Podiatric Health
Section Newsletter
Fall 2011

Chair's Report: James J. DiResta, DPM, MPH

Greetings from your APHA Podiatric Health Section chair. As our Annual Meeting in Washington, D.C., is quickly approaching, our section has been busy at work preparing for what we hope will be another exciting and informative program for our members. Dr Jim Christina, our scientific program chair, has put together a series of lectures that I know you will find of interest. If you haven’t registered yet, please consider joining us in our nation’s capital this year.

The past year as you all know has been a bit rocky for health care reform. After Congress and our president provided us with a potential milestone for future public health practice with the passage of the Affordable Care Act, the implementation of the proposed programs has been, well, less than anticipated. Legal challenges to the Affordable Care Act in our court systems and the downturn of the U.S. economy have left many things on the shelf, but these forces are only more likely to result in drastic reform in time. For those of us in clinical practice and who are on the verge of facing payment reform, liability reform and the implementation of Medicare ACOs, our futures have never been more uncertain. In my state of Massachusetts we have already seen the beginning of many reform measures, and some, like that of Blue Shield’s AQC (Alternative Quality Contract), have been unnerving for us in podiatric practice.

Our public health section was well represented at the APMA meeting this summer in Boston, where Dr. Janet Simon moderated the afternoon section. Dr. Jeremy Cook presented on the AQC contract and its summary report in the NEJM and the emerging and ever threatening ACO. Dr. Helfand enlightened us all on where we have been in podiatric public health, from mandated foot screenings in greater Philadelphia to the development and the implementation criteria for foot care coverage in Title XVIII.  Our chair-elect, Dr. Emily Cook, provided a thoughtful and fast paced talk on the podiatrist role in public health and left all realizing that what we as podiatrist do in our daily work IS public health.

Elsewhere in this newsletter you will find my summary report on the APHA midyear meeting held in Chicago. I have provided the APHA leadership with a more extensive report on my attendance, and that has been posted on the APHA Leadership Corner.

Our proposed Podiatric Public Health Fellowship at The Dartmouth Institute at DMS has received approval from APMA, and we will begin advertizing the program, which will be open to graduating third year podiatric residents beginning in summer of 2012. If you are presently a resident or are involved in a podiatric residency program at your hospital, please pass this information on to residents you feel might be interested and could benefit from this program.

In summary, now, more than ever before, our seat at the public health table in the midst of these changes could not be at a more critical point for ourselves, our profession and all those involved in both maintaining and improving the foot health of our nation.  Please support us as our collective voice is our real chance to be heard by those who write and drive policy changes in health care delivery.

James J DiResta, DPM, MPH   

PHPPMC Updates

APMA’s Public Health and Preventative Podiatric Medicine Committee, or PHPPMC, closely mirrors in leadership the POD Section and has been assisting with many administrative functions for the Section. Without the PHPPMC’s support staff, the POD Section’s ability to reach out to our profession would be extremely limited.

The current PHPPMC priority is the development of a public health fellowship that will be available to a podiatric resident in 2012 through the Dartmouth Institute for Health Policy and Clinical Practice. Jim DiResta, DPM, MPH, our current POD Section chair and PHPPMC member, has birthed this exciting opportunity not just for the future Public Health Fellow but clearly for our profession. Jim is an alumnus of the Dartmouth program and had the network of contacts there to move the proposal of a post-residency fellowship into real time.

With APMA’s financial assistance, this Public Health Fellowship will be based at one of the best recognized centers for health policy evaluation and innovation, the Dartmouth Institute. The PHPPMC as it was developing this fellowship concept was extremely pleased with survey results from our current podiatric residents that indicated a high interest in pursuing advanced education in public health as well as the recognition that these skills would be a very marketable addition to a podiatric medical education. The fellowship will soon be publicized through APMA media and to our current podiatric residency programs with applications accepted through Dec. 15, 2011.

PHPPMC has also continued its efforts focused on student involvement in the POD Section and has two student committee members, Cheree Eldridge from NYCPM, and Meredith Ward from Des Moines University. NYCPM has an active Public Health chartered club that will be having several members presenting at this year’s APHA Annual Meeting in Washington, D.C. This club’s templated structure is available to all the other colleges of podiatric medicine to make it an easier process in the establishment of similar organizations.

PHPPMC has also established a membership grant fund to assist in APHA student membership recruitment, and continued funding of this effort is being sought. A contribution to this fund for student memberships is a worthy investment in the future of our POD Section. 

PHPPMC was a sponsor of a well attended educational track at the APMA’s annual educational meeting in Boston. The panel of presenters, Emily Cook, DPM, MPH, Jeremy Cook, DPM, MPH, and Arthur Helfand, DPM, are all active POD Section leaders and all received very positive evaluations from the attendees who identified the value of this information sharing. PHPPMC has plans to continue with this educational sponsorship for the 2012 APMA meeting in Washington, D.C.

Submitted by Janet Simon, DPM
Chair, PHPPMC

APHA Update

PHACT: Call for Federal Public Health Funds at Work in Your State

 

In addition to attending town hall meetings this year, APHA would like for you to share a story about why public health funding is important in your community or state. Preferably, the funding would come from one of these three sources: 

1.  Centers for Disease Control and Prevention.

2.  Health Resources and Services Administration.

3.  Prevention and Public Health Fund.

 

Examples can provide:

    An approximate estimate of the amount of the funding received.

    Location of the program (city, state).

    A summary of the program/intervention (PH issue and intervention being used).

    Any examples of positive outcomes to date.

Make all submission to http://www.apha.org/advocacy/tips/stories.htm or email us at phact@apha.org.

Thanks for taking action to protect public health!


Check out APHA’s Advocacy Track at this year’s Annual Meeting
APHA will host a one-day advocacy track of sessions during the 2011 Annual Meeting in D.C. on Monday, Oct. 31, 2011, and all APHA members are encouraged to attend to sharpen their public health advocacy skills. For more detailed information regarding the particular sessions, refer to the 2011 online program (
http://apha.confex.com/apha/139am/webprogram/start.html ) and enter the session number to see the list of planned speakers and topics to be covered. Attendees will be eligible for CE credit.

Ø  “Nailing your policy: Creating APHA’s policy buddy system,” Session 3007.0, 8:30 a.m.-10 a.m.

Ø  “Media Advocacy: Breaking through the crowded news cycle,” Session 3119.0, 10:30 a.m.

Ø  “The Who, What & How of Advocacy,” Session 3216.0, 12:30-2 p.m.

Ø  “Mobilizing a public health campaign,” Session 3318.0, 2:30-4 p.m.

Ø  “The Role of Social Media in Public Health,” Session 3417.0, 4:30 p.m.


Drexel University Online:
APHA is pleased to announce a new collaboration with Drexel University Online. Under this program, APHA members and their families are eligible for special tuition discounts of up to 25 percent when they enroll in any of Drexel’s online courses. Drexel University Online offers a wide range of courses in a flexible online format, including CEPH-accredited programs in biostatistics and epidemiology.
Please see the APHA partnership page for more details (http://www.drexel.com/APHA ).

Any agreement entered into between Drexel University Online and an APHA member, employee or family member, is with Drexel University Online and not with APHA.  APHA does not endorse any products or services displayed or referred to in conjunction with this partnership and is not responsible for the actual content of Drexel University Online programs.


Let APHA host your public health career day at the Annual Meeting

Employers, this is your opportunity to meet thousands of public health professionals and qualified candidates for hire. Job seekers, here is your chance to market your resume, meet recruiters and sign up for a professional career coaching session, either an individual or group session. Advance your public health career and find new prospects with APHA’s Public Health CareerMart. Find out more  http://www.apha.org/about/careers/am_careers2011.htm.


APHA’s Public Health Buyer’s Guide links users to industry products
http://publichealthbuyersguide.com is designed specifically for public health professionals, allowing easy search of vendors from a link on the APHA website’s home page, www.apha.org. Within the Public Health Buyer's Guide, public health professionals will be able to easily locate products and services unique to our industry without the clutter of general Internet search engine results.


Public Health and Equity Principles for Transportation

APHA has recently released a list of 10 Public Health and Equity Principles for Transportation. These policies recognize the various impacts that transportation policies can have on public health — they can lead to an increased risk of heart disease, asthma, obesity and mental health disorders — especially on vulnerable populations, including the elderly, the poor and individuals with disabilities. We believe that if transportation policies are reviewed and evaluated with these principles in mind, we will be better able to ensure that health and equity are well-represented. By holding transportation policies to a stated set of standards, we can encourage a transportation system that supports health, and direct funds to programs that improve health, equity and well-being. It is essential that other organizations — at the national, state and local level — demonstrate their support for these principles by joining us as signatories. Please sign on to show your organization’s support for these essential principles.


APHA Annual Meeting

From Oct. 29 – Nov. 2, 2011, join us in Washington, D.C., for the APHA 139th Annual Meeting and Exposition. Our section will have a strong presence at the meeting. View the sessions sponsored by our section by visiting the interactive Online Program (http://apha.confex.com/apha/139am/webprogram/start.html ). Search the program using keyword, author name or date. Don’t forget to stop by our new Section and SPIG Pavilion (Booth 3073) in the Public Health Expo next to Everything APHA. For more information about the Annual Meeting, visit www.apha.org/meetings/AnnualMeeting.


Win a free Annual Meeting registration!
Forward the contact information for new companies or organizations that you would like to see included as exhibitors at the Annual Meeting to Priya Bose, Meetings and Exhibits Coordinator, at priya.bose@apha.org. Anyone submitting a qualified lead for potential new exhibitors will be entered into a drawing for a free full registration. Get to know our exhibitors before the meeting on our Virtual Expo (http://www.expocadweb.com/11apha/ec/forms/attendee/indexTab.aspx )!

APHA Podiatric Health Section Schedule 2011

PODIATRIC HEALTH

J. R. Christina, DPM, Planner

MONDAY, OCT. 31, 2011: 6:30 a.m.

253.0 Podiatric Health Business Meeting

Grand Hyatt

Wilson

Moderator: J. R. Christina, DPM

TUESDAY, NOV. 1, 2011: 8:30 a.m.

4062.0 Community programs promoting foot and ankle care

Grand Hyatt

Independence Ballroom D

8:30 a.m. — Healthy Communities for Healthy Aging: The Toledo Experience M. J. Rubin, DPM

9:00 a.m. — Effect of Caloric Restriction and Protein Intake on Insulin-like growth factor and Insulin-like growth factor binding protein-3 A. Bhalja, BA; A. Iorio, DPM, MPH, FACFAS, FACFAOM, CPED, FACWCA

9:30 a.m. — Geometric Alignment of the Metatarsal Heads P. Demp, AB, DPM, MA, MS, PhD, CAS, CMath, FIMA

TUESDAY, NOV. 1, 2011: 12:30 p.m.

4233.0 Any pertinent topic on lower extremity care and its role in public health

Grand Hyatt

Independence Ballroom C

12:30 p.m. — Risk Factors for Hallux Valgus: The Framingham Foot Study E. Cook, DPM, MPH, CPH; J. Cook, DPM, MPH, CPH; A. DuFour, MS; V. Casey, PhD, MPH; M. Hannan, DSc, MPH

1:15 PM — Foot Pain in Relation to the Foot Biomechanical Measures in the Framingham Foot Study J. Cook, DPM, MPH, CPH; E. Cook, DPM, MPH, CPH; A. DuFour, MS; V. Casey, PhD, MPH; M. Hannan, DSc, MPH

TUESDAY, NOV. 1, 2011: 2:30 p.m.

4329.0 Programs promoting good foot and ankle care for people with diabetes

Grand Hyatt

Independence Ballroom C

2:30 p.m. — Diabetes & peripheral arterial disease and their increasing stress on the public health system T. Chappell, BA; A. Iorio, DPM, MPH, FACFAS, FACFAOM, CPEDFACWCA

3:00 p.m. — Endocrine Disrupting Chemicals and Effects on Public Health J. Roy, MS; A. Iorio, DPM, MPH, FACFAS, FACFAOM, CPEDFACWCA

APHA Midyear Meeting Report 2011

          Implementing Health Reform – A Public Health Approach  

Prepared and submitted by James J DiResta, DPM, MPH, Chair, Podiatric Health Section

In late June I had the good fortune of representing our section at the APHA midyear meeting held in Chicago. I have provided a more detailed and expanded version of what follows to the APHA leadership as one of the expected deliverables from my time spent listening and learning at this timely event, but I hope what follows will give you a flavor of what has taken place, where health care reform may be going and where our section needs to be involved.  The sessions began with remarks from Dr. Benjamin setting the tone for the next few days and introducing various speakers including Illinois Gov. Pat Quinn, APHA President Dr. Linda Murray, Cook County Health Executive Dr. Terry Mason and Commissioner of the Chicago Department of Public Health Dr. Bechara Choucair. There was an interesting talk from Celinda Lake who displayed many tables and graphs concerning polling people about public health and health care delivery issues. Take home point: people don’t have the best connotation of just what public health is, and although people favor availability of public health delivery systems such as public hospitals, they don’t necessarily favor them for themselves or their family. What the polling has shown is that women control health issues in the family and men relinquish this control to women. The final talk of this session was from the former governor of Michigan, Jennifer Ganholm, JD, and was met with great applause as she stressed the importance of bringing our public health agenda to the stakeholders that we have hired, namely our legislators.

I then attended a breakout session, Public Health and Quality Care, with talks from Bonnie Zell, MD, MPH, who described her work with the National Quality Forum and Population Health. This initiative focuses on health and health care delivery for population health in collaboration with providers, schools, businesses and others in the community. The National Quality Forum is involved in defining Population Health Measures, Measure Application Partnerships and is commissioned by CMS to provide the endorsed measurements felt to be the “gold standard” with the goals of centering on Better Care, Affordability, and Healthy People/Healthy Communities.

Mary Hansen, RN, PhD, from Des Moines University, spoke on her work with the Institute of Medicine committee that established “Using Measurement to Improve Population Health” and stressed data and indicators and need to MEASURE.

Lee Francis, MD, MPH, spoke of his work in Implementing Health Care Reform at the Community Health Center level with his work at Erie Health Care Centers in the Chicago area as both administrator and clinician. His talk stressed the “4 Gaps” of Sustainability, Health Profession Shortages, Insurance Card and the Social Determinants of Health and lastly Guaranteeing Quality.

Oklahoma Commissioner of Health Terry Cline, PhD, gave us a detailed outline of achieving Accreditation and the link he finds between assuring Quality Improvement and Accreditation. He stressed adapting best practices and using gaps as opportunities for improvement.

The Q&A session, although interesting, landed us in the same old problem of the disconnect between providers of health care delivery on the patient level and public health initiatives on the population level. Even more concerning was the real take home for me as to DATA and ownership and control of data in proving the backbone for change. And that like the old adage “follow the money,” it’s now “follow the data,” and truly (although no one said it quite so bluntly) DATA IS KING, and we know who owns and controls the data, and it is not the public health folks but rather payers and medical provider organizations.

I next attended the session on Seeking Common Ground: Various Approaches to Improving Population Health, which was moderated by Susan Dentzer, editor in chief of Health Affairs, and included a talk and then a panel discussion with three very different individuals ranging from John McDonough, DPH, MPA from the Harvard School of Public Health and a previous congressman who is well-versed in state-level health care reform, to Julie Eckstein, who is an expert on payment reform and vice president of the Center for Health Transformation founded by Newt Gingrich, and finally, Oliver Fein, MD, from Weil Medical School who leads the charge on a single payer payment system. Our moderator spoke of the present “health crisis” pointing to childhood obesity, teenage smoking, chronic preventable diseases, and shortened life span for Americans, particularly women. She spoke of the “Triple Aim” of ACA as outlined by Don Berwick and the IHI Institute for Healthcare Improvement.

John McDonough spoke of the importance of the “lobbyist process” and the ACA in addressing public health, prevention and wellness. He like many of the other speakers this week spoke of the overarching theme of bridging the workforce in primary care and public health. He spoke of the success of Massachusetts health care reform in eliminating ethnic discrimination in obtaining health insurance. He also spoke of the assault on public health, which is presently being debated by our politicians and others as they debate the ACA going forward.

Julie Eckstein took a more right wing approach where she advocated for the individual taking responsibility for his/her own health care, BUT she did favor the common ground area of building healthy communities by working to support individuals on the community level and partnering and collaborating at the local level with faith communities, schools, police depts., etc… and felt HIT will be a strong pathway to success.

Oliver Fein, MD, stressed the single payer system, which unfortunately was not the basis of ACA, which really builds on our present system. But he as others stressed the least important place for medical care vs. public health initiative in improving population health. Another theme brought in here and several times at other panels was the new IRS requirement that “not for profit hospitals” have to conduct and have to report a “community healthcare needs assessment.”  He also stressed how MEDICAID drives public health on the state level.

The next session, Connecting Public Health and Clinical Prevention, was moderated by Jim Galloway, MD, assistant U.S. surgeon general, and discussed the release this month of the National Prevention Strategy, which outlines a shift from sickness to prevention and wellness. Speakers included Capt. Linde-Feucht, MD, who is the chief public health officer at HRSA, who updated us on HRSA and its mission to achieve access and health equality. HRSA is responsible for the care of 19 million Americans, oversees 8,100 clinical sites and 7,500 National Health Corps professionals and works actively to improve the public health workforce. She sees her work as prevention, which requires bridging of public health and primary care. She spoke of expanding community health centers and the $11 billion provided by the ACA that involves primary care services, oral health, behavioral health and other “enabling services” and one that we need to at least explore to see if there is any room even if not mandated directly for the expansion of podiatric care services. She also cited the recent commencement at Harvard Medical School where the commencement speaker, Dr. Atul Gawande, who we all know from his work on reducing healthcare errors, lowering infection rates in hospitals and reducing variations in health care delivery,  noted 35 members of this years’ HMS class were also receiving the MPH degree. We need to ask ourselves in podiatry what benefit a proportional group of graduating doctors of podiatric medicine would have with an MPH degree. I can speak personally from my own experience and from this midyear meeting that we need to increase this part of our DPM workforce if we want a seat at the table with these “new” joint degree providers who will have great influence in policy changes in future health care delivery. Much discussion followed on patient centered care, medical home model and ACOs, the large role the Institute of Medicine is playing in the data gathering and early implementation of the ACA and the Institute's work on integrating public health and primary care.

Next was Deborah Chang, MPH, vice president for policy and prevention at Nemours, who spoke on child health promotion and took a traditional medical model and expanded this model on a continuum of care by working with schools, community organizations to ensure that all children grow up healthy. She stressed the power of the electronic health record in achieving change.

For more on the meeting please see my notes in the Leadership Corner of the APHA website.