Heading toward Health Reform?

It is beginning to look like health reform could happen, as committees get closer to agreeing on a package and as compromises get made.

On October 16, 2009, ASPH and 43 other public health organizations sent letters of support for the prevention and public health workforce provisions in the House Tri-Committee and Senate Health, Education, Labor and Pensions Committee bills to President Obama. [Read the letter] Any bill that doesn’t address such issues as prevention, workforce and cost will have missed an important opportunity to reshape some of the forces that have caused current problems.

I have been reading an interesting book that is germane to debates about whether some countries manage their health care in ways that produce higher quality, more accessible and more affordable care. TR Reid has written a fascinating book called The Healing of America: a global quest for better, cheaper and fairer health care. His basic premise is that we could learn a lot from countries with better outcomes, countries where health care may be better and fairer. Seeking treatment for a problem shoulder, he visited France, Germany, Japan, UK and Canada. In describing how his shoulder would be treated in each country, he provides a window into choices we might consider in restructuring health care.

I appreciate the fact that faculty members at our School, including Drs. Jon Oberlander, Tom Ricketts and Dean Harris, have been voices of reason in a debate that too often has been one-sided, combative and mean-spirited. (See Health care reform entry.)

Thanking our donors

Last week, we held our third World of Difference dinner, hosted by local Chapel Hill entrepreneur, communications guru and former voice of the Tar Heels Jim Heavner. He really did his homework learning about the School, and it was interesting and gratifying to hear our accomplishments articulated by Jim in a no-holds barred satirical, witty manner. This event is to thank our most generous donors, people who support professorships, student scholarships, buildings, unrestricted funds and so much more. They are the people who make the difference between a really good School and a great School.

We awarded Jonathan Kotch, MD, MPH, the Carol Remmer Angle Professorship in Children’s Environmental Health. Talk about distinguished… Drs. Marcia and Carol (her amazing mother) Angle are two awesome women who have legacies of impact that are stunning. Dr. Kotch has made many contributions to children’s environmental health, but what really struck me about him is that he has trained 150 students. That is a powerful number!

Awed by our students

I am used to being impressed by our students, but the two students who spoke at dinner, Jillian Casey and Virginia Senkomago, overwhelmed us with the force of their words and the experiences that brought them to us. One, Jillian Casey, US born, Phi Beta Kappa UNC undergrad, global health experience, stellar academic training, whose life was changed forever when her parents were killed last year in a horrible traffic accident. Yet, she picked herself up and continued on with her dream of going to public health school. Last spring, she needed financial aid to turn the dream into a reality. We managed to get her support as an Annual Fund Scholar, and she is in her first year as a HBHE student. Professor and Department Chair Jo Anne Earp, ScD was a force to be reckoned with in her relentless pursuit of financial aid. Listening to Jillian tell her story made a lot of us barely able to hold back tears.

Virginia Senkomago, who was born in Uganda, and grew up in Uganda and Kenya, talked about how, as a child, she had been sick often with malaria, and how this made her want to do something in the health arena. She said she wanted to give back and to return to her country to improve the state of health. She had gone to Yale for her MPH and is now a doctoral student at UNC, supported through the generosity of the Tellus Educational Foundation and Louise and Derek Winstanly, Derek Winstanly spoke movingly about why he and Louise gave this scholarship. We also were so pleased that Andrew Waters, of the Tellus Educational Foundation, was in the audience as well to meet Virginia and hear her story. It was an impressive evening, one that reminded me yet again how many people feel a deep loyalty to the School. We need to earn that loyalty every day.

(Photos of the event will be posted shortly.)

12 days to our CEPH reaccreditation site visit!

Happy Monday! Barbara

Celebrating Biostatistics (Bios)

Last week, we celebrated the 60^th anniversary of our department of Biostatistics featuring a huge Festschrift for Professor Gary Koch. During the week-long celebration,  Professor Larry Kupper also was honored for his contributions to the field and to our School. I really admire Larry, and he has won numerous teaching awards in recognition of his role in the classroom. He is appreciated equally as a statistical collaborator on research projects.

The Festschrift for Dr. Gary Koch was held Monday night, and as I looked around, the room was a “who’s who” in biostatistics. It is remarkable how many outstanding statisticians were trained at our School and how many really excellent collaborators have been associated with them. They all came together to recognize Gary and his remarkable contributions. Gary is an eminent statistician, and I’m also very fond of him. When I reviewed  his CV before the event, I was struck by how many different topics he’s studied and in how many areas he’s made significant contributions. His contributions, though, weren’t only the statistical consultation he gave. Many people talked  about how Gary’s mentoring changed their lives He cared about them as people. Their comments reminded me of the important roles our faculty members play in their students’ lives and how positive that impact can be when faculty members are committed fully to the experience. Gary and his wife Carolyn have supported students very generously and are role models in that regard.

The planning committee* for the anniversary event did a great job, and there were lots of amazingly funny, clever and warm tributes, especially to Gary’s legendary propensity for breakfast meetings at some, shall we say, interesting restaurants. There also were several days of state-of-the-science presentations on different aspects of biostatistics.

Experiencing NYC’s new menu standards

I was in NYC over the weekend for a meeting. It was my first trip since menu labeling began. My husband and I went to one of our favorite restaurants, Le Pain Quotedian. It was great to have calorie counts for food and drink items on the menu. For people who heard Dr. Tom Frieden talk at our School a couple weeks ago, this was his and Michael Bloomberg’s policy. What will it take to make this a policy in North Carolina? I do wonder about the accuracy of the calorie calculations and what can be done to assure careful calculations.

While in NYC, we went to an exhibit on design innovation at the Cooper-Hewitt National Design Museum. The focus was not just on design but also on the materials chain and how the entire process can be made more sustainable.

There’s convergence of thinking across multiple fields toward more global sustainability, environmental stewardship, social responsibility, and user-centered design. These trends are totally aligned with public health. We should develop new partnerships given the multiple companies and organizations interested in these issues.

Happy Monday, Barbara

*BIOS 60^th Anniversary and Festschrift Organizing Committee Members: John Bailer, Jianwen Cai, Jennifer Clark, Stephen Couch, Rebekkah Dann, Ed Davis, Jason Fine, Stuart Gansky, Joan Gillings, Amy Herring, Melissa Hobgood, Beth Horton, Peter Imrey, Michael Kosorok, J. Richard Landis, Lisa LaVange, Dustin Long, Evie McKee, Maura O’Donoghue, Tania Osborn, Lauren Paynter, Margaret Polinkovsky, John Preisser, Frank Rockhold, Todd Schwartz, Betsy Seagroves, Maura Stokes, Beth Weiner, Alison Wise, Robert F. Woolson

Dr. Frieden visits

We were so excited that the new CDC director Tom Frieden, MD, MPH, visited with us last week. I was thrilled that our School turned out over 400 people to listen and participate in a conversation with Dr. Frieden. See his bio for background about his local and global experience.

Frieden spoke about 4 priorities:

1. Improving public health surveillance and epidemiology as key foundations for public health. He said it is not sufficient to collect data; data also must be disseminated in a way that is useful for decision making.

2. 

   Support state and local public health action. He said that evidence-based practices don’t just appear. The work of the Task Force on Community Preventive Services is a good example of how evidence is reviewed and summarized.

3. Strengthen global health work. He said that we all are connected by the air we breathe. Partnerships with other countries are important.
4. Improve impact in affecting health policies. Our efforts should facilitate healthier choices.  He spoke about the challenge of altering the trajectory of this country around obesity, a topic about which he already has done so much as the NYC Commissioner of Health who banned trans fats in most NYC restaurants.

I am really encouraged by Dr. Frieden’s priorities and by his emphasis on closing the implementation gap—the chasm between what we know and what we do. He also stressed the importance of providing information that can be used for decision making and emphasized that we in public health should be prepared with evidence-based, well-messaged programs.

We celebrate public health: 10 years of the NCIPH

On Friday October 9, 2009, we celebrated 10 years of the North Carolina Institute for Public Health (NCIPH) with a program that recognized the vision of President Emeritus Bill Friday in conceiving the mission of the NCIPH, Bill Roper, MD, MPH, in creating it, Richard House, Rachel Stevens and others in birthing it and Ed Baker, Jr., MD, MPH, MSc and his team in making it a 21st century powerhouse. I appreciate how important the NCIPH is to NC, particularly to our state and local health directors. Happy birthday and looking forward to many years of working together to improve public health in North Carolina.

NCPHA celebrates 100 years

Last week, the NC Public Health Association (NCPHA) celebrated its 100th year in Asheville, NC. The evening before the meeting, Dave Potenziani, Peggy Glenn and I met with alumni and several of their spouses to get feedback about how the School is doing and what we could do better. We talked about how local health departments (LHDs) are being asked to do more and more-with less and less. Unfunded mandates are a way of life for health departments. A recent National Association of County and City Health Officials (NACCHO) study found that 51% of LHDs were affected by lost hours, layoffs, attrition and mandatory furloughs. This is really unfortunate given the resource-deprived environments in which they already were operating. Over the last 12 months, according to the survey, 55% of LHDs made cuts to important public health programs. The people with whom we met were feeling these cuts, and they look to our School to help. Two messages were clear. These health department directors really value the North Carolina Institute for Public Health (NCIPH) and worry that large, recent cuts indicate a lack of commitment to it. The cuts were mandated by the legislature and do not represent a lack of commitment on our part. The cuts are making things tough, but we will weather them.

These LHD directors also want more of our students to go beyond the counties surrounding the School for their field work. This seems really logical, and we can do better on this. There are some pockets within the state that face health problems similar to those seen in the developing world - both diseases and lack of access to health care. Some students interested in global health may be drawn to these challenges.

What’s not to like about being in places like Asheville, Hendersonville and Wilmington and many other, counties around the state. We have some of the strongest health departments and directors anywhere. Our students could learn a lot and do some good.

Anyway, we had some good discussions, and will work harder to extend our reach.

Our School and its students and faculty were well-represented at the North Carolina Public Health Association (NCPHA) Annual meeting.

I really love Asheville. Its old buildings are a little funky and create an interesting, intimate feeling. It’s a walkable city, surrounded by beautiful mountains. It’s a health conscious city as you can tell by all the signs for massage therapists, wellness centers and healthy food. And for those of us who love dogs, it’s a dog-friendly city-which is OK by me! The trip reminded me of how fortunate I am to live in North Carolina and how important it is to go out beyond the Triangle.

I won’t comment about the losing football game. What’s there to say!

Happy Monday! Barbara

Retirements

Saturday night, Bernard and I joined well over 100 people at a retirement party given by Health Behavior and Health Education, in honor of Linda Cook’s 35 years at the School as a student services manager. For many of our applicants, people like Linda are their first point of contact with the School.  Linda and her colleagues in other departments interpret rules and requirements for our students, and along with many faculty members, help students find financial aid and jobs and support them through life’s crises. They are cheerleaders, advocates and, sometimes, the conveyers of tough love. Frankly, if faculty members were asked to play all these roles, they would get fewer grants and publish fewer papers.  Anyway, the party was spectacular, not in terms of lavishness (it wasn’t) but in the love and loyalty that was displayed and celebrated. JoAnne Earp did a wonderful job recounting, in human terms, the many ways she, as a chair, came to depend on Linda.  Happy retirement Linda! We thank you for everything.  By the way, in this very budget-sensitive year, readers should know the party was made possible by donations from many people, including me.

Thanks and good-bye also to Lesa McPherson, HR manager in Epidemiology, who will retire Wednesday after 30 years at UNC and the School. She got a great send-off from people in Epidemiology and elsewhere in the School who will miss her.  Lesa has been through many changes in the state personnel policies over the years, and has efficiently managed to guide many faculty and staff members through the sometimes-confusing HR policies and procedures. She and all the School’s HR managers keep on top of changes to policies and procedures that allow so many of us to get paid on time. They’re also there to help with any problems or grievances that might arise. We are so grateful for their diligence and patience.

I am moved by the loyalty of people to the School and the School to them.  Unfortunately, we have had to lay people off from their jobs this year (not Linda or Lesa).  This is a difficult topic to discuss because of personnel issues that preclude us from more than general statements, but it has been painful for everyone involved.

NCPHA

I will be meeting some of our alumni and attending the opening session of the North Carolina Public Health Association (NCPHA) in Asheville tomorrow.  Happy Monday! Barbara

New NC Cancer Hospital dedicated

On last week’s very hot Wednesday, I attended the opening ceremony for the new NC Cancer Hospital. It’s a beautiful, light-filled, human scale building. The new hospital represents an amazing transformation from the early 20^th century TB sanitarium that was the Gravely Building. The setting for cancer care at UNC now matches the quality of the health care providers, procedures and science.

Shelley Earp, III, MD, Lineberger Professor of Cancer Research, and director, Lineberger Comprehensive Cancer Center, received a standing ovation even before he spoke. Everyone in that audience understood how much the new hospital bears the imprint of Shelley’s dedication and passion for our patients, this state and UNC.

I was especially moved by Carolyn Sartor, MD, associate professor and chair, clinical research radiation oncology, who spoke movingly, with hope and positivity, about her roles as healer, scientist and patient. She talked about living well with cancer and about all the people in the future who will live well with cancer, because of North Carolina’s investment in cancer care. She said, “We bring the best of the past and the hope for the future.”

The latest issue of our School’s magazine, Carolina Public Health, focuses on the impressive efforts of our faculty to defeat cancer. With the generosity of the University Cancer Research funds, we all can have great hope for the future.

Happy Monday. Barbara

A field of dreams in Chapel Hill

(Monday, Sep 14)

My husband and I paid a visit to the emerging HOPE Garden on Homestead Road in Chapel Hill. Imagine a field of dreams in which UNC students, partnering with others, are cutting bamboo, assembling raised planting beds, creating trellises for beans and other vegetables to grow and much more. (They’re also eating, talking and seemingly having a good time.) They are doing more than creating beds for plants; they are sowing seeds of hope for the homeless and other individuals who will benefit from the fruits (and vegetables) of their labor. David Baron is the heart, soul and brain behind the operation. But he has had a lot of help from many people. Orange County gave land to the project, Department of Parks and Recreation has helped, NC State faculty and stud

ents are providing landscape architecture advice, APPLES is offering service credit, and UNC students are contributing their notable enthusiasm and hard work. And that’s just the tip of the iceberg. This isn’t just about giving to the homeless. It is also about collaborating with them, teaching them and providing the foundation for new independence. We came away uplifted by the potential of the garden but also by the realization of what our students can do when they put their minds to it. David’s tenacity, inventiveness, charisma and vision are awesome. If anyone is interested in volunteering, get in touch with David Baron. The article below from the UNC news provides more detail. There also are beds for anyone to rent to grow food—local, healthy and pretty cheap.

UNC sophomore David Baron receives a Projects for Peace grant for HOPE Garden
Wednesday, May 06, 2009

A sustainable way to address homelessness in Chapel Hill resulted in a $10,000 grant for its creator, David Baron of Atlanta, a sophomore at the University of North Carolina at Chapel Hill. Baron’s Homeless Outreach Poverty Eradication (HOPE) Garden was one of more than 100 student-initiated projects to receive a Davis Projects for Peace grant from philanthropist Kathryn W. Davis.

HOPE Garden is a partnership of Carolina students and the Town of Chapel Hill working in collaboration with the N.C. State University department of horticulture science. In this project, homeless people will train and work alongside volunteers and mentors in a community garden, with land donated by the town. The workers will gain valuable job skills and income, while the organic produce they grow will be sold on the UNC campus and given to disadvantaged families, who could not otherwise afford to buy this fresh, high-quality and nutritious food.

“HOPE Garden will promote employment security, food security and the overall security that comes from strong community ties,” Baron said. “It will promote peace by bridging the gaps that exist in the Chapel Hill community, while providing program participants and the community at large with a greater sense of communal security.”

Davis Projects for Peace invited all students from partner schools in the Davis United World College (UWC) Scholars Program plus students at International Houses worldwide and Future Generations to submit plans for grassroots projects for peace, to be implemented during the summer of 2009. University students from nearly 100 campuses will collectively receive over $1 million in funding during the summer of 2009 for projects in all regions of the world.

Happy Monday. Barbara

Each year as dean, I enjoy the first week of School more than the last year. Easy for me, of course, no books to purchase, no worry about exams to come and no classes. Each year, new students come with great experiences behind them, tremendous commitment, excellent GREs and grades, and immense motivation to change the world for the better.

This year, it was exhilarating to welcome our 529 new students, talk with them about why they have come here and, in some cases, alleviate their anxieties about how well they will perform. From our really smart new undergrads in environmental sciences and engineering, biostatistics, health policy and management and nutrition, to our new master’s and doctoral students across the School, it’s hard not to be excited by what these students already have done in their lives and what they hope to accomplish.

FHI fellows make first-rate presentations

For the last four years, 14 of our students have been selected to serve as FHI fellows through  the generosity of Family Health International, under the leadership of Ward Cates, MD, MPH, President of Research at FHI and a member of our School’s Advisory Council, and Lucy Siegel, PhD, Director of Research Resource Development at FHI.  They’ve  worked with Peggy Bentley and Gretchen Van Vliet at the School to develop the program. Last Friday, Gretchen, Sian Curtis, me, and several others from our School went to FHI’s offices to participate as three UNC FHI fellows (Heather Marlow, MCH, Kate Clouse, EPI and Kate Patterson Gilles, HBHE) presented their work. I doubt most of us on the faculty were as polished at their ages as the three women who presented their work. They’re having excellent, diverse research experiences, developing and testing interventions to reduce risk of AIDS, evaluating clinical trials to prevent AIDS and examining other aspects of the AIDS problem. They’re using new technologies like mobile phones to communicate with at-risk populations, analyzing quantitative and qualitative data, learning how culture influences behavior and spending time in clinics with patients.  The variety of experiences will give them a great head start on their careers after they complete their degrees. We are so grateful to FHI for partnering with us to provide these fellowships.

Senator Kennedy dies; end of an era

I did not think Ted Kennedy’s death would hit me as hard as it did. Unlike the tragic deaths of his brothers, he lived his life in both years and accomplishments. He was there for so much of my life, championing the causes in which I and so many more others believed, exhorting us to do better, care more, treat people fairly, provide health care for all, advocate for those who could not do so themselves-the kinds of fundamental beliefs we in public health hold dearly. Not a perfect man, he was nevertheless a good man. Without Kennedy’s moving oratory and nearly messianic belief in health insurance for all, bitter partisan battles could overwhelm the momentum for change. I hope not.

I was in my mid-20s when I was leaving the Capitol after a hearing about breast cancer reconstruction and insurance coverage (Not so long ago, people debated whether reconstruction should be covered.), an issue on which Ted Kennedy was far ahead of many other people of his time. I mistakenly got on the elevators reserved for Senators and Representatives and was alone on the elevator with Ted Kennedy. I wish I could say that in that brief passage, I said just the right thing, but no such luck. He smiled, I smiled, and we disembarked. Still, it was a moment to remember, even years later when we’d been at some of the same Washington events, and I’d been to testify on the Hill, participated in Rose Garden events and become comfortable in DC. Still, there was always Kennedy.  There is no one like him and his passing is a loss for us all. Still, his dreams should not die.

Happy Monday, Barbara

Welcome back students!

Welcome to our ~1050 returning students and our ~540 new students!

I was so pleased to meet some of you on Saturday at the “Supporting Diversity at SPH” orientation and on Monday at the “School-wide Welcome” for new students that was organized by Assistant Dean for Students, Felicia Mebane (on right extending her hand) and her team (Office of Student Affairs). I am so impressed by the enthusiasm, commitment and curiosity our new students showed.

We’re committed to the full expression of diversity—race, ethnicity, gender, age, country of origin, sexual orientation, political views and disability.

We’re a tolerant school with a track record of civil discourse (unlike those health care town halls!). We don’t tolerate intolerance.

As a dean, I’m accountable. Public health is grounded in diversity, and we want to be more diverse. Help us!

I’m looking forward to Thursday’s “BSPH Welcome/Welcome Back” event.

To all SPH students

I hope your year at UNC Gillings School of Global Public Health is an exceptional one. Please don’t hesitate to e-mail me (brimer@unc.edu) and let me know about your successes and concerns.  Most of all, enjoy your time here, including our incomparable Carolina fall! Go Heels!

Happy Monday.

Barbara

Health care reform — another chimera?

Note: I wrote this Saturday, August 15th. When I got the papers Monday morning, front page articles splashed the news that President Obama might be willing to support a health reform plan without a public plan. It’s a huge change, but one that might make the legislation more palatable — or not. Saturday, it seemed that the whole thing was unraveling. So I wrote…

A lot of people all over the country are talking about what kind of health reform package we will have. I am an optimist on most things. When it comes to health reform, my optimism is shaded with deep concern. The igniting of extreme passions (illustrated by the appearance of guns at health reform rallies), especially on the part of anti-health care reformers, is causing me to worry that, yet again, health care reform will be just another chimera, a vision and dream deferred. Each time health care reform seems breathtakingly close, fear-mongering drowns out rational voices. I spent a few hours in the Atlanta airport last week and found myself speaking back to Lou Dobbs (on CNN) as he authoritatively spoke one mistruth after another about health reform. There was no one answering him but me — mostly under my breath.

The problems with our health care non-system have been catalogued — more than 47 million Americans uninsured, great disparities between those who are minority and those who are not, access problems, waste, geographic mal-distribution of health care, uneven quality of care, and health outcomes that, for many indicators, are worse in the US than in other countries. As Gawande, Berwick, Fisher and McClellan wrote in the New York Times August 13th, “So we are trying to decide if we are willing to change-willing to ensure that everyone can have coverage.” In 2009, we should conclude that we are willing to ensure that all Americans can have health care coverage.

There are many good analyses of the current bills. The bills have many common themes — guaranteed issue, administrative simplification, some but not all cover preventive services, transparent purchasing marketplace, minimum benefit package, individual mandates in some but not all plans, health care delivery reforms, workforce reform (includes public health), and allowable services dependent in part on comparative effectiveness. There’s a lot more, but these are some of the common elements. There’s no discussion of tort reform, but that needs to be fixed.

John Oberlander, PhD, Associate Professor of Health Policy and Management at our school, is one of the most astute commentators about health reform. Here are some links to his recent articles.

There’s no perfect system, but we can do better. We should do better.

Welcome back students!

I look forward to meeting our new students and talking with those who are returning. I love the fact that the sounds of students have begun to replace the sounds of silence in our atrium. Wishing you all a great year!

Happy Monday, Barbara

• Learning from Failure in Health Care ReformPicking the Right Poison — Options for Funding Health Care Reform, N Engl J Med 360:2045, May 14, 2009 Perspective

• Great Expectations — The Obama Administration and Health Care Reform
  N Engl J Med 360:321, January 22, 2009 Perspective

• Health Care and the Recession, N Engl J Med 360:e5, January 22, 2009 Perspective

• The Partisan Divide — The McCain and Obama Plans for U.S. Health Care Reform, N Engl J Med 359:781, August 21, 2008 Perspective

• Health of the Nation — Coverage for All Americans,N Engl J Med 359:777, August 21, 2008 Perspective

• Presidential Politics and the Resurgence of Health Care Reform, N Engl J Med 357:2101, November 22, 2007 Perspective