Wednesday, November 19, 2014

Closing General Session: ‘We can make health everyone’s business’




Risa Lavizzo-Mourey’s light bulb moment came during her medical training, when she was doing her rotations at a hospital in Boston. There, she met “Patient Ruth.” Ruth was homeless — she came into the hospital with swollen feet and skin ulcers that made it terribly painful to walk. She’d been in and out of the hospital many times, her medical file bulging with records.

A day after Lavizzo-Mourey, who’s now the president and CEO of the Robert Wood Johnson Foundation, first met Ruth, the patient was discharged. The hospital had done its job, giving Ruth a warm bed for the night, some food and basic health care. But as Ruth left the hospital, she still had no home, no job, no access to healthy food, no social support. None of the conditions that make for healthy people and healthy communities would meet Ruth outside that hospital door. Unfortunately, she would most certainly return in need of more help.

But what if instead of ushering Ruth back out into the cold, the hospital had connected her with the very services and support that could keep her out of the hospital, Lavizzo-Mourey asked a crowd of hundreds at the Closing General Session of APHA’s 142nd Annual Meeting and Exposition, which welcomed more than 12,500 people to New Orleans. Why wasn’t preventing a re-admission the fundamental goal of every visit to the hospital, she wondered. It was a transformative moment and one that redirected Lavizzo-Mourey to the world of public health, where she’s now a leader in the movement to build a nationwide culture of health.

“The effects of where you live are so profound that your ZIP code may in fact be as important as your genetic code in how well and how long you live,” she told attendees.

So, what does a culture of health look like? Imagine a society in which promoting health is as important as treating disease, Lavizzo-Mourey said. Imagine a world in which doctors openly share medical notes with their patients and engage in honest discussions about the value and price of care. Imagine neighborhoods and cities where optimal child health is a matter of fact — not a matter of chance. Imagine families and towns in which employers, policymakers and teachers all work together to help make the healthy choice, the easy choice. This is what a culture of health looks like, Lavizzo-Mourey said, and it is achievable.

“It’s a bold idea and it’s one that I believe is possible,” she said.


Of course, there are many challenges and the current data on Americans’ health is not particularly encouraging. But if we put our heads together and commit to reaching out and partnering with nontraditional public health partners, we can build a culture in which all people can access the opportunities that afford lifelong health, Lavizzo-Mourey said.

“That’s what it’s going to take to make a culture of health happen,” she said. “Cranking up the volume on a nationwide call for change.”

And this year’s host city of New Orleans is the perfect inspiration. After the devastation of Hurricane Katrina, public health leaders decided the best way to rebuild the city was to put it on a trajectory to become one of the healthiest cities in America. In turn, public health officials reached across sectors, convening partnerships, leveraging knowledge and resources, and integrating health as a consideration in everyday policymaking. That shift in thinking is “part of the incredible comeback spirit that we felt in every corner of this town for the last week,” Lavizzo-Mourey said.

“It’s not going to be easy; in fact, it’s going to be hard,” she said. “But if we combine passion and purpose, I know we can raise the health of everyone in America to the level that this great nation deserves and when we do, we will indeed have a powerful story to tell. A story that we can start telling today.”

Building a culture of health and the importance of partnerships were common themes throughout today’s Closing General Session. In fact, both philosophies are central to APHA’s strategic priority of building the healthiest nation in one generation.

J.T. Lane, assistant secretary at the Louisiana Department of Health and Hospitals Office of Public Health, called on state health agencies to strengthen their support and advisory role in local communities. For example, he encouraged session attendees to help communities identify local public health champions and nontraditional partners. However, he added, be cognizant of local dynamics and help communities tailor efforts that will grow and sustain over time.

“Societal change requires changes in us,” Lane said. “We can make health everyone’s business.”

Mary Wakefield, administrator of the U.S. Health Resources and Services Administration, echoed those sentiments but from a rural perspective. Contrary to some popular thought, Wakefield noted that living in rural America isn’t always “a ticket to longer or healthier lives.” In fact, life expectancy has been consistently lower in rural areas than in urban areas and that gap is widening.

“If your ZIP code is a rural one, one’s health status might be at particular risk,” Wakefield said. 

Rural communities face a number of challenges to building a culture of health, including less access to care and high rates of poverty. But these challenges are ones that can be overcome, Wakefield said. Indeed, the notion of “pulling together” is a strong one in rural neighborhoods and a strength of rural communities overall. In rural America, health really is everyone’s business, she said.

Howard Koh, former U.S. assistant secretary for health and a professor at the Harvard School of Public Health, told session attendees that with the implementation and success of the Affordable Care Act, it’s the perfect time for a paradigm shift in how our country thinks about health and prevention. Of course, none of this work is easy, he said. (On that note, Koh said: “Blessed are the flexible so we shall not be bent out of shape.”) Still, there’s no more important work than improving and safeguarding the health of our nation.

“When prevention works, you get to enjoy the miracle — the absolute miracle — of another perfectly healthy, normal day,” Koh said.

And so let’s end another energizing Annual Meeting with a challenge from new APHA President Shiriki Kumanyika, who called on her hundreds of colleagues at the Closing General Session to join APHA’s movement to create the healthiest nation in one generation. In particular, Kumanyika urged attendees to reach out and partner with the for-profit sector. Private sector action is integral to improving health and in pushing forward on issues such as climate change and health equity — in fact, public-private partnerships hold “incredible potential for accelerating our movement,” she said. Indeed, it’s to public health’s own detriment that it overlooks the power of the private sector to improve the nation’s health, she told attendees.

“I’m tired of being on the sidelines,” Kumanyika said. “I’m ready to have a conversation.”

We hope you’ll join that conversation, too. Visit APHA and sign our pledge to help build the healthiest nation in one generation.

And we’ll see you next year in Chicago for APHA’s 143rd Annual Meeting and Exposition, where the theme will be “Health in All Policies.” Until then, be healthy!

— K.K.

Above from top to bottom: Closing General Session keynote speaker Risa Lavizzo-Mourey; session panelists, from left to right, Mary Wakefield, J.T. Lane and Howard Koh; and outgoing APHA President Joyce Gaufin, left, passes the gavel to incoming APHA President Shiriki Kumanyika. Photos by Jim Ezell, courtesy EZ Event Photography

A little birdie told me so: Tweet of the day

On this last day of the APHA 142nd Annual Meeting and Exposition, the tweet of the day goes out to a group of public health folks who are not only talking the talk, but walking the walk. Bike on!


Go out and play!: The role of parks in health

It should be no surprise that attendees at a Wednesday session on the role of parks in healthography didn’t sit still.

Audience members got out of their seats and gathered around a table of maps, giving input on how to improve a local park in Miami-Dade County, Florida, during a session on “The Role of Parks in Healthography: The Unique Contribution of Our Nation’s Greatest Resource to Health and Wellbeing."

Session presentations focused on improving and expanding parks and recreation spaces and programs via partnerships with the Miami-Dade County Parks, Recreation and Open Spaces Department and the University of Miami.

Attendees were asked to give their input about Marva Y. Bannerman Park, a park surrounded my multiple schools and located in one of the county’s low-income neighborhoods.

Suggestions included planting more trees, adding more street lighting to reduce crime, and building a playground or splash pad for younger children. One idea was to have an “edible forest” garden with nutrition educational labels for certain plants.

“The ideas that come out of this group today will be taken back to the people planning this park,” said Joanna Lombard, a professor of architecture at the University of Miami.

Presenters also looked at the impact of access to recreational spaces on people with the poorest health. A study of 250,000 Medicare beneficiaries ages 65 and older in Miami-Dade County, found that when comparing a low level of green spaces to a higher level of green spaces, there was a 15 percent difference in the prevalence of diabetes and a 13 percent difference in prevalence of hypertension in surrounding neighborhoods.

“We believe these are evidence that having more greenery in your environment may be beneficial by promoting opportunities for physical activity and possibly just time spent outdoors,” said session presenter Scott Brown, a research assistant professor at the University of Miami Miller School of Medicine. “South Florida is a subtropical climate, so you need shade trees to encourage people to spend time outside.”

The power of access to green space and recreation in improving health is evident in the Fit2Play program, an ongoing Miami-Dade County Parks, Recreation and Open Spaces Department initiative to get local kids more physically active.

The University of Miami Miller School of Medicine partnered with Miami’s parks department to see how effective the program was in keeping kids healthy. The university brought in its team of pediatric specialists to train parks department field staff in measuring the kids for data on blood pressure, waist and hip circumference and more.

Since 2010, more than 760 kids who participated in Fit2Play improved across the board in lowering blood pressure, improving cardiovascular fitness and increasing their knowledge about health and wellness, such as nutrition, said Sarah Messiah, a Miller School of Medicine research associate professor.

“Our kids who started the program obese for their age and gender actually lost weight throughout the school year,” Messiah said. “The kids who started normal weight, stayed normal weight. That’s just as important to prevent those kids that come in normal from gaining weight.”

— N.M.

Cue the media montage

The APHA 142nd Annual Meeting and Exposition is bursting with new science — so much science that it’s bound to find its way outside the walls of the New Orleans convention center. And, indeed, findings from the Annual Meeting have made it onto the pages and screens of news outlets around the country. For your public health reading pleasure, here is a quick round-up of Annual Meeting news coverage.

• 
Time: The surefire way to eat healthier  



• North Carolina Health News: The cost of not wearing a helmet 

Philadelphia Inquirer: Home cooking helps keep the calories down

• 

Baltimore Sun: Public health experts stress importance of trust in West Africa as they fight Ebola 

• Fox 8 Live News: Researcher releases study at NOLA Ebola conference 

• Examiner.com: Obesity risk more likely to be higher for disabled adolescents 

U.S. News and World Report: Alcohol taxes may give boost to public health, economy 



• Medscape: Legislation fails to boost HPV vaccine uptake

Global lessons in disaster preparedness

 
“I wish I could have told that story to a larger audience this weekend,” said U.S. Army Lieutenant General Russel L. HonorĂ© at a Wednesday morning session on disaster mitigation and U.S.-Cuba cooperation.

The story he is referring to occurred in 2005 when the Ernest N. Morial Convention Center, which is hosting this year’s APHA Annual Meeting, was a collection point for 60,000 people during Hurricane Katrina. Nine years ago, a hospital was set up in what is now the Public Health Expo hall and people filled the streets, desperately waiting for help. Mentally ill individuals were particularly hard to treat during the aftermath, as they had gone days without medication. It took a week to get elderly patients to safer locations. Buses were called in to evacuate people after the hurricane hit. In the end, action was taken too late for too many.

The devastating consequences of Katrina motivated HonorĂ© to travel to Cuba to learn about that country’s disaster preparedness system, which had been proven to be effective and efficient. During the session, he noted that Hurricane Katrina passed through Cuba before it got to Louisiana; however, the negative impacts on Cuba were nowhere near the effects the storm had on New Orleans.

“Cuba is a country of 10 million and a poor country,” he said. “But their priority is to save lives.”

Guillermo Mesa Ridel, director of the Latin American Center for Disaster Medicine, discussed the strategies that Cuba uses to reduce the impacts of natural disasters and implement emergency preparedness plans. The country’s disaster mitigation plan is highly committed to prevention efforts: national drills prior to hurricane season and the training of carrier pigeons as a method of emergency communication are some of the innovative ways that Cuba prepares for disasters. Ridel also emphasized the importance of not creating new vulnerabilities during the disaster recovery phase.

The session presenters highlighted lessons that the United States could learn from Cuba, a country that considers disaster preparedness to be part of their culture. In fact, the Cuban definition of a disaster is not the natural event that takes place, such as a hurricane. The true disaster is the aftermath — damage to infrastructure, economic consequences and especially the loss of life.

A Cuban citizen among the audience concluded the session with these thoughtful words: “For every Cuban person, a disaster happens when one person dies.”

— S.L.

Above photo: Earlier this week, APHA Executive Director Georges Benjamin, left, signed a memorandum of understanding with C. Alcides Ochoa Alonso, right, president of the Cuban Society of Public Health. The memorandum formalizes a partnership between the two organizations aimed at strengthening public health capacity and leadership in the Americas. Photo by Michele Late, courtesy APHA Flickr

Here’s how public health finally won the soda debate


Attempts to enact soda taxes have failed over and over again, in big cities and small communities. And all that losing is precisely why public health has finally won.

On Nov. 4, 75 percent of Berkeley, California, residents voted in favor of Measure D, an ordinance to impose a 1-cent-per-ounce tax on high-calorie sugary drinks. It was the first-ever soda tax to pass in the U.S. by popular vote, and presenters at Wednesday’s session on “Beverages: Promoting Healthy Choices” explained how it happened.

According to session presenter Pamela Mejia, of the Berkeley Media Studies Group, the California cities of Richmond and El Monte as well as Telluride, Colorado, failed to pass similar measures in 2012 and 2013 — and that failure helped change the conversation surrounding the soda debate from one framed by big soda corporations to “authentic community voices,” Mejia said. (FYI: Fifty-five percent of San Franciscans voted for a 2-cents-per-ounce soda tax this past November as well, however that proposal needed two-thirds of the vote to pass into law.)

“As my boss Lori Dorfman said, Richmond and El Monte threw big pebbles in the soda tax water,” Mejia said. “Berkeley and San Francisco have pushed boulders in.”

The media played an integral role in past soda tax failures, including at least 30 failed ballot measures, as well as in the recent voter breakthrough, according to Susan Klitzman of the CUNY School of Public Health. Mejia found 653 news articles covering the tax proposals in Richmond, El Monte and Telluride. Among the articles, anti-tax sentiments were more frequently visible, insinuating harmful ramifications for local economies and personal freedom.

Perhaps not surprisingly, most of these messages were covertly paid for by the soda industry, including almost $4 million from the American Beverage Association spent in Richmond and El Monte alone.

“Local anti-tax coalitions were very powerful,” Mejia said. “It’s important to know your opposition and what they will say.”

Across the country, the first citywide soda size limits almost passed in New York City in 2012, after the New York City Board of Health proposed capping the size of sugary beverages served in restaurants and movie theatres at 16 ounces. Klitzman said that a LexisNexis search of news articles and opinion pieces were heavily skewed against the tax — 52 in opposition, 17 in favor — thanks to a large corporate influence. New Yorkers for Beverage Choices, a group financed by the soft drink industry, launched well-funded public and media relations efforts as well as political and legal campaigns against the rule, Klitzman told session attendees. Also, the corporate-funded Center for Consumer Freedom ran a full-page ad in The New York Times with a tagline, “New Yorkers Need a Mayor, Not a Nanny.”

Ultimately, the limits were approved in 2012 but overturned by New York courts, which also rejected the city’s final appeal in June. Still, session presenters called for continued perseverance, education and messaging.

“Be persistent,” Klitzman said. “Building political will takes time. To do so, we need to better educate top reporters and the media folks about the issue.”

— D.G.

Above, a campaign poster from Berkeley vs. Big Soda.

When it comes to food, place matters

A photo of the Circle Food Store in the heart of New Orleans shows the place submerged in six feet of water in the days just after Hurricane Katrina hit. But thanks to the work of a public-private partnership known as the Fresh Food Retailer Initiative, which is aimed at improving food access in underserved areas, the same store is now thriving. And they’re known for the cheapest bell peppers in town (usually four or five for just $1).

During a session on “New Orleans Foodography: Place-based Food Access Issues in the 10th Year After Katrina,” researchers and health advocates talked about ways the area continues to recover. Even before being devastated by the hurricane, New Orleans was an area that, like many cities, was home to many low-income, minority communities with no grocery stores and few healthy food options. The key to change, however, was partnerships.

Getting grocers and the grocery industry on board is a critical step to improving food access, said session presenter Julia Koprak of the Food Trust. Another local success story she shared: a once-abandoned, boarded-up building on North Broad Street and Bienville Avenue that’s now an “innovative, fresh-food hub.” Known as the ReFresh project, it includes a Whole Foods Market, a cooking school for at-risk youth and a community garden.

Other presenters talked of the challenges both in measuring food access and in getting residents in underserved communities to adopt what’s known as alternative food networks, which could include farmers markets and community-supported agriculture.


Over at Tulane University, the Prevention Research Center is working to prevent or reduce overweight and obesity in the greater New Orleans area by shedding light on the social and physical environment factors that impact people’s physical activity levels and diet. Presenter Yuki Kato of Tulane's Department of Sociology worked to understand why residents of the local Hollygrove neighborhood, which is predominantly black and low-to-middle-income, were not buying fresh produce at a newly opened market. The market offers a weekly $25 box of produce or a la carte purchases, with no membership required.

What Kato and her colleagues discovered was that the market had become popular with nearby residents from higher-income areas, but not among residents in Hollygrove. One big challenge: Hollygrove residents weren’t on Facebook or Twitter, which is where the market was posting weekly specials and other information. Kato said that “digital divide” needs to be addressed in future outreach efforts.

Today, researchers at Tulane and elsewhere are working to track the ways stores and markets can help people live healthier lives. Check out this roundup of the Prevention Research Center’s recent work and learn more about ways to get healthy food projects off the ground from the Food Trust.

— D.C.

For the win: APHA honors public health leaders






Congratulations to all of the honorees at last night's annual APHA Public Health Awards Reception & Ceremony. During the event, public health practitioners were recognized for their perseverance, advocacy, innovation and dedication to the health of all. It was another night of public health passion in action!

Above photos from top to bottom: Howard Koh, former U.S. assistant secretary for health and currently a professor at the Harvard School of Public Health, accepts the Sedgwick Memorial Medal, APHA's most prestigious and oldest award that recognizes distinguished service to public health; outgoing APHA President Joyce Gaufin presents former U.S. Surgeon General Joycelyn Elders with the Presidential Citation; XinQi Dong, of Rush University's Institute for Healthy Aging, accepts the APHA Award for Excellence, which honors meritorious contributions to health; past APHA President Deborah Klein Walker, right, presents Nancy Stoller, faculty at the University of California-Santa Cruz, with the Victor Sidel and Barry Levy Award for Peace; and APHA Executive Director Georges Benjamin presents this year's Help Us Help Them donation — of more than $30,000! — to the Second Harvest Food Bank of Greater New Orleans and Acadiana. Photos by Jim Ezell, courtesy EZ Event Photography