Category Archives: Prevention
A recent report from the Institute of Medicine found that young athletes in the United States face a "culture of resistance" to reporting when they might have a concussion and to complying with treatment decisions. That culture can result in students heading back to school too quickly—when they should be resting their brains to prevent short- and long-term complications.
"The findings of our report justify the concerns about sports concussions in young people," said Robert Graham, chair of the committee and director of the national program office for Aligning Forces for Quality, at George Washington University, Washington, D.C. (Aligning Forces is a program of the Robert Wood Johnson Foundation.) "However,” says Graham, “there are numerous areas in which we need more and better data. Until we have that information, we urge parents, schools, athletic departments, and the public to examine carefully what we do know, as with any decision regarding risk, so they can make more informed decisions about young athletes playing sports."
Recently, Righttime Medical Care, a chain of urgent care centers in Maryland, opened a number of HeadFirst sports injury and concussion centers in the state, staffed with health professionals who can assess injuries for concussions as well as evaluate students for return to play—in consolation with a team of experts who work with HeadFirst staff. HeadFirst will this year be presenting and publishing data on the more than 10,000 youth it has examined and treated for concussion in just the past two years.
NewPublicHealth recently spoke with Robert Graw, MD, head of Righttime and HeadFirst, about the need for better prevention, evaluation and treatment of concussions to prevent long-term health problems and disability.
NewPublicHealth: Why did Righttime add concussion care to the services provided?
Robert Graw: My son is an orthopedic surgeon and talked to me about the number of injuries he was seeing. We decided a few years ago that we’d learn as much as we could about preventing head injury and the consequences of head injury, and then promote that information through Righttime’s call center and through the visits that people made to our sites.
In the process of learning as much as we could we realized that the knowledge base of how people evaluate and manage concussions had changed drastically in the last five years as people have done more research. So, we then gathered together a group of consultant physicians and neuropsychologists to determine best practices. We met with them frequently, and then had them train our provider staff so that all of them became much more informed about what a concussion really is, the best way to evaluate them and the guidelines for management going forward.
A new infographic from the Office of the U.S. Surgeon General highlights collaborations within the federal government and between the health and healthcare sectors to help improve prevention outreach. These efforts are part of the cross sector National Prevention Strategy launched by the office several years ago.
Current examples of collaboration include Million Hearts, an initiative of the U.S. Department of Health and Human Services to prevent one million heart attacks by 2017. The initiative includes a commitment by close to 150 large private medical practices in the United States to get hypertension control rates above 80 percent in their communities.
You can also view the fully interactive infographic here.
>>Bonus Link: Read interviews and listen to podcasts about the National Prevention Strategy conducted with former and current U.S. Cabinet Secretaries and agency heads.
IOM Report: More Evidence-Based Practices Needed to Help Treat and Prevent Psychological Disorders among Service Members and Families
Between 2000 and 2011, almost 1 million service members or former service members were diagnosed with at least one psychological disorder either during or after deployment, according to recent research by the Institute of Medicine (IOM). As a follow up, the U.S. Department of Defense (DOD) asked the IOM to evaluate the department’s efforts to prevent psychological disorders among active-duty service members and their families. That report was recently released.
The report includes recommendations on how the DOD can improve care.
Finding 1: DOD has implemented numerous resilience and prevention programs for service members and their families, but it faces a number of challenges, including an insufficient evidence base to support its interventions and a lack of systematic evaluation and performance measures.
Recommendation 1: By targeting resources to develop the evidence base and disseminate that evidence, DOD’s prevention efforts can be both more effective and cost effective.
Finding 2: There is a need for DOD to improve approaches for identifying and intervening with service members and their members who may already have or may be at risk for developing a psychological disorder.
Recommendation 2: DOD should dedicate funding, staffing and logistical support for data analysis and evaluation to support performance monitoring of programs for accountability and continuous improvement.
Finding 3: Screening, assessment and treatment approaches for psychological health problems are not always implemented between and within the DOD and the U.S. Department of Veterans Affairs (VA) in a consistent manner or aligned with the evidence base, which threatens the delivery of high-quality care and hampers evaluation efforts.
- There are opportunities to improve processes of training and evaluating clinicians, including the incorporation of continuing education and supervision; standardized periodic evaluation; and a greater emphasis on coordination and interdisciplinarity.
- The DOD and VA should invest in research to determine the efficacy of treatments that do not have a strong evidence base.
- Both departments should conduct systematic assessments to determine whether screening and treatment interventions are being implemented according to clinical guidelines and departmental policy.
- Accessible inter-department data systems should be developed to assess treatment outcomes, variations among treatment facilities and barriers to the use of evidence-based treatment.
- Read the complete report.
- Read a NewPublicHealth interview with Jonathan Woodson, MD, Assistant Secretary of Defense for Health Affairs about the National Prevention Strategy.
- Learn more about the state of mental health in the military from this infographic from the American Psychiatric Association embedded below.
While it has been decades since polio was a critical threat for much of the developed world, the disease—a virus that can spread from person to person and affect the brain and spinal cord with the potential for paralysis—still causes disease and death in the developing world. Earlier this year cases were reported in Syria, while in Israel the polio virus was found in soil likely from human waste infected with the disease, prompting a revaccination campaign among children age 5 and under. Polio has continued to spread in Afghanistan, Nigeria and Pakistan, and has been reintroduced and continues to spread in Chad and in the Horn of Africa after the spread of the virus was previously stopped. Other countries have seen small numbers of cases recently after no cases for decades.
Because even a small spread of the disease could reach the United States if infected individuals carry the virus here, the U.S. Centers for Disease Control and Prevention (CDC) several years ago made polio one focus of their Emergency Operations Center. CDC staff work with the World Health Organization and foreign health departments on vaccination campaigns aimed at fully eradicating the disease.
>>Bonus Content: View the CDC's infographic, "The Time to Eradicate Polio is Now."
NewPublicHealth spoke recently with Sona Bari, senior communications officer at the World Health Organization about the efforts underway to eradicate polio globally.
NPH: How are you able to detect polio outbreaks?
Sona Bari: We have a global surveillance system for polio and know from it that since 1988 the reduction of the disease has been over 99 percent. Polio is now endemic, which means indigenous polio virus transmission has never been stopped in parts of three countries: Nigeria, Afghanistan and Pakistan. So the surveillance is important because you can get polio down to very low levels like you do now, but it can reemerge. To completely eradicate polio you have to have an effective intervention, which is largely by vaccination. And you can be bring polio under very tight control by massive vaccination, but the virus is very good at finding children who are unvaccinated or under-vaccinated, and in Nigeria, Afghanistan and Pakistan we still have large groups of unvaccinated children. So the reason that polio transmission has not been stopped in these areas is that not enough children are vaccinated.
NPH: Why is there insufficient vaccination in those countries?
Bari: The basic reason is the quality of vaccination activities. Do these countries have decent health systems—strong routine immunization systems where children are regularly taken to a medical facility for their immunizations? When there are mass vaccination campaigns, are we reaching all children? Then there are, on top of that, layers of political complexities. In one part of Pakistan, for example, there is a ban on polio vaccinations by the local warlords. So there are access and security issues, layered on top of the difficultly of reaching all who need vaccines in countries such as Nigeria or Pakistan. That said, we know that these circumstances are not unique. They may differ from country to country, and each country does have a unique combination of the obstacles, but polio has been eradicated in countries that are far poorer than Nigeria or Pakistan, that have had worse conflict and that have perhaps much worse health systems. So it can be done.
New reports from the U.S. Centers for Disease Control and Prevention (CDC) show that 39 percent of adults and 41 percent of children six months and older got their flu shots for the 2013-2014 season by early November—a rate similar to flu vaccination coverage last season at the same time.
Other flu shot statistics of note this year include:
- Vaccination among pregnant women (41 percent) and health care providers (63 percent) is about the same as it was this time last year
- High rates were seen again this year among health care providers including pharmacists (90 percent), physicians (84 percent) and nurses (79 percent), but the CDC reported much lower vaccination rates among assistants or aides (49 percent) and health care providers working in long-term care facilities (53 percent)
“We are happy that annual flu vaccination is becoming a habit for many people, but there is still much room for improvement,” says Anne Schuchat, MD, director of the National Center for Immunization and Respiratory Diseases at CDC. “The bottom line is that influenza can cause a tremendous amount of illness and can be severe. Even when our flu vaccines are not as effective as we want them to be, they can reduce flu illnesses, doctors' visits, and flu-related hospitalizations and deaths.”
Seasonal influenza activity is increasing in parts of the United States. Further increases in influenza activity across the country are expected in the coming weeks. “If you have not gotten your flu vaccine yet this season, you should get one now,” said Schuchat.
The CDC’s report comes just ahead of the observance next week of National Influenza Vaccination Week (NIVW), which is scheduled each year for the second week in December because vaccination rates tend to fall off toward the end of November. It’s hardly too late to get the flu vaccine: flu season usually peaks January through March, and the virus—and the potential to catch it—often lasts as late as May.
People who haven’t had the flu shot should make it a priority to do so as soon as possible for at least two reasons. One, providers tend to return their unused vaccines toward the end of the year, which can make it hard to find a vaccine if you still need the shot (check this flu vaccine finder for providers in your area, and call ahead to be sure they have supplies on hand). Two, it takes two weeks for the flu vaccine to take full effect, so the sooner you get it the more protected you are against people harboring the flu during the upcoming holiday party season.
Still on the sidelines about getting the shot? The CDC has some impressive numbers from last year’s flu season: flu vaccination prevented an estimated 6.6 million influenza-associated illnesses and 79,000 hospitalizations during the 2012-2013 flu season.
>>Bonus Links: Learn more about preventing and treating influenza on NewPublicHealth.
>>Bonus Content: CDC's infographic on the benefits of the flu vaccine (full size PDF).
In the face of health care reform, funding challenges, and increased collaboration, public health faces a promising yet unclear future in terms of both financial support and program reach. On Saturday, the Robert Wood Johnson Foundation co-hosted a forum with the American Public Health Association (APHA) in advance of the APHA 2013 Annual Meeting to discuss these issues – and more. Leading minds from the fields of public health, government and business met to get to the bottom of a crucial question: how do we move public health forward?
In the opening session, Paul Kuehnert, Director of the Public Health Team at the Robert Wood Johnson Foundation, explained that the field’s challenge lies in “skating where the puck is going to be.” APHA Executive Director Georges Benjamin echoed that sentiment, nothing that the forum was “an opportunity to figure out where the public is going and then, when the wave comes, be right there to catch it.” The ensuing breakout sessions furthered this overarching theme with panels that discussed both the challenges they’ve faced -- and the opportunities they’ve found for success.
>>NewPublicHealth will be on the ground throughout the APHA conference speaking to public health leaders and presenters, hearing from attendees on the ground and providing updates from sessions, with a focus on how we can build a culture of health. Follow the coverage here.
Re-Thinking How We Pay for Public Health and Prevention
One panel discussed funding challenges that public health departments face and solutions that have been reached across the country. John Auerbach of Northeastern University’s Institute on Urban Health Research, and former health commissioner of Massachusetts, touched on health care reform as a vehicle for preventive care. “Nearly 75 percent of those insured in Massachusetts have had a preventive care visit in the last 12 months,” he explained. In other words, people who are insured are twice as likely to get care that could actually prevent them from getting sick, instead of having a treat a more serious illness. Auerbach also discussed development of the state’s Prevention and Wellness Trust Fund — a four-year, $60 million public health trust supported by a one-time assessment on health insurers and largest clinical providers. Auerbach stressed that this source of funding was important, particularly because it’s insulated from the variability of public funding and political tides.
By focusing on the critical services and programs that are truly necessary for the public health system to work, the Seattle and King County Health Department has developed a minimum package of public health services needed for all projects to success. David Fleming, Director and Health Officer in the Seattle/King County Health Department, and his staff determined the money needed to fund such a package in both per capita and overall costs. Washington State is now working with RWJF and other stakeholders to determine the feasibility of defining and costing these foundational services at the national level.
In honor of World Polio Day, the U.S. Centers for Disease Control and Prevention (CDC) will highlight polio eradication work around the globe on Twitter and Facebook. Development of the polio vaccine has reduced the disease worldwide by 99 percent, with only Afghanistan, Nigeria and Pakistan as the remaining polio endemic countries in 2012.
But both in endemic countries and in countries where polio was thought to have been vanquished, cases persist. According to the Global Polio Eradication Initiative, just this week eleven new wild poliovirus (WPV) cases were reported, including one from Afghanistan, two from Ethiopia, four from Pakistan and four from Somalia. The total number of WPV cases for 2013 is now 296, with 99 from countries that have not yet been able to eradicate the disease and 197 from countries that have seen outbreaks. In Israel, for example, while no cases of paralytic polio have been reported, environmental surveillance suggests that virus transmission (first detected in February 2013) continues in parts of the country’s southern and central regions. A vaccination campaign for children under age ten is ongoing.
On December 2, 2011, CDC Director Thomas R. Frieden, MD, MPH, activated CDC’s Emergency Operations Center (EOC) to strengthen the agency’s partnership engagement through the Global Polio Eradication Initiative (GPEI). Activation of the EOC has provided enhanced capacity for CDC’s polio eradication support program, which trains public health volunteers in the United States and globally to improve polio surveillance and help plan, implement and evaluate vaccination campaigns.
Additional EOC activities include:
- Publication of several joint World Health Organization Weekly Epidemiologic Record/CDC Morbidity and Mortality Weekly Reports (MMWR) highlighting polio eradication progress.
- Collaboration with GPEI partners on detailed country-plans for expanded technical and management support, including assistance with outbreak responses, surveillance reviews, vaccination campaign planning and monitoring, and data management.
- Provision of operational support to Nigeria for the country’s FY 2012 Polio Eradication Emergency Response Plan. The plan focuses on enhancing management and leadership skills to improve program performance.
- The development of indicators for monitoring polio vaccination campaign performance in the areas of planning, implementation and evaluation.
- Review of WHO-proposed outbreak response protocols for all polio-affected countries.
“If we fail to get over the finish line [to fully eradicate polio],” says Frieden, “we will need to continue expensive control measures for the indefinite future…More importantly, without eradication, a resurgence of polio could paralyze more than 200,000 children worldwide every year within a decade.”
Have you heard the story about the Prevention and Public Health Fund? A “no” wouldn’t be surprising.
Have you heard the story about the almost 200,000 preventable deaths in the United States each year due to heart disease and stroke? Probably so.
The latter was big news last week, inspiring headlines and handwringing across the country. Men are twice as likely as women to die of preventable cardiovascular disease. Blacks are twice as likely as whites. Southerners are at far greater risk.
Most of the stories emphasized how all this unhealthy living is the result of unhealthy lifestyle choices. But is that the whole story?
“Largely absent from most of the stories covering the study was context—a hard look at the social and environmental conditions that help explain the findings—as well as some explanation of what it might take to really change things and prevent large numbers of needless deaths.” They also tended to suggest “that poor health is essentially a personal moral failing, while ignoring the vastly different realities that exist in different communities in this country.”
That’s the thesis of a recent Forbes opinion piece, which looks past the round number of “200,000” and other statistics detailed by the U.S. Centers for Disease Control and Prevention (CDC), and points attention to the very real obstacles to healthy living that far too many people face.
The CDC study also discussed the importance of addressing the economic and social determinants that influence the health of individuals and communities (though this went largely unacknowledged in most media accounts, according to the Forbes piece). The CDC pointed out strategies that help create conditions for healthier living, including policy changes that increase access to health care, that give people healthy local food options and that build walkable communities—changes that can only be made by communities, not individuals.
That brings us back to the Prevention and Public Health Fund. Created by the Affordable Care Act, the Fund’s grantees have spent the past three years doing all these things—helping states, cities and tribes create safer, healthier communities.
“That’s a story that needs to be told, with context.”
>>Read the full piece, “200,000 Preventable Deaths A Year: Numbers That Cry Out For Action -- And Better Reporting.”
The United Nations Foundation believes that, for the biggest public health obstacles facing the world, it will take all nations and all sectors working toward solutions to succeed. So the Foundation works to make that a reality, bringing together partnerships, growing constituencies, mobilizing resources and advocating policies that can help everyone—in both the developing and developed world.
NewPublicHealth recently spoke with Kathy Calvin, President and Chief Executive Officer of the United Nations Foundation, about the organization’s many efforts to improve health both globally and locally—and how these two goals can support each other.
NewPublicHealth: What changes have you seen in global health during your time in the field?
Kathy Calvin: The number of nonprofits dedicated to health issues has quadrupled it seems, and real progress has been made, which is the most important point—that we’re actually seeing a reduction in maternal deaths and newborn deaths and preventable diseases such as measles and diarrhea and pneumonia. I mean, there’s just been enormous progress, with still much more to happen. But it’s been an exciting time after what I think has been a pretty discouraging period where no amounts of foreign aid seemed to be making a difference. I attribute that partly to some innovations in research and financing, but also to the fact that a lot of governments in Africa actually have prioritized women and prioritized health in some pretty significant ways. And I think we’ve had a very enlightened government in the last five years here, too, in terms of what we’re doing overseas.
So, it’s been exciting to see it. Health is not my background. I’ve really been privileged to see both how serious and significant the challenges are, but also how much good can be done with just a little bit of organized effort.
NPH: When you talk about enlightened government, what are some examples? What is making the difference now?
Calvin: Well ironically it isn’t all that political. In fact, some of the biggest shifts took place under President George W. Bush’s administration with his creation of the President’s Malaria Initiative—until then, there had been zero real depth of interest and progress on malaria—as well as PEPFAR, which some people criticized because it was so bilateral, but it had a huge impact in allowing the current administration to really set some ambitious goals for reducing and eliminating parent-to-child transmission and setting that audacious goal of an AIDS-free generation.
Who better to offer up advice on summer sun protection than the Los Angeles County Health Department? Recently the department warned its residents to “practice summer sun smarts” to protect themselves from skin cancer, which, at 1 million diagnoses per year according to the Environmental Protection Agency, is now the most common form of cancer among Americans.
July is recognized as "UV Safety Month" to encourage everyone—not just those in Los Angeles—to protect themselves from ultraviolet (UV) rays, a major risk factor for most skin cancers, by using sunscreen and avoiding prolonged sun exposure during peak hours. “Simple sun safeguards can go a long way in protecting the health of you and your family this summer,” says Jonathan E. Fielding, MD, MPH, the departments’ director of public health.
In other summer sun safety news, this week the National Highway Traffic Safety Administration (NHTSA) and SAFE KIDS Worldwide partnered up to promote National Heatstroke Prevention Day this past Wednesday, July 31. NHTSA and their partners used this opportunity to educate parents on the dangers of leaving children in unattended vehicles in the summer heat, as there have already been over 20 heat-related deaths of children in cars this summer. Children’s body temperatures can spike three to five times faster than an adult’s, and even cool temperatures in the 60s can cause the temperature in the car to rise well above 110 degrees Fahrenheit—so safety steps are critical at all times.