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Community Health Planning and Policy Development
Section Newsletter
Fall 2005

Fall Message from the CHPPD Chair -
Time of Great Sadness, Time for Action

 
The new discussion board at www.chppd.org


















Just as we were entering the exciting months before our APHA Annusl Meeting, and we were all finalizing our plans for the New Orleans visit, a storm of awesome proportions turned the lives and property of the Gulf Coast region to shambles. I have since watched in horror and disbelief, then numbness and all of the other emotions of the proverbial seven stages of grief as the events have since unfolded.

Although a time of great sadness at the loss, it is also a time of great opportunity for us, both personally and professionally. The immediate response was very important, and the long-range commitment to the cleanup and rebuilding, not just of possessions, but also of spirit, will be equally, if not more, important. The time and money we initially invested has been an impressive demonstration of the American willpower and survivability. We must also examine how we can do even better, and plan activities and policies for the future that make health care even more reliable and responsive to people’s needs, both urgent and ongoing.

As I have repeatedly said before, communication is one of the most important things that we can work on this year. This takes many forms from local and state interaction to annual face-to-face conference contacts. We had an emergency CHPPD Leadership conference call on Sept. 9 to share our perceptions and start laying foundations for future actions. This will be followed up by a continuing planning dialogue on our CHPPD Forum, a new branch of our Web site, which can be accessed by any Section member at <www.chppd.org>. It is our intent to convert frustration into energy, which can be constructively channeled into supportive actions for everyone in need.

The Annual Meeting has been moved to Philadelphia on Dec. 10-14, a time when some prior registrants can’t come, but others now can. Now is a more important time than ever to take this opportunity to network with your colleagues of interest, to share your thoughts, to examine your frustrations, to evaluate our path, and to recommit to a brighter future. I hope that you will join me in December at our sessions, our business meetings, our reception and our many other events to reinvest together. Visit <www.ahpanet.org/CHPPD> for more details, and enjoy the new look and functionality of our Web site.

Hurricane Katrina – A First-Hand Account

Larry Bradshaw and Lorrie Beth Slonsky are paramedics from California, SEIU Local 790, who were attending an EMS conference in New Orleans at the time Katrina struck.

Sept. 6, 2005, 11:59

Two days after Hurricane Katrina struck New Orleans, the Walgreen's store at the corner of Royal and Iberville streets remained locked. The dairy display case was clearly visible through the widows. It was now 48 hours without electricity, running water, plumbing. The milk, yogurt, and cheeses were beginning to spoil in the 90-degree heat. The owners and managers had locked up the food, water, Pampers, and prescriptions and fled the city. Outside the Walgreen's windows, residents and tourists grew increasingly thirsty and hungry.

The much-promised federal, state and local aid never materialized, and the windows at Walgreen's gave way to the looters. There was an alternative. The cops could have broken one small window and distributed the nuts, fruit juices, and bottled water in an organized and systematic manner. But they did not. Instead, they spent hours playing cat and mouse, temporarily chasing away the looters.

We were finally airlifted out of New Orleans two days ago and arrived home yesterday (Saturday). We have yet to see any of the television coverage or look at a newspaper. We are willing to guess that there were no video images or front-page pictures of European or affluent white tourists looting the Walgreen's in the French Quarter.

We also suspect the media will have been inundated with "hero" images of the National Guard, the troops and the police struggling to help the "victims" of the Hurricane. What you will not see, but what we witnessed, were the real heroes and sheroes of the hurricane relief effort: the working class of New Orleans. The maintenance workers who used a fork lift to carry the sick and disabled. The engineers who rigged, nurtured and kept the generators running. The electricians who improvised thick extension cords stretching over blocks to share the little electricity we had in order to free cars stuck on rooftop parking lots. Nurses who took over for mechanical ventilators and spent many hours on end manually forcing air into the lungs of unconscious patients to keep them alive. Doormen who rescued folks stuck in elevators. Refinery workers who broke into boat yards, "stealing" boats to rescue their neighbors clinging to their roofs in flood waters. Mechanics who helped hotwire any car that could be found to ferry people out of the city. And the food service workers who scoured the commercial kitchens improvising communal meals for hundreds of those stranded.

Most of these workers had lost their homes, and had not heard from members of their families, yet they stayed and provided the only infrastructure for the 20 percent of New Orleans that was not under water.

Day 2
On Day 2, there were approximately 500 of us left in the hotels in the French Quarter. We were a mix of foreign tourists, conference attendees like ourselves, and locals who had checked into hotels for safety and shelter from Katrina. Some of us had cell phone contact with family and friends outside of New Orleans. We were repeatedly told that all sorts of resources including the National Guard and scores of buses were pouring in to the city. The buses and the other resources must have been invisible, because none of us had seen them.

We decided we had to save ourselves. So we pooled our money and came up with $25,000 to have 10 buses come and take us out of the city. Those who did not have the requisite $45 for a ticket were subsidized by those who did have extra money. We waited for 48 hours for the buses, spending the last 12 hours standing outside, sharing the limited water, food, and clothes we had. We created a priority boarding area for the sick, elderly and newborn babies. We waited late into the night for the "imminent" arrival of the buses. The buses never arrived. We later learned that the minute they arrived in the city limits, they were commandeered by the military.

Day 4

By day 4 our hotels had run out of fuel and water. Sanitation was dangerously abysmal. As the desperation and despair increased, street crime as well as water levels began to rise. The hotels turned us out and locked their doors, telling us that the "officials" told us to report to the Convention Center to wait for more buses. As we entered the center of the city, we finally encountered the National Guard. The Guards told us we would not be allowed into the Superdome as the city's primary shelter had descended into a humanitarian and health hellhole. The guards further told us that the city's only other shelter, the Convention Center, was also descending into chaos and squalor and that the police were not allowing anyone else in. Quite naturally, we asked, "If we can't go to the only two shelters in the city, what is our alternative?" The guards told us that that was our problem, and no, they did not have extra water to give to us. This would be the start of our numerous encounters with callous and hostile "law enforcement."

We walked to the police command center at Harrah's on Canal Street and were told the same thing, that we were on our own, and no, they did not have water to give us. We now numbered several hundred. We held a mass meeting to decide a course of action. We agreed to camp outside the police command post. We would be plainly visible to the media and would constitute a highly visible embarrassment to city officials. The
police told us that we could not stay. Regardless, we began to settle in and set up camp. In short order, the police commander came across the street to address our group. He told us he had a solution: we should walk to the Pontchartrain Expressway and cross the greater New Orleans Bridge, where the police had buses lined up to take us out of the city. The crowed cheered and began to move. We called everyone back and explained to the commander that there had been lots of misinformation and wrong information and was he sure that there were buses waiting for us. The commander turned to the crowd and stated emphatically, "I swear to you that the buses are there."

We organized ourselves, and the 200 of us set off for the bridge with great excitement and hope. As we marched past the Convention Center, many locals saw our determined and optimistic group and asked where we were headed. We told them about the great news. Families immediately grabbed their few belongings and quickly our numbers doubled and then doubled again. Babies in strollers now joined us, as well as people using crutches, elderly clasping walkers and other people in wheelchairs. We marched the two to three miles to the freeway and up the steep incline to the bridge. It now began to pour down rain, but it did not dampen our enthusiasm.

Approaching the bridge

As we approached the bridge, armed Gretna sheriffs formed a line across the foot of the bridge. Before we were close enough to speak, they began firing their weapons over our heads. This sent the crowd fleeing in various directions. As the crowd scattered and dissipated, a few of us inched forward and managed to engage some of the sheriffs in conversation. We told them of our conversation with the police commander and of the commander's assurances. The sheriffs informed us there were no buses waiting. The commander had lied to us to get us to move.

We questioned why we couldn't cross the bridge anyway, especially as there was little traffic on the six-lane highway. They responded that the West Bank was not going to become New Orleans, and there would be no Superdomes in their city. These were code words for, "if you are poor and black, you are not crossing the Mississippi River and you are not getting out of New Orleans."

Our small group retreated back down Highway 90 to seek shelter from the rain under an overpass. We debated our options and in the end decided to build an encampment in the middle of the Ponchartrain Expressway on the center divide, between the O'Keefe and Tchoupitoulas exits. We reasoned we would be visible to everyone, we would have some security being on an elevated freeway and we could wait and watch for the arrival of the yet-to-be-seen buses.

All day long, we saw other families, individuals and groups make the same trip up the incline in an attempt to cross the bridge, only to be turned away. Some were chased away with gunfire, others were simply told no, others were verbally berated and humiliated. Thousands of New Orleanders were prevented and prohibited from self-evacuating the city on foot. Meanwhile, the only two city shelters sank further into squalor and disrepair. The only way across the bridge was by vehicle. We saw workers stealing trucks, buses, moving vans, semi-trucks and any car that could be hotwired. All were packed with people trying to escape the misery New Orleans had become.

Our little encampment began to blossom. Someone stole a water delivery truck and brought it up to us. Let's hear it for looting! A mile or so down the freeway, an army truck lost a couple of pallets of C-rations on a tight turn. We ferried the food back to our camp in shopping carts. Now secure with the two necessities, food and water, cooperation, community, and creativity flowered. We organized a clean-up and hung garbage bags from the rebar poles. We made beds from wood pallets and cardboard. We designated a storm drain as the bathroom and the kids built an elaborate enclosure for privacy out of plastic, broken umbrellas, and other scraps. We even organized a food recycling system where individuals could swap out parts of C-rations (applesauce for babies and candies for kids!).

This was a process we saw repeatedly in the aftermath of Katrina. When individuals had to fight to find food or water, it meant looking out for yourself only. You had to do whatever it took to find water for your kids or food for your parents. When these basic needs were met, people began to look out for each other, working together and constructing a community.

If the relief organizations had saturated the city with food and water in the first two or three days, the desperation, the frustration and the ugliness would not have set in.

Flush with the necessities, we offered food and water to passing families and individuals. Many decided to stay and join us. Our encampment grew to 80 or 90 people. From a woman with a battery powered radio we learned that the media was talking about us. Up in full view on the freeway, every relief and news organization saw us on their way into the city. Officials were being asked what they were going to do about all those families living up on the freeway? The officials responded they were going to take care of us. Some of us got a sinking feeling. "Taking care of us" had an ominous tone to it.

Unfortunately, our sinking feeling (along with the sinking city) was correct. Just as dusk set in, a Gretna Sheriff showed up, jumped out of his patrol vehicle, aimed his gun at our faces, screaming, "Get off the fucking freeway." A helicopter arrived and used the wind from its blades to blow away our flimsy structures. As we retreated, the sheriff loaded up his truck with our food and water.

Once again, at gunpoint, we were forced off the freeway. All the law enforcement agencies appeared threatened when we congregated or congealed into groups of 20 or more. In every congregation of "victims" they saw "mob" or "riot." We felt safety in numbers. Our "we must stay together" was impossible because the agencies would force us into small atomized groups.

In the pandemonium of having our camp raided and destroyed, we scattered once again. Reduced to a small group of eight people, in the dark, we sought refuge in an abandoned school bus, under the freeway on Cilo Street. We were hiding from possible criminal elements but equally and definitely, we were hiding from the police and sheriffs with their martial law, curfew and shoot-to-kill policies.

Air-lifted

The next days, our group of eight walked most of the day, made contact with the New Orleans Fire Department and were eventually airlifted out by an urban search and rescue team. We were dropped off near the airport and managed to catch a ride with the National Guard. The two young guardsmen apologized for the limited response of the Louisiana guards. They explained that a large section of their unit was in Iraq, and that meant they were shorthanded and were unable to complete all the tasks they were assigned.

We arrived at the airport on the day a massive airlift had begun. The airport had become another Superdome. We eight were caught in a press of humanity as flights were delayed for several hours while George Bush landed briefly at the airport for a photo op. After being evacuated on a coast guard cargo plane, we arrived in San Antonio, Texas.

There the humiliation and dehumanization of the official relief effort continued. We were placed on buses and driven to a large field where we were forced to sit for hours and hours. Some of the buses did not have air-conditioners. In the dark, hundreds if us were forced to share two filthy overflowing porta-potties. Those who managed to make it out with any possessions (often a few belongings in tattered plastic bags) were subjected to two different dog-sniffing searches.

Most of us had not eaten all day because our C-rations had been confiscated at the airport because the rations set off the metal detectors. Yet, no food had been provided to the men, women, children, elderly, and disabled as they sat for hours waiting to be "medically screened" to make sure we were not carrying any communicable diseases.

This official treatment was in sharp contrast to the warm, heartfelt reception given to us by the ordinary Texans. We saw one airline worker give her shoes to someone who was barefoot. Strangers on the street offered us money and toiletries with words of welcome. Throughout, the official relief effort was callous, inept, and racist.

There was more suffering than need be.

Lives were lost that did not need to be lost.

Reprinted with permission from Socialist Worker at http://www.socialistworker.org where the article was first published. Karen Valenzuela, CHPPD member, read the article on a labor management listserv and suggested that it may be of interest to members.

Accountability and Reparations: A Public Health Response to Destruction in the Gulf Coast

As we grapple with horror, frustration, compassion and rage in the wake of Katrina, Americans must mobilize a call for both accountability and reparations. The abuses we are witnessing are deeply rooted in failures of policy and leadership that have undermined our social cohesion, our physical and public health infrastructures, our environmental and physical safety. It’s time for a policy agenda that revitalizes our nation.

Accountability. After the September 11 attacks we had no choice but to address our trauma as a nation. After Katrina, we watched innocent people die as a consequence of racism, poverty and inequality. We need a truth and reconciliation process that demands accountability from high officials who diverted funds from repairing New Orleans’ imperiled levees and into tax cuts and military adventures, as well as from individuals who blocked the path of fleeing citizens, turned away supplies, or separated families as though they were property. We have to name and confront these acts before we can move forward to punish, forgive and remedy.

Reparations. A program of reparations will be different on the Gulf Coast than it was in New York City, but the goal is the same: to make whole people and communities. Rebuilding the Gulf Coast offers the opportunity to rebuild lives and communities. Then as now, we must spend what it takes. Here is an initial list of some policies we need to implement:

Invest public dollars in lifting the community out of poverty. Give job preference to Gulf Coast residents who want to return home. Create physical structures, and a social and public health infrastructure, that support their lives. Our response must be more than another lucrative no-bid contract to Halliburton.

Provide publicly funded health care services, including mental health and social services, to the populations of Louisiana, Mississippi and Alabama. We don’t know the death toll yet, but it appears to be staggering. Treating and maintaining the community’s health needs will demand safe, effective and responsive health facilities. For those who choose to remain in their newly adopted communities, the task will be more complex. However they must be guaranteed access to health care during and after relocation.

Clean up the environmental pollution that created Cancer Alley in New Orleans.

Finally, support revitalizing the unique artistic and musical culture that flourished in the Gulf Coast and enriches our national life.

We must ask our fellow citizens and our leaders to articulate and expand on a program of Accountability and Reparations. Fundraising, while essential, is not enough. It is time for action.

Opportunities to help with Katrina Response

APHA has been working to connect members with opportunities for taking direct action in responding to the hurricane and providing links on how to contribute. Please visit http://www.apha.org/preparedness/Katrina_relief.htm for the latest information and opportunities. The Association has offered its assistance to federal officials and provided technical resources in the form of relevant APHA publications to relief teams and others.

Information regarding APHA’s New Orleans Partners

APHA will be contracting with several of the New Orleans partners for the meeting in Philadelphia. This includes the child-care provider, official photographer, florist and security vendor, who are all based in New Orleans.

Each year APHA designates a local charity from our host city to receive contributions from Annual Meeting attendees. This year's New Orleans-based charity is Bridge House, a long-term alcoholism and drug addiction treatment center. Bridge House will receive all contributions received to date. Since the hurricane has had widespread damage across the entire Gulf Coast, we're planning to broaden the reach of our contributions and are now coordinating donations during the time of our Annual Meeting on behalf of APHA to assist in the recovery and rebuilding efforts. APHA has made a lead contribution of $5,000 and has asked Annual Meeting attendees to join in contributing what they can.

Steele wins 2005 CHPPD Masters Student Abstract Submission Award

 
Natalie Steele won the 2005 CHPPD Masters Student Abstract Submission Award for "Peer-centered services for homeless youth: Creating effective systems." Natalie just completed her MPH degree in Health Administration and Policy from Portland State University, which is part of the larger Oregon MPH Program. Her research interests lie in continuous quality improvement and safety and health care finance, and her community interests center on access to quality health care and promoting prevention and healthy lifestyles. Since graduation, Natalie is working with the Oregon Department of Human Services' Office of Medical Assistance Programs (OMAP), as the quality improvement coordinator and contracts administrator. OMAP administers the Oregon Health Plan, an innovative program that operates Medicaid with expanded eligibility to provide medical assistance to more community members in need. Please stop by Natalie’s presentation to show her your support.

Vojvodic wins 2005 CHPPD Doctoral Student Abstract Submission Award

Rachel Westheimer Vojvodic, MPH 
Rachel Westheimer Vojvodic, MPH
Rachel Westheimer Vojvodic, MPH, is awarded the doctoral student abstract submission award for "Methods for analyzing emergency department use as an indicator of primary care access problems: Evidence from Houston, Texas." Rachel is a PhD student in the Management, Policy, and Community Health program at the University of Texas School of Public Health, where her research interests regard how health system structure and policies translate into the delivery of services. Rachel received her BS in health professions and health care administration from Texas State University, and her MPH in health services organization from the University of Texas School of Public Health. Unfortunately, Rachel will be unable to join us at the Annual Meeting in Philadelphia, due to her baby’s impending due date. But we wish her much luck with her new family and graduate work, and look forward to another excellent submission next year.

Cheryl Utter Awarded 2005 James R. Kimmey Award for Excellence in Health Planning Practice

 
Cheryl Utter, MS, MBA, manager of health program administration at the Monroe County Department of Health in New York, was nominated for her work in influencing and shaping useful Community Health Assessments in New York State. She is recognized for her ability to bring diverse groups together to work on a common purpose. Cheryl is active with the Health Action Committee in Monroe County, N.Y., and in local-state workgroups that advise on Community Health Assessment and Performance Management Workgroups. The Report Cards by the Health Action Committee in Monroe County is identified an example of good Community Health Assessment Practice.

CDC Assessment Initiative Awarded Blum Award for Excellence in Health

 
The CDC Assessment Initiative was nominated for creating linkages between health care and public health, and for maximizing resources. Since 1992, the Assessment Initiative has entered into cooperative agreements with 15 states to develop new systems and methods to improve how data are used in the public health policy- and decision-making process. The project’s budget of approximately $2.5 million currently funds seven states for a five-year period and also supports CDC project staff and an annual conference focused on practical issues relating to community health assessment practice, data access and data utilization. Specific examples of their activities include:

  • Using data to influence public heath policy:
    The Missouri Department of Health and Senior Services (DHSS) used Assessment Initiative funds to develop an integrated data warehouse and a web-based, interactive health data query system (http://www.health.state.mo.us/MICA/nojava.html). Among the users of this system was a report for a foundation that was in turn formed a basis for a statewide grant program. In 2002, data generated from this system was presented to the Missouri Health Foundation. The Foundation’s Board of Directors was tasked with identifying health priorities to form the basis for a statewide grant program.


  • Linking disparate data sets to understand public health issues:
    Assessment Initiative resources were used by the Oregon Department of Human Services to form a partnership with the state's Office of Medical Assistance Program (OMAP) to facilitate the availability and use of data on health risks, health status, preventive services, and clinical outcomes in the Medicaid population.


  • Using information to strengthen infrastructure and foster collaboration: Through the CDC Assessment Initiative, the New York State Department of Health developed an evaluation tool to rate the overall completeness and usability of community health assessments (CHA) completed by local health departments. One outcome of this process was the development of an electronic CHA Clearinghouse designed to share examples of promising assessment practices, CHA data sources/tools, and links to evidence-based community health practices. The Clearinghouse is available at: <http://www.health.state.ny.us/nysdoh/chac/index.htm>.

Poll results: CHPPD members like “Discussing ideas with other professionals

How members would like to be involved bar chart 
Bar chart showing how CHPPD members would like to involved in section activities
A Web survey was sent out in early August to Community Health Planning and Policy Development (CHPPD) Section members to assess their interest and needs in related to planning and policy development. Members were given two weeks to respond, and were informed that the first 100 responses would be counted as the CHPPD Section was trying out a free web survey service used. In all, 106 members responded within the two weeks. Of these 75 percent completed the survey on the first day, and 90 percent by the second day.

Members were asked three questions in the survey. They were:

  1. Why did you choose CHPPD as your primary section?

  2. If you were to be involved in an activity of your choice within CHPPD, what would it be?

  3. If you were put in a room with other community health planning and policy development professionals you don’t know, what in your opinion, is a good strategy to get to know them?


In addition, members were asked about their primary role in community health and/or health care, which region of the United States, or country outside the United States they worked in, and were invited to share any other comments.

The Findings


Academicians (26.3 percent, n=26) and Administrators (25.3 percent, n=25),were strongly represented among survey respondents, followed by educators/outreach coordinators (12 percent, n=12), students (9 percent, n=9), policy developers (8 percent, n=8), other (7 percent, n=7), and retired (2 percent, n=2). The Mid-Atlantic Region (27.3 percent, n=27) and West (22.2 percent, n=22) were strongly represented, and members from other regions Mid-West (14 percent, n=14), South (13 percent, n=13), Southwest (10 percent, n=10), West (22.2 percent, n=22) also responded. There were also two respondents from Canada.


  1. Of the 106 members who responded to the survey, 80.2 percent (n=85) chose the CHPPD as their primary section because they wanted to keep updated on health planning and policy information.

  2. Of the 98 members who responded to the second question, 64.3 percent (n=63) said they would like to be involved in discussing ideas with other professionals.

  3. In all, 47.1 percent (n=48) of the 102 members who responded to question 3 suggested that walking up to a colleague and asking them how they are involved in the field of community planning and policy development, in their opinion, is a good strategy to get to know them.


The detailed survey findings are posted on the CHPPD Web site at <http://www.ahpanet.org/CHPPD/>.

Next Steps


The CHPPD leadership committee members, at their Sept. 23 conference call, suggested that the Section Council members review the survey findings, and submit a response to the membership at the APHA Annual Meeting in Philadelphia. If CHPPD members would like to participate in the leadership committee conference call, please contact CHPPD Section Chair Tom Piper at <macquest@mac.com>.

Perinatal Data Available on the Web, a Free Resource from the March of Dimes

Pi Chart showing adequacy of prenatal care. 
Adequacy of prenatal care
The Perinatal Data Center at the March of Dimes offers the latest maternal and infant health-related data through PeriStats, http://www.marchofdimes.com/peristats. PeriStats is a free site that provides easy access to statistics on perterm birth, infant mortality, tobacco use, cesarean section rates and health insurance coverage. For many of these indicators, information is available by race, ethnicity, and maternal age. Data are available for the United States, states, major counties and cities and comparisons can be made across geographic areas. There are over 60,000 graphs, maps and tables on PeriStats. All data are referenced, provide concise bullet points for easy interpretation, and provide the related Healthy People 2010 objective. In addition, graphs, maps and tables are set up so you can easily copy them and place them in your own presentation.

PeriStats also provides some hard-to-find statistics such as the Adequacy of Prenatal Care Index. Users of PeriStats can easily copy charts and use them in their own presentations. PeriStats is a good resource for anyone looking for information on perinatal health. The information is useful for policy-makers and health planners at state, regional and local levels who need to understand maternal and infant health issues and be able to convey the information in simple, easy formats.

Through funding from the National Library of Medicine, National Institutes of Health, and in collaboration with the New York Academy of Medicine, PeriStats also allows users to search the PubMed/Medline database for literature on nearly fifty related maternal and infant health topics.

Future plans for PeriStats include updating the mortality and natality data in the fall when the new data are available and the addition of birth defects data. PeriStats also publishes an online newsletter with information on the latest data and research findings. Some of these findings will be presented at APHA Annual Meeting in December.

Joann Petrini, PhD, MPH, director of the Perinatal Data Center, will be doing an oral presentation titled “Quantifying the overlap between prematurity and birth defects.” The presentation will present the findings of research in which the overlap between birth defects and preterm births was quantified for 13 states, approximately 25 percent of all births in the United States. In addition, Joann will be doing a poster presentation on the “Financial costs of prematurity for business.” You can also meet other members of the Perinatal Data Center at a poster presentation titled “Preterm, near-term, and post-term: The changing distribution of gestational age” and learn about how gestational age has decreased and the impact on birthweight.

Citizens Health Care Working Group

The Citizens Health Care Working Group (CHCWG) is a national panel created by the 2003 Medicare law. Its charge is to engage Americans over the next two years in “a nationwide public debate about improving the health care system to provide every American with the ability to obtain quality, affordable, health care coverage.” In March 2005, it began its 2-year process of organizing public debate on how to get "Health Care that Works for All Americans." The Working Group will sponsor community meetings nationwide starting this fall as well as electronic means for public input. Its final recommendations are due out in the spring of 2007.

Questions posed by the Working Group for citizen input are:

  1. What health care benefits and services should be provided?

  2. How does the American public want health care delivered?

  3. How should health care coverage be financed?

  4. What trade-offs are the American public willing to make in either benefits or financing to ensure access to affordable, high quality health care coverage and services?



It is important that public health advocates participate in these community forums. The CHCWG meeting schedule has not yet been announced, but the first meeting is expected to be scheduled for the latter part of October, and meetings will likely continue through the first half of next year. The Working Group will develop a set of recommendations based on the feedback from community meetings on:

  • Health care coverage.

  • Ways to improve and strengthen the health care system.



Following a public comment period, the Working Group will submit a final set of recommendations to Congress and the President. Visit the Citizens Health Care Working Group Web site for more details.

Universal Health Care Explained

Remember the old saw about California, “If it’s going to happen, it will happen first in California?” That most populous of our states has been leading the way in many national trends for a long time now, so one wonders if it could now be a harbinger of the beginning of the first true universal health care system for the nation.

There have been parallels between California and the nation in this for at least 60 years. At about the time that President Truman was proposing to establish a national health care system, an idea shot down by the AMA, AHA, and Sen. Taft of Ohio among others, then Republican Governor (and later Chief Justice of the U.S. Supreme Court) Earl Warren was proposing it in California. Currently, State Sen. Sheila Kuehl (D-Santa Monica) is proposing single-payer legislation (SB 840) to provide a system in which the state government would provide health insurance to all.

Under this plan, the state’s residents would pay for their health care through their taxes instead of paying insurance premiums, and health insurance would no longer be sold in the state. That alone would excise an enormous cost from the state’s health care burden. As for hospitals and other providers, they would once again be paid under fee-for-service, an arrangement they should like better than being subject to so many administratively differing health plans. And the efficiency of having just one system with greatly reduced administrative costs (planning replaces marketing) and tremendous purchasing power over pharmaceuticals, medical devices, supplies, and equipment, would result in an affordable system covering everyone. Of course, its ability to truly cover everyone, and its ability to expend its resources on prevention and public health rather than on the profit motive, is what inspires those of us who still have the public interest at heart, and see health care as a right. In this view, it is fitting that individual means should be translated into the public purchasing power that can work for the public good, but that good will only be realized if legislators’ oversight of all the program’s parameters provides for continued commitment to those principles under which the program was originally established.

While advancing these ideas, it must also be admitted that government-run programs are always subject to all the pitfalls of politics. Like all government, this too must be government by the people, for the people. That means that it will work only so long as the people’s eternal vigilance provides the accountability to make government service a moral imperative. And in an era when “public” has been denigrated and “private” oversold, and taxes abhorred in favor of paying more out of individual motivation and discretion, it will be easy for conservatives and the private sector to instill fear in voters just as they did with the Clinton Plan in 1994, and also with another single-payer legislative initiative that failed in California at the same time.

Computing Cost Savings/Affordability



The National Coalition on Health Care (NCHC) has studied various scenarios for providing universal health care and has analyzed four of them intensively.

  1. Employer mandate supplemented by individual mandates where necessary.

  2. Expansion of existing programs that currently provide coverage to defined populations.

  3. Development of a new program modeled after the Federal Employees Health Benefit Program (FEHBP).

  4. A universal, publicly financed, single-payer program.



All four approaches to universal health care would result in overall cost savings nationally out of the same efficiencies California wishes to realize. The NCHC employed Professor Kenneth Thorpe of Emory University to compute the savings that would be projected to accrue from operationalizing each plan. Thorpe projected that the cost savings in each plan’s tenth year (2015) would range from $125 billion to $182 billion. He also made projections for the total change in spending (i.e., the cumulative savings) for each in comparison with the nation’s present “system” for the years 2006 through 2015, and came up with the following figures:

  1. $320 billion reduction.

  2. $320 billion reduction.

  3. $370 billion reduction.

  4. $1,136 billion ($1.136 trillion) reduction.



These net savings accrue even after taking into account the increases in federal spending needed to secure universal coverage. The Thorpe report summarizes the impact of these plans on national health care spending as follows:

System-wide health care reform, along the lines that the Coalition’s specifications envision, would produce substantial reductions in national health care spending — reductions that would begin soon after reforms were phased in and that would increase over time.

As projected by the Centers for Medicare and Medicaid Services, national health care spending would be expected to rise under current law — that is, in the absence of major health care reform — from nearly $2.1 trillion in 2006 to more than $3.8 trillion in 2015. That means that the proportion of our gross domestic product devoted to health care spending would jump from about 15.6 percent now to 19 percent in 2015 — an increase of 3.4 percentage points. (On p.12 of the Thorpe report).


Public Health vs. the Profit Motive



Universal Health Care can be more than just efficient in its use of public resources. It can serve the greatest good by taking two more radical steps.

  • Adopting a public health model for its goals and priorities.

  • Eliminating the profit motive from health care.



Making public health a national priority means empowering communities to support the best possible health status for everyone in them. This gives us a set of imperatives sorely missing from today’s health care: To provide health education as a fundamental part of everyone’s right to public education so that they may become promoters of their own wellness; to foster health promotion, primary care, and disease prevention; and to enable all community members to understand and participate in public forums on health policy.

The principles of compassion, fairness and social justice that define public health are incompatible with the profit motive in health care. Rather, the resources taken out of the community to fund health care should be returned as benefits to the community.


This article is also posted at http://www.ahpanet.org/Health_policies.html#Universal.

Upcoming Events

Oct. 15, 1st Greenwich Multicultural Health & Heritage Fair in Greenwich, Conn.:
The Community Health Planning Office of the Greenwich Department of Health in Greenwich, Conn., is chairing a town-wide collaborative venture to bring a variety of health, health screening opportunities and multilingual health information to the community. For more information, contact Stephanie R. Paulmeno, MS RN,C. NHA at <spaulmeno@greenwichct.org>.

Dec. 1-3, 4th International Community Indicators Conference in Burlington, Vt.: This conference will help channel energy toward these initiatives and the 4th International Conference will focus on:

  1. New information and technology tools.

  2. The current effort to produce a set of Key National Indicators.

  3. Integration of community indicators work with local government performance measurement.

  4. The successes and future opportunities in using indicators of children’s well being and family health.

  5. Refined indicators that help measure and promote decisions on public health, sustainability and community improvement.

  6. The need to understand, highlight models, and provide training on productive USE of community indicators.



For more information, contact Ken Jones, coordinator for the Community Indicators Consortium at (802) 229-607, or <kjones@gmied.org>.


Dec. 8-9, First Annual Nemours Conference on Child Health Promotion in Wilmington, Del.: Additional information on some of our speakers is available at http://www.nemours.org/internet?url=no/nhpec/conference.html. For more information contact Tavanya Giles, MPH, CHES, at <tgiles@nemours.org>.

Reports Released

Reports on South Eastern Pennsylvania's Uninsured and Asian Health:
Since 1983, the Community Health Data Base (CHDB) has provided local health and social services organizations with local, population-based data for health and social service planning, policy and program development. The CHDB is a critical resource for area health and social service agencies and is the only database of its kind, not only in the Delaware Valley, but nationally as well. The central component of the CHDB is the Southeastern Pennsylvania Household Health Survey. The survey has been conducted nine times since its inception – in 1983, 1987, 1991, 1994, 1996, 1998, 2000, 2002, 2004. The next survey will be conducted in the summer of 2006. This year, the CHDB produced two reports examining vulnerable populations in the region. Both reports utilize the most recent data available from Philadephia Health Management Corporation's (PHMC) 2004 Southeastern Pennsylvania Household Health Survey.

The reports are:


  • The Uninsured In Southeastern Pennsylvania

  • An Exploration of Asian Health in Southeastern Pennsylvania

The reports can be viewed at <www.phmc.org/chdb>. To learn more about CHDB, contact Francine Axler at <Francine@phmc.org> or (215) 985-2521.


Healthy Iowans 2010 Mid-Course Review Released and other updates:
More than 400 Iowans, representing about 200 organizations, were involved in revising and updating Iowa’s state health plan, Healthy Iowans 2010.  Healthy Iowans 2010 Mid-Course Revision is on the Iowa Department of Public Health Web site:  <www.idph.state.ia.us>.  To obtain a CD ROM, contact Dr. Louise Lex, Iowa Department of Public Health, at <llex@idph.state.ia.us>. Presentations from the recent Governor’s Conference on Public Health: Barn Raising V Conference, held July 28-29, are on the event’s Web site: <www.thehealthconference.org>. FITNET, a daily e-mail message about staying healthy in mind, body, and spirit, reaches well over 350,000 people.   To receive the message, send an e-mail to Tim Lane at <tlane@idph.state.ia.us>.

$20,000 Allocated for Award Winners of Best Community Indicators Project

The Community Indicators Consortium with the Brookings Institution - Urban Markets Initiative, are looking for the Best Community Indicators projects to highlight and reward at the Dec. 1-3, 2005 4th Annual Community Indicators Conference in Burlington, Vt.

A panel of reviewers will evaluate each nomination to identify those indicators projects that have been the most effective in triggering change in their communities. Courtesy of the Urban Markets Initiative, $20,000 is available to be allocated to awards winners. The number and size of the awards will be determined by the quality of the nominations. The top three winners also will receive a travel stipend to attend the conference; in addition, each winner will receive free conference registration.

Book Review: Urban Sprawl and Public Health

Urban Sprawl and Public Health: Designing, Planning, and Building for Healthy Communities
by Howard Frumkin, Lawrence Frank, & Richard Jackson


What is sprawl? And what does it have to do with health? The two physicians (Jackson and Frumkin, both APHA members) and landscape architect/transportation planner (Frank) who teamed up to write this book present case after case of the impact our planned, built environment has on health, and argue persuasively that it’s time for a closer look at our communities through a much different lens. It is accepted both as a belief based on common sense and policy based on evidence that the places we live, work and play have a great deal to do with how we feel, emotionally and physically.

The word sprawl invokes a host of negative associations when applied to describing where we live and work. Quickly, cheaply built large subdivisions of homogenously designed homes in an otherwise largely rural area with no basic services – schools, groceries, library, stores — anywhere near enough to get to without a car. A decade ago, James Kunstler wrote in The Geography of Nowhere: The Rise and Decline of America’s Man-made Landscape that sprawl is “depressing, brutal, ugly, unhealthy and spiritually degrading.” Sprawl is credited with the demise of American cities as the heavily tax subsidized highway system allowed families to live in ever greater numbers in the burgeoning suburbs while the main wage-earner commuted ever-longer distances daily to a job in the city. The majority of the book provides chapter-by-chapter details of the health effects of sprawl, everything from reduced physical activity as peoples’ auto-dependence consumes several hours each day in driving, to how this compromises mental health, increases the pollutants people breath, and even reduces ‘social capital,’ defined as peoples’ sense of connection with one another and their willingness to voluntarily reciprocate in the life and needs of community. The authors present a cogent and heartrending picture of the increasing isolation of people who travel mostly in their single occupancy vehicle, leaving their homes each day from garages with electric doors, rarely knowing let alone socializing with neighbors or depending on or helping them in times of need. All of this, they say, is brought about by the ways in which our built environment obstructs our social interactions with one another. Instead, they argue, imagine communities that provide places that nurture and promote interactions both socially and with nature.

The book is meant to appeal to a wide audience of designers, urban planners, architects, health care providers, public health professionals, public officials and anyone who understands the power of both place and sense of community in the health of individuals and the communities in which they live.

Eight years into my own career in public health, I stumbled –reluctantly initially — into the role of city planning commissioner at the suggestion of the mayor of my small city. A non-public health friend whose advice I valued insisted that my misgivings about “knowing nothing about planning” were far less important than my credentials as a public health professional, a perspective he knew to be absent and yet completely necessary for a more rational approach to urban and community design. Graduating to City Council four years later, I had to marvel at my friend’s accurate instinct: public health became a major source of information and the compass that guides and informs my votes about zoning, land use, annexations, parks and trails, capital facilities projects –the host of decisions and planning that are local government officials’ daily fare. Though my community has a way to go yet to achieve the density, walkability, bikeability, transit-centered, civically oriented and socially cohesive place I envision with most of the services we need close by provided by locally owned businesses, it’s much closer than when I started.

In a recent interview with Northwest Public Health (spring 2005), Howard Frumkin heralded the traditional convening function of public health as a way to get community dialogue going about improving a community’s safety, attractiveness, sustainability and health. Local governments also try to do this! We begged for citizen input throughout the four-year planning process for our town center. I believe our eventual plan was significantly improved by what we heard from people in our community. It seems to me public health in particular could be of great help as city councils consider questions of community development, sustainability, safety and what creates the strong ‘sense of place’ that inspires civic pride, engagement and attachment to community.

Significantly, Urban Sprawl and Public Health was published by Island Press, a 20-year-old non-profit whose principal purpose is the publication of books on environmental issues and natural resource management. As a growing number of public health professionals recognize the interdependence between our work and that of others in fields with which we haven’t traditionally worked, the audience for this expanding literature on the impacts of the built environment can only expand as well, which is a very good thing for all of us.

By Karen Valenzuela, a member of APHA’s Executive Board who is serving her sixth year as a member of the Tumwater City Council in Washington state. She works for the Washington WIC Program.

Letters to the Editor

Enjoyed Steen's article Universal Health Care Revisited in Spring 2005 issue


CAPITAL edition of our Section (Spring 2005) newsletter --thanks to you both! I particularly enjoyed John Steen's article on Universal Healthcare Revisited......The new Working Group on Trade & Health has planned a plenary and two scientific sessions on the topic for the Annual Meeting in New Orleans.

Karen Valenzuela, Executive Board Liaison

YMCA Activate America expanded to 34 cities

I wanted to bring your attention to an important announcement about the advancement of the YMCA Activate America: Pioneering Healthier Communities Project, a grassroots mobilization of communities to respond to the public health challenge of obesity and physical inactivity. One year after launching the Project, YMCA of the USA, the expansion of the initiative to 20 additional communities, spreading the movement to 34 cities. Combined with the earlier 14 participants, these newly named communities are forming the foundation of an aggressive social movement that is mobilizing leaders in communities to respond to public health issues. For more information, visit http://www.ymca.net/activateamerica

Julie Grandstaff, Account Coordinator, Stanton Crenshaw Communications, <jgrandstaff@stantoncrenshaw.com>