Category Archives: Q&A
Flu season in the United States typically runs from November through March, with the peak coming in January and February. But people can catch the flu both earlier than the usual start time and after the usual end of the season. In addition, the severity of the flu season can vary with from 3,000 to 49,000 U.S. deaths in a given year, an average of more than 200,000 hospitalizations and millions of illnesses, according to the U.S. Centers for Disease Control and Prevention (CDC).
Flu shot season has a shorter time table, so many pharmacies and doctors’ office that are well stocked at the moment can run out before Christmas, making it difficult for people who put off their vaccinations to find a vaccine location and protect themselves.
And despite a yearly campaign to get people to roll their arms up, less fewer than half of adults and less than 60 percent of kids received a flu shot last year. NewPublicHealth recently spoke with Carolyn Bridges, MD, the CDC’s associate director for adult immunizations about what keeps people from getting the flu shot and how more people can be encouraged to get the vaccine.
NewPublicHealth: What is it that keeps people from getting the shot?
Carolyn Bridges: I think there are a number of things. Certainly, we have pretty good awareness about the recommendations for the influenza vaccine, although some people may just not realize that they are potentially at risk. The current recommendations call for all persons six months of age and older to get an annual flu vaccine, with rare exceptions. But the vaccine recommendations have changed over time and in the last few years have been broadened to include [just about] everyone. For some people the message hasn’t gotten to them that in fact they are now included in the group recommended for a yearly flu vaccine
NPH: What common misconceptions do people still have about the flu vaccine?
Bridges: In terms of the safety, some people question or are worried about getting the flu from the flu vaccine. That’s still a common comment that we receive. Sometimes people will certainly have body aches or some tenderness in the arm where they get their flu vaccine, but that’s certainly not the same as getting influenza, and those symptoms generally are very self-limited and go away within two to three days. But the flu vaccine cannot cause the flu.
Ebola and U.S. Quarantines: Q&A with James Hodge and Kim Weidenaar of the Network for Public Health Law
On Monday, the U.S. Centers for Disease Control and Prevention (CDC) released new guidelines for people who have been exposed to the Ebola virus, either returning home from affected West African countries or looking after patients in the United States.
The guidelines establish four levels of risk -- "high" risk, "some" risk, "low" risk and "no" risk -- and recommend restrictions and health monitoring for each category.
Under the guidelines, people at high risk of Ebola exposure would be confined to their homes in voluntary isolation, while people carrying some risk would have their health and movements monitored by local officials. Those at high risk or with some risk would have daily in-person check-ups from state and local health departments for 21 days.
Immediately after yesterday’s CDC press conference, NewPublicHealth spoke with James Hodge and Kim Weidenaar, attorneys with the Network for Public Health Law, responded to questions from NewPublicHealth about laws and regulations that impact quarantines.
NewPublicHealth: Is there any legal support under United States law for possible quarantines for returning health workers and travelers from West Africa?
James Hodge and Kim Weidenaar: Yes, provided quarantine is limited in duration, consistent with due process, and based on known or suspected exposures.
Public health authorities must be prepared to demonstrate that 1) the subject of quarantine is actually or reasonably suspected of being exposed to an infectious condition, 2) that the infectious condition (like Ebola) poses a specific threat to the public’s health, 3) that the terms of quarantine are warranted, safe, and habitable, and 4) that procedural due process including fair notice, right to hearing, and right to counsel are provided.
News today that a fourth case of Ebola has been diagnosed in the United States underscores the urgent need to have health workers not just ready, but also willing to treat patients with the illness. Next Wednesday, the National Coordinating Center on Public Health Systems and Services Research (PHSSR) will be hosting a webinar on legal protections to help facilitate health worker willingness. Daniel Barnett, MD, an Associate Professor in the Department of Environmental Health Sciences at the Johns Hopkins Bloomberg School of Public Health, will be the main presenter. Barnett and three Bloomberg colleagues, Leonie Ratko, JD, PhD, MPH, Jon S. Enrick, JD, MPH Carol B. Thompson, MS, MBA received funding from the Robert Wood Johnson Foundation and PHSSR to study the issue. PHSSR's Center is funded by RWJF and based at the University of Kentucky.
NewPublicHealth recently spoke with Barnett.
NewPublicHealth: What are the concerns with respect to health workers being prepared to take some risks in order to protect the public?
Daniel Barnett: There’s been a longstanding tacit dysfunction about preparedness trainings: That if you train someone in knowledge and skills in terms of how to respond, that will necessarily translate into a willingness to do so. But our work has shown that “training to knowledge equals training to willingness” is a false assumption. In other words, I can teach someone how to recognize anthrax or some other infectious disease agent under a microscope, but that in no way ensures that that individual will be willing to come to work to look at anthrax or another infectious disease agent under a microscope, and by analogy, any other type of frontline public health or health care response.
That’s been, frankly, a missing piece in public health preparedness training nationally and internationally, and I think that we need to really rethink paradigms of preparedness training and education to take a more holistic approach. In other words, an approach that recognizes that frontline healthcare workers and public health workers have fears and concerns attached to a whole variety of aspects of the events at hand.
Recent data out of California has shown that close to 90,000 children go to the emergency room for dental care each year. Although the cost of those visits is tens of millions of dollars, often little more is done than prescribing antibiotics to control infections. While that is important, after such a visit a child’s teeth remain decayed, posing significant risks for adult dental health problems, which can lead to illnesses, deaths, huge out of pocket costs and reduced job opportunities if teeth are noticeably missing.
But California is now also the first state in the nation to permit dentists to take care of underserved kids and adults virtually. A law passed at the end of September vastly expands the Virtual Dental Home, a demonstration project that uses telehealth technology to bring dental services directly to patients in community settings, such as preschools, elementary schools and nursing homes.
Under the program, dental hygienists and assistants perform preventive care and provide patient information electronically for review by an off-site dentist. Under the direction of the dentist, the providers can also place temporary fillings—no drilling required—which can last for years, according to Jenny Kattlove, an oral health policy analyst for The Children’s Partnership, a children’s advocacy group. Patients who need more advanced care are referred to a dentist, and often they’re the dentist who worked with their technician.
A recent Pew study examined how the Virtual Dental Home worked at an elementary school in Sacramento, where the program provided cost-effective services to low-income children who did not have a regular source of dental care. Care under the Virtual Dental Home is paid for under California’s Medicaid program.
According to research by the University of the Pacific Arthur A. Dugoni School of Dentistry, which operates the Virtual Dental Home pilot program, more than 30 percent of Californians are unable to meet their oral health needs through the traditional dental care system. More than half of California’s Medicaid-enrolled children received no dental care in 2012 and even fewer received preventive care services.
NewPublicHealth recently spoke with Kattlove about the new law and its potential as a model for dental care for low income individuals across the country.
NewPublicHealth: What is the most significant advantage of the Virtual Dental Home?
Jenny Kattlove: The Virtual Dental Home is a way to diversify or disperse the workforce so that all the professionals are working at the top of their skills and expertise. By putting dental hygienists in a community setting and having them take care of the majority of the care that the child needs, the dentist can be in the clinic or in their dental office taking care of the more complex needs and supervising the hygienist.
The U.S. Department of Health and Human Services last week announced grants totaling almost $100 million aimed specifically at mental health services for young adults. The grants will go to several organizations—including those that work with at-risk kids—within schools and in communities to reduce gun violence.
New private funds have also emerged. For example, in November the National Alliance on Mental Illness (NAMI) will announce the winners of the Connect 4 Mental Health Community Innovations Awards they launched last year along with the National Council for Behavioral Health and several pharmaceutical companies. Applications for the awards close October 3. The goal of the competition is to increase awareness of successful mental health treatment models that can be replicated in other parts of the country.
Recently, NewPublicHealth spoke with NAMI Executive Director Mary Giliberti, JD, about improvements in U.S. mental health care, issues that still need to be addressed and how the work of the award winners can help improve mental health care treatment.
NewPublicHealth: What progress do you point to with respect to treating mental health in the United States and what still needs work?
Mary Giliberti: In terms of progress, I think there is some increased recognition of mental health and substance use conditions as real health conditions, and the need for mental health to be addressed as part of the overall health care system. That includes federal parity requirements in health insurance—including plans offered through state health insurance marketplaces, Medicaid expansion plans and in private insurance—and efforts to coordinate mental health and physical health care, such as incentives and expectations outlined in the Affordable Care Act (ACA). Some examples of this include:
- Incentives for community mental health centers to improve capacity to treat individuals in their care holistically and via integrated care. This latter point is being supported through the distribution of demonstration grants offered as part of the ACA.
- Creative use of technologies, including tele-mental health and future potential through health information technology innovations.
- The evidence of some communities working hard to align and better coordinate systems, including criminal justice solutions.
Other examples of progress include continued development of community-based services, such as adding peers and families as part of the treatment system.
As the number of cases and deaths soar, the Ebola outbreak in West Africa is rightfully front and center in the news, both in terms of the disease’s progress and of the need for funds and manpower. However, infectious disease specialists are urging public health leaders to also stay vigilant in preventing and handling outbreaks of many other infectious diseases. Earlier this month, the White House issued the first ever executive order on antibiotic resistance to help prevent the 20,000 U.S. deaths that occur each year because of infections are resistant to available antibiotics.
Writer David Olsen reported last week in GlobalHealthHub that, based on figures from the World Health Organization (WHO) and UNAIDS, at least three disease in West Africa are currently claiming more lives than Ebola: Malaria, tuberculosis and AIDS. No one is suggesting a slow down in the Ebola efforts—in fact public health experts are urging ever greater ramping up—but as Olsen points out, “another of [Ebola’s] terrible legacies may be that it will distract attention and resources from other diseases that are killing far more people worldwide.”
Over the next few weeks NewPublicHealth will be doing a series of research and outbreak updates on several infectious diseases and their impact in both the United States and globally, starting today with HIV/AIDS.
This Saturday was HIV/AIDS awareness day for U.S. gay and bisexual men. According to the U.S. Centers for Disease Control and Prevention (CDC), one in five gay men in 20 major cities is estimated to be HIV positive, with about one third not knowing they are positive. The Kaiser Family Foundation (KFF) estimates that, based on CDC data, 12-13 percent of gay men are HIV positive and that there is evidence that the situation is worsening. Between 2008 and 2010, the CDC reported new infections rose 12 percent overall among gay men, and 22 percent among younger gay men, with the highest increases among men of color.
A new survey released late last week by KFF found that at a time when infections among gay and bisexual men are on the rise, more than half of gay and bisexual men say they are not personally concerned about becoming infected; only three in ten say they were tested for HIV within the last year, despite CDC recommendations for at least annual testing, with even more frequent testing recommended by many health departments.
In the last few months, several prominent national and state public health leaders have announced plans to move on to new things, including David Fleming, MD, MPH, the former Public Health Director in Seattle & King County Washington, who NewPublicHealth spoke with last month. We also recently spoke with Joshua Sharfstein, MD, secretary of Maryland’s Department of Health and Mental Hygiene, who will leave his post at the end of the year to teach at the Bloomberg School of Public Health at Johns Hopkins University as part of the faculty of the School of Health Policy and Management.
Earlier this year, Sharfstein gave the commencement address at the graduation ceremony of the University of Maryland School of Public Health, and had this to say about the importance of ensuring the public’s health:
“The premise of public health is that the wellbeing of individuals, families and communities has fundamental moral value. When people are healthy, they are productive, creative and caring. They enjoy life and have fun with their friends and families. They strengthen their neighborhoods and they help others in need. In short, they get to live their lives.”
NewPublicHealth: What prompted you to move to academia at this point in your career?
Joshua Sharfstein: It's a chance to help train hundreds of new public health leaders as well as work in depth on issues that are important to me. I am especially looking forward to getting to work closely with so many talented faculty at the Johns Hopkins Bloomberg School.
NPH: How have your research and teaching skills benefitted from your time as deputy director of the U.S. Food and Drug Administration (FDA) and your position with the state of Maryland?
Sharfstein: I've seen a lot of public health in action at the local, state and federal level. My goal will be to show students how important, interesting, engaging and—at times—strange public health can be. I have a research interest in why certain policies are pursued and others are not—and how public health can be successful in a difficult political and economic climate.
Faces of Public Health: Q&A with Andrea Gielen, the Johns Hopkins Center for Injury Research and Policy
The U.S. Centers for Disease Control and Prevention (CDC) recently awarded $4 million to the Johns Hopkins Center for Injury Research and Policy at the Bloomberg School of Public Health to further fund its work on injury prevention research and policy development. According to the CDC, injuries are the leading cause of death in the United States among people ages 1 to 44, costing the country $406 billion each year. And across the globe, 16,000 people die from largely preventable injuries every day.
“This funding will allow us to advance our work in closing the gap between research and practice in new and innovative ways,” said Andrea Gielen, ScD, ScM, the center’s director. “Whether fatal or non-fatal, injuries take an enormous toll on communities. Our faculty, staff and students are dedicated to preventing injuries and ameliorating their effects through better design of products and environments, more effective policies, increased education and improved treatment.”
The five-year grant will support several innovative research projects on key issues, including evaluating motor vehicle ignition interlock laws, studying universal bicycle helmet policies, testing m-Health tools to reduce prescription drug overdose and evaluating programs to prevent falls among older adults. The center will also continue to offer training and education to public health students and practitioners, as well as to new audiences that can contribute to injury prevention.
NewPublicHealth recently spoke with Gielen about the CDC grant
NewPublicHealth: What are the goals for each of the four research areas for which you’ve received funding?
Andrea Gielen: Each of the four is a full research projects with specific aims. For example, with ignition interlock laws—which are car ignitions that can’t start unless a breathalyzer confirms that a driver is sober—there’s been a little bit of evidence that they reduce alcohol-related motor vehicle crash injuries and deaths, but there are two gaps. There has never been a national study of the impact of these laws, and we don’t know a whole lot about how they’re implemented. What is it about ignition interlock policies and how they’re implemented that’s really related to their impact on reducing fatal crashes?
We want to look at all four projects in the same way: We’ll be looking at barriers and facilitators to how policies that we think are effective are adopted and implemented, and what it is about that adoption and implementation of the processes that make these policies effective.
Almost every day brings reports of new cases of Ebola, the often-fatal virus now impacting multiple countries in West Africa. According to the U.S. Centers for Disease Control and Prevention (CDC), the 2014 Ebola outbreak is the largest Ebola outbreak in history. Spread of the disease to the United States is unlikely—although not impossible—and efforts are underway to find vaccines and cures, including scale-ups of drug development and manufacturing, as well as human trials for vaccines both in the United States and around the world. However, in West Africa the epidemic is impacting lives, economies, health care infrastructure and even security as countries try a variety of methods—including troop control—to get citizens to obey quarantines and other potentially life-saving instructions.
Late last week, NewPublicHealth spoke with Laurie Garrett, senior fellow for global health at the Council on Foreign Relations. Garrett has written extensively on global health issues and was on the ground as a reporter during the Ebola outbreak in Zaire in 1995.
NewPublicHealth: What are your key concerns with respect to the current Ebola outbreak?
Laurie Garrett: My main concern has been about the nature of the international response, which could be characterized as non-response until very recently. And now that the leadership of the international global health community has finally taken the epidemic seriously, it’s too late to easily stop it. We’ve gone through the whole list of all the usual ways that we stop Ebola and every single one of them was initiated far too late with far too few resources and far too few people—and now we’re in uncharted territory. We’re now trying to tackle a problem that has never reached this stage before and we don’t know what to do. The international response is pitiful, disgusting and woeful.
NPH: How do you account for such a poor response?
Garrett: First of all, the World Health Organization (WHO) is a mere shadow of its former self. When I was involved in the Ebola epidemic in 1995 in Kikwit, Zaire, the WHO was recognized worldwide as the leader of everything associated with outbreaks and infection, and it acted aggressively. It didn’t have a huge budget, but it still was able to take the problem very seriously and the resources that were needed were available, and more importantly a very talented leadership team combining the resources of the U.S. Centers for Disease Control and Prevention; WHO; Medicin San Frontiers (Doctors Without Borders); and the University of Kinshasa, Zaire, came together. They respected each other. They were on board together. They worked very closely with the local Red Cross, and they were able to conquer the problem pretty swiftly.
Last June, the Washington Post held a live event, Health Beyond Health Care, which brought together doctors, bankers, architects, teachers and others to focus on health beyond the doctor’s office. The goal of the Washington, D.C., event—which was co-sponsored by the Robert Wood Johnson Foundation others—was to showcase examples of communities working with partners to create cultures of health.
Healthy Detroit is a shining example. The project is a 501(c)(3) public health organization dedicated to building a culture of healthy, active living in the city of Detroit. It was formed less than a year ago in response to the U.S. Surgeon General’s National Prevention Strategy (NPS.) The NPS offers guidance on choosing the most effective and actionable methods of improving health and well-being, and envisions a prevention-oriented society where all sectors recognize the value of health.
NewPublicHealth recently spoke with Nicholas Mukhtar, founder and CEO of Healthy Detroit.
NewPublicHealth: How did Healthy Detroit get its start?
Nicholas Mukhtar: I was just about to the MPH part of a joint MPH/MD degree and had always wanted to be a surgeon. But as I started living in the city and getting more involved in the community, I really saw a different side of health care, and to me it just became more rewarding to focus on the systemic issues in the health care system, more so than treating people once they already got sick. I’ve now finished the MPH part of my degree, and am starting on my MD degree.
So I started sending out a number of emails to different people and reached out to Dr. Regina Benjamin, then the U.S. Surgeon General, as well as local individuals. And then we established our mission, which was really to build a culture of prevention in the city while implementing the National Prevention Strategy.