One researcher is looking at why poor U.S. counties also tend to have higher prevalence of risky sexual behavior and alcohol consumption. Another is studying abuse of children with birth defects.
“If it hurts or kills people, it's ours,” said Dr. Georges Benjamin, executive director of the American Public Health Association, which this week is gathering in Chicago to present findings from research by people such as by Dantrell Simmons of HHS' Substance Abuse and Mental Health Services Administration.
His research looked at alcohol consumption in Mississippi counties whose populations had more than a 25% share of African-Americans who had ever been in prison. Simmons found a correlation between what he calls alcohol abuse, “social capital” and access to alcohol. Simmons came to this realization by studying the state's 36 dry counties, where alcohol wasn't sold but was consumed in large amounts.
While the rural dry communities didn't have liquor stores, Simmons said it was also likely they didn't have churches, schools or grocery stores, either. He added that often rural stores that sell alcohol also sell groceries and gasoline, and serve social and financial functions—like cashing people's checks.
Simmons concluded that societal, neighborhood, and individual factors need to be factored into alcohol beverage control policies and HIV interventions, since the number of at-risk sexual behaviors were higher in those counties as well.
That's the kind of approach the APHA is adopting and promoting during this week's annual conference in Chicago. Members are being asked to think about “health-in-all-policies” initiatives that mean public health professionals work with law enforcement, transportation officials, environmentalists, educators, beauticians and barbers, churches and anyone else who can shape policy informed by conversations and analysis provided by community partners.
Members of the American Public Health Association have given themselves a monumental task: Making the U.S. the healthiest nation in one generation's time.
Reaching this goal will require “working on a broader scale than ever before,” said Shiriki Kumanyika, APHA president and University of Pennsylvania professor emeritus of epidemiology.
Some of these areas include breastfeeding, pregnancy, HIV/AIDS, mental health, nurse and public health workforce issues, the social determinants of health, violence, and obesity, nutrition and exercise.
Other topics included emergency preparedness, the health impact of fracking, suicide, alcohol, tobacco, vaccines, hearing loss, indoor tanning, the Ebola virus, asthma, hypertension, tuberculosis, matching service dogs with veterans, and “drowsy driving.”
Bethanie Van Horne, with the University of Texas Health Science Center at Houston, is researching abuse that occurs to children with birth defects. Her research shows that children born in Texas from 2002 to 2009 suffering from spina bifida were at higher risk for maltreatment before age 2 than children with no birth defects;, children with Down syndrome were at higher risk after age 2; and those with a cleft lip or palate were at increased risk up to age 10.
“The social work side is clear,” Van Horne said. “But a lot of people don't recognize it as a public health issue.”
APHA members hope this kind of work will open up federal and state coffers, especially when public health officials are being asked to do more with less.
Attorney Denise Chrysler with the Network for Public Health Law said state legislators have mandated screening newborns for certain conditions even though there isn't evidence to support the benefits of testing. The result is that resources are diverted from screening programs with proven benefit, she said.
“Technology moves faster than the evidence showing the need for the test,” Chrysler said.
U.S. Surgeon General Vivek Murthy, who recently unveiled a public health campaign aimed at using urban planning to create more walkable cities, suggested that one way to keep pushing through these challenges was to recognize how promoting good health, ultimately, results in promoting equal opportunities.
Environmental effects on public health are a major issue being discussed at the meeting. Benjamin said the public health community doesn't need convincing that climate change is real, but “there are people who need convincing that there's something you can do about climate change.”
“When you're worrying about making sure that all the kids in your community get vaccinated, that the water is safe to drink, that your restaurants are safe to serve food to patrons, and you have a limited budget, trying to get this issue of climate change on your agenda sometimes is a little tougher,” he said.
Murthy suggested that one way to keep pushing through these challenges was to recognize how promoting good health, ultimately, results in promoting equal opportunities.
“This is about something much bigger than health,” he said. “The pursuit of health is the pursuit of justice.”