Tag Archives: public health

Public Health’s ‘Moonshot’ – Part 1

Advocates for cancer research and prevention efforts converged in Washington, D.C. last week for One Voice Against Cancer’s (OVAC) annual lobby day on Capitol Hill. OVAC, a collaboration of roughly 50 national non-profit organizations, delivered a unified message to Members of Congress on June 6 on the need for increased cancer-related appropriations. A point of discussion in my meetings with legislative staff was the President’s Budget Proposal for FY 2018, which featured budget cuts at both the National Institutes of Health (NIH) and Centers for Disease Control and Prevention (CDC) and increases for the Department of Defense. Armed with OVAC “asks”, I decided to focus my meetings with legislative staff from Senators Burr and Tillis and Representative Butterfield on the economic impact in North Carolina if funding levels were reduced. North Carolina is home to three National Cancer Institute (NCI)-designated cancer centers, which are awarded over $2B in annual NIH funding and employs thousands of employees.

Our advocacy training included a presentation by Dr. Warren Kibbe from NCI on the state of NIH funding and a quick brief on the Cancer Moonshot Initiative. Led by former Vice President Joe Biden, the initiative focused on concentrated and collective action to accelerate a decade’s worth of progress in preventing, diagnosing and treating cancer into a five-year time frame. The Cancer Moonshot has buy-in from academic, public and private sector partnerships. My immediate thought: why doesn’t public health have this type of dedicated initiative with annual federally-appropriated funds?

The Robert Wood Johnson Foundation’s Culture of Health initiative is public health’s “moonshot”. Its Action Framework parallels the Cancer Moonshot Initiative in identifying focus areas and key performance metrics to measure progress. RWJF’s Culture of Health has achieved significant buy-in from a myriad of cross-sector stakeholders. The only distinction between the two initiatives, from my perspective, is dedicated federal support. Imagine the possibilities if public health’s “moonshot” received the same attention and resources as the Cancer Moonshot Initiative. A decade’s worth of progress in a 5-year timeline for the social determinants of health would really change the trajectory of the field of public health.

In the next few posts, I plan to take a deeper dive on exploring innovative ways to address the social determinants of health, specifically at the local level, in the city where I currently live – Durham, North Carolina.

Below, I offer background on the U.S.’s healthcare system to provide a larger context the many layers and contributors to an individual’s health outcomes.

********************

Healthcare expenditures in the United States was approximately $3.2T, or $9,900 per capita, in 2015 which accounted for 17.8% of its gross domestic product (GDP). When compared to 12 other high-income member countries of the Organization for Economic Cooperation and Development (OECD), the U.S. spent significantly more annually. According to the Commonwealth Fund, the U.S. spent roughly $3000 more than Switzerland, the runner-up in per capita spending, in 2013. As a result, it outspent the next highest spender, France, by 5.5% of GDP in 2013. But despite its additional spending, the U.S. underperforms on population health outcomes such as life expectancy and chronic disease prevalence when compared with other OECD countries. Additionally in its analysis, the Commonwealth Fund compared healthcare expenditures to those spent on social services – retirement, disability benefits, employment programs and supportive housing, among others – for 11 OECD countries. In this comparison, the U.S. spent the least on social services at 9% of GDP, with Canada and Australia spending 10% and 11% of GDP, respectively. France and Sweden spent the most on social services at 21% of GDP. This imbalance in spending, posit the authors, may contribute to the country’s poor health outcomes.

Policies to improve population health have historically focused on the healthcare system according to Kaiser Family Foundation’s Heiman and Artiga. The Affordable Care Act, signed into law in 2010, expanded access to healthcare services for millions of Americans. However, as the authors explain, research demonstrates that healthcare is a relatively weak health determinant. Individual health behaviors, genetics and a broad range of social and environmental factors account for 90% of an individual’s risk for premature death. Thus, addressing the factors outside of the healthcare system may play a key role in improving population health outcomes, and the value it generates could justify reallocation of current spending levels.

Social determinants of health are “the structural determinants and conditions in which people are born, grow, live, work and age”. Examples of social determinants of health include social economic status, educational attainment, the physical environment, employment and social support networks. Social determinants form the basic foundation for each individual and his/her life experience. It also sets a baseline for future health outcomes. For example, an individual who is unemployed for an extended period of time may become homeless, food insecure and have limited access to healthcare services. It’s reasonable to conclude that this individual may be at higher risk of premature death due to his/her life experience. Unfortunately people all over the world have lives filled with adversity and struggle. Social, economic and/or environmental disadvantage creates differences in health outcomes, also known as health disparities, in populations across the world. One goal of Healthy People 2020, a strategic 10-year plan to improve U.S. population health, is to achieve the highest level of health for all people. Health equity includes the elimination of health and healthcare disparities.

One population of interest are known as “high utilizers” or vulnerable patients with complex social, behavioral and health needs. According to Anderson, the top 5% of individual utilizers account for about 50% of overall healthcare expenditures. Programs that pair patient navigators, community health workers and behavioral health resources with identified “high utilizers” have been implemented recently with hopes of improving health outcomes and generating value. A thorough review and analysis of the results for impact and effectiveness in improving health and cutting costs for this subset of patients is a critical next step.

Advertisements

Public Health in Action – Anchored Upstream

river.jpeg

Public Health River Metaphor

A man was fishing in the river when he noticed someone was drowning. He pulled them out and attempted to resuscitate them. Shortly afterwards, he noticed another person in the river and saved them too. He then noticed another, and another and another. Soon he was exhausted and realized he would not be able save all of the drowning people.

He went further upstream to find out why all these people were falling into the river.

On arriving further upstream, he discovered a broken bridge was causing people to fall into the river and end up drowning where he had been fishing.  He decided he would fix the bridge to stop them falling in, instead of fishing them out after they were already drowning.

**********

There’s a radio ad campaign for the Powerball Lottery in my local area, Raleigh-Durham, North Carolina that has stood out to me more than the hundreds of others I hear on the radio. In the ad,’Wolfman’ (picture Michael J. Fox in the Teen Wolf movie) visits the barber shop for his regular hair cut. ‘Wolfman’ throws out a few ideas – maybe I should shave it all off? “Or maybe a mullet?” His barber asks why the sudden change from his usual cut. ‘Wolfman’ described that his life was so monotonous lately and he wanted to change things up a bit. The barber then responds by recommending that ‘Wolfman’ purchase a Powerball ticket because every jackpot is worth at least $40 million – a life-changing amount; a change that  coincidentally ‘Wolfman’ was looking for. A disclaimer followed in the final seconds stating the odds of winning a Powerball jackpot, which was a measly 1/292 million. Ads, like this one, that tap into our well of emotions leave us particularly susceptible to any product that marketers are hawking, despite the impossible odds or practical necessity in one’s life.

While 1/292 million are nearly impossible odds, 1/4 seems almost certain in comparison. A recent article from the Atlantic highlighted results from Urban Institute’s study on medical debt. 23.8% of adults under 65 in the US has medical debt. Southern states, like Mississippi and Arkansas, have higher rates of medical debt – both over 35%. Furthermore, insurance coverage had a minimal positive effect: 23% of adults with health insurance still had medical debt compared to 31% of uninsured. As mentioned in the article, this has been a common criticism of the Affordable Care Act, aka Obamacare: that expanding health insurance does little to reduce high costs of health care for individuals (out-of-pocket costs) as well as the healthcare system as a whole.

Health policy in most recent years have been focused primarily on health insurance and affordable access to healthcare services. In the river metaphor above, focusing on health insurance would be akin to pulling people out of the river while they were drowning – providing them healthcare when they were sick, rather than figuring out how to prevent, or at least greatly reduce the risk of, illness. In public health and health care lingo this is what’s referred to as “looking upstream.”

In my interview below, Dr. James Leone, professor at Bridgewater State University, describes his career in “looking upstream.” Other upstream heroes of mine include:

Dr. Rishi Manchanda

Dr. Camara Jones

***************

Me: How did you end up doing the work that you’re currently doing?  Describe your journey to your current role as professor at Bridgewater State University.  Describe why you’re passionate about Improving men’s health…why others should care about the health disparities between genders.

James Leone: My journey into public health education and higher education was a bit random/arbitrary. I began in clinical practice serving as a certified athletic trainer (ATC) where I worked in various settings including: professional with the New England Patriots, clinical outreach at high school, collegiate and physical therapy clinics. I also worked with coordinating rehabilitation clinics and strength and conditioning services in a variety of settings. Not too long into my clinical practice, I received an offer to teach sports medicine/athletic training at Southern Illinois University Carbondale, which was a new challenge for me professionally. I continued to teach and clinically practice, but my love of education rose to the top of my priorities, so I pursued a PhD in public health education. I saw value in what I could contribute on an individual level with people, however, my brain has always been geared towards the “bigger picture” – I guess you can say I embrace an upstream mentality/approach. This was my entry into health promotion and public health studies. I made my way up to Bridgewater State University (BSU) after serving on faculty at Southern Illinois University Carbondale, Northeastern University, and The George Washington University (GWU). Additionally, I currently serve as an adjunct professor at Northeastern University where I have taught courses in athletic training, physical therapy, physician assistant studies, and recently in the master of public health program.

As previously mentioned I have embraced a more “upstreamist” approach in my world and professional view. That said, I realized that male health always seemed to be lacking whether from personal experience or reviewing study after study and large data sets. I always have championed efforts to advocate for groups, be it my athletes or gender (in this case). Also, in 2007 I was approached by my former Chairperson at GWU to offer a class in men’s health, which I quickly embraced since my thought process was already in-tune with this topic. I quickly realized that evidence was lacking in terms of “why” men live sicker and die sooner than women. Also, there were few academic resources (i.e. books) from which to facilitate the topic. I set out consuming as much as I could to develop my course and my knowledge in this area of research. This journey led me to propose a textbook on male health (published in 2012) as well as develop two courses on male health (one at GWU and the other at BSU, presently). I am currently pursuing opportunities to develop male health curricula further so that beyond greater awareness of the topic and issues, we can move dialogue into action and advocacy by training public health professionals and providers on gender-specific needs of men and boys.

So, why do I care about male health topics? I have always been an advocate for people, ethics, and basic human rights. Poor health outcomes in males challenges these aforementioned principles, negatively impacting overall population health. From the public health perspective, we are morally and professionally obligated to help right these wrongs so as to create a more equitable society aimed at a “true public health for all.” I believe Sir Geoffrey Vickers captured it best in his quote, “public health consists of “a successive re-defining of the unacceptable.” I believe gender disparities, particularly those affecting men have been “unacceptable” and warrant our full and undivided attention at present times.

Me: What inspires you on a daily basis, especially when things get hard?

JL: My commitment is based on my ethics and morals, which guide my actions. My intolerance for average often guides my “drive” to improve most things in my personal life and professional practice. Knowing that I do work that directly corresponds to people’s health and experiences is more than enriching for me on a daily basis. When times get rough I often remain mindful of the transient nature of life and experiences – the viewpoint “nothing is guaranteed in life” often helps me to keep my life and work perspectives in check most days.

Me: I saw your presentation at this year’s American Public Health Association (APHA) conference on men’s health as a national security concern.  Can you describe your perspective on this issue?

JL: I was in a graduate school lecture discussing public health initiatives and Harry Truman’s 1946 speech was referenced in the talk. As part of that talk, Truman commented on the nature of the military and investing in the health of the youth to strengthen the defense system of the U.S. Of course, at the time, the vast majority of the military were younger men whose overall health and qualifications for military service were being called into question. The latter point got me thinking as to what it would be today; likely, things have gotten worse with rising overweight and obesity issues nationally. This perspective motivated my presentation at APHA in November. Overall, I think this is an incredibly important issue for two main reasons: 1. Of course we want to a strong system of defense if called upon, and 2. And perhaps most importantly, poor men’s health brings to light the overall issues in male health in the U.S. When we are able to gain the attention of the Department of Justice and Department of Defense, we might actually see Congress move on some of the issues in men’s health that we have been advocating for over the past few decades.

Me: What made you decide to be involved in the men’s health movement and the American Public Health Association Men’s Health Caucus (MHC)?

JL: I saw the APHA MHC as a strong platform from which to pool my energies and resources on advancing male health. I value like-minded people, but also, I am challenged by various ways of thinking and working towards solutions in these groups. I have learned that even though there is a shared value and perspective, we all have something unique to contribute to the conversation over men’s health. The men’s health movement attracts me simply because we as a society must look upstream to the issues that we generalize and deal with downstream. We have grown too normalized with poor men’s health and the forces that drive it. I think working with Men’s Health Network, MHC, and APHA can embolden an area that has gone largely unnoticed even at the detriment of society.

Me: What are the current needs in the Boston metro area (or focus in on the city you live in) as they relate to social determinants of health (i.e SES, poverty, access to care, transportation, safety, etc.)?

JL: I consider Boston and the surrounding areas as “lucky” because we have so much access to health, healthcare, education, and most of the social determinants that can positively affect population health. However, when we look below the generalized population data, we still see a consistent and stark contrast in the health of the privileged and the socially marginalized as with most other major cities. Boston struggles to meet the needs of harder to reach populations and men just like most other major cities in the U.S. We do have some excellent and progressive programming such as the Men’s Health Center (Whittier Street) in Roxbury and the men’s health program through Cambridge, however, the salient question is always: are we meeting the needs of the most vulnerable at the right moments so as to promote long-term individual and population health – I guess time and statistics will tell that story.

Public Health in Action – Seas of Change

pexels-photo-186636-1

We’re nine days into the new year. Nine days into a fresh start, a clean slate. Many shared in eager anticipation and relief for 2016 to be over and done with in both mainstream and social media. But even though we’ve entered 2017, a magic reset button wasn’t pressed. The same issues we faced 10 days ago will still be the same issues we face this year and for many years after.

I imagine that Jason Roberts faced the same realization over a decade ago. Issues do carry over, year after year, unless something or someone shook things up. Earlier today, I watched Jason’s story as a regular citizen in a neighborhood of Dallas, Texas. His curiosity led to endless questions. The single most important question that kept popping up was “why not?” Why can’t things be different? With a mix of curiosity, resourcefulness, creativity, determination and passion, he made significant, long-lasting impacts that improved the quality of life in those Dallas neighborhoods, block by block.

****

I was born in 1983 and I spent most of my childhood before the internet ever existed. I grew up playing sports outside, trading sports cards, playing video games and reading comic books. I was even caught up in that Pog epidemic of the 90s – try explaining Pogs to a teenager nowadays and they’d probably tell you “there’s an app for that”.

Terry and Justin Raimey grew up on comics too, and they were also passionate about food. Their passions fused when they co-founded Black Streak Kitchen.

Terry shares a snapshot of their story below.

****

Me: How did you end up doing the work that you’re currently doing?  Describe your journey to your current roles as co-founders of Black Streak Kitchen (BSK).  Describe why you’re passionate about improving health behaviors in youth through nutrition education…why others should care about the work you’re doing.

Terry L. Raimey: Justin and I have always had an interest in health, wellness and cooking. Our mom and dad cooked everyday when we were kids, so we never really ate out. When we moved out of our parents’ home, we carried on the tradition of cooking for ourselves – creating new dishes by combining fresh meats, vegetables, fruits, grains and spices.

I am a writer and Justin is the artist and graphic designer of everything Black Streak Entertainment (Black Streak Kitchen’s parent company). We wanted to do something new and unique with our stories and artwork, something no one else in the comics and animation industry had ever done.

One day, I saw an ad for one of those grocery/recipe delivery services and thought it would be really cool to apply our artwork to something like that, and gear it towards kids, teens and families. So, we created Black Streak Kitchen as a source to teach kids, teens and families that cooking healthy can be delicious, while also teaching them how the ingredients can benefit their bodies and minds.

I love to cook and create new dishes by fusing unorthodox fresh ingredients and flavors. I love how eating healthy makes me feel and look; it’s very satisfying to me. And I want everyone to experience that satisfaction.

According to a study published in the Journal of the American Medical Association, the amount of children with type-2 diabetes, which is associated with obesity, jumped more than 30% from 2000 to 2009. When we were growing up, diabetes was an ‘old-person’ disease and obesity was a grown-up problem, but today, these conditions are affecting our children. One of the best way to combat America’s failing health grade is through cooking and nutrition education. Black Streak Kitchen provides cooking and nutrition education while making the presented material fun and entertaining.

Black Streak Kitchen Recipe.jpg

Image of recipe from Black Streak Kitchen

 

Me: What inspires you on a daily basis, especially when things get hard?

TLR: Seeing the reactions of the people we introduce to our brand, getting messages and comments from parents on how our app and comics teach them and their kids so much about cooking and nutrition, and even getting props from chefs and nutrition professionals is what motivates us to keep pushing. We pray and work hard, so it’s a true blessing when the Lord answers through the words of people who enjoy our brand.

Me: Can you tell us more about your collaboration with educators and any key outcomes or success stories from your comic books?

TLR: Well, our first comic doesn’t drop until January 15, but as far as collaborators, we’ve been blessed to have some accomplished chefs come on board. Chef Ed Harris will be featured as a Character Chef in our first issue, presenting his recipe “Roasted Cauliflower Stir Fry”. Chef Harris is the winner of Food Network’s ‘Chopped’ season 4 and ‘Iron Chef International’. We are also collaborating with Chef Robert Stewart, winner of ‘Guy’s Grocery Games’, ‘Cutthroat Kitchen’ and star of OWN Network’s ‘Raising Whitley’. Another collaborator of ours is Chef Ethan Taylor. He is the owner of ‘Great EETS’ catering in Los Angeles, CA. He works as a personal chef for numerous A-list celebrities, like Justin Beiber, Jamie Foxx and Mary J. Blige. All of these professionals have great elements to bring to our brand and help us succeed.

Me: What role do you envision comics and visual art having in educating youth?  How much of an impact did comic books play while you two were growing up?  Where do you foresee BSK in the next 5 or 10 years?

TLR: The use for comics and art are limitless. Fusing education with whimsical and visually appealing artwork grabs kids’ attention like nothing else, so it’s the perfect marriage. When were kids, we were big fans of comics. I read every monthly Spider-Man series in publication, and Justin was a big fan of Japanese manga. Comics sparked my imagination and took me on adventures that I could never experience in real life. As a matter of fact, we are still big comic fans!

In 5 to 10 years, we will have a home delivery service where we will deliver our recipe comics and the ingredients for our recipes to families homes. We will also have a cooking and nutrition animated series featuring our characters and signature Black Streak style. Having Black Streak Kitchen product lines through licensing is also a goal of ours.

Me: What are the current needs in the city live in as they relate to social determinants of health (i.e SES, poverty, access to care, transportation, safety, etc.)?

TLR: We live in a suburb outside of Youngstown, Ohio. Youngstown used to run off of the steel industry, but once the steel mills shut down, the city was hit hard. Unemployment is high, schools have been shut down, public transportation is limited, there are no grocery stores to purchase healthy food, and there is little opportunity to succeed – it’s quite depressing.

Giving back is important to Justin and I, so we want to sponsor the establishment of community gardens in urban neighborhoods where fresh produce is hard to come-by. Establishing community gardens provides a sustainable food source for the neighborhood residents to draw from. It also helps bring the community together and helps the youth of the community learn a constructive skill that will benefit them for life.

We want to build our own kitchen entertainment empire, while also helping people in need, in particular, black youth.

Public Health in Action – Vital Plan Strives for Impact, One Person at a Time

vital plan

There’s one lecture from graduate school that I constantly remember. In that particular Healthcare Delivery in the U.S. course lecture, my professor walked through a clinical visit with a recurring patient. Medical students and residents learn to obtain three important pieces of information from the patient: chief complaint (the reason for their visit), symptoms and a brief medical history. He then opened it up to us – was there anything else we would like to know? Coming from a public health perspective, our questions dove deeper into the social determinants of health -physical environment (housing), SES (access to health insurance, employment), etc. –  to clarify if there were any underlying issues causing the patient to return with similar health issues. That deeper dive, he said, was the distinction between the fields of medicine and public health.

An article published by WBUR last month illustrates a shift in medical school and residency programs to integrate public health principles, most notably the social determinants of health, into their learning objectives.

A holistic understanding of each patient is ideal when tailoring a plan not only to treat illness, but to achieve long-term well-being. The whole-person approach to treating chronic illness is what makes Vital Plan a unique part of the vast healthcare landscape.

My interview with CEO Braden Rawls catching up 2 years after our first interview, below.

******************************************

Me: I can’t believe it’s been almost 2 years since I published our first blog interview.  How’s Vital Plan?  What’s new that you can share with us?

Braden Rawls: It’s been a busy two years! Vital Plan has grown its customer base significantly, and this has allowed us to recruit ten new team members to continue improving our programs and expanding our reach. What really clicked for Vital Plan was selling our herbal supplement products in bundles alongside supportive health programs. Our signature program is the Restore Program, which includes four supplements plus health coaching support and a six month online course with education about restoring balance in the body through diet and lifestyle.  We’ve received very positive feedback on this program from customers and have expanded it to an international audience, with customers across Europe, Canada and Australia.

Me:  Why was it important for Vital Plan to become B Corporation Certified?

BR:  B Corp certification is important for Vital Plan to showcase third-party verification of our commitment to doing business with integrity. We are on a mission to restore and rebuild trust in the herbal supplement industry after its reputation was tarnished by deceitful players. Being able to showcase our commitment to doing business with integrity has already proven valuable in gaining new customers and recruiting talent. From the start, our goal has been to empower everyone that our organization teaches individuals to become more proactive about their health and to be mindful of the way they live. B Corp gives us a framework to support this mission and put best practices in place to grow our company in a smart, sustainable way.

Me:  One of the illnesses that Vital Plan focuses on is Lyme Disease.  Could you describe why it’s been a major focus for Vital Plan?  How does Vital Plan’s approach differ from traditional approaches?

BR:  Lyme disease is an illness that is personal for Vital Plan, as our founder, Dr. Bill Rawls, suffered with pain and insomnia for many years before ultimately testing positive for Lyme disease. However, Dr. Rawls’ personal struggle motivated him to research microbial illness from all angles, and he feels that Lyme disease is only one microbe of thousands behind chronic illnesses such as fibromyalgia, chronic fatigue syndrome and rheumatoid arthritis. Dr. Rawls believes that the true problem is not the stealthy microbes, but rather suppression of our immune systems that is allowing these stealthy microbes to flourish. He feels that chronic immune dysfunction is the real driver of the increase in chronic disease in developed countries, as exposure to toxins, radiation, stress and processed foods has depressed our immune system and is allowing microbial disease to flourish.

Me:  Vital Plan’s belief in addressing the underlying causes of disease is non-traditional.  Could you speak why your team is so passionate about taking this route?

BR:  The approach of treating symptoms is valuable for helping an individual to live more comfortably short term, but it is generally not a long term solution for fostering wellness.  Our team believes that disease in the body is often the result of environmental and dietary factors that are under our control, such as inflammatory food, chronic stress, and exposure to toxins and microbes. Through awareness of these disease factors, we believe that better health is in reach for many individuals. We feel that herbal medicine and natural healing modalities are also effective tools for individuals to take advantage of to promote healing and restore balance in the body.

Me:  Based on the patients that Vital Plan serves, what would you say are the biggest challenges for them to get back to normal? “Normal” being before their respective diseases produced symptoms so severe that it affected their quality of life.

BR:  For many people, diet and lifestyle changes are very difficult. However, once a person realizes that the food they are eating (or busy schedules they are slaves to) is making them sick, the changes become much easier to adopt. When you begin to associate foods or lifestyle practices with feeling good, your body will begin to crave those foods and practices instead of the ones that make you feel bad. It is all about training your brain to make those connections. Accelerating those connections for people is a big part of the mission behind our programs at Vital Plan.

Public Health in Action – Acceptable Risk

CA Healthy Nail.png

 

Have you ever gone to work knowing you weren’t feeling too great or knew you were sick?  I definitely remember at least a handful of times when I’ve gone to work and potentially exposed co-workers to my cold or flu.  And I have no doubts that a majority of us have done the same.

But let’s say you worked in a more public setting, like a hospital or restaurant, where illness could spread to a larger population.  Would that influence the decision to stay home?  At least half of workers in more public settings show up to work sick, according to a recent NPR article.  Participants of the poll listed a variety of reasons for showing up to work sick, including a lack of paid time off or concerns over job security.  But another reason was inadequate back-up staff.  Sick employees didn’t want to overburden their co-workers in their absence.

Now imagine an opposite scenario where employees are at higher risk for illness or injury while at work; where exposure to toxic chemicals is part of the job.  Nail salon workers fall into this group and are routinely exposed to such chemicals, resulting in reproductive and developmental issues or cancer.  Does an increased risk to health issues have to be a necessity for nail salon workers?  Fortunately, not.  The California Healthy Nail Salon Collaborative (CaHNSC) was established in 2005 to improve the health, safety and rights of this workforce.  My interview with Catherine Porter, policy director of the Collaborative, below describes their impact on the industry in California.

************************************

Me: How did you end up doing the work that you’re currently doing?  Describe your journey to your current role with the CA Healthy Nail Salon Collaborative – why is CaHNSC important to you? Why is it important to customers?

Catherine Porter: I have a great passion for workers’, particularly women workers’, rights and health.  As an employment rights attorney, I represented clients in gender and race discrimination claims and also represented teachers in arbitration and layoff hearings. After a breast cancer diagnosis at the age of 40, I decided to work on a policy level to have a greater impact on larger social, legal, and environmental issues such as eliminating the epidemic of cancer and other chronic diseases linked to toxic chemical exposures. I worked in an organization that focused on women with cancer and the environmental links to the disease; at another organization I focused on occupational safety and health, including workplace chemical exposures. I started with the California Healthy Nail Salon Collaborative (Collaborative or CaHNSC) in 2008 and now serve as its policy director.  Working with the Collaborative represents a natural progression of policy issues for me because we focus on environmental health and safety rights for both workers and women.

The Collaborative is having a positive impact on a vulnerable population of low-wage women workers. On the policy front, we are working to reduce exposures to toxic chemicals that are pervasive in nail salons. We also provide information regarding labor law rights and obligations, and work to ensure this important information is available and accessible to the nail salon community.  In California, manicurists are predominately Vietnamese immigrant women of reproductive age. Language can be a barrier to understanding occupational safety and health and labor rights.  The Collaborative has sponsored successful legislation that requires California state agencies to provide improved language access for the nail salon and other immigrant communities in California.

The Collaborative has built relationships in the nail salon community by providing trainings on healthier and more fair ways to do business.   Our successful advocacy for Healthy Nail Salon Recognition Programs (HNSRPs are now operational in four counties and one city) contribute to a safer and more enjoyable experience for nail salon customers.  These local programs acknowledge and support nail salons that use less toxic products and practices in their shops.

For example, nail salons must use products that do not contain the “Toxic Trio” of dibutyl phthalate, toluene, and formaldehyde, all known to cause reproductive and developmental harm or cancer.  Salons also must improve their ventilation and participate in trainings about how to avoid the most toxic exposures. According to our survey data, most salon owners that participate in the program say that they and their workers feel healthier and that they have experienced an increase in customers.

Me: The CA HNSC is involved with advocacy efforts – what legislation is realistic in the next few years and what would your ideal legislation look like?

CP: To promote the spread of Healthy Nail Salon Recognition Programs (HNSRPs) across California and beyond the current five jurisdictions, the CaHNSC and Asian Health Services of Oakland (AHS) are currently sponsoring AB 2125 (David Chiu) which requires a state agency to inform local county and city governments across California about HNSRP guidelines, and to conduct activities to improve consumer awareness of these local programs.  AB 2125 passed the state Assembly and two Senate policy committees with overwhelming support. It currently awaits consideration in the Senate appropriations committee. One reason AB 2125 has received such large bipartisan support is that it involves an incentive approach to policy change; it calls for rewarding good behavior as opposed to penalizing bad behavior.

However, frequently, a legal prohibition or requirement is necessary and most effective to change behavior, but it is much more difficult to get the necessary support from both sides of the aisle in Sacramento for this kind of policy.

For example, cosmetics are woefully under-regulated as there is no requirement for cosmetic products to undergo pre-market safety testing.  Furthermore, manufacturers are not required to list ingredients on the labels of professional cosmetics. And the chemical components of the ingredient known as “fragrance” do not have to be disclosed to consumers.

Ideally, filling these three gaps in cosmetics policy would be a good starting point for some meaningful legislation.  In fact, such a measure was introduced in Washington, D.C. by U.S. House Representative Jan Schakowsky (D – 9th).  But proposals like this are unlikely to receive enough support given the current political makeup of the Congress and the ongoing influence of the chemical and personal care products industries.

From a wider lens view, other legislation that would positively impact nail salon and other low income women workers include establishing a single payer health system; overturning Citizens United; and a state measure reining in the cost of housing including rental rates.

Me: What inspires you on a daily basis, especially when things get hard?

CP: We have strived to bring the voices of local Vietnamese nail salon workers to policy debates.  When I hear their powerful messages as they enthusiastically advocate for safety and health in the workplace, I am reminded of why my Collaborative colleagues and I do this work. This year, during the course of our campaign for AB 2125, many nail salon colleagues and Collaborative member organizations representing the local Vietnamese community participated in lobby days and hearings in Sacramento.   It is deeply satisfying to see a largely immigrant community become engaged in the political life of America as a result of the Collaborative’s Leadership Trainings and other education and outreach efforts.

Me: In your opinion, how effective are community outreach efforts like the Healthy Nail, Beauty Salon and Barbershop programs compared to other forms of health education (e.g. presentations, one-on-one, small group, etc.)?  Specifically – reaching target audiences where they spend recreational time (in a nail salon or barbershop).

CP: The most effective outreach efforts rest on relationship-building to develop trust and common ground among parties.  Our work with the nail salon community and successful implementation of Healthy Nail Salon Recognition Programs (HNSRPs) involve ever stronger ties with nail salon workers and owners.  Outreach workers are generally native Vietnamese speakers and understand how to bridge cultural differences.  They make in-person visits to salons to get to know the individual workers and owners. Over time, they begin to tell salon owners and technicians about the Collaborative’s work and how to make nail salons healthier for themselves and their customers.  Salon workers and owners will be invited to trainings on safety, health, and labor law as well as community gatherings sponsored by the Collaborative. County or city staff responsible for HNSRP implementation also conduct on-site trainings at the salons and convene small group informational meetings at the Collaborative offices. All written materials and spoken word are offered in Vietnamese and English.  We also make sure we have fun – community members and Collaborative staff come together regularly to share food and stories about work life in nail salons.

Me:  What are the current needs in the Bay Area relate to social determinants of health (i.e. SES, poverty, access to care, transportation, safety, etc.)?  Ties to nail salon workers and their need to work at potentially unhealthy workplaces.

CP:  The cost of housing and the need for more affordable housing are critical social or physical determinants of health in the San Francisco Bay Area. Two of the ten most expensive residential rental markets are cities in the San Francisco Bay Area—San Francisco and San Jose.  The City and County of San Francisco (64%) and Alameda County (60.9%) rank the highest and 5th highest respectively when it comes to fair market rent as a percentage of single mothers’ median income.

Some of the highest rates of women working in low-wage jobs are in San Francisco Bay Area counties.  Almost 34% of women in Santa Clara County, almost 27% in Contra Costa County, and approximately 25% in Alameda County, work in low-wage jobs.

This underscores the importance of increased consumer awareness of working conditions in this beauty services industry and the need for nail salon workers and owners to receive fair payment from their customers for services like manicures and pedicures.  AB 2125, which would mandate a statewide consumer awareness program, would be an important contribution toward a generally more sustainable nail salon industry.

Public Health in Action – A Silent Health Crisis

seniorsad.jpeg

Of all the things in the fields of both public health and healthcare that pique my interest and attention most, it’s health disparities, specifically the numbers 5 and 7.  In a country as productive and innovative as ours, it’s a particularly vexing reality check whenever I’m faced with those two numbers, which I’ve listed below along with their respective contexts.

5  – the difference, in years, of life expectancy between genders

*Life Expectancy at Birth in 2013: Female 81.2 years  Male 76.4 years

**Races considered: Hispanic, White, Black

5 & 7- the difference, in years, of life expectancy between females & males respectively

*Longest life expectancy to shortest in each gender

Health disparities are the end products of a variety of complex factors including, but not limited to the social determinants of health: SES, transportation, access to healthcare, employment, etc.  Additionally, they are also impacted by biological (our genes and family history), social (our culture and networks) and environmental (our physical surroundings) factors.  Lastly, health disparities are impacted by individual health behaviors and lifestyles.

The numbers 5 and 7, to me, represent a collective challenge: how can we bring these numbers down, thereby reducing  health disparities in our country?  What other perspectives do we need outside the fields of public health and healthcare to reduce health disparities?

My conversation with Steve Petty, Corporate Director for Community Health Improvement at INTEGRIS Health could offer some insight to the issues I’ve raised above.

****

Me: How did you end up doing the work that you’re currently doing?

Steve Petty: I have been working in health care for 29 years.  I started in a marketing/public relations role and several other areas and have worked in community and employee wellness for the last 20 years.

In community wellness, our mission (the same as INTEGRIS Health) is to improve the health of the people and communities we serve.  Our department works in many at-risk, minority and under-served communities.  The state of Oklahoma has very poor health indicators for about everything you can possibly imagine.  We are working to provide health, wellness and health education services to those most in need, but to also educate people in general about the need to take care of themselves – know their health numbers (blood pressure, cholesterol, etc.), to get routine and regular exams, among others.

One area that continued to grab my attention was comparatively poor health indicators for men.   It was alarming to discover that such few men actually went to a regular doctor or health provider, let alone had access to any type of screenings.  INTEGRIS had been doing a Women’s Health Forum for many years then.  Most of their outreach efforts were for women who had insurance (employer-based or from retirement) but a majority of them were proactive with their health for the most part.

Two of my colleagues and I developed a proposal that would address men’s health in a different way that wasn’t intimidating to men, but still covered all aspects of their health and education.  Our leadership liked the idea, but a few seemed skeptical that we would be able to attract men to a health event.  We were confident that we could succeed if we tied it to something they were interested in, so, naturally, we partnered with the local sports radio station and used humor to make it a different kind of health event.

In our first event in 2004, over 300 men attended our event and we’ve had steady attendance ever since.  We continue to add more events and health screenings which have proven successful and have replicated many of these screenings and events in our rural communities where we have smaller hospitals and populations with limited access to health education programs and services.

We started planning our event back in 2003 and realized there wasn’t a lot of information on men’s health events anywhere.  Through internet searches, I stumbled upon the Men’s Health Network (MHN) webpage.  We finally found a resource to help us secure health education literature for our upcoming men’s health conference and MHN’s Jim Boyd and Scott Williams were crucial partners in planning that event and others since.  MHN has been one of our biggest supporters and partners in our efforts to improve the health of men and boys in Oklahoma.  The partnership has given me the opportunity to present our program and services across the country and at the 2009 International Society on Men’s Health in Vienna, Austria.  I’ve served on several committees through recommendations by MHN, and that’s how I got involved with the American Public Health Association (APHA) Men’s Health Caucus (MHC).  I was fortunate enough to be involved with the caucus early and have served in several positions since its inception in 2008.  I currently serve as the chair for the MHC and represent our group in the APHA’s Caucus Collaborative.

Me: What inspires you on a daily basis, especially when things get hard?

SP: I’m inspired by all the work being done which focuses on the health of men and boys.  It’s amazing to see how awareness and interest to keep men healthy has escalated over the years among government officials, businesses, marketing professionals and the public as a whole.   I’m also inspired by all of the great programs and services we’ve implemented here in Oklahoma, not just for men, but to improve health outcomes for the entire population, including children, senior citizens and minority populations.  We have a long way to go to show impact, but we are slowly making progress throughout the state.

Me: Can you share some of the progress you’ve made at INTEGRIS as it relates to men’s health outreach?

SP:  A large percentage of men have only limited contact with physicians and the health care system as a whole. Men not only fail to get routine check-ups or preventive care, but often ignore symptoms or delay seeking medical attention when sick or in pain. These poor health habits take their toll – beginning at early ages and rising significantly as males reach retirement age.

Because INTEGRIS is determined to raise awareness of this “silent crisis” and turn the tide, we’ve implemented an innovative men’s health initiative, Men’s Health University (a.k.a. Men-U). It’s designed to educate men and their families on the importance of men taking charge of their own health. Established in 2004, Men-U consists of free screenings and information, physician seminars, an annual wellness fair, (the 2006 event drew more than 700 people), and this website devoted solely to men’s health.

INTEGRIS Health Edmond- Shoot Straight! Keep your health care goals on target.JPG

By bringing men back into the health care system, INTEGRIS is helping them overcome one of their biggest health risks – that of just being a man. And knowledge is power. Even if males are aware of just two numbers, blood pressure and cholesterol, and take active steps to lower them if either reaches an unhealthy range, it can make a huge difference in their longevity.

African American Men's Health Summit 2015- Registration Table.JPG

Me: Describe your vision for Integris Health.  Where do you see Integris and/or MHC in 1, 5 or 10 years and what kind of impact do you plan to make?

SP: My vision for INTEGRIS Health is really coming together for our community.  INTEGRIS is one of the few health systems in Oklahoma that gives back to the community in such a substantial manner.  We are finding new partnership and collaborative opportunities with agencies and organizations who have similar missions.  Additionally, we continue to explore innovative ways to make an impact on the health and wellness of our communities by sharing resources and services with partners like the Regional Food Bank, Oklahoma City County Health Department, the local Federally Qualified Health Center, churches and colleges.  All of these groups are coming together to hold events, offer services, programs and share resources, all of which help us improve the lives and health of our targeted communities.  I hope in the next year, our work to develop a comprehensive health, wellness and education resource center will come to fruition.  I hope we can replicate this model across our service areas in the next 5 to 10 years.  This will make a huge impact on patient access, especially if we can get other hospital systems to join with us.

Me: What are the current needs in Oklahoma City as they relate to social determinants of health (i.e SES, poverty, access to care, transportation, safety, etc.)?

SP:  The needs in all of these areas listed above are, unfortunately, not being met in many areas.  We observe access to care being a recurring obstacle for many individuals.  People can’t afford health insurance through the Affordable Care Act and/or their co-payments, so they have to use our emergency departments as a clinic or their healthcare provider.  We have about 19 free clinics in the metro area that are at capacity due to unmet needs of populations with limited resources or circumstances – uninsured, undocumented and underprivileged.

****

Oklahoma, as a state, faces many challenges as documented in their annual state report, however, passionate community leaders like Steve Petty and his colleagues are working diligently to improve health outcomes at the local level.

“Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.” –Margaret Mead

If you’re interested in learning more or working with Steve to improve health and well-being in Oklahoma, contact him at Stephen.Petty@integrisok.com.

 

How Digital Health will Disrupt the US Healthcare System

runner

One-sixth of the US economy is spent on the US healthcare system.  About $2.8 trillion is spent annually or an average of $8,500 per person.  When compared to other countries, the size of the healthcare system alone would rank fifth in the world.  An informative article from Vox analyzes this spending through various comparisons and graphs.

US Healthcare: Past & Present

In the past decade, healthcare reform in the US has focused on providing people with more access to healthcare by means of affordable health insurance.  Key facets of the Affordable Care Act include non-discrimination of potential enrollees with chronic conditions and creating health insurance exchanges which helped consumers buy insurance.  Though strongly contested through King vs. Burwell and National Federation of Independent Business vs. Sebelius, the ACA remains as intact as law.

On the other end of the health spectrum is public health and preventive medicine.  The main principle of public health is prevention through health education, epidemiology and health behavior change, among others.  Several industries have grown in the space outside of direct healthcare, including health/wellness/fitness, complementary and alternative medicine and most recently wearable technology through apps and sensors, illustrated in a TED talk by Ted Wolf in “quantified self

Startups & The Future of Health

The market size of offerings outside of the healthcare space is growing and appears to be an ongoing trend.  Key stakeholders in healthcare are jockeying for position.  Hospitals systems like the Mayo Clinic and Cleveland Clinic, insurance companies like Blue Cross and Kaiser Permanente as well as retail giants CVS and Walgreens have all embraced recent trends.  The onus has been on consumer engagement to improve population-level health outcomes.  For example, Kaiser Permanente celebrated a 10-year anniversary of their social marketing campaign KP Thrive last year and continues to promote healthy lifestyles in partnerships with national initiatives. Even CVS rebranded to CVS Health to “help people on their path to better health.”

Two startups based in the Triangle of North Carolina have been growing rapidly and have the potential to impact population health.  First is startup, Validic, based in Durham, NC.  It offers wellness companies and healthcare providers a platform to manage and analyze their patients’ wearable technology-based data.  In its most recent round of funding, Validic secured another $12.5 million, which included Kaiser Permanente’s ventures arm, Kaiser Ventures.  Considering the number of apps to collect health data from various sources, Validic looks to be a key player in data aggregation and management of personal health data.

The second startup that grabbed the attention of “high-profile investors” a few weeks ago is Predictify.me. The Raleigh-based startup takes large data sets and “extrapolates” them into the future data sets.  Future data sets enable analysts to forecast and can plan strategic moves accordingly.  Chief Data Scientist, Dr. Usmani, is renowned for his work in public safety and counter-terrorism in his native country of Pakistan.  Despite starting in the private sector for consumer buying habits, Dr. Usmani and Predictify.me aims to focus on making social impact.  Innovating to improve the healthcare system just may be the social impact that Predictify.me is looking for.  Imagine if predictive analysis took place with an individual health consumer.  How might researchers, public health practitioners and companies utilize this to keep individuals healthy?

The US economy cannot sustain the pace of healthcare spending and the potential applications outside of the healthcare system seem ready to bring more value for each dollar spent.  How wearable technology will affect population-level health outcomes is still unknown.  But with Validic, Predictify.me and others leveraging technology to obtain, manage and analyze data sets, don’t be surprised if health outcomes start to improve.

Originally published on Startup Grind