Saving the best for last

Well, the end is finally here, and who better to send us off than three former U.S. surgeons general.

At the standing-room only Annual Meeting Closing Session, public health workers poured in to hear words of wisdom from public health’s top movers and shakers: Past Surgeons General Richard Carmona, Joycelyn Elders and David Satcher. (And by the amount of camera flashes going off and rounds of enthusiastic clapping and woo-hoos, the three speakers resembled rock stars more than public health workers — of course, wouldn’t it be great if everyone viewed their local public health worker with the reverence usually reserved for the faces of MTV?)

During what was the best session that this blogger has ever attended over seven Annual Meetings, the three docs didn’t hold back — not once. When asked what their advice is for the next surgeon general, Elders said don’t let anything get in the way — always remember to have clarity of vision, be consistent in what you do, be committed and stay in control. After saying “amen” to Elders’ advice, Satcher gave some of his own: The new surgeon general must remember that she or he is part of a relay team — accept the baton and the responsibility to sustain and preserve past good works, while still reacting to new opportunities and challenges. After his “hallelujah” to Satcher’s advice, Carmona gave a bit of his own: Embrace a life-long commitment to the office.

“Once a surgeon general, always a surgeon general,” Carmona told the audience.

All three public health role models also spoke of the many obstacles they faced, and how the world of politics often tried — and was unfortunately sometimes successful — in hamstringing the sound science of public health. Satcher told of the surgeon general’s report on sexual health that the president decided not to support, Carmona told of a correctional health report that collapsed under political pressure, and Elders spoke of her STD prevention truth-telling and…well, I think we all remember what happened after that. But despite everything, the three docs persevered and continue today to rally for public health and prevention.

For this writer, Carmona seemed to put it best: “You are the surgeon general of the people of the United States,” not the surgeon general of the Republican Party or the Democratic Party, he said. The Office of the Surgeon General is often viewed as the most credible office in the federal government, Carmona said, so speak up for the science, keep the office untarnished and always represent the people.

And speaking of representing the people, we’ll end the 2008 Annual Meeting blog with some more wise words from outgoing APHA President Linda Degutis.

Voting, she said, is the “ultimate public health intervention.”

See you next year in Philadelphia for “Water and Public Health: The 21st Century Challenge.”

— K.K.

Photo by Jim Ezell/EZ Event Photography

It's how cold back east?

Take one last look Midwesterners and East Coasters before we fly home to our winter coats and wind chills. Sigh....

Another beautiful blue view from the San Diego Convention Center terrace

Nov. 4 is just the beginning

How are we going to get health reform front and center on the national agenda, no matter what happens on Nov. 4?

Appeal to people’s common sense.

“Our people’s health is an investment, not an expense,” said Larry Adelman, executive producer of the knockout documentary “Unnatural Causes: Is Inequality Making Us Sick?” He and three other health reform advocates reminded those of us gathered for Tuesday’s “Health Access and the Election: What Happened, What Didn’t, What’s Next” session that you can apply a health lens to every issue. And it’s never too late to speak out for universal coverage.

“I believe, and I think the polling evidence supports this, that most Americans want to be fair to people and that most Americans think that if you’re sick, you deserve care,” said Linda Rae Murray, APHA Executive Board member and a champion of health equity. “So the fundamentals that we’re talking about here, that health care is a basic human right, I think is something that Americans as a people accept, despite of what our government says.”

Both John McCain’s and Barack Obama’s health plans (check out the Center for Policy Analysis’ comparison of the plans) would be a drop in the bucket as far as meaningful reform, the session presenters said. Yet, the public health community needs to keep pushing for real change and find new bedfellows to make it happen.

“We have to find a way to talk about this that allows us to bring in allies on the health reform question,” Murray said. “It’s not the economy, two wars, education or health reform. Everything is health.

“I think if we back up and not worry about all the graphs and the pie charts, if we back up and just speak in plain English to people in this country, we should be able to pass — not in the first 100 days — real health reform in this country that includes single payer as the basement and builds on top of that.”

Let’s just say if Murray were running for president, she’d have my vote.

— D.C.

This smile brought to you by fluoridation

It’s a bit hard to imagine that there’s still opposition to fluoridation, but lo and behold, the Annual Meeting’s very own 2008 host city just recently declared victory for its residents’ pearly whites.

Just this past June, the San Diego City Council voted unanimously to fluoridate the city’s water supply — a victory due, in part, to the blood, sweat and tears of public health advocates, who never stopped rallying support for this proven prevention technique. In a Tuesday afternoon session on “Fluoridation in California: Is San Diego Fluoridated?” key figures responsible for San Diego’s new fluoridated future told of their journey, the obstacles they faced and the ways they overcame. And like the interwoven wires of my junior high braces, their victory relied on a large network of stakeholders and community leaders to set the fluoridation record straight.

But first, let’s take a trip back to the 1950s, when opponents argued that fluoridation was a communist conspiracy (seriously, they did). Regardless, in 1952 San Diego decided to fluoridate its water supply, but suffered a major setback in 1954 when a ballot initiative passed making fluoridating San Diego’s water illegal. Fast forward to 1995: the California governor signs legislation requiring certain water agencies to fluoridate, but only with nontaxpayer funds — and so San Diego was exempt. But in 2007, San Diego’s First 5 Commission, which promotes wellness among young children via tobacco taxes, voted to give San Diego water districts funds to fluoridate.

It’s a good thing too: San Diego Council President Scott Peter told session attendees that San Diego is the largest U.S. city that doesn’t fluoridate its water, and only 9 percent of the city’s imported water is fluoridated. Plus, studies have found that hundreds of thousands of California children suffer from tooth decay, with Hispanic children suffering at nearly twice the rate, said Eleanor Nadler, director of the San Diego Fluoridation Coalition. Finally, presenter Marjorie Stocks, of the California Dental Association Foundation, stressed the long-term coalition building and patience needed to bring fluoridation to any community.

“Fluoridation is not a sprinter’s game, it’s definitely a marathon,” she said.

So raise your glasses (of fluoridated water) to public health prevention!

— K.K.

The envelope please...

APHA rolled out the red carpet last night during its annual awards ceremony honoring some of public health's most innovative pioneers, passionately persistent advocates and creative community caretakers. Above, APHA award recipients smile for the camera. Take a bow!

Photo by Jim Ezell/EZ Event Photography

Who turned up the heat?

When you leave San Diego to head home, you may wish that your city’s weather were just as mild and sunny year-round.

But be careful what you wish for. According to presenters at Tuesday’s “Weather, Heat and Health” session, mortality increases as ambient temperatures rise above a city-specific threshold (i.e., a 100-degree day in Phoenix isn’t as damaging as a 100-degree day in Boston).

The risk not only varies between cities, but within cities, said presenter Audrey Smargiassi, whose research used satellite images to locate “hot spots” within cities. Part of the increased mortality linked to heat is tied to socioeconomic status, she said, and more research is needed to tease out the causes.

Norman King, of Montreal’s health department, said that city officials should continue the research to find better ways to protect susceptible populations in urban areas.

“It’s one thing to document the fact that people are more vulnerable to heat events in these micro-urban heat islands, but the question is what do we do about it,” he said.

King’s department distributes educational materials and uses the media to spread the word that heat waves can be deadly. He said their effects tend to be more dramatic if they come early in the warm season, before the public’s awareness is heightened.

If you want more information about weather and public health, the National Environmental Education Foundation offers free information for meteorologists to help them incorporate public health and environmental messages into their broadcasts. And here’s an additional online resource to check out: heat-waves.org, a site dedicated to analyzing climate change in urban areas.

Well, that’s it for this blogger and public health student at this year’s APHA Annual Meeting. It’s been a great time, and I’m leaving more inspired than ever to continue my education and career in public health. Thanks for reading and safe travels!

P.T.

Wednesday’s Have You Heard...

Well, aren’t you special: Students get free access to APHA’s Public Health Expo Wednesday only, 8:30 a.m. to 12:30 p.m. Visit the Exhibitor Registration counter in the convention center’s Sails Pavilion to register. Connect with hundreds of public health vendors, including schools of public health, federal and state health agencies, and nonprofit and advocacy groups. For even more info on why public health might be right for you, visit the Association of Schools of Public Health’s Pathways to Public Health.

Pac-Man does public health: Is video game technology one of public health’s many new frontiers? Find out Wednesday during session 5164.1, "Games and Simulations in Information Technology," in the Manchester Grand Hyatt Randle Ballroom E from 12:30 to 2 p.m. Speakers will touch on topics such as using video games to promote healthy living among children and how the “infection” of hundreds of online game players with a virtual disease led to the “first opportunity to examine the potential use of persistent virtual worlds in the advancement of public health.” Cool.

Doctor, Doctor, Doctor: That’s right, three of the nation’s former top docs — Surgeons General Joycelyn Elders, David Satcher and Richard Carmona — talk shop during the meeting’s Closing General Session, “Becoming the Healthiest Nation: A Dialogue with the Former U.S. Surgeons General,” from 2:30 to 4 p.m. in Room 6 C/F of the San Diego Convention Center.

No recess for nutrition

It’s hard enough to get adults to eat a healthy diet — and we’re supposed to know better. Ensuring children have access to healthy foods and encouraging them to actually eat those healthy foods is a whole other animal.

Panelists at Tuesday afternoon’s session “School Food Innovations: Making Sustainable Change” discussed the challenges and opportunities for improving our nation’s school food environment.
Despite the unfortunate (and all too common) lack of nutrition education in her school district in Charlottesville, Va., Alicia Cost raised awareness of healthy meal choices in a pilot program called C.H.O.I.C.E.S. (Creating Healthy Opportunities and Initiatives in the Cafeteria for Everyone).

Meals and side items were assigned a red, yellow or green stoplight symbol based on federal fat and saturated fat standards, and signs and posters were placed in the cafeteria to show students how to put meal components together to create a healthier meal. Although there were no observed decreases in purchases of “red” menu items at the school for fifth- and sixth-graders during the study period, students did show increased understanding of nutrition, and Cost is hopeful that with increased education and funding, a larger impact can be realized.

Another school food challenge is marketing within schools, as described by Lisa Kraypo of Samuels and Associates, a California-based public health research firm. From the obvious ads on beverage vending machines in high schools to the more subtle scholarship and fundraising programs, companies want their brand to be known from an early age. An example is a fundraising effort called McDonald’s McTeacher’s Night, where teachers work at a McDonald’s and encourage students and their families to eat dinner at the restaurant to raise money for the school.

But foods within the schools aren’t the only concern when it comes to childhood nutrition. Marnie Pureil, of the Built Environment and Health Project at Columbia University, studied the proximity of fast food restaurants and convenience stores to urban schools in New York City and found that zoning differences and other features of the built environment account for the higher prevalence of inexpensive, energy-dense food near schools serving low-income and ethnic groups at greater risk of obesity.

What do you think are the biggest challenges in improving childhood nutrition? The incessant ads for gooey candies and sugary snacks? The lack of nutrition education in schools? Or improving parents’ commitment to healthy diets for their kids (and understanding what that means)?

— P.T.