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Last week at the CDC
I spent a couple days at the Centers for Disease Control’s (CDC) meeting of the Task Force on Community Preventive Services. The Task Force reviews evidence in various areas critical for public health and makes recommendations on the basis of comprehensive evidence reviews. We should use evidence for decision making about what to do in public health as well as in medicine. Using ineffective strategies when effective ones are available is poor practice in either case.At the last meeting, we reviewed several topics, including the use of technology-based interventions for obesity prevention and maintenance of weight loss, comprehensive risk reduction and abstinence education interventions to prevent adolescent pregnancy, HIV, and other sexually-transmitted infections, using population levels of alcohol consumption as an indicator of excessive alcohol consumption and vaccination programs in schools to increase vaccination coverage in children and adolescents. Being on the Task Force helps me stay current with the literature in a lot of different areas. I am glad that the Obama administration seems to understand the importance of evidence in resource allocation and decision making.
Nicholas D. Kristof, a voice for public health in the New York Times
Kristof has been a hero of mine for some time. In fact, he is one of the best writers anywhere about public health issues. In his blog, Kristof wrote that “My Sunday column was inspired by ‘Food, Inc.,’ the new documentary playing in theaters nationwide. I argue that at the same time we examine our health care system, we should also take a look at our agribusiness system, which — I argue — tends to promote an unhealthy diet.” He talked about the latest E. coli outbreak which caused a recall of Nestle cookie dough. Who’d think of cookie dough as a breeding ground for E. coli! One of our faculty members, Professor Mark Sobsey, is trying to develop a better test for E. coli.
Will there be health care reform?
As I have said before, I am old enough to have been through these debates multiple times. This time, though, there is encouraging news from recent polls. Voters want change. Not only do they seem to be willing to pay more, but they appear to support a public insurance option — that means an option not as the only option. See Paul Krugman’s Op Ed in today’s New York Times. With nearly 50 million Americans uninsured and millions more under-insured, the time for waiting is long past. But the details will help to decide whether key people can overcome their differences and come together in compromise for the common good.
There’s a lot of talk about a “Public” Health Plan or a “Public-Health Plan.” The use of “public health,” in this case, is essentially a health plan for the public as opposed to how we think about public health in terms of the public’s health. Nuances aside, what really will make it a public health plan is if it guarantees access for all Americans, incentivizes prevention, encourages wise, evidence-based decision-making about health care, manages quality and provides reasonable payments to health care providers. Here are a couple links to different points of view, for and against a public option — in the interest of encouraging civil discourse on difficult topics.
Lancet on public health
The Lancet editors published a new manifesto for the CDC June 6th, with advice for the new CDC director Dr. Tom Frieden. He’s known especially for his work to remove transfats from NYC restaurants, a bold, significant move. It’s a good call to action. I especially like the editors’ statement that
“traditional public health will need to move from a focus on disease interruption and biomedical interventions to catalyzing social change and providing support for behavior change-from chronic diseases and obesity to HIV/AIDS. Other long-term priorities include revitalizing the discipline of public health…The agency should continue to have a big role in global health…”(p.1919).
These are good suggestions that I will return to in the next few weeks. Behavior change requires a lot of attention and some new ways of thinking.
Belated Happy Father’s Day to all fathers
I really appreciate my own father who was one of the earliest effective communicators in the fight against smoking — and still an astute thinker.
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Comments
@Roy Baron: "While I have some very strong personal, value-based, opinions on the direction of health care reform, I am neither wise enough nor sufficiently schooled in the various economic implications to weigh in publicly or to go out on a limb. Of one thing, however, I am certain. Unless we as individuals and a nation heed the messages implicit in the documentary “Food, Inc.,” no success in the reform of health care delivery will be sufficient to overcome the escalating health, economic, and environmental devastation created by current policies and practices in our food industry. " - Roy you`re right!
Roy Baron
06/29/2009
While I have some very strong personal, value-based, opinions on the direction of health care reform, I am neither wise enough nor sufficiently schooled in the various economic implications to weigh in publicly or to go out on a limb. Of one thing, however, I am certain. Unless we as individuals and a nation heed the messages implicit in the documentary "Food, Inc.," no success in the reform of health care delivery will be sufficient to overcome the escalating health, economic, and environmental devastation created by current policies and practices in our food industry. This film, which I saw earlier this evening, is a wonderful distillate of lay-friendly material already published by Eric Schlosser and Michael Pollan. Yet I was understandingly struck by both the limited attendance at the showing and the choir-like composition of the audience. Not much "new information" conveyed at this upscale Atlanta location. We should all be getting mad, and "mad as hell!" A couple of suggestions/challenges: First, I hope this documentary and related publications are incorporated into the (required?) curriculum of the Gillings and other schools of public health. Second, our schools of public health and other public and private health organizations need to work more effectively with the authors and producers of this lay-friendly material to encourage and assure its dissemination to a wider audience.
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The views expressed in this blog are Barbara Rimer’s alone and do not represent the views and policies of The University of North Carolina or the Gillings School.
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