Learning from the lessons of history

Just this past weekend, six workers were killed in a grain elevator explosion in Atchison, Kansas. Four of them were younger than 25 years old. It was a sad reminder of why we need strong workplace health and safety standards, said David Michaels, assistant secretary of labor for occupational safety and health, during today’s Closing General Session, which focused on “The case for workplace health and safety: 100 years after the Triangle Fire.”

Hundreds of the 13,000 attendees at this year’s Annual Meeting packed into a convention center room to hear about the progress we’ve made so far and the very real — and sometimes successful — attempts to roll back workplace safety standards happening today. But let’s start with the inspiration for this year’s closing session and the deadliest industrial disaster in New York City’s history: The Triangle Shirtwaist Factory fire of 1911.

One hundred years ago, 146 people died — 125 of them young women — when a fire broke out at the garment factory, which was located on the eighth, ninth and 10th floors of a building. The workers ran toward the exit, but it was locked. Many workers jumped from the windows of the factory; some so that their parents would have something to bury. When police found the women’s bodies, they noticed their nails had torn off, as they had tried to claw their way out. During their funerals, 100,000 workers marched through the streets demanding change. The outrage eventually led to sweeping reforms, such as the passage of the Fair Labor Standards Act, minimum wage requirements and the elimination of sweatshops.

Fast forward to today and there’s much to celebrate, Michaels told attendees. Since the creation of the Occupational Safety and Health Administration, the rate of fatal workplace injuries has declined dramatically. The agency conducts about 40,000 inspections a year and offers a variety of health promotion tools and campaigns, such as a smartphone app in English and Spanish that tells workers how to work safely in dangerous temperatures.

Unfortunately, it’s not all good news, Michaels noted. Twelve workers die in the United States every day from workplace injuries and as many as 50,000 workers die from illnesses in which workplace exposures were a contributing factor. And the current anti-regulatory political climate is hardly a friendly place for making more inroads, especially when the popular mantra is that regulations are job killers. Of course, the data shows otherwise, as safe workplaces promote productivity and decrease time away from the job.

“OSHA standards don’t kill jobs; they stop jobs from killing workers,” Michaels said to loud applause.

Outside our borders, shameful working standards are making it even harder to maintain current U.S. standards and continue moving forward. That’s why we all have to join forces — worldwide — for workers’ rights and safety, said closing session speaker Leo Gerard, international president of the United Steelworkers. Before beginning his address, Gerard showed film footage similar to that of the Triangle Shirtwaist Factory fire. Except this footage happened just last year in a garment factory in Bangladesh, where a fire broke out and the exits were locked. Dozens were killed or injured; again, some jumped to their deaths. The factory produced popular brand-name clothing sold here in the United States; its workers paid hardly enough to live on. That’s why there’s a responsibility on all of us to internationalize the workplace standards we enjoy here at home, Gerard said, noting that we can’t allow “globalization and rotten trade deals to cause health and safety regression anywhere in the world.”

“If we don’t do it, our kids and our grandkids will have a lesser quality of life,” Gerard said. “Worst of all, we’ll be allowing workers in other countries to get killed while we stand silent.”

Worker safety is an issue “we need collective action on,” said session speaker Darryl Alexander, director of health and safety for the American Federation of Teachers. Currently, Alexander said, we’re seeing working conditions deteriorating like never before — today, workers are being sent the message that “hazards and exposures…are just part of the job.” In fact, many of today’s workplace injuries simply go unidentified. But with your help, she urged session attendees, we can make a difference.

“From a public health perspective, (work is) probably the most important social determinant for health that there is,” Alexander said.

Well, dear readers, it’s been another energizing APHA Annual Meeting — this blogger feels refreshed and ready to speak up in support of public health. As new APHA President Mel Shipp said at the closing session: “This coming year will be important — no, critical — for public health.”

See you next year at APHA’s 140th Annual Meeting in San Francisco, where the theme will be “Prevention and Wellness Across the Lifespan.” And don’t forget about APHA’s 2012 Midyear Meeting in Charlotte, N.C., which has a theme of “The New Public Health: Rewiring for the future.”

— K.K

Above, from left to right, Closing General Session speakers David Michaels, Leo Gerard, outgoing APHA President Linda Rae Murray and Darryl Alexander. Photo courtesy Jim Ezell/EZ Event Photography

A world of possibilities

We can begin to end the AIDS epidemic now.

If there’s one message we should take to Congress and to other government leaders contemplating cuts to global health programs, it’s that.

Chris Collins, vice president and director of public policy for amfAR, told Annual Meeting attendees that the state of global health hangs in the balance with the current budget crisis. Reducing federal funding for global health programs will only backfire on American initiatives at home and abroad and cost more in the long run.

“By cutting funding, you don’t solve the problems, you do more damage,” Collins said.

Funding for global programs cost the U.S. government “only one-quarter of one cent, but the economic, humanitarian and diplomatic returns are huge,” Collins said during this morning's session on the “State of the U.S. Global Health Initiative.”

Ann Starrs, president of Family Care International, said global health initiatives seek to achieve more “value for the money” when it comes to health.

“We don’t just want to prevent death,” Starrs said. “We want to promote health.”

Starrs works specifically on improving health conditions for women and girls via strategic coordination and integration as well as using gender equity approaches.

“We want to make services more convenient for the user and more efficient for the institution implementing the services,” she said.

Katherine Monahan, deputy executive director of the U.S. State Department’s Global Health Initiative Office, said the United States is a world leader in global assistance and that it’s important to sustain that leadership.

“We have much to share with the world,” Monahan said. “We are making a difference in the lives of people all over the world because Americans care.”

The immediate budget crisis may pose a challenge to Global Health Initiative goals, but it is important to continue to bring America’s best policies and practices to the global table to help in three strategic areas: saving more mothers and children, creating an AIDS-free generation and challenging the world to step up to health challenges.

“The future is looking really good,” Monahan said. “We’re really excited.”

John Donnelly, vice president and senior editor at Burness Communications and a correspondent for the Global Post, said it is important to have storytellers both here in the states and in Global Health Initiative countries promote the initiative's activities.

Through his work as a global health journalist, he’s found mainstream coverage of global health issues decreasing.

“There’s almost no one covering global health policy anymore,” he told session attendees. “They find it dull.”

Without storytellers on the ground, he said, it is difficult to garner political support for global health programs that ultimately affect the way we live here in the states. He and others on the session panel urged the audience to speak to their congressional representatives about the importance of supporting global health programs.

“Bring a story with you of how (the Global Health Initiative) impacts you on the local level,” he suggested.

Donnelly, who has spent much time traveling through Africa and seeing first-hand how U.S. global health initiatives make a difference, noted that when in-country organizations and American initiatives work together to support the same goals, progress can be made.

“Things succeed when relationships are strong,” Donnelly said. “When it’s working well, there are advances.”

— L.R.

The winning team

Are you ready for battle?

Because today's public health leaders are carving away at some of today’s greatest health risks. In fact, when we approach it from a winnable battles framework, anything is possible.

That was the focus of this morning's session on "Winnable Battles," a Centers for Disease Control and Prevention initiative addressing 10 key public health topics, including food safety, HIV, motor vehicle injuries, nutrition and obesity, teen pregnancy and tobacco. The topics were chosen based on the magnitude of these health problems across the United States.

Session presenter Thomas R. Frieden, director of CDC, discussed progress on the Winnable Battles front and called on attendees to avail themselves of all available resources to help improve health outcomes and reduce health disparities. Frieden emphasized that although we’re facing significant public health challenges today, there has been considerable progress in recent years, such as increased life expectancy and, in some states, improved air quality. For instance, the Million Hearts program is just one example of CDC-led efforts to work across federal agencies as well as with private and nonprofit partners to reduce heart attacks and stroke. Frieden said he is confident the program will meet its ambitious goal of preventing 1 million heart attacks and strokes over the next five years.

John Auerbach, public health commissioner in Massachusetts, described how CDC’s Winnable Battles campaign has helped states focus their program efforts toward changes that have a wide impact, but cost little.

For example, in Oregon, the Multnomah County Health Department is developing and implementing strategies to address nutrition-related health risks and developed a countywide action plan to improve health. Aurbach explained that health departments are successfully engaging with policy and other decision-makers, as “Winnable Battles is a non-partisan issue, and everyone can be involved.”

Frieden called attendees to action with a quote from President Franklin Roosevelt: “There are many ways of going forward, but only one way of standing still.”

Click here for more info on CDC's Winnable Battles initiative.

— M.S.

Above, CDC Director Thomas Frieden smiles at a Wednesday morning Annual Meeting session. Photo courtesy Jim Ezell/EZ Event Photography

A little birdie told me so: Tweet of the day

On this last day of the 139th APHA Annual Meeting, the tweet of the day comes from Twitterer LeahHealth, who said: On the shuttle for last day of #APHA11 it is like riding the public health school bus.

Advocacy in action

This morning, APHA Executive Director Georges Benjamin took a short break from his busy Annual Meeting schedule to lend APHA's support to a key piece of public health legislation.

Standing on the grounds of the Capitol building along with members of Congress and fellow public health advocates, Benjamin reaffirmed APHA's commitment to the Climate Change Health Protection and Promotion Act. Introduced today by Rep. Lois Capps, D-Calif., the legislation calls for developing a national strategic plan that will equip public health agencies with the tools to prepare for, identify and respond to the health threats of climate change. In addition to supporting the bill, APHA was also involved in developing its language.

"Climate change poses a real and present health threat for our country today," Benjamin said in an APHA news release. "It can affect the air we breathe and the water we drink. It also can severely threaten our nation's food supply. If left unaddressed, climate change could exact an enormous toll on communities across the nation. The bill introduced today would send a real lifeline to public health officials who are on the frontlines of protecting our health, preventing disease and keeping families safe."

If you want to take action on behalf of the Climate Change Health Protection and Promotion Act, call the U.S. House of Representatives switchboard at 202-225-3121 to connect with your member of Congress and urge them to sponsor this bill. For more info on climate change and health or to download a free copy of APHA's new publication, "Climate Change: Mastering the Public Health Role," visit www.apha-environment.org.

Above, APHA's Georges Benjamin speaks at a Wednesday morning news conference in front of the Capitol in support of the Climate Change Health Protection and Promotion Act. Behind him is Rep. Lois Capps, D-Calif., and Jeff Levi, executive director of Trust for America's Health. Photo courtesy Don Hoppert

Won't you be my (smoke-free) neighbor?

Anti-tobacco advocates have conquered restaurants and bars, public outdoor spaces and many college campuses. Now, they’ve got their sights set on engaging residents of apartment buildings and condominium complexes in efforts to make healthier living spaces.

There’s a growing movement across the country to enact smoking bans in multi-unit housing, and California is leading the charge. The communities of South Pasadena, Richmond, Belmont and Sebastopol have all prohibited smoking in apartment buildings and condos. And there seems to be more on the way.

“It’s a public health issue," said Statice Wilmore, tobacco control coordinator for the Pasadena Public Health Department. "It’s a quality of life issue.”

Wilmore spoke yesterday on a panel with other anti-tobacco advocates during a session on “Don’t Catch My Drift: Smoke-free Multi-Unit Dwellings.”

Wilmore gave an overview of how Pasadena succeeded in prohibiting smoking on patios, balconies and outdoor common areas in multi-unit housing. The Pasadena Public Health Department also was pivotal in establishing smoking bans in new housing construction projects effective immediately. Most importantly, the department successfully advocated for a gradual phase-in of completely smoke-free multi-unit housing by 2013.

Pasadena’s smoke-free campaign began with a comprehensive survey of the community’s attitudes toward smoking. The survey revealed that 77 percent of the community supported prohibiting smoking in outdoor areas; 63 percent supported a smoking ban in residential areas; 80 percent favored laws to create non-smoking multi-unit housing; and 72 percent wanted to live in a completely smoke-free building.

“Framing the issue is very important,” Wilmore said.

Instead of focusing on individual health benefits of smoke-free policies, the public health department presented other benefits, such as a reduction in fire hazards in the home, decreasing insurance premiums and decreased expenses for landlords to clean out smokers’ units for rental purposes.

In a pilot test conducted in a small part of Alachua County, Fla., Lisa Nackers, a doctoral candidate at the University of Florida in Gainesville, found that residents preferred an incremental, stepwise policy change toward going smoke-free in multi-unit housing. That process would start with smoking bans in indoor common areas, then in outdoor common areas and on to individual units until a total ban on smoking is reached. This “foot-in-the-door” technique has the potential to affect policy change throughout the county, she said.

“We all know there is no safe level of exposure to secondhand smoke,” Nackers told session attendees. “And we know that most exposure is in the homes.”

Nackers’ research suggests that anti-tobacco advocates work closely with multi-unit housing property managers to implement policy changes. As tenants and building owners’ awareness increase, smoke-free dwellings will be the way of the future, she said. In fact, property owners should offer smoke-free units as a benefit of living in their buildings.

Warren Ortland, staff attorney with the Public Health Law Center in St. Paul, Minn., surveyed owner-occupants and interviewed property managers, finding that before drafting any policy, advocates should first provide education to all parties and assess attitudes toward the policy. Policies should be based on the activity — smoking — and not on any individual’s status, a position often taken by smokers who believe bans infringe on their personal rights.

Ortland suggests residential associations take up smoking bans and decide for themselves how to best implement them. Changing associations’ declarations are more likely to withstand legal challenges, he noted, and courts are generally deferential to association decisions.

— L.R.

Happy teeth

Even though it's preventable, oral disease is the No. 1 chronic disease in children. Unfortunately, oral health is not often the first thing that comes to mind when you think of primary care — a problem many advocates and practitioners have been trying to change.

Gum disease and cavities don't just affect a child’s appearance. Oral health problems can inhibit nutrition and physical development and without access to good preventive care, they can be exceptionally costly to fix.

In Tuesday afternoon’s session on “Mouths Matter: Maryland Leading the Way,” Harry Goodman, director of Maryland’s Office of Oral Health, discussed ways in which Maryland is blazing the trail for improved oral health services for children. Oral health advocates and leaders at the state and national levels jumped into high gear when the state suffered a devastating loss that got significant media attention: Deamonte Driver, a 12- year-old boy from Prince George’s County, Md., had an untreated dental infection that resulted in more than $250,000 in medical costs and ultimately led to Driver's death in 2007.

Goodman showed a picture of Driver and asked session attendees to “never to forget this face.” Driver’s life could have been saved by routine preventive care, Goodman said.

Since Driver’s death, Maryland has advanced a number of policy efforts that are bringing the opportunities for better oral health to the state's under-served children. Among the efforts: Maryland established an oral health advisory committee to advocate for better access to care; the state successfully passed legislation to create an oral health safety net; surveillance efforts have been conducted to gather data on schoolchildren; and a five-year oral health plan was developed. Through federal funding, Maryland is also launching an oral health literacy campaign targeting low-income families.

Debony Hughes, of the grassroots organization the Deamonte Driver Dental Project, credits a number of policy champions for the state's progress, including Maryland Gov. Martin O’Malley, Sen. Ben Cardin, D-Md., and Rep. Elijah Cummings, D-Md. With the help of state funding, the Deamonte Driver Dental Project established a mobile dental clinic, which has provided preventive services for more than 1,000 children in 19 of Prince George’s County's elementary schools.

In fact, the mobile unit is parked right now in the Public Health Expo, so go check it out and get a tour of the colorful, traveling dental clinic.

— M.S.

Best and brightest

Congratulations to all of this year's APHA award winners! Thanks for helping lead the way to a healthier world!

Above, from top to bottom: APHA's Distinguished Public Health Legislator of the Year Jan Schakowsky, D-Ill., receives her award from APHA Executive Director Georges Benjamin at last night's APHA Public Health Awards Reception and Ceremony; former U.S. Surgeon General David Satcher (at left in the photo) receives APHA's Sedgwick Memorial Medal; Satcher (at left) mingles with new APHA President-elect Adewale Troutman at the awards reception; and reception attendees smile for the camera. Photos courtesy Jim Ezell/EZ Event Photography

Wednesday's Have You Heard

Celebrate diversity: Lesbian, gay, bisexual and transgender well-being will be the focus of session 5062, "Policy Impacting LGBT Health," which starts at 8:30 a.m. in room 149A of the convention center. (Think of your early-morning attendance as a tribute to D.C.'s marriage equality!)

Fit kids: Come hear from experts in the field at session 5090, "School-based Fitness Testing for Large-scale Surveillance of Student Fitness Levels and Childhood Obesity," at 8:30 a.m. in meeting room 14 of the Renaissance Hotel. I know it's early, but think of the kids!

Fighting the good fight: Centers for Disease Control and Prevention Director Thomas Frieden will be on hand for Wednesday's session 5096, "Winnable Battles," which starts at 10:30 a.m. in room 146C of the convention center.

Hola!: Feel that ocean breeze? Then maybe you're already at special session 5101, "APHA Goes to Cuba: Lessons Learned from the Island Nation," which runs from 10:30 a.m. to noon in room 151AB of the convention center.

First peoples: Learn more about health issues affecting the country's native communities in session 5159, "Native Health Issues and their Importance in the Public Health System: A Panel Discussion," which starts at 12:30 p.m. in meeting room 14 of the Renaissance Hotel.

Lessons from the past: Believe me, we're tired too. But definitely not too tired to make it to this year's Closing General Session from 2:30 to 4 p.m. in room 146AB of the convention center. This year's session will focus on "The case for workplace health and safety: 100 years after the Triangle Fire" and will feature addresses from APHA President Linda Rae Murray; David Michaels, U.S. assistant secretary of labor; Leo Gerard, international president of the United Steelworkers; and Darryl Alexander, director of the Health and Safety Program at the American Federation of Teachers. Take a gander at this guest blog post about why you can't miss this session.

Guest post: Don't miss this year's Closing Session

by Liz Borkowski
Even if you fear your brain won’t hold another shred of public health information by midday Wednesday, don’t miss the Closing General Session, where the timely topic will be “The case for workplace health and safety: 100 years after the Triangle Fire.”

On March 25, 1911, a fire raced through the Triangle Waist Company factory in lower Manhattan. A collapsed fire escape and locked doors prevented many of the garment workers from reaching safety, and 146 workers were killed. Many of them were young women who’d recently emigrated to the United States and were a crucial source of support for their families. Many jumped to their deaths as they tried to escape the flames.

“On that spring afternoon, the sound of frantic screams and wailing fire truck bells awakened the conscience of America,” U.S. Secretary of Labor Hilda Solis said in a speech on the 100th anniversary of the Triangle disaster. “The fire opened our eyes to the tragic consequences of wretched working conditions.”

Galvanized by the disaster, advocates demanded — and won — laws requiring better working conditions. Frances Perkins, who witnessed the horrific scene from a nearby park, became secretary of labor under President Franklin D. Roosevelt and played a key role in the National Labor Relations Act and Fair Labor Standards Act.

One hundred years later, rates of occupational fatalities and injuries have dropped dramatically. The Centers for Disease Control and Prevention considers improvements in workplace safety to be one of the top 10 U.S. public health achievements of the 20th century. The earliest systematic survey of workplace fatalities covered Allegheny County, Pa., where in 1907, 526 workers were killed in that county alone. The National Safety Council estimated the 1912 toll of occupational fatalities nationwide to be between 18,000 and 21,000. Contrast that to 2009, when 4,551 workers were killed on the job, according to the Bureau of Labor Statistics.

This drop in worker deaths is an important achievement, but the latest numbers also remind us that we still have a long way to go. We’ve also seen some horrific 21st-century workplace disasters as well: 29 workers killed at the Upper Big Branch Mine in West Virginia; 11 in the BP/Deepwater Horizon disaster in the Gulf of Mexico; and seven in the explosion at the Tesoro refinery in Washington state.

And then there are the smaller, but no less significant, tragedies in which workers are suffocated in trench collapses, crushed by heavy equipment, electrocuted, burned…the list goes on and on. If you’ve got a few minutes (and if you’re like me, some tissues nearby), I encourage you to visit the Weekly Toll blog to get a clearer picture of the lives we lose to unsafe workplaces every week.

These workplace disasters injure as well as kill, but we don’t even have a satisfactory count of how many people are injured or made ill on the job. From health care workers with back injuries to farm workers poisoned by pesticides, thousands are suffering because their workplaces, while generally safer than those of 1911, aren’t as safe and healthy as they should be.

At tomorrow's Closing General Session, we’ll hear from four great speakers:

• Linda Rae Murray, president of APHA and chief medical officer of Illinois' Cook County Department of Public Health;

• David Michaels, U.S. assistant secretary of labor for occupational safety and health;

• Leo Girard, international president of the United Steelworkers; and

• Darryl Alexander, director of health and safety for the American Federation of Teachers.

I expect they’ll tell us more about how workplace health and safety has improved and how much it still needs improving. And I’m sure we’ll learn about what the public health community needs to do to make sure the spirit of reform that caught fire after the Triangle disaster burns even brighter.

The Closing General Session runs from 2:30 to 4 p.m. on Wednesday, Nov. 2.

Liz Borkowski is a research associate at the George Washington University School of Public Health and Health Services and a member of APHA’s Occupational Health Section. She runs the public health blog The Pump Handle.

In the above photo, a construction worker in 1943 is about to affix a wooden plank using a hammer and nails. Notice that he's not wearing any of the protective gear, such as protective eyewear and a hard hat, that he would be required to wear today. Photo courtesy the Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health

Career highlights

APHA Annual Meeting attendees took advantage of one-on-one career coaching sessions at the Everything APHA booth inside the Public Health Expo. Visit APHA's CareerMart for more on public health job opportunities.

Photos by Jim Ezell/courtesy EZ Event Photography

Public health on the silver screen

Since 1970, the country has seen a downward trend in black lung disease, also known as coal worker’s pneumoconiosis, which is caused by breathing coal dust over a period of time.

But in the last 10 years, we’ve seen the number of cases double. In the film, “Faces of Black Lung,” Annual Meeting attendees heard the stories of coal miners who shared how their lives have changed since being diagnosed.

“I never thought about taking care of myself," said one patient, as he sucked on his oxygen tube for air. "Never thought about X-rays. I just thought about my family.”

Now he can’t say two words without gasping, his labored breathing a symptom of the disease.

Black lung patients were among several voices heard in personal narratives shown on the big screen at a Tuesday afternoon session of the 8th Annual APHA Film Festival. In addition to the coal miners’ stories, today’s session featured films about breast cancer patients, blood cancer survivors, prisoners at risk for HIV, teens concerned with the health of their environments, parents discussing teen driver safety, hospital employees sharing their reasons for getting a flu shot, and Wisconsin health workers explaining how they handled the H1N1 pandemic.

Seven-minute clips of each film were selected for their diversity in addressing a variety of public health concerns.

Two high school students from Brownsville, Texas, narrated the film “Health and Environment Action Network,” which illustrates how the Hispanic community can prevent environmental illness and disease. The film is part of a national and local movement to improve air and water quality. Produced by the Brownsville Community Health Center, the film shows public health experts concerned about air quality working in Brownsville and other border towns.

“We see a lot of truck traffic here,” said one resident. “People should keep their young children indoors in the early morning when traffic is heavy.”

A rough cut of the film “Designing Healthy Communities” showed how an unhealthy physical environment can shorten our lifespan by as much as five years. For example, living in a city like Riverside, Calif., can increase the risk of lung disease by 30 percent, experts warned.

In “No Warning Shots,” which was produced by the Center for Health Justice, health workers are shown visiting prison populations in California to discuss the risks and realities of HIV and AIDS. The video is shown to new prisoners in the state.

The Wisconsin Division of Public Health produced “Facing a Pandemic: Wisconsin’s Response to 2009 H1N1 Influenza,” a documentary that takes the viewer on a step-by-step journey of how the state handled a public health emergency and won.

The Leukemia & Lymphoma Society produced “Paths to Recovery: Stories from Two Blood Cancer Survivors” to show the daily struggles of patients.

“It never goes away entirely, even when it’s in remission,” said one patient. “There’s still no cure.”

Don't miss tomorrow's film festival showing, session 5160, at 12:30 p.m.

— L.R.

The fallout

A nuclear disaster in a plant near Chicago would force the evacuation of 7 million people and could deliver fatal doses of radiation to 20,000 people, said a speaker at an APHA session on "In the Wake of Fukushima: Is Nuclear Energy Healthy for Communities?" this afternoon.

Furthermore, said Andrew Kanter, president-elect of Physicians for Social Responsibility, the nuclear fallout plume would be so large that many local emergency responders would not be permitted to go near the scene to help because of the danger.

The dangers of nuclear power are well-known, particularly after the Fukushima disaster in Japan earlier this year, said speakers during the scientific session. They argued that America should seek other methods of alternative energy.

While the Three-Mile Island near-meltdown in 1986 had “put a major crimp in the expansion of nuclear power in America,” those seeking alternative energy sources have backed it as a cleaner alternative, said Robert Gould, president of the San Francisco-Bay Area chapter of Physicians for Social Responsibility.

The session highlighted the risks of a nuclear disaster and noted that in addition to the Chernobyl, Three-Mile Island and Fukushima crises, there have been other near-misses that could put the public’s health at risk.

Kanter noted that the vast majority of the fallout from the Fukushima disaster went over the ocean rather than toward Japan’s most populous cities. Despite that, radiation hotspots were found in Tokyo and elsewhere.

Dangers he listed during his talk included possible releases from active plants, releases resulting from the unsafe storage of nuclear waste and the many potential dangers of a terrorist attack at a nuclear energy plant.

He highlighted another scenario, in which the Indian Point nuclear reactor near New York City has a meltdown. That scenario would cause 3,500-44,000 immediate deaths, 100,000-500,000 long-term deaths from cancer and other diseases, and $1.1 trillion-$2.1 trillion in economic damage.

In her presentation, Jacqueline Patterson, environment and climate director of the NAACP, said nuclear power plants are disproportionately located near low-income communities. Furthermore, she said, uranium mining disproportionately affects American Indian and indigenous communities.

All three speakers pointed to a greater need for research into alternative fuel sources and an examination of the true potential fallout of a serious nuclear incident on American soil.

— C.T.

A little birdie told me so: Tweet of the day

Today's tweet of the day comes from Twitterer trulyjoannies and goes out to all you fellow Twitterers using the hashtag #apha11: tweetup sounds so fun! i hope to attend the conference and tweetup with you folks someday!!

We hope so too!

'We're ready to take the lead'

Thoughts on this year's Opening Session from past APHA President Virginia Caine. For more soundbites from meeting attendees, visit APHA's YouTube channel.

Picture this

What image does climate change conjure in your mind?

According to Maria Blair with the American Cancer Society and one of the speakers at this morning's session on “Climate Change and Health: The Global Challenge,” this is a key question that must be answered to help contextualize the issue and mobilize action.

Kim Knowlton, senior scientist with the Natural Resources Defense Council and chair of APHA’s Climate Change Workgroup within the Environment Section, discussed the need for short-term action to offset current and future health risks. She pointed to data that found 2011 to be a year in which all-time high temperatures were broken across the United States.

“Adaptive measures are already happening in cities around the world,” Knowlton told attendees. “Climate change is the health issue that unifies so many pressing health issues of the day.”

After a survey of experts identified significant limits among European health agencies in dealing with climate-related impacts on infectious disease, session presenter Jan Semenza, along with the European Centre for Disease Prevention and Control, helped develop an adaptation tool and software program that health officials can use. The tool allows decision-makers to project risks and map regions or areas that might be at greatest risk for a host of different pathogens based on a variety of potential climate change factors.

Although health departments, nonprofit organizations and a number of federal agencies are working toward preventing climate-related health risks, there remains a disconnect among many policy-makers and the general public about the effects of climate change on the public’s health.

Session presenter Maria Blair challenged the public health community to think about whether “we are framing the problem and engaging people in the right way on this issue.”

“I don’t know about you, but I haven’t heard people reflect lately on that awful climate change-induced snowstorm we had the other day or recent climate change-causing heat waves or drought,” Blair said.

We need to mainstream the “complex issue of climate change to be successful and help provide the right tools for those making choices at the local level,” she noted.

Building resilience doesn’t happen overnight and climate change is not a problem that a single institution can solve. Slowly but surely, however, it seems we’re moving the levers to get there.

— M.S.

Recipes for disease

Wonderful and terrifying.

That’s how one audience member described today’s presentation about the safety of our food supply. An expert panel discussed the issue at this morning's session on “Contaminants in our Food Supply: Persistent Gaps in Monitoring, Assessment and Control of Contamination” and offered solutions to the problem as well as tips to better protect the food we consume.

The picture the panel presented was generally grim. While our food supply is vulnerable to pesticide and chemical exposures, the government’s response is outdated and inadequate, they said. One in six Americans gets sick from food-borne illness and nearly 3,000 die each year as a result. While threats from imported produce are increasing, monitoring and enforcement of safety standards lag. And even if food is produced safely, transport and storing processes contribute toxins that leave the most vulnerable in our population at risk.

But there is hope and there are some solutions. Earlier this year, President Barack Obama signed the federal Food Safety Modernization Act, which aims to ensure the U.S. food supply is safe by shifting the focus of regulators from responding to contamination to preventing it. It’s a prevention-oriented approach that also tightens inspection and compliance regulations.

“We overhauled the food safety system for the first time in 70 years,” said Erik Olson, deputy director of the Pew Health Group. “Progress will be made. But there’s still unfinished business. Meat and poultry laws haven’t been updated in decades, and food additive laws haven’t been updated since 1958.”

Session presenter Karen Wong, an Epidemic Intelligence Service officer with the Centers for Disease Control and Prevention, studied flaws in the FDA assessment of Gulf Coast seafood after the catastrophic BP oil spill. She found the FDA analyses, particularly for detecting polycyclic aromatic hydrocarbons, or PAHs, are inadequate to protect the health of those who consume shrimp and oysters from the Gulf Coast. PAHs are a group of more than a hundred different chemicals, many of which have been proven to be carcinogenic. PAHs may increase health risks for children and the developing fetus, cause genetic damage to the fetus and contribute to low birthweights. For example, during the Exxon Valdez oil spill, FDA estimated it would take 10 years until PAHs would no longer be detectable in the water. But 13 years later, there were still detectable levels of PAH, Wong said.

“The FDA should update its risk assessment methods,” she told session attendees.

She suggested federal agencies better target their health advisories to give people more information. Lastly, she advised consumers exercise caution when eating seafood.

Miriam Rotkin-Ellman, staff scientist at the Natural Resources Defense Council, said more attention should be paid to imported produce, which is often contaminated with illegal pest residue.

“We see a pattern of repeat violations," Rotkin-Ellman said of a study conducted between 2004 and 2008. "The same violations are found increasing every year.”

Guatemalan peas, for example, continually show up on a list of vegetables with high violation rates, she said.

Even though there is ample evidence and reason for concern, FDA is not testing for some pesticides, Rotkin-Ellman said. Health risks associated with pesticides include toxicity at acute and low levels, cancer and reproductive development toxicity, especially during the early stages of life. In addition to improving and updating FDA testing methods of pesticides, she recommends an outreach program to educate growers on the harms of pesticides.

“It’s not easy to figure out what pesticides are used in what, even for experts in the field,” she said. “We also need education at the federal level.”

What does all this mean for the average consumer at home? The experts say buying organic produce may reduce exposure to some chemicals, but not all. Washing leafy greens, even pre-washed greens, may help a little. Finally, be an informed consumer. Rotkin-Ellman suggested checking out whatsonmyfood.org for more information.

“The point is not to scare people, but to point out gaps,” she said.

— L.R.

Making memories

Stop by the PHun Photo booth on the third floor of the convention center and snap yourself a photographic souvenir or visit the Everything APHA booth at the Public Health Expo for a 139th Annual Meeting t-shirt.

Photos by Michele Late/courtesy APHA's Flickr page

Extra! Extra! Annual Meeting makes headlines

Public health is making news this week. APHA Annual Meeting presentations and events have been picked up by major media outlets around the country. Check out the roundup of headlines below.

Associated Press via Washington Post — Study in Wash. state suggests more violence among kids of combat veterans, including daughters

The study, to be presented Monday at a public health conference in Washington, D.C., was based on a 2008 questionnaire survey of about 10,000 students in the 8th, 10th and 12th grades in Washington. That state has the sixth largest active duty population in the country...

Los Angeles Times — Chronic health problems plague immigrants decades after move

Is migrating to the United States hazardous to your health? If you’re Latino and have lived in the states more than 20 years, you might want to listen up: Researchers at the University of North Carolina at Chapel Hill have found that the longer immigrants have lived in the U.S., the worse their health gets...

The Atlantic — Study of the Day: Teens Want to Lose Weight But Don't Know How

New research suggests that obese adolescents want to shed pounds, but smoking, non-diet soda and video games are getting in their way...

WebMD — Study: Too Much Sugar in Drinks Marketed to Kids

It's no surprise that many sodas have a lot of sugar. What may be more surprising is that many fruit drinks, often billed as healthier alternatives, are often loaded with close to the same amount of sugar and calories...

National Journal — HHS Releases Leading Health Indicators for the Next Decade

The Health and Human Services Department announced its Leading Health Indicators on Monday, a list of metrics for measuring public-health progress that is adjusted every 10 years...

UPI — Grandma's birth control problems persist

Hormonal birth control is different from that of 30 years ago but even with lower hormonal levels many of the same problems remain, U.S. researchers say...

HealthDay News — Many Parents Skipping Kids' Shots, Putting Other Kids at Risk

By signing an affidavit that says "all or some immunizations are contrary to my beliefs," California parents can bypass requirements that their children be fully immunized before attending school, and new research indicates that many are choosing to do so...

Modern Healthcare — Park announces public-health app challenge

An HHS mobile-device application contest unveiled today aims to encourage software developers and public health professionals to co-design programs that mitigate public health problems...

All the power in the Twitterverse

Social media's public health gurus spoke to a standing room-only session yesterday afternoon on the "Role of Social Media in Public Health." One of the presenters was APHA's very own social media master Michele Late, creator of the association's Twitter @publichealth, which now has more than 141,000 followers and was recognized earlier this year by Time magazine as one of the 140 best Twitter feeds.

Visit NewPublicHealth.org for more coverage of yesterday's session.

Above, APHA's Michele Late talks to session attendees about using Twitter to your advantage. Photo courtesy Jim Ezell/EZ Event Photography

Men at work

How do you talk to a man and get him to listen?

You give them what they want. It might seem like a trite answer, but for Dr. Kelly Bethea, director of adolescent health at the Einstein Healthcare Network in Philadelphia, it’s what’s working in her Male Adolescent Health Initiative, better known as MAHI. To get male adolescents involved in their own health and to get them to participate in their own preventive care, health professionals have to find out what motivates these men.

“You have to figure out what he values, and give him something for his time,” Bethea said during Monday's session on "Community Health Initiatives for Successful Communication to Men." “You have to really understand your audience and what they want. If they want respect and trust, you give that to them.”

In addition to conducting focus groups to find out what motivates a man to take a more active role in his health, a successful community program should get the buy-in of their intended audience. Albert W. Pless, Jr., program manager for the Cambridge Public Health Department in Massachusetts, said that striking partnerships with other community-based organizations is one way to get in with the reluctant male patient.

Pless described the Men’s Health League Program in Cambridge and how it succeeded in getting 30- to 45-year old men of color to take the reins of their health. The community health partnership worked closely with experts at Harvard and the Massachusetts Institute of Technology to conduct programs in barber shops, fitness centers, gyms and in community centers. They recruited chefs to conduct cooking demonstrations, organized citywide basketball tournaments and led shopping tours at grocery stores.

Pless got the men involved by giving them what they wanted — access to a personal trainer at the gym, free membership to a fitness facility, group workout classes and, oddly enough, wrist bands.

“We asked what would incentivize them to come, and they said wrist bands,” Pless told session attendees.

The wrist bands symbolized a brotherhood of sorts. The men enjoyed meeting other men like themselves, who shared the same goal of improving their health, Pless said.

For a Hispanic community in San Mateo, Calif., gold medals and the adulation of their kids motivated men to improve their health in the My Hero nutrition program.

“The message we provided to them was that they were important, their kids look up to them and they are role models,” said Lydia Guzman, a registered dietitian with the San Mateo County Health System. “They wanted respect, which for them meant empowerment.”

Guzman and her colleagues wanted to conduct a nutrition class specifically for men, but knew no one would show up, even with the promise of free food.

“We used children and the ‘nag factor’ as change agents,” she said.

School children wrote letters to their heroes, and the fathers were asked to come to the school to be presented with their hero medals. While at the school, health professionals were on hand to share cooking techniques and health information. These fathers wanted the respect of their children, and My Hero showed the fathers and father figures that they were empowered to not only improve their health, but their children's health as well, Guzman said.

Michael Rovito, assistant professor and director of the Men’s Health Initiative at the University of Central Florida in Orlando, said the challenge in reaching college-age men is helping them understand how their current health status will affect their health in the long run. And information is key.

“I want to get guys informed so that they’re not as scared as I was,” he noted after he explained how his own health scare at the age of 17 led him to believe he might die. “I had no idea what was happening, where I could go and what I could do.”

Today, Rovito is involved in reaching that hard-to-get college man by using social media platforms and college campus events to draw attention to issues such as self-exams for testicular cancer. Another event, March Mustache Madness, encouraged men to grow their facial hair to raise awareness for men’s cancer.

“You really have to know your audience in order to get your message to them,” Rovito said.

— L.R.

Great expectations

The word on the street is ACHIEVE. It's a public health program that's making a real difference at the local level on a number of fronts, according to a Monday afternoon session of the same name.

ACHIEVE (Action Communities for Health, Innovation and Environmental Change) is a project of the National Association of County and City Health Officials, and yesterday's session focused on how the program is working with a number of local health departments to create systems change through capacity building and policy development. The ACHIEVE approach centers on a process of community engagement and aligns with recent community transformation grants that were awarded via the Affordable Care Act.

As part of the program, NACCHO assessed what local health departments need to help improve the environments where people live, learn, work and play and identified competencies for local health department leaders. According to session speaker Kenneth Smith of NACCHO, “the key is fostering leaders who are able to engage the political system to make things happen.” And public health departments “need training to navigate political and bureaucratic environments,” he said.

In fact, ACHIEVE is having an impact just across the river in Alexandria, Va., where the health department has been making strides in childhood obesity prevention. Carrie Fesperman Redden, a health planner with the city's health department, led efforts to develop the Alexandria Childhood Obesity Action Network through its 2009 ACHIEVE grant from NACCHO. Following a process of community engagement, the city of Alexandria developed an action plan and found a groundswell of support for implementing it among a cross-section of organizations, agencies and community members involved in the process. In addition, the network has received attention from Alexandria’s council members and for the first time, health goals were included in the city’s 2010-2015 strategic plan. With help from the Alexandria health department in drafting language as well as the support and advocacy efforts of the obesity network, the Alexandria City Council also recently passed a complete streets resolution.

At the end of the day, we can say this program is successfully building healthier communities and ACHIEVE-ing great things.

— M.S.

Time to check those stocks

Don't forget to stop by APHA's Get Ready booth at the Public Health Expo for all of your emergency preparedness needs. You can also learn more about APHA's Flu Near You Challenge and the annual Set Your Clocks, Check Your Stocks campaign, which reminds folks to check their emergency stockpiles when daylight saving time ends this Sunday, Nov. 6.

Above, a visitor checks out the Get Ready booth. Photo by Michele Late