Addendum: The Circle of Death (by PowerPoint)

As I mentioned in my first day post, I was delighted when I received a flash drive along with my registration materials that contained speaker bios, PowerPoint slides for each panelist’s talk, and background materials for some presentations. One advantage was that I was able to follow each panelist’s presentation on my laptop instead of furiously taking notes and annoying the attendee sitting next to me with my rapid 80 wpm typing. I can also now look over the slides from the sessions I could not attend.

The second advantage was the ability to blog during the sessions – because I was able to tune out the moderator as (s)he read the text from panelist bios, or the speakers themselves as they read from their slides. Alas, this meant that I still annoyed the attendees unfortunate enough to sit next to me…while they were surfing Facebook on their smart phones and iPads because they had zoned out, too.

I wonder if it ever occurs to speakers that no one will listen to them talk if they can just read the slides on the screen. Granted, many speakers did a great job by elaborating on the content of their slides by discussing programs or activities that related to the text; however, we were most likely not listening to that, either – because we were reading their slides. Most PowerPoint presentations are designed as stand-alone pieces and are written to be read rather than as presentation tools, which is what they are supposed to be. This leads to a high concentration of bulky jargon and large words, which in turn causes the speaker to stumble over some words and mumble others as they wade through their slides. If you have had training in public speaking, you understand that people read differently than they listen. Anyone listening to these presentations would be absolutely lost, as they would be unable to process the barrage of bureaucracy-speak that is clumsily read aloud by each speaker as quickly as possible to leave time for other panelists to read their slides just as quickly so that we can get to questions.

Luckily, we all know what is going on because we are reading their slides rather than listening to anything.


This is the circle of death – by PowerPoint. We all go to sessions and panel presentations, read slides, yawn, get bored, and then give the same types of presentations to pay it forward and bore the audience listening to us. It is a disservice to everyone: it numbs the minds of audiences everywhere and allows presenters to escape a true public speaking experience.

The only way to break the circle of death is to build your presentations differently. Use as few words on your slides as possible. Use pictures and data so that your audience is forced to listen to you explain them – you know it better than they do, so you should not have to read it off your slides. Additionally, if we are actually listening to you, we will get your jokes when you actually crack them, thus bypassing the awkward silence as we emerge from our stupor with the realization that you strayed from your “script.” Better still if you do not need any slides at all! It is a truly intimidating and earth-shattering prospect, but I promise that it is possible – orators did it for thousands of years before computers and teleprompters were invented.

Break the circle of death. Save us from having to read your slides while we ignore you reading from your slides. I may not be able to blog as much, but hey – I am much happier to be listening to you instead.

APHA Mid-Year Meeting, Day 2: Public Health Jobs, Prevention, and Wellness (and why the heck does APHA serve sodas at lunch?)

I get frustrated sometimes with the academic nature of policy presentations. I have spent enough time in masters classes and government work to be used to lofty language and bureaucracy-speak, but I wonder at its utility at a conference that is focusing on how the public health rubber is meeting the road in this climate of health reform. The breakout session I attended this morning was on the public health workforce. I scratched my head while trying to understand the connection between the session topic and the Brian Smedley’s (from the Joint Center for Political and Economic Studies) presentation on the disparities between white-dominated and minority neighborhoods (the moderator had to make the connection for the audience). Cynthia Lamberth from the University of Kentucky raised some good points on planning for changes in the number of public health workers that will be driven by reform. She said that while many universities and states are in a “wait and see” mode, we cannot afford to wait – hospitals and clinical establishments and planning now, and the field of public health should be following suit. (She also pointed out the convoluted and outdated hiring practices that make it so difficult for public health graduates to get jobs in academia or with the government, which I definitely appreciated).

The presentation that got me up to the microphone, however, was one by John Lisco of the CDC on their various fellowship programs. Any students or recent graduates reading this blog are most likely familiar with at least a few of these programs – Public Health Prevention Service, Epidemic Intelligence Service, Presidential Management Fellows, etc. – and are also familiar with how incredibly competitive they are. The competitiveness of a program is not a bad thing in and of itself, but in an economic climate (and corresponding job market) like ours, finding work is extremely difficult no matter where the vacancy is. On top of that, many of these fellowship programs have highly specific rubrics and ranking criteria – while the essays have very vague prompts. You have to know someone on the inside to know what the selection panel is looking for in your essay, and how to make yourself stand out among thousands of qualified applicants.

On the other hand, it was great to hear about the experiences of communities implementing prevention and wellness program during the afternoon sessions. Major areas of focus included obesity, smoking cessation, and working to make health foods available in low socioeconomic neighborhoods. I was particularly impressed by the results of tobacco-cessation program in Indiana presented by Carla Sneegas, Executive Director of the Indiana Tobacco Prevention and Cessation Program. The program used a fax-referral system that targeted employers, allowing them to fax in a form to enroll in the program to help their employees quit smoking. The program utilized various approaches, including “quitting competitions” and monetary incentives, and some employers had cessation rates of 50% or more. Kudos to Ryan Kellog from Seattle and King County for calling out APHA on having soft drinks at lunch. He added a slide at the end of his presentation on the Communities Putting Prevention to Work program in King County with the picture of the spread with Coke, Sprite, and Diet Coke. “Why the heck were there sugar-sweetened beverages at lunch today?” Good question, indeed.

APHA Mid-Year Meeting, Day 1: Technology and Socializing

Greetings from APHA’s Mid-Year meeting in Chicago!  This year’s meeting is on healthcare reform, which is fortunate for me – with so much focus on international health news and topics, I unfortunately do not know much about the intricacies of the new healthcare reform legislation, or how it is being implemented on the ground.  I think many Americans are in the same position, however, so hopefully I will gain a better understanding of reform and be able to pass it on to you, the reader!

Upon checking in, I was given a flash drive in addition to a program and a badge holder.  This is such a great resource – it contains speaker bios and (most of) the PowerPoint presentations from each session.  After I arrived this afternoon, I attended one of the first break-out sessions of the conference, “Technology Implications of Health Reform.”  The panel was made up of a representative from CDC, the Kentucky state health commissioner, and the CEO of the Cabarrus Health Alliance (which, believe it or not, is actually a county health department!).  Each one gave his perspective on implementing electronic medical records and building a health information exchange on the federal, state, and county level, respectively.  While I appreciate the excitement surrounding the possibilities of electronic health records (EHRs), I pointed out that even clinicians and health institutions that have them are not able to use them beyond searching for records by patient name or consultation date, plus whatever queries have been pre-programmed into the software by the vendor so that the practice can get the “Meaningful Use” dollars from the government.  I have experienced this in my public health surveillance work – providers have no idea how to pull the information that we are looking for from their records.  We have a long way to go before EHRs are useful on a large scale to public health surveillance and research.

Later in the evening, I had a chance to meet some of the APHA section representatives that were given the same opportunity as I was to attend the meeting.  This is apparently the first year that APHA has been able to bring section representatives to the mid-year meeting, so it is exciting to be a part of it.  The challenge will be thinking about how the information at this meeting can be applied to the activities of the IH section.  What do you think?

Giving Mom(s) a Piece of the Pie: Adding MNCH to the Global Fund

Last week, APHA, along with 58 other organizations, put its John Hancock on an open letter to the board of the Global Fund (pdf), calling on the Fund to “to fully fund the current mandate of the Global Fund; to strengthen the Global Fund’s engagement in maternal, newborn, child, and reproductive health (MNCH); and to mobilize additional resources to support such engagement.” Family Care International, which authored and coordinated the letter, reported an encouraging response from the Global Fund: the board committed to providing guidance to countries on how to integrate MNCH into their requests and to exploring the possibility of “broadening its engagement” as it develops its strategic plan for the next five years.

The prospect of adding MCNH to the Global Fund, while popular, is not without controversy. MCH advocates have been calling on donors to scale up these programs for many years, and proponents argue that organizations like the Global Fund have the drive and resources to implement and coordinate the programs that are so desperately needed to prevent the millions of needless maternal and newborn deaths each year. Others maintain that the Fund’s vertical approach is not appropriate for this issue: Alanna Shaikh argues that a narrow approach focusing on a few factors that affect maternal mortality would not be very effective, and that the funds would be better used by improving health systems in general. The Fund’s shortage of funds is an additional complication – it made headlines this past October when pledges from donors reached a meager $11.7 billion, short of the $13 billion it had set as the bare minimum to maintain its current programs and miles away from the $20 billion it had hoped to raise to expand operations.

IH members raised some very good points in the discussion leading up to the sign-on. MNCH is obviously a top priority and well deserving of attention, and the Global Fund’s current scope is limited in what it can currently do to address these issues. However, the call to expand the Fund’s activities must come with a commitment to help raise the funds needed to do so and to ensure that the energy put toward maternal health works with, and not against, the other programs. It will interesting to see the direction the Fund takes with this as it moves forward.

Make Peace, Not War: State Department’s Quadrennial Review Emphasizes Conflict Prevention

The whole world is buzzing this week about the latest “gate”scandal. This time it is “Cablegate,” sparked by a series of US diplomatic cables released by Wikileaks, which apparently shocked the world by demonstrating that things are not always as they seem on the surface with international politics. Aside from my confusion about why exactly this was news (isn’t it generally accepted in the diplomatic community that everyone is collecting information to send back their HQs?) and my dismay that work to combat human rights violations could be compromised, I was encouraged by the fact that release demonstrated that the State Department is very interested in the the UN and invested in stability and conflict prevention. For example, diplomats were asked to gather intelligence on Ban Ki-Moon’s plans for Iran, as well as information on Sudan and the Darfur conflict, Afghanistan, Pakistan, Somalia, Iran, and North Korea. (The jury is still out on whether this constitutes actual spying, which is illegal at the UN according to international treaties.) The State Department’s own Quadrennial Diplomacy and Development Review affirms this. The review is expected to be released in mid-December. Meanwhile, a draft summary revealed greater emphasis on improving civilian response to conflict. While response has (of course) been mixed, many organizations, including Oxfam America, have praised its emphasis on conflict prevention and response.

Photo credit: Dr. Diane Budd, MSF

This has enormous public health implications as well. In war, obviously, people die. They also get injured, sick, raped, tortured, and traumatized. As APHA’s policy statement on armed conflict and public health points out, the damage that is done to population health and health systems as a result of armed conflict is colossal, devastating, and expensive. In addition to high mortality and injury rates, there are numerous, and often unseen, morbidity complications, including psychological trauma and severe or disabling injuries. Women are left more vulnerable as men are killed, and are targeted for rape, forced impregnation, and sexual slavery by armed groups. Children suffer from malnutrition and are often targeted for ethnic cleansing. Health systems are impaired (if not completely disabled) as equipment is destroyed, supply systems break down, and health workers flee, and they often face a higher burden due to the increased health care needs of the population ravaged by the violence. It is also really expensive: Medact estimated in 2002 that the financial burden of the Iraq war could exceed $150 billion, which would address the health care needs of the world’s poorest over four years.

The policy paper calls for a change in the mindset of public health professionals that war is “an inevitable force in the world” and argues that the profession should embrace the role of conflict prevention as a form of public health prevention. The State Department has indicated that it wants to take that step – shouldn’t we as well?