‘Public health is the voice of conscience’

Not surprisingly, this blogger felt like hibernating for a month when she woke up to the final day of her eighth APHA Annual Meeting. But upon walking into the Closing Session of the Philly meeting, I immediately felt that second wind take hold. People were excited…and the speakers more than delivered, talking about why we must all work together if we’re to become a healthier nation.

Howard Koh, assistant secretary for health at the U.S. Department of Health and Human Services, took to the lectern first, telling the story of his journey as the son of immigrants coming to the United States. His parents, he said, insisted that their children have a “life of mission, a life of purpose and a life of service.” No wonder then that he entered the field of public health — a field he described so eloquently as “science in the service of society.” As we move forward in this age of health reform, Koh said, public health must make sure its compassionate voice stays front and center.

“Public health is the voice of conscience in the rat race of health care,” he said.

Yvette Roubideaux, new director at the Indian Health Service, reminded attendees that when it comes to health reform, the communities that she serves “face the same challenges as the rest of the U.S. health care system — we are in it with you.” And although Roubideaux said the current resources available to run IHS “clearly are not enough for us to sufficiently meet our mission,” more funding is not always the only answer to better health.

“The only way that we are going to improve the health of communities is to work in partnership with them,” Roubideaux said.

Next up, Mary Wakefield, new administrator of the U.S. Health Resources and Services Administration, who described HRSA as being about the “business of eliminating health disparities.” Wakefield said one of her biggest priorities since filling HRSA’s top position has been bringing a public health perspective to the entire agency. HRSA, she said, is “open for business.”

“You at APHA are critical to achieving that end, you’re critical to achieving the mission of HRSA,” she said.

(And a funny side note: In a discussion on health reform, APHA’s Executive Director Georges Benjamin asked Wakefield and Roubideaux what they needed from audience members to accomplish the goals of reform. Wakefield’s answer? “Everything.”)

Let’s finish off the 2009 Annual Meeting with a quote from Benjamin (who, by the way, announced that this year’s meeting welcomed more than 12,000 — 12,000! — public health professionals.)

“Now’s the time for people to really band together,” he said. “Now’s the time you really need an association like the American Public Health Association.”

See you next year in Denver for APHA’s 138th Annual Meeting!

— K.K.

Above: HRSA Administrator Mary Wakefield, left, and IHS Director Yvette Roubideaux speak to Closing Session attendees. Photo courtesy Jim Ezell/EZ Event Photography

Keep washing those hands

“It may be that, given the size of this convention, that a couple of people are about to get sick from H1N1,” said Richard Schieber of the Centers for Disease Control and Prevention’s H1N1 Community Mitigation Task Force.

Does that mean you should have been holed up in a hotel room the past few days instead of attending scientific sessions? Should you avoid airplanes because of an increased infection risk?

“Those are very good questions,” he told about 200 people gathered for a late-breaker session on H1N1 lessons learned on Wednesday morning.

Gee, thanks, Dr. Schieber.

What he and other CDC personnel did tell us was that the H1N1 flu pandemic has provided a lot of federal-level lessons to help guide public health practice in the future. And, as most of us know, it’s also been a bumpy ride.

This blogger is like a lot of frustrated parents out there. My 6-year-old son has asthma so is considered one of the 42 million people at highest priority for H1N1 vaccination. Only problem is, he wasn’t eligible for the nasal mist administered at his elementary school because he has asthma. His pediatrician hasn’t received any doses of the injectable vaccine.

His 9-year-old and 11-year-old sisters did get the nasal vaccine. So at least two of my three children are covered. Except the 9-year-old will need a second dose for what CDC officials consider a “robust immune response.” Anybody want to guess how likely it is that a second dose will be available anytime soon?

“We’ve done what we could to get the vaccine out quickly,” said Jay Butler, who leads CDC’s H1N1 Vaccine Task Force. “It’s still a trickle. We’re trying to make it faster, but it’s still a trickle. It’s absolutely maddening.”

Schieber did unveil a bit of good news during the session. Recent surveys show a majority of people are following infection-control advice on washing their hands regularly and avoiding touching their face. CDC plans a major flu communications blitz in airports starting Nov. 19.

Check the latest on the federal H1N1 and seasonal flu response and guidance at www.cdc.gov/flu, www.pandemicflu.gov and www.cdc.gov/flu/weekly.

— D.C.

Safe (and healthy) travels

On the last day of the meeting, while everyone’s preparing to head home by plane, train or automobile, this blogger went to one final session — on the topic of healthy transportation policies.

Interestingly, injury prevention advocates are starting to advocate the same type of measures that environmentalists and active transport proponents have been preaching: better land-use planning, mixed-use design and public transportation. It’s not just about making the roads safe with safer cars and responsible drivers, it’s about getting more people off the roads altogether.

“We need to break down silos, even within the health field,” said session presenter Janani Srikantharajah of the Prevention Institute.

Injuries are not “accidents,” Srikantharajah said, and they can be prevented. While the nation is justifiably outraged at the estimated 45,000 annual U.S. deaths attributable to lack of insurance coverage, they should also be outraged by the 41,000 annual deaths caused by traffic crashes, she said. The financial toll of traffic injuries is staggering as well, at $230 billion or about 2.3 percent of our GDP.

We need to work together, speak the language of planners, and start spouting phrases like "complete streets," "multimodalism," "context sensitive design" and "smart growth," said Todd Litman of the Victoria Transportation Policy Initiative in Canada.

Litman said transportation is a public good that should be about all its users, not just drivers. It’s about social justice and goes beyond affordable transportation to encompass affordable housing in walkable neighborhoods, “urban villages” with schools, parks and grocery stores.

Other session speakers talked about efforts to reduce driving on college campuses and create healthier food environments with the help of smart transportation policies. For more on how healthy food and transportation policies intersect, here's a similar presentation from one of today’s speakers, Kami Pothukuchi of Wayne State University.

And for more on healthy transportation policies, check out the new report put together by Policy Link, the Prevention Institute and the Convergence Partnership: “The Transportation Prescription: Bold New Ideas for Healthy Equitable Transportation in America.”

Safe travels everyone!

— P.T.

Image by Diego Bervejillo, courtesy iStockphoto

Something's in the water

Max Zarate-Bermudez, an epidemiologist with the Centers for Disease Control and Prevention, cites many more cases and deaths caused by waterborne disease outbreaks than those caused by foodborne outbreaks. Still, for some unknown reason, food safety seems to be a much sexier topic, gaining a higher degree of media and public attention.

Thankfully, Wednesday morning’s session on preventing food and waterborne illness detailed efforts by CDC to build an Environmental Health Services Network, or EHS-Net, at the national level and, in the word’s of pop star Justin Timberlake, bring sexy back to environmental health.

The federal government doesn’t even have a true grasp on the actual numbers of outbreaks in the states, part of the impetus to create EHS-Net. According to Vince Radke, a sanitarian at CDC, the challenge is that each state houses multiple agencies that handle water-related issues (for example, New York has 12, nine for Tennessee). Information and data on waterborne disease is often parsed out among many agencies and utilities.

EHS-Net is working on many fronts to develop multi-state projects and participating states are also managing their own individual projects. And why should states and localities care about surveillance for waterborne disease? As CDC’s Zarate-Bermudez explained, “waste and contamination of water sources can deeply impact the water cycle.”

On an even scarier note, research presented by Mansoor Baloch, also of CDC, shows that between 1948 and1994, 40 percent of waterborne disease outbreaks resulted from unknown water contamination sources.

To confront these challenges and prevent future water-related outbreaks, CDC is also promoting a new systems approach via water safety plans and watershed-based health systems. Such efforts will better protect the public health and provide long-term change and process improvement in water management.

Sounds like a win-win all around.

— M.S.

A little birdie told me so: Tweet of the Day

Wednesday's Tweet of the Day from Annual Meeting Twitterers using the hashtag #apha09 comes from Twitter user R71:

"Just ran a few miles in the rain w/twisted ankle not smartest thing I've done but now rejuvinated for final day at #apha09."

man, the things people do in the name of public health :)

Kicking the can

It’s not news that kids in the United States, and adults for that matter, are drinking too much soda.

It’s also not news that soda is one of the easiest culprits to blame for overweight and obesity, as the “liquid candy” is so ubiquitous and nutritionally barren. But presenters at yesterday afternoon’s session on reducing consumption of sugar-sweetened beverages are doing something about it. They shared their interventions to improve kids’ diets and offered some lessons learned.

It sounds simple, but encouraging after-school programs to serve water instead of soda or juice can lower overall calorie consumption, as the calories from beverages are typically not replaced by other foods. Caregivers can be encouraged to institutionalize this change, which is important because of the high turnover rates of after-school programs. Simple, repeated messaging and reinforcement of the cost savings of water compared to sugar-sweetened beverages is also an effective tactic. Overall, something as straightforward as encouraging a switch to water at places where kids learn and play can be a tool for preventing obesity and encouraging positive dietary habits at a young age.

While one intervention focused on promoting the virtues of water, an effort in the San Francisco Bay Area took the alternate approach — urging people to pledge to cut out soda for an entire summer.

The Bay Area Nutrition and Physical Activity Collaborative (BANPAC) conducted a “Soda Free Summer” campaign during the summer of 2008, urging area residents to take a pledge and “rethink their drink.” BANPAC involved more than 100 organizations in the six bay area counties and distributed pledge cards, promotional materials and hosted educational workshops on how to “Be Sugar Savvy.”

Post-intervention interviews found that the majority of those surveyed remembered the campaign, and two-thirds of respondents said they made a behavior change toward better health during the campaign. Almost half, at 47 percent, reported drinking less soda and sports drinks.

Liz Craypo, of Samuels and Associates, who helped organize and evaluate the “Soda Free Summer” campaign, said the campaign was a successful model that can be used as a foundation for further healthy food policy changes.

Addressing year-round change was one recommendation by campaign organizers and residents alike.

Regardless of the season, “there’s really no place for soda in a kid’s diet,” Craypo said.

— P.T.

Image by Brandon Glenn, courtesy iStockphoto

All you need is love

There’s a lot of talk this year about budget constraints and the squeeze on grant-funded research and health improvement projects.

Luckily, the Native Health Initiative doesn’t rely on dollars to improve the health of American Indians.

“What is our funding source? It’s love,” said Shannon Fleg during an informal initiative meeting in the convention center yesterday. “It’s a human-to-human element of wanting to serve others.”

Founded in 2004, the initiative is “a partnership to address health inequities through loving service.” It began in North Carolina and now has sites in New Mexico, California, Minnesota and Arizona. Some projects include grants to help young American Indians carry out community improvement efforts as well as a cultural approach to tobacco education, prevention and cessation called “Decolonize Tobacco — Breathe Tradition, Not Addiction.” Tribal communities have hosted college student interns for five consecutive summers to work on tribal community health projects.

It’s one of those miraculous projects where the interns and volunteers take away as much as the community members they are “helping.” It’s a cultural exchange and just a way of “going back to the ways our people already know,” Shannon said.

“A lot gets done when no one cares who gets the credit,” said Shannon’s husband and group-co-founder Anthony Fleg, a primary care physician in New Mexico. “We’re a partnership — a linking entity.”

The initiative is important because of the significant health disparities so painfully prevalent in many American Indian communities, not to mention the lack of exposure for many health professions students to American Indian communities and issues. There’s also been long-standing under-representation of American Indians in the health professions, untapped resources in the communities themselves, and a lack of effective partnerships between universities and communities to improve health.

“The best solutions for improving the health of communities will always come from the communities themselves,” Anthony said.

At this point in the meeting, this blogger raced back to grab her camera out of the press office, as Shannon said some the tribal elders might show up.

They didn’t, but I did meet the Fleg’s 15-month-old daughter Nizhoni, a name that means “beautiful” in Navajo, who is a delightful little child who acts like she’s never met a stranger. She smiled easily for me and grasped my hand like an old friend, even offering me a bite of her pretzel. May we all be so warm and welcoming to our fellow humans.

— D.C.

Above: Nizhoni Fleg, the youngest member of the Native Health Initiative (she really is a member), illustrates some loving kindness.

Encore

It's the last day of the 137th APHA Annual Meeting, and I'm still hearing people talk about how much they liked Sunday's Opening Session speakers. So, here they are one more time: From left are Surgeon General Regina Benjamin, APHA's Georges Benjamin, EPA Administrator Lisa Jackson and filmmaker Celine Cousteau.

Photo courtesy Jim Ezell/EZ Event Photography