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This past Saturday morning, our home doorbell rang, and I sprang up with the expectation of greeting someone interested in trimming our mesquite trees or painting our house (both of which do need to be done). However, to my surprise, I found myself greeting Dr. Leland Fairbanks. Dr. Fairbanks is a retired physician well known in Arizona for his tireless work in tobacco control. Indeed, he is a public health icon and one of my local heroes.
He handed me a set of campaign brochures for various candidates for Tempe City Council and patiently explained why he supported each candidate. I listened to him for a bit, thanked him for his information, and assured him that I would be voting in the upcoming election.
We had actually met at an Arizona Public Health Association meeting many years ago, but I don’t believe he remembered me. So, before he walked off, I felt compelled to express my admiration for his past work. But before I could utter anything, he noticed the name on our door (“Casa de Hirano”) and commented that a woman with the last name of “Hirano” used to work on tobacco control with the state health department. I confirmed that my wife Rosalie had directed the state tobacco control program in the late 1990s. He smiled and said to say “hello” and then ambled off to visit with my neighbors.
I recount this story not as a chance encounter with a public health icon, but because I was so inspired that a man in his early 80s was going door to door on a Saturday morning advocating for things in which he believes. If anyone has earned a leisurely Saturday morning, it is he. I promised myself that on Monday morning I would make a few phone calls in support of a hepatitis B funding bill currently under consideration by Congress. Please consider taking a moment in the upcoming week to advocate for something you believe in.
- Doug Hirano, MPH, APCA Executive Director
Recently, I had the good fortune of spending some time with Dr. Leonard Syme. Dr. Syme is Professor Emeritus at the UC Berkeley School of Public Health and for some time now has been decrying the traditional public health approach that would have experts descending upon stricken communities with “risk factor” based interventions. Indeed, he is quite fond of recounting the failure of his five-year project funded by the National Cancer Institute that attempted to reduce smoking rates in Richmond, California.
“Richmond is a poor city with high rates of unemployment, crime, and drug use. It also has heavy levels of air pollution from nearby oil refineries. At the time, there were few health facilities. And our research team descended on this troubled community with a brilliant plan to do a smoking cessation project! It is doubtful that smoking was high on the priority list of people in this community, but our team paid little attention to that.”
Dr. Syme emphatically states that these types of community interventions have not worked in the past and will not work in the future. However, one approach he believes has promise is to involve communities in addressing their own concerns.
“The evidence now shows that no matter how elegantly wrought a physical solution, no matter how efficiently designed a park, no matter how safe and sanitary a building, unless the people living in those neighborhoods can in some way participate in the creation and management of these facilities, the results will not be as beneficial as we might hope.”
In other words, assisting individuals and communities to develop a sense of control over their own destinies, he believes, is an important part of the equation of good health.
Those of us working to improve the health of communities would be wise to consider Dr. Syme’s insights. He has only come to these conclusions after a quarter of a century of study of risk factors and associated interventions. By the way, I don’t think Dr. Syme is necessarily advising us to drop a disease-based focus (e.g., breast cancer, smoking and hepatitis B), but it certainly seems advisable to acknowledge the interests of the communities and to ensure their maximal involvement in their own health.
- Doug Hirano, MPH, APCA Executive Director
The National Viral Hepatitis Roundtable (NVHR) recently issued a press release decrying the fact that controlling hepatitis B and C is not among the “six winnable battles” identified by the Centers for Disease Control and Prevention (CDC).
Here are some excerpts from the release:
"The CDC's newly released 'six winnable battles' strategy makes a mockery of the broad-based, comprehensive, and integrated public-health strategy that our nation so desperately needs. In seeking to win six narrowly defined health care battles, the CDC may well lose the overall public-health war.
"The CDC's omission of viral hepatitis from its list of 'winnable battles' is not simply an oversight - it's an abdication of duty to many Americans who may well lose their battle with chronic viral hepatitis in the decades to come."
In a prior blog entry, I had commended the CDC for having the wisdom (and nerve) to identify just a few key health areas for strategic focus.
However, I fully expect that other passionate and well-intentioned public health agencies and advocates will join the NVHR in questioning the completeness of CDC’s winnable battle list. And, I think, most will have a good argument. There are many, many other areas of extreme public health urgency (e.g., diabetes, substance abuse, Novel H1N1 flu, and domestic violence, to name a few). However, it should be pointed out that the six winnable battle areas (HIV, motor vehicle injuries, obesity/nutrition/physical activity/food safety, healthcare associated infections, teen pregnancy and tobacco) cover a lot of ground in terms of health impact, and there is crosscutting value in effectively working on these health concerns (e.g., efforts to control HIV also benefits efforts to control the spread of other sexually-transmitted diseases, including hepatitis B and C).
Most importantly, though, the CDC is the leading public health institution in the world, and as a citizen and a public health professional, I expect the agency to exert leadership. The identification of “winnable battles” is a bold and controversial step. It provides strategic perspective to those of us battling in the trenches, but shouldn’t be perceived as a mandate.
As I stated in my prior blog entry, for those of us working on improving health among Asian Americans and Pacific Islanders, controlling hepatitis B is our “winnable battle”. In that regard, I will continue to support the efforts of the NVHR (APCA is a member) to put hepatitis B and C on the national radar screen and to advocate for additional resources.
-Doug Hirano, MPH, APCA Executive Director
Public health practitioners are justifiably proud of the improvements in health status over the past 100 years. In fact, the Centers for Disease Control and Prevention has generated a list of the ten greatest public health achievements from 1900 to 1999. Major achievement areas include immunizations, tobacco, motor-vehicle safety, and control of infectious diseases, among others.
Now, ten years into the 21st century, those of us practicing public health must ask ourselves about our progress in this century. My sense is that we’ve made relatively slim headway in the past decade. Indeed, the end of the 20th century saw an unprecedented and largely unabated rise in childhood and adult obesity, and the beginning of the 21st century has seen deadly global outbreaks of SARS and novel H1N1 flu. Rates of tobacco use are still hovering around 20% here in the United States, and far higher in many other countries.
So, where do we go from here? Well, the CDC has offered a relatively new way of thinking about our 21st century health challenges. They have coined the term “winnable battles” to describe “public health priorities with large-scale impact on health and with known, effective strategies to intervene.” Winnable battle areas include HIV, motor vehicle injuries, obesity/nutrition/physical activity/food safety, healthcare associated infections, teen pregnancy and tobacco.
Interestingly, several winnable battle areas (i.e., tobacco and motor vehicle injuries) also show up on the list of the 20th century ten greatest public health achievements. Be that as it may, I think it is wise to generate a “winnable battle” list. It provides a clear health agenda for health departments, community-based organizations, and others interested in wide-scale health improvement.
For Asian Americans and Pacific Islanders though, I would add two additional winnable battles:
1. Screening and referring to medical care those individuals with chronic hepatitis B infection; and,
2. Increasing rates of screening for breast, cervical and colon cancer;
One in ten Asian Americans and Pacific Islanders carries the hepatitis B virus (HBV), a major cause of liver cancer. Most are unaware of their infection. A simple blood test can detect the presence of the virus, and there is now treatment that can decrease the likelihood of serious liver disease due to HBV infection.
Studies indicate that Asian Americans and Pacific Islanders do not receive preventive screenings for breast, cervical and colon cancer as often as non-Hispanic whites. The scientific literature now includes proven interventions to increase screening rates for these cancers among AAPIs.
A focus on winnable battles is efficient and sensible. We must act on this knowledge. Let’s hope that our collective legacy includes success in these areas.
Doug Hirano, MPH, APCA Executive Director
Last week, I tuned into an interesting Robert Wood Johnson Foundation webinar on communicating about health. We in public health often talk about the “social determinants” of health. When this term is used without explanation, I’m relatively certain it means very little to the average person. However, translated, this means that health outcome is largely predicted by the physical, economic, and social environment in which one lives.
According to research cited during the webinar, Democrats support the notion that societal factors influence health. For Democrats, for instance, poverty is a hole created by systems imbalances that trap individuals and puts them at risk for poor health. On the other hand, Republicans tend to view health metaphorically as an individual journey in which people have an opportunity to make choices. Poor choices result in roadblocks to good health.
Now, this research is not about whether Democrats or Republicans are correct about the real factors behind poor health. The value of generating deep metaphors is to gain a better understanding of the frames people use to view the world. In other words, for those of us who often communicate about health matters, it’s not about who is right or wrong, it’s about finding a common language that speaks persuasively to multiple viewpoints. I would urge you to explore the RWJF website for further information.
-Doug Hirano, MPH, APCA Executive Director
Thanks to Will Humble, director of the Arizona Department of Health Services for the following reference. For anyone with more than a passing interest in public health, his blog is worth checking out.
Will’s most recent blog post references the Center for Disease Control and Prevention’s publication called Science Clips. This weekly report provides a summary of CDC-authored publications and key scientific articles in featured topic areas (e.g., “communicable diseases” and “maternal and child health”). It’s “one stop shopping” for individuals interested in keeping up-to-date on health research. The links will direct you to the related abstracts as listed in PubMed – a compendium of the peer-reviewed scientific research. Unfortunately, access to the full articles is largely limited to those with electronic subscriptions to the specific journals in question. Still, through access to the abstracts, it’s a simple means to stay current on all things public health.
Community capacity to conduct population-based health improvement work is severely lacking in most parts of the country. Most of the expertise in public health resides within local and state health departments and is deployed at the community level with varying levels of success. Fortunately, there is a little known program out of the federal Centers for Disease Control and Prevention known as the Public Health Prevention Service. This program places individuals known as “Prevention Specialists” in public health settings – both governmental and community-based – for two years. Prevention Specialists come at no cost to the participating agencies and bring Master’s level training and at least two years of public health experience, including one year at the CDC.
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