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Community Health Planning and Policy Development
Section Newsletter
Spring 2008

A Message from the Chair

Dear Friends and Colleagues,

I trust that this note finds you all well. The Section had a tremendous

response to its call for abstracts this year – many thanks to all of you who submitted your work for review. It was an extremely competitive round. Special thanks go out to Roy Grant and Danielle Green for their able leadership during the entire process. Our section is well poised to sponsor yet another important APHA policy – this time on Vitamin D. Azzie Young has patiently and passionately (hard to do both) shepherded this proposal along its way. Look for details in the fall newsletter. The Policy Dialogue group is winding up its three-part series on Health and Civil Rights; be sure to visit the Web site at http://www.apha.org/membergroups/sections/aphasections/chppd/benefits/ppd_conf.htm to get details on podcasts, PowerPoint presentations and the blog. Thanks to Darrell Montgomery for his team’s efforts, especially the guidance and determination offered by Bob Griss, who inspired this series of sessions.

The one thing that CHPPD really is in need of right now and for the next two years is a leader for the Membership Committee. Emylou Rodriguez is coming to the end of her term, and it would be helpful for someone to co-chair with her through the 2008 Annual Meeting, then take over the reins. Please send a note to Emy at ERodriguez@marchofdimes.com or to Priti Irani at pri01@health.state.ny.us if you are willing to step up and help.

We have so much work in front of us and so these times are difficult. I am aware that many organizations have hiring freezes on. This means heavier workloads for those in positions now, and harder times for those breaking into the field or whose grants have not been refunded. Please know that your section will do its best to provide extra value to you for your membership and try to create forums where you can feel stimulated and supported.

Yours in service,

Sue Myers, Chair, sue.myers@healthequityassociates.org 

Review: 'What is Public Health?'

Communication Team members of the Community Health Planning and Policy Development Section asked friends, colleagues or family to comment on the Public Health Sticker campaign video clip recently released by the Association of Schools of Public Health. The video clip is animated and lively, and shows a group of college students putting stickers on objects that symbolize public health and explaining their reasons for doing so. Communication Team members were asked to show the clip to someone who did not know as much about public health, explain why this person was asked, and share their responses. This is what we learned:

I asked my son, Darius, because when he was in second grade,

Darius as Captain Jack Sparrow

a teacher's aide asked him what his mother does, and he said she is a doctor (and I am not). Ever since then, I have tried to explain to him what public health is. Now he is 10 years old, and in fourth grade, and the video clip engaged his interest. He said, "I think public health is about what is good for you and what is not." I was particularly struck to see the young man who said he thought public health was about cancer, and followed it up by smoking his cigarette.

Priti Irani, Research Scientist, New York State Department of Health and CHPPD Chair Elect.

I had my sister review the clip. I chose her because she teaches a course on media and pop-culture to college freshman at Indiana University. I thought it would be interesting to see her perspective since she is in tune with how her students view health issues and ways of catching the attention of the lay population through media. Her thoughts: It was catchy and innovative. She felt like it was a representation of what we in public health strive to do -- educate and empower. In the beginning no one new what public health was, but by the end everyone was repeating the message of what public health is, indicating that the campaign was successful. She felt that a lay audience would understand the message and come away feeling excited about the idea of getting involved in public health in some way. She liked the documentary-style interviews and believes that this style appeals to young audiences.

Ashley Wennerstrom, DrPH Student, University of Arizona and CHPPD Section Student Committee Chair.

I showed the video clip to my spouse and three children. My oldest child is out of college and working in the world of business. My other children are still in school -- one in college and one is still working his way through high school. Their comments follow:

"When this video started, it reminded me of the puzzled look I usually get when I tell people that your specialty is in public health. Many folks don't have a clue, responding, well, is that like, ummm, AIDS or something? I don't really know what that is. In a very simple way, the clip successfully demonstrates the wide range of issues in the field of public health."

"At first I didn't really get the video nor see where it was going. It helped me realize that all of your environment and surroundings contribute to your health, which isn't something I would have thought of otherwise."

"I thought the video was informative and will be a good tool for teaching the community about public health."

"I did not know much about public health until I saw this video, and now I have a better understanding about what it is."

- Charles Magruder, MD, Atlanta, Georgia.

I asked an author friend to review the video because she is both imaginative and resourceful, but generally secluded from everyday life due to her writing habits. She is very observant, and a good judge of character and reaction, so I asked her to view the video, then give me an immediate written response, which resulted in the following: "I myself was amazed at how many aspects of public health there are. Thought the progression from the 'huh?' looks at the beginning, through the sticker campaign, to the summary and responses at the end, did a nice job of presenting the topic."

- Tom Piper, Immediate Past-Chair, CHPPD, and Certificate of Need Director, Jefferson City, Missouri.

Cydney Urbanek

I work in a lab area, and I randomly picked one of the laboratory technicians, Cydney Urbanek. I asked, "Do you know what public health is?" She had a blank face, and I asked her to watch the video. Cydney said "I did not realize how much public health affects the environment. I agree with riding bikes to decrease the amount of toxic fumes, and that’s why I ride my bike..."

– Dawn Alayon, Student, Univesity of Florida, Communications Team Liaison.

I had my wife view the video. While she is fairly educated, with an MA in Behavioral Science, and has worked for about 13 years as an autism specialist, she has a much different perspective from that of a public health practitioner. She is focused entirely on the individual, to the point that we used to have heated discussions concerning appropriate research techniques; behavior analysts often use sample sizes of four or five and generalize from these. Anyway, she thought it was neat the way everyday items were demonstrated as a "public" aspect of health and was surprised, in a positive way, by the inclusion of some (e.g., police car).

– Scott Koertner, Coordinator, Global Crisis Response, Heart to Heart International, Kansas.

To watch the video, 'What is Public Health?', visit http://www.whatispublichealth.org. You can also join in the Public Health Sticker campaign. Contact Laura Biesiadecki at lbiesiadecki@asph.org, and give her your e-mail address so you can be invited to the Flickr group, and a mailing address to where stickers can be sent. Instructions are posted at http://www.thisispublichealth.org/campaign.html.

Public Health Perspectives in Pictures

I just got back from a long trip that took me to Dubai , Beirut , Damascus and Amman . I had the opportunity to tour clinics and go on home visits with mobile medical teams that primarily provide basic medical services to Iraqi and Palestinian refugees. It was both extremely educational and heartbreaking.

 

While on this trip I took two pictures that are interesting from a public health perspective and thought I would share them. 

 

 

This photograph was taken in the Old City of Damascus, Syria, and shows a public drinking spot.  There is a metal cup attached to a chain for the public to share, and the writing above it asks that thanks be given for the water.  Closer to home, public health practitioners in Kansas like to point out that in 1909 Kansas passed the first state law to abolish the common drinking cup - the "tin dipper" – in public places and the common glasses beside coolers in railroads. This innovative public health campaign was led by Dr. Samuel J. Crumbine of the Kansas State Board of Health. Photo courtesy Scott Koertner

 

This is a poster about the hazards of smoking taken in a primary health clinic in Amman, Jordan, that provides free medical care to Iraqi refugees and poor Jordanians.  It is interesting because it depicts not only a cigarette, but also shows a nargila, otherwise referred to as a hookah or "hubbly bubbly.” The nargila is popular in the Middle East and is used to smoke flavored tobacco.  Unlike other countries I have been to in the Middle East, Jordan has anti-smoking posters absolutely everywhere.  Another commonly seen poster depicts the end of the nargila as the head of a cobra. Photo courtesy Scott Koertner

 

By Scott Koertner, Scott.Koertner@hearttoheart.org

Scott Koertner is a Global Crisis Response Coordinator for a Kansas City humanitarian aid organization – Heart to Heart International – and has the opportunity to travel many places his father says, “he probably shouldn’t go to.” He has 10 years of military service and is trained as a disaster preparedness specialist. He holds undergraduate degrees in mathematics and chemistry from Washburn University and will complete his Master of Public Health in the summer of 2008, from the University of Kansas Medical Center. Professionally, he has worked both for the Kansas Department of Health and Environment as the State’s Strategic National Stockpile Coordinator, and for a local health department as a public health emergency preparedness planner.

 

The views, opinions, and judgments expressed in this message are solely those of the author. The message contents have not been reviewed or approved by Heart to Heart International.

New Co-Editor, Schiffman, Brings Diverse Interests to Section

My name is Elizabeth Schiffman, and I’m happy to be the newest newsletter co-editor for the Section. I haven’t been a part of APHA for long, but I’m excited about this opportunity to learn more about the CHPPD Section and the work that it does. I was able to attend and present at the 2007 Annual Meeting ,and I learned a lot about the different directions public health can take and the variety of opportunities it offers. I’m looking forward to another poster session this fall in San Diego and the chance to participate in the activities of the CHPPD Section.

I am relatively new to the field of public health — my background is in international studies and human rights. I have an MA in international human rights from the University of Denver, and a BA in international studies from the University of Minnesota. I am originally from Minnesota, but right now I am in Colorado working for Denver Environmental Health as a program administrator on the VB/I-70 Community Health Program. The program focuses on preventing lead poisoning in five target neighborhoods in Denver through community outreach and education. It’s funded by the EPA, and is a first of its kind in that it incorporates a community health and education program along with a traditional superfund site remediation project. Working on this program has been a great learning experience. In the future I would like to work on other projects that would allow me to explore some of my other health interests, which include health literacy, global health, the intersection of health and human rights issues, and health policy.

In my spare time, I love to read, knit, and hang out with friends. My dog also keeps me busy doing things she thinks are fun, liking going for walks and going to the park. My other favorite is traveling and exploring new places, although I haven’t had a chance to do much of that lately. If you have any questions, suggestions, or just want to say hello, send me an e-mail at elizabeth.schiffman@denvergov.org.

New Student Representative, Alayon, Eager to Serve

Hello all! My name is Dawn Alayon, and I have been recruited to be the new student representative to the CHPPD Section's Communications Committee. I became a member of APHA in September 2007, and during the November 2007 Annual Meeting, I really enjoyed spending time with the students of this committee. In particular, Amy Carroll-Scott, the immediate past chair, took the time to speak with me about CHPPD and the public health field in general. Since I have only been a part of APHA for a short period of time, I am honored to have such a great opportunity to serve on the Student Committee.

 

Dawn and Amy at the 2007 Annual Meeting

I am entering my second year as a Master of Public Health Student at the University of Florida with a concentration in public health management and policy. In 2004, I graduated with a Bachelor of Science in business administration with a major in economics and a minor in history. Currently, I work for UF's Department of Urology as a grants assistant, dedicated to principal investigators who perform research on prostate cancer. Recently, I participated in public health field work in El Salvador for my spring break, and I enjoyed my hands-on experience learning about that country's health care system.

During my short time in this position, I have participated in two conference calls: one for the Communications Team and another for the Student Committee. The Communications Team, created in March 2007, focuses on the newsletter and the Web site. As with other Section committees, we want to serve the CHPPD Section. Because my focus is on students, I want to try to serve and accommodate their interests. As seen in past newsletters, we have had a "Student Perspective" piece. Are students interested in anything else in addition to the student articles? For the Web site, should we have a dedicated student section? My function for my team and the students will be a reflection of those who are vocal in providing feedback. I appreciate constructive criticism and suggestions. Please do not be afraid to speak up.

I am still learning about the organization and how all of its sections function. I have enjoyed participating in the conference calls, and I cannot wait until the Annual Meeting in San Diego. I hope that I will be a great asset for the CHPPD Section. Please feel free to send me your comments or ideas, or even just an e-mail to introduce yourself. My e-mail address is dcalayon@hotmail.com.

Experiencing Public Health Issues in El Salvador During Spring Break

Instead of relaxing on a beach or engaging in well-deserved sleep for my spring break, I participated in the University of Florida’s Second Annual Public Health Spring Break in El Salvador. The trip allows public health and anthropology students to participate in community-based work. We were divided into two teams: the field work team in El Limón, which made medical and housing assessments in Canton El Limón, one of the poorest towns in the municipality of Torola, and the epidemiological team, which assessed the current surveillance systems of the Department of Morazán. Alba Amaya-Burns, MD, MSc, CTM, a clinical associate professor in the Department of Behavior Science and Community Health at UF, created this program in 2007.

Photo courtesy of Dawn Alayon

I participated in the field work team in Canton El Limón. This community is located on an almost secluded mountainside with a steep incline, presenting accessibility problems and making travel to and from the village to the neighboring town of Torola difficult. As for the roads leading to the community, they are unpaved and very uneven, forcing the use of pick-up trucks to drive on the rough terrain. In addition, the community does not have electricity or running water. El Limón has community leaders and health promoters, and we worked closely with them to coordinate health visits in the homes. Our goals were to focus on the environment and perform health assessments, using the Ministry of Health’s health files (carpetas).

For water, each family had several containers and walked to a water source daily to refresh the supply. The same water source was used for both drinking and cleaning clothes, and due to the probable contamination, we supplied Puriaqua, a chlorination agent, to purify their water. Each family was trained on its proper usage, and we hoped that the incidence of diarrhea would decline. As for cooking, almost every family cooked on fire stoves, and the ceilings were noticeably burned from the smoke. Many families did not cook outside due to the rain during the wet season. During the interviews, families often cooked food, and the smoke was pervasive throughout the home. This can cause major health problems, including upper respiratory ailments. Food stores in the home were in danger of being contaminated due to the presence of animals in the home — I remember one home where the pig constantly kept walking through the door. In many other homes, chickens would jump on the tortilla makers or eat kernels on the ground.

The epidemiology group worked with Dr. Erick Gomez, the director of the local health clinic for the Municipality (Unidad de Salud). Located in Perquín, this local health clinic is the only one in the area. Nabih Asal, PhD, FACE, professor of epidemiology in the Department of Epidemiology and Biostatistics at UF, headed the epidemiology group, and they studied the surveillance system. Due to a lack of access to laboratories and staff, the system relies heavily on diagnosing infectious diseases by symptoms alone.

The family stories were extraordinary. While completing the carpetas, we noticed every family member suffered from some level of malnutrition, as the diets consisted mostly of tortillas made from corn. For many of the families, the hens were so malnourished that they were unable to lay eggs. In particular, we visited the home of a family who were considered outcasts. The grandmother knew she was in the early stages of dementia, and the man of the house was a 15-year-old boy. Due to his obligation to financially sustain the family, he had only a third-grade education.

On our last day in El Limón, we gave a poster to community members, who in turn expressed their appreciation for our presence and hoped that we would return the next year. We left encouraging, positive messages for the community to remember such as "Puriagua makes the water better." Our poster was left on the community leader’s home, or the "culture house," so it would be readily accessible to all the community.

I was very humbled by the experience. In order to be well-rounded public health professionals, I believe all public health students should venture outside the United States and observe other health care systems.

I would like to acknowledge the members of the group: Alba Amaya-Burns, MD, MSc, CTM, Allan Burns, PhD, Nabih Asal, PhD, Mai Asal, John Gaines, MD, Mirna Amaya, Ana Amaya, Kathryn Evans, Susan Fesperman, Dyanne Herrera, Amy Non, and Trey Perez. Each of us relied on our expertise to sustain each other during the trip, and we hope to return for Spring Break 2009.

If you are interested in learning more about the program, please feel free to contact me directly at dcalayon@hotmail.com .

By Dawn Alayon, Student Representative to the Communications Committee

A Personal Experience of Community Public Health in Cuba

On Dec. 10, 2007, my husband and I traveled with a mission team from Oklahoma Volunteers in Mission to Havana , Cuba . As humanitarians, we were issued a license by the U.S. T reasury to legally go to Cuba . A primary goal of this mission was to assist in the rebuilding of a church in Pilón , Cuba that was destroyed by Hurricane Dennis in 2005. As a public health professional, I was very interested in observing the public health system in Cuba , having read about the country’s public health strategies that have resulted in health indicators comparable to industrialized countries in a country that has an average annual income of around $2,500 per year.

 

So, what does community health look like in Cuba? I can give you a snapshot from my experience in Pilón, which is a town of about 30,000 located on the southeast coast of the island of Cuba, a 14-hour bus ride from Havana. Our team of 12 stayed at the home of the pastor, so we got a little more insight into Cuban life than a stay at a nearby resort would have afforded us. How many of us would put up with 12 guests plus six family members in a home of less than 1,000 square feet? The home was small but comfortable; the pastor had borrowed bunk beds from the local school for us to sleep on.

 

Although we drank only bottled water, the home had basic conveniences such as running water, a flush toilet and a telephone! The kitchen included a refrigerator, sink and propane cook stove. We were served very generous meals and observed the butchering of a goat and a pig during our visit. The pig was for a holiday pig roast, and I watched with interest as we waited for a local health inspector to come and check the pig out before it was killed. Our hosts explained his inspection had something to do with flies (I wonder what my sanitarians would think of that). After the health inspsector gave his approval, the pig was slaughtered out in the back yard. During our seven day stay we ate every meal with our hosts, and no one was afflicted with any of the diarrheal illnesses we commonly associate with foreign travel. 

 

Shari Kinney getting physical activity shoveling sand to mix concrete as she helps with re-building a church in Pilón, Cuba

We had two interesting experiences with Cuban health care. The first was our interpreter from Havana who had lost a filling in a tooth. After a phone call to the local clinic, the bus driver drove her to the clinic. She was gone about an hour, returning with a new filling. The second instance was during a pick-up basketball game with the Americans when one of our Cuban friends injured his foot. He went to the local clinic/hospital and an hour later returned with a knee high white plaster cast and explained that he had “broken his foot.” However, there was no walking boot or crutches – he fashioned a cast boot out of a tennis shoe and was able to ride his bicycle. We supplied him with some Tylenol for pain. Over-the-counter medication is in very short supply in Cuba.

There were many aspects of this Cuban community that explain their good health. All women have access to prenatal care from their local physician – Cuba has more doctors per capita than virtually any country in the world (reportedly 1:170). The diet in Cuba appeared to be primarily rice and plantains and local fresh produce, with limited meat and dairy products. I especially enjoyed the strong Cuban coffee, which was served espresso style or with hot milk. We also enjoyed flan for dessert. There was little processed food available to the local population; we were able to purchase canned soda, chips and candy bars at tourist stores.

In Pilón there were virtually no automobiles, so most people walked or rode bicycles around town. The home where we stayed was across the street from a children’s park and another park that seemed to be more for adults. There was also a bus station for travel to other communities, and hitch hiking is also very common. All children went to school at no cost and wore identical school uniforms. We were told that everyone had the opportunity for free primary and secondary education, but also advanced education based on test scores, including vocational training. One of our interpreters was a teacher at the local teacher’s college.

Although the standard of living in Cuba was far below what we have in the United States, public health has been made a priority by the government, and every citizen seems to have access to health care.

By Shari Kinney, MS, MPH, RN; Cleveland and McClain County Health Departments, Norman, Okla., and CHPPD Section Policy Chair

 sharik@health.ok.gov.

Health Care and Human Trafficking

From the 16th to the 19th centuries, approximately 645,000 slaves were brought to what is now the United States.1  By the 1860 Census, the U.S. slave population grew to 4 million.2  The Emancipation proclamation and the 13th Constitutional Amendment of the mid 1860s were thought to have abolished slavery in the United States -- until the global recognition of human trafficking brought modern day slavery to light.

From Rescue and Restore Campaign brochure http://www.acf.hhs.gov/trafficking/index.html  

Human Trafficking Defined

The Trafficking Victims Protection Act of 2000 provides for protection of victims, prosecution of traffickers, and international prevention strategies to address this crime. This law defines trafficking as any commercial sex act induced by force, fraud, or coercion; or, in which the person induced to perform acts is not 18 years old. The definition also includes recruitment, harboring, transportation, provision, or obtaining of a person for labor or services, through use of force, fraud, or coercion, for the purpose of involuntary servitude, debt bondage, or slavery.3

Modern Day Slavery

Of the 600,000 to 800,000 people coerced or forced into crossing international borders each year, about 14,500 to 17,500 end up in the United States. Millions more are internally trafficked within the borders of their own countries.4

Threat to Communities

After drug dealing, human trafficking is tied with the illegal arms industry as the second largest criminal industry in the world today, and it is the fastest-growing.5 Many of the world’s major sex traffickers may be connected to organized crime groups, who may use the profits to fund other criminal activities. This may equate to more drugs, crime and terrorism in our communities.

Identifying and Protecting Trafficking Victims

The Department of Health and Human Services’ Office of Refugee Resettlement (ORR) “certifies” trafficking victims for eligibility to receive the same rights and benefits as refugees. These include social service systems under the Medicaid program, including health care. Nongovernmental organizations provide shelter, clothes, food, psychological services and immigration services. Since 2004, there have been 1,175 certified victims of human trafficking from 77 countries.6

Health Implications

Human trafficking is a global public health issue. Health issues are ignored until they are critical or life-threatening. Dirty and crowded living conditions, coupled with poor nutrition, cause health conditions such as scabies, tuberculosis and other communicable diseases.

Chronic back, hearing and vision problems may occur from working in dangerous agriculture, sweatshop or construction conditions. Long-term untreated issues such as cardiovascular or respiratory problems, diabetes or cancer may be present. Bruises, scars and other signs of physical abuse and torture may be visible.7

Sexually transmitted infections, human papillomavirus, pelvic inflammatory disease, permanent damage to reproductive organs, and HIV/AIDS are often the result of forced prostitution.8,9 Victims may be coerced, or in desperation to escape their pain, willingly succumb to drug use.10

Victims of trafficking often endure brutal conditions that may result in psychological trauma, such as anxiety, depression, sleep disorders, and post-traumatic stress disorder, disorientation, confusion, phobias and panic attacks. They may suffer feelings of helplessness, shame, humiliation, denial, disbelief or culture shock from being in a strange country.11

Malnourishment may be present especially in child victims, as are dental issues. Additionally, children denied social, moral and spiritual development may suffer growth and developmental problems.12

Public Health’s Role

In public health, the identification, support and service coordination for victims of sexual and domestic violence has made significant progress. In Florida, public, private and nonprofit agencies on state and community levels work together to establish protocol and build infrastructure to ensure comprehensive care is provided to each victim. This same effort is needed in public health for the identification and support of victims of trafficking.

Create and maintain awareness

Consider who may be victims working in restaurants, hotels, tourism; or panhandling. Incorporate health and human trafficking information into existing programs, policies, education and curricula. Display and distribute trafficking awareness resources, including Rescue & Restore materials found at www.acf.hhs.gov/trafficking. Free posters, brochures, fact sheets and cards are available in several languages and include tips on identifying victims.

Take action

If you think you have identified a trafficking victim, call the National Human Trafficking Resource Center at (888) 373-7888. The hotline has assisted more than 4,000 callers in determining if a person is a trafficking victim, and finding local resources to help victims.13

Conclusion

Trafficking denies women, children and men basic freedom. Trafficking robs communities of potential productive members of society,and exposes victims to violence, injury, disease and death. Trafficking is a detriment to public health, both economically and in the potential for widespread health issues.

References

1. Slavery in America: An Educators Site, New York Life (http://www.slaveryinamerica.org/)

2. Population of the United States in 1860, compiled from the original returns of the eighth census, under the Direction of the Secretary Interior, by Joseph C. G. Kennedy, Bureau of Census Library, Government Printing Office, 1864 (http://www2.census.gov/prod2/decennial/documents/1860a-15.pdf)

3. Trafficking Victims Protection Act of 2000 (TVPA), Public Law 106-386 22 United States Code, § 7102(8)

4. Attorney General’s Annual Report to Congress on U.S. Government Activities to Combat Trafficking in Persons Fiscal Year 2006 (released May 2007), (http://www.usdoj.gov/ag/annualreports/tr2006/agreporthumantrafficing2006.pdf)

5. Campaign to Rescue and Restore Human Trafficking: Human Trafficking Fact Sheet (January 2008), US Department of Health & Human Services, Administration of Children & Families, (http://www.acf.hhs.gov/trafficking/about/fact_human.html)

6. Attorney General’s Annual Report to Congress on U.S. Government Activities to Combat Trafficking in Persons Fiscal Year 2006 (released May 2007)

7. Campaign to Rescue and Restore Human Trafficking: Common Health Issues Seen in Human Trafficking Victims Fact Sheet (October 2007), US Department of Health & Human Services, Administration of Children & Families, (http://www.acf.hhs.gov/trafficking/campaign_kits/tool_kit_health/health_problems.pdf)

8. Stolen Smiles: The physical and psychological health consequences of women and adolescents trafficked in Europe, Cathy Zimmerman, Mazeda Hossain, Kate Yun, Brenda Roche, Linda Morison and Charlotte Watts. London School of Hygiene and Tropical Medicine (LSHTM), 2006, http://www.lshtm.ac.uk/genderviolence/recent.htm

9. Health Consequences of Trafficking in Persons Fact Sheet (August 2007), US Department of State Office to Monitor and Combat Trafficking in Persons (TIP), (http://www.state.gov/documents/organization/91537.pdf)

10. Campaign to Rescue and Restore Human Trafficking: Common Health Issues Seen in Human Trafficking Victims Fact Sheet (October 2007), US Department of Health & Human Services, Administration of Children & Families, (http://www.acf.hhs.gov/trafficking/campaign_kits/tool_kit_health/health_problems.pdf)

11. Stolen Smiles: The physical and psychological health consequences of women and adolescents trafficked in Europe, C. Zimmerman, M. Hossain, K. Yun, B. Roche, L. Morison, C. Watts, LSHTM, 2006

12. Campaign to Rescue and Restore Human Trafficking: Child Victims in Human Trafficking Fact Sheet (November 2004), US Department of Health & Human Services, Administration of Children & Families, (http://www.acf.hhs.gov/trafficking/campaign_kits/tool_kit_social/child_victims.pdf)

13. Attorney General’s Annual Report to Congress on U.S. Government Activities to Combat Trafficking in Persons Fiscal Year 2006 (released May 2007)

By Florida Surgeon General Ana M. Viamonte Ros, MD, MPH, and Rhonda Thomas-Poppell, Government Operations Consultant

None So Blind As Those Who Will Not See

From the 4th Quarter 2007 issue of Health Planning TODAY.  To read the full article, click here.


It seems obvious that we have closed minds about American health care, a condition that has been ascribed to American education as well. Twenty years ago, Allan Bloom’s The Closing of the American Mind (Simon & Schuster, 1987) took a radically unorthodox view of American education much as the documentary Sicko is now doing for health care. His philosopher’s observation on an insidious political process at work in our society provides insight into the real barrier we face in policy reform, not just in health care: "The most successful tyranny is not the one that uses force to assure uniformity but the one that removes the awareness of other possibilities, that makes it seem inconceivable that other ways are viable, that removes the sense that there is an outside." (p.249)

Doublethink

On Sept. 24, 2007, John Goodman, National Center for Policy Analysis president, issued an e-mail "Health Alert" announcing that he was establishing "the Mondrian Award for Ineffectiveness in Health Policy." Interested, I read on only to learn that "the award will go to the program, agency or proposal that promises the least health outcome for the most dollars spent," and that he had given it the name "Mondrian" to signify the minimalist nature of the health policy thus selected. I was eager to find out which policies he had in mind, but he hadn’t yet selected one. Instead, he just wished to discuss the award’s potential to identify so much waste. Then I came across this:

Were he alive today, Lyndon Johnson would surely qualify for a Lifetime Achievement Mondrian for giving us Medicare. This program has an unfunded liability six times the size of Social Security's.

If this doesn’t look to you like a distorted view of our social and political reality, nothing I could write will reveal it to you. I just wonder how much of the distortion is economic, how much is political, and how much is moral.

There is a moral blindness in our nation, evident in national politics ever since Ronald Reagan said in a speech in 1964: "We were told four years ago that 17 million people in America go to bed hungry every night…. Well, that was probably true. They were all on a diet." And now, due to our political blindness, the nation has been put on such a diet for the last seven years.

The President’s explanations about why he would veto the expansion of SCHIP proposed by Congress led him to assert that the uninsured "have access to health care in America. After all, you just go to an emergency room." This can have some credence only for those who have no concept of what a health care system is, nor any appreciation of the proper role of public health and prevention in it. If they did, they would see the need to use emergency rooms for any but true emergencies as failures that ought to be obviated by a health care system that places public health on top and values personal medicine for providing a medical home for health education and preventive care. And it is the lack of such care leading to the misuse of ERs that causes people to descend into bankruptcy and poverty. Here we see the promulgation of the same distortion "that removes the awareness of other possibilities," and through it, "removes the sense that there is an outside," in the fateful words of Allan Bloom. I hope the time has come for us to see what lies outside such a treasonable lack of governance.

The Price of Everything; the Value of Nothing

The almost total ascendancy of libertarian values over communitarian ones – too much freedom – exacts a serious moral, social, and emotional price. The orthodoxy of neoclassical economic theory elevated to a sort of secular religion has managed to redefine "the cost of living" in terms of the alienation of those who follow it, alienation from our authentic self and from our obligations to each other. We manage to think we love our individualism without realizing how misguided our ways of expressing it have become. All these blind spots should be seen for what they are: symptoms of how we have come to live our everyday lives without a sense of the values implicit in living a mindful life intentionally. We no longer seem to see that the meaning of life consists of giving life meaning.

And so, Bloom’s insight is that the most successful tyranny is the blindness that results in our living out the sort of impoverished lives that match the conception of human nature contained in orthodox neoclassical economics. Health care is just one of the important social institutions needing to be reformed. The success of that will be determined by how well we are able to see through the smokescreen of societal myths far upstream from it. We must see that there is an outside and redeem our original values in that clearer light that restores a truer vision of the good life.

By John Steen, Consultant in Health Planning, Health Policy, and Public Health, jwsteen@expedient.net

An Update on CHPPD Sessions at the 2008 APHA Annual Meeting

Convention Center, San DiegoThis year the Community Health Planning and Policy Development Section received more than 400 interesting and well prepared abstracts for the 2008  APHA Annual Meeting. It was difficult choosing among them to fill our approximately 50 oral, poster and roundtable sessions, and we had to reject some very interesting work. In this article I will give an overview of our 2008 program and offer some pointers that may be useful when you submit your abstract next year.

 

Our goal over the past several years has been to emphasize the “policy” aspect of CHPPD’s profile in APHA. We prioritized presentations that bring together sound scientific methodology, interesting findings, and policy implications for health care in the United States. With the extremely different approaches to health reform of the two presidential candidates, and the protracted difficulty getting agreement between Congress and the current administration over public health insurance expansion, we expect a lot of interest in presentations that deal with these issues. Other continuing areas of CHPPD focus are health disparities, vulnerable populations, and community partnerships.

 

Here are some of the highlights of our upcoming program. You can get the day and time for the sessions and read the abstracts online by going to www.apha.org/meetings and searching the scientific program by session number.

 

We will feature two sessions that review findings from the health reform experience in Massachusetts (sessions 3203.0 and 5145.0). Session 4171.0 will explore strategies to maintain insurance coverage for vulnerable children. Several sessions will focus on ways to reduce health disparities for vulnerable populations: 3022.0 focuses on culturally relevant health education materials; 3112.0 discusses ways to enhance access and reduce emergency room visits; 3205.0 focuses on rural populations, 4083.0 on inner city children, and 4346.0 on immigrant populations. Session 4168.0 is a special session describing the role of school-based health centers in meeting the needs of medically under-served children, and 4256.0 discusses the health care safety net. Several sessions will focus on chronic conditions (5148.0) including asthma (3204.0), cancer (3400.0), and HIV (3310.0).

 

Maintaining our public health focus, we will have sessions on building the public health work force (4015.0); assessment, planning and financing (4344.0); and community planning to improve maternal and infant health (5146.0). Concern about obesity continues, and we will have several sessions including strategies for prevention (4167.0 and 4255.0), intervention (4345.0), and measuring outcomes (3113.0).

 

One of the many reasons that CHPPD attracts such a strong array of abstracts is the diversity of subjects we include in the Section. This year we will have two important sessions on disaster and emergency preparedness (5036.0 and 5096.0), and continue our focus on the slow pace of recovery for children and families affected by Hurricane Katrina (4014.0 and 5039.0). One session will discuss the enhanced medical home for children, incorporating access to mental health and child development services (4169.0). Other CHPPD sessions describe the use of Web-based technology to reduce disparities (3402.0), health care as a civil right (5147.0), and, focusing on an important health policy issue, the value of Vitamin D for optimal health (3401.0). One session will feature five of the excellent abstracts we received from students (3202.0, discussing community-based research, planning and services).

 

All of these themes will be further featured in our poster sessions and roundtable. These presentation modalities provide opportunities for interaction with the presenters and networking with people that share your interests and priorities.


If you want more information, please contact me at rgrant@chfund.org or our Program Committee Co-chair, Dr. Danielle Greene, at dgreene@health.nyc.gov.

By Roy Grant, Chair, Program Committee, rgrant@chfund.org

Tips on Writing Abstracts for APHA’s Annual Meeting

Even though the Comm

Bruce Occena discussing his poster at the 2005 conference
unity Health Planning and Policy Development (CHPPD) section had many sessions, we had to reject lots of really strong and interesting abstracts. Here are some of the things that we took into account.

 

First of course was the peer review process. Each abstract is reviewed (blind) by three volunteer reviewers. We are grateful to this year’s reviewers and encourage all of you to consider becoming a reviewer for the section. Once the reviews were in, however, we had to choose among the highly rated abstracts. Sometimes there were too many good abstracts on the same topic and we chose the best from among them. Having an original topic or point of view is encouraged, but the topic must fit into the parameters of the section. Some good abstracts were not right for CHPPD and we transferred them to more appropriate sections.

 

Poster sessions each accommodate 10 presentations, and this means that CHPPD will have 70 poster presentations at the 2008 conference. If you submit your abstract with the choice “oral only,” we will not consider you for a poster presentation and your chances of having the abstract accepted will be reduced.

 

Finally, the APHA 250 word limit is very brief and requires that you highlight the most important aspects of your work. The final abstract should be succinct, well organized and include original data to the extent possible. Abstracts that are substantially below the word limit suggest that the idea is not fully developed.

 

By Roy Grant, Chair, Program Committee, rgrant@chfund.org

 

Spending Summer Scoping San Diego, Oct. 25-28

Annual Meeting logoCommunity Health Planning and Policy Development Section members are preparing for the APHA Annual Meeting in San Diego.  There are opportunities for  all of you to be involved, whether you are going to be there in person or spirit.

Policy Reviews: In July, the revised new policy statements will be posted on the APHA Web site.  The Section policy chair will send out an e-mail requesting members review and comment on policies with a link to an online form.  The comments will be reviewed and shared at the Annual Meeting by Section representatives.  For more information, contact Shari Kinney, ShariK@health.ok.gov.

Annual Meeting Logistics: Section members are working on organizing the business meetings, the Section Social, the exhibit booth, and other networking opportunities.  If you would like to be involved, please contact Ashley Wennerstrom, ashwen@email.arizona.edu, or Emy Lou Rodriguez, ERodriguez@marchofdimes.com.

More information on the Program and events leading the Annual Meeting are posted, and will continue to be updated on the Section Web site at http://www.apha.org/membergroups/sections/aphasections/chppd/.