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Community Health Planning and Policy Development
Section Newsletter
Fall 2007

A Message from Chair Sue Meyers: CHPPD Moving Forward With a Record 2,005 Members

Dear Colleagues:

 

First, the big news. We have more members today than ever before in Section history.  As of August 2007, Community Health Planning and Policy Development was 2,005 members strong.  This is clearly the result of a team effort across our four major committees:  Membership, Program, Policy and Resolutions, and Students.

We entered the year facing a range of challenges and are making good progress on all fronts. Among our accomplishments:

  • Finalized the member manual, streamlining functions and committees and expanding leadership opportunities by adding co-chairs to the Membership and Program Committees.
  • Released an on-line survey to help the Planning and Policy Dialogues Session Work Group finalize its plans for valuable member interaction in between APHA Annual Meetings. 
  • Impacted policy at the national level by assisting with the soon-to-be adopted Uniform Emergency Volunteer Health Practitioner Act model state law language. 
  • Had a competitive field for the Governing Council positions .
  • Made some fundamental structural changes in how we budget, program and operate.

Section Council and Governing Council members certainly had their "shoulder to the wheel" this year in order to achieve these successes.  However, we are now entering a new season, and there are three major challenges before us.

First, Section Council will be charged this year with determining the ways in which we can create maximum value for members and take advantage of the enormous social and intellectual capital of our membership.  To this end, we will undergo a visioning and work plan process at the business meetings of the Annual Meeting this fall. Formal committee reports will be made available online in lieu of taking valuable face-to-face time. In order to make time for visioning and to engage as many members as possible, we will not entertain candidates during our meeting times. Instead, we will conduct one or two audio-conference calls for candidates for APHA Executive Board and officers of the organization to present their qualifications and field questions.  These two calls will be open to all members. Please check the Section’s Web page for candidate audio-conference call details.

 

Second, we need to assess how we partner and think strategically about ways in which we should collaborate with other sections and organizations outside of APHA.

 

Third, we need to continue moving forward with being more pro-active in advancing policy.  The Planning and Policy Dialogues Sessions should help us in this regard.

 

We seem to do well when taking on three challenges a year.  I believe 2007-2008 will be a great year for our section.

 

As a last note, I was chair of the Inter-Sectional Council Nominations Committee this year and am pleased to announce that our immediate past chair, Tom Piper, made the recommended slate for ISC Steering Committee. Tom has the full support of CHPPD. We wish him well in the election.

 

Yours in service,

 

Sue Myers

 

CHPPD Business Meetings Open to All Members

All CHPPD members are invited to the business meeting and social hour at the Annual Meeting in Washington, D.C.  It is one way to connect e-mails to people. There is a lot more that goes on. If you are going to attending the Annual Meeting, we hope to see you there.  Be sure to introduce yourself to one of the CHPPD officers.  The locations of these meetings will be listed in your program guide.

Dates and Times of CHPPD Business Meetings

Day/Time                       

Session  #   Meeting  Description              

Sun.day, Nov.  4

10:00  - 11:30 a.m. 185.0     Visioning Session
2:00  - 3:30 p.m. 212.0 New Member Orientation
4:00  - 5:30 p.m.      253.0 Student Committee Business Meeting
Mon.day, Nov .5
6:30  - 8:00 p.m. 321.0 Social Hour

New SPIG, Two Forums Demonstrate Growing and Shared Public Health Interests

Governing Councilors at a MeetingWhat do you call a group of 100 unaffiliated APHA members who organize around a unique and emerging public health issue?  A Special Primary Interest Group (SPIG). Within three years, if and when a SPIG recruits 250 members, it can apply to become a section.

 

What do you call 75 APHA members who formally get together from various sections and SPIGs to address a public health issue with potential for specific action?  A forum. Forums need the written support of at least two APHA sections. 

 

The APHA Executive Board, based on member feedback, voted to approve a new SPIG – Health Informatics and Information Technology (HIIT) – and two forums – “Trade and Health” and “Family Violence Prevention.”

 

HIIT (http://www.pubhiit.org/aboutus.html): Aims to improve the public's health and facilitate prevention through innovative and effective information technology and informatics approaches.  Contact: Chair Diane L. Adams, MD, MPH, CHS-III, dla8315@aol.com; Chair-elect Sandra A. Worrell, MS, sandraworrell@sbcglobal.net.

 

Trade and Health Forum: Brings different disciplines within APHA together to better understand the impact of trade agreements.  Among future activities proposed: developing and promoting policies that advance economic development while sustaining life, healthy society, and the environment; supporting proposals that expand access to safe water and sanitation; and ensuring that public health professionals participate in trade negotiations with health implications.  Contact: Chair Ellen Shaffer, ershaffer@cpath.org; co-chair Anna Gilmore Hall, agilmorehall@hcwh.org.

 

Family Violence Prevention Forum: Plans to build a clearinghouse on issues related to family violence prevention, including violent and abusive acts perpetrated against a parent, child, sibling, or someone in the role of family member. Contact: Chair Michael Durfee, MD, michaeld55@aol.com; Vice-Chair Peggy Goodman, MD, goodmanp@ecu.edu.

 

Also being considered are a request from the Disability SPIG to be approved as a section, and “Public Health and Genomics” to be a forum.

 

Disability SPIG: Works to broaden the knowledge base and awareness regarding disability and related phenomena among all public health professions and to provide policy advice to APHA on public health policies and programs for prevention and services to enhance the quality of life for persons with disabilities, including increased public and professional awareness. Contact: Chair Gloria Krahn, PhD, MPH, krahng@ohsu.edu; Chair-elect James Rimmer, PhD, jrimmer@uic.edu.

 

Public Health and Genomics: Educate the public health workforce to understand the basics of genetics and the implications of genomics; provide communities with appropriately designed information that promotes good heath in the context of genetic information; prevent the misuse of information and technology; and ensure that genetic information is used to decrease health disparities.  Contact: Acting Chair Jody Platt-Garcia, jeplatt@umich.edu; Acting Co-Chair: Emylou S. Rodgriguez, erodriguez@marchofdimes.com.

 

Finally, one last riddle.  What do you call two or three APHA members who get together?  A promising start.

 

For information on setting up APHA Forums or SPIGs, please contact Fran Atkinson, MSM,  APHA director of component affairs, at frances.atkinson@apha.org.

 

By Priti Irani, Chair Elect, pri01@health.state.ny.us

 

Governor's Conference on Public Health

Archived video files from the Governor’s Conference on Public Health: Barn Raising VI, Iowa’s premier public health event for 2007, are available for viewing on the conference’s state-of-the-art Web site: www.thehealthconference.org .   The conference was held August 2-3 at Drake University in Des Moines.  

 

The Web site contains nine video files, including a keynote address by Julie Gerberding, MD, MPH, director of the Centers for Disease Control and Prevention, and presentations by Vermont State Sen. M. Jane Kitchel and John McDonough, PhD, MPA, executive director, Massachusetts Health Care for All.  Kitchel and McDonough played lead roles in advancing affordable health services for everyone in their states.  Dr. Martin Collis, Canadian pioneer wellness expert, highlighted the second conference day with a keynote and final address.  Both can be viewed on the conference Web site.

 

More video files will soon be available, including the presentation “Doing What’s Right: Ethical Issues in Public Health” by Peter D. Jacobson, JD, MPH, director of the Center for Law, Ethics, and Health at the University of Michigan School of Public Health.  A presentation on accreditation, assessment, and quality improvement will also be added. Presenters were Leslie Beitsch, MD, JD, director of the Center on Medicine and Public Health at Florida State University, and Lee Thielen, MPA, executive director, Colorado Association of Local Public Health Officials, and the Public Health Alliance of Colorado.

 

A Healthy Communities magazine debuted at the conference is aimed at increasing awareness of what is happening across the state from the biggest community — Des Moines (on the front cover) — to some of the smallest — George (on the back cover).  The publication can be used as a very practical planning guide for community leaders to take action.  Plans are under way to put the magazine on the Web site.  A draft is now available.  Contact Tim Lane, editor, for a hard copy by sending him an e-mail at tlane@idph.state.ia.us.

Photojournalist Kael Alford to Share Stories About “Unembedded” Images at APHA Annual Meeting

 

Thorne Anderton's photo:  Najaf, Iraq - August 27, 2004 on "Unembedded" exhibit flyer

 

Kael Alford, one of the four freelance photojournalists whose photographs make up the exhibit and book by the same name, Unembedded, will share some of the stories behind the images at the exhibit opening Monday, Nov. 5, at 7:30 p.m.  Unembedded is a national touring exhibit of 60 images that tell the story of the war's impact on the lives of the Iraqi people "on the ground" where the war is being waged.  It includes panels on the war's impact on returning American veterans, their families, and communities.  The CHPPD Section leadership voted to contribute $250 toward supporting the exhibit.

 

When asked how the idea for this exhibit came about, Alan Baker, APHA chief of staff, said, “We were approached by the Peace Caucus and the Labor Caucus.  At about the same time, several board members were approached, and the requests they received were forwarded to us. The big question was always space for several days, as we wanted to do it from the start, and we knew our members would be interested.  During the first few calls with the Labor and Peace Caucuses, we decided to do it at the AFL-CIO office after we learned it was too big for the APHA building.”

 

For more information on the exhibit, contact Alan Baker at alan.baker@apha.org; Pamela Wilson, Labor Caucus at pwilson@dpeaflcio.org; or Patrice Sutton, Peace Caucus at psutton2000@yahoo.com.

 

By Priti Irani, Chair Elect, pri01@health.state.ny.us

Sessions on War, Veterans Health and Iraq

CHPPD Congratulates and Welcomes Secretary Elect, Section Councilors and Governing Councilors

The Community Health Planning and Policy Development Section congratulations and welcomes new elected officers.  About 9 percent of Section members voted in the election, held May-June, compared to 12 percent APHA-wide.

 

Secretary Elect (2007-2008)

Wendy Todd, MPH, is a program associate with the Blue Shield of California Foundation.  Todd says that she brings three key skills to the CHPPD Section as the secretary-elect:  “First and foremost, I would accurately and concisely capture the conference call conversations.  Complete meeting minutes will help members follow through on the next steps and course of action determined on each call.  Second, I would bring strong organizational skills to the Section so that members can easily and efficiently access necessary information.  Finally, my strong networking skills would help this Section conduct outreach to potential new members.” Todd acknowledges that she is very passionate about addressing complex health issues through a public health approach.  She says, “I am beginning to realize that many of my colleagues in the world of philanthropy do not have the same orientation.  Therefore, I am looking forward to participating in the CHPPD Section, where I will be able to collaborate with colleagues committed to advancing a public health approach.  I think this Section has the potential to make great accomplishments within and beyond APHA, and I look forward to playing an active role in the Section’s efforts.”  Todd is a member of the Northern California Grantmakers’ Organizational Effectiveness and Professional Development Committee and participates in the Marin County Chapter of the National Alliance for the Mentally Ill. E-mail: wendy.todd@blueshieldcafoundation.org.

 

Section Council Members (2007–2010)

Katharine E. Witgert, MPH, is a legislative policy analyst with the Office of Program Policy Analysis and Governmental Accountability in the Florida Legislature. Witgert has served for the past three years on the Section Council, acting as secretary for two years.  She brings her knowledge of the Section’s evolving priority issues and emerging strategies for achieving our annual goals.  She is interested in continuing to expand Section activities to be inclusive of its large membership and in further developing the section's role in APHA governance. E-mail: kwitgert@hotmail.com.

 

Mohammed Saka, MJ, FMCPH, MBA, MPH, is a program officer with Pathfinder International in Abuja, Nigeria.  A medical doctor and specialist in public health, Saka has over eight years of experience in clinical medicine as well as public health practice and management. Having acquired a solid academic and research-oriented training, he is focused and result-oriented in his practice of public health. Saka’s background in clinical practice has enabled him to view health from a human angle and prepared him for the challenges of managing community health interventions as a humanitarian activity, not as an analysis of facts and figures. Saka has lived in and had professional stints in more than 15 Nigerian states across all the geopolitical regions. This has enabled him to understand the multi-cultural nature of various Nigerian communities and the customs of people in many parts of the country. His humble background and disposition make it possible for him to communicate and work effectively with all people, with excellent results. Saka says, “I have a good sense of humor, which has helped me in no small way to coexist effectively with the people with whom I work.” Dr. Saka has a special interest in: epidemiology; control of infectious diseases, specifically STI/HIV, AIDS, tuberculosis, and malaria; reproductive health; routine immunization; nutrition; and family planning as well as health planning and management. E-mail: msaka@pathfind.org, sakamj1@yahoo.com.

                                                                            

Governing Council Members (2007-2010)

Apryl R. Brown, MPH, MD, BS, is an instructor in physiology, anatomy, and introductory biology at the Wayne County Community College District in Detroit, Mich. As the Detroit Medical Reserve Corps Coordinator,  Brown oversees a local unit affiliated with a national community-based organization whose agenda is to address the public health priorities of the U.S. Surgeon General, such as increasing disease prevention, eliminating health disparities, improving health literacy, and strengthening public health preparedness.  At Wayne County Community College District, Brown works as a biology instructor preparing students for various careers in health care.  Brown co-reviewed an environmental public health book for the CHPPD Section newsletter in winter 2007.  In addition, she belongs to the Michigan Public Health Association as well as the Global Health Council.  As a Genetic Alliance Advocate Partner, she participated in the Genetic Alliance Day on Capitol Hill by visiting members of the House of Representatives to discuss genetic-related issues.  She was inducted into the Delta Omega Honorary Society of Public Health as a result of her dedication to public health community service.  As an APHA Governing Councilor, Brown would utilize her leadership skills evolved from her professional and civic public health endeavors to insure that all residents of the United States have the knowledge and access to live hazardous-free and healthy lives. E-mail: aprylrbrown@yahoo.com.

 

Monica Chan, MBA, is a contracts and grants analyst at the University of California, San Francisco. Chan has been a core member of CHPPD’s leadership team for over 10 years. She has served as secretary, chair, and both Section and Governing Councilor.  As chair, she also served as a member of the Intersectional Council.  Chan actively works to develop and strengthen CHDDP’s relationships with other sections and SPIGs, and participates in abstract reviews and the annual program as a presenter, moderator, and/or session monitor.  Currently, she also serves on the board of the Diabetic Youth Foundation (www.dyf.org), an organization that assists children and families in gaining confidence and independence in dealing with conditions  in a constantly changing treatment environment. Chan brings with her knowledge of how CHPPD and other sections fit into APHA as an organization, and the negotiation skills to promote our interests.  With her knowledge of CHPPD’s interests and priorities and her relationships with representatives of other sections and SPIGs, she says she will "work with newer members to help them grow within the organization.  At the end of my term, I hope to have represented the interests of CHPPD, and have shared my knowledge so that the section has an expanding group of active leaders.” E-mail: verdi74@earthlink.net.

 

Judith Gorbach, MPH, PhD, is a public health consultant based in Massachusetts.  For seven years, Gorbach has served as the program chair and as a member of the Section Council of CHPPD. In 2004, Gorbach received a lifetime award for serving on the executive board of the Massachusetts Public Health Association.  At MPHA, Gorbach worked on policy issues in the field of reproductive health and was chair of Child Health for eight years.  For 10 years, Dr. Gorbach served on the executive board of the New England Public Health Association in the positions of treasurer and advocacy chair. She identified, researched, and developed advocacy positions for the six New England states, used APHA policy positions for guidance, and became familiar with APHA’s process of developing and voting on policy issues. Gorbach’s career in public health includes working in Massachusetts, the University of Chicago, and India. In the Massachusetts Department of Public Health, Gorbach was director of Adolescent Health, Family Planning and director of Prevention Services in the HIV/AIDS office.  She says, “My professional background has prepared me for serving on the Governing Council, where I will push for expanding services for improving the public’s health.  I am interested in the area of new scientific developments that move us into previously unthinkable approaches and treatments."  E-mail: jagorbach@post.harvard.edu.

 

Shari Kinney, MPH, MS, RN, is an administrator with the Cleveland and McClain County Health Departments at the Cleveland County Health Department/Oklahoma State Department of Health, Kinney is a current Governing Council member and was interested in being elected by the Section for a second term. In her first year as Governing Councilor, Kinney participated in the CHPPD Leadership meetings, midyear Governing Councilor meeting, the APHA policy forums and APHA strategic planning meeting. She also participated in all the Governing Council sessions at APHA. She has gained experience as a Governing Councilor, and has become more effective in representing the section at the Governing Council. Based on what she has learned this year, Kinney is working more closely with the other Governing Councilors and the Action Board. Kinney brings several assets to the position of Governing Councilor. She is an administrator for a local county health department, which means she works at the local level doing community health planning and policy development. She also has experience working at the state level in community planning and policy development, having worked for the Oklahoma State Department of Health for many years in maternal and child health. Kinney is an active member of the Oklahoma Public Health Association, currently serving as chair of the Finance Committee and is a past president. She is currently a DrPH student at the University of Oklahoma College of Public Health in health administration and policy. She says, “My goal this year is to get more input from our section regarding APHA policies, procedures, and candidates for APHA leadership positions."  E-mail:  ShariK@health.ok.gov.

 

Karen Valenzuela, MPA, MA, is the local health liaison with the Washington State Department of Health Office of Drinking Water. After serving one year on the Governing Council, representing the Section, Valenzuela was elected to APHA’s Executive Board and is serving out her last year of a four-year term on the board.  Prior to that, Valenzuela chaired APHA’s Nominating Committee (2002) as well as the Committee on Affiliates (1999), and represented the Washington State Public Health Association on the Governing Council for six years.  She has also served on a number of APHA committees and working groups. Valenzuela’s goal while a member of APHA’s Executive Board is to work mainly on improving the board’s transparency in decision making and planning, improving its relationship with the Governing Council, and encouraging fellow CHPPD Section members into positions of leadership.  Having served as an Executive Board member provides Valenzuela with a better understanding of how to get things done in APHA, what challenges face our organization, and the role of the Governing Council in APHA’s structure, decisions, and actions. Valenzuela says, “I believe the relationship between APHA’s Executive Board and the Governing Council needs to be strengthened, and I think the Governing Council must continue to hold the Executive Board accountable for all it directs the Board to accomplish.  Though I see the board as far more transparent now than five years ago, I think the Governing Council should never relax its vigilance, and should continue exerting strong influence in APHA’s policy- and decision-making.” E-mail: Karen.valenzuela@doh.wa.gov.

 

By Priti Irani, Nominating Committee Chair, pri01@health.state.ny.us. Priti worked with Tom Piper, Immediate Past Chair, and Jennifer Lavely, Director of Gilpin County Public and Environmental Health Services, Colorado.

Progress in Community Health Partnerships: Research, Education, and Action

The first issue of Progress in Community Health Partnerships: Research, Education, and Action, a national peer-reviewed journal dedicated to the work of community health partnerships, was published in spring 2007. PCHP addresses topics related to the growing field of community-based participatory research while promoting further collaboration and elevating the visibility and stature of CBPR in order to eliminate health disparities and improve health outcomes.

 

The mission of PCHP is to identify and publicize model programs that use community partnerships to improve public health, promote progress in the methods of research and education involving community health partnerships, and stimulate action that will improve the health of people in communities. Each issue includes peer-reviewed articles of original research involving community health partnerships and other scholarly articles on a broad range of topics relevant to CBPR.

 

Unique features of the journal include Community Policy Briefs for all original research and systematic reviews as well as our Beyond the Manuscript Podcast of post-study interviews with authors of selected articles. The briefs are widely distributed, not just to subscribers.  The post-study interviews give authors the opportunity to share additional insights about their work. 

 

We encourage you to visit the journal’s home page at http://pchp.press.jhu.eduThere you will be able to access:

 

*Sample Articles

   A Vision for Progress in Community Health Partnerships

 

   Guidelines for Writing Manuscripts about Community-

  Based Participatory Research for Peer-Reviewed Journals

 

*Community Policy Briefs

*Beyond the Manuscript Podcasts

*CBPR Writing Workshops

*Author Guidelines

*Subscription Information

What Needs to be Reformed?

Lately, there have been a growing number of books and articles about what is wrong with American health care. There is certainly no lack of problems to cite, but most accounts somehow fail to focus on the basis for virtually all of the truly serious ones: The way that healthcare has become a big business, a source of profits second to none.

 

This issue lies at the heart of a great ideological divide in health policy. On one side of that divide you’ll find conservative economic theorists (followers of Milton Friedman), business school professors, and the FTC, all pushing “free markets,”(1) “competition,” and “consumer choice.” On the other side, you’ll find most physicians, most hospitals, and (what’s left of) community-oriented health care and “the safety net.”

 

The easiest way of defining the issues is to have an advocate of what you oppose who is truly articulate in representing their side. Regina Herzlinger, a professor at the Harvard Business School, is such a person. Her book, Market-Driven Health Care (Perseus Books, 1997), was one of the seminal documents in promoting health care as a business, what she calls “entrepreneurialism,” and she has just published Who Killed Health Care? (McGraw-Hill, 2007). Her side has given us concierge medicine, specialty hospitals, and “consumer-directed benefit design.” She would replace defined-benefit plans with defined-contribution plans, a step that amounts to “every man for himself.” She would have government policies reward those who display healthful behaviors, as if they weren’t already rewarding themselves, policies that would benefit the fittest, not the sickest, and further polarize the society. Her side advocates “consumer choice” to the extent of wanting the government to issue hospital report cards for consumers to use like Zagat restaurant guides. (2) Doesn’t she realize that most consumers have no use for a Zagat guide, though they might well wish they had? Some of us consume a lot less than others. 

 

She makes it very clear that the issues are what health care is, and what role the government has in it. My side wants the government to regulate hospitals by setting and enforcing high standards that ensure superior outcomes everywhere, obviating the need for “consumers” – patients - to “shop around.” We see quality assurance as a public health function, and health insurance as the socialization of risk. She sees us protecting the status quo at the expense of the consumer, but only the status quo has a safety net for the weak. (3) In a recent editorial, she writes: “Time and again the regulatory status quo blocks entrepreneurship…. No wonder the 20 or so doctors enrolled in my class "Innovating in Health Care" at Harvard Business School are ruefully driven to earn MBAs once they realize they can innovate in medicine better as an entrepreneur than as a doctor.” (4) I still find it bizarre that there are academics whose minds are so warped by their economic ideology that they can only see health care that way.(5) Worst of all, it is clear how they see people’s lives – as statistics on a societal market spreadsheet for which the only goal is efficiency. It reconfirms my belief that health care is seen with far more insight by sociologists than by economists, especially conservative economists whose ideology would give us an ever more Darwinian society.(6)

 

The late Eli Ginzberg termed it “the monetarization of health care.” Its transformation from a not-for-profit, community-oriented social system of health care into an industry, has radically changed the behavior of providers and the experience of patients. It is not often noted in the United States that our physicians are entrepreneurs by virtue of how they are paid – by the procedures they perform – permitting if not encouraging them to enhance their incomes by doing more and more costly procedures. (7) By contrast, in the rest of the world’s nations, physicians are largely working on salary, with no incentive to adopt more costly modes of care. And no incentive to concentrate on high-tech treatment rather than on the preventative and diagnostic modes of care that, along with meaningful communication with patients, is of greater efficacy in improving health status.

 

Regardless of how a health system is structured, its quality will always be a function of the conscience and dedication of its caregivers, so their ethos of devotion to their patients is priceless. How ironic then for us to see profit-driven, high-cost medicine as the price we pay for incentivizing physicians to perform well, instead of as a measure of the depreciation of professional life, the corruption of medicine.

 

The process of medicine’s becoming a business was well-described 25 years ago by Paul Starr, who traced the transformation of the power of American medicine, but today even that formidable power is compromised by the investor and business wealth that controls politics. Starr explained how in 1934 American medicine scrupulously fended off the involvement of investors interested in making a business of medicine by adopting a code of ethics to prohibit profit making from the practice of medicine.(8)  Whatever capital might be necessary to fund its practice, e.g., to establish a hospital, would be contributed by the community that would benefit by it.

 

What has since been transformed is the value system of health care, from Samaritan hospitals nourished by their community roots to investor ownership of facilities and control of caregivers as instruments for profit making. For-profit hospital chains have acquired community hospitals, destroying their fiduciary role for their communities, and often closing them simply to eliminate a competitor for market share. It has also been called “the commodification of medicine,”(9) and it represents the triumph of greed. (10) Worst of all, that greed, masquerading as market ideology, has not only corrupted the ethos of health care, it has subverted the principles of our Democracy in the interests of feeding itself.(11)

 

Paul Starr explained how this was possible in the very first sentence of his book: “The dream of reason did not take power into account.”(12) As one who entertains “the dream of reason,” I’m inclined to want to speak truth to power, never more so than now that rationalizing health care delivery is once again taking its proper place on our national political agenda. And yes, I do write as an idealist, but my idealism is a form of resistance. I wish to see a national debate that addresses what is needed rather than merely what is politically feasible, avoiding the trap of offering only partial solutions. My hope is that the time has once again come to, in that celebrated phrase of Teddy Roosevelt’s, “dare mighty things,” recapturing the promise of America in the spirit that has always defined it, a nation once again aiming at a common good.(13) We haven’t dared mighty things since The Great Society gave us Medicare and Medicaid and Bill Moyers said, “Ideas are great arrows, but there has to be a bow. And politics is the bow of idealism.”(14)

 

We have a moral responsibility to act on what we know, and to seek to improve our knowledge and understanding when the welfare of others is involved. In such a situation, not to act is a moral failing. Those who work in public health know that better than most, being sustained by a philosophy of moral idealism and optimism.(15)

 

Because I see this as an ethical enterprise on a political scale, I believe that the public’s judgment on it needs to be informed political consent. We need to have sorted out and achieved some consensus on our core political values and given them some currency in political discourse, to be “presupposed and operating in the background” as Rawls said, if we are not to lose our way in seeking solutions to seemingly intractable problems.

 

I now see an opportunity, the first since 1994, to reframe the health care debate at a higher level of political discourse by asking the right questions. Those questions should address the premises of the social contract, those on which our political system is based. The political process can deliver a product befitting our nation only if it is carried out at a level at which our highest national values are accessible. Only by raising it to such a level can we escape being once again mired in the morass of myths, prejudices, and lies that have characterized it since then.

 

We live in a liberal democratic state, one that values individual freedoms.(16) It also values as priceless the worth of individuals as ends in themselves, a value derived solely from the humanity they have in common, a quality that does not vary according to their health nor to their instrumental value to society. This notion of the good in which liberty and equality are joined, together with a sense of justice as fairness, are what citizens need to exercise good judgment in the political arena.(17)  It is pluralistic not unitary, but there is what John Rawls called an “overlapping consensus” of compatible views (18), and that consensus is what makes a just polity possible. For an egalitarian health care system to ensue from political consensus, that consensus must also embody communitarian principles. Here in the United States, we lack for a European sense of social solidarity, having instead the social Darwinism we like to call “rugged individualism.” However, the latest data in social epidemiology strongly suggest that such “rugged individualism” is even more antithetical to improving our health status than the differentials in health care access it supports.(19) 

 

We should understand what the gold standard in health policy is before politics and policy clash. Empowering the electorate to do the right thing for everyone in our nation involves educating them before they are put in a position to compromise in the inevitable political negotiations. Those negotiations will seek a good, not a perfect result, but to achieve it, someone must advocate for the perfect. Health is too precious in its own right and too requisite for all else not to. We must be aware of the societal cost of allowing the good to be the enemy of the perfect … too many priceless lives are involved.

 

                     "Power concedes nothing without a demand. The struggle for justice must never be adjourned. The forces of injustice do not take vacations. Societies are not static in this regard. They await the political and civic energies of individuals who engage the arenas of power, multiply their numbers and emblazon in deeds and institutions the immortal principle that ‘Here the People Rule.’"

 

                                                                           -- Ralph Nader(20)

 

“The dream of reason” in American politics is that we distribute societal goods on an egalitarian basis, but such is clearly not the case. We are all ultimately responsible for the conditions in which Americans live, conditions that can be seen as human rights abuses. That so many Americans lack health insurance, with the attendant inequities in access and disparities in health status, qualifies as such. "Human rights violations are not accidents; they are not random in distribution or effect. Rights violations are, rather, symptoms of deeper pathologies of power and are linked intimately to the social conditions that so often determine who will suffer abuse and who will be shielded from harm." (21) We will never see the problems in American health care until we see our own hypocrisy in how we defend our shortcomings.

 

“If a nation expects to be ignorant and free in a state of civilization, it expects what never was and never will be.”

 

                                                     -- Thomas Jefferson

 

References

 

1. For an analysis of the absence of “free market” conditions in health care, see RG Evans, “Going for the gold: the redistributive agenda behind market-based health care reform,” J Health Polit Policy Law 1997;22:427-66; and T Rice, “Can markets give us the health system we want?,” J Health Polit Policy Law 1997;22: 383-426.

 

While “competition” constitutes the dominant ideology for economists, it is seen more clearly by anthropologists as one of our society’s principal “myths,” conveniently used to explain and justify the economic activity of business. What is left out of the conservative economic and political accounts is how the limits to competition in the form of norms, rules, laws, and social institutions, for which government is responsible, are necessary for it to produce social goods. This was well documented by Amitai Etzioni in his The Moral Dimension (1988).

 

2. An edifying example of her arguments, and proof that I’ve not misrepresented her, is available in an online interview: Robert S. Galvin, “Consumerism and Controversy: An Interview With Regina Herzlinger,” Health Affairs, 24 July 2007. http://content.healthaffairs.org/cgi/content/full/hlthaff.26.5.w552v1/DC1. 

 

3. The Emergency Medical Treatment and Active Labor Act (EMTALA, 1985) has been criticized by conservatives for requiring hospital emergency rooms to treat everyone who has a real emergency. "Even physicians in those emergency rooms don't fully get the point that by being compassionate, and generous, and gracious, they are, in essence, destroying their own livelihoods as well as their own hospitals."

Madeleine Pelner Cosman, PhD, Esq, “Illegal Aliens and American Medicine,” Journal of American Physicians and Surgeons, 10:1 (Spring 2005), pp. 6-10. http://www.jpands.org/vol10no1/cosman.pdf.    

 

4. “Where Are the Innovators in Health Care?” The Wall Street Journal, July 19, 2007. http://www.manhattan-institute.org/html/_wsj-where_are_the_innovators_in_health_care.htm. Intelligent regulation limits greed, and that may be a better explanation of why she has those 20 MBA students.

 

5. Richard A. Epstein is the most prominent proponent of the conservative/libertarian tradition established by Milton Friedman at the University of Chicago, where he directs the Law and Economics Program, and like Friedman, he is a senior fellow of the Hoover Institution at Stanford. His new book, Overdose: How Excessive Government Regulation Stifles Pharmaceutical Innovation, is well critiqued by Arnold S. Relman, a longtime editor of The New England Journal of Medicine and professor at Harvard Medical School, in The New Republic: “To Lose Trust, Every Day,” July 23, 2007. http://www.tnr.com/doc.mhtml?i=20070723&s=relman072307. Relman reveals how far from reality Epstein’s ideology takes him.

 

 

6. "None of the prominent universal health care proposals does anything to alleviate spending because none would have patients choose between health care and other uses for their money.” Devon Herrick, National Center for Policy Analysis, July 24, 2007. http://www.ncpa.org/sub/dpd/index.php?Article_ID=14806. No comment from NCPA here about alleviating suffering. Conservative economists seem to see health insurance only as a “moral hazard” contributing to greater spending.

 

7. Among the few exceptions are the salaried physicians in the Veterans Health Administration System, those who work for some large insurers like Kaiser Permanente, and some who are employed by large group practices.

 

8. In the same year, Henry Sigerist published American Medicine (W.W. Norton, 1934) in which he criticized the placing of monetary value on physician services through fee-for-service as an insult to the profession: “Are physicians really supposed to be inferior to professors, judges, or clergymen? Those whose minds are on riches had better join the stock exchange.” (p.184) The cause is currently being fought by Arnold Relman. In a July 1, 2007 interview in The Chicago Tribune, he said, “The vast bulk of medical service should be delivered by doctors paid a salary for their time and effort. That would bring medicine in line with most other lawyers and architects and engineers and accountants and teachers. And you need an integrated, organized system of doctors who manage their own affairs. The model should be prepaid group practices, like the Mayo Clinic and the Marshfield Clinic in Wisconsin and the Kaiser Permanente medical groups and many others.”

 

9. Edmund D. Pellegrino, “The Commodification of Medical and Health Care: The Moral Consequences of a Paradigm Shift from a Professional to a Market Ethic,” Journal of Medicine and Philosophy 24, no. 3 (1999): 243-66.

 

10. The threat to public health was noted by Toby Citrin in an editorial in which he upholds its unique role as the legitimate advocate of the community that validates it. Toby Citrin, “Public Health – Community or Commodity?” The American Journal of Public Health; 88:3 (March 1998): 351-352. http://www.ajph.org/cgi/reprint/88/3/351.

 

11. For an admirably clear, up-to-date documentation of this, see Market Based Health Care: Big Money, Politics, and the Unraveling of U.S. Civil Democracy, Institute for Health & Socio-Economic Policy, June 22, 2007. Accessible at: http://www.calnurses.org/research/pdfs/ihsp_marketbasedhealthcare_062607.pdf. The Institute is a non-profit policy and research group that includes an advisory board comprised of scholars from the Albert Einstein College of Medicine, Boston University, Harvard University, the Canadian National Federation of Nurses Unions, the New School in New York, and the University of California. Its report (pp. 9-11) details how in 1993-94, the Department of Justice and the Federal Trade Commission contravened their own antitrust, pro-competition principles in the interest of promoting the development of mergers and networks to enable greater profits.

 

12. Paul Starr, The Social Transformation of American Medicine (New York: Basic Books, Inc., 1982), p. 3

 

13. In the past century, the suffragette and the civil rights movements furnish instructive examples of successfully operationalizing ideals as political principles that expanded our body of laws founded on human rights.

 

14. Time Magazine, October 29, 1965.

 

15. Perhaps that great idealist, Henry Sigerist, said it best: “The public health worker should be more than a technician. He should be an idealist. He needs a philosophy to guide his actions, a desire for change to improve the health of his people and a continuous intellectual curiosity for how to do it.”

 

16. But we don’t do a very good job of defending them. Have a look at: http://action.aclu.org/site/PageServer?pagename=AS_why_care_about_civ_lib.

17. John Rawls, "Justice as Fairness: Political, Not Metaphysical," Philosophy and Public Affairs 14 (1985): 223-251.

18. John Rawls, "The Idea of an Overlapping Consensus," Oxford Journal of Legal Studies, 7, no. 1 (1986); "The Domain of the Political and the Overlapping Consensus," New York University Law Review 64 (May 1989): 233-255; Political Liberalism (Columbia University Press, 1993), p.15.

 

19. There is a new appreciation for the roles of social justice and social capital in improving health. See for example N. Daniels, B. Kennedy, and I. Kawachi, "Why Justice Is Good for Your Health: Social Determinants of Health Inequalities," Daedalus 128, no. 4 (1999): 215-51, and I. Kawachi, B. Kennedy. The Health of Nations: Why Inequality Is Harmful to Your Health. (The New Press, 2002).

 

20. Civic Arousal (Pamphlet, 2004).

 

21. Paul Farmer, Pathologies of Power: Health, Human Rights, and the New War on the Poor. With a foreword by Amartya Sen (University of California Press, 2003), p.7. Dr. Farmer argues that there are three approaches to improving health care – charity, development, and social justice – but only social justice is adequate to the task. (p.152) And Amartya Sen argues that development is not the acquisition of more goods and services but what he calls “capabilities,” the freedom to live the kind of life one chooses to live. In Development as Freedom (Knopf, 1998), pp. 87-110.    

 

By John Steen, Consultant in Health Planning, Health Regulation, and Public Health, jwsteen@expedient.net. This article appeared as the President's Message of the Health Planning Today, 3rd Quarter 2007 Issue available from http://www.ahpanet.org/. REprinted with permission.

Book Review: Made to Stick: Why Some Ideas Survive and Others Die

What made the “Don’t Mess with Texas” anti-litter campaign so successful that it produced a 29 percent decline in trash-tossing on the state’s highways?  Why has the urban legend of kidney thieves drugging unwary travelers and robbing them of their kidneys survived for decades?  Why did the ad campaign featuring Jared, the college student who cut his weight in half by eating Subway sandwiches, stand out among a plethora of weight-loss marketing efforts?  The answers to these and other questions about communication that has a lasting impact are offered by brothers Chip Heath, a Stanford University professor of organizational behavior, and Dan Heath, an education consultant based in North Carolina, in Made to Stick: Why Some Ideas Survive and Others Die.

 

The authors spent a decade analyzing the “stickiness” of a message – those that are understood and remembered, and thus have lasting impact.  Using behavioral and brain sciences research as well as social history, the authors developed explanations for what makes an idea both memorable and convincing.  In addition to studying marketing messages and urban legends, the Heath brothers examined proverbs, political speeches, news reports, classroom lessons, and management directives to determine the elements of sticky ideas and messages.

 

The Heath brothers attribute the “sticky terminology” they use to one of their favorite authors, Malcolm Gladwell, who wrote the bestseller The Tipping Point in 2000. In his book, Gladwell contends that innovations that produce a “tipping point” or social epidemic are due to their “stickiness.” Gladwell offers three simple rules that can explain the socialization of behavior: “The Law of the Few,” “The Stickiness Factor,” and “The Power of Context.”  However, he did not explain why some ideas stick and others do not, and thus the Heath brothers take the next step.  They refer to books written by Gary Klein, Stephen Denning, Jim Collins, Stephen Covey, and many others in a similar genre that revolve around what makes some decisions or outcomes better for some people and organizations.

 

According to the authors, the stickiest ideas have much in common.  They found that to be remembered, understood, and used, a message has to be a SUCCESs – Simple, Unexpected, Concrete, Credible, Emotional, and have a Story that puts the message into a context.  They devote a chapter to each of these elements, using short stories and parables to illustrate why some ideas stick and others are forgotten soon after they are expressed.

 

One especially memorable story presented by the authors illustrates the power of emotions in a message.  Researchers at Carnegie Mellon University wanted to understand how people responded to an opportunity to make a charitable contribution to an abstract cause versus a charitable contribution to a single person.  The researchers asked participants to complete a survey, after which they received

payment in five one-dollar bills, and they were unexpectedly given an envelope and a charity-request letter asking them to donate some of their money.  Participants who received the charity request letter featuring statistics about the magnitude of the problems facing children in
Africa, on average, contributed $ 1.14.  When participants received a request letter with the story of single young girl, Rokia, they gave an average of $2.38.  The researchers tried a third letter, using some of the statistics and the story of the young girl.  Now the participants donated $1.43.  The researcher theorized that statistics makes people think analytically, and they donate less money. 

 

The authors confirmed this theory by working with two groups of people.  They primed one group to think analytically, asking questions such as “How many feet will an object travel if...?”  The second group was primed to think emotionally by asking them, “What do you feel when you hear the word ‘baby.’” Each person in the two groups were given the Rokia letter and charity envelope.  The “analytically primed” group donated $1.26, and the “emotionally primed” group donated $2.36. The researchers concluded that the mere act of calculation caused participants to reduce the amount donated to charity.

 

In each chapter, the authors present “idea clinic” case studies to help the reader work through making a message “more sticky.”  The comments analyze the weaknesses and strengths of the message. The authors state this is a side bar and can be skipped.  However, these exercise offer valuable learning opportunities.  Still, the clinics could have been strengthened if different types of messages and media such as letters, Web sites, posters, and radio messages were used as exampled. CHPPD members may be interested in also reading the book Don’t Make Me Think: A Common Sense Approach to Web Usability by Steve Krug, as it uses this “clinic” concept very effectively. 

 

Although alluded to in the chapter on being concrete, the power of photographs and other types of images in making messages sticky could have been better addressed.  In this chapter, the authors introduce Jerry Kaplan, a young innovator who tossed a simple briefcase to venture capitalists at a meeting, and convinced them to invest in GO Corporation, inventing PenPoint, a pen-based operating system.  Photographs and images have an invaluable stake in appealing to emotions.  For example, the book cover uses the image and feel of “duct tape” to make the concept of stickiness both literal and figurative.

 

Made to Stick is an easy-to-read book that should be of interest to public health professionals, all of whom must communicate concepts, ideas, and messages successfully.

 

Reviewed by Priti Irani, Chair Elect, pri01@health.state.ny.us and Renée Wilson-Simmons, Newsletter Co-Editor, RWilson-Simmons@aecf.org

 

We would like to thank Rebecca Head, Chair-Elect, Environmental Section; Miriam Labbok, Chair-Elect, International Health; and Betty Berkemeir, Public Health Nursing, Chair-Elect, Inter Section Council for recommending this book.

APHA is Blue, the Meeting has a Green Tinge and There are Many Choices

The color of APHA logo may be blue, but there is no doubt that the 2007 APHA Annual Meeting is tinged with green. The APHA Green Meeting Committee, made up of members of the Environmental and Food & Nutrition Sections, worked with APHA’s Anna Keller to implement several green initiatives. In addition to the green initiatives implemented by APHA at this year’s Annual Meeting, there are cultural culinary experiences suggested by John Steen.

 

  1. Healthy Restaurant Options at http://www.apha.org/meetings/highlights/environmental/SustainableRestaurants.htm highlights restaurants that employ food production methods that are healthy, do not harm the environment, respect workers, are humane to animals, provide fair wages to farmers, and support farming communities. 

  1. Linen & Towel reuse programs (http://www.apha.org/meetings/highlights/environmental/LinenReuse.htm) provides information on hotels that participate in linen and towel reuse programs that help save water and energy as well as reduce waste water and use of chemicals. Even if a program is not established, guests can request that their bed sheets not be changed.

  1. Carbon Offsets (http://www.nativeenergy.com/Splash/apha/apha.html?APHA ) APHA has teamed up with Native Energy to offset the carbon dioxide we produce as a result of travel to the Annual Meeting. For a minimal fee registrants can compensate for the impact of their travel on the environment by supporting environmental programs aimed at reducing carbon emissions.

More information on APHA’s green initiatives are available at http://www.apha.org/meetings/highlights/environmental/. For more information, contact Anna Keller at anna.keller@apha.org, or Maureen O’Neill at oneill.maureen@epa.gov.

 

In addition, Washington, D.C., offers a cultural epicurean experience. Here are suggestions from CHPPD’s John Steen to please diverse palates and budgets. 

 

If you want to try Chinese in Chinatown, try Full Kee (202-371-2233) at 509 H St (5th St.). Order from the house specialties, not the tourist menu; the meal-size soups garnished with roast meats are the best in Chinatown. Tried-and-true dishes include the Hong Kong style soups (try the shrimp-dumpling), steamed dumplings, crispy duck, eggplant with garlic sauce, fish dishes, and sautéed leek flower. Cash only.

 

The Matchbox (202-289-4441), at 713 H Street, just west of 7th Street, is good value. It has an eclectic lunch and dinner menu, including good personal pizzas in the true New York style. Sunday Brunch, 11-3; regular menu thereafter. Open until 1:00 a.m. on Friday and Saturday nights.

 

On 7th Street:

Jaleo (202-628-7949), 480 7th Street - just south of E Street - is one of the best places anywhere for tapas (over 50 to choose from); also good wine and sangria.

 

Legal Sea Foods (202-347-0007), at 704 7th Street at G Street, for fine seafood.

 

Rosa Mexicano (202-783-5522), at 575 7th Street at F Street is a very upscale, beautiful, eclectic Mexican restaurant.

 

Clyde's of Gallery Place (202-349-3700) is an upscale American restaurant (same ownership as the Tower Oaks Lodge) at 707 7th Street at G Street, next to the Verizon Center

 

Other options:

 

Zaytinya (202-638-0800) at 701 9th Street at G Street has Mediterranean food, including Greek tapas in a fine setting. As tasty as it is healthful!

 

Luigino (202-371-0595) at 1100 New York Avenue at 11th Street is the best nearby Italian option. No lunch on Saturday and Sunday.

 

Tosca (202-367-1990) at 1112 F Street (11th – 12th Streets) is a more elegant Italian restaurant. No lunch on Saturday. Closed on Sunday. Expensive.

 

Rasika (202-637-1222) at 633 D Street (7th St.) has Indian food. Closed on Sunday.

 

Five Guys Chinatown (202-393-2900) at 808 H Street at 8th Street is the place for takeout burgers & fries from 11 a.m. on.

 

Full Kee and Five Guys can be considered inexpensive. Clyde’s, Rosa Mexicano, and Jaleo are a bit expensive. The rest are moderate.

 

By John Steen, Consultant in Health Planning, Health Regulation and Public Health, jwsteen@expedient.net & Priti Irani, CHPPD Chair-Elect, pri01@health.state.ny.us

Letter to the Editor - Public Health and Human Rights are Related

Dear Editor,

I just wanted to compliment John Steen on his 'Public Health and Human Rights' article in the Winter 2007 issue of our section's newsletter. A couple of years ago when several of my APHA pals and I were discussing the Annual Meeting theme, some people in the conversation felt that a theme like 'public health and human rights' was too provocative, too in-your-face, and thus too risky.

I felt sounder minds prevailed in that particular argument, for precisely some of the reasoning so well articulated in John's article -- that public health and social justice/human rights really can't be separate things. Thankfully, we have Paul Farmer to carry that message in a very public way since Jonathan Mann was so abruptly lost to us all. It's nice to have good writers/researchers like John Steen to remind us periodically what the full spectrum of public health entails.

I really liked his article, and hope to see more of that in our section newsletter. Well done!

From Karen Valenzuela, CHPPD Liaison to the APHA Executive Board