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Community Health Planning and Policy Development
Section Newsletter
Spring 2010

Chair’s Message: Gearing Up for a Lesson in Community Engagement?

Priti Irani, Chair
In March and April of 2010, the 1,700 or so Community Health Planning and Policy Development (CHPPD) Section members were invited to participate in a Section priorities feedback survey. Members were told that the information provided would be used to identify and match interests and expertise with action plans for this year and upcoming years.

 

After one reminder, 98 members responded, making for a 6 percent response rate. By any standards, this is a low response rate.  It is consistent with past response rates to surveys conducted by the Section. 

 

For every Section priority area, at least one or more of the respondents indicated he/she would work on it as their first choice. This is very encouraging! Forty-three of the respondents are new members, 20 percent are students, and 9 percent have been Section members for 10+ years. Members from all regions of the United States responded to the survey with most representation from Regions V (IL, IN, MI, MN, OH, WI); and III (DE, MD, PA, VA, WV, Washington D.C.).

 

Findings

The top four priorities members want to work on as a first choice are:

  1. community health improvement
  2. social determinants of health
  3. community-based participatory research
  4. health reform, quality of health care, and certificate of need

The top two projects members would like to work on are:
    1. Write an APHA proposed policy or organize an invited session on social justice/social determinants of health (power, poverty, education, etc.)
  1.                 2. Be part of the CHPPD Section Rapid Response Team who provides written comments on specific federal regulations (Healthy People 2010, Obesity Task Force, health reform, etc.)
     
    The top two activities respondents would like to work on are:
    1. coordinating an oral presentation/poster session for the Annual meeting
    2. contribute to the newsletter

    Discussion

    During the May 18 Section conference call, there was discussion about the relevance of the low survey response rate. Most agreed that while the response rates were low, the 98 respondents offered a starting point for reaching out to Section and APHA members.

     

    In the past, the Section has conducted surveys, shared the results and moved on. This time, I hope we will consider this a study in community engagement, and be more purposeful in how we move on.

     

    Some questions we have the opportunity to explore:

    • What will it take to mobilize members, many of whom are new?
    • Will these members help reach out to other members? What will this look like?
    • Will the mobilization strategies result in action, or will it make no difference?

     

    The major challenge for the Section is rotating volunteer leadership and membership. The strengths are the passion and genuine interest among members to engage communities.

     

    Conclusion

    Section members are beginning the dialogue. If you have suggestions or comments regarding the survey or follow-up, please contact me at pri01@health.state.ny.us.

     

    - Priti Irani, CHPPD Section Chair

  2. Vote Online in Section Elections by July 23

    The 2010 election polls are now open. We encourage you to vote; it directly affects the future of the Section and the Association. Please follow the simple steps below to login and vote.

    1. Go to the APHA voting site: https://www.esc-vote.com/publichealth
    2. In the first box enter your Unique PIN: (e-mailed to you on Friday, June 18). Press the tab key.
    3. In the second box enter your APHA Member ID Number.
      Press the tab key.
    4. Click on the "Login" button to begin voting.

    Please note that ballots are tallied by an outside vendor - to ensure that your vote is confidential.

    If you need assistance, you can click on the "Help" button on the login page to access the help screen or call (866) 720-4357 to speak with an Election Services Co. customer service representative. Please note that you must cast your ballot by Friday, July 23 by 11:59 p.m. EDT.

    CHPPD Section Seeks Annual Meeting Program Co-Chair and Newsletter Co-Editors

    Program Co-Chair must have strong organizational skills

     

    APHA Annual Meetings are organized and run by volunteers. Each session has a chair and co-chair, who plans and organizes the section's portion of the APHA Annual Meeting, along with the help of volunteer reviewers. The CHPPD Program Co-Chair position is for a two-year term starting after the Annual Meeting in 2010 and effective through 2012. This is a volunteer position. The co-chair has to be an APHA member and attend both the 2011 and 2012 conferences. 

     

    This position has waves of intense work, especially from March through July as abstract submission, session and moderator assignments have to be met, and again around the Annual Meeting. Strong planning skills, computer skills and attention to detail are a must. A good deal of coordination, timely communication, a sense of humor and flexibility are needed to effectively work with APHA, CHPPD leadership, other APHA sections, abstract submitters and reviewers, presenters and moderators.

     

    We are looking for someone who is enthusiastic and can commit to attend the APHA Annual Meeting for year 2011 as well 2012. Interested in this exciting opportunity? E-mail Padma Arvind at padma.arvind@co.middlesex.nj.us.

     

    Newsletter Co-Editors need community engagement and technical skills

     

    CHPPD seeks two Newsletter Co-Editors. Probably a more accurate title would be “Community Engagement Specialists”.  Newsletter co-editors engage CHPPD members in development, publishing and evaluation of the newsletters, and ensure timely publication of the electronic newsletters. The newsletters includes articles on topics of interest to the Section as well as articles on how the Section is advancing the profession; links to relevant web sites; information on obtaining professional resources; message from the chair; information on upcoming conferences; and the APHA Annual Meeting. 

     

    There is an opening for two Newsletter Co-Editors, and there will be training and mentorship available for each Co-Editor. Estimated time commitment is about 2-5 hours over a two-week period in January, June and September when articles have to be submitted online, with lighter time commitment in between. One of the Co-Editors will be nominated for a one-year term, and the other a two-year term. This is a voluntary position.  he newsletter editor must be comfortable with using technology, and have access to Windows operating system. 

     

    Interested in becoming more involved with your CHPPD Section? E-mail Sami Jarrah at sami.kamal.jarrah@gmail.com or Elizabeth Schiffman at elizabeth.schiffman@gmail.com. 

    An Inconvenient Truth: Politics, Economics and Ethics

    In making health equity fundamental to its mission, public health has adopted social justice as a profoundly political theme. The very act of defining public health is a political act. Public health must acknowledge that it cannot pursue its vision of better health for all as a human right without confronting the political and economic power opposed to it. It must begin by addressing the disparity between its goals and its means. The separation of epidemiology from political engagement reflects moral blindness. I concur that “a determined desire to achieve equality in health makes obvious the need for political action to effect fundamental social change,” and “…perhaps more assuredly than for any other health field, public health can never be depoliticized without losing its very essence and effectiveness.”[i]

     

    In its landmark 1988 report, the Institute of Medicine identified some “appreciable barriers to problem solving in public health,” including “limits on effective leadership, including poor interaction among the technical and political aspects of decisions.”[ii] It found that “public health agencies are having difficulty striking a balance between political responsiveness and professional values.”[iii]

     

    The acknowledgement that the health status inequities of whole populations are the result of a world being remade in a neoliberal image carries with it the promise of the ability to reverse that process through designs promoting greater equity and social justice. That is a decision societies must make, but first they must understand how and why to make it. It is not the role of public health to manage the democratic political process, but it assuredly is its role to inform it.

     

    Much good research has been conducted on the social determinants of health as agents adversely affecting the health status of populations, agents whose existence is properly seen as a challenge to public health’s mission. The problem is that public health fails to identify the people with the economic and political power behind those agents. “It is not inequalities that kill, but those who benefit from [and perpetuate] the inequalities that kill.”[iv] “Disease is a social and political category imposed on people within an enormously repressive social and economic capitalist system, one that forces disease and death on the world’s people.”[v] In public health’s failure to identify this, it implicitly operationalizes the neoliberal policy model[vi] of assignment of responsibility for health status to the individual.

     

    It was claimed that “a major thrust” of the WHO’s Commission on the Social Determinants of Health was “turning public health knowledge into political action,”[vii] but its report never made those linkages clear. It failed to ask the question why we are burdened by those social determinants, to ask for the causes of “the causes of the causes,”[viii] a question needed to arrive at the insight that the public’s health is politically and economically as well as socially determined. Political pathology is the cause of the causes of the causes.

     

    This is abundantly clear in an excellent Canadian report: Social Determinants of Health: The Canadian Facts.[ix]  It describes a situation in Canada that is very similar to that in the U.S., but it includes “policy implications” that are properly governmental/political. “Our key message is that the health of Canadians is much less determined by the health care system than we typically think. Much more important are public policies that influence our living conditions,” says Dennis Raphael, the report’s co-author. And Ronald Labonté, Professor and Canada Research Chair, Globalization and Health Equity, University of Ottawa is even more pointedly specific: “We have lived through three decades where the predatory greed of unregulated markets has allowed (and still allows) some to accumulate ever larger hordes of wealth and power while denying others a fair share of the resources they need to be healthy. This book is a fast-fact reference and an invitation for Canadian health workers to join with social movement activists elsewhere to reclaim for the public good some of these appropriated resources.”

     

    Public health is entrusted with the authority to exercise the diligence necessary to protect the public’s health. To carry out that responsibility with professionalism and integrity requires that it be independent of excessive political influence that would undermine its effectiveness. Ideally, public health leaders should be seen as having the ethics and politics defined by the value of truth, together with the freedom to correct policy errors.


    By John Steen, Consultant

    [i] Hillel W. Cohen, Mary E. Northridge, “Editorial: Getting Political: Racism and Public Health,” AJPH, 90 (6), June 2000, p.842. http://ajph.aphapublications.org/cgi/reprint/90/6/841.

     

    [ii] Institute of Medicine, The Future of Public Health, National Academy Press, 1988, p.107.

     

    [iii] Ibid., p.154.

     

    [iv] Vicente Navarro, “What We Mean By Social Determinants of Health,” Global Health Promotion, 16,

    no. 1, 2009, p.15.

     

    [v]  Vicente Navarro, “What We Mean By Social Determinants of Health,” International Journal of Health Services, Volume 39, Number 3, 2009, p.440. http://baywood.com/hs/ijhs393A.pdf

     

    [vi] A succinct definition of neoliberalism: “…the role of the state in all dimensions of economic and social life should be reduced in order to free up the enormous potential of market forces (usually referred to as “free” market forces), by deregulating world trade, increasing the mobility of capital and labor, and eliminating social arrangements (such as social pacts and protectionism) that [stand] in the way of the full development and expansion of capitalism.” Vicente Navarro, ed., Neoliberalism, Globalization, and Inequalities: Consequences for Health and Quality of Life, Baywood Publishing Co., 2007. Introduction, p.1. http://www.baywood.com/intro/338-3.pdf.

     

    [vii] Michael Marmot, “Social Determinants of Health Inequalities,” The Lancet, 365 (9464), 1099-1104, March 19, 2005. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(05)71146-6/fulltext#.

     

    [viii] This is a phrase used by Sir Michael Marmot.

     

    [ix] Mikkonen, J., & Raphael, D. Social Determinants of Health: The Canadian Facts. Toronto: York University School of Health Policy and Management (April 28, 2010). http://www.thecanadianfacts.org/The_Canadian_Facts.pdf.

     

     

    A Change in Perspective

    Public health professionals have a moral obligation to advocate for innovative traffic safety programs that integrate solid research methodologies instead of ad hoc programs rooted in common sense. The first step in re-engineering the communication roadmap between transportation-public health professionals must begin on common ground. Applying an accepted theory from the medical field; the Biopsychosocial model (BPS), an ecological framework based in part on the Social Cognitive Theory developed by Bandura can be used to cross the communication abyss. Using discipline specific terminology and building on existing knowledge from both fields, a cross correlation of the Venn diagram defines each corresponding circle represented in Figure 1. For example, the biology (structure and function) of an individual can be applied to the engineering (structure and function) of a particular road segment. The fundamental principles of this relationship matrix are similar to the Federal Highway Administration perspective of Context Sensitive Solutions; defined as “a collaborative, interdisciplinary approach involving all stakeholders to develop a transportation facility that fits its physical setting, preserves scenic, aesthetic, historic and environmental resources, while maintaining safety and mobility.” The only difference between the BPS and CSS is seen in the concept titles. However, the models are not distinct, but synergistic. It is this interconnection that influences the overall health of an individual. Public health and transportation professionals have a similar goal, “a culture of safety”, we just don't understand what the other is saying!
                                                        - APHA Graduate Poster Session Submission, June 11, 2010

    The public health problem of traffic-related crashes and the impact on a community is devastating: “In 2006, 42,642 persons died in traffic crashes in the United States. That statistic breaks down to 116 every day, about 5 every hour and 1 every 12 minutes. Looking at it another way, each traffic fatality results in about 60 injuries: more than 7,000 every day, 300 every hour and 1 every 12 seconds.”1

    These incidents are not random events. Rather, they are predictable and preventable. Traffic crashes adversely affect persons of all ages; there is no discrimination based on socioeconomic status, season or hour of the day.1 Each person who drives or rides in a motor vehicle, walks, bicycles on or across a road is at risk of death and injury.1 Unfortunately when it comes to traffic safety, we as a society possess a perspective of complacency in which traffic-related crashes and injuries are an accepted outcome. 

    As public health professionals, we have a moral obligation to advocate for innovative traffic safety programs that integrate solid research methodologies instead of ad hoc programs rooted in common sense. An efficient traffic safety program includes driver behavior and education, law enforcement, roadway engineering, traffic patterns and environmental attributes all working together to affect the overall health of the public. Historically the focus has been on building a safe roadway, but there is an error in this thinking. Roads were built to serve the needs of people. When the human element is left out of the engineering concept, it is the behavior of the individual driver who will ultimately determine the level of safety on a particular roadway. 

    What is needed is a multidisciplinary collaboration to create a “culture of safety.” According to Robert Foss, “the first step is to set a new direction to re-engineer the existing infrastructure and modify the current values and beliefs within the traffic safety profession.” This is not an easy task. In working to achieve this goal, it will be vital to include public health professionals as part of the transportation team. Advocating for change will require that all disciplines involved in a transportation project are communicating with a similar language to avoid misunderstandings.  

    In an effort to bridge the transportation-public health communication abyss, one can apply an accepted theory from the medical field. The biopsychosocial model (BPS) is a general ecological framework based in part on the Social Cognitive Theory developed by Bandura. Using discipline specific terminology and building on existing knowledge from both fields, the biology (structure and function) of an individual can be applied to the engineering (structure and function) of a particular road segment. This cross correlation is applicable for each corresponding circle represented in Figure 1.

    Figure 1: Biopyschosocial Model (BPS) and the Biopysychocial Transportation Model. Diagram developed and adapted by Karyn M. Warsow, MPH, MS.

    The fundamental principles of this relationship matrix are similar to the Federal Highway Administration perspective of Context Sensitive Solutions (CSS), defined as “a collaborative, interdisciplinary approach that involves all stakeholders to develop a transportation facility that fits its physical setting and preserves scenic, aesthetic, historic and environmental resources, while maintaining safety and mobility.”2 The only difference between the BPS and the CSS or BPST is seen in the concept titles (Figure 1). However, the models are not distinct, but synergistic. It is this interconnection that influences the overall health of an individual.

    In reality, public health and transportation professionals have a similar goal -- “a culture of safety” -- we just don’t understand what the other is saying! This is an opportunity for creative and well versed public health professionals with knowledge of both disciplines to bridge the communication gap. 
     
    - Karyn M. Warsow, MPH, MS, Representative to the Policy and Resolutions Student Committee, and DrPH Student , Johns Hopkins Bloomberg School of Public Health, Department of Health Policy

    References 

    1. Improving Traffic Safety Culture in the United States:The Journey Forward (May 24, 2010). Retrieved From: www.aaafoundation.org
    2. Context Sensitive Solutions (May 16, 2010). Retrieve From: http://www.ite.org/css/
    3. The Biopsychosocial Approach (May 14, 2010). Retrieved From: http://cnx.org/content/m13589/latest/ and http://en.wikipedia.org/wiki/Biopsychosocial_model

    Role of Health Scientists in Health Politics

    We live in a world where globalization is on the rise and society is interconnected and more multifaceted. One of the most contentious issues in the global health arena is health politics.

    Present economic situations strain the United States at the local, national and international levels. Health scientists are encountering many problems when trying to overcome these difficulties. Despite these problems, globalization provides several opportunities for health scientists. During this age of globalization, there are numerous possibilities that health scientists can utilize to achieve their potential as representatives of change, but their self-determination depends upon precise and carefully executed strategies. Because the globalization process exists with a range of variance in political, social and monetary scope, there are vast opportunities for health scientists to effect positive changes to world health policy.

    Global dominance configurations are becoming increasingly important in formulating health policies (Garrett 2009). Global health is identified as the result of cultural, social, economic and environmental factors. These factors are considered main indicators of population health. Health scientists are defined as the persons whose expertise is in the field of health economics in addition to the making of policy; these persons are able to develop and implement health policies in an effort to reduce health care inequalities at local, national and international levels.

    An appropriate education for health scientists is a key basic for improving population health. In order to become winners in the ever-changing world health politics field, there must be a change in educational opportunities. Health scientists are in a prime position to make unprecedented strides and become the persons in charge of improving the global health situation. In an age of economical globalization with changing political situations, with decreasing funding for public and community health that includes increased emphasis on technological solutions for health problems, health scientists are a bit of an incongruity.

    According to Garrett (2009), currently the United States is confronting its worst budgetary and economic difficulties since the Great Depression. It is in no position to cut its foreign assistance spending due to several factors such as its humanitarian concerns, political influence, global stability and national security. Global health scientists must incorporate new approaches to strengthening health systems in addition to sustaining older approaches in order to decrease global health inequalities at the local, national and international levels. 

    Health scientists should campaign for solutions that eliminate disparities in health. In order to be effective at changing health policies at local, national and international levels, health scientists must have an understanding that comes from the traditional Western sciences as well as a firm understanding of multicultural methods of understanding health.

    One task of health scientists is placing the health consequences of existing policies on the political agenda. This task is complicated by the necessity to constantly expand and change to stay current with the rapid technological, social, environmental and economic changes. Health scientists must focus on increased education and skills which develop the ability to access, as well as being able to assess, information; they must communicate and respond quickly, in addition to being able to use the knowledge gained to develop then implement health policies effectively. This situation can be convoluted by the challenges globalization presents to cultural and local community identity.

    Joint projects involving global health issues have the chance to be accomplished through health politics. Due to the complexity of global health, it is difficult for health scientists to address all health determinants. However, health politics is multifaceted, each country and nation has different needs, and there are so many factors involved that there is a great demand for health scientists in today’s world.

    Because of global economic conditions, money is always an issue. This lack of funding presents a piece of the reasoning why access to such services is available for all. Some Sub-Saharan African regions spend between $4 and $30 (in U.S. currency) per capita per year on health. A large part of this spending is provided through private sectors (World Bank 2001).

    Because the globalization process exists with its degree of variance in political, social and monetary concerns, there are vast opportunities for health scientists to effect positive changes to world health policy. That same variance requires an exceptional understanding of the forces that drive global change. An education in the financial and cultural structure of globalization is just as important as the extensive knowledge of medical information a health scientist must possess. World health policy can be enacted and maintained on a scale never before seen and in a manner which provides greater benefits. The key policy-makers will be health scientists.


    References
    Garrett, L.A. (2009). The future of foreign assistance amid global economic and financial crisis advancing global health in the U.S. development agenda. New York: The Council on Foreign Relations, Inc.

    World Bank. (2001). World development indicators, Washington DC.

    - Uzma A. Zumbrink, MPH

    CATCH a Healthier Way of Living

    As reported in F as in Fat: How Obesity Policies are Failing in America, obesity rates continue to climb in Oklahoma, with a rate of 28.1 percent. The state of Oklahoma has decided to do something about it.

     

    The Cleveland County Health Department and the Community After-School Program are partnering with many community partners to implement the Coordinated Approach to Child Health (CATCH) Kids-Club  evidence-based program. CATCH Kids-Club is a coordinated school health program designed to promote physical activity and healthy food choices. CATCH Kids-Club is being implemented in six elementary after-school programs in Norman, Okla., where kids are most at risk for being overweight.

     

    After implementing the program for three years, children are changing their behaviors! Significant changes occurred in both years one and two of the program. Children were choosing popcorn without butter, low-fat milk, grilled chicken, and they knew that food choices made a difference in getting heart diseases or cancer. There was a 37 percent increase in three or more servings of vegetables eaten the prior day, which helps to combat Oklahoma’s dead-last ranking (50th) in fruit and vegetable consumption. Additionally, significant increases were found in physical activity among participants: 8.4 percent in year one and 17.7 percent in year two.

     

    With parent involvement a challenge, CATCH Kids-Club coordinators have been working to excite parents about healthy eating and physical activity. Coordinators have held healthy tasting events with parents and children to try new snacks, sent home healthy cookbooks, games to play with their children, and communicated with parents via best-identified methods. Through these efforts, parents are requesting this program continue in the after-school environment, because they are not getting this information during the school day.

     

    Want more information? Check out the CATCH website and the Oklahoma State Department of Health website at the links below:

    www.catchinfo.org or www.ok.gov/health/Community_Health/Community_Development_Service/Health_Promotion/CATCH/index.html

    - Amanda James, BS, CHES, Health Educator, Cleveland and McClain County Health Departments, amandac@health.ok.gov

    Approaches to Planning and Policies in the United States and Hungary: A Fulbright Scholar's Perspective

    Introduction

    In community health planning and promotion, non-governmental organizations (NGO’s) develop national and international advocacy through inter-agency and local and global collaborations. This article compares local and global roles of an NGO in the United States and Central Europe, based on community assessment with Susan G. Komen for the Cure and health promotion in rural Hungary in 2009.

     

    Comparing approaches in the U.S. and Hungary

    In the United States, NGO’s use health promotion, needs assessment, and fund-raising events to increase support for programs and services. For community assessment of breast cancer services in North Texas, morbidity and mortality data were combined with interviews and focus groups with community leaders, service providers, breast health educators and navigators, screened patients and survivors. Findings were applied to prioritize programs: prevention outreach with diverse groups; collaboration with local health and social agencies; funding for screening and treatment for uninsured women (Susan G. Komen for the Cure, 2009).

     

    In Hungary, the health care system provides care for all residents, with hospices for cancer patients. Public and non-profit health and social agencies collaborate with communities to promote rural health, service access, social integration and empowerment of disadvantaged groups. Social mobility, poverty and marginalization vary among urban and rural populations. Many Roma (“gypsies”) are unemployed, due to deindustrialization and low education (Szelenyi, 2006); many attend “special schools” for those with mental disabilities, behavioral problems, language or cultural differences. Few studies have compared their health with that of the national population, but life expectancy remains lower. Health promotion is advocated to improve poor health in Roma settlements (Kosa, et al, 2007).

     

    The international Komen Foundation, Open Society Institute Roma Initiatives and American Jewish Joint Distribution Committee coordinate community health education and screenings with Red Cross, local health and social agencies. Every woman aged 45-65 is eligible for breast cancer screening once in two years; about one-third are screened, and men and younger women with family histories of cancer also receive services.

     

    Event in Hungary Photo Sue G. Lurie, Ph.D.
    Of over 20 regional health events in 2009, three were observed during the author’s Fulbright lectureship (Semmelweis University, Budapest): Me’lyk’ut, a town in southeastern Ba’cs-Kiskun region; Nyiregyhaza, in northeastern Szabolcs region near Ukraine and Romania, a former military site with an anti-Roma history; and an eastern Roma town, Tizabo’, north of the city of Szolnok in Ja’sz-Nagykun region. In both of the latter areas, Roma families depend on social assistance.

    The “Roma Minority Self Government” leader, a liaison between the municipality and his community, coordinated the first event with collaborating agencies and regional ministry of health medical director. Roma families from this and surrounding towns participated, followed by non-Roma. Families participated in games, received food (goulyash, bread, fruit) and entertainment. Nurses, staff and volunteers provided free screenings for breast cancer, blood pressure, glucose, allergies, COPD (lung capacity), strength, vision tests, and health education, including family planning and HIV/AIDS.

     

    Health Screenings. Photo Sue G. Lurie, Ph.D.
    The second event followed one near the Slovakian border, where a “Pink Walk” had drawn some Roma participants. At the second site, Roma HumanNet and health agency staff and volunteers provided education and screenings; Austrian social work students observed this collaboration. Breast cancer screening was referred to a health care center, but Roma are marginalized to the town’s outskirts, and many women lack transportation.

    The third event was initially planned with a nearby town. A large number of families received screenings and health education at this site, where children presented pictures of fruits and vegetables. Roma entertainment was preceded by a Roma national health expert’s presentation on the need for empowerment that was challenged as “not helping the Roma.” Such a response (possibly) reveals local priorities for direct services.

     

    Comparing National and Global Advocacy by NGO’s

    Community health promotion and planning by NGO’s in the United States are designed to increase local awareness and support for programs and services, with inter-agency collaboration. International non-governmental health planning that promotes empowerment for health equity is integrated through local and global collaborations. In this process, community priorities must be addressed.

     

    References cited:

    Kosa, Z., et al. A Comparative Health Survey of the Inhabitants of Roma Settlements in Hungary. American Journal of Public Health 2007:97:853-859. 

     

    Lada’nyi, J., Szele’nyi, I. Patterns of Exclusion: Constructing Gypsy Ethnicity and the Making of an Underclass in Transitional Societies of Europe. East European Monographs, Boulder, Colorado. Columbia University Press, New York. 2006.

     

    Susan G. Komen for the Cure Tarrant County Affliate. Community Profile Report. 2009.

    By Sue G. Lurie, PhD, Assistant Professor, Social and Behavioral Sciences, School of Public Health, UNT Health Sciences Center, Fort Worth, Texas.

     

    APHA Initiatives on Transportation and Public Health

    As we all appreciate, our health is profoundly affected by our transportation decisions and options. Limited opportunities for physical activity, higher exposure to poor air quality, higher incidences of adult and childhood obesity and greater prevalence of asthma and cardiovascular disease are a few of the inequities brought by poor transportation policies.

    As part of our effort to enhance crosscutting activity and knowledge among various APHA members and sections, APHA is developing advocacy materials and helpful information related to the links between transportation and public health. If anyone is interested in learning more about this initiative, sharing success stories or lessons learned, or establishing a new Forum on Transportation and Public Health, please reach out to us! Interested members are asked to contact Eloisa Raynault at eloisa.raynault@apha.org.

    Switch: Endearing and a Must-Read for Community Health Practitioners

    Switch: How to Change Things When Change is Hard is a collection of stories about the rider, the elephant and the path. This non-fiction book released earlier this year by brothers Chip Heath and Dan Heath confronts the challenge of change.

     

    In the first chapter, the popcorn bucket story is captivating. In this true life experiment by Dr. Brian Wansink, director of the Food and Brand Lab at Cornell University, movie-goers were given free, bad, a-few-days-old-popcorn. One group was given a medium-size bucket, and the other group was given a large bucket. Both buckets had popcorn that would have been too much for one person to eat on his/her own. The movie-goers were told that, in return for the free popcorn, they had to answer a few questions about the concession stand. 

     

    After they watched the movie, the popcorn buckets were collected, and weighed. Even though the popcorn was bad, and several of the movie-goers complained, and even wanted their money back forgetting that it was free, would you guess which group ate more popcorn? You may have guessed. It was the group with the large bucket of popcorn! Dr. Wansink, in his book Mindless Eating, concludes that when this study is repeated in different states, they reach the same conclusion. People eat more from a bigger container.

     

    This is an illustration of the path. If you want to eat less, eat from a smaller plate. If you are going to snack, don’t eat from the packet, instead pour some of the snack in a small container and you are likely to eat less.

     

    The rider is a metaphor for the brain or rational thinking. We need to know the facts and have a rationale for action. We collect data and justify why we are taking a course of action. 

     

    The elephant is an metaphor for emotional perspectives. The Heath brothers caution that the elephant is very powerful and should not be ignored. For example, many of us have, at some point, worried about our weight, and the rider in us, our brain, agrees that there are good reasons to be in control of our weight. Yet sometimes we fail. We fail because of our elephant or emotional aspects. We make excuses that it is okay to eat one piece of dark chocolate because research has shown it is healthy, but then the number of pieces we consume at one sitting increases and sabotages our goal of portion control.

     

    Switch has numerous stories illustrating the power of the rider, the elephant and the path. One of my favorite stories is about how a teacher motivated disruptive students from the back of class to arrive in time and behave. 

     

    Chip Heath and Dan Heath are excellent storytellers and teachers. The book has short “clinics” that get one to think through situations and engages the reader. The stories about what it takes to change the system are so hard to explain. Switch does this very well, and that is why I recommend it as a “must-read” for all community health practitioners. In many ways, the metaphor to the rider-elephant-path reminded me of the endearing stories such as L. Frank Baum’s Wizard of Oz, Mary Pope Osborne’s The Brave Little Seamstress, and so many others that I have enjoyed.

     

    On their website, the Heath brothers have posted the first chapter of the book and other valuable resources. Their previous book, Made to Stick, was reviewed in the fall 2007 issue of the CHPPD Section newsletter.

     

    Here are selected resources to help you satisfy your rider, motivate the elephant and walk the path toward healthier communities:

     

    Community Health Status Indicators: The Community Health Status Indicators (CHSI) provide an overview of key health indicators for local communities. The CHSI report contains over 200 measures for each of the 3,141 United States counties.

     

    Community Health Rankings: Compares the overall health of a county, with the health of other counties in the state. Ranking also includes factors that contribute to health, such as health behaviors, quality of health care and social and economic factors. This resource is from the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.

    The Association Between School-Based Physical Activity, Including Physical Education, and Academic Performance: New CDC literature review indicates that student physical activity can have positive effects on grades and test scores.

    - Priti Irani, CHPPD Section Chair

    CHPPD Business Meetings at the 2010 Annual Meeting in Denver

    Members are invited to all business meetings and the CHPPD Section Social.

     

    Sunday, Nov. 7, 10 a.m. – 11:30 a.m.

    Focus: Addressing Social Determinants of Health through Community Health Planning and Policy Development - Part I

     

    Sunday, Nov. 7, 2:00 p.m. – 3:30 p.m.

    Focus:  Addressing Social Determinants of Health through Community Health Planning and Policy Development - Part II (new member and student perspectives)

     

    CHPPD Section Social – Collaborating with the Community-Based Public Health Caucus to organize an event on the evening of Sunday, Nov. 7.