Public Health
Public Health is the science of protecting and improving the health of communities through education, promotion of healthy lifestyles, and research for disease and injury prevention. (What is Public Health? Association of Schools of Public Health )

Five Minutes Or Less For Health


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Acting Surgeon General, Rear Admiral Boris Lushniak discusses the Tobacco-Free College Campus Initiative, and welcomes you and your campus to lead by example in the fight against tobacco!

Ebola in the U.S.—Politics and Public Health Don’t Mix
By Judy Stone
“Against stupidity, even the gods strive in vain.” — Fredirich Schiller
I’ve been glued to the Ebola news, riding the roller coaster of emotions. While  very impressed with CDC’s director, Dr. Tom Frieden’s, initial press conference (10/2/14), I became infuriated at the subsequent statements from Lisa Monaco, Homeland Security Advisor, and the tragicomedy of the Dallas hospital’s farcical response, prompting this post.
Dr. Frieden was calm, reassuring and authoritative in handling this CDC press conference. He conveyed the critical messages well, “Remember, Ebola does not spread from someone who is not infectious. It does not spread from someone who doesn’t have fever and other symptoms. It’s only someone who is sick with Ebola who can spread the disease.” And he was candid: “It is certainly possible that someone who had contact with this individual, a family member or other individual could develop Ebola in the coming weeks. But there is no doubt in my mind that we will stop it here.” He emphasized basic, proven public health strategies of careful infection control, contact tracing, and isolation.
In contrast, although she acknowledged the possibility of a secondary case, Ms. Monaco appeared less credible as she stated, “I want to emphasize that the United States is prepared to deal with this crisis both at home and in the region. Every Ebola outbreak over the past 40 years has been stopped. We know how to do this and we will do it again.”
While I agree that we have the knowledge, experience, and resources to be able to control Ebola, most of the experts are academicians or practice in relatively well-heeled ivory towers. I have practiced Infectious Diseases and Infection Control for 30+ years, primarily in a number of community hospitals, and offer a different perspective here, based on these experiences.
Administrators vs. Practitioners
Increasingly, decision makers are administrators who are disconnected from the realities of patient care. The latest fad, for example is to design hospitals to look like hotels and be “inviting” to patients, although they are very dysfunctional for delivering patient care, especially problematic in ICUs.
Similarly, when “bioterrorism preparedness” first became the rage, our hospital and health department focused on high tech units and hazmat suits while ignoring basic hygiene. I went ballistic, given that there was no soap nor any paper towels in the public school bathrooms, something the county health commissioner said was “not within their purview.” Gotta have priorities, right?
It is not all that different now. One hospital I am familiar with has Powered Air Purifying respirators (PAPRs), purchased with bioterrorism preparedness grants, but neither stethoscopes nor other dedicated equipment for isolation rooms. So nurses and docs gown up to go in the room of a patient with a “superbug” but take their stethoscopes into the room and then on to other patients, perhaps remembering to wipe it down first.
The problems with controlling Ebola cases in the United States is not that we can’t care for people well, or with good infection control. We absolutely can. But the Dallas case abundantly illustrates some of the problems in caring for anyone with a communicable illness, whether a antibiotic resistant organism (aka “superbug) like carbapenem resistant enterobacter (CRE), measles or Ebola.
(More from Scientific American)

Ebola in the U.S.—Politics and Public Health Don’t Mix

By Judy Stone

“Against stupidity, even the gods strive in vain.” — Fredirich Schiller

I’ve been glued to the Ebola news, riding the roller coaster of emotions. While  very impressed with CDC’s director, Dr. Tom Frieden’s, initial press conference (10/2/14), I became infuriated at the subsequent statements from Lisa Monaco, Homeland Security Advisor, and the tragicomedy of the Dallas hospital’s farcical response, prompting this post.

Dr. Frieden was calm, reassuring and authoritative in handling this CDC press conference. He conveyed the critical messages well, “Remember, Ebola does not spread from someone who is not infectious. It does not spread from someone who doesn’t have fever and other symptoms. It’s only someone who is sick with Ebola who can spread the disease.” And he was candid: “It is certainly possible that someone who had contact with this individual, a family member or other individual could develop Ebola in the coming weeks. But there is no doubt in my mind that we will stop it here.” He emphasized basic, proven public health strategies of careful infection control, contact tracing, and isolation.

In contrast, although she acknowledged the possibility of a secondary case, Ms. Monaco appeared less credible as she stated, “I want to emphasize that the United States is prepared to deal with this crisis both at home and in the region. Every Ebola outbreak over the past 40 years has been stopped. We know how to do this and we will do it again.”

While I agree that we have the knowledge, experience, and resources to be able to control Ebola, most of the experts are academicians or practice in relatively well-heeled ivory towers. I have practiced Infectious Diseases and Infection Control for 30+ years, primarily in a number of community hospitals, and offer a different perspective here, based on these experiences.

Administrators vs. Practitioners

Increasingly, decision makers are administrators who are disconnected from the realities of patient care. The latest fad, for example is to design hospitals to look like hotels and be “inviting” to patients, although they are very dysfunctional for delivering patient care, especially problematic in ICUs.

Similarly, when “bioterrorism preparedness” first became the rage, our hospital and health department focused on high tech units and hazmat suits while ignoring basic hygiene. I went ballistic, given that there was no soap nor any paper towels in the public school bathrooms, something the county health commissioner said was “not within their purview.” Gotta have priorities, right?

It is not all that different now. One hospital I am familiar with has Powered Air Purifying respirators (PAPRs), purchased with bioterrorism preparedness grants, but neither stethoscopes nor other dedicated equipment for isolation rooms. So nurses and docs gown up to go in the room of a patient with a “superbug” but take their stethoscopes into the room and then on to other patients, perhaps remembering to wipe it down first.

The problems with controlling Ebola cases in the United States is not that we can’t care for people well, or with good infection control. We absolutely can. But the Dallas case abundantly illustrates some of the problems in caring for anyone with a communicable illness, whether a antibiotic resistant organism (aka “superbug) like carbapenem resistant enterobacter (CRE), measles or Ebola.

(More from Scientific American)

Keep Your Child from Getting and Spreading Enterovirus D68
Avoid close contact with sick people
Wash your hands often with soap & water
Cover Your coughs and sneezes
Avoid touching your face with unwashed hands
Clean and disinfect surfaces
Stay home when you’re sick
For more information, see www.cdc.gov/non-polio-enterovirus/EV68/
(From CDC)

Keep Your Child from Getting and Spreading Enterovirus D68

  • Avoid close contact with sick people
  • Wash your hands often with soap & water
  • Cover Your coughs and sneezes
  • Avoid touching your face with unwashed hands
  • Clean and disinfect surfaces
  • Stay home when you’re sick

For more information, see www.cdc.gov/non-polio-enterovirus/EV68/

(From CDC)

Jack Ohman: Americans’ concern over Ebola
(From Jack Ohman, The Sacramento Bee’s editorial cartoonist)

Jack Ohman: Americans’ concern over Ebola

(From Jack Ohman, The Sacramento Bee’s editorial cartoonist)

gov-info:

HHS SAMHSA Gov Doc/Data: 2013 Substance Use and Mental Health Estimates 
This Report provides 2013 estimates on the prevalence of substance abuse and mental illness in the U.S. Also reports on the need for and barriers to substance use treatment, mental health care, and co-occurring substance use disorders and mental illness.

gov-info:

HHS SAMHSA Gov Doc/Data: 2013 Substance Use and Mental Health Estimates

This Report provides 2013 estimates on the prevalence of substance abuse and mental illness in the U.S. Also reports on the need for and barriers to substance use treatment, mental health care, and co-occurring substance use disorders and mental illness.



First Imported Case of Ebola Diagnosed in the United States


CDC confirmed on September 30, 2014, through laboratory tests, the first case of Ebola to be diagnosed in the United States in a person who had traveled to Dallas, Texas from West Africa. The patient did not have symptoms when leaving West Africa, but developed symptoms approximately five days after arriving in the United States.
The person sought medical care at Texas Health Presbyterian Hospital of Dallas after developing symptoms consistent with Ebola. Based on the person’s travel history and symptoms, CDC recommended testing for Ebola. The medical facility isolated the patient and sent specimens for testing at CDC and at a Texas lab participating in CDC’s Laboratory Response Network. CDC and the Texas Health Department reported the laboratory test results to the medical center to inform the patient. Local public health officials have begun identifying close contacts of the person for further daily monitoring for 21 days after exposure.
The ill person did not exhibit symptoms of Ebola during the flights from West Africa and CDC does not recommend that people on the same commercial airline flights undergo monitoring, as Ebola is only contagious if the person is experiencing active symptoms. The person reported developing symptoms several days after the return flight.
CDC recognizes that even a single case of Ebola diagnosed in the United States raises concerns. Knowing the possibility exists, medical and public health professionals across the country have been preparing to respond. CDC and public health officials in Texas are taking precautions to identify people who have had close personal contact with the ill person and health care professionals have been reminded to use meticulous infection control at all times.
We know how to stop Ebola’s further spread: thorough case finding, isolation of ill people, contacting people exposed to the ill person, and further isolation of contacts if they develop symptoms. The U.S. public health and medical systems have had prior experience with sporadic cases of diseases such as Ebola. In the past decade, the United States had 5 imported cases of Viral Hemorrhagic Fever (VHF) diseases similar to Ebola (1 Marburg, 4 Lassa). None resulted in any transmission in the United States.
(From CDC)

First Imported Case of Ebola Diagnosed in the United States

CDC confirmed on September 30, 2014, through laboratory tests, the first case of Ebola to be diagnosed in the United States in a person who had traveled to Dallas, Texas from West Africa. The patient did not have symptoms when leaving West Africa, but developed symptoms approximately five days after arriving in the United States.

The person sought medical care at Texas Health Presbyterian Hospital of Dallas after developing symptoms consistent with Ebola. Based on the person’s travel history and symptoms, CDC recommended testing for Ebola. The medical facility isolated the patient and sent specimens for testing at CDC and at a Texas lab participating in CDC’s Laboratory Response Network. CDC and the Texas Health Department reported the laboratory test results to the medical center to inform the patient. Local public health officials have begun identifying close contacts of the person for further daily monitoring for 21 days after exposure.

The ill person did not exhibit symptoms of Ebola during the flights from West Africa and CDC does not recommend that people on the same commercial airline flights undergo monitoring, as Ebola is only contagious if the person is experiencing active symptoms. The person reported developing symptoms several days after the return flight.

CDC recognizes that even a single case of Ebola diagnosed in the United States raises concerns. Knowing the possibility exists, medical and public health professionals across the country have been preparing to respond. CDC and public health officials in Texas are taking precautions to identify people who have had close personal contact with the ill person and health care professionals have been reminded to use meticulous infection control at all times.

We know how to stop Ebola’s further spread: thorough case finding, isolation of ill people, contacting people exposed to the ill person, and further isolation of contacts if they develop symptoms. The U.S. public health and medical systems have had prior experience with sporadic cases of diseases such as Ebola. In the past decade, the United States had 5 imported cases of Viral Hemorrhagic Fever (VHF) diseases similar to Ebola (1 Marburg, 4 Lassa). None resulted in any transmission in the United States.

(From CDC)


Gap in Diet Quality Between Wealthiest and Poorest Americans Doubles, Study Finds
Higher costs and limited supermarket access are cited as barriers to health.


By Tracie McMillan (Published Sept. 1, 2014)
The diets of low-income Americans have worsened in the past decade, even as the diets of the wealthiest Americans have improved, according to a new study that is among the first to measure changes in diet quality over time by socioeconomic status. Overall diet quality in the United States remains poor, said the lead author of the study, published Monday in the Journal of the American Medical Association Internal Medicine.
Although the study found that the diet of all Americans improved on average between 2005 and 2010, the progress masked a decline in diet quality among the poor. The result: a doubling of the gap in diet quality between the wealthiest Americans and the poorest.
The study attributed the change to the higher cost of convenient and healthy meals, as well as limited access to quality supermarkets in some poorer neighborhoods.
Frank Hu, a study author and co-director of the Program in Obesity Epidemiology and Prevention at the Harvard School of Public Health, cautioned against taking the improvements as a sign that Americans eat well. “This is really almost like an American diet report card,” Hu said. “This has the good news that there has been some improvement in overall diet quality, but the report card still doesn’t look very good.”
The report comes at a time when the food choices of low-income households are in the national spotlight. Legislators and advocates have suggested restricting what foods can be bought with the federal Supplemental Nutrition Assistance Program (SNAP, also known as food stamps) in an effort to promote health. First Lady Michelle Obama has made healthy diets a central part of her campaign to end childhood obesity. Today two-thirds of Americans of all classes are overweight or obese, with higher rates among the poor.
(More …..)

(From National Geographic)

By Tracie McMillan (Published Sept. 1, 2014)

The diets of low-income Americans have worsened in the past decade, even as the diets of the wealthiest Americans have improved, according to a new study that is among the first to measure changes in diet quality over time by socioeconomic status. Overall diet quality in the United States remains poor, said the lead author of the study, published Monday in the Journal of the American Medical Association Internal Medicine.

Although the study found that the diet of all Americans improved on average between 2005 and 2010, the progress masked a decline in diet quality among the poor. The result: a doubling of the gap in diet quality between the wealthiest Americans and the poorest.

The study attributed the change to the higher cost of convenient and healthy meals, as well as limited access to quality supermarkets in some poorer neighborhoods.

Frank Hu, a study author and co-director of the Program in Obesity Epidemiology and Prevention at the Harvard School of Public Health, cautioned against taking the improvements as a sign that Americans eat well. “This is really almost like an American diet report card,” Hu said. “This has the good news that there has been some improvement in overall diet quality, but the report card still doesn’t look very good.”

The report comes at a time when the food choices of low-income households are in the national spotlight. Legislators and advocates have suggested restricting what foods can be bought with the federal Supplemental Nutrition Assistance Program (SNAP, also known as food stamps) in an effort to promote health. First Lady Michelle Obama has made healthy diets a central part of her campaign to end childhood obesity. Today two-thirds of Americans of all classes are overweight or obese, with higher rates among the poor.

(More …..)

(From National Geographic)

Gun crime is more prevalent in the US than in other rich countries
In 2012, Max Fisher compared gun homicide rates in wealthy countries, using UN data. The US was far ahead of the non-Mexico members of the OECD, with only Chile anywhere close.
A big part of this is that the US just has many more guns per capita than any other country:
 
(Reddit/The Guardian/Phillybdizzle)
That doesn’t explain all the variation in homicide rates; lots of poor countries, particularly in Central America, have gun homicide rates many times that of the United States. But among developed countries, homicide is much, much higher in the US, even after the great crime drop of the 1990s, and even including non-gun methods, as this chart from Duke sociologist Kieran Healy illustrates:
 
(Kieran Healy)
(From VOX)

Gun crime is more prevalent in the US than in other rich countries

In 2012, Max Fisher compared gun homicide rates in wealthy countries, using UN data. The US was far ahead of the non-Mexico members of the OECD, with only Chile anywhere close.

A big part of this is that the US just has many more guns per capita than any other country:

firearm ownership

(Reddit/The Guardian/Phillybdizzle)

That doesn’t explain all the variation in homicide rates; lots of poor countries, particularly in Central America, have gun homicide rates many times that of the United States. But among developed countries, homicide is much, much higher in the US, even after the great crime drop of the 1990s, and even including non-gun methods, as this chart from Duke sociologist Kieran Healy illustrates:

assault-deaths-oecd-ts-all-new.0.png

(Kieran Healy)

(From VOX)

Prevalence* of Self-Reported Obesity Among U.S. Adults by State, BRFSS, 2013
Obesity prevalence in 2013 varies across states and regions
No state had a prevalence of obesity less than 20%.
7 states and the District of Columbia had a prevalence of obesity between 20% and <25%.
23 states had a prevalence of obesity between 25% and <30%.
18 states had a prevalence of obesity between 30% and <35%.
2 states (Mississippi and West Virginia) had a prevalence of obesity of 35% or greater.
The South had the highest prevalence of obesity (30.2%), followed by the Midwest (30.1%), the Northeast (26.5%), and the West (24.9%).
Source: Behavorial Risk Factor Surveillance Systems, CDC.
*Prevalence estimates reflect BRFSS methodological changes started in 2011. These estimates should not be compared to prevalence estimates before 2011.
(From CDC)

Prevalence* of Self-Reported Obesity Among U.S. Adults by State, BRFSS, 2013

Obesity prevalence in 2013 varies across states and regions

  • No state had a prevalence of obesity less than 20%.
  • 7 states and the District of Columbia had a prevalence of obesity between 20% and <25%.
  • 23 states had a prevalence of obesity between 25% and <30%.
  • 18 states had a prevalence of obesity between 30% and <35%.
  • 2 states (Mississippi and West Virginia) had a prevalence of obesity of 35% or greater.
  • The South had the highest prevalence of obesity (30.2%), followed by the Midwest (30.1%), the Northeast (26.5%), and the West (24.9%).

Source: Behavorial Risk Factor Surveillance Systems, CDC.

*Prevalence estimates reflect BRFSS methodological changes started in 2011. These estimates should not be compared to prevalence estimates before 2011.

(From CDC)

The Food Gap Is Widening
Wealthy people are eating better than ever, while the poor are eating worse.

By James Hamblin
Nutritional disparities between America’s rich and poor are growing, despite efforts to provide higher-quality food to people who most need it. So says a large study just released from the Harvard School of Public Health that examined eating habits of 29,124 Americans over the past decade. Diet quality has improved among people of high socioeconomic status but deteriorated among those at the other end of the spectrum. The gap between the two groups doubled between 2000 and 2010. That will be costly for everyone.
The primary conclusion of the study is interesting, though, in that its focus is diet quality among the population as a whole. Without accounting for socioeconomic status, there has been, the study reads, “steady improvement.” People aren’t eating more vegetables, or less red or processed meat, and their salt intake increased—which the researchers call “disconcerting”—but Americans are eating more good things like whole fruit, whole grains, nuts, legumes, and polyunsaturated fats.
Frank Hu, a professor of nutrition and epidemiology at Harvard and one of the study’s authors, led with the good news when we spoke by phone.
“The good news is that the overall quality of the U.S. diet has been increasing in the past decade,” he said. Hu likened the study to a nutrition report card, saying that “the grade is not that great, kind of in the B- range.” (“Not that great” might be more like a C- or D+ by non-Harvard-professor standards.)

(More from The Atlantic)

The Food Gap Is Widening

Wealthy people are eating better than ever, while the poor are eating worse.
By James Hamblin

Nutritional disparities between America’s rich and poor are growing, despite efforts to provide higher-quality food to people who most need it. So says a large study just released from the Harvard School of Public Health that examined eating habits of 29,124 Americans over the past decade. Diet quality has improved among people of high socioeconomic status but deteriorated among those at the other end of the spectrum. The gap between the two groups doubled between 2000 and 2010. That will be costly for everyone.

The primary conclusion of the study is interesting, though, in that its focus is diet quality among the population as a whole. Without accounting for socioeconomic status, there has been, the study reads, “steady improvement.” People aren’t eating more vegetables, or less red or processed meat, and their salt intake increased—which the researchers call “disconcerting”—but Americans are eating more good things like whole fruit, whole grains, nuts, legumes, and polyunsaturated fats.

Frank Hu, a professor of nutrition and epidemiology at Harvard and one of the study’s authors, led with the good news when we spoke by phone.

“The good news is that the overall quality of the U.S. diet has been increasing in the past decade,” he said. Hu likened the study to a nutrition report card, saying that “the grade is not that great, kind of in the B- range.” (“Not that great” might be more like a C- or D+ by non-Harvard-professor standards.)

(More from The Atlantic)