Epidemiology
Section Newsletter
Fall 2003

Message From The Chair

The New View from the IOM

Several newsletters back I referred to the Institute of Medicine’s 1988 report "The Future of Public Health." Whether one agreed with its findings and recommendations or not, it was an influential book in outlining the mission of public health and its core functions, though perhaps with greater consequences in public health practice settings than in academia. Now IOM has issued two follow-up volumes: The first, "The Future of the Public's Health in the 21st Century" (FOPH21C), is the successor to the 1988 report. Of particular interest to epidemiologists is the strong emphasis on what the report calls “multiple determinants of health” and “the ecological model.” The second report, "Who Will Keep the Public Healthy? Educating Public Health Professionals for the 21st Century" (WWKPH), takes the first book’s perspective as the basis for discussing the needs of the new public health workforce and for making recommendations about new competencies and approaches for public health education. These recommendations have important implications for all of us, whether in public health agencies, educational institutions, or other settings. The emphasis on a population health perspective in FOPH21C is closely tied to repeated calls for a stronger governmental public health infrastructure as “backbone” for broader linkages and partnerships across agencies and sectors concerned with the public’s health. Similarly, WWKPH emphasizes the importance of partnerships between schools of public health and other disciplines within the academy, as well as with external partners.

In addition, WWKPH recommends adding eight additional competencies for public health professionals: informatics, genomics, communication, cultural competence, community-based participatory research, global health, policy and law, and public health ethics. Finding space in already packed curricula, not to mention people with expertise to teach in these areas, will be a challenge and will require creative solutions that will, no doubt, depend on the very sorts of partnerships the recommendations call for.

At the University of South Carolina Arnold SPH we are instituting a one-day seminar for all incoming public health students to introduce them to some of the concepts in these reports. We hope to demonstrate the importance of integrating multiple disciplines to address public health problems. A central part of the seminar is presentation of a specific public health problem that representatives of all departments will address in smaller group sessions. We want to engage the students in conversations about how their own field of study relates to the other disciplines of the school in trying to address an important public health challenge. Perhaps we can devote some time at next year’s APHA Annual Meeting to discussions of the implications of these reports for our section and for epidemiology as a discipline.

Robert

PS: For more information, go to the National Academies Press Web site, <www.nap.edu>, and click on Public Health Collection. Scroll down and you’ll find both volumes.

Three Students Selected to Paricipate In Governing Council Shadow Program

In early January, the Epidemiology Section Leadership discussed various ways to encourage student members to become more involved in the Section as well as APHA. Students had run for and lost elections for Governing Council (GC) positions in the past due in part to their lack of experience with GC and the Section. It was decided that students needed experience with GC before they would be viable candidates for future GC positions. To this end, the Leadership developed the Governing Council Shadowing Program. Epidemiology Section student members were encouraged via e-mail and the Section newsletter to submit an application for two positions. These students would “shadow“ other Section members at Governing Council meetings at the 2003 APHA Annual Meeting in San Francisco as well as Epidemiology Section business meetings. Shadows would be involved in discussing resolutions with other Section members at the Business meetings as well as vote proxies as needed. These students would then have first option to run for a slot representing the Epidemiology Section on the Governing Council in 2004.

The selection committee was charged with finding students who were passionate about public health, interested in translating public health research to policy, and wanted to become more involved in the Epidemiology Section and APHA governance. The committee was pleased with the quality of the eight applicants and had difficulty limiting their selection to just two students. After consulting with Section Leadership, it was decided that three students would be selected. All students who submitted applications were notified on July 1st via e-mail as to the final results. The following students were selected.

1. Celestine Buyu is pursing an MPH in Epidemiology at the University of Michigan School of Public Health and anticipates graduating in May 2004. Celestine was born in Kisumu, Kenya and completed a summer externship in Kenya studying malaria epidemiology.

2. Jodi P-Juan Clark, MD, completed her residency in June 2000 at the University of Miami in Florida. She is currently pursuing an MPH with concentrations in epidemiology and health policy at Florida International University and has plans to pursue a DrPH.

3. Arpi Terzian, MPH, is a first year PhD candidate in epidemiology at The Johns Hopkins University Bloomberg School of Public Health. Arpi currently serves as the Epidemiology Student Organization’s student representative to the Hopkins student assembly and is co-leading the student health and human rights organization.



Section leadership extends their warmest congratulations to these students and looks forward to their participation at the upcoming APHA meeting. We extend an invitation to all the applicants as well as any interested students to participate in the business meetings and to visit the epidemiology booth.

Continuing Education Opportunities In Statistics and Epidemiology at the 2003 Annual Meeting

As part of its efforts to support statisticians in public health practice, the Statistics Section is sponsoring three Continuing Education Institutes at the 2003 APHA Annual Meeting in San Francisco.

On Sunday, Nov. 16, Mike Stoto (RAND and Harvard) will offer a half-day course in "Statistical Methods for State and Local Public Health Data." Aimed at public health practitioners, this short course will introduce participants to statistical methods appropriate for state and local public health data and address practical aspects of their use. Topics to be covered are: 1) issues in the development and use of state and local public health data for community health indicators reports, performance measurement, public health report cards; 2) surveillance and outbreak detection for bioterrorism and emerging infections; and 3) privacy and confidentiality in the public release of state and local public health data.

On Saturday, Nov. 15, Andrew Lawson (University of South Carolina) and Richard Hoskins (University of Washington) will offer a full-day institute on "Spatial Epidemiology and Geographical Information Systems" (GIS). The purpose of this Institute is to provide an introduction to the geographical analysis of disease incidence and indicate how to use that information to communicate with policy makers and a community. The first half-day will focus on basic concepts in spatial epidemiology: relative risk, confounders, ecological bias, control diseases, expected rates, standardization and SMRs. The second half-day is designed to introduce participants to the use of a GIS for public health disease surveillance, health status and risk factor assessment.

Back for a third year, Tom Lang will offer an Institute on Sunday, Nov. 16, on "Interpreting and Reporting Public Health and Medical Research." The purpose of this workshop is to help participants to become more informed consumers of the public health and biomedical literature. Several techniques and tools for critically appraising the literature will be presented, including perspectives to reading the literature, checklists for authors and readers, and references to aide readers. The bulk of the workshop is structured around a series of 13 general questions about the purpose, design, conduct, analysis and interpretation of a research study.

These short courses are co-sponsored by the Epidemiology Section and the American Statistical Association. More detail is available on the web at <www.apha.org/meetings/continuing_ed.htm>.

2006 North American Congress of Epidemiology

The 2001 North American Congress of Epidemiology held in Toronto was a great success. As a follow-up, the Society for Epidemiology Research, American College of Epidemiology and the APHA Epidemiology Section have begun plans for a second North American Congress. The Congress will be held the second or third week of June 2006 in Seattle, Washington. In addition to the above societies, the following societies have committed to participate as co-sponsors: American Academy of Pediatrics-Epidemiology Section, Statistics in Epidemiology, American Statistical Association Statistics (ASA),
Council of State and Territorial Epidemiologists (CSTE), International Epidemiology Association, International Society for Environmental Epidemiology (ISEE), International Society for Pharmacoepidemiology (ISPE), Society for Pediatric & Perinatal Epidemiology (SPER), and the Society for the Analysis of African American Public Health Issues. Co-sponsors will arrange symposia and otherwise assist in putting on the meeting. We hope other societies will join as well!

The arrangements for the second Congress resulted from the efforts of the Epidemiology Leadership Group. The Group first met at the 2001 Congress and has had intermittent meetings since that time. In addition to arranging for the 2006 Congress, they have developed a directory of Epidemiology Societies, which you can access from the APHA-EPI section Web site or directly at <www.acepidemiology.org/societies/>.

David Mechanic to Receive Rema Lapous Award for 2003

David Mechanic, PhD- Winner of Rema LaPouse Award 
David Mechanic, PhD
David Mechanic, University Professor and Rene Dubos Professor of Behavioral Sciences at Rutgers University-New Brunswick, is the recipient of the Rema Lapouse Award by the Mental Health, Epidemiology, and Statistics Sections of the American Public Health Association. Mechanic, who will be honored at an award ceremony at a special session at the 131st APHA Annual Meeting, will present a special address at a session in his honor on Monday, Nov. 21, 2003 in San Francisco.

Milton Terris established this award in 1972 to honor his wife, Rema Lapouse, a founding member of the Mental Health Section. The award is granted annually to recognize leaders in the field who have made significant contributions to the scientific understanding of the epidemiology and control of mental disorders. Psychiatric epidemiology concerns the etiology, course, outcome, prevention, intervention and rehabilitation of mental illness. Prior awardees have included H. Warren Dunham, Morton Kramer, Lee Robins, Jerome Myers and George Brown.

Internationally known, Mechanic is presently Director of the Institute for Health, Health Care Policy and Aging Research; the Center for Research on the Organization and Financing of Care for the Severely Mentally Ill; the Rutgers Program in Mental Health Services Research Training; and the Robert Wood Johnson Foundation Investigator Awards Program in Health Policy. Elected to the National Academy of Science in 1991, he has served on numerous national and international committees, advisory panels and task forces. He received his PhD in Sociology from Stanford University and began his career at the University of Wisconsin, Madison. In addition to training research scientists, he has authored, coauthored, or edited 23 books and hundreds of articles, chapters and reports, which have appeared in many languages. He is expert on medical sociology, health services research, psychiatric epidemiology, and health policy. David Mechanic, a sociologist, is a worthy selection for the most coveted award in psychiatric epidemiology.

The APHA Network on Globalization and Health Report: Fall 2003

FTAA THREATENS GLOBAL HEALTH; PLANS COINCIDE WITH APHA ANNUAL MEETING


How does the global economy affect health status and disparities in health status, public health systems and policy, access to coverage within private and public health care systems, occupational health and safety, injury control, environmental health, access to pharmaceuticals and to safe water, and social and economic equality? What do international trade agreements have to do with public health?

Members of the APHA Network on Globalization and Public Health will address these and other issues during the APHA Annual Meeting in November 2003. A Town Hall meeting on Nov. 16 from 2 to 4 p.m. in the San Franciscos Moscone Convention Center will offer brief presentations, and a chance to network with some local and national research and advocacy groups based in the Bay Area. The meeting will include observers from the September meeting of the international World Trade Organization ministerial in Cancun, Mexico, and members of international public health associations. Join the planning with an e-mail to Ellen Shaffer <ershaffer@cpath.org>. (Please see final schedule for exact room location.)

This year’s APHA Annual meeting takes place just before the international gathering of trade ministers in Miami planning the Free Trade Area of the Americas (FTAA). FTAA would extend NAFTA to the entire western hemisphere (except Cuba). The Network will help sponsor a press conference and other FTAA-related events.

APHA has been actively involved in support of its 2001 resolution, which opposes including health care, water, and other vital human services in international trade agreements. Along with the Center for Policy Analysis on Trade and Health (CPATH) and the American Nurses Association, APHA alerted members of Congress in July that smaller scale nation-to-nation trade agreements were setting dangerous precedents for international agreements such as FTAA. The letter, which was circulated to the U.S. House of Representatives by Rep. Sherrod Brown, explained that U.S. agreements with Singapore and Chile will:

Impede access to life-saving medicines, contradicting Congress earlier support for policies that would modify the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS). They will: allow patents to be extended beyond the 20-year term required by TRIPS; require a 5-year waiting period before governments can provide generic producers access to the test data produced by pharmaceutical companies, delaying affordable access to medicines; and restrict how governments provide marketing approval and sanitary permits for medicines. Pharmaceutical companies could block production of generic medicines.

Ease the terms of trade on tobacco products, reducing tobacco tariffs for Singapore to zero. While public health protections have reduced tobacco use in the United States, this provision will make it easier to dump tobacco products in Singapore.

Open the door to further privatization and deregulation of vital human services including standards for health care professionals, and provision of health care and water, sectors better addressed through open international collaboration rather than through commercial trade negotiations. While some services and some professions are exempted from coverage by some trade rules, these exemptions are too narrow to assure full protection. The United States has no exemptions for water and sanitation, leaving the country open to challenges from foreign private corporations and their subsidiaries.

Grant foreign private investors greater rights than U.S. investors. Under NAFTA, similar provisions have led to lawsuits by private companies that overturned important health and environmental protections. Again, this contradicts the negotiating objectives of the Trade Act of 2002.

Other social and public services are poorly defined, leaving trade tribunals rather than elected officials and regulators to decide whether basic public health protections are barriers to trade. Covered services include income security or insurance, social security or insurance, social welfare, public education, health, and child care. Trade panels are not required to have any expertise in health care or public health.

The letter urges Congress to advocate for trade agreements that exclude vital human services such as health care and water, that improve access to life-saving medications, and that do not threaten efforts to reduce exposure to dangerous substances. Further, it encourages support for enforceable commitments to advancing population health, and to achieving universal access to health care and to safe, affordable water in the United States and internationally. The U.S.-Singapore and U.S.-Chile Free Trade Agreements do not meet these objectives, and therefore should not serve as models for other trade agreements, including the Free Trade Area of the Americas (FTAA) or the Central America Free Trade Area of the Americas (CAFTA).

The CPATH Web site, <www.cpath.org>, provides additional background information on economic globalization and health. APHA groups involved with the Network include: Medical Care, Mental Health, Environmental Health, International Health, Injury Control and Emergency Health Services, and Occupational Health and Safety sections, Peace Caucus, Socialist Caucus, Spirit of 1848, DisAbility Forum, Hawaii Public Health Association and the Public Health Association of New York City.

131st Annual Meeting of the American Public Health Association-Program Highlights

There are many exciting general sessions at this year’s Annual Meeting, but we would like to call your attention to the following three:

· President’s Session (3256.1) Monday, Nov. 17, 2:30 P.M.-4:00 P.M.

· Critical Issues in Public Health (4088.1) Tuesday, Nov. 18, 10:30 A.M.-12:00 P.M.

· APHA Closing Session (5190.0) Wednesday, Nov. 19, 4:30 P.M.-6:00 P.M.

Each session will include presentations on issues of great importance to the fulfillment of the public health mission in the 21st century by panels of outstanding experts. The panels are designed to provoke participants to view the future of their profession and to develop strategies for assuring public health effectiveness in the future.

Brief descriptions of these Sessions are provided below. For further information on the Sessions, go to <www.apha.org/meetings/sessions.htm>.

President’s Session

This session will focus on the challenges and opportunities facing public health in the 21st century. Topics to be discussed are: the Institute of Medicine’s recommendations on the future of public health practice and education; strategies to eliminate health disparities; mobilizing public support for universal health care; and a summary of the present state of public health as a “starting point” for the future.


Critical Issues in Public Health

This Session will further amplify the discussion of issues of central concern in the 21st century. The topics to be covered in this session are: new strategies to reduce the prevalence of substance abuse; approaches towards controlling the epidemic of obesity; strategies to reduce the high incidence of traffic accidents; and dealing with the threat of emerging zoonotic infections.

Closing General Session

For the first time, the Closing General Session will feature a panel discussion. Three areas of central concern to public health in the 21st century will be discussed. The topics to be covered are: the impact of the rapidly advancing science of genomics on public health; the threat of new and emerging infectious diseases; and the promise of technology in helping disabled people to overcome their physical limitations.