Wednesday, November 19, 2014

Closing General Session: ‘We can make health everyone’s business’

Risa Lavizzo-Mourey’s light bulb moment came during her medical training, when she was doing her rotations at a hospital in Boston. There, she met “Patient Ruth.” Ruth was homeless — she came into the hospital with swollen feet and skin ulcers that made it terribly painful to walk. She’d been in and out of the hospital many times, her medical file bulging with records.

A day after Lavizzo-Mourey, who’s now the president and CEO of the Robert Wood Johnson Foundation, first met Ruth, the patient was discharged. The hospital had done its job, giving Ruth a warm bed for the night, some food and basic health care. But as Ruth left the hospital, she still had no home, no job, no access to healthy food, no social support. None of the conditions that make for healthy people and healthy communities would meet Ruth outside that hospital door. Unfortunately, she would most certainly return in need of more help.

But what if instead of ushering Ruth back out into the cold, the hospital had connected her with the very services and support that could keep her out of the hospital, Lavizzo-Mourey asked a crowd of hundreds at the Closing General Session of APHA’s 142nd Annual Meeting and Exposition, which welcomed more than 12,500 people to New Orleans. Why wasn’t preventing a re-admission the fundamental goal of every visit to the hospital, she wondered. It was a transformative moment and one that redirected Lavizzo-Mourey to the world of public health, where she’s now a leader in the movement to build a nationwide culture of health.

“The effects of where you live are so profound that your ZIP code may in fact be as important as your genetic code in how well and how long you live,” she told attendees.

So, what does a culture of health look like? Imagine a society in which promoting health is as important as treating disease, Lavizzo-Mourey said. Imagine a world in which doctors openly share medical notes with their patients and engage in honest discussions about the value and price of care. Imagine neighborhoods and cities where optimal child health is a matter of fact — not a matter of chance. Imagine families and towns in which employers, policymakers and teachers all work together to help make the healthy choice, the easy choice. This is what a culture of health looks like, Lavizzo-Mourey said, and it is achievable.

“It’s a bold idea and it’s one that I believe is possible,” she said.

Of course, there are many challenges and the current data on Americans’ health is not particularly encouraging. But if we put our heads together and commit to reaching out and partnering with nontraditional public health partners, we can build a culture in which all people can access the opportunities that afford lifelong health, Lavizzo-Mourey said.

“That’s what it’s going to take to make a culture of health happen,” she said. “Cranking up the volume on a nationwide call for change.”

And this year’s host city of New Orleans is the perfect inspiration. After the devastation of Hurricane Katrina, public health leaders decided the best way to rebuild the city was to put it on a trajectory to become one of the healthiest cities in America. In turn, public health officials reached across sectors, convening partnerships, leveraging knowledge and resources, and integrating health as a consideration in everyday policymaking. That shift in thinking is “part of the incredible comeback spirit that we felt in every corner of this town for the last week,” Lavizzo-Mourey said.

“It’s not going to be easy; in fact, it’s going to be hard,” she said. “But if we combine passion and purpose, I know we can raise the health of everyone in America to the level that this great nation deserves and when we do, we will indeed have a powerful story to tell. A story that we can start telling today.”

Building a culture of health and the importance of partnerships were common themes throughout today’s Closing General Session. In fact, both philosophies are central to APHA’s strategic priority of building the healthiest nation in one generation.

J.T. Lane, assistant secretary at the Louisiana Department of Health and Hospitals Office of Public Health, called on state health agencies to strengthen their support and advisory role in local communities. For example, he encouraged session attendees to help communities identify local public health champions and nontraditional partners. However, he added, be cognizant of local dynamics and help communities tailor efforts that will grow and sustain over time.

“Societal change requires changes in us,” Lane said. “We can make health everyone’s business.”

Mary Wakefield, administrator of the U.S. Health Resources and Services Administration, echoed those sentiments but from a rural perspective. Contrary to some popular thought, Wakefield noted that living in rural America isn’t always “a ticket to longer or healthier lives.” In fact, life expectancy has been consistently lower in rural areas than in urban areas and that gap is widening.

“If your ZIP code is a rural one, one’s health status might be at particular risk,” Wakefield said. 

Rural communities face a number of challenges to building a culture of health, including less access to care and high rates of poverty. But these challenges are ones that can be overcome, Wakefield said. Indeed, the notion of “pulling together” is a strong one in rural neighborhoods and a strength of rural communities overall. In rural America, health really is everyone’s business, she said.

Howard Koh, former U.S. assistant secretary for health and a professor at the Harvard School of Public Health, told session attendees that with the implementation and success of the Affordable Care Act, it’s the perfect time for a paradigm shift in how our country thinks about health and prevention. Of course, none of this work is easy, he said. (On that note, Koh said: “Blessed are the flexible so we shall not be bent out of shape.”) Still, there’s no more important work than improving and safeguarding the health of our nation.

“When prevention works, you get to enjoy the miracle — the absolute miracle — of another perfectly healthy, normal day,” Koh said.

And so let’s end another energizing Annual Meeting with a challenge from new APHA President Shiriki Kumanyika, who called on her hundreds of colleagues at the Closing General Session to join APHA’s movement to create the healthiest nation in one generation. In particular, Kumanyika urged attendees to reach out and partner with the for-profit sector. Private sector action is integral to improving health and in pushing forward on issues such as climate change and health equity — in fact, public-private partnerships hold “incredible potential for accelerating our movement,” she said. Indeed, it’s to public health’s own detriment that it overlooks the power of the private sector to improve the nation’s health, she told attendees.

“I’m tired of being on the sidelines,” Kumanyika said. “I’m ready to have a conversation.”

We hope you’ll join that conversation, too. Visit APHA and sign our pledge to help build the healthiest nation in one generation.

And we’ll see you next year in Chicago for APHA’s 143rd Annual Meeting and Exposition, where the theme will be “Health in All Policies.” Until then, be healthy!

— K.K.

Above from top to bottom: Closing General Session keynote speaker Risa Lavizzo-Mourey; session panelists, from left to right, Mary Wakefield, J.T. Lane and Howard Koh; and outgoing APHA President Joyce Gaufin, left, passes the gavel to incoming APHA President Shiriki Kumanyika. Photos by Jim Ezell, courtesy EZ Event Photography

A little birdie told me so: Tweet of the day

On this last day of the APHA 142nd Annual Meeting and Exposition, the tweet of the day goes out to a group of public health folks who are not only talking the talk, but walking the walk. Bike on!

Go out and play!: The role of parks in health

It should be no surprise that attendees at a Wednesday session on the role of parks in healthography didn’t sit still.

Audience members got out of their seats and gathered around a table of maps, giving input on how to improve a local park in Miami-Dade County, Florida, during a session on “The Role of Parks in Healthography: The Unique Contribution of Our Nation’s Greatest Resource to Health and Wellbeing."

Session presentations focused on improving and expanding parks and recreation spaces and programs via partnerships with the Miami-Dade County Parks, Recreation and Open Spaces Department and the University of Miami.

Attendees were asked to give their input about Marva Y. Bannerman Park, a park surrounded my multiple schools and located in one of the county’s low-income neighborhoods.

Suggestions included planting more trees, adding more street lighting to reduce crime, and building a playground or splash pad for younger children. One idea was to have an “edible forest” garden with nutrition educational labels for certain plants.

“The ideas that come out of this group today will be taken back to the people planning this park,” said Joanna Lombard, a professor of architecture at the University of Miami.

Presenters also looked at the impact of access to recreational spaces on people with the poorest health. A study of 250,000 Medicare beneficiaries ages 65 and older in Miami-Dade County, found that when comparing a low level of green spaces to a higher level of green spaces, there was a 15 percent difference in the prevalence of diabetes and a 13 percent difference in prevalence of hypertension in surrounding neighborhoods.

“We believe these are evidence that having more greenery in your environment may be beneficial by promoting opportunities for physical activity and possibly just time spent outdoors,” said session presenter Scott Brown, a research assistant professor at the University of Miami Miller School of Medicine. “South Florida is a subtropical climate, so you need shade trees to encourage people to spend time outside.”

The power of access to green space and recreation in improving health is evident in the Fit2Play program, an ongoing Miami-Dade County Parks, Recreation and Open Spaces Department initiative to get local kids more physically active.

The University of Miami Miller School of Medicine partnered with Miami’s parks department to see how effective the program was in keeping kids healthy. The university brought in its team of pediatric specialists to train parks department field staff in measuring the kids for data on blood pressure, waist and hip circumference and more.

Since 2010, more than 760 kids who participated in Fit2Play improved across the board in lowering blood pressure, improving cardiovascular fitness and increasing their knowledge about health and wellness, such as nutrition, said Sarah Messiah, a Miller School of Medicine research associate professor.

“Our kids who started the program obese for their age and gender actually lost weight throughout the school year,” Messiah said. “The kids who started normal weight, stayed normal weight. That’s just as important to prevent those kids that come in normal from gaining weight.”

— N.M.

Cue the media montage

The APHA 142nd Annual Meeting and Exposition is bursting with new science — so much science that it’s bound to find its way outside the walls of the New Orleans convention center. And, indeed, findings from the Annual Meeting have made it onto the pages and screens of news outlets around the country. For your public health reading pleasure, here is a quick round-up of Annual Meeting news coverage.

Time: The surefire way to eat healthier  

• North Carolina Health News: The cost of not wearing a helmet 

Philadelphia Inquirer: Home cooking helps keep the calories down


Baltimore Sun: Public health experts stress importance of trust in West Africa as they fight Ebola 

• Fox 8 Live News: Researcher releases study at NOLA Ebola conference 

• Obesity risk more likely to be higher for disabled adolescents 

U.S. News and World Report: Alcohol taxes may give boost to public health, economy 

• Medscape: Legislation fails to boost HPV vaccine uptake

Global lessons in disaster preparedness

“I wish I could have told that story to a larger audience this weekend,” said U.S. Army Lieutenant General Russel L. Honoré at a Wednesday morning session on disaster mitigation and U.S.-Cuba cooperation.

The story he is referring to occurred in 2005 when the Ernest N. Morial Convention Center, which is hosting this year’s APHA Annual Meeting, was a collection point for 60,000 people during Hurricane Katrina. Nine years ago, a hospital was set up in what is now the Public Health Expo hall and people filled the streets, desperately waiting for help. Mentally ill individuals were particularly hard to treat during the aftermath, as they had gone days without medication. It took a week to get elderly patients to safer locations. Buses were called in to evacuate people after the hurricane hit. In the end, action was taken too late for too many.

The devastating consequences of Katrina motivated Honoré to travel to Cuba to learn about that country’s disaster preparedness system, which had been proven to be effective and efficient. During the session, he noted that Hurricane Katrina passed through Cuba before it got to Louisiana; however, the negative impacts on Cuba were nowhere near the effects the storm had on New Orleans.

“Cuba is a country of 10 million and a poor country,” he said. “But their priority is to save lives.”

Guillermo Mesa Ridel, director of the Latin American Center for Disaster Medicine, discussed the strategies that Cuba uses to reduce the impacts of natural disasters and implement emergency preparedness plans. The country’s disaster mitigation plan is highly committed to prevention efforts: national drills prior to hurricane season and the training of carrier pigeons as a method of emergency communication are some of the innovative ways that Cuba prepares for disasters. Ridel also emphasized the importance of not creating new vulnerabilities during the disaster recovery phase.

The session presenters highlighted lessons that the United States could learn from Cuba, a country that considers disaster preparedness to be part of their culture. In fact, the Cuban definition of a disaster is not the natural event that takes place, such as a hurricane. The true disaster is the aftermath — damage to infrastructure, economic consequences and especially the loss of life.

A Cuban citizen among the audience concluded the session with these thoughtful words: “For every Cuban person, a disaster happens when one person dies.”

— S.L.

Above photo: Earlier this week, APHA Executive Director Georges Benjamin, left, signed a memorandum of understanding with C. Alcides Ochoa Alonso, right, president of the Cuban Society of Public Health. The memorandum formalizes a partnership between the two organizations aimed at strengthening public health capacity and leadership in the Americas. Photo by Michele Late, courtesy APHA Flickr

Here’s how public health finally won the soda debate

Attempts to enact soda taxes have failed over and over again, in big cities and small communities. And all that losing is precisely why public health has finally won.

On Nov. 4, 75 percent of Berkeley, California, residents voted in favor of Measure D, an ordinance to impose a 1-cent-per-ounce tax on high-calorie sugary drinks. It was the first-ever soda tax to pass in the U.S. by popular vote, and presenters at Wednesday’s session on “Beverages: Promoting Healthy Choices” explained how it happened.

According to session presenter Pamela Mejia, of the Berkeley Media Studies Group, the California cities of Richmond and El Monte as well as Telluride, Colorado, failed to pass similar measures in 2012 and 2013 — and that failure helped change the conversation surrounding the soda debate from one framed by big soda corporations to “authentic community voices,” Mejia said. (FYI: Fifty-five percent of San Franciscans voted for a 2-cents-per-ounce soda tax this past November as well, however that proposal needed two-thirds of the vote to pass into law.)

“As my boss Lori Dorfman said, Richmond and El Monte threw big pebbles in the soda tax water,” Mejia said. “Berkeley and San Francisco have pushed boulders in.”

The media played an integral role in past soda tax failures, including at least 30 failed ballot measures, as well as in the recent voter breakthrough, according to Susan Klitzman of the CUNY School of Public Health. Mejia found 653 news articles covering the tax proposals in Richmond, El Monte and Telluride. Among the articles, anti-tax sentiments were more frequently visible, insinuating harmful ramifications for local economies and personal freedom.

Perhaps not surprisingly, most of these messages were covertly paid for by the soda industry, including almost $4 million from the American Beverage Association spent in Richmond and El Monte alone.

“Local anti-tax coalitions were very powerful,” Mejia said. “It’s important to know your opposition and what they will say.”

Across the country, the first citywide soda size limits almost passed in New York City in 2012, after the New York City Board of Health proposed capping the size of sugary beverages served in restaurants and movie theatres at 16 ounces. Klitzman said that a LexisNexis search of news articles and opinion pieces were heavily skewed against the tax — 52 in opposition, 17 in favor — thanks to a large corporate influence. New Yorkers for Beverage Choices, a group financed by the soft drink industry, launched well-funded public and media relations efforts as well as political and legal campaigns against the rule, Klitzman told session attendees. Also, the corporate-funded Center for Consumer Freedom ran a full-page ad in The New York Times with a tagline, “New Yorkers Need a Mayor, Not a Nanny.”

Ultimately, the limits were approved in 2012 but overturned by New York courts, which also rejected the city’s final appeal in June. Still, session presenters called for continued perseverance, education and messaging.

“Be persistent,” Klitzman said. “Building political will takes time. To do so, we need to better educate top reporters and the media folks about the issue.”

— D.G.

Above, a campaign poster from Berkeley vs. Big Soda.

When it comes to food, place matters

A photo of the Circle Food Store in the heart of New Orleans shows the place submerged in six feet of water in the days just after Hurricane Katrina hit. But thanks to the work of a public-private partnership known as the Fresh Food Retailer Initiative, which is aimed at improving food access in underserved areas, the same store is now thriving. And they’re known for the cheapest bell peppers in town (usually four or five for just $1).

During a session on “New Orleans Foodography: Place-based Food Access Issues in the 10th Year After Katrina,” researchers and health advocates talked about ways the area continues to recover. Even before being devastated by the hurricane, New Orleans was an area that, like many cities, was home to many low-income, minority communities with no grocery stores and few healthy food options. The key to change, however, was partnerships.

Getting grocers and the grocery industry on board is a critical step to improving food access, said session presenter Julia Koprak of the Food Trust. Another local success story she shared: a once-abandoned, boarded-up building on North Broad Street and Bienville Avenue that’s now an “innovative, fresh-food hub.” Known as the ReFresh project, it includes a Whole Foods Market, a cooking school for at-risk youth and a community garden.

Other presenters talked of the challenges both in measuring food access and in getting residents in underserved communities to adopt what’s known as alternative food networks, which could include farmers markets and community-supported agriculture.

Over at Tulane University, the Prevention Research Center is working to prevent or reduce overweight and obesity in the greater New Orleans area by shedding light on the social and physical environment factors that impact people’s physical activity levels and diet. Presenter Yuki Kato of Tulane's Department of Sociology worked to understand why residents of the local Hollygrove neighborhood, which is predominantly black and low-to-middle-income, were not buying fresh produce at a newly opened market. The market offers a weekly $25 box of produce or a la carte purchases, with no membership required.

What Kato and her colleagues discovered was that the market had become popular with nearby residents from higher-income areas, but not among residents in Hollygrove. One big challenge: Hollygrove residents weren’t on Facebook or Twitter, which is where the market was posting weekly specials and other information. Kato said that “digital divide” needs to be addressed in future outreach efforts.

Today, researchers at Tulane and elsewhere are working to track the ways stores and markets can help people live healthier lives. Check out this roundup of the Prevention Research Center’s recent work and learn more about ways to get healthy food projects off the ground from the Food Trust.

— D.C.

For the win: APHA honors public health leaders

Congratulations to all of the honorees at last night's annual APHA Public Health Awards Reception & Ceremony. During the event, public health practitioners were recognized for their perseverance, advocacy, innovation and dedication to the health of all. It was another night of public health passion in action!

Above photos from top to bottom: Howard Koh, former U.S. assistant secretary for health and currently a professor at the Harvard School of Public Health, accepts the Sedgwick Memorial Medal, APHA's most prestigious and oldest award that recognizes distinguished service to public health; outgoing APHA President Joyce Gaufin presents former U.S. Surgeon General Joycelyn Elders with the Presidential Citation; XinQi Dong, of Rush University's Institute for Healthy Aging, accepts the APHA Award for Excellence, which honors meritorious contributions to health; past APHA President Deborah Klein Walker, right, presents Nancy Stoller, faculty at the University of California-Santa Cruz, with the Victor Sidel and Barry Levy Award for Peace; and APHA Executive Director Georges Benjamin presents this year's Help Us Help Them donation — of more than $30,000! — to the Second Harvest Food Bank of Greater New Orleans and Acadiana. Photos by Jim Ezell, courtesy EZ Event Photography

A picture's worth a thousand words

When Aaron Shirley was hospitalized in Mississippi decades ago, his room was in the basement. The only way his kids could visit was to stand outside and talk to him through a window.

“It was difficult to explain to them why I was in the basement,” Shirley said in a film titled “The Power to Heal,” which was shown during yesterday’s late afternoon Film Festival session. That film, which detailed the horrendous racial segregation of the nation’s hospitals and how dedicated health care volunteers and civil rights activists pressed for change, was just one of the many offerings of this year’s film festival. Organized by the Health Communications Working Group of the Public Health Education and Health Promotion Section for 11 years running, the festival showcases some of the best in health communication work.

Storytelling is an effective technique used in many of the films. One film told the story of 35-year-old Roberto Garcia, who suffocated under the weight of palm fronds while trimming a palm tree in California. The film, dedicated to Garcia and his family, outlined safety measures to prevent future palm tree worker deaths and was used to promote worker safety during Workers’ Memorial Day. Another film, based on a true story, featured the story of a mother reunited with her 16-year-old daughter after 12 years. The child’s father had kidnapped her and taken her from Italy to the United States. The reunion was complex, to say the least.

From promoting dental hygiene among children to stories of pregnant moms and efforts to shed light on the danger of mercury poisoning, the films offered a fascinating look at health issues. One film showed the transformation of an apartment complex to a smoke-free living facility and how such moves not only benefit people’s health, but property owners’ bottom lines a well.

Gary Black, who has organized the film festival from it inception and has a passion for health communications, told session attendees that he hoped they would be inspired to make their own public health films. Some of those films are high budget and slickly produced, he noted, but some cost as little as $1,500 to make. He pointed out that Laura Styles, who produced the film on preventing palm tree worker fatalities, was sitting in the film festival audience just a few years ago when she became inspired to start producing films herself.

APHA Film Festival offerings are being shown today through 2 p.m. in MCC 207. Come see what all the buzz is about.

— D.C.

Above, "Preventing Palm Tree Trimmer Fatalities" from the California Department of Public Health

Reproductive rights advocates: 'Reclaim that moral high ground'

P. Ellen Parsons was a scientific researcher and a champion for women’s health and public health. It only makes sense, then, that Parsons is remembered with a session that reminds public health advocates that her work is not done.

At Tuesday’s “P. Ellen Parsons Memorial Session: Stirring the Pot to Defend Women’s Rights in New Orleans and Nationally,” representatives from four organizations spoke of their work to defend reproductive health access for women, especially poor women, in Louisiana and beyond.

Louisiana is a particular microcosm of the ways reproductive health access, and especially abortion access, has been restricted. In Louisiana, many laws are designed to restrict providers from offering abortion care: a mandatory 24-hour waiting period; mandatory counseling and ultrasound (done 24 hours before the abortion, requiring two separate trips to the clinic); and a 20-week gestational limit. Similarly, laws are also designed to restrict women from getting abortions they want: Medicaid does not cover abortion in Louisiana; women younger than 18 must have parental consent or a judicial bypass (requiring young women who are not able to talk to their parents about needing an abortion to talk to a court instead, often without legal representation); and there are only five clinics that provide abortion statewide.

And despite the fact that by age 45, one in three women will have had an abortion, women who do seek the procedure still face stigma.

“Despite all the restrictions and stigma, our phones keep ringing,” said Jessie Nieblas, a board member of the New Orleans Abortion Fund, an all-volunteer nonprofit organization that offers some financial assistance to women who cannot afford their abortions on their own. The fund's clients are mostly women of faith, women of color and women who are either in school or working, but need financial help. Most already have an average of two children they are caring for.

In New Orleans specifically, disparities in health, access and vulnerability are painfully clear, according to session presenters.

“We know what happens after disaster,” said Lisa Richardson, director of research and evaluation at the Institute of Women and Ethnic Studies. “We know there’s heightened vulnerability.”

And it’s not just women seeking abortion who are affected. Amanda Dennis, an associate at Ibis Reproductive Health, pointed out that across the country, as the number of abortion restrictions in a state increase, the number of policies that support women’s and children’s well-being actually decrease.

So what can public health advocates do? Stand for the facts and be vocal about them, for one thing. Renee Carter, chair-elect of APHA’s Medical Care Section, told session attendees that it’s the responsibility of public health leaders to be advocates for reproductive health. We need to remind lawmakers that when women’s right to abortion was legalized with Roe v. Wade, deaths related to abortion decreased dramatically. Session presenters urged: Tell policymakers that abortion restrictions do not eliminate abortion, but that they do encourage unsafe abortion.

“What is our responsibility," Carter asked. "We need to feel obligated and take action."

And advocates must also “reclaim that moral high ground,” Nieblas concluded. “Because we are right. We are the ones advocating for better outcomes and better access.”

— L.W.

Former Surgeon General Antonia Novello: 'You do not invent policy out of fear'

Need a little extra energy on this last day of a jam-packed 142nd APHA Annual Meeting? We've got you covered. Video of Monday night's general session with five former surgeons general and current Acting Surgeon General Boris Lushniak is now up and ready to inspire. Above is video of Antonia Novello, the 14th surgeon general, who brought the house down with her remarks. For all the video coverage, visit APHA's YouTube page.

APHA Storify: Expo!

This morning's Storify post features all the fun and festivity of the Public Health Expo. Today's the last day to check out the hundreds of public health booths — the Expo will close its doors at 12:30 p.m.

Tuesday, November 18, 2014

Wednesday’s Have You Heard

Nursed back to health: Learn about the role that public health nurses can play in building a culture of health at session 5080, “Public Health Nursing and Policymaking,” from 8:30 to 10 a.m. in room 222 of the Ernest N. Morial Convention Center. The session will feature presentations on smoke-free campuses, rural health and much more.

Last call: The Public Health Expo closes its doors early today, so don’t miss your chance to peruse hundreds of public health booths. The Expo, which is located in Halls B/C of the convention center, is open on Wednesday from 8:30 a.m. to 12:30 p.m.

Pro-health, pro-choice: Women’s reproductive health is in real jeopardy, with legislators across the country passing proposals that limit access to services that are central to women’s health. Discuss the problem during session 5093, “Separate and Unequal: The Political Geography of Reproductive Rights, Reproductive Justice and Reproductive Health,” from 10:30 a.m. to noon in the Rivergate room of the convention center.

Pencils down!: For the first time, public health practitioners will be taking the Certified in Public Health Exam on site at the Annual Meeting. To learn more about studying for and registering for the CPH exam, visit the National Board of Public Health Examiners.

Temporary work, permanent injury: Temporary workers face unique hazards on the job — and they’re hazards that are becoming more common as the temporary workforce grows. Hear from experts on the emerging issue in session 5184, “Precarious Work: Day Laborers and Temp Workers,” from 12:30 to 2 p.m. in room 340 of the convention center.

Not good-bye, just see you later: Wrap up your 142nd Annual Meeting experience with our Closing General Session from 2:30 to 4 p.m. in the Great Hall of the convention center. This year’s closing will feature remarks from Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation, on strategies to build the healthiest nation in one generation. Other panelists will include Mary Wakefield, administrator of the Health Resources and Services Administration; J.T. Lane, assistant secretary of the Louisiana Department of Health and Hospitals Office of Public Health; and Howard Koh, former assistant secretary for health.

Above, Annual Meeting attendees smile for the camera. Photo by Natalie McGill, courtesy APHA Flickr

Support tobacco-free retailers! (And partner with your local pharmacist!)

When William Shrank, chief scientific and medical officer at CVS Health, first started working at CVS, he and his young daughter stopped by the retailer to pick up a snack. When they got to the cashier, she looked behind the register counter at the wall of cigarettes. She looked up at her dad and asked, “You’re a doctor. How can you be selling cigarettes?”

She promptly told him to tell Troy to do something about it. (That’s Troyen Brennan, executive vice president and chief medical officer at CVS.) It just so happened that this adorable story took place around the same time that CVS actually was considering eliminating tobacco from its stores. And as we all know, CVS eventually did kick tobacco to the curb in September, dropping a product that previously brought the company $2 billion in annual revenue. When Shrank showed his daughter the newspaper headlines about the landmark decision, she was so excited that she told everyone at school that she made it happen.

Of course, the CVS decision to stop selling tobacco involved a lot more than the pleas of a young girl. But her excitement is a sign of a major cultural shift in how we think about tobacco, and CVS’ decision is emblematic of a smoke-free cultural norm that public health helped to build over five decades of anti-tobacco efforts.

“We’re all recognizing more and more that health does not just happen when the patient is sitting in front of the doctor — health happens between those visits to the doctor,” Shrank told attendees during a Tuesday session on “Prescription for Health: Tobacco-Free Pharmacies.”

In the new health care environment ushered in by the Affordable Care Act, we all have to start caring more about what our patients are doing in between visits, said Shrank, noting that CVS Health is the largest retail clinic operator in the nation. In that vein, CVS had long been working to leverage all of its resources toward promoting higher quality and lower costs. But lurking in the background of the company’s drive to promote health was a giant inconsistency — CVS sold tobacco and helped heighten the visibility of the deadly product every time a customer went up the register only to be confronted with a wall of tobacco marketing.

“We took a close look at ourselves,” Shrank said. “We can not purport to be a company focused on health if we are responsible for selling the source of the single most preventable cause of illness in the U.S.”

Today, millions of CVS customers no longer see a wall of cigarettes when they enter and exit the retailer. Instead they see promotions for the company’s many cessation programs and aides. This is public health in action.

“We’ve been really humbled by the support that we’ve gotten from the community, far more than any of us anticipated,” Shrank said. “It’s done big things for morale at CVS and helped us coalesce around this deep, profound vision and belief that we can do something meaningful.”

CVS Health got a lot of applause at the Tuesday session, including a jubilant shout-out from session presenter Fred Mayer, president of Pharmacists Planning Service, Inc., a California nonprofit that offers a wealth of health awareness programs, from smoking cessation in January and February to poisoning prevention in March to cell phone safety in August. (And Mayer was adamant — “Use our campaigns!” he urged attendees.)

Mayer said that his organization launched its first smoking cessation campaign 50 years ago, and having pharmacists on board was key. On many occasions during the session, he urged attendees in seriously enthusiastic fashion to reach out and partner with local pharmacists.

“We are the most available, acceptable and accessible of all health care people,” he said. “Anybody can walk into a pharmacy.”

Mayer said that following the CVS move, he and his colleagues are going after Walgreens to do the same. Spread the message, he said, that dropping tobacco is good for the bottom line.

“You can make more money by being good,” Mayer said. “It’s all about making money, folks…that’s the game.”

To learn more about the CVS decision and ways to build public health-private partnerships to end tobacco use, check out this webcast of an APHA-CVS symposium held in September.

— K.K.

Healthography in the Americas

“There is no doubt that this is a disease of the poor,” explained Jennifer Crowe from the National University at Costa Rica. “This is drastically clear.”

Crowe, a panelist at a global health session on environmental health in the Americas, discussed chronic kidney disease of unknown origin in Central America. Unlike kidney disease related to common risk factors, such as diabetes, hypertension and obesity, very little is known about the cause of chronic kidney disease of unknown origin, which has occurred mostly on the Pacific coast of the region.

What is known is that it’s related to the social determinants of health, such as income, and it usually affects men, particularly sugar cane workers. In fact, farmworkers, workers who perform hard labor and those who live in regions where the condition is prevalent are particularly vulnerable to this type of kidney disease.

The leading hypothesis as to what causes chronic kidney disease of unknown origin is exposure to extreme heat and dehydration, Crowe told attendees at the Tuesday session. However, others researchers have put forth theories surrounding the role of nephrotoxins, such as pesticides. Crowe noted the desire of researchers to “latch on to one hypothesis” to explain this disease; but the reality is that the exact cause is largely unknown and the illness is most likely caused by several factors.

Chronic kidney disease is one of the many environmental health issues that are burdening populations in the Americas and overwhelming the region’s health care systems. Horacio Riojas Rodriguez, a presenter from the National Institute of Public Health of Mexico, discussed another environmental health problem of serious concern: air pollution.

Health issues caused by outdoor air pollution, which affects about 36 million people in Mexico alone, have increased alongside urbanization and population growth — and it’s a concerning trend considering the Americas is the most urbanized region in the world. Additionally, another 22 million Mexicans are exposed to indoor smoke associated with the burning of solid fuels inside the home. In an effort to reduce health issues caused by air problems, the country has worked to establish air quality monitoring stations and programs that promote the use of clean cookstoves, Rodriguez said.

The session’s presenters were brought together by the Pan American Health Organization, which is working to address the health issues and inequalities caused by global environmental changes. In an effort to tackle these problems in an organized manner, PAHO is working to support and strengthen a collaborative network in Latin America to positively impact environmental health policy and drive promising solutions.

Visit PAHO to learn more about the organization’s environmental health efforts.

— S.L.

A little birdie told me so: Tweet of the day

Today's tweet of the day is all about self confessions and good decisions. It's also a reminder that public health policy works!

APHA adopts 16 new policies

Earlier today, APHA's Governing Council officially adopted 16 new policies that will help guide the Association's actions and activities. The policies cover a range of topics, such as bullying and gay youth, the regulation of electronic cigarettes, and protecting workers from Ebola and other infectious diseases. To read short summaries of all 16 newly adopted policies, check out this APHA news release.

Labor of love

On its 100th anniversary, APHA's Occupational Health and Safety Section members were greeted with a special video message from David Michaels, U.S. assistant secretary of labor for occupational safety and health, during their celebratory centennial session earlier today. During his remarks, Michaels acknowledged the great progress that's been made in protecting worker lives and health.

Still, he said, 12 U.S. workers die every day due to work-related injuries, and advocates continue to face industry opposition to worker protection efforts. Michaels called on session attendees to bring the plight of vulnerable workers to the public — to convince people that it's not just about the quality of the product, but the quality of the working conditions from which the product came.

Happy anniversary OHS Section! Keep up the good fight!

Can we patch the umbrella?: The fight for Medicaid expansion

Advocates like Heidi Sinclair of Doctors for America are working hard to encourage Medicaid expansion in all states because when it comes to health coverage, “we have an umbrella with a hole in it,” she said during this morning’s session on Louisiana’s fight for Medicaid expansion.

Her group has active campaigns in 13 states that have yet to expand Medicaid to cover people with incomes up to 133 percent of the federal poverty level. For example, in Texas, which has the nation’s highest rate of uninsured residents at 24 percent, nearly 785,000 people fall into the “coverage gap” left by not expanding Medicaid. In Florida, the number is nearly 1 million.

But the group’s advocacy has helped turn the tide in Arizona, Ohio and Pennsylvania, three states that initially opted not to expand coverage but then changed course.

“Nothing could save more lives in terms of health policy in the United States in this decade than following up with Medicaid expansion,” said session moderator Ramon Castellblanch of San Francisco State University.

Alma Stewart, a leader for Medicaid expansion in Louisiana who organized Saturday’s rally near the convention center, stressed that the fight for expansion is about improving health. Louisiana consistently ranks low in the yearly America’s Health Rankings report, most recently coming in 48th on measures such as obesity, physical inactivity and percentage of children living in poverty.

“That’s the reason why it’s important for us to really advocate and do the work,” said Stewart, president and founder of the Louisiana Center for Health Equity.

The coalition Healthcare For Everyone In Louisiana has held “Dying for Coverage” vigils and reached out to lawmakers to stress the need for change, Sinclair told session attendees. She estimated that up to 260,000 people in the state fall in the coverage gap. In many of the states where doctors are pushing for expansion, the focus is no longer on changing the opinions of state policymakers but on getting the public into the fight.

“Probably our best bet at this point is an emphasis on advocacy in the community rather than trying to sway the legislature,” she said.

Everyone can play a role in helping bring health coverage to more Americans, the presenters said. Check out APHA’s action alert on protecting the Affordable Care Act for starters.

— D.C.

Most musical meeting ever!

Attendees at a Tuesday morning session celebrating the 20th anniversary of APHA's Spirit of 1848 Caucus were surprised with a joyous jazz performance and definitely found their New Orleans spirit!

Photos by Michele Late and Kim Krisberg

Mentor programs groom young adults to become public health leaders

Many teens are used to being taught by someone else, whether it be a schoolteacher or a parent.

But when it comes to developing the next generation of public health workers, sometimes it’s better for the teen to become the teacher.

Presenters at Tuesday’s "Mentoring Models to Engage Youth as Active Public Health Leaders" session highlighted how young adults across the country are taking charge of programs that not only improve their health but the health of their families.

In the No Heart Left Behind program, Delaware teens learn about nutrition, cardiovascular disease risk and behavioral health, then use that knowledge to serve as teen coaches, said session presenter Lanae Ampersand of Christiana Care Health System in Wilmington, Delaware. As a coach, the teens teach their parents both at home and at outside educational events, such as at dance classes, how to improve their families’ health. Christiana Care partners with school-based health centers and schools to put on the program.

“Our teen coaches felt like it was a lot of fun,” Ampersand reported. “We got to see them say, ‘Wow I can do this. I can make a difference. Adults listen to me.’”

Since receiving funding in 2012, No Heart Left Behind has reached over 5,000 adults and teen coaches, with staff tracking more than 600 adults and teens over three years.

Teens self-reported an increase in the daily average of vegetables they eat, from 2 to 2.2 servings. Adults increased their daily fruit servings as well, from 1.9 to 2.3 servings — a 20 percent increase, Ampersand said.

“We were able to focus on educating an underserved population,” Ampersand said. “You teach the teen and you can see them teach the family member. And the family member…they’re sharing with their co-worker, at church. You can start to see how it can spread the message to the community as a whole.”

To the north up Interstate 95 in Philadelphia, high school students in the Teens 4 Good program participate in an urban community garden effort, in which they learn about farming, business operations and nutrition education during a six-week summer internship.

“They decide how much they’ll sell things for, what things will be planted,” said session presenter Katelyn Hurley of Thomas Jefferson University’s Department of Family and Community Medicine, where she conducted research on the program. “Our teens really appreciate the opportunity to be heard and for actions to be taken as they provide suggestions for this business.”

Surveyed teens who had participated in the program for multiple years said the experience forced them to break out of their shells and become leaders to guide the newer students. The teens also said they learned a variety of work readiness skills, such as the importance of being dependable and showing up to work on time, Hurley said.

Running since 2005, Teens 4 Good allows young people to not only gain a deeper understanding of workplace and leadership skills, but the health issues facing their communities, such as food insecurity, Hurley said.

— N.M.

Above, Lanae Ampersand speaks during Tuesday’s “Mentoring Models to Engage Youth as Active Public Health Leaders” session on the No Heart Left Behind Program. Photo by Natalie McGill

Public health giants among us

Who was more wowed during yesterday’s general session, “The Doctors Are In” — the surgeons general or the audience?

“I’m like a little kid in a candy store, to be so blessed among such incredible public health lions,” said Acting U.S. Surgeon General Boris Lushniak shortly after taking the stage.

Joycelyn Elders, who took the helm of the U.S. Office of the Surgeon General in 1993, gave props to the public health community for making a huge difference in teen health.

“It is you and the public health service that has reduced our teenage pregnancy rate 57 percent,” she said to applause. Then she called on all of us to work to make our nation healthier.

“We all want healthy people and healthy communities,” Elders told session attendees. “We want a health care system that’s available, affordable, accessible and crisis-responsive. It needs to be patient-oriented.”

As APHA and other groups are urging Senate confirmation of surgeon general nominee Vivek Murthy, which has been stalled due to politics, former Acting Surgeon General Steven Galson called on colleagues to forge ahead. Don’t use the Senate impasse as an excuse not to pursue “a vigorous public health agenda,” he said.

“Leadership in public health does not require Senate confirmation,” Galson said, also to great applause and cheers from the crowd. “Yes, worry about the decline of the position of surgeon general, but don’t let that stop any one of you from being a public health rabble rouser and focusing on science and focusing on clear issues.”

When APHA Executive Director Georges Benjamin asked each of the surgeons general how we can push ahead with our goal to create the healthiest nation in one generation, they had solid advice.

Elders said we need to empower patients to get more involved in their own care.

 “You’re the leaders,” she said. “You’re the transformational leaders who will make the difference if we’re going to have a healthy society.”

Antonia Novello, who was the first woman to serve as surgeon general and knows a thing or two about blazing new trails, said to create the healthiest nation, we must speak the right language.

“Prevention cannot work unless you understand the culture of the people,” Novello said.

The most recent surgeon general, Regina Benjamin, said we need to work hard to spread truth.

“There’s so much misinformation out there — so much bad information — and people take advantage of the lack of knowledge to instill fear,” she said. “Trust is the biggest thing that we’re missing right now. Be a trusting voice for the American people.”

Former Surgeon General David Satcher, who founded the Satcher Health Leadership Institute at Morehouse College, said health disparities need our attention.

“We have a saying at the institute,” he told attendees. “In order to eliminate disparities in health we need leaders. We need leaders, first and foremost, who care enough. But we also need leaders who know enough. And we need leaders who will persevere until the job is done.”

So get out there and persevere. Be public health rabble rousers!

— D.C.

Above photos from top to bottom: Public health practitioners flock to meet former U.S. Surgeon General Antonio Novello after yesterday's Monday General Session; and APHA Executive Director Georges Benjamin, far right, applauds the surgeon general-packed session. Photos by Jim Ezell, courtesy EZ Event Photography

Experienced the Expo yet?

Empty out that APHA Annual Meeting tote bag, stop by the Public Health Expo and fill up on tons of free public health swag! The Expo, which is located in Halls B/C of the Ernest N. Morial Convention Center, will be open today until 5:30 p.m. and Wednesday from 8:30 a.m. to 12:30 p.m.

Above photos from top to bottom, members of APHA's Lesbian, Gay, Bisexual and Transgender Caucus of Public Health Professionals and Public Health Social Work Section greet visitors at their booths at the Public Health Expo; Annual Meeting attendees peruse the poster sessions at the back of the Expo; and lastly, an aerial overview of the giant Public Health Expo. First two photos by Michele Late, courtesy APHA Flickr; last two by Jim Ezell, courtesy EZ Event Photography

Community health workers reaching world's most vulnerable

“I am always surprised by what community health workers can do,” said Jennifer Weiss, a health advisor at Concern Worldwide, “They can do a lot!”

At a Monday global health session on the role of community health workers, Weiss was one of four presenters who spoke about the importance of empowering CHWs and providing them with skills to combat preventable diseases. According to the World Health Organization, CHWs are typically local volunteers with limited training who are chosen by their communities to help improve the health of local residents. The session highlighted why this approach holds such promise in areas where resources are scarce and health workers are few.

The presenters hailed from organizations funded via the U.S. Agency for International Development’s Child Survival and Health Grants Program and working in the African nations of Niger, Kenya and Zambia. In an effort to reduce preventable child and maternal deaths, the organizations’ projects trained CHWs to provide health care in their own communities.

For example, in Niger, Concern Worldwide worked with 21 mothers in a region where only 53 percent of the population lives near a health care facility. The mothers were shown how to treat pneumonia and diarrhea, test for malaria, and identify the signs of serious malnutrition in children. Because the mothers had low reading and writing skills, CHWs used pictures to train them in how to deliver the potentially life-saving services. Over the course of the program, the mothers provided more than 5,000 treatments, and the treatment of malaria and diarrhea nearly doubled.

A similar project in Kenya organized by HealthRight International trained 1,000 CHWs to provide health education and refer serious cases to appropriate health services. CHWs also learned to recognize the common signs of danger during pregnancy, birth and post-delivery. Such knowledge is vital, as deaths among newborns in Kenya are much higher within community settings than within health facilities.

The final project highlighted at the Annual Meeting session and which was organized by Save the Children took place in a rural region of Zambia — a region that welcomed its first district hospital in 2013. The goal of the project was to create partnerships between CHWs and health professionals. Among the CHWs’ new duties was to accompany pregnant women to health facilities to give birth and as a result, deliveries at the facilities increased significantly.

While the highlighted CHW projects enjoyed success, they also faced a number of challenges, presenters reported. One of the biggest challenges was a lack of CHW supervision, which stemmed in large part from a shortage of skilled health care professionals. Another concern is the quality of the care that CHWs provide. Nevertheless, the projects demonstrated that CHWs do indeed hold great potential for providing desperately needed care in their communities and that their contributions can ultimately save lives.

— S.L.

APHA Storify: Public health rock stars (also known as the surgeons general)!

This morning's APHA Storify rounds up some of the best reactions to yesterday's Monday General Session featuring five former surgeons general as well as current Acting Surgeon General Boris Lushniak. As one audience member tweeted: "Just a panel of straight bosses."

Monday, November 17, 2014

Tuesday’s Have You Heard

Place matters: Get your healthography on with APHA Special Session 4109, “When ZIP Code Trumps Genetic Code: The Power of Prevention, Community and Convergence,” which runs from 10:30 a.m. to noon in the Rivergate room of the Ernest N. Morial Convention Center. The session will feature remarks on health equity, community transformation, social bonds and much more.

Rest those weary feet: Stop by the Mix and Mingle Lounge right in front of the entrance to the Great Hall in the convention center, take a break, catch up with friends, take advantage of free WiFi, put on some locally inspired props and have fun in the photo station.

Veteran health and homelessness: Learn how to help those who’ve served and sacrificed for us at “Medical and Behavioral Health Care for Veterans Who Are Homeless,” session 4212, from 12:30 to 2 p.m. in Eglinton Winton of the Hilton New Orleans Riverside. The session will feature presentations related to Medicaid expansion, brain injury, behavioral health, Social Security disability benefits and more.

Poster-rama: Don’t miss out on the wealth of public health research being offered at poster sessions throughout Tuesday as well as Wednesday morning in the back of the Public Health Expo. Check the Annual Meeting program for times and topics.

Take this job and love it!: Looking for career advice? You’ve come to the right place. Stop by APHA CareerMart located within Everything APHA at the Public Health Expo for information on posting resumes, signing up for private career coaching and even meet with potential employers.

It’s a chemical world: The harmful effects of chemical exposures often first appear in worker populations. Check out session 4448, “Chemicals and Occupational Health Risks,” to hear presentations on topics such as work-related exposures and breast cancer, the health of nail salon workers and efforts to eliminate carcinogenic exposures among auto workers.

Roll out the red carpet: Say congratulations to this year’s exceptional public health practitioners at the annual APHA Public Health Awards Reception & Ceremony, which is held Tuesday evening from 6 to 8:30 p.m. in rooms 220-222 in the convention center. Among this year’s honorees are Howard Koh, former U.S. assistant secretary for health, as well as former U.S. Surgeon General Joycelyn Elders.

Above, Annual Meeting attendees have fun with props in the Mix and Mingle photo station in the convention center. Photo by Michele Late, courtesy APHA Flickr

Motivational messaging

Let's end this Monday of the APHA Annual Meeting with a little lift-me-up to bring you into Tuesday and a teaser of our coverage of the surgeon general-packed Monday General Session, which we'll post tomorrow morning. Below is video from Acting Surgeon General Boris Lushniak's Opening Session presentation on Sunday as well as an APHA TV interview with our very own APHA executive director, Georges Benjamin.

Join the public health movement

How can we reach our goal of creating the healthiest nation in one generation?

Everyone’s going to have to work together toward “bold, transformative change,” said Steven Woolf, of Virginia Commonwealth University, during today’s session on “Healthiest Nation in a Generation: Linking Science and Policy.”

“We really do have to start changing the conversation away from health care and physical health,” said Paul Jarris, executive director of the Association of State and Territorial Health Officials.

APHA Executive Board member Paul Meissner, who also chairs the APHA Strategic Planning Committee, asked session attendees to brainstorm ways we can measure whether we’re closing in on the goal of improving the nation’s health. We need to do so, as many of the panelists pointed out, because data is a key driver of change.

Woolf shared some data based on a study of 17 developed countries that found the U.S. does poorly — in fact, it often places dead last — on many measures of health. And our high obesity rates, lower life expectancy and other bad grades in comparison to our peer countries don’t boil down to simple answers.

“There is no single explanation that could account for all these different problems,” Woolf said.

The U.S. has the highest child poverty rates of the 17 countries in the study, and that’s been the case since the 1980s. Americans eat more calories than people in other developed countries, and we tend to have less investment in social services, social programs and safety net programs. To read the data for yourself, download a copy of “U.S. Health in International Perspective: Shorter Lives, Poorer Health.”

“If we keep doing what we’re doing now, it’s pretty clear that’s not going to work,” Woolf said. “A lot would have to change just to get us to average.”

Want to help turn the tide? Sign APHA's healthiest nation pledge. And check out our Healthiest Nation in One Generation pages online.

— D.C.

In the above video, Steven Woolf talks about U.S. health in an international context. Video courtesy the National Academies

A little birdie told me so: Tweet of the day

Today's tweet of the day comes from @deenachisolm, who indulged in a little local flavor. Looks delicious! 

Walking the walk

Public health students from the University of South Carolina brave the cold and don their Mardi Gras beads for today's walking tour of New Orleans, which was organized by APHA's Physical Activity Section.

Photo by Kim Krisberg

Fighting Ebola with #FactsOverFear

“How very little can be done under the spirit of fear.” — Florence Nightingale

During today’s standing-room only special session on the Ebola outbreak, panelists talked about what we all can do to help respond to one of the most challenging public health problems of our time.

“Ebola requires outside-of-the-box thinking,” said session presenter Kim Kargbo, president and CEO of Women of Hope International (, who asked the packed audience to get involved in the response. “It’s also an all-hands-on-deck situation.”

Lack of trust has been a huge barrier to controlling the outbreak in West Africa, said Timothy Roberton, of Johns Hopkins University. He went to Guinea in July and August to interview Red Cross volunteers who were working to educate local residents about Ebola and help stop its spread. In one village, according to a volunteer, the people would not allow anyone to disinfect the body of a deceased taxi-motorcycle driver suspected of dying from Ebola.

The volunteer’s account, relayed by Roberton: “We went to negotiate with the family, but they said ‘no, don’t touch the body, it’s not Ebola.’ They even used stones and clubs to hit us. So the community themselves buried the body. Now, after two weeks, there has been devastation. More than 20 to 30 people have died there. Eventually, when people realized how much death there was, they came to pray at our feet and told us that if there is a death, we can go there.”

Kargbo told a heart-wrenching story of a woman named Sally in Sierra Leone who first lost her mother to Ebola, then also a daughter before dying of the disease and leaving a 2-week-old baby orphaned.

Nigeria’s ability to eradicate Ebola has hinged on a vigorous public health response, said panelist Olajide Idris, commissioner of health for the Lagos state. That included outreach via radio and social media, a help line and website, and, most importantly, he said, “we went into the community” to debunk rumors, conduct training on personal protective equipment and work in close partnerships with local leaders.

 “We’re not out of the woods yet,” Idris said. “We continue to be vigilant.”

A huge part of the public health response to the outbreak, Roberton said, should involve working to build trust in the most impacted areas.

“We need people in communities to adopt protective behaviors, but these behaviors have profound implications for families,” he said. “It’s not a simple thing to tell a mother she cannot touch a sick child if he has a fever.”

Panelist Emmanuel d’Harcourt, physician and senior advisor for the International Rescue Committee, promoted a new report called “A Different Kind of Army” that outlines what fighting Ebola effectively should look like.

 “The good news is that Ebola is very beatable,” d’Harcourt said. “It is imminently possible to stop Ebola and even to keep it from coming in the first place.”

On the anti-fear front, panelists talked of using the science to educate people about the likelihood of contracting Ebola.

“It’s important to treat the fear of Ebola with a significant dose of reality,” said session presenter Catherine Womack, of Bridgewater State University. “Many people are afraid of Ebola when, in fact, what they should be getting is flu shots.”

For free fact sheets in English and Spanish on Ebola and its prevention, visit APHA’s Get Ready campaign.

— D.C.

Above, Olajide Idris, commissioner of health for the Lagos state of Nigeria, speaks to a standing room-only session on Ebola. Photos by Jim Ezell, courtesy EZ Event Photography

Hear that smoke-free sound!

Earlier today, APHA Annual Meeting attendees took their passion for health to the streets and called on local policymakers to pass smoke-free workplace legislation in the great city of New Orleans. Organized by the #SmokeFreeNola campaign, the Smoke-Free New Orleans Secondline Parade and Rally began at the convention center and wound its way in true New Orleans fashion to Fulton Street Square alongside the sounds of the Hot 8 Brass Band. You've never seen a smoke-free rally quite like this one! Make sure to watch the above video — and don't forget to turn up the volume.

Photos and video by Michele Late, courtesy APHA Flickr and APHA YouTube

In giving, we receive

The connections between charity and health reform were center stage during a Monday Annual Meeting public health funder session on "The ACA and Philanthropy: Strategies to Support Implementation." To learn more about becoming a public health donor and expanding the public health donor base, stop by the Tuesday morning Public Health Funder/Donor Business Meeting from 7 to 8 a.m. in the Hilton Warwick. Thinking about donating to APHA? Visit our donation page for more information.

Above, presenters and attendees at a session about the Affordable Care Act and philanthropy. Photos by Jim Ezell, courtesy EZ Event Photography

Not easy in the Big Easy: Curbing youth violence in New Orleans and beyond

New Orleans Mayor Mitchell Landrieu doesn’t want much from his administration during his second term. He says he has a single goal: To get black boys to stop shooting each other.

He doesn’t want you to water that message down. He doesn’t want you to broaden it. He wants to make his city safe for the demographic that’s most likely to be the victims, and the perpetrators, of violence. He’s talked with them and asked them why so many believe they won’t reach their 22nd birthday — and why they say they don’t care if that prediction becomes reality.

“Essentially what these kids tell you when you really speak to them — they can’t really articulate it this way — but they tell you, ‘I have been forsaken,’” Landrieu told a packed room at a Monday morning session on “Changing the Context: Youth Violence Prevention Through Community Change.” “You know this already.”

Landrieu’s presentation was ostensibly about NOLA for Life, the mayor’s comprehensive murder reduction program. But his conversation with public health leaders really focused on the epidemic of black youth violence in America — and the lack of urgency the public and national government seem to have in ending a culture of violence.

“When 628,000 citizens are killed in America since 1980…(that’s) more American citizens that were killed in all of the wars in the 20th century,” Landrieu said. He noted that half of those victims were black men. “Here’s my question to America: Why doesn’t that move us to do something? We went to war over 3,000 people killed on Sept. 11, 2001. How many people have to be killed to move us?”

Through NOLA for Life, New Orleans has taken a multi-pronged approach to violence reduction. Law enforcement plays a big part, as 100 gang members have been indicted in a multi-jurisdictional effort to curb violence in neighborhoods. But it goes beyond that, said session presenter Howard Spivak, director of the Centers for Disease Control and Prevention Injury Center’s Division of Violence Prevention. In the last 30 years, violence prevention has moved from a punitive framework to a preventive one. And that means offering social services and reaching young men before they fall into violence.

In New Orleans, a big portion of that is employment opportunities. The city has a 52 percent unemployment rate among black men, but NOLA for Life’s Pathways to Prosperity has trained 1,000 young men for jobs, has gotten 300 hired through the program, and partners with Tulane University and Louisiana State University to encourage the area’s biggest employers to reach out to this huge potential workforce.

Another large component is community engagement. Landrieu said he has seen midnight basketball games, coupled with big-name speakers, garner interest and encourage investment in neighborhoods and communities. And other panelists agreed. Charles Branas, professor of epidemiology at the University of Pennsylvania, says that in his own Philadelphia neighborhood, he has seen how vacant lots turned to green spaces reduce gun violence in the area.

“Once you clean these spaces, people take an interest in them. They tend to become invested,” he said.

Beatriz Solís, director of health communities for the California Endowment, said it’s not surprising that by engaging with disenfranchised communities, they become safer and more involved in maintaining that safety.

“You need that people power in there, residents and young people,” she told session attendees. “You need people to be engaged and informed so they’re really transforming and keeping systems accountable.”

In New Orleans, Landrieu says there’s still a lot of work to do. But it’s already paying off, he says: the current city murder rate is the lowest it’s been since 1970.

— L.W.

Above, New Orleans Mayor Mitchell Landrieu talks to a packed Annual Meeting session. Photo by Lindsey Wahowiak

New CCDM edition now available; download Ebola chapter for free

The latest edition of APHA’s renowned guide to controlling disease is now out and for sale at the Public Health Expo.

The 20th edition of the “Control of Communicable Diseases Manual,” which includes new updates on Ebola, West Nile virus and Middle East respiratory syndrome, is designed to serve as a comprehensive field manual for epidemiologists and public health practitioners working to control and curb infectious disease. All 138 chapters of the new edition have been updated with the latest information and three diseases — Japanese encephalitis, West Nile virus and Rift Valley Fever — now have their own chapters.

To aid in the Ebola outbreak, APHA has made the manual’s Ebola chapter free to download.

In addition, the manual contains a new chapter on the interconnectedness of human, animal and environmental health and the critical role of partnerships between public health practitioners, veterinarians and ecologists.

“We can learn a lot from the agents of infectious diseases,” said David Satcher of Morehouse School of Medicine and a former U.S. surgeon general in an APHA news release. “They teach us the value of eternal vigilance and the price of neglect of our public health infrastructure. We need CCDM to remind us of the challenge we face and to keep us updated as to the latest approaches to control of these communicable disease agents.”

To pick up a copy of the brand new edition, stop by APHA Press at the Public Health Expo or visit APHA Press online. 

A life in words

Michael Patrick MacDonald, author of "All Souls: A Family Story from Southie," signed copies of his book today at the Public Health Expo. In the book, MacDonald chronicles his family's life growing up in a poor neighborhood in Boston and the struggles of working-class communities. Right before his book signing, MacDonald spoke about the effects of poverty and trauma on low-income black and white communities during a scientific session titled "Too Young to Die: Teen Black Homicide and White Suicide." Stop by APHA Press at the Public Health Expo to pick up a copy of MacDonald's book.

Photo by Kim Krisberg

Forming partnerships to prevent prescription drug abuse state by state

When Paul Jarris had a bicycle crash this summer and injured his collarbone, the 30 Percocet pills prescribed to him in the emergency room seemed to be a pretty standard amount. It would help keep his pain at bay until he could see a surgeon.

But in just the next 10 days, he received prescriptions for 210 additional opioid pills from three different health providers.

“Fortunately, I knew enough not to fill it," said Jarris, executive director of the Association of State and Territorial Health Officials. “But we have to keep in mind, very well-intentioned people get addicted in the health care system. We really do have a systematic problem in this country with prescription opioids.”

That problem is one that organizations such as ASTHO are hoping to change with the help of state-based organizations.

In Monday’s session on “Mobilizing State Action to Prevent Prescription Opioid Misuse, Abuse and Overdose,” Jarris joined other presenters to discuss what is being done across the nation to prevent, reduce and treat the opioid abuse epidemic.

There have been 125,000 prescription drug-related deaths between 1999 and 2010, and health providers wrote more than 259 million opioid painkiller prescriptions in 2012, said Grant Baldwin, director of the Division of Unintentional Injury Prevention at the Centers for Disease Control and Prevention’s National Center for Injury Prevention and Control. Additionally, in 2012, 16,000 people died from a prescription-related overdose — that’s one death every 33 minutes, Baldwin told session attendees.

One of the initiatives working to turn the tide on opioid abuse is ASTHO’s President’s Challenge to reduce unintended overdose deaths and nonmedical use of controlled prescription drugs by 15 percent by the end of 2015, said Terry Cline, president of the ASTHO Board of Directors. Currently, 46 states and two territories — Guam and the Northern Mariana Islands — have joined the pledge, said Cline, who is also commissioner of the Oklahoma State Department of Health.

The challenge calls on agencies and organizations across those states and territories to pledge to make inroads into worrisome abuse rates or create new programs concentrated on four areas: prevention and education; monitoring and surveillance; law enforcement; and treatment and recovery.

When it comes to prevention and education, more than a dozen states have pledged to step up their overdose prevention activities and widen access to naloxone, a drug that can be used to reverse an opioid overdose and can be easily administered by first responders and other bystanders.

In New Jersey, for example, a naloxone pilot program has been expanded statewide. Today, New Jersey state troopers and police in all 21 counties can get certified to administer the life-saving drug, Cline said.

“We are only as strong as our weakest link,” Cline told session attendees. “If we neglect any piece of this, our approach will not be as effective as it could be otherwise.”

Visit ASTHO’s President’s Challenge for more information and get statistics on the opioid abuse epidemic at the Centers for Disease Control and Prevention.

— N.M.