Podiatric Health
Section Newsletter
Fall 2005

EDITOR'S MESSAGE

Our fall edition offers history, current events and heartfelt emotions. I thank all our contributors for their timeliness. A special note of appreciation to Chih Yen, DPM, who found her computer "fried" and first article missing due to after effects of a Florida hurricane.

Information pertaining to the New Annual Meeting Dates:

As announced, the APHA Annual Meeting will be in Philadelphia, Dec. 10-14, 2005. The APHA Web site is being updated as new information becomes available. Please visit <http://www.apha.org/meetings/new_orleans_update.htm> for details.

With the change of venues and times for the APHA Annual Meeting, a second fall Newsletter may be considered to update all Section members as to Philadelphia happenings. The relocation of this meeting has several positives for our section. First, Philly is a bit more accessible and additional members have expressed intent that they will be attending. Discounted rates have been extended through November for members who previously had not registered. Housing details are being worked on. Second, our Section will be planning to host a program for Temple podiatry students to further our goal of increasing student involvement in public health. I would ask members who plan on attending the December meeting to RSVP their attendence to me. That way, our plans can include you!

APHA has been working to connect members with opportunities for taking direct action in responding to the hurricane and providing links on how to contribute. Please visit <http://www.apha.org/preparedness/Katrina_relief.htm> for the latest information and opportunities. The Association has offered its assistance to federal officials and provided technical resources in the form of relevant APHA publications to relief teams and others. Text from our Public Health Management of Disasters, 2nd Edition, is now available on the above Web page

Information regarding our New Orleans Partners:

APHA has contacted our New Orleans-based partners and is happy to report that the Association will be contracting with several of them for the meeting in Philadelphia. This includes the child-care provider, official photographer, florist and security vendor, who are all based in New Orleans.

Each year APHA designates a local charity from our host city to receive contributions from Annual Meeting attendees. This year's New Orleans-based charity is Bridge House, a long-term alcoholism and drug addiction treatment center. Bridge House will receive all contributions received to date. Since the hurricane has had widespread damage across the entire Gulf Coast, we're planning to broaden the reach of our contributions and are now coordinating donations during the time of our Annual Meeting on behalf of APHA to assist in the recovery and rebuilding efforts. APHA has made a lead contribution of $5,000 and will ask Annual Meeting attendees to join us in contributing what they can.

Return to Top

MESSAGE FROM THE CHAIR

My original plan for this edition of my message was to speak to each of you about how public health fits into our podiatric life. It is my sincere belief that we all have vested interest in keeping public health at the forefront of podiatric medicine and podiatric medicine at the forefront of public health. Many who are active in their practices may not realize that what they do every day impacts the public health of their patients. Keeping people walking and moving is one of the most basic ways to combat obesity in all age groups. That’s what we do. Fighting the loneliness and isolation of the elderly and disabled by providing home visits is also what we do. Working as a team to educate and treat patients with chronic diseases such as diabetes mellitus and arthritis to save limbs and relieve suffering -- that’s what we do. Fully participating in special populations such as Veterans’, HIV/AIDS patients, poor and rural areas -- that’s what we do. Addressing global health problems such as clubfoot and other orthopedic conditions where lack of ambulation can sentence one to a lifetime of social dependency -- well, that’s what we do.

Each podiatrist who has a special interest in solving the problems of patients wherever they may be found has a home in the Podiatric Health Section of the American Public Health Association. This home is where you can bring your creativity, energy and concern to bear on our professional problems along with the resources of an entire cadre of like-minded professionals. Why is it so hard to recruit new members?

The podiatric role within a larger picture of the health arena is evident in so many areas that one needs to only look at the role of podiatrists in the latest crisis to see that we still have much work to do. APMA has taken a leading role in aiding our colleagues affected by hurricane Katrina. Jobs are being found, and efforts are being made to help wherever we can. THAT’S WHAT WE DO. Unlike the response at Ground Zero in New York, which was established with the leadership of the NYCPM, there has been no clear-cut role for podiatrists in the aftermath of the flooding of New Orleans and destruction of much of the Gulf Coast. Barry University students have experience in responding to local needs in previous hurricanes, but this has not translated into a defined role and response on a national basis.

While thousands are homeless, I want each of you to find your way home to this effort and this organization. We need you today to change the face of public health to reflect the reality and talents of today’s podiatrists. Please come to Philadelphia to further WHAT WE CAN DO.

Return to Top

HISTORY OF THE PODIATRIC HEALTH SECTION

The evolution of the Podiatric Health Section of the American Public Health Association began in the 1950s, when two members of the profession, Marvin W. Shapiro, DPM, and the late Abe Rubin, DPM, joined APHA. Shapiro believed that podiatric medicine's greatest contribution could come in the field of public health, and he recognized the potential for that by urging the integration of the profession within APHA. He initiated his plan by exhibiting at APHA annual meetings, a practice that continues today. He sought to demonstrate the wide range of foot problems and the services offered by podiatric physicians to not only treat these problems, but also to prevent many of the complications associated with them. Shapiro's perseverance resulted in his being awarded fellowship status in APHA, the first podiatric physician to be so honored.

Continuing with Shapiro's projected goal, the American Podiatry Association, which became the American Podiatric Medical Association (APMA) in 1984, established a series of committees in the 1960s that had public health issues as their focus, including committees on podogeriatrics, podopediatrics, and health mobilization for civil defense.

In 1962, the Public Health Service funded the first podiatric project in Philadelphia, called "Keep Them Walking.” The program was designed to provide education and information for the older patient. The data from this three-year study later would furnish the documentation for podiatric medicine's eventual inclusion in Medicare. During the following year, the APA developed an exhibit for the APHA meeting in Kansas City called "Keep Them Walking.” This was a cooperative effort involving APHA, the Philadelphia Department of Public Health, and St. Luke's and Children's Medical Center. Eugene Gillis, health commissioner; Norman Ingraham, deputy health commissioner; Catherine B. Hess, chief of chronic diseases; and James C. Giuffre, medical director, lent their support to the project.

Several members of the Public Health Service -- especially Austin B. Chinn, Donald Conwell, and Glen W. McDonald -- recognized the importance of foot health for the older patient and helped the podiatric profession gain visibility for the project. Arthur E. Helfand, DPM, became the second podiatric fellow of APHA in 1963, an honor that resulted from his "Keep Them Walking" project.

In 1970, APMA established a Council on Public Health, which brought all of the APMA-related committees under one umbrella, fostering a coordinated public health policy and a mechanism for pursuing APHA section status for the profession.

John R. Carson joined the APMA staff in 1969 and had public health as one of his primary responsibilities. With the support of Executive Director Seward P. Nyman, DPM, APMA invested its talent to bring its message to the public health community. When the records are written, John R. Carson's dedication and integrity will clearly surface and show that he was the catalyst that brought about the relationships that were to follow.

APMA expanded its efforts to include not only an exhibit, but also scientific programs at APHA meetings. Additionally, APMA sponsored receptions honoring APHA's leadership at annual meetings in Houston and Minneapolis. Many past APMA presidents were just a few of the leaders who lent their active support for an APHA section as a high priority issue for the profession.

In 1972, at the 100th APHA Annual Meeting, the association’s governing council created the Podiatric Health Section. What is important to note is that APMA agreed to provide staff and financial support during the developmental stages of this effort. Helfand was installed as the first Section chairperson. The Section was granted three seats in APHA's Governing Council for the 1973 APHA Annual Meeting, and active podiatric medical participation has remained constant ever since.

Over the years, APHA has adopted many resolutions that have dealt specifically with podiatric medicine. Some treated podiatric medicine's need to participate and be included in all comprehensive health care programs. In 1975, APHA adopted and published the Functional and Educational Qualifications of Podiatrists in Public Health. Chaired by Helfand, this important publication received input from Irvin Kanat, DPM; Darrel Darby, DPM; Clarence Bookbinder, DPM; Jerome Shapiro, DPM; Robert Heil; Richard Baerg, DPM; Dave Rubenstein, DPM; Theodore H. Clarke, DPM; and Gerald A. Gorecki, DPM.

During these early years, the Section boasted a membership of 750 podiatrists, two times greater than today. Hopefully, that level of involvement can be achieved again.

Over the years, APHA has funded two major podiatric projects. The first, from 1974 to 1976, was "Big Foot,” a health education project for elementary school children. The second, which is currently in progress, is the re-casting of the function and educational qualifications document, which will be embraced by APHA as a position paper. No other external organization has opened so many doors for podiatric medicine and made it an equal partner in the development of health policy than has APHA.

THE FUTURE
A document of the American Public Health Association's Podiatric Health Section, "The Functions and Educational Qualifications for Podiatrists in Public Health,” published in the American Journal of Public Health in 1975, has continued as the official definition and delineation of the profession in the arena of public health.

In 1996, a mini-grant from APHA established a special commission to develop a revised and formal position for the Podiatric Health Section in order to assure quality foot care for the American people through the next decade.

In this time of change, the profession needs a national formal statement that outlines the functions of the doctor of podiatric medicine in the public health sector in order to effectively identify the profession's roles and responsibilities for the future. APHA is the organization to take the lead in this endeavor, as it did in 1975.

The members of the special commission appointed to develop the new report on podiatric medicine and public health are: Arthur E. Helfand, DPM, director; David Arlen, DPM, MPH; Lelia F. Banks, DPM; James R. Black, DPM, MPH, PhD; Kenneth C. Canter, DPM; Gerald A. Gorecki, DPM, MPH; Melvyn Grovit, DPM, MS, CDE; Robert Guytine, DPM; Howard G. Malin, DPM; Katheryn M. Moss, DPM; Jeffrey M. Robbins, DPM; Michael A. Robinson, DPM, MPH; and Marco Rubio-Ardila, DPM, MPH.

Podiatric medical activities in the field of community or public health span many areas of concern. While maintaining the traditional base of primary care as a major delivery function, the podiatric medical practitioner is also involved in education and prevention efforts, as well as newer methods of administration.

The functions of DPMs in public health can generally be divided into six primary categories: preventive, diagnostic and therapeutic care; program administration; program development and consultation; podiatric health education; professional education; and research. The categories are not mutually exclusive, and each is often related to, and dependent on, one or more of the others. For example, research activities include, but are not limited to, the following areas:

• Methods for the prevention and control of foot and related conditions.


• The social science and educational aspects of achieving better health for individuals and groups in their community setting.


• Effective administrative methods and evaluation programs.

In August 1983, the APMA House of Delegates formally approved podiatric public health as a special area of podiatric medical practice. The American Public Health Association had already established its Podiatric Health Section in 1972. The American Board of Podiatric Public Health granted life diplomate emeritus status to all of its existing diplomates on January 31, 1995, certifying all diplomates without any time limitation. Of these diplomates, those who remain continue to serve as the core of the special area of practice.

Podiatric public health embraces the concept of total community involvement and care, which has as its aim the prevention and maintenance of a healthy and ambulatory population. Podiatric public health must now look to the future and to the policies relating to the development of health care. Future objectives and goals for this special area of podiatric medical practice are as follows:

• Advocating a national, preventive foot health strategy.


• Ensuring the consideration of podiatric medical concerns in the formation of public health policy.


• Promoting the importance of foot health and increasing the public's access to foot health prevention and treatment services.


• Monitoring and communicating foot health needs to the public.


• Promoting recognition of the need for an effective, equitable, and affordable foot care system for the public.


• Advising on the organization, delivery and financing of foot care services.


• Promoting public health policy for the prevention and treatment of foot and related conditions.


• Developing public policy positions and guidelines for clinical care.


• Promoting the functions and educational qualifications for podiatric medical physicians in public health.


• Focusing attention on the pedal and related complications of systemic disease and the educational and preventive measures required to reduce disability.


• Working to assure podiatric medical care for the elderly and supporting policies for ambulatory care, long-term care, and mobility.


• Promoting the role of podiatric health in improving health service administration, including cost-benefit and operations research, outcomes measurements, critical pathways, algorithms, and monitoring the organization of health services.


• Advancing health promotion and education.


• Promoting the activities related to training public health professionals.


• Establishing guidelines for podiatric medical care in health care settings.


• Promoting podiatric medical programs in the field of public health.

The ability of podiatric medicine to participate as an equal partner in the development of the nation's health policy has been earned. Recognition of that need is a solid base for the profession as it moves to the next century.

Return to Top

Conference on Aging Resolution

RESOLUTION FOR THE 2005 WHITE HOUSE CONFERENCE ON AGING

Whereas, there is a critical need to recognize the public health relationship to the entire fields of gerontology and geriatrics, and

Whereas, the American Public Health Association working through its Task Force on Aging, has appointed a Task Force on Aging to develop a framework to help guide the future of services for the aging, with a special emphasis on prevention, and

Whereas, the content of that plan is as follows:

Scope of Public Health and Aging

Population of interest
All adults aged > 65 years; adults aged < 65 years with chronic illnesses and disabilities.

Population diversity must be adequately documented and considered based on:

• Ethnic identification
• Socioeconomic status
• Age, particularly adults aged 75-84 years and those aged > 85 years

Orientation to health and disease

Place strong emphasis on healthy aging by maximizing health promotion, disease prevention, and injury risk reduction initiatives at individual, community, state, and national levels.

Encourage initiatives and solutions that recognize the scarcity of public funds, but also strongly advocate to creatively maximize access to health and supportive services according to need in the least restrictive environment.

Encourage the development and maintenance of strong familial and/or friendship networks.

Promote the value of intergenerational programs to expand social networks.

Infectious disease prevention and control:

• Encourage prevention and timely detection of influenza, pneumonia, and human immunodeficiency virus.

Chronic disease and injury prevention and control:

• Encourage use of all chronic disease screening procedures insured by Medicare.


• Encourage appropriate assessment for risks of falling.


• Minimize incidence of adverse drug events due to polypharmacy.


• Encourage appropriate and indicated use of vision, hearing, dental, and podiatric care services.


• Encourage adoption of exercise regimens and smoking cessation. Encourage proper nutritional habits and adequate fluid intake.


• Promote awareness of the potential health risks associated with excess alcohol consumption and self- medication.

Tertiary prevention to improve or prevent further decline in function due to acute illness, chronic illness, or injury:

• Maximize availability of rehabilitation therapy services, including gait, balance, and strength training.


• Maximize availability of mental health services.


• Promote recovery to resume prior activities and maximize quality of life.


Terminal illness care:



• Maximize access to palliative care to assure death with dignity.


• Increase involvement of public health organizations in end of life care initiatives.
  


Community orientation

Encourage uniform surveillance methods to monitor and report trends in acute and chronic diseases and injuries at state and local levels.

Promote partnerships among public health departments, Area Agencies on Aging, State Units on Aging, and disease-specific voluntary organizations in carrying out health promotion, disease prevention, and injury risk reduction programs.

Maximize availability of alternative living arrangements.

Promote awareness of the critical role played by family, neighbors, and friends (i.e., informal caregivers).

Enhance efforts to educate informal caregivers about chronic disease management and available community resources to promote their own health and well-being.

Population-based interventions

Encourage replication or adaptation of Abest practices@ aimed at health promotion, disease prevention, and injury risk reduction.

Encourage intergenerational social and recreational activities.

Promote public policies for chronic care oriented toward consumer choice and service delivery in home and community-based settings.

Encourage expansion and adaptation of existing service delivery models that pool diverse public and private funding sources to serve chronically ill adults living at home but at risk for nursing home admission (e.g., Program of All Inclusive Care to the Elderly, or PACE).

Encourage adoption of evidence-based interventions to minimize the incidence of elder abuse and neglect.

Environmental issues

Maximize opportunities for repairing and retrofitting private residences to promote aging in place at home.

Maximize protection of the nation=s food supply.

Encourage development of transportation and mobility alternatives.

Regulation, consumer protection, and access to services
Simplify eligibility and application procedures to maximize access to publicly financed health and social services.

Improve opportunities for consumers with literacy limitations to learn about services.

Ensure physical access to all available health and long term care services.

Empower consumers to communicate more routinely with their health care providers about diagnosis and treatment options.

Maximize safety and quality of care in supervised living environments.

Maximize financial access to, and awareness of quality of, privately financed living arrangements and supplemental health/long-term care insurance products.

Encourage evaluation of Medicare benefits to reorient focus on healthy aging and maximization of independence rather than to disease treatment.

Encourage vigorous investigation of elder abuse and neglect complaints, and strict enforcement of regulations protecting older adults from abuse and neglect.

Health care workforce

Promote education and training initiatives to increase the supply of health care professionals and paraprofessionals with proven expertise in geriatrics and long term care practices and policies.

Promote education and training initiatives to increase the supply of administrative personnel with proven expertise in geriatrics and long term care settings.

Encourage all Schools of Public Health and Masters of Public Health programs to expand curricula to maximize opportunities in aging and public health careers.

Strongly encourage existing health care providers to be proactive in explaining benefits under the Medicare program.

Research

Promote research efforts with funding from public sector and private sector sources to continue building scientific evidence about:


• Promising public health interventions that could improve health status and quality of life.


• Quality of care in existing health care services and service coordination programs.


Encourage the development and dissemination of state of the art approaches to measure the processes and outcomes of new interventions and existing services.

Therefore Be It Resolved, that the 2005 White House on Aging adopt THE SCOPE OF PUBLIC HEALTH AND AGING as a working document to plan for the future needs of aging in the United States.

Return to Top