Author Archives: NewPublicHealth

Hot Weather Ahead: Take Precautions

Jul 6, 2012, 7:59 PM, Posted by NewPublicHealth

“Record-breaking heat will continue to make headlines” is how the National Weather Service began its forecast for the weekend and into next week. So it’s a good time for a reminder about taking hot weather precautions, especially for outdoor workers, in this blistering weather.


The Occupational Safety and Health Administration is continuing the campaign it began last year to help protect outdoor workers in extremely hot weather. In 2011, 30 workers died of heat-related causes and thousands became ill. Each year tens of consumers die of heat-related illnesses.

OSHA maintains a frequently updated website as part of its outreach campaign to raise awareness among workers and employers about the hazards of working outdoors in hot weather. Resources include training tools and posters for employers and many are aimed at workers with limited English proficiency.

OSHA is also partnering with the National Oceanic and Atmospheric Administration (NOAA) on weather service alerts. NOAA’s Heat Watch page now includes worker safety precautions when extreme heat alerts are issued.

Drinking water often, taking breaks and limiting time in the heat can help prevent heat illness for outdoor workers and anyone else spending time in the heat.

Watch a video with David Michaels, PhD, MPH, Department of Labor Assistant Secretary for Occupational Safety and Health, on protecting workers working during extreme heat.

And the hot temperatures around the country beg precautions by non-workers as well.

The Centers for Disease Control and Prevention reminds people that during high humidity sweat does not evaporate as quickly, which can keep your body from releasing heat as fast as it may need to. In addition, age, obesity, fever, dehydration, heart disease, mental illness, poor circulation, sunburn and prescription drug and alcohol use can interfere with sweating and being able to cool off in very hot water. Not cooling off can cause body temperature to rise and can result in severe illness and even death.

Pay attention to these precautions:

  • Stay in an air-conditioned indoor location.
  • Drink plenty of fluids.
  • Wear loose, lightweight, light-colored clothing and sunscreen.
  • Schedule outdoor activities carefully.
  • Pace yourself.
  • Take cool showers or baths to cool down.
  • Check on a friend or neighbor and have someone do the same for you.
  • Do not leave children in cars.
  • Check the local news for health and safety updates.

>>Bonus Link: Read a CDC Frequently Asked Questions page about extreme heat.

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

North Little Rock Mayor: It's About Giving People a Reason to Want to Live Here; Health is Added Inspiration

Jul 6, 2012, 5:19 PM, Posted by NewPublicHealth

Pulaski County, Ark., home to the city of North Little Rock, ranked 21st out of 75 counties in the state in the 2012 County Health Rankings. North Little Rock Mayor Patrick Hays recognized need to take action to improve the health of his residents, so he and his colleagues began an employee wellness program in earnest. As Mayor Hays and Alderman Beth White wrote in a recent blog post, “The benefits of employee wellness programs are clear: reduced healthcare costs, increased productivity and healthier employees. With those benefits in mind, the City of North Little Rock is an example of how a city government’s commitment to health and fitness benefits both employer and employee The city’s Fit 2 Work program offers employees healthier workplaces that offer greater options for getting and staying healthy, including healthier vending machines and discounts at community centers that offer physical fitness programs.

Fit 2 Work is just one component of the overall Fit 2 Live program, which aims to create an environment that empowers the community to adopt healthy life choices. This initiative, supported by grants from the National League of Cities’ Institute for Youth, Education & Families, which is funded by the Robert Wood Johnson Foundation, and a CDC Communities Putting Prevention to Work (CPPW) grant, includes safe routes to school efforts, joint use agreements, built environment improvements such as walking and biking trails, and school wellness improvements.

NewPublicHealth spoke with Mayor Hays and Fit 2 Live Coordinator for the City of North Little Rock, Bernadette Rhodes, about their efforts to create a healthier city.

NewPublicHealth: Tell us about the Fit 2 Work program for the City of North Little Rock.

Mayor Hays: I have been here at City Hall about 23.5 years. I’m very proud of a lot of things we’ve done, but this has to be pretty much at the top of the list. These are things we’ve long understood to be a priority. I’ll give you a little bit of background—75 percent of my budget goes toward employee benefit costs. The old adage of “follow the money” is absolutely true. I’ve got 900 folks who work directly for me. We, like many in the country, are experiencing fairly significant increases in premiums in our medical costs. We tried to be as sensitive to preventive efforts to keep our employees healthy as we could be. About eight years ago, the city wrote a check for $300,000 to form its own health clinic. We wanted to have health screenings, and options for our employees with a great deal of accessibility to annual physical exams, screenings, blood work and more.

We are focusing on our workforce to give them the options to be healthy. We’re also trying to be a little creative with our employees to allow them to join a 10-week Weight Watchers program—that was 16 pounds ago that I was a beneficiary of that program—as well as discounts at our excellent community and senior centers.


North Little Rock Mayor Patrick Hays

NPH: The Fit2Live initiative includes a broad set of programs to create a healthier city. Why is it critical for a growing city to make health a priority?

Mayor Hays: We are serious about both our employees as well as our community having healthy options at vending machines, through the use of walking paths and in other aspects throughout the community. About 20 years ago I started building trails in North Little Rock because I wanted to make sure it was a place people wanted to live. We had been flat in population since the 1960s. People were moving to the suburbs, not unlike what was happening all over the country, but I made the decision that I wanted to do things to make people want to live here. We started out with trails, improving our parks and building sidewalks. I’m proud to say some of the dirt paths I walked through as a kid are now sidewalks and trails. We felt that competing for young people’s time was something we need to do, and what better way to do it than creating options for recreation—so we put a basketball court under an interstate overpass. We lit it, and sometimes we have midnight basketball.

Our inspiration was more geared toward wanting people to live in the community and giving them reasons to do it than it was because of the health epidemic. Now the health side of things has certainly taken on an added inspiration over the last five to 10 years. We like to think we were ahead of the game. We’re excited about what’s happened and where we are.

We received a $1.5 million Communities Putting Prevention to Work (CPPW) grant from the CDC to fight obesity and other health-related issues. We of course are partnering with our high schools and other organizations throughout the community to make this happen.

>>Read more on the North Little Rock CPPW grant.

NPH: What changes are you hoping to see in six months or a year?

Mayor Hays: The thing I want to ensure is that what’s in my head has been institutionalized so it’s not up to any one person. We need to ensure the foundation has been laid, and we do feel we’re there. We’ve got a built environment committee when it comes to utilization of trails and buildings and other things that together create a healthier community. We’ve got the Fit2Live leadership team.

All of this will be carried on in this city after my term is up because of the foundation we’ve laid and the enthusiasm of the staff and leadership. That together with the funding we secured has laid the groundwork to make healthier lifestyles and choices an institutionalized part of the way our city works.

NPH: Who were some of your important partners, and what is the overall role of partnerships in your work?

Mayor Hays: We formed a coalition of teams, and collectively if you’re at the table you have more likelihood to buy in to the outcome, and that’s been a big part of the success of our programs. I would include our employees themselves as one of our key partners, as well as the state, the Department of Health, Chamber of Commerce, Department of Parks and Recreation and others.


Bernadette Rhodes, Fit 2 Live Coordinator for the City of North Little Rock

Bernadette Rhodes: The neighborhood associations have also been critical in getting the word out about what we’re doing. For example, the built environment committee organized a tour and discussion of a new bike and pedestrian trail that’s going to be paved and built in an abandoned railroad spur.

Hays: These pedestrian trails are not only good for physical activity, they also promote interaction. Social integration is absolutely critical. People need to see each other in ways other than hollering at each other through a car window.

NPH: What are some of the milestones in what has been achieved with the CPPW grant?

Rhodes: We’ve had the grant for almost two years now. In our community action plan we identified quite a few ways in which we wanted to combat obesity. The first one is in schools. We partnered with the school health coordinator for the district and worked with her to revise the school district wellness policy and to draft a district employee policy. Those policies have been drafted and reviewed by the superintendent and approved to go on to the school board for a vote. It strengthens the existing wellness policies a lot. Schools were required to have a wellness policy, but a lot of times they were just bare bones. For example, vending machines would have to be at least half healthier options, and the signage on the front of the machine has to be water or 100% fruit juice and not a soft drink. It also says food is not to be used as a reward with the kids. Another big thing is implementing SPARK PE, a national evidence-based program that incorporates physical activity and nutrition education, and that was implemented across the board with all PE teachers as well as city community after-school programs.

The second thing is healthy food options. We passed guidelines through the City Council to encourage all departments within the city to change the way they offer food, whether it’s in meetings or catered events and of course vending machines. We adopted a model called “Go, Slow, Whoa” and per the guidelines, half of those foods offered should be “Go” or “Slow.”

The third thing is joint use agreements. We had some money to renovate existing facilities around the city—community centers, parks and schools. For example, a lot of elementary schools had basketball courts but the nets were gone and there was no way to play on them. We went through and refurbished all of those so they’re usable. We’ve also been ordering signs to put up in the parks and around walking trails to say they’re open for use to the public at certain times, and one lap equals a quarter of a mile—to ensure people know these facilities are available to them for use.

NPH: How do you measure progress?

Rhodes: We have an evaluator who’s been working on getting hard numbers on all of our vending machines. He created a baseline and went around and categorized existing foods in the vending machine using go, slow, whoa. After these guidelines are implemented, he’ll go around and measure the changes that have taken place.

With joint use agreements, the evaluator will measure the quality of those facilities and the usage both before and after. They have a tool that allows you to observe the usage of the facility and the type of physical activity they’re engaging in.

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

Afternoon Update: FDA Approves First Over-the-Counter Home Use HIV Test Kit

Jul 3, 2012, 6:54 PM, Posted by NewPublicHealth

The Food and Drug Administration (FDA) has approved the first in-home HIV Test. The test, called OraQuick, does not require a prescription and can detect the presence of antibodies to human immunodeficiency virus type 1 (HIV-1) and type 2 (HIV-2). HIV is the virus that causes acquired immune deficiency syndrome (AIDS).

Consumers use the test by swabbing the upper and lower gums inside of their mouths, then placing the fluid sample collected in a vial that comes with the kit. Results are available within 20 to 40 minutes. The FDA says a positive result does not mean that an individual is definitely infected with HIV, but that additional testing should be done in a medical setting. And a negative test result does not mean that an individual is definitely not infected with HIV, especially if exposure to the virus was within the past three months.

Clinical studies have found that one false negative result would be expected out of every 12 test results in HIV-infected individuals and one false positive would be expected out of every 5,000 test results in uninfected individuals.

OraSure Technologies, which makes the test, will have a consumer support center open 24/7 to help consumers conduct the test and to make referrals for information on prevention and treatment once the test is completed.

“Knowing your status is an important factor in the effort to prevent the spread of HIV,” said Karen Midthun, MD, director of the FDA’s Center for Biologics Evaluation and Research. “The availability of a home-use HIV test kit provides another option for individuals to get tested so that they can seek medical care, if appropriate.” According to the FDA, the test will be targeted to people who would not otherwise be tested. “There’s a large group of people who are infected, and don’t know it,” says Midthun. “And even if they are engaged in behaviors that would put them at risk of getting HIV, they may be reluctant to visit their doctor or a health care facility to be tested.”

The Centers for Disease Control and Prevention estimates that 1.2 million people in the United States are living with HIV infection. About one in five are not aware they are infected. There are about 50,000 new HIV infections every year. Many of these new infections are transmitted from people who are unaware of their HIV status.

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

Supreme Court Affordable Care Act Decision: Who to Watch For Analysis

Jun 28, 2012, 3:42 PM, Posted by NewPublicHealth

The earliest reading of the Supreme Court’s decision this morning on the Affordable Care Act finds that much of it is upheld as constitutional. Read the full court ruling here

Sites worth following throughout the day include:

Several public health and advocacy organizations have also released statements:

UPDATES -- Thanks to TFAH for sharing additional statements as they've come through.

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

CDC Pilot Trains Pharmacists and Retail Clinic Staff to Provide Testing for HIV/AIDS

Jun 27, 2012, 6:40 PM, Posted by NewPublicHealth

In observance of National HIV Testing Day, the Centers for Disease Control and Prevention (CDC) has announced a pilot project to train pharmacists and retail store clinic staff at 24 rural and urban sites to deliver confidential rapid HIV testing. The goal of the pilot, according to CDC, is to extend HIV testing and counseling into the everyday services offered by pharmacies and retail clinics. The project is part of CDC’s efforts to support its 2006 testing recommendations, which call for all adults and adolescents to be tested for HIV at least once in their lives.

“We know that getting people tested, diagnosed and linked to care are critical steps in reducing new HIV infections,” said Kevin Fenton, MD, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention. “By bringing HIV testing into pharmacies, we believe we can reach more people by making testing more accessible...”

CDC estimates that 1.1 million people are living with HIV in the United States, yet nearly one in five remains unaware of the infection. In addition, one-third of those with HIV are diagnosed so late in the course of their infection that they develop AIDS within one year. That can delay treatment and increase potential transmission of the virus to partners.

Why community pharmacies? According to the CDC, millions of Americans shop at pharmacies every week and about 30 percent of Americans live within a 10-minute drive of a retail clinic. The pilot will last for two years, and the training will focus on rapid HIV testing and counseling and linking people diagnosed with the virus to treatment and support. Based on lessons learned, CDC plans to develop a comprehensive toolkit for that pharmacists and retail clinic staff.

Bonus Link: The Alliance for Health Reform recently held a briefing for Congressional staffers about retail clinics. Access the briefing webcast here.

More on HIV/AIDS testing:

>>Weigh In: What other initiatives do you think might be good opportunities for collaboration between public health and retail clinics?

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

AcademyHealth Annual Research Meeting: Many Employers Still on the Wellness Sidelines

Jun 27, 2012, 3:45 PM, Posted by NewPublicHealth

Three entities in Minnesota shared their experience with workplace wellness programs at this week’s AcademyHealth Annual Research Meeting. Employers can play critical roles in improving the health and lifestyles for their employees and their community, but many are still on the learning curve of why it’s important, according to presenters at the session.

Marc Manley, MD, MPH, chief prevention officer of Blue Cross Blue Shield (BCBS) of Minnesota says “workplace wellness needs a business plan, not just a culture.” Manley says to be successful, workplace wellness plans need goals and a decision on who will pay for it. It also needs a long-term commitment—at least three years, says Manley, since most firms can’t afford to introduce every wellness incentive—such as healthier foods, incentives for healthier lifestyles, and company-based programs such as smoking cessation and weight loss—all at once.

Manley adds: "You also need infrastructure, communication with employees, feedback, incentives, goals, a measurement strategy; and a lot of employers just don’t have this in place for wellness."

Examples of things to focus on include the types of food offered throughout the workplace, and what you will do to make the healthy choice the easy choice, such as pricing healthier foods differently than less healthy ones.

Manley, who is also the chief medical officer for Invitation Health & Wellness, a consulting arm of BCBS Minnesota aimed at widely sharing evidence-based practices, says small firms often want to know what they can introduce that’s fully free of financial costs that will help improve the health of their employees. Manley says he does have one suggestion: have CEOs model healthy behaviors, and serve as role models.

Wellness initiatives at BCBS Minnesota, which has 3,500 employees and 2.5 million members, include online and telephone behavior coaching, unlimited office visits to physicians and dieticians, discounts to lifestyle programs such as weight loss classes, provider incentives, paid media campaigns, lobby for strong health policies such as active transportation and funding of local community efforts to promote physical activity and healthy eating. Also needed, said Manley, are data to establish priorities, evidence-based strategies that support goals, measureable goals, and measurement and reporting of progress.

“Firms that have a business plan for a healthier workplaces connected to a culture of health, are more likely to succeed in helping employees get and stay healthy,” says Manley.

Manley cited a 2012 study in the American Journal of Health Promotion that found that workplace wellness programs can produce, on average, reductions in sick leave, health plan costs, and workers’ compensation and disability insurance costs by around 25 percent.

Target’s corporate headquarters are based in Minneapolis, and recently the company started a “wellbeing” initiative as its inaugural project for workplace wellness. While they’ve started some wellness projects, such as reducing the cost of fruit in the cafeteria, well being is what the company is after, to start—including camaraderie and teambuilding efforts. "When they go home we want them feeling good about where they work," says Kara McNulty, senior group manager of medical affairs at Target, who added that the biggest influence from well being on health is on stress-related disease such as coronary artery disease and depression.

McNulty says team members with a higher rate of well being are more likely to stay with the company, volunteer in the community and participate in health surveys. Target’s next steps will be to grow participation in the well being program, study the role of well being “captains” and establish more actionable measurement systems.

At a panel convened by the Alliance for a Healthier Minnesota, a collaborative private and public stakeholders, Target was one of the firms discussing an accreditation program for wellbeing. The program sets standards for workplace wellness programs in three areas: organizational engagement and alignment; population health management and well-being; and outcomes reporting.

Tom Mason, head of the Alliance for a Healthier Minnesota and the final speaker on the session on workplace wellness, said that although business is not often seen as a change agent, real health care reform requires both business and public health. “There has to be coalition building, we have to stick with it for the long haul, and we have to do have forward looking companies."

The Alliance has completed focus groups with small companies on their thinking with regard to workplace wellness, with results to be released in the fall. “The big challenge is small business,” says Mason; "in Minnesota 65 percent of those employed, work for small companies."

Dr. Manley added a twist to his presentation that showed the relative ease of introduction of small changes, especially for a willing audience. He bemoaned the need for conference attendees to spend so much of the meeting sitting, and challenged the sessions attendees to get out of their chairs and stand, and even move their arms and legs a bit, after each speaker—and just about everyone did as he asked, after a careful look around to be sure they wouldn’t be the only ones. “Changing a norm is not so easy,” said Manley. “But it’s possible if you start thinking about what you need to do.”

>>Weigh in: What’s a small change your community has made that has increased, even slightly, physical activity among a group?

>>Bonus Interview: Read a NewPublicHealth Q&A with Tom Mason of the Alliance for a Healthier Minnesota

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

AcademyHealth Annual Research Meeting

Jun 27, 2012, 2:09 PM, Posted by NewPublicHealth

We’ll never know if it was the spirited discussions or Tropical Storm Debby, which is pummeling northern and central Florida, that kept most of the 2,000-plus attendees at this year’s AcademyHealth Annual Research Meeting—this year in Orlando—indoors and packed into the sessions and the exhibit hall at just about every minute of the meeting this year. Public Health was a featured topic, according to AcademyHealth president and CEO Lisa Simpson, and a session on the IOM report on the integration of public health and primary care, led by the committee chair, Paul Wallace, MD, was a featured, and well-attended, session as well.

Not surprisingly, many public health officials made their way into a ballroom very early Tuesday morning to hear three health law scholars, Sara Rosenbaum of the George Washington University, Timothy Jost of Washington and Lee and Mark Hall of Wake Forest, talk about the issues likely contemplated by the Supreme Court Justices as they considered the cases brought against the Affordable Care Act. Critical for public health were the discussion points aired just before the session ended, concerned with continued state and federal budget cuts including cuts to the Centers for Disease Control and Prevention and other divisions of the Department of Health and Human Services, which could impact public health service delivery now underway, as well as implementation of the Affordable Care Act, if it is upheld.

Health disparities were also a focus of several sessions, as well as the topic that won the student poster award of the conference. Stephen Vance, a fourth-year medical student at the University of North Carolina at Chapel Hill School of Medicine, won the best student poster award for his work with Aida Lugo-Somolinos, MD, of the medical school, on clinical trial enrollment barriers faced by the Hispanic population in North Carolina. Vance’s research found that the barriers identified by the Hispanic participants in the study differ from those expected by clinical investigators.

The study provided a questionnaire for physicians on their perceptions of why more members of the Hispanic community don’t enroll in clinical trials, and also collected patient questionnaires on trial participation from close to 400 members of the Hispanic community.

The physician responses showed that they viewed language and transportation as the key barriers. But the patient responses showed other concerns including worries about what participating might cost them, concern about missed work time and a lack of understanding about the potential benefits of trial participation, including access to health care. The researchers say the following should be considered as a means to enroll more members of Hispanic communities in trials:

  • Provide information about studies to health care providers in areas with large Hispanic populations
  • In large cities, create partnerships with Hispanic advocacy groups
  • Communicate that trial participation is not necessarily costly and may take no more time than a regular doctor’s appointment
  • Include a person fluent in Spanish on the research team

“Before this study, I would have thought that transportation and language were the key barriers,” says Vance. “It’s really a lack of understanding of what a clinical research project entails.”

“Perhaps as clinicians, we’re asking the wrong questions,” says Vance, who is on track to get an MBA as well as his MD degree, and plans to go into health management. “This study focuses on the Hispanic community, but should push us to look at the reasons why other groups are underrepresented in trials.”

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

Health Impact Assessment Looks at Potential Impact of USDA Nutrition Standards on Student Health, School Budgets

Jun 26, 2012, 6:12 PM, Posted by NewPublicHealth

Jessica Donze Black, Kids' Safe & Healthful Foods Project

Updating nutrition standards for snacks and beverages sold in school so that they meet the most recent Dietary Guidelines for Americans could help students maintain a healthy weight and support school food service revenue, according to a first-of-its-kind health impact assessment (HIA) released today by the Kids’ Safe & Healthful Foods Project and the Health Impact Project. This is the first HIA completed to inform a new federal rule. The Kids’ Safe & Healthful Foods Project and Health Impact Project are both collaborations of The Pew Charitable Trusts and the Robert Wood Johnson Foundation.

NewPublicHealth spoke with Jessica Donze Black, RD, MPH, project director of the Kids' Safe & Healthful Foods Project, about the HIA findings.

The snacks and drinks sold in school vending machines, stores and à la carte lines are sometimes called “competitive foods” because they compete with school meals for students’ spending. The U.S. Department of Agriculture (USDA) last issued nutrition standards for competitive foods in 1979, but they mostly covered foods sold in cafeterias at meal times. Since then, says Black, the nutrition environment has changed dramatically, and now there is food sold all over the school throughout the school day. In December of 2010, Congress directed USDA to update those standards, and the proposal is due soon.

The HIA was designed to assess the health impact of the updated nutrition standards, as well as their impact on school and district budgets. According to Black, the HIA found that changing the school environment to make healthier foods more available would change students’ eating patterns, increasing their consumption of fruits, vegetables and low-fat dairy. That change, says Black, could ultimately to lead to less chronic disease.


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Competitive Foods: First Health Impact Assessment on a Federal Rule

Jun 26, 2012, 6:11 PM, Posted by NewPublicHealth

A first-of-its-kind health impact assessment (HIA) released today by the Kids’ Safe & Healthful Foods Project and the Health Impact Project looked at updating nutrition standards for snacks and beverages sold in school from a perspective of both student health and school budgets. This is the first HIA completed to inform a new federal rule.

NewPublicHealth spoke with Aaron Wernham, MD, MPH, director of the Health Impact Project, about what this HIA represents for the field.

NewPublicHealth: Isthis is the first time an HIA has been done on a federal rule?

Aaron Wernham: This is a somewhat new topic for HIA. There have been a number of HIAs of federal agency decisions. So, for example, developing permits for mines and oil and gas activities, but this is the first time that we’re aware of that an HIA has addressed a federal rule-making process.

NPH: Why was HIA the right tool to use in this circumstance?

Aaron Wernham: We advocate for doing an HIA on a decision where it absolutely adds value. There are some decisions for which the health implications may be obvious and are already being addressed, and other decisions where there really aren’t such important health implications. In this case we felt as if some of the health implications were known, or at least suspected as far as the potential nutritional benefits, but there were a lot of questions, such as just what are those benefits and how strong is the evidence for them? So I think that was one reason why we thought the HIA would be very valuable was really to put all of that evidence together into a clear picture to help USDA think through the nutritional benefits for children in setting these standards.

The second question, which really sealed the deal, was the realization that setting nutritional standards is great, but what about the practical challenges that schools may face implementing them? So, HIA was the right tool for this job because it really is a good way to bring the perspectives of the different stakeholders into the picture as well as the best available evidence. The HIA serves to make sure that you’re considering not just what might appear best for health on the face of it, but really a deeper look at the tradeoffs and how to make sure that that ultimate decision is a win/win.

NPH: What implications does this HIA have for the practice of HIAs as a tool to enforce important policy?

Aaron Wernham: I hope and believe that the information in this HIA is going to be useful to USDA as they make their decisions on this rule. But I also think that it’s a pilot to help us understand how do you do HIA well to inform a high level federal regulatory decision? What are the data needs? How do you put together a solid team to do the analysis? What sorts of information are most useful? How do you make sure that all of the stakeholders are collaborating effectively through the process? So I think we’ve learned a lot about that through the process of doing this HIA, and I think that will strengthen the field going forward into doing more HIA work at this level. As the first HIA on federal rule making, we wanted to make sure that it was adequately resourced and done very rigorously.

As a field, we also recognize that there’s really a downside to not considering health when we make many decisions—both small or local decisions and larger federal decisions. The National Research Council, in its review of HIA, said that HIA is valuable because it seeks to correct the fundamental problem of failing to consider health at all in decision making, and even with a lack of perfect data it’s still a valuable tool because it’s better to identify potential health risks and benefits than to ignore them. HIA can really be fit for different purposes and different levels of resources.

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

Paul Wallace: Public Health and Primary Care

Jun 22, 2012, 3:15 PM, Posted by NewPublicHealth

Primary care and public health share a common goal but historically have functioned independently of each other. However, health experts say that better integration of the two disciplines could result in critical improvements in the health of individuals and communities. The Centers for Disease Control and Prevention and the Health Resources and Services Administration asked the Institute of Medicine (IOM) to look at issues related to the integration of primary care and public health, and the resulting report was released earlier this year.

The recent report on integrating was so groundbreaking, that it has launched a number of discussions and publications on the issue, including a keynote panel at the recent 2012 Keeneland Conference, a first ever joint issue of the American Journal of Preventive Medicine and the American Journal of Public Health and a session on the report at next week’s AcademyHealth Annual Research Meeting by the IOM report’s committee chair, Paul Wallace, MD. NewPublicHealth spoke with Dr. Wallace, Director of the Center for Comparative Effectiveness Research at the Lewin Group, about the committee’s critical finding and recommendations.

The IOM identifies a set of core principles common to successful integration efforts, such as involving the community in defining and addressing its needs. The principles provided in this report can serve as a roadmap to move the nation toward a more efficient health system.

NewPublicHealth: What were the key findings were in the report?

Dr. Wallace: There are many instances in which communities have figured out aspects of integration but, as we learn over and over again in health care, solutions often need to be locally adaptive, and that holds true in thinking about how integration takes place as well.

I think what was very helpful for us was recognizing that integration is really a continuum, sort of extending from either being disintegrated or, if you will, parallel play on one end up through quite formal partnerships or mergers on the other end. There are opportunities for creating better care and efficiencies along that continuum. For public health to be aware of what primary care is doing and for primary care to be deeply aware of what public health is doing would be a substantial element of progress.

NPH: Why is integration coming about now?

Dr. Wallace: It isn’t quite yet. Until about a hundred years ago health care was the province, almost exclusively, of the clinician-patient relationship. Previously, though, if you go back 150 years, in medical schools, there was really a sort of blending of what we now would think of as public health and what we think of as health care. But the Flexner Report back in the early 20th century re-configured how medical education took place, which changed the structure of medical schools, and public health wasn’t really part of that.

The other thing that happened was that public health was figuring out what it needed as an academic base, and that was about the time that the Rockefeller Foundation stepped up and started funding separate schools of public health. So really what happened is that the education and the academic foundation sort of diverged and they followed separate paths for most of the last century.

NPH: With stronger collaboration between public health and health care, what could be achieved?

Dr. Wallace: I think if you look at it from a patient-centered perspective, there would be rational and consistent availability and access to a whole range of services like healthy food and the ability to exercise, and it would be reinforced by our public policy. There would be a shared awareness of who are the people at greatest risk, perhaps related to data and information systems. There would be an alignment between messaging from public health agencies and what you would hear in your clinician’s office. And in the clinician’s office there would be recognition that it isn’t just about doing physical exams and prescribing pills, it’s also thinking about aspects of healthy living such as active living and healthy eating.

But I think that there really would just be a blending of the whole continuum, and I think that the other really important thing is that a lot of the emphasis would shift from fixing things through health care to more of a proactive context of prevention, and really primary prevention. It’s about not waiting until people have high cholesterol and heart attacks and then trying to treat them with lipid-lowering drugs, but thinking how you get ahead of this in public schools, in the workplace and in our communities.

NPH: Would money be saved with the appropriate integration?

Dr. Wallace: Another way to think about it would be—can we get more health for the dollars we’re spending? We certainly could make the system more efficient. There are a lot of issues of maldistribution, for instance, where we tend to over-treat certain people in certain ways, and as a consequence there are other folks who are poorly treated. The disparities discussion I think is a very rich one that’s right in the middle of this.

Over time, we might start to see spending migrate from very high-risk dollars on things that are very unlikely to work with expensive interventions, to more fundamental upstream interventions that will have dividends over many years.

NPH: Is it sufficient to just have primary care and public health at the table together to solve the massive problems that have been created?

Dr. Wallace: If you really want to create health on a community basis, you need public health and you need the health care delivery system, primary care, but almost all of the successful programs also have some third party. And that third party may be government, it may be schools, it may be a faith-based organizations. It gives you sort of a place to convene. Rather than having public health and primary in a tug of war over who is bigger and brighter and smarter, you realign that effort to think about how we can collectively engage to support this third party. That sort of triangulation I think is a really critical thing about trying to bring these mindsets and forces back together.

NPH: What are the next steps to the report’s findings?

Dr. Wallace: What was different about this report we feel is that it involved people who have a direct interest in this, who are motivated to actually do some things to try and support this. CDC and HRSA, who together commissioned the report, between them have a footprint that really extends into every community. They’re actively thinking together about a lot of things that we’ve suggested, but a lot of our suggestions reflected openness from them to where they want to go. CDC and HRSA are increasingly aware of what each other are doing, they actively cooperated in funding the study and they’re collaborating now in thinking about some funding models.

There are also workforce issues. There probably is a set of workers who are critical to this and they aren’t necessarily traditional health care roles, but they’re more like the community health worker who can help people with education. They’re in the community, they understand the culture, they understand the nuance and may be more effective at translating some of these messages.

NPH: What made it feasible to have a receptive audience for this report now?

Dr. Wallace: There is a growing understanding of what population health is, and in a sense that population health is bigger than either primary care or public health and it’s only going to get addressed if they do it collaboratively. The other really critical factor that makes things different now is the availability of data. That is just fundamentally changing people’s thinking. An example of that would be creating community-wide registries that can be used to recognize where there’s opportunity such as pockets of a city that have a very high incidence of asthma, and then being able to think about what are the community or public health-based interventions.

Data democratization is also creating new levels of transparency and accountability. There’s this growing recognition that you can now know what is going on, where before people always wondered or hypothesized.

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