By Dr. Colleen Bridger, MPH, PhD.
San Antonio Metropolitan Health District
America leads the world in medical research and medical care and for all we spend on health care, we should be the healthiest people on earth. Yet on some of the most important indicators, like how long we live, we’re not even in the top 25, behind countries like Bosnia and Jordan. There is growing recognition that health starts – long before illness – in our homes, schools and jobs. In fact, only about 20 percent of a person’s health happens in the doctor’s office – the rest happens out in the world and things like healthy air and water may not be in a person’s control.
Addressing these “social determinants of health” is not only important for fostering a healthier population, but also for reducing health disparities that are often rooted in social and economic disadvantages.
The challenge is, how do we – health departments, community organizations, doctors, clinicians, and health companies – collectively work to address these issues outside our walls and think more systemically about potential solutions?
This was the topic of conversation at a recent symposium hosted by the San Antonio Health Advisory Board that brought together nearly 140 of San Antonio’s leaders from more than 70 nonprofits, health systems, technology solutions and health benefits providers. Each with a stake in the game, we talked at length about understanding these issues, taking action in the clinical setting, and looked at what other communities are doing for best practices to set the course for San Antonio’s future.
Many groups are already asking the people they serve questions about some of the four core social determinants of health areas: 1) housing/utilities; 2) food insecurity; 3) transportation and 4) interpersonal safety. These domains are priority because of clear evidence that they are associated with a host of negative health outcomes.
What we didn’t realize is how vastly the screenings differ from one another. It turns out that screenings for things that keep us healthy in our communities, schools and workplaces are disparate, so much so that the data cannot be captured and evaluated in a meaningful way.
This poses a barrier for us to look at community health issues from a systemic perspective, as we do not have data that we can aggregate to assess a complete picture of our community’s health status and risks associated with social and environmental factors. This data is necessary to improve our ability to understand the “upstream” factors affecting our community’s health. It could also inform the provision and funding of community resources by providing data showing the need for such services.
The first step to getting there is tangible and actionable. We need a standardized set of questions – one simple screening – around each of the four core social factors that hold people back from being healthy. That will help maintain strong citywide focus on social determinants of health and allow for uniform collection of data on unmet needs.
Beyond just the screening tool, the creation of a shared platform for accessing the data once collected is also essential to solving this problem. The screening tool takes care of step one, but that data needs to go somewhere, so a central tech solution is necessary to aggregate and access the information.
All Americans should have the opportunity to make the choices that allow them to live a long, healthy life regardless of their income, education or ethnic background. We need to stop thinking of health as something we get in hospitals and doctors’ offices, but instead as something that starts in our families, in our schools and workplaces, on our playgrounds and parks, and in the air we breathe and the water we drink. Standardizing how we ask those questions will help us better understand the challenges our community faces and help us focus our work on addressing those challenges. What we can learn from a standardized approach to addressing social determinants of health in every person in our city ranges from how to help individuals in need when we see them, to uncovering population health issues that may be solved more efficiently and effectively.
Public health professionals all over the country are leveraging practice and policy strategies to address the issue of trauma, including incorporating a “trauma-informed” point of view into the way they conduct business. In recent years, public health science and practice has become more cognizant of the evidence of, and action needed, to support those who suffer from trauma. This awareness and response is starting to transform the field.
By Joseph P. Iser, MD, DrPH, MSc
Chief Health Officer
Southern Nevada Health District
As a clinician and a public health professional, I see every day how technology can help providers give patients useful information, better care, and drive better outcomes. As doctors, we use online toolkits to help treat our patients, eReferrals to provide more efficient access to smoking cessation resources, and electronic health records can make everything more accessible for both providers and patients. In my role as the Chief Health Officer of the Southern Nevada Health District, I’ve also come to see what a valuable public health tool technology and social media can be. In our agency, we use Twitter, Facebook, and YouTube throughout the year to educate and motivate our community on public health issues from violence, to STDs, and of course, the flu. We created a new video earlier this year about the importance of the flu vaccine and have a Twitter account dedicated to information about the flu.
By Mitch Stripling, MPA, Assistant Commissioner, Bureau of Agency Preparedness and Response; Colin Stimmler, MA, Senior Director for Agency Preparedness and Response at the New York City Department of Health and Mental Hygiene
Disasters like Hurricane Michael show how severe the public health impacts from a coastal storm can be. When disasters like this strike, many local and state health workers are often willing to help in another jurisdiction, but they aren’t quite sure how.
By Dan Huff, Director of Environmental Health, and Gretchen Musicant, Commissioner of Health, Minneapolis Health Department
This blog originally appeared here on The National Association of County & City Health Officials (NACCHO) Essential Elements Blog.
Jaequan Faulkner, 13, started selling hot dogs in front of his Minneapolis home in 2016, calling his establishment “Mr. Faulkner’s Old Fashioned Hot Dogs.” His food stand came back this summer bigger and better than before, and it grew popular with customers in the neighborhood.
Recently, his business came to the attention of local officials when someone complained that he did not have official permits.
To make sure people are safe from food-borne illnesses, all events that serve food to the public in Minneapolis must be permitted, and violators are subject to an immediate shutdown.
By Dr. Jeff Duchin, Health Officer for Public Health – Seattle & King County
This blog originally appeared here in the Public Health - Seattle & King County blog Public Health Insider
Firearm-related injury and death, from suicide to accidental injury and homicide – is a major public health problem and a leading cause of premature death in King County and nationally. In 2016, 663 adults and 20 children died from a firearm injury in Washington state, including 144 adults and 7 children from King County.
Firearm-related injuries have very high personal and financial costs to individuals, families and society – and that’s why prevention is essential. In 2015, the cost of firearm fatalities alone (not counting non-fatal injuries) in King County was almost $200 million from medical costs and lost productivity, and nationally the cost is in the hundreds of billions of dollars each year.
By Deborah A. Moore, Assistant Director, Human Services Division, Houston Health Department and Scott Packard, Chief Communications and Public Affairs Officer, Houston Health Department
When you think of Older Americans Month, toilets probably aren’t the first thing to come to mind. But at the Houston Health Department, commodes are a major component of one of the Harris County Area Agency on Aging’s most gratifying programs.
Allow me to take a step back to explain.
By Rachael Banks, Public Health Director, Multnomah County Health Department
After years of unacceptable disparities data, we knew we had to do something different. In the summer of 2015, Multnomah County Health Department (MCHD), set out to create a community health improvement plan (CHIP) centered on things that are largely outside of the control of the individual. In response, MCHD released a request for proposals (RFP) for the coordination of a CHIP that was created in partnership with communities of color. Oregon Health Equity Alliance (OHEA) was selected as the contractor to lead the development and implementation process for the CHIP.
Throughout 2016 OHEA, with the support of MCHD’s Health Equity Initiative (HEI), intensive community engagement and outreach (forums and interviews) were conducted to gather input from a variety of communities including: African-American, Asian, Immigrant/Refugee, Latino, Native American, Pacific Islanders, and youth and elders of color. The outreach and engagement was followed by a tremendous amount of planning, analyzing and prioritizing areas over the next year. Through these engagement efforts, a framework was developed outlining 23 goals and over 150 strategies.
The world-wide scientific consensus is clear: climate change is real, it is being driven by human causes, and we must act now to avoid its worst effects. However, it also clear that leadership in the fight against climate change will not come from Washington, D.C. anytime soon. The EPA is being targeted for huge budget cuts, and the U.S. withdrew from the Paris Climate Accord. In a heartening trend, businesses, community organizations, non-profits, states, counties and cities are stepping up to fill this leadership vacuum. Within this growing coalition there is one player that is often overlooked: local Health Departments. We have a unique perspective and the community connections to play a significant role in helping our communities adapt to the effects of climate change while also fighting against its causes.
By Narintohn Luangrath, Special Assistant to the Baltimore City Health Commissioner and
Dr. Leana S. Wen, MD, MSc, FAAEM, Baltimore City Health Commissioner
At a commencement ceremony several years ago, Dr. Linda Rae Murray, then-president of the American Public Health Association, recounted a famous saying: “When public health works, we’re invisible.” She followed that by urging the graduates to “refuse to be invisible, because […] we need to lend our strength and our science to broad social movements whose goal is to make things better.”
When public health is invisible, we only end up talking about it when things go wrong; people tend to think about public health agencies as entities that respond to infectious disease outbreaks or shut down a restaurant due to health code violations. We frequently think about health as healthcare, but what determines how long and how well we live is less about what happens in the doctor’s office and more about where we live, the air we breathe, and the availability of other resources in our communities. At the Baltimore City Health Department (BCHD), we believe that all issues – education, housing, employment, public safety, and beyond – can and should be tied back to health. We are committed to making the progress earned through public health visible, and to make the case for incorporating health-in-all policies across the City.
By Joseph Iser, MD, DrPH, MSc, Chief Health Officer, Southern Nevada Health District
This blog originally appeared in County Line Magazine
Every year on March 24 the health care community commemorates World TB Day to bring attention to a preventable disease that still impacts many people in the United States and around the world. This year’s theme is “Wanted: Leaders for a TB-Free United States. We can make history. End TB.” It is a call for health care partners to work together on a local, national, and international scale to eliminate the disease.
Health care providers are instrumental in this process. For many patients, TB can present as a bad cold or respiratory infection that won’t go away. Physicians should always consider the possibility of TB when examining a patient with an ongoing respiratory infection, especially if it is accompanied by a persistent cough, night sweats, loss of appetite, and fatigue.
In 2017, King County launched our new food safety rating system with the goal of making it the best rating system in the country. With a year under our belt, Public Health – Seattle & King County’s food safety team is proud to say that the new system has achieved measurable success.
- Over 75 percent of all restaurants in King County now have easy to understand food safety rating signs in their front windows. This has greatly improved the ability for consumers to quickly assess the food safety practices at each restaurant.
- Anecdotally, our food safety investigators report an increased interest from restaurant owners in improving their food safety practices, which means that the placards are motivating restaurants to do better. The number of perfect scores from all restaurants across King County increased 3 percent in 2017 from 52 percent to 55 percent.
- The ratings provide a more complete picture of food safety than any other rating system across the country. Ratings reflect the trend of critical food safety practices over time in each restaurant and take inspector differences into account to make sure the playing field is level.
By Dr. Rex Archer, Director of Health, Kansas City, Missouri Health Department
After the trauma of the events surrounding the Las Vegas mass shooting, stories of horror and heroism unfolded from that horrible act. My compassion and prayers felt somewhat hollow. I am in a position to move my compassion to actions that make a difference and to save many lives. That is why I am in public health. Yet, the enormity of the challenge seems daunting.
By Meredith Li-Vollmer, Public Health - Seattle-King County
The news from Hurricane Harvey has been heart wrenching. Among the memorable images that emerged was one of nursing home residents sitting in wheelchairs, waist-deep in flood water as they waited for help to arrive. As reported by the New York Times, among the thousands of posts to volunteer rescue groups were common pleas such as “East Houston, 9:53 p.m.: Needs evacuation, one elderly person in a wheel chair” and “Northeast Houston, 5:36 a.m.: He’s on bottled oxygen now, and running out. Nausea from lack of oxygen has already started.” As some of the most vulnerable in the community struggled, news also covered the toll that the hurricane has taken on the world-class hospitals in the Houston area who were well prepared with back-up generators but hampered by the extremity of the weather and flooded roadways to evacuate patients and bring in emergency vehicles, food, and supplies. Hurricanes and floods aren’t just acts of nature. They are also public health emergencies.
By Dr. Julie Morita, Commissioner of Health, Chicago Department of Public Health
Flipping my calendar from July to August, always yields a sense of melancholy as I can see the less structured, long, warm days of summer rapidly disappearing and the busy, regimented, new school year entering into sight. While many people overcome the sorrow of the summer ending with “Back to School” shopping for backpacks, new clothes and school supplies, since becoming a pediatrician almost 25 years ago, I have sought consolation in knowing that “Back to School” means that millions of school-aged children throughout the US will be receiving health examinations and vaccines, which prevent serious diseases including measles, mumps, whooping cough, and polio.
By Dr. Mary T. Bassett and Stanley Brezenoff
If there was any hope that Senate Republicans could bring some sanity into the national discussion around the future of our health care system, such hope completely vanished on Thursday. Like the House's health care bill, the Senate's proposal is nothing less than an all-out attack on public health and our public hospital system, and its consequences will be devastating for New York City and the country.
By Jesse Chipps, HIV Planning Council Administrator, Public Health - Seattle & King County
June is National Lesbian, Gay, Bisexual and Transgender (LGBT) Pride Month, and each year at this time hundreds of King County employees, department directors and public officials march together in Seattle’s Pride Parade. Rainbow tinsel laden vehicles, bubble machines, and matching t-shirts pull the group together as One King County.
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.
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.
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.