Category Archives: APHA IH Section

APHA (@PublicHealth) late-breaker policy on HIV testing for immigrants posted

Note: This was cross-posted to my own blog.


As I mentioned in my recap of the 2015 APHA Annual Meeting, I authored a late-breaker policy, “Opposition to Policies Requiring a Negative HIV Test as a Condition of Employment for Foreign Nationals,” that was put forth by the IH Section and passed by the Governing Council with overwhelming support. That policy has now been finalized and posted to APHA’s Policy Statement Database. You can read the full text of the policy here.

According to APHA Joint Policy Committee (JPC) guidelines,

Approved late-breaker policy statements will be considered valid, but interim for one year. Late-breaker policy statement authors will need to revise, update, and resubmit their policy statements to the standard proposed policy statement review process…Late-breaker policy statements will be subject to full review and reaffirmation in the next annual policy development cycle. If the late-breaker is not resubmitted, it will expire after one year.

I am working with the Section’s Policy/Advocacy Committee to develop a standard policy proposal as a follow-up to the late-breaker, which will be submitted for consideration at this year’s Annual Meeting in Denver.

Mary Anne Mercer featured in JHU Magazine

Our Section’s own Mary Anne Mercer was featured in the Winter edition of Johns Hopkins magazine! The piece tells the story of Dr. Mercer’s career in public health, with a particular focus on a program she developed in East Timor to decrease maternal mortality by combining a text-message alert service for pregnant women with a training program for midwives. The article is a slightly longer read, but here is an excerpt:

Back in Seattle, Mercer began writing SMS messages that could be sent to pregnant women, dispensing advice and reminders about how best to stay healthy. These were translated into Tetum, the most commonly spoken language in the country. HAI purchased smartphones to distribute to midwives, and Mercer flew out in January 2012 to oversee the first midwife training. The program was simple. When a woman came in for her first prenatal care visit, the midwife asked if she had a phone, and if she did, the midwife took her picture and some basic information: her name, her estimated due date, her phone number, the village in which she lived, and other pieces of identifying information. Then, twice a week, the woman began receiving messages appropriate for her stage of pregnancy. The first message read: “Congratulations on your pregnancy! You should be checked by the midwife at least 4 times at a health center to ensure a healthy pregnancy and healthy baby.” A first trimester message read, “During the [antenatal] visit the midwife will measure your blood pressure and feel your belly to see how your baby is growing and moving.” A message as the woman’s due date approached was, “The baby is getting bigger and may cause your back to hurt. You should stay active but try not to lift heavy things like water or other children.” The messages were meant in part to get women to think about having a midwife, now trained by HAI, present for the delivery. After birth, the messages continued for six weeks, with advice on postpartum and newborn care.

The program’s early results were so impressive that HAI and Catalpa International were asked to scale up the program into three new districts, with a tentative plan to expand to all of the country’s 13 districts in the next five years. In Manufahi, the number of deliveries in clinics rose by 70 percent, and total births assisted by a skilled attendant, whether at home or in a facility, increased by 32 percent. But Mercer is the first to take those numbers with a grain of salt. “There are a lot of complicated factors involved in evaluating whether the program works,” she says. The ultimate outcome they hope for, of course, is decreased maternal mortality. But those numbers are hard for HAI or the Timorese Ministry of Health to measure, given how expensive and difficult it is to gather them. So the key outcome measure remains whether the women use a midwife or doctor. In the most densely populated area with the largest number of midwifery staff—the places “close to the road,” as Mercer would have said in Nepal—the results were swift and impressive: more women came in for prenatal care visits, more women had their births attended by a skilled attendant, and more births occurred in a health facility.

The full article is available here.

APHA’s Georges Benjamin writes a letter on health workers in Syria

APHA Executive Director Georges Benjamin has written a letter to the members of the UN Security Council to enforce a resolution to end attacks targeting health care workers in Syria. You can read the text below.


Dear United Nations Security Council members:

On behalf of the American Public Health Association, a diverse community of public health professionals who champion the health of all people and communities, I write to call on the United Nations Security Council to enforce resolution 2139 to put an end to the attacks on health workers and facilities in Syria.

In over four and a half years of conflict in Syria, nearly 700 health workers have been killed and more than 300 medical facilities have been attacked. According to well-documented reports, the Syrian government is responsible for over 90 percent of these assaults. The disruption of health services is being used as a weapon of war. This year, by the end of October, attacks on medical facilities in Syria had already surpassed the number of attacks for any other year since the conflict began in 2011.

The attacks have decimated the country’s health system. In Aleppo, only 10 hospitals remain of the 33 hospitals that were functioning in 2010. About 95 percent of doctors have been detained, killed or have fled leaving one doctor for every 7,000 residents. There are shortages of medicine and necessities such as clean water and electricity. Hospitals are overwhelmed with patients needing emergency care for conflict-related injuries and patients are dying from treatable conditions.

In February 2014, the United Nations Security Council unanimously passed resolution 2139 demanding that all parties immediately end all forms of violence. The resolution strongly condemned attacks on hospitals and demanded that all parties respect the principle of medical neutrality, and that medical personnel, facilities and transport must be respected and protected. Passing the resolution was a critical first step, but now almost two years have passed since it was adopted and the attacks have continued. We urge the Security Council to take immediate steps to ensure that the resolution translates into meaningful progress to protect health workers and their patients in Syria.

Sincerely,

Georges C. Benjamin, MD
Executive Director

WHO Video: Global Road Safety – Time for Results

This video, posted to YouTube by WHO last Friday, focuses on road safety and traffic accidents, which are a major – and frequently overlooked – global health issue. The video features narration from WHO Director General Margaret Chan, actress Michelle Yeoh, and several people directly impacted by road accidents or fatalities.

The description reads:

This short film, produced for the 2nd Global High-Level Conference on Road Safety held in Brazil in November 2015, highlights the tragic consequences of the lack of safety on the world’s roads and the urgent measures needed to address this health and development crisis. Road traffic injuries take the lives of some 1.25 million people each year, and are the leading cause of death for young people aged 15-29 years.

For more information, visit: http://www.who.int/violence_injury_prevention/road_traffic/en/

Urban Jungle by M. L. Tatum

I returned to Northeast Ohio for a brief visit and was feeling a bit nostalgic; however, I did not stroll through my childhood neighborhood with the same ease of once upon a time ago. I felt a bit apprehensive. With an expressionless face, I kept my head up, looking straight ahead, and making no eye contact, this just did not feel right; it felt so wrong being on guard. What happened?  I am missing the past when neighbors use to watch out for each other. It was okay for strangers to wave and even engage in verbal interactions. What has happened to this once—thriving, working class community? It’s difficult to imagine the beauty of manicured lawns, various flower shrubs, and fruit trees, or the streets filled with vibrant life, as children played ball or hide and seek.

The term “urban jungle” adequately describes the unaesthetic appearance of dilapidated homes, storefronts, and gas stations in need of repair. Not to mention, the abandoned buildings with exposed frames (I assume this is from random people ripping off the siding for quick cash), missing window frames and doors, allowing access to anyone wishing to enter, the yards with overgrown grass and shrubs. It’s a bright beautiful day, but these streets appear dim with an overcast of gloominess.

Urban decay is a public health nightmare. Moreover, the number of related health issues that need to be addressed are overwhelming, including, but not limited to: teen pregnancy, substance abuse, inadequate nutrition, food deserts, gun violence, obesity, lead poison, HIV cases, high school drop- out, unemployment, single parent homes, crime, and the list goes on. In this particular urban community, the land area is 3.09 square miles with 5,782 persons per square mile, in contrast to 282 persons per square mile in the state of Ohio (U.S. Census Bureau, 2015).  According to the most recent US Census Bureau report, the median household income in 2009-2013 for this community was $20,577. Forty two percent of the population lived below the poverty level during this time, with only 33% of the residents owning their home.

Sadly, this is one of many “urban jungles” within the United States that is in need not of destruction, but support. Those who empathize and have the skills should offer assistance to community leaders who are struggling to make a difference.

Potential can, and does, exist anywhere and everywhere. Even in this urban blight, I can see a few community gardens trying to produce edible foods in between abandoned buildings, an adolescent engaging with an elderly man, and a woman picking up trash along the street. These are the stakeholders who would benefit the most from support in such communities.  As humanitarians, it would behoove us to engage, inspire, and assist those who desire positive change, for these communities to thrive once again.  It would not only benefit the immediate community, but us as a nation, overall.urban blight

At least one Congressman is being reasonable about Syrian refugees

In response to an online petition, Dr. Amy Hagopian, our Section’s Nominations Committee Chair, received the below thoughtful reply from her Congressman, Adam Smith (D-WA). The petition asked that U.S. welcome refugees from Syria, despite opposition from xenophobic governors around the country. Here’s a link to a petition YOU can sign!


Dear Amy,

Thank you for contacting me with your concerns regarding the situation in Syria. I appreciate hearing your thoughts on this important issue.

The civil war in Syria is a highly complex struggle between Bashar al-Assad’s authoritarian regime and the fragmented groups that oppose it. As the conflict in Syria has become more violent and protracted, radical elements that directly and seriously threaten our and our allies’ security have become more powerful. It has also become an enormous humanitarian catastrophe. Since the unrest and violence began in 2011, the number of Syrians seeking refuge in neighboring countries or Europe has increased above 4 million. The United Nations Refugee Agency reports that 12.2 million people inside Syria have been affected by the conflict, with nearly 7.6 million displaced internally.

The tragic terrorist attacks in Paris have complicated the situation even further. Our number one priority must be protecting the United States and the American people from terrorist attacks. In the strongest possible terms, I condemn the cowardly attacks in Paris and send my deepest sympathies to the victims. I also welcome the French government’s increased efforts to combat terrorists in Syria. It is important that as we fight terrorism, we must stay true to the values enshrined in our Constitution, remember that we are a nation of immigrants, and not let terrorist groups define or change who we are.

Amidst the conflict, radical groups – like Jabhat al Nusra and the Islamic State of Iraq and Syria (ISIS) – have established safe havens and where, they have attracted substantial financial resources. The strongest and most violent group, ISIS, has continued a campaign of terror and has launched violent and deadly attacks in Northern and Western Iraq. ISIS victories over the Iraqi armed forces have made them a real and dangerous threat to the government in Baghdad and the region. Additionally, the civil war in Syria has attracted a large number of foreign fighters, including from Europe, many of whom are fighting with forces affiliated with ISIS or al Qaeda. As we have seen, these foreign fighters may eventually return to their home countries or go to others where their new combat skills and increased radicalization can be used to subvert other governments.

The civil war in Syria has devolved into a protracted conflict that is dangerously destabilizing. The increasing flows of refugees to neighboring countries place a real strain on already over-burdened public services. Sectarian tensions are on the rise and can lead to further displacement of refugees as host communities become increasingly frustrated with the length of their stay. The humanitarian crisis is quickly shifting from being a consequence of the Syrian conflict to being a potential driver of conflict itself, threatening regional stability. Additionally, the increased activity of Hezbollah, the Iranian-allied militia within Lebanon, and its involvement in the Syrian conflict has escalated tensions between Lebanon and Israel, presenting a great security risk.

The United States has not turned a blind eye to the hurt and suffering of the Syrian people and has been the largest contributor of humanitarian assistance to the crisis, providing over $4.1 billion between Fiscal Years 2012 and 2015. These funds have been used to provide critical, lifesaving services for internally displaced populations within Syria and refugees in neighboring countries, including Jordan, Iraq, Lebanon, Turkey, and Egypt. Channeled through United Nations (UN) agencies and non-governmental organizations, U.S. emergency assistance provides Syrian families with food, medical care and supplies, shelter, and funding for water, sanitation, and hygiene projects.

Due to the worsening refugee situation and immediate need for increased assistance, on July 31, 2015, the U.S. Agency of International Development (USAID) announced an additional $65 million in emergency food assistance. These funds are for the UN World Food Program (WFP), which serves approximately 4 million people inside Syria and 1.6 million refugees in neighboring countries every month.

To help address the refugee crisis, I have taken a number of steps. I supported increased funding for refugee-related program in Fiscal Year 2016 so that resettlement agencies have the resources necessary to help these refugees. I believe that helping our partners in the region and European allies cope with this stressful and destabilizing situation is in our national interest and ultimately helps keep this crisis from devolving into further chaos. I also joined a letter to Secretary of State John Kerry and Secretary of Homeland Security Johnson asking them to increase the number of people eligible to apply for refugee status. I have also called for the Department of State and Homeland Security (DHS) to improve coordination of the lengthy security check process for those applying for asylum, as well as informing families when some but not all of their members have been cleared. Finally, I have joined other members in advocating for the U.S. to increase the number of refugees we are admitting through our resettlement program from 70,000 to 85,000 per year.

To date, of the millions of law-abiding Syrian refugees, less than 1,800 have been resettled in the United States. Applicants for refugee status are held to the highest level of security screening through which we evaluate travelers or immigrants to the United States. If as a result of the security process, U.S. security agencies cannot verify details of a potential refugee’s story to that agency’s satisfaction, that individual cannot enter the United States. I will continue to pursue ways to make sure our vetting process is effective, without unduly burdening bona fide refugees fleeing the terrible situation in Syria and Iraq.

To be very clear, the United States thoroughly vets all refugees. Refugees are subjected to an in-depth interagency vetting process that includes health checks, verifications of biometric information to confirm identity, and multiple layers of biographical and background checks. Moreover, applicants get interviewed in-person. Members of the interagency team includes the FBI’s Terrorist Screening Center, the State Department, DHS, the National Counterterrorism Center, and the Department of Defense. The background check process takes between 18-24 months, happens before an application is approved; and occurs long before a refugee would be able to enter the United States.

The American SAFE Act of 2015, H.R. 4038, which was brought to the House floor for a vote by House Republicans on November 19, 2015, would effectively shut down resettlement of refugees from the Syria and Iraq region. It is wrong to deny asylum to refugees on the basis of inaccurate assumptions, fear, and prejudice, and that is why I voted against it. We must continue to stand strong as an international community and remember that refugees are fleeing terrible conditions and persecution. As we move forward, let us unite to use the tools at our disposal – diplomatic, military, intelligence, and development – to defeat extremism and the terrorism it breeds.

I have also heard several concerns regarding U.S. military involvement in Syria. I am acutely aware of the great cost we incur in both blood and treasure when we ask our men and women in uniform to secure our interests abroad. I share your concerns about becoming militarily involved in another costly conflict in the Middle East. Any consideration of the use of U.S. military force is not one to be taken lightly – especially considering our experiences in Iraq and Afghanistan and the limited ability to affect certain outcomes in those countries. Ultimately, this is a fight between the Syrian people about who will control the future of their country.

The best way to protect ourselves and our allies in the region from the chaos in Syria is by building the Syrian moderate opposition’s capacity so they can stand their ground and fight this war. There is no easy way to identify those elements in the opposition that we can work with, although we have some developed some local allies, such as the Iraqi and Syrian Kurds and some local Sunni allies and are working to identify additional such forces that we can support. By helping those who are fighting ISIL, the U.S. can ensure moderate elements have a chance at playing a role in the creation of an inclusive transitional government, if a peace deal were to be reached in the future.

Due to the extremely concerning developments in Syria and Iraq, the President has taken a number of actions. First, the United States has conducted literally thousands of airstrikes intended to degrade ISIS in Syria and Iraq, reduce their ability to raise money, and to support the local allies we have identified. We are also currently retraining and equipping a number of brigades in the Iraqi Army and Congress has provided over $1 billion for this process. The President also decided that training and equipping moderate elements of the opposition was necessary in Syria. On June 26, 2014, he requested $500 million as part of a supplement to the budget request known as “overseas contingency operations.” These funds would be used to train and equip vetted elements of the Syrian armed opposition to help then fight against the Assad regime. As you may know, this training program did not meet expectations nor objectives and the training portion has been suspended. Since that time, however, the approach has transitioned to equipping moderate elements in hopes of empowering them in this fluid situation, and the President has announced that fewer than 50 U.S. Special Forces will be deployed to Syria to help accomplish this goal. I will continue to monitor developments in the region, understanding that there are always risks involved in conflict and I do not take them lightly.

Moreover, I support the Obama Administration’s diplomatic efforts to find a political solution to the situation in Syria that respects the rights of people. While those efforts have not yet produced any sort of agreement that would lead to an end of the war in Syria, I believe that it is helpful to have the major international countries that are involved in the conflict in Syria discussing possible ways to bring about a political transition and end to the civil war. Hopefully, such a course forward would also address the underlying causes of the refugee crisis. Until a solution can be found, we must continue to help those seeking refuge. We cannot let what happened in Paris cloud our judgement, drive policy or destroy the fabric of what America stands for. We need to be strong and smart to fight terrorism. If we turn our backs on refugees, then we risk making ISIS stronger.

Again, thank you for contacting me with your concerns regarding these important issues.. Rest assured that I will closely follow the continuing developments as they arise. Should you have any additional questions or concerns, please do not hesitate to contact me again.

Sincerely,

Adam Smith
Member of Congress

Ebola after the fact: a news round-up

The Milken School at GWU sent out an interesting e-mail earlier this week with a collection of media stories (basically, a news round-up) about the Ebola outbreak in West Africa. I get quite a few messages from PR departments because I manage the IH Blog, but MPH@GW usually puts good information together, so I do not have any qualms sharing it here:

The recent outbreak of Ebola in West Africa has claimed thousands of lives, and although fewer infections are reported each day, the fight to stamp out the virus continues, and the ripple effects of Ebola will be felt for years to come. Many in the public health community blame the media for inciting hysteria about the risk of contracting Ebola in the United States and contributing to vast misinformation about the outbreak. Despite fear mongering headlines and news features, progress against the crisis is being made, and technological advances are being discovered that will improve the next response to an outbreak of this magnitude. MPH@GW is featuring coverage of the crisis that focused on the real story, and not sensationalist headlines, and highlighted truth, heroism, and new advances.

The hysteria surrounding Ebola in this country was indeed frustrating to just about every public health professional I work with, and it led to some really disappointing political pandering and discrimination. The round-up itself is pretty good, too – I recommend checking it out.