Community Health Planning and Policy Development
Section Newsletter
Winter 2007

Chair's Message

Achievements, Challenges and Vision for CHPPD’s Future            

 

Tom Piper, Paul Meissner and Sue Myers

 

Dear Friends,

 

Please join me in thanking Tom and Paul for their service over these past few years as chair and immediate past chair...a special “tip of the hat” goes out to Priti for her dedication as newsletter editor and now for her service as chair-elect...and a very gracious nod goes to Frances Atkinson and Tanisha Battle back at the APHA “home office.”

 

We head into the New Year as the fourth largest section in APHA with nearly 1,700 members on our roster.  As both a large and diverse section, we have strengths and challenges.  I see three major challenges for the coming year. One is creating added value for Section members; two is creating additional ways for members to become involved in meaningful ways; and, three, we will need to replace five Governing Councilors in the coming election - this is a significant opportunity for the Section.  The good news is we have a veteran, and diverse, Section Council in place.  Now we need to be very thoughtful about the perspectives and skills we elect to represent our section as Governing Councilors.  (More on the roles and responsibilities of Governing Councilors and the nomination process in the next issue...).

 

I understand that many of you may not be able to attend the APHA Annual Meeting due to lack of company/agency sponsorship or personal constraints.  I also understand that you are passionate and committed to your profession and you have much to share, as well as a desire to learn. 

 

In the coming months I expect to share with you our progress in becoming more proactive in policy matters as well as create additional venues for dialogue and learning through the launching of audio-conference calls, Webinars, maybe even add podcasts and blogspots, in order to bring maximum possible benefit to all of our members.   Please contact me directly at myers@telerama.com or (866)432-6303 if you would like to help create this new educational service.

 

Membership Chair EmyLou Rodriguez will be reaching out to all of us to address membership engagement strategies.  As always, our Program Committee, now chaired by Roy Grant, will create a robust, dynamic annual program. Please join me in thanking EmyLou and Roy for taking on these two critical roles for our section. We seek to identify a policy chair to head the Policy Committee that will strongly enhance perceived CHPPD membership value as well as move forward thoughtful, impactful policy on the national level. 

 

Last, but most certainly not least, I want to take this opportunity to thank Amy Carroll Scott for her especially effective leadership with the students of our section.  You have my continued support for meaningful student involvement throughout every aspect of our section’s work, and I welcome you as a new Governing Councilor for the Section.

 

Until we connect again, and yours in service,

 

Sue Myers

Apply for APHA Boards, Committees Positions by March 30

Consider nominating yourself or a colleague for opportunities on the APHA boards, committee positions by completing a nomination form available at http://www.apha.org/NR/rdonlyres/BBBA7A31-AFDC-420A-AA09-990896E6969B/0/NominationForm.doc with a CV or resume by Friday, March 30, 2007 to natalie.raynor@apha.org. Information on duties and responsibilities of elected APHA officers can be accessed online at www.apha.org/nationlinks/ .  A description of the Boards, committees and their responsibilities are listed below.

 

Action Board (nine positions available, three-year terms) - forumulates, plans, organizes and implements Association policies and an anuula legislative program.

Constitution and By-Laws Committees (two positions available, three-year terms) – considers and makes recommendations on proposed changes to the APHA Constitution or By-Laws.

American Journal of Public Health Editorial Board (five positions available, 3-year terms) - provides oversight and recommendations to the AJPH editor-in-chief and managing editor on APHA’s monthly peer-reviewed scientific journal.

Education  Board (five positions, three-year terms) – works with APHA learning and professional development program staff to maintain professional knowledge and increase technical proficiencies of members.

Annual Meeting Program Planning Committee (five positions available, one-year term) - add expertise to APHA Annual Meeting program and theme.

Equal Health Opportunity Committee (three positions, three-year terms) – focus on affirmative action issues with APHA and public health.

Awards Committee (four positions available, two-year terms) – focuses on APHA’s Sedgwick Medal and Award for Excellence

International Human Rights Committee (five positions, two-year terms) – advises on international human rights concerns.

Committee on Affiliates (five positions available, two-year terms) – represents APHA’s state and regional Affiliates.

Publications Board (four positions, three-year terms) – oversees all books developed and published through APHA.

Committee on Membership (chair position, one-year term) – advises APHA Membership Department on membership retention and recruitment efforts.

Science Board (five positions, three year terms) – ensures that all APHA policy statements are evidence-based.

Committee on Women’s Rights (two positions, three-year terms) – concerned with women’s rights, including a focus on gender inequities in health care and health policy.

The Nation’s Health Advisory Committee (three positions, two-year terms) – advises the editorial staff of The Nation’s Health newspaper on issues such as editorial content, design, and the newspaper’s web site.

The Nominating Committee’s election slate for officers will be published in The Nation’s Health during the summer, after which members will have a chance to nominate by petition.  The Governing Council will elect officers at APHA’s 135th Annual Meeting in Washington D.C.

Newsletter Readership Continues to Climb

For the first time in 1½ years, one quarter of CHPPD Section members read the fall issue of the newsletter.  In September-October 2006, 415 visitors viewed 517 pages of the newsletter.  This represents a 17 percent increase in readership over 2005’s Fall issue that had 386 visitors. Members spent at least four minutes reviewing information, indicating he/she read at least one article.

The fall issue of a newsletter usually has the highest readership of the three issues published in the year, possibly because of the interest in the Annual Meeting.  The CHPPD fall 2007 issue did better in readership as compared  to other section newsletters that it has been compared to in the past with exception of the Community  Health Worker Special Primary Interest Group (SPIG).  The membership in the CHW SPIG is significantly smaller than CHPPD. 

I continue to follow CHW readership because this level of involvement is not impossible for larger sections. This scenario is discussed extensively in Malcolm Gladwell’s “The Tipping Point”. This book is mentioned in the CHPPD Reading Club at http://www.chppd.org/phpbb/viewtopic.php?t=8.  In his book, through case studies, he illustrates that team camaraderie, and efficiency, decreases when units get larger.  In his book, he describes how one corporation splits up its workers into smaller work groups as soon as it hits the limit to maintain efficiency.  So what do you think is “The Tipping Point” for involvement in the CHPPD Section?

Wilson-Simmons and Wright New CHPPD Newsletter Co-editors

Renée Wilson-Simmons and Brad Wright are going to be starting as the new CHPPD newsletter co-editors starting from the Spring-Summer issue. 

 

Renée is the senior associate for adolescent health and development

 Renee Wilson-Simmons

Renee Wilson-Simmons

at the Annie E. Casey Foundation Senior Associate for Adolescent Health & Development.  She manages foundation initiatives and related grants and activities concerning adolescent health and development, including reproductive health, with a focus on identifying, developing, and taking to larger scale evidence-based interventions for families and youths involved with public human service systems.  Before joining the foundation, Renée was a senior scientist at Education Development Center with responsibility for the development and implementation of a range of projects that addressed the health and safety needs of youths living in high-poverty urban areas.  She was also director of the Health Promotion Program for Urban Youth at Boston City Hospital, principal investigator of the first Office of Minority Health-funded grant to develop a community-based coalition to prevent homicide in the African American community, and director of a five-year National Institutes of Health study of the long-term impact of a comprehensive adolescent health program on reductions in multiple-risk behaviors related to violence, substance abuse, and early and unprotected sexual activity among inner-city African American and Hispanic youths. Renée’s email is: RWilson-Simmons@aecf.org.

 

 

Brad Wright

Brad’s career in health policy began with plans to pursue a medical degree. Intending to provide charity care to the underserved, he studied biology at the University of Georgia. Soon, however, he began to question systems-level issues, wrote an honors thesis comparing the Swedish and U.S. health systems, and, by the time he graduated in May 2003, concluded that he wanted to become an advocate for social justice and health system reform.  After college, Brad worked for a year with the Georgia Department of Public Health as an Environmental Health Specialist before enrolling in the masters program in health policy at The George Washington University’s School of Public Health and Health Services. While in Our Nation’s Capital, Brad learned about health policy firsthand while working with the March of Dimes Office of Government Affairs, the Partnership for Medicaid, and the Association of Clinicians for the Underserved (ACU). In fact, Brad still works part-time as the health policy and advocacy assistant for ACU. Brad is currently pursuing his doctorate in health policy and administration with a minor in political science and policy development at the University of North Carolina at Chapel Hill, where he also works as a teaching assistant. His research focuses on barriers to health care access and the social determinants of health in underserved populations. He is also interested in Medicaid reform efforts and studies of community responsiveness in primary care organizations. Brad’s email is: bradwright@unc.edu.

  

Welcome, Renée and Brad.  We look forward to reading the newsletter this year and next.

 

Tsou Presented 2006 CHPPD Section Award

 

Karen Valenzuela with Walter Tsou, MD

Walter Tsou, MD was presented the Section Award in deepest appreciation for his unflagging energy and commitment to our section, to the American Public Health Association, and to improving the health and well-being of all people.                

 

                             

Borders and Malekafzali Win Student Awards

The Doctoral Student Award was presented to Stephen Borders, PhD, for his abstract entitled "Non-emergency medical transportation: A multi-dimensional look at this access barrier."

 
Amy Carroll-Scott presents plaque to Stephen Borders
Stephen recently received his PhD in May of 2006 from Texas A&M in health systems planning. In his dissertation, he examined transportation barriers to preventive care services in the Texas Medicaid program. Today, Stephen is one of the newest faculty members of the School of Public and Nonprofit Administration at Grand Valley State University, where he teaches health policy, financial management, and research methods. In addition, Stephen also recently received a $60,000 grant from the Michigan Department of Community Health to establish and update new practice standards and coordinate for the regionalized perinatal system in Michigan. He has also recently published a paper on the public health work force in Human Resources for Health.

                

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

2006 Blum Award Presented to Hodge for Drafting “Model Public Health Act”

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

 

Over a period of three years, from 1999-2001, Hodge and the “Turning Point Public Health Statute Modernization National Collaborative” created the comprehensive model public health law. From a health planning perspective, a model public health framework is perhaps the most essential contribution as laws provide

James Hodges receives plaque from Sue Myers

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

Submit Nominations for 2007 Blum, Kimmey and Section Service Awards by April 30

Do you admire the planning or policy work done of a colleague or a group? If so, you should consider nominating her or him for a Community Health Planning and Policy Development Section award. Each year, the CHPPD Section, working in conjunction with the American Health Planning Association, accepts nominations until April 30 in order to present three awards at its annual meeting.

 

The Henrik L. Blum Award for Excellence in Health Policy recognizes an individual, group of individuals, or an organization who/that has demonstrated excellence, creativity, and innovation in the development and/or implementation of health policy. The award is in honor of Henrik L. Blum, MD, MPH, Professor Emeritus of Health Policy and Planning in the School of Public Health at the University of California at Berkeley.

 

The James R. Kimmey Award for Excellence in Health Planning Practice recognizes an individual who has demonstrated excellence, creativity, and/or innovation in health planning practice that constitutes a significant contribution to health planning which goes beyond the expectations of routine job performance and is evidenced by accomplishments. This award is given jointly with the American Health Planning Association. The CHPPD Section Service Award is given to a Section member who has made a significant contribution to the Section's operations and/or other activities.

 

These awards are presented at an Awards Ceremony during the APHA Annual Meeting. All Section members are welcome and encouraged to submit nominations for any of these awards. The award nomination forms are available at http://www.chppd.org/Planning_awards.html

Please fax or e-mail a copy of the completed form to to both Ann Umemoto umemoto@marchofdimes.com, fax: (914) 997-4501, phone: (914) 997-4496 and Sue Myers myers@telerama.com, fax: (410) 939-1195 , phone: (866) 432-6303.

New CHPPD Student Assembly Liaison, Has Diverse Interests and Big Role

  Let me take this opportunity to introduce

 
Marnie Purciel, CHPPD Student Assembly Liaison
myself. My name is Marnie Purciel, and I am very excited to be the new APHA Student Assembly (SA) Liaison to the CHPPD Section. First, let me tell you a little bit about myself. I am in my third and final year of a joint masters program in public health and urban planning at Columbia University. My interests are in GIS methods, health disparities, nutrition and physical activity-related chronic disease prevention, and in examining and changing the mechanisms through which neighborhoods affect health. I currently work for the Institute for Social and Economic Research and Policy at Columbia on a Built Environment and Health Initiative.

 

As your Section liaison, I will be an active participant in the SA liaison program as well as a member of CHPPD’s new student committee, of which I was a founding member. I am really looking forward to working with the student committee and the SA to recruit new student members to CHPPD, to advocate for CHPPD students' needs within the Assembly, to encourage student participation in CHPPD and SA activities, and to assist students in figuring out how CHPPD and APHA can help advance their careers. Although I am filling big shoes by taking on this role after Amy Carroll Scott set the standard of excellence so high, I have several new goals to help continue the tradition of strengthening the student voice within CHPPD. I will be a vocal advocate for CHPPD students within the Assembly by strengthening the connections between CHPPD members and the Assembly and by building the foundations for student involvement. I would like more of our students and regular members to take advantage of the National Mentorship Program as mentees and mentors. This will require strong and open communication and coordination between SA processes and CHPPD leadership. I will promote greater feedback about SA activities to CHPPD leadership, and I will communicate your input to the SA on issues that you feel are important to all students.

 

Please feel free to contact me with your ideas and suggestions, or even just to say hello. Although I’ve been a member of APHA for a few years now, I still struggle with the complexity of this organization. Any advice for a new committee member is welcome and appreciated. I am looking forward to working with CHPPD members and leaders to facilitate the entry of the next generation of public health professionals into APHA and CHPPD. Thank you for helping me to support student’s efforts to excel.

 

by Marnie Purciel

marnie_purciel@hotmail.com

 

Alumni Database Has Information about Scholarships, Jobs, Internships for Students

 

This year, the APHA-SA Opportunities Committee provided more resources to students regarding scholarships, conferences, job postings, potential employers, and fellowships/internships. In addition to these endeavors, the committee revamped the Student Assembly (SA) Alumni Database. The Alumni Database is meant to not only allow the SA to keep track of their past members, but it also provides current and potential students access to learn about possible careers in the public health field.

 

To access the Alumni Database, students can visit the SA website (www.aphastudents.org) and click on the Opportunities Committee webpage. Here students can look at job positions that public health professionals currently in the field hold. Prospective public health students could access this database and view jobs that people with public health degrees have to gain a better understanding of the wide variety of career paths available to them. Alumni range from recent graduates working in fellowships or entry-level positions to seasoned health professionals with well-established research agendas.

 

The SA Opportunities Committee Co-Chairs are working to increase participation of SA alumni in the Alumni Database. Anyone who at one time was a member of the Student Assembly (previously entitled Public Health Student Caucus) can visit the website, complete the form available on the Opportunities Committee webpage (www.aphastudents.org/phso_alumni_db.php) and return it to jlcremeens@aol.com. This endeavor depends on the cooperation of the SA alumni. With APHA-SA alumni support, the Database can become a wonderful resource for the next generation of public health students. We hope you will consider taking a few moments to add yourself to the Alumni Database.

 

If you have any questions or want more information, please feel free to contact Jennifer Cremeens or Anna Pollack, the Opportunities Committee Co-Chairs at opportunities@apahstudents.org.

 

by Jennifer Cremeens

jlcremeens@aol.com

 

KaiserEDU Invites Students to Submit Health Plan Recommendations for Essay Contest by March 30, 2007

KaiserEDU.org’s invites undergraduate and graduate students to write a 1,500-word essay on health plan recommendations. Deadline for submission is March 30, 2007. The essays will be judged on originality, expression of ideas, strength of argument, and clarity, and winners, who will win $1,000, will be notified by May 1, 2007.

 

The essay should be from the perspective of a person who has just accepted a job as a senior advisor to a presidential candidate (does not have to be an actual candidate) for the 2008 election. The first task is to prepare a memo for the candidate outlining your recommendation for the candidate's health plan. The memo should discuss what the centerpiece of the candidate's health plan should be, why this issue is important to the voters, the potential challenges that the candidate may face in promoting the plan, and how it would be communicated to the public. The candidate can have any political affiliation.

 

Entries must be submitted by email to EssayContest2007@KFF.org, with two Microsoft Word document attachments only: Entry Form and essay.  For more information about Rules and Requirements visit http://cme.kff.org/Key=12108.HpY.C.C.KlkLvR

Announcing Planning and Policy Dialogue (PPD) Forums

Looking for a way to keep current on important policy or planning issues without expense or inconvenience?  Or maybe you’re looking for a way to stay connected with your CHPPD colleagues?   CHPPD is exploring various technological and process options for creating Forums where CHPPD members can learn and dialogue with each other on critical planning and policy issues.   CHPPD is looking at ways we can conduct webcasts, create podcasts, audioconference calls, use threaded discussions etc. in order to create these distance-based forums.   We expect that we will also use the soon to be released APHA e-Communities as a part of our Forums.  Please hold April 13, 3:00 pm – 4:30 pm for a pilot webcasts on “Health Literacy” (date and time subject to change – details available soon!).

 

Please stay on the look out for a member survey of topics you would like to discuss and technology you would like to use.   If you’d like to volunteer to serve on a short term work group to plan these Forums, please contact Sue Myers at myers@telerama.com.  We are especially interested in finding individuals who regularly use webcasting or podcasting or who are experienced in planning series of debate/dialogue/educational sessions. 

 

Susan M. Myers, MA, MPH

President, Health Equity Associates

myers@telerama.com

866-432-6303

What on Earth Does a Governing Councilor Do?

 

Shari Kenney, CHPPD Governing Councilor

What on earth does a Governing Councilor do? I spent the last year finding out (and I am still learning), so I thought I would share with other Section members who might like to join the Governing Council. It really is fun!

 

The APHA Constitution and Bylaws describes the composition of the Governing Council in Article IV and its functions in Article VI. Each section gets a minimum of two elected representatives and additional representatives based on the number of members in the section. CHPPD has seven members who are elected for two-year terms. The term begins after the Annual Meeting in the year the member is elected and ends two years later after the Annual Meeting (I had some trouble figuring out how this worked).

 

In brief, the functions of the Governing Council include establishing policies, amending the Bylaws of the Association, receiving the report of the accomplishments and financial status of the organization and reports from the various boards of the organization. The Council also elects the Executive Board, the officers of the Association and honorary members.

 

This year the Governing Council had a work session to provide input to the APHA Strategic Map: 2007-2009, and we also participated in lively discussions and approved policies including Pandemic Flu and the Risks of Nanotechnology. Of course the Governing Council does involve politics. Each member has the right to speak to issues and shape the policies of APHA - and we represent YOU the members.

 

The most important duty of a Governing Councilor is to attend the Annual Meeting, attend the Governing Council sessions and be present to VOTE! This is a pretty big commitment as it involves coming to the meeting a day early for the first session on Saturday, attending policy discussions (not required but very helpful to have an informed vote), attending roundtable sessions to participate in strategic planning and spending an entire day (this year it was Tuesday) in the Governing Council Session and voting on policy proposals, officers and the Annual Meeting.

 

What if for some reason you cannot attend the Annual Meeting? You can designate a proxy. That proxy must be a member of APHA and your section and you must notify the secretary of the Governing Council prior to the meeting of the Governing Council (APHA Governing Council Handbook).

 

Whew! That is a lot. Also in preparation for the Annual Meeting you need to participate in the monthly CHPPD leadership teleconferences and in the mid-year Governing Council teleconference. Keep in mind you have to keep your membership current to be on the Governing Council.

 

While the Governing Council is a fair amount of work and time commitment, really is fun and a rewarding experience. You get to work with a lot of great people, and you have the opportunity to shape health policy. Please feel free to e-mail me if you want to know more or have any questions.

 

Shari Kinney, MPH, MS, RN

CHPPD Governing Councilor

sharik@health.ok.gov

Street Science Sheds Light on Role of Community and Scientists in the Fight for Environmental Health Justice

Book Review

 

Street Science: Community Knowledge and Environmental Health Justice by Jason Corburn showcases the relationships of community resident activists called street scientists and their counterparts who are public health professionals of various disciplines.

 

Chapters 1 and 2 provide an introduction to how the book is organized, perspectives on the relationship between community-based participatory research and street science, and definition of local knowledge as referenced in street science. Illustrations are presented throughout this book on how various community organizations work fervently in order to protect the health of residents.

 

In chapter 3, street scientists - in this instance residents of the Greenpoint/Williambsurg community organized by the Watchperson Project - interview immigrants who eat fish from the East River.  The Watchperson Project survey determines that local anglers catch between 40 – 75 fish per week, averaging 57 fish per week. They estimate each family member of an angler eats approximately 9.5 local fish per week.  A diet involving fish eaten from East River exposes the immigrants to potential toxins such as chlordane, polychlorinated biphenols and mercury.  The street scientists effectively educate the EPA scientists about the extent to which immigrants ate fish caught from the East River. 

 

In chapter 4, a coalition of community organizations involving street scientists worked with public health professionals of the New York City Department of Health to investigate the causes of the escalating rates of childhood asthma occurring in the Greenpoint/Williamsburg Latino community.  The quality of clean air and environmental air pollutant factors were evaluated in order to detect the possible causes of this chronic disorder.  Chapter 5 describes the increased risk a community from lead poisoning due to sandblasting work in preparation for repainting on the Williamsburg Bridge. Chapter 6 describes the development and utilization of "community risk" maps to educate about environmental impacts.

 

The pace of the book is slow in the beginning (the first two chapters) as the author explains basic concepts, and picks up from Chapter 3 on when the case studies are described.  Street Science is messy process, and decisions do not always work out as intended, but there is value added to true understanding of risks, and contributing factors.

 

For example, residents are able to demonstrate increased lead levels in the soil due to sandblasting on the Williamburg Bridge, and are successful in getting a court order to stop the process based on soil analysis results. Government officials are forced to consult with the community and get input.  There is major discord between the expert consultant hired by the community and community residents on what strategy they should focus on to address the process.

 

In the scenario with asthma incidence, the Latino community is unable to partner with the Hasidic Jew or Polish communities in implementing a survey.  The Hasidic Jews lead a life isolated from the “outside,” explains the Rabbi, and they do not talk publicly about health, and will not open doors to strangers, in this case surveyors. The Polish community did not feel ownership of the survey as it was headed by a Latino organization, El Puente.  However, El Puente had more success in working in partnership with the United Jewish Appeal for Hasidic Jews when they worked on the environmental toxic mapping project that did not involve individual surveys.

 

There were a few instances when the content needed clarification.  In an introductory chapter, the author attempts to differentiate between street science and types of community-based participatory research (CBPR) that do not allow for dialogue between community and “traditional” experts such as scientists and academia.  The reviewers wondered if this was a CBPR that was conducted in name only, as isn’t the intent of CBPR truly to engage the community as in Street Science?  The author often compares environmental street scientists to AIDS Coalition to Unleash Power (ACT UP), the AIDS advocacy group.  In one instance (p. 143), the author quotes from a 1996 personal communication by B. Epstein of Hunts Point Community Development Corporation in the Bronx that said: Clearly, the “constituency” for asthma is mostly children of the urban poor and people of color, not the largely white, well-off organizers of the AIDS movement.  This statement is not challenged, nor is there an effort to explore what made these strategies more successful. 

 

On the other hand, when an issue is explored, such as the reluctance of the Hasidic Jewish and Polish communities to participate in a survey initiated by a Latino community-based organization, it makes for intriguing reading.

 

All in all, the book Street Science makes for intriguing reading that demonstrates how residents fight in order to resolve environmental injustices in their community.

 

Dr. Apryl R. Brown is a biology instructor at Wayne County Community College District in Detroit.  Furthermore, she is the coordinator of the Detroit Medical Reserve Corps, which is a local unit of a national, community-based organization working to address the public health priorities of the U.S. Surgeon General.  Dr. Brown is a member of the APHA-CHPPD/Michigan Public Health Association, Global Health Council, Genetic Alliance Advocate Partner, and the American Association of University Women.  As a result of her dedication to public health community service, Dr. Brown will be inducted into the Delta Omega Honorary Society of Public Health through the Eta Chapter at Tulane University School of Public Health and Tropical Medicine.

 

Priti Irani is the Project Director - Assessment Initiative, a CDC-funded cooperative agreement, working at the Public Health Information Group, Center for Community Health, New York State Department of Health.  She enjoys reading, and thanks the CHPPD membership for offering her the opportunity to review resources. She is also the out-going editor of the CHPPD newsletter, and the Chair-Elect of the Section.

Public Health and Human Rights: A Book Review and Commentary

Many of us have just returned from the edifying and inspiring sessions and events of the 2006 Annual Meeting in Boston whose theme was “Public Health and Human Rights.” I hope it inspired you to delve more deeply into this topic, of late as provocative in world politics as it is timely in public health. It raises a wide range of issues in public health ethics, and here are some resources I recommend for your reading.[i]

 

Ever since its publication eight years ago, I’ve appreciated New Ethics for the Public’s Health, edited by Dan E. Beauchamp and Bonnie Steinbock (Oxford University Press, 1999) for its broadly literate and philosophical treatment of its subject. Its editors chose 29 readings that reflect conceptual and policy challenges to the practice of public health, and organized them under nine sections, providing each with a discursive overview that identified the issues covered and provided a context for seeing how the selections fit into the unique community perspective of public health.

 

Oxford University Press is now publishing a revised edition under the title, Public Health Ethics: Theory, Policy, and Practice, edited by Ronald Bayer, Lawrence O. Gostin, Bruce Jennings, and Bonnie Steinbock. It includes 25 mostly new readings under six sections, each prefaced by an introductory essay. The strength of this approach is to make accessible a set of readings representing paradigms of reasoning on key public health issues, not polemics. The excellent general introduction by Beauchamp and Steinbock from the original book is reprinted with minor changes.

 

Among the new readings included is one that is must reading for anyone concerned with the future of public health: “The Future of the Public’s Health: Vision, Values, and Strategies,” by Lawrence O. Gostin, Jo Ivey Boufford, and Rose Marie Martinez  (Health Affairs 23[4]: July/August 2004, 96-107).

 

The moral dimensions of public health practice are best appreciated through examination of difficult cases. The task facing public health is a practical one of exercising good judgment about the needs of populations in particular contexts, and that judgment and the insight needed for it is best developed through the examination of real cases in which the choice among alternative courses of action can be seen more clearly than the choice among alternative ethical theories. The right thing to do is then seen as contained in one’s understanding of the particulars of the case. This places priority on life wisdom about good actions – what one ought to do (Aristotle’s praxis) – over knowledge derived from theories.

 

The tensions in our society that afflict the practice of public health reflect the age-old opposition between the individual and society that concerns political and ethical theory. So for a public health ethic, we must look to the ideology that governs our political thought, and that is liberalism.

 

At the foundation of the liberal political tradition is the idea that a person has a dignity and worth that social structures should not be permitted to violate. It was the core value in the political philosophy of John Locke and David Hume, and in the moral philosophy of Immanuel Kant, and it is reflected in medical ethics. American devotion to individualism is reflected in the concept of market-justice. But the liberal tradition also promotes social justice, and this is increasingly being seen as the core value in the mission of public health, one opposed to market-justice. It seeks the fair and equitable distribution of both the benefits and the burdens of the society.[ii]

 

And that was the prevailing political ethic in this country for much of the past century, the one responsible for Social Security, Medicare, and Medicaid. For, in the words of President Franklin Delano Roosevelt (Second Inaugural Address, 1937), “The test of our progress is not whether we add more to the abundance of those who have much; it is whether we provide enough for those who have too little,” followed a generation later by President John F. Kennedy’s, “If a free society cannot help the many who are poor, it cannot save the few who are rich.”

 

One of Hubert Humphrey's speeches contained the lines "It was once said that the moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; and those who are in the shadows of life, the sick, the needy and the handicapped."

 

The task of moral and political philosophers has been to reconcile these sometimes conflicting themes in medical and public health practice, in individual liberties and social demands, a task well stated in an AJPH article by Daniel Callahan and Bruce Jennings:

 

"It is one thing to say that public health rests on a communitarian foundation and quite another to determine how best to relate that foundation to our individualist culture, particularly in that members of this culture have been historically hostile toward government. The conflict, long endemic in our society, between the right of individuals to be left alone and the needs of the larger public does not make it easy to develop population-based health strategies that must, on occasion, ignore the special needs of individuals".[iii]

 

The philosophical approach that best exemplifies the liberal heritage was fully developed in John Rawls’ A Theory of Justice (Harvard University Press, 1971). In it, he operationalized a process for determining moral judgments based on our intuitive sense of fairness, a kind of “procedural justice,” that squares individual freedoms with social needs. Through it, he restablished the tradition of setting political deliberation on a foundation of moral argument. His “first principle of justice” neatly expresses the liberal view of the aim of government: “Each person is to have an equal right to the most extensive total system of equal basic liberties compatible with a similar system for all.” (p. 302)

 

Aristotle saw that ethics is a branch of politics. Public health is part of government, and like government, just what it is will be continually redefined by politics and public policy. The oft-quoted mission offered by the Institute of Medicine in its The Future of Public Health (1988) – “fulfilling society’s interest in assuring conditions in which people can be healthy” – is the role of government, not of public health.[iv] In the WHO’s World Health Report 2000, its Director-General, Dr. Gro Harlem Brundtland, stated explicitly that “the careful and responsible management of the well-being of the population – stewardship – is the very essence of government.” The late Jonathan Mann observed that people cannot be healthy if governments do not respect their rights and dignity as well as engage in health policies guided by sound ethical values. And so in seeking the best ground for the ethics of public health, I think we need to look to the very best in public policy, and that is human rights.

 

Human rights reflect ethical principles, incorporated into national and international legal systems, governing respect for the dignity, integrity, autonomy, and freedom of persons. Writing from the perspective of history, Arthur M. Schlesinger, Jr. labeled them “roughly the idea that all individuals everywhere are entitled to life, liberty and the pursuit of happiness on this earth.”[v] Integral to health as a human right is recognition of the right to the essential social determinants of health and well-being, and deprivation of these rights has been shown by social epidemiology to be a barrier to good health defined as physical, mental and social well-being. Therefore, the aims of public health in assuring conditions in which people can be healthy require it to embrace the universally recognized standards for human rights adopted in 1948 by the United Nations as the Universal Declaration of Human Rights.[vi] Jonathan Mann believed that the promotion and protection of health and human rights are “inextricably linked.” Human rights violations adversely affect the community's health, coercive public health policies violate human rights, and advancement of human rights and public health reinforce one another. Unfortunately, in our schools of public health, courses in human rights are even scarcer than courses in public health ethics.[vii]

 

Dr. Albert Schweitzer believed it to be an ethical imperative for physicians to serve where most needed, and unless physicians in training serve in public health settings, they will never understand why. And I think that medical practice suffers when medical ethics is taught in medical schools without reference to global health. Dr. Paul E. Farmer, Keynote Speaker at our Boston Conference, writes that, “without a social justice component, medical ethics risks becoming yet another strategy for managing inequality,” and "equity is the central challenge for the future of medicine and public health.”[viii]

 

by John Steen

Consultant in Health Planning, Health Regulation, and Public Health

jwsteen@expedient.net

 

______________________________________________________________________________________

1 The relevance of this theme was well presented in an editorial by Rosalia Rodriguez-Garcia and Mohammad N. Akhter in the May 2000 issue of the American Journal of Public Health: http://www.ajph.org/cgi/reprint/90/5/693.pdf.

 

2 For an excellent article that explores how social justice sheds light on major ongoing controversies in the field of public health, see “What Does Social Justice Require for the Public’s Health? Public Health Ethics and Policy Imperatives,” by Lawrence O. Gostin and Madison Powers. Health Affairs, 25, no. 4 (2006): 1053-1060, and Social Justice: The Moral Foundations of Public Health and Health Policy
by Madison Powers and Ruth Faden (Oxford University Press, 2006).   

3 “Ethics and Public Health: Forging a Strong Relationship,” Daniel Callahan and Bruce Jennings, AJPH, Vol 92, No. 2 (February 2002). 169-176. The authors provide a timely overview of the relationship, and well-considered recommendations for what more is needed.

 

4 For a brief summary of all the things we might expect of our government here, see “What the federal government can do about the nonmedical determinants of health,” by Nicole Lurie, Health Affairs, Vol 21, Issue 2, (March/April 2002) 94-106.

http://content.healthaffairs.org/cgi/content/abstract/21/2/94.

 

5 “Human Rights and the American Tradition,”  Foreign Affairs, Vol. 57, Number 3 (1978). http://www.foreignaffairs.org/19790201faessay9904/arthur-m-schlesinger-jr/human-rights-and-the-american-tradition.html.

 

6 Available at http://www.un.org/Overview/rights.html.

 

7 Nine years ago, APHA adopted Policy Statement #9813 promoting “Human Rights in the Curricula of Health Professionals.” http://www.apha.org/legislative/policy/policysearch/index.cfm?fuseaction=view&id=165.

 

8 Pathologies of Power: Health, Human Rights, and the New War on the Poor. With a foreword by Amartya Sen (University of California Press, 2003).

 

            *****************************************************

 

For a Model Curriculum on Ethics and Public Health developed by the Associated Schools of Public Health (ASPH), the Health Resources and Services Administration (HRSA), and The Hastings Center, go to: http://www.asph.org/document.cfm?page=723.

 

Public health professionals who wish next to examine contemporary issues from a legal as well as a moral perspective would do well to read Public Health Law and Ethics, edited by Lawrence O. Gostin (University of California Press, 2002), companion website available at: http://www.publichealthlaw.net/reader/. This collection of readings in public health law, ethics, and human rights provides a rigorous analysis of the philosophical, political, economic, and jurisprudential dimensions of government intervention to assure the health of the populace, and Professor Gostin provides a commentary on the meaning and importance of each selection.

 

For a timely analysis of moral and legal issues in American medicine and bioethics together with a plea for a more global rights-based perspective, see American Bioethics: Crossing Human Rights and Health Law Boundaries by George J. Annas
(New York: Oxford University Press, 2005).

 

The finest book I know for explaining the moral, legal, and practical significance of human rights to us and our nation is, In Our Own Best Interest: How Defending Human Rights Benefits Us All, by William F. Schulz, executive director of Amnesty International USA (Beacon Press, 2001).

  


Health Planning in the Indian Health Service: Trends and Issues: Part I

Introduction

July 2005 marked the fiftieth anniversary of the Indian Health Service, a unique public health care system of almost 600 facilities employing over 16,000 health care workers providing service to 1.6 million American Indians and Alaska Natives.  This comprehensive health system evolved from nineteenth century treaty contracts between the United States government and tribes, becoming part of the Public Health Service in the then Department of Health, Education and Welfare on July 1, 1955.  This two-part paper will briefly describe the history of planning for services, facilities and staffing in the Indian Health Service during its 50 year history, examine the current planning process, and discuss important new policy issues in planning for future needs.

 

History and Description

The IHS is one of the oldest health care systems in the United States to include programs of preventive, curative, rehabilitative, and environmental health services.  The statutory basis for the government to provide health care to American Indians began with assignment to the War Department in 1803. The Bureau of Indian Affairs (BIA) began to build hospitals and facilities with limited funding following the Snyder Act that authorized funds for federal health programs for all recognized tribes in 1921.  In 1926 Commissioned Corpsmen of U.S. Public Health Service were assigned to augment staffing.  The Indian Reorganization Act of 1934 provided funding to construct many additional hospitals such as Albuquerque, New Mexico (1934), Fort Defiance, Arizona (1938), Browning, Montana (1937), Cherokee, North Carolina (1936), and Crown Point, New Mexico (1939).

 

On July 1, 1955, the Indian Health Service became part of the Department of Health, Education and Welfare and inherited from BIA a patchwork system of 61 facilities, serving 500,000 American Indians and Alaska Natives. [i]

From the beginning, the Mission of the IHS was to raise the physical, mental, social and spiritual health of American Indians and Alaska Natives to the highest level.  Following the transfer, the Indian Health Service initiated a program of accelerated building and staffing new and replacement facilities to meet changing health care needs.   With the first appropriation in 1956, the focus of the initial building program of the reorganized Indian Health Service was to update the hospitals inherited from the BIA that were inadequate to meet the needs for infectious diseases, dental problems and nutritional deficiencies.  Additional hospitals were needed to address the leading illnesses of the era that included dysentery, diarrhea, tuberculosis, pneumonia, and communicable childhood diseases such as measles and mumps, and to serve areas that previously had no facilities.

 

Table 1:Number of facilities constructed between 1955 and 2005.

 

Decade

Hospital

Health Center

Health Station

1950s

 

3

11

1960s

12

17

36

1970s

9

18

 

1980s

11

8

 

1990s

5

15

 

2000s

2

5

 

 

          Hospitals are inpatient facilities with less than 30,000 inpatient days and limited specialty care.  Health Centers are ambulatory care facilities operating a minimum of 40 hours a week staffed with a basic health team providing services for acute and chronic ambulatory problems.  Health Stations are ambulatory care facilities, fixed or mobile, geographically separate from an inpatient or health center facility and operating with less than a basic health center staff or less than 40 hours a week.  The system also includes several large referral centers with specialty care and inpatient days greater than 30,000 in Gallup, N.M.; Phoenix and Anchorage, Alaska.

 

The Indian Health Care Improvement Act of 1976 began a shift from treating communicable diseases to prevention and the incorporation of traditional healing practices.  The 1990s brought new funding authorities such as Joint Ventures with tribes, Small Ambulatory Grants Renovation and Construction Program, and the contracting and compacting of facilities construction and management out of IHS to tribal ownership and control.

 

Throughout this period all facilities were constructed to provide care in a primary care focused system staffed mostly with primary care providers.  The goal today is to assure that comprehensive, culturally acceptable personal and public health services are available and accessible to American Indian and Alaska Native people. The result is a system that operates 594 facilities through direct service, tribal ownership and management or the Urban Health program.

 

 

Figure 1: Administrative structure encompasses 12 regions

 

Each area office has a director and a core of administrative, engineering and planning staff ranging from 17 to 50.  Areas designate administrative service units to plan and manage inpatient and ambulatory programs that may include one or more facilities serving the population within an established standard of accessibility.  Each service unit has a manager as do the facilities within the service unit. Many of the service unit designations reflect historical service patterns and usually encompass a single reservation or tribe.

 

Reporting structure

Service is provided in these facilities by IHS personnel if the facility is owned and managed by the IHS; otherwise tribes own and manage facilities through self determination contracts and self governance compacts. 

 

 

          The earliest planning model incorporated an existing operational health system in an iterative process of planning, implementing, monitoring and evaluation. 

 

 

Iterative planning model

It used demand forecasting – measuring the size of the service population in each area and determining their requirements for health care.  Demand was expressed in “inpatient days” and “outpatient visits.”   It called for maximum involvement of Indian tribes in defining their health needs, setting health priorities and managing the delivery system.

 

To aid in the planning process and provide consistency in service, the IHS developed several planning guidelines.  The first of these was the Resource Allocation Criteria (RAC) developed by a multi-disciplinary team of IHS staff between 1972 and 1977 to “provide IHS with a comprehensive, systematic and consistent process for determining resource requirements”.[ii]  The committee used historical data from IHS facilities to develop standards for staffing and workloads for the following inpatient departments: laboratory, X-ray, medical records, physical therapy, occupational therapy, surgery, pharmacy, housekeeping, laundry, nursing, medicine, dietary, maintenance, surgery and anesthesiology. In addition, the RAC provided criteria for demand forecasting, ambulatory care services, community health services, special programs, administration, and contract services.

 

The RAC also established the following accessibility guidelines:

          15 minutes for emergency care.

          30 minutes for ambulatory care.

          90 minutes for inpatient care.

          240 minutes for inpatient specialty care.

Once the criteria for staffing and workloads were developed they were benchmarked with national planning guidelines.

 

The RAC was converted to a spreadsheet format in the 1980s, updated and renamed the Resource Requirements Methodology (RRM).  In its current Excel format, RRM2005 continues to use formulas that calculate staffing needs based on factors such as primary care provider visits and average daily patient load.[iii]

 

The Health Facilities Planning Manual was published in 1980 for use by Headquarters, area planning officers, service unit planners, regional offices of facilities engineering and construction and tribal health planners.[iv]  It used workload and staffing as criteria for the allocation of space. It also outlined many of the spatial concepts and terminology still in use.

 

The current planning process builds on this early model, adding these automated tools to project population, workloads, and space requirements.  Planning for a new or replacement facility, the area planner develops two written planning documents, the Project Justification Document that outlines the need for the facility, its size and staffing and the Program of Requirements that provides information for architects and engineers.

 

The planning steps in developing the Project Justification Document (PJD) and Program of Requirements (POR) are: (1)estimate population; (2) plan services; (3) project staff; and (4) plan space.

         

          It begins with the establishment of the Project Leadership Team with area IHS and Tribal members.  This work team reviews the planning assumptions and area master plan, identifying communities needing additional service and determining the type and location of the proposed facility.  To validate the need for a facility the team works with the statistical officer to develop accurate population estimates and projections.

 

The next step is to plan the services that the facility will provide.  For this step the project leadership team consults with clinical and professional staff at the service unit, area and headquarters level.  Once services are approved, the area planner can use special IHS planning software tools to project workloads to plan staff and space.

 

The Health Systems Planning Process that replaced the Health Facilities Planning Manual in 1999 is a FOXPRO program that uses inputs of communities for health facilities to project population and produce workload statistics, space projections, equipment lists and room templates[v].  It interacts with the earlier developed RRM to project staffing needs based on primary care visits and workload.

 

Inputs for the software included key drivers and standards developed by workgroups of disciplines (specific medical specialties), collection and analysis of data from twenty service units with recently completed facilities such as inpatient beds days by specialty, births, etc, ancillary workloads and questionnaires on operations practices and problems, analysis of projected workloads and defining characteristics from Project Justification Documents and Program of Requirements from 27 planned facilities, documentation and approval of space programming and design notes, and development and approval of architecture and medical equipment, furniture and design criteria.  The resulting software also meets guidelines from the American Institute of Architects and Society of Construction Engineers, and other professional organizations.

 

The current HSP2007 provides for a standard set of services based on population, remoteness of area, and availability of alternative services nearby.  The area may propose additional services by providing justification to the Headquarters Division of Clinical and Preventive Services. It also attempts to combine the RRM staffing into a single system with the population, workload and space projections.

 

Both the Resource Requirement Methodology and the Health Systems Planning Process provide very general guidelines.  The approval process is iterative with special area needs and circumstances incorporated into the Project Justification Documents by adjusting the projections of the Health Systems Planning Process and Resource Requirement Methodology. An example of an adjustment is increasing the projected visits because of higher than average health needs within an area.   With the approval of the staffing and space projected by the Resource Requirement Methodology and Health Systems Planning Process, adjusted for local needs, the Project Justification Documents is approved and the Program of Requirements developed.

 

With the approval of the Project Justification Documents and the Program of Requirements, the project is then added to the IHS Priority List, a list of facilities that are then proposed for funding.  With the budget proposal, additional adjustments can be made to allow for changes in population and staffing needs.  Once funding is received, contractors perform the architectural planning and construction.

 

[i] F. Mullan, Plagues and Politics (New York: Basic Books, Inc., 1989).

 

[ii] Resource Allocation Criteria for Indian Health Services (Rockville, MD: USDHEW, 1978) iii.

 

[iii] http://www.ihs.gov/NonMedicalPrograms/PlanningEvaluation/pe-facilities-planning.asp#rrm.

 

[iv] Health Facility Planning Manual (Rockville, MD: U.S. Department of Health and Human Services, January 1981).

 

[v] http://www.ihs.gov/NonMedicalPrograms/PlanningEvaluation/pe-facilities-planning.asp#hsp.


by Lucy Vogel,MS, MBA
Planning Evaluation and Research
Indian Health Service, Department of Health and Human Services
lvogel@hqe.ihs.gov

Part I - Asking the Right Questions

The following are the President’s Messages from Health Planning Today, 3rd and 4th Quarter 2006 issues. Reprinted with permission.

 

John Steen

My temperament is that of an idealist, and my education prepared me to teach moral philosophy, so it shows in how I now write on health policy. It leads me to want to address the categorical shortcomings I always find in the otherwise growing body of serious writing on universal health care and the health care system this nation deserves, and to do so the way I used to teach philosophy in graduate school.

 

To teach is to show others how to think clearly, and that can’t begin unless we have questions in mind. So what I’m asking is, “What questions should guide us in determining how to describe the health care system that would provide optimal benefits for the American people?” To answer that we must have a context in which we see the whole picture: Our nation, its people, and our values.

 

With what tools do we proceed? Clear thinking requires that logic governs thinking driven by moral values, for we must begin with the insight that we are raising major moral questions. And beginning with a vision, we must proceed from the general to the particular, from our goals for our society to the means for reaching them – the health care system we would design. It will save time if we list our questions simply as, “who, what, why, and how,” though logic requires that we address them in a somewhat different order. The context for our thinking will be developed in considering how to answer them:

 

  • What: Good health. What are the conditions that produce good health in a society?

 

  • Why: Because health is fundamental to enjoyment of the “life, liberty, and the pursuit of happiness” that we hold to be our birthright. Compassion for our fellow man and concern for our communities as places supportive of the flourishing of those qualities implies that health is to be seen as an important national goal. This imperative can be expressed by promoting health as a human right.

 

  • How: By maximizing the ability of individuals, families, and communities to define and realize their own well-being.

 

  • Who: It will require the participation of everyone to realize these benefits.

 

These are questions that can be addressed by national health planning, the sort of questions that were raised by the World Health Organization in producing its World Health Report 2000. The ultimate questions for a discipline must be answered by principles from another, more fundamental one. Commentators usually refer to the roles played by competition and regulation, business and government, but these are political and economic policy questions that need to be addressed in the same way as our questions about what kind of a healthcare system we ought to have. Because

ours are moral questions, they must be answered by each and every one of us, and to do so effectively, we need education in clear thinking.

 

We Americans need to relearn responsibility for our own development and the role of education in empowering that process. With better education comes more personal discipline and greater participation in public life. Only then can the universal aims of public health be realized through a society that holds education and government in high esteem. There are many excellent articles on improving health in our society in our most informative newspapers, magazines, and journals, not to mention books, but these are all written by and for those well-educated individuals we’ve come to see as an elite. The distances between people need to be reduced by closing the economic, social, and political divides that we’ve allowed to develop through a deficiency of caring.

 

Of paramount importance is how these values are perceived. The business sector fully understands W. I. Thomas’s principle that “if men define situations as real, they are real in their consequences,” and they spend enormous sums ensuring that we see their products in the best light, and remain blind to their faults. To counter this, we must all teach each other to see more clearly what we’ve been missing – the big picture. For a society as for an individual, its ultimate expression is the face it puts on itself.

 

More than any other nation, throughout our history we have revered the freedom and the initiative to maximize profits, and we have celebrated those who succeed. But having succeeded, the best of them acknowledged their debt to the nation that offered such opportunities. Rather than setting them apart, wealth opened their eyes to their connectedness to all those who helped to earn it for them. In this, they saw themselves as trustees for the interests of the communities that truly owned the resources they had tapped and expanded.  They still knew how to ask, “If I am only for myself, then what am I?”

 

Education is key to this because these are the ultimate questions for all of us: What is the healthy life? So it all leads back to Socrates/Plato and Aristotle. Are you surprised? And from them we get some fundamental clarifications for our thinking. One is that nothing requires us to adopt a moral perspective for our vision. It has to be our own bent as a person to see these questions within a moral context, and to use a moral compass in deciding them. How else to see compassion and reverence for life as the greatest human qualities, and good government’s fostering of egalitarian principles of human rights and social justice through public health as the right health care system? For it is universal health caring that we most lack in our country now, and the effort to revive it should have what William James called “the moral equivalent of war.”

 

Winston Churchill’s prosecution of World War II solidified his small nation through such an approach, and at the time he stated that “Americans always try to do the right thing – after they've tried everything else.” Haven’t we done that by now? And, if not now, when?  

In Part 2, to be published in the spring/summer issue, John Steen will continue the discussion in the context of the U.S. health system performance.

by John Steen
Consultant in Health Planning, Health Regulation, and Public Health
jwsteen@expedient.net

Wired and “No Tipping” – The Boston Experience

When they tell you that you can have a TV and access the internet at your table before describing the menu at a restaurant, you remember.  That’s wholesome networking. Tom Piper (past chair) and I had dinner at the Legal Seafood test-kitchen restaurant, that

Tom Piper with portable PC

is down the street from the Seaport Hotel.  Tom could not resist trying out the internet, and it was amazing. I ordered a “Scrod in Mysore Rasam”.  If you are familiar with Indian food, you know it is sacrilege to add anything remotely non-vegetarian, including fish, into a rasam ( a peppery tomato sauce with hint of sweetness). So I had to try it. It was exquisite.  I guess we were eating in one of the most-wired places in Boston, and that is how the Seaport Hotel advertises itself on the web.

 

I stayed at the Seaport Hotel.  That too was a pleasant experience.  I do enjoy having access to free internet service.  I checked into the hotel early in the morning, and the doorman helped me with my luggage.  It was too early to check in, so checked in bags in storage, and took out some change to “tip” the doorman.  And he says, “No ma’am.  That’s not necessary”.  Later, that day as I took the elevator to my room, I saw the notice “Please refrain from tipping”.

 

As I was leaving the hotel and waiting for the shuttle to take me to the Convention Center, I met Elizabeth Zelazek, MS, RN who was wearing the elegant black ribbon indicating that she had been presented the APHA Executive Director’s citation.  She said that she had been to the Kennedy Center for the celebration and to accept her citation. On her way out, after picking her coat, she attempted to tip the coatroom attendant.  And he said:  No, thank you madam.  I cannot accept that.

 

Do you think this is a Boston thing?

by Priti Irani, Newsletter Editor

On Finding Passion, Strategy and Good Things at APHA

For the 2006 APHA Annual Meeting, I had been accepted for an oral presentation, a  poster session and had written proposed policy.  I missed most of the Section business meetings because I was asked to be at the public hearing on a policy I had written.  It was “Conduct research to build an evidence-base of effective community health assessment practices” available at http://www.apha.org/advocacy/policy/policysearch/default.htm?id=1330 discussed in the  “Environmental and Occupational Health” category.  I had never attended the policy hearing.  The passion and strategizing at the hearings is evident.  The audience was intimate, knowledgeable and interested.  The authors summarized their policy papers, feedback they had received from sections, and how they responded.  The audience asked questions, and got straight answers. 

 

The moderator, Debbie Hettler, did a good job allocating equal time for discussions of the six policy papers. The discussions were modeled on the “speed dating” model, and I don’t mean this disrespectfully.  There was not enough time to for members to understand the issue if they had not studied the paper, or for authors to make any in-depth corrections. The assumption was that members had read the papers before attending the hearings.  It whets one’s appetite about the issues discussed.  I would attend a hearing again.  However, if you want the authors to seriously consider your comments in the revised versions of their papers, they should get the feedback by June/July, soon after the draft policies are posted on the web in March.

 

Other Good Things:

 

  • Noted with interest how interested and organized other sections are regarding policies.  There seems to be a team who reviews the policies and provides feedback to the authors after the first draft and at the public hearings.  This is good for the authors, leaves a favorable perspective of the section among the audience, and adds strengths to important policy statements.  Our section is hoping to take up this practice of formally reviewing and writing original papers.  If you are interested in policy activities, please contact Sue Myers, chair at myers@telerama.com.
  • I would like to thank the International Health, Epidemiology, Public Health Education and Health Promotion, Public Health Nursing Sections and the Minnesota Public Health Association for their invaluable feedback on the community health assessment policy paper.
  • Simplicity and clarity of the Public Health Education and Health Promotion Exhibit booth that won the ribbon for the best section booth.  PHEHP had a trade show style portable exhibit, and used acrylic frames for photographs and posters.  It looks professional, and was very effective.
  • The volunteers – students, and members - who staffed the CHPPD booth. 

by Priti Irani, Newsletter Editor

APHA’s Nifty New Website Has Just the Tool for You. Let Your Finger Do the Networking

 

What you need:

Member ID (listed on your American Journal of Public Health or Nation’s Health)

Password (First Initial and Last Name e.g. pirani for me)

 

To locate members:

 

  1. Go to http://www.apha.org/about/membership/, and click on “Member Directory” on the column on the left.
  2. Enter your Member ID and Password when prompted.
  3. Start Search.   

For example if you wanted to know who were the APHA-CHPPD section members in Maine, type CHPPD for section, and ME under state, and submit to see the name of members.

 

Happy Networking!