Emergency Preparedness: A Blended Emphasis on Collaboration

Public health and health care preparedness experts met together at the 2012 Joint Preparedness Conference, where a major focus was greater collaboration between agencies and partners throughout the federal government to achieve maximum public benefit. The conference was sponsored by the Centers for Disease Control and Prevention Office of Public Health Preparedness and Response (OPHPR) and the Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response.

Both offices award annual preparedness grants to all fifty states, several large cities and all U.S. territories, but previously required grantees to apply and report separately. The conference, which also  included representatives from the Association of State and Territorial Health Officers (ASTHO), the National Association of County and City Health Officials (NACCHO) and other partners, brought the experts from both funding streams into the same room along with the project managers who handle both health care and public health.

“The emphasis is on aligning the efforts between public health and heath care,” says Steven F. Boedigheimer, CDC Deputy Director of OPHPR’s Division of State and Local Readiness, who led the conference.

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Healthy Babies: HHS Adds an Initiative to Help Reduce Preterm Births

Healthy Babies is the focus of the annual President’s Challenge of the Association of State and Territorial Health Officials, and this week the U.S. Department of Health and Human Services (HHS) put funding behind the issue as well, announcing the Start Strong initiative. The first activity of the initiative will be to give out more than $40 million in grants, through the Center for Medicare and Medicaid Innovation, to test ways to reduce the current high rate of premature births.

According to HHS, more than half a million infants are born prematurely in America each year, a rate that has grown by 36 percent over the last 20 years. Children born preterm are at risk for death and also often require significant medical attention, early intervention services and special education, and have conditions that may affect their productivity as adults.

The Center will award grants to health care providers and coalitions to improve prenatal care to women covered by Medicaid. The grants will support the testing of enhanced prenatal care through several approaches under evaluation, including:

• group visits with other pregnant women,
• birth centers providing case management, and
• maternity care homes where pregnant women have expanded access to better coordinated, enhanced prenatal care.

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Faces of Public Health: Mary Selecky

Mary Selecky, Washington State Department of Health

Mary Selecky, Secretary of Health for the Washington State Department of Health is one of the longest standing state health officials in history. NewPublicHealth caught up with her at last week’s Association of State and Territorial Health Officials Annual Meeting to talk about her tenure in governmental public health, her advice for new health officials and who she’s worked with along the way, even beyond the traditional public health realm.

NewPublicHealth: What was your favorite session at ASTHO?

Mary Selecky: It was really important for us to have that session [with Andy Goodman] about story telling because we get a little too myopic and academic—and we really do need to tell this public health story, especially in these tough economic times.

NPH: How have you seen the current economy impact governmental public health? Is it the worst that you’ve seen it during your years in the field?

Mary Selecky: I’ve had the fortune of being in public health for 32 years; I learn something new every day and there’s always an opportunity and a challenge. Our state wasn’t able to buy vaccines for all kids—yet it presented an opportunity for us to sit down with different partners and our insurance company recognized that the partnership with government was a win-win. But I think this is a scary time for public health because what we in the field think of as core public health functions—making sure the water and food is safe, making sure kids are immunized and that we follow-up on the community’s health—aren’t going to be funded the same way.  We have to let go of the old ways we’ve been doing something while we protect our successes. We have new challenges where we have to figure out how to take those on. So we really have to figure out how to do our business differently.

NPH: What does the future of public health look like in terms of the issues you see dominating our discussions over the new few years, besides budget?

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Scott Burris With an Update on Public Health Law: A NewPublicHealth Q&A

Scott Burris, Public Health Law Research

Update on 10/31: Scott Burris is at APHA and gave an overview this morning at the 2011 APHA annual meeting on how far the initiative has come since its inception two years ago.

The program has funded somewhere between $8 and 9 million dollars in public health law research so far, said Burris, many of which are starting to bear results. Researchers from Boston University School of Law and Harvard Medical School showed that companies that make antibiotics are encouraging the (over)use of those antibiotics by clinicians, a practice which is known to lead to antibiotic resistance.

PHLR is now focused on creating an online research community called SciVal for sharing methods, best practices and advances in the field. (PHLR staff is showcasing this new app at their booth #2060, so stop by to check it out if you’re here in Washington attending APHA). Burris also encouraged the audience to visit the PHLR website to take advantage of a wealth of resources on methods, all meant to guide this burgeoning field.

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Public Health Law Research (PHLR), a Robert Wood Johnson Foundation program based at Temple University, represents an initiative to promote effective regulatory, legal and policy solutions to improve public health. The program will have a strong presence at the American Public Health Association Annual Meeting this year both during meeting sessions and at the Program’s booth on the exhibit floor. NewPublicHealth spoke with Scott Burris, JD, director of the program, about some of the upcoming presentations and booth demonstrations.

NewPublicHealth: Will you have many research results to show at this year’s APHA Annual Meeting?

Scott Burris:  This is now Public Health Law Research at age 2.4 years. We are just starting to get results from our grantees, the people we funded in the first round and a few in the second and we have a number of them appearing at APHA this year. Our booth will have a complete guide to PHLR related events at APHA. Our Methods Core Member, Jeffrey Swanson, a professor at Duke University, is getting the 2011 Carl Taube Award for distinguished contributions to mental health services research. At our the booth, #2060, we’ve got a beta version of our Public Health Law Research Community application, which will eventually capture everybody who’s written in Public Health Law Research and all the papers that have been published. We’ll be demonstrating the app at our booth. We’ll also be showing our brand new seven-minute animated video about PHLR—popcorn included.

NPH:  Can you point to some key PHLR research projects that will be presented at the APHA meeting?

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State Public Health and Public Health Heroes

Susan Cooper Awarded ASTHO Presidential Meritorious Service Award

Last week, the Association of State and Territorial Health Officials (ASTHO) released the latest iteration of the Profile of State Public Health, with support from the Centers for Disease Control and Prevention and the Robert Wood Johnson Foundation, at their Annual Meeting. The meeting also offered a chance to recognize public health heroes from the field.

The Profile of State Public Health provides a snapshot of state public health agencies and the contributions they make to the health of the nation.

Some of the key findings include:

• State health agencies continue to connect people with access to personal health services. For example, 84 percent of agencies support health disparities or minority health initiatives and about 75 percent provide direct support for primary care providers.
• State health agencies are prioritizing prevention. The vast majority offer tobacco prevention and control services (88 percent), HIV prevention programs (84 percent) and injury prevention programs (80 percent).
• Almost three-quarters of state health agencies (72 percent) plan to pursue public health accreditation.
• The state and territorial health agency workforce includes over 100,000 full-time employees.
• The average number of vacant positions at state health agencies is 288. Presumably due to budget cuts and hiring freezes, state health agencies are  only recruiting for 15 percent of these positions.

The report is designed to enable public officials and policy-makers to make well-informed decisions to strengthen America’s public health system.

In addition to shining a spotlight on the contributions of state and territorial health agencies as a whole, state projects and individuals that have helped improve the lives and health of Americans were also highlighted and recognized for their efforts with awards at the ASTHO Annual Meeting.

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HRSA’s Mary Wakefield on Healthy Baby Efforts: A NewPublicHealth Q&A

Mary Wakefield, Health Resources and Services Administration

The annual Association of State and Territorial Health Officers (ASTHO) President’s Challenge will focus on infant mortality and healthy babies this year. ASTHO’s Healthy Babies Project will support state health officials and their staff in improving infant health outcomes.

ASTHO is collaborating with several organizations and government agencies, including the Maternal and Child Health Bureau of the Health Resources and Services Administration (HRSA). The latest HRSA data shows that 29,138 infants died before their first birthday—an infant mortality rate of 6.8 deaths per 1,000 births in 2007, which is unchanged from the previous year. And one in eight babies is born too soon, according to the March of Dimes, posing health and development risks for the baby and stress issues for the family. NewPublicHealth spoke with HRSA Administrator Mary Wakefield, PhD, RN, about the partnership.

NewPublicHealth: This collaboration is not your first with ASTHO?

Dr. Wakefield: We’ve actually had a longstanding relationship with ASTHO and we’ve worked with their leadership and their board and members on different issues over the years. This year their new president David Lakey, from Texas, has a particular focus on improving birth outcomes, and this is one of those areas we focus on at HRSA, particularly through our Maternal Child Health Bureau. We very much share the same concerns and I think complement each other’s efforts. We’re working in partnership with ASTHO on this and also working with other stakeholders too, including state divisions of Maternal and Child Health, the American Academy of Pediatrics and the March of Dimes.

NPH:  What are some programs at HRSA that address healthy babies?

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ASTHO 2011-2012 President’s Challenge: Healthy Babies

David Lakey, ASTHO President

For the last few years, each annual meeting of the Association of State and Territorial Health Officials has kicked off a yearlong President’s Challenge that focuses on a particular health issue impacting all states. Judith Monroe, MD, now the director of the Office for State, Tribal, Local and Territorial Support at the Centers for Disease Control and Prevention used her Presidential Challenge in 2008 to highlight the need to “walk the talk” by promoting wellness in health department worksites.

In 2010 Paul Halverson, director of the Arkansas Department of Health, devoted his President’s Challenge to injury prevention, a topic prominent at this year’s ASTHO annual meeting as well. And last year John Auerbach, state health commissioner in Massachusetts and ASTHO’s outgoing president, made health equity his cornerstone initiative. The focus on these health issues has extended well beyond the challenge year and health officials continue to make them a priority.

For the 2011-2012 President’s Challenge, incoming president David Lakey, MD, commissioner of the Texas Department of Health, is focusing on healthy babies because too many are born too soon, often resulting in developmental and health issues that impact their entire lives.

NewPublicHealth spoke with Lakey about his President’s Challenge, why preventing preterm birth is such a critical issue and key partners across the country to help accomplish his goal to reduce prematurity in United States by 8 percent by 2014.

NPH:  How did you come to focus on healthy babies for your President’s Challenge this year?

Lakey:     About a year and a half ago when we were discussing the challenges that all of us were facing in the southern part of the United States, Regions 4 and 6, all of us brought up the challenge that we have with prematurity and infant mortality.

I guess the other part of my interest is my background. I’m an infectious disease physician but I did pediatric training and spent time helping to care for premature babies and the consequences that come with that, whether it was intellectual disability or problems with the lungs or other abnormalities.

So we saw this as an issue that we needed to put some focus on. It is also an area that has significant ethnic disparities. If you look at the rates in the African American community, they’re about twice as high as in other populations. And we also started to understand not only the human aspect but also the economic aspect that prematurity is a driver of our Medicaid budgets in our states. We can not only improve health outcomes and improve people’s lives but also do it in a way that saves money for the states and helps us drive our health costs in our system down.

NPH:  What are some of the proven strategies for improving these health outcomes?

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“Health Equity Needs to be a Part of the Public Health DNA”

Hispanics are three times as likely to get pregnant as teens. Infants born to black women are up to three times more likely to die than infants born to women of other races and ethnicities. American Indians and Alaska Natives born today have a life expectancy that is 5.2 years less than the U.S. average. And lower income residents report fewer healthy days across all races and ethnicities (according to a Centers for Disease Control and Prevention report). The statistics are striking and disturbing – health disparities persist.

John Auerbach, MBA, outgoing president of ASTHO and commissioner of the Massachusetts Department of Public Health, helped to make health equity a priority for health officials with his year-long President’s Challenge to reduce disparities [read a Q&A with John Auerbach on the Challenge here]. Yesterday at the ASTHO Annual Meeting, he led a discussion with Anna Whiting-Sorrell, MPA, director of the Montana Department of Public Health and Human Service and Joshua Sharfstein, MD, MPH, secretary of the Maryland Department of Health and Mental Hygiene on progress in advancing health equity in the last year and challenges still ahead.

“Health equity needs to be part of the public health DNA – a thread that runs through the core activities we pursue in public health,” said Auerbach.

Topics in the discussion included how to talk about racism (if you’re talking about it at all, you’re headed in the right direction), and efforts to make the public health workforce better reflect the people it serves. Another major theme of the discussion was how to measure programs that address health equity.

“We have to decide what is success. Is it just how many people call the quit-line? Or is it broader health?” said Whiting-Sorrell.

The conversation showcased some of the videos and campaigns targeted at reducing health disparities. Sharfstein discussed a video his office created to address infant mortality.

“We tried to understand the striking data in infant mortality. Every year there would be 20-25 preventable deaths per year, almost all African American babies, often because of unsafe sleeping patterns,” said Sharfstein. “We decided the mothers who’d lost children were the best conduit to get the message out.”

This moving video was the result:

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Injuries Are Not Accidents: NewPublicHealth Q&A with Dan Stier

Daniel Stier, Network for Public Health Law

Injuries are the leading cause of death for people ages 1 through 44 in the United States, according to the latest data from the Centers for Disease Control and Prevention. Many of those injuries could be prevented – a key issue for the Association of State and Territorial Health Officials, which released an injury prevention guide for health officials and devoted a president’s challenge to the issue two years ago.

A survey by the Network for Public Health Law found that only 10 states have comprehensive injury prevention authority.  NewPublicHealth caught up with Daniel Stier, JD, director of the Network for Public Health Law, about injury prevention at the ASTHO Annual Meeting.

NewPublicHealth: What is the focus of your talk at the ASTHO meeting?

Daniel Stier:  It’s a broad view of injury prevention. Starting a number of years ago, I was contacted by Dr. Mel Kohn, who is the state health officer in the state of Oregon, and he was concerned about the lack of injury prevention authority in Oregon’s statutes and said he was advised by his lawyer to go rather slow on injury prevention activities because of this. So he and I and others have been working together to really study what’s going on at the state level in injury prevention and we found that only a handful of states are mandated to conduct comprehensive injury prevention activities including surveillance assessments and policy development.

NPH: What issues are particularly critical in injury prevention?

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Terry Cline at ASTHO: NewPublicHealth Q&A

Terry Cline, Oklahoma Commissioner of Health

National public health department accreditation, which launched last month, is a key topic among presenters and participants at the Association of State and Territorial Health Officers Annual Meeting, which began yesterday. Terry Cline, PhD, the Oklahoma Commissioner of Health, was among the speakers at today’s session on accreditation and quality improvement.

At the ASTHO session today, Cline said, “It’s a way of thinking, it’s a way of constantly holding ourselves accountable. It’s really changing a mindset, which is incredibly powerful.”

“This is the way we are going to raise the bar in population health,” said Cline. NewPublicHealth spoke with Cline about the benefits of accreditation and the plans for pursuing the credential in his state.

NewPublicHealth: How has Oklahoma been involved in preparing for public health department accreditation?

Cline: We were actually the only state that was a beta test site for the state level, the local county health department level and the tribal level. So we have been marching down this path as big believers in the power of accreditation and the need for accreditation in public health. At the state and one county level, Comanche County, applications have already been filed.

NPH:  What do you think the state and its local health departments stand to gain from accreditation?

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