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Adding Diversity to the Ranks of Public Health Nursing Leadership: Q&A with Shirley Orr, MHS, APRN

Nov 19, 2014, 11:39 AM

Today at the American Public Health Association annual meeting in New Orleans, Shirley Orr, MHS, APRN, a Robert Wood Johnson Foundation Executive Nurse Fellow and public health consultant, and Doris Brown of the Louisiana Department of Health, will be talking about opportunities for nursing leaders to implement the recommendations of a 2010 Institute of Medicine Report entitled “The Future of Nursing.” This report looks at ways that the nursing profession can transform itself in order to better align with population health and more effectively collaborate to create a healthier overall population.

NewPublicHealth recently spoke with Orr about how nurses can help improve community and population health. This interview has been lightly edited for clarity and length.

NewPublicHealth: What does the nursing profession need to do in order to align itself with a focus on population health?

Shirley Orr: A couple of things in particular that stand out are education and diversity. We recently did a public health nursing enumeration that was funded by the Robert Wood Johnson Foundation, and we found two things in particular relating to the recommendations. First, that overall, public health nurses need new skills and they need higher levels of education to be able to function more collaboratively and within collaborations—both within health care and with other community partners.

Second, we found that nationwide, the demographic profile of public health nurses does not look like the population that we serve. Ethnic minorities are very much underrepresented among public health nursing—particularly in leadership roles.

We have a very urgent need to recruit more nurses of color into the ranks of public health nursing leadership.

NPH: Why is that necessary?

Orr: A core component of nursing curriculum today is culture competency. That being said, we also know that having nurses who understand populations very, very deeply by having a frame of reference for that population and being a member of that population really are able to help to get the highest level of engagement from the population. They’re also best prepared to understand the culture, the needs, the motivations about populations, so they’re really best positioned to be able to carry out in partnership strategies that are going to make a difference long-term in the health of populations. 

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APHA 2014: A ReFreshing Collaboration is Building Better Health in New Orleans

Nov 18, 2014, 1:13 PM

If we as a nation are to succeed in building a Culture of Health that benefits every individual, it will require collaboration across sectors, open communication among diverse organizations and a willingness to step out of traditional practices to find effective interventions.

On Monday, Robert Wood Johnson Foundation Vice President Michelle Larkin showcased one example of this innovative collaboration that is occurring on the edge of a low-income neighborhood in New Orleans, just a few miles away from this year’s American Public Health Association (APHA) annual meeting.

At the corner of North Broad Street and Bienville Avenue sits The ReFresh Project—an innovative fresh food hub located in a former warehouse that had been vacant since Hurricane Katrina struck the city nine years ago. Today the site is home to a Whole Foods Market, Liberty’s Kitchen, The Goldring Center for Culinary Medicine and an onsite farm.

The goal of the hub, according to project founder Jeffrey Schwartz, is to create new eating, working, exercise and community living cultures.

Each aspect of the Refresh Project is designed to realize these goals. 

The ReFresh Project in New Orleans, La.
  • At the Whole Foods market, which anchors the Refresh project development, products are specifically chosen to be both high quality and affordable. Specifically, the store carries more store-line products and often has more sale items than other stores in the Whole Foods chain. Two healthy eating educators are also located on-site to answer questions, craft recipes, and host tours.
  • At Liberty’s Kitchen, a culinary work readiness and leadership program for at-risk youth, New Orleans youth ages 16-24 who are out of work and out of school are given an intensive and hands-on food service training, case management, job placement services and follow-up support. Ninety percent of Liberty’s Kitchen Youth Development Program participants are employed on graduation out of the program and 80 percent are still employed at the six-month benchmark, according to the organization.

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Faces of Public Health: Georges Benjamin, MD, APHA

Nov 14, 2014, 2:38 PM

The American Public Health Association (APHA) annual meeting begins next week in New Orleans, the first return to the area for the 15,000-strong meeting since Hurricane Katrina nine years ago. This year’s theme is Healthography, or, as APHA Executive Director Georges Benjamin, MD, recently said, “where you live matters.”

Earlier this week, Benjamin spoke with NewPublicHealth about key issues and presentations for this year’s meeting. The following interview has been lightly edited for clarity and length.

NewPublicHealth: “Healthography”—what is it and why is important especially right now?

Georges Benjamin: We know for sure that place matters, and I think New Orleans is an excellent example of that truth. It’s a wonderful city, but certainly has had huge health challenges. In our annual America’s Health Rankings survey that we do with the United Health Foundation and Partnership for Prevention, Louisiana consistently ranks as one of the lowest states in the nation for health. When you also consider the environmental tragedies that the state had—two storms in short succession and then the Gulf oil spill—the challenges of place and health become especially clear.

So the concept of the geography in which you live and your health is taking center stage as we head to New Orleans. As just one example, our opening session speaker, Isabel Wilkerson, wrote the book “The Warmth of Other Suns,” which deals with the great migration of Americans who moved from one place to another to try to achieve a better life.

NPH: What are some of the other highlights of this year’s meeting?

Benjamin: We’ve got the acting U.S. Surgeon General coming, Dr.Boris Lushniak, and he is going to talk a great deal about health and place. He’s an amazing speaker around the issues of place-based health, how we build our communities and things that we can do to make the healthy choice the easy choice.

In addition, Risa Lavizzo-Mourey, the president and CEO of the Robert Wood Johnson Foundation, will be the keynote speaker for the closing session on Wednesday, where she will talk about the foundation’s new Culture of Health and how they are playing a leading role in building a future where every American has the opportunity to live the healthiest life possible, regardless of where they live.

As RWJF clearly knows, when you design things, you get exactly what you design, and we’ve designed an environment and a culture around health that creates an unhealthy environment. So, if we redesign that culture to improve our health, we can make a big difference.

NPH: Why is building a Culture of Health so important?

Benjamin: Most people living in the United States are not as healthy as they can be, and so APHA believes that we need to build a movement to be the healthiest nation, and we think we can do that in a generation. So, this meeting is the first component of our new strategic direction which aligns very closely with RWJF’s strategic direction.

Our goal is for the United States to be number one and not be number 36 in terms of quality of our health. We think there’s an opportunity to do that through the kind of things that APHA does with education, policy development, legislative advocacy, and building grass roots and grass tops movements to get us there.

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Ending Healthcare Waste, Improving Healthy Lives: Q&A with the L.A. Department of Public Health’s Jonathan Fielding

Nov 11, 2013, 3:03 PM

Physicians in a doctor's office, talking on the telephone.

In a report released last year, the Institute of Medicine found that the United States wastes billions of dollars each year on such unnecessary spending as inefficiently delivered services, excess administrative costs, fraud and missed prevention opportunities. In response, a group of senior public health scholars at the UCLA Fielding School of Public Health, led by Jonathan Fielding, MD, MPH, a professor at the school and the director of the Los Angeles Department of Public Health, published an article in the American Journal of Preventive Medicine on the improvements to population health the country might realize if only the wasted money was devoted instead to the social and environmental determinants of health. If the government could reap 45 percent of the wasted medical care costs, argues Fielding and his co-authors, and invested those resources in sectors such as education, jobs, healthier foods and transportation infrastructure, the health of millions could be markedly improved and society would see additional social benefits.

Jim Marks, Senior Vice President and Director, Health Group at the Robert Wood Johnson Foundation echoed this approach at the recent American Public Health Association (APHA) annual meeting in Boston.

"We know lots about the cost of illness, but very little about the value of health,” he said.

Marks also said that focusing on health as the ultimate goal tends to eclipse some of the social determinants that can have enormous impact on people’s lives. “Most people don’t want good health as their outcome, they want a quality life. They want to travel, take care of grandkids, have a rich family and social life—you can only do that if you’re healthy,” said Marks. “It’s unrelated to good quality medical care. It’s related to education, safe neighborhoods, [and other social factors].”

According to Marks, improving public health isn’t about curing individual diseases or fixing specific injuries. Rather, it’s about everything; the diseases are the end result of the system we live in. And with all the data we have available, we know it’s a system that needs fixing, said Marks.

Marks’ thoughts came at an APHA panel Fielding moderated in a closing day session about the health impact of investment in major social and environmental policies and interventions; information gaps and how they can be filled; and how the discussion of health spending can be re-framed so that U.S. resources can be invested most productively.

NewPublicHealth spoke with Fielding about better uses for the wasted health care spending just before the start of the APHA meeting.

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Social Media and Hurricane Sandy: Q&A with Jay Dempsey and Vivi Abrams Siegel

Nov 7, 2013, 3:11 PM

Hurricane Sandy made landfall last year during the American Public Health Association’s (APHA) annual meeting in San Francisco. Several sessions at the annual meeting this year in Boston, one year after the storm, focused on the response during the hurricane that killed dozens, injured hundreds and destroyed thousands of homes.

In a key session Monday, communications specialists from the U.S. Centers for Disease Control and Prevention (CDC) reported on a study of new media preparedness and response messaging implemented before and after the disaster. As Hurricane Sandy approached landfall, the CDC’s National Center for Environmental Health (NCEH) assisted state and local public health partners by developing and sharing storm-related messaging across several social media channels, including an SMS text subscription service to directly reach people affected by the storm.

CDC determined what topics would need coverage each day, ranging from preparing for the storm's arrival to post-storm safety and clean-up. Once messages were posted, they were retweeted across several CDC Twitter feeds and on social media channels of local health departments. The recent CDC study found that leveraging social media turned out to be very important for driving a steady increase in traffic to CDC emergency response web pages. For example, a message about safe clean-up of mold produced 14,881 visits. The number of NCEH Twitter followers also increased—there were 4,226 twitter followers at the beginning of October before the storm, and that grew to 5,215 followers—a 23 percent increase—once the storm hit.

>>NewPublicHealth was on the ground throughout the APHA conference speaking to public health leaders and presenters, hearing from attendees on the ground and providing updates from sessions, with a focus on how we can build a culture of health. Find the complete coverage here.

Ahead of the APHA meeting, NewPublicHealth spoke with Jay Dempsey, a health communications specialist in the National Center for Environmental Health who presented the data at the APHA meeting and Vivi Abrams Siegel, a health communications specialist in the CDC Office of Public Health Preparedness and Emergency Response about the findings and the growing importance of social media before, during and immediately after disasters.

NewPublicHealth: What’s most important about the recent study on social media and disaster preparedness and response?

Jay Dempsey: The case study is an overview of the lessons that we learned from using social media to disseminate emergency and preparedness messaging ahead of and during and immediately following Hurricane Sandy. Some of the things that we knew going in during the response to Hurricane Sandy was that a growing number of people are using social media to get information just before and during a disaster or an emergency. So knowing that, we leveraged our social media channels and the first thing we saw was a pretty substantial increase in web traffic. We’re able to track the number of page visits that come exclusively from social media and make a determination of approximately how much social media drove traffic to those particular pages.

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Making a Collective Public Health Impact through Diverse Partnerships

Nov 7, 2013, 1:36 PM

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It’s no secret that public health department budgets have been shrinking in the past few years. In the face of the recession, public health professionals must seek new and diverse partnerships in order to achieve greater impact despite the lack of funding. The topic of one session at the American Public Health Association (APHA) Annual Meeting held in Boston was just that—how to increase impact through strategic partnerships with unlikely partners.

“The need for austerity and efficiency opens up the conversation for collective impact,” said Joseph Schuchter of the University of California-Berkeley School of Public Health. Partnerships can include a wide array of non-public health entities, including non-profit organizations, businesses and schools. The APHA panel discussed different approaches to successful partnerships that advance public health programs.

Leadership Training

The Center for Health Leadership and Practice provides group leadership training for cross-sector teams that are working together to advance public health. “We may all be talking about the same thing, we’re just using different vocabulary and styles,” says VP of External Relations and Director Carmen Rita Nevarez. The Center provides existing partnerships with the tools and training needed to move forward in the same direction, while understanding that individual efforts may differ. More than 90 percent of program participants agree that the approach is effective in supporting intersectoral leadership development and most teams report regularly engaging other sectors as a result.

Networked and Entrepreneurial Approaches

Networked and entrepreneurial approaches to partnerships offer public health professionals with resources and allow them to reduce the negative externalities of the economy. The impact investment market constitutes an $8 billion industry that is eager to fund novel solutions to social problems. In order to succeed in these partnerships, the field of public health must work with social entrepreneurs and investors to highlight the potential return on investment for prevention programs and produce irrefutable outcomes.

Backbone Organizations

The Community Health Improvement Partners (CHIP) serves as a backbone organization for a larger, cross-sector childhood obesity initiative. Cheryl Moder of CHIP shared her insights into the role of such an organization and how to successfully grow a diverse partnership. A backbone organization must serve as mission leaders by recruiting and retaining partners and support aligned activities so that they connect to one another. In addition, backbone organizations must navigate the challenges of larger partnerships—such as developing and retaining trust, encouraging equal partner recognition and shared measurement and evaluation—in a way that suits the needs of partners from different sectors.

>>NewPublicHealth was on the ground throughout the APHA conference speaking to public health leaders and presenters, hearing from attendees on the ground and providing updates from sessions, with a focus on how we can build a culture of health. Find the complete coverage here.

This commentary originally appeared on the RWJF New Public Health blog.

Regulating Tobacco: Q&A with FDA's Mitch Zeller

Nov 6, 2013, 3:05 PM

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Tobacco featured prominently as a public health issue at the American Public Health Association (APHA) meeting this week, including a regulatory update from Mitch Zeller, JD, who became director of the U.S. Food and Drug Administration’s (FDA) Center for Tobacco Products earlier this year. Zeller previously worked on tobacco issues in government as associate commissioner and director of FDA’s first Office of Tobacco Programs, and also as a U.S. delegate to the World Health Organization (WHO) Working Group for the Framework Convention on Tobacco Control.

NewPublicHealth spoke with Zeller ahead of the APHA meeting.

Mitch Zeller, JD, Director of the FDA’s Center for Tobacco Products Mitch Zeller, JD, Director of the FDA’s Center for Tobacco Products

Mitch Zeller: I think most broadly my goals are to help give the center and the agency the greatest chance of fulfilling the public health mission behind the law passed in 2009 giving the Food and Drug Administration authority over tobacco. This really is an important piece of legislation. It’s really stunning that in 2013—with everything that we know about the harms associated with tobacco use—that it remains the leading cause of preventable death and disease both in this country and globally.

There are some very powerful tools that Congress has given FDA to use wisely and supported by evidence. That’s where I think, the greatest opportunity lies: to use the tools relying on regulatory science to try to protect consumers and reduce the death and disease toll from tobacco.

There are two areas where I think these tools can make a profound positive impact on public health. The first is something called product standards, which is basically the power to ban, restrict or limit the allowable levels of ingredients in tobacco or tobacco smoke. We are exploring potential product standards in three areas: toxicity, addiction and appeal. And we are funding research in all three areas and working very hard behind the scenes to find out what our options are for potential product standards in those three areas.

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Violence Prevention: Q&A with David Satcher

Nov 6, 2013, 10:21 AM

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David Satcher, MD, PhD, was a four-star admiral in the U.S. Public Health Service Commissioned Corps and served as the 10th Assistant Secretary for Health and the 16th Surgeon General of the United States—at the same time. He was Surgeon General from 1998 through 2001, and under his tenure he tackled disparities in tobacco use and overall health equity, sexual health and—critically—youth violence.

Satcher was a key speaker in a recent American Public Health Association (APHA) Annual Meeting Town Hall Meeting on a global approach to preventing violence. NewPublicHealth spoke with Satcher about approaches to preventing violence as a public health issue.

NewPublicHealth: How do you take a public health approach to preventing violence?

David Satcher: When you take a public health approach, public health experts pose four questions:

  • First, what is the problem and what is the magnitude, the nature and distribution of the problem?
  • The second question is: what is the cause of the problem or the major risk factors for the problem?
  • The third question is: what can we do to reduce the risk of the problem?
  • And finally, how can we then implement that more broadly throughout society?

So, when we say we’re taking a public health approach, that’s what we’re talking about.

What we’ve tried to do and what we need more of is to really study the different causes of violence and violent episodes. They’re not all the same. I’ve dealt with a lot of the mass murders; I was Surgeon General when Columbine took place and the Surgeon General’s Report on Youth Violence in part evolved from that. And obviously there, as in most mass murders, we’re dealing with, among other things, mental health problems and easy access to weapons combined. I don’t think the same is necessarily true for gang violence, which causes thousands of deaths each year. With youth violence and gangs, I think there you’re dealing with a culture of insecurity where young people feel that in order to protect themselves they need to be members of gangs and they need to be armed.

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Violence: Can We End the Epidemic?

Nov 6, 2013, 10:16 AM

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“We live in a culture of violence,” said Larry Cohen, MSW, founder and executive director of the Prevention Institute, in a morning session on violence prevention at the American Public Health Association (APHA) Annual Meeting, held this year in Boston, Mass.

“Just as air, water and soil affect our health, the social environment affects the spread of violence through our communities,” said Cohen.

One of the most important factors in the environment that influences the perpetration of violence is actually more violence. Basically, violence begets violence. It spreads like a disease.

“It’s like the flu,” said Gary Slutkin, MD, PhD, Founder and Executive Director of Cure Violence. “The greatest predictor of a case of the flu is a preceding case of the flu. It’s the same thing with violence. Violence is an infectious disease.”

Slutkin shared a study of one community that found that exposure to community violence in one form or another was associated with a 30 times increased risk of committing violence—but what was most striking is that statistic held true, even controlling for poverty, race, crowded housing and other factors that could have an impact on violence. The effect is also “dose dependent,” according to Dr. Slutkin. That is, the more violence you witness or experience, the more likely you are to perpetrate violence.

The good news is that “we know how to prevent epidemics,” said Slutkin. “We need to recognize that this is a preventable problem. We need to build a movement,” agreed Cohen.

Cure Violence focuses on the very same steps used to prevent the spread of infectious disease in their work to help prevent the spread of violence:

  1. Detect and interrupt the transmission of violence, by anticipating where violence might occur.
  2. Change the behavior of those most at risk for spreading violence.
  3. Change community norms to discourage the use of violence as an acceptable and even encouraged way to handle conflict.

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APHA 2013: Preparedness Lessons From Hurricane Sandy

Nov 5, 2013, 3:36 PM

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Just over a year ago, Hurricane Sandy made landfall in the United States. Estimated damage came to $65 billion, at least 181 people in the United States died and power outages left tens of millions of people without electricity for weeks.

In the aftermath of this devastating event, the public health community continued efforts to make Americans aware that public health needs to play a much larger role in emergency response and recovery.

And in an American Public Health Association (APHA)-sponsored session on Wednesday, panelists discussed how they can draw on disaster response incidents to analyze policy implications for preparedness and response efforts to protect the health of workers, communities and the environment—with particular emphasis on promoting health equity.

"Addressing health disparities and environmental justice concerns are a key component of Sandy impacted communities," said the moderator of the panel, Jim Hughes of the National Institute of Environmental Health Sciences (NIEHS).

Kim Knowlton of the Natural Resources Defense Council and Columbia Mailman School of Public Health stressed that public health needs to advance environmental health policies post-Sandy, especially in regards to helping vulnerable populations.

"Climate change is a matter of health. It's such a deep matter of public health," she said. "We have to make a bridge between public health and emergency response preparedness communities," adding that "This is also an opportunity for FEMA to put climate change into their process for hazard mitigation planning and risk assessment.”

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