Thursday, November 8, 2007

Until we meet again

Another year, another successful APHA Annual Meeting.

Final counts put this year’s meeting attendance at more than 14,000 people — that’s 14,000 people who may be more motivated to contact their legislators and advocate for public health; 14,000 who could have learned a new, innovative way to improve their community’s health; 14,000 who made new public health friends; and 14,000 who hopefully returned home with a renewed sense of mission.

APHA’s new president, Linda Degutis, DrPH, MSN, certainly seemed energized during her remarks at yesterday’s Closing Session, calling on attendees to be public health advocates and educate decision-makers about public health’s critical role. She emphasized that public health must be the voice for those who are too sick, too scared or too young to speak for themselves. Degutis spoke loud and clear: denying State Children’s Health Insurance Program coverage for uninsured kids is unacceptable; sending troops into war and then denying them access to care upon their return is unacceptable; and keeping maternal health services out of reach for undocumented immigrants is also unacceptable.

Step into the advocacy arena, she told attendees, and don’t be “intimidated by those with more money and power.”

Speaking of advocacy, CNN’s Sanjay Gupta, MD, broke some good news at the closing, announcing that this week Texas voters passed Proposition 15, a $3 billion bond plan to support cancer research and prevention. Tuesday’s vote on Proposition 15 was the reason Gupta, a member of the Lance Armstrong Foundation board, replaced original session speaker Lance Armstrong, who was in Texas gathering support for the measure.

Gupta told attendees that now — more than ever before — cancer is an important topic in presidential candidate circles. In fact, a number of top White House contenders recently spoke at a presidential forum hosted by the Lance Armstrong Foundation, he said. And they should be talking: “Cancer is and continues to be a national threat,” Gupta noted.

At the Closing Session’s end, APHA’s Executive Director Georges Benjamin, MD, FACP, sent his public health colleagues home with a not-so-small homework assignment: to help pass a strong SCHIP bill, eliminate health disparities and continue supporting a robust public health infrastrucutre.

“It can be done — it must be done,” he said.

On that positive note, see you next year in San Diego for APHA’s 136th Annual Meeting, “Public Health Without Borders.”

— K.K.

Wednesday, November 7, 2007

The body politic

Abortion. The HPV vaccine. Maternal mortality. Three very different issues, but all serving as poignant examples of the inherent dangers of allowing politics to supersede women’s health.

These three topics were the central issues discussed in today’s special session, “Women’s Health: In the Political Crossfire,” which shined a spotlight on the detrimental health effects of allowing politics and ideology to dictate evidence-based public health practices.

Abortion — perhaps the most obvious women’s health issue that finds itself overshadowed by politics — was discussed within the slippery-slope framework of increasing regulation. As noted by panelist Louise Melling, a lawyer with the American Civil Liberties Union’s Reproductive Freedom Project, the 2007 Supreme Court ruling on partial-birth abortion — which upheld a federal ban on the procedure — demonstrated the degree to which the nation’s highest court has reversed course since 1973’s landmark Roe v. Wade. Melling provided telling examples to support the idea that increased limitations on a women’s right to choose fly in the face of efforts to protect and improve women’s health.

In his discussion of recent attempts to mandate HPV vaccinations, panelist Lawrence Gostin, JD, LLD, a professor of global health law at Georgetown University, also argued that politics present real dangers to women’s health. Gostin, who feels that mandating the vaccine should be a last resort, argued that issues of social justice arise when a vaccine is mandated for one group and not another. This is significant, he said, because although men and women are equally affected by HPV, states that do mandate vaccination only require women to get immunized. And though the vaccine has been approved by federal safety agencies, the HPV vaccine has not been subjected to large-scale, long-term clinical trials.

The final panelist, Deni Robey, JD, added a global perspective to the discussion. Robey works for Americans for UNFPA, an organization that works to build American support for the United Nations Population Fund, which provides critical reproductive health services to women worldwide. She discussed how U.S. politics not only affect women domestically, but globally. Looking specifically at the disturbingly high rates of maternal mortality around the world, Robey illustrated the connection between the current U.S. administration’s refusal to fund certain international contraceptive programs and the continued numbers of women dying — needlessly — during childbirth. The U.S. government — the only government that won’t contribute to UNFPA because of ideological differences — has withheld close to $200 million in funding since 2002. That’s $200 million less that can be used to help the upwards of 16 per 100 women who die while giving birth in nations with the worst maternal mortality rates.

In the end, women’s health and politics will probably continue to mingle in the same circles for quite some time, but the question remains: What will we do to change the situation?

— B.L.

Best in show

Before the events of the past few days begin to fade from memory and we all slide back into our usual routines, let us know what your favorite part of the 135th APHA Annual Meeting was. If everyone will look to their right, you'll see a conveniently placed poll to help you answer that question. Was it the Public Health Expo, the scientific sessions, a Section social...or the curious "other." (If it was "other," please satisfy our curiousity and leave us a comment.)

And don't forget to check in with this blog on Thursday for highlights from the Closing Session as well as last-minute news from meeting.

A side of subsidy with your veggies?

What does the government tell us we should eat more of? Fruits, vegetables and whole grains. What foods does the government support with the vast majority of its food subsidies? Dairy and meat products.

What’s wrong with this picture? In the quest for a modern federal farm bill, public health experts need to be at the table, said the speakers at yesterday’s panel entitled “Farm Bill Renewal: Going Forward with Nutrition and Food Policy Outcomes.”

You’ve heard statistics on the rising rates and costs of obesity and chronic disease in the United States. Yet the government provides our most vulnerable populations — those who rely on federal nutrition assistance programs — with high-cholesterol, high-fat foods from subsidized agriculture.

As panelist Hope Ferdowsian, MD, MPH, of the Washington Center for Clinical Research and George Washington University, put it: “As public health professionals, we need to be adamant about shifting subsidy supports to more healthful foods. It’s up to us to at least get in there and participate in the conversation.”

While the farm bill is obviously very complicated and requires input from multiple sectors, it makes sense to base agricultural subsidies on health considerations and eliminate subsidies that promote unhealthy foods, Ferdowsian said. In Poland, changes in subsidy regulations led to increased fruit imports and was actually associated with a reduced incidence of heart disease, she added.

Roni Neff, PhD, SM, of the Johns Hopkins University Bloomberg School of Public Health (and the school’s Center for a Livable Future), linked the concept of the human right to food with food agricultural policy. Analyzing the issue within a human rights framework establishes policy responses as obligations rather than charity or economic strategy, and holds countries to standards that protect individuals, Neff said. The right-to-food approach considers sustainability, economic access, energy conservation and nutrition programs to overlap with the overall goals of the farm bill.

Thus far, Neff noted, the right-to-food ideology has been irrelevant to policy development, and agricultural stakeholders continue to dominate the debate.

“I believe nobody in Congress would necessarily think about the right to food, or care, unless we in public health and our allies make them care,” Neff said.

Currently, the federal farm bill, which includes funding for nutrition and food security programs, is being debated on the floor of the U.S. Senate. To take action and encourage your senators to support a healthy farm bill, visit APHA’s advocacy site.

Extra food for thought: In the United States, the average vegetable travels 1,500 miles from farm to plate.


Tuesday, November 6, 2007

APHA: Climate change is public health

APHA announced that it’s putting itself front and center in the movement to educate people on the current and future effects of climate change, unveiling 2008’s National Public Health Week’s theme: “Climate Change: Our Health in the Balance.”

At a news conference held earlier today, APHA Executive Director Georges Benjamin, MD, FACP, put his proverbial “foot” down, telling reporters that “today, we are taking our seat at the table.” In other words, climate change is already having and is expected to have serious effects on people’s health and so public health must make its voice known — it’s public health workers that have the experience, technique and knowledge to prepare people for an environmentally uncertain future.

Jonathan Patz, MD, MPH, who spoke at the news event and has been a lead author of Intergovernmental Panel on Climate Change reports (the IPCC shared the Nobel prize with Al Gore this year), noted that climate change is more than political — it’s a moral issue too. It’s disadvantaged, vulnerable populations in the developed and developing world — the people who bear the least responsibility for emitting greenhouse gases into the air — who will bear the brunt of climate change’s health effects: heat waves, floods, more severe weather events and rises in vector-borne diseases, such as malaria.

Patz noted that it wasn’t until the risks of secondhand cigarette smoke became well known that smoking bans really gained momentum. And like secondhand smoke, our highly consumptive lifestyles and greenhouse gas emissions are having a negative health effect on those who bear little — if no — responsibility for the current crisis.

Thankfully, some local public health agencies are already building their seat at the climate change table. In Multnomah County, Ore., health department Director Lillian Shirley, MPH, MPA, said workers are already talking about what climate change-affected diseases should be on their radar, how they should prepare for more severe floodwater and snowmelts and whether their region will be susceptible to rises in vector-borne diseases.

At the news conference, Shirley said Multnomah health workers are putting public health preparedness methodology to work to get ready for climate change as well as talking about the positive incentives needed to promote behavior change. All the little things can add up, she said, like an employer who installs on-site showers to motivate employees to walk or bike to work. Shirley called on her public health colleagues to be vigilant locally where people work, play and live.

“The canary in the coal mine is local jurisdictions,” she said.

More information on 2008’s National Public Health Week, which runs April 7–13, 2008, will be available in December online. For information now, stop by the National Public Health Week booth at the Public Health Expo, booth number 535.

— K.K.

Being healthy is, like, totally cool

The eclectic group of presenters at this morning’s “Health Promotion and Young Adults” session was “in true APHA fashion,” said moderator Michelle Chuk, MPH. From binge drinking to disaster preparedness, the topics were varied, but a recurring theme was the importance of using the media to get messages out to youth and their parents.

When it comes to preparing college students for natural disasters or other emergencies (recent teachable examples include the San Diego wildfires and the Virginia Tech shootings), Judith Taylor, EdD, said it’s important to include young people in the discussion and planning stages. Developing individualized plans within families, schools and other groups instills the need for personal responsibility in planning for the worst (while hoping for the best). Taylor’s survey of students found that just 43 percent of participants had discussed with family how to prepare for a disaster, and only 22 percent had developed a formal plan. Taylor’s recommendation? “Make a plan, develop a kit, stay informed.”

Switching gears — what does the rock band Queen have to do with health education on STDs, depression and eating disorders? Well, the band’s HIV/AIDS awareness benefit concert in 1992 was the inspiration for Benjamin Levy, a fourth-year medical student at Emory University, and his friends to start Music Inspires Health, a non-profit organization educating youth on health issues through collaboration with musicians in concerts, videos and on the Web. With advice from an advisory board of doctors and with help from the music industry, Levy and his partners plan to launch a health education Web site and multimedia-based concert tour that entertains and informs. Striving to be like a “cool, older sibling” and getting out health information in an accurate, interactive and nonjudgmental way, Levy wants to focus on topics that teens are already curious about, but haven’t found the answers to in health class or elsewhere.

Game on! In after-school programs, getting adolescents to exercise is more than just providing a gym with a basketball and a jump rope. The approach of program organizers is crucial to success and overcoming barriers such as gender expectations, attitudes, space and finances, according to Tracy Nichols, PhD. She found that actively engaging adolescents in activities they are receptive to is more effective than trying to force new activities on them. But cultural, economic and age differences between the adolescents and providers can negatively affect the provider’s expectations. Thus, Nichols said that the providers themselves should be targeted for education — not just on the importance of physical activity for health and its associated fringe benefits, but also on how to implement successful programs without perpetuating assumptions such as girls like to sit on the sidelines or cheerlead so they don’t mess up their hair, and boys are competitive and aggressive and don’t like activities like dancing.

The remaining two panelists tackled college binge drinking. Natoshia Askelson, MPH, studied media coverage of drinking in college, and whether newspaper articles discussed strategies parents could use to reduce their child’s alcohol use. Turns out, parents have a lot more influence than they realize — but they grossly underestimate their child’s sexual activity and alcohol use. Ryan Martin, MS, discussed his study of protective behavioral strategies among college drinkers that limited negative consequences of alcohol use such as lower academic performance and overdoses. Martin said universities should actively promote protective behavioral strategies such as alternating alcoholic drinks with non-alcoholic drinks, using a designated driver and eating while drinking alcohol.

Now that you’ve read about efforts to educate youths on a variety of topics, what do you think are the best ways to target teens and young adults for health messages? And how do these methods differ from successful approaches to other age groups?

— P.T.

Click and shoot: Photos of war

They say actions speak louder than words, but sometimes pictures can leave you speechless.

That was the feeling this blogger felt walking among photographs at Monday’s opening reception for “Unembedded: Four Independent Photojournalists on the War in Iraq.” Presented in the lobby of the AFL-CIO building downtown, the photographs depict the effect of the war on Iraqi lives in a stark and truthful way — a way that often only photojournalists can capture.

I can’t speak for how others at the reception felt as they took in the 60 images and coinciding captions explaining the photos, but I’ll take a guess that a few emotions were pretty common: anger, frustration, sadness, motivation to do something … a bit of hopelessness. But no matter how you feel, the photos will move you in a very visceral way. Here is just a handful of what you’ll witness:

A father holding his child amid the rubble of his city; angry residents gathering together after a missile is accidentally launched and kills nearby residents; an Iraqi boy celebrating after setting fire to a U.S. vehicle; a young Iraqi amputee, civilians fleeing in fear and an Iraqi psychiatric patient afraid she’ll be stuck in a hospital for life.

Posted throughout the photo exhibit are the facts and figures of war. Here are a few:

— After the 2003 U.S. invasion, Iraq’s only long-term mental hospital was looted, and the 1,200 patients left — 600 have not returned.

— One in 10 U.S. soldiers who qualify for disability compensation are 100 percent disabled.

— Thirty-five percent of returning U.S. troops visited a mental health clinic during their first year back.

— Acute malnutrition among Iraqi children has more than doubled from 2003 to 2005.

— The estimated $456 billion spent on the Iraq war through 2007 could have provided 195 million U.S. kids with health care, 3.6 million affordable housing units and 75 million university scholarships.

A speaker at last night’s reception seemed to put everything in perspective: “Right now, the world is in a state of emergency.”

The Unembedded exhibit will be on display at the AFL-CIO building, 815 16th St., NW, through Thursday, Nov. 8, from 7 a.m. to 7 p.m. each day. The exhibit is presented by APHA as well as the Association’s Peace and Labor caucuses. Anyone who would like to donate to support the cost of the exhibit, can send checks made payable to APHA (note Unembedded) to Pamela Wilson, c/o Department for Professional Employees, AFL-CIO, 1025 Vermont Ave., N.W., Suite 1030, Washington, D.C. 20005.


Street fighters

AIDS activists took to the D.C. streets on Saturday, Nov. 3, to raise awareness about D.C.'s disproportionately high HIV/AIDS infection rate and to motivate their fellow community members — as well as the city's policy-makers — to take action now. Organized by the Metropolitan Washington Public Health Association, the neighborhood march and community speak-out highlighted the city's continuing HIV epidemic in which as many as one in 20 residents are HIV positive. For more information, visit MWPHA.

Photo courtesy MWPHA

Distance learning

In South Asia, you can count the number of schools of public health on one hand, despite a population of 1.5 billion. Compare that with about 30 schools of public health for a nation of more than 300 million in the United States, and the opportunities for growth become glaring.

At yesterday’s World Federation of Public Health Associations panel discussion on establishing schools of public health in developing nations, Richard Cash, MD, MPH, of the Harvard School of Public Health, and Gregory Pappas, MD, PhD, of Aga Khan University in Pakistan, stressed the importance of increasing recognition of the public health profession and training more faculty to institute and expand master’s of public health programs.

Training public health practitioners in their own countries while simultaneously creating a demand for public health degrees is the goal, as is tailoring the programs to prepare graduates to face the specific challenges of their communities. The benefits of training public health practitioners in their home country include drastically less expensive tuition than in the United States, and the opportunity to do in-person field studies, Cash told attendees.

Of the graduates at the Achutha Menon Center for Health Science Studies — the first Indian university to offer an MPH degree — only 8 percent of graduates migrated elsewhere to work. The statistic leads credence to the notion that more schools of public health are necessary to develop a local work force and improve health outcomes.

“It is my belief that if you really want to improve the public health…[in South Asia], you are going to have to train locally, for a whole variety of reasons,” Cash said.

At the James P. Grant School of Public Health at BRAC University in Bangladesh, students take part in field work and training that will hopefully improve the quality of life for local populations, including projects on water and sanitation, family planning, immunization, malaria, HIV/AIDS, nutrition and tuberculosis, just to name a few.

One challenge in furthering public health programs abroad is the difficulty of procuring trained faculty. However, increased funding for exchange programs among U.S. universities would help, Cash said. Other challenges include creating a demand for public health education in the work force and equating the importance of public health graduate work with other medical-related degrees. Currently, public health workers without a medical background can find it difficult to find work in their home country, Pappas said. At India’s Achutha Menon Center, students must first have a medical or other post-graduate degree to even get into public health school.

In Pakistan, the focus on traditional medicine should be shifted to include more preventive and health promotion measures, Pappas said. The country is facing the “double burden” of afflictions commonly found in developing countries as well as high rates of chronic disease. Pakistan’s rates of hypertension are similar to that of the United States, Pappas said.

Shortages of doctors and a lack of public health infrastructure are serious concerns in the developing world, and new structures are needed to unite efforts working to solve both problems. Partnerships with U.S. schools of public health and local research projects are also vital, Pappas said.

“Research is essential to the vibrancy of the program,” he said. “Research leads to new programs and informs the coursework.”

A webcast of this session, “International Public Health Education: The Experience from MPH Programs in Developing Settings Worldwide,” will be available via the Alabama Public Health Training Network on Wednesday, Jan. 16, 2008. Visit the Web site for more information.

— P.T.

Monday, November 5, 2007

It’s our turn: Putting health reporters on the hot seat

The tables were turned today as top D.C. reporters gave public health professionals the opportunity to ask them questions for once. The lively Q&A was a central component of Monday's session, “Communicating Your Public Health News Through the News Media.”

The panel of journalists featured Nancy Shute, senior writer with U.S. News & World Report; Julie Rovner, health reporter for NPR; Scott Falk, managing editor for BNA’s Health Care Information Division; and Susan Levine, health care reporter with the Washington Post.

A key theme that emerged in each of the panelist’s remarks was that their jobs have gotten harder over the years. The panel was not shy about giving the audience an insider’s view to the fact that media outlets are in a state of flux with the advent of the digital age. They pointed out that more than 12,000 journalists have been laid off in recent years as outlets trim staff to meet budget crunches.

These trends laid the foundation for much of the panel’s advice. With journalists busier than ever but still very interested getting our stories out to the public, here are a few tips offered by the panel for public health workers:

Pick the right reporter and the right story. Levine says she gets 250 e-mails a day. If your subject line doesn’t fit with what the reporter covers or isn’t attention-grabbing, it is not getting opened.

Be sure the topic is relevant to the outlet. Look at previous stories that news outlet has done — does your issue fit in with what they cover? Do your research and you won’t waste their time or yours.

Give reporters access to the experts and authority figures. Be sure that your researchers and executives are available and accessible. Reporters want to get the information straight from the horse’s mouth.

Don’t ignore reporter requests. This advice is especially important with a controversial topic or a potential crisis. Most reporters aren’t out to get you and want to give you a chance to tell your side of the story. If you don’t return their calls and the story goes out without your information, you’ll be stuck playing defense.

Get to know your local reporters and teach them about public health. The panel admitted that public health isn’t always easy to “get.” They suggested taking time to educate reporters and get to know them in the process.

— B.L.

War and peace

War. What’s it good for?

That was the question during a Monday session on the health effects of war and the conclusion was resounding: War is bad for public health.

Public health professionals came together at the APHA Peace Caucus-organized session to discuss public health and war, focusing on landmines, nuclear weapons and the mental health problems of war veterans.

Former APHA president Barry S. Levy, MD, MPH, a public health consultant and adjunct professor at Tufts University School of Medicine, and Victor W. Sidel, MD, professor of social medicine at Montefiore Medical Center and Albert Einstein College of Medicine, introduced the session. The two co-authored the book War and Public Health, which is now available at APHA’s PubMart in the Public Health Expo.

Susannah Sirkin, deputy director of Physicians for Human Rights and a co-recipient of the 1997 Nobel Peace Prize for her work on the International Campaign to Ban Landmines, spoke about the problems that remain nearly 10 years after she helped to pass the Ottawa Treaty, an agreement of 125 nations to ban landmines.

Fifteen thousand to 20,000 annual casualties due to landmines happen each year, she said, particularly in countries such as Colombia, Afghanistan and Iraq, while hundreds of thousands of people who have survived landmine disasters lack proper physical and emotional treatment. She encouraged health professionals, who are often the first to see the direct damage, to alert policy-makers to the dangers of landmines in order to bring about a legislative freeze on their production.

Evan Kanter, MD, PhD, staff psychiatrist at the VA Puget Sound Health Care System, discussed the high prevalence of mental health problems among Iraq war veterans. As the number of U.S. soldiers killed in Iraq approaches 4,000, Kanter said, an expected 300,000 U.S. soldiers are expected to suffer psychiatric casualties. In 2006, the suicide rate in the U.S. Army was the highest rate ever measured in 26 years of record-keeping, he said. The National Center for Post Traumatic Stress Disorder estimated that 12 percent to 20 percent of returning veterans will suffer from the disorder, Kanter said, pointing to the immense medical and fiscal costs such statistics present. The disorder is particularly prevalent in soldiers who have multiple deployments.

Also discussed at the session was the APHA-sponsored exhibit "Unembedded — Four Independent Photojournalists on the War in Iraq," a national touring photojournalist exhibit that explores the impact of the Iraq war on the lives of Iraqi people. The exhibit will be open through Thursday, Nov. 8, at the AFL-CIO building, 815 16th St., N.W.

— A.B.

Change is in the air

Even if Brian Schwartz, MD, MS, does have a “hyper-paranoid view of the world” — his words, not this blogger’s — the audience didn’t seem to mind. In fact, it seems the world needs more “hyper-paranoid” outlooks if we’re actually going to do something about climate change, according to speakers at a Monday morning scientific session on “Global Climate Change and the Public Health Community: Mobilizing for Precautionary Action.”

Speaking before a standing room-only crowd, Schwartz talked about what health professionals can do to help change the individual behaviors that impact climate change. There must be dramatic reductions in greenhouse gas emissions in the next 10 years if we are to prevent the “catastrophic” events scientists predict will happen.

So, where to start? Schwartz recommends we begin by changing our behaviors and lifestyles — that health professionals help to “reconnect this disconnect” between our behavior and its effects on the climate. And health professionals, he said, should begin by serving as role models for their communities.

Schwartz added that Americans trust their doctors above most other professionals, and so that leaves health providers with a wide open opportunity to start a conversation with their patients about how to change their behavior in ways that benefit their health and the climate at the same time. Public health workers are already having these types of health promotion conversations, so how do we begin framing the climate change conversation in the same successful way public health has framed smoking and eating Big Macs, Schwartz asked.

Well, maybe the way is by promoting the numerous co-benefits that people will realize when they begin tweaking their behaviors to lessen their climate change impact, said Howard Frumkin, MD, DrPH, director of the Centers for Disease Control and Prevention’s National Center for Environmental Health, who spoke about the public health response to climate change at the session.

For example, driving less not only means less greenhouse gas emissions, it means more physical activity and exercise (exercise is also good for mental health), more social interaction with your community, less car crashes (which drops your injury risk) and less of the harmful emissions that make it harder people with asthma to enjoy the outdoors. Plus, Frumkin said, the actions we must take in the face of climate change are already in line with public health’s core functions: monitoring health, investigating disease, informing and educating the public, developing sound policy and mobilizing support.

And the time is ripe: session presenter Timothy Profeta, JD, MEM, said that after years of working with policy-makers, he’s never been more optimistic that the federal government will begin to act soon on climate change. The United States emits 25 percent of the world’s greenhouse gas emissions, and so that means we hold most of the “chips” at the international negotiating table, Profeta said. But until “we get to the table,” he said, “I don’t think anyone else will show their cards.”

What kind of activities do you already do in your everyday public health work that’s connected to climate change? Do you think public health should be at the forefront of the climate change debate?

— K.K.

Good humor man

Who knew that former U.S. Surgeon General C. Everett Koop, MD, was not only a leading public health advocate and anti-smoking hero, but also a comedian. Last night, Koop, above, performed alongside entertainers with the Capitol Steps political comedy show at the Washington Convention Center.

Photo courtesy EZ Event Photography

Take two Wikis and call me in the morning

Blogs, Wikis, podcasts and virtual worlds. Public health workers have a wide range of new media available nowadays to help spread the word about public health. But do they work?

According to a panel of federal, educational and private sector health workers who spoke at a session at APHA’s 135th Annual Meeting this Monday, the answer is a resounding “yes!”

More and more health workers, educators and agencies are using new electronic media to reach out and connect with the public, with encouraging results. Among those setting the example for the rest of us in public health is the Centers for Disease Control and Prevention. Last year, CDC successfully used blogs, podcasts, webinars, photo-sharing sites and other media to publicize seasonal flu vaccinations, drawing 12,000 people to its seasonal flu Web site in just one week.

CDC planners even went so far as to set up a flu clinic on Whyville, an online virtual reality world for children, to give virtual flu shots and answer kids' questions, reported presenter Erin Edgerton of CDC. More than 134,000 Whyville visits were made to the “clinic,” and almost 20,000 kids received virtual shots.

Online virtual worlds such as Whyville and Second Life present a new opportunity to improve health education of the public, said presenter Lucy Annang, of the University of South Carolina. For example, CDC has a virtual public health office in Second Life where real staff answer users’ health questions. Other organizations that have a presence in Second Life include the American Cancer Society and Brigadoon, which addresses Asperger’s syndrome.

At the college level, public health students at the University of Michigan are tackling issues such as depression and eating disorders via a new health podcast series. Students have responded well to the podcasts, said presenter Sara Abelson, and new topics are being considered for future podcasts.

“Health educators have an opportunity to lead the field with creative use of podcasting technology,” Abelson said.

While such new media methods may not reach everyone — particularly older Americans and those who don’t have access to computers — they allow health workers the potential to reach more people and improve their health and lives, presenters underscored.

“We need to adapt to an evolving world,” Annang said.

— M.L.

Expo-nential opportunities

What do key chains, hand sanitizer and packet of dried plums have in common? They’re just a small sample of the bounty of giveaways available at the APHA Public Health Expo.

When the doors opened Sunday afternoon, flocks of APHA Annual Meeting attendees eagerly dispersed to hundreds of booths to speak with representatives, gather information and, of course, pick up lots of free goodies. It was like a public health free-for-all.

The Expo, which will continue through Wednesday, includes more than 700 booths where attendees can learn about public health careers, publishers, computer and pharmaceutical companies, schools of public health, health-related government agencies and other public health service and product-related organizations. Chatting with booth representatives today, Expo-goers had the chance to network and drop off resumes with prospective employers, learn more about public health research and opportunities, and collect souvenirs.

In Publishers’ Row, visitors swooped up Rand Corporation’s “Research at a Glance” briefs on topics ranging from reducing obesity to consumer-directed health care. Mingling in the row of schools of public health, visitors at the Drexel University School of Public Health booth learned about academic programs while snacking on pretzels. In the cluster of technology companies, visitors got an up-close look at the Gaumard Scientific Company Inc.’s life-size human simulators — don’t worry, they’re for educational uses only. And after gathering informational brochures and pamphlets from around the room, visitors relaxed in armchairs at the Department of Health and Human Services’ Office of Public Health and Science booth to read over their materials.

If you’re stopping by the Expo this week — and why wouldn’t you? — navigating the event need not feel overwhelming. Walk two steps in the door and a large map will help you plot your trip. Feeling adventurous? Then just pick a direction and wander. If you get lost, just look up for the giant signs pointing out general booth categories, such as “Schools of Public Health,” “Publishers” or “Everything APHA.”

And you might want to bring an extra bag with you — just in case your eyes are bigger than your tote bag.

— A.B.

Poster sessions: A one-stop shop

While it’s easy to get lost in the seemingly endless rows of booths at APHA's Public Health Expo, it’s worth the effort to make your way to the poster sessions alllllllllll the way in the back of the room.

Stopping by the poster sessions is a great way to get an overview of the important initiatives and research happening at universities, departments of health and other public-health minded organizations. Tailor your visit to your needs by fast-forwarding through all the posters, or lingering with the presenters for an in-depth explanation of a few studies.

Take it as an opportunity to speak with researchers on a topic you’re already working on, or learn about a new issue that you may not have time to attend a full session on.

Here are just a few highlights from Sunday afternoon’s poster session:

• The Orange County Health Department in Florida pioneered postpartum nutrition education programs for Hispanic and black women, tailoring the programs to the groups separately to account for cultural differences. Ninety-four percent of women who completed the 24-week “Better Weight for a Better You” program lost weight.

• A poll of voters in Ohio found that helmet use among all-terrain vehicle riders would double if a law were passed to require helmet use. The Columbus Children’s Research Institute found high public support for safety initiatives, including legislation requiring helmet use, safety classes, as well as age and passenger restrictions.

• A study of racial and ethnic disparities in gestational diabetes mellitus in Oregon found that Asian and Pacific Islanders had higher rates than some other groups. However, misidentification of other ethnic groups, namely American Indians, may play a role in this outcome. Regardless, 70 percent of women with gestational diabetes will eventually develop type II diabetes, which can be used as a justification for glucose testing in postpartum health care, according to the research from Oregon Health and Sciences University.

From college binge drinking to baseball injuries to ageism in hospitals, there was something new for all public health professionals. If you missed today’s poster sessions, be sure to check out future poster presentations in the coming days (and at dinner that night, you can wow your colleagues with an array of statistics, such as the rate of pertussis in the United States).

Preview the upcoming poster sessions in the online schedule.

— P.T.

Sunday, November 4, 2007

A bright future for public health?

Like many public health workers, Julie Gerberding admits that sometimes the burden can feel too big — that sometimes it helps to seek out a different view.

That view, she told attendees at the Annual Meeting’s Opening Session on Sunday, can be seen from her garden, where sometimes she said she feels like reveling and other times, she feels like wielding a hatchet. Some nights, though, the director of the Centers for Disease Control and Prevention said she looks over her garden and notices fireflies hovering about — and she thinks of her fellow public health colleagues. Like fireflies, public health workers represent “flashes of brilliance” — and the efforts of such workers are extraordinary, she said. But while each worker flashes their own “light,” public health workers as a collective haven’t been able to link together in a sustainable way, Gerberding said.

Part of the reason is because of the country’s failure to invest properly in the public health system as well as its failure to truly address health inequities. Even though the United States is the wealthiest nation on the planet and we spend the most on health care, our health indicators lag far behind those of other industrialized countries. However, Gerberding noted that the time is ripe to establish a “new vision” for America’s health, to move toward creating a health — not health care — system driven by two principles: health protection and health equity. Such a system may seem far off, but it’s not “pie in the sky,” Gerberding said. Public health workers, she said in her closing remarks, can help “create an illumination that will change the world.”

Following Gerberding, award-winning public health author and practitioner Laurie Garrett spoke before the audience of thousands on the seemingly overwhelming state of global public health. The gaps in indicators like life expectancy and maternal mortality between the wealthiest and poorest nations is only getting wider and simply throwing money — even lots of money — at the problem won’t solve the issues, Garrett said. For example, many on-the-ground programs in Africa working on HIV/AIDS simply don’t have the infrastructure or the workers to effectively administer massive amounts of funds. One organization said it had spent more than a third of its funds just to build a road from the clinic to the community, Garrett told Opening Session attendees.

Garrett said one of the biggest obstacles to truly improving global health is the massive shortage of health care workers in places like sub-Saharan Africa — and the United States isn’t helping. Faced with our own shortage of nurses, Garrett said U.S. policy-makers have failed to invest more in nursing education or make sure nursing professors are paid a decent salary (a comment to which the audience gave a round of applause) and are instead recruiting health workers from abroad. In short, “we don’t have an HIV crisis, we have a health care worker crisis,” she said. A crisis that could be mitigated by investing in community health workers, Garrett said.

The billions of dollars already in the global public health pot must be used more effectively, Garrett said. Organizers must step away from the traditional charity model and move toward models that encourage dignity, self-reliance and sustainability.

Before Gerberding and Garrett took to the stage, previous speakers spoke of the need to continue building a strong public health movement, supporting fair public health policies and working to create unity among traditional and non-traditional public health partners. Opening Session speaker and APHA President Deborah Klein-Walker, EdD, seemed to sum up the Annual Meeting’s overriding theme best: “I am committed to public health because it is the practice of social justice.”

Did the Opening Session speakers talk to your concerns about the future of public health? Will it change your outlook as you spend the next few days learning about new ways to improve the health of your community?

— K.K.

For another take on APHA's 135th Annual Meeting Opening Session, visit the Pump Handle public health blog.

Gerberding photo courtesy EZ Event Photography

Lost childhoods

A tin miner in Bolivia, a welder in India, bricklayers in Nepal and workers in a Guatemalan firecracker factory — all hazardous occupations and all performed by children.

The lives of such children were the focus of a presentation during Saturday’s activist summit organized by APHA’s Occupational Health and Safety Section and attended by workplace safety and health advocates. During the presentation, David Parker, MD, MPH, a medical epidemiologist, showed photographs from his book, “Before Their Time: The World of Child Labor.”

According to the book, 320 million children worldwide younger than 16 work, with 150 million employed in hazardous industries. Throughout the book, Parker discusses the detrimental health outcomes of child labor, not only from the hazardous effects of industrial substances, such as lead, on a developing body and mind, but from having to forfeit an education so a child can help support her or his family.

During the question-and-answer period, a participant commented that the reality is that many families would face starvation without their children’s extra income. Poverty, the participant said, is at the heart of child labor. Parker agreed, adding that a strong public health system must also be central in the movement to curb child labor. Public health systems are needed so families, especially mothers, can stay healthy, he said. Increasing access and support for reproductive health services is particularly critical. Women in developing nations face a disproportionately high maternal mortality burden, and many fathers don’t care for their children if the mother dies, leaving many kids to seek dangerous work to survive, Parker said.

Unfortunately, as social support systems are stressed more and more under the weight of preventable disease and death, child labor numbers will continue to rise, Parker noted. Economic development, he said, won’t solve the child labor problem on its own — public health must be part of the solution.

Visit Parker’s Web site for more information and to view photos from his book.

— K.K.

Making sure no one is left behind

When public health emergencies strike, how do we meet the needs of different populations, and in particular, people living with disabilities?

Those attending yesterday’s Student Assembly meeting on improving public health preparedness systems, heard from Eileen Elias, MEd, deputy director of the Office on Disability at the U.S. Department of Health and Human Services, and Leon Larson, senior program analyst in the HHS Office of the Assistant Secretary for Preparedness and Response, on just that subject. The presenters described the limited mechanisms currently in place at the federal, state and private levels to enforce comprehensive preparedness planning that addresses the unique challenges facing people with disabilities.

Elias pointed to Hurricane Katrina as a case-in-point for the major challenges people with disabilities may face during emergencies. When Katrina struck the U.S. Gulf Coast, Elias said, many people with disabilities were separated from their caregivers, service animals, needed prescriptions and other social supports during evacuations and while they stayed at shelters.

However, to ensure that the needs of people with disabilities are met when future emergencies occur, HHS’s Office on Disability has formed a partnership with the Office of the Assistant Secretary for Preparedness and Response. The two offices are jointly offering emergency planning and response documents, including a “shelter assessment tool” and an “emergency planner toolkit,” as a part of their efforts.

During the question-and-answer session with Elias, Student Assembly Chair-elect Tamar Klaiman noted that Hurricane Katrina as well as the attacks of Sept. 11 not only “brought home” the reality of disasters striking on American soil, but also led to increased funding for research into public health emergency preparedness, providing the necessary resources to develop an effective knowledge base.

Visit the APHA Annual Meeting site to find more scientific sessions on public health and emergency preparedness.

— A.B.

Saturday, November 3, 2007

Public health students 'get ready'

APHA’s Student Assembly helped kicked off the 135th Annual Meeting today with “Get Ready: Improving Public Health Infrastructure and Infectious Disease Prevention.” Welcoming students from a variety of public health schools, student meeting Director Bryn Bird and Student Assembly Chair Darren Mays, MPH, opened the meeting with a few helpful tips for Student Assembly members to help them make the most of their time at the meeting.

For starters, Mays recommended that students check out the Student Assembly booth, number 1422 in the schools of public health section of the Public Health Expo. There, attendees can learn more about the Assembly and how to get involved with volunteer opportunities as well as in Assembly committees. Information at the booth will also be available for those interested in visiting Capitol Hill on Monday, Nov. 5, and advocating on behalf of public health.

Also, an official student welcome and orientation event on Monday will provide an overview of the Student Assembly for those new to APHA. The event, which takes place from 12:30 p.m. to 2 p.m. in room 202A of the Washington Convention Center, will include a discussion with APHA’s president-elect candidates, an awards session and an informal candidate roundtable.

After Bird’s and Mays’ welcoming remarks, Lynn Goldman, MD, MPH, professor and chair of the Interdepartmental Program in Applied Public Health at Johns Hopkins University Bloomberg School of Public Health, presented the keynote address at the student gathering. She discussed the need to improve the public health infrastructure to better support emergency preparedness activities, citing examples of poor public health preparation and management during Hurricane Katrina and the terrorist attacks of Sept. 11, 2001.

When such emergencies occur, Goldman said, it is crucial that the voice of science reaches key decision-makers, and that risk communication is effectively and accurately relayed to the public.

“People want information that holds up, not spin control,” she said.

Goldman stressed the importance of the Student Assembly in focusing the public health agenda on current and “real” issues. She advised Assembly members heading into the public health work force to be “clear, grounded and forceful” when talking to the media to ensure that necessary health information reaches the public. Preparing the public to be “responders” and to take preventive measures is a key goal of public health, she said.

— A.B.