Category Archives: Public health agencies
In the last few months, several prominent national and state public health leaders have announced plans to move on to new things, including David Fleming, MD, MPH, the former Public Health Director in Seattle & King County Washington, who NewPublicHealth spoke with last month. We also recently spoke with Joshua Sharfstein, MD, secretary of Maryland’s Department of Health and Mental Hygiene, who will leave his post at the end of the year to teach at the Bloomberg School of Public Health at Johns Hopkins University as part of the faculty of the School of Health Policy and Management.
Earlier this year, Sharfstein gave the commencement address at the graduation ceremony of the University of Maryland School of Public Health, and had this to say about the importance of ensuring the public’s health:
“The premise of public health is that the wellbeing of individuals, families and communities has fundamental moral value. When people are healthy, they are productive, creative and caring. They enjoy life and have fun with their friends and families. They strengthen their neighborhoods and they help others in need. In short, they get to live their lives.”
NewPublicHealth: What prompted you to move to academia at this point in your career?
Joshua Sharfstein: It's a chance to help train hundreds of new public health leaders as well as work in depth on issues that are important to me. I am especially looking forward to getting to work closely with so many talented faculty at the Johns Hopkins Bloomberg School.
NPH: How have your research and teaching skills benefitted from your time as deputy director of the U.S. Food and Drug Administration (FDA) and your position with the state of Maryland?
Sharfstein: I've seen a lot of public health in action at the local, state and federal level. My goal will be to show students how important, interesting, engaging and—at times—strange public health can be. I have a research interest in why certain policies are pursued and others are not—and how public health can be successful in a difficult political and economic climate.
The worst Ebola outbreak in history has now claimed 1,145 lives, according to the World Health Organization (WHO). In the two days to August 13, 76 people died and there were 152 confirmed, probable and suspected new cases in Guinea, Liberia, Nigeria and Sierra Leone. NewPublicHealth has been following the outbreak in West Africa closely. You can read our ongoing coverage of the Ebola epidemic here. Below is a look at the latest news on the outbreak:
- While stating its belief that the magnitude of the outbreak has been “vastly” underestimated, WHO continues to partner with individual countries, disease control agencies, agencies within the United Nations system and other organizations to combat the Ebola epidemic. “Practical on-the-ground intelligence is the backbone of a coordinated response,” the global health organization said in an update, noting that the U.S. Centers for Disease Control and Prevention (CDC) is providing computer hardware and software that should enable real-time reporting and analysis. The World Food Programme is also delivering food to the more than one million people living in quarantine zones; the food shortage has been compared to a “wartime” situation.
- The medical charity Médecins Sans Frontières (MSF) estimates that it will take public health officials at least six months to bring the Ebola outbreak under control. "In terms of timeline, we're not talking in terms of weeks, we're talking in terms of months,” said MSF President Joanne Lui, according to the BBC. “We need a commitment for months, at least I would say six months, and I'm being, I would say, very optimistic."
- Kent Brantly, MD, one of two U.S. aid workers infected in Liberia who received an experimental Ebola treatment, continues to improve and hopes to be “released sometime in the near future.” He is being treated at Emory University Hospital in Atlanta, Ga. The family of Nancy Writebol, a missionary from Charlotte, N.C., said she also continues to improve and doctors remain optimistic.
- The U.S. Department of State has ordered family members of staff members at the U.S. embassy in Freetown, Sierra Leone, to evacuate the country, announcing the order as part of reconfiguring of resources to better respond to the Ebola outbreak. The order stated: “We remain deeply committed to supporting Sierra Leone and regional and international efforts to strengthen the capacity of the country’s health care infrastructure and system—specifically, the capacity to contain and control the transmission of the Ebola virus, and deliver health care.”
This week, David Fleming, MD, MPH, stepped down as public health director of Seattle and King County in Washington State after seven years leading the public health agency. Over that period, among many other accomplishments, he led the department’s efforts to sign up more than 165,000 residents under the Affordable Care Act and oversaw a 17 percent drop in obesity rates in partnering schools.
NewPublicHealth spoke with Fleming about his views on the mission of public health.
NPH: How has public health changed since you began your career?
David Fleming: The mission of public health has not changed—and that's to prevent unnecessary illness and death—but what has been changing is what the nature of that prevention is. Increasingly, it is in chronic diseases, injuries and, importantly, the driving force of underlying social determinants of health. So public health has changed from being more of a direct service agency where we have frontline public health workers who are out there providing treatment to people and preventing infectious diseases, to really more of a collaborative kind of agency where we need to be working with a wide range of partners outside of the traditional domains of public health to help them implement the changes that need to happen. It's a fundamental shift, I think, in the business model of public health that we're in the process of witnessing today.
NPH: When you point to some of the achievements that you've had, whether they're specific changes in the state or specific models of examples that you've given to other states, what would you point to?
Fleming: First off, I think it's important to say that public health is a team sport, and so when I talk about accomplishments, I'm talking about accomplishments of the department in which I work on this and the staff that work here. I think that we have been successful at pivoting to that future that we were talking about a moment ago, at looking at how health departments can attack the underlying social determinants of health.
Increasingly, it is health disparities that are driving poor health in this country. We have been successful here in beginning to figure out how to partner with other sectors—the education sector to reduce obesity in our poorest school districts, for example. We’ve also worked with the community development sector to begin making investments in our poorest neighborhoods to increase the healthiness of our communities, so that people who live in them can be healthy, as well. At the end of the day, I think that we have been trying to lead this new path where public health is a partner in communities with all of the other entities that are capable of influencing health and figuring out how to make that happen.
Close to fifty college undergraduates got a bird’s-eye view of public health careers this summer during the Summer Public Health Scholars Program (SPHSP), a partnership with Columbia University’s College of Physicians and Surgeons, College of Dental Medicine, School of Nursing and Mailman School of Public Health.
“I’ve learned that public health isn’t just about medicine,” said 2014 participant Richmond Laryea, a junior at the University of Central Florida. “It’s about things like the security and safety of public parks, places for farming, transportation, and education—it really takes place in every sector."
>>Bonus Content: Watch participants in last year’s program talk about their public health internships.
The program, which is funded by the U.S. Centers for Disease Control and Prevention’s Office of Minority Health and Health Equity, is designed to show students the range of public health practice. Students typically spend three days at an internship, one day in the classroom and one day on a field trip to places such as the Harlem Children’s Zone. Each student is also mentored by the Mailman School’s associate dean of Community and Minority Affairs.
Laryea said his career plan is to become a cardiothoracic surgeon, but with some time spent gaining a public health degree, as well.
“With my experience in public health, I’ve learned that I want to look into a community approach to help others as a whole, instead of just helping an individual person,” he said.
Public health agencies where students are performing fieldwork this summer include the Northern Manhattan Perinatal Partnership, BOOM!Health, the South Bronx Overall Economic Development Corporation and New York City’s Correctional Health Services.
The National Institute of Allergy and Infectious Diseases (NIAID), a division of the National Institutes of Health, is set to begin an early-stage clinical trial for a vaccine to protect against the Ebola virus. The trial should begin as early as September. The vaccine to be tested was developed by the NIAID’s Group Health Research Center in Seattle and does not contain infectious Ebola virus material. Instead, it’s what is known as an adenovirus vector vaccine containing an insert of two Ebola genes. The vaccine works by entering a cell and delivering the new genetic material, causing a protein expression that activates an immune response in the body. Researchers have seen success with studies in primates.
The vaccine being tested is not the experimental serum that was used on two Ebola-infected health workers recently evacuated from Liberia. In those cases, Samaritan’s Purse, the aid organization that sent the health workers to Africa, contacted officials from the U.S. Centers for Disease Control and Prevention (CDC) in Liberia to discuss the status of various experimental treatments they had identified through a medical literature search. CDC officials referred them to an NIH scientist in West Africa familiar with experimental treatment candidates who was then able to refer them to pharmaceutical companies working on experimental treatments. The serum being used is made by Mapp Biopharmaceutical of San Diego, Calif.
Read more on NIAID Ebola vaccine research.
>>Bonus Content: The CDC has released a new Ebola infographic.
Health Beyond Health Care: RWJF-Sponsored Washington Post Live Event Sparks Conversation on Creating a Culture of Health
“Health Beyond Health Care” was the focus of a Robert Wood Johnson Foundation (RWJF)-sponsored Washington Post Live Forum today that looked at how creative minds in traditionally non-health fields—such as bankers, architects, designers and educators—are working together to build a Culture of Health in the United States.
“No matter where you live and how much money you have, you should have the opportunity to live a Culture of Health,” said RWJF President and CEO Risa Lavizzo-Mourey, MD, MBA.
>>View the full archived live stream of the forum.
Lavizzo-Mourey said RWJF began its work on the concept of a U.S. Culture of Health in 2009, when the foundation’s Commission to Build a Healthier America released a report recommending the concept. Last year, the Commission came together to see what progress had been made. Among the sites embracing the concept is Marvin Gaye Park in Washington, D.C. Once known as “Needle Park,” the community has transformed itself through lighting and landscaping. This was possible “because the community embraced the principles of a Culture of Health and demonstrated how, from the ground up, people partnering can change the nature of their community and make it healthier,” she said.
Pointing to the most recent Commission report, Lavizzo-Mourey said that looking at communities undergoing changes pushed the Commission to conclude that in order to improve health as a nation, we have to change communities—especially low-income communities—so that people can make healthy choices every day. That also means that health care has to connect with non-health care.
“Each of you,” she told the audience of thought leaders and policy makers, “is uniquely positioned to make changes that can get us to a nationwide Culture of Health.”
The day’s speakers spoke about innovations in their fields that are helping to create local changes in health, and which are often scalable for communities across the country.
“The most successful projects are those that start with bringing communities together to first assess the need, and then prioritize them and move forward with a particular project,” said Sister Susan Vickers, RSM, Vice President of Community Health, Dignity Health, who added that just about all the loans that Dignity Health has made to nonprofits in the community have been repaid.
Why a focus on health? “Health summarized all [of the other factors],” said David J. Erickson, PhD, Director, Center for Community Development Investments, Federal Reserve Bank of San Francisco. “The best predictor for future health for a third grader is whether they are reading on a grade level. Community development is big, but not big enough, and the medical system is not big enough either. We need to start aligning all of these sectors so we’re all working in the same direction to turn these neighborhoods around.” [Editor’s Note: Read a previous NewPublicHealth Q&A with Erickson.]
“We have to treat health as a national treasure—a natural resource—and put it up on the level of the seriousness of the economy,” said Rear Adm. Boris D. Lushniak, Acting U.S. Surgeon General. “The economy doesn’t do anything without a healthy people.”
Recovery after a disaster can take years or even decades—but what most people don’t realize is that recovery starts even before the disaster occurs. Resilience is about how quickly a community bounces back to where they were before a public health emergency—and only a healthy community can do that effectively.
NewPublicHealth recently spoke with Alonzo Plough, PhD, MPH, Vice President, Research-Evaluation-Learning and Chief Science Officer at the Robert Wood Johnson Foundation, about taking steps toward recovery even before a disaster occurs.
NewPublicHealth: What are some important aspects of preparedness that help prepare responders and the community for recovery from a disaster?
Alonzo Plough: Connectivity between organizations, between neighbors, between communities and formal responder organizations is absolutely critical to building community disaster resilience. This allows recovery to go more smoothly because the partners who have to work together in recovery have been working together and connecting to communities prior to a disaster event. Managing the long tail of recovery is easier if there has been recovery thinking in the preparedness phase.
NPH: One of the issues for the panel at the recent Preparedness Summit is the impact of the news spotlight when a disaster occurs, and then the impact of that spotlight turning off. How does that focus impact recovery?
Plough: Often the initial media frames are to wonder why there weren’t preventive mechanisms. In the case of the mudslides in Washington State, for example, why weren’t there zoning restrictions or regulatory restrictions? That initial media frame often will point a finger to ask why houses were allowed to be built in an at-risk location. Why were building permits given at all?
But none of that really addresses the long-term issues of communities working toward recovery, regardless of the specific event. There is a disruption of life as people know it in a disaster that goes on for a long, long period of time. The media doesn’t really capture the complexity of that while they’re focused on the short-term outcomes. When the media focus goes away, the appropriate agencies and organizations who need to be engaged continue their engagement.
A recent survey by the Federal Emergency Management Agency (FEMA), found that only 34 percent of Americans said they would have access to financial, insurance and other records if they had to evacuate in a disaster. Now that hurricane season has begun, that slim response is pushing FEMA regional directors to promote financial preparedness along with other safety reminders.
“Don’t hinder your recovery if disaster strikes. Take the time now to ensure critical documents are safely stored, valuables are adequately insured, and potential spending needs are planned for,” said Andrew Velasquez III, regional administrator for the FEMA Midwest region.
Among FEMA’s tools and advice:
- FEMA has created an Emergency Financial First Aid Kit which provides reams of information, including documents to store online or on a flash drive, such as household bills, credit card statements and loan information. That information can help stabilize your financial status after a disaster and can be critical for avoiding fines if you are late on bills and for certain loans and grants.
- FEMA also recommends enrolling in online banking, direct deposit for paychecks and Go Direct for online deposits of federal benefits such as social security. This will help people avoid disruptions in income due to a disaster.
- FEMA recommends people keep some cash or traveler’s checks in a plastic bag in their Go Kit. After many disasters power outages keep ATMs offline, just when many businesses—also without power to process credit card transactions—were often requiring payment in cash only.
- Take the time now to print out a copy of Recovery after Disaster: The Family Financial Toolkit, developed by the University of Minnesota Extension and North Dakota State University Extension Service after disasters in those states. The toolkit is full of critical information such as what information you’ll need to show to secure a small business loan if your business is destroyed. The kit also has fill-in logs that help keep track of assistance you’ve requested and responses.
>>Bonus Link: The 2014 Consumer Action Handbook has information on avoiding financial scams including many that people can fall prey to after a disaster.
Millions of people have now seen their phone shake and heard it wail with news of an impending tornado or other disaster. Two years ago the wireless industry rolled out a free service known as wireless emergency alerts, and wireless carriers representing more than 98 percent of subscribers agreed to participate.
People with older phones, however, may not be able to access the alerts. Brian Josef, general counsel for the CTIA—The Wireless Association in Washington, D.C., recommends checking for the capability when buying a new phone and. For your current phone you can check with your carrier’s customer service office to see whether you automatically get the alerts.
People who can’t receive the texts, or who want a double layer of information, can sign up with local emergency management offices and get alerts via phone, text, email and in some cases Twitter—although sessions at the recent Preparedness Summit in Atlanta indicated that while Twitter is growing, it is still not used by many local and state health departments. Check the bottom of your health department home page to find the Twitter handle, if there is one.
Josef also points out that you may find that a neighbor got an alert and you didn’t—but that’s because the alerts are geo-targeted. If you and your neighbor were a few miles away from each other when an alert went out, only the one in harm’s way would get pinged.
But the apps won’t do you much good if your phone loses its charge. Preparedness experts recommend keeping a charged extra battery and portable charger on hand, and some emergency radios also include phone/device chargers.
Other tips to conserve your smartphone battery, according to Mary Clark, Chief Marketing Officer of the mobile technology company Syniverse, include:
- Reduce the brightness of your screen
- Close unnecessary apps
- Use text messages to communicate with friends and family
- Send an initial text to those most important detailing your plans
- Turn off unneeded options such as Wi-fi and Bluetooth
Center for Community Health and Evaluation Releases First National Evaluation of HIAs: Q&A with Tatiana Lin
Health impact assessments (HIAs) are evidence-based analyses that estimate future health benefits and risks of proposed laws, regulations, programs and projects. They provide decision makers with an opportunity to minimize health risks and enhance health benefits. HIA practitioners say the tool allows for more informed—and potentially healthier—decisions related to land use, transportation, housing, education, energy and agriculture.
The Center for Community Health and Evaluation, a division of Group Health Research Institute, a nonprofit based in Seattle, recently published a national study on HIAs that looked at their utility and potential improvements.
The new study outlines how HIAs change decision making and highlights evidence that HIAs can also lead to stronger cross-sector relationships, greater attention to community voices and longer-term changes beyond the initial decision the HIA is focused on.
Key findings of the Center’s evaluation include:
- HIAs can contribute directly to the decision-making process and help achieve policy outcomes that are better for health.
- There are opportunities to advance the HIA field in the areas of stakeholder and decision-maker engagement, dissemination and follow-up.
- Attention to specific elements can increase likelihood of HIA success.
A past HIA funded by a grant from the Health Impact Project, a program of the Robert Wood Johnson Foundation and the Pew Charitable Trusts, was conducted in 2012 by the Kansas Health Institute (KHI) and looked at the health impacts of building a casino in Southeast Kansas (a law that would move such a project forward was enacted last month).
NewPublicHealth recently spoke with Tatiana Lin, the author of the HIA and a senior analyst at KHI, about the recent HIA evaluation and lessons learned from the HIAs KHI has worked on so far.