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NEWS ALERT: HHS Prevention and Wellness Initiative. September 18, 2009

Posted by Michelle Lugalia in Policymaking, Politics, Research.
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Big news from Sebelius! Great steps forward for public health. I look forward to seeing what community initiatives will burgeon from this…

Check it out below and in full length at the website.

American Recovery and Reinvestment Act: Summary of the Prevention and Wellness Initiative- Community Component.

The Department of Health and Human Services (HHS) has created a comprehensive initiative for the $650 million allotted for chronic disease prevention efforts in the American Recovery and Reinvestment Act of 2009. The goal of this initiative – Communities Putting Prevention to Work – is to reduce risk factors, prevent/delay chronic disease, promote wellness in children and adults, and provide positive, sustainable health change in communities.

Communities Putting Prevention to Work will address the leading preventable causes of death and disability, namely obesity and tobacco use, by expanding the use of evidence-based strategies and programs, mobilizing local resources at the community-level, and strengthening the capacity of states. As a result of these efforts, powerful models of success are expected to emerge that can be replicated in other states and communities.

The cornerstone of the initiative is the Community Program ($373 million), with cooperative agreements to be awarded to communities through a competitive selection process.

  • The Centers for Disease Control and Prevention will support evidence-based community approaches to chronic disease prevention and control in selected communities (urban and rural) to achieve the following prevention outcomes:
    • Increased levels of physical activity;
    • Improved nutrition;
    • Decreased overweight/obesity prevalence;
    • Decreased tobacco use; and
    • Decreased exposure to secondhand smoke.
  • Communities will implement a set of evidence-based interventions related to the behaviors listed above which aim to achieve broad reach, high impact, and sustainable change.  The specific amount of funding per community will be determined by a mix of interventions, population size, ability to reduce health disparities, and likelihood of success.
  • Communities will assemble an effective communitywide consortium with a history of working with partners such as local and state health departments and other governmental agencies, health centers, schools, businesses, community and faith-based organizations, academic institutions, health care, mental health/substance abuse organizations, health plans, and other community partners to promote health and prevent chronic diseases.
  • This component also includes a robust support plan to ensure funded communities are successful and that the communities are able to evaluate the impact of their efforts. The plan consists of a three-pronged approach: program support, community mentoring, and evaluation.
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KISS for Self-Rated Health? July 26, 2009

Posted by Katelyn Mack in Research.
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KISS — the acronym widely recognized for the philosophy ‘Keep It Simple Stupid’ — has characterized the measurement of overall population health in many epidemiogical surveys, including some of the largest in the US. This measure: self-rated health.

The question:  “Would you say your health in general is excellent, very good, good, fair or poor?” Is asked in major nationally representative surveys such as the National Health Interview Survey (NHIS), the Behavioral Risk Factor Surveillance Survey (BRFSS), the National Health and Nutrition Examination Survey (NHANES), and the Current Population Survey (CPS). Many public health professionals and epidemiologists have relied on responses to this question to measure a groups’ overall health and wellbeing. It is clearly easier to ask someone to rate their own overall health than to take blood pressure, pulse, weight, height, and ask a slew of disease-specific questions.

The downfall to this type of measurement of health is obvious: it is impossible to know why someone rates their health as excellent vs. fair. Nonetheless, researchers have used this measure to track trends in health over time and as a stand-in when other more invasive health measures are not available. Often, those who respond to this questions are categorized as in either “excellent, very good, or good” health or “fair or poor” health.

The use of this binary categorization may be flawed according to a recent article in the American Journal of Epidemiology by J. Salomon and colleagues, which challenges the reliability and consistency of this question to measure trends in population health over time.

Salomon et al. present data from the 4 health surveys mentioned above with data from 1998 to 2007 and compares trends in self-rated health, breaking it down by gender, age, race/ethnicity, and education. They report conflicting trends across the surveys (e.g. NHIS shows an increase in fair/poor health over time, while CPS shows a decrease in fair/poor health). They also find that certain subgroups have a higher likelihood of having inconsistent reports across surveys: young people (20-49 years), Hispanics, and those who lack a high school education. Because fair/poor responses are mostly inconsistent across surveys when looking over time, the authors suggest using an “excellent” or “excellent/very good” if analyzing data using this measure.

With reliable, accurate information being at the heart of any social epidemiological study it is imperative that these inconsistencies be reviewed and improved upon. How might this impact social and behavioral research? We have used and relied upon this measure of ‘health’ for a long time and applaud the fact that it is ‘reliable’ and easy to administer (i.e. cheap). The authors highlight the implications that these inconsistencies might have on disparities research and studies on socioeconomic status — since those with the lowest education, and racial/ethnic minorities are less likely to have consistent trends across surveys.

A thought: Even though the authors break this data up by subgroups (gender, age, race, education) — might the differences in sampling methodology and design (even the timing, placement, and order of the question within the survey!) have the consequence of creating the inconsistencies that we see?

We need to keep it simple – for time and money’s sake. But let’s make sure we avoid acting stupid. What could be a better way to quickly and easily capture peoples’ overall health status? Do you have a different ‘favorite’ measure?

HHS Video Contest: Flu Prevention July 23, 2009

Posted by Katelyn Mack in Uncategorized.
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Have you wanted to create a real PSA? Interested in public health? This is a great opportunity to get some hands on experience. (…I am so excited about this…)

According to an HSPH announcement:

Kathleen Sebelius, U.S. Department of Health and Human Services Secretary, has announced that the agency is running a contest on YouTube in which you can film and post a public service announcement about preventing H1N1 flu. The winner’s video will appear on television, and the winner will receive $2,500. The deadline is August 17, 11:59 pm EDT.

Listen to Secretary Sebelius and find out more at the Flu.gov site.

Put on your thinking caps and get to work — August 17 is just around the corner!

Health Reform Bills Collide: House vs. Senate July 17, 2009

Posted by Katelyn Mack in Disparities, Health Reform, Policymaking.
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Yesterday APHA revised its comparison of the Senate HELP Committee and House Tri-Committee Bills for health reform. My last post highlighted how the Senate Bill incorporated aspects of the social determinants of health into the health reform agenda. How does the House Bill stack up in comparison? I used the APHA and Kaiser Family Foundation websites as guides and this is what I found:

  • Only the House Bill actually creates a trust (Prevention and Wellness Trust) that will be the source of funding many of the prevention, wellness, and community-based activities it promotes. The Senate bill states that CDC and other public health agencies would be ‘directed’ to make changes.
  • Both propose the creation of a prevention ‘task force’ that will provide an evidence-based review of  community-based interventions to improve health. The House Bill also includes a specific authorization for a task force focusing on clinical preventive services.
  • Both increase funding for prevention research. The House Bill specifies the amount of funding available from the Prevention Wellness Trust and suggest an increase from FY2010 to FY2019.
  • Only the Senate Bill includes a Worksite Wellness promotion campaign. (I’m not sure this is actually necessary to include in the Bill…)
  • Both include an annual report that would have indicators on the performance of the nation’s health and health care system. (YES!)
  • The Senate Bill includes creation of a “National Prevention, Health Promotion and Wellness Council” that sounds grounded in social determinants of health. It will include Secretaries from agriculture and environment to transportation and education that will help create a national strategy for health promotion.

I was also glad to see attention being paid to health disparities in the Bills (though its presence is slightly underwhelming). Unfortunately while experts in public health agree that inequitable health (differences in health between the rich and poor, White and non-White, and by gender) is a major problem for our nation’s health the public has not caught on to that reality (at least that is what a KFF President and CEO, Drew Altman suggests).

I also noticed many public health workforce provisions in the Bills, which may help to quell the enormous exodus of physicians from primary/family care (…do medical students even think about a primary care career any more?) to specialized medical care. Obviously specialized medical care is great, but perhaps if we had better preventive and family care services we wouldn’t require so much of it!

It will be interesting to see how the Bills change as they go through the revision process. *Fingers crossed* that they make it through! There is a lot of potential with some of the community- and evidence-based decision making and fact-finding. Will it serve to deal with one of the biggest health reform issues — costs? Ummm…I’m not so sure.

Health Reform Jumps First Senate Hurdle July 15, 2009

Posted by Katelyn Mack in Disparities, Health Reform, Policymaking, Politics.
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The Affordable Health Choices Act, legislation supported by the American Public Health Association, passed through the Senate Health, Education, Labor and Pensions (HELP) Committee this afternoon. Some of the most exciting aspects of the bill (…in terms of social determinants of health) are:

  • Establishing a program at the Centers for Disease Control and Prevention to “facilitate the use of health impact assessments to gauge the public health implications of major decisions regarding the built environment, including housingtransportation systems, waste disposal sites and other land-use planning decisions.
  • Establishing a grant program for state and local governmental and community-based organizations to implement evidence-based community preventive health activities to reduce chronic disease rates,address health disparities (including social determinants of health), and develop a stronger evidence base of effective prevention programs and interventions.
  • Collecting data and conducting research on the health and healthcare of populations that have traditionally experienced health disparities…in efforts to improve the quality and effectiveness of health services.” (quotes are taken from an APHA e-mail blast, emphasis mine)
I am excited that these components of the plan take a social determinants approach to some of the health system issues that are currently lacking. Additionally, it was wise to articulate the needed move toward an evidence-based health care system, not only in terms of medical treatment, but also prevention activities!

While many health reform advocates are hopeful at this point, the slim (partisan) margin by which this bill was passed is worrisome (13-10). Next, the Senate Finance Committee holds a markup of its version of the legislation and later their version is merged with the recently passed HELP Committee bill.

Up next — how do the House and Senate health reform legislation compare? Great question!

What does climate change have to do with it? July 13, 2009

Posted by Katelyn Mack in Climate Change, Disparities, Events, Violence.
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An article on the intersection of climate change and social determinants of health (SDH) in Global Health Promotion recently caught my eye. Climate change interventions ought to consider the social context in which they (will) occur in order to prevent a widening of health inequalities.

How will climate change impact health? The authors cite the effects of climate change on the frequency and intensity of natural disasters, lessening of water and food security, and alterations in the geographical distribution of infectious diseases (such as malaria and other mosquito-driven diseases).

My attendance at the 2009 Humanitarian Action Summit at Harvard University brings one more health impact of climate change to mind; one that is inextricably linked to social determinants, as well: violence and war. As food security is threatened and resources become more scarce malnutrition and starvation are not the only consequences. This insecurity can easily manifest in social unrest. We are seeing it in humanitarian emergency settings. Children, adolescents, and men are joining militias and moving into new territory (wreaking havoc on whoever may live there and be most unprotected — often women and children). What results is gender-based violence, community chaos, and a survival mentality. Intense urbanization is also a common consequence, as the article discusses. (Read this article by Peter Walker from Tufts University for more on this topic – he presented at the Summit).

Climate change must be taken seriously in public health. We must at least include the food and water effects of climate change in our domestic and international agendas. Glad to see PAHO taking this seriously — perhaps they will get this stuff into AJPH soon…

 

UPDATE 07/21: I just got wind of a Working Paper on the Social and Governance Dimensions of Climate Change: Implications for Policy by Robert Foa (of Harvard!) as part of the 2010 World Development Report. The key recommendation is to create national policy environments that are amenable to environmental legislation. How? He suggests gender quotas and supporting civil society groups. Surprised? (…this is just taken from the abstract…I haven’t read it yet!)

And the Band Plays On June 15, 2009

Posted by Michelle Lugalia in Disparities.
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Since the 1980s, HIV/AIDS has  had several names (GRID) and statistically many faces. First it was inappropriately and stereotypically pictured as a ” homosexual” and “immigrant” disease, then hemophiliacs began to develop similar symptoms around the nation. Soon it took the face of  sub-saharan Africa, then African American women, and now it seems we are almost full circle with recent surveillance results from several city and state departments indicating that Men who have sex with Men represent majority of new infections and known risk. This has fueled several research studies with social determinants implications for future intervention and prevention efforts.

The current issue of the American Journal of Public Health focuses on African American health and HIV and in majority of the articles highlights, the rising burden of the virus on Black Men who Have sex with Men.

June Issue of AJPH

June Issue of AJPH

Based on data from several states, a commentary estimates that ” Black MSM account for an increasingly large proportion of AIDS cases and have the highest rates of AIDS mortality among MSM..” adding that “Moreover, rates of unrecognized HIV infection and sexually transmitted infections are higher among Black MSM than among other MSM” and that “Black MSM in the United States now experience rates of HIV infection that rival those among the general population in the developing world”.

Chicago’s, whose rates and differences are comparable to other large US Cities, recent surveillance shows:

  • Black MSM at least 2.5 times greater rate than White and Hispanic MSM
  • Black MSM have high rates across the age spectrum
  • In young Black MSM the disparity is 7 times more than young white MSM

What drives these disparities? Past literature often pointed to behavioral differences as major drivers behind these numbers. However, folks analyzing the reasons why this is so are pointing to the social context and daily realities of Black MSM. Additionally, recent data from the Chicago HIV Behavioral Surveillance on MSM, Project CHAT, reiterates these points by ruling out traditional differences in HIV sex and drug risk behaviors as causes. It has found that:

  • White MSM have the highest mean number of sex partners (10.41 vs. 7.24 (Black) vs. 7.88 (Hispanic).
  • Across several risky sexual behaviors (unprotected anal sex, unknown HIV status , concurrent sexual partners etc) there were no startling differences across ethnicities
  • There were also no significant differences of illicit substance use across samples (all between 47-49% using)

They concluded that  “overall sexual and drug use risk behaviors do not seem to readily explain racial disparity of MSM infection and incidence rates”.

So what is driving these differences?

The previously quoted AJPH article points to stigma, internalized homophobia, and access to services  as potential determinants. It mainly states findings from several studies showing that:

  • Black MSM have been observed to have higher levels of internalized homophobia and rarer disclosure of homosexual orientation than MSM of other racial groups.
  • Black MSM are more likely than White MSM to perceive that their friends and neighbors disapprove of homosexuality, to report that they have sex with women, and to self-identify as heterosexual.
  • Among HIV-positive MSM, Blacks are less likely than others, to have access to private clinics, to express HIV-related health concerns to their medical providers, to use outpatient health services, to report satisfaction with medical personnel in outpatient settings, to report an absence of nondiscriminatory practices among medical staff, to trust the quality and competence of outpatient medical services, and to trust physicians.
  • In addition, HIV-positive Black MSM were found to be less
    likely than other MSM to receive and be on highly active antiretroviral therapy or to perceive that they had access to medications.
  • Others have pointed to the high incarceration rates of Blacks compared to other races, but recent data shows that those infected within correctional facilities were actually infected prior to their sentencing.
  • Black MSM  statistically have overlapping sexual relationships and have limited sexual networks and fewer diversity of available sexual partners.

In a society where we have identified solutions, medicines and numerous sources of funding, it is a shame that these numbers are where they are. Several intervention efforts are already underway and some, such as the sexual network strategy, are championing current initiatives.

As a public health student I am excited about the work that can be done and how this type of research can inform future effective intervention and prevention efforts directed at a surprisingly overlooked group of individuals.

Get your data on! June 13, 2009

Posted by Michelle Lugalia in Research.
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Ever needed the right piece of data to make your argument or paper more convincing?

Ever needed those elusive census numbers that often take forever to find?

Ever just needed to look up some random fact on trends from some random U.S. Agency?

Have no fear! Search no more! DATA.gov is here!!!

Search your heart out! I am so loving our administration right now.

Also!

check out Wolfram Alpha….they are revolutionizing the internet and possibly your future biostats problem sets. These folks’ goal is to: “make all systematic knowledge immediately computable and accessible to everyone. We aim to collect and curate all objective data; implement every known model, method, and algorithm; and make it possible to compute whatever can be computed about anything”.

thank you Wolfram Alpha…

Tackling ‘Food Deserts’ in Illinois June 5, 2009

Posted by Katelyn Mack in Disparities, Neighborhoods, Nutrition, Politics.
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A FRESH FOOD FUND has been established in Illinois to address the problems associated with limited access to fresh fruits and vegetables in low-income, underserved areas of the State. Also known as ‘food deserts’, these areas see higher rates of obesity, diabetes, cardiovascular disease, and overall poor health of children and adults. Often they exist at the intersection of many vulnerabilities for poor health including structural violence, low socioeconomic status, racial segregation, and lack of access to health care.

According to a recent news digest report by the Robert Wood Johnson Foundation, the Illinois General Assembly has recently funded supermarket expansion into underserved areas of the state in order to improve the supply of fresh fruits and vegetables in those locations.

Pennsylvania began a Fresh Food Financing Initiative in 2004 to incentivize the growth of corner stores (remember those neighborhood grocery stores back in the day?) and eliminate food deserts. New York City is also trying to provide tax and monetary incentives to small businesses to provide fresh produce in poor neighborhoods. (Both discussed in a recent New York Times editorial)

To learn more about what is happening around the nation to eliminate food deserts and its associated health disparities check out TheFoodTrust.org.

Black-White Disparities in Preterm Birth May 13, 2009

Posted by awooley in Disparities.
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In the last 50 years, infant mortality rates in the United States have declined.  However, disparities in infant morality rates across racial and ethnic groups persist.  Black infants are more than twice as likely to die in their first year of life than their white counterparts (CDC 2000 and CDC 2008).  Preterm birth (birth prior to 37 weeks gestation) is a major contributor to infant mortality disparities. These black-white disparities in preterm birth persist with increasing socioeconomic status, suggesting that this disparity is not due to socioeconomic position.  Black college-educated women have higher rates of PTB than their white college-educated counterparts  (Schoendorf et al., 1992). Attempts to increase access to prenatal care and offer intensive prenatal case management have not influenced these disparities. 

Could it be that racism-associated stress, a form of psychosocial stress, encountered long before conception may increase the risk of preterm delivery and begin to explain this disparity?  Sociologist Arline Geronimus posits that experiences of discrimination, rather than socioeconomic position, may explain women’s health inequalities among black women, particularly those residing in high poverty urban areas.  Geronimus introduced the concept of the “weathering hypothesis,” whereby the body exhibits consequences of and responses to chronic exposure to social, economic and political exclusion arising from racial discrimination. Psychosocial stress resulting from these cumulative experiences may prematurely age or weather the reproductive system, contributing to the increasing the risk of poor birth outcomes among older black women.  Moreover, in utero exposure to a deteriorated environment results in a generational transfer of the weathering process (Geronimus, 1992 and Geronimus, 2001).  Considering this weathering framework, it seems that interventions to address these disparities must begin prior to conception to improve the mental and physical health of women and girls of color to counteract the bio-psychosocial consequences of racial discrimination.

 

Works Cited:

Centers for Disease Control and Prevention. Office of Minority Health and Health Disparities. Fact Sheet: Eliminate Disparities in Infant Mortality.  http://www.cdc.gov/omhd/AMH/factsheets/infant.htm Accessed 9 Feb 2009.

Centers for Disease Control and Prevention. Healthy People 2010: Understanding and improving health (2nd Edition). Nov 2000. http://www.healthypeople.gov/Document/html/uih/uih_2.htm#goals Accessed 9 Feb 2009.

Geronimus AT. The weathering hypothesis and the health of African-American women and infants: evidence and speculations. Ethnicity and Disease. 1992; 2(3): 207-221.

Geronimus AT. Understanding and eliminating racial inequalities in women’s health in

The United States: The role of the weathering conceptual framework. JAMWA 2001; 56: 133-136

Schoendorf K.C., Hogue C.J.R., Kleinman J.C., Rowley D. Mortality among infants of black as compared with white college-educated parents. New England Journal of Medicine 1992; 326: 1522-1526.