Newsletter Draft PDF

2009

PH

IT

Public Health Issues Today is a publication by Rutgers University students to inform the community about current issues regarding health and policy in New Jersey. In collaboration with a broad spectrum of public health professionals, PHIT aims to provide research and raise awareness of on-going issues in society.

2011

PHIT MISSION STATEMENT

People often hear about the health care system all over the news; it is compared between nations, detailed in bills, and hotly debated. This is a system that not only encompasses the health care system, but plays an overall role in the health of a nation. Public health tackles complex issues through basic foundations that build into a stronger system. The government—federal, state, local—place a lot of emphasis on developing this system. The Centers for Disease Control and Prevention (CDC) outlines ten essential public health services. The National Public Health Performance Standards Program (NPHPSP), of which the CDC was a collaborator, utilizes these public health services to develop assessments of local and state public health systems as well as the local public health governance. The CDC outlines the 10 essential public health services which provide the framework for the NPHPSP:

1. Monitor health status to identify and solve community health problems.

2. Diagnose and investigate health problems and health hazards in the community.

3. Inform, educate, and empower people about health issues.

4. Mobilize community partnerships and action to identify and solve health problems.

5. Develop policies and plans that support individual and community health efforts.

6. Enforce laws and regulations that protect health and ensure safety.

7. Link people to needed personal health services and assure the provision of health care when otherwise unavailable.

8. Assure competent public and personal health care workforce.

9. Evaluate effectiveness, accessibility, and quality of personal and population-based health services.

10. Research for new insights and innovative solutions to health problems.

These essential public health services are implemented on three major levels: federal, state, and local. The performance of these duties is also assessed in a local public health system, state public health system, and local public health governance. The National Public Health Performance Standards Program (NPHPSP) is one of the collaborative efforts in public health. The partners involved in NPHPSP range from CDC to NACCHO to the American Public Health Association (APHA). Their mission is “to improve the quality of public health practice and performance of public health systems.” The NPHPSP implements its standards by focusing on three instruments of assessment: the state public health system, local public health system, and local public health governance. (Continued on page 5)

Public Health Issues Today

Public Health System of the United States

Snigdha Kanakamedala

Volume 1, Issue 1 Fall 2011

In this Issue: Public Health System of the United States 1 Philosophical Exemptions in Vaccinations 2 Antibiotic Stewardship’s Role in Response to the Growing Threat of Antibiotic Resistance 2 Breastfeeding Policies 3 Emergency Preparedness 3 Common Cold and the Flu 4 NJPHA: Approach to New Jersey’s Obesity Epidemic 4 Get PHIT 6 Budgets Cuts on Local Health Departments 7

Do You Know What You Drank This Morning? 9

State and Local Public Health System of New Jersey 10 New Jersey Schools Advocate Healthy Eating 10 Healthy People, Healthy Communities 12 Injury Prevention in Day Cares 13 The Future of Health Care 14

“Parents would go

forward with

philosophical

exemptions or find ways

to philosophically

exempt their children

from becoming

immunized…”

Public health has made significant strides in the

past century with one of its most successful

accomplishments being the use of vaccines to

immunize individuals. In an article published by the

Journal of American Medical Association, scientists at

the CDC were asked to name ten great advancements

in the last ten years (from 2001 to 2010) within the

spectrum that is public health. Vaccines that have

helped prevent deadly communicable diseases were

among the ten winners and the first to appear in the

article. The marvel that is immunization has brought

into play a number of other vaccinations for other not

so pleasant illnesses.

Although it has been globally demonstrated that

immunizations have improved the health of humans,

many failed to get vaccinated, particularly children as

being the first in line to receive immunizations.

Countless children are not vaccinated due to religious

or medical exemptions. This is a cause for worry

because without vaccines, epidemics of preventable

diseases are at the brink of being fully abolished and

could resurface.

Many parents who do not fall under the categories

of medical or religious exemptions still want to avoid

having their children vaccinated. This need for

“philosophical exemption” is based on personal

superstitions, fears and beliefs. In New York Times

article, “Why Parents Fear the Needle,” author Michael

Willrich explains how many parents still believe that

vaccinations cause autism, thanks to a deceptive 1998

paper. 40% of American parents still refuse to

vaccinate their children in spite of evidence that

vouches for its effectiveness, because any statistical

evidence that demonstrates a slight risk associated

with their use tends to alarm parents.

In a 2009 study by the National Vaccine Program

Office of the Centers for Disease Control and

Prevention, the results demonstrated that parents

would go forward with philosophical exemptions or

find ways to philosophically exempt their children

from becoming immunized due to fears of adverse

effects from the vaccinations as well as trust issues

with the government and healthcare providers. It

concluded that many parents would prefer that their

children be exempt from vaccinations because of

their doubts towards the credibility of the

information provided about the vaccine. (Continued

on page 5)

Philosophical Exemptions in Vaccinations Chani Burgos

Antibiotic Stewardship’s Role in Response to the Growing Threat of Antibiotic Resistance

Jacqueline Baron

Antibiotic resistance has emerged as a growing public health threat challenging the healthcare system of the United States. Prolonged hospital stays, increased incidence of adverse events, and a substantial increase in healthcare expenditure have resulted from drug-resistant infections (Hirshon et al. 1946). Furthermore, antibiotic-resistant infections, such as methicillin-resistant Staphylococcus aureus and Clostridium difficle, pose significant secondary complications to the treatment course. The threat of antimicrobial resistance is intensified by the lack of research and development devoted to the production of novel antimicrobials. In order to reverse the upward trend in antibiotic-resistant infections, healthcare institutions are partnering with infectious disease specialists to implement antimicrobial stewardship programs.

These conservation programs strive to decrease the incidence of antibiotic-resistant infections while improving patient care and reducing instances of adverse patient outcomes. Antimicrobial strategies often incorporate a variety of techniques, including formulary restriction and post-prescription feedback review, as a means of accomplishing the goals of an antimicrobial stewardship program. An antibiotic stewardship or conservation program serves to improve

long-term patient outcomes while simultaneously ensuring effective fiscally sound medical therapies. Specifically, antimicrobial stewardship programs are instituted in order to improve patient outcomes while simultaneously minimizing toxicity, secondary infections, and the rise of newly emergent antibiotic-resistant organisms. The optimized selection and dosage of antimicrobial therapies is utilized as a key strategy to achieve this feat. Antibiotic stewardship programs promote the prescription of appropriate treatment courses in order to reduce negative clinical outcomes. The design and implementation of an antibiotic stewardship program is formulated in order to reduce morbidity and mortality rates of healthcare institutions. The implementation of an efficient conservation program saves healthcare institutions substantial financial resources in addition to reducing the overall cost of medical treatment.

Financial impediments serve as a barrier to the implementation of a stewardship program, however. Healthcare institutions are reluctant to provide the initial financial support needed to institute an antimicrobial conservation effort. Federal guidelines delineating the importance of antibiotic stewardship programs through statistically significant data and analysis can facilitate the implementation of an antibiotic stewardship program. Health care administrators must also be convinced of the effectiveness of antibiotic stewardship programs in non-traditional healthcare settings. To date, majority (Continued on page 6)

Tips from UNICEF

Steps to Successful

Breastfeeding

1. Train all health care staff in skills necessary to promote and encourage breastfeeding

2. Inform all pregnant women about the benefits and management of breastfeeding 3. Help mothers initiate breastfeeding within one hour of birth 4. Show mothers how to breastfeed and maintain location – even if separated from their infants 5. Give infants no food or drink other than breast milk, unless medically indicated 6. Practice “rooming in” – allow mothers and infants to remain together 24 hours a day 7. Give no pacifiers or artificial nipples to breastfeeding infants 8. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic

Dear PHIT,

Breastfeeding is beneficial for babies, and exclusive breastfeeding up to six months is encouraged for optimal child development and health. Studies have shown that those benefits also extend to new mothers and to public health in general. Reasons why a mother may choose to breastfeed include maternal closeness, healthy eating habits, and reduced risk for infection and allergies. According to a Vital Signs CDC report, “A baby's risk of becoming an overweight child goes down with each month of breastfeeding.” Breastfeeding promotion is a major goal of public health initiatives at the national, state, and individual healthcare facility levels. The choice to breastfeed is personal, but that choice can either be supported or undermined by what happens in the hospital in the first few days after delivery. Though most efforts are made by the formula companies to sell their products, new policies will likely cause an increase in breastfeeding practices, with a focus on providing more supportive environments for new mothers. Babies’ health benefits include protection from many illnesses, maternal bonding, and biological defenses against infections. This means healthier babies, happier parents, and lower health costs for individuals and governments. Mothers who choose to breastfeed also experience advantages for their own health. Achieving “baby-friendly” status is cost-neutral for the average hospital. It is possible to speculate that the money saved from treating disease and buying formula could surpass the amount that’s needed to be spent by a hospital to improve its breastfeeding policies.

PHIT Fact!

New Jersey has bills in

practice that urge school

boards to be equipped

with both AEDs and

trained staff…

…however, nowhere is this

binding!

Breastfeeding Policies Lauren Johnson

Marketing efforts by formula companies have been a hindering force to successful breastfeeding policies. Formula is an important alternative for mothers who truly cannot breastfeed for one reason or another, however it provides only a small percentage of the nutrients found in mothers’ milk. There are also hospital constraints that can prevent mothers from establishing basic breastfeeding knowledge such as not having the capacity or resources to keep mothers for a 24-hour stay or hospitals that place newborns in a separate ward to be monitored or receive treatment. Although societal and institutional factors may impede breastfeeding rates, there currently is a new major paradigm shift that regards breastfeeding as the healthier, easier, and smarter choice for new mothers. The Baby-Friendly Hospital Initiative (BFHI) seeks to increase the number of breastfed infants through a series of steps (see figure to left). The policy initiatives and mother education practices currently being used in hospitals can only be improved with time.

Emergency Preparedness Alexsandra Apostolico

For many years, there has been a struggle in the public health sector to increase public access to automated external defibrillators (AEDs) in order to increase the chance of one’s survival. However, as with many issues in the public health sector, funding for such programs are often hard to come by for many public arenas. In response to a need of better access to AEDs, many PAD (public access to defibrillators) programs have been implemented and researched nationally. The benefits of increasing access to AEDs must also be weighed with the costs of implementing and maintaining such a program. Many bills that are currently in practice in New Jersey urge school boards to be equipped with AEDs and trained staff.

In order for a program of this nature to be successful, there must be an increase of trained lay responders (public that is on scene at time of incident, who may or may not have specific training or affiliation with a medical or health care background) in the use of an AED. Without public awareness and training about the use of an AED, increasing access to these devices would render useless. Many are familiar with CPR, yet CPR is a technique used simply to sustain life; it does not reverse, or cure the effects of sudden cardiac arrests (SCAs). The only way to reverse SCAs is to shock the heart into a normal rhythm. This can be done in two ways: either in hospital or out of the hospital in the form of defibrillation. There must be someone on scene with knowledge of what to do and at the right moment. It is imperative to have an influx of the public trained to use AEDs because time is the biggest factor concerning the survival rate of victims experiencing sudden cardiac arrests. Additonally, programs must be implemented to increase public access to AEDs where it is economically feasible. Although formal training is not necessary in order to correctly use an AED, training of individuals in highly public settings (teachers, coaches, cashiers, doorman etc.) will reduce the hesitation when it comes to an emergency. Public access to AEDs means nothing without those who are able and willing to use them.

NJPHA: “Building Healthier Communities: A Transdisciplinary Approach to New Jersey’s Obesity Epidemic”

Origins & Control

Dr. George Rhoads, the Interim Dean of the

UMDNJ-SPH, spoke on December 6, 2011 at

New Jersey Public Health Association’s annual

meeting about the obesity epidemic occurring in

New Jersey. He compared behaviors of people

today to the creation of foie gras (French for fat

liver from a purposefully fattened goose or

duck) – those today force-feed ourselves to the

point of excess. He points out this trend is a

worldwide dilemma and it affects more than

health. For example, 27% of young men are

rejected from the military for having a high BMI

(body mass index). Having high BMI’s account

for 16% of diseases worldwide.

Early & Late Health

If obesity hits early, there are a range of

health problems that can occur. These include

high blood pressure, increase in lipids,

cardiovascular risk, loss of self-esteem,

psychiatric problems, compromised ability to

exercise, and even sleep apnea. It is best to

prevent obesity through education and good

eating habits early because it is easier to

avoid rather than treat obesity. If every obese

person could lose the excess weight effortlessly,

there would not be an obesity epidemic.

For those that have suffered from obesity

for many years, there are multiple and more

serious health effects that are harder to treat

and/or live with. A few examples are type two

diabetes, orthopedic problems, joint

replacements, heart attack, stroke, disability,

lymphedema, cancer, and death. Obesity is not a

joke; it can quickly develop into a life-

threatening stage if action is not taken.

Policy Making

At the conclusion, Dr. Rhoads pointed out

that we must address obesity in kids and we can

achieve this best through policy. Similar to the

action taken on lead, we must understand the

danger of obesity and combat it in several ways.

Improving school lunches, increasing physical

activity, providing education on healthy eating,

and selling fruits and vegetables.

Every year when autumn makes its appearance and turns into winter, there’s a consistent trend of people of all ages becoming sick. This trend is apparent, yet who or what exactly is the culprit? Sometimes it takes a few questions to determine the answer and more often than not, the common cold or the flu is to blame. Yet, how can one tell the difference? Refer to the chart on the left to decide whether or not you are suffering from a cold or the flu. The flu is a viral infection caused by a respiratory virus known as the influenza virus – it is preventable with a vaccine. A common cold is also a viral infection, but it is caused by varying types of viruses therefore no vaccine exists. However to avoid both the cold and flu, precautions are similar. Wash hands often, don’t share cups or utensils, and avoid contact with those affected. An additional defense for the flu would be to also get the flu shot. Furthermore, don’t categorize your sickness as a cold straight off the bat. If you suspect you may have the flu, it’s important to call your doctor right away. Bacterial diseases such as pneumonia or strep throat can also resemble the flu or cold. You can never be too safe!

Do you know… the difference between

a common cold and the flu? Aisha Akhter

Concern Flu Cold

Was the onset of illness…

Sudden? Slow?

Do you have a… High fever? No/mild fever?

Is your exhaustion… Severe? Mild?

Is your head… Achy? Headache free?

Is your appetite... Decreased? Normal?

Are your muscles… Achy? Fine?

Do you have… Chills? No chills?

PHIT Fact!

America has the highest rate of

obesity in the world.

New Jersey’s obesity rate has

increased by 90% in the past

15 years!

[ ]

Dear PHIT,

Is bottled water safer to drink than public drinking water?

“Bottled water is

not any safer than

tap water. The

difference lies in

the government

regulator: Bottled

water is regulated

as a food by the

Food and Drug

Administration.

Tap water is

covered by the

Safe Water

Drinking Act,

administered by

the Environmental

Protection

Agency.”

“Public health

tackles complex

issues through basic

foundations that

build into a

stronger system.”

(Continued from page 2)

Unfortunately, these parents fail to see the

necessity for childhood vaccinations for a variety of

reasons. Children who are of age to go to school are the

most vulnerable group when it comes to susceptibility

of preventable infectious diseases and thus have the

highest attack rates of these diseases. Children are at

risk of contracting diseases, a chain reaction occurs

where people in their peripheral are also at risk of

transmission of these diseases. Even if only some

children are vaccinated, outbreaks can happen and

cause epidemics because “epidemics occur even in

immunized populations when clusters of susceptible

individuals exist and are exposed to a contagious

individual.” This is precisely why all children must attain

proper vaccinations; if all children are vaccinated, the

vaccination will remain strong and immunity will not

dull out. In terms of the betterment of public health,

herd immunity is an important concept within the scope

of immunizations. According to the National Institute of

Allergy and Infectious Diseases, if a significant portion of

a populace is protected from a disease through

vaccination, then the majority of the community is not

at risk because there will be only a very small likelihood

of an outbreak.

Herd immunity not only saves the lives of those

who may not be able to be immunized, but also creates

a positive impact on the economy. In an article

published by the Journal of the Academy of Pediatrics,

herd immunity for the disease, Hepatitis A has

demonstrated to have decreased the number of monies

spent on immunizations for the disease. The decline of

the disease was much higher than expected for only

protecting individuals who had the vaccine. It was then

concluded that there was such a decrease in the disease

courtesy of herd immunity. As a form of public health

intervention, it concluded that herd immunity had the

ability to make prevention programs for infectious

diseases more cost-effective.

Research has demonstrated that when

philosophical exemptions are allowed, the number of

under-vaccinated children across the states rises. The

state of New Jersey allows only medical and religious

exemptions. Although New Jersey does not have

philosophical exemption in place, it does not mean

people have not tried. Marianne McEvoy, Registered

Nurse and former president of the New Jersey

Association for Public Health Nursing Administrators

stated that about a year ago or so many individuals

instigated adding philosophical exemptions to the list of

New Jersey exemptions. NJPHNA went as far as to

document the reasons why it would be unacceptable to

allow philosophical exemptions in New Jersey and

demonstrated it to the Senate.

The war regarding philosophical exemptions is a

debate nationwide. If there is a separation of church

and state, yet religious exemptions are allowed, by not

allowing philosophical exemptions, does this mean that

the government is imposing and controlling what we

have a say in? Or is it a question of the public’s health is

more important than an individual belief? One thing is

for sure: vaccines have given a great deal to the

advancement of public health.

Philosophical Exemptions in Vaccinations (continued)

Chani Burgos

(Continued from page 1) Overall NPHPSP seeks to provide standards all

the while identifying areas of state and local improvements so that “day-to-day public health issues as well as public health emergencies” receive effective responses.

The statewide performance improvement planning requires implementing multiple assessments in order develop statewide action plans. The definition assigned to the local public health system is merely extended to accommodate health and well-being to the state level (State public health system). In order to have a representative assessment, an ideal group is one which is “broadly representative of the public health system partners.”

The local system improvement planning requires planning of every responding local public health system based on CDC quantitative reports as well as ideas from prior assessments. The local public health system is defined as “any organization or entity that contributes to the health or well-being of a community.” The Local Public Health System includes the ten essential services it is tasked with upholding and also includes specific model standards under each service.

Finally, the governance body improvement planning requires that a plan is formed for the board of health and that the boards work with local health officials and agencies to identify a plan for

Public Health System of the United States (continued)

Snigdha Kanakamedala

improvement. Governing bodies are defined as “the individual, board, council, commission, or other body with legal authority over the primary governmental public health agency, usually defined as the health department” (Local Public Health Governance). The authority not only varies by state but also within state jurisdictions. It seeks to keep moving towards continuous quality improvement so that the board of health members understand their role and strengthen their abilities as overseers of public health.

(Continued from page 2) of the research supporting the effectiveness of antimicrobial stewardship has been conducted in tertiary or university-associated medical centers.

Impediments to the successful implementation of an antimicrobial stewardship program include lack of financial resources or available staff. Therefore, continuing research through randomized, clinical trials and surveillance-based techniques are needed to convince the medical community of the efficacy of antimicrobial stewardship programs in health care settings of varied sizes and geographic localities. In coming years, the advocates of antimicrobial stewardship must build on the broad applicability of antimicrobial conservation efforts across a variety of medical settings. Additional studies evaluating the effectiveness of antimicrobial strategies incorporating large sample sizes and the reduction of confounding variables may be used to evidence the great measures of change that can be implemented as a result of an antibiotic stewardship program.

Shaping NJ is the state of New Jersey partnership for the Nutrition, Physical activity and

Obesity Program. The Shaping NJ goal is to reduce obesity and promote healthy and active

communities. Shaping NJ works in communities, health care facilities, work sites, child care,

and schools. The program focuses on environmental and policy changes around obesity

and chronic disease prevention. Obesity is a serious public health issue that puts citizens at

greater risk of chronic diseases like diabetes, hypertension, and heart disease. It is not enough

to promote physical activity and healthy eating habits. People need access to healthy foods and

safe environments for play and recreation.

Shaping NJ encourages a high intake of fruits and vegetables, physical activity, and the practice of

breastfeeding. Nutrition is significant in health promotion and disease prevention. Eating right can help reduce

the risk of obesity and chronic diseases. Physical activity gets the heart pumping and strengthens muscles.

Scheduling 30 minutes for physical activity makes a whole difference in a person’s lifestyle. For the busy adult,

before or after work is an ideal time to jog, walk, or cycle. Children are encouraged to partake in recreational

activities and play. In regards to breastfeeding, research shows that breast milk is the best food for a baby.

Breastfeeding contains nutritional, economical, and emotional benefits for a mother and baby.

Shaping NJ focuses on these key behaviors:

TV Viewing Fruit & Vegetable Consumption

Energy Dense

Food Consumption Physical Activity

Sugar-Sweetened

Beverage Consumption Breastfeeding

Dear PHIT,

What can I do with a Public Health major?

“Public health is a multi-disciplinary

field with areas such as health policy and

management, behavioral science

and health education,

epidemiology, environmental and

global health. A bachelor’s degree is for areas like health

education and environmental

health. A master’s degree is for

management, administration, and university teachings. A doctoral degree is

for the highest levels of

administration, research, or

university teaching positions.”

“…advocates of antimicrobial

stewardship must build on the broad

applicability of antimicrobial conservation

efforts across a variety of medical

settings.”

Antibiotic Stewardship’s Role in Response to the Growing Threat of Antibiotic Resistance (continued)

Jacqueline Baron

Get PHIT Eurelle Hao IN

CR

EASE

DEC

REA

SE

Dear PHIT,

What is public health?

“Public health is the

science of protecting

and improving the

health of entire

populations. Public

health professionals try

to prevent issues from

happening or re-

occurring through

educational programs,

policies, services,

research, and

regulating health

systems and some

health professions.

Public health is the

fight for health care

equity, quality, and

accessibility.”

Public health works towards improving the overall health of a population at a community-based level through the emphasis of illness and injury prevention, as well as the reduction of preventable chronic disease

1. The global

economic crisis has led to massive budget cuts, affecting the growth of developing countries. Furthermore, the sharp decline of the United States economy has led to significant budget reductions and increased levels of unemployment. Individuals without health insurance in the community, as a result of job loss, are now relying more on the assistance of health care systems. In turn, the increasing demands, and insufficient availability of resources heavily pressure public health infrastructure. As a direct result of decreased funding and weakening public health infrastructure, local health departments are finding it more and more difficult to protect the general health of a community-based population, thus resulting in adverse consequences and strain.

Budget cuts have made a rough impression globally. The global economic crisis has resulted in the loss of millions of jobs worldwide, especially developing countries, who suffer the most. When developed countries such as the U.S., U.K, France and Germany face such economic struggles, international financial aid distributed to developing countries is dramatically reduced. According to BBC News, in 2009, a predicted 51 million jobs globally could have been lost due to the global economic crisis.

Without proper federal funding to public health systems, services provided have greatly reduced in quality. Public health services require stable infrastructure, which is at risk due to a lack of funding. Resource reductions, such as staff cuts, negatively impact the capacity of public health systems to respond to health hazards in a timely manner. The purpose of public health infrastructure is to provide care to increasing demands as well as to implement productive public health practices. Public health infrastructure is weakening through cost reductions, and the repercussions are not only negatively affecting those whom have lost their jobs, but also the individuals who remain on staff.

Before the Great Recession, the state of New Jersey was already in an economic crisis; thus, their ability to overcome the reduction in funding has been difficult. To compensate, the state has reduced funding to various organizations in New Jersey, one being health care. For example, Governor Chris Christie put a freeze on New Jersey FamilyCare enrollment for adults. The Freeze on New Jersey Family Care became effective as of March 1, 2010. Therefore, parents within 134% - 200% of the Federal Poverty Level, which were not previously enrolled in New Jersey FamilyCare will not be allowed to enroll. This action will directly affect 39,000 adults.

According the U.S. Bureau of Labor statistics in comparison to other states in the nation, New Jersey lost more jobs. In addition, between 2008 and 2009 New Jersey lost over 114,000 jobs. To add to this deficit, in January 2010 over 9,100 positions disappeared. As financial and human capital are depleting in the state of New Jersey, the need for population-based health care is essential.

Public health services require stable infrastructure, which is at risk due to a lack of funding. Resource reductions, such as staff cuts, negatively impact the capacity of public health systems to respond to health hazards in timely manner. The purpose of public health infrastructure is to provide care to increasing demands as well as to implement productive public health practices.

As more public health workers become unemployed, the ability of workers in the field, to manage and protect the health of the population, reduces. Furthermore, with reduced funding towards public health methods, health care services with become disjointed due to a lack of preventative based services. For example, many health departments around the nation are cutting back on the number of community-based prevention services such as pregnancy prevention or clinical mental health services. Decreased federal investments in healthcare and the surplus of individuals without health insurance, leaves state and local health departments saturated with individuals seeking medical assistance. Health departments are responsible for protecting the health of the public. In most situations, local health departments (LHDs) are the first to arrive on scene during an on scene during an epidemic breakout. Although local health departments are essential to protecting the overall health of the community, they often go unnoticed. One LHD official stated, “Unless there is an outbreak, no one even knows that we exist. We operate diligently and quietly in the background, keeping our community healthy and safe.”

Funding for LHDs comes from a combination of local taxes, as well as state and federal grants. In response to the economic downturn, federal and state grants have not been able to fully provide for the high demands of local health departments, thus, adding to the already insecure public health infrastructure. Countrywide, about $300 million has been removed from local health department budgets in 2008.The decrease in funding resources has negatively affected LHDs to fulfill their responsibilities and effectively generating health care delivery.

Assessments, policy developments, and assurance are important roles to health changes in the community. Assessments are evaluation and information on the release of hazardous substances. According to the Agency for Toxic

“According the U.S. Bureau of Labor statistics in

comparison to other states in the nation, New Jersey

lost more jobs.”

Economic Crisis, Budget Cuts and Their Effects on Local Health Departments

Mona Hariri

Pro

and Disease Registry (ATSDR), factors which must be considered in all public health assessments are: (1) nature and extent of contamination, (2) demographics (population size and susceptibility), and (3) pathways of human exposure (past, current, future).

Policy formation can assist in the

reduction of multiple causes of health

concerns. For example, policy development

can require all children below the age of two

to receive a type of vaccination. When LHDs

attempt to implement a policy, they will

present their issue to the county or city

executives or boards, to mandate and

enforce the policy. Such policies can include

the requirement of vaccinations in schools,

setting up health clinics in the community, or

improved disease supervision in the local

community. “Increasingly, assessment and

policy development work address

preparedness for biological threats and other

emergencies where the local health

department frequently plays a leadership role

since disease outbreaks, environment

hazards, and natural disasters such as floods

and earthquakes affect human and

environmental health

profoundly.”

Without the support

of the local population

through assurance, LHDs

would have difficulty

functioning. Although,

assessment and policy

development are essential

roles of LHDs, assurance

builds trust and confidence in LHDs within a

community. The purpose of assurance is to

clearly and effectively communicate to the

public the identification of an outbreak and

efforts taken to safeguard community health.

Interactive communication with local citizens

in a community reduces uncertainty and

chaos through informing and educating

citizens regarding steps they can take to

improve their health status. Effective

communication between LHDs and

individuals in a population created

community partnerships. Thus, improving the

trust these community members have in the

LHDs, promotes collaborative change in

preventative efforts.

Funding resources are received from a

combination of local, state and federal

government capital. The federal government

provides the greatest amount of funding

from a diverse range of resources: (1) the

Centers for Disease Control and Prevention

(CDC), (2) the Health Resources and Services

Administration (HRSA), and (3) the Substance

Abuse and Mental Health Service

Administration (SAMSHA). With the U.S.

economy in turmoil, many of the health

administrations previously listed are also

facing budget cuts, thus, affecting their

overall funding allocated to LHDs. Roughly

17% of financial income is received from the

state, but it has passed through the federal

government. However, with negative effects

still being felt from the Great Recession,

responsibilities of LHDs are being negatively

impacted.

LHDs can no longer afford to staff as

many health care workers as in previous

years. Between 2009 and June 2010, in 28

states around the nation, over half of LHDs

lost staff. In addition, more than half (52%) of

all LHDs experienced adverse repercussions

in 2010, loosing over 6,000 employees which

decreased the working capacity by one-third.

Furthermore, the individuals who are still employed face the repercussions of tight budgets though the in inability of LHDs to offer salary rises due to wage freezes. One

health officer stated, “We have not been able to offer raises and the lagging salary scale we operate by has been a detriment in recruiting and

retaining qualified people.” When positions become available, they are not filled quickly. When attempting to employ interested candidates, one local health officer stated, “Due to the low wages offered to new employees, I will begin an interview stating the salary amount. There have been times when individuals will stop the interview because he/she will not work for the amount offered.” LHDs have difficulty offering competitive salaries because of the drastic reduction in funding, which in turn, has many qualified professionals switching to more competitive, higher paying fields. With the recent downturn of the U.S. economy, LHDs are faced with fewer resources. To make up for reduced funding, LHDs have been forced to cut effective prevention programs and other programs essential to protecting the health of their communities. Furthermore, with the drastic reductions in prevention programs, many susceptible populations will seek medical attention in emergency room visits, thus,

increasing the burden of healthcare cost on the economy. LHDs frequently use public health laboratories, during the assessment of potential disease outbreaks. Many LHDs depend on the state-operated public health laboratories to analyze test samples and provide accurate results. While public health laboratories are essential for the collaborative entity of LHDs, one public health laboratory director cautioned, “CDC provides categorical funding, which is in essence organizing my lab and determining what we do. But CDCs categorical funding has allowed the state general funds to be reduced.” In total, 96% of all governmental laboratories have had some form of detrimental budget cuts resulting in reduced staffing, and the inability to purchase quality equipment. Public health laboratories are now less prepared to respond to emergency scaled events in a timely manner due to decreasing capital from the state government. The repercussions on public health laboratories directly affect their ability to function at maximum potential. The Affordable Care Act, recently passed

by Congress and endorsed into law by

President Barak Obama in March 2010, will

help protect the health of the population.

With the recent passage of this law, $650

million will go towards a “Wellness and

Prevention Fund,” in hopes of improving the

nation’s health through focused prevention

programs. The Affordable Care Act improves

health care accessibility and improves the

burden of health care costs on the nation

through various measures, one of which

includes increased funding to preventative

care. Since the burden of medical costs will

be reduced due to more citizens becoming

insured than uninsured, more focus can be

put towards prevention techniques and

public health goals.

Moving forward, preventative care

programs have the potential to save millions

of lives by diagnosing medical conditions at

an early stage before they become life

threatening. Focusing more attention, and

federal funding towards organizations, which

offer prevention programs, can greatly

reduce long-term costs and health

consequences of the nation. These efforts

can be done through community partnerships

and educating the public about the

importance of organizations, like LHDs, which

offer such services. With economic hardships

increasing stresses endured by the nation’s

citizens, preventative care is essential to

improve the health of these individuals.

“Governor Chris Christie put a freeze on New Jersey

FamilyCare enrollment for adults. The Freeze on New Jersey Family Care became

effective as of March 1, 2010. Therefore, parents within

134% - 200% of the Federal Poverty Level, which were not

previously enrolled in New Jersey FamilyCare will not be allowed to enroll. This action

will directly affect 39,000 adults.”

According to recent news and tests, most well water in the United States is not safe for

drinking or personal use because of environmental pollution and contamination. Bacteria, chemicals, and elements pollute water sources, exposing many people to serious conditions and illnesses each and every day. These contaminates are beginning to seep into private water wells, and cause issues throughout the state of New Jersey. At this point in time, all of the sources of water are contaminated with some sort of pollutant. Contamination of drinking water has been an ongoing issue in private water wells in the state of New Jersey. Arsenic is one of the leading contaminants of drinking water, and has proven to be unsafe if ingested. It is also important to discuss how ground water gets contaminated, and how water could be prevented from arsenic contamination.

The Environmental Protection Agency, and The New Jersey Environmental Health Association strives to reduce levels of arsenic in private water wells. People in the community should be aware that there is a Private Well Testing Act in place. The Private Well testing Act will be discussed in detail throughout the paper. The goal of the PWTA is to ensure that people that are purchasing properties that use private wells are protected and aware of the quality of water that is being dispersed from the well prior to their purchase. Arsenic is associated with numerous health risks that can affect properties and people that use private water wells; therefore, it is significant to do research and inform the community and homeowners on what they can do to reduce water from becoming contaminated by arsenic. Arsenic is an element that is produced by nature and can be found in the Earth’s crust and all throughout the environment. There have been many uses for the element. It is interesting to note that during the 18

th-20

th century, arsenic was used in medicine for various reasons. It was commonly

used in the treatment of cancerous tumors, and is still used today, but only in subtle doses that are not toxic to the human body. Although in some cases, arsenic may be used for the betterment of life, it causes a number of environmental issues in the state of New Jersey. The contamination of drinking water by arsenic has caused various toxic epidemics throughout many communities. Arsenic and its isotopes are commonly categorized as toxic and poisonous elements. Therefore, it is obvious that it may not be ingested in large amounts, especially in drinking water. Studies have shown that even a low dose of arsenic compromises the human body’s immune system, which can result in serious illness or death, in some cases. The International Agency for Research on Cancer classifies arsenic as a group 1 carcinogen, which means that it is an agent that causes cancer in humans. Predominately, arsenic is used as a wood preservative. Arsenic naturally exists in 2 forms in ground water, as arsenite or arsenate. The element may change in the environment, but it cannot be degraded. Due to the fact that arsenic is a natural element that exists in the earth, it can be found all throughout the environment and in ground water. The Department of Environmental Protection states that “the chemical and physical properties of the geologic material may enable the arsenic to become mobile” (Buchanan), and this is where arsenic may become dangerous to human consumption. Results from testing conducted by the New Jersey Geological Survey indicate that “elevated levels of arsenic exist in some aquifers of the Piedmont Province where arsenic has been detected at levels above 5 parts per billion (ppb). Levels as high as 60-80 ppb have been detected in drinking water in this area” (PWTA Program). The Environmental Protection Agency steps in and conducts research and tests to see where the levels are at in surrounding towns and counties. When this study was conducted, 49 out of 238 wells were over the limit of 5ppb. Because of increased levels of arsenic, in September of 2002, all private water wells were required to test of arsenic in the water if there located in the 10 counties of the Peidmont region. In the past, arsenic was used as a pesticide, before other ingredients were available. As a result, arsenic is used by farmers and crop holders in fertilizers and as pesticides. Therefore, if they sprayed arsenic pesticides on the soil or ground, there may be a possibility for it to get into a well and contaminate the water. The other ingredients in the pesticide can interact with arsenic to make it mobile and toxic for consumption and ingestion. So, water may be contaminated by arsenic solely because arsenic exists naturally in the earth, or it may be as a result of man that continues to utilize arsenic for agricultural reasons. Since arsenic occurs naturally in the environment, soil, and nature, it may enter the “air, water, and land from wind-blown dust, and may get into water from runoff and leaching. A 2008 article from the Environmental News Service observes the increase of radioactive arsenic in drinking water near Trenton, NJ. (Continued on page 11)

The new health care reform, passed by President Barack Obama, leaves hope for individuals personally affected by the Great Recession. This is because, as more citizens in the U.S. are losing their main source of income and becoming uninsured, access to preventative care programs can significantly reduce the long-term burden our nation will face.

Improvements to public health infrastructure heavily rely on the populations’ ability to recognize the positive impacts public health has on community-health. Although, as LHDs are faced with prioritizing which services are “more important,” the perception of availability to health services may shift in a community. Therefore, less members of the population are utilizing these services, increasing the risk of chronic medical repercussions, which could have been avoided. Building a solid foundation of community trust and participation in local advocates increases the likelihood of policy initiatives, thus, speeding up positive changes, which can be made in organizations offering preventative services such as LHDs.

Do You Know What You Drank This Morning? Kristina Reveron

The New Jersey’s Department of Health and Senior Services developed standards that correlate with the national standards and thus the ten essential services. According to the Department of Health and Senior Services, New Jersey’s governmental public health system is being “modernized to ensure the highest level of local health department practice and performance.”

In 2003, new regulations were developed so that the system could experience the potential benefits such as a healthier populations, improved handling of emergencies and disasters, improved data collection and analysis, increased capacity to partner with private and nonprofit health systems to leverage resources, improved infrastructure to strengthen all local programs, and increased ability to focus resources, target areas of need and develop justifications for additional funding.

The local board of health refers to any board of health with the authority to “regulate public health or sanitation by ordinance.” The term local health agency, on the other hand, refers to any local, regional, or county agency or department that is “administered by a full-time health officer and conducts a public health program pursuant to law.”

One of the most often asked question is to define the meaning of “public health.” New Jersey local standards define it as “organized societal efforts to protect, promote, and restore the people’s health, and societal activities undertaken to assure the conditions in which people can be healthy.” The standards make sure to specifically point out that this does not only mean government-based efforts but organized community efforts that “prevent, identify, and counter threats to the health of the public.” The definition assigned to the local public health system is extended to accommodate health and well-being to the state level.

In order to have a representative assessment, an ideal group is one which is “broadly representative of the public health system partners.” The New Jersey state public health system performance assessment (SPHSPA) found on the website of the New Jersey Local Board of Health Association is an example of the NPHPSP’s assessment and how quality improvement is achieved. It goes through all the essential services and standards and looks at where improvement was made, where improvement can be made and attempts to foster a conversation about each service. For example, the assessment concludes that workforce improvement achieved the least improvement. Pinpointing the issues, ranging from the need for improved technology to how specific populations like immigrant groups are difficult to reach, assures that a system gets better.

PHIT Fact!

“In 2009,

36.6% of

adults in New

Jersey

consume

fruit 2 or

more times

per day

compared to

the 32.5% of

adults in the

U.S.”

“…prevent,

identify, and counter

threats to the health of the

public.”

The State and Local Public Health System of New Jersey Snigdha Kanakamedala

The New Jersey Department of Agriculture and Rutgers Cooperative Extension’s Department of Family and Community Health Sciences have granted nine New Jersey schools to receive $7500 mini-grants for programs to encourage good nutrition to students. These programs will encourage students to consume more fruits and vegetables, as well as learn about good nutrition and promote locally grown produce. Aura Elementary School in Elk Township; Cape May City Elementary School in Cape May; Chesterfield Township Elementary School; Ethel McKnight Elementary School in East Windsor; Francis A. Desmares Elementary School in Flemington; Knowlton Township Elementary School; Mount Prospect Elementary School in Basking Ridge; Queen City Academy Charter School in Plainfield; and Uptown School Complex in Atlantic City are the nine schools chosen to pilot this nutritious program. These schools are required to utilize their min-grants to promote healthy eating through interactive lessons and activities that will link classroom education to the foods served in their cafeteria. A school garden will also be planted in each of these nine schools. The schools must grow at least three different vegetables that will be harvested and sampled by the students. The mini-grants are part of a $340,250 Team Nutrition Training Grant from the United States Department of Agriculture to train foodservice professionals, increase fruit and vegetable consumption, and promote locally grown produce in school meals. New Jersey’s Department of Agriculture will work with Rutgers Cooperative Extension’s Department of Family and Community Health Sciences on this two-year grant project.

New Jersey Schools Receive Grants to Advocate Fruit and Vegetable Consumption Eurelle Hao

Continued from page 9

“Tens of thousands of New Jersey residents are drinking polluted water from private wells, according to a new state report, and radioactive contamination is the most common violation of state standards.” (Drink Safe Water in NJ). The Private Well Testing Program, which will be further explained throughout the paper, samples thousands of private water wells near Trenton, NJ and other cities throughout the state. The samples show a significant increase in the amount of contaminants in the water. In 2008, 51,000 of the private wells were tested, and 12 percent failed the standard levels of contaminants allowed in drinking water. This means that 12 percent of the residences that were tested were drinking contaminated water for years that they were not aware of. Out of all contaminants, including nitrates and fecal matter, arsenic was sampled in 1,445 of the wells, and arsenic was found in more of the private wells than any other contaminant.

Knowledge regarding such types of contaminants may prove to be very beneficial. The article explains that “the public is ignorant of the dangers of drinking well water because there is no requirement to inform neighbors of a polluted well in their vicinity, and there is no requirement to clean up the pollution” (Environmental News Service). High costs of fixing contamination issues may result in homeowners disregarding the issue at whole. At times like this, people may turn the other cheek and continue to drink contaminated water, and let their families and neighbors continue to consume the arsenic into their bloodstream. The state of New Jersey does not require contamination problems in private wells to be fixed. The Private Well Testing Act and its regulations state that it is not required to treat water if a standard level is exceeded, and this is where the problems begin to occur.

The Environmental Protection

Agency has a standard for the levels

of contaminants in a public water

supply. The EPA has set the arsenic

standard for drinking water at 10 parts per

billion. This standard was enforced in January

23, 2006, which provided more protection to

citizens who have been exposed to

contaminants in the past. The Safe Drinking

Water Act does not cover private wells.

Unfortunately, the

Environmental Protection Agency does not

set standards for private water supplies. It is

encouraged by the EPA that if a private well

goes above 10ppb then a homeowner should

fix the problem and reduce exposure to

arsenic. This is given as a suggestion, and not

a mandatory action, therefore, not every

homeowner is obligated to decrease the

amount of arsenic in their private well. This

allows for a continuance of contamination

and a possible spread to neighbors’ water

supply, etc.

There were studies conducted in other countries which found that there was harmful health effects associated with arsenic. Studies show that people who “regularly for many years drank water containing arsenic at 100 ppb to 300 ppb…developed several kinds of cancer” (Toxic Substances – Arsenic), including lung, liver, kidney, prostate, and skin cancer. These people also had darkened skin spots on their palms and soles of their feet. The darkening of certain parts of the skin is linked to skin cancer and other skin diseases.

Breathing in large amounts of any toxic substance can affect a human’s respiratory system. The inhalation of arsenic can cause severe irritation to the nose and lining of the lungs. The Agency for Toxic Substances and Disease Registry claims that “Exposure to lower levels can cause nausea and vomiting, decreased production of red and white blood cells, abnormal heart rhythm, damage to blood vessels, and a sensation of "pins and needles" in hands and feet.” These are symptoms for low levels of arsenic, which proves that increased levels could cause other unfavorable symptoms within the human body.

A known disease caused by the consumption of arsenic is arsenicosis. The World Health Organization categorizes it as a water-related disease throughout the world. WHO states that “Drinking water rich in arsenic over a long period leads to arsenic

poisoning or arsenicosis” (World Health Organization). Arsenicosis is caused by the toxic substance of arsenic, which has been exposed over a span of 5-20 years. “Arsenic-rich water over a long period

results in various health effects including skin problems such as color changes on the skin, and hard patches on the palms and soles of the feet, skin cancer, cancers of the bladder, kidney and lung, and diseases of the blood vessels of the legs and feet, and possibly also diabetes, high blood pressure and reproductive disorders” (World Health Organization). Arsenicosis could also be a result of occupational safety and health because there are industrial occupations that handle arsenic, which have shown to have their workers be exposed to the toxin. “Arsenic contamination in water may also be

due to industrial processes such as those involved in mining, metal refining, and timber treatment” (World Health Organization). The problem associated with arsenicosis is that since it has delayed effects and is not reported or documented well, people are not aware of its severity in their communities. Some people may not even be aware that this disease exists worldwide.

The Private Well testing Act wants to ensure that purchases and people who are leasing the properties served by private wells are fully aware of the quality of the drinking water source prior to sale or lease to a home or business. The PWTA was signed on March 2001 and became effective September 2002. The PWATA requires that the wells be tested for 29 contaminants, which include bacteria, nitrate, lead and 26 organic chemicals. In the

graphic representation of the tests for Arsenic and E. Coli, an illustration of the private wells from September 2002 to April 2007 has been shown. A total of 51, 028 wells were tested and about 13% of the estimated 400,000 private wells in NJ are used for drinking. Mercer and Hunterdon Counties exceeded the standard levels several times. Bergen, Essex, Hudson, Hunterdon, Mercer, Middlesex, Morris, Passaic, Somerset, and Union were tested for arsenic contamination as well along with Sussex and Warren counties for high levels of arsenic in their soil. If levels are out of the norm, the PWTA database distributes a copy of the results to the county or local health department.

Bottled water and boiling water are short term solutions to this issue. Homeowners who have private wells may think of switching over to public water systems .There are two different types of treatments that are used. One is called a point-of-entry treatment, and it is a system that treats the water for the household. The second one is called a point-of-use system which treats the water at the kitchen tap, similar to a water filter. It is important that the homeowner consults with a health official or health department that will give them the best option and resources to decrease their health risks of exposure to arsenic.

Annual Address on the State of Health of New Jersey:

“Healthy People, Healthy Communities”

On November 3rd

, 2011, Commissioner Ms. O’Dowd, gave her annual address at the 2011 New Jersey Department of Health and Senior Services Conference. Many issues were addressed concerning the functionality and ability of the public health sector to continue to provide outstanding care in the state of New Jersey. Usual topics were discussed such as vaccines (especially pertaining to the present flu season) every year it is estimated that businesses spend on average 10.4 billion dollars annually towards flu-ridden employees. Health departments around New Jersey must continue to dispute the propaganda campaigns against adverse effects of vaccines, particularly pertaining to mental health. Ms. O’Dowd also addressed the issue of obesity in New

Jersey (as well as the rest of America) and the benefits of Baby-Friendly hospitals, which promote the act of breast-feeding with new moms. Along with the many benefits of breastfeeding for both the mom and baby (increased immunity, uterine health etc) it is now shown that breastfeeding can reduce childhood obesity by up to 30%. Ms. O’Dowd also discussed her interest in involving palliative care (which focuses on pain, stress, and symptom relief in serious or terminally ill patients); Ms. O’Dowd expressed her own personal interest in this issue. Ms. O’Dowd also stressed the need for creating a “self-sustained infrastructure” as well as facing the everlasting challenges with funding and budget cuts.

Forest Benefits They support up to 90% of known terrestrial species and offer a variety of habitats for plants, animals, and micro-organisms

1 acre of forest absorbs 6 tons of carbon dioxides and puts out 4 tons of oxygen – this is enough to meet the annual needs of 18 people!

Trees help conserve soil and water, control avalanches, prevent desertification, protect coastal areas, and stabilize sand dunes

During a heavy rain, a healthy forest can absorbs as much as 20,000 gallons of water in an hour

Trees also shade buildings which reduces air conditioning use, resulting in reduced amounts of carbon dioxide emitted by power plants

Healthy trees can add up to 15% to residential property value

Njparksandforests.org

Alexsandra Apostolico

Dear PHIT, Who is at most risk for an accidental injury?

“Accidents occur most

commonly in toddlers and preschoolers compared to adolescents and adults.”

PHIT Fact!

“It is estimated

that 11 million

children in the

U.S are enrolled

in daycare on

either a part-

time or a full-

time basis.”

From window falls to bumps and contusions from hard toys, the day care center is not as safe as we all may wish it to be for our children. However, it is a place that brings millions of children to every year to learn, to grow and explore. There were 528 hospitalized home injuries involving playground equipment, and 145 such day care injuries. Fractures were the most common injury, and the head was the most commonly involved body region. So with the promise that many day care centers provide parents and caretakers; this child friendly environment can be improved and transformed into a safer day care center. A few steps that can be taken to avoid future injuries in children such as strategies for caretakers to prevent further injuries, a day care safety inspection program to eliminate current flaws, suggest injury control and eliminate the two common infectious diseases found in day care environments and hiring a nurse practitioner to help do so, and also an injury prevention program recommended by The National Committee for Injury Prevention and Control. These are just a few steps that can help for a safer day care center. How to Prevent Playground Injuries:

All areas of the playground should be visible at all times

Children should be closely monitored by child care provider

Climbing equipment and swings should be set in concrete footing at least 6 inches below ground surface

All pieces of playground equipment should be designed specifically for the body dimension of the child

Make sure the apparatus matches the appropriate activity for the age group that is using it

Check the playground everyday for hazards such as trash or foreign matter, loose equipment, sharp surfaces in equipment, or inadequate surfacing

Teach children to safely play indoors and outdoors Indoor Safety:

Openings that could entrap a child’s head or limbs

Elevated surfaces that are inadequately guarded

Lack of specified surfacing and fall zones under and around climbable equipment

Mismatched size and design of equipment for intended users

Insufficient spacing between equipment

Tripping hazards

Components that can pinch, sheer, or crush body tissues

Equipment that is known to be of hazardous type

Sharp points or comers

Splinters

Protruding nails, bolts, or other components that could entangle clothing or snag skin

Loose, rusty parts

Hazardous small parts that may become detached during normal use or reasonable foreseeable abuse of the equipment and that present a choking, aspiration, or ingestion hazard to child

Injury Prevention in Day Cares Tanjina Islam

PHIT Fact!

“Nearly 4 million

people with

Medicare who

reached the

prescription drug

coverage gap,

known as the

Donut Hole in

2010, received a

$250 rebate

check. Through

July 2011, 1.28

million Americans

have received

50% discount on

their prescription

drugs.”

Today’s economic and political climate is having a direct impact on the United States’ healthcare and healthcare delivery system. On March 23, 2010, President Barrack Obama signed the Patient Protection and Affordable Care Act (PPACA), a bill that will “set in motion reforms that generations of Americans have fought for and marched for and hungered to see.” The Affordable Care Act puts in place comprehensive health insurance reforms that will roll out over four years and beyond, with most changes occurring by 2014. Since being signed into law, the bill has implemented many changes between 2010 and 2011—from targeting insurance company issues to promoting preventive care. The recently passed health reform focuses on two general aspects: “Patient’s Bill of Rights” and “Preventive and Quality Care.”

The Affordable Care Act implements a new Patient’s Bill of Rights to put American consumers back in charge of their health coverage and care. The Patient’s Bill of Rights is about “giving families the security they deserve and ending insurance industry abuses.” The PPACA implements changes not only in Patient’s Bill of Rights, but Preventive and Quality Care as well. The legislation emphasizes that focusing on preventive care is more rewarding, rather than seeing how many patients a doctor can see in one day or how many hospital beds a hospital can keep full. There is a large focus on rebuilding the primary care workforce. There are incentives in the law to “expand the number of primary care doctors, nurses and physician assistants, including funding for scholarships and loan repayments for primary care doctors and nurses working in underserved areas.” The healthcare delivery system is undergoing a transformation like never before. “Economic and political forces have combined to create tremendous pressure to control costs, ensure safety and quality and increase healthcare access.” Through the Patient Protection and Affordable Care Act, key features emerge from the legislation: Patient’s Bill of Rights and Preventive and Quality Care. Both key points exhibit changes in today’s current health care legislation. The proposed changes in the new healthcare reform plan strive to achieve a healthcare delivery system of value-over-volume and wellness-over-prevention.

The Future of Health Care Eurelle Hao

HEALTH CARE REFORM IMPLEMENTATION

Improved consumer information and 50% discount in Part D Donut Hole on Individual insurance coverage ....... assistance ……prescription drugs ……mandate Access to insurance for uninsured Improving consumer assistance Health insurance exchanges ....... individuals with pre-existing conditions ……begin operations $250 rebate for Part D beneficiaries in the Ensure coverage for individuals ....... Donut Hole ……participating in clinical trials Extend dependant coverage until 26 Extend dependent coverage until 26 ……even if employer offers coverage Prohibition of lifetime limits Eliminate pre-existing condition exclusions Eliminate annual limits ....... for children under 19 Prohibit cancellation of insurance when you Elimination of all pre-existing ....... get sick …..condition exclusions for all ages

MARCH-SEPTEMBER 2010 JANUARY 2011 JANUARY 2014

NJ Health Association Updates New Jersey Public Health Association (Representative: Michelle Kennedy) The New Jersey Public Health Association is a

volunteer-based, non-profit organization dedicated to advancing and supporting the cause of public health in New Jersey. The organization takes an active and multi-faceted approach to furthering this objective, focusing on health policy, environmental regulations, citizen engagement, and the reduction of health disparities. Membership is encouraged by the organization and is open to students, organizations involved in public health, professionals, and retirees. The NJPHA offers a variety of committees for members to become involved in, including advocacy, newsletter, mentoring programming, and information technology committees. The president-elect, Sarah Kelly, MPH, will take over leadership of the organization as of January 1, 2012. Recent advocacy issues for the organization include opposition against cuts to the operating budget for the New Jersey Poison Information and Education System. Governor Christie received recommendations to limit funding substantially or to completely eliminate the Poison Control Center. Therefore, the NJPHA advocated on behalf of keeping the center open in order to protect the welfare of the general public. Additionally, the NJPHA holds numerous public health events throughout the year, open to health professionals and members of the general community. The organization held its Annual Conference, “Building Healthier Communities: A Transdisciplinary Approach to New Jersey’s Obesity Epidemic” on December 6, 2011.

New Jersey Health Officers Association

(Representative: Peter Tabbot) The New Jersey Health Officers Association (NJHOA) is a private, non-profit association consisting of public health and allied health professionals. The Association, which was founded in 1911, is largely composed of those individuals who run New Jersey’s local health departments. The Association has several objectives it strives to achieve. The Health Officers Association works towards improving its level of knowledge and awareness of existing public health information. In addition, the association effectively communicates to various public health administrations in the state and collectively works to tackle public health concerns. Next, the members of New Jersey Health Officers Association work together to promote uniformity in public health procedures, laws and ordinances. Collaboration is also encouraged between health professionals and public health agencies in the state. Further, the association functions solely as a not for profit organization, protecting the rights of health officers and public health personnel. In the past, New Jersey Officers Association and New Jersey Association of County Health Officers (NJACHO) functioned as separate units. The NJACHO leadership concentrates on issues of importance to county health officers, whereas, the NJHOA advocates issues relating to all local health officers. However, both professional organizations will merge together to tackle public health issues and speak as one, unified entity. Effective in November, there will be a new slate of health officers comprised of both township health officers and county health officers to oversee collaborative efforts. To celebrate 100 years of public health, the New Jersey Health Officers Association hosted a commemorative centennial celebration, “A Better State of Health.” The event took place at the Newark Museum on December 2, 2011. The event included a champagne toast, hors d’oeuvres, light dinner, open bar, presentations, live jazz music and a brief retrospective on the last 100 years of public health in New Jersey. Furthermore, during the centennial event, guests had exclusive access to the Museum’s Ballantine House exhibit, as well as a new exhibit, entitled “Generation Fit: Steps to a Healthier Lifestyle.”

New Jersey Health Officers Association

(Representative: Robert Gogats)

Mr. Robert Gogats, a member of the New Jersey Health Officers Association (Country interest), is currently in the process of a merger that this organization is undertaking with NJHOA (New Jersey Health Officers Association), which has been long awaited and long overdue. By the end of November, township health officers and county health officers will work together to solve New Jersey’s public health issues. Mr. Gogats expressed his concern about budget cuts across the board that will cut back on spending in the short run, but will have a major impact on future responses to outbreaks of disease. This is clearly a dire issue that NJCHOA is dealing with. Mr. Gogats expressed his concern that there is not enough communication with the public about the importance of public health in their everyday lives. If the public realizes the direct impact that the public health sector plays in their overall well-being, budget cuts may be confronted with more protest from the public. In response to the Annual Address on the State of the Health of New Jersey, given by Commissioner Ms. O’Dowd , Mr. Gogats agrees that “changes *need to be made in order to+ be able to afford the title wave of diabetes, mental health issues and disease prevention we are heading towards.”

New Jersey Society for Public Health Education (Representative: )

The New Jersey Society for Public Health Education is a state-level branch of SOPHE, the national organization which assists health educators in furthering their professional goals and contributing to better practices for health education. NJSOPHE advocates policies that further health education, as well as creating collaborative partnerships among public health organizations and improving health education goals statewide. In 2012 in particular, advocacy will be centered on

topics selected by board members as the most urgent. NJSOPHE’s initiatives involve collaborative partnerships among groups like the American Hospital Association and Rutgers University. Currently, NJSOPHE leaders are taking a critical look into what can be done about obesity, fitness, and nutrition in New Jersey communities. NJSOPHE is now collaborating with ShapingNJ, a Department of Health and Senior Services project with a strategic plan to promote healthy lifestyles

1. ShapingNJ involves a set of

23 core strategies aimed at making the healthy choice the easy choice for everyone.

The New Jersey Association for Public Health Nursing Administrators (Representative: Kathryn Whitehead)

The NJAPHNA’s Mission Statement states, “20 Years of Excellence in Public Health Nursing Providing One Voice to Public Health Nursing Throughout New Jersey.” Their purpose is “To bring Public Health Nurses throughout the state together and collectively learn and support each other.” The purpose of learning from each other is to understand where each of them comes from. Since all of the nurses involved come from different regions and counties from New Jersey, learning from one another will allow for them to understand how different counties and regions work. The goals, initiatives, and incentives of the NJAPHNA are to be the one voice of all the nurses in New Jersey. Together the association wants to come together, include nurses from across the state and develop one unified idea for particular issues as well as develop a set of particular practice standards of nurse. The list of current officers can be found on their website: http://www.njaphna.org/

Aside from being vocal about the issue of philosophical exemptions for vaccines, t association has also placed efforts for the mandate for hepatitis B and Meningococcal to be required of children in schools; one of their members Sharon Clugston testified in front of the New Jersey Congress in support of the mandate. They are an association proud of their strong educational programs for Public Health nurses. Among the programs they’ve had for their nurses are programs for understanding Cyber Bulling, Social Networking and its impact as well as all-programs of what to do with people who are in crisis. The all-day programs provide the nurses with tools as to how to help deescalated situations where people are in panic. The association meets four times a year. Their last meeting of the year took place in the Holiday Inn in Princeton, New Jersey on December 9

th, 2011. The title is “Public Health without Borders;”

a reverend will be present as well as a fellow member of the association and they will speak on and about missions to Haiti they have done. The meeting will be from 9am to 2pm. In addition to the four meetings annually, the executive board (officers) meets an additional four times a year. Any Registered Nurse who has had some sort of Public Health capacity can be a part of the association; additionally RN’s that are in academia can also be.

The New Jersey Environmental Health Association

(Representative: Marconi Gapas) The NJEHA has been a recognized affiliate of the National Environmental Health Association since 1963. The organization’s mission still holds true to its original certificate, it is “to support the professional growth of environmental health specialists, provide a unified and informed voice in the development of public health practice and policy, and enhance the ability of members to aptly promote environmental and public health locally, regionally and globally”. There are over 400 members in the NJEHA that represent more than 1,000 professionals throughout New Jersey. The members consist of Registered Environmental Health Specialists, Health Officers, and other members in the public health field. The organization provides professionals with various opportunities for development and improvement, as well as an informational newsletter to the public seasonally. The NJEHA holds an annual educational conference and exhibition each year, and in March 2011, it will be held in Atlantic City, NJ. Along with arsenic contamination in New Jersey, Mr. Gapas has a special interest in educating his colleagues about flood response. He asked Kristina to make a presentation for his organization that will be featured at the annual conference, based on an outline and plans written out for flood response teams. It will educate public health professionals on procedures and protocol to abide by before, during, and after a devastating flood.

http://www.njaphna.org/

PHIT

Public Health Issues Today Contributors

Association Liaisons: Alexsandra Apostolico Jacqueline Baron Chani Burgos Mona Hariri Lauren Johnson Snigdha Kanakamedala Kristina Reveron Newsletter Team: Aisha Akhter Eurelle Hao Tanjina Islam Website Team: Savreet Bains Nicolette Cobbold Apurva Mallampati

Public Health Issues Today

Fall 2011

A Letter from the Editors…

We would like to thank you for taking the time to read our publication. Through hard work, diligence, and passion, the PHIT team has published a

newsletter that will hopefully achieve a growth in health awareness for the Rutgers community and beyond. This unique learning experience allowed us to work both independently and as a group. Our in-depth research into the public health profession opened the doors to a better understanding of this multidisciplinary field. With this knowledge, we hope to have conveyed

the purpose of public health: to preserve and promote universal health. We would like to give a very special thanks to Professor Peter Tabbot and our associate liaisons. For more information on the research conducted

and their authors, please visit our website at: www.wix.com/thephit/fall2011.

DISCLAIMER: During the preparation of this newsletter, every effort was made to present accurate information. Nevertheless, the material contained within this newsletter is student-generated and does not necessarily contain accurate, updated information. It also does not express the views of Rutgers University, PHACE, or the associations mentioned herein. For any questions concerning the reproduction of any of the articles contained in this newsletter, please contact Peter Tabbot.

http://www.wix.com/thephit/fall2011

Newsletter Draft PDF

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