.

>>Bonus Content: Follow NewPublicHealth’s ongoing coverage of the Ebola outbreak in West Africa.

Wed, 3 Sep 2014 12:52:00 -0400 New Public Health Infectious diseases Public policy Ebola Infectious disease Recommended Reading <![CDATA[Public Health News Roundup: September 3]]> file

EBOLA UPDATE: HHS Partners with Mapp Biopharmaceutical on Development of Ebola Treatments
(NewPublicHealth is monitoring the public health crisis in West Africa.)
The U.S. Department of Health and Human Services has contracted with Mapp Biopharmaceutical Inc. for the development of an Ebola treatment. The funding will come through the Assistant Secretary for Preparedness and Response’s Biomedical Advanced Research and Development Authority. Under the 18-month, $24.9 million contract, Mapp will also continue the development and manufacture of its existing Ebola drug, ZMapp, which was used to successfully treat two Americans who were infected in the outbreak in West Africa. “While ZMapp has received a lot of attention, it is one of several treatments under development for Ebola, and we still have very limited data on its safety and efficacy,” said Nicole Lurie, MD, assistant secretary for preparedness and response, in a release. “Developing drugs and vaccines to protect against Ebola as a biological threat has been a long-term goal of the U.S. government, and today’s agreement represents an important step forward.” Read more on Ebola.

CVS Announces All Stores are Now Tobacco Free
Tobacco products are no longer sold at any of the approximately 7,700 CVS/pharmacy locations, the company announced today, almost a month ahead of its planned tobacco-free schedule. The company also announced that is has changed its corporate name to CVS Health. "Every day, all across the country, customers and patients place their trust in our 26,000 pharmacists and nurse practitioners to serve their health care needs," said Helena B. Foulkes, President of CVS/pharmacy, in a release. "The removal of cigarette and other tobacco products from our stores is an important step in helping Americans to quit smoking and get healthy." Read more on tobacco.

Study: Double Mastectomies and Lumpectomies Carry Similar Survival Rates
Double mastectomies for early stage breast cancer are no more effective than lumpectomies at improving survival rates, according to a new study in the Journal of the American Medical Association. Analyzing data on more than 189,000 patients in California, researchers found that while the percentage of women who opted for double mastectomies climbed from 2 percent in 1998 to 12.3 percent in 2011—and that in 2011 approximately one-third of patients younger than 40 chose to have a double mastectomy rather than the potentially breast-conserving lumpectomy—the death rates for the two treatments were similar. The researchers said their findings are especially significant for women at average risk. Read more on cancer.

Wed, 3 Sep 2014 10:38:00 -0400 New Public Health Public health News roundups Ebola Cancer Tobacco <![CDATA[Public Health Campaign of the Month: Know Where to Meet Your Family in an Emergency]]>

NewPublicHealth continues a new series to highlight some of the best public health education and outreach campaigns every month. Submit your ideas for Public Health Campaign of the Month to

The Federal Emergency Management Agency (FEMA) is starting off National Preparedness Month with a series of stark, dark and attention-getting public service advertisements (PSAs) developed in cooperation with the Ad Council. They are set in what looks to be a dark, crowded school auditorium and showcase an intact family sheltering from the storm, and another family unable to locate their son. The obvious focus is on making a plan to know where all family members are when disaster strikes, but the auditorium—with too few chairs, no apparent cots and little room to move or stretch—gives a rare glimpse into what a public shelter looks like during an emergency and adds to the urgency of making that plan.

“The first step to preparing for disasters is simple and it’s free—talk to your family and make a plan,” said Craig Fugate, FEMA administrator. “Do you know how you’ll reunite and communicate with your family during an emergency? Through our continued partnership with the Ad Council, this year’s campaign illustrates how making a plan can keep families together and safe during a disaster.”

According to a recently released FEMA survey, 50 percent of Americans have not discussed or developed an emergency plan for family members about where to go and what to do in the event of a local disaster.

“Our Ready campaign with FEMA exemplifies the power of advertising in influencing both awareness and behavior change,” said Peggy Conlon, president and CEO of the Ad Council. “While we have significantly increased the numbers of families who have taken key steps to be more prepared, there are still too many who do not have a plan in place. These conversations about what to bring and where to go are integral and can impact your family’s safety in the event of an emergency or disaster.”

According to Conlon, since its 2003 launch the campaign has generated 71 unique visitors to the website, which includes links to PSAs and other detailed information on how to make a disaster plan and where to access more information.

Each week throughout this September will have a different focus on emergency preparedness topics such as how to plan for specific needs before a disaster, how to build an emergency kit, how to practice for an emergency and—this year’s PSA campaign theme—how to reconnect with a family after a disaster.  This year’s campaign will culminate with a day of action, National PrepareAthon! Day on September 30, when people in communities across the nation will practice what to do in advance of an emergency. Practicing a preparedness action in advance of a disaster makes you better prepared to handle any emergency you may encounter.

You can follow the campaign on Facebook and Twitter.

Tue, 2 Sep 2014 14:09:00 -0400 New Public Health Emergency preparedness and response Families Disasters Public Health Campaign of the Month Preparedness