Wednesday, November 6, 2013

APHA Opening Session


The opening session of the 141st Annual Meeting of the American Public Health Association (APHA) was keynoted on Sunday by Sir Michael Gideon Marmot, Professor of Epidemiology and Public Health at University College London, and author of "The Status Syndrome: How your social standing directly affects your health and life expectancy." He had spoken to this large public health assembly 5 years earlier and was making a reprise to demonstrate that not much progress has been made in reducing health disparities during that time frame.  

He began his talk by quoting from W.H.Auden's poem Crisis and Upheaval, written at the beginning of World War II when European countries were under siege and were waiting for some support from their allies.
In the nightmare of the dark
All the dogs of Europe bark,
And the living nations wait,
Each sequestered in its hate.

He used this quotation to make the point that the problems of disparities in the U.S. today, like the threat to Europe posed by the Nazis of the 1930s, are blatantly evident, yet policy makers and leaders in the public and private sectors are choosing not to act. He went on to highlight some of the "nightmares" that we are facing. Among OECD (organization for economic cooperation and development - "developed" countries) the U.S. has:
* the lowest life expectancy for men and second lowest for women
* the 2nd worst maternal mortality
* the 2nd highest non-communicable disease mortality
* the 4th highest infectious disease mortality
* the highest injury mortality
* and the list went on

He recognized the the need to develop sustainable programs and policies but reminded the crowd that "We don't do things because they are cost effective and cheap. We do things because they are right."  He emphasized that we must "Put fairness at the core of all policies" and stated the obvious that "Policies that don't lead to fairness are unfair."

He closed his speech with this line from Pablo Neruda:  "Rise up with me, against the organization of misery." He encouraged - he pleaded with - the crowd of several thousand to get engaged in addressing the social conditions within our society that are literally killing people. He urged all present to change the dominant narrative in our society from one that has led to the "organization of misery" to one that embraces collective societal responsibility and supports programs and policies that improve the health of all members of our communities.  

The speech by Dr. Marmot set the tone for the entire conference. The theme of disparities and health equity was evident in almost every session. It was underscored and addressed most bluntly in a session that reported on an Institute of Medicine (IOM) study (Poorer Health - Shorter Lives) that compared the health status of the US with other OECD countries. The data shared mirrored those presented by Michael Marmot. What was different was that the members of the IOM panel that carried out the analysis of the data from around the world, concluded that the health outcomes in the US are the result of "A culture that values individualism, individual freedom and survival of the most fortunate over social solidarity."  

This blunt statement reinforces the importance of the work that is being done throughout MDH to address disparities by actively engaging our community partners in developing a new  narrative about what creates health and what we need to do to "rise up against the organization of misery."  If we are truly data-driven, the disparities in our state should challenge us to do what defines public health - working with the broad community to "collectively create the conditions in which everyone has the opportunity to be healthy."


Monday, November 4, 2013

APHA Annual Meeting

Sunday, November 3, 2014

Greetings from Boston,

For the next 3 days, 13,000 public health professionals from around the world will be in Boston for the 141st annual meeting of the American Public Health Association (APHA). I am here at the invitation of the Robert Wood Johnson Foundation (RWJF) and the Centers for Disease Control and Prevention (CDC) to do a couple of presentations on "Advancing Health Where It Starts - Where People live, Work, Learn, and Play," and on "Minnesota's Efforts to Build a Movement for Healthy Children."

The first presentation was on Saturday as part of a pre-conference workshop sponsored by RWJF and APHA. The workshop was keynoted by Mildred Thompson, Senior Director and Director of the Center for Health Equity and Place at PolicyLink. She focused on the fact that where one lives is important to one's health. Place matters. 

She also highlighted the increasing diversity in contemporary America and how that is affecting place. A heartening piece of information that she shared was that a recent poll by the Center for American Progress revealed that 71 percent of Americans support taking steps to reduce racial and ethnic inequality in our country. 

Ms. Thompson also outlined what she saw as the major roles for public health in today's world.  She stated that public health should be a:
* Catalyst for action
* Convener of broad groups
* Liaison to the community
* Developer of new practices and polices that get institutionalized
* Source of new and progressive data sources and analysis

Following her, David Fleming, Seattle and King County Health Officer, outlined a Framework for the Foundational Services of Public Health - the programs and capabilities that need to be present (not that we would like to be present) in any heath department at any level of government. The Foundational Programs were:
* Communicable Disease Control
* Chronic Disease and Injury Prevention
* Environmental Public Health
* Maternal, Child, and Family Health
* Access to Clinical Care
* Vital Records.

The Foundational Capabilities in each and all of these Programs are:
* Assessment  (surveillance and epidemiology)
* Emergency preparedness and response
* Communications
* Policy development and support
* Community partnership development
* Business competencies

I must admit that I have some disagreements with this list. Regardless, the first of these two presentations focused on the new directions and opportunities that are available for public health  agencies. The second outlined the core programs and competencies needed by governmental public health. They encompassed what many consider the "old" and  "new" public health - both of which are important.

The session I was part of followed these two. I was fortunate to be paired with Gretchen Musicant (Commissioner of Health for Minneapolis) and Doran Schrantz (Executive Director of ISAIAH). I started off by paraphrasing Garrison Keillor - we're from Minnesota, where the health care system is strong, public health good looking, and our health statistics are above average - unless you are a person of color or an American Indian. The three of us then talked about the collaborative approach among state and local public health and community organizations that has been influential in helping to change the narrative in Minnesota about what creates health. Our efforts with the Statewide Health Improvement Program (SHIP), Healthy Minnesota 2020, the State Innovations Model (SIM) grant, and the Health Equity report that we are crafting were used as examples of how to effectively engage and empower communities in creating a healthy physical and social environment that benefits everyone. I think we added some additional components to the "new" public health. 

The public health world is interested in what we are doing and anxious to see what results our efforts bring.  So am I.

The APHA meeting kicked-off in earnest this afternoon with a general session that featured Sir Michael Marmot and Sarah Weddington.  I'll fill you in with some of the highlights later.