Please send items of interest for the E-News -- and any other feedback -- to E-News editor Kevin Sherin, MD, MPH. . Thanks!
1) Academic Health Department Awards
2) California Leads in Controlling Obesity & Tobacco
3) Obituary for Ron Davis, MD, MA (1956-2008)
4) Tobacco Control Action Items
5) AAPHP's Resolutions at AMA Interim Meeting
6) Epidemiological Criminology
7) CME on "Mental Health in Disasters"
8) Membership and Recruitment
9) New Information on MDR-TB and XDR-TB
10) Spreading the Word
1) Academic Health Department Awards:
Your AAPHP held its annual membership meeting at the American Public Health Association (APHA) in San Diego on October 26th. We honored four public health physicians from across the nation with Presidential Certificates of Lifetime Meritorious Service for their work in establishing and maintaining academically based teaching health departments. Each of these honorees is an AAPHP member, most of them for many years.
CARL BRUMBACH, MD, MPH, of the Palm Beach County
(Florida) Health Department was honored for creating the first community health center in Florida and for establishing a preventive medicine residency in the Palm Beach County Health Department.
JEAN MALECKI, MD, MPH, was also recognized for efforts to establish the Palm Beach County Health Department as an academically based teaching department.
C. WILLIAM KECK, MD, MPH, of the Akron, Ohio Health Department was recognized for creating a longstanding academic health department with the Northeastern Ohio Universities Colleges of Medicine and Pharmacy (NEOUCOM).
LEONARD MORSE, MD, MPH, of the Worcester
(Massachusette) City Health Department was honored for establishing the Worcester City Health Department as a rotation for University of Massachusetts students, preventive medicine residents, Harvard School of Public Health alumni, and Boston University College of public health alumni.
AAPHP's vision is to create a network of teaching health departments across the country to apply effective public health principles in the development and maintenance of data-driven population based services. Greater coordination and synergy between local health departments, colleges of public health and medicine, and other community partners can result in the development of academic health departments whose core components represent service, teaching and research.
As defined in a recent Institute of Medicine report, a public health physician is one
"whose training, practice and world view are based in large part on a population focus rather than individual practice; that is, on assuring the availability of essential public health services to a population using skills such as leadership, management and education as well as clinical interventions."
AAPHP's mission is to promote the public's health; educate the nation on the role and importance of the public health physician?s knowledge and skills; and foster communications, education, and scholarship in public health. AAPHP represents physicians from all specialties who work in public health, and who help protect the health of all Americans.
2) California Leads in Controlling Obesity & Tobacco:
Our AAPHP educational speaker in San Diego was the Deputy Secretary of Health for the State of California, AAPHP member BONITA J. SORENSEN, MD, MBA. Dr. Sorenson is an endocrinologist and expert on diabetes and obesity as a risk factor for chronic diseases, as well as a tobacco control expert who oversees California's huge tobacco control program.
Dr. Sorensen is Chief Deputy Director for Policy and Programs for the California Department of Public Health, which was formed by splitting the former California Department of Health Services into the new Department of Public Health (CDPH) and the new Department of Health Care Services (DHCS).
Dr. Sorensen noted California's abundance of statewide partners, of local initiatives, and of non-governmental initiatives. Although his cigar smoking gets a lot of publicity, Governor Schwarzenegger supports many public health initiatives. There is a lot of physician leadership in state and local public health.
The California Department of Public Health has five "Centers" reporting to the Director's Office: the Center for Chronic Disease and Health Promotion, the Center for Infectious Diseases, the Center for Family Health, the Center for Environmental Health, and the Center for Healthcare Quality. Because obesity cuts across multiple centers' subject areas, there is a "Coordinating Office for Obesity Prevention" reporting to the Director's office. Lisa Hershey MPH directs the Coordinating Office for Obesity Prevention.
California is exceptionally large and diverse.
Overweight and obesity are close to the national average. California has pioneered many healthy-lifestyle and healthy-environment initiatives, especially school-based programs.
Governor Schwarzenegger has outlined a "Ten-Step Vision for a Healthy California", emphasizing environmental and cultural support for individuals' diet and exercise choices. One slogan is that "Access to healthy food is key to a healthier California". Another slogan, used as a banner in walking parades, is "We Love To Walk!"
The Governor's Health Care Reform program has "Prevention, health promotion, and wellness" as one of its three pillars. (The other two are "Coverage for all Californians" and "Affordability and cost containment.")
A public-private partnership, "Get Healthy California!", will emphasize social marketing of physical activity and healthy foods, by the health care industry as well as by government. Future trends may include land use planning, social norm changes, and a focus on equity. The WIC food package is expected to shift toward healthier foods in 2009. Private-sector marketing can help to "sell" the changes in ways that WIC can't. One of the emphases of California's Biodiversity Council is to get children outside, and to get them comfortable with outdoor activities.
California's tobacco control program has, in most respects, been a model for the nation. California has addressed, or is making progress toward, 25 of the 30 state-addressable measures in the IOM's 2007 "Blueprint for Reducing Tobacco Use". California's adult smoking rate is the second-lowest in the country. However, the tobacco industry still spends freely to influence new smokers and to keep current customers.
From 2003 to 2007, the inflation-adjusted price of cigarettes in California declined 15%. This 15% decrease in price is likely to increase adult smoking prevalence by 3%, to increase per capita cigarette consumption by 6%, and to increase youth smoking prevalence by 9%. Prevalence statistics are already showing the first signs of the predicted trends.
The percentage of smokers who think about quitting leveled off in 2003. The number of cigarettes smoked per day by daily smokers has leveled off and may be increasing.
In response, the CDPH will try to limit secondhand smoke exposure in multifamily housing, will target interventions primarily to populations designated as "priority", and will implement training programs and other initiatives to promote program efficiency. The Department notes a lot of free cigarette "sampling" to vulnerable populations (especially in venues frequented primarily by young adults) and is advocating a statewide ban on this sampling.
In response to a question, Dr. Sorensen noted that CDPH has reached agreements with six major studios to include CDPH's anti-smoking messages in all DVD's produced for worldwide use.
California often follows New York City's lead on public health issues. After New York City implemented restaurant menu labeling rules, Governor Schwarzenegger supported a similar measure in California and it was passed in the last year.
AAPHP thanks Dr. Sorensen for sharing news of California's good work!
3) Obituary for Ron Davis, MD, MA (1956-2008):
Longtime AAPHP member, staunch public health and anti-tobacco advocate, and AMA's 2007-2008 President RONALD M. DAVIS, MD, MA died November 6, 2008 at age 52. From the obituary posted by Dr. Davis' family:
"Ronald M. Davis, MD passed away peacefully in his home surrounded by his loving family, on November 6, 2008 after a courageous fight with pancreatic cancer. Ron was the beloved husband of Nadine (nee Messina), the proud father of three sons, Jared, Evan, and Connor, the loving son of the late Alice Komessar (Saul) and the late George Davis (Joyce), loving son-in-law of Mae and the late Frank Messina, dear brother to 9 siblings ...
and uncle to many adoring nieces and nephews.
"Ron's star shone very brightly, albeit too briefly, in the medical community. He graduated medical school from the University of Chicago, where he also received a Master of Arts in Public Policy Studies. He completed a Preventive Medicine Residency Program at the U.S Center for Disease Control (CDC). Following his training, he served under Surgeon General C. Everett Koop as the Director of the Office on Smoking and Health at the CDC in Rockville, Maryland. Subsequently, he served as Chief Medical Officer for the Michigan Department of Public Health, until assuming his most recent position as Director, Center for Health Promotion and Disease Prevention for the Henry Ford Health System in Detroit, Michigan.
"Ron was the founding editor of Tobacco Control, an international publication of the British Medical Journal, and North American Editor of the British Medical Journal from 1998 to 2001. A prolific author, Ron wrote or co-wrote hundreds of articles in peer-reviewed journals, as well as an equal number of editorials and contributions in the lay press. He served as an expert witness to Congress on public health issues, issuing nearly a dozen reports and providing frequent oral testimony.
A gifted educator, Ron gave countless lectures and educational seminars, dedicating his career to the service of the public, his colleagues and the next generation of physicians.
"After many years of dedicated service, Ron reached the pinnacle of American medicine, being elected as President of the American Medical Association in June of 2007. He has received numerous awards and honors, including the Surgeon General's Exemplary Service Medal and the Surgeon General's Medallion, The American College of Preventive Medicine?s Distinguished Service Award, the American Thoracic Society's Distinguished Service Award, and most recently the American Public Health Association's 2008 Lifetime Achievement Award for his career-long fight against alcohol, tobacco, and other drugs.
"While these prestigious awards and accomplishments are extraordinary, Ron's ultimate legacy will be the strength of his character - impeccable integrity, graciousness, the highest ethical standards, a beautiful smile, respectful manner, and an intense dedication to his family and friends whom he loved so much.
"In lieu of flowers, donations in Ron's memory may be made to the following organizations:
The American Medical Association Foundation Ronald M. Davis, M.D. Legacy Honor Fund
515 North State Street
Chicago, Illinois 60610
The Pancreatic Cancer Action Network (PanCAN)
2141 Rosecrans Avenue
El Segundo, CA 90245
"A great man has passed...."
The family's obituary -- and more about Ron's illness, including messages left by well-wishers throughout the year -- can be viewed at http://www.carepages.com/carepages/rondavis/updates/1811420
An AMA Press Release - "AMA Immediate Past President Ron Davis loses battle with cancer, leaves enduring AMA and public health legacy" is at http://www.ama-assn.org/ama/pub/category/20255.html .
4) Tobacco Control Action Items:
AAPHP has gone on record as declaring that the current FDA/Tobacco bill is so distorted in favor of the Philip Morris company that, if passed in its current form, it will do more harm than good in terms of future rates of teen smoking and future tobacco-related illness and death.
While the bill does contain some commendable elements, the distortions and limitations in this bill and the designation of FDA as the regulatory agency while imposing near-total limitations on FDA authority create the situation in which, on balance, the bill will do more harm than good. AAPHP has posted its analysis of this bill and recommendations for amendment on www.aaphp.org, under "tobacco issues."
We will attempt to meet with Representative Waxman and Senator Kennedy to try to convince them of the value of amending the bill to protect public health while retaining the support of most, if not all, current legislative sponsors.
In the context of considering how best to amend the FDA/Tobacco Bill, the AAPHP Tobacco Control Task Force has explored the issue of tobacco harm reduction -- recommending that smokers who are unable or unwilling to quit can dramatically reduce their risk of tobacco-related illness and death by switching to less hazardous smokeless tobacco products. In this process, we were surprised by the quality of the literature and the dramatic reductions in risk that could be secured.
As an action item, the AAPHP General Members in attendance at the San Diego meeting considered and, with one minor change in wording, adopted the proposed Harm Reduction Resolution. The resolution and White Paper are posted at http://www.aaphp.org, under "Tobacco Issues."
5) AAPHP's Resolutions at AMA Interim Meeting:
AAPHP's resolutions for the AMA Interim Meeting were included in the E-News for 2008-10-20.
"Texting while Driving: Preventing Disaster" was adopted, with substantial favorable publicity.
"Oppose Sale of Tobacco in Pharmacies" was considered
-- erroneously, we think -- as a reaffirmation of existing policy, rather than as an extension of existing policy. We plan to try again in the spring.
"Oppose Sale of Firearms Where Patients Receive Health Care" was defeated. Most testimony against the resolution was based on "second amendment rights"
rather than on public health concerns.
We will continue to explore opportunities to improve AMA's public health policies whenever possible.
6) Epidemiological Criminology:
Dr. Hugh Potter, from the University of Central Florida, invited your President and E-News editor to attend his panel on Epidemiological Criminology at last month's APHA meeting in San Diego.
Cheryl Easley, PhD, APHA's President-Elect and Dean of the College of Health and Social Welfare at the University of Alaska, Anchorage, spoke on the Virtual Center for Epidemiological Criminology, of which she is now an Executive Board member.
The boundaries between Epidemiology and Criminology are of course man-made. Criminology used an epidemiological approach before John Snow did his famous study of the Broad street pump. John Snow used criminology data collection methods, including sophisticated mapping, similar to those used by modern epidemiologists.
Risk factors for violence, suicide, and homicide in our communities reflect the social determinants of health. Risk factors for infectious disease, teen pregnancy, and victimization are similar.
Translating this research into community based programming and partnerships at the local level is a priority for all public health and justice officials.
LET'S WORK TOGETHER ON THIS and let AAPHP help lead the way!
7) CME on "Mental Health in Disasters":
Longtime AAPHP member and former AAPHP Board member MARC A. SAFRAN, MD, MPA will present a Continuing Education audioconference on "Mental Health in Disasters and Other Crises" on TUESDAY, NOVEMBER 18,
2008 from 1:00 pm to 2:00 pm Eastern Standard Time.
The conference is sponsored by the U.S. Centers for Disease Control and Prevention, where Dr. Safran has worked for many years.
To participate "live" in this conference, call
(888) 790-1924. The passcode for this session will be 5081736. You may download the PowerPoint presentation, beginning the day of the conference, at http://www.emergency.cdc.gov/coca/callinfo.asp .
CME and other continuing education credits (including CNE, CHES, and CEU) will be available at the presentation, and for one year afterward, through the CDC Training & Continuing Education Online system at http://www2a.cdc.gov/TCEOnline/ . The course code will be EC1265 from 2008-11-18 through 2008-12-17.
Then the course code will change to WD1265, valid from 2008-12-18 until 2009-11-18.
The objectives for the 2008-11-18 session are to help participants to: (1) Give examples of how mental health and mental illness may impact upon the outcomes of disasters and other crises; (2) Improve their own organizations' emergency planning for mental health aspects of crisis management; and (3) Consider at least one strategy to help recognize and respond to mental health issues in their professional roles.
AAPHP thanks Dr. Safran. We hope other AAPHP members will help our colleagues by sharing news of educational events.
8) Membership and Recruitment:
All AAPHP physicians are urged to go to the website at http://www.aaphp.org, download the 2009 Membership Invoice form, and remit the 2009 Dues at your earliest convenience. A check is preferred for transaction purposes to reduce the costs to the organization. We work hard to optimize our resources on your behalf. Please share our website and opportunities for advocacy and collaboration on national health, public health policy and AMA policy with as many colleagues as possible.
AAPHP strives to be the best value for your membership dollars of any organization you belong to.
Takeisha C. Davis, MD, MPH, the regional Health Officer for the New Orleans Region, has agreed to be AAPHP's liason to APHA's Medical Care Section. Her colleague, Dr. Rony Francois, former Secretary of the Florida Department of Health, and now the Health Officer for the Lousiana Bureau of Hospitals and Public Health, is also one of our newest AAPHP members. Congratulations, Rony and Takeisha!
9) New Information on MDR-TB and XDR-TB:
Newsweek reported on 2008-10-29 that extremely drug-resistant tuberculosis (XDR-TB) has received "almost no attention." A new 50-city global campaign uses dramatic pictures by photographer James Nachtwey and the internet to show that XDR-TB kills one in six infected. Speaking for the World Health Organization, Anna Cataldi stated that pandemic flu concerns have eclipsed messages about XDR-TB. Global laboratory resources are inadequate to provide an exact count of XDR-TB cases, but estimates range from 30-50,000.
Florida's Department of Health is grappling with multiply drug-resistant TB (MDR-TB). The highest rate of MDR-TB is now seen in the Dominican Republic.
As with other infectious diseases, lack of adherence to treatment regimens is a root cause of drug resistant forms of TB. Many nations lack sophisticated resources, especially those of laboratories and directly observed therapy or DOT.
Refugees are at greater risk of TB. The US leads the globe in relocation of refugees, and Florida leads the US in number of refugees. BCG vaccine is offered in other nations to prevent TB meningitis in children. A PPD greater than 15 can never be attributed to BCG vaccine. Weakly positive PPD's after 10 years can NEVER be attributed to previous BCG vaccine.
10) Spreading the Word:
Please tell your friends and colleagues about AAPHP's representation of Public Health Physicians.
E-News subscriptions are still free, on request, to any interested physician or medical student.
We welcome new subscribers and members. Thank you for your support!
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