2008 Summer in the City Series Schedule

The Summer in the City Series, a joint program of the Center for Community Health and the Department of Community and Preventive Medicine, has released its schedule for 2008.  The series consists of lunch-hour discussion on a variety of public health topics.

Unless noted, the discussions are from 12:00 to 1:00 PM and are held in Room K-307 in the Medical Center and include a light lunch.  The schedule is as follows:

July 8: Health-e-Access: Using Technology to Increase Care for Children

Ken McConnochie, M.D., MPH, director, Health-e-Access Telemedicine Network and professor of Pediatrics (Please note that this session only is scheduled 12:15 to 1:15 pm)

July 15:  Nourishing our Neighborhoods

Chris Hartman, co-manager, South Wedge Farmers’ Market

Eleanor Coleman, Southwest Area Neighborhood Association

Katrina Korfmacher, Ph.D., community outreach coordinator; research assistant professor, Environmental Health Sciences Center

July 22: Creating Urban Villages in the Rochester Children’s Zone (RCZ)

Ellen Lewis, interim team leader, RCZ

Rev. Glenn Alexander, pastor, Holy City International Church of God in Christ; board member, RCZ; Sector 10 Co-Chair, North East Neighborhood Alliance

July 29: Teen Smart Driving: What Parents Should Know

Anne Brayer, M.D., associate professor of Emergency Medicine and Pediatrics

Lynn Babcock-Cimpello, M.D., associate professor of Emergency Medicine and Pediatrics, co-directors, Injury Free Coalition for Kids of Rochester

For more information: CenterforCommunityHealth@urmc.rochester.edu or 276-3056

Rochester’s New Lead Law

Dr Katrina Smith Korfmacher recently published an article in the Journal of Public Health Management and Practice  on Rochester’s Lead Law and the Coalition to Prevent Lead Poisoning.

Abstract:  In December 2005, the City Council of Rochester, New York, passed an amendment to its municipal code requiring inspection for and correction of lead hazards. Local lead-poisoning prevention advocates had long recognized the need for stronger lead policy to address Rochester’s high rate of childhood lead poisoning. Between 2000 and 2005, a diverse coalition of educators, healthcare professionals, community members, researchers, government officials, and many others worked to develop a strategy for ending childhood lead poisoning in Rochester by 2010. Their experience in defining the issue, mustering resources, and structuring their decision-making processes is informative for other communities seeking to overcome barriers to improved primary prevention policy.

 

Health Disparities in Rochester: What Needs to be Done

In a follow-up to the previous post (Report Details Disparities in Care), Nancy Bennett, M.D. and Wade Norwood have written a piece that appeared in today’s Democrat & Chronicle. Bennett is director of the URMC Center for Community Health and Norwood is director of Community Engagement for the Finger Lakes Health Systems Agency.

The piece (which appears below) addresses the underlying factors behind disparities in our community, the progress that has been made, and the challenges that remain.

Spread good health to all corners of Rochester

Dr. Nancy Bennett and Wade Norwood

In the World Health Organization’s comparison of the health of nations, the United States ranks 24th, below most industrialized nations. However, the United States spends more per capita, and our expenditures are rising faster than those in any other country. While the reasons for this paradox are many, one critical factor is the persistence of health disparities based on race, ethnicity and socioeconomic status.

To improve our country’s health, we must improve the health of our most vulnerable populations. While we all are cared for by the same health systems, white suburban populations enjoy relatively good health, but poor urban and rural populations do not.

One example of these horrible inequalities was reported this month by the Dartmouth Atlas Project: African Americans are more likely to suffer leg amputations than white people.

The reasons for such differences are complex.

• African Americans have higher rates of obesity and smoking, putting them at greater risk for diabetes and peripheral vascular disease, heightening the risk of amputation.
• African Americans are likely to have poorer access to primary and specialty care, which might improve the management of chronic disease, thus preventing complications.
• African Americans often have poorer access to advanced surgical alternatives to amputation.

Although these differences may be related to the adequacy of insurance, studies have shown that differences remain even when coverage is equal. We need to understand, through public health and health services research, the complexities of this pathway so that we can eliminate inequalities.

Report Details Racial Disparities in Care

The Dartmouth Atlas Project has released a report titled Disparities in Health and Health Care Among Medicare Beneficiaries.  While disparities in care are generally associated with race and socioeconomic factors, the Dartmouth report reveals that geography also plays an important role.  The report examines geographic disparities in the rates of leg amputations (a complication of diabetes), screening for breast cancer and diabetes, the prevalence of primary care physicians, and ambulatory care vs. hospitalization rates. You can read a NY Times article on the report here.

The Robert Wood Johnson Foundation used the data in the report as a platform to announce $300 million in new grants to fight health disparities.

The Democrat and Chronicle reports on the Rochester numbers in the report (full article after the jump) and notes that that while progress has been made in areas such as immunizations and mammograms, disparities in diabetes care remain.  According to the most recent Monroe County Adult Health Survey, 20 percent of African Americans in the county have diabetes – more than twice the number of whites and Latinos.

CDC Survey Details Teen Behavior

The Centers for Disease Control and Prevention has released its 2007 Youth Risk Behavior Survey. The news is decidedly mixed. The number of teens smoking, drinking, and having sex is down, but risky behavior (drug and alcohol use and attempted suicides) remains high among Hispanics. This is of particular concern as Hispanics are one of the fastest growing populations.

The survey also shows that efforts to convince teens to delay or practice safe sex appear to be faltering. After several years of declines, the sexual behavior rates have leveled off and there is evidence that rates of teen sex may be going up while condom use may be on the decline.

You can find the CDC report and additional data here. You can read articles about the study in USA Today here, the Washington Post here, Reuters here, and the Associated Press here.

Exposing an Invisible and Silent Monster Devouring Our Children (Part 3)

This is the third is a series of three posts on the historic community response to lead poisoning in Rochester New York. You can read the first two posts here and here.

After becoming Principal of an urban, high-needs elementary school in Rochester, I set out to “level the playing field” for my school’s children and community. After raising nearly seven million dollars, replacing almost the entire school teaching staff, and creating numerous school/community partnerships, I noticed that I still had a core of children with critically serious learning and behavioral deficits. Puzzled by this, I was the first principal known to review my school children’s public health records, and what I found horrified me. What follows is the last of a three-part story of the epic battle with what I call “the invisible and silent monster that devours our children”. — Ralph Spezio

“Child Advocacy and a Community’s Heroic Response”

In Rochester, NY, our community has not only “put a face” on this silent and invisible monster through education, we have mobilized ourselves to eventually slay the terrible beast that has created carnage and devoured so many of our children in the past. In our community-wide advocacy for children, we have evolved and surpassed many other communities throughout New York State and America in regard to how we view and solve the health issues of our children.

Far too often, many communities visualize problems in what can be called silo-thinking. That is, it is the common believe in many communities that children’s health is the sole responsibility of the Health Department, and children’s safety is the sole responsibility of the Police Department, etc. and in Rochester and Monroe County, we have clearly stepped forward to say that these issues are much too complex and inter-related for us to be myopic or naively simplistic in finding solutions. In any community, I believe that we are all accountable for the health and safety of our children.

The Coalition to Prevent Lead Poisoning has many treasured partners at the government as well as grass-roots levels. The Monroe County Health Department certainly has provided courageous and visionary leadership. Our contributing partners also come from individuals, community organizations, foundations, the business community, as well as grass-roots neighborhood associations. The University of Rochester Medical Center has been a long-standing advocate and partner.

Our City and County governments have also shown courageous leadership in creating new paths forward for the advocacy of child health. The City of Rochester passed the first City Housing Ordinance in the state for primary prevention of childhood lead poisoning, and the Rochester City School District just passed the first primary prevention School Board policy in New York State and one of the most comprehensive in the nation to protect children. State legislators from the Rochester region are on the threshold of passing a major state law for primary prevention of lead poisoning and we expect that this law will become a reality in the 2008 state legislative session.

Even though Rochester/Monroe County is on the national forefront in the work to provide healthy homes for children and families to help eliminate chronic diseases such as asthma and the ravages of lead poisoning, there is much more work to be completed locally. We must celebrate and secure the accomplishments and progress that we have made as a community to date, and we must monitor this progress and evaluate its ongoing effectiveness.

Relentless child advocacy, primary prevention, and the promotion of healthy environments and healthy lifestyles need to be a central focus of everyone in our society. It is my belief that any civilized society is measured primarily by how well it takes care of its children. If the adults within that society do not mobilize to protect children, who will? Children do not have an organized voice. They can not lobby on their own behalf. They have very little control in regard to their environment. They rely almost entirely upon adults.

In Rochester/ Monroe County, I believe that we have a lot to be proud of in regard to our collective work in primary prevention of child health and safety. We still have a long way yet to go, but by “linking arms” and partnering, by sharing responsibility and accountability, and by joining together to search and find critical solutions, we will find our real success as a community. This success will be measured, not only in the excellent health of our children, but also in their undiminished potential for a happy and productive future.

NYSHealth to Fund Mental Health and Substance Use Initiatives

The New York State Health Foundation (NYSHealth), a fund created with the proceeds of the conversion of Empire BCBS to for profit status, has announced that it is adding “Integrated Mental Health/Substance Use Services” as one of its priority areas. This initiative is divided into two components: integrating services and an initiative for returning veterans.

The following is from the NYSHealth website:

Nearly 1.4 million people in New York State suffer from co-occurring mental health and substance use disorders; however, individuals with co-occurring mental health and substance use disorders rarely receive services that effectively address both of these issues. For years, the mental health and substance use systems of care have operated separately, and regulatory and financial barriers have restricted integration of these services. Not surprisingly, poor health outcomes are associated with co-occurring disorders in the absence of integrated care and individuals with co-occurring disorders are at higher risk for other serious medical problems, homelessness, violence, social isolation, and early death. NYSHealth has set as a priority area the integration of mental health and substance use services in New York State, and is dedicated to advancing potential solutions. As a component of this priority area, NYSHealth has identified returning Iraq and Afghanistan war veterans and their families as a high-need, sub-population whose broad mental health needs are not being met.

The Foundation is committing $10 million over the next 5 years for its Integrative Services initiatives and $2 million over the next two years for its Returning Veterans program.

ABC’s Priorities

James Norman, the president and CEO of Action for a Better Community, a Rochester-based “community action agency” and frequent collaborator with the Medical Center on a number of projects, has a piece in this week’s Democrat and Chronicle about his organization’s activities.

ABC, community partners build ladders out of poverty, ill health

During May, Community Action month, more than 1,000 grass-roots agencies nationwide celebrate the victories in the war against poverty and make a special effort to raise awareness about the challenges still facing communities.

The National Community Action Partnership in Washington, D.C., of which Action for a Better Community Inc. is a member, launched an ambitious campaign in January titled “Rooting Out Poverty.” This bold initiative draws from the experience of the national network of community action agencies. Including five action themes, the campaign is a call to action, inviting local agencies like ABC to take this national campaign to the local level. The five themes are:

• Maximize participation.
• Build an economy that works for everyone.
• Invest for the future.
• Maximize equality of opportunities.
• Ensure healthy people and places.

These themes are only the framework; the real work can only be done locally, tapping into this community’s ingenuity and collaborative spirit to find solutions for our unique challenges.

Seminar on Mental Health Program for At-Risk Children

The Summer in the City Series launches its 2008 season with presentation and discussion entitled “Fostering Recovery: Mental Health, Child Welfare and Recovery Working Together for Families.”

The topic is a new joint program involving the University’s Department of Psychiatry, the Mount Hope Family Center, the Monroe County Department of Human Services, and the Monroe County Family Court that provides children and parents in welfare and foster care programs with the mental health care they need to thrive and stay together as a family.   The program is funded by a grant from the U.S. Department of Health.

You can read a news release about the launching of the program here.

The series, which is sponsored by the Center for Community Health, will take place on Tuesday, June 3 from 12:00 to 1:00 PM in K-307 in the Medical Center.  Speakers include: Wendy Nilsen, Ph.D., the principal investigator of the project, and Cynthia Lewis, LMSW, ACSW, director of Child and Family Services with the Monroe County Department of Human Services.

A light lunch will be served.  For more information, contact centerforcommunityhealth@urmc.rochester.edu or 276-3056.

The Hazards of Pharmaceuticals in the Home and the Environment

Several stories have recently appeared in the news about the effects of pharmaceuticals in the water supply. The reported negative impacts include hormone disruption in fish, raising questions about potential impacts on human health. There are concerns about the effects of long term human consumption of these and other chemicals. Household pharmaceuticals can get into the water supply because conventional waste and drinking water treatment does not effectively eliminate most of the pharmaceutical compounds such as endocrine disruptor compounds found in oral contraceptives. Some of these chemicals enter the wastewater system when they are excreted by people who take these drugs. In other cases, chemicals may get into the wastewater when people flush old or unwanted medicine down the toilet. Flushing has been recommended in the past as a way to safely dispose of pharmaceuticals. However, because treated wastewater is released into surface water bodies, chemicals remaining in the effluent may affect wildlife or if the water eventually enters drinking water systems, humans may be affected. Below are two recent examples of how EHSC researchers and community outreach agencies are focusing on studying and eliminating pharmaceuticals in our environment.

It is important to safely dispose of unwanted pharmaceuticals to avoid accidental poisonings by children or others. Flushing them down the toilet is no longer a recommended method of disposal. People are discouraged from simply throwing unwanted medicines in the trash since children might pull them out of the trash, or once in a landfill, these chemicals may eventually seep out in drainage water. The only guidance issued to date by a federal agency regarding the disposal of medications (by consumers and other end users) is the guidance issued in February of 2007 by the White House Office of National Drug Center Policy. However several states and localities have developed their own approaches to this issue. In Washington State, a coalition of local and state governments, and non-profit organizations, developed a pilot program in which pharmacies took back unwanted medicine, (www.medicinereturn.com). Legislation that would have implemented this program on a statewide basis was introduced in 2007 but has not been passed. The New York State Legislature is also considering a bill (A. 840) that would regulate the collection and disposal of both prescription and over-the-counter drugs by manufacturers of such drugs. Until such a program is instituted, community collection days may be the safest option (See ‘What Can I Do?’).

• In March 2008, 3rd year Toxicology graduate student Fanny Casado presented a talk called “Endocrine Disruptors with estrogenic activity: Promises and Challenges.” The presentation discussed the current widespread use of estrogen-based hormonal therapies that has opened opportunities to do epidemiological studies of the risks and benefits. Endocrine disruptor compounds (EDCs) are defined as chemicals, such as those found in oral contraceptives, that can alter the physiology of endocrine or hormone systems in wild-life and humans. When these chemicals were first introduced, disruptive effects were not fully appreciated. Several different lines of research have elucidated some of the mechanisms of action of these compounds, specifically the ones with estrogenic activity, giving rise to guidelines and restrictions on their use. Despite numerous investigations using in vivo models that provide information about exposure, the relationship between human diseases of the endocrine system and exposure to environmental EDCs is poorly understood.
• Action for a Better Community (ABC), an EHSC Community Advisory Board member, teamed up with the Ruth A. Lawrence Poison Control Center, the City of Rochester, Monroe County Department of Environmental Services, and the Center for Environmental Information to take part in the Environmental Protection Agency’s Great Lakes Earth Day Challenge on April 19th. This event provided opportunities for people to safely dispose of unwanted medicines as well as electronic waste. Over 55,000 doses of unwanted medicine were collected from 66 people at this event. On June 7th, there will be a free Unwanted Pharmaceuticals Collection from 8:00am-1:00pm at the City of Rochester Water Bureau, 10 Felix Street. For more information about this collection, contact Ted Murray at ABC, 325-5116.