Addressing health inequities means doing things differently

Parks are great but not if they aren’t located in neighborhoods that face high obesity and diabetes rates. Bike paths are awesome, but they won’t have much of an impact in the community if they aren’t well distributed across the city. And just because we’ve done something a certain way for 20 years isn’t a good reason to keep doing it – particularly when it comes to improving health.

Once again, public health leaders at APHA’s Midyear Meeting are talking about how they are doing things differently to tackle the problem.

A Tuesday session, “Achieving Health Equity: Solutions from the Field,” highlighted local initiatives to underscore health as an issue of justice.



“When we look at what is causing inequities in health, we come to accept it based on evidence. That really, social determinants of health play an enormous role in determining health outcomes,” said Barbara Ferrer, executive director of the Boston Public Health Commission.

Ferrer says the heart and soul of Boston are people of color.

“In those neighborhoods, you will see much worse outcomes. Be it foreclosures, elevated blood levels, higher hospitalization rates."

She and her colleagues have developed a health equity agenda to rid the city of these prevailing health equities that center on reducing low birth weights, tacking obesity, lowering chlamydia rates and building community capacity.



“We’ve really entered into areas where we’ve traditionally not been active,” Ferrer said.

And those efforts are starting to see results.

In 1999, the city was home to 90 dumpster storage lots. Today, there are only 12. Two hundred community garden plots are now in its place. The city has done more work around gun laws, paid sick leave and tobacco control.

“Policies that are good for health aren’t always health policy.”

APHA President-elect Adewale Troutman underscored this notion for the audience. He stressed the need to recognize structural factors that improve health conditions – be it land space, jobs, transportation, air quality.

“You have to ask yourself, can you do this work or do you need to change it and find another mechanism to make it work? Are we willing to take a risk changing society and structure?”

Opening session: 'The biggest risk of American health care today is that it will fail the moral test'

Uncertainty. It's a theme that many public health practitioners are all too familiar with these days. So much is changing so fast. And yet it's vital that public health keep up, adapt, transform, move forward — make itself into a lean, mean disease-fighting machine. It's a lot for a public health plate that's not only already overflowing, but being asked to hold more and more food with tinier and tinier plates. (Excuse the food metaphor; this blogger skipped lunch.)

Luckily, North Carolina — our generous host for the Midyear Meeting — has had some success tackling the problem. Its answer: Focus on continuous quality improvement; really zero in. According to opening session speaker Laura Gerald, North Carolina's state health officer, the state has fully embraced the concept of quality improvement. A few examples: The state was the first to mandate all local health departments achieve accreditation; strategic public-private partnerships, such as the North Carolina Center for Public Health Quality, are rapidly driving momentum toward quality improvement across the state; and work to coordinate healthy living efforts and build capacity in under-served communities is creating new opportunities for better health all the time.

Gerald said cost-containment measures and budget cuts are driving the need to find quality improvement strategies that increase efficiency while preserving and enhancing health outcomes. But even with quality improvement, budget cuts present a huge challenge, she said. For example, she said this year the state shifted its master settlement agreement monies that used to go toward tobacco education and prevention back to North Carolina's general fund. That means tobacco funds have gone from $18 million to $2.7 million. It also means that Gerald doesn't know how the state is going to sustain the hard-fought declines it has accomplished in youth tobacco use.

"'It appears I wasted my time studying medicine and public health when I should have been studying magic...(now that I'm being expected to) pull stuff out of thin air," she said to a roomful of knowing laughs.

Opening session speaker E. Winters Mabry, health director with the Mecklenburg County Health Department, noted that if you've seen one North Carolina Health Department, you've seen one North Carolina Health Department. However, accreditation has become the common bond that brings the state's health departments together, he said.

He told attendees about the department's largest effort — its school health program. Mabry said the department has worked hard to build close relationships with local school systems and now has a school health staff of 150 and a budget of $10 million. With more than 10 percent of students coming to school with serious chronic illnesses, such as asthma and diabetes, the school nurses provide case management and track specific indicators, such as grades, behavior and health outcomes. Last year, Mabry said, nurses managed thousands of children and had positive outcomes in the 95 percent. This is "special work," said Mabry, who ended his time at the opening session mic with a quote from Frederick Douglass: "It is easier to build strong children than to repair broken men."

Next up came keynote speaker Donald Berwick. A man who APHA Executive Director Georges Benjamin introduced with this quote: "When the dust settles...people will clearly see that the steps and programs that he initiated...will transform the way medicine is practiced in this country and many people will live longer because of that."

Berwick, former administrator of the Centers for Medicare and Medicaid Services, started off by noting that while he has great affection for the public health community and readily accepted APHA's invitation to speak, he didn't actually know what to say. He had writer's block (a common and not always preventable affliction among bloggers too.) The question he was asked to speak on — how public health can thrive in a changing health care landscape — was a hard one; one that doesn't submit itself well to easy soundbites, he said. Nevertheless, it's a problem with a solution, Berwick told attendees.  

First, he spoke about the Affordable Care Act — a law that he said holds great promise. Berwick said the law does two things: it tries to make health care a human right as well as make health care sustainable through improvement measures. Improvement, he said, was his compass when he was working in Washington, D.C. And you need a compass, "so you don't lose your mind," he joked. Improvement was the "how" to improve the system; the "what" was defining what improvement meant. That "what" question is what brought Berwick and CMS to pursue its now-famous triple aim: population health, experience of care and cost per capita. At the end of the day, Berwick said the system must embrace improvement strategies to sustain itself and serve the people.

"The biggest risk of American health care today is that it will fail the moral test," he said.

So, what does it all mean for public health? Berwick said the honest answer is that, well, he doesn't know. He discussed some of the classic problems that public health still faces: Like how do we tell the story of a disease we prevented from happening in the first place? How do we effectively make the case in an era of economic restraint that prevention has value that goes beyond saving money? That even though prevention doesn't always save money, it's still worth doing. And, finally, how does public health communicate its story?

Here was his prescription for public health: reduce costs in public health where you can; cooperate — don't work in silos; partner with nontraditional entities, such as employers and health systems; help reduce health care costs and waste; and focus and mobilize.

"Public health needs mobilization too," he said. "If there isn't political force behind the public health endeavor, it will remain frail."

To hear more from Berwick, check out this video (which is also at the top of this post) on APHA's YouTube Channel.

A little birdie told me so: Tweet of the day

As is now tradition during APHA meetings, we'll be posting a Tweet of the Day from Twitterers using the official meeting hashtag, which this year is #APHAMid12. Today's Tweet of the Day comes from past APHA President Deborah Klein Walker, known as @DKWpublichealth, who tweeted in response to opening session speaker and North Carolina State Health Officer Laura Gerald:

NC Health Officer Gerald states prevention efforts funded by tobacco tax has been drastically cut #APHAmid12 @APHAAnnualMtg What next?

This blogger imagines similar sentiment can heard within the halls of budget-strapped health departments around the country. Let's just hope that what's next isn't an uptick in tobacco use.

So many reasons, too little time

People come to APHA meetings for all kinds of reasons. Networking, learning, presenting, celebrating. North Carolina resident Paul Jung, a member of the U.S. Public Health Service, needed to get his APHA fix. He said he came to this year's Midyear Meeting to get a "boost to hold me through until the APHA Annual Meeting in the fall…and since it's in my backyard, it made it even easier."

Jung says he's most interested in the meeting's public health workforce track. He's hoping to discover some innovative ways that the U.S. Public Health Service can effectively work with local public health folks. And, he said he's looking forward to catching up with fellow service members from around the country.

Joy Reed, a fellow North Carolina resident attending from Raleigh, is at the Midyear Meeting for a couple reasons. First, she's come to promote the first enumeration study of public health nurses since the 1950s. Reed, who's the public health nursing director for the North Carolina Department of Health and Human Services, said the study will gather data on numbers, demographics as well as job descriptions for the country's public health nurses.

If you want more info on the Robert Wood Johnson Foundation-funded study, which is just beginning to roll out, introduce yourself to Reed. She's easy to spot — she's the one wearing a pin that says "Public Health Nurse. Count Me In."

"The networking is the biggest benefit for me," she said.

Of course, Reed said it'll be nice to be with fellow public healthers when the Supreme Court's health reform decision comes down on Thursday.

Michael Meit, co-director of the NORC Walsh Center for Rural Health Analysis, flew into Charlotte to present during a session on health equity. But he said he's also excited about coming together with fellow public health practitioners to "think strategically" about public health's future. Meit will be presenting on the issues and struggles confronting America's rural communities, where he said public health is often nonexistent or underdeveloped.

Meit said that while "I love public health — it's what I do," he does believe the field needs to make more of an effort to connect with rural communities. In fact, he said that public health overlooks rural communities to its own detriment, as rural residents tend to be very active in politics and have a stronger voice with their representatives. We need to start a different dialogue, Meit said.

"We need to change the dialogue from government and taxes to clean water, safe food, healthy children and healthy families," he said.

Health department accreditation is what's piquing Noble Maseru's interest here in Charlotte. The health commissioner for the city of Cincinnati, Maseru said he's also hoping to learn about new approaches to prevention as well as new ways to partner with the clinical sector. He's hoping Thursday's Supreme Court decision will be a time of "jubilation."

Catherine Bolek, director of sponsored research at the University of Maryland-Eastern Shore, traveled to Charlotte to search for new grant opportunities — or as she called it, "I'm chasing the dollar."

Why did you decide to come to Charlotte? Let us know in the comments section below!

Hello Charlotte!

Greetings from Charlotte and the start of APHA's 2012 Midyear Meeting! It's gonna be an exciting three days filled with anticipation for Thursday's Supreme Court decision on health reform. But until then, it's time to get to work. Or as they say in the South, let's go hog wild for public health!  

Above, a few snapshots from the literary-themed park known as The Green, which is just a couple blocks from Midyear Meeting headquarters at the Westin Hotel in downtown Charlotte.

A welcome letter from APHA's Dr. Benjamin

Dr. Georges Benjamin

Greetings public health colleagues,

As you all know, these are uncertain times for public health. Budgets are on the decline, staff and services are being cut, and hard-fought gains in community health and public health capacity hang in the balance. In addition, new and celebrated sources of public health support, such as those within the landmark Prevention and Public Health Fund, are under near constant threat of elimination. And with the fate of the Affordable Care Act now in the hands of the Supreme Court, the future seems even murkier than before.

That's the bad news. The good news is that public health is no stranger to uncertain times. We know how to overcome seemingly insurmountable obstacles to improving our communities' health — we've done it before and we'll do it again...and again and again. It's what we do. Still, continuing our work toward long-held public health goals means quickly adapting to new constraints, taking advantage of new opportunities and technologies, prioritizing efficiency and effectiveness, and learning how to communicate our successes in compelling and relatable ways.

These are not easy tasks, which is why coming together to share promising practices, discuss pressing problems and solutions, and learn from each other's experiences is vital. It's why I hope you'll join me and your fellow public health practitioners from all over the nation at APHA's 2012 Midyear Meeting in Charlotte, N.C., from June 26 to 28. With a theme of "The New Public Health: Rewiring for the Future," the Midyear Meeting will offer a variety of insightful sessions and presentations from local, state and federal public health leaders.

Just a few of the meeting's many highlights include: A special evening session on the Supreme Court's health reform decision (cross your fingers!); sessions covering the latest in successful public health advocacy and social media use with tools and info you can bring home with you; and more than one opportunity to network with new and old public health friends. Click here for a complete schedule of sessions and speakers.

Of course, no matter where you are June 26-28, you can keep up with all the happenings via APHA's social media and news offerings, including the APHA Meetings Blog, our Public Health Twitter (don't forget to use the hashtag#APHAMid12) and our Public Health Newswire.

I hope to see you soon in Charlotte. Together, I know we can make a difference.

Best (and healthy) wishes,
Dr. Georges Benjamin

Celebration or frustration?: Charlotte & the Supreme Court health reform decision

Are you as nervous as I am? Cause I'm pretty nervous. In fact, just thinking about the upcoming Supreme Court decision on the fate of the Affordable Care Act makes me feel like I've had one too many cups of much-too-strong coffee. My fingers are so crossed right now that I'm not sure if I'll ever be able to straighten them out again.

What does make me feel better is knowing that around the same time the Supreme Court decision is released I'll be surrounded by fellow public health admirers and practitioners who also believe that health care should be a right and not a privilege. That's because this blogger will be at APHA's 2012 Midyear Meeting in Charlotte, N.C., which takes place June 26–28, and I hope you'll be there too.

Of course, whichever way the decision comes down, it's sure to be THE topic of conversation at the Charlotte gathering. That means not only will attendees have the chance to mull over the (good or bad) news with colleagues from across the country, we'll also get to hear perspectives from some of the nation's top public health leaders.

And whether the court comes down for or against the historic health reform law, either decision means public health has some major work to do, which is what the Midyear Meeting is all about — getting public health ready to survive and thrive into the future. (Already on the meeting schedule for the evening of Tuesday, June 26, is a special session called "29 States, Nine Justices, Two Lawsuits: What does it all mean for the nation's health?")

To learn more about what exactly was argued before the Supreme Court, check out this article from APHA's The Nation's Health newspaper. And for perspectives from public health advocates on what they thought of the health reform arguments before the Supreme Court, check out this article from the public health blog The Pump Handle. (Disclosure: This article was also written by yours truly.)

APHA also commissioned a new analysis by the National Health Law Program of the major issues at stake and potential rulings.

Here's to hoping that Charlotte will be a time for celebration! Keep those fingers crossed!

A sneak peek at keynote speaker Donald Berwick

Berwick

As most of you already know, APHA meetings are packed with inspirational speakers and noted public health leaders. (Anyone remember the 2010 APHA Annual Meeting with opening session speaker Cornel West? Well, if you saw it, you wouldn't forget it. And if you didn't, then here you go. Get ready for some serious social justice with this video.)

This year's Midyear Meeting in Charlotte, N.C., will again offer an impressive roster of movers and shakers in public health. So, we thought we'd offer a little sneak peek at the Midyear Meeting's opening session speaker, Donald Berwick, who took the helm of the Centers for Medicare and Medicaid Services shortly after the signing of the Affordable Care Act in 2010. During his tenure at CMS, Berwick oversaw significant changes, including the expansion of evidence-based preventive services for Medicare enrollees. Today, Berwick is a senior fellow at the Center for American Progress.

Read more about Berwick's thoughts on the challenges facing public health in this Q&A with APHA's newspaper, The Nation's Health. And to learn more about the speakers you'll see in Charlotte (in just a few weeks!) take a look at this year's Midyear Meeting schedule.