Chiropractic Health Care
Section Newsletter
Spring 2004

Wellness at Work

In cooperation with the Communications Staff at Cleveland Chiropractic College, Dr. Ashley Cleveland has started writing a small column for publication on the college’s intranet page, Cleveland Today. Many faculty and staff members use Cleveland Today as their homepage. The column is entitled “Working Well” and is initially covering some of the numbers with which people should be concerned in order to live a long, healthy life. So far, the column has covered the number of servings of fruits and vegetables one should consume each day for maximum health and easy tips to achieve this without bringing the scale and measuring cup to every meal. The next columns will address achieving 10,000 steps each day and maintaining a BMI that is at or below 25.

Dr. Killinger to Serve on Task Force on Aging

On April 26, 2004, Dr. Lisa Killinger was asked to serve on the APHA Task Force on Aging. This task force is co-chaired by APHA members Ruth Polombo and Rick Fortinsky, and is working hard to include, in its membership, participants from multiple APHA sections. Lisa has sent in an initial survey, identifying areas of public health work in aging that may be relevant to the chiropractic health section. The task force will meet regularly, via conference call, and members should watch the APHA-CHC Section Newsletter for periodic updates.

Scope of Public Health and Aging: Framework to Help Guide Aims of the Task Force on Aging

American Public Health Association
March, 2004

Population of interest
· All adults aged > 65 years; adults aged < 65 years with
chronic illnesses and disabilities
· Population diversity must be adequately documented and
considered based on:
o Ethnic identification
o Socioeconomic status
o Age, particularly adults aged 75-84 years and
those aged > 85 years

Orientation to health and disease
· Place strong emphasis on healthy aging by maximizing
health promotion, disease prevention, and injury risk
reduction initiatives at individual, community, state,
and national levels.
· Encourage initiatives and solutions that recognize the
scarcity of public funds, but also strongly advocate to
creatively maximize access to health and supportive
services according to need in the least restrictive
environment.
· Encourage the development and maintenance of strong
familial and/or friendship networks.
· Promote the value of intergenerational programs to
expand social networks.
· Infectious disease prevention and control:
o Encourage prevention and timely detection of
influenza, pneumonia, and human immunodeficiency
virus.
. Chronic disease and injury prevention and control:
o Encourage use of all chronic disease screening
procedures insured by Medicare.
o Encourage appropriate assessment for risks of
falling.
o Minimize incidence of adverse drug events due to
polypharmacy.
o Encourage appropriate and indicated use of
vision, hearing, dental, and podiatric care
services.
o Encourage adoption of exercise regimens and
smoking cessation.
o Encourage proper nutritional habits and adequate
fluid intake.
o Promote awareness of the potential health risks
associated with excess alcohol consumption and
self-medication.
· Tertiary prevention to improve or prevent further
decline in function due to acute illness, chronic
illness, or injury:
o Maximize availability of rehabilitation therapy
services, including gait, balance, and strength
training.
o Maximize availability of mental health services.
o Promote recovery to resume prior activities and
maximize quality of life.
· Terminal illness care:
o Maximize access to palliative care to assure
death with dignity
o Increase involvement of public health
organizations in end of life care initiatives.

Community orientation
· Encourage uniform surveillance methods to monitor and
report trends in acute and chronic diseases and injuries
at state and local levels.
· Promote partnerships among public health departments,
Area Agencies on Aging, State Units on Aging, and disease
specific voluntary organizations in carrying out health
promotion, disease prevention, and injury risk reduction
programs.
· Maximize availability of alternative living arrangements.
· Promote awareness of the critical role played by family,
neighbors, and friends (i.e., informal caregivers).
o Enhance efforts to educate informal caregivers
about chronic disease management and available
community resources to promote their own health
and well-being.

Population-based interventions
· Encourage replication or adaptation of “best practices”
aimed at health promotion, disease prevention, and injury
risk reduction.
· Encourage intergenerational social and recreational
activities.
· Promote public policies for chronic care oriented toward
consumer choice and service delivery in home and
community-based settings.
· Encourage expansion and adaptation of existing service
delivery models that pool diverse public and private
funding sources to serve chronically ill adults living at
home but at risk for nursing home admission (e.g.,
Program of All Inclusive Care to the Elderly, or PACE).
· Encourage adoption of evidence-based interventions to
minimize the incidence of elder abuse and neglect.

Environmental issues
· Maximize opportunities for repairing and retrofitting
private residences to promote aging in place at home.
· Maximize protection of the nation’s food supply.
· Encourage development of transportation and mobility
alternatives.

Regulation, consumer protection, and access to services
· Simplify eligibility and application procedures to
maximize access to publicly financed health and social
services.
· Improve opportunities for consumers with literacy
limitations to learn about services.
· Ensure physical access to all available health and long
term care services.
· Empower consumers to communicate more routinely with
their health care providers about diagnosis and treatment
options.
· Maximize safety and quality of care in supervised living
environments.
· Maximize financial access to, and awareness of quality
of, privately financed living arrangements and
supplemental health/long-term care insurance products.
· Encourage evaluation of Medicare benefits to reorient
focus on healthy aging and maximization of independence
rather than to disease treatment.
· Encourage vigorous investigation of elder abuse and
neglect complaints, and strict enforcement of regulations
protecting older adults from abuse and neglect.

Health care workforce
· Promote education and training initiatives to increase
the supply of health care professionals and
paraprofessionals with proven expertise in geriatrics and
long term care practices and policies.
· Promote education and training initiatives to increase
the supply of administrative personnel with proven
expertise in geriatrics and long term care settings.
· Encourage all Schools of Public Health and Masters of
Public Health programs to expand curricula to maximize
opportunities in aging and public health careers.
· Strongly encourage existing health care providers to be
proactive in explaining benefits under the Medicare
program.

Research
· Promote research efforts with funding from public sector
and private sector sources to continue building
scientific evidence about:
o promising public health interventions that could
improve health status and quality of life;
o quality of care in existing health care services
and service coordination programs.
· Encourage the development and dissemination of state of
the art approaches to measure the processes and outcomes
of new interventions and existing services.

WFCs CAT Public Health Project

For several years the World Federation of Chiropractic (WFC) has been an international association of national associations, with the chiropractic associations of over 80 nations as its members. The WFC has also been accepted and designated as a non-governmental organization officially affiliated with the World Health Organization (WHO). A few years ago the WFC appointed a committee called the Health for All Committee and charged it with the responsibility for coordinating WFC's international public health projects with those of WHO. The members of the Health for All Committee and the WFC regions they represent are:

· Rand Baird, DC,MPH--- Chairperson
· Evalie Heath, DC --- Africa
· Bruce Vaughan, DC --- Asia
· Efstathios Papadopoulos, DC --- Eastern Mediterranean
· Anthony Metcalfe, DC --- Europe
· Sira Borges, DC,MD --- Latin America
· Deborah Kopansky-Giles, DC --- North America
· Inger Villadsen, DC --- Pacific
· Gary Auerbach, DC --- North America
· David Chapman-Smith, ex officio

In addition Drs. David Koch and Medhat Alattar of Palmer and Palmer---Florida serve as resource advisors to the committee.

Although it has many health initiatives and projects and programs WHO's number-one cabinet-level health priority for the past few years has been its Tobacco Free Initiative which includes its widely publicized Framework Convention on Tobacco Control (FCTC). The WFC is generally supportive of many WHO projects, and some have clear chiropractic applications (nutrition, exercise, obesity, etc.), but with limited resources the WFC has chosen to direct the Health for All Committee to coordinate and concentrate its efforts on WHO's anti-tobacco use efforts. To that end, the Health for All Committee recommended tobacco policies adopted by the WFC at its international congress in 2003 and developed some anti-tobacco materials for use by DCs in their own offices. The Health for All Committee has named their project CAT (Chiropractors Against Tobacco), and the CAT materials including office brochures and instruction sheets, colorful high-impact posters, and questions to ask during new patient histories can all be easily downloaded from the WFC Web site and printed on a color printer or taken as a computer file to a printer for printing in quantity.

As part of its ongoing work, a pilot study of the usefulness and acceptance of these CAT materials is being undertaken now as a collaborative effort of the WFC, the APHA Chiropractic Health Care Section, and the research departments of Parker and Palmer Colleges of Chiropractic with Dr. Cheryl Hawk as the principal investigator. A select group of chiropractic offices with prior experience in practice-based research was solicited and almost immediately 30 offices eagerly volunteered to participate and began receiving training materials in April. Although small in scale this important pilot study will help validate the materials and also could possibly lead to a larger scale study. Check out the WFC Web site at <www.wfc.org> to sample the materials.

WALK THE HILL FOR PUBLIC HEALTH

Nov. 9, 2004
8:30 a.m. –12:00 p.m.

On Nov. 9, 2004, you are invited to walk the halls of Capitol Hill with hundreds of other public health professionals to advocate on issues important to public health.

This day will start with a rally and briefing on the status of public health issues in Congress. Our advocacy efforts on the Hill will concentrate on important public health issues.

APHA anticipates hundreds of people advocating on this day; therefore, APHA will be arranging all Hill visits. Participants will be meeting with their legislators in groups. As a group you will have time to prepare for your meeting at the briefing.

Join your section in rallying for public health. Each section will be represented with signs at the rally. Don’t let your section go unnoticed. A registration form for the rally and Hill day will be up on APHA’s Web site soon! In the meantime, spread the word and encourage your colleagues to participate.

When you complete the registration form to advocate, you will receive a confirmation by e-mail. APHA will be sending out updates leading up to the Hill day and will notify all participants of their visit at the rally and briefing.

On November 9, join us in letting Congress know that the public health community is a POWERFUL community.

For more information regarding our Hill day, please contact our Action Board Representative, Rand Baird, at <drrandbaird@worldnet.att.net>, or the Director of Grassroots Advocacy, Lakitia Mayo, by e-mail at <lakitia.mayo@apha.org> or by telephone at (202) 777-2515.

We look forward to walking the halls of Capitol Hill with you in November!

National Public Health Week – April 5 – 12, 2004

Several chiropractic colleges participated in National Public Health Week this year. The theme was Disparities in Health. At Palmer College, information about National Public Health Week and quick facts related to health were sent via e-mail to all faculty. It was hoped that this would raise awareness among the local chiropractic educational community about both National Public Health Week and the APHA Chiropractic Health Care Section. Public health resources and Web sites (such as <www.apha.org>) were featured in these informational e-mailings. Such efforts require a minimum of time from our APHA-CHC members and do keep APHA on our colleges’ radar screens. Next year we would like to see many more colleges participate in some way during National Public Health Week 2005.

The following quick facts were used at Palmer College.
1. Health Disparities
Did you know...
Native Americans experience twice the incidence of disability due to chronic low back as non-native Caucasians in America. African Americans and Hispanics suffer higher incidences of hypertension, diabetes, and heart disease than their Caucasian counterparts. Such disparities in health can be eliminated. Chiropractors can play an active role in eliminating health disparities by actively providing sound recommendations on healthy behaviors and lifestyles to their patients at risk, and can strive to insure equal access to healthcare for all Americans.

Resources: Center for Health Statistics, Mortality and Morbidity Weekly Report, The American Public Health Association, and the Center for Disease Control.

2. Smoking:
Did you know...
The most common reason that people quit smoking is that their doctor told them to quit. If a patient is considering quitting, the most important thing you can do, as a chiropractor, is to tell them they need to quit for health reasons, and provide resources and information to help them quit. A great resource is: <www.surgeongeneral.gov/tobacco/tobaqrg.htm>.

Source: U.S. Public Health Service

3. Overweight/Obesity:
Did you know….
* The annual U.S. health care cost related to obesity is approximately $115,000,000,000 (115 billion).
* Each year, 300,000 deaths in the United States are associated with obesity.
* Approximately 2/3 of American adults are overweight or obese! (NHANES Survey Data)

Chiropractors can take an active role in helping to stop this epidemic, by:
1. Educating patients about the serious health risks related to
obesity;

2. Recommending healthy lifestyle changes to our patients,
including physical activity, and replacing some empty
calories with wholesome foods like vegetables and fruits; and

3. Advising patients to drink more water (replacing some of
their high-calorie drinks with the healthier, no-calorie
alternative).

For more information, you can visit these sites:

<www.surgeongeneral.gov/topics/obesity/>; and

<http://health.nih.gov/result.asp/476>.

4. Healthy Bones: Did you know...
It's never too late to increase your bone density. Whereas we used to think that we could, at best, slow the rate of bone loss in our older patients, numerous studies now indicate that it is never too late to start building bone, naturally. In patients over 65, a simple (carefully monitored and designed) routine of regular weight lifting or walking, along with calcium supplementation can increase bone density in even the oldest, most frail patients. So, what are you waiting for? Learn more, and take an active role in improving the bone health of your patients.

<www.nof.org> (National Osteoporosis Foundation)

Membership News

At the annual Association of Chiropractic Colleges and Research Agenda Conference held in March in Las Vegas, APHA-CHC members managed to recruit 12 new members to our ranks! These new members come from chiropractic education and research and even include chiropractic college presidents! This is great news. Remember to encourage students and colleagues to join the APHA Chiropractic Health Care Section.

Cleveland Chiropractic College Says, “Turn Off the Television!”

April 19 - 25, 2004, was the official TV-Turnoff Week. At Cleveland Chiropractic College of Kansas City, Dr. Ashley Cleveland worked with Amelia Trollinger in Communications to create provocative fliers that were posted around campus reminding people of the health impact of excessive television consumption. The fliers included visual images as well as quick facts that often escape the attention of the public. For instance, “90 percent of Saturday morning television commercials market unhealthy/high-sugar foods to children.” Other fliers addressed the number of violent acts a person would avoid seeing by not watching television for a week, and statistics relative to obesity in the United States, which is directly linked to a sedentary lifestyle.

APHA Annual Meeting To Offer New Technology

 
NEW! E-ssentialLearning Expanded Access to Annual Meeting Sessions

APHA is expanding the educational experience of both presenters and attendees at the APHA Annual Meeting by investing in LCD projectors, computers and new Web-based technology for all scientific sessions. This new technology will enable voice and PowerPoint presentations to be recorded and uploaded to the APHA Web site following the meeting, thus extending the life of the meeting and providing access to hundreds of actual scientific session presentations that Annual Meeting registrants may have missed while attending other sessions.

Annual Meeting attendees can receive full access to these expanded sessions by registering for E-ssentialLearning on the Annual Meeting registration form. Special introductory discounted fees are $25 for Annual Meeting session presenters, $50 for APHA members (who are not session presenters), and $100 for non-members and are in effect for anyone registering for the full APHA Annual Meeting by the Oct. 1 pre-registration deadline. These fees will increase substantially for anyone registering on-site at the Annual Meeting in Washington.

Log-in information and password access to these E-ssentialLearning sessions will be provided to registrants immediately following the Annual Meeting.

NEW! Presenters Able to Upload PowerPoint Presentations in Advance

LCD projectors and computers are now included as part of the standard audiovisual package in each session room. This new technology will enable presenters to upload their PowerPoint presentations in advance of the meeting and have them pre-loaded on the APHA session computers. Individual presentations then begin with a click of the mouse. The cost and inconvenience of bringing a computer to the Annual Meeting has been eliminated for presenters allowing them to take advantage of new technologies and be a part of the E-ssentialLearning experience.