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Archive for May, 2009

Why public health matters to us all, etc

Tuesday, May 19, 2009

tot060.jpgSpeaking without a net

Last week, I gave a talk titled Why does public health matter to us all? at Carolina Meadows, a retirement community in the Chapel Hill area where my parents live. It is a wonderful community, the kind there are too few of in this country. The support, services and people are fabulous. Although I’d committed to give the talk months ago, it was only about six weeks ago that I learned the room did not permit either slides or video. As an academic, I have become undoubtedly far too dependent upon these tools. And we have a wonderful School video I’d really wanted to show. Once it became obvious that I’d have to create a new presentation, I adapted, with some mental resistance. As I assembled the facts about why public health matters to us all, I became more enthusiastic about the assignment and more appreciative of how important it is to create messages before the slides. It is too easy to become dependent on slides, and sometimes the key points get lost in the dramatic presentation of the slides themselves. There have been many commentaries focused on why powerpoint can be deadly, and they’re right, up to a point.

Here are just a few of the reasons why public health matters to us all…

  • When one person is infected with an infectious disease, it can put us all at risk. As the latest flu virus A(H1N1) shows us so clearly, diseases don’t stop at borders. We are more vulnerable than ever before to diseases that can be transmitted around the world.
  • Lack of access to medical care due to lack of insurance or poor insurance is a national crisis and a local crisis. We have more uninsured people in North Carolina than many other states. In 2006-2007, 22 percent of North Carolinians were uninsured and didn’t have a usual source of health care. The number has increased.
  • Lack of coverage hurts us all. Many uninsured people delay needed care and end up sicker, with bills shifted to others. In North Carolina, people with health insurance pay more for their health insurance premiums  – on average, an additional $438 per individual and $1,130 per family — to help pay for the cost of uncompensated care for the uninsured.
  • The World Health Organization estimates that globally, more than 1.6 billion adults are overweight and 400 million are obese. They estimate that by 2015, there will be 2.3 billion overweight adults. This is a global epidemic that affects us all. Over 180 million people worldwide have diabetes; this number is expected to double by 2030.
  • 36% of North Carolinians are overweight and 30 percent are obese. We have the eleventh highest obesity prevalence in the United States.
  • 30% of our high school students are overweight or obese, and only 44 percent of our high school students meet adequate physical activity levels. Diabetes costs North Carolina $5.3 billion annually due to medical expenses, lost productivity and indirect costs.

And these are only some of the reasons why public health matters. Lack of safe water and sanitation, high-quality maternal and infant health care, and effective violence prevention and so many other issues plague our state, nation and world. Our School conducts research, teaches about and provides service in all these areas and many more.

The Carolina Meadows audience was astute, well-informed and very interested in public health. I appreciated the invitation. And once I got over needing to create a new presentation, it was a good reminder that sometimes one should fly without a net and go without slides!

Nicholas Kristof article

On Sunday in the New York Times, Nicholas Kristof had a very poignant article in which he described becoming pregnant as one of the most dangerous things a woman in Africa could do. In Sierra Leone, 1 woman in 10 dies in childbirth. We can do better. He closed with the line, “…women can be saved in childbirth — but only if their lives become a priority.”  I so appreciate Kristof’s observations on the world. He can awaken millions of people to this problem. Our School works on many aspects of this issue, including family planning. A  new WHO Collaborating Centre in global reproductive health, led by Herbert B. Peterson, MD, professor and chair of the maternal and child health department and a professor of obstetrics and gynecology at the UNC School of Medicine, will develop evidence-based guidelines for family planning and reproduction.

To Twitter or not to Twitter

I really want to use the new social media effectively. But I am trying to grapple with longer days, shrinking budgets and growing needs. There’s a lot of evidence that people in their 20s and 30s use Twitter and that for many of our students, Facebook is the way to communicate. But I am trying to figure out how to do it all and have it all. For the first time, I cannot answer all my e-mails and return all calls every day. So I find myself wondering, how many friends can I handle? I’d appreciate advice from readers.

Administrative review-onward

I was going to talk about the outcome of my administrative review, a process all senior leaders at UNC undergo in the fourth year of five-year terms. However, it’s late, and I risk trying my readers’ patience. So, next week, expect a few comments. Bottom line: I am pleased to have been reappointed. It is an incredibly difficult job, but it is the job I want to do. I love this School and University.

Happy Monday! Barbara

Commencements — Onward Graduates!

Thursday, May 14, 2009

What a week it was!

Our School’s Commencement

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We graduated 312* students—65* BSPH, 197* Master’s students and50* doctoral students and recognized 220 students who were awarded certificates. Many of them were at our School’s ceremony May 9th. I loved seeing our students cross the stage and accept their diplomas (actual diplomas are mailed to them), watching them with their families and seeing the joy of families and friends celebrating their graduates. As I have said before, I came to appreciate this ceremony rather late in life, but I am now a true believer.

As I said in my commencement remarks, we celebrated the transition from the people our students were to the people they had become. I’ve appreciated the opportunity to get to know and interact with many of our students, and I have watched with familial pride as they have matured, taken on leadership roles and become more self-confident. It’s the great joy of this job, and I love it. During the ceremony, we celebrated the fact that our graduates won 6 Impact awards from the Graduate School for research benefiting the state of North Carolina. Two graduates were inducted into two of UNC’s most prestigious honorary societies. 12 graduates were recognized with prestigious external fellowships. One of our graduating students, Elizabeth Torrone, won the Graduate School’s Boka W. Hadzija award for distinguished service by a graduate or professional student. Our students received many other awards from their departments and other organizations. They all are impressive!

I also congratulated students on their volunteerism and gave examples of Engineers without Borders, Minority Student Caucus, Global Health Advisory Committee and the many students who have run road races and marathons for causes and served up beans and rice to fight hunger. I was touched when the mother of one of our graduates came up to me during the reception and said she was so glad that I mentioned our students’ volunteerism. I told her that we expect our students to excel academically and to publish—that’s what professionals do. Volunteering is something that they don’t have to do, but it is so important to the future of the world. I am proud of our students for their wonderful track record of volunteering, their academic achievements and the kind of people they are.

“Being socially responsible means that you commit yourselves to the idea that everyone’s well being is interconnected.”

– Gary R. Grant, Executive Director, Concerned Citizens of Tillery (N.C.)
Gillings School of Global Public Health commencement ceremony
May 9, 2009, Memorial Hall

Sunday Commencement May 12th

unc-commencement-bachelors.jpgWhat a wonderful day it was! The student who spoke implored the graduates not to become disillusioned or cynical if they have difficulty finding jobs. That’s good advice. It is a hard world right now, but our students will prevail.

Desmond Tutu, Archbishop Emeritus and Nobel Peace Prize Winner, Commencement Speaker

tutu_unc-commencement_may09.jpgThe UNC website includes Tutu’s speech in video and transcript formats. Read or watch. He was marvelous, and he had the most wonderful rapport with our students. I like this quote from his speech. “It is such a fantastic privilege and joy to be here with you today. You are just an extraordinary bunch of people. I have a dream that my children everywhere will know that they belong in one family, a family that has no outsiders…

And you, you fantastic people over there. God says, ‘Go on dreaming. Go on being the idealistic people you are. Go on being the ones who believe that poverty can indeed be made history. Go on believing that it is possible to eradicate hunger.’ How can we live and sleep comfortably, knowing that millions of our sisters and brothers go to bed hungry? God says ‘Please, please, help me; help me to make this world a little more compassionate. Help me, please, help me to make this world a little more gentle.’”

Don’t allow yourselves to be affected by the cynicism of oldies like us. Dream, dream, dream of a world that is going to be without terror because there will be people … nobody will have become so desperate, desperate because of poverty, of disease, of hunger.”

Students and all readers, dream. Together, we can make the world a better place! Happy Wednesday. Barbara

(*=number not yet cleared)

Flu, what you can do to stay healthy and commencement

Monday, May 4, 2009

What you can do to stay healthy

Stay informed. This website will be updated regularly as information becomes available.


• Influenza is thought to spread mainly person-to-person through coughing or sneezing of infected people.


Take everyday actions to stay healthy.

    1. Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.


    2. Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hands cleaners are also effective.


    3. Avoid touching your eyes, nose or mouth. Germs spread that way.


    4. Stay home if you get sick. CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.

Follow public health advice regarding school closures, avoiding crowds and other social distancing measures.


Develop a family emergency plan as a precaution. This should include storing a supply of food, medicines, facemasks, alcohol-based hand rubs and other essential supplies.

(From CDC website)

Keeping flu away

The world is preoccupied with a term few people had heard of before a couple weeks ago, A(H1N1). How quickly we learn the new language of fear and contagion. Fortunately, our School has a really skilled All-Hazards Preparedness Committee, and they rallied immediately as soon as it became clear that we needed to react proactively to this global threat. When I say react proactively, what I mean is that our School should respond in the appropriate way, thinking and acting ahead not just waiting for something to happen. For example, we should be prepared to make the right decisions to protect our faculty, students and staff. That means knowing when the School should be open and when it should be closed. It means informing people about what’s happening and how they can protect themselves and others from the virus. Next week, we will start providing hand wipes people can use as an additional protective measure. We should be decisive, proactive and unafraid in dealing with a threat like this and control what can be controlled. As our infectious disease colleagues tell us, a lot is known about influenza viruses.

We also are trying, as acting Centers for Disease Control and Prevention (CDC) Director Rich Besser, MD, and others remind us, to keep the risk in perspective. Each year, about 36,000 people in the US die from the flu. It is not a benign disease for some people. We’ve learned to live with the flu, and rarely does the average person think about these deaths, as tragic as they are. Words like pandemic have an ominous sound that frightens people. The word means across the world, thus, now, there are cases around the world, but to many people, it sounds like catastrophically across the world. So far, we have not seen catastrophe. It’s a situation about which we should take prudent, cautious and appropriate action, with attention to the ethical issues involved.

I’ve been really impressed by what David Weber, MD, MPH, professor of medicine and epidemiology  and associate director, UNC School of Medicine, has been doing to both lead the hospital’s response planning and to communicate about the flu. He told us that UNC Hospitals did an amazing job of finalizing a new emergency wing that has special air handling for infectious diseases. It was supposed to be ready in June but opened May 1, a full week early.

Our SPH preparedness center (N.C. Center for Public Health Preparedness), led by Pia MacDonald, PhD, assistant professor, is doing an excellent job around flu issues. And they have deployed our Team Epi-Aid student volunteers to help the state’s Department of Health and Human Services triage calls.

Jeffrey Engel, MD, state health director, NC Department of Health and Human Services, came to the School Friday to meet with us. As health director, he succeeds Leah Devlin, DDS, MPH whom we think the world of. Dr. Engel has the right perspective on this new flu, and seems to be doing an excellent job of leading North Carolina through it. And we are working closely with the Department of Health.

Most people consider the CDC website the most credible source of information about the flu. Our homepage now has a direct link. At the end of this post, I have pasted tips from the CDC website about staying healthy.

There’s been some good writing in the newspapers (which I still read every day in print) about flu. Reading the New York Times story about the first fatal case in Mexico was yet another wake-up call about how lack of access to good health care can be fatal. First, the woman treated herself, with OTC antibiotics and other measures, then, after she saw no improvement, she visited a doctor who gave her antibiotics and sent her away. By the time she finally got to a hospital, she was desperately, hopelessly ill. There was a good article in the Durham Herald-Sun April 30th by Priscilla Wald, PhD, an English professor at Duke and author of the book Contagious. She wrote that the threat of a pandemic is precisely the moment at which we should be thinking about the fact that access to health care is not a luxury, and that lack of access is a global disaster.

I’ve been reading the 1977 IOM report about how the 1976 swine flu outbreak at Fort Dix, NJ was handled. It’s a cautionary tale about really bad decision making, about how pride, the lack of an evidence foundation and competition between agencies led to a disastrous set of decisions. As the introduction to the report says, “In the waning days of the flu season, the incoming Secretary of what was then the Department of Health, Education and Welfare, Joseph Califano, asked Richard Neustadt and Harvey Fineberg to examine what happened and to extract lessons to help cope with similar situations in the future. The result was their report, The Swine Flu Affair: Decision-Making on a Slippery Disease.”

 Commencement-less than a week away

The campus feels deserted, but the exodus was not apparent. Commencement is less than a week away. I look forward to seeing our graduating students, their families and friends and our faculty and staff.

Happy Monday! Barbara