Posts Tagged ‘prevention’

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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(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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A couple weeks ago, President Obama proposed $3.5 billion in cuts to the federal Prevention and Public Health Fund as part of the President’s Plan for Economic Growth and Deficit Reduction.

And as the Prevention Institute alerted me to via e-mail, the Senate Appropriations Committee approved a bill on September 21st that “zeroed out funding for the CDC’s Youth Violence Prevention activities – suddenly and without input”.

The e-mail I received pointed out that elimination of this $19.7 million in funding would have a devastating impact on violence prevention efforts across the country and compromises decades of work.

I agree wholeheartedly. Even more frustrating though, is the fact that not only do these cuts to prevention and public health funding affect critical work, they go against the very purpose of these funding cuts, i.e. “economic growth and deficit reduction.”

Cutting prevention funding does NOT help the economy or the deficit. Whether it’s the Prevention and Public Health Fund, CDC’s Youth Violence Prevention efforts, or other funding streams, public health takes a systems level, upstream approach to preventing population-level health problems – this means a lot of public health efforts are targeted at things like helping people find jobs or gain a better education, and making neighborhoods safer and revitalizing communities. These things make our economic situation better, not worse.

As the Prevention Institute points out:

“Cutting prevention may seem to save a few dollars in the short run, but it will cost an enormous number of lives and money in the long run…Prevention shows a 5-to-1 return on investment. Cutting 3.5 billion in prevention would shut the door to as much as $20 billion in potential savings in health care costs in the future.”

And there are a lot of other cost savings too – keeping youth out of the criminal justice system, keeping community members gainfully employed, and more.

I understand that cuts need to be made, but let’s stay away from cutting things that are actually saving us money, shall we?

Pick up the phone, call your senators and representatives (I just did!), and try to make it to clear to politicians and the general public that prevention funding is not merely an expendable cost, but an investment – and one that is far more likely to pay off than pretty much any other.

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For the last couple weeks, we’ve been taking a closer look at Wikipedia in class – a truly fascinating phenomenon, but I’ll spare you the details in this post (check out the Wikipedia article on Wikipedia if you’re interested in how collaborative writing by volunteers across the world has led to an astonishingly reliable compilation of articles covering nearly every topic under the sun).

So, I said I’d spare you the details, but then what is this post about? You’re going to accompany me through my very own Wikipedia journey, which starts with the creation of a user page – mine is here. The next step is picking an article to edit. I decided to go with suicide prevention, given my experience at the Virginia Department of Health this past summer (where I worked primarily on suicide prevention) and the course on suicide prevention I took here at the public health school in the Spring. After deciding on an article, it was time to evaluate it. We were told to assess: comprehensiveness, sourcing, neutrality, readability, formatting, and illustrations.

My Evaluation of the Wikipedia “Suicide prevention” Article

While the introductory list of suicide prevention strategies is fairly comprehensive, the article itself suffers from gaping holes. Overall, the core of the article as it stands now is “Interventions” – but almost all those listed are mental health interventions. Moreover (and particularly distressing to this engineering-turned-public-health-student), there is no discussion of evaluations of these interventions, their effectiveness, etc.

As I anticipated, another major component missing from the article (besides a brief mention in the introductory list) is lethal means reduction (reducing the odds that an attemper will use highly lethal means), which was a major focus of our class, and an integral part of a public health approach to suicide prevention. But the missing content from this article goes far beyond just this subtopic – the suicide prevention gatekeeper trainings and crises centers that formed the centerpiece of the day-to-day suicide prevention activities at the state health department this summer are not even mentioned, nor is there adequate mention of suicide prevention resources such as the national phone line (which is of particular concern given that someone may land on this page when they or someone they know is at risk for suicide).

The article also fails to provide an adequate overview of the topic, with things like the National Strategy for Suicide Prevention not mentioned at all. Suicide prevention can also vary by subpopulations, with youth suicide prevention being a particularly important one (and one that I’m particularly aware of given my work this past summer on looking at peer-to-peer suicide prevention programs on college campuses), but no subpopulations are highlighted. Even the missing content I’ve pointed out so far ignores a huge component of suicide prevention – approaches to suicide prevention outside the U.S.

The sourcing of the article is also lacking, with the article actually flagged for unverified content, specifically a lack of inline citations. In the entire article, there are only two inline citations, neither of which are (to my knowledge) particularly key sources in the field. There is tons of research out there on the topic of suicide prevention and there are also tons of websites for different organizations, programs, and interventions. The citations here are thus definitely not up to par. Even the further reading and external links fail to capture the depth and breadth of the information currently out there (or even link to the most fundamental of resources, like the CDC’s page on suicide prevention).

The article is not currently written from a neutral point of view, because, as I mentioned, it has a heavily mental health focus (with little or no mention of other approaches to suicide prevention, such as gatekeeper training and lethal means restriction). It is also entirely U.S.-centric, with little or no mention of approaches in other countries, differences in suicide prevention globally, etc. (except for a recently added link to an Australian suicide prevention program in the “See Also” section.)

The article is fairly readable and well written, and seems to adhere to the Wikipedia Manual of Style in terms of formatting. There are a few illustrations, and although they are relevant, they do not connect to the text (as currently written).


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Where better to start than with musings on this most fundamental question: what is public health?

When I was visiting grad schools, I remember overhearing a conversation another prospective student was having with a professor – the student was telling the professor that he could not make up his mind about what exactly he wanted to, and she responded, “Can’t make up your mind? This is the field for you.”

Indeed, public health sometimes seems like it has multiple-personality disorder – hospital administration and management, nutrition, environmental health, epidemiology, behavior health, health policy, biostatistics, health education, epigenetics – the list of subtopics within public health goes on and on, and sometimes there seems to be no tie but a connection (and that too, sometimes a very indirect connection) to protecting and improving health.

But there actually is an overarching approach that distinguishes public health from other fields (including medicine). The two key words: population and prevention.

As the Johns Hopkins Bloomberg School of Public Health’s motto so fittingly states, public health is about “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.

Interestingly (and unfortunately), the focus on population and prevention (which in many ways defines public health), may well be the very reason we don’t spend enough on public health, as David Hemenway eloquently points out in an issue of the New England Journal of Medicine from earlier this year.

He highlights four key reasons for underfunding:

  • Because public health prevents, benefits lie in the future, and people prefer immediate gratification.
  • Because public health addresses populations, beneficiaries are unknown – public health deals with statistical lives, not identifiable people – and people have stronger emotional and moral reactions to identifiable victims than statistical ones.
  • Benefactors in public health are often unknown as well – public health has little news value (“saving statistical lives doesn’t make for good human-interest stories or photo ops”).
  • Public health initiatives often require societal change – and that’s hard.

I could not agree more with this assessment, and sincerely hope the public health community makes a concerted effort to illustrate the importance of public health to our colleagues in medicine and other related disciplines, to our friends and family, and to our country and world. This blog is my little contribution towards that goal – a small step in the pursuit of public health.

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