Community Health Planning and Policy Development
Chair Message: Envisioning How to Contribute to Community Health at the Annual Meeting
|Amy Carroll-Scott, Section Chair|
An idea that came up at our CHPPD business meeting in Denver last November, and which members and leaders have been talking about since, is to organize a community action for our members and colleagues at this year’s Annual Meeting in Washington, D.C. Some APHA sections and working groups have done an excellent job of organizing walking or driving tours during the Annual Meeting that draw attention to local needs and/or effective local strategies that address those needs. However, CHPPD members feel they wanted to move beyond a tour by contributing our manpower and resources to actually physically tackle a need in a local community.
I see several benefits to our Section by making this happen this year and, if successful, every year. CHPPD’s vision statement is “A dialog and action nexus for community health planning and policy leaders”. This vision has been easier to achieve on a national level, as this is the scale at which we convene at the Annual Meeting, and engage with each other on APHA and other national policy issues. What has consistently proven more difficult is engaging in local dialog and action in a meaningful way. Although we all come from a local context, and our experiences there shape our perspectives and the majority of our scientific session presentations, we don’t have a natural way to contribute together to a local need or policy in between Annual Meetings. This could be that opportunity. And it should be led by our members who live and work in that local context so we can learn more about the rich fabric of local history, while contributing to an action that meets an identified need.
This could also provide CHPPD with an opportunity to partner substantively with a local community-based organization in each city where the Annual Meeting is held – building stronger ties to the very organizations many of us partner with in our work. Our members have time and again recognized that APHA membership and engagement is difficult for staff of small community-based organizations because the membership fees, registration, travel, and time off are often beyond the means of a small organization. Moreover, it may be less clear to a small organization what the value of APHA and CHPPD membership is to them, when there are no professional rewards for activities such as scientific presentations. Therefore I argue it is incumbent on us to make the case for that value. We can start to do this by offering a community action each year that both highlights effective work of a local community-based organization and provides networking opportunities between organization members at each Annual Meeting. Members have also proposed starting a community-based organization award. This could not only highlight the wonderful work of local organizations to address health, but could also include a cash award to help offset membership or registration fees. Certainly, our work in CHPPD benefits when community voices are better represented in our scientific sessions, business meetings, and leaderships.
Ideas for this action have included a neighborhood clean-up, community garden planting, or building of a playground, and the planning group has decided that this first annual action will be a mural project. We wanted to focus on the built environment because members have consistently told us this is an area of interest for them. Indeed, CHPPD is partnering with the Environment Section on their Built Environment Workgroup, a perfect collaboration of our two Sections’ interests and expertise (if interested in joining, please contact Tony Delucia). As we all know in our work in communities, the characteristics and conditions of the environments in which community members live, work, and play have a significant effect on their mental and physical well-being. Green, safe, and attractive neighborhoods impart feelings of self-worth to residents, and provide more opportunities for walking, exercising, interacting with neighbors, and other healthy behaviors. Thus a mural project, particularly one focused on health and the local community history, is a perfect fit for this first action.
The planning committee is now looking for partners in this effort – local artists, youth organizations, architecture departments, and neighborhood beautification efforts. If you have thoughts about these ideas, or would like to join the planning committee, please contact our community action planning group leader, D.C.-based Michelle Johnson. All are welcome, but consider this a call to action to our D.C.-based members to join this effort. We can’t do it right without you! The event will occur on the Saturday before the Annual Meeting. So if you are interested in joining us, please plan to be here for Saturday when making your travel plans.
As always, for more information about upcoming Section teleconference calls, previous call minutes, and committee and workgroup activities and works-in-progress, please join the CHPPD Insider wiki.
Yours in health,
Amy Carroll-Scott, PhD, MPH
Return to Top
CHPPD Section Annual Meeting Program Committee Call for Moderators
YOU CAN EXPECT ANOTHER WONDERFUL ANNUAL MEETING PROGRAM IN 2011.
A very special THANKS to the many volunteers who reviewed the 480 abstracts that were submitted to the CHPPD Section for presentation at this year’s Annual Meeting. It was an enormous task that required great dedication to ensure that each proposal received a fair and thorough review. To ensure the best possible CHPPD program in Washington, D.C., three reviewers were assigned to rate each proposal. By far, the most popular topic was “Effective Planning and Policy Development Toward Improving Mind, Body and Community Health.” Other popular topic areas were “Community-Based Participatory Projects that Increase Underrepresented Voices," "Improvement Approaches Toward Building Healthy Communities," and "Using GIS in Community Health Planning & Policy Development.”
Request for Moderators
Please let us know if you would be interested in volunteering to serve as a Moderator for a scientific session at the conference. If so, please provide the information below:
Moderator information needed:
Phone number (Work):
Phone number (Cell, to contact you while at the conference):
Preference for session to moderate:
1. List which session number(s) you would like to moderate.
2. List 3-5 specific topics of interest for sessions you would like to moderate.
Should a session need to be moderated, we would love to call upon you.
Thank you again for your assistance.
We look forward to the many excellent presentations that were selected for the 2011 Annual Meeting, and we hope to see you in October!
Padma Arvind, email@example.com
Cheryl Archbald, firstname.lastname@example.org
Return to Top
Pfizer Stipends Available for 12 Students, Registration Scholarships for 4 More for Annual Meeting
APHA is proud to announce the availability of need-based scholarships, sponsored by External Medical Affairs, Pfizer Inc., for student members to attend the 139th Annual Meeting and Exposition in Washington, D.C., from Oct. 29-Nov. 2, 2011. Twelve students will be granted registration and up to a $500 stipend to use toward food, lodging and transportation. An additional four students will be given Annual Meeting registration only. Recipients of the scholarships will be chosen based on financial need and essay. As part of the award, students will be strongly encouraged to attend at least one Section business meeting. Please inform the student members of the Section about this unique opportunity! Visit:
for complete details and application. Please contact Pooja Bhandari at
with any questions.
APHA Student Assembly members Photo courtesy APHA
Submitted by Pooja Bhandari, APHA
Return to Top
Upstream Public Health Addresses Transportation Health Equity
This spring, Upstream Public Health conducted a review of research and policies related to transportation health equity to identify effective policies and best practices to support health equity through the transportation system. With feedback from organizational partners working at the intersection of health, transportation, and equity, Upstream developed a set of Transportation Health Equity Principles.
Photo courtesy APHA
The principles are focused on reducing disparities for those impacted by transportation inequity. “People of color, people experiencing poverty, people with disabilities, and people who experience language barriers are disproportionately impacted by burdens of the transportation system but do not receive an equal share of the benefits.”
Upstream will use the principles below as a guide for policy development and advocacy.
1. Ensure equal access to essential goods & services, jobs & economic opportunities, and healthy foods & places.
We all rely on the transportation system every day to get from home to school, work and other destinations, but affected communities experience limited accessibility and mobility because of historical underinvestment and disinvestment. These unfair burdens negatively impact health through increased transportation costs, limited economic and educational opportunities, limited access to healthy goods and services, and limited housing options.
2. Engage & empower impacted communities early & often, with opportunities to have real influence during all stages of decision-making.
Meaningful public participation processes are open, inclusive, and provide participants with opportunities to shape transportation outcomes. Affected communities are often underrepresented or are not offered meaningful opportunities to participate. As a result, community disempowerment and projects with flawed outcomes negatively impact health.
3. Implement transportation funding & investment policies that address historical disinvestment for impacted persons & for underserved neighborhoods.
Funding for transportation investments must be equitably distributed and collected in order to promote health equity and to ensure that affected communities – especially low-income earners – have affordable transportation options. In addition, because transportation and housing costs make up the majority of a household’s budget, policies must integrate housing and transportation policy.
4. Promote access to jobs, including in the transportation sector.
Income affects health in many ways, and low-income and communities of color experience unemployment at higher rates than other communities. Transportation investments can be used to increase access to jobs in all industries for affected communities. Within the transportation system itself, leadership and employment opportunities for affected communities should be developed. These opportunities will support health through stable, family-wage incomes and increasing community capacity to address transportation issues.
5. Prioritize transportation investments that ensure healthy & safe communities.
Healthy communities need safe options for active modes of transportation that help reduce air pollution.However, the communities that we have identified as most affected are often disproportionately burdened with unsafe transportation environments and too few transportation options.
6. Adopt transportation policies that promote environmental justice & sustainability.
Affected communities disproportionately suffer from transportation-related air, water, and noise pollution, all of which can have significant negative impacts on health. These same communities will also experience unfair burdens from climate change. Reducing the burdens faced by these affected communities must be supported by efforts to promote stability and sustainability. This will ensure that these populations benefit from investments and do not experience the harmful effects of displacement.
The full document, which can be found here, includes two example policies or actions that support each principle. These examples provide an opportunity for adaptation of the principles to be an effective tool for different interest groups or campaigns.
Submitted by Heidi Guenin, Transportation Policy Coordinator, Upstream Public Health
Return to Top
Transportation Equity and Health: New Tools & Resources
These are exciting times when considering the many ways our transportation systems impact health and equity in our communities. Congress extended the current federal surface transportation bill until Sept. 30, 2011, and Congressional committees are aiming to draft a new transportation bill before this latest extension ends.
Want to learn more about the connections between transportation, equity and health? View our archived webinar series, subscribe to the monthly transportation and health eNewsletter that offers an array of new events and updates, and download the newly released online public health and transportation toolkit and accompanying resources today.
We also invite you to send a message to your members of Congress urging that they ensure that strong public health provisions are included in the federal surface transportation reauthorization. For more information, visit http://apha.org/transportation.
Submitted By Natasha Williams, Component Affairs Coordinator, APHA
Return to Top
Perspectives on Draft Healthy People 2020 Leading Health Indicators
In March, the Institute of Medicine released the draft leading health indicators ( http://www.nap.edu/catalog/13088.html ) with two recommendations. The 12 health indicators were listed under Recommendation 1, and 24 objectives listed under Recommendation 2 for consideration by the U.S. Department of Health and Human Services for guiding a national health agenda:
The Committee recommends that the following indicators be used by HHS as the Healthy People 2020 Leading Health Indicators:
- Proportion of the population with access to health care services
- Proportion of the population engaged in healthy behaviors
- Prevalence and mortality of chronic disease
- Proportion of the population experiencing a healthy physical environment
- Proportion of the population experiencing a healthy social environment
- Proportion of the population that experiences injury
- Proportion of the population experiencing positive mental health
- Proportion of healthy births
- Proportion of the population engaged in responsible sexual behavior
- Proportion of the population engaged in substance abuse
- Proportion of the population using tobacco
- Proportion of the population receiving quality health care services
Process and Background
The Institute of Medicine considered Healthy People 2020’s four overarching goals: (1) Attain high-quality, longer lives free of preventable disease: (2) Achieve health equity; eliminate disparities; (3) Create social and physical environments that promote good health; (4) Promote quality of life, healthy development, and healthy behaviors across life stages. The IOM also took into consideration the four cross-cutting "Foundation Measures." These measures will be used to monitor progress toward promoting health, preventing disease and disability, eliminating disparities, and improving quality of life.
The IOM committee established eight criteria for selecting objectives, and used a conceptual framework that interfaced life course perspective with the health determinants and health outcomes model. The life course approach is based on two concepts: 1) the impact of specific risk factors and determinants of health varies during the life course and 2) health and disease result from the accumulation of the effects of risk factors and determinants over the life course.
The committee also divided into three groups that approached identifying the 24 objectives in three different ways to arrive at the draft 12 indicators and 24 objectives. The Leading Health Indicators are designed to raise public awareness and interest, motivate action by diverse groups, and provide feedback on progress over the decade.
In summary, the process used by the IOM committee is very complex and thoughtful. There is broad consensus for the need to identify a finite manageable number of leading health indicators.
Analysis to ensure a balanced approach
What is especially interesting to read in the report is the different ways the 24 objectives were analyzed to ensure a balanced approach. They were analyzed to answer whether they are representative of the:
health determinants and health outcomes categories of policy, physical environment, social/economic, health behavior, health and health care services and outcomes to ensure a balanced approached.
life stages and Healthy People 2020 topics
components in the federal health reform (this is part of Appendix A)
Consideration before finalizing draft leading health indicators
1. Assessing local availability of data on leading health indicators before finalizing: Before releasing the draft Leading Health Indicators report, the IOM released another thoughtful report, "For the Public’s Health: The Role of Measurement in Action and Accountability." It clearly articulated the need to have data available at the local level to track improvement as that was a major barrier with using Healthy People 2010 leading health indicators. It would be helpful to have seen an analysis of the 24 objectives, data sources, and availability of data at the local level across all states.
2. Hardship Index for Social Determinants of Health but not Leading Health Indicator? The IOM suggested exploring using the use of the Hardship Index for monitoring socioeconomic aspects of the social determinants of health. It is curious why then it was not explored for as a leading health indicator? While education does serve as a proxy for socioeconomic indicator, if there is another option, why not use it?
3. Analysis of policy type in leading health indicator: In December 2009, the Community Health Planning and Policy Development Section submitted comments on draft objectives. One suggestion was to analyze the type of policies: was it downstream, mid-stream or up-stream from the prevention perspective in Healthy People and the Leading Health indicators as the focus for the approach is primary prevention. It would be helpful to conduct such an analysis before finalizing the indicators.
The approval of a final report is expected sometime before the end of the year.
By Priti Irani, MSPH, Immediate Past-Chair and Louise Lex, PhD
Priti Irani works at the New York State Department of Health and Louise Lex works at the Iowa Department of Public Health. The perspectives expressed in this article are those of the authors only, and not of the organizations or the CHPPD Section or that of APHA.
1. Committee on Leading Health Indicators for Healthy People 2020; Institute of Medicine. Leading Health Indicators for Healthy People 2020: Letter Report. (2011). This free PDF is available at http://www.nap.edu/catalog/13088.html
2. Committee on Public Health Strategies to Improve Health; Institute of Medicine. For the Public’s Health: The Role of Measurement in Action and Accountability. (2010) This free PDF is available at http://www.nap.edu/catalog/13005.html
Healthy People 2020 at http://www.HealthyPeople.gov
Return to Top
Green Goals for 2011 Annual Meeting
The 2011 APHA Annual Meeting theme "Healthy Communities Promote Healthy Minds and Bodies" gives APHA members an opportunity to build on the 2009 and 2010 themes of Water and Social Justice as public health priorities.
Green Goals. The APHA Food and Environment Working Group, the Environment Section's 100th Anniversary Committee, and APHA are setting goals to reduce waste and promote a sustainable, just, and healthy food and water system.
Got Trash? We encourage everyone at APHA 2011 to increase efforts to reduce trash, especially paper and plastic.
The Diversion Rate (the recycling/trash ratio) in D.C. at APHA 2007 was 34 percent.
The Diversion Rate in Denver at APHA 2010 was 52.75 percent.
Can we achieve a Diversion rate of 75 percent at APHA 2011?
-- The D.C. Convention Center’s water fountains and food service sinks provide filtered water! Bring your own refillable bottle to the conference to cut down on plastic waste.
-- Plan events using local resources and services that encourage wise use of water and other resources. If you need advice or suggestions, contact us: email@example.com
-- Buy food sourced from sustainable producers and distributors.
-- If using disposables, use compostable products and use the facility compost program. Label containers so compostables do not go into the waste stream.
-- Take advantage of the D.C. Convention Center's Green Initiatives: http://www.dcconvention.com/Planners/Large/GreenInitiatives.aspx
-- Learn more about APHA 2011 Environmental Initiatives: http://www.apha.org/meetings/highlights/environment.htm
Be an Ambassador of public health and social justice in your own community. Share information about the social justice, public health and environmental problems caused by bottled water and water privatization, especially disposable plastic water bottles. Use the "Resources and References" below and on the Food and Environment Working Group’s Facebook page: https://www.facebook.com/topic.php?uid=134564799935654&topic=6959
Share ideas for waste reduction at APHA 2011 programs, scientific sessions, events and exhibits. Send your questions and suggestions to Ellie Goldberg firstname.lastname@example.org and join the conversation on the Food and Environment Working Group’s Facebook page https://www.facebook.com/APHA.food.and.environment.
The APHA Food and Environment Working Group is a multi-disciplinary collaboration across APHA Sections, housed in the Food & Nutrition and Environment Sections. Colleagues work together to protect public health by promoting and cultivating a safe, healthy, just and sustainable food system.
If you would like to work with us toward these goals, contact Rebecca Klein, email@example.com, Working Group membership is open to all APHA members.
~ ~ ~ ~ ~ ~ Resources and References ~ ~ ~ ~ ~ ~ ~
Bottled Water Myths
Bottled Water: Get the Facts
Blue Gold, Maude Barlow
Return to Top
It Does Take a Village
We have a toxic culture, one full of myths that blind us to how the society really works and for whom. American Exceptionalism indeed! It tells us that we are blessed with unlimited opportunities to better ourselves, and that if we fail to do so, it is solely our own failing. By promoting individualism and materialism at the expense of community solidarity, it damages our mental health. That culture is what shapes the behavior of everyone in the society by teaching us how to see ourselves and the world, so it will not do for public health to promote better lifestyles for everyone while failing to identify and confront all the socio-cultural influences adverse to its goals. To do so is implicitly blaming the victim.
The failure to provide the full story is an oversight unacceptable from an agency like the CDC tasked with the missions of prevention and promotion, as well as from agencies like the National Research Council of the National Academy of Sciences whose mission is to inform citizens.
The dysfunctional nature of our culture is evident in the depreciation of our communities. Too many of our cherished myths promote “free enterprise” without reference to the value of investing in the community that sustains us. Success in our society today results from a competition that separates us from our fellows. Our lives are fragmented – no longer do they track the kinds of lasting social relationships we used to have. It is increasingly difficult for us to find the meaning and purpose in our lives on which our wellbeing depends.
And it is children who suffer most from adverse childhoods in that culture when they lack consistent emotional connections to caregivers. They develop without the social sense and the empathy that would connect them to others. They often don’t learn the values that empower us to care for ourselves and for others.3 For these reasons, public health must place greatest priority on improving the quality of life for families. That can only be accomplished through everyone’s efforts once everyone sees all that is to be gained and all that must be done. I think that is the goal for public health: To reveal the ways in which wellbeing may be achieved. We cannot avoid seeing that society is our patient.
The public health ethic is one that seeks fundamental social change. It seeks a society that maximizes the human capacities to flourish of each and every one of its members, but that can only be achieved through empowerment of the community that supports them. Healthcare workers can incentivize individuals to meet certain goals, but communities can incentivize them to live better lives. Community derives its strength from a commonality of interests that requires a measure of social and economic equality.
Public Health Practice: Informing the Debate
Public health must identify all of the impediments to good health no matter how far upstream they are found. Its moral voice is needed more today than ever before in its history. When will we stop pulling babies out of the stream and make our way all the way upstream to the spring into which they are being dumped? That’s the spring we all have to drink from.
I want public health to regain its integrity by returning to its mid-nineteenth century roots and confronting the barriers to social justice in their political context. I think it may be more willing to risk doing that if it sees itself standing on the shoulders of giants. Public health’s key tool is epidemiology, and that epidemiology is political. Most of all, its obligation is to explain to its patient – the society – how power and privilege are distributed and used to drive agendas that oppose health and well-being for all.4 If it fails to do this, it remains part of the conspiracy opposed to greater equity and to the health improvement for all that can only be realized through greater equity.5
The greatest triumphs of propaganda have been accomplished, not by doing something, but by refraining from doing. Great is truth, but still greater, from a practical point of view, is silence about truth." – Aldous Huxley, Forward to Brave New World (1946)
It does take our whole village to correct this, but our village cannot do so without first understanding what is happening and who is responsible for it. It is happening well upstream of the health system, which is where public health must go to reveal the pathology of our dominant political and economic ethic, and to reaffirm its responsibility for showing the way toward wellness for all. Public health has always had an important story to tell, that of the human condition, and to fulfill its own ethic, it must complete the story.
Submitted by John Steen
2 According to a commentary by Michael Marmot and Ruth Bell, the Robert Wood Johnson Foundation's Commission to Build a Healthier America fails to address structural drivers of health inequity over personal responsibility. See their, “Improving Health: Social Determinants and Personal Choice,” American Journal of Preventive Medicine (Supplement), 40(1), January 2011, S73-S77. http://www.rwjf.org/pr/product.jsp?id=71591
3 For a convincing study of how the social capital in communities can reduce the risk for adverse health outcomes among its members, see Gary W. Evans and Rachel Kutcher, “Loosening the Link Between Childhood Poverty and Adolescent Smoking and Obesity: The Protective Effects of Social Capital,” Psychological Science, vol. 22, no. 1, January 2011, pp. 3-7. http://pss.sagepub.com/content/22/1/3.abstract.
4 For a good example of explaining this, see, Mayer Brezis and William H. Wilst, “Vulnerability of Health to Market Forces,” Medical Care 49(3): 232-239, March 2011. http://journals.lww.com/lww-medicalcare/pages/currenttoc.aspx.
5 There is a poem, “Apolitical Intellectuals,” by Otto Rene Castillo that says all that need be said about this: http://www.marxists.org/subject/art/literature/castillo/works/apolitical.htm.
For a recent analysis of the interplay of the social determinants with other relevant contextual factors, see Solar O, Irwin A. A conceptual framework for action on the social determinants of health. Social Determinants of Health Discussion Paper 2 (Policy and Practice), WHO, 2010. http://bit.ly/hhFPdW.
Return to Top
Genomics Forum Engages in Policy and Education
The Genomics Forum
is an official component of the APHA. We currently have 903 members representative of a diverse genetics and public health community. Our members are academic researchers, community leaders, nurses, social workers, physicians, genetic counselors, students, advocates and much more from across the globe. We share a common interest in assuring that genomics is researched and applied responsibly for individual and community health. We would like to invite you to join the forum, include an article in our upcoming newsletter, share resources, and/or collaborate with us on projects.
Since its inception in 2008, the Genomics Forum has engaged in updating APHA policies on genomics and public health; for example our policy on Genetic Literacy was recently accepted. The Policy Committee is currently focused on cancer genomics.
At APHA, the Genomics Forum has a robust program of oral and poster sessions. We have a special focus on working with other APHA Sections, SPIGs, and Caucases to co-sponsor sessions. Last year, we were able to co-host a special plenary session on how technology can help to reduce health disparities. We also co-sponsored sessions with several other groups. The Program Committee is currently working on putting together the program for the 2011 APHA Annual Meeting on healthy communities.
The Genomics Forum has many ways to communicate with current members and reach out to potential new members. We have a website, Facebook page and Twitter account where you can learn more about the Genomics Forum and issues of interest to the Public Health Genomics community. The Membership and Communication Committee is currently working on reaching out to members of APHA and creating a networking newsletter along with other projects to improve the Genomics Forum experience.
The Translational Genomics and Workforce Development Working Groups are working together to survey APHA members and schools of public health about needs for education on public health genomics.
The Healthcare Policy Working Group is currently working to formulate a policy statement to guide health care workers’ use, interpretation, and dissemination of genetic test results. This is a great opportunity for new members of the Forum.
The Gene-Environment Working Group is working on setting new priorities and is another great way for new members to get involved.
The Genomics Forum serves as a venue to explore our diverse perspectives on how this is best achieved through the work of our committees, workgroups, and at our Annual Meeting.
Ways to become involved:
* Join the Forum (it's free)
* Like our Facebook page or follow us on Twitter. Links can be found at our website.
* Participate in a committee
Work on updating the APHA policies on genomics and public health
Help design the annual program at APHA
Support networking amongst Genomics Forum members and beyond
* Participate in a working group
If you are interested in participating in the Work Groups please Join the Committee here
* Participate in a webinar
Sponsored by the APHA Genomics Forum, Genetic Alliance, and the Center for Public Health and Community Genomics. For additional session information please see the descriptions on the Genetic Alliance Website.
* Submit articles or events
Publish an article or event you are holding in our newsletter or blog by e-mailing Membership and Communications Chair Nicole Exe. Notify our membership about an article or event on our Facebook or Twitter by contacting Nora Isack.
Submitted by Nora Isack, MPH, Secretary, Genomics Forum
Return to Top
Central Virginia Health Care Project
The Chesterfield Community Services Board, Daily Planet Health Clinic, Goochland Free Clinic and Family Services, Goochland-Powhatan Community Services Board, and the Richmond Behavioral Health Authority have joined forces to establish the Central Virginia Health Care Project, or CVHCP. CVHCP will provide comprehensive and integrated medical and behavioral health care to the uninsured in the region who experience mental health problems and do not currently have access to services. The CVHCP received an award totaling $267,071 from the Virginia Health Care Foundation, to support the project during the first three years.
The CVHCP sought competitive funding through A New Lease on Life, a $2 million special initiative of the Office of the Attorney General of Virginia, the Virginia Association of Community Services Boards, the Virginia Association of Free Clinics, the Virginia Community Healthcare Association, and VHCF. A New Lease on Life, administered by VHCF, was established to address unmet needs including primary medical care and access to prescription medications for uninsured public mental health clients and basic mental health services for uninsured patients seen by health safety net organizations.
Funding for the project is primarily being used to deploy a part-time psychiatric nurse practitioner to the two health clinic sites and a part-time family nurse practitioner to the three public mental health agencies. Beth Rafferty, LCSW, the Richmond Behavioral Health Authority’s hental health director, comments, “Thanks to the funding from the Virginia Health Care Foundation, the five organizations involved in our project have been able to provide integrated behavioral and medical health care to uninsured adults. These individuals have not in the past been able to access the essential care that they needed to continue to be productive and functional members of our community.”
Benefits of such an integrated system of care include enhanced identification and treatment of chronic conditions like diabetes, hypertension, and depression for the individuals being treated and, at a systems level, a reduced dependence on local hospital emergency rooms. Partnering with community resources, like the Kroger Pharmacy where patients are assisted with obtaining low-cost medications, is essential to the success of this project, as is working to help people get access to health insurance for their long-term benefit.
Robert Osborn, LCSW, Daily Planet Behavioral Health Program coordinator, said, "The Daily Planet has increased the availability of psychiatric services by one-third through CVHC Project funding. There is now greater access for people who otherwise may not have received psychiatric help, as well as a reduction in waiting times for those in need of services. It is inspirational to see what can be accomplished when community agencies come together for a common purpose.”
During the first project year, a total of 410 people in the region received services as a direct result of the A New Lease on Life initiative through more than 1,300 face-to-face patient contacts. At the two community health centers, 277 individuals received services during the grant year. Medical services were provided to 133 individuals at the three public mental health agencies. The demand for psychiatric services has been such that one site, a small rural clinic, was able to justify and secure funding for a part-time clinical social worker to provide additional supportive services and counseling to its patients.
The project is collecting outcomes data for both psychiatric and medical services. Utilizing the Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor, Suicidal Depression Screening tool, the psychiatric nurse practitioner can evaluate the level of success of the intervention and make appropriate adjustments. During the first project year, eligible participants demonstrated an average score reduction (i.e. improvement in symptoms related to depression) of 4.86 points (on a scale of 1-9, 9 indicating full-blown depression).
Medical services were suspended for the last quarter of the first project year due to a staffing shortage, resulting in difficulty capturing valid medical outcomes data. However, for the current project year, data on blood pressure readings and Body Mass Index will be captured for all hypertensive patients. For patients with diabetes, the nurse practitioner will report on changes in HBA1c levels.
The project also is tracking patients’ utilization of emergency departments for non-urgent care, kept appointment rates, the value of prescriptions filled for patients via pharmacy assistance programs and subsidies, and the overall value of medical and mental health services provided to uninsured patients. Quantitative and qualitative patient satisfaction data is being tracked and reported every six months for the life of the project.
Project staff have been challenged to overcome obstacles like transportation barriers, lingering stigma about mental illness, poor motivation on the part of persons with serious mental illness to seek medical treatment, and lack of education among primary case managers about the value of an integrated approach. Yet many project patients do see the value of these services in their own lives, like the individual who commented, “The staff knows our situation and is helping us greatly. Me and my family are so grateful for this clinic…these [staff] have literally saved my life.”
Submitted By Amy Andrews
Return to Top
2011 Healthy Eyes Healthy People® Community Grants Program is Under Way
The American Optometric Association and Optometry Cares
The AOA Foundation recently announced the 8th annual funding of the Healthy Eyes Healthy People ® Community Grants Program. The 2011 grants are made possible through a generous grant from Luxottica. Over the course of the past seven years, the program sponsors have contributed a total of $1,080,000 for nearly 300 grants, which have gone directly to state optometric association community outreach projects to educate the public and allied groups on the importance of vision care and have improved the lives of thousands of patients.
In an effort to challenge the ineffectual status quo: no change in vision objectives for children from Healthy People 2010, and encourage the growth of community-based solutions to tackle undiagnosed children's vision disords, this year's Healthy Eyes Healthy People ® grants will focus directly on Healthy People 2020 children's vision objectives.
Despite the current efforts to provide vision care for children, there is considerable evidence of disparities in both the access and utilization of professional vision care among children. Sadly, appropriate assurance of access to early and timely comprehensive vision care services by a professional eye care provider is often being sidetracked by low sensitivity vision screenings that produce an inordinate number of "false negatives" and/or symptomatic children simply not being referred to professional eye care services directly.
The AOA believes that this public health emergency in children's vision and eye health must be resolved and that targeted efforts and new data from carefully selected 2011 Healthy Eyes Healthy People ® grant applicants will be helpful in steering a course of action to more fully address the vision and eye health needs of America's children.
Applicants should address one of the following two objectives of the Healthy Eyes Healthy People ® program:
V-1 Increase the proportion of children age 5 years and under who have visited (had an eye examination by) an eye care provider in the preceding 12 months.
V-2 Reduce visual impairment in children and adolescents.
The AOA continues to work with U.S. agencies to strengthen their resolve to establish a more comprehensive approach to children's vision and eye health protections.
"We are grateful for Luxottica's on-going support of the Health Eyes Health People ® Community Community Grants Program,” noted Fred H. Dubick, OD, MBA, chair of the Community Grants Committee. “The hallmark of HEHP projects is the collaborative efforts developed among optometrists and other community stakeholders, which help to ensure adequate access to services for local patients.”
“Healthy Eyes Healthy People has proved to be an extraordinary outreach program, providing greater access to vision care services in communities throughout the country,” said Andrea Dorigo, President, Luxottica USA. “We are honored to support HEHP and encourage all AOA member optometrists to develop projects designed to improve the visual health and well being of people in their communities.”
Grant applications must be officially submitted by an AOA-affiliated state optometric association. However, all AOA member optometrists may apply for the grants through their state optometric association. A state optometric association can submit more than one application. In addition to the completed application form, letters of commitment, timeline, and budget are required. Incomplete applications will not be accepted.
States may apply for more than one grant, and each grant is worth up to $5,000.
To learn more about the program, please visit: http://www.aoa.org/hehp.xml or contact AOA HEHP staff member Uzma Zumbrink, DHSc, MPH at (800) 365-2219, ext. 4146, or UAZumbrink@aoa.org.
Funding made possible by Luxottica.
Submitted by Uzma Zumbrink
Return to Top
Electronic Health Records Cyber Terrorism: The Elephant in the Room
Disaster is not only defined by an act of God, but by those crisis situations that arise due to rogue and state sponsored terrorist groups organized for economic, political, criminal, religious and occult causes.1 Advances in technological sophistication, specifically the invention of the Internet, have not only narrowed the global communication gap, but have opened the back door to a new kind of adversarial attack; cyber terrorism.2,3 To date, there have been no known cyber terrorist attacks in the United States that have resulted in the catastrophic loss of life or physical destruction indicative of a usual terrorist assault.2,3 This leads one to ask, is the threat of a digital Pearl Harbor real or simply confabulated by government, security firms and the media to evoke fear over the possibility of what “might” happen ?2 The technological advancement of complex computer hardware and software including networks and information systems has resulted in technologically dependent countries at greater risk and more susceptible to an unanticipated disruption due to a cyber terrorist assault.2,3 An act of cyber terrorism can be executed remotely and anonymously. It is an opportunity for terrorists to inflict massive physical and structural damage, elicit a psychological impact, and gain media attention, all of which makes a virtual attack so appealing.2,3 Al-Qa’ida and other terrorist groups have already used the Internet to distribute propaganda, collect data on potential targets and weapons, communicate with followers, recruit, raise money, and facilitate operations. They have also advocated the conduct of cyber attacks and engaged in hacking activities.3
The interconnectivity and complexity of the proposed national electronic health record network, no matter how well regulated and/or standardized, creates an environment of susceptible to a cyber terrorist attack. The real question is “Why would a terrorist be interested in hacking into or damaging a national interoperable electronic health record Internet-based system?” The most logical answer is financial gain (i.e. medical identity theft, reimbursement fraud), the not so obvious answer, to create a distraction. A distraction of this magnitude, coupled with a planned violent event(s) sets the stage for mayhem thus crippling emergency response, invoking the psychological impact of mass hysteria and physical destruction with loss of life. All of which could be exploited by the media, furthering the terrorist agenda.
The scientific literature and legal sector deny any possibility of a cyber terrorist in America. This level of ignorance leads one to contemplate if the peer-reviewed literature was in fact funded by government to advance an earlier political agenda denying the existence of cyber terrorism. What is even more interesting are the numerous accounts of scholars depicting terrorist as Western business men in which a cyber attack would not be an efficient use of investment capital. This denial of accountability and projecting Western ideals onto that of a terrorist mindset is not based in reality. To quote Ayn Rand, “Reality, the external world, exists independent of man's consciousness, independent of any observer's knowledge, beliefs, feelings, desires or fears. This means that A is A, that facts are facts, that things are what they are — and that the task of man's consciousness is to perceive reality, not to create or invent it."
On Jan. 25, 2011 legislation was introduced as the Cyber Security and American Cyber Competitiveness Act of 2011, making cyber terrorism an urgent national priority. The act includes safeguards to protect consumers by preventing identity theft and fraud, and guarding against abuses of personal information.4 A national interoperable electronic health records network should be viewed as a component of the nation’s critical infrastructure similar to that of transportation, water and energy; in addition, to being included in any and all applicable cyber terrorism legislation. Taking these facts into consideration, Figure 1, which was originally developed (publication pending) to describe the interplay between public health and transportation, is also applicable to any major infrastructure, including a national interoperable electronic health records network.
Figure 1 Created by Karyn M. Warsow, MS, MPH, DrPH Candidate, Johns Hopkins Bloomberg School of Public Health, Department of Policy Management and Leadership (publication pending)
The conceptual model focuses on the elements involved in infrastructure development and sustainability. The intersecting circles represent the commonalities between the elements with the outer circle, an integrated fiscal and strategic management approach, driving the process. It is the synergy between the component parts that has the greatest impact on the health. As the security of personally identifying information and personal health information continue to be a public concern and the demand for accountability increases, it will be imperative for health care organizations to meet the psychological assurances of information protection along with the physical health care needs of a growing and mobile population. This cannot occur without innovative security measures, effective risk management and investment modeling aimed at curtailing the threat of a potential cyber terrorist attack.
While cyber terrorist threats to the proposed national EHR network may “appear” less likely than a physical attack, it could prove more damaging due to the disruption of technologies and the interconnectivity of the nation’s critical infrastructures.2,3 Thus, the proposed electronic health records network and the threat of a cyber terrorist attack is in fact the elephant in the room.
Submitted by Karyn M. Warsow, MPH, MS, DrPH(c), Johns Hopkins Bloomberg School of Public Health, Department of Policy Management and Leadership
1. Warsow KM, Karna K, Morgan W: Bioterrorism Preparedness: Thinking globally acting locally. Leadership in Public Health Volume 6 (1), Fall 2002:39-48.
2. Cyber Terrorism: How Real is the Threat? United States Institute for Peace (April 14, 2011). Retrieved From: www.usip.org
3. Stohl, M. Cyber Terrorism: a clear and present danger, the sum of all fears, breaking point or patriot games? Crime Law and Social Change. Full article retrieved from: http://www.springerlink.com/content/y816117ww6058jp7/
4. S. 21: Cyber Security and American Cyber Competitiveness Act of 2011 (April 25, 2011). Retrieved From: http://www.govtrack.us/congress/bill.xpd?bill=s112-21
Return to Top
A New Model for Health Planning
Community health planning has long been carried out with the aim of rationalizing the delivery of health care to make it more accessible, acceptable, efficient and accountable in meeting the full range of health needs in communities. The fullest development of its model (1974-78) saw it as a precursor for a system of national health insurance that would be universal as a matter of right. The political will for such a national program has disappeared, but the vision of health care as a human right has continued to grow.
Montana now furnishes us with a model for Twenty-first Century America. In December 2008, the City-County Board of Health of Lewis & Clark County in Western Montana became one of the first communities in the United States to recognize its obligation to ensure universal access to health care based on seeing it as a human right. It adopted a resolution appointing a Task Force on Local Access to Universal Healthcare consisting of community members, labor representatives, health care providers, public health representatives, senior citizens, and health advocates, charged with conducting a community needs assessment that engages community members in an assessment of their needs, and creating an action plan that:
· “Identifies and prioritizes specific strategies and action options that the Board of Health and the Lewis & Clark City-County Health Department should consider to address the lack of access to healthcare, particularly local options for universal healthcare, including but not limited to developing a single payer system, establishing a local universal healthcare zone, expanding community health centers into the hub of a universal primary care network, and asking citizens to consider passing a resolution on the right to healthcare;
· “Sets principles, parameters, objectives, and benchmarks for preferred action options, with due weight given to the community consultation findings;
· “Identifies specific strategies, actions, and recommendations that local government officials should make to state government, and federal government leaders regarding the best options for addressing the lack of access to healthcare and achieving universal healthcare in Lewis and Clark County.”1
In an interview with The Helena Independent Record on December 12, 2008, Alan Peura, then Helena city commissioner and Health Board member who spearheaded the Task Force's work, described the motivations underlying the project. “Starting with health care as a human right, we thought maybe we can get to places that we never got to before. We said, ‘Let’s see what we can do to change the debate, and maybe end up with some solutions that we don’t even know exist at this point.’”
The Task Force submitted its community needs assessment in October 2010 and proceeded to develop its Recommendations and Action Plan. It completed its Plan in February 2011, updated it in April 2011, and submitted its final report on May 31, 2011.
Here are its recommendations from that report:
St. Peter’s Hospital, in Helena, is the county’s only general hospital. The Task Force recommended that the Board enter into a dialogue with the hospital seeking “to increase transparency in the hospital’s planning processes, and to establish effective mechanisms of community participation in hospital planning and operations.” Specifically, it recommended “raising awareness about St. Peter’s Hospital’s legal obligation to the community, derived from its tax-exempt status, which could potentially be challenged in the courts, if necessary.” The report further notes that additional funds may have to be raised to enable both the hospital and the Cooperative Health Center (a FQHC) to meet the community’s health needs. It wishes to enable the FQHC to make primary care universally accessible, recommending that the “board seriously consider embarking on a process of creating a public hospital tax district.” Such tax districts are permitted under Montana law. Alternatively, the county would need to introduce legislation in the state legislature to acquire the authority to propose a local income tax to fund additional services.
In its conclusion, the Task Force states that “the Board should pursue all recommended options for increasing equity in health care access by initiating an alternative health care plan that is community based or publicly financed, so that receiving needed care no longer depends upon having a certain level of income or wealth in order to buy access to care as a market commodity. Instead, the health care providers in Lewis & Clark County should start working toward the provision of health care as a public good, shared by and directly accountable to county residents.”
Perhaps Sen. Max Baucus, chair of the Senate Finance Committee, should be embarrassed now in seeing his home state leading a movement not just for a single-payer plan, but for healthcare as a human right!
Submitted by John Steen
Return to Top
APHA 139th Annual Meeting and Exposition Registration Now Open
Registration is now open for the APHA 139th Annual Meeting and Exposition in Washington, D.C., Oct. 29 - Nov. 2, 2011. More than 1,000 cutting edge scientific sessions will be presented by public health researchers, academicians, policy-makers and practitioners on the most current public health issues facing the nation today. For registration and more information about the Annual Meeting, visit www.apha.org/meetings
Our Section will have a strong presence at the meeting. View the sessions sponsored by our Section in the interactive Online Program (http://apha.confex.com/apha/139am/webprogram/start.html
). Search the program using keyword, author name or date. Don’t forget to visit the Section and SPIG pavilion in the Public Health Expo next to Everything APHA to speak to a Section representative.
Return to Top
Update on APHA Book Publications – June 2011
I am very pleased to announce that there are a
number books in production as well proposals for books that have been accepted,
and work on them is under way. Furthermore, several authors of current
products will be available to sign their books at the fall APHA Annual Meeting
in Washington, D.C.
APHA members of all sections are encouraged to
using existing, new and emerging products in their academic courses. These
resources are also very relevant to policy, prevention, advocacy and client
care initiatives. Please encourage your colleagues to use these timely and
evidence-based resources. Go to the APHA website to find out more: www.aphabookstore.org
We are also looking for new proposals for books. If
you have an idea for a book, please send a few paragraphs describing the idea,
intended audience and your qualifications to Nina Tristani, Director of
Publications, APHA, firstname.lastname@example.org
Thank you for supporting APHA Books and promoting
Norman Giesbrecht, PhD, Chair, APHA Publications
• Environmental Health and Racial Equity in the United States,
Authors: Robert D. Bullard, PhD; Glenn S. Johnson, PhD; and Angel O. Torres,
Books at Printer in June
• Megacities and Public
Health, Omar Khan, MD, MHS
• Public Health Management of Disasters, 3rd edition, Linda Landesman
Books Currently in Production
• Injury Prevention for
Children and Adolescents: Research Practice, and Advocacy, 2nd edition, Karen
D. Liller, PhD
• School–Based Health Care, Terri Wright, MPH and Jeanita Richardson, PhD
Books in Development
• Control of Communicable
Diseases Manual, 20th Edition
• Control of Communicable Diseases Lab Book
• Compendium of Methods for the Examination of Foods, 5th Edition
• Caring for Our Children, 3rd edition
• Standard Methods for the Examination of Water and Wastewater, 22nd
• Communicating Public
Health Information Effectively is now on Kindle.
Jossey-Bass: Emerging Infectious Diseases published in April
Jones and Bartlett Learning books to be published before the 2011 Annual Meeting:
Essentials of Biostatistics in Public Health, Essential Case Studies in Public
Health: Putting Public Health into Practice, Global Health 101, Field
Epidemiology in Public Health Practice, Epidemiology in Women's Health,
Essentials of Health, Culture and Diversity, Epidemiology of Chronic Disease,
Introduction to Air Pollution Science, and Essentials of Program Planning and
APHA is also co-publishing with Wiley, Designing
Healthy Communities by Richard Jackson. The book is a companion to a PBS series
to air this fall.
Submitted by APHA Publications Board
Return to Top
NCI Launches Interactive Cancer Control Community of Practice
The National Cancer Institute has launched Research to Reality, an online community of practice that links cancer control practitioners and researchers. Research to Reality extends the work of Cancer Control P.L.A.N.E.T. by providing opportunities for discussion, learning and enhanced collaboration.
Through Research to Reality, you can engage with your colleagues and share experiences in a way that facilitates the development of partnerships, and strengthens connections and interactions among individuals and organizations involved in cancer control and prevention.
We hope you will stay involved with Research to Reality and take advantage of the interactive features that will make Research to Reality your “go to” place for information on emerging issues and hot topics in evidence-based cancer control practice.
Features of the Research to Reality website include:
· Monthly cyber-seminars
· Discussion forums
· An events calendar
· Featured partners
· Community profiles
We invite you to check out Research to Reality and join the conversation at http:// ResearchtoReality.cancer.gov.
Return to Top
Community Health Planning and Policy Development Newsletter Archives