Highlights from the 2017 State of the Public’s Health Conference

The 6th annual State of the Public’s Health (SOPH) conference was held Tuesday, October 17, 2017 and featured presentations from top national, regional, and state public health leaders. View the conference program here.

Keynote Speakers:

  • Laura Hanen, MPP, NACCHO Interim Executive Director and Chief of Government Affairs,
  • Claude-Alix Jacob, MPH, Chief Public Health Officer for the Cambridge Public Health Department and NACCHO Immediate-Past President
  • J. Patrick O’Neal, MD,  Commissioner, Georgia Department of Public Health

Conference Briefs:

As rural hospitals, healthcare become scarce, telehealth still shows promise

By Emily Webb

Rural Georgia has a healthcare problem. Though one in five people in Georgia live in rural areas, only one in ten physicians practice in these areas. Hospital closures have become commonplace. All the while, rural counties consistently have higher rates of chronic disease, obesity, and infant mortality, compared to urban districts.

“We need to find other ways to get specialty care and get providers out to these rural communities,” said Mason Reid, a legal consultant with Boling & Company.

As an attorney serving the healthcare industry, Reid and his partner William Boling are witness to the changing landscape of healthcare. In their view, telehealth — technology used to deliver medical and health services to consumers — is the future of providing care to rural populations.

Their presentation at the State of the Public’s Health Conference in Athens, Georgia, on October 17 served to update the crowd of public health professionals and researchers of the current state of affairs of telehealth.

“Telehealth is such a critical tool in the toolbox right now,” Boling said, though rural communities have been slow to adopt it due to a lack of resources or infrastructure.

Telemedicine offers an option for care close to home. Now, many patients rely on hospitals to access basic health services like diabetes care. A wider adoption of telemedicine could help keep hospitals open, said Reid.

Since fall 2016, Jenkins County and Baldwin County hospitals have been sold in distress. Jefferson County and Monroe County appealed to their communities, which agreed to extra taxes to keep their hospitals alive.

Due to Georgia’s decision to reject Medicaid expansion, Disproportionate Share Hospital payments (DSH) and Indigent Care Trust Fund payments (ICTF), both of which provide crucial financial support for hospitals that take on a majority of underinsured or uninsured patients, continue to peter out.

“For hospitals, especially, but for all rural providers, [it’s] a difficult environment that we’re in,” said Boling.

Boling and Reid are hopeful about the growth of telemedicine. In a recent study conducted by Kaufman Hall & Associates, 21 percent of respondents said they would choose to have video visits for middle-of-the-night care.

“Consumers are developing more of an appetite for this,” Reid said. “Maybe some of the stigma around telemedicine as being unsafe or unreliable is going away.”

Boling and Reid describes three models for telehealth, all of which have pros and cons for implementing in rural communities. The main hurdle, said Boling, for taking on any model for telehealth is the novelty of it.  Healthcare providers and patients, he said, must be open to it.

Still, Boling and Reid remain optimistic. The proposed CHRONIC Care Act, which is currently making its way through Senate committees, would expand telehealth with federal funding.

“High-end specialists and subspecialists can grow a business model around this [bill], and the local community hospitals and the local community patients all benefit. It’s a win-win-win-win,” said Boling.

CDC program improves prenatal testing for HIV

By Prajakta Dhapte

Prenatal testing for Human Immunodeficiency Virus (HIV) is a crucial method for preventing the transmission from mother to baby.

“CDC stats show that, the sooner a pregnant woman gets linked to care or intervention, her chances of delivering a HIV infected baby is reduced to a mere 1 percent,” said Marcie McClellan at the State of the Public’s Health Conference in Athens, Georgia, on October 17th.

Although there has been a significant drop in the number of perinatal HIV infections since the 1990s, it still remains the most common route of infection in children according to CDC reports. In Georgia, the mother to child HIV is higher than the national rate, according to the Enhanced Perinatal HIV Surveillance.

Early intervention in the form of routine HIV testing, anti-retroviral (ARV) drug therapy, caesarean delivery, education and support on avoidance of breast feedings are some of the crucial steps that may help prevent transmission.

In 2007, the CDC launched the One Test, Two Lives (OTTL) campaign, a nation-wide campaign which  provided obstetric providers with resources to promote universal voluntary prenatal testing for HIV for all pregnant women.

“According to a recent study, providers exposed to OTTL materials are more likely to include HIV testing as a regular screening test with pregnant patients,” McClellan said, who worked on developing content for the campaign with JBS International.

The CDC recommends an “opt-out” approach in which pregnant women are informed about the inclusion of the HIV test along with other standard prenatal tests and has the opportunity to decline the test. The opt-out approach has helped increase testing rates among pregnant women, said McClellan.

Although there are several interventions available in the market, there are still barriers preventing women from getting tested for HIV infections. One of the primary issues is the stigma associated with HIV testing. McClellan recommends that healthcare providers normalize the conversation about HIV testing.

“Make the talk about HIV testing a routine practice by incorporating it within the standard group of tests,” said McClellan. “Be transparent and provide all the necessary prevention and treatment information to the patient.”

Newer tools have been introduced by the CDC in order to make HIV testing more accessible and more conceivable for both OB/GYNs and pregnant women.

The Due Date Calculator, for example, predicts the estimated date of delivery and more importantly this tool highlights the ideal time to test a pregnant woman for HIV and provides reminders that it is never too late to test for HIV.

Other materials like fact sheets and posters that highlight the benefits of prenatal testing and explain the HIV test results to the patients and clinicians have also been made available by the CDC. Interventions like these and more will potentially help reduce the burden of perinatal HIV transmission and ensure a healthy future for newborn babies.

Georgia Dept. of Health aims to reduce word gap with new program

By Alex Boss

The more words babies hear during their first 18 months of its life, the better they can read by the third grade. However, some babies hear fewer words from their parents and fall behind in their reading skills.

Kimberly Ross is trying to fix this word gap by educating parents during visits to Woman, Infant and Children (WIC) clinics.

“The idea is to get the message to parents through work forces such as WIC clinics,” said Ross, who manages the Early Brain Development & Language Acquisition Program Manager at the Georgia Department of Public Health.

This initiative is part of the Talk With Me Baby project, which is led by six leadership organizations with the goal of bridging the word gap in babies. Ross presented an overview of the project and its goals at the 2017 State of the Public’s Health Conference in Athens, Georgia on October 17th.

The program presented educational information in two phases. Phase one focused on informing parents through video material.

“We played a video in the waiting room of the WIC clinics,” said Ross, “It was a passive approach.” The downside was that many parents did not remember the material.

In phase two, WIC nutritionists had direct tools they could use with their patients, including a flip chart, stickers and a fridge magnet. The flip chart featured graphics on one side and coaching language skills on the other for parents to use with their children. The stickers included fun facts or pictures, and the fridge magnet had description for language that tied into food.

Out of all the tools used with patients the fridge magnet was the most informative and influential.

“They learned the most from it,” said Ross, “Staff like the magnet because participants could pick a goal.” The flip chart also received positive reviews. “The flipchart was engaging and staff liked how visual it was,” said Ross.

A limitation of the study is the low response rate, says Ross, which was 23 percent. However, looking towards the future Ross spoke about other initiatives in motion outside of the WIC clinics.

“There’s a pilot going on for early care teachers and in the Grady hospital system,” said Ross. “They are becoming a Talk With Me Baby hospital, so we’re looking at them as a pilot, for building this ecosystem where everybody who works in a mother baby unit is trained. We are trying to see what is really going to support this language rich environment.”

Birmingham’s Greg Townsend offers model to improve health equity in divided communities

By Sydney Shadrix

“All I wanted was a box of Cracker Jacks.”

Then an eight-year-old boy, Greg Townsend remembers taking his 25 cents to the neighborhood corner store, which sat on the dividing line of the black community and the white community in Birmingham, Alabama.  Like many stores in the 1960s segregated South, one side of the store was designated for white customers; the other for colored customers. On this day, the division presented a problem for Townsend — only the white side had Cracker Jacks.

Townsend, who now serves as the health services administrator for the Jefferson County Department of Health in Birmingham, Alabama, was determined to get his treat.

“Being the man that I am—the young boy that I was—I walked over to the white side of the store to get my box of Cracker Jacks,” Townsend said.  “They told me as I was leaving, ‘You people — your people — shop on the other side of the store. You don’t come on this side.’ But, I still got my box of Cracker Jacks.”

Stores may no longer be overtly segregated, but for many in Jefferson County today, the impact of racial and ethnic divisions are reflected in access to quality health services.

“There are still people — still communities — searching for their box of Cracker Jacks,” Townsend told attendees at the State of the Public’s Health Conference in Athens, Georgia on October 17.

Health equity means that everyone has a fair opportunity to live a long and healthy life.  Unfortunately, Townsend explained, that is not the case in Jefferson County.

Single-parent households make up almost of a quarter of all households, and 26.3 percent of children are living in poverty. For every unemployed white person, two African Americans are unemployed. The infant mortality rate for African Americans is nearly three times higher compared to whites in Jefferson County.

Statistics like these illustrate how social determinants matter, Townsend said. “There is a 10-year difference in quality of life because of poverty and all of the other issues that we have,” Townsend said. “Ten years.”

To take on health disparities, communities must work together to address the divide. Better health can be achieved by promoting physical activity, creating a built environment, optimizing healthcare access, and improving mental health.

Yet, these goals cannot be accomplished by one person or by one health department.

Townsend suggested six principles for advancing health equity, which emphasize the importance of bringing community voices — those who have been negatively impacted by health disparities — to the table to develop, implement and evaluate new programs. in the development, implementation, and evaluation of new programs.

‘The time is now,” Townsend said. “We work in healthcare. We take care of people- from the wealthiest to the least, from the 99 percent to the one percent. The time is now for us in healthcare to take the leap if we’re going to create a health equity movement.”

Improving health literacy can play key role to prevent opioid misuse

By Chris Herbert and Dannie Parker

According to the CDC, approximately 140 people die in the U.S. from opioid overdoses every day. Georgia’s overdose rate is increasing faster than any other state, and having doubled since 2009.

Henry N. Young, the Kroger Associate Professor of Pharmacy at UGA’s School of Pharmacy, led a panel discussion on using health literacy as a tool to combat the state’s rising opioid addiction rates at the State of the Public’s Health Conference in Athens, Georgia on October 17.

Typically, a person’s initial exposure to opioids when they are prescribed by a doctor in a legitimate medical situation. However, not understanding doctors’ jargon or medical literature is directly affecting improper use of opioids statewide.

“At least 14 percent of adults have less than basic health literacy … and 9 out of 10 lack the skills necessary to manage their healthcare properly,” said Aimee Dyal, assistant professor of health promotion at Kennesaw State University

Thirty-two percent of patients receive no communication about their medications from providers and pharmacists, said Michael Crooks, pharmacist and care coordination and interventions technical lead with Alliant Quality. “In healthcare, we do a pretty poor job in discussing these medicines,” Crooks said.

The panel emphasized several techniques for providers to better convey messages to patients without high levels of health literacy. Use of plain language, focused message, visual cues, colors, symbols and “teach back” – requiring the patient or caregiver to explain in their own words back to the provider – have proven to be effective methods. Encouraging patients to be active and asking questions during the visits is vital.

Young stressed the importance of teaching patients about the dangers of incorrectly using the drugs and also about the unintentional harm drug sharing can do to the people they love.

Young was quick to quash the myth of the opioid epidemic being supplied by the illegal drug trade. “Drug sharing is not criminal like we think,” said Young. “Most un-prescribed opioids are given to someone from a family member or friend with the intention of helping that person.”

A muddled medication list also adds to the potential for opioid abuse. Patients with multiple providers are frequently overprescribed opiates, said Crooks. To avoid receiving double doses of opiates, patients and caregivers are encouraged to physically bring current medications to each medical appointment.

“You are the source of truth. Your medicines are the most accurate source that truth. I do best when I get to look at your actual medicines versus looking at a list,” Crooks said.

Young believes professional development education for local physicians and pharmacists will improve patients’ health literacy and help reduce opioid abuse. Working with the UGA Archway Partnership, Young is developing the program for the surrounding Athens area.

And there is more to come. Young is dedicated to combating substance abuse. “One of the things I really get jazzed up about- my overarching goal- is to help patients use medication safely and appropriately.”

Policy plans in the works to reduce opioid abuse in Georgia

By John Slights and Brittany Jefferson

Ohio, West Virginia, and Utah. When we talk about the opioid epidemic, it’s usually about these states, which have been the hardest hit by heroin and prescription drug abuse and overdoses. Thus far, the state of Georgia has not been a part of the conversation, but it may be soon.

“Georgia is number 11 in the country for heroin deaths per capita,” said Amanda Abraham, an assistant professor of public administration and policy at the University of Georgia. “We are what’s known as a second-tier state – we aren’t the worst of the worst when it comes to this epidemic, but we’re quickly rising and we’re not far removed from it at all. There is reason to be alarmed.”

Abraham was one of three panelists who spoke to Georgia’s growing opioid crisis at the State of the Public’s Health Conference in Athens, Georgia, on October 17th. The panel, which included Substance Abuse Research Alliance (SARA) director Jim Langford and Lawrence Bryant with the Georgia Department of Public Health, outlined the latest data on opioid abuse as reported in SARA’s recent white paper.

“In the United States, you can get heroin in almost 10 to 15 minutes upon arriving in any town,” said Langford.  “What makes this drug so dangerous is how easy it is to obtain.”

In 2016, there were 50,018 heroin-related deaths in the United States, but “the CDC estimates that number could be 40 percent higher, since a lot of heroin deaths remain unreported or are the result of a health condition related to the drug’s abuse,” Langford said.

Abraham added that 68.8 percent of all drug-related deaths in the state of Georgia for 2017 are estimated to be related to opioids or heroin.

“The main issue is that a lot of these deaths are taking place in rural areas,” Abraham said.  “People lack access to the proper resources for treatment and don’t have access to proper medical care, which is why we are seeing so many heroin-related deaths in these parts of the state.”

The white paper outlined eight strategies state legislators should consider in developing drug abuse prevention policy.

“We have to work together and collaborate,” Bryant said, who also offered an update on DPH’s simultaneous efforts to tackle the epidemic. “It’s going to take a team effort from public health officials and the public.”

Bryant advocated for increasing funding for treatment for heroin addicts in the state, as well as increasing access to treatment, largely for those addicted living in rural areas.

“We need to work together to change the culture for addicts, from one of shaming addicts to having compassion for addicts.  We must change the rhetoric.”

Bryant knows first-hand about the dark side of drug addiction and the salvation of rehabilitation. He was once addict himself before receiving treatment for substance abuse and turning his life around.

“Often times when we’re doing our work, we don’t always hear the stories of the people that were impacted,” he said. “On August 26, I celebrated 26 years of continuous sobriety. Once the work that we are doing can be implemented, people’s lives can be changed.”

SARA’s finalized white paper, which will provide a framework for legislators to enact the appropriate changes to decrease overdoses and improve access to treatment, will be available at the end of the year. The Georgia Department of Public Health’s fully-developed proposal to combat the heroin epidemic will be unveiled in early February of next year.

Two Georgias Initiative launches, seeks to reduce health disparities in rural counties

By Talia Levine

Four years ago, a series of hospital closings in rural Georgia highlighted a disturbing trend in the state’s healthcare landscape. As county health rankings continued to seat mostly rural counties in the bottom 10 slots, the disparities in access to and quality of health between urban and rural communities have become too obvious to ignore.

“This notion of ZIP code determines how long you live and how well you live in terms of health and health status is truly alive and well as it describes rural Georgia,” said Dr. Gary D. Nelson, president of the Healthcare Georgia Foundation, to a crowded auditorium at the State of the Public’s Health Conference in Athens, Georgia on October 17th. “ZIP code is becoming more of a factor than genetic code in describing the problems and the fate of rural Georgians,” he said.

It has been said that there are two Georgias in terms of economic vitality. Although originally offered in an economic context, the Healthcare Georgia Foundation recognized the applicability of this description to the health disparities between rural and urban residents of Georgia.

The foundation is dedicated to advancing the health of all Georgians and to expanding access to affordable, quality healthcare with an emphasis on underserved individuals and communities. The Two Georgias Initiative responded to the increasingly place-based inequities they noticed in health access and services.

“By that we mean the pursuit of creating conditions in which everyone has the opportunity to achieve their full potential through the elimination of disparities,” Nelson said.

The Two Georgias Initiative hopes to improve the lives of rural Georgians through partnerships with communities in need of support. The foundation awarded its first 11 Community Partnerships in June of this year. Among other criteria for selection, Nelson mentioned readiness and inclusion as two important qualities initiative-ready communities demonstrated.

Partner communities had to be willing to abandon traditional healthcare models and to explore new methods of delivering healthcare in their communities. These communities also understood the need for those most adversely affected residents to have a voice in an effective solution.

In the first year, grantees will focus on building partnerships in their communities, and creating a Community Health Improvement Plan (CHIP) and an Evaluation Plan. The second year will be devoted to implementation activities. Lisa Medellin, Senior Program Officer of Healthcare Georgia Foundation, noted that communities bring their own strengths to the program that will serve them well in this process.

“They are resilient communities. They have dedicated residents and engaged local leadership,” Medellin said. “Some of them have challenges—limited resources and fragile non-profit infrastructures—but they still do have a lot of assets.”

Grantees will also benefit from Healthcare Georgia Foundation’s partnerships with other organizations working towards bridging gaps in inequities. The Emory Prevention Research Center will provide capacity building to partnerships and assist with evaluation plans. Georgia Tech Health Analytics Group will translate data into formats more useable for important health decision-making.

Although the foundation has set up a scaffold for partner communities over the next two years, Nelson recognizes that health is an increasingly broad term, and that successful initiatives will recognize the myriad of factors that impact the health of a community’s residents.

“As the largest health foundation in the state, I don’t think anybody wants this foundation to stray from its health mission,” Nelson said. “Yet at the same time, we know we have to go upstream to truly move the needle on health outcomes, and to do so means we are going to have to figure out a way to address transportation, housing, poverty, jobs, you name it.”

The foundation knows that each community’s challenges will be different, and a technical assistance team is in place to assist them in identifying priorities. Central to the initiative is the tenet that each community must determine its own way forward. Although Nelson would love to see the program succeed and expand, he said the first step is for communities to decide what success means for them. Part of equity is returning control to the community.

“This is a movement moment as I like to describe it,” said Nelson. “This is about accelerating impact, it’s about delivering impact, it’s about measuring impact, and it’s about sustaining impact in rural Georgia, and we’re putting the control, the ownership, the flexibility and choice in the hands of rural Georgians to figure out how best to do that.”

UGA partners with, empowers rural communities to reduce obesity

By Lauren Baggett

Obesity is a serious and costly problem in Georgia, and the burden is greater in low-income, rural, and minority communities. Calhoun and Taliaferro are two rural counties in Georgia that, like most rural counties, experience high rates of poverty, chronic disease and obesity. In fact, around half of the people living in Calhoun and Taliaferro counties are obese.

But time and research have shown that reducing obesity requires more than encouraging communities to eat more vegetables and exercise more often.

“You can’t tell someone to walk more when there’s nowhere to walk. That’s a lost message,” said Courtney Still, program coordinator for Healthier Together Still presented an overview of the project, which just wrapped up its first year, at the State of the Public’s Health conference in Athens, Georgia, on October 17th.

Created through a partnership between University of Georgia Cooperative Extension, the College of Family and Consumer Science and the College of Public Health, the Healthier Together project tackles obesity from an environmental approach. The environment of a place — access to fresh food, access to safe places to exercise, social networks — dramatically impacts the health of its residents.

Extension staff in both counties gathered interested community members to form coalitions to create strategies to reduce and prevent obesity in their communities through education, promotion, and policy and environmental changes within the community. In the Healthier Together model, collaboration is key.

Coalitions include members representing diverse groups and organizations, including Family Connection, school systems, law enforcement, local businesses, and city and county government.

The coalitions had a hand in developing action plans for their communities, which included projects that would not only increase healthy eating and physical activity in the short term, but would also include environmental and policy changes that support health in the long term.

When the Healthier Together project began, the only place to buy food in Calhoun county was a convenience store. In July, the county installed its first community garden. Taliaferro held its first Bike Rodeo event, and the local school now has raised beds. In November, the coalitions met with a representative from Fresh Stop Markets, a CSA-type program designed to connect local farmers with communities lacking access to fresh produce.

Future projects will include a visit from an expert on building pedestrian-friendly infrastructures and a lesson on smart lunchrooms from Still herself. All of these individual steps, she says, will hopefully lay the path to behavior change.

“We’re trying to make the healthy choice, the easy choice,” said Still.