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Chiropractic Health Care
Section Newsletter
Fall 2009

Chiropractic to Make a Splash at the 2009 APHA Annual Meeting

The APHA Annual Meeting will take place Nov. 7-11, 2009 in Philadelphia. This is the largest gathering of public health professionals in the world with attendees numbering over 12,000. The Chiropractic Health Care (CHC) Section is one of 25 major sections in APHA. Once again the Section will present five strong scientific sessions along with two business meetings and a joint social with the Public Health Education and Health Promotion (PHEHP) Section and the School Health Education and Services (SHES) Section. We will have a notable presence in the exhibit hall with our Megabooth in conjunction with Vision Care, Oral Care and Podiatry.


The CHC Section will hold its annual business meetings on Nov. 8 and 9 and the scientific sessions will be held on Monday, Nov. 9. Presenters representing many of the major chiropractic colleges and research departments will be presenting their research at the following sessions:


1.     Chiropractic Education and Public Health: This session will look at a number of topics related to chiropractic education, including surveys of student attitudes, creation of a new program in a prominent medical college, and needs assessment for chiropractic at the state level.

2.     Current Research in Chiropractic: This session will look at the attitudes chiropractic students have toward the use and teaching of physical therapy, at how different strategies can be used for testing, and how baseline levels of pain and other outcome measures can predict final self-reported pain.

3.     Developing Integrative Approaches to Patient Care: This session provides papers looking at the use of chiropractic in military settings, both in terms of integration and of the characteristics of those already in the system. In addition, utilization issues are described for referral patterns between MDs and CAM practitioners, as well integration patterns at a chiropractic college teaching clinic setting.

4.     Models of Wellness Care in Practice: The primary topic discussed in this session is health promotion, and this is looked at in different settings. In addition, healthy diets are described as they were developed and implemented in a community-based chiropractic college teaching clinic. Information is given on influenza biology, in recognition of the global H1N1 flu crisis, and chiropractic attitudes toward immunization are described and reviewed on way to a new proposal for same.

5.     Adverse Event Reporting and UPIRTSO: The primary purpose for this session is to examine adverse event reporting within chiropractic research settings. In addition, this session will look at how fractures have been reported in the chiropractic literature, and it will provide information relating to a public health Web site for use by chiropractors.


Chief among the goals for the coming year is to expand awareness of musculoskeletal issues as a major public health concern. The time has come for the CHC to take a leadership role in the Association. Musculoskeletal disease is a significant public health problem that is contributing to the rising costs of health care. The CHC, through joint efforts with the U.S. Bone and Joint Decade, will work to elevate awareness of this issue and be an integral part of working toward efforts to improve prevention and work toward more cost-effective care. The goal of the incoming chair is to see the CHC submit a resolution to have the Governing council endorse the tenets of the U.S. Bone and Joint Decade and also to see APHA have a dedicated session to addressing public health issues associated with musculoskeletal disease. For more information about attending the APHA annual meeting, please visit


The Chiropractic Health Care Section of APHA, founded in 1995, has maintained a critical role in public health issues such as wellness, health promotion and disease prevention in the context of chiropractic policies and practices. For more information about the CHC, please visit

Chiropractors, Register Now for the Annual Meeting!



APHA Annual Meeting & Exposition - Register for the meeting and make your hotel reservation soon (advance registration closes Oct. 2, housing closes Oct. 9). Note: Presenters must be individual members of APHA to present their paper(s) and must register in advance for the meeting. Session organizers and moderators are also required to be members and pay the appropriate registration fee. Hope to see you in Philadelphia!

Public Health Focus Issue of the JMPT 2009 – Another Success!

The August 2009 issue of the Journal of Manipulative and Physiological Therapeutics provides a special focus on public health issues and chiropractic care. This second annual issue offers a wide range of public health topics from preventive health services training and chiropractic care of older adults to hygiene and the evidence-based Web site that the Chiropractic Health Care Section offers on immunizations and vaccines (see below for the JMPT table of contents).


Through the generosity of the National University of Health Sciences and Elsevier, the CHC Section will receive extra copies of this special issue of the JMPT for distribution at the APHA Annual Meeting, the chiropractic sessions, and the CHC booth.


We are already beginning to prepare for the 2010 issue. Articles for the 2010 public health-themed issue of the JMPT can be submitted throughout this year and should be submitted no later than Feb. 1, 2010. Guidelines for submissions can be found at: or by contacting the editor at



Journal of Manipulative and Physiological Therapeutics

Volume 32, Issue 6, (July/Aug 2009)



Public Health, Wellness, Prevention, and Health Promotion: Considering the Role of Chiropractic and the Determinants of Health

Claire Johnson, DC, MSEd, and Bart N. Green, DC, MSEd



Characterization of Health Status and Modifiable Risk Behavior Among United States Adults Using  Chiropractic Care as Compared With General Medical Care

Harrison T. Ndetan, MSc, MPH, Sejong Bae, PhD, Marion Willard Evans Jr., DC, PhD, CHES, Ronald L. Rupert, MS, DC, and Karan P. Singh, PhD


Reliability and Validity of the Photogrammetry for Scoliosis Evaluation: A Cross-Sectional Prospective Study

Karen Ruggeri Saad, MA, Alexandra S. Colombo, and Silvia M. Amado João, PhD


Chiropractic Care for Older Adults: Effects on Balance, Dizziness, and Chronic Pain

Cheryl Hawk, DC, PhD and Jerrilyn Cambron, DC, PhD


Pilot Study of the Effect of a Limited and Extended Course of Chiropractic Care on Balance, Chronic Pain, and Dizziness in Older Adults

Cheryl Hawk, DC, PhD, Jerrilyn A. Cambron, DC, PhD, and Mark T. Pfefer, RN, MS, DC


Personal and Professional Immunization Behavior Among Alberta Chiropractors: A Secondary Analysis of Cross-Sectional Survey Data

Emily A. Medd, BScH and Margaret L. Russell, MD, PhD


Improving Preventive Health Services Training in Chiropractic Colleges Part II: Enhancing Outcomes Through Improved Training and Accountability Processes

Gary Globe, DC, MBA, PhD, Daniel Redwood, DC, James W. Brantingham, DC, PhD, Cheryl Hawk, DC, PhD, CHES, Lisa Terre, PhD, Denise Globe, DC, MS, PhD, and Stephan Mayer, DC


The Impact of Microbial Surveys on Disinfection Protocols in a Chiropractic College Environment

Kara Burnham, PhD, David Peterson, DC, Darcy Vavrek, ND, MS, and Mitchell Haas, DC


Hand Hygiene and Treatment Table Sanitizing in Chiropractic Teaching Institutions: Results of an

Education Intervention to Increase Compliance

Marion W. Evans Jr., DC, PhD, CHES, Michael Ramcharan, DC, Harrison Ndetan, MSc, MPH, Rod Floyd, DC, DrPH, Gary Globe, DC, PhD, MBA, Mark Pfefer, DC, MS, RN, and James Brantingham, DC, PhD


Survey of Health Attitudes and Behaviors of a Chiropractic College Population

William N. DuMonthier, DC, Michael T. Haneline, DC, MPH, and Monica Smith, DC, PhD


An Audit of Health Products Advertised for Sale on Chiropractic Web Sites in Canada and Consideration of These Practices in the Context of Canadian Chiropractic Codes of Ethics and Conduct

Stacey A. Page, PhD and Jaroslaw P. Grod, DC



A Model Framework for Patient Safety Training in Chiropractic: A Literature Synthesis

Beatrice Zaugg, DC, MME and Martin Wangler, DC, MME



A Public Health Immunization Resource Web Site for Chiropractors: Discussion of Current Issues and Future Challenges for Evidence-Based Initiatives for the Chiropractic Profession

Raheleh Khorsan, MA, Monica Smith, DC, PhD, Cheryl Hawk, DC, PhD, and Mitchell Haas, DC, MA


To access the above articles, please visit the journal online:

Public Health, Musculoskeletal Disorders and Chiropractic: The Time is Now

Musculoskeletal disorders cost the United States approximately $850 billion per year.1  Worldwide, musculoskeletal conditions are the most common causes of severe long-term pain and physical disability.  In addition, aging populations throughout the developed world will experience significant increases in musculoskeletal conditions, with attendant increases in costs to those countries.  Joint diseases account for half of all chronic conditions in the elderly. Forty percent of all women over the age of 50 are expected to suffer at least one osteoporotic fracture in their lifetime.  In the United States alone, musculoskeletal conditions are a leading cause of disability, accounting for more than 130 million patient visits to health care providers annually. They are the number-one reason people visit their physician, and affect nearly 50 percent of Americans over the age of 18. 1  Musculoskeletal research is at the precipice of major breakthroughs that likely will change the way bone and joint disorders are treated and prevented throughout the world. These research efforts promise major benefits for patients who have musculoskeletal conditions.


"Public health is the approach to health care that is concerned with the health of populations, including health promotion and disease prevention services."2 Given the above facts, musculoskeletal disorders certainly qualify as a public health problem.  APHA is the oldest and largest public health organization in the country. The Association currently has many different affiliated disciplines, but none of these disciplines focuses on addressing the public health crisis of musculoskeletal disorders. The time is now for the Chiropractic Health Care Section of the APHA to address these issues. 

As part of the vision for this goal we have started to put some steps in place. At the May meeting of the World Federation of Chiropractic meeting in Montreal, Rand Baird and Paul Dougherty met with Georges Benjamin, MD (executive director of APHA) and Toby King (executive Director of the U.S. Bone and Joint Decade) to discuss how the chiropractic profession may serve as a bridge between these two large multidisciplinary organizations to address the burden of musculoskeletal disease on the public's health in the United States.  The goal of this meeting was to discuss the possibility of APHA endorsing the tenets of the U.S. Bone and Joint decade. In addition they discussed the possibility of increasing awareness of musculoskeletal disease at the APHA Annual Meeting by requesting a dedicated session specifically addressing public health and musculoskeletal diseases. This dedicated session will be multidisciplinary and will facilitate discussions between different groups about musculoskeletal issues. For example, the APHA Disability Section could have a joint session with the CHC Section to discuss the role of chiropractic care in patients with disabilities and the Maternal and Child Health Section may hold a session that discusses the role of prevention in osteoporosis. 

The following are action steps generated from this meeting:

1.      Submit a resolution to APHA proposing that APHA endorse the tenants of the U.S. Bone and Joint Decade in order to:

a.      Raise awareness and educate the world on the increasing societal impact of musculoskeletal injuries and disorders.

b.      Empower patients to participate in decisions about their care and treatment.

c.      Increase global funding for prevention activities and treatment research.

d.      Continually seek and promote cost-effective prevention and treatment of musculoskeletal injuries and disorders.

2.      Submit a formal proposal to the APHA Executive Director and Member At Large committee to have a dedicated session for musculoskeletal disorders at the 2010 Annual Meeting.

While this is not a large list of action steps, this will take effort from multiple members of the CHC Section. We also want to involve the ACA in this process to encourage the ACA to make a larger emphasis on the public health burden of musculoskeletal disorders. This will be accomplished through proposing a formal presentation to the ACA Board of Directors to encourage a stronger emphasis of public health issues that chiropractors can address and then propose more formal training in these areas such as fall prevention, osteoporosis prevention and injury prevention.

“It is my hope that we will see this project be a success and that we will see the chiropractic profession rise to a greater level of participation in the public health arena,” said Paul Dougherty, incoming chair of the Chiropractic Health Care Section. “It is my vision to see the CHC become the leader in addressing the public health crisis of musculoskeletal disorders.”


U.S. Bone and Joint Decade

1.      United States Bone and Joint Decade: The Burden of Musculoskeletal Diseases in the United States. Rosemont, IL. American Academy of Orthopaedic Surgeons; 2008.

2.      Johnson C, Baird R, Dougherty PE, Globe G, Green BN, Haneline M, et al. Chiropractic and public health: current state and future vision. J Manipulative Physiol Ther. 2008;31:397-410.

The 2009 annual Board of Directors Meeting of the U.S. Bone and Joint Decade

Dr. Bonnie Hillsberg Shares Information from the HRSA Workforce Summit

Health Resources and Services Administration

 The Health Care Workforce Crisis:  A Summit on the Future of Primary Care in Rural and Urban America

August 10-12, 2009


The Health Resources and Services Administration held a Summit in August to address the health care workforce as the country approaches health reform.  HRSA Director Mary Wakefield and her staff put together a three-day summit that included numerous breakout sessions addressing trends in the primary care work force, building a diverse primary care work force, innovative practices, meeting a broad range of patient needs, community driven medical education: healers of the future, rural primary care workforce: what we need to know about the need and what needs to be done, the National Health Service Corps session, the changing face for primary care and implications for the work force, work force development and health reform. 

My primary reason for attending was to get chiropractic on the map as much as I could.  I attended as a Board Member of the Association for Clinicians for the Underserved (ACU) 

I spoke to many HRSA staff and several keynote speakers including J. Lloyd Michener, MD, clinical professor and chair of the Department of Community and Family Medicine, Duke University Medical Center, to make sure that chiropractic was not an afterthought and that our profession would be included in whatever future work force policies were to come out of this meeting.

One of the highlights of the meeting was meeting directly with the HRSA staff and speaking frankly about where we are with the demonstration project and why we need to go through this again, what Congress will do and what the future looks like for our profession.  I had many conversations with Rick Smith, who is the director of the National Health Service Corps and Bureau of Clinician Recruitment and Services.  One good thing that came out of my conversations and constant reminder that chiropractic needed to be at the table with health care work force policies was the closing remarks on the final day of the summit.   Rick Smith included chiropractic in his closing statement, which is a step forward.  Poor Rick – he will never get rid of me until we get chiropractic permanently in the National Health Service Corps.

This was an excellent meeting as it made people think out of the box and look for creative solutions to the health care work force shortage.  We know that there will be primary care shortages in this country.  Unfortunately, HRSA staff still thinks in the old paradigm of medical silos.  It is my recommendation to HRSA and all that we start broadening our horizons and think of care under the umbrella of health which includes everyone (chiropractors, optometrists, dentists, nurses, midwifes, massage therapists, acupuncturists, social workers and the like) so that we are all on an equal footing and the patient has the choice to see who ever they want.  In addition, the primary care shortage can only be helped if HRSA recognizes that these shortages are due to multiple factors that will not change for years to come:  the cost of education, the cost of setting up a private practice, the lack of information in a physician’s medical education on health policy, public health, nutrition, etc.  Physicians cannot be everything to everyone.  Other professional disciplines can work in tandem with primary care specialists to make sure that patients are receiving the care that they need.

What could HHS/HRSA be doing now to address primary care workforce issues and shortages?

·         Stop addressing primary care in silos.  We have to start opening up the doors to other health care professionals who provide service and are part of the delivery of “primary care.”  If you want to really think “outside the box,” then think of the human body and all of the systems that make up who we are:  Structure, Nutrition, Mental Health, Dental and Vision with special attention given to our body’s systems when it needs it (Cardio, Lung, Gastro, Ear/Nose/Throat, etc.). This is what care is all about – taking stock in how we can help keep our body healthy, in good spirit and in the most optimal state it can be in.


·         The power of opening up the silos will allow people to have choice and access to care that they have been denied for years in both rural, urban and underserved communities.


·         Although this is not under the domain of HRSA – the United States Public Health Service Commissioned Corps has an age limitation – you cannot serve if you are older than 44.  Sixty-five is the new 44, and this could help a great deal with the shortages that the United States is experiencing in under-served and rural communities.  There are plenty of middle aged American providers who would like to work in underserved communities throughout the US but are locked out because of the age barrier.  These productive, well seasoned providers are considered “too old.”  This is a waste of a good, useful, available, trained and plentiful work force.

·         To date, HHS has announced the availability of nearly $200 million in ARRA workf orce funds, of a total $300 million, to expand HRSA’s National Health Service Corps.  The funds will pay for student loan repayments for primary care medical dental and mental health clinicians who wish to practice, for a minimum of two years, in NHSC sites that treat underserved and uninsured people.  Chiropractic was not included. 

What important "next generation" ideas do you have that you think HHS/HRSA needs to consider about the primary care work force in the future?


·         Change the cost of education.  This is one of the factors that influences our health care system.  If we keep raising the cost to become a “primary care professional,” we will lose the opportunity for anyone to be able to practice or to work with the under-served communities.  Mounting educational debt is part of the health care problem in this country.  This financial burden now plagues most professional students throughout their adult life, competing with housing, food and other basic necessities.


·         It is also difficult for primary care physicians to survive if they feel that working with the under-served is a rescue mission that they are being thrown into without support. Without a transdisciplinary approach to primary care involving nutrition, nursing, chiropractic, podiatry, optometry, etc., the system is set up to fail.  A single person only has so much time, but a team can support one another and provide 360 degree care for a patient without overburdening anyone.  Many primary care physicians are struggling to keep small practices alive and cannot manage the necessary work and still meet their expenses. In order to provide better quality of care, it is necessary to have a transdisciplinary approach and all resources in place. 

As the nation moves closer to health reform, we must continue to work closely with HRSA staff to ensure that chiropractic has a permanent place not only the National Health Service Corps but in federal policies related to health reform and work force development.



Bonnie S. Hillsberg, DC, MHA, MEd, with Richard J. Smith, III.  Dr. Hillsberg is an APHA Action Board Member for the Chiropractic Health Care Section.  Smith is the Associate Administrator of the Bureau of Clinician Recruitment and Service for the U.S. Department of Health and Human Services Health Resources and Services Administration.


Massachusetts Chiropractic Society Sponsors Public Health Event in Boston

This past June of 2009 in Boston marked the 3rd Annual Partners Health Care & Channel 56 Health & Fitness Exposition for which the Massachusetts Chiropractic Society was a participant and sponsor.  As coordinator for the MCS, I have been making sure that the MCS participates every year in this event.  In addition to participating, we have also had the privilege of having presentations for the past two years.  Last year's presentations were focused on basic understandings of chiropractic health care, and this year we decided to pursue chiropractic management of symptomatic presentations relating to immune system problems such as asthma and the neurobehavioral disorder ADD/ADHD.  We chose those two topics for a couple of reasons. One is that we are trying to stem a grass roots public health educational effort to diffuse the public’s perception on chiropractic health care.  On keeping our message on vertebral subluxation detection and correction, which is consistent with the state law here in Massachusetts, we can expand the public’s knowledge about chiropractors and broaden understanding beyond just neck and back pain.  Second was the fact that many children concomitantly suffer with these medical problems, so we attempted to educate the public on the safety and efficacy of our conservative care and to let the public know that they have another health care option rather than just medication.  Third was to emphasize the excellent results that chiropractic health care provides and how our care is severely underutilized which could be viewed as a public health problem to increase our services around the country so that more effective health care policies could be implemented within our health care system.  For more information, comments or suggestions, feel free to contact Dr. Scott Darragh from the MCS at


Scott A. Darragh DC, MPH, MT(ASCP) 
Bay State Centre Family Chiropractic, LLC. 
340 Main Street Suite 102 
Melrose, MA 02176

(781) 662-3333 (office)
(781) 662-4466 (fax)

Vice President - Public Health Education - Massachusetts Chiropractic Society

 American Public Health Association

 International Chiropractic Pediatric Association

 American Chiropractic Association

Three New Books from APHA Press

APHA Press has three books in production of interest to epidemiologists and other health professionals that will be available at the Annual Meeting. 

They are: Chronic Disease Epidemiology and Control, 3rd Edition by Patrick Remington, Ross Brownson and Mark Wegner and two books by Steven S. Coughlin, Ethics in Epidemiology and Public Health Practice, 2nd Edition and Case Studies in Public Health Ethics, 2nd Edition. 


APHA Career Guidance Center

Don't miss this opportunity! Sign up now for a one-on-one or a group session with a professional career coach at the APHA Annual Meeting & Exposition. These coaches can guide you in strategizing the next phase of your career and help you define your goals. Select a 45-minute individual session or a 90-minute group session. The group sessions are designed according to your career needs. To see which session best fits you, please read about each coach's experience and education before setting an appointment. If you have never experienced coaching before, this is a wonderful introduction to what may become a useful service for your career!
This is the link to the the Career Guidance Center: