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.

K.K.

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.

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.