Highlights from the 2015 State of the Public’s Health Conference

The 4th annual State of the Public’s Health (SOPH) conference was held Tuesday, October 6, 2015 and featured presentations from top national, regional, and state public health leaders. View the conference program here.

Keynote Speakers:

  • Jeff Levi, Executive Director of Trust for America’s Health, will explore opportunities and challenges of advancing public health in a reforming health care system;
  • José Carlos León Vargas, International Cooperation and Development Director of Solidaridad Internacional Kanda, will share insights about creating inclusive communities that address health disparities;
  • Kaye Bender, President and CEO of Public Health Accreditation Board, will discuss the benefits and barriers to public health accreditation;
  • Brenda Fitzgerald, Commissioner of the Georgia Department of Public Health, will give an update on the state’s current public health initiatives

Conference Briefs and Commentary:

The following video playlist features commentary from keynote speakers, organizers, and participants. All content, including the session briefs below, were produced by graduate students in the Health & Medical Journalism Program at UGA’s Grady College of Journalism and Mass Communication.

Introduction

By Sandra L. McGill

More than 300 health professionals attended the University of Georgia’s fourth annual State of Public Health Conference on Tuesday, October 6. It featured keynote addresses from Dr. Jeff Levi, Executive Director of the Trust for America’s Health, and José Carlos León Vargas, Director of the Solidaridad Internacional Kanda in Mexico.

Funding for the conference came in part from the Healthcare Georgia Foundation.
Also speaking at the conference were Dr. Kaye Bender, President and CEO of the Public Health Accreditation Board, and Dr. Brenda Fitzgerald, Commissioner of the Georgia Department of Public Health and State Health Officer.

Much of the day was devoted to workshops, where participants address critical topics including tobacco cessation and prevention, building a public health workforce, public health accreditation, ACA implementation and health literacy as a key to public health.
Scholars from throughout the state presented research findings in a poster session featuring more than 40 recent studies.

Looking back to the 2014 conference, “It’s a little humbling to think of all that’s happened in just one year,” said Dr. Marsha Davis, Associate Dean for Outreach and Engagement in the College of Public Health. In her welcome address, Davis cited milestones such as the Supreme Court’s upholding of the Affordable Care Act, the banning of smoking on Georgia campuses, the Ebola crisis, the Disneyland measles outbreak, and other incidents affecting the state, nation and world.

Davis also emphasized work that needs to be done. Although more Georgians have health insurance than ever before, the percentage of uninsured residents remains one of the country’s highest. Rural hospitals are closing, too many Georgians die of preventable diseases, and too many children live in poverty.

But Davis ended on an upbeat note. “Everyone has a role in public health,” Davis said. “We’re not alone—we’re all in this together.”

Audio Story about the College of Public Health’s annual SOPH conference
Video Commentary from Dean Phillip Williams, Dean of the College of Public Health
Video Commentary from Dr. Marsha Davis, CPH Associate Dean of Outreach and Engagement

Morning Keynote: Dr. Jeff Levi, Executive Director of the Trust for America’s Health

By Meera Naqvi

Keynote speaker Dr. Jeff Levi called public health “a broad and daunting landscape,” but he emphasized that the health of Americans be improved if public health professionals, medical providers, and social service agencies combine forces and work together.

The United States ranks at the bottom of a list of 17 industrialized countries on most health indicators, said Levi, Executive Director of the Trust for America’s Health. The conventional wisdom is that this happens even though “the U.S. way outspends other countries on healthcare,” he said.

But appearances can be misleading. If you add up what other rich nations spend on both healthcare and social services, their costs are very close to per capita spending in the United States. Health outcomes in the U.S. may be worse, however, because we lag the rest of the industrialized world when it comes to investment in services such as housing and education. Now that the Affordable Care Act is in place, the Centers for Medicare and Medicaid Services emphasizes that a national prevention strategy will mean better coordination of medical and social services. This makes sense, Levi said, because much of what affects health happens outside the four walls of the clinic, he emphasized.

“Investment in social services has a health return,” Levi said. The two most important social determinants of health are housing and education, and “the biggest predictor of longevity is income and or education status.”

Children who do well in school will be healthier for their entire lives, and an early start is key. Pre-school programs for children as young as three make a big long-term difference in health outcomes. “Early development is vital,” he said.

Stable, safe housing is also key; people with housing insecurity experience are more likely to become ill.

Levi points to Hennepin County, Minnesota, as a place where medical and social service agencies have partnered to successfully. Their integrative approach has improved the outcomes for residents while also cutting spending, Levi said.

Among their initiatives are a unified data system and an outpatient center that helps people recover from alcohol or substance abuse. The partnership takes a holistic approach, so that if a homeless person seeks medical care they will also receive housing assistance. Costs of care fall for someone who is safely housed.

“Yes, we’re doing God’s work in public health, but we also have to show return on investment,” Levi said.

Audio Story about about moving from treatment to prevention
Video Commentary from Dr. Jeff Levi

Lunch Keynote: Dr. Brenda Fitzgerald, Commissioner of the Georgia Department of Public Health and State Health Officer

By Erin Geoffroy

“Sometimes, we are tested,” said Brenda Fitzgerald, looking across a room filled with public health officials, scholars and students from throughout Georgia. Fitzgerald, the commissioner of the Georgia Department of Public Health and state health officer, was referring to the Ebola panic that shook the country last fall.

Between March 2014 and September 2015, more than 28,000 people were diagnosed with the potentially deadly Ebola virus, nearly all of them in three West African Counties. International travel restrictions snapped into place and Hartsfield-Jackson in Atlanta became one of only five United States airports where flights from  Africa were allowed to land.

Although two Ebola patients arrived at Emory University Hospital in Atlanta on August 2, public panic did not break out until October. That was when a Liberian man died in a Dallas hospital and two nurses who cared of him were infected.

Georgia’s leaders knew they needed a plan  Governor Nathan Deal quickly established an Ebola response team that included Fitzgerald, top law enforcement officials, the state medical examiner, funeral directors, and other key groups. The Department of Public Health sent letters to 40,000 physicians, providing guidelines for handling suspected Ebola patients.

Having a single information source for everyone was crucial. “Right from the beginning, we had a single number: 866-PUB-HEALTH,” said Fitzgerald.

Worried consumers could call for information. Hospitals called to report any suspected cases and to report how many beds they had available in case of an outbreak.

State leaders created several tools that would be useful if the spread of Ebola becomes a real threat in Georgia.  Fever is an indication of infection, and one of these was a smartphone app that medical personnel could use to send twice daily temperature readings to the department of health.

Fitzgerald is proud of the state’s efforts during the crisis. A legacy of the effort is a regional plan for coordinating outbreak response and transportation, which she said is now a model for other states.

Fitzgerald beamed when she said, “I believe that everyone was tested and found formidable.”

Audio Story about Georgia’s plan for ebola response
Video Commentary from Dr. Brenda Fitzgerald

Afternoon Keynote: José Carlos León Vargas, International Cooperation and Development Director, SiKanda (Solidaridad Internacional Kanda)

By Elizabeth Best

José Carlos León Vargas believes in the power of community. In 2009, Vargas had a revelation about changing the meager lives of the poorest of the poor in Brazil and Southern Mexico. He realized that people living in slums, and or subsisting on the edge of giant trash dumps, could transform their own lives if they learned to grow their own food and construct houses and schools from scavenged material.

Today he is the director of SiKanda, a nonprofit group he co-founded in 2009 with his wife. The name means “transformation,” or “change” in Mixtec, and that is what the organization strives to do in one impoverished community after another in the province of Oaxaca, Mexico.

In his keynote address, Vargas, encouraged a “bottom up” approach to helping others and working with charitable organizations. He emphasized how crucial it is to engage those who need help and educate them about using existing resources in totally new ways.

He also encouraged public health workers to focus one community at a time to have the biggest impact. His organization has helped more than 7,000 people in 12 locations in Oaxaca – but not all at once.

As a case study for his talk, Vargas focused on a group of people living on the edge of a landfill. Sixty-five percent of the adults are women, because most of the men have migrated north to find work. They lived in flimsy lean-tos and earned $2 to $3 per day. He described teaching the people how to use earthworms to turn garbage into compost, which they sold for money and used to grow their own vegetables.

earning to produce their own food helped the community members have a more economically sustainable lifestyle and to eat healthier diets. Sikanda makes healthy eating a priority in their programs because 10 percent of Mexico’s population suffers from diabetes.

SiKanda raised $400 from donors and set out help local people build small, sturdy houses for their families. Working from a plan developed for the project, Vargas bought some materials and helped fabricate construction materials from recycled materials found in the landfill. These houses protected families from potential illness and poor weather conditions.

People in the community want education for their children, and SiKanda recently
built a one-room school building and stocked it with books and furniture.

Vargas is now trying to raise social awareness about communities such as the one by the landfill. Privileged Oaxaca residents know Paris or London better than the outskirts of their own city, he said. So he is bringing them to look at some of SiKanda’s projects, hoping to build support.

New Directions in Tobacco Prevention and Cessation in Georgia

By Anshool Deshmukh

Three teams from the Georgia Department of Public Health shared the stage during the workshop on tobacco prevention and control. Oluwayomi Fabayo and his colleagues used small, mobile monitors to measure the indoor air quality establishments that are exempt from Georgia’s ban on smoking in public places. Sampling in five cities found that particles and chemicals remain in the air long after smokers extinguish their cigarettes, putting anyone who enters the environment at risk for adverse health effects, Fabayo reported. Although smoking has been prohibited in shops, restaurants and most workplaces since 2005, the Georgia Smoke-free Air Act exempts bars and 18-and-older establishments as well as designated smoking areas. These findings indicate that legislators should eliminate these loopholes if the goal is to guard Georgians against health dangers associated with secondhand smoke, said Fabayo, program and policy, advisor for the Georgia DPH.

Turning to help for smokers, Kayla Lloyd reported that promoting the Georgia Tobacco Quit Line to physicians pays off in terms of tobacco cessation. Doctors who participate in the Georgia cAARds Program makes pacts with doctors who agree to ask every patient whether they smoke, advise them about the benefits of stopping, and refer them to the Georgia Tobacco Quit Line for follow up. This phone service provides support seven days a week for smokers looking to quit the deadly habit, said Lloyd, the state’s tobacco cessation coordinator. It has a 33 percent quit rate and is meant to help smokers who can’t make it to face-to-face support groups because they live in rural areas or lack transportation.

The final key to making smoking a thing of the past is to influence children and young people before they light up, said Anne Marie Coleman, also a DPH advisor. Raising the prices of tobacco products, developing anti-tobacco media campaigns and involving communities in restricting minors’ access to such products are key in curbing youth smoking rates. The rise of e-cigarettes presents another problem, as they are viewed as a “safe” alternative, an incorrect and dangerous assumption, Coleman said.

The presenters emphasized that any tobacco use is dangerous, a message they are working to get out to the public.

Audio Story about Georgia’s tobacco problem
Video Commentary from Anne-Marie Coleman, Georgia Department of Public Health
Misconceptions surrounding e-Cigarettes and tobacco cessation

Building a Public Health Workforce for a Healthier Georgia

By Shelby Jarret

Internship programs, partnerships with academic institutions and on-the-job training can all help relieve some of the pressures felt by public health providers whose programs are perennially short on resources.

Field placement programs advised by the Region IV Public Health Training Center are a win-win situation for students and for the health departments that supervise them, Laura M. Lloyd and Melissa Alpern of the center said. Internship programs at the Rollins School of Public Health, East Tennessee State University, and Florida A&M University are good examples, the presenters said.

Workshop participants agreed that having interns benefits a public health program, but they had suggestions for increasing the yield for both parties. The best field placements assign interns to work on clearly defined, discrete projects with measurable outcomes.

Partnerships with academic departments are another way that local public health programs amplify their impact. Dr. Jimmie Smith is a public health physician who serves as a liaison between Mercer University’s public health school and the North Central Health District. Both are headquartered in Macon, and they have a formal agreement that turns the health district into what Smith called an “academic health department.” As a teaching health department, this program addresses concerns regarding the separation of education and public health practice.

One of the innovations of this program is Operation T.R.I.M. (Taking Responsibility by Informing Men). Students distribute free condoms in Macon barbershops as a way to increase personal protection against HIV and other sexually transmitted infections. The program was created by students and mostly managed by them, and illustrates the types of novel interventions possible in an academic health department.

Another way to expand the impact of the existing public health workforce is to make sure that their training is targeted to genuine needs and kept up to date. Professionals throughout Region IV say they need reinforcement in cultural competencies, financial planning, leadership and environmental health. In response, Laura Lloyd said that the Region IV Public Health Training Center offers free online courses, lectures, practice academy trainings and webinars on these topics.

Audio story about Academic Health Departments
Video Commentary by Dr. Jimmie Smith

Leveraging Implementation of the Affordable Care Act to Advance Community Health in Georgia

By Elizabeth Fite

Individuals who need health coverage are not the only ones affected by implementation of the Affordable Care Act (ACA). In addition to the 541,080 Georgians who signed up for insurance during the latest open enrollment period, health care providers, hospitals and communities are also feeling its effects.

Nonprofit hospitals are now required to conduct a Community Health Needs Assessment (CHNA) every three years. Ideally, the results will enable communities to judge whether these hospitals — which are exempt from taxes — are delivering enough health benefits to the community they serve.

“There weren’t a lot of people thrilled about the Affordable Care Act to begin with, and then there’s also the case that it has placed an additional requirement on our hospitals,” said Fenwick Broyard, executive director of Community Connection of Northeast Georgia. His organization contracted with the two hospitals in Athens to study health needs in the 17 counties they serve.

“Hospitals have a choice as to whether or not to view this as an obligation or an opportunity,” Broyard said.

Beth Stephens of Georgia Watch reviewed CHNAs from 38 hospitals across Georgia, and she saw substantial variation in the quality of the assessments. Although some were thorough and well executed, others had shortcomings, such as failing to gather information from vulnerable populations, said Stephens, health access program director for the public interest watchdog group.

The Athens hospitals made a special effort to gather input from people whose voices often go unheard in policy debates, Broyard said. The two institutions worked well together despite being in competition with each other, he said, and saw the needs assessment as an opportunity to better serve the community.

Future CHNAs could be improved by greater collaboration between hospitals and health departments, which are valuable sources of public health expertise, said Reinetta Waldrop, an assistant professor in community health and preventive medicine at Morehouse School of Medicine.

“Hospitals are required to collaborate with public health and community-based groups to address these community health needs,” Stephens said. “Right now is a great time to reach out and get engaged with your hospital in that next CHNA process and also volunteer to be an active participant in that assessment process and share your insight.”

Audio Story – Why public health professionals participate in the SOPH each year…
Video Commentary from Dr. Jean O’Connor, Chronic Disease Prevention Director, Georgia Department of Public Health
Video Commentary from Dr. Margaret Holt, retired UGA Professor of Adult Education, who is currently working at the National Network of Public Health Institutes