Driving? Turn the Phone Off!

Andy

Driving is debatably the biggest public safety and public health issue of our nation. It is the leading cause of death among Americans ages 1 to 34, and the leading cause of long-term disability for all (McMillin, 2010). Statistically speaking, it is the single most dangerous activity most of us will do today. Skydiving or flying are insurmountably much safer activities, despite what our society believes. So why as a nation do we allow any mobile phone use in the car by the driver, something that drastically increases the probability of an automobile accident to persist?

As noted in the NYTimes article, “AT&T Chief Speaks Out on Texting at the Wheel”, research has shown that texting while driving increases ones risk of a crash beyond that of even an impaired driver with a 0.8 blood alcohol level (Richtel, 2012). A large majority of the population believes the BAC legal limit driving law to be a necessary piece of legislation. It only seems obvious to ban something more dangerous than something that is already banned.

Now some of you will say, texting is regulated in some states. This is obvious, however I’m wondering if we need a ban of total mobile phone use by the driver in the car. Plain and simple, mobile phones distract a driver in numerous ways. Manual manipulation of the phone such as texting or dialing significantly detracts from the time spent viewing the road. Unless you were blessed with the ability to use your two eyes independently, this presents a huge problem. In addition, there exist many distracting effects of the phone conversation through emotion or cognitive reasoning. Studies have shown that splitting cognition between two events greatly reduces the efficiency of any single activity. This is evidence to support the ban of total mobile phone use in the car, since the duration of a typical phone conversation can be up to two orders of magnitude greater than the time required to dial or answer the phone (Strayer, 2003).

Someone dies in a highway crash every 13 minutes (American Osteopathic Association). We must pass legislation that bans mobile phone and other electronic devices use while driving. Is even one life worth a text or phone call? What if that life was yours or your loved ones? The phone call can wait, especially if it’s your last.

Andy Mychkovsky is a first year HMP student at the School of Public Health.

Promoting a Culture of Health

Desiree

On September 12, 2012 I attended the kick-off of the National Tobacco-Free College Campus Initiative here at SPH.

Dr. Howard Koh, Assistant Secretary for Health at the Department of Health and Human Services, U of M President Mary Sue Coleman, and SPH Dean Martin Philbert gave remarks on the significance of this day in history.

SPH faculty members have contributed greatly to tobacco policy. I am proud to be a student at an academic institution that continues to be so heavily invested in improving the health of so many.

All 3 U-M campuses became smoke free on July 1, 2011.

A panel of tobacco experts offered their perspectives on implementing a tobacco-free campus initiative. The following is just some of the insight they gave on what is necessary for a campus to go tobacco-free:

• It takes effort from everyone
• Take time to implement
• Broaden the ways and reason for a campus to go tobacco-free
• Use peer enforcement

My niece started kindergarten this fall. I look forward to her beginning college in the future, and never knowing a time when people used tobacco on campus.

To view a video of the kick-off, follow the link here:  Tobacco Free College Campus Initiative Launched at U-M

Why I do it with (Mathematical) Models

Josh Havumaki

Apologies to our friends in the bio-stats department. There is a definite need for statistical methods in public health. Many of the tools that biostatisticians use are well established and necessary for things like causal inference. However, there are certain questions that aren’t sufficiently addressed by statistical techniques. Therefore, dynamic mathematical models have become more prominent in epidemiology and other branches of public health.

Here are a few public health issues that can be explored more effectively using dynamic mathematical models.

1) Figuring out the best way to vaccinate a population. If GAVI allocates enough influenza vaccine to the government of Indonesia to inoculate 10% of the population, where should the prevention efforts be focused to ensure maximal coverage (e.g. rural vs. urban populations)?

Past literature has focused on sharing the worlds vaccine or antiviral stockpile. For example, if the wealthiest countries share only a fraction of their influenza vaccines with the developing world, the effects would be much greater than expected. As the strategy becomes more cooperative, the containment efforts become more effective – even for the countries sharing their vaccine or antiviral stockpiles.

2) Building multi scale representations of how disease progresses and spreads. The beauty of dynamic modeling is in its modularity. It is possible to combine a cellular model of influenza pathology with one of transmission dynamics at the population level. This can provide information about interplay between levels.

3) The right kind of dynamic model (i.e. an agent based model) can grant insight into the stochastic (random or unpredictable) nature of pandemics. If a small influenza outbreak of occurs in Southeast Asia, what is the threshold that needs to be reached before it becomes a pandemic. This can factor in things like herd immunity and heterogeneity of susceptibility in the population due to immunity.

The major caveat is that accurate and quantitative data to validate and inform dynamic models can be difficult to find especially in lower resource countries (where many pandemics start). However, data quality is ever improving and organizations are becoming more strategic about collecting and synthesizing large amounts of information as seen in fields like health informatics.

Conferences: GLC Reaching Excellence in HMP Symposium and Net Impact Conference @ Ross

Saurabh Vyas

Farewell to Fall,

I am writing this sitting by a huge glass window at a cafe I usually frequent to get my daily fuel – coffee. The weather in the past few days in Ann Arbor has been lovely, and I must say this has been a great Fall with lots of sunshine, a weather to envy and go for a run… As much as I would love to just be outside and soak up the sun, I have been quite caught up with a number of events over the past couple of days. My finance exam was only a fraction of that. One of the biggest events that I am excited about is the upcoming GLC Reaching Excellence in HMP symposium. As I had mentioned in my last blog post (which has been a while ago), the event is all set to be the biggest event at the School of Public Health attracting alumni of the Health Management and Policy program from all over the country. On last count there were more than 600 delegates already registered, consisting of students, alumni and distinguished speakers like Dr. Donald Berwick (Administrator of CMS), John Griffith (distinguished Professor in HMP department), Beth McGlynn (Asso. director RAND corp.), Stephen Shortell (Dean of UC Berkeley School of Public Health) among others. More details regarding the speakers can be found at - http://www.sph.umich.edu/hmp/glc/reaching_excellence/speakers.html The symposium is on November 5th at the Mendelssohn theater in the Michigan League, followed by tailgate and a football game the next day.

So, what makes this symposium so special? For me, there are three major reasons which make it very exciting. First, with the current health reform debate ( I am still unsure if things will actually be ‘implemented’ – more on that in my next post), there are a lot of ideas regarding the implementation and integration with the current health system. This event will be a great platform to hear and even discuss the effects of reform from various healthcare angles – be it provider, insurance, or life-sciences. Second, the biggest alumni event for HMP Department, it is an amazing opportunity to meet and get inspired from alumni around the country, at a single location itself !! It is an unparalleled chance to expand your network. Third, for the students looking for internships, and job opportunities, it provides a platform to meet leaders of organizations and learn more about the organization, and may be they will find something that ‘clicks’ and ‘love’.

Another conference, which starts tomorrow is at the Ross Business School – Net Impact 2010; which will focus on issues ranging from microfinance to social entrepreneurship and corporate sustainability.

As the days pass, the weather will get colder. Though I had vowed to capture the Fall this year with my camera as much as possible, I have fallen behind on that front. But here is a photo that is a glimpse into the beauty of Fall. The photo was taken at the main Diag near the Graduate Library.

How Public Health Fields Work Together

Carrie Rheingans

Sitting in my introductory environmental health class recently, I had a flash of complete understanding about how all the varied fields of public health work together. U-M School of Public Health divides the fields five ways: Environmental Health Sciences, Health Behavior and Health Education, Health Management and Policy, Epidemiology, and Biostatistics. I’m going to stick to these divisions to explain my understanding.

Professor Hu was discussing how the environmental health scientists would collect information about the exposures people have to something in their environment, and how the epidemiologists would design studies to compare various populations’ health outcomes based on that exposure. Biostatisticians would evaluate the data and create reports in conjunction with the epidemiologists. Health behaviorists and educators would interpret these studies and figure out ways to help people change their behaviors to avoid exposure to things that negatively impact health. People who write health policies would also interpret the epidemiological studies to make policies that can make structural changes to help people be able to change their behaviors to improve their health.

A great example that illustrates all this is smoking. Recently, in Michigan, public places went smoke-free. This was a health policy change, and many of the people working for that law change are actually staff and alumni of U-M SPH! Prior to that, lots of other parts of public health had been trying to reduce people’s exposure to smoke – either first-hand or second-hand. Epidemiologists and biostatisticians had been collecting data for years about the detrimental effects of second-hand smoke on people who work in smoky environments. Health behavior change specialists were working with individuals to quit smoking, or to learn to avoid second-hand smoke if they were non-smokers. In the end, all the fields of public health worked together to bring about individual, community, and state-wide changes that will improve the public’s health.

Healthcare Reform: A Health Promoter’s Perspective

Carrie Rheingans

As a health promoter, I often think about how to prevent disease from even happening. One characterization I heard about the U.S. healthcare system was from former U.S. Surgeon General Dr. Joycelyn Elders at last year’s Public Health Practice Symposium was that the U.S. doesn’t even have a ‘health’-care system – we have a ‘sick’-care system. I think that is really true – we as a country fund treatment a lot more than prevention activities. I see this same priority in in the field of HIV too. It’s relatively easy to prove that you’ve served the health needs of people living with HIV compared to how much HIV you prevented from happening (measuring what didn’t happen gets tricky, right epid people?!)!

Healthcare reform made me remember something that was said at orientation in fall 2008 when Health Behavior & Health Education (HBHE) Chair Marc Zimmerman was introducing us to the U-M SPH. He gave a general overview of each of the five U-M SPH departments and how they work together. When he got to the Health Management and Policy (HMP) department, he said that we in HBHE really work closely with them. At first, I found this absurd, because I had the impression that HMP was all about making money in the healthcare business and HBHE was all touchy-feely and focused on really working with individuals to cater to their health behavior change needs (neither is entirely true; they are both much, MUCH more than that). His point was that the research that comes out of HBHE can inform the policies that are made – incentives and disincentives (=fees) for example.

All that being said, I really appreciate that this new bill adds more of a focus on prevention and funding prevention research and programs. I have a suspicion that the strength of two large businesses – health insurance and drug companies – has had an effect on the over-focusing on treatment and under-focusing on prevention. Politicians are the ones who make these laws, and they want to keep their jobs, so they vote and make laws in the interests of those who fund their campaigns (which sometimes are their constituents, but are often large, profitable companies). Don’t get me wrong; I’m not a business-hater. We obviously need health insurance and medications with this new bill.

As someone in public health, it’s difficult to argue that over 30 million more people having health insurance is a bad thing… and with the new funding of prevention activities, there may even be job security in my future! Dean Kenneth Warner sent a reflection email to all SPH students, faculty and staff the day after the bill passed claiming “This is an occasion for public health celebration”. On Tuesday in my intro to the U.S. healthcare system class I’m taking this semester with Dr. Richard Lichtenstein in HMP, he was happy that the bill finally passed, though he jokingly lamented having to change all his lecture slides for future semesters. I think that’s a small price to pay for a better quality of life for millions of people living in this country

Here are some thoughts from many faculty in SPH about healthcare reform

Here’s a video of Dr. Lichtenstein discussing healthcare in the U.S. (this video is a very quick synopsis of the class I’m taking with him this semester)

U-M’s University-wide collection of voices from within the University on the healthcare debate

What is Public Health?

David McCormick

So what exactly is public health?  If you’ve ever wondered about this question, you’re not alone – the Association of Schools of Public Health realized about a year ago that most people don’t really have any idea what public health professionals do, or what the field of public health offers, so they made this handy website and the video below.



(Link to the video in its original context.) One of the coolest parts of this campaign: you can get the stickers for free!

I like the idea of the ASPH’s campaign and think it’s great that the video shows a lot of public health’s “hidden” aspects, but I wish that the video would show some of the dramatic effects that public health has had on society. While public health is a very broad field, it doesn’t include everything (although it’s a fun game to try to find some connection to public health in everyday objects – think “Six Degrees of Separation” for public health dorks).

The best example is smoking – once it became clear that tobacco smoking was a major health hazard (from epidemiologic research), programs to help people quit started (thanks to Health Behavior and Health Education), and eventually policy changes were made (courtesy of Health Management and Policy) so that smoking is now banned in public places in most states (MI recently passed such a law).

Other examples of changes made by public health professionals are as basic as the regulation of drinking water and ensuring that our food supplies, especially meat, remain disease-free.  Going back to infectious diseases, the national vaccination program has eliminated almost all of what were formally the “childhood diseases” – no-one born in my generation has had to experience widespread polio, measles, or whooping cough outbreaks.  (A list of the 10 greatest public health achievements is found here).

So as a tool for raising awareness, the video is great, but I hope that it encourages people to look deeper into public health.  There really is something for everyone in this field, from microbiology nerds (like me) to those of a political nature (how else would we get public health laws passed?).

Mystery Meat

Tiffany Yang

What are kids eating in school?

I remember as a kid getting one of those trays with a carton of milk, a main dish (no vegetarian options back then, at least at my school), a side of carrot sticks or mushy peas, and maybe some canned fruit cocktail. All of it was up to nutrition standards set forth by the United States Department of Agriculture’s (USDA) National School Lunch Program (which public and not-for-profit private schools can choose to participate in) so I was definitely getting my caloric, vitamin, etc. needs. However, the food was not appetizing at all. OK. I take that back a little bit. It was a little exciting to me because I never got to eat “American” food at home so it was interesting (for a while) to eat fruit cocktail (yuck) and salibury steak (….).

Maybe I have strange notions about how things would have changed from when I was a child to what kids are eating these days, but it looks like not much has changed. This blog follows a teacher as she bravely eats what is being served in the school cafeteria. And it is not pretty. She concedes that most nutrition guidelines are being met with the lunches, but that they are just horrible. Some foods aren’t even completely thawed before they’re served (like the fruit cups) and everything seems to be packaged individually. This really confuses/angers me. When I had lunch, we got everything plopped onto a compartmentalized tray. It looks like this school just has one smooth tray and everything is in their own little shrink-wrapped or packaged bundle. This is a ridiculous waste of non-recyclable products (styrofoam, saran-wrap, plastic containers and trays, etc.). I guess I can kind of see them trying to reduce cross-contamination of foods when you have a big vat of it, but, honestly, I think individual packages are are such a waste (especially when you have a huge school population and this is happening everyday).

There are some advocates for reforming school meals, though, and they are starting to get some attention in the media. Jamie Oliver, a chef, is advocating meals that are less processed, freshly prepared,and local if possible. Alice Waters, of Chez Panisse fame, basically started the local farm to school idea with the edible schoolyard project where kids help grow foods that can be used in their school. Ann Arbor public schools picked up on this idea a few years ago and integrated The Agrarian Adventure into their school. The Agrarian Adventure consists of programs that expose, teach, and encourage students to gain knowledge about the where their food comes from, how to create a relationship with the foods they eat, and understanding the impact food has on their health. As for their school lunches, The Agrarian Adventure helped foster a collaboration between the public schools and the Ann Arbor Farm-to-School program to bring local fruits and vegetables to the school lunches.

So, while my school lunches were pretty dreary and many current school lunches are unappetizing, the hope is that proper nutrition as well as acceptable taste, texture, and (hopefully) environmental concerns such as packaging, local, sustainable, organic, etc., can play a bigger role in the foods that students are eating everyday.

World AIDS Day 2009

Carrie Rheingans

Today is World AIDS Day: a day where 5,500 people will die of AIDS and 8,200 more will become infected with HIV – 152 of them in the United States of America. The Joint United Nations Programme on HIV/AIDS just released a report that says that AIDS is the leading cause of death globally in women of reproductive age. We know that HIV is a worldwide crisis, already devastating countries across the globe and poised to ravage others… unless we continue to work to stop AIDS. If you’re a regular blog reader, you know I’m not a person who just spews statistics; you know I like action (see previous posts about work with youth in the USA, youth in Peru, outreach in the USA and Peru, and advocacy). So for this World AIDS Day, I want to share with you some things you can do to help stop AIDS.

1. Volunteer in your local community. The HIV/AIDS Resource Center is Ann Arbor’s local AIDS service organization and is always accepting volunteers. You can also contact the Washtenaw Interfaith HIV/AIDS Network (WIHAN) to volunteer. You can find non-governmental organizations around the world in the Global South through the International AIDS Alliance.
2. Educate yourself and spread your knowledge. Correct myths and discriminatory and stigmatizing language when  you hear it. Good resources: UNAIDS - Kaiser Family Foundation – CDC - MDCH - Avert – AIDS.gov – google.org
3. Get yourself tested for HIV. Free testing is offered all week in the local community (see complete listing here), or you can text your zip code to “KNOWIT” (566948) to find a local testing site.
   

   KNOW YOUR STATUS!

4. Support organizations serving people living with HIV by donating directly to them rather than buying some product that only contributes a minuscule portion of its profits. Your donation goes further when it goes directly to the organization.
5. Write a letter to the editor of your local media source, call into radio stations, and send emails to friends, family and colleagues with things people can do. Describe the epidemic in your local community and challenge people to act. Call on elected officials to fund important services that keep people alive.
6. Attend World AIDS Day and World AIDS Week educational  and action events near you. The Ann Arbor area has many events going on this week – see a complete listing on the World AIDS Week website.
7. Be creative and use your skills to make a difference in your community!

 

Carrie in front of the AIDS memorial in Durban, South Africa

Michigan Community Conversation for a National AIDS Strategy

Carrie Rheingans

Michigan got its chance to give feedback to the White House Office of National AIDS Policy on Wednesday, 18 November 2009. From across the state, providers, people living with HIV, and people affected by HIV came and gave their recommendations, suggestions, and demands on video tape and in writing.

I was the statewide organizer for this event as part of my social work internship at the HIV/AIDS Resource Center (HARC). This experience was the perfect combination of public health and social work that I hope to gain from my dual degree program (MPH/MSW). When the nationwide community conversations were announced, many people across Michigan wondered why we didn’t have one scheduled near us, especially considering the fact that some zip codes in Detroit have higher HIV prevalence than some countries that receive emergency money form the United States government. The Campaign to End AIDS contacted me after hearing from a few outspoken Michiganders and we did a lot of grassroots organizing in a few short weeks to pull off this successful event. See the Between the Lines article and the Michigan Messenger article for further coverage.

The conversation was only two hours long, and the majority of the time was occupied by community members speaking about what they wanted in a National AIDS Strategy. The night started with welcomes from Craig Covey, Ferndale mayor (Ferndale is the city where the event was held) and longtime staff member of the Michigan AIDS Coalition, Christine Campbell and Larry Bryant of the Campaign to End AIDS, and Charles Pugh, President-elect of the Detroit City Council. Charles also moderated the event.

Below are some of the things people told the White House:

“When is the last time we got together as a community of loving, living people when funders weren’t making us?”

“We need quality healthcare for LGBT people living with HIV and AIDS – we need to strengthen doctor-patient relationships because people are not comfortable coming out to their doctors”

“Viagra and Cialis have aided in the resurgence of sexually transmitted infections in senior housing complexes. We need more education and prevention in these locations”

“The church, rid of stigma, denial and fear, becomes a change agent”

“my barrier [to being an AIDS advocate] is childcare”

“I wanted post-exposure prophylaxis and the nurse didn’t even know what it was!”

“We need the same laws coast to coast – enough with a patchwork of different laws about HIV”

“I missed class tonight to be here on my birthday to tell you that we need rec centers for our kids to have something safe to do after school”

“Michigan prisons don’t hand out condoms or test for HIV when people are released – but we know that people are still having sex and they need to get tested because they might need to get right into care”

It was great to hear people from as far away as Kalamazoo, Flint and Lansing gathering to speak out about such an important issue.

Larry Bryant from the Campaign to End AIDS introduces the event as moderator and President-elect of the Detroit City Council Charles Pugh looks on