Highlights from the 2018 State of the Public’s Health Conference
The 7th annual State of the Public’s Health (SOPH) conference was held Thursday, October 18, 2018 and featured presentations from top national, regional, and state public health leaders. View the conference program here.
Featured Keynote Speakers:
- William Foege, MD, MPH, epidemiologist, Gates Foundation Global Health Senior Fellow, and former Centers for Disease Control and Prevention Director
- Umair Shah, MD, MPH, Executive Director, Harris County Public Health in Texas, and NACCHO Past-President
- Laura Magana Valladares, PhD, President/CEO, Association of Schools & Programs of Public Health (ASPPH), and Academic Dean, National Institute of Public Health in Mexico
- J. Patrick O’Neal, MD, Commissioner, Georgia Department of Public Health
Infant and maternal deaths remain a challenge in Georgia, despite progress
By Emily Webb
While there are various efforts in Georgia aimed at reducing the risk of death and other adverse events among new moms and their babies, there’s still a long way to go, noted speakers at the seventh State of the Public’s Health Conference at the University of Georgia.
During a session at the Oct. 18 event in Athens, experts from The March of Dimes, Healthcare Georgia Foundation and UGA’s College of Public Health painted a grim picture of how well issues like maternal and infant deaths, preterm births and access to prenatal care are addressed statewide.
“We have a major challenge,” said UGA public health professor José F. Cordero, during a session on promoting healthy starts for mothers and infants. He and others highlighted some of the statistics they find most alarming.
For example, at 7.5 deaths per 1,000 live births, the Peach State ranked among the top ten worst in the country on infant mortality rates— which refers to how frequently a child dies before reaching his or her first birthday. That’s according to 2016 data from the Centers for Disease Control and Prevention. Nationally, the average rate was 5.9 deaths per 1,000 live births.
Georgia also has the highest maternal mortality rate in the U.S., at 46.2 deaths per 100,000 births, according to the 2018 Health of Women and Children Report from America’s Health Rankings, an organization that provides health-related data for policymakers, advocates and individuals.
Likewise, there is concern when a baby is born before 37 weeks of pregnancy, or preterm. In fact, a report released by the March of Dimes one week after the conference found a slight increase in preterm births over the past year, rising from 11.2 percent to 11.4 percent.
The report reiterated that more work needs to be done. But health care workers continue to face several challenges addressing these problems, and one of the biggest issues is access to care, panelists said.
“High rates of preterm births in areas of the South are related to a separate issue, poor access to prenatal care,” Cordero explained. “These are the same areas [where] there are major limitations in access to obstetricians and midwives,” he said.
Access to proper pre- and postnatal care may also be limited due to lack of health insurance coverage. An estimated 19.4 percent of women in Georgia between the ages of 18 and 44 are uninsured, according to 2018 data from the America’s Health Rankings’ report on the health of women and children.
To turn things around, perhaps the state could benefit from more diverse approaches.
“Public health is not a one size fit all,” said Danielle Brown, director of maternal and child health at the greater Atlanta-area March of Dimes.
As an example, she discussed the March of Dimes’ implementation of a program called the Prematurity Prevention Workgroup, a group of healthcare and medical professionals that join together to offer prenatal care and education, and address disparities in priority areas in the state, among other efforts. The workgroups, originally launched in Savannah, bring pregnant women together in a group with providers to discuss labor, infant care, family planning and postpartum care.
“We wanted to develop a program that was a little more flexible,” Brown said, noting that the program serves a dual purpose. When moms bring their infants for regular checkups, the clinicians will also turn their focus to the issues the mother’s may be facing.
In another example of efforts underway, Andrea Kellum, a senior program officer at Healthcare Georgia Foundation, discussed Taking Care of You. The evidence-based program works to reduce adverse birth outcomes, like preterm births, sleep-related deaths and babies born with low birth weights through targeted community interventions.
Still, panelists agreed more work could be done, a message that was reinforced by the March of Dimes’ president, Stacey Stewart, in an announcement about the new report on preterm pregnancies.
“We must all come together to take concrete, common sense steps to reverse this alarming trend,” Stewart said. “By expanding proven programs and innovative solutions we can shift our healthcare system to improve treatment and preventive care for moms and lower the preterm birth rate. Birth equity is our goal; it can be reached.”
New partnerships, mixed-methods approach to improve community health outcomes
We can collect all the data in the world, but without designing and implementing policies, how useful can that data really be?
New data collection and implementation methods are two integral components pushing us to craft meaningful partnerships within our communities. At least that’s what Grace Bagwell Adams, assistant professor in UGA’s College of Public Health and principal investigator of the Athens Wellbeing Project, suggests is the driving force towards improving community health outcomes.
Adams presented at an afternoon session, “How to Win Partners & Influence Policy,” during the State of the Public Health’s Conference, held Oct. 18 on the UGA campus. Her presentation explored the partnership between the Athens Wellbeing Project and Envision Athens, a community-wide effort strategizing the community and economic development in Athens for the next 20 years.
“Our hope is that we have changes in outputs – changes in service delivery methods, mechanisms and target groups,” said Adams.
The Athens Wellbeing Project (AWP) serves to empower Athens with meaningful data in order to improve decisions and service delivery that impact the quality of life. Its core focuses on collecting information over a variety of domains, or issue areas, such as housing, health, safety and lifelong learning.
Because the Athens Wellbeing Project is not a policy-making organization, its partnership with Envision Athens is crucial to the development of long-lasting policies. “We have to take a mixed-methods approach,” said Adams.
AWP’s approach is three-tiered: representative sampling, collaboration across service areas and transparency in sharing results with the public. It aims to make data a public good and allow communities to understand how it impacts their daily lives.
Prior to her collaboration with Envision Athens, Adams found that many Athens organizations were engaged in needs assessments but were collecting data separately, proving to be inefficient. When these institutions come together, however, data can be collected on issues across the spectrum and allow organizations to work collectively on solutions.
Highlighted in the presentation were case studies on agriculture and behavioral health that proved the success of new partnerships.
The first case study focused on improving food security in Athens. Food swamps, a term coined in the public health sphere, were districts that contained little to no grocery stores with nutritious foods but had an abundance of fast-food restaurants. In response to this data, St. Mary’s Mobile Market changed its route to deliver more fresh foods to these food swamps.
Similarly, the case study on behavioral health found that areas where families could not afford health insurance or did not have access to mental health resources were supported by local hospitals and public safety groups.
These two issues, Adams explained, were only samples of how the utilization of data and partnerships can improve health outcomes.
“We finally have a mechanism to put the data to work. The vehicle is the strategic action plan that’s emerged at the local level,” Adam concludes. “The thing that’s going to make us the most effective is being inclusive of the partners we have at the table to move forward.”
Healthy food initiatives aim to combat the rising obesity epidemic
Lack of access to healthy food, worries about food insecurity and unhealthy diets are major concerns in Georgia, and several non-profit and government organizations are working diligently to address the issues.
Strategies such as community gardens, farm-to-school programs and food-sharing were among the solutions shared by panelists last month during the seventh annual State of the Public’s Health Conference at the University of Georgia.
Speakers from the Georgia Farm to Early Care and Education Coalition, Everybody Eats Fresh Free Fridays Network and Healthier Together outlined local initiatives.
But they also noted the limited scope of the efforts and said there is more work to be done to expand the positive outcomes to more communities across the state and nationwide.
Denise Everson, program development coordinator for Healthier Together, encouraged attendees to turn troubling health statistics into opportunities to deploy new strategies.
“When you get the prize for being a community with a high rate of obesity…it creates a unique opportunity,” she said. “Not only [to address] issues related to the obesity rate, but also chronic disease-related issues.”
That’s what led Healthier Together— a two-year initiative that uses federal funding to introduce community-based interventions— to Taliaferro County, about 90 miles east of Atlanta. There were no fast-food outlets in the county, but there were also no grocery stores.
“You would need to drive out of the county to find one. Which is why they identified access to healthy food as something that they wanted to work on as a community,” said UGA healthy living specialist, Courtney Brown. She was one of the panelists, and part of a university program that collaborates on local efforts.
Healthier Together introduced a community supported agriculture program that included a community garden, and a student-sustained vegetable garden that offers fresh produce at the local elementary school and an area farmer’s market.
A similar mission was outlined by the Georgia Early Care and Education Coalition, with a focus on children ages six and younger. “Starting early is our mantra,” said Roslyn Johnson-McCurry, a board member and trainer for the program.
The goal is to link young people to healthy produce, educate them about nutrition and engage them in hands-on activities, like gardening. “Children learn by doing,” said Johnson-McCurry.
The program is beneficial in multiple ways: “We are helping [teachers] develop a curriculum where the children are actively engaged. So they’re doing their own gardening and not just watching their teachers,” she said.
The early care program estimates it may affect the lives of eight million children enrolled in early child-care settings, by introducing them to the healthy behaviors that can have long-lasting effects, like reducing obesity rates. An estimated 22.8 percent of children ages two to five are overweight or obese, according to Johnson-McCurry’s research.
“Obesity places them at risk of what used to be adult onset diseases… or conditions you would normally see in older people like diabetes, high-blood pressure and cholesterol,” Johnson-McCurry said.
Still, while some programs are introducing better food choices into the community, others turned their focus to reducing food waste.
On a field trip to a local food bank, Savannah-area teenagers Ilya Snyder and Jonathan Gibson learned that unused food was thrown away at the end of every week. That inspired the 2012 launch of Everybody Eats Fresh Free Fridays, an effort to increase access to healthy foods for populations that face food insecurity, poverty and those living in food deserts.
Instead of allowing unused food to be tossed, the project collects it from the America’s Second Harvest of Coastal Georgia food bank and redistributes it to those in need. So far, the administrators say, it has distributed nearly 48 tons of produce to families in need, with about 180 individuals being served every Friday each month at all of its sites.
“What’s nice is we are solving two problems at once— connecting people with healthy foods and also preventing waste,” said Cristina Pasa Gibson, chronic disease prevention director of the Coastal Health District in Savannah and one of the founder’s mom.
Panel says Athens’ Oconee River Greenway provides path to improved health
By Mike Terrazas
At least since the development of New York’s Central Park, urban planners have recognized the public value and popularity of city green spaces. Research shows that even limited exposure to green spaces can have significant positive health impacts, and over the past few decades, the North Oconee River Greenway Trail has provided one such option for Athens-Clarke County (ACC) residents.
In a panel discussion that was part of UGA’s State of the Public’s Health conference, five community members offered a case study of the Greenway project and how it navigated the straits of government and public opinion to arrive at its present form as 6.5-mile network of trails. Titled “Greenways to Better Public Health,” the panel was held Oct. 18 in the Georgia Center for Continuing Education.
Public green spaces have been tied to a host of health benefits. Exposure to green spaces—even through windows or in virtual reality environments—has been associated with improved academic performance from students and lower levels of stress markers, such as heart rate and blood pressure, as well as lower levels of the stress hormone cortisol, said Jennifer Gay, associate professor in UGA’s College of Public Health.
Madeline Van Dyck, founding chair of the Oconee River Land Trust, showed a video about the Greenway’s beginnings after it was voted into existence by the ACC unified government in 1992. Van Dyck described the effort as a labor of love, honoring the many individuals who worked on the project both before and after 1992 as “the anatomy and physiology of leadership” who turned a legislative action into actual physical reality.
However the Greenway was not always embraced by ACC leadership, said Melinda Cochran-Davis, assistant director of ACC Leisure Services, who guided the audience through the Greenway’s meandering political path leading to. Nevertheless, she said, despite the ups and downs, its supporters persisted. “Athens is blessed because we have a lot of active, passionate people,” Cochran-Davis said.
Volunteers Jake Maas and Mark Ralston talked both about future plans for the Greenway and related trailways, but also about making creative use of alternate funding options. Maas, director of proposal enhancement in UGA’s Office of Research, serves as the Greenway’s communications and outreach chair and leveraged his grant-writing expertise to help the project land significant funding from the National Fish & Wildlife Service, in addition to the $10 million it secured in 2017 through a successful Athens-Clarke County T-SPLOST vote that will roughly double the current linear mileage of trails.
Ralston talked about the Firefly Trail, a planned multi-use path connecting Athens to Union Point, Ga., along 39 miles of unused railway. Ralston serves as general chair for the effort, which he acknowledged would be expensive—concrete trails, which he said are preferred for their durability, cost about $1.5 million per mile—but also said could literally pay off, citing a Georgia Tech study on the trail’s potential economic impact that determined it would be used by more than a million people and generate some $14.7 million for the local economy each year.
Hidden lead remain a hazard in Georgia’s schools and homes
Not enough is being done in Georgia to remove lead from the water systems that run beneath schools and local communities. And a growing mistrust of the water supply could have a negative impact on other public health initiatives, like efforts to tackle the obesity epidemic.
Those were some of the concerns raised by panelists during a session at the Oct. 18 State of the Public’s Health Conference at the University of Georgia. The panel focused on lead, an odorless hazard, that can negatively impact a child’s growth and development.
Journalists recapped an investigative report in which they not only found high amounts of lead in the water pipes of schools and other buildings statewide, but also very little oversight.
“There are a few states that require all schools’ drinking water and fountains to be tested for lead. Georgia is not one of them,” said Andy Miller, the editor and CEO of Georgia Health News.
A 2017 story Miller co-authored with Brenda Goodman, a WebMD senior news writer, said the current system leaves families in the Peach State “uninformed and unprotected.”
Meanwhile, UGA researchers said the poor water quality could also be a leaky valve in the nation’s attempt to address other public health concerns, like high obesity rates.
“The best practice we teach is to serve water indoors and outdoors and make it available as self-serve for our children,” said Caree Cotwright, an assistant professor in the College of Family and Consumer Sciences at UGA. But her team’s survey of childcare workers found fewer than 40 percent were providing water as the top alternative to sugary beverages like sodas.
“Something was going on,” Cotwright said. “Is it water mistrust?” Recent lead findings, she said, should raise alarm bells for many reasons.
For one, there is no safe level of lead in the blood of children, according to the Centers for Disease Control. Exposure to the metal can result in damage to the brain, slowed growth, and behavioral, speech and hearing issues.
Furthermore, it can be difficult to get to the root of the problem, as the symptoms of lead toxicity overlap with other conditions. “Lead poisoning in children can look like features on the autism spectrum,” Goodman explained.
At least four million households have children living in them that are being exposed to high levels of lead, the CDC estimates. According to the Environmental Protection Agency, a high-risk home is a home built before 1986 that has lead pipes. Other examples include homes with lead corrosion, where the metal from paint dissolves and leaks into the water supply.
The panelists are continuing to pursue research into the topic.
Cotwright, is planning to further study the cause for water mistrust among childcare providers. Her team wants to understand the factors that determine the choice of beverages served to children. She also believes that sharing tips on water safety and on how to properly test water for lead could help ease concerns for childcare professionals.
Miller and Goodman submitted the results of their lead investigation to the EPA, and the agency said it would begin conducting inspections and recording results more efficiently.
“We need to follow up on that,” Miller said.
In the meantime, Georgia Health News plans to look further into “hot spots” in the state, where test results have found high rates of children with too much lead in their blood to understand the reasons behind the statewide variations.