‘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

Unacceptable...and totally preventable

The ladies of Tuesday afternoon’s Martha May Eliot forum on water and maternal and child health are putting a positive spin on toilet talk. In fact, they urge more conversation around sanitation and the magnitude of the public health risks associated with diarrhea.

The stats are quite staggering: 1.5 million children die every year of diarrhea and 88 percent of diarrheal deaths worldwide are attributable to unsafe water, inadequate sanitation and poor hygiene. Still, according to each speaker, there’s real need to elevate the status of these issues as funding, public awareness and intervention on these fronts seem to have taken a backseat to the fight against HIV/AIDS.

In an effort to raise the profile of diarrhea and its significant impact on child survival, UNICEF and the World Health Organization recently released a report in October on “Diarrhea: Why Children Are Still Dying and What Can Be Done?” The report provides a seven-point plan for stemming the unfortunate, preventable problem.

In many countries, the greatest sanitation challenges result from having to change social norms in order to advance healthier communities, and a big part of these efforts are in education and maintaining sensitivity to cultural norms. Another big challenge, according to presenter Therese Dooley of UNICEF, is the “issue around privacy and dignity for women and girls, which is why these issues don’t get addressed.”

One participant from Bangladesh noted that many schools in her region don’t even provide safe restrooms for students.

“We put our children in schools for six to eight hours a day,” Dooley said. “Shouldn’t we ensure it’s the safest and healthiest place it can be? We really need to stop the avoidance of talking about toileting.”

To find more on this issue, visit UNICEF.

— M.S.

Wednesday's Have You Heard

Cover that cough (with your elbow): Looking for the latest data on the H1N1 epidemic? Attend session 5093, “Latebreaker: 2009 H1N1 Influenza — Status Update and Lessons Learned from CDC,” from 10:30 a.m. to noon in Marriott Grand Ballroom Salon G.

Where’s the beef (been)?: If you’re planning to go with meat for lunch, this may not be the best session to attend right before lunchtime. But, on the other hand, you should probably have those veggies anyway. You decide at session 5104, “Meat Matters: Effects of Industrial Meat Production on Human & Environmental Health,” in room 103C of the Pennsylvania Convention Center.

Pride in health: Unfortunately, gay, lesbian, bisexual and transgender youth often suffer from disproportionate rates of certain health problems, especially when it comes to mental health. To hear about some best practices in reaching out to and helping this vulnerable population, consider attending session 5170, “LGBT Youth: Research, Policy and Health Outcomes,” from 12:30 p.m. to 2 p.m. in room 111A of the convention center.

Federal send-off: Before you hop in your trains, planes and automobiles, don’t forget to attend the Annual Meeting’s Closing Session from 2:30 p.m. to 4 p.m. in Ballroom A of the convention center. This year, the send-off session features panelists Howard Koh, assistant secretary for health at the U.S. Department of Health and Human Services; Mary Wakefield, administrator of the Health Resources and Services Administration; and Yvette Roubideaux, director of the Indian Health Service.

A woman's burden

The postcard image of a woman balancing a water jug on her head might at first seem exotic and mysterious, but in reality it is anything but.

In many developing nations, the burden of insufficient water often falls — literally — on the shoulders of women. According to speakers at a Tuesday morning session on water and women’s health, collecting and managing a household’s water supply puts women at risk for a host of illnesses and injuries, including head and back injuries related to carrying the 40-pound jugs on their heads.

Fetching heavy loads of water also puts women at risk of encountering violence and abuse at the water source, being involved in pedestrian road fatalities, sustaining injuries from falling, developing pregnancy complications and losing opportunities related to education and employment. In one study, women in India even said the heavy jugs wore off their hair.

In more than two dozen developing countries, collecting water is predominantly a woman’s responsibility, said presenter Gopal Sankaran of West Chester University of Pennsylvania, who noted that it takes about three hours a day to collect enough water to meet the drinking, cooking and basic hygiene needs of a family of six. Fetching the water requires women to carry the jugs over mountainous terrain, and once home, the water is often allocated first to the men in the household, even to the exclusion of infants and children.

In many developing nations, children start carrying water at an early age, said fellow presenter Padmini Murthy, of New York Medical College School of Public Health and who's also covering the APHA Annual Meeting on Medscape's public health blog.

“They start training the girls at about age 4, and will start with a little bowl of water and work up,” Murthy said, noting that the age at which water-carrying begins varies by region.

“Immediate gains from nearby access to safe drinking water will result in improvement in women’s health and reduced women’s workload,” said Susan Sorenson of the University of Pennsylvania in Philadelphia.

— T.D.J.

No bailouts here

Tuesday afternoon’s session on the economy and public health was timely for the APHA Student Assembly to take on in light of this country’s financial woes.

However, the topic that caught this blogger’s attention was on the protective health benefits of microfinance in the developing world.

I’ve heard a little about microfinance, made famous by Professor Muhammad Yunus’ Grameen Bank, but I hadn’t heard about it in the context of public health. Empowering people to use their own skills to free themselves from the depths of poverty using modest loans? Sounds good to me! And it may help improve health outcomes associated with poverty, malnutrition, lack of immunizations and poor sanitation? Even better!

According to presenter Chethan Bachireddy, a medical student at Yale University, microfinance can be a powerful tool to lift people out of poverty and improve health outcomes. Bachireddy studied the use of microfinance as a coping mechanism during Indonesia’s financial crisis. He found that even in dire economic times when loans were scarce, individuals who had previously used microfinance were better able to save money. Ultimately, they tended to weather the economic crisis better than others.

Bachireddy said the poor need more safety nets, as illustrated by his example in Indonesia.

“I find it counterintuitive that the poor are the most vulnerable, yet they are the least likely to have access to things like health care and credit,” he said.

For more on microfinance, check out the Financial Access Initiative, a consortium of researchers from New York University, Yale and Harvard who are looking into ways the financial sector can help low-income families in developing nations. What are your thoughts on microfinance as a means of reducing poverty and improving health status?

— P.T.

A little birdie told me so: Tweet of the Day

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

"Overheard at #apha09 'everyone has purell not candy this year'"

Nice to see public health workers walkin' the walk and talkin' the talk!

World Health Day 2010: 1,000 Cities, 1,000 Lives

Turns out our Annual Meeting presenters aren’t only leaders in public health, but some are comedians as well. At a Tuesday afternoon session on megacities and health, presenter David Vlahov opened with a quote from a “14th century” mystic.

“Make me one with everything,” the mystic said….as he ordered a hot dog. (The audience cracked up, with the guy sitting behind me calling it a “zen moment.”)

But on to non-laughing matters. Vlahov, director of the Center for Urban Epidemiologic Studies at the New York Academy of Medicine, spoke about tackling health issues in megacities (generally defined as cities with more than 10 million residents) and growing cities. The topic seems especially pertinent, as 60 percent of the world’s population will be living in cities by 2030.

While there are some diseases that may flourish in cities, there’s no “urban genotype,” Vlahov said, which is why health workers and researchers must focus on improving the living conditions and other social determinants that affect health.

“We have to think about health beyond health services,” Vlahov said.

To learn more about this growing issue, visit the Megacities and Health Project Blog, which is also a space for people interested in a proposed book about megacities that would be published by APHA Press. You can also visit the International Society for Urban Health. Or you can start getting ready for World Health Day 2010, which will focus on urban health with a theme of “1,000 Cities, 1,000 Lives.”

— K.K.

Reach out and touch someone

If you’re trying to expand your online and social media outreach to improve public health, I have a nice little inside scoop for you.

The folks at the Office of Disease Prevention and Health Promotion are coming out with a “Health Literacy Online” guide to developing user-friendly Web sites and other online tools in January. Want to be on the distribution list? Send an e-mail to Health Literacy Fellow Sean Arayasirikul at sean.arayasirikul@hhs.gov (and, yes, he said it was OK for me to post his e-mail address on our blog).

He and his colleagues have done a lot of study into how to reach people with low health literacy. A redesigned www.healthfinder.gov site, which took five years from conception to launch, shows some fruits of that labor. Pages are less text-heavy and give visitors easy-to-follow small steps to improve their health. We can all get behind that.

“We all kind of want to be snazzy when we present information, but a linear, simple approach works best,” Arayasirikul said at a Tuesday afternoon session on health literacy in the digital age.

While only 37 percent of U.S. adults with less than a high school education use the Internet, more than 94 percent of adolescents and young adults go online regularly. That means any public health education message and other outreach had better have an online presence in the near future because that’s the way to reach people, whether it’s via a computer, smartphone or other device.

“Information, because it can be accessed anywhere, I think, can be leveraged more,” said Ana Tellez, who works with Arayasirikul at the ODPHP.

Session attendees brainstormed on the challenges of using social media and other online tools to expand public health outreach, and one common gripe was the fact that many workplaces aren’t exactly hip to the happenin’. Some bosses ban Facebook use in the office, and the review process for online postings can bog down efforts to get credible information out there quickly.

Be persistent, Tellez said, and take it one bite at a time.

“Don’t ask for a whole cake,” she said about expanding social networking and other online efforts. “Ask for a little sliver.”

— D.C.

Hit 'send' for better health

Talk about looking into the future of public health. This public health blogger was transfixed by the innovative, amazingly creative ideas discussed during a Tuesday morning session on mobile technology and health. With more than 4 billion mobile phones globally (and that number probably changed in the two seconds it took me to write that), it makes perfect sense to use the platform to reach people with what can be life-changing health information.

Paul Meyer, head of Voxiva, a company dedicated to “mobile centric information solutions,” offered the most insightful quotes of the session. While the United States is a leader when it comes to the Internet, in mobile health, “we’re the followers,” he said. The rest of the world went mobile much quicker than us in the United States because the Internet is simply not accessible for much of the world’s people, he said.

“So, even if you have the world’s greatest Internet strategy, you’re still only halfway there,” Meyer said, adding that soon it won’t be a matter of if you should have a mobile strategy, but a matter of defending “why you don’t have a mobile strategy.”

After all, he said: “The best Web site in the world isn’t going to remind you to take your pill in the morning.”

Meyer’s new endeavor, Text4Baby, is scheduled to launch this January. Created in partnership with groups such as HHS and the National Healthy Mothers, Healthy Babies Coalition and supported by telecom companies, the free service (in fact, the first free mobile texting service in the United States) will send expecting moms three healthy messages per week, and after giving birth, the mobile service will start sending different tips, like info on child vaccine schedules. (Wanna copy of Meyer’s Annual Meeting presentation? Send a text to 311411.)

Finally, presenter Josh Nesbit, head of FrontlineSMS: Medic, told the story of his journey to the forefront of the mobile health movement. Working in Malawi, Nesbit observed how difficult and burdensome it was for community health workers to keep connected with the region’s tiny (very tiny) handful of physicians. So, with a small grant and a creative touch, Nesbit provided the workers with cell phones and the know-how to keep in touch with not only the physicians, but with each other. With the new mobile technology, the workers could do things like text a patient’s HIV/TB drug adherence report to a doctor. How freaking cool is that?

The big lesson, Nesbit said, is making sure the technology works for the people using it.

“If it doesn’t work for the end user, then it doesn’t work, period,” he told session attendees.

Find out more by visiting FrontlineSMS: Medic and read how text messaging is literally saving people’s lives. You can also visit CDC’s mobile health site for info on how the nation’s top public health agency is using cell phones to improve health here and around the world.

Wanna donate your old phone to help others? Visit Hope Phones to find out how to donate your old cell phone to a medical clinic in a developing country.

And one more thing: For more in-depth coverage of this new frontier, check out these two recent stories from The Nation’s Health, APHA's newspaper: "RU healthy? Public health efforts take on text messaging" and "Cell phone popularity a barrier for public health data collection: More Americans forgoing phone landlines."

— K.K.

Image courtesy iStockphoto

The collective well

Forget the old adage "don’t try this at home." Tuesday morning’s session on “Public Health and Global Water Issues: From Policy to Collective Action” defied the age-old golden rule.

The session featured an outstanding group of speakers from various organizations working collectively to pool human capital and expertise on water resource management to drive collective action through the Philadelphia Global Water Initiative.

PGWI President Stanley Laskowski envisions the organization as a model and hopes other cities will duplicate its efforts to build their own networks around global water supply issues. He stressed the need to “connect more nodes and build collaboration.” PGWI is pitching in to help the world meet the UN Millennium Development Goals for water and sanitation on a global scale, and they’re doing some pretty cool work.

Human rights activist and founder of Traveling Mercies, Aldo Magazzeni, is one of PGWI’s collaborators who has done extensive work throughout Afghanistan building water systems so that villages have access to clean and safe drinking water. His presentation was a composite of remarkable images of the villages and people he's helped over the years. He told stories of the impacts that sanitation, hygiene, and safe drinking water have on the communities he’s served. And although he claims his work is only a drop in the bucket, over the past seven years, Aldo has helped build 14 large water systems in Afghanistan.

Why is all this so important? Because the statistics are just unacceptable: Did you know a child dies every 15 seconds from a water-related problem? Even worse, in the countries where the needs are greatest, organizations don’t have the resources or technology to handle these water crises. And according to Bob Giegengack, of the University of Pennsylvania’s Department of Earth and Environmental Science, “a large number are suffering from avoidable water shortages.”

“There is enough water to go around,” he said. “We must use it more responsibly.”

— M.S.

Soldiering on

“Winter soldiers,” a term coined as a result of a 1776 writing by Tom Paine, describes people who stand up for the soul of their country, even in its darkest hours:

“These are the times that try men’s souls. The summer soldier and the sunshine patriot will, in this crisis, shrink from the service of their country; but he that stands it now, deserves the love and thanks of man and woman.”

Thus, it is fitting that winter soldier is also the name of a documentary filmed at an event of the Iraq Veterans Against the War in 2008. The resulting film, “Winter Soldier: Iraq and Afghanistan,” was screened at APHA’s Annual Meeting this morning, part of the meeting’s many film and technology sessions.

In the film, former servicemen and women describe, in brave detail, their experiences during and after their military services. With raw emotion on display, they took on torture, sexual harassment, veterans’ health care services, post-traumatic stress disorder and suicide attempts.

Their anger, disappointment and shame shone through as they told filmmakers about picking up the pieces of their lives after the military failed them. Several veterans described the stigma associated with seeking mental health treatment (the so-called “suck it up and drive on” mentality) — a mentality so powerful that many servicemen and women stay silent for fear of destroying their careers if they were to admit to suffering from PTSD or depression.

Perhaps the strongest voices speaking out against the wars in Iraq and Afghanistan are those who were there and can articulate the human tolls they personally witnessed and suffered. Let them tell you about it themselves — video segments of “Winter Soldier” are available online.

To find more APHA Film Festival events, check your program for "Film and Technology" sessions.

— P.T.

Eye of the tiger

Thanks to unseasonably mild temperatures and some of the most cheerful personalities I’ve ever come across, the second annual APHA Physical Activity Special Primary Interest Group 5K Fun Run/Walk really lived up to its name this morning.

I’m not kidding. It really was fun.

Turnout was about equal to last year’s inaugural event in San Diego, with 50 or so sleepy-eyed but energetic APHA-ers gathering in the pre-dawn darkness to squeeze in some exercise before a day of meetings. Another draw this year was the chance to run those “Rocky” steps at the Philadelphia Museum of Art. They’re not as tough as they look, especially if you take them one at a time.

We had to contend with some city traffic (groups of us stopped at red lights along the route and figured it was interval training). That gave us a chance to talk public health, which is always a good thing.

APHA member Dick Wittberg told me about a project in his home state of West Virginia that found school kids learn better when they’re fit. Jessie Kimmick, who so graciously let me snap her photo on the way back down the Rocky steps, was enjoying the mild morning because back home in Minnesota, running outside this time of year takes layers of technical fabrics and lots of steely resolve to brace the icy chill.

But we all figure if President Obama can find time to exercise, we can too. We know obesity is a big killer in America. The SPIG folks are working to bring attention to the need to incorporate physical activity into public health policy and advocacy. They also want us to be moving every day. You can do it!

Special thanks to SPIG Chair Steven Hooker and member Genevieve Dunton for organizing this year’s run. I’m looking forward to running with them in Denver in 2010.

Kick off the last day of this year’s Annual Meeting by joining SPIG members for a water aerobics session tomorrow morning at 6:30 a.m. (I know, but then you’ll be alert for the rest of the day) at the Hyatt Regency, 210 S. Christopher Columbus Blvd.

— D.C.

Top photo: Jessie Kimmick shows off her "Rocky" muscles during the Physical Activity SPIG's 5K Run/Walk. Bottom photo: Runners celebrate completing their run. Photos by Donya Currie

Open wide

American Dental Association President Ron Tankersley showed grace under fire when a packed room of oral health advocates pressed him on why his organization has opposed the use of dental health therapists to increase access to care.

APHA policy, as well as the majority of people at the oral health session yesterday, supports the Alaska Dental Health Aide Therapist program and other outside-the-box solutions to the continuing access to oral health care crisis in the United States. The American Dental Association initially opposed the creation of the dental therapist program, which takes members of Alaska Native tribes and trains them on providing oral health services in communities where oral health services can be a plane ride away.

Now the House version of the federal health reform bill includes a provision forbidding the Indian Health Service from setting up the dental health therapist program anywhere but Alaska. Huh?

The continued opposition to “unsupervised” dental health work force members, be they dental hygienists or dental health therapists or others with oral health training, “is neither evidence-based nor good for public health,” said Scott Tomar, president of the American Association of Public Health Dentistry and a University of Florida professor (go Gators!).

Tankersley, who did get a round of applause and even a hug after being grilled by session audience members, said the American Dental Association understands “that by having allied personnel do more, everyone would be more effective.”

“The ADA takes a lot of hits because we tend not to be nimble enough,” Tankersley said. “We are cautious, I admit.”

The session, by the way, was centered on an Institute of Medicine Oral Health Workforce Report released in August that calls for innovative solutions to the oral health access problem. As with many issues, “we really are short on data that helps us make good policy decisions,” said Marcia K. Brand, deputy administrator of the Health Resources and Services Administration, which now is funding an oral health study.

“There is no doubt that we’ve got to collaborate,” Brand said. “It’s going to take everyone to increase access.”

— D.C.

Feeling green?

Mitigating the effects of climate change and its negative impacts on human health requires a strong cross-section of public health advocates. Monday afternoon’s session on climate change, nursing and public health brought together a core group of public health experts hoping to confront these challenges.

The session brought together lead researchers, experts and practitioners to first provide a broad federal climate change framework and then hone in on specific (and successful!) instances of state and local actions that demonstrate momentum on reducing our emissions.

John Balbus, of George Washington University’s School of Public Health, noted how changed the climate (pun intended) is this year when it comes to discussions of global warming and proposed federal climate legislation. In contrast to the landscape during last year’s APHA Annual Meeting, the urgency for passing climate legislation has stemmed, he said.

Balbus described how the election and the new Congress really changed the game.

"There was lots of momentum last year and then health care reform happened,” he said.

Despite the slowdown (and the recent economic meltdown), the session speakers expressed strong optimism. Balbus detailed examples of federal regulations as well as Environmental Protection Agency efforts through its soon-to-be released endangerment finding that highlight lots of “activity on all fronts that can have cascading health benefits if done right.”

M. Kathleen Murphy, health services coordinator for Milwaukee Public Schools, provided a poignant case study of how the Milwaukee school system worked to effectively limit pollutants that disproportionately affect the city’s lower-income communities. As one of the leading U.S. cities with poor air quality and high rates of asthma, the city sought real reform. Milwaukee officials conceived and more recently implemented a host of strategies to limit bus emissions and other efforts to improve the region’s air quality. For example, they have stipulations in contracts with city delivery trucks and buses that reduce emissions by incorporating anti-idling requirements in most transportation vehicles. What a simple, yet awesome idea.

Balbus’ closing remarks captured the important role the public health community has in facilitating real change on such issues.

“We’ve come a long way,” he said. “There’s a lot of work that needs to be done. A lot of advocacy is needed. The health care sector is needed to continue to demonstrate its own greening and that these goals can be reached.”

— M.S.

So much free stuff, so little time

Only two days left to make your way around the more than 700 booths at the Public Health Expo. Hope you have your walking shoes on...

Photo courtesy Jim Ezell/EZ Event Photography

Tuesday's Have You Heard

Cool runnings: For all you early birds, APHA’s Physical Activity Special Primary Interest Group is hosting its second annual 5K Fun Run/Walk. Runners and walkers should meet at 6:15 a.m. in the lobby of the Downtown Courtyard Hotel, the corner of Arch and N. Juniper Streets, and the route will take you along the Benjamin Franklin Parkway to the museum steps made famous in “Rocky.” (Yo Adrian!)

Water women: As water is the theme of this year’s Annual Meeting, check out session 4005 on “Water and Women’s Health,” from 8:30 a.m. to 10 a.m. in Marriott Franklin 11. Those that get to the session on time can hear an especially interesting presentation on the health effects that women in developing nations encounter from having to carry water over long distances — a burden that “literally and figuratively” weighs such women down.

Harvest time: This blogger is lucky to live in a city with more than a handful of local, fresh farmer’s markets. But not everyone is so fortunate to have regular access to fresh, affordable fruits and vegetables. Learn how you can bring locally grown foods to your community (and help support local farmers) by attending session 4284, “Locally Grown: Strategies to Support Local Economies and Public Health,” from 2:30 p.m. to 4 p.m. in room 107B of the Pennsylvania Convention Center.

And the winner is: Come cheer on your fellow public health professionals during APHA’s annual Public Health Awards Ceremony and Reception from 6:30 p.m. to 8:30 p.m. in room 108A of the Pennsylvania Convention Center.

No butts about it

Even if you’re an environmentalist or a tobacco control expert, you may not have thought much about the public health toll of the 1.6 trillion cigarette butts disposed each year worldwide.

More than just litter, cigarette butts are toxic waste that leaches cancer-causing chemicals into water and air.

The speakers at today’s session on “Banning Butts” are looking for ways to frame the issue, build scientific evidence and support regulations that will help alleviate the deluge of tobacco waste that pollutes our cities and enters our watersheds.

One consequence of this waste entering water supplies is the toxicity to marine life. One study discussed by investigator Rick Gersberg of San Diego State University found that a concentration of about one smoked cigarette butt per liter of water killed half the fish studied in a four-day period. Gersberg said potential sublethal effects and bioaccumulation should be considered in future studies, as well as the identification of the specific compounds responsible for the toxicity.

Elizabeth Smith of the University of California at San Francisco spoke about her very clever look into tobacco industry documents. She found out (spoiler alert!) that the last thing industry wants is for “antis” and “greens” to band together to support regulation of tobacco waste, which most likely would mean that industry would be responsible for paying for cleaning up disposed filters. She also found some unintentionally funny suggestions from a focus group of smokers that the cigarette industry convened. To deal with the filter waste, why don’t the companies give it another life by making it usable as food for animals or a breath mint for humans, perhaps? Yeah, sounds real appetizing.

For now, filters are still non-biodegradable toxic waste that isn’t regulated. Today’s speakers are trying to change that by building public awareness and supporting regulations that would make the industry that creates the waste financially responsible for dealing with it. That’d sure be another kick in the butt to the cigarette companies, wouldn’t it?

To get involved in getting rid of cigarette waste, visit the Cigarette Butt Pollution Project.

—P.T.

Strength in numbers

Have you heard that African proverb, “When spider webs unite, they can tie up a lion”?

It’s true. Just ask anyone who’s successfully mobilized an advocacy campaign around a public health issue.

“Our strength is greater when we are united,” said Jirair Ratevosian, MPH, who shared advocacy tips during a Monday morning session on mobilizing a campaign around a public health issue.

One of his charges as deputy director for public policy at the American Foundation for AIDS Research has been to push for an end of the ban on federal funding for needle exchange programs.

Whether your issue is national, state or local, Ratevosian suggests breaking it down into bite-size steps:

1. Bring people together.
2. Set smart, measurable objectives.
3. Get the facts (these help determine your advocacy priorities).
4. Choose your targets (who has the power to make the change you want?).
5. Understand the policy- and decision-making process (this is especially important for voting timelines on legislation).
6. Build alliances and coalitions.
7. Choose your tactics (this could include letter-writing campaigns or Capitol step protests, depending on your group’s personality).
8. Renew, review and re-energize.

Step eight has been important in the needle exchange discussion, Ratevosian pointed out as he displayed an old 1987 letter from then-HHS Secretary Donna Shalala to U.S. Sen. Tom Harkin asking for an end to the federal funding ban.

Every presenter during the advocacy session said success hinges on consensus-building. But as Steven J. Huleatt said, it’s “not an easy process. It’s not necessarily a pretty process.” He was one of the local Connecticut health directors fighting a drastic funding cut this year.

APHA Governing Councilor Durrell Fox talked of the long effort to gain national recognition for community health workers.

“We had to find a way to find unity,” Fox said about community health workers, who are as diverse a group as you’ll find anywhere in public health. “A core, committed group was key to our mobilization efforts.”

Session moderator José Ramón Fernández-Peña would also like to remind us that signing on to APHA Action Alerts — “those annoying e-mails from the APHA Action Board” — is one easy way to tie up that lion.

— D.C.

Just tweet it!

Today, APHA held its first-ever Tweet-up. What's that, you say? (No worries, I didn't know either.) It's a gathering of fellow public health Twitterers who get together to talk about social media and, of course, do a little tweeting from a common event. So, why should public health enter the Twitter and larger social media realm. Just ask Twitterer @healthpolicygroup.

"I think social media is an exciting realm," said @healthpolicygroup. "Twitter is especially interesting in that it makes you be precise and consice in what you want to communicate. And in public health, that's very important."

Twitterer @publichealth couldn't agree more: "There is a real benefit to using social media tools in public health, particularly in communicating information and interacting with other users."

Still wondering what Twitter is? Check out APHA's Public Health Twitter!

What's your story (morning glory)?

There are some new guests at APHA’s 137th Annual Meeting showcasing the importance of public health professions in a very big way. You may be familiar with them if you, like this blogger, are an avid National Public Radio fan. StoryCorps has made its way to APHA!

StoryCorps, an independent nonprofit partner of NPR, is one of the largest national oral history projects. The group stages interviews (that are more along the lines of an informal conversation), between two people who have an intimate or personal relationship with one another. Each interviewee selects the person who will interview them. This may be a mentor, a colleague, a friend or anyone they are comfortable with. The goal is to capture, preserve and honor the story behind one’s life, and in APHA’s case, StoryCorps is doing just this for leaders in the field of environmental public health.

StoryCorps founder and radio documentarian Dave Isay, conceived of the project as a way to give people the time and space to tell their stories. Each conversation is recorded on CD and preserved at the Library of Congress.

Throughout the APHA Annual Meeting, StoryCorps is providing a dynamic group of 17 APHA members and leaders in the environmental public health field with the opportunity to tell their stories. One facilitator working with StoryCorps noted that this venue is particularly fitting, as public health professionals have a “strong sense of purpose in their respective areas of expertise and this passion is conveyed through the recorded conversations.”

This blogger got a glimpse at one scheduled interview between APHA Executive Director Georges Benjamin and his wife Yvette Benjamin. The two emerged from the interview room excited to share their stories with the world.

“We’re a public health family,” Georges Benjamin said. “Capturing this story is wonderful for the public record.”

Yvette Benjamin emphasized the importance of providing younger generations, especially those with public health interests, with a deeper understanding of the context in which “we’ve gotten to where we are today.”

When asked if they learned anything new about each other in the process, both Benjamins smiled and shook their heads.

“After 30 years of marriage, there’s not much new news to share” said Georges Benjamin.

Check back on the environmental public health section of the APHA Web site to access the stories in the coming weeks.

— M.S.

A little birdie told me so: Tweet of the Day

Today's Tweet of the Day from those of you using the #apha09 hashtag is from Twitter user iamrrm:

"Hey #APHA09 talk reminds me that I have not had a cigarette in 5 months! Yay me! (Now if I could just see my feet again.)"

Congrats!

Healthy People 2020 needs you!

When Penelope Slade-Sawyer touted the life-saving value of prevention this morning during a session on Healthy People 2020 and said “I hope I’m preaching to the choir here” it was clear that she was, indeed.

“The ultimate goal of Healthy People is to have a healthier nation, and prevention is how to get there,” said the director of the U.S. Health and Human Services Department’s Office of Disease Prevention and Health Promotion to an overflow crowd.

Slade-Sawyer heads the arm of HHS in charge of getting Healthy People 2020 in shape and ready for public distribution by the end of next year. One of her eye-catching pie charts drove home the woeful state of prevention funding — 95 percent of current health care dollars pay for curative medicine, and just 5 percent for preventive measures.

The Healthy People initiative has grown exponentially since kicking off in 1979. Healthy People 2010 had 467 goals, and it looks like Healthy People 2020 will have close to 600.

One challenge is to balance between the traditional “encyclopedic approach” and one that’s user-friendly. That’s where you come in.

“Give us your opinion,” said Slade-Sawyer, at the Healthy People 2020 site. And in the never-ending search for evidence-based best practices, “evaluate what you do. Let us hear about it.”

New topic areas for Healthy People 2020 will include adolescent health, quality of life, social determinants of health and health care-acquired infections, to name a few. Carter Blakey, known affectionately by her HHS colleagues as “Mrs. Healthy People,” said federal health officials are working to make the new objectives more user-friendly than the telephone book-sized Healthy People 2010 that’s been tough to update and cross-reference.

“Hopefully we’ll go farther than just giving you objectives this decade but also give you some strategies,” Blakey said.

The dream is Healthy People 2020 relational databases, with data available down to the county level. People like Richard Klein, chief of the Health Promotion and Statistics Branch of the National Center for Health Statistics, are working to make that happen using GIS mapping technology.

“Funding- and weather-permitting, we hope to have a much better database,” Klein said.

Click here for current Healthy People data.

— D.C.

Press club

Now that this blogger (and formally trained reporter) has finally stopped gushing over these photos, I can tell you what they’re all about. Today, about a dozen sixth-graders from Stewart Middle School in Norristown, Pa., visited the APHA Annual Meeting in Philly to do a little reporting for their school newspaper, the Stewart Healthy Times. Student reporters grilled public health researchers on everything from tobacco to H1N1 flu to how to prevent getting sick in the first place.

To learn more about Healthy Times, a school-based newspaper program that engages students in promoting health, fitness, nutrition and safety, visit the Food Trust, or stop by session 5084 on Wednesday morning from 8:30 a.m. to 10 a.m. in Marriott 413 to hear more about the Healthy Times program.

Above at top and middle: Young reporters from Stewart Middle School show off their press badges and take notes during a news conference. Bottom: Past APHA President Walter Tsou takes questions from the young reporters.

Peak your interest?

At Monday morning’s session on public health in an era of resource depletion, the panelists did their best to put a positive spin on what can be a very depressing topic. Energy, food and water security are daunting issues that will surely test the world sooner than we’d like.

Howard Frumkin, of CDC’s National Center for Environmental Health, highlighted the concept of “peak oil” and its relevance to public health. It’s scary when you realize how much we rely on petroleum products in our everyday lives — and how quickly, relatively speaking, our society became so reliant on petroleum for transportation and the manufacturing of so many everyday products.

Even if you walked over to the conference from your hotel today, you probably used something made from petroleum without even realizing it. Did you put in contacts? Take a medication? Drink from a disposable cup or bottle?

We in public health need to work with our colleagues in transportation, agriculture, housing, planning, architecture, manufacturing, etc. as we work toward a society less reliant on petroleum — because it won’t always be cheap and plentiful. Although Frumkin emphasized the need for planning and educating the public over the more apocalyptic story lines, he still said it’s not a matter of if, but when the dwindling quantities remaining in oil reserves become too difficult and expensive to extract. The scientific consensus is that the world will reach maximum oil production, also known as “peak oil,” sometime between 2005 and 2030.

Turning to water, Wenonah Hauter, executive director of Food and Water Watch, described water access as one of the most devastating crises, but said she is encouraged by a growing grassroots movement to amass political will to improve access to clean water and reduce the massive burden of water-related diseases worldwide.

“The good part of the story is there is this water justice movement that is growing,” she said, as is increased pressure on the international financial institutions she said are responsible for many of the failed policies that have privatized and taxed water out of reach of the people who most need it.

Click here to read more about Food and Water Watch’s take on the Water for the World Act, legislation introduced in Congress to provide clean water and sanitation to 100 million by 2015.

— P.T.

In a good mood? Don't read this

H1N1 flu. The economic recession. Health reform. Just a few issues described as “late-breaking” in a Monday morning session on recent developments affecting public health. Though I can think of a few more words to describe the topics: Huge, overwhelming, scary, exciting, nerve-wracking, stressful, confusing…..

“Stressful” would be a good way to describe Stephen Ostroff’s presentation on H1N1 flu trends in Pennsylvania. The state’s physician general, Ostroff said between 7,000 and 8,000 cases of H1N1 flu are being reported to state health officials each week, constituting an “unprecedented” fall wave of the virus. In fact, instead of describing the surge of flu cases as a “wave,” Ostroff called it the H1N1 “fall tsunami.” Luckily, Ostroff said H1N1 doesn’t seem to be any more virulent than regular seasonal flu, though it does differ in its magnitude of transmission and in the age groups most affected, mostly young people ages 5 to 19. (Squirt. Sorry, that was me. Just applying more hand sanitizer.)

Steffie Woolhandler, a professor at Harvard Medical School and a co-founder of Physicians for a National Health Program, put a bit of a damper on this blogger’s elation over the passage of Saturday’s national health reform bill. Woolhandler predicted that millions of Americans would still go uninsured even if the health reform bill goes into effect, noting research recently published in the American Journal of Public Health that found that 45,000 Americans die every year due to a lack of health insurance. She urged attendees to continue the call for real universal health care, cautioning them to watch carefully as health reform continues its way through the halls of Congress.

“It would be a grave mistake to underestimate the power of the insurance industry,” she said.

Carolyn Cannuscio, a professor at the University of Pennsylvania, reported on health and the economic recession, eliciting a good few chuckles from the crowd as she highlighted businesses that haven’t seemed to suffer: the makers of the canned, inexpensive meat Spam, condom makers and candy sellers. (Perhaps, she said, candy sales can be explained because people are self-medicating?) But with the nation’s unemployment rate above 10 percent, it’s certainly not all laughs. Unemployment or the stress of possibly losing one’s job puts a heavy strain on people’s mental health and well-being, as does the horrific event of losing one’s home to foreclosure, she said. Plus, the research is clear: Lower incomes often lead to greater health risks.

“Are we doing our best to assure the conditions in which people can be healthy,” Cannuscio asked.

Are you?

— K.K.

Life on the inside

Life is hard enough for an adolescent girl or boy, but can you imagine what it would be like if your mom was in prison?

Kids whose mothers are behind bars don’t have it easy, said Jane Siegel, PhD, an associate professor of criminology at Rutgers University. Speaking at a Monday morning session on women and correctional health, Siegel said that over the last three decades the incarceration rate has been increasing far faster for women than for men, even though women make up a small percentage of the U.S. prison population.

Concerned about the health and safety of incarcerated women’s kids, Siegel recently interviewed 17 children — ages 8 to 18 — whose moms had been in a state prison for a year. Most of the children were living with relatives.

Siegel’s research turned up some interesting findings. The good news: “These kids were incredibly resilient,” Siegel said, noting that they have had to overcome obstacles in their lives that most people, even adults, would never dream of having to deal with. The kids she interviewed — nine girls and eight boys — didn’t tend to have behavioral problems and were “all about trying to be just like other kids,” she said, with video games, shopping and hanging out with friends topping their to-do lists.

But the big burden of having a mom behind bars is the “emotional difficulty these kids have to face,” said Siegel, who was struck by the children’s “sense of longing” for family. Most of the kids were sad or depressed, she said, and to make matters worse, the children have to deal with reconciling their negative images of their mothers with their love for their mothers.

“These kids have an awful lot to cope with,” Siegel said.

— T.D.J.

Sounds of music

The Sounds of Philadelphia wowed crowds of APHA Annnual Meeting attendees on Sunday night with their musical revue and fancy footwork.

Photos courtesy Jim Ezell/EZ Event Photography

Get ready for National Public Health Week 2010

I know. It feels like we just celebrated National Public Health Week, but then again, it’s never too late to start planning for next year’s observation — especially since the theme has officially been announced! The theme for National Public Health Week 2010, to take place April 5–11, is “A Healthier America: One Community at a Time,” and will focus on making America the healthiest nation in one generation (if this sounds familiar, it’s because APHA officially has a campaign to accomplish this generational goal — check out the very cool video below.)

Also check out the National Public Health Week 2010 Web site now for info on how to start planning a week of raising public health awareness and building healthier communities where you live, work and play. Or if you’re with us in Philly, visit the National Public Health Week booth, #1442 in the Public Health Expo.

'You’ve gotta tell the truth to fix it'

The newly published third edition of “Health Issues in the Black Community” is a sobering read, but as co-editor Henrie Treadwell, PhD, told APHA members lining up for a signed copy Sunday afternoon, “you’ve gotta tell the truth to fix it.”

Health disparities will vex our country until we pull together to tackle the problem in more than a piecemeal way, she said. And now that the House of Representatives has passed a comprehensive health reform bill, that might actually happen.

“I’m hopeful,” Treadwell said as she signed copies of the book on Sunday afternoon. “In this era of health reform, we might be able to have a smaller book next time.”

Treadwell described the book as a “sad affirmation that we haven’t done enough” when it comes to eliminating health disparities — life expectancy for black Americans is shorter than for white Americans. The book offers chapter by chapter of examples of health issues that hit hard in the black community, from homicide and violence to chronic health conditions, substance abuse and obesity.

“I think this book is a critical read for those who are concerned about health disparities and access to care,” said former APHA President Caswell Evans, DDS, MPH, who co-authored a book chapter on oral health.

Trends outlined in the book include the fact that black boys and men are unlikely to have access to quality health care.

“Their best hope for health care is prison or none at all,” Treadwell said. A turnaround is possible, though.

“It can be done. It really can. I don’t think I would invest all the time and energy to just put words to paper, but to put the inspiration out there,” she said.

And just before the end of the one-hour book signing session, when Treadwell walked across the expo hall to hand-deliver a copy to new Surgeon General Regina Benjamin, MD, she reminded a gaggle of admiring young public health professionals of their important charge.

“We have to work to make this book smaller in the future,” she said to nodding agreement. “We have to fix something.”

To purchase a copy of “Health Issues in the Black Community,” visit the Everything APHA booth at the Public Health Expo.

— D.C.

Above: Author Henrie Treadwell signs copies of her book on Sunday at the Public Health Expo. Photo courtesy Jim Ezell/EZ Event Photography

Monday's Have You Heard

One flu over the cuckoo’s nest: This blogger has been washing her hands like crazy to avoid the flu, and even though my soft skin is suffering, my health is not. So if you’re like me and looking to go flu-free, stop by APHA’s Get Ready booth, #511 at the Public Health Expo, which is being presented in partnership with the Centers for Disease Control and Prevention and offers an extravaganza of free flu materials and information...and free hand sanitizer!

Ready for the next decade?: Already accomplished all the Healthy People 2010 goals in your community? Well, you’re in luck because Healthy People 2020 is just around the corner. To learn more, attend session 3010, “Healthy People 2020: Setting the Health Agenda For the Next Decade,” from 8:30 a.m. to 10 a.m. in Marriott Independence 3.

Action!: Hey you movie buffs! Did ya know the APHA Annual Meeting features its very own film festival? Well, it does and it’s pretty darn cool. Check your programs for a number of film sessions, which you can find by looking for the listing “Film & Technology Session.”

Butt out: Ever wonder if all those nasty cigarette butts we see all over our streets and sidewalks aren’t only ugly, but bad for our health and environment? Find out at session 3191, “Banning Butts: The Environmental Case for Eliminating Tobacco Waste,” from 12:30 p.m. to 2 p.m. in Marriott Grand Ballroom Salon B.

Public health swag!

If you thought you were overwhelmed by the phonebook-sized schedule you were handed at registration, wait until you check out the Public Health Expo. There’s a lot to see and do, and you might even see the U.S. surgeon general milling about — I just did!

I can’t begin to do the expo justice in a short blog entry — but there are plenty of free goodies to be found. Perhaps not surprisingly, a hot item this year is hand sanitizers in every size and shape imaginable.

Luckily, I managed to skirt by the Stata booth, a statistics software business, without too many terrible flashbacks from biostatistics class. No offense to the fine people staffing the booth, I just couldn’t bring myself to linger there.

But, here are a few highlights I would suggest checking out.

If you’re a job seeker, network with some of the organizations offering jobs and fellowships. In particular, the National Biosafety and Biocontainment Training Program was recruiting interested public health graduates, as was the Association of Schools of Public Health. They have a new fellowship in injury prevention and traffic safety that is accepting applications now!

In light of Environmental Protection Agency Administrator Lisa Jackson’s comments on asthma prevalence in the United States, check out CDC’s Emergency Preparedness and Response booth. They have some new materials on asthma, including a report called “Breathing Easier” and a guide for parents called “Help Your Child Gain Control Over Asthma.”

If you’re a big Twitter user, the Johns Hopkins University Center for a Livable Future’s booth has a flat screen TV broadcasting conference attendee’s Tweets.

The National Library of Medicine offered several demonstration sessions today on recent updates to PubMed and other information resources. Check out their booth for more info if you missed that.

You may also score invites to other events at the expo. Physicians for Human Rights is hosting a reception tomorrow from 6:30 p.m. to 8 p.m. in room 403 at the Marriott. It’s open to all with free food and drink as well as great conversation on health and human rights. No need to hold an MD to get involved — the group is looking for new members from all areas of public health.

What did you enjoy at the expo? Tell us about your organization’s booth!

— P.T.

Above: APHA's Get Ready booth

Post-It

Female genital mutilation in Tanzania. The dangerous mix of truck drivers and sleep apnea. School-based obesity prevention. Computer literacy skills among public health nursing students.

If you’re looking for a wide range of public health topics, check out the poster sessions located at the back of the Public Health Expo. They’re compelling, hard-hitting and unforgettable.

“I think it’s hard to conceptualize how different life can be for a different culture,” said Emory University doctoral student Aaron Siegler, MHS, whose poster on female genital cutting prevalence and instrument sanitation among the Maasai tribe of Tanzania highlights the fact that education is a powerful weapon.

His study showed that when girls and women have any education at all, they are less likely to undergo the practice that’s long been considered a rite of passage, even though it's outlawed.

Poster presenter Dara D. Mendez, PhD, MPH, looked into young black women’s perspectives on communication with mother figures surrounding sexual health and well-being. Guess what? They want to talk about the nitty gritty of sex, HIV/AIDS and how their mothers and other female elders dealt with sexual intimacy.

Then I was stopped in my tracks by photos of people who died on the job. The grinning face of 26-year-old Austin J. Sawicki, who died when a steel beam fell on him while he was working on a construction site. Vincint Don Lavite, 38, who suffered a fatal fall at a cement plant in Missouri. The poster exhibit was just one of many touching on such occupational health and safety issues as pesticide exposure, hearing loss, respiratory symptoms in workers with asthma, and effects of age and night work on the mental health of people working in a correctional institution.

For workers on the road, Florida A&M’s Felicia N. Green, MPH, found that sleep apnea is prevalent among truck drivers, but they are often scared to seek treatment for fear of losing their jobs.

“It’s a big issue that I think can be changed,” she said. “A lot can be changed for the better.”

And that, after all, is why many of us work in the public health field.

Poster sessions run at different times daily through Wednesday morning. Check out the program for a detailed schedule.

— D.C.

Waterworld

There is no mistaking this year’s theme for APHA’s 137th Annual Meeting. Water and public health is front and center, especially once you set foot in the Public Health Expo hall. Hand sanitizers may be among the most popular giveaways, but water resource management is clearly on the minds of many.

Among the 650 booths present at the expo, two deserve honorable mentions and creative kudos for highlighting this year’s water and public health theme in a particularly unique way.

First is the Environmental Protection Agency for its booth dedicated to the “3Ts” campaign. The 3Ts, (training, testing, and telling) is an outreach program for school officials and child care operators that builds awareness about water quality and seeks to reduce lead in drinking water. Visit the booth and get yourself a copy of the 3Ts toolkit — a how-to guide that can be adapted for local use to reduce risk of childhood lead exposure. After all, lead-free is best for me. (And you! It’s the campaign slogan; I didn’t come up with that one on my own.)

The second water-themed award-winning booth (in this blogger’s view) is the aptly named Infectious Awareables (otherwise known as iAwareables). The company debuted at APHA’s Annual Meeting in 1997 and the rest is history. iAwareables, booth #1405, has a remarkably large collection of awareness products (ties, scarves, etc.) that are designed to promote awareness and feature bacteria, viruses and other scientific images. They even have a whole line of products featuring water-borne illnesses! The goal, they say, is to promote interest and discussion around serious public health issues.

It seems the company has done very well for itself: According to People magazine, “the ties are spreading like swine flu.” The public service-minded company also donates a significant portion of its proceeds to organizations dedicated to research, education or treatment.

And with the holidays approaching, who wouldn’t appreciate a tie or a pair of bioboxers featuring E. Coli or the norovirus? I know it gets me in the mood….

— M.S.

A little birdie told me so: Tweet of the Day

From Twitterers using the #apha09 hashtag, here's today's Tweet of the Day from Twitter user pk3v:

"Great to be with SO many others that believe access to health care is a universal, fundamental, human right."

Right on.

'Environmental protection is public health protection'

On the heels of the historic passage of health reform legislation last night on Capitol Hill, it’s no surprise that it was on everyone’s mind during today’s Opening Session of the APHA Annual Meeting in Philly. In fact, APHA Executive Director Dr. Georges Benjamin kicked off the session with a big smile and this quip: “How’d you like that House vote last night?” And by the sound of the whooping applause, it seemed everyone liked it, indeed.

Following Dr. B (as he’s affectionately called around the APHA offices), Philadelphia officials welcomed the nation’s largest public health gathering to their city, describing why Philly is such an appropriate meeting place for such a gathering of public health minds. It’s a city of firsts, they all said, the first city with a nursing school and a medical school, the first to have a public hospital, the first to have a medical dispensary designed to care for the poor, and the location where the first woman was awarded a doctorate of medicine. Decades later, Philadelphia is still leading the way with tobacco-free laws, celebratory child immunization rates and a happily high number of residents who walk to work. No wonder city health commissioner Don Schwarz said he feels like the “most fortunate public health official in the nation.”

A few speeches later came a well-deserved standing ovation for a late-breaking speaker, new U.S. Surgeon General Regina Benjamin (no relation to APHA’s Dr. B), who told attendees her personal public health story. As a physician, she said, there were simply things “my prescription pad wouldn’t take care of,” such as making sure patients were breathing fresh air, drinking clean water. She told of patients having trouble with their prescription meds, not necessarily because they couldn’t pay, but because they couldn’t read the label. Or of another patient, who even though she had insurance, couldn’t afford the co-pay for the pain medication she so desperately needed. The experiences will move with Benjamin into her new office as surgeon general, where she said she is “proud to welcome 300 million Americans as new patients.”

Fellow federal official Lisa Jackson, administrator of the U.S. Environmental Protection Agency, took to the Opening Session stage next — a woman Dr. B described as “putting the protection back into environmental health.” Illuminating the connections between environmentalism and human health, Jackson noted that “environmentalism started because of concerns over public health.”

“Environmental protection is public health protection,” Jackson said.

Near the end of her speech, Jackson called on the public health attendees to get involved in reforming the nation’s chemical management law, known as the Toxic Substances Control Act. Since the law's creation in 1976, EPA has only regulated five chemicals out of tens of thousands, Jackson said. (Shocking, right?) And with today’s kids receiving a steady infusion of chemicals even before they start to eat solid food, it’s time for a change, she said, asking for attendees’ help in making it happen.

“Help us do a better job of bringing our work together,” Jackson asked attendees.

Finally, filmmaker and granddaughter of legendary ocean explorer Jacques Cousteau, Celine Cousteau, spoke before the crowd to tell the story of why the health of the world’s oceans is also important for the health of the world’s people.

“It is all completely connected,” Cousteau said. “All of our actions have a reaction somewhere.”

P.S. To get involved in Jackson’s call to reform the nation’s chemical safety law, download EPA’s “Essential Principles for Reform of Chemicals Management Legislation.”

— K.K.

Top: New U.S. Surgeon General Regina Benjamin; bottom: EPA Administrator Lisa Jackson. Photos courtesy Jim Ezell/EZ Event Photography