Alternative and Complementary Health Practices
Letter from ACHP Co-Chairs
Dear ACHP Friends,
We want to wish each of you a happy and healthy New Year of the Rabbit! In Chinese philosophy the rabbit is a harbinger of peaceful cooperation and togetherness. Promoting abundance and the blessings of plenty for all, in the Rabbit Year we are encouraged to set aside our differences and work together to make a difference.
In a heartening show of enthusiasm and support, members have taken up the challenge to become more active in our SPIG and thus bring us closer to becoming a bona fide section! Our slate of leadership is impressive, and we want to acknowledge the efforts of everyone mentioned below:
Deborah Hughes-Ndao, MPH Debhughesndao@gmail.com
Bei-Hung Chang, ScD email@example.com
Douglas Chung, PhD, MSW, MA Chungd@gvsu.edu
Kim Tippens, ND, MSAOM firstname.lastname@example.org
Elizabeth Sommers, PhD, MPH, LAc Elizabeth.email@example.com
Paul Kadetz, PhD, MSN, MPH firstname.lastname@example.org
Anupana Kishakkeveettil Anu@scchis.edu
Prasad Vinjamurry, MD Prasadvinjamury@scuhs.edu
Governing Council Co-Chairs
Donna Feeley, MPH, BSN, RN email@example.com
Richard Harvey, PhD firstname.lastname@example.org
Carla Wilson, MA, LAc DAOM (candidate) email@example.com
National Center for Complementary and Alternative Medicine Liaison
Adam Burke, PhD, MPH, LAc firstname.lastname@example.org
This information can be accessed via our website at the APHA homepage.
Congratulations to everyone on our ACHP roster for your participation and “going the extra mile” to further the cause of ensuring that health care including wellness is a right, not a privilege.
Special thanks to our new ACHP Website Chair, Carla Wilson, who has bravely gone where no one has gone before and updated our Leadership Roster and corrected the infamously incorrect spelling of our name “complimentary” to “complementary.”
Our group counts on our membership and friends to promote our work and heighten ACHP’s visibility. Please consider contributing an article or update to the next issue of our newsletter and sharing your work and successes with colleagues throughout the United States. Submissions can be forwarded to Beth Sommers.
By the time you’re reading this, abstracts will in the process of being reviewed for the next APHA Annual Meeting, which will be held in Washington, D.C., in late October 2011. Thanks to all those who submitted their work as well as to the reviewers and program planners whose dedication makes such an important contribution to the work of our SPIG.
In this issue you’ll find reports on work-in-progress and updates from members Dyanne Ladine, Manoj Sharma, Purvi Mehta and Brandon Eggleston, as well as a profile of new member Roy Mankovitz. APHA’s new liaison to our group, Christopher Day, provides us with his background and interests in a brief bio.
We hope you enjoy this issue’s content. Let us know if there are any other features you’d like to see. Students – we’d love to have your input! Consider contributing a short description about yourself and your work.
Happy New Year of the Rabbit!
Anne Doherty-Gilman, MPH Anne_Doherty@dfci.harvard.edu
Elizabeth Sommers, PhD, MPH, LAc Elizabeth.email@example.com
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Mid-Year ACHP Tele-Meeting
Mid-Year ACHP Tele-Meeting
Our group held a teleconference on May 12, 2011, during which about 15 members participated and discussed a number of topics including:
Planning for the APHA Annual Meeting
Updates on policy-related activities
Process of becoming a section
It was great to speak with members from around the country who expressed their ongoing interest and commitment to developing ACHP and keeping the mind/body/spirit in public health.
APHA is holding its Annual Meeting this year in Washington, D.C., from Oct. Oct. 29 through Nov. 2. This year’s theme is “Healthy Communities promote Healthy Minds and Bodies”, which definitely reflects our group’s priorities!
Anne Doherty reported that ACHP received approximately 60 abstracts for presentation. There will be four poster sessions planned for Sunday and Monday (on the broad topics of health promotion, research, health practices, and special topics). Round-table discussions are on the agenda for Monday, and oral sessions will be held on Monday and Tuesday (in the areas of pediatrics, CAM usage, mind-body approaches, and cancer and other chronic conditions).
Because of general interest in working more closely with federal-level agencies such as NIH’s National Center for Complementary and Alternative Therapy (NCCAM) and the National Cancer Institute’s specialty area on CAM, we are trying to arrange a special session in which representatives from these agencies can present and have dialogue with our members. Stay tuned! Adam Burke has been our liaison with NCCAM and is doing a great job of establishing linkages. Jay Borneman also expressed interest in working on developing a session related to national policy.
In addition to the impressive slate of oral and poster presentations planned, we discussed staffing and content for our information booth in the Exhibition Hall. Although the new way in which the exhibition space has been designed doesn’t allow for demonstrations like we’ve offered in the past (e.g. massage or acupuncture), we’d like to offer a movement opportunity like yoga or Tai Chi in the mornings on Monday and Tuesday (this will probably be scheduled around 7 a.m. because other presentations and activities start at 8 a.m.). Beth Sommers will check into the possibilities for finding a space to do this.
Members indicated that we’d like to have more of a presence at our information booth this year in order to promote our work and our group’s agenda. Because so many attendees of APHA visit the Exhibition Hall, this is a great opportunity to increase our visibility within APHA. Paul Kadetz volunteered to organize the staffing schedule of when our members will be at the booth.
We’d like to have materials at the booth that represent the variety of activities and interests of our members. Materials can include brochures, booklets, or newsletters from your organization. Although we don’t have the capacity to sell items from the booth, sample copies of books or journals can be displayed. Please feel free to bring materials to the Annual Meeting and display and distribute them at our booth!
To foster our commitment to students, we’d like to give awards for student posters this year. As a developing future strategy, Rick Harvey suggested working with a corporate sponsor to offer awards to other presenters as well.
Please note the change in the day of our Business Meeting: it will be held on Tuesday evening this year; details about time and location will be in the conference program.
In order to carry out these ideas for the Annual Meeting, volunteers will be needed for the following activities:
Staff our booth for one hour (Monday and Tuesday)
Contact Paul Kadetz (firstname.lastname@example.org)
Lead a class in Tai Chi or yoga
Contact Beth Sommers (Elizabeth.email@example.com)
Review student posters and determine awards
Contact Beth Sommers (Elizabeth.firstname.lastname@example.org)
Develop a “national policy leaders” presentation
Contact Adam Burke (email@example.com)
Donna Feeley and Rick Harvey have been doing a fantastic job representing ACHP in the policy realm of APHA. They both have been offering a mind/body/spirit perspective to APHA policy review.
Donna attended an Advisory Group meeting in D.C. related to Health Promotion, Integrative Health and Public Health. We’ll hear more about this at our Business Meeting in November.
A quick update on the process of applying to become a Section within APHA:
ACHP is currently a Special Interest Group (SPIG) and would like to “grow up” to be a Section! Section status confers greater visibility within APHA and access to some additional resources. In order to qualify for Section status, a group has to achieve a number of benchmarks in the following areas:
Consistently have leadership positions in the following categories: Chair or co-chairs; secretary, Governing Council member, Section Council member, membership committee, newsletter editor(s), program planner(s).
Promote a competitive and diverse slate of officers.
Appoint members for APHA leadership roles (Action Board, Science Board, Education Board).
Produce three newsletters/year.
Offer high-quality scientific sessions (posters and oral presentations) at the Annual Meeting.
Actively participate in APHA policy-making activities.
Promote student involvement.
Increase membership (minimum of 250 members needed for Section status).
All these require person-power! We’ve made great advancements over the past few years and need to keep our momentum going and growing.
Thanks to all the tele-meeting participants. It’s truly a pleasure and honor to work with each of you.
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APHA Annual Meeting and Exposition
From National Cancer Institute’s Office of Cancer Complementary and Alternative Medicine Newsletter Fall 2010 Vol. 5 Issue 2
Reprinted with permission
American Public Health Association Annual Meeting & Exposition
More than 13,000 public health professionals attended the 138th APHA Annual Meeting & Exposition from Nov. 6-10, 2010, in Denver, Colo. More than 1,000 scientific sessions, 700 booths, and over 4,000 scientific papers detailed the latest public health challenges. The theme of this year’s meeting focused on the link between social justice and public health and featured Dr. Cornel West and Dr. Bill Jenkins as the keynote speakers.
Complementary and alternative medicine was a topic of interest to many meeting attendees, with two days of CAM-related sessions held by APHA’s special primary interest group
Alternative and Complementary Health Practices. Anne Doherty-Gilman, associate director of the Zakim Center for Integrative Therapies, Dana-Farber Cancer Institute and program chair for the Alternative and Complementary Health Practices group was very pleased with the quality of the CAM-related sessions.
"This year's Alternative and Complementary Health Practices sessions included an impressive array of innovative public health initiatives and scientifically rigorous studies that offered important guidance to those of us working in this field. It was truly inspiring to see the breadth of high quality work being done to advance the evidence base for these therapies and to promote access to wellness and whole person care," Doherty-Gilman said. Highlights included a session on CAM for Cancer and Chronic Diseases and a special session that Isis Mikhail, MD, MPH, DrPH, OCCAM’s Extramural Research Program director, and Wendy Weber, ND, PhD, MPH, from NCCAM led on NIH grants applicable for the public health field.
Mikhail was also impressed with this year’s meeting. "There is a growing interest in CAM research at APHA," he said. "It’s evident not only through the CAM-related conference sessions, but also through the attendees I talked to about cancer CAM research and the research abstracts presented during the poster sessions." Dr. Mikhail also participated in NCI’s "Meet the Expert" session at the NCI expo booth. As one of 19 NCI experts she was able to connect with many researchers interested in funding opportunities at NCI.
NCI has a large presence at APHA, connecting with health professionals about NCI programs, products, and services. This year the NCI expo booth won first place for a non-profit, island exhibit booth. Improved IT services at the booth allowed meeting attendees to order NCI publications and have them shipped directly to their offices. NCI also had a big screen TV showcasing NCI websites and a seating area for presentations of interest to meeting attendees.
OCCAM Staff Attends Leading Integrative Oncology Conference
The Society for Integrative Oncology hosted its Seventh International Conference at the New York Academy of Medicine in New York City, Nov. 11-13, 2010. The Society for Integrative Oncology (SIO) is a non-profit organization of research professionals and practitioners dedicated to studying and facilitating cancer treatment and the recovery process through the use of integrated complementary treatment options. SIO’s conference draws attendees from around the world because of its important lectures, scientific sessions and tight focus on the field of integrative oncology. The title of this year’s conference, "Integrative Oncology: Informing the Debate in Practice, Research and Public Policy", placed an especially important focus on public policy in this time of health care reform and changes.
OCCAM’s Communications and Outreach Program exhibited at the conference and handed out research grant information and patient education materials to attendees as well as discussed aspects of OCCAM’s research portfolio. Information about funding opportunities in integrative oncology was of great importance to those that visited the booth. Dr. Isis Mikhail, MD, MPH, DrPH, director of the Extramural Research Program at OCCAM sat on a panel titled: "Career Development Workshop for CAM Practitioners and Students." Dr. Mikhail noted, "This workshop was received very positively by the audience that included a group of physicians, junior research investigators, practitioners, post-doctoral fellows, among others. The panel included speakers from NIH (NCCAM, NCI, National Institute of Nursing Research), cancer research organizations (American Cancer Society and American Institute for Cancer Research), and academia; and addressed different areas of interest and prospects for career development. A number of attendees used this opportunity to communicate with the speakers who made themselves available for additional inquiries after the end of the session." Dan Xi, PhD, program officer at OCCAM also took part in a panel titled: "Whole Systems Workshop" in which she presented a talk titled: "Traditional Chinese Medicine, Systems Biology and Systems Medicine". She stated that the topics of the workshop were extremely relevant to Cancer CAM research because: "many CAM interventions use personalized whole systems approaches to patient care. This provided the platform for research methodology discussion, information exchange, and education."
Conference chair Heather Greenlee, ND, PhD, wrote that this year’s conference goals included addressing the challenges facing integrative oncology in the era of health care reform, identifying gaps in integrative oncology comparative effectiveness research and issues related to reimbursement for services. Three days of scientific sessions covered various aspects of integrative oncology from emerging research in vitamin D supplementation, energy balance in cancer survivorship and patient advocacy. Information about the conference and the Society for Integrative Oncology are available at the Society’s website at http://www.integrativeonc.org/.
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Report from Herban Health
Report from Herban Health -
Our organization, Herban Health, was the beneficiary of the good work that the Alternative and Complementary Health Practices group has been doing over the years in placing holistic health care on the agenda of APHA. We were honored to be chosen to make two poster presentations at this year’s 2010 APHA Annual Meeting, one entitled “Holistic Healthcare Services Responsive to the Local Community: Collaboration on a Shoestring”, and the other “A No/Low Cost Model for Promoting and Providing Holistic Healthcare to Medically Underserved Communities of Low Income Families, Homeless People and People in Recovery”.
Herban Health, based in East Palo Alto, Calif., is a 501©3 organization made up of primarily volunteer acupuncturists. Our goal in going to the APHA conference was: 1) to support ACHP’s work in highlighting not only the treatment of the whole person but also how the individual cannot be separated from the society in which he/she lives; and 2) to show that anyone who is involved in health care, from providers to administrators to community organizations, can integrate into their services holistic health care for people with very low income.
Herban Health’s working model is one way of reaching the medically underserved. We are primarily interested in supporting all attempts to reach this important part of our society. Our particular model provides free bilingual holistic health care to people who have little access to health care resources; the homeless, people in recovery, undocumented people, and others who fall through our leaky health care system. We now provide between 400-500 free treatments each month, including acupuncture, massage, nutritional and lifestyle advice, as well as classes in yoga, meditation, nutrition and other subjects that are in response to the expressed interests of our patients.
Our model is based on two assumptions. One, people know their own situations best, and so health care services need to be responsive to their needs. In so doing, we believe that the overall patient outcomes are improved. Two, for people with limited resources, the best way to reach them is going to their community-based organizations, such as senior centers, homeless shelters, churches, etc. Not only do we reach people more efficiently in this way, but also we are allowed to use space at these organizations without paying any rent. For holistic health care services, we primarily rely on volunteer providers, although we support having providers be paid and we are actively seeking funding to that end. To date, we are working with a recovery center for drugs and alcohol, an organization that provides food and clothing for people in need, a homeless shelter and a local community health clinic. In addition we have started a mobile acupuncture clinic based on the community acupuncture model, using portable zero gravity reclining chairs.
In summary, Herban Health: 1) encourages the alternative and complementary health services community to integrate into its goals the provision of services to the medically underserved in our society; and 2) stresses that there are ways, such as our model and many others, where anyone can participate in providing those services.
For more information or ideas, please contact us at: herbanhealthepa.org, telephone (650) 327-7894, address: 1765 East Bayshore Road unit 205 East Palo Alto, CA 95430.
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Stress and Anxiety Relief Through a Social Cognitive Based Yoga Program
Stress and anxiety relief through a social cognitive based yoga program
Purvi Mehta, MA, MS, & Manoj Sharma, MBBS, PhD, University of Cincinnati
Yoga aims to achieve equilibrium between the body, mind and soul. It is often viewed as an alternative form of therapy for ailments such as depression and anxiety. In particular, this ancient Indian technique has been widely used for reducing stress in the hectic lives of millions. Its components of asanas (postures), pranayama (breathing techniques), shava asana (relaxation), and dhyana (meditation) aid the individual in controlling the five senses leading to a reduction of mental activity. This eventually leads individuals into a nirvana-like state, where relief from stress and anxiety is achieved. While the premise of yoga is constant and unchanged, many schools of yoga exist: Hatha, Bikram, Iyengar, Kundalini Yoga, Siddha Samadhi, Sudarshan Kriya Yoga (SKY), Silver Yoga, and Sahaj Yoga. Practicing yoga for as little as 15 minutes daily enables the individual to reap its benefits.
Yoga combined with a theoretical framework can be used to build an intervention to alleviate stress and anxiety levels in adults. The social cognitive theory has been noted for its role in changing health behaviors. According to the theory, the individual learns through a triad of behavior, environmental factors and personal factors. There are nine constructs comprising the theory: knowledge, outcome expectations, outcome expectancies, situational perception, environment, self-efficacy, self-efficacy in overcoming impediments, goal setting or self-control, and emotional coping. While using all of the constructs for an intervention is not possible, a few should be chosen. Self-efficacy and expectations are known to be the best predictors of behavior change, as they enhance confidence in a particular behavior and beliefs/values of the outcomes of performing the particular behavior.
A 50 minute yoga class for 10 weeks based on the social cognitive theory has been developed for stress relief in adults. Discussions about the benefits of yoga (outcome expectations), relating those benefits to personal lives and discussion on values (outcome expectancies), asanas (poses or postures) in small steps to build self-efficacy (15-20 minutes), pranayama (breathing techniques) in small steps to build self-efficacy (5-10 minutes), shava asana (relaxation) in small steps to build self-efficacy for 5 minutes and dhyana (meditation) in small steps to build self-efficacy (5-10 minutes) were components of the intervention. Self-efficacy was built by talking about role models in yoga and persuading participants that they can practice yoga every day for 30 minutes. A question and answer session was also held with participants on ways to increase their self-efficacy, expectations and self-control which will help them reduce stress. Participants were encouraged to share tips that help them practice these strategies. Self-control was built by asking participants to self-reward after regular practice of yoga every day for one week. These topics were addressed every week. In addition, an email to the group was sent mid-week with tips and reminders to practice strategies discussed at the yoga session.
Based on this program, it was found that social cognitive theory is a useful framework for teaching yoga. Overall, a yoga practice with a social cognitive theory framework can be effective in reducing stress and anxiety in adults.
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New CAM Research
Gray's Behavioral Inhibition System as Mediator between Mindfulness and Wellbeing
This study tested whether an accepted psychological theory, Gray's Behavioral Inhibition System, or BIS, is one way to explain how mindfulness leads to feelings of well-being. Mindfulness is a state of mind that allows focusing on the present moment with a non-judgmental or accepting attitude. While mindfulness is thought to be associated with feelings of well-being, there is a lack of neurobiological evidence to explain this connection. The Behavioral Inhibition System is known to create negative emotions, such as anxiety. (BIS may be thought of as similar to the "fight or flight" response.) The current study hypothesized that practicing mindfulness will not only lead to feelings of well-being, but will also lessen the negative effects of BIS. Study results supported these hypotheses by reporting that there was a strong total effect between the Behavioral Inhibition System and the negative emotions that go along with it and that of mindfulness on well-being. People who practiced mindfulness had higher scores of well-being and lower BIS scores. BIS can therefore be thought of as a "mediator" of mindfulness towards well-being.
Sauer S, Walach H, Kohls, N. Gray's Behavioural Inhibition System as a mediator of mindfulness towards well-being. Personality and Individual Differences. 2011; 50.
Systematic Review of Integrative Health Care Research
A systematic literature review to assess the level of evidence for integrative health care was conducted, focusing on randomized controlled trials, controlled clinical trials, and systematic reviews. Of the 11,891 total citations only six clinical studies, including four randomized controlled trials, met the authors' inclusion criteria. One challenge of the study was the variety of definitions for the term "integrative health care," as the authors found that definitions range from the incorporation of complementary and alternative medicine into conventional medicine to the idea that integrative health care constitutes a new type of medical practice. The authors adopted the principle that integrative health care research is the study of the incorporation of CAM with biomedicine as a collaborative and integral part of the health care system. The authors found that the reviewed studies provided limited evidence of the effectiveness of integrative health care in some modalities; however integrative health care regimens appear to be generally safe. The authors concluded that more research consisting of randomized controlled trials should be conducted in order to build a stronger evidence based body of knowledge on the effectiveness of integrative health care.
Khorsan R, Coulter I, Crawford C, Hisao A. Systematic review of integrative health care research: randomized controlled trials, clinical controlled trials, and meta-analysis. Evidence-Based Complementary and Alternative Medicine. 2011; 6361134.
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Publications of ACHP members
Hot off the Press! Publications of ACHP members
Acupuncture and relaxation response for substance use disorder recovery. Chang BH, Sommers E, Herz L. Journal of Substance Use Dec. 2010;15(6):390-401.
Kadetz, P. 2011. Endangered Practices: Challenging the discourse of health care integration. In V. Scheid and H. Macpherson (eds.) Integrating East Asian Medicine into Contemporary Healthcare: Authenticity, Best Practice and the Evidence Mosaic. London: Elsevier.
Kadetz, P. 2011. Assumptions of Global Beneficence: Health care disparity, the WHO, and the effects of global integrative health care policy on local levels in the Philippines. Biosocieties. (6):88–105.
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New Member Profile
New Member Profile
: Roy Mankovitz
I am a new member of APHA’s ACHP SPIG and wanted to share some recent personal accomplishments related to my work:
I have published three books in the area of nature-based illness prevention: The Wellness Project -- A Rocket Scientist's Blueprint for Health; The Original Diet -- The Omnivore's Solution; and Nature's Detox Plan -- A Program for Physical and Emotional Detoxification. Background can be found at http://www.MontecitoWellness.com .
Currently, I am completing a science-based thriller novel (working title is The Fourth Generation), predicting the effects of genetically modified foods on our great-grandchildren. I expect publication in 2011.
I am also in the process of co-authoring the following books: The Omnivore's Delight on the health and ecological benefits of including pastured animal foods in your diet; The Original Workout on the types of exercise that most closely mimic those from our paleo heritage; and The Original Cookbook on modern ways to prepare the foods from our ancestral diet.
: "Montecito Wellness"
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Heading Toward APHA’s Annual Meeting
Heading Toward APHA’s Annual Meeting…
ACHP members in the Washington, D.C., area (or elsewhere) who are interested in planning our exhibition booth for the Annual Meeting in October are invited to contact Beth Sommers. Various elements of planning the booth include: soliciting and collecting materials for display and organizing staffing schedule. This is a great way to meet and greet other ACHP and APHA members!
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Update APHA Book Publications
Update on APHA Book Publications – June 2011
I am very pleased to announce that there are a
number books in production as well proposals for books that have been accepted,
and work on them is under way. Furthermore, several authors of current
products will be available to sign their books at the fall APHA Annual Meeting
in Washington, D.C.
APHA members of all sections are encouraged to
using existing, new and emerging products in their academic courses. These
resources are also very relevant to policy, prevention, advocacy and client
care initiatives. Please encourage your colleagues to use these timely and
evidence-based resources. Go to the APHA website to find out more: www.aphabookstore.org
We are also looking for new proposals for books. If
you have an idea for a book, please send a few paragraphs describing the idea,
intended audience and your qualifications to Nina Tristani, Director of
Publications, APHA, firstname.lastname@example.org
Thank you for supporting APHA Books and promoting
Norman Giesbrecht, PhD, Chair, APHA Publications
• Environmental Health and Racial Equity in the United States,
Authors: Robert D. Bullard, PhD; Glenn S. Johnson, PhD; and Angel O. Torres,
Books at Printer in June
• Megacities and Public
Health, Omar Khan, MD, MHS
• Public Health Management of Disasters, 3rd edition, Linda Landesman
Books Currently in Production
• Injury Prevention for
Children and Adolescents: Research Practice, and Advocacy, 2nd edition, Karen
D. Liller, PhD
• School–Based Health Care, Terri Wright, MPH and Jeanita Richardson, PhD
Books in Development
• Control of Communicable
Diseases Manual, 20th Edition
• Control of Communicable Diseases Lab Book
• Compendium of Methods for the Examination of Foods, 5th Edition
• Caring for Our Children, 3rd edition
• Standard Methods for the Examination of Water and Wastewater, 22nd
• Communicating Public
Health Information Effectively is now on Kindle.
Jossey-Bass: Emerging Infectious Diseases published in April
Jones and Bartlett Learning books to be published before the 2011 Annual Meeting:
Essentials of Biostatistics in Public Health, Essential Case Studies in Public
Health: Putting Public Health into Practice, Global Health 101, Field
Epidemiology in Public Health Practice, Epidemiology in Women's Health,
Essentials of Health, Culture and Diversity, Epidemiology of Chronic Disease,
Introduction to Air Pollution Science, and Essentials of Program Planning and
APHA is also co-publishing with Wiley, Designing
Healthy Communities by Richard Jackson. The book is a companion to a PBS series
to air this fall.
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Transportation Equity and Health
Transportation, Equity and Health
These are exciting times when considering the many ways our transportation systems impact health and equity in our communities. Congress extended the current federal surface transportation bill until Sept. 30, 2011, and Congressional committees are aiming to draft a new transportation bill before this latest extension ends.
Want to learn more about the connections between transportation, equity and health? View our archived webinar series, subscribe to the monthly transportation and health eNewsletter that offers an array of new events and updates, and download the newly released online public health and transportation toolkit and accompanying resources today.
We also invite you to send a message to your members of Congress urging that they ensure that strong public health provisions are included in the federal surface transportation re-authorization. For more information, visit http://apha.org/transportation.
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Alternative and Complementary Health Practices Newsletter Archives