Learning from the lessons of history

Just this past weekend, six workers were killed in a grain elevator explosion in Atchison, Kansas. Four of them were younger than 25 years old. It was a sad reminder of why we need strong workplace health and safety standards, said David Michaels, assistant secretary of labor for occupational safety and health, during today’s Closing General Session, which focused on “The case for workplace health and safety: 100 years after the Triangle Fire.”

Hundreds of the 13,000 attendees at this year’s Annual Meeting packed into a convention center room to hear about the progress we’ve made so far and the very real — and sometimes successful — attempts to roll back workplace safety standards happening today. But let’s start with the inspiration for this year’s closing session and the deadliest industrial disaster in New York City’s history: The Triangle Shirtwaist Factory fire of 1911.

One hundred years ago, 146 people died — 125 of them young women — when a fire broke out at the garment factory, which was located on the eighth, ninth and 10th floors of a building. The workers ran toward the exit, but it was locked. Many workers jumped from the windows of the factory; some so that their parents would have something to bury. When police found the women’s bodies, they noticed their nails had torn off, as they had tried to claw their way out. During their funerals, 100,000 workers marched through the streets demanding change. The outrage eventually led to sweeping reforms, such as the passage of the Fair Labor Standards Act, minimum wage requirements and the elimination of sweatshops.

Fast forward to today and there’s much to celebrate, Michaels told attendees. Since the creation of the Occupational Safety and Health Administration, the rate of fatal workplace injuries has declined dramatically. The agency conducts about 40,000 inspections a year and offers a variety of health promotion tools and campaigns, such as a smartphone app in English and Spanish that tells workers how to work safely in dangerous temperatures.

Unfortunately, it’s not all good news, Michaels noted. Twelve workers die in the United States every day from workplace injuries and as many as 50,000 workers die from illnesses in which workplace exposures were a contributing factor. And the current anti-regulatory political climate is hardly a friendly place for making more inroads, especially when the popular mantra is that regulations are job killers. Of course, the data shows otherwise, as safe workplaces promote productivity and decrease time away from the job.

“OSHA standards don’t kill jobs; they stop jobs from killing workers,” Michaels said to loud applause.

Outside our borders, shameful working standards are making it even harder to maintain current U.S. standards and continue moving forward. That’s why we all have to join forces — worldwide — for workers’ rights and safety, said closing session speaker Leo Gerard, international president of the United Steelworkers. Before beginning his address, Gerard showed film footage similar to that of the Triangle Shirtwaist Factory fire. Except this footage happened just last year in a garment factory in Bangladesh, where a fire broke out and the exits were locked. Dozens were killed or injured; again, some jumped to their deaths. The factory produced popular brand-name clothing sold here in the United States; its workers paid hardly enough to live on. That’s why there’s a responsibility on all of us to internationalize the workplace standards we enjoy here at home, Gerard said, noting that we can’t allow “globalization and rotten trade deals to cause health and safety regression anywhere in the world.”

“If we don’t do it, our kids and our grandkids will have a lesser quality of life,” Gerard said. “Worst of all, we’ll be allowing workers in other countries to get killed while we stand silent.”

Worker safety is an issue “we need collective action on,” said session speaker Darryl Alexander, director of health and safety for the American Federation of Teachers. Currently, Alexander said, we’re seeing working conditions deteriorating like never before — today, workers are being sent the message that “hazards and exposures…are just part of the job.” In fact, many of today’s workplace injuries simply go unidentified. But with your help, she urged session attendees, we can make a difference.

“From a public health perspective, (work is) probably the most important social determinant for health that there is,” Alexander said.

Well, dear readers, it’s been another energizing APHA Annual Meeting — this blogger feels refreshed and ready to speak up in support of public health. As new APHA President Mel Shipp said at the closing session: “This coming year will be important — no, critical — for public health.”

See you next year at APHA’s 140th Annual Meeting in San Francisco, where the theme will be “Prevention and Wellness Across the Lifespan.” And don’t forget about APHA’s 2012 Midyear Meeting in Charlotte, N.C., which has a theme of “The New Public Health: Rewiring for the future.”

— K.K

Above, from left to right, Closing General Session speakers David Michaels, Leo Gerard, outgoing APHA President Linda Rae Murray and Darryl Alexander. Photo courtesy Jim Ezell/EZ Event Photography

A world of possibilities

We can begin to end the AIDS epidemic now.

If there’s one message we should take to Congress and to other government leaders contemplating cuts to global health programs, it’s that.

Chris Collins, vice president and director of public policy for amfAR, told Annual Meeting attendees that the state of global health hangs in the balance with the current budget crisis. Reducing federal funding for global health programs will only backfire on American initiatives at home and abroad and cost more in the long run.

“By cutting funding, you don’t solve the problems, you do more damage,” Collins said.

Funding for global programs cost the U.S. government “only one-quarter of one cent, but the economic, humanitarian and diplomatic returns are huge,” Collins said during this morning's session on the “State of the U.S. Global Health Initiative.”

Ann Starrs, president of Family Care International, said global health initiatives seek to achieve more “value for the money” when it comes to health.

“We don’t just want to prevent death,” Starrs said. “We want to promote health.”

Starrs works specifically on improving health conditions for women and girls via strategic coordination and integration as well as using gender equity approaches.

“We want to make services more convenient for the user and more efficient for the institution implementing the services,” she said.

Katherine Monahan, deputy executive director of the U.S. State Department’s Global Health Initiative Office, said the United States is a world leader in global assistance and that it’s important to sustain that leadership.

“We have much to share with the world,” Monahan said. “We are making a difference in the lives of people all over the world because Americans care.”

The immediate budget crisis may pose a challenge to Global Health Initiative goals, but it is important to continue to bring America’s best policies and practices to the global table to help in three strategic areas: saving more mothers and children, creating an AIDS-free generation and challenging the world to step up to health challenges.

“The future is looking really good,” Monahan said. “We’re really excited.”

John Donnelly, vice president and senior editor at Burness Communications and a correspondent for the Global Post, said it is important to have storytellers both here in the states and in Global Health Initiative countries promote the initiative's activities.

Through his work as a global health journalist, he’s found mainstream coverage of global health issues decreasing.

“There’s almost no one covering global health policy anymore,” he told session attendees. “They find it dull.”

Without storytellers on the ground, he said, it is difficult to garner political support for global health programs that ultimately affect the way we live here in the states. He and others on the session panel urged the audience to speak to their congressional representatives about the importance of supporting global health programs.

“Bring a story with you of how (the Global Health Initiative) impacts you on the local level,” he suggested.

Donnelly, who has spent much time traveling through Africa and seeing first-hand how U.S. global health initiatives make a difference, noted that when in-country organizations and American initiatives work together to support the same goals, progress can be made.

“Things succeed when relationships are strong,” Donnelly said. “When it’s working well, there are advances.”

— L.R.

The winning team

Are you ready for battle?

Because today's public health leaders are carving away at some of today’s greatest health risks. In fact, when we approach it from a winnable battles framework, anything is possible.

That was the focus of this morning's session on "Winnable Battles," a Centers for Disease Control and Prevention initiative addressing 10 key public health topics, including food safety, HIV, motor vehicle injuries, nutrition and obesity, teen pregnancy and tobacco. The topics were chosen based on the magnitude of these health problems across the United States.

Session presenter Thomas R. Frieden, director of CDC, discussed progress on the Winnable Battles front and called on attendees to avail themselves of all available resources to help improve health outcomes and reduce health disparities. Frieden emphasized that although we’re facing significant public health challenges today, there has been considerable progress in recent years, such as increased life expectancy and, in some states, improved air quality. For instance, the Million Hearts program is just one example of CDC-led efforts to work across federal agencies as well as with private and nonprofit partners to reduce heart attacks and stroke. Frieden said he is confident the program will meet its ambitious goal of preventing 1 million heart attacks and strokes over the next five years.

John Auerbach, public health commissioner in Massachusetts, described how CDC’s Winnable Battles campaign has helped states focus their program efforts toward changes that have a wide impact, but cost little.

For example, in Oregon, the Multnomah County Health Department is developing and implementing strategies to address nutrition-related health risks and developed a countywide action plan to improve health. Aurbach explained that health departments are successfully engaging with policy and other decision-makers, as “Winnable Battles is a non-partisan issue, and everyone can be involved.”

Frieden called attendees to action with a quote from President Franklin Roosevelt: “There are many ways of going forward, but only one way of standing still.”

Click here for more info on CDC's Winnable Battles initiative.

— M.S.

Above, CDC Director Thomas Frieden smiles at a Wednesday morning Annual Meeting session. Photo courtesy Jim Ezell/EZ Event Photography

A little birdie told me so: Tweet of the day

On this last day of the 139th APHA Annual Meeting, the tweet of the day comes from Twitterer LeahHealth, who said: On the shuttle for last day of #APHA11 it is like riding the public health school bus.

Advocacy in action

This morning, APHA Executive Director Georges Benjamin took a short break from his busy Annual Meeting schedule to lend APHA's support to a key piece of public health legislation.

Standing on the grounds of the Capitol building along with members of Congress and fellow public health advocates, Benjamin reaffirmed APHA's commitment to the Climate Change Health Protection and Promotion Act. Introduced today by Rep. Lois Capps, D-Calif., the legislation calls for developing a national strategic plan that will equip public health agencies with the tools to prepare for, identify and respond to the health threats of climate change. In addition to supporting the bill, APHA was also involved in developing its language.

"Climate change poses a real and present health threat for our country today," Benjamin said in an APHA news release. "It can affect the air we breathe and the water we drink. It also can severely threaten our nation's food supply. If left unaddressed, climate change could exact an enormous toll on communities across the nation. The bill introduced today would send a real lifeline to public health officials who are on the frontlines of protecting our health, preventing disease and keeping families safe."

If you want to take action on behalf of the Climate Change Health Protection and Promotion Act, call the U.S. House of Representatives switchboard at 202-225-3121 to connect with your member of Congress and urge them to sponsor this bill. For more info on climate change and health or to download a free copy of APHA's new publication, "Climate Change: Mastering the Public Health Role," visit www.apha-environment.org.

Above, APHA's Georges Benjamin speaks at a Wednesday morning news conference in front of the Capitol in support of the Climate Change Health Protection and Promotion Act. Behind him is Rep. Lois Capps, D-Calif., and Jeff Levi, executive director of Trust for America's Health. Photo courtesy Don Hoppert

Won't you be my (smoke-free) neighbor?

Anti-tobacco advocates have conquered restaurants and bars, public outdoor spaces and many college campuses. Now, they’ve got their sights set on engaging residents of apartment buildings and condominium complexes in efforts to make healthier living spaces.

There’s a growing movement across the country to enact smoking bans in multi-unit housing, and California is leading the charge. The communities of South Pasadena, Richmond, Belmont and Sebastopol have all prohibited smoking in apartment buildings and condos. And there seems to be more on the way.

“It’s a public health issue," said Statice Wilmore, tobacco control coordinator for the Pasadena Public Health Department. "It’s a quality of life issue.”

Wilmore spoke yesterday on a panel with other anti-tobacco advocates during a session on “Don’t Catch My Drift: Smoke-free Multi-Unit Dwellings.”

Wilmore gave an overview of how Pasadena succeeded in prohibiting smoking on patios, balconies and outdoor common areas in multi-unit housing. The Pasadena Public Health Department also was pivotal in establishing smoking bans in new housing construction projects effective immediately. Most importantly, the department successfully advocated for a gradual phase-in of completely smoke-free multi-unit housing by 2013.

Pasadena’s smoke-free campaign began with a comprehensive survey of the community’s attitudes toward smoking. The survey revealed that 77 percent of the community supported prohibiting smoking in outdoor areas; 63 percent supported a smoking ban in residential areas; 80 percent favored laws to create non-smoking multi-unit housing; and 72 percent wanted to live in a completely smoke-free building.

“Framing the issue is very important,” Wilmore said.

Instead of focusing on individual health benefits of smoke-free policies, the public health department presented other benefits, such as a reduction in fire hazards in the home, decreasing insurance premiums and decreased expenses for landlords to clean out smokers’ units for rental purposes.

In a pilot test conducted in a small part of Alachua County, Fla., Lisa Nackers, a doctoral candidate at the University of Florida in Gainesville, found that residents preferred an incremental, stepwise policy change toward going smoke-free in multi-unit housing. That process would start with smoking bans in indoor common areas, then in outdoor common areas and on to individual units until a total ban on smoking is reached. This “foot-in-the-door” technique has the potential to affect policy change throughout the county, she said.

“We all know there is no safe level of exposure to secondhand smoke,” Nackers told session attendees. “And we know that most exposure is in the homes.”

Nackers’ research suggests that anti-tobacco advocates work closely with multi-unit housing property managers to implement policy changes. As tenants and building owners’ awareness increase, smoke-free dwellings will be the way of the future, she said. In fact, property owners should offer smoke-free units as a benefit of living in their buildings.

Warren Ortland, staff attorney with the Public Health Law Center in St. Paul, Minn., surveyed owner-occupants and interviewed property managers, finding that before drafting any policy, advocates should first provide education to all parties and assess attitudes toward the policy. Policies should be based on the activity — smoking — and not on any individual’s status, a position often taken by smokers who believe bans infringe on their personal rights.

Ortland suggests residential associations take up smoking bans and decide for themselves how to best implement them. Changing associations’ declarations are more likely to withstand legal challenges, he noted, and courts are generally deferential to association decisions.

— L.R.

Happy teeth

Even though it's preventable, oral disease is the No. 1 chronic disease in children. Unfortunately, oral health is not often the first thing that comes to mind when you think of primary care — a problem many advocates and practitioners have been trying to change.

Gum disease and cavities don't just affect a child’s appearance. Oral health problems can inhibit nutrition and physical development and without access to good preventive care, they can be exceptionally costly to fix.

In Tuesday afternoon’s session on “Mouths Matter: Maryland Leading the Way,” Harry Goodman, director of Maryland’s Office of Oral Health, discussed ways in which Maryland is blazing the trail for improved oral health services for children. Oral health advocates and leaders at the state and national levels jumped into high gear when the state suffered a devastating loss that got significant media attention: Deamonte Driver, a 12- year-old boy from Prince George’s County, Md., had an untreated dental infection that resulted in more than $250,000 in medical costs and ultimately led to Driver's death in 2007.

Goodman showed a picture of Driver and asked session attendees to “never to forget this face.” Driver’s life could have been saved by routine preventive care, Goodman said.

Since Driver’s death, Maryland has advanced a number of policy efforts that are bringing the opportunities for better oral health to the state's under-served children. Among the efforts: Maryland established an oral health advisory committee to advocate for better access to care; the state successfully passed legislation to create an oral health safety net; surveillance efforts have been conducted to gather data on schoolchildren; and a five-year oral health plan was developed. Through federal funding, Maryland is also launching an oral health literacy campaign targeting low-income families.

Debony Hughes, of the grassroots organization the Deamonte Driver Dental Project, credits a number of policy champions for the state's progress, including Maryland Gov. Martin O’Malley, Sen. Ben Cardin, D-Md., and Rep. Elijah Cummings, D-Md. With the help of state funding, the Deamonte Driver Dental Project established a mobile dental clinic, which has provided preventive services for more than 1,000 children in 19 of Prince George’s County's elementary schools.

In fact, the mobile unit is parked right now in the Public Health Expo, so go check it out and get a tour of the colorful, traveling dental clinic.

— M.S.

Best and brightest

Congratulations to all of this year's APHA award winners! Thanks for helping lead the way to a healthier world!

Above, from top to bottom: APHA's Distinguished Public Health Legislator of the Year Jan Schakowsky, D-Ill., receives her award from APHA Executive Director Georges Benjamin at last night's APHA Public Health Awards Reception and Ceremony; former U.S. Surgeon General David Satcher (at left in the photo) receives APHA's Sedgwick Memorial Medal; Satcher (at left) mingles with new APHA President-elect Adewale Troutman at the awards reception; and reception attendees smile for the camera. Photos courtesy Jim Ezell/EZ Event Photography