Community Health Planning and Policy Development
Chair's Message: Demonstrating the Value of CHPPD
Dear Friends and Colleagues,
I’m proud to say I will bend over to pick up a lucky penny off the sidewalk. There’s value there and the exercise won’t hurt me, either. CHPPD’s leadership has been looking at how we provide value – and added value – to its members this past year. While we’re not entirely there yet, we've made some progress during the past year.
But allow me to back up a moment. Value is relative and probably best pegged to some sort of scale – and related to vision/mission. A group of CHPPD members gathered together on a November 2007 Sunday morning and began an open discussion of what CHPPD’s vision and mission should be as we move forward. This discussion will be concluded during a March 2008 conference call. Based on the consensus reached during this second meeting, Section committees will craft work plans and objectives that are needed to reach the Section’s vision, mission and goals. I can give you a sneak peek based on the work of the group last November by telling you that the vision is of a Section that proactively and effectively influences public health policy.
Now, shift gears. Three bucks and change. That’s the amount of money from each member’s dues that goes to the primary section of that person. Just like that lucky penny, three bucks are three bucks, and we want to make sure that the money is used for the benefit of most if not all of our members. That’s why we will likely not fully subsidize the member social at the Annual Meeting social hour; only 50-60 people out of 2100 attend this event. Instead, we’ll direct these funds to activities that benefit more people.
That’s also why we're trying out ways of connecting with one another in between Annual Meetings. Essentially, we're working to shift both the focal point (i.e., from the Annual Meeting to ongoing relationships) and the fulcrum (i.e., from individual/small groups to collective power) of how we as a section operate.
You’ve heard about the upcoming Planning and Policy Dialogue sessions we are planning on Health as a Civil Right. More details will come shortly. I think you’ll be quite excited to see our program plan for this series.
Also, I want to encourage members to take advantage of opportunities to do what many of you have asked about or told us about in the annual member survey – get together on a regional basis to network in between Annual Meetings.
One example: If a local health department is sponsoring a “town hall” meeting in response to the upcoming PBS/NACCHO Disparities Series, consider planning the presence of a CHPPD contingent to support our NACCHO colleagues.
Another: If there is a state public health association (affiliate) conference coming up that you can attend, consider organizing a gathering of CHPPD members. We want to support our friends at the affiliate level, too.
CHPPD has some nice ribbons we use to let folks know we belong to CHPPD when we're out and about at the APHA Annual Meeting. Maybe we need to start thinking about wearing our ribbons when we're at the state affiliate meetings or special functions like the PBS-local health department town hall meetings. It's really up to you all to push for this.
If you're interested, here’s one of the first things you can do: Join the membership committee. It won’t take much time, and you can help build new traditions that will serve CHPPD members long into the future. Write to ERodriguez@marchofdimes.com, our membership chair, and she’ll hook you into the action.
We enter the New Year with reasons for optimism and plans for action, so be a part of it. You’ll get your three bucks worth, I promise.
Yours in service,
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Mini-quiz: How Well Do You Know the CHPPD Section Members?
In all, 205 Community Health Planning and Policy Development (CHPPD) Section members responded to the membership involvement survey last September. The survey responses posted at http://www.apha.org/membergroups/sections/aphasections/chppd/benefits/membership.htm are very informative. What did you learn from reading members responses? With this mini-quiz, find out how well you know the CHPPD Section members. Answers to the quiz are at the end of this issue.
1. What percentage of Section members responded to the survey?
2. In what Section activities were respondents most interested in being involved?
a. Helping with the APHA Annual Meeting
b. Policy development
c. Member involvement
3. What aspects of the Section are the regular members most interested in?
a. Learning from other researchers and practitioners
b. Community health
c. Staying updated on policy and planning issues
4. What aspects of the Section are student members most interested in?
a. Learning from other researchers and practitioners
b. Community health
c. Staying updated on policy and planning issues
5. What activities did survey respondents participate in most?
a. Presenting papers at the Annual Meeting
b. Reviewing abstracts
c. Contacting a legislator
6. What benefit was not mentioned by members in relation to their participation in Section/APHA activities?
a. Helped me learn new skills or information
b. Was able to attend the meeting at no cost
c. Promoted at work
7. What is the biggest reason, based on the survey, for members not participating in Section/APHA activities?
b. None of the activities interested members
c. Do not know how to get involved
By Priti Irani, CHPPD Chair Elect
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Jeffrey Myers Receives Blum Award for Work on Environmental Contaminants
Jeffrey Myers of the Wisconsin Environmental Public Health Tracking program (WI EPHT) was recognized with the Henrik L. Blum Award for Excellence in Health Policy for his work at the Wisconsin Department of Natural Resources developing tools and methods for evaluating the public health consequences of environmental contaminants, and effectively applying the work to impact policy.
The model used in the current project is the Regional Air Impact Modeling Initiative developed by U.S. EPA Region 6. Mr. Myers led the efforts and collaborated with the model’s developers to utilize this cutting-edge technology for the evaluation of ambient air quality issues in Wisconsin. The approach is novel as it provides an assessment of many different contaminants from multiple sources in order to provide a more comprehensive estimate of human exposure and the potential for health impacts. More traditional techniques evaluate sources and contaminants individually, and thus are unable to accurately evaluate the cumulative exposure effects.
|Blum Award winner Jeffrey Myers (left) being congratulated by Governing Councilor Karen Valenzuela (right) while Chair Elect Priti Irani looks on. Photo by Tom Piper.|
The technology enabled Mr. Myers to identify areas of high risk, isolate the major contributor, and develop a targeted approach for reducing the specific emission. Collaborative activities between the industry, health agencies and environmental agencies resulted in the elimination of the hazard from that source. The data and information from the WI EPHT program served as the basis for the emitting facility volunteering to change to production procedures that simultaneously benefited their objectives, improved air quality in the surrounding community and protected human health.
Mr. Myers thanked his collaborators Mark Werner, Marni Bekkedal, and Kristen Malecki for nominating the project in the first place, and Rob Thiboldeaux and Dr. Henry Anderson who were also instrumental in efforts to work with the company to reduce their emissions. He thanked his project team – John Roth, Dan Meinen, and Ted Cauwels. Finally he thanked his family – wife Dawn and daughters Elspeth and Gabrielle – saying “they have accompanied me on this trip, and I could not ask for better traveling companions.”
Dr. Henrik L. Blum was a professor of health administration and planning at the University of California, Berkeley, and a champion of public health as social justice. Among his contributions is that of using community organizing skills along with social and economic concepts in the development and implementation of health care delivery and health policy.
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Papke, England Win 2007 Student Awards
The New Year often opens with many resolutions that look and feel like military regiments. What about investing more time in the interests and activities that already stimulate good fortune? Like your interests that drive the research you are currently doing. Resolved: students firmly believe their many contributions to the public’s health is an integral piece to the reconstruction of this nations health care system! Thus make it your resolution to present at the 2008 APHA Annual Meeting in San Diego.
The year ended with much joy and success for the students in CHPPD due to their many achievements. Mary Elise Papke and Manon England were awarded the 2007 CHPPD Section's student award for top-scoring PhD and masters student abstract submissions at the Annual Meeting in Washington, D.C. Congratulations to you both! Your accomplishments will surely inspire other students to submit the work they are dedicated to doing that benefits more than the selective eyes that graze the pages detailing your work.
Beyond the studious nature of both Mary Elise and Manon, both have interests that compliment and balance their lives. Mary Elise Papke, a student at the
University of Illinois Chicago School of Public Health submitted an abstract titled “Evaluating Community Partnerships: Application of Social Network Analysis." This project aimed to advocate for adolescent girls through teen pregnancy prevention evaluations. It was inspired by a sociology course she took at UIC with Professor Y. Youm on networks and organizations, and she was advised by Professor Pamela Popielarz. Mary Elise is interested in engaging dialogue about teen pregnancy with local health departments; as it is a rising issue in our nation’s health. Her involvement in several coalitions and partnerships helps her think of innovative ways to stay involved with the issues surrounding teen pregnancy. In addition to her presentation of her research at the APHA Annual Meeting, Mary Elise was also privileged to present her research to the Midwest Political Science Association.
|Mary Elise Papke, PhD student abstract winner (left), explains her abstract to program chair Roy Grant (right) while student committee program liaison Aneesah Akbar-Uqdah (center) looks on. Photo by Tom Piper.|
Along with her academic interests, Mary Elise is a mother who shows much love and adoration to her daughter. She finds comfort in cooking, gardening, traveling, and appreciates the natural beauties of life while taking walks in Lake Park verlooking Lake Michigan.
Manon England, a graduate student at the University of Alaskan Anchorage, submitted an abstract titled Use of electronic health records to promote regular screening for hepatocellular carcinoma in persons with chronic hepatitis B or hepatitis C infection. Manon’s abstract addressed a rather new yet much needed issue in health care; electronic records. Manon argues that at-risk Hepatitis C or D patients' need for regular serologic screening could be more efficiently promoted through electronic record keeping. This promotion can significantly help patients remember their screenings and prevent negative clinical outcomes. Electronic records can particularly be useful to communities most at risk for Hepatitis including Asian communities and others who live with diabetes and other chronic diseases.
Manon was encouraged to do this project by professors who thought she would have a great deal to gain from the experience of presenting at the APHA Annual Meeting. From this experience she realized how easy it is to remain focused on a single topic until you look through a different, wider lens. The Annual Meeting allowed her to become aware of larger issues in health care. “APHA provides one with the opportunity to think about those larger issues and break away from your day to day activities that your job requires.”
As Manon earns her final credits for her Masters of Public Administration at the University of Alaskan Anchorage, she is searching through the field of public health for a place that will allow her to explore and incorporate her many interests. She is mostly interested in the way that insurance has affected health care in the United States and different policies that will allow health care to become less expensive. However, epidemiology and veteran health also pose possible avenues to advance in with her degree. Congratulations once again to both of you for your outstanding work!
It is apparent that students come packaged in many sizes and present themselves with an array of colors. CHPPD would like to welcome more vibrant light and enthusiasm and add a ribbon to your packaging by presenting you with our 2008 student abstract award. Let it be resolved that you submit your abstract to the student section of CHPPD.
By Aneesah Akbar-Uqdah, firstname.lastname@example.org, CHPPD Student Committee Program Liaison and Student Committee Chair-Elect
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Scott Receives Section Award
Amy Carroll Scott, PhD(c), MPH, was presented the Section Service Award in deepest appreciation for her committment to the Section. Amy works at the UCLA Center for Health Policy Research and is aiming to complete her doctoral degree at the UCLA School of Public Health in June 2008. Amy founded the Student Committee and has set the students on a strong foundation. The Student Committee is a very vocal group within the CHPPD Section as evidenced by the newsletter contributions in this issue.
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Submit Nominations for 2008 Blum, Vision and Section Service Awards by March 10
Do you admire the planning or policy work done by 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 Monday, March 10 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 newly-established Vision 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.
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.
All awardees receive an inscribed plaque that is presented at an Awards Ceremony during the Annual Meeting of the American Public Health Association, October 25-28 in San Diego. All Section members are welcome and encouraged to submit nominations for any of these awards. The award nomination forms are available at http://www.apha.org/membergroups/sections/aphasections/chppd/benefits/award_nominations.htm.
Please fax or e-mail a copy of the completed form to both Ann Umemoto email@example.com, fax: (914) 997-4501, phone: (914) 997-4496 and Priti Irani firstname.lastname@example.org, fax: (518) 473-0476 , phone: (518) 474-2543.
Also, nominations for the APHA Awards are due April 18, 2008. Information and nomination forms for these awards are at http://www.apha.org/about/awards/.
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Cardelle: On Being Elected to the Nominating Committee of APHA's Governing Council
At the 2007 Annual Meeting, I had the honor of being nominated and elected to the Nominating Committee of APHA’s Governing Council. The Nominating Committee is made of 11 Governing Council members
and is responsible for the nominations of APHA officers. It is composed of the president and the executive director as non-voting members and nine voting members of the Governing Council. The Committee serves from the time of its election until the reading of the Committee report at the first regularly scheduled session of the Governing Council at the next Annual Meeting.
|Alberto Cardelle (left) Photo courtesy Tom Piper|
The Nominating Committee identifies interested APHA members who want to be nominated and run for president of the association and for Executive Board membership. APHA's Executive Board is a 24-member body that serves on behalf of the Governing Council and meets regularly throughout the year to discuss Association business. The Executive Board carries out established Association policies and adopts interim public policy between meetings of the Governing Council. It assures proper direction for the administrative work of the Association, it acts as trustee of all Association resources, it reviews and coordinates the recommendations of Association boards and committees, and it has responsibility for specific membership functions relating to election, finances and termination.
The Committee is also charged with ensuring that all of the Association’s constituencies have an equitable opportunity to become involved in the Association’s governance. Each Committee member identifies specific constituencies that they will contact and work with at identifying individuals interested in serving. As a member of the CHPPD Section I not only reach out to members of our section but also to caucuses and special interest groups that have historically not been represented in the Association’s governance structure. I will work with our section’s leadership to identify members of our section interested in being nominated for office, but I also encourage any of our members interested in serving in any of these important capacities to contact me at email@example.com .
I was elected to the Committee by first running for Governing Council within our section. I was nominated because of my work with our section and my work with a caucus of which I am a member. And finally I was elected by the Governing Council because of the hard work of my fellow CHPPD governing councilors campaigned for me within the general council. The opportunity to meet a diverse set of individuals through the work of the Section and the caucuses is the best way of getting involved in APHA.
By Alberto Cardelle, CHPPD Governing Councilor
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Wennerstrom, New CHPPD Student Chair, Brings Experience and Passion to Section
I am originally from Denver, and I attended the University of Colorado at Boulder, where I majored in Spanish and
international affairs. I spent a semester during my junior year studying in Costa Rica. In 2003, I moved from Boulder to New Orleans to become an AmeriCorps Volunteer In Service To America (VISTA). I spent my year of service doing grant writing, fundraising and volunteer coordination at New Orleans Area Habitat for Humanity, where I remained on staff for an additional year after my AmeriCorps term ended.
In 2005, I decided to return to school to pursue an MPH, which seemed like the perfect way to put my passion for health and social justice into action. The University of Arizona (UA), with its strong emphasis on community programs and serving diverse populations, was a natural fit for me. In 2007, I completed my MPH with a concentration in maternal and child health and decided to enter the DrPH program in public health policy and management. In my two and a half years at UA, I have been fortunate to work on a wide variety of projects that reflect my interests, including a state-wide community health worker advocacy study, an internship focusing on corporate social responsibility in agriculture in Sonora, Mexico, increasing access to breast and cervical cancer screening for a Native American tribe, and coordinating a border health service learning institute.
On a personal level, I love to travel, hike, cook, enjoy the outdoors and practice yoga . I am very excited about the opportunity to serve as chair of the CHPPD Student Committee. I look forward to working with and getting to know the members of our section!
By Ashey Wennerstrom, CHPPD Student Chair
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Vote for CHPPD Section Leaders from May 16 to June 20, 2008
In May, you will receive an email from APHA alerting you to Section Election. We hope you will take a couple minutes to vote for your section leaders. Section elections will run from May 16th through June 20th.
CHPPD Section Leaders are being elected for the following positions:
• Chair Elect (one position, two-year term),
• Secretary-Elect (one position, two-year term),
• Section Councilors (three positions, two with a three-year term, one with a two-year term),
• Governing Councilors (three positions, two-year term) nominations.
The nominating committee - Priti Irani, Tom Piper and Jennifer Lavely - are delighted with the response, and would like to thank members who agreed to be nominated for Section Leadership positions.
By the CHPPD Nominating Committee
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Section Seeks to Nominate Members to APHA Boards and Committees, Deadline: March 31
Governing Councilor Karen Valenzuela is coordinating responses from Section members interested in serving on APHA boards and committees. Currently there are a number of positions open for nominations. The full list of open positions and the nomination form is available at http://www.apha.org/about/gov/leadership/Full+list+of+2008+Open+Positions.htm. The CHPPD Section has representation on the Action Board, Constitution and By-Laws (expiring 2008) Committee, Education Board, Equal Health Opportunity Committee, Science Board (expiring 2008) and The Nation’s Health Advisory Committee (expiring 2008). Please contact Karen at Karen.Valenzuela@DOH.WA.GOV.
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Interested in Reviewing Abstracts? Contact Section Program Chairs
If you are interested in reviewing abstracts, you should contact program co-chairs Roy Grant (firstname.lastname@example.org) and Danielle Greene (email@example.com). Most reviewers will be assigned about 10 abstracts, which should not take very much time. The reviewing process is done on-line, and you can stop and resume as fits your schedule. Most reviewers report enjoying the process. The deadline for abstract submissions to CHPPD of Feb. 8 was extended by one week to Feb. 15. Prospective reviewers, please do contact the program chairs as soon as possible.
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Spiderwoman with a Web of Connections?
Do you ever feel like you’ve just walked into a spider web when you enter a room full of amazing professionals that you want to get to know? Have no fear. You, too can be a Spiderman or Spiderwoman and create your own web of connections.
Every year the APHA Annual Meeting has an Exhibition Hall that is often a main attraction for young professionals. The exhibit room is full of intensive positive energy that inspires conference participants to engage in conversations with those who are serious and passionate about the work they do in public health and explore the many facets of public health. This kinetic energy has a way of defusing the anxiety that is often felt by young professionals that inhibits us from engaging in dialogue with more experienced professionals.
|Creating connections: Student Committee Program Liaison Aneesah Akbar-Uqdah (left) with new Student Committee Communications Liaison Dawn Alayon. Photo courtesy Dawn Alayon|
The CHPPD Section is very enthusiastic about keeping students involved and valuing our voice. One of the many ways the Section shows their dedication to student leadership is by allowing students to partner with a senior member of CHPPD to volunteer at the booth in the exhibit hall. By partnering with a mentor, students are able to learn more about the CHPPD Section and encourage interested guests to actively participate in the Section. Because the exhibition hall is a main attraction for all conference participants including the younger attendees, you often find yourself speaking with ambitious students.
Volunteering at the booth gives you a feeling of empowerment and also allows you to practice your networking skills. It gives you the opportunity to widen your circle of public health professionals both young and old. The most important thing to remember and truly believe is that your involvement and personal interests in public health is a significant contribution to the field, even if you are not sure what direction you want to pursue in the field of public health. Sometimes, we forget that what we are doing as students is just as meaningful as what experienced professionals are doing. In fact, our engagement and leadership is what will drive the development of health care nationwide.
A professor by the name of Dr. Tracey Hucks instilled in me that knowledge is fluid. Remembering this will help dissolve and eliminate barriers constructed to make our search of knowledge difficult. Continue to seek knowledge from the cradle to the grave; it will keep you forever young. The CHPPD Section is proud of student involvement, and you should be, too. Sign up to volunteer at the booth at next year’s APHA Annual Meeting!
By Aneesah Akbar-Uqdah, firstname.lastname@example.org, CHPPD Student Committee Program Liaison and Student Committee Chair-Elect
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The APHA Experience
The APHA Annual Meeting can be an overwhelming experience. I have attended five of them and finally developed a plan of attack! The key is to stay consistent and focused on one or two topic areas. This year the conference was held in Washington, D.C. in November - a time when California’s health reform debate seemed to be over despite lots of community organizing efforts. So I went to the conference with a predilection to learn more about how public policy actually does change given so many strong forces that maintain the status quo. I ended up finding answers (or perhaps more questions) as a result of attending conference sessions, meeting with colleagues, and exercising around the National Mall. Below is a snapshot of my takeaways that I put together on the plane ride back to California.
Advocacy efforts and influence strategies are alive and well in Washington, D.C. They live just beyond the Capitol walls. They exist in the monuments around the National Mall, in the photography exhibits of Ansel Adams and Annie Liebowitz, and in the upcoming PBS series called Unnatural Causes www.unnaturalcauses.org.
|Photo courtesy Unnatural Causes: Is Inequality Making Us Sick? www.unnaturalcauses.org|
As we enter a new year, I am inspired to think about ways we can support ‘alternative’ advocacy efforts – ones that move people to think, feel, and behave differently than they have in the past. This approach may stray from the traditional advocacy strategies that rely on the theory of change that if you educate and harp on policy-makers, then they will adopt your policy agenda. An alternative approach to advocacy may require the development and use of new tools and more creative frames for messages.
For example, the story of the health care delivery system and health outcomes in popular media needs to change. Currently it appears that only the poor get sick and it is because they are lazy, illegal, don’t have access to meds, won’t go to the doctor, or have bad genes. The story needs to be about changing the conditions/environment that we work and play in so we can live healthier lives. Policy change needs to focus on the dangerous conditions in which we were born into or live in.
A new story will be told through the premiere of Unnatural Causes, a seven-part PBS series, in March 2008. I saw segments of this series at the conference and felt so hopeful that the general public may begin to shift their thinking and practices from the medical model to a public health model to address health issues. There was some discussion at the conference about the impact this film could have on county health department workers and planners. County health departments are charged with making regulatory changes to create health equity. There is an assessment tool being used to measure, compare, and correlate across counties the change that is/isn’t occurring around creating health equities. Counties will need to create new regulations and reallocate funds to create health equality. Structural changes within the counties are needed and will require work across silos (unfair housing, employment, racism, etc). Right now DHHS spends 97 percent of funds on treatment and 3 percent of funds on prevention (and upstream approaches). How about spending 20 percent on prevention by 2020?!
As usual, I left the conference feeling inspired by all the good work public health workers are doing to make the world a healthier place for everyone. Conference sessions and colleagues from around the country provided me with useful, stimulating information that will help me push boundaries and advocate for positive changes in new and different ways.
By Wendy Todd, MPH, Secretary Elect
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Students Can be Involved in Creating Policy at APHA
Joe is an Epidemiologist for the Child Policy Research Center at Cincinnati Children’s Hospital. He is also a student in the Departments of Planning and Environmental Health at the University of Cincinnati. Joe has substantial experience working in state and local public health as well as the academic and non-profit sectors. He also served two years as an epidemiologist for Doctors Without Borders in Africa. His interests include addressing key determinants of health in the built and policy environs, and providing evidence for advocacy. Joe is the student representative to the CHPPD Policy and Resolutions Committee.
The farm bill. Global warming. Regulations on junk food and marketing strategies in the midst of an obesity epidemic. Child health insurance. One cannot avoid the fact that public health issues are taking precedent in our legislative halls, are at the forefront of a presidential election, and are becoming increasingly important in the minds of the American people and the international community.
Like our public health colleagues, we are excited to be in this field at such a timely juncture. But our involvement in APHA and the Community Health Planning and Policy Development Section makes us unique. Not only can we research a topic and provide evidence to help inform decisions. Not only can we build strategies and programs to address the issues. We are much more proximate to action. We can create policy!
As a student, it's often easy to get caught up in coursework, unsure how to translate theory to action. However, student participation in the crafting and review of APHA policy not only provides an opportunity for students to take action on issues they are passionate about, but also ensures that diverse perspectives and insights on current initiatives are gathered from the entire APHA membership. The student protest of generations ago is not lost – only transformed into a more effective but no less prudent policy advocacy.
Where does one sign up? CHPPD members, including students, are encouraged to review APHA policy proposals and decide whether or not the Section should support them. At the Annual Meeting, CHPPD Policy Committee reviewers articulate the Section's views at policy hearings, authors or their proxies are given a chance to defend their proposals, and Governing Council members will discuss, possibly amend, and vote on the proposals. Proposals approved by the Governing Council then become official policy of APHA.
At last year’s 135th Annual Meeting, CHPPD commented on 19 policies including three late-breakers. Of these 12 were approved. The CHPPD Section did support Azzie Young, PhD's, proposed policy “Call for research and education into Vitamin D deficiency.” On the recommendation of the Joint Policy Council, Dr. Young withdrew the policy and is collaborating with sections to submit it for the 2008 Annual Meeting. New proposed policies are due to APHA by Feb. 19, 2008.
Does all this really matter? “Passed at the annual conference in 2004, Creating Policies in Land Use and Transportation Systems that Promote Public Health illustrates how policies should work,” says Donald Hoppert, APHA's director of Government Relations. Crafted by members of the Maternal and Child Health Section, it addressed transportation as an important public health issue, especially regarding childhood obesity. This policy became the theme for 2006 National Public Health Week , and helped inform legislation such as The Healthy Places Act of 2006 (S. 1067/H.R. 398), a bill introduced by Sen. Obama, D-Ill., and Rep. Solas, D-Calif..
To get involved with the CHPPD Student Section and the Policy and Resolutions Committee, write to Joe Schuchter at email@example.com. The CHPPD student leaders plan to launch an online resource this fall, which will include periodic policy updates and action items.
By Joe Schucter, Student Liaison, CHPPD Policy and Resolutions Committee
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Students Invited to Submit Original Essays on Health Policy by March 17
Undergraduate and graduate students are invited to participate in the KaiserEDU.org Second Annual Student Essay Contest on a major health policy. The health policy issue areas are: controlling health care costs; eliminating racial and ethnic health disparities; expanding health promotion and disease prevention efforts; improving women's health; and improving the quality of health care. Deadline for submission is March 17, 2008. Last year, Brad Wright, CHPPD newsletter editor, won first place in the essay contest.
The context for the 2008 essay is: The date is November 24th, 2008. You have just started a job as an analyst working on the president elect's health care transition team. The director of the transition team has asked you to draft a memo to flesh out the health priorities for the new administration on a major health policy issue. Select a candidate and an issue area (from the list below) and identify the major policies or strategies that the next administration could develop to advance this issue. Make sure to include evidence and analysis to support your recommendations. Your priorities and strategies should be consistent with the proposals forwarded by the candidates in the campaign. You should also address the challenges in implementing your recommendations, such as budgetary and political considerations, delivery system issues, and how different stakeholders and constituencies would perceive the proposals.
The first place winner will be awarded $1,000, and the second place winner $500. The essays must not exceed 800 words and must be original work, prepared by one author only. Entries must be submitted online only at http://www.kaiseredu.org/essay/essaycontest2008.asp. No e-mails will be accepted. Entries will be judged by a panel of professionals with experience in health policy and politics from inside and outside the Kaiser Family Foundation. Winners will be notified by May 1, 2008. For more information about rules and requirements, visit http://cme.kff.org/Key=13707.HTm.C.C.Lz9LSp.
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“Unembedded:” Impressions at the APHA Annual Meeting
Special thanks to the Community Health Planning and Policy Planning Section for supporting the “Unembedded” exhibit at the 2007 APHA Annual Meeting in Washington, D.C. It was a brisk 30-minute walk from the Convention Center, where most the APHA events were held, to the AFL-CIO office, the site of the “unembedded” exhibit. APHA, the Labor Caucus and the Peace Caucus sponsored the exhibit. According to official estimates, 250 people attended the Opening Reception and more than 1,000 viewed the exhibit between Nov. 4 and 9.
The panels were interesting. The space was crowded. Crackers, cheese and fruit kept the attendees entertained through the speeches at the Opening Reception. Kael Alford, one of the photojournalists whose work was featured in the exhibit, narrated some of the stories behind the photographs using a PowerPoint presentation.
|Photojournalist Kael Alford at the Opening Reception. Photo by Tom Piper|
The “Unembedded” exhibit had large panels with text explaining the stories and public health statistics. The photographs that I remember most were those of happy Iraqi women playing in the river. There was a photograph of a family outing by the river. Men and women bathed in different areas. Ms. Alford said that, as an American journalist, she assumed a unique social status, and could move between the men’s and women’s areas taking photographs.
There were pictures of helplessness. A son sitting on the floor by his injured mother whom doctors had judged to be beyond their resources to help. There were pictures of fear, anger, pain, destruction and sadness. Pictures of war.
At the event, union leaders, politicians and advocates shared their perspectives. I wished the exhibit had been closer, or better still, within the Convention Center, so I could have visited it again. I was pleased to learn that the exhibition inspired others to bring it to their cities next year, including potential shows in Cleveland, Minneapolis, Seattle and Vancouver.
For more information about the traveling schedule, the authors, the book, or other details, go to http://www.unembedded.net.
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Part I: Getting a Maternal and Child Health Project Started in Babil Province, Iraq
A member of the Community Health Planning and Policy Development Section was assigned work with the Iraqi Health Ministry, and others, to support medical and public health infrastructure development sent in this report. This narrative recounts an experience with getting a maternal child project off the ground. Part I describes the assessment process and how funds were approved. Part II, to be published in the spring issue, describes the process of transferring the funds to a non-governmental organization.
Shortly after I arrived, I learned I was the only person addressing public health issues in my unit. I served with a Civil Affairs Brigade near Baghdad. As this unit had responsibility for all areas in Iraq from a civil affairs perspective, I was free to consider all geographic regions in the country. The possibilities became even more enticing when I determined that my boss and the commander of the unit had little interest in determining what public health should accomplish, and simply asked that I stay safe. Of course, I needed to keep them informed, and they would probably prefer something that made the military look good, but for the most part I was free to pursue any area I desired.
Within a few days, I made good use of the superb military communication capabilities and was able to assess available information about Iraq, identifying critical public health needs. As you might imagine, there was virtually no end to the public health issues that needed to be addressed. The very high maternal, infant and child mortality rates stood out prominently and spoke to my heart. Having plentiful supplies of safe water and basic sanitation could be considered more critical, but our engineers were addressing those issues with ample resources.
Once I had determined the important areas I wanted to address, I retrieved and reviewed documents from the World Health Organization that described ways to remedy these problems in a country like Iraq. Fortunately, many people had assessed appropriate interventions for similar circumstances, often focusing on common problems that routinely emerge during conflicts. There was no shortage of proven interventions suitable for maternal and child health. Many promising avenues existed to greatly reduce the extent to which young mothers die during childbirth, and there were basic, simple and inexpensive strategies to dramatically decrease the number of children who succumb to preventable infectious diseases.
I had one final task to perform before I began to explore the bureaucratic components of this process – identify/develop a survey instrument. This was needed to establish baseline capabilities. That is, I needed data to describe how things stood before the interventions began so I could hopefully demonstrate how things improved following program implementation. Even in these circumstances, the Army prefers to objectively demonstrate how its resources have served to ameliorate suffering. This task was a little more difficult and time-consuming, but I was not deterred and was soon ready for the next step.
It was now time to identify an non-governmental organization that would be suitable for such a project. After consulting with the medical command in Iraq, I found an organization that seemed ideal and arranged a meeting. They agreed with the approach and recommended a location that was very pleasing to me – the area south of Baghdad where Babylon once stood. The latest information indicated this was the area with the greatest need. Finally, they identified key items they would require in a contract to ensure their safety.
At this point, I felt I was ready to brief my commander in the Civil Affairs Brigade and arranged a time through his aide. I first described the logic I used to identify the most critical public health issues, and then outlined the programs and interventions that were planned. Subsequently, I pointed out the critical contractual issues that were important to the NGO, including the need for military personnel to avoid the sites where the interventions were established. They felt this was necessary for their safety as experience indicated insurgents would make them targets if they knew the military was involved. Here is how the meeting unfolded.
“What?” resounded the commander after I completed this point. He stared at me resolutely and then continued brusquely, “Are you goin’ native on me, Charley?”
My pre-planned presentation came to an abrupt halt as I quickly searched for words to respond. All the while, possible interpretations of his query roamed through my mind. Fear intervened when I soon realized my involvement in this process might be in jeopardy if I failed to provide an appropriate, brief response in a timely manner. I became anxious as his gaze became more intense and I could almost see the suspicion form in his furrowed brow.
Soon I calmly and softly relayed what I thought he might want to hear, hoping that humility and subservience would pleasingly drip from each word. “Of course not sir. I understand fully the importance of assuring our visibility and making certain that people appreciate our efforts. However, I also felt it was important to abide by your primary directive – staying safe.” This seemed to assuage him as his visage relaxed. I completed the briefing a short time later and received permission to proceed. The required documents were then immediately placed in front of him and his signature was acquired. I subsequently left the briefing room as quickly as possible.
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Native Health Initiative: Addressing Health Inequities Through Partnerships
Nályééh (pronounced Nah ahl yeh) = Navajo word meaning 'giving back' in the form of a pay back to a due owed.
In the summer of 2007, a cadre of hundreds of volunteers worked tirelessly in the American Indian communities of North Carolina to fulfill nályééh.
Some were tribal leaders, including health professionals, ministers, educators, elders, and youth. Others were the 28 students who volunteered much of their summer to volunteer as “Health Justice Interns.” These students represented health (medicine, nursing and public health) and non-health fields, and came from Canada, Norway and across the United States.
|Native Health Initiative volunteers|
Without speaking to the individual projects that transpired, the process behind this summer and the Native Health Initiative’s work over the past three years is worth exploring, hoping that what we have learned can be transferred to programs in other populations and communities. We will look at three unique aspects of this program – ownership, framework and coalition-building.
“What we’ve seen in the past is that when outsiders come in they want to force changes”
- Mark Deese (Tuscarora), NHI Mentor
When volunteers arrive in North Carolina, their questions as to what exactly they will be doing are answered by the NHI coordinators with, “Not quite sure.” Indeed, the locus of control within NHI’s projects rests in the hands of community leaders, known as NHI Mentors. These Mentors develop projects based on the areas of highest need in their Tribes, along with consideration of which projects will be most sustainable given the community’s resources. This has been a priority for NHI since its inception, which took place, not on a college campus, but in a meeting of community and health leaders in a Pembroke church. (Pembroke is the center of the Lumbee Tribe’s community, and is the largest American Indian community in the Eastern United States). At this meeting, the name of the project, along with its core principles, were decided.
Though there are challenges that arise with this approach, we have seen an unprecedented amount of community support for NHI because of the Tribal ownership of the project. NHI has taken further steps to ensure this, such as mandating that at least 50 percent of any grant won by NHI will be directed to our community partners.
“The fact that American Indians live sicker and die younger is an injustice, and we must call it for what it is. Period.”
- Shannon Fleg (Navajo), NHI co-coordinator
NHI operates on a unique conceptual framework that leads to concrete outcomes. First, we use health equity, the absence of systematic differences in health across population groups[i], as our gold standard for our work, believing that (1) the majority of disparities in health in the United States are unjust, unfair and preventable, and should therefore be called as such – health inequties, and (2) that health equity is a needed gold standard, reminding us that nothing short of the elimination of inequities in health is ethically acceptable.
Secondly, NHI operates under the model of loving service as our guide in this work. Taken largely from the example lived out in indigenous culture, loving service reminds us that our ultimate goal in this work is to give from our hearts, to share our cultures and lives with one another, and to never forget the value of the people we are working alongside. The aspect of nályééh is central to this work, as NHI’s students and community members work with a sense of humble indebtedness, espousing the “savior ethic” only insofar as promising to save (and change) ourselves.
This framework has tangible results. For instance, the spirit of loving service has allowed NHI to build genuine relationships and trust that allowed us to carry out a summer program in 2007 for $4,000 that would otherwise have cost more than $50,000; In other words, in-kind donations, based simply on the human-to-human connections fostered by NHI, are our primary funding source! While it is more difficult to see a change in the way of health statistics regarding health equity, we do know that NHI has become an educator of thousands of health professionals of tomorrow on this subject, through our various projects, lectures, workshops, and most recently, through the creation of a course in American Indian health at the UNC School of Medicine.
“It is amazing how much gets done when no one cares who gets the credit”
- NHI mantra
Initially, NHI’s partners included the American Indian tribes of North Carolina, organizations within these Tribal communities, and the N.C. Commission of Indian Affairs. The hesitation to partner with a university or university-affiliated programs was well-founded initially considering the history of exploitative research in American Indian communities by such institutions.
However, as NHI gained the trust of the American Indian community, many benefits arose to partnering with organizations beyond the indigenous community, including the chance to put American Indian health on the agenda of minority health and service-learning groups that had never before worked with this population. “I think one of the most important aspects of building partnerships in our work is the ability, in a non-confrontational way, to remind people that American Indians are often the forgotten minority, relegated to long-ago history, left to suffer in obscurity,” says NHI co-coordinator Shannon Fleg.
What has emerged from NHI’s partnerships is a growing attention to American Indians within the UNC campus community, along with a larger sense of the common struggles and injustices facing communities of color throughout the state and country.
We hope that our fellow APHA members will find this description of the Native Health Initiative’s approach insightful, and useful to your specific programs and communities. The issues of ownership, framework and coalition-building are essential for our collective work in empowering communities to better health, and moving away from the ivory tower approach to “doing public health.” Moreover, we hope that NHI turns our collective energies to seek the Navajo principle of nályééh as our guide, replacing NIH funding and publications as our measure for our work.
Please read more about our project and contact us with questions or opportunities for partnerships at www.unc.edu/~flega.
By Anthony Fleg, firstname.lastname@example.org
. Anthony is an MD/MPH candidate at the University of North Carolina in Chapel Hill. He is a coordinator of the Native Health Initiative. In a letter on the Web site, Anthony explains, "With close to $0 budget, we have worked hard since 2004, under the guidance of our community mentors in 5 tribes…between the 27 health professions volunteers, community mentors, and tribal members, we have put our collective 10,000+ volunteer hours into making NHI what it is!"
[i] Braveman P, Gruskin S. Defining equity in health. J Epidemiol Community Health 2003; 57: 254-258.
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States and Health Care Reform: Solutions or Illusions?
In recent years, Oregon was first on the road of good intentions. More recently, it was followed by Tennessee, Minnesota, Maine, Vermont, Massachusetts, California..., with Maine being the first with universal health insurance as its objective (Dirigo Health Reform Act, 2003). Shouldn’t it be clear by now where the road leads? Can states really expect to go it alone, or are they perpetrating illusions?
The greatest value to health care delivery would be achieved through a single-payer[i] health care system, the only way of attaining both universal coverage and built-in cost control, for its administration would be a function of public policy. And that would enable it to employ its power of reimbursement to create a health care system to match, one that could promote wellness through public health and primary care. But such a program is both politically infeasible and impossible for a state without federal support. Federal funding through Medicare, Medicaid, SCHIP and other federally controlled programs would have to be made available.
States need to rely on employer-provided health insurance to subsidize their plans, so they are forced to see this as part of their solution instead of the problem it is. At best, it is a two-edged sword in that the state then assumes responsibility for completing a service package that is more adequate than that included in private insurance. And should a state wish to require that employers cover their employees with adequate health insurance, under ERISA, the state may require a federal waiver to do so. Almost everything else a state does to ensure its citizens have insurance tends to undermine the need for, and the willingness of, employers to continue bearing the burden of providing it. And it is hard for states to avoid employing administratively complicated means tests, graduated premiums, copays, deductibles, uncovered expenses and other such cost-saving devices that soon become barriers to care, effectively preventing them from achieving universality. All these ploys do is to obscure the fundamental principle that no private insurance instrument can do anything to make health care more affordable in the aggregate. On the contrary, by adding 20 percent or more in overhead in the form of marketing, processing enrollments and collecting premiums, they make costs even more unaffordable.
Access to universal health care will never be achieved until we realize that private insurance and employer-provided coverage are the Trojan horses of the American health care non-system.
States have no control over medical cost inflation, being unable to set prices, limit utilization or reverse the inexorable demographics of aging. The inflation in costs is due to service factors beyond state control, primarily the erosion of primary care, and the waste fueled by the profit motive – the administrative inefficiencies of private insurance companies, the expense of high-tech modalities, and ever higher prices. The price of private insurance too rises much faster than inflation[ii] and state tax rates, so each year that passes widens the gap between the costs of state-funded universal health insurance and the ability of a state to cover the costs. And no allowance is made for the effects of all the state’s players “modeling the system,” resulting in higher costs than originally projected. States are required to have balanced budgets, so they soon reach a point where their plans become economically or politically unsustainable, or ineffective in solving their original problems. And to the extent that a state were successful, it would attract as new residents those people most costly for it to cover.
None of this should be seen as critical of states’ efforts to better extend a safety net over their medically uninsured, and that is in fact about all they can achieve through their attempts at “universal health coverage.” How many such political experiments does it take before we will perceive these tragedies as farce?
From following state politics, one would never think there could be a science of health policy. Wouldn’t you think that states would know by now that they haven’t the means to support a program to ensure adequate health care for all of their citizens? And that the principal reason why they can’t is because they won’t … limit the profits of their insurers and other profit centers in their health care industry?[iii] Why do most state programs add to the profits of providers, providers who benefit from the waste represented in that fragmentation of effort? Doesn’t this bring us to consideration of the politics of states, and of the nation?
Political Options, Social Consequences
An imbalance between rich and poor is the oldest and most fatal ailment of all republics. -- Plutarch
Plutarch was quite literally correct. Life expectancy is greatest in those nations that display the lowest income inequality gradients – Japan and the Scandinavian countries – while nations like the United States and the United Kingdom with higher gradients have lower life expectancies. And here in the United States, the states with the least income disparities – Utah, Iowa, New Hampshire – have the best population health, while those with the greatest disparities – Louisiana, Mississippi, New York – have the worst.
The very painful fact that explains the states’ dilemma is that we have allowed the polarization of our population by income to grow to the extent that it precludes a means of achieving universality in affordability. To achieve this now utopian goal, we would either have to impose highly graduated premiums according to income, or return to the highly progressive income taxes we had a half-century ago. And this, the most equitable solution for our society as a whole, is the least politically feasible of all. The moral here isn’t just about health care, it fits the whole society. True health care reform will require us to once again see taxes as “what we pay for a civilized society.” (Oliver Wendell Holmes, Jr.)
It isn’t just that the perception of inequality has adverse health consequences, poverty also prevents its victims from participating more fully in what their communities have to offer. New York Times columnist Nicholas Kristof, writing about what he saw in post-Katrina New Orleans, provides this commentary: What we've seen over and over is that even if there is a free clinic, the poor family may depend on a single mother who doesn't have a car or driver's license and so can't get there. Or she can't afford the gas. Or her car doesn't have insurance. Or she doesn't understand how serious the symptoms are. Or she is working at a low-level job where she can't just ask for time off to take a child to the clinic. Or she doesn't speak English. Or she's illegal and is worried that INS agents may look at the clinic's records. Or she's got three other small children and can't leave two at home while she takes her sick child on a series of bus rides to the clinic. Or...the possibilities are endless. The point is that making medical care accessible to the poor requires much more than making it free.[iv]
And the larger point is one that needs to be appreciated by the electorate and the candidates: Health care reform to achieve universal health care will be of limited benefit to those most in need of it unless we address those upstream factors that are uniquely the province of good governance. Poverty is one, for it is exclusionary. The most effective way of overcoming the syndromes of poverty is through the liberating empowerment of good education, but poverty is also the major impediment to its success.
So what is the outlook for true health care reform? I find it in a highly provocative statistic: There are 172 countries that conduct elections. The United States is 139th in the percentage of eligible citizens who vote. If we were truly serious about improving public health, first among its “Ten Essential Services” would be Encouraging People to Participate in the Political Process.
It seems that the only positive outcome of all of this might be to inform and motivate the electorate to seek nationally the solution that their states have tried, and failed, to achieve. And that will have to start with the realization that we have long gotten used to looking at this and other major social problems with blinders on. Among our blind spots are:
- Giving disproportionate weight to individual freedoms over communitarian needs;
- Translating love of freedoms into “market competition” as the answer to all needs without appreciating the need for government to set rules and standards making those “markets” responsible for producing public goods;
- Thinking that being poor is a moral failure for which the individual alone is responsible;
- Believing that our taxes are inordinately high (They are lower in relation to GDP than any other nation in the OECD[v]), and seeing income redistribution as inequitable;
- Seeing government, and especially its spending, as the problem. (This is half right. We are the government, but our ignorance is the problem.)
- Failing to so much as understand the very concept of “public health,” and valuing medical cures instead of the temperate lifestyles that would improve quality of life and largely obviate need for them.
- Making all these things into ideological/political struggles among special interests instead of seeing them for what they are – an imperative to all of us to practice greater compassion and civitas.
But what has to be the most embarrassing of all national blind spots is our parochial view of health care itself, one that blinds us to our status as a third-world nation in terms of health care outcomes. Embarrassing us not only to the rest of the world but to ourselves for achieving so little true benefit for what we spend. Worst of all, it blinds us to the lessons available in the many examples of more efficient health systems of the world’s nations, and in the efforts of the World Health Organization to promote public health, lessons that ought to guide us toward improvement.[vi] Instead, our nation’s most outstanding feature is being the world’s only industrialized nation that does not have health care as a right of citizenship, and resists doing anything about it, instead attacking its advocates as villains. All this serves to do is to obscure the fact that designing a health care system that efficiently provides the means to improve the health status of all citizens is not especially complex. What is inordinately complex are the forces battling any fundamental change to the status quo, forces behind a national battle intended to exhaust far more effort than needed for an effective solution.
These days it can be depressing to acknowledge that we live in a democracy, for as has often been noted, in a democracy, people get the government they deserve. Before we can expect to develop a health care system that works in our interest, we will need to develop a democratic process and a government that does. The best way, really the only way, to improve public health is to improve the public in it.
[i] A more radically egalitarian set of values along with even greater efficiency could be achieved through a no-payer system – one owned and operated by the government as in the U.K. and the Scandinavian countries. If health care is seen to be a right, then its provision is an entitlement.
[ii] In 1987, health insurance cost 7.7 percent of median family income. By 2004, even with the intervening cost-dampening effects of managed care, that figure had risen to 18 percent.
[iii] Eliot Spitzer’s promise to do nothing less than this as New York’s new governor distinguishes him from the politics-as-usual approach in other states. See my “Health Care Reform in New York: Looking Forward and Looking Back,” in Health Planning TODAY, 1st Quarter 2007.
[v] BMJ, doi:10.1136/bmj.39042.375544.BE (published 23 November 2006).
[vi] It seems obvious that we have closed minds about American health care, a condition that has been ascribed to American education as well: "The most successful tyranny is not the one that uses force to assure uniformity but the one that removes the awareness of other possibilities, that makes it seem inconceivable that other ways are viable, that removes the sense that there is an outside." Allan Bloom, The Closing of the American Mind (Simon & Schuster, 1987), p. 249. This book’s radically unorthodox take on higher education opened it and our culture to scrutiny, much as the documentary Sicko is now doing for health care.
Used with permission from the June 2007 issue of Health Planning TODAY. By John Steen, Consultant in Health Planning, Health Regulation, and Public Health, email@example.com.
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Answers to CHPPD Section Survey Mini-quiz
The Fall 2007 survey CHPPD member summary and detailed results are at http://www.apha.org/membergroups/sections/aphasections/chppd/benefits/membership.htm. Below are the correct answers to the CHPPD survey mini-quiz published at the beginning of this issue.
Number of answers correct in mini-quiz
6 – 7
Right on. We hope you are on the Section/APHA leadership team.
3 – 5
Not bad. You have much to learn, many interesting Section members to meet.
0 – 2
Much to do. Don’t be shy…we are a very friendly Section.
1. a. The survey was implemented in fall instead of the summer time in hopes that the response rate could be increase. The response rate to the survey increased by 3 percent. This was likely due to a higher student response. It is estimated, based on survey response, participation in APHA election and newsletter readership that Section membership involvement was between 10 - 12 percent in 2006 and 2007.
2. b. Policy Development is the activity that members said that they were most interested in.
3. c. Regular members were most interested in staying updated on planning and policy issues.
4. b. Eighty percent of student members said that they were interested in community health, and 64 percent were interested in connected with researchers and academics.
5. c. Most respondents said that they contacted a legislator in the past year.
6. c. Promotion may have been implied when respondents said that it helped them with their work. “Being promoted at work” was not specifically mentioned. “Was able to attend the meeting at no cost” was mentioned by a student member who probably won an award or a membership raffle.
7. c. Most members did not know how to get involved in Section/APHA activities. In fact, 100 members expressed an interest in being more involved and wanted to be contacted by a Section leader. If you are among the members who do not know how to be involved, please don’t wait to be asked. Contact a member of the leadership team via e-mail and say, "I would like to be more involved in Section activities.”
By Priti Irani, CHPPD Chair Elect
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Deadline for Spring Issue is May 10, 2008
Deadline for the Spring issue of the newsletter is May 10. If you are interested in writing an article, or writing a Web resource, training, movie or book review, please contact the editors, Brad Wright, at firstname.lastname@example.org
, or Priti Irani, at email@example.com.
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