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National Public Health Week kicks off today!

Let’s start with the basics: what is public health?

Ultimately, public health is about prevention at the population level.

As the Johns Hopkins Bloomberg School of Public Health’s motto so fittingly states, public health is “protecting health, saving lives – millions at a time.” We design neighborhoods more conducive to exercise; we strive for improvements in hospital systems so as to reduce mistakes; we pursue policy changes to ban false marketing by cigarette companies – all these things affect not one or two people, but hundreds, thousands, and millions.

Public health is also largely about prevention – keeping bad things from happening in the first place, as opposed to solving or managing already-present problems (although public health does a fair bit of that too). We clean environments to prevent asthma, we don’t provide inhalers; we teach you to cough into your elbow to prevent the spread of flu, we don’t prescribe antiviral medicine; and we redesign cars and roads to prevent injury, we don’t perform surgery.

Focusing on just this kind of population-level prevention, National Public Health Week offers us the following daily themes:

In addition to the above topics, National Public Health Week provides us a time and space to delve into the idea of integrating primary care and public health, an idea that was the focus of a recent IOM reportas explained on the occupy healthcare site just a couple days ago.

In addition to the case studies mentioned in that post, the operation of community health centers back when they originated provides a phenomenal example of true integration of primary care and public health.

The community health center movement started about 45 years ago, with roots in the civil rights and social justice movements of the 1960s, and with some incredible leaders at the helm. At the dawn of this movement, community health center leaders saw health as but an entry point to solving a broader range of problems, without raising the same level of opposition as more blatantly political “social change” programs. The goal was to not just to provide primary care and related outreach and patient education, but to address social determinants of health through job development, nutrition, sanitation, and social services. All while maintaining a core principle of respect for and involvement of community residents (aided by the legal requirement that governing boards of community health centers must be composed of at least 51% consumers).

While community health centers in the U.S. continue to do phenomenal work providing much-needed high-quality primary care services to largely underserved populations, most have become primarily – some entirely – deliverers of medical care. I would love to see these centers take a turn back to the roots of the community health center movement, propelled by grassroots advocacy by community members, national organizations such as the National Association of Community Health Centers, and advocates for integration of primary care and public health such as those of us here.

For more tips and action steps, visit www.nphw.org!

This post is cross-posted at http://occupyhealthcare.net 

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In our attempts to encourage people to lead healthier lives, we often make the mistake of bombarding them with facts and stats, do’s and don’ts, assuming the problem is a lack of knowledge. But let’s be honest – most people know that French fries are not the healthiest food in the world, fruits and vegetables are good for you, and that you really ought to exercise regularly.

So, what’s the problem? One aspect of the problem is of course the systems level issues of food access, cost, time and space to be active, etc. that we have mentioned before.

Another aspect though is one of attitude and culture.

Feel Rich, which launched in December, is attempting to address just this (sidenote: the organization’s CEO and others involved were on a SXSW Panel just this past weekend).

Feel Rich’s goal is the creation of a health and fitness culture born from the urban and hip-hop community’s love and respect for music, movement, and entertainment. Their message: health is the new wealth.

As opposed to your typical public health campaign centered on facts, stats, and do’s and don’ts, Feel Rich is attempting to first foster a desire for health (in other words, crafting an attitude and creating a culture that sees health as critical and desirable as wealth), engaging urban youth in a meaningful way that speaks to their interests. In Feel Rich’s own words – “It’s health on your terms, fitness in your style, and food choices that make sense on the streets where you live.” It’s also about making health and wellness cool.

I think it’s an exciting and inspiring approach, and the way the Feel Rich movement taps into attitudes (not just information), reminds me of the baby carrots campaign I’ve written about before. After all, whether we’re talking about the junk food industry, big tobacco, or pretty much any other product we see commercials for, appealing to emotion and attitudes is the way advertising is done. It’s long past due that prevention and health promotion advocates started utilizing this powerful strategy.

Feel Rich ties this powerful appeal to attitude and culture with empowering information on food, fitness, and health, and an array of videos and stories to engage and inspire their audience.  And with over 3 million YouTube views, it looks like they are doing just that.

I’ll close with some food for thought on this topic from David Katz’s most recent Huffington Post article:

“What if health were more like wealth?

  • If health were like wealth, we would value it while gaining it — not just after we’d lost it.
  • If health were like wealth, we would make getting to it a priority.
  • If health were like wealth, we would invest in it to secure a better future.
  • If health were like wealth, we would work hard to make sure we could pass it on to our children.
  • If health were like wealth, we would accept that it may take extra time and effort today, but that’s worth it because of the return on that investment tomorrow.
  • If health were like wealth, society would respect those who are experts at it.
  • If health were like wealth, young people would aspire to it.

This post is cross-posted at http://occupyhealthcare.net 

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Carmen shared with us a couple great Martin Luther King, Jr. quotes in her Occupy Healthcare post on Monday, and it inspired me to take a look at some of Dr. King’s other quotations. So many of them captured concepts relevant to public health that I wanted to share some of my favorites here. Here’s hoping we can take some of Dr. King’s wisdom and apply it to our work!

“True compassion is more than flinging a coin to a beggar; it is not haphazard and superficial. It comes to see that an edifice that produces beggars needs restructuring.”

I think this quote truly captures the essence of public health – public health isn’t about treating individuals with band-aids or quick fixes; it is about protecting health and saving lives– hundreds, thousands, sometimes millions at a time – by restructuring the systems that produce sickness, violence, and other problems that ail our society.

“Rarely do we find men who willingly engage in hard, solid thinking. There is an almost universal quest for easy answers and half-baked solutions. Nothing pains some people more than having to think.”

Indeed, we often see programs and initiatives implemented without nearly enough strategic planning and thought to sustainability, input from communities, constructive criticism, and/or evaluation (formative or post-program evaluation). Public health work (any work, really) is difficult and nuanced. We have to think hard and critically about what works and what doesn’t, and whether we are helping, hurting, or making no difference at all. At the risk of repeating myself one too many times – good intentions are not enough.

All labor that uplifts humanity has dignity and importance and should be undertaken with painstaking excellence.”  

Speaking of good intentions not being enough – I think we all owe it to ourselves and society to not rest upon the fact that we are at least trying to help, but to undertake our work with “painstaking excellence”.  If we’re going to try to do this, let’s try to do it right.

“It may be true that the law cannot make a man love me, but it can stop him from lynching me, and I think that’s pretty important.”

I have to admit, this quote made me laugh. And it’s a good point – laws and policies have their limitations, but they are also an incredibly powerful tool for change, particularly at the level of populations and systems.  I recently came across the Network for Public Health Law, and particularly love their overview of different public health topics.

And lastly, a quote from Dr. King that speaks for itself:

“Our lives begin to end the day we become silent about things that matter.”

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Speaking of New Year’s Resolutions, here’s another one to add to our lists: give wisely. With the holiday season just behind us, many have volunteered time and/or donated money, and perhaps even made resolutions to do a better job of it in 2012.

Our #occupyhealthcare principles, and an array of other important causes, are being actively pursued by nonprofits around the world, and many of us have and will in the future donate our money and volunteer our time with these organizations.

In doing so, it is important to remember that good intentions are not enough – a trap we often fall into in social service fields. We think we are helping others, so we go home feeling good about ourselves, but we don’t spend nearly enough time challenging our assumptions about whether or not what we’re doing (or what organizations we support are doing) is actually making any kind of sustainable difference.

The Boston University Economics Club highlights one common trap we fall into in an article entitled “When is it a bad idea to give the poor free stuff?”This criticism of TOMS Shoes also describes the problem of free stuff outcompeting local goods, but goes further, pointing out issues such as doing things for instead of with people, marketing ploys disguised as awareness raising,  harboring a “whites in shining armor” mentality, and failing to match the needs of those on the ground.

This last one is a particular pet peeve of mine – we often fall into the trap of taking up the cause du jour, never mind what people on the ground actually need. Daniel Halperin addresses the issue of well-intentioned but far-from-optimal (as far as improving health outcomes) donations towards HIV/AIDs prevention and treatment in a wonderful 2008 op-ed in the New York Times. He speaks of the 100-to-1 “disastrously inequitable” imbalance between U.S. spending on AIDS programs ($3 billion) vs. safe-water projects ($30 million) in Africa. This despite the fact that most African nations have a stable adult H.I.V. rate of 3% or less and despite the fact that in certain African countries, AIDS money remains unspent as even state-of-the-art H.I.V. clinics cannot accept such large influxes of cash, and in others, children suffering from basic diseases are left untreated (as clinics cannot afford to stock basic medicines) while H.I.V.-infected children are offered exemplary treatment.

Another example is breast cancer related “awareness-raising” and fundraising in the United States. Injury, violence, and a host of other diseases all claim more lives than breast cancer.  This is not to say breast cancer doesn’t deserve any attention, but all the hype seems to have contributed to misperceptions about the risk of breast cancer vs. other cancers and diseases, not to mention the ridiculous slogans that objectify women, potentially furthering social norms that contribute to gender-based violence and other problems. On top of this, many of the efforts are entirely nonsensical (e.g., Yoplait’s pink yogurt lids) – unless your goal is to increase revenue for the companies that sponsor them. Even more distressing is when the products being promoted in the name of breast cancer awareness actually contain ingredients that have been linked to increased risk of breast cancer.

As one blogger put it, “The ostensible focus of all this pseudo-philanthropic pink jockeying is a kind of nebulous breast cancer “awareness,” rather than any serious effort at prevention or investigation into what actually causes breast cancer in the first place.” One of the comments on this blog post captures the issue well: “If there was some real research into the root causes of cancer or providing widespread access to quality healthcare (prevention, early detection, dealing with the disease, cure) for women, maybe I would understand. Instead a friend gives me a T-Shirt that says “Save the ta-tas” and I am supposed to believe that all is right in the world.”

How can we avoid some of the traps mentioned above, and give in ways that are more likely to contribute to actual, sustainable change?

*Choose wisely – be critical, and do your research. It’s hard to truly measure a nonprofit’s impact, but we can at least try to get a better sense of their work. What exactly does the organization do? How well does what they do match the needs of those they aim to help? What does research and evaluation say about the kinds of tactics they use? Is their work sustainable? Are they engaging and empowering those they try to help?  In addition to these, goodintents.org provides a fabulous list of  Dos and Don’ts for Disaster Donations and issues and tips related to voluntourism, and Think Before You Pink provides questions to ask before you buy pink (but much of what they say is relevant to looking into any cause).

*When volunteering, maximize your impact by volunteering in a way that puts your skills to use. Check out sparked.com: even more than their online, micro-volunteering approach, I appreciate the idea of trying to match a person’s skills (web design, marketing, legal, etc.) with the needs of an organization.

*Start local. Contributing your time and money to local organizations doing good, smart work (choosing wisely is still important) can help build a sense of community (for you and those you work with) and help you build long-term relationships with the organizations you choose to support and those that turn to the organization for its services. It can also be easier to get a sense of an organization’s work when you can be there in person – it’ll make for wiser giving anda more personal sense of the impact the organization and your support is having.

Here’s wishing everyone Happy and Wise Giving in 2012!

(This post is cross-posted at http://occupyhealthcare.net). 

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(Note: this post is cross-posted at Occupy Healthcare.)

An op-ed in the New York Times last week described the United States’ disproportionate spending on healthcare in comparison to other social services that have an impact on health – a characteristic that puts us in the minority, as one of only three industrialized countries. The chart below shows the ratios of healthcare:social service spending in the U.S. vs. peer countries (for details on these numbers and information on which countries are included, check out the published study).

In addition, when considering the combined spending on health and social services, the U.S. no longer leads the pack (as it does when examining only healthcare spending) – in fact, we come in 10th of 30 OECD countries examined. Furthermore, the authors of the study found that infant mortality, life expectancy, and potential years of life lost outcomes were significantly worse in countries where health-care spending was high and social-service spending low.

As the authors note, “The implication of our findings is that, if improved population health is our goal, then the United States should be looking beyond the health-care system to achieve that goal. Current reforms—targeting medical care and health services only—are unlikely to deliver that result.”

Amen. So, let’s look beyond the healthcare system. Each Monday starting today, I’m going to kick off our week here at #occupyhealthcare examining something outside the healthcare system that has enormous implications for our health (i.e. social determinants of health). I’ll try to end each post with a practical step or two you can take to address the topic at hand.

This week, let’s talk urban planning.

The idea that where you live, learn, work, and play is a major – perhaps the major – factor influencing your health is a core principle of public health.  Place matters.

While this idea encompasses far more than just physical living space, physical living space is certainly a key component. Development decisions can affect our physical health (through walkability, green spaces, proximity to healthy foods, pollution caused by vehicular traffic), our emotional and mental health (length of commutes, spaces for social interaction) and societal well being (spaces for civic engagement, degree of segregation by race and income).

Many in the fields of urban planning and public health have come to this realization, epitomized by the smart growth movement, which holds among its principles:

*Mixed land uses

*Mixed income housing – providing a range of housing opportunities and  choices

*Taking advantage of compact building design

*Creating walkable neighborhoods

*Preserving open space, farmland, natural beauty, and critical environmental areas

*Fostering distinctive, attractive communities with a strong sense of place

*Providing a variety of transportation choices

*Encouraging community and stakeholder collaboration in development decisions

Imagine the potential benefits:

*Less segregation could lead to more equitable policies across communities, and ultimately more equitable health and wellness outcomes

*More walkability and green spaces could increase physical activity

*Providing a variety of transportation choices could minimize our reliance on motor vehicles, and the resulting pollution and sedentary lifestyle

*Attractive communities with a strong sense of place could make us happier and more connected, reducing rates of depression

The list goes on. Moreover, many of these benefits have already been demonstrated through research. It is clearly time for us – and the U.S. – to invest in smart growth for healthier, happier communities.

So, what can we do? Today’s practical step: encourage use of health impact assessments in your local community when any kind of development project is being discussed, and advocate for state and federal laws that mandate or incentivize HIAs. HIAs provide a way to assess the health impact of any policy (development or otherwise) and would likely reveal the positive impact of smart growth, and the detrimental impact of development projects that don’t take into account smart growth principles. Certainly, there are complexities and challenges involved in conducting HIAs, and it is important to make sure they are being conducted in useful, cost-effective ways – but that is a topic for another post! Despite the complexities, I think HIAs when done well provide a concrete way to start thinking about the specific ways in which any policy that impacts the places we live also impacts our health and well being – and hopefully provide the impetus to start not just thinking about, but acting upon the results.

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Note: This post is cross-posted at Occupy Healthcare – be sure to check out the other posts there, and check out #occupyhealthcare on twitter too, the movement is growing! 

In my last post, I wrote about the importance of occupying an array of fields that impact our country’s health. Lest this task seem too daunting to be accomplished, I thought I’d take a moment to highlight some success stories on this front.

Access to healthy foods is an important determinant of health and an important factor in health inequities. The Food Trust, a non-profit based out of Pennsylvania, is tackling this problem, aiming to make healthy food available to all. Among their many innovative projects is the Pennsylvania Fresh Food Financing Initiative, a grant and loan program to encourage supermarket development in underserved neighborhoods throughout the state, an idea that is now being replicated nationally. Some other creative developments in the field of nutrition and healthy food access: taking a page out of the junk and fast food industry’s book, with their billions spent on marketing, and branding baby carrots in a way that’s fun and exciting; and tapping into behavioral economics to redesign cafeteria lunch lines in a way that increases purchase of healthy foods and decreases purchase of unhealthy foods (an inexpensive and effective approach!).

Given that homicide and suicide are among the leading causes of death among those age 1 to 34, violence prevention is another key aspect of attaining the health our society deserves. Chicago-based CeaseFire combines research and street outreach to track violence, interrupt and intervene (with well-trained professionals from the communities they represent with a background on the streets), and engage in longer term risk reduction and behavior and norm change. Even more exciting – it’s working.

Neither access to healthy foods nor neighborhood safety – not to mention walkability, pollution-free environments, and a host of other things – is possible without intelligent and innovative urban planning. Thankfully, we have the likes of The Congress for the New Urbanism working to promote walkable, mixed-used neighborhood development, sustainable communities and healthier living conditions.

And while our national political discussion is so bogged down by discussions of whether to help low-income individuals and families that we haven’t had a conversation about how best to help them, organizations like the Family Independence Initiative, which was featured in the New York Times this past summer, are taking an approach radically different from our typical social service model, tapping into the strengths and support systems of low-income families, allowing them to determine their own paths and advance together. This too, has been shown to work.

Across all of these health-related issues, the media plays a role in shaping behaviors and norms, and Hollywood, Health, and Society is bridging two drastically separate sectors with its work to provide entertainment industry professionals with accurate, timely, and engaging information and case examples for health storylines, as well as study the content and impact of these storylines.

Of course, just because it’s not all about healthcare doesn’t mean healthcare isn’t at the table – healthcare providers can play just as important role in prevention and promotion as they do in treatment, and places like the Codman Square Health Center make that crystal clear. A community health center in one of the most impoverished areas of Boston, the Center provides a range of public health and community services (ranging from computer classes and financial help to fitness opportunities and hands-on cooking classes, not to mention youth services, civic engagement initiatives, and a close linkage with the Codman Square Academy charter school).

So, as daunting as the task of occupying for health seems, there are many people in many places doing amazing things. To quote the founder of the Codman Square Health Center: “We need to create integrated systems that promote community and health values. Like all change such cultural shift will take a generation or more to accomplish. But I am reminded of the story President John F. Kennedy told of the French leader who asked his gardener to plant a rare tree on his estate. ‘But the tree won’t bloom for 100 years’ the gardener said. The response: ‘In that case, plant it this afternoon.’”

So here’s to starting planting – and occupying. Cheers.

 

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Note: This post is cross-posted at Occupy Healthcare – check it out to read the comments posted there, as well as the rest of the occupy healthcare posts. 

Certainly, there is a need to occupy healthcare. Healthcare is essential, and the prevention and treatment that happens in clinics and hospitals, emergency rooms and community health centers, is integral to improving and saving lives.

Yet, while medical care is essential, it accounts for only an estimated 10-15% of preventable mortality in the U.S. The true causes of our country’s poor health outcomes and health inequities – and thereby the real solutions to improving health – are not rooted in the provision of healthcare.

They are rooted in communities: in sidewalks and parks, in access to healthy food and adequate housing, in clean air and safe neighborhoods.

What does this mean? It means that to alter health outcomes and inequities, we must go beyond occupying healthcare.

We must occupy the junk food and fast food industries, whose marketing power and lobbying power (leading to the maintenance of skewed agricultural subsidies) impact what we eat and what is available for us to eat.

We must occupy the criminal justice system. The U.S., with less than 5% of the world’s population, has almost 25% of its prisoners, the majority of whom arepeople of color, people with mental health issues and drug addiction, and people with low levels of educational attainment. This exacerbates poor health outcomes related to substance abuse and mental health; worsens health inequities by race, ethnicity, and socioeconomic status; and to boot, has done little if anything to make neighborhoods safer.

We must occupy zoning policies and construction and planning industries to improve inequities in access to healthy food, enhance safety and walkability, reduce unintentional injuries (which are the leading cause of morbidity and mortality among children in the U.S.), and reduce the excessive energy use and pollution that stems from our homes and buildings, as well as long commutes in personal motor vehicles (of which we have more in this country than licensed drivers).

We must occupy the welfare system, which focuses on services that – despite what are often good intentions – do not empower citizens, tap into their problem solving capacity, or enhance their ability to take collective action to better their communities, as John McKnight argues in an article entitled “Services are Bad for People”.

We must occupy the news and entertainment media. Whether it is news stories that inaccurately and dangerously link bullying directly to suicide in a way that can elevate suicide contagion risk by suggesting suicide is a natural response to bullying; fictional TV characters eating hordes of junk food day in and day out, without any consequences; or music videos that normalize gender-based violence, the media play an enormous role in our perceptions of what is “normal”, shaping our behaviors in a way that has significant impact on health outcomes.

The list goes on. Our health is determined more by where we live, work, and play – our physical and social surroundings – than anything else. And the list of institutions, industries, policies, and laws that unjustly impact these places and environments extends many miles, and spans many fields.

So, yes, we should occupy healthcare. But let’s not make the mistake of stopping there. There’s a lot more to be changed…revolutionized…occupied.

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