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Community Health Planning and Policy Development
Section Newsletter
Fall 2006

From the CHPPD Chair: The Glory of Fall

 
Fall Flower in bloom
The breathtaking beauty of autumn flowers are a fitting tribute to the wonderful summer we have enjoyed, and the promise of harvest ahead. It is a time to prepare for our annual pilgrimage to the APHA conference. This year, Boston is our host, and we have so much to plan for.


My message is short and to the point: come to Boston, join your friends and colleagues in our CHPPD Section, make new friends and expand your network. Set aside Nov. 5-8, 2006, and make the trip. We will make it worth your time, resources and effort. Here are the times and locations of the CHPPD business meetings.


Sunday, Nov. 5, 2006

10:00 a.m.-11:30 a.m., Boston Convention Center (BCC) 261
219.0 CHPPD: New Member Orientation and Policy Development

2:00 p.m.-3:30 p.m., BCC 207
231.1 CHPPD: Nominations and candidates

4:00 p.m.-5:30 p.m., BCC 150
261.0 CHPPD: Section Council, Planning, Other


5:30 p.m.-7:00 p.m., BCC Exhibit Hall
CHPPD: New Connections

Monday, Nov. 6, 2006

6:30 p.m.-8:00 p.m., BCC 158

330.0 CHPPD: Social Hour, Networking and Awards

Please visit http://apha.confex.com/apha/134am/techprogram/ for a detailed description of all APHA sessions, their times and locations. Visit our Web site at http://www.chppd.org for more information, or contact me. See you in Boston.

CHPPD Collaborating with Sections on Survey for Volunteering in Emergency Response

The Community Health Planning and Policy Development Section is working with several sections on a brief survey available at http://www.surveymonkey.com/s.asp?u=356542615966 through Oct. 10, 2006. It is intended to elicit feedback from public health practitioners regarding their attitudes and perceptions regarding volunteering to provide medical or public health services as an individual in a professional role for emergency response, especially when deployed away from one’s home state. This information will help inform the debate around language to be included in the “Uniform Emergency Volunteer Healthcare Practitioner Act” (UEVHPA).


The other APHA sections involved are: Alcohol, Tobacco and other Drugs; Public Health Education and Health Promotion; Oral Health; Medical Care; and International Health. For questions about the “Uniform Emergency Volunteer Healthcare Practitioner Act” (UEVHPA), please contact James G. Hodge Jr., JD, LLM at (410) 955-7624 or jhodge@jhsph.edu. For questions about the survey, please contact Sue Myers, CHPPD Chair Elect at (412) 725-4619 or myers@telerama.com.

More Than Half of CHPPD Members Do Not Know How to Get Involved With Section

When asked, “What are the reasons for not being actively involved in CHPPD or APHA activities?” 55 percent of survey respondents said, “I do not know that such opportunities are available to me”. Among the suggestions for getting members more engaged are: “Offer some unique, short-term opportunities to participate”; “More focus on policy issues whether federal, state or local levels. Some international perspectives as well.”; and “I need a Maine network. Who in Maine belongs to this section?” There are 71 responses, enough to keep the CHPPD Section busy for a year.


About 62 percent of the 117 respondents indicated that they would be willing to take on a role of facilitating an activity alone or with a colleague; 38 percent were not willing to take a lead role either because they are too new, or have other priorities. Several respondents indicated lack of time as a barrier for involvement in Section activities.


In all, 132 CHPPD members, or 9 percent of CHPPD members, completed the survey. Of these respondents, 54 percent are currently active in CHPPD Section or APHA activities, 46 percent percent are not currently active. Survey respondents were from almost all regions of the United States, and there were a couple of international members who responded as well. Respondents’ professional activities span all 28 Healthy People 2010 focus areas, as well as all 10 of the Essential Public Health Services.


For more detailed survey results, please visit the CHPPD Web site at http://www.chppd.org, or http://www.surveymonkey.com/Report.asp?U=238795338166.

Would You be Interested in Staffing CHPPD Booth No. 103?

Chair-Elect Sue Myers is coordinating sign-up of the CHPPD Booth 103 at the Annual Meeting in Boston. The times available are listed below. Please e-mail Sue at myers@telerama.com the preferred date and time that you would like to staff the booth, and include your e-mail address.

CHPPD Booth will be staffed at the following times:
Sunday, Nov. 5
Set up at noon, 12 - 3 p.m. and 3 - 6 p.m.
Monday, Nov.  6
9 a.m. - 12 p.m.; 12 p.m. - 3 p.m. & 3 - 6 p.m.
Tuesday, Nov. 7
9 a.m. - 12 p.m.; 12 p.m. - 3 p.m. & 3 - 6 p.m.
Wednesday, Nov.  8
9 a.m. - 12 p.m.; Take down at noon

Hodge Awarded the Blum Award for Excellence in Health Policy

 
James G. Hodge, Jr., JD, LLM
James G. Hodge, Jr., JD, LLM
James G. Hodge, Jr., JD, LLM, is awarded the Henrik L. Blum Award for his outstanding contributions to the field of public health law, specifically for his leadership as a chief architect and facilitator for the “Turning Point Model State Public Health Act” project, funded by the esteemed Robert Wood Johnson Foundation.     

Over a period of three years, from 1999-2001, Hodge and the “Turning Point Public Health Statute Modernization National Collaborative” created for the first comprehensive model public health law.  In these days of increased public health threats of bioterrorism, pandemic flu and chronic disease, and given the fact that while states have broad constitutional powers, they have all over time developed a number of locally drafted, fragmented responses to local aspects of regional or national issues, the rationale for such an undertaking was abundantly clear.   


 

From a health planning perspective, a model public health framework is perhaps the most essential contribution as laws provide the mission, functions, and powers of health agencies, sets standards for their (and their partners’) actions, and safeguard individual rights. This award recognizes the significance of the drafting of this Model Act; more importantly, it celebrates the high degree it has been accepted, embraced and utilized by states. To date, subject matter or specific language of the Model Act has been introduced in whole or part through 79 bills, in 32 states; 37, or about half, of these bills have passed.  Moreover, 37 states and territories have passed bills or resolutions, which are closely aligned with the Model Act. The work of creating this Model Act was funded by the Robert Wood Johnson Foundation and conducted as a part of the activities of the Center for Law and the Public’s Health at Georgetown and Johns Hopkins Universities: a CDC Collaborating Center Promoting Health through Law; and a WHO/PAHO Collaborating Center on Public Health Law and Human Rights.  Other key collaborators for the Model Act were Larry Gostin, JD, LLD (Hon); Kristine Gebbie, PhD, FAAN; and Deborah Erickson.

Borders, Malekafzali are 2006 CHPPD Student Abstract Submission Award Winners

The Community Health Planning and Policy Development Section is pleased to announce the 2006 winners of the first annual student abstract submission awards. Please join us in congratulating these students, as they received excellent scores through the blind abstract review process. They will be presented with their awards at the CHPPD Social Hour on Monday night of the Annual Meeting in Boston.


 
Steve Borders win PhD student award
Steve Borders win PhD student award
The Doctoral Student Award has been awarded to Stephen Borders, PhD, for his abstract entitled "Non-emergency medical transportation: A multi-dimensional look at this access barrier." Stephen recently received his PhD in May of 2006 from Texas A&M in health systems planning. In his dissertation, he examined transportation barriers to preventive care services in the Texas Medicaid program. Today, Stephen is one of the newest faculty members of the School of Public and Nonprofit Administration at Grand Valley State University, where he teaches health policy, financial management, and research methods. In addition, Stephen also recently received a $60,000 grant from the Michigan Department of Community Health to establish and update new practice standards and coordinate for the regionalized perinatal system in Michigan. He has also recently published a paper on the public health work force in Human Resources for Health.


 
Shireen Malekafzali wins Masters Student Award
Shireen Malekafzali wins Masters Student Award
The Masters Student Award this year was awarded to Shireen Malekafzali, BS, for her abstract "Developing healthier land use policies through community planning and partnership: Case study of the Eastern Neighborhoods Community Health Impact Assessment." Shireen is in her last year as an MPH student at San Francisco State University, where she specializes in both urban and rural environmental health and justice issues. Currently she works as a research associate at the San Francisco Department of Public Health. Her work is focused on a community health impact assessment, which aims to develop a more equitable model of civic participation and incorporate a more holistic health perspective in land use planning. With a Bachelor of Science in environmental studies, Shireen's work is grounded in a holistic, ecological approach, while her passion for social justice helps form her perspective.

Hansen’s Disease, Health Insurance Among the 60 Featured Sessions at the Boston Annual Meeting

In light of the theme Public Health and Human Rights, we have an invited session on the historical issues of Hansen's Disease (leprosy), and an entire poster session # 3078.5 on Monday, Nov. 6 at 10:30 devoted to this issue. The poster session will be portions of the exhibit from the New England Public Health Museum temporarily moved to the APHA Annual Meeting. I hope all our Section members will get a chance to visit this unusual exhibit.


This year we have more sessions than ever before. Our final tallies are: 60 sessions total; 10 poster sessions; and 50 oral sessions. The oral session include five round tables, 15 invited sessions (two are AHPA sessions) and 30 contributed scientific sessions.

We continue to have many sessions on Methodological Techniques and Tools Utilized in Health Care Planning, Policy Development and Evaluation. More and more of these sessions include the new technologies of mapping and the use of Internet tools. There are sessions addressing all the issues of accessing care, whether it is a matter of disparities due to race, ethnicity, language, insurance or economics. We will have sessions on partnerships, nutrition and chronic diseases. This year in addition to our usual topics, there are many sessions addressing the issues of disasters. Some sessions look back on how past disasters were handled, and others address the need to prepare for and meet the needs of disasters due to natural causes (hurricanes, floods), or bioterrorism and pandemics.

Of special interest to some of our section members may be the session # 3301 on Monday, Nov. 6, at 2:30 p.m. titled Providing Insurance and Removing Barriers to Health Care for the Uninsured. There is an abstract by Michael Doonan on the new health care law in Massachusetts. He worked on drafting it and seeing it through the legislature. John McDonough will be speaking at the closing session on this law as well. Many thanks to all the Section members who helped in putting this program together.

Mountains Beyond Mountains About Keynote Speaker Paul Farmer is Timely Suggestion in CHPPD Reading Club


 
"Mountains beyond mountains" book cover
In the CHPPD Reading Club, Karen Valenzuela, the CHPPD liaison to the APHA Executive Board  writes: "For the few left among us who haven't yet read this wonderful and inspiring book about a true public health hero in our midst, now is the time! Dr. Paul Farmer, the subject of the book, has been confirmed as the opening keynote speaker at our Annual Meeting in Boston later this year. Knowing about his life's work as Tracy Kidder so richly details it will no doubt enhance his message considerably. For a brief review in the Washington State Public Health Association newsletter, see
http://www.wspha.org/wspha_winter_2005_newsletter.pdf."


In the Washington State Public Health Association newsletter review of the book, Karen writes, "It is masterfuly written by award-winning writer and documentarian Tracy Kidder, chronicling the life and work of Farmer in the impoverished community of Cange, Haiti, during and after the reign of Baby Doc Duvalier."

Paul Farmer, MD, PhD, is a well-known leader in health and human rights. Farmer is a founding director of Partners in Health, an international organization that tackles issues around the globe, including AIDS and women’s health in urban Massachusetts, as well as tuberculosis treatment in the prisons of Siberia, Russia. A medical director of a clinic in rural Haiti as well as an attending physician at the Brigham and Women’s Hospital in Boston, Farmer has worked in infectious disease control for nearly two decades and is an authority on AIDS and tuberculosis. He will be joined by a longtime advocate for human rights Helene Gayle, the former director of the Centers for Disease Control and Prevention’s National Center for HIV, STD and TB Prevention and former director of HIV, tuberculosis and reproductive health at the Bill & Melinda Gates Foundation.


 
Reading "mountains" on Acadia, Maine
Reading "mountains" on Acadia, Maine's carriage road
I did read the book on Karen’s suggestion, and it is indeed fascinating. He started working in Haiti when he was 23 years old. His family was not wealthy, and growing up, he lived with his family out of a trailer. I was as fascinated by the friends he made on the way. Ophelia Dahl, author Roald Dahl’s daughter, now manages his the non-profit organization "Partners in Health" that they founded along with Jim Kim, a classmate from Harvard Medical School. It was fascinating to Tom White, a large-hearted Boston business who financed their humanitarian efforts till his money ran out, and his wife Didi who was studying anthropology in Paris when the book was written. The characters are endearing. The book is a lesson about how a small team of dedicated people can make a difference in the world.

Writing an APHA Resolution? KISS

Last fall, I listened carefully to what members of the Joint Policy Committee had to say at the special session on writing APHA position papers or resolutions at the Annual Meeting in Philadelphia. The emphasis was on the paper being well-researched, thoughtful and well-referenced. I reviewed the information on the Web site that discussed the differences between a position paper and a resolution, and read Kathy Witgert’s article in the Winter issue of our newsletter.  The result – in January of this year, I wrote a 19-page position paper with more than 60 references on “Evaluating Community Health Assessments.” After two revisions, I have a much shorter four-page paper titled “Conduct research on to build an evidence-based of effective community health assessment practice” with 40 references.  What I learned from my first experience with writing for APHA is:


  1. Keep in Short Stupid (KISS).  In my first version of the position paper, I explained community health assessment, frameworks, and process, and in the revised version, I only mentioned the process, implying those interested in learning more should read the references. I would suggest that APHA's Joint Policy Council recommend a reasonable page limit.
  2. There is a preference for resolutions, which are more action-oriented, than position statements.
  3. Recommendations should be listed at the end, rather than in the beginning.
  4. It is helpful to get buy-in from other sections, and the time to get that is before the Annual Meeting so you can enlist members to be co-authors at the Annual Meeting.
  5. You can build momentum and excitement if you can build on a current policy activity. As an example of one method of supporting evaluation of community health assessments, I have suggested the legislation exemplified in S.2506/H.R.5088 which calls for assessing the health impact of the built environment on children’s health.
  6. Confirm that the latest versions of the paper are posted online.

Many thanks to Charles Tresser, Debbie Hettler and Harry Perlstadt for helping with the editing and reviewing process. There are 20 resolutions in four categories in areas related to “health disparities”, “environmental and occupational health”, “access to care”, and “public health science and infrastructure” being considered this year. The resolutions, that can be accessed by APHA members, are at http://www.apha.org/private/2006_proposed_policies/2006_policies.htm

One State’s Workable Plan for Reaching Vulnerable Populations in Widespread Emergencies

A fundamental paradox underlies planning to identify and reach vulnerable populations in a widespread emergency. The paradox is that identifying special populations and their needs requires resources that are available mostly to over-arching organizations, such as states, but only a local community can really understand and reach its own special populations. The paradox is compounded by the demands of daily public health work, and lack of staff and lack of funding often prevents comprehensive planning at every level.


State level planners are usually sufficiently removed from local exigencies that most statewide plans do not include special or vulnerable populations, with the sometime exceptions of translations into Spanish. Yet state level planning is key to enabling a process that can help at the local level in counties and municipalities.


An ongoing discussion in public health communication has been the jurisdictional level at which effective planning can take place. Most citizens assume that "government" planning permeates every level of federal, state and local activity. But public health professionals know that planning can and should take different forms to various community needs. The best results come from cooperative efforts.


 
Kelly Reinhardt of Jane Mobley Associates conducti
Kelly Reinhardt of Jane Mobley Associates conducting a workshop
An excellent example is the Commonwealth of Kentucky's Cabinet for Health and Family Services/Department for Public Health, which decided to develop a state-led planning process with localized components and the goal of being able to reach everyone in Kentucky if a widespread emergency should dictate.


It is an ambition thrown into dramatic relief by recent disasters. Images that dominated the media in the aftermath of Hurricane Katrina shocked a nation that had imagined its governments at every level were prepared for most widespread emergencies – if not terror, then at least weather-related events. The ugly reality of Katrina revealed that the most vulnerable people – poor, sick, aged, mentally or physically challenged or others outside the channels of mainstream communication – were disadvantaged in the broadest sense of the word. At the same time, the communication failures around Katrina underscored the widely broadcast recognition that communication gaps or errors have continued to plague response to terror events in America in the past five years – notably the events surrounding September 11, 2001, as well as the anthrax attacks that followed.


By now it is clear that communication is an element of emergency preparedness that has not uniformly received the priority focus required to reach all citizens effectively with information they can use to help themselves and others. Combining the broad-based requirements of public health crisis and risk communication planning -- "Be First. Be Right. Be Credible." -- with the localized challenges of identifying and reaching special populations is daunting.


Few planning models exist, and much of the information about effective communication activities is anecdotal and limited to event-specific experiences in particular locations. But debate about whether preparedness communication planning at a state level can really make a difference in individual/local communities was set aside in Kentucky, and the project begun because Kentucky's DPH decided that state level planning for vulnerable populations not only could make a difference for communities statewide, it had to.


Why? Much of Kentucky's population can be considered "vulnerable." By national standards, Kentucky's population is disproportionately poor; moreover, the state is home to an increasing population of limited- or non-English speaking residents, as well as comparatively high numbers of migrant workers, residents who are disabled and a growing elder population. The rural areas of Kentucky are legendary for their difficult topography and remoteness from modern services. Kentucky needed planning to reach those populations with actionable information simply to meet a baseline of emergency readiness set by the state Commissioner of Public Health in 2001: "to process large numbers of sick people, whatever the reason."


The Kentucky results thus far include:



  • an accessible body of knowledge about people living in the state, both vulnerable and mainstream residents: how they get information, whom they trust, what triggers their action-related decisions in health emergencies;
  • a developing database of community outreach resources that augments the state Health Alert Network;
  • a growing volunteer "safety net" of resource people trusted by different populations (e.g. deaf, Hispanic, remote rural);
  • closer connections with traditional and non-traditional media outlets throughout the state;
  • collateral materials that support the planning initiative and raise public awareness of Kentucky Department for Public Health and emergency preparedness;
  • successful use of some elements of the plan for events such as ice storms, Monkey Pox and hurricane aid; and
  • future phases to continue the work into increasingly localized settings in cities, towns and rural areas.

Perhaps the most important lesson of the process to date has been the recognition of the gap between "preparedness authorities" (elected and appointed officials, health and emergency professionals, the media) and the public at large. While excellent planning has linked agencies, health and emergency services providers and many levels of government, the links stopped there in terms of communication planning. Research confirms that this is true in many states. In general, comprehensive emergency planning has been designed to connect authorities, agencies and providers – but little has been done to build an operational, connected network from this top level to the ground level.


Kentucky now has in place a statewide database -- a community outreach information network (in Kentucky called the KOIN) -- designed to operate during an extended power outage and focused on reaching vulnerable populations . This state has taken a leadership role in building the connections needed to create a safety net for all its citizens, as well as providing an emergency communications preparedness model of effective collaboration across all jurisdictions, deep into communities and neighborhoods.

Victoria Houston is a Senior Associate with Jane Mobley Associates, a Kansas City-based community outreach firm. JMA was engaged in 2002 by the Kentucky Cabinet for Health Services to create a plan for reaching special populations and has received successive grants to implement the plan, creating and building the KOIN network, conducting training and exercises and producing supporting materials. JMA specializes in the critical infrastructures of health, emergency preparedness, water, and transportation, providing verbal and visual messages, media management, group process, and community development to help jurisdictions, institutions and public-serving organizations develop and implement research-based strategy around inclusive communication. Recently the firm completed The Workbook for Identifying, Locating and Reaching Special Populations for the Centers for Disease Control and Prevention. The workbook is available to download from the Web, formatted and ready to print, at http://www.bt.cdc.gov/workbook.

Public Policy and the Obesity Epidemic: A Provider's Perspective

 
Age-adjusted prevalence of overweight and obesity
Age-adjusted prevalence of overweight and obesity among U.S. adults, age 20-74*
Given the realistic fiscal limits of funding the U.S. health care system, it is important that resources be directed towards the most cost effective measures to improve the public health. Public attention towards reducing the prevalence of obesity is one area that promises significant benefits if it can be achieved. Obesity is associated with significant health risk and increases the prevalence of diabetes, hypertension, cardiovascular disease, gallbladder disease and arthritis. Over the past few decades, the prevalence of obesity in the United States has progressively increased with the proportion of persons with a BMI of >25.0, rising from 47.1 percent in the 1970s to 66.2 perent in 2004 and doubling of the levels of obese persons with a BMI of >30.0 from 15 percent to 32.9 percent, respectively. There is much debate as to the cause of this epidemic, including the increase in consumption of high caloric food and drink and the reduction in physical activity. Likewise, there is much debate over the solution and means of both prevention of the development of newly obese individuals and the means of helping already obese individuals to reduce their body mass index.


An effective solution must be firmly based in a realistic understanding of physiology, human nature and an understanding of the economic impact of public policy on both industries and individuals.


First, consider the reality of human physiology. The human body is designed to sustain periods of plenty and periods of scarcity as occurs in the normal seasonal cycles of nature. We are therefore designed to eat whenever food is available and to store excess calories for use as energy when food is unavailable. Therein lies the first problem -- food is rarely unavailable in American society.


Furthermore, the human body operates as efficiently as possible. Since the most efficient source of energy is to burn carbohydrates, these will always be consumed by the body first. Excess calories not immediately required for consumption will be stored as fat for later use. Herein rests the problem: as long as there is sufficient dietary consumption of carbohydrates to meet our caloric expenditures, we will not use stored fat reserves.


Next, consider human nature. The development of self discipline is a challenge for most people. Virtually everyone has some areas of life in which they have difficulty with self control. While self discipline should be nurtured, it is time we accepted the fact that for most people, perpetual self discipline in a social environment that does not support healthy choices is extremely difficult.


Finally, consider the economic factors which influence our dietary choices. On the industry side, fat, sugar and salt are added to food primarily for two reasons, to satisfy consumer preference and to prolong shelf life. Both of these factors (high consumption and prolonged shelf life) contribute to the ability of the food industry to offer these foods at a lower price. On the consumer side, the affordability of these foods as well as societal norms and acquired taste preferences contribute to increased consumption, particularly in lower socioeconomic populations.


In view of these considerations, public policy should be directed towards supporting healthier consumer choices with regard to diet and exercise. One important aspect should include financial subsidies for fresh foods and taxes on highly processed foods, particularly those containing excessive amounts of fat and refined carbohydrate. This would remove some of the existing economic barriers to making better dietary choices for both industry and consumers. Just as we would not expect the population to individually boil or filter their water supply in order to provide clean water, it is unrealistic to expect the population to regulate diet and exercise through solely individual efforts. Exercise could be encouraged by local and regional planning and government subsidies for neighborhood walkways and "no drive" areas in central business districts. Similarly, employers and schools should be encouraged to remove foods that contribute to obesity from vending machines and cafeterias and replace them with healthier choices to help people increase dietary compliance and develop healthier food preference. Public policy should focus on ways of aligning financial incentives with health-promoting behavior for both communities and individuals.

Health Planning's Beginning: A Tribute to Dr. Henrik Blum

 
Dr. Henrik Blum. Photo courtesy of Berkeley News.
Dr. Henrik Blum. Photo courtesy of Berkeley News.
In the last newsletter, I provided a brief account of some of the late Dr. Henrik Blum's contributions to public health, including his role in fostering community health planning, notably through the Orange County Health Planning Council, and the Western Center for Health Planning in San Francisco. His approach was to see the community itself as his patient. He is known at Berkeley as "The Father of Health Planning," and was surely its most devoted mentor. Along with Dr. Herman Hilleboe, Dr. Leonard S. Rosenfeld, Robert M. Sigmond and others, he first outlined the principles and methods we know as health planning some 40 years ago.


Subsequently, in my President's Message for the AHPA's Health Planning Today, I added a brief account of the rest of community health planning's history to the part played in it by Dr. Blum. Now, I'll provide it here.


It is well to be reminded that health planning arose out of communities, with its roots in both public health and medicine. And to find its antecedents, we need to go to Rochester, N.Y., where a form of health planning can be traced back to 1918 when its Community Chest Plan was established. In the 1920s, the Plan's executive committee reviewed requests for hospital capital fund drives. In the 1930s, administrators of six local hospitals began to meet formally to discuss problems. In 1936, The Community Chest commissioned a series of studies of health care in Rochester. In 1939, the Rochester Hospital Council was incorporated by the six local hospitals. Such early planning efforts were also taking place in cities, like Pittsburgh and Detroit, that were centers of major industries. The Hospital Planning Council of Greater New York was the first in 1938. But only eight such hospital planning councils were formed between 1938 and 1962.


Federal health planning efforts may be traced back to the monumental report of the Committee on the Costs of Medical Care, which analyzed the inadequacies of the health system in 1933.* The first major effort of the federal government to promote health planning began with the Hill-Burton Hospital Construction Act in 1946, which mandated that states assess the need for hospitals and establish statewide priorities for the allocation of funds for new hospitals. Hospitals receiving Hill-Burton funds were required to provide charity care to the medically indigent. In Rochester, the Council of Rochester Regional Hospitals was formed to upgrade health care in rural hospitals.


Mature community health planning in Rochester dates from 1961. In 1959, Rochester area hospitals initiated a drive to raise more than $30 million to finance 500 additional hospital beds. In 1960-61, Marion Folsom (vice president of Kodak, and former secretary of the federal Department of Health, Education and Welfare) founded the Patient Care Planning Council to plan for Rochester's health care needs.


He organized a committee of consumers, hospital administrators, physicians, and business and government representatives to objectively assess the capacity needs of Rochester's hospitals. Based on it, the Council reduced the hospital drive's objective from $30 million to $14 million, and reduced the number of additional hospital beds from 500 to 140. This was the paradigm for New York's certificate of need program in 1964, the first state regulation of capital expenditures by hospitals and nursing homes, and the earliest model for state-regional linkage of planning and regulation.**


Amendments to the Hill-Burton Act in 1962 mandated the formation of state and regional health planning agencies with federal support. A voluntary not-for-profit network of regional health planning agencies in major metropolitan areas conducted needs analyses and advised states on construction priorities in their areas. Their numbers grew from eight in 1962 to 33 in 1964 and 50 in 1965.


Through the Partnership for Health Act of 1966, the federal government established Comprehensive Health Planning Agencies, and in Rochester the following year, the Wadsworth Committee was formed to study inner city health care needs. It recommended creating a network of neighborhood health centers. In 1973, with business support, three HMOs were established.


The 1974 National Health Planning Law then created the most extensive system of community health planning agencies, known as Health Systems Agencies (HSAs), the nation has ever had, following a template of one HSA for every one million people, on average, in each state. In Rochester, the Finger Lakes Health Systems Agency was one of the 205 HSAs. In 1978, local hospitals established the Rochester Area Hospitals Corporation to promote continued cooperative planning among themselves. Beginning in 1980, along with insurers and government representatives, they managed community-wide hospital revenues and improved the solvency of their hospitals through the Hospital Experimental Payments Program (HEP). Throughout the decade, HEP established a global community-wide revenue cap for hospital-based inpatient and outpatient care.


These two historical streams of health planning – personal health in Rochester, and public health in California – have since come together around their common client, the community. In March 2004, the Finger Lakes HSA adopted a revised mission statement that moves from health systems analysis to seeking community solutions to problems of the health of the community, recognizing the broadened focus of the Agency that has been operationalized for at least a decade.


For more than a decade, the Alameda County Public Health Department in California has been moving away from a "service" to a "capacity-building" approach to public health. The Department is a leading practitioner of "the new public health," strengthening communities from within to play a greater role in their own health. It actively involves residents in the planning, evaluation, and implementation of health activities in their communities. To do this it has Community Health Teams in 10 neighborhoods across Alameda County, and it has taken to training community leaders to work with their own neighbors to address common concerns. And so, the focus of "the new public health" is community organizing, and the community is the patient.


And that brings me back to Dr. Henrik Blum. In 1983, he gave us this insight into the political marginalization of health planning. The very same reasoning can be used to explain why we don't yet have a national health care system.


Can there be meaningful health planning when so little else is publicly planned? It is my conviction that how health planning is set up is not altogether a result of special interest forces. Its mandate is determined by such societal forces as traditions, socioeconomic political outlooks, formal governance structures, and availability of resources. A society such as ours has strong anticollective biases, fears of government expressed as endless, built-in checks and balances, many levels of government, and many regional differences. Thus we will surely require, but have a difficult time developing, a strong national sense of direction that is melded with powerful state if not local participation to allow for ample variation in accordance with local needs and yet falls within nationally set goals. Our planning machinery is likely to be set up in just those ways that have allowed the health sector to create the problems that upset us so. Only under truly stressful shortages of resources, major calamities, or war are major changes going to be demanded of a given sector. That is what we are seeing today, and the official health planning machinery continues very much to one side of the action.***


___________________________________________________________


* Committee on the Costs of Medical Care, Medical Care for the American People: The Final Report of the Committee on the Costs of Medical Care, Chicago: The University of Chicago Press. 1932.


** In 1971, New York State became the first to set hospital rates, greatly strengthening that linkage. In Maryland, as early as 1968, the Health Services Cost Review Commission was the first agency to attempt regulation of hospitals comparable to that for public utilities, while encouraging comprehensive health planning agencies to develop a state plan.


*** Book Review: "Health Planning: Lessons for the Future, by Bonnie Lefkowitz." Inquiry, 20, 390, 1983.

An Opportunity For Live Policy Research

Before this decade is over, two sea changes in the public health system will
converge. The first comes about among Rural Health Centers (RHC's) and Federally
Qualified Health Centers (FQHC's). These safety net role players in the
intrinsic fabric of community health are undergoing structural changes not
foreseen by their creators1. RHC's, in particular, face painful
recruitment obstacles, as they strive to find primary care clinicians, and
increasingly look to hospitals for franchise-type arrangements in order to meet
infrastructure needs2. FQHC's are reacting to pressure to augment
their battle against the compelling urban problem of health disparities with new
service lines – dental health, mental health day treatment, and elder
care3. Both have accepted, perhaps begrudgingly, the need to seek
external charitable funding to sustain operations2,3.


A second sea change, the production of the first doctoral-prepared nurse
practitioners (DNP's), is bubbling slowly through the health system. As a
practice-based professional, the DNP ostensibly will not only have advanced
clinical skills but also leadership qualifications. By 2010, the first wave of
DNP's will engage the health system. Nurse practitioners have evolved over a
30-year period; changes in practice and prescription privileges, reimbursement,
enabling legislation, credentialing, and accreditation have occurred slowly – to
the extent that nurse practitioners have demonstrated that they are clinically
skilled, safe, affordable, quality-oriented, collaborative
practitioners.4 Not surprisingly, the evolution of a practice
doctorate in a practice discipline is a legitimate progression. The growing
complexities of care, the aging of the U.S. population, and the dwindling number
of primary care physicians all contribute to the need for increased knowledge
and practice competency in advanced clinical nursing practice5.


Community health centers and nurse practitioners have been called "natural
partners"6, and we see the convergence of RHC/FQHC structural changes
and the introduction of DNP's as an immense opportunity to further our
understanding of how health status, health resources, and access are
inter-dependent. Not since the mid-1980s, when the physician assistant model was
standardized and recognized7 (the nurse practitioner movement was
well under way by the late 1970s8), has the public health system had
an opportunity to assess the impact of a new clinician on health status and the
health of communities.


As the sea changes converge, there will be many, many policy issues to
explore. To be sure, both the RHC/FQHC and nurse practitioner models seek to
achieve equal access to equal health care in geographical areas where neither is
easy to accomplish. The timing also is excellent: Public health has retuned to
systems thinking in order to assess the realities of practice within complex
environments9. As a foundation for thoughtful research we propose a
framework for analysis of the evidence, based on the classic work of
Donabedian10 and Nagel11, described in Table 1 below, that
builds upon four hierarchical constructs of health policy: efficiency,
effectiveness, efficacy, and equity.


This will be an exciting time for community health professionals and students
alike – as the opportunity presents itself for ground-level research.


summary="Converging Movements: RHC/FQHC Structural Changes and Introduction of DNP's Proposed Framework for Analysis"
border=2>



























Table 1: Converging Movements: Rural Health
Center(RHC)/Federally Qualified Health Centers (FQHC) Structural Changes and
Introduction of Doctoral-prepared Nurse Practioner's (DNP) Proposed Framework
for Analysis
Element & DescriptionHigh Level MetricExamples of MetricsAnalytical Framework
EFFICIENCY
Efficiency is simply the cost per
unit of something
Cost per BenefitCost per visit, or Cost per episode of care
or, Cost per
FTE
Does efficiency increase or decrease? With the introduction of
new financial structure and a new clinician, how is it measured?

At a
high level, one would look for improved efficiencies.
EFFECTIVENESS
Effectiveness is the comparison
of various efficiency measures with other throughput metrics, usually over
time.
Cost per Benefit vs. Cost per Benefit
or, Cost per Event at
Time1
vs. Cost per Event at Time2
Pre-Post measurements using DNP start-date as boundary.
For
example: Costs of diabetic retinal exams, or rates of fully immunized
4-year-olds
What trends are visible? Are these relationships direct or
indirect?

A reasonable starting assumption is that adding a DNP to
community health center service mix will increase effectiveness, especially in
secondary and primary prevention services.
EFFICACY
In this framework, efficacy is the
overall net benefit when the trade-offs between the costs of both care and
quality are considered.
Benefits considered with Costs, along an outcome measureConvergence or regressed point where increased costs do not
increase (or lower) benefits, for example:
Cost per episode of care for
chronically ill adults paired with reductions in acute events.
A certain level of expenditure is mandatory before satisfactory
quality outcomes, and at some point increasing costs add very little to quality
measures. Many quality outcomes don’t improve overnight (weight loss is a good
example).

One viable question for RHC’s and FQHC’s is: Can the center
sustain the added costs of a new clinician while, over time, health care
outcomes (hopefully) improve?
EQUITY
Equity represents our hopes for fair
and just health care.
Benefits = f{cost, quality, time, values, social goals}Survey data (below) compared to metrics (above), for
example:
(1) Positive community opinion, (2) self-reported health assessment,
(3) numbers of targeted populations receiving sustained, appropriate, health
services -- compared with cost per episodes of care.
Will the convergence of RHC/FQHC structural changes and the
addition of DNPs meet our hopes for fair and just care to the people within
community health center target areas?

References


1Rural Health Services Act, PL 95-210. 1975.


2Gale JA, Coburn AF. The Characteristics and Roles of Rural
Health Clinics in the Unites States: A Chartbook.
Portland, Maine: Edmund
S. Muskie School of Public Service, University of Southern Maine; 2003.


3Cox L. Health care reauthorization. NACHC Community Health
Forum Magazine
. 2006;7;2. Available at href="http://www.nachc.org/magazine">www.nachc.org/magazine .


4 href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=9090512&query_hl=4&itool=pubmed_docsum">Ford
LC. A deviant comes of age. Heart Lung. 1997
Mar-Apr;26(2):87-91.


5 href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16115508&query_hl=22&itool=pubmed_docsum">Mundinger
MO. Who's who in nursing: bringing clarity to the doctor of nursing
practice. Nursing Outlook. 2005 Jul-Aug;53(4):173-6.


6Flinter M. Residency programs for primary care nurse
practitioners in federally qualified health centers: a service perspective.
Online Journal of Issues in Nursing. 2005;10. Available at: href="http://nursingworld.org/ojin/topic28/tpc28_5.htm">http://nursingworld.org/ojin/topic28/tpc28_5.htm.


7Duke University Medical Center. Physician Assistant History
Center. Available at: http://www.pahx.org/.
Accessed August 16, 2006.


8 href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=3881696&query_hl=28&itool=pubmed_docsum">Silver HK, Ford LC, Ripley SS, Igoe J. Perspectives 20 years later. From the
pioneers of the nurse practitioner movement. Nurse Pract.
1985;Jan;15-8.


9Green LW. Public health asks of systems science: to advance our
evidence-based practice, can you help us get more practice-based evidence?
Am J Public Health. 2006;96;406-409.


10Donabedian A. Quality, Cost, and Clinical Decisions. Annals of
American Acad of Politics and Soc Science. 1983; 468(1); 196-204.


11Nagel SS. Public Policy: Goals, Means and Methods. 1983. St.
Martin's Press, New York City, NY.


About the Authors


Patricia House, MPH, PhD, is a project consultant for the Global Health
Division of Electronic Data Systems, Boston, and a longtime APHA member.


Lynne E. McEnroe, MA, MSN, APRN, BC, is executive assistant to the dean,
School of Nursing, University of Medicine and Dentistry of New Jersey, Newark,
N.J., and is an Advanced Practice Community Health Nurse.

Laurie Garrett’s Betrayal of Trust: The Collapse of Global Public Health - Candid, Well-Researched, Calls for Renewal of Civic Discourse

 
Book cover photo by John Steen
Book cover photo by John Steen
One systemic defect in the many state and regional bioterrorism preparedness planning efforts now under way is the absence of a communitarian perspective. As evidence of the national, and even international blindness underlying the problem, and as a definitive description of its scope, there is a book that should be read by anyone who cares about public health, health policy, and public policy. It is Betrayal of Trust: The Collapse of Global Public Health, by Laurie Garrett (Hyperion, 2000).


In 754 pages, including 154 pages of endnotes, the author details the recent epidemiological threats that have challenged world public health, including pneumonic plague in India, Ebola in Zaire, the collapse of public health in the former Soviet Union, and last but certainly not least, the erosion of public health in the United States at the very time when we are threatened by bioterrorism ("Preferring Anarchy and Class Disparity: The American Public Health Infrastructure in an Age of Antigovernmentalism."). And to the maxim that all health is public health, she would have us add that all public health is global.


Amid a wealth of epidemiologic detail, Garrett manages to provide a cogent description and commentary on the American political milieu in which public health resources have risen and fallen. The nearest thing to a Golden Age of Public Health here was, in retrospect, the major advances in disease control made at the turn of the twentieth century, but all that seems to have been forgotten after World War II, except for a brief period in LBJ's Great Society in the mid-1960s.


The effects of our neglect of and even hostility toward public health over the past 20+ years are detailed at the city (New York City), county (Los Angeles County), and state (Minnesota) level. Minnesota can be seen as having briefly developed a population health system with a communitarian focus that was arguably the best ever achieved by any state.


That public health's problems are a reflection of an ancient dichotomy is best explained in the opposition of Hygeia and Panakeia in Greek mythology, where Hygeia represents public health promotion within a socialist political system, and Panakeia represents curative personal health within a free enterprise system. Our current perception of this is revealed in how we spend 1 percent of our health care dollar on hygiene, and 99 percent on panaceas.* Public health is contained within a political compact between people and their government, and when people no longer trust nor support their government, the commitment represented by public health can no longer be fulfilled.


Garrett's view here is as broad as that of the World Health Organization's World Health Report 2000 that was published at the same time as her book. Each details the failures of world health systems seen as a function of each nation's quality of governance and stage of economic development. (For a summary of the WHO report, see my "With Liberty and Justice for All?" from the 3rd Quarter 2000 issue of Health Planning Today accessible at http://www.ahpanet.org/files/With%20Liberty%20and%20Justice%20for%20All.pdf .) I would argue that the answer to public health's problem is to be sought in a renewal of civic discourse and engagement, i.e., more democracy. That Garrett would probably agree is shown by her dedication of her book to the late Dr. Jonathan Mann, a powerful advocate of a very broad vision of public health as providing leadership in the promotion of human rights.


Laurie Garrett has been a science and medical reporter at Newsday since 1988, and is the author of The Coming Plague, a best-seller in 1994. She is the only recipient to have awarded the three big "P"s of journalism - the Pulitzer, the Peabody and the Polk. She received her second George C. Polk Award, Best Book of 2000, for Betrayal of Trust. In March 2004, Laurie took the position of Senior Fellow for Global Health at the Council on Foreign Relations.


___________________________________________________________________


* When viewed on a per capita basis, Americans spend an estimated $4,000 per capita each year on personal medical care, compared to an estimated $44 for population-based public health services.

Citizens’ Health Care Working Group Issues Interim Recommendations

It has been a year since I wrote about the Citizens’ Health Care Working Group (CHCWG), and it’s time to review what has happened since then. The Group, a committee of 14 members, was created by the Medicare Prescription Drug, Improvement and Modernization Act of 2003, Sec. 1014, to provide for the American public to "engage in an informed national public debate to make choices about the services they want covered, what health care coverage they want, and how they are willing to pay for coverage."


Between last fall and this spring, the Group held a series of about 50 community meetings at which they heard from over 25,000 people. On June 1, they issued a set of interim recommendations on "health care coverage and ways to improve and strengthen the health care system based on the information and preferences expressed at the community meetings." That was followed by a 90-day public comment period that ended on Sept. 1, during which they heard from over 4,000 individuals. The Group is using those comments to refine its proposals before issuing final recommendations to Congress and the President at the end of September. The Medicare prescription drug law requires five congressional committees to hold hearings on the report in 2007.


To access their Interim Recommendations with commentary (Updated on July 18):
http://www.citizenshealthcare.gov/recommendations/interim_recommendations.php


HIGXYZ93HIGZYX The Group’s six interim recommendations are:


  1. Guarantee financial protection against very high health care costs.
    No one in America should be impoverished by health care costs. Establish a national program (private or public) that ensures:

    • Coverage for all Americans,
    • Protection against very high out-of-pocket medical costs for everyone, and
    • Financial protection for low income individuals and families.

  2. Support integrated community health networks.
    The federal government will lead a national initiative to develop and expand integrated public/private community networks of health care providers aimed at providing vulnerable populations, including low-income and uninsured people, and people living in rural and under-served areas, with a source of high quality coordinated health care by:

    • Identifying within the federal government the unit with specific responsibility for coordinating all federal efforts that support the health care safety net;
    • Establishing a public-private group at the national level that is responsible for advising the federal government on the nation’s health care safety net’s performance and funding streams, conducting research on safety net issues, and identifying and disseminating best practices on an ongoing basis;
    • Expanding and modifying the Federally Qualified Health Center concept to accommodate other community-based health centers and practices serving vulnerable populations; and
    • Providing federal support for the development of integrated community health networks to strengthen the health care infrastructure at the local level, with a focus on populations and localities where improved access to quality care is most needed.

  3. Promote efforts to improve quality of care and efficiency.
    The federal government will expand and accelerate its use of the resources of its public programs for advancing the development and implementation of strategies to improve quality and efficiency while controlling costs across the entire health care system.

    • Using federally-funded health programs such as Medicare, Medicaid, Community Health Centers, TRICARE, and the Veterans’ Health Administration, the federal government will promote:

      • Integrated health care systems built around evidence-based best practices;
      • Health information technologies and electronic medical record systems with special emphasis on their implementation in teaching hospitals and clinics where medical residents are trained and who work with underserved and uninsured populations;
      • Reduction of fraud and waste in administration and clinical practice;
      • Consumer-usable information about health care services that includes information on prices, cost-sharing, quality and efficiency, and benefits; and
      • Health education, patient-provider communication, and patient--centered care, disease prevention and health promotion.

  4. Fundamentally restructure the way that palliative care, hospice care and other end-of-life services are financed and provided, so that people living with advanced incurable conditions have increased access to these services in the environment they choose.
    Individuals nearing the end of life and their families need support from the health care system to understand their health care options, make their choices about care delivery known, and have those choices honored.


    • Public and private payers should integrate evidence based science, expert consensus, and culturally sensitive end of life care models so that health services and community-based care can better deal with the clinical realities and actual needs of chronically and seriously ill patients of any age and their families.
    • Public and private programs should support training for health professionals to emphasize proactive, individualized care planning and clear communication between providers, patients and their families.
    • At the community level, funding should be made available for support services to assist individuals and families in accessing the kind of care they want for last days.

  5. It should be public policy that all Americans have affordable health care.
    All Americans will have access to a set of core health care services. Financial assistance will be available to those who need it.
    Across every venue we explored, we heard a common message: Americans should have a health care system where everyone participates, regardless of their financial resources or health status, with benefits that are sufficiently comprehensive to provide access to appropriate, high-quality care without endangering individual or family financial security.
  6. Define a ‘core’ benefit package for all Americans.
    Establish an independent non-partisan private-public group to identify and update recommendations for what would be covered under high-cost protection and core benefits.

    • Members will be appointed through a process defined in law that includes citizens representing a broad spectrum of the population including, but not limited to, patients, providers, and payers, and staffed by experts.
    • Identification of high cost and core benefits will be made through an independent, fair, transparent, and scientific process.
    • The set of core health services will go across the continuum of care throughout the lifespan.
    • Health care encompasses wellness, preventive services, primary care, acute care, prescription drugs, patient education, treatment and management of health problems provided across a full range of inpatient and outpatient settings.

      • Health is defined to include physical, mental, and dental health.
      • Core benefits will be specified by taking into account evidence-based science and expert consensus regarding the medical effectiveness of treatments.

Comparison of the public testimony with these recommendations reveals numerous areas where they reflect current administration policies more than the public’s input. For example, there was public consensus for ensuring that health costs not threaten "individual or family financial security." In the recommendations, the CHCWG supports protection against "very high health care costs," the approach promoted by the administration through high-deductible, catastrophic coverage. The administration’s proposal of tax credits to cover health care expenses was not supported by public participants who favored an equitable, progressively-funded insurance system covering everyone. Instead, the recommendations include the statement that "no specific health care financing mechanism is optimal."


There is a recommendation for "consumer-usable information about health care services that includes information on prices, cost-sharing, quality and efficiency, and benefits." This tenet of consumer-directed health care is actually contrary to the preponderance of public testimony favoring a system offering a comprehensive set of services. Nowhere in their recommendations do they acknowledge the strong desire expressed in their public hearings for national health insurance.


And their statement, "We understand that the transition from the current system to a system that includes all Americans will take time and that multiple financing sources will need to coexist during the move to universal coverage," is an expression of their bias for incremental improvements over more definitive ones. The initial release of the Interim Recommendations included a target date of 2012 for realization of a health care system for everyone. In spite of public support for a specific target date, the date was removed from the revised recommendations.


The two greatest deficiencies in the Group’s Interim Recommendations are its failure to address specifics with regard to methods of financing a comprehensive health care system, and ways of establishing the political policies to lead us there.

The Quick Guide to Health Literacy


The Quick Guide to Health Literacy by the U.S. Office of Disease Prevention and Health Promotion is written for health professionals at the national, state, and local levels.  It contains:



  • A basic overview of key health literacy concepts.
  • Techniques for improving health literacy through communication, navigation, knowledge-building, and advocacy.
  • Examples of health literacy best practices.
  • Suggestions for addressing health literacy in your organization.

If you are new to health literacy, the Quick Guide will give you the information you need to become an effective advocate for improved health literacy.  If you are already familiar with the topic, you will find user-friendly, action-oriented materials that can be easily referenced, reproduced, and shared with colleagues.


The Quick Guide to Health Literacy and other tools for improving health literacy can be found at www.health.gov/communication/literacy.  If you would like to request a hard- opy of this resource, or if you have any questions, please contact Stacy Robison at (240) 453-8271 or at stacy.robison@hhs.gov.

CHPPD Has Elected New Leaders, Irani is Chair Elect

CHPPD has elected new leaders. We would like to congratulate:

Chair-Elect - Priti Irani, MS


Section Council - Ann Umemoto, MPH, MPA, and Azzie Young, PhD, MS, MPA


Governing Council - Alberto Jose Cardelle, PhD, MPH, and Amy Carroll, MPH


I would also like to note that we are disappointed in CHPPD member participation in the electoral process. Only 11.3 percent of CHPPD members voted, as compared to the overall 15.7 percent voting rate of all APHA members. We can do better than that! We should do better than that! We need to do better than that!


As we move forward and provide support to our new leaders, it is clear that getting our membership engaged in our activities remains a challenge.

The position of secretary elect is vacant. If you are available to fill this position, please contact me, or Tom Piper, at macquest@mac.com.


 
Priti Irani
Priti Irani
In her nomination form, Priti said: I enjoy bringing diverse people to the table, finding common ground, exchanging ideas and working collaboratively towards a common purpose. As the current Community Health Planning and Policy Development (CHPPD) newsletter editor, I have the opportunity for doing just this. As the CHPPD chair, I would continue to strengthen collaborative efforts. I am the Assessment Initiative Project director at the New York State Department of Health. Before joining the state, I'd worked at the local level for a non-profit organization and local health department in a number of planning and health promotion partnerships, and coordinated an HIV parent education program. I have a Masters of Science degree in Public Health from the University of Massachusetts in Amherst.

Cardelle and Carroll elected to Governing Council

 
Alberto Cardelle
Alberto Cardelle
Dr. Alberto Cardelle is an associate professor and the chair of the Health Department at East Stroudsburg University (ESU). ESU offers an accredited MPH program, and undergraduate programs in Community Health and Health Services. His areas of research include public health infrastructure, health disparities and international health policy. He is on the Board of Directors of the Pennsylvania Public Health Association, and the Pocono Healthy Communities Alliance, and serve as president of the Latino Alliance of Northeastern Pennsylvania.


Over the last four years Dr. Cardelle has been on the executive committee of the Latino Caucus of APHA. He served two terms as scientific program chair and vice-chair and now serves as Caucus chair. Through his positions in the caucus, he has been able to advance the policy issues important to the caucus membership. This is what he would like to continue doing as governing councilor representing CHPPD. Dr. Cardelle wants to ensure that the APHA Governing Council adopts policies and resolutions that represent the goals of the section membership. These would include policies and resolutions that emphasize the importance of public policies on the status of the public's health, and that highlight the critical role the nation's public health infrastructure plays in assuring the health of the public.


 
Amy Carroll Scott
Amy Carroll Scott
Amy Carroll Scott is a third-year doctoral student in the Community Health Sciences Department of the UCLA School of Public Health. She has been a member of APHA since 1995, serving in various leadership roles. Over the years, her career has focused on the areas of community-based public health research, mobilization, and advocacy, and so she has found a natural affiliation with the Community Health Planning and Policy Development Section. For the past two years, Ms. Scott has served as the first Student Assembly liaison to this section, and she has used this position to take a more active role in our section and create new opportunities for students within CHPPD. During this time, she successfully worked with CHPPD leadership to develop two new student abstract submission awards, institutionalize a submission feedback process for new student submitters, commit CHPPD funds to support student travel scholarships to the Annual Meeting, and create a new permanent Student Committee within the section. Ms. Scott would like to see her role as further representing the student voice within the structure and governance of both CHPPD and APHA and continuing to attract new student members to our section.

Young and Umemoto Elected to Section Council

 
Azzie Young, PhD, MS, MPA
Azzie Young, PhD, MS, MPA
For more than 25 years, Azzie Young, PhD, MS, MPA, has played a major role in public health. She is a member of APHA, held leadership roles in the Maternal and Child Health Section and has served as a moderator for APHA scientific papers in the CHPPD Section for approximately five years. Dr. Young brings leadership skills, real-world experiences at various levels, and extensive knowledge about community health planning and health policy. The goal is to provide support to the Section and leadership for emerging public health policies and issues.


Dr. Young held top management positions in the Kansas Department of Health and Environment, the state's public health agency, including chief of health chemistry, state director of maternal and child health and a cabinet level appointment as Secretary of the Department of Health and Environment. Currently, Dr. Young is the president and chief executive officer of Mattapan Community Health Center, Boston. Under her leadership, the faith-based Health Care Revival Initiative was published in the American Journal of Public Health in 2002. Dr. Young has MS and PhD degrees from the University of Nebraska in organic chemistry. She also received a MPA from the Kennedy School of Government at Harvard University.


 
Ann Umemoto.  Photo credit Akina Younge
Ann Umemoto. Photo credit Akina Younge
Ann Umemoto works for the Office of the Medical Director in the March of Dimes National Office, where she devotes her energy to planning and developing maternal and infant health promotion programs. Before the March of Dimes she worked at Downstate Medical Center in Brooklyn and Montefiore Medical Center in the Bronx. She earned her masters in health planning at UC Berkeley and masters in public administration from Harvard. She has been active in the CHPPD Section serving as Governing Council Member and Section chair in the past. She is also a member of the Asian Pacific Islander Caucus for Public Health. She is very pleased that over the years, the Section membership has grown and new people have been integrated into the Section as members and as leaders. The Section is made of people with diverse interests in public health, and this broad territory has created an atmosphere of open arms.

Third Showcasing of Health Informatics Information Technology Group

The third showcasing of the Health Informatics Information Technology group will take place once again at the APHA Annual Meeting. The HIIT group is the result of many efforts of APHA members who have recognized a need for its representation in the organization.


 
Health Informatics Information Group website image
HIIT Business Meetings
2:30 p.m.-4:00 p.m. Saturday No. 118.1 - Health Informatics Information Technology (HIIT) Group Business Meeting I
8:00 a.m.-9:30 a.m. Sunday No. 200.1 - Health Informatics Information Technology (HIIT) Group Business Meeting II


Presentations
Session 1: 3012.0: Monday, Nov. 6, 2006: 8:30 a.m.-10:00 a.m.
Oral - Information Technology and the Role of the Community in Addressing Cancer Disparities
Session 2: 3095.0: Monday, Nov. 6, 2006: 10:30 a.m.-12:00 p.m.
Oral - Environmental Public Health Tracking - Utilizing Informatics for Environmental Surveillance
Session 3: 4110.1: Tuesday, Nov. 7, 2006: 12:30 p.m.-2:00 p.m.
Oral - Lessons Learned from Hurricane Katrina: Need for Dissemination of Information


Detailed Session Information can be found under the Innovations Project of APHA Information at http://apha.confex.com/apha/134am/techprogram/program_582.htm


HIIT Informatics related posters will be on display Monday, Nov. 6 from 4:30-5:30 p.m. Visit the Health Informatics Information Technology group at booth number 858 or at www.pubhiit.org (Web site is being revised).

When 10 is Not Perfect for CHPPD Newsletter Readership

 
CHPPD newsletter readership visitors and pages vie
CHPPD newsletter readership visitors and pages viewed, June 05 to June 06
The number of pages of the June CHPPD Newsletter viewed, and the number of unique visitors more than doubled when compared to the readership level in June 2005. In June 2006, 310 visitors viewed 253 pages of the newsletters, as compared to in June 2005, when 82 visitors viewed 91 pages. The trend is encouraging. More CHPPD members are contributing articles to the newsletter, and beginning to consider it a resource. I would like to thank the new and veteran contributors for their help.


 
Newsletter readership across selected sections
Newsletter readership across selected sections
Twelve percent of members, who identified CHPPD as their primary section, read the newsletter in June 2006. This is an improvement over the 5 percent of members who read the newsletter in June 2005. When compared to other sections, CHPPD still lacks behind. Number of vistors per 100 members for CHPPD is 12 percent, for MCH 14 percent, for the smaller Community Health Worker Special Primary Interest Group, 25 percent, and for the larger sections, such as Epidemiology, 14 percent and Public Health Education and Health Promotion, 13 percent. As the current issue of the section newletter can be accessed without a password, the actual number of members reading it may be lower


We can estimate that CHPPD member engagement in section or APHA activies is about 10 perecnt based on the 12 percent readership rate, 11 percent voting rate as indicated by Paul Meissner who has an article in this issue, and a 9 percent CHPPD member involvement survey response rate. A CHPPD member engagement of 10 percent is not healthy. There are suggestions from members who completed the survey on how to better engage members, and more than 60 percent have indicated that they would like to more involved in CHPPD/APHA activities. The CHPPD leadership team will discuss and prioritize these suggestions, and they will be published in the winter issue of the newsletter that will be a available by February 2007. If you are going to the APHA Annual Meeting, please join us at the CHPPD business meeting to discuss ideas for member involvement.

Did You Like The APHA Diet Story? Share your Annual Meeting Experiences and Photos

Members thought Elaine Ho's "The APHA Diet" experience was a good one, and would be happy to publish more stories of members' experiences at the Annual Meeting. I have copied the APHA Diet story again for those who may have missed it.


"You haven’t heard of the APHA diet? Just ask Karen Ho, CHPPD member from Honolulu, Hawaii. Karen was so busy attending meetings and sessions at the APHA Annual Meeting in Philadelphia that she barely found time to eat. So finally, on the third day of the meeting, she was determined to get to the corner Dunkin Donuts and buy some breakfast. And she did.


Just as she unwrapped the sandwich and was getting ready to take a bite, she noticed a gentleman, who seemed homeless or at least fallen on hard times, gesturing at her. She figured he was asking her for money. So she gestured back, asking if he would like her sandwich. And he shrugged and said, “That will do.” So she gave him her sandwich. Aloha to the APHA Diet."

Interested in Collaborating on book review of Street Science for the Next Newsletter?

Would you be interested in collaborative on a book review, Street
Science: Community Knowledge and Environmental Health Justice
by Jason
Corburn with me?  If so, please contact me by October 31, 2006.  The
review has been submitted in time for the winter issue by January 10,
2007.  Below is the editor's note about Street Science.


 
"Street Science" book cover
When environmental health problems arise in a community, policymakers must be able to reconcile the first-hand experience of local residents with recommendations by scientists. In this highly original look at environmental health policymaking, Jason Corburn shows the ways that local knowledge can be combined with professional techniques to achieve better solutions for environmental health problems. He traces the efforts of a low-income community in Brooklyn to deal with health problems in its midst and offers a framework for understanding "street science" -- decision making that draws on community knowledge and contributes to environmental justice.


Like many other low-income urban communities, the Greenpoint/Williamsburg neighborhood of Brooklyn suffers more than its share of environmental problems, with a concentration of polluting facilities and elevated levels of localized air pollutants. Corburn looks at four instances of street science in Greenpoint/Williamsburg, where community members and professionals combined forces to address the risks from subsistence fishing from the polluted East River, the asthma epidemic in the Latino community, childhood lead poisoning, and local sources of air pollution. These episodes highlight both the successes and the limits of street science and demonstrate ways residents can establish their own credibility when working with scientists. Street science, Corburn argues, does not devalue science; it revalues other kinds of information and democratizes the inquiry and decision-making processes.


Jason Corburn is Assistant Professor in the School of International and Public Affairs and the Urban Planning Program in the Graduate School of Architecture, Planning and Preservation at Columbia University. From 1996 to 1998, he was a senior environmental planner with the New York City Department of Environmental Protection. Jason is also a member of APHA-CHPPD.