Congress should honor women’s health by committing to Zika funding

By Monica Valdes Lupi, JD, MPH, Executive Director, Boston Public Health Commission

This content was originally printed as an op-ed in The Hill newspaper.

This week is National Women’s Health Week, and at the Boston Public Health Commission, it marks the launch of our Zika virus prevention and outreach efforts.

In my health department, we are responsible for educating the public about how they can protect themselves from the virus, support mothers who may have become infected during their pregnancies and support families that are raising babies with microcephaly — a devastating brain defect caused by the disease.

Last summer, we did all of this without access to federal funds. This year, federal officials are warning that we may need to do so again in the absence of federal funding, which puts Bostonians, and all Americans, at greater risk as the outbreak makes landfall and spreads.

Last year, it took Congress 233 days to provide funding to cities and states that were combatting the virus. Congress has yet to provide additional funding to respond to the new Zika virus threat, and federal officials are warning that it may run out in the middle of the mosquito season.

At the same time, the American Health Care Act, recently passed by the House of Representatives, weakens our response to infectious disease outbreaks like Zika by threatening to cut the Centers for Disease Control and Prevention by 12 percent. In fact, more than half of local public health departments expect 8.5 percent or higher cuts in the Public Health Emergency Preparedness funding that supports their Zika education and outreach efforts.

All of the reasons that made Zika a threat last summer are here again in 2017. The mosquito is still present, its breeding grounds are still plentiful in our backyards and human travel is still frequent. While areas in the south like Florida, Texas and Louisiana are at acute risk of local infections because they host the vector mosquito that harbors the virus, many other places are at risk because they are travel hubs.

Boston is one of those cities. Our city is a major travel hub where many residents journey to Zika zones for work or play, and over a quarter of our population is made up of immigrants, whom we proudly serve. Many of these residents spend the year planning and saving for summer trips home to their families in places that include Puerto Rico, the Dominican Republic and Brazil.

To date, 51 Boston residents, including 42 women, have been infected with Zika, and all of these infections have been travel-associated. At least one of these Boston women gave birth to a baby born with microcephaly. Now more than ever, in a globalized world, our local public health prevention and treatment measures must keep pace as infectious diseases cross borders. 

Local health departments like mine are essential in the fight against Zika. Congress recognized this last year when Boston received $100,000 in one-time funding to reach women at risk of Zika infection. We prioritized empowering people with information. Our education, outreach, and prevention efforts focused on women and their partners who would be traveling to hotspot countries and might be considering pregnancy.

Our infectious disease teams hit the ground running by engaging the community and meeting the most at-risk individuals in the places where they live, work, play, and pray. Our outreach staff visited small businesses like travel agencies, bakeries, check-cashing stores, dental offices and faith-based organizations. We translated educational materials into Spanish, Portuguese and Haitian Creole. We also created and shared an animated informational video.   

Groups like the Big Cities Health Coalition and the March of Dimes are advocating to protect emergency preparedness funding in the federal government’s budget to sustain current Zika response efforts. Increased funds would help communities maintain systems created with last year’s supplemental funds, including the capacity to identify and investigate a potential or ongoing Zika outbreak, coordinate response with both government and private entities and distribute Zika prevention kits that include insect repellent, window screens and other supplies.

Even if you set aside the argument that this sort of prevention avoids a massive amount of human suffering, the economic argument is very strong. These efforts are far less expensive than caring for a generation of Zika babies suffering from microcephaly, whose care will likely require millions of dollars per child.

As we celebrate National Women’s Health Week, Boston is gearing up again to secure the resources mothers need to ensure their babies are born healthy. It’s time for Congress to show a similar commitment to mothers and families by protecting the health of women and babies as we start a new summer with the Zika virus.

Monica Valdes Lupi is the Executive Director of the Boston Public Health Commission. She is also a member of the Big Cities Health Coalition, a forum for the leaders of America’s largest metropolitan health departments to exchange strategies and jointly address issues to promote and protect the health and safety of the 54 million people they serve.






Combining Disciplines, Reducing Stigma: How Long Beach Incorporates Mental Health into Public Health

By Kelly Colopy, MPP, Director, Long Beach Health Department

May is Mental Health Awareness Month, which brings a heightened awareness and opportunity to support the mental and emotional health of those in our communities experiencing a mental illness.  As individuals and families, as well as communities and organizations, we are learning that we all know someone, often close to us, who has experienced some level of mental illness in their lifetime.  Nearly 1 in 5 adults (43 million) in the United States experiences a mental illness each year.  The impacts of mental illness diagnosis vary widely; some have serious impacts on the ability to perform major life activities.  Access to treatment has improved with the passage of the Mental Health Parity and Addiction Equity Act of 2008 and under the Affordable Care Act in 2010, yet more capacity for treatment is needed.  The conversations are increasing at the systems level as we work to grow healthy supportive environments and increase access to mental health resources in our community.  Yet, at an individual and community level, the conversations continue to be difficult.  The stigma, while lessened, still remains.

Recognizing the Signs of Mental Illness

Many individuals and families remain unsure about the signs of mental illness and are uncomfortable broaching the subject with those they love.  Thankfully, there are many resources available to learn more.  For instance, the National Alliance for the Mentally Ill (NAMI) website includes helpful information on how to recognize the signs of a mental illness.  These include:

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  • Feeling excessively sad or low; worry or fear
  • Confused thinking or problems concentrating and learning
  • Extreme mood changes or prolonged or strong feelings of irritability or anger
  • Avoiding friends and social activities
  • Changes in sleeping habits or feeling tired and low energy
  • Changes in eating habits such as increased hunger or lack of appetite
  • Difficulty perceiving reality
  • Inability to perceive changes in one’s own feelings, behavior or personality ("lack of insight”)
  • Abuse of substances like alcohol or drugs
  • Multiple physical ailments without obvious causes (such as headaches, stomach aches, vague and ongoing “aches and pains”)
  • Thinking about suicide
  • Inability to carry out daily activities or handle daily problems and stress
  • An intense fear of weight gain or concern with appearance (mostly in adolescents)

Mental Health First Aid training provides information and practice on how to identify the signs of mental illness and how to hold what may seem like difficult conversations.  Learn more about these trainings at:  It’s important to talk from a place of support and trust, staying away from blame.

What are we doing in Long Beach?

While the Long Beach Department of Health and Human Services (LBDHHS) is not considered a mental health service provider, we recognize the importance of integrating mental health supports into our service model as well as encouraging polices and social environments that support mental health.  In the past two years, we have integrated mental health counselors into our clinical settings to support those with HIV, and in other programs such as Black Infant Health to provide greater and easier access to support.  In addition, the Department partners closely with the Los Angeles County Department of Mental Health (DMH) and many community-based providers to engage people in services, particularly for those experiencing homelessness.  The DMH and Mental Health America are co-located at our one-stop Multi-Service Center for the Homeless to ensure expedited access to services.  The city is working closely with the DMH to locate a Behavioral Health Urgent Crisis Center (BHUCC) within Long Beach to increase access to mental health services for those in crisis and those involved with law enforcement or emergency services due to their mental illness.  We also seek to include prevention/intervention services for those at-risk of losing subsidized housing due to mental illness.

In 2014, the LBDHHS integrated mental health into its strategic plan, officially highlighting the importance of mental wellness to health.  At that time, a cross-department subcommittee began work on de-stigmatizing mental illness within the Department and in the community.  They developed a campaign called “Healthy Mind, Healthy Me, Healthy LB” and developed trainings, resource guides and post cards to help people connect to resources.

Looking Forward

Mental health, like physical health, would benefit from a stronger population health model.  Mental health is often discussed in direct service terms, including treatment, groups, and medication.  These are certainly necessary and continuing to increase access to these services is important in a time when resources are not meeting the need.  However, it is also important to look upstream and engage in a population health model, to promote physical and social environments that promote mental health.  These may include addressing trauma in communities, reducing violence, strengthening parenting and engagement in families, building opportunities for positive relationships and supports, and safe outdoor spaces for outdoor activities and nature, to name a few.  These population-focused opportunities, when partnered with the individual-level services, create a powerful combination for promoting mental health in our communities.


Four Ways We Are Measuring Affordable Care Act Proposals

By Patty Hayes, Director, Public Health—Seattle & King County

This blog originally appeared in Public Health Insider

Any reform or replacement for the Affordable Care Act should help people lead healthier lives. We believe that’s the underlying purpose for health care reform (while acknowledging that there are economic and other reasons to reform, as well). We’re tracking four key areas that help us measure each proposal.

Health Equity and Minority Health in Bexar County and the City of San Antonio

By Vincent R. Nathan, PhD, MPH, San Antonio Metropolitan Health District

Bridging Health Equity Across Communities" is the theme of this April’s U.S. Department of Health and Human Services (HHS) Office of Minority Health (OMH) National Minority Health Month. Over the past month,  HHS OMH, with their partners, worked to raise awareness about efforts across health, education, justice, housing, transportation and employment sectors to address the factors known as the social determinants of health – environmental, social and economic conditions that impact health.  San Antonio, Texas joins DHHS in celebrating, and more importantly, recognizing the disparities in health among different groups.

Earth Day – A Celebration of Environmentalism and Environmental Justice for All

By Cynthia Harding, MPH, Robert Gilchick, MD, MPH and Angelo J. Bellomo, REHS, QEP, Los Angeles County Department of Public Health

Earth Day, celebrated each year on April 22, commemorates the birth of the modern environmental protection movement.  Started in 1970 during an era when pollution was rampant in our country, Earth Day is credited with bringing the concept of environmental protection into the national political agenda.  The first Earth Day was marked by massive rallies and demonstrations advocating for a healthy and sustainable environment.  In 2017, Earth Day will be marked by a national call to action around science, with a march in Washington DC and other communities throughout the nation.

The Chief Health Strategist Role in Tarrant County, Texas: Building Walkable Streets and Greener Food Carts

By Vinny Taneja, MBBS, MPH, Director of Tarrant County Public Health

Fort Worth and Arlington are both located in Tarrant County, a fast growing community of approximately 2 million individuals living within 902 square miles. Like many large urban communities, neighborhoods vary significantly by culture, race/ethnic background, income, education, green space, housing, crime and many of other social determinants of health.

More than the ACA: We Can’t Stop Fighting Now

By Dr. Oxiris Barbot, First Deputy Commissioner, NYC Health Department

This op-ed originally appeared on

Since the start of the new presidential administration, the onslaught of policies and executive orders have been met with outcries from communities, organizations and elected officials. In the medical community, there was an almost unprecedented bipartisan opposition to the White House’s proposed American Health Care Act. To some, the protection of the Affordable Care Act has given us a rare time to celebrate, rest and regroup.

Now is not that time.

Marking National Public Health Week, “Healthiest Nation 2030,” by Defending the CDC’s Support for Prevention in Local Communities

By Chrissie Juliano, MPP, Director of the Big Cities Health Coalition

This year’s American Public Health Association’s (APHA) National Public Health Week (NPHW) challenges us to think about what the “Healthiest Nation 2030” means. As we focus on this charge, we find ourselves again working to defend huge cuts in public health funding at the Centers for Disease Control and Prevention (CDC) and elsewhere.

Fighting TB in San Jose: New Urgency with Federal Funding at Risk

By Tara Perti, MD, MPH, Assistant Health Officer and Tuberculosis Controller at the Santa Clara County Public Health Department

Tuberculosis (TB) remains an enormous global problem and is one of the top ten causes of death in the world.  As we live in a global community, infectious diseases common in other countries also affect the United States.  In the United States, in 2015, 9,557 patients were diagnosed with TB disease

The ACA Replacement Would Devastate America’s Health

By Leana Wen, MD, MSc, FAAEM, Baltimore City Health Commissioner

This blog originally appeared on 

As a physician who has treated patients in the emergency department before and after the Affordable Care Act was instituted, I have seen firsthand how it has transformed the lives of many of my patients. And as the health commissioner for Baltimore city, I have seen how it has safeguarded the lives of more than 40,000 residents in my city, and millions more around the country, who would otherwise be uninsured.

ACA Repeal Would Mean Massive Cuts To Public Health, Leaving Cities And States At Risk

By Chrissie Juliano, MPP, Director of the Big Cities Health Coalition

This blog was originally posted in Health Affairs.

When the Affordable Care Act (ACA) was passed a little over six years ago, it brought with it the promise of health insurance for all Americans. It also sought to begin to shift the paradigm for health care in this country, emphasizing value over volume, and recognizing the importance of prevention coupled with appropriate access to care.

Repeal of ACA would imperil a little-known part with a huge impact

By Gretchen Musicant, MPH, BSN,Commissioner,  Minneapolis Health Department

The debate about the future of the Affordable Care Act (ACA) is in full swing, and many know that repealing the ACA would leave almost 20 million Americans without health care coverage. This is of great concern.

But the fact that repealing the law would also decimate the already-fragile public health system in America is not known to many policymakers or members of the public.

To End HIV/AIDS, Cities like Ours are Leading the Way by Setting Bold Goals

By Anthony Stamper, Denver Department of Environmental Health

This was originally published as an op-ed in The Hill newspaper.

On December 1st, communities across the nation will commemorate World AIDS Day. First memorialized in 1988, World AIDS Day offers the opportunity for people worldwide to unite in the fight against HIV, show support for people living with HIV, and remember those who have died. We know that in the U.S. the number of people living with HIV and AIDS is concentrated in cities, and that cities are also the most ambitious leaders in the fight against the disease. This World AIDS Day, Denver can report some major victories in fighting the disease that policy makers at every level should study carefully.

Live Today: The Big Cities Health Inventory 2.0 – Success and Challenges

By Chrissie Juliano, MPP, Director of the Big Cities Health Coalition

Today we launch version 2.0 of our Big Cities Health Inventory (BCHI), an online, open access data platform that allows the public health field, media, researchers, the public, and policymakers to look across more than 50 health and socio-demographic indicators from 28 cities – in total more than 17,000 data points. We also have a number of case studies available, highlighting innovative work in our member cities.

November is National Diabetes Month: How We’re Fighting Diabetes in Long Beach, CA

By Kelly Colopy, Director, Long Beach Department of Health & Human Services

November marks National Diabetes Month in America, and it could not be more important for us to seize this chance to educate more Americans about the disease, and help them find out more about what they can do to fight it. More than 29 million U.S. adults have diabetes, and 25% of them don’t know it. Additionally, about 86 million adults—more than a third—have prediabetes, and 90% of them don’t know it. This wave of chronic disease costs money. More than 20% of health care spending is for people with diagnosed diabetes. A 2012 study estimates the total costs of diagnosed diabetes at $245 billion.

Congress Took 233 Days To Respond. Here’s How To Prepare For The Next Zika

By Barbara Ferrer

Dr. Ferrer is a member of the Coalition's Alumni Council, as the Former Director of the Boston Public Health Commission. This blog originally appeared on

Congress recently passed federal funding for the nation’s response to the Zika virus, and the manner in which they provided those funds exposed a serious flaw in the way our nation handles disease outbreaks. In the time between the White House’s initial request for funding in February and the passage of the bill in September, the outbreak escalated dramatically, nearly unchecked by federal lawmakers. The entire process took a grand total of 233 days, which is simply far too long. It did not need to be this way.

Battling AIDS in Houston Latin-American communities

By Chrissie Juliano, MPP, Director of the Big Cities Health Coalition

This article was originally printed as an op-ed in The Hill newspaper.

October 15 will mark National Latinx AIDS Day across America, which is an opportunity to take stock of the great strides made towards defeating the virus and eliminating the stigma it can create. (The term Latinx serves as a gender-neutral alternative to Latino/Latina).

Science has come a long way since HIV and AIDS became a part of the national consciousness in the early 1980’s, but as experts have learned, if those advances are not shared with everyday people, and if awareness about the disease and how to prevent it does not grow, then disease rates can continue to climb, despite breakthroughs in the laboratory.

New York Leading the Way with Paid Family Leave

By First Deputy Commissioner Oxiris Barbot, MD, New York City Department of Health and Mental Hygiene, and Deputy Commissioner George L. Askew, MD, FAAP, Division of Family and Child Health

Today is National Child Health Day. On this day, and every other day, we at the New York City Department of Health and Mental Hygiene are pursuing an ambitious child health agenda with the goal of advancing health equity by undoing injustice.  

For New York City’s children, inequities in social, environmental and economic conditions can determine health outcomes well before birth. Strong family relationships and community supports, however, can protect against toxic environments shaped by poverty and racism. Unfortunately, many working parents must choose between bonding with a new child and returning to work because their jobs fail to provide paid time off, making paid family leave a key policy for advancing child health equity.  

Congress Finally Funded the Zika Fight – Here’s How We Can Respond Quicker to the Next Outbreak

By Chrissie Juliano, MPP, Director of The Big Cities Health Coalition

Before Congress left town this week for the end of this year’s campaign season, they provided funds to respond to the Zika outbreak – an exercise that took them far too long.

Since Zika emerged in the U.S., and the Administration first requested funds in February, the Zika virus has infected more than 3,300 Americans in the states and almost 20,000 in the U.S. territories, and those numbers continue to rise daily. In Puerto Rico alone, an estimated 50 pregnant women are infected each day, presenting daunting odds for their unborn children. Mosquito season is winding down in some parts of the country, and exists year round in others, but regardless, experts believe the worst is yet to come, as additional cases of Zika surface and the health system begins to care for these Zika-disabled children.

In Houston, Flood Response Success is about Taking the Long View

September is National Preparedness Month, so we asked the City of Houston, a Big Cities Health Coalition member, to share the lessons learned from their 2016 "Tax Day Day Flood." How did the public health department assist Houston residents, and did they consider their job done once the streets were dry?

by Raouf R Arafat, MD,MPH, Assistant Director, Houston Health Department

From April 16-18, 2016, the Houston area experienced widespread flooding.  First responders conducted 1,200 high-water rescues; over 6,700 houses were damaged in the region; overall property damage was estimated at $5 billion. Eight residents perished when their vehicles were trapped in high water. Four months later, Houston Health Department employees are still attempting to address the needs of flood victims through long-term case management.