Jerome Adams

The Nation's Health spoke with U.S. Surgeon General Jerome Adams, MD, MPH, about what he plans to accomplish. Photo courtesy EZ Event Photography.

How do you plan to uphold your promise to put science before politics as surgeon general?

As surgeon general of the United States, I think what is important is that we engage the right partners and show them how embracing health and embracing our priorities will lead to them being more prosperous, will lead to them being safer and more secure, will lead to them being able to provide for themselves and their families. And if we do that, then it’s not really putting science before politics, it’s understanding that science needs to be part of the complicated multi-variant policy equation, but that it’s one of several components. If we’re going to expect people to listen to and embrace the science, then we have to listen to and embrace their priorities.

Read the full Q&A with Adams in The Nation's Health.

Beth Bell

Beth Bell, MD, MPH, serves as director of the Centers for Disease Control and Prevention’s National Center for Emerging and Zoonotic Infectious Diseases. As its director, Bell is a leading expert in examining epidemics around the world and the public health response to them. She spoke with The Nation’s Health and gave a review of the year in diseases for 2015, as well as some insight on what the future might hold in the field.

Looking beyond Ebola, what were some of the biggest issues and outbreaks that you saw in 2015, and what did the center do to respond to those?

Last year, we saw a number of large foodborne outbreaks. In the United States we have a cluster detection system, which is based in every public health laboratory in the country, and for a foodborne illness it’s called PulseNet.

At any given time, we here at CDC are monitoring anywhere between 15 and 40 clusters that we identify based on our DNA fingerprinting methodology, and some of those turn into outbreaks, and some of them turn into large multi-state outbreaks.

This last year…we had an outbreak of listeria associated with Blue Bell ice cream. We really never had seen listeria contaminating ice cream before, and this was a very large outbreak. Listeria is a particularly deadly infection for pregnant women, immunocompromised people and elderly people, and so we always see a lot of hospitalizations, and unfortunately deaths, with listeria outbreaks.

Read the full Q&A with Bell in The Nation's Health.

Georges Benjamin

In 2017, police shot and killed almost 1,000 people in the U.S., according to a tracking project from The Washington Post. Julia Haskins, reporter for The Nation’s Health newspaper, interviews Georges Benjamin, MD, executive director of APHA, about the problem of police violence in the U.S., and how it affects the health of the public.

How is police violence a public health issue?

Violence, in all of its forms, is a public health issue because it impacts both physical health and mental health. It's a significant problem, because violence can lead to injury and even death and undermines both the sense of community well-being and the sense of personal well-being. And we know that like other violence, police violence is preventable.

Read the full Q&A with Benjamin in The Nation's Health.

Patricia Flatley Brennan

As director of the National Library of Medicine, Patricia Flatley Breenan, oversees the largest biomedical library in the world, with data available to both professional and lay audiences. She spoke with The Nation’s Health about the value of NLM as it enters its third century of service to the public.

Why is the National Library of Medicine so important to public health?

I think probably the most important thing is that we have a strong commitment to public health research information data. Tox Town is a repository of information about toxic exposure. We also have a resource called TOXNET, a suite of databases that has information on over 400,000 different chemicals. And we have a website for health service research and public health information programs. And this is research informally of the National Information Center for Health Services Research. NICHSR provides outside links to the health services research and public health partnerships that make it possible for a local public health community to find quick information about things such as Indian health or perhaps to provide help with training resources about toxicology. We view our partnership in public health…as being one of our critical target areas.

Read the full Q&A with Brennan in The Nation's Health.

Jonca Bull

Jonca Bull, MD, FDA's assistant commissioner for minority health, talked with The Nation’s Health about some of the barriers to diversity in clinical trials and FDA’s efforts to spread awareness and show transparency about who is participating to inform outreach in the the future.

How diverse are U.S. clinical trials currently? Where are the biggest gaps?

I think it varies. The basic question is how much variability in terms of the disease burden, what patient characteristics are most critical that would raise the significance of diversity in a clinical trial.

Optimally, we are very interested in seeing populations, as stated in our policies, that reflect the population that use the products in the post-market environment.

There certainly are challenges. We live in a world where medical product development is a global enterprise. A real challenge for us is establishing that populations are adequately comparable so that the data that informs an approval decision is as accurate and close as possible to the population here in the U.S. will use the product.

Read the full Q&A with Bull in The Nation's Health.

Michael Botticelli

Michael Botticelli, MEd, might be uniquely prepared to serve as director of the U.S. Office of National Drug Control Policy: When he was sworn into the job in February this year, he had 25 years of sobriety. Botticelli has been open about his own history of alcohol abuse, and how the option for a treatment program, rather than jail, helped set his life’s course for work in public health. 

How can public health advocates partner with others to reduce drug use and its consequences?

Part of our office is to really look at better integration of substance use disorders into mainstream medical care. I always say that we have bifurcated systems of care, when you get your general medical care on one side and you get your behavioral health care on another. I think that is kind of emblematic of the training that happens both in terms of (the) medical profession and in terms of public health schools. Part of what I think we’ve been trying to do and the others have been really (is) to generate a level of education and understanding on why it’s important to look at substance use disorders as part of both population health, but also individual health.

I think that there is this cultural divide about treating “those people:” that they are too disruptive, that they are too difficult to treat and incorporating them as part of overall medical care is seen as too problematic, and they can only be serviced well in a specialty treatment system. But what’s happened over really the past few years, particularly with the Affordable Care Act, is that we are seeing the kind of models as well as delivery systems that are integrating substance use disorder treatment in mainstream medical care.

Read the full Q&A with Botticelli in The Nation's Health.

Listen to the podcast with Botticelli.

Sylvia Burwell

From work championing insurance coverage under the Affordable Care Act to ensuring that U.S. children have opportunities for health, U.S. Department of Health and Human Services Secretary Sylvia Burwell has overseen a range of public health issues since she became secretary in June 2014. Burwell spoke with The Nation’s Health about how her experiences prepared her to become a leader in U.S. health.

More than 16 million Americans have gained health insurance coverage through the ACA. Where are the greatest successes?

When it comes to access, affordability and quality, the Affordable Care Act is working.

For access, we have the historic number of people who are now covered, thanks to different aspects of the law. Since the law was passed five years ago, about 16.4 million uninsured people have gained health coverage. That’s the largest reduction of the uninsured in four decades.

And that progress was made in part to the greater affordability of coverage. Nearly 80 percent of 2015 marketplace customers who selected a plan using Healthcare.gov could purchase coverage for $100 or less after tax credits. Children can stay on their parents’ plans until age 26, preventive services like screenings and well-woman visits are covered at no out-of-pocket cost and lifetime caps on coverage are a thing of the past.

Read the full Q&A with Burwell in The Nation's Health.

Gail Christopher

Because of factors such as a history of racial discrimination, many Americans are locked into a cycle of unfavorable health outcomes and face unequal opportunities to factors that can support a better life, such as access to quality education and safe housing. The W.K. Kellogg Foundation’s Truth, Racial Healing and Transformation enterprise is creating fact-finding forums across the U.S. where people who struggle with health disparities can reach common ground. Gail Christopher, DN, vice president of the enterprise, talked with The Nation’s Health.

How does racial inequity lead to health inequity in the U.S.?

We have known for some time that there are just consistent and persistent…racial health disparities and inequities. Many of those disease conditions are directly linked to stress and key environmental factors or the social determinants of health and well-being.

Because of our residential segregation and our lack of equitable investment in communities and in neighborhoods, there is more adversity, there is more stress oftentimes that takes the form of violence.

Sometimes it takes the form of just chronic unemployment and the lack of access to resources. This translates into physiological and biochemical precursors for altered body function. The link between adversity and trauma and disease is much better known and understood today than it was 50 years ago. So there’s that sort of pre-disposition, if you will, to illness that’s aggravated by the social conditions in which people live. But there’s also a lack of access to equitable health care because of the residential segregation and the inequality that shows up on the ground with a disinvestment or patterns of disinvestment within communities.

Read the full Q&A with Christopher in The Nation's Health.

Hazel Dean

Hazel Dean, ScD, MPH, is the deputy director of the Centers for Disease Control and Prevention’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention. She is widely recognized for her work in addressing disparities in HIV and sexually transmitted disease rates. With continuing disease challenges on the horizon, Dean spoke to The Nation’s Health about her top priorities, new prevention opportunities and why social media is a critical public health communication tool.

Your CDC center oversees a wide range of health issues, from multidrug-resistant TB to continuing disparities in HIV infection. What have been the most significant accomplishments?

Six particularly remarkable accomplishments, among many, come to mind. First, highly effective antiretroviral therapy has greatly extended life expectancy among people living with HIV and resulted in a dramatic drop in AIDS deaths. Additionally, consistent pre-exposure prophylaxis use now reduces HIV transmission, and considerable progress has been made in other highly effective interventions, such as male circumcision, STD treatments, antiretrovirals and vaccines. For hepatitis C, advances in antiviral treatments have helped cure infection, reduce transmission and prevent deaths. For STDs, better testing, treatments and partner management have reduced syphilis by 22 percent and gonorrhea by 34 percent among blacks. Finally, annual tuberculosis cases in the United States have reached an all-time low.

Despite these accomplishments, however, our center still has many urgent priorities, not the least of which are limiting antibiotic-resistant gonorrhea and reducing STDs among young people. We cannot claim victory yet over tuberculosis and must continue to take steps toward its elimination. While improved treatments for hepatitis C are a major step forward, there is still a great need for more widespread testing to make people aware of their infection so that they can benefit from new life-saving treatments. Progress in HIV prevention has been uneven, and gay and bisexual men and blacks continue to be most affected. We must ensure that all prevention strategies reach all populations equally.

Read the full Q&A with Dean in The Nation's Health.

Karen DeSalvo

More hospitals and health care facilities across the nation are making an effort to move toward more efficient care, such as adopting an electronic health records systems. Karen DeSalvo, MD, MPH, MSc, acting assistant secretary for health and national coordinator for health information technology at the U.S. Department of Health and Human Services, talked with The Nation’s Health about how recommendations in the new Federal Health IT Strategic Plan released in December will play a role in improving the quality of health care and what she sees in the nation’s future under her leadership.

You have dedicated your life to improving the health of your community. What are your goals as the acting assistant secretary of health?

We have to mobilize all the resources of public health in its forms as local and state jurisdictions, but also in the many other ways that it comes together to work for the public’s health through public health institutes, as an example, through foundations and other efforts. To really see that we’re leveraging all the resources, that we are working across sectors outside of medicine, outside of public health, into transportation and education and housing, as an example, to create safe places that are healthy where all kids can grow up and everyone can fulfill their potential. I just want to be a voice for that.

Read the full Q&A with DeSalvo in The Nation's Health. Download a podcast with DeSalvo on The Nation's Health podcast page.

Victor Dzau

Victor Dzau, MD, has had an exciting term since assuming the presidency of the National Academy of Medicine in July 2014. For one thing, the organization was not called NAM when he came on board — its membership voted in 2015 to transform the then-Institute of Medicine into the National Academy of Medicine. Now, the independent NAM is branching even further into what it means to develop meaningful research to be used in health fields. Dzau spoke with The Nation’s Health about the future of the academy and its ongoing work.

What new NAM initiatives are you most excited about?

The one that we are very excited about…is called Vital Directions in Health and Health Care. A year ago, we were well aware that there’s going to be a change in U.S. administration. Our members, our council are saying, what would it look like under new administration? What are things that still haven’t quite been achieved? What are things that we need to think about going forward?

We convened a steering committee of 18 members, which commissioned over 100 experts to write papers, 19 in total, under the three themes: health and well-being, or health and wellness; health care delivery; and science and technology. Under those three themes are specific papers that look at life course management, social determinants of health, precision medicine, payment reform, science and technology for the future.

On Sept. 26, these reports were released by (the Journal of the American Medical Association) as what they call viewpoints. On the same day, we (had) public discussion we call a national conversation of the various Vital Directions. We can have authors and also non-authors to come and sit together and talk about what we believe are the issues that should inform the next U.S. administration and get input from the public. Following all this, we’ll have a synthesis paper that will bring together all these dialogues into one final paper, published in Perspectives and in JAMA. That’s going to happen around December.

We are thinking and hoping that this initiative will inform the next U.S. administration. Therefore, we are beginning to reach out to transition teams and to work with the next administration after the election, and begin to work with them in any fashion we can to help advise them.

Read the full Q&A with Dzau in The Nation's Health.

Anthony Foxx

With the intersections between public health and transportation planning recognized as a key consideration in improving community health, Anthony Foxx, secretary of the U.S. Department of Transportation, spoke with The Nation’s Health about the many ways in which health and opportunity are driving the future of transportation.

Health conditions related to physical inactivity, such as obesity, heart disease and diabetes, have reached epidemic proportions in some American communities. How do you see DOT’s role in confronting our chronic disease problem?

I think this is a place where local communities are ahead of the federal government, and the federal government needs to catch up.

I was a mayor before becoming secretary of transportation, and we worked very hard to expand bicycle lanes in my city, to put together more robust sidewalk programs so people had safe places to walk. At the federal level, a lot of the resources that we do spend on pedestrian and bicycle facilities are sometimes maligned because there’s a sense that the dollars should be spent on highways or spent on other things. But when you go to any metropolitan area in this country, people are looking for ways to get out of traffic and get into a healthier way of moving around, and that’s something the federal government should be supporting.

And that’s why we launched the Safer People, Safer Streets campaign, which was our way of beginning to lean much more into this issue by providing good guidance to communities on how to design a roadway to be more accommodating to pedestrians and bicyclists. Then there’s a host of things that our Federal Highway Administration is doing. We’ve done audits in several states already to look at their pedestrian and bicycle access points and given direct feedback on how to do it better. Not only are we having an impact on the ground, we’re actually teaching our own Federal Highway Administration how to think more broadly about the connection between what they do and public health.

Read the full Q&A with Foxx in The Nation's Health.

Howard Frumkin

During the 2017 APHA Annual Meeting, Howard Frumkin, MD, DrPH, MPH, professor of Environmental and Occupational Health Sciences at the University of Washington School of Public Health, discussed the “Lancet Countdown: Tracking Progress on Health and Climate Change 2017” report, of which he is a co-author. APHA served as co-publisher of the “Lancet Countdown 2017 Report: U.S. Briefing.” Frumkin shared highlights of the report, and how public health advocates can use it today.

The countdown outlines policy-level steps that can be taken to fight climate change. Why start there?

Well, it’s really important to start at two different levels simultaneously. One is policy. At the federal and state levels, we need to do things like shift our primary energy sources, shift our transportation system and change the incentives in our food system so that all those systems can contribute less to climate change.

But it’s also important to start at the very personal and community levels. We need to shift our preferences in eating toward less meat-heavy diets. We need to shift our preferences in transportation away from gas-guzzling, single-occupancy vehicles to walking, biking and transit. We need to use less energy, insulate our houses better, use fewer resources, reuse and recycle more. All of those traditional environmental behaviors and attitudes are very important at the individual and community level, but they need to be accompanied, of course, by policy changes.

And then, of course, in the public health sector, where we are responsible for driving a lot of adaptation, protecting the public from the impacts of climate change, we need to step up and do even more than we’re doing, protecting people from disasters like floods and fires and droughts, protecting people from the expansion of infectious diseases, protecting people from expanding allergic illnesses, protecting people from respiratory hazards due to worsening air pollution.

Read the full Q&A with Frumkin in The Nation's Health. And learn more about the Lancet Countdown Report and climate change and health.

Tom Frieden

Since stepping down as CDC director, APHA member Tom Frieden, MD, MPH, has been busy with a new global public health initiative, Resolve to Save Lives. The purpose of the initiative is twofold: Resolve to Save 100 Million Lives aims to reduce cardiovascular disease, while Resolve to Prevent Epidemics will target infectious disease epidemics. Over the course of the five-year program — funded by Bloomberg Philanthropies, the Chan Zuckerberg Initiative and the Bill & Melinda Gates Foundation — Resolve to Save Lives will implement best practices in low- and middle-income countries to curb preventable deaths. The Nation’s Health spoke with Frieden, an APHA member, about what to expect.

How will Resolve engage with local public health advocates and stakeholders to pursue improved health outcomes?

Most countries have the determination and the will to improve the health of their citizens, but may need help turning that determination into action. We’re not going to tell countries what to do, rather, we’ll help countries reach the goals they’ve already set for improving heart health or epidemic preparedness. Engagement with local public health leaders is critical to our success and the health of their country.

Read the full Q&A with Frieden in The Nation's Health. And learn more about Resolve to Save Lives.

Sandro Galea

APHA member Sandro Galea, MD, DrPH, MPH, dean and professor at the Boston University School of Public Health, was the keynote speaker at the Nov. 3 opening session of APHA’s 2019 Annual Meeting and Expo in Philadelphia. In addition to his academic leadership, Galea is a gun violence researcher, an outspoken advocate on social determinants of health and author of a new book, “Well: What We Need To Talk About When We Talk About Health.”

What do you think we get wrong — as a country — when we discuss health?

Right now, the way we understand health rests on a conflation of health and health care. And that conflation has real implications, because it means that we understand health as being the product of clinical intervention, when in fact, clinical intervention in health care is about healing people once they’re sick.

Health should be about keeping people healthy, and that means we need to invest in the forces that keep people healthy.

That means having opportunities for employment; having good education, primary education and secondary education; having stable, affordable housing; and having economic opportunities that lift people from poverty. Those are the forces that we ultimately should couple with our health.

It is the job of public health to create an understanding of the conditions that generate health, and we should take that job seriously

Read the full Q&A with Galea in The Nation's Health.

Brett Giroir

The Nation's Health talked with the assistant secretary for health at HHS about ending America's HIV epidemic.

What has happened since "Ending the HIV Epidemic: A Plan for America" was announced in February?

...Our latest total (as of mid August) shows we have interacted with 29 different jurisdictions, including 13 site visits and 42 listening sessions, because we really want to listen and learn and interact with the community.

This is not us coming to Jackson, Mississippi, and saying, “This is the way to do it.” We’re here to listen and learn.

This is really very important, because what we want is the communities to come together to understand what’s right in their communities — that they have the resources to do those planned grants so that when the money becomes available, hopefully with the new budget, that they’re ready to spend it and to actually start implementing in their community plan.

In addition to that, we’ve awarded $6 million to four jurisdictions for pilot sites. That’s DeKalb County in Georgia; Baltimore; East Baton Rouge, Louisiana; and the Cherokee Nation of Oklahoma.

These places met predefined criteria, and have made progress in this regard and have certain standards. We want to jump-start their effort, not only to get those communities started — but that they can serve as exemplars that all of the communities can learn from and we can learn from, as well.

So we’re not just sitting on our hands. We’re not waiting for new money. This is a serious initiative. We have all been on the road. Me, others and particularly Dr. (Robert) Redfield (head of the Centers for Disease Control and Prevention) have been out there working in communities.

Read the full Q&A with Giroir in The Nation's Health.

The Nation's Health also talked with Giroir when he became the new assistant secretary for health at HHS, also the new leader of the U.S. Public Health Service Commissioned Corps, about his goals as wells as the topics of preparedness and resilience in the midst of a national public health crisis.

What are the top priorities you hope to accomplish during your tenure as U.S. assistant secretary for health?

My main overriding goal is to support the transformation of our sick care system into a health-promot- ing system. If you look at our offices, we have so much emphasis on prevention, early detection, elimination of disparities — it just fits so well into one of (HHS Secretary Alex Azar’s) primary pillars of value-based transformation of the system.

I have my nine words that I like as our governing philosophy that I want everyone to think about...My nine words are health for all, health by all and health in all.

Read the full Q&A with Giroir in The Nation's Health.

J. Nadine Gracia

As a pediatrician whose patients lived in low-income, minority communities, J. Nadine Gracia, MD, MSCE, saw firsthand how factors such as socio-economic status, education levels and lack of access to healthy foods affect minority health. Today in her role as deputy assistant secretary for minority health and the director of the Office of Minority Health at the U.S. Department of Health and Human Services, Gracia is using her experiences to promote programs that will turn the tide on health inequity, such as the Affordable Care Act. Gracia shared with The Nation’s Healththe strides her office has and will continue to make to promote equitable access to health as a priority.

How has your work as a physician influenced your approach to creating national public health interventions affecting U.S. racial and ethnic minority populations?

One of the things that I learned quickly in my practice is how important these broader social determinants of health really impact the health and well-being of the children and families that I served. If you’re caring for poor families struggling to make ends meet or a child who doesn’t have access to high quality education…the mother who has to make the decision between paying the bills and buying medication or taking her child to medical visits, it gives you perspective on some of the challenges that families and certainly children face.

Part of my training as a pediatrician was to do home visits to patients in my practice and it was an eye-opening experience to be able to go to their homes and see the communities that they lived in. To see where, in many cases, they lack access to transportation…where the cost of getting healthy food was certainly a challenge, that provides a great deal of perspective and influences me as I consider and work in developing programs and policies to benefit those communities so that they can truly reach their full potential for health.

Read the full Q&A with Gracia in The Nation's Health.

Download a podcast with Gracia on The Nation's Health podcasts page.

Debra Houry

Healthy People 2020 has an objective on preventing fall-related deaths, signaling a need for more health care providers and communities serving seniors to put the issue on their radar screens. As director of CDC's National Center for Injury Prevention and Control, Debra Houry, MD, MPH, talks with The Nation's Health about the consequences of not addressing risk factors for falls and what CDC recommends on clinical and community-based levels to educate the public about falls prevention.

Why do Americans need to be concerned about injury and violence prevention?

Injuries are a leading cause of death in this country. In the first half of life, more Americans die from injuries and violence — such as motor vehicle crashes, falls or homicides — than from any other cause, including HIV, cancer or the flu. Injuries and violence affect everyone, regardless of age, race or economic status. And, in America, deaths from suicide, opioid overdose and car crashes have been going up in recent years. In 2015 alone, injuries and violence led to 214,000 deaths, 2.8 million people hospitalized and 27.6 million emergency room visits.

The economic costs are also staggeringly high. The total lifetime medical and work loss costs of injuries and violence in the U.S. was $671 billion in 2013.

Read the full Q&A with Houry in The Nation's Health.

Freeman Hrabowski

From his days as a child leader in the civil rights movement in Birmingham, Alabama, to his work supporting young minorities’ interests in science, technology, engineering and math fields, Freeman Hrabowski, PhD, MA, has spent most of his life advocating for equitable opportunities — especially in higher education. He will keynote the opening session of APHA’s 143rd Annual Meeting and Exposition on Sunday, Nov. 1, in Chicago. Hrabowski talked with The Nation’s Health about the importance of increasing minority participation in science-related fields and the consequences of inaction.

Why is it important for underrepresented students to pursue STEM careers? What barriers stand in the way?

There are several reasons that come to mind. Number one, many of the jobs available today and in the future require backgrounds in STEM areas and much of our economy depends on the STEM infrastructure in our country. At the same time, an increasing proportion of the American population consists of people from minority groups. And unfortunately, right now, too few minorities are entering those careers.

Read the full Q&A with Hrabowski in The Nation's Health.

Tony Iton

The California Endowment's 10-year, $1 billion initiative, Building Healthy Communities, has already made significant progress toward its 2020 goals: The campaign has supported work to insure 4.5 million Californians, slash school suspensions and expulsions and help nearly 1 million people reclassify their former low-level felonies as misdemeanors, opening doors to housing and employment opportunities. The Nation’s Health spoke with California Endowment Vice President Tony Iton, MD, JD, MPH, an APHA member, about creating a people-powered movement in the name of public health.

Why is it so important to bring young people into conversations about improving health outcomes in their communities?

We recognized fairly early on in our work that youth were the rocket fuel of change…You look around and look at the Parkland youth, you look at Black Lives Matter, you look at marriage equality movements — these are driven by young people. And what we recognized is that our role is really to organize them and kind of stay out of the way, and also that the kinds of changes we were looking for to promote health in California required a social movement, that they weren’t just technical policy issues, they are political issues.

We realized that we needed to essentially help catalyze a social movement, that these issues were fundamental to politics, and if you want to change politics you’ve got to bring power to the table, and that meant we needed to organize people. And when you study the history of movements, you recognize that it means you have to organize the youth.

Read the full Q&A with Iton in The Nation's Health.

David Kitchen

The Nation’s Health spoke to David Kitchen, PhD, associate professor of continuing studies at the University of Richmond and author of "Global Climate Change: Turning Knowledge Into Action," about what extreme weather events mean for environmental and public health, and how people will be forced to adapt to an increase in such crises.

What role do scientists have in communicating the effects of climate change and making the connection between climate change and extreme weather events?

Ten years ago, I’d have said the scientists just need to present the evidence and the logical community would come to the conclusion they needed to do something. Scientists should be informing policy makers and educating the public. We should be trying to communicate about the issues of climate change.

Read the full Q&A with Kitchen in The Nation's Health. And learn more about the Year of Climate Change and Health.

Rima Khabbaz

Under a new challenge released in September, CDC is calling on governments, businesses and other organizations around the world to commit to taking action against antibiotic resistance, which is one of the world’s most urgent threats to health. APHA has signed the challenge, committing to raise awareness of antibiotic resistance and advocate for funding for research and development of new drugs and vaccines. The Nation’s Health spoke with Rima Khabbaz, MD, director of the National Center for Emerging and Zoonotic Infectious Diseases, about the challenge.

Why is it so important to bring young people into conversations about improving health outcomes in their communities?

Public health...has really come to the forefront of addressing the problem of antibiotic resistance.

We have an antibiotic lab response network where we have seven regions that have now the ability to improve diagnostics to be able to detect emerging infections.

Resistance is not just a problem of individual health care facilities. Resistance spreads from facilities to other facilities and to the community, so (public health) has stepped in to address it and be part of the solution to detect emerging infections quickly.

If you quickly and aggressively are able to detect new and emerging resistance…(you can) go full speed to contain it.

We also, I think, need public health workers to be involved in the fight by being able to talk about this, about the risk and best practices as far as antibiotic prescribing both in the professional work and in their personal role as champions of public health.

Read the full Q&A with Khabbaz in The Nation's Health. For more on antibiotic resistance and to commit to the challenge, visit www.cdc.gov/drugresistance.

Boris Lushniak, MD, MPH

Acting Surgeon General Boris Lushniak, MD, MPH, says Americans need to pay better attention to protecting their skin. Skin cancer, he says, is a year-round threat. Lushniak will join former surgeons general for a discussion of the future of health in America at APHA’s 142nd Annual Meeting and Exposition at 4:30 p.m. on Monday, Nov. 17, in New Orleans. First, he answered some questions about his skin cancer awareness campaign and what we all can do to help.

The call to action has five goals. What is your office doing to make those goals a reality?

The call to action is not just the office saying, “Here is what we’re going to do.” In reality, we turn to everyone out there, to all aspects of society. I turn, yes, to the federal family, to the government, to legislators. But I also turn to the individuals. I turn to schools. I turn to businesses, to employers.

An example is that in the call to action we really go out to all the schools across the United States, saying “Listen, look at what you are exposing your children to potentially during the day with outdoor recess.” Outdoor recess is very important. We want kids to be outdoors. But can you begin looking at the idea of shady areas? Can you begin looking at the concept of having kids allowed to wear hats when they’re outdoors? To allow them to apply sunscreens onto their skin to protect them from ultraviolet radiation? Have you looked into the idea of timing outdoor recess at a time period where the ultraviolet radiation isn’t at its highest?

People who are employers of outdoor workers: Do you have break areas where the workers can be under shade? Are the workers allowed to wear protective clothing and use sunscreen on the job? Are you part of this mission to decrease the health effects of ultraviolet radiation on you, on your workers and on your business?

Read the full Q & A in the October issue of The Nation's Health.

Molly Marti

Now more than ever, people need tools and resources to adapt to a changing climate, according to Mollie Marti, PhD, JD, president and CEO of the National Resilience Institute. Marti, an APHA member, spoke to The Nation’s Health about how climate change affects health, and what people can do to resist such harm.

What should be the public health community’s role on this issue?

I think the role on public health, and psychologists and people who are focused both on building awareness and providing education, must be on building that personal and psychosocial resilience.

Because what’s happening as we don’t have those capacities is there’s a higher level of fear. And there’s fear-based human reaction to these climate impacts, and so that’s going to decrease our ability to think clearly, it’s going to decrease our ability to work collaboratively. And all of that is going to decrease our ability to look at it with a broader perspective and see what is needed. How do we cut emissions, how do we prepare for climate impacts? And humans, when they’re in a fear response, or reaction, aren’t able to be thinking clearly and creatively and innovatively and collaboratively.

If we don’t really focus on building up this resilience base, building up this capacity, then it’s going to be a negative spiral, and that spiral can start moving more and more quickly.

Read the full Q&A with Marti in The Nation's Health. And learn more about the Year of Climate Change and Health.

Gina McCarthy, MS

When Environmental Protection Agency Administrator Gina McCarthy, MS, announced EPA's Clean Power Plan on June 2, the proposal was met with support from the public health community. The plan, part of President Barack Obama's Climate Action Plan, would cut carbon pollution from existing power plants by 30 percent by 2030. The plan is estimated to lead to 150,000 fewer asthma attacks per year and an 8 percent reduction in electricity bills. EPA is accepting comments on the plan until Dec. 1. McCarthy took the time to answer some questions about the plan and EPA's goals of making the air Americans breathe better.

You're focusing a big portion of EPA's efforts on power plants, through the Clean Power Plan. Why power plants, and why now?

Today, about one-third of America's carbon pollution comes from power plants. But right now, there are no national limits to the amount of carbon pollution that existing plants can pump into the air we breathe. We limit the amount of toxic chemicals like mercury, sulfur and arsenic that power plants put into our air and water. But they can dump unlimited amounts of carbon pollution into the air. It's not smart, it's not safe and it doesn't make sense.

Climate change endangers our health and safety. Warmer temperatures mean longer allergy seasons, more smog leading to more asthma and respiratory problems and growing zones for disease vectors like mosquitoes. And 2012 was the second-most expensive year in U.S. history for natural disasters.

This proposal is about protecting our health, our economy and our children's future.

Read the full Q & A in the November/December issue of The Nation's Health.

Alfredo Morabia

In January, Alfredo Morabia, MD, PhD, MPH, MHS, was named the next editor-in-chief of APHA’s  American Journal of Public Health. Morabia, a renowned epidemiologist who has worked around the globe, will bring a new voice to the journal, which has been helmed for the past 16 years by Mary Northridge, PhD, MPH. As a public health advocate, he had lots to say to  The Nation’s Health about his upcoming editorship.

The big goal that APHA is focused on right now is making the U.S. the healthiest nation in one generation. How do you think AJPH and APHA can work together on that?

First of all, I think being related to APHA is a great asset for the journal. It’s a terrific asset, because it’s got access to a large audience of people who have expertise in different domains who are following the policy, who know what’s coming up and what’s needed and connections with people who actually make the policy.

I think there’s a lot to learn from the members of APHA. And this interaction should go both ways. The journal can generate the information on the topics of major interest. And I see this also as a very dynamic and enriching dialogue between APHA and the journal. It’s really very important for me.

I think the journal can help reach that goal of the healthiest nation in one generation for several reasons. It’s a great goal. It needs to be supported by evidence. And this is what the journal does. It carries the best research and brings it in a traditional way to the attention and the usage of those who are involved as practitioners, working in communities, involved in health (advocacy).

There's something brilliant about the goal of the healthiest nation in one generation, something I like very much. We cannot become healthier alone.

We need to hurry up because one generation is tomorrow. It’s very soon. So to reach that, we need to build and (learn from) experiences that exist worldwide.

Read the full Q&A with Morabia in The Nation's Health.

Charlotte Parent

No longer applying bandages to problems that only get worse, the New Orleans Health Department is working to address social determinants of health, the roots of many public health issues in the Crescent City. Taking a neighborhood-by-neighborhood approach, Director Charlotte Parent told The Nation’s Health about how she and her team are working to make their communities healthier and stronger than ever before.

What lies ahead for the health department and health in New Orleans?

We are working on our programs that we put in place to ensure that they stay here. But, we are also focused on health equity. That’s our latest initiative that we have in place. As an accredited health department, we’ve been trying to figure out how do we take our staff forward to understand what equity is.

It wasn’t only about how we bring new initiatives. We want to make sure that whatever we’re putting forward is touching everyone in the way that will be the most effective for everyone. For those that need more, we’re making sure that we do that. Those who maybe not need as much, we’re also touching them, too.

So, equity is our next stand. And hopefully in the next couple of years you’ll hear more about New Orleans around health equity, and equity in general.

Read the full Q&A with Parent in The Nation's Health.

Charlotte Porter

When Charlotte Porter, MPH, took over as deputy director of the Federal Emergency Management Agency’s Individual and Community Preparedness Division early this year, she already had preparedness in her sights for years. The former director of the office of FEMA’s National Advisory Council, Porter has seen the importance of preparedness played out during many local and national emergencies. As September is National Preparedness Month, Porter spoke with The Nation’s Health on the importance of being ready in case of disaster.

When we talk about preparedness, what are we talking about? What is it that we need to be prepared for?

Americans need to be prepared for really any and all potential hazard or disaster that they may be susceptible to. We have found that nearly 60 percent of American adults have not yet practiced on what to do in a disaster by participating in a drill or a preparedness exercise at work, home, or school in the past year.

And that’s really the whole point of America’s PrepareAthon!, which is a grassroots campaign to not only educate and bring awareness to individuals and communities, but also to encourage them to take action with the education that they receive so that we build a muscle memory of sorts to increase the nation’s preparedness and resilience at the individual level.

Read the full Q&A with Porter in The Nation's Health.

Amelie Ramirez

As COVID-19 spread throughout across the U.S. this spring, it highlighted worsening health disparities faced by minority populations in the U.S., including Hispanics. In April, half of U.S. Hispanics said they or someone in their household had taken a pay cut, lost their job or both because of the coronavirus outbreak. Preliminary data has also shown that Hispanics make up an unequal proportion of coronavirus cases in some states. In a recent podcast, The Nation’s Health spoke with Amelie Ramirez, who is the director of Salud America.

How does COVID-19 impact Hispanics in the U.S. differently?

One of the reasons we think (we’re seeing a disproportionate impact) is our population, our Latino community, really has a lot of different co-morbidities that are making it more difficult perhaps to get the treatment that they need.

For example, we have higher rates of diabetes, obesity, cardiovascular disease, asthma in our community, so that if they are impacted by COVID-19, their cases are probably more complicated because of that.

Read more or listen to the full podcast.

Robert Redfield

Centers for Disease Control and Prevention Director Robert Redfield, MD, recently spoke with APHA's Public Health Newswire about the state of public health and the agency’s plans for 2019.

We’ve seen a flood of headlines lately on falling vaccination rates and new cases of previously eliminated infectious diseases, such as measles. What’s the CDC’s approach to turning the tide on vaccination?

Immunizations are our strongest and most powerful public health tool. Vaccines have been so successful, many people have forgotten how serious vaccine-preventable diseases can be. The recent spate of measles cases is a wake-up call for Americans. CDC is redoubling efforts to reach out to vaccine-hesitant parents and public health leaders to remind them of the solid science behind recommended immunizations. The key is for individuals to embrace vaccination for themselves, their families, their communities, their schools, and their churches. Science that sits on the shelf has no value.

Read the full Q&A with Redfield in Public Health Newswire.

Dara Richardson-Heron

Dara Richardson-Heron, MD, is the chief engagement officer for the All of Us Research Program, a long-term federal study dedicated to building one of the largest biomedical datasets in the world. Heron leads efforts to engage 1 million people, including groups typically underrepresented in health science studies. The National Institutes of Health program launched in May 2018, and one year later, 80% of the 142,000 people who have signed up are from underrepresented groups, including over half who are racial and ethnic minorities.

How do you build the trust of underrepresented individuals so they are comfortable taking part in a federal health study? After all, the U.S. has a history of unethical research on minorities.

We are intentionally not shying away from these issues. Instead, we are partnering directly with key stakeholders who are our trusted community and provider organizations and participant partners.

And we are acknowledging and addressing these realities head-on and sharing the progress that has been made to prevent these historic transgressions and breaches of trust that have happened in the past, such as human subjects protection, education and training, institutional review boards, and other laws and policies that protect human research participants.

But simultaneously, we must share the great news that research has the potential to be a powerful change agent — one with the potential to begin chipping away at the really unacceptable health disparities that we see in many communities.

And certainly at the All of Us Research Program, we are doing our level best, with both our words and our deeds, to make it abundantly clear that we are committed to helping those who have concerns understand that the only way we can learn more about, and hopefully one day eliminate, health disparities, is to have much more robust and diverse participation in research and clinical trials. You really can’t have precision medicine for all if all of us aren’t reflected in the research.

Read the full Q&A with Richardson-Heron in The Nation's Health.

Cecile Richards

Planned Parenthood President Cecile Richards will be the opening keynote speaker at APHA's 2016 Annual Meeting, and she said there is much for public health advocates to be proud of — and more work still to be done

What are some recent victories for Planned Parenthood and public health, and what battles do we still need to fight?

We just had the recent Supreme Court decision, which of course struck down some of Texas’ new abortion restrictions. It’s impossible to overstate the importance of this decision not only for people in Texas, but now for people all across the country. The court really recognized that the laws that were passed in Texas under the guise of helping women in fact did just the opposite. What we’ve seen since that decision is that restrictions in six states have already been stopped. It has absolutely made a huge difference in particularly some of those states, like Mississippi and Alabama, where we’ve been a health care provider for a long time. These are states where there is very little access to safe and legal abortion as it is.

There are still enormous barriers to women to access safe and legal abortion, particularly for women who are low-income, for women who live in parts of the country that have legislatures and/or governors that have been unfriendly to their rights, and so there is a ton of work left to do.

I think the other big victory that has happened in the last few years was of course the Affordable Care Act, which writ large was probably the single biggest piece of progress for women’s health that I can remember...

I’d say probably the biggest challenge that we are focused on at Planned Parenthood, we are really focused on creating health care equity in America. Even as we make progress on types of medicines, availability, insurance coverage, we are seeing still enormous inequity in the ability to access this care. Women of color, immigrants, LGBT people are disproportionately impacted by restrictions on health care access. And for too many people, birth control services, transgender services, abortion services are out of reach because of folks’ income or because of where they live or because of just the environment or, frankly, their employer. There are other issues that are related — including maternal and infant mortality, rates of unintended pregnancy, prevalence of HIV infection, STDs — that people of color experience in disproportionate numbers.

It is unconscionable that so many people are going without health care. We have to do more as a country. That is really I think our biggest call to action.

Read the full Q&A with Richards in The Nation's Health.

Griffin Rodgers

More than 20 million Americans may have lab tests showing kidney disease, and rates are growing among adults. Kidney damage can cause waste to build up in the body, and is linked to heart disease and other health problems. In advance of March’s observance of National Kidney Month, The Nation’s Health spoke with Griffin Rodgers, MD, MACP, director of the National Institute of Diabetes and Digestive and Kidney Diseases, about kidney disease risks and steps for prevention.

Who is at greatest risk for kidney disease and why?

People at greatest risk for chronic kidney disease, or CKD, are people who have diabetes, high blood pressure, cardiovascular disease or a family history of kidney failure. Diabetes and hypertension, at least in this country, are the leading causes of kidney damage. Nearly 1 in 4 people with diabetes has CKD, while about 1 in 5 with hypertension has CKD.

Research also shows that there’s a correlation between heart disease and kidney disease. People who have cardiovascular disease are at higher risk for developing kidney disease. Conversely, people with kidney disease are at a high risk for developing cardiovascular disease.

Read the full Q&A with Rodgers in The Nation's Health.

Mark Rosekind

Mark Rosekind, PhD, serves as the 15th administrator of the National Highway Traffic Safety Administration. On the job for more than a year and a half, Rosekind has led NHTSA in its work to improve both vehicle safety and driving safety. Recently, that work has included addressing behavioral change to improve safety for both drivers and pedestrians. The Driving Behavioral Change in Traffic Safety Summit, held in March in Washington, D.C., served as a platform to begin advocating for Americans to take small steps to keep themselves safe, as well as improve the safety of their communities. Rosekind shared his insight with The Nation’s Health shortly after the summit.

What’s coming up for NHTSA that the public health community can help engage in?

Almost a year ago, we identified drowsy driving as a new initiative, and so this coming year we’re going to have a variety of activities that roll out throughout this year focused on drowsy driving.

And the other thing I would just say is that based on our five regional summits, we are going to gather everybody back up in the fall, have a meeting, talk about the near-term kinds of activities that all of us can engage in to help address the lives we need to save and also take a look at the future and think about, “What would a 25-year vision look like if we had no deaths on our roadways?”

And I think that’s a scenario we’d all like to envision, but it’s going to have to be a very different world than the one we live in right now.

Read the full Q&A with Rosekind in The Nation's Health.

Mary Wakefield

Mary Wakefield, PhD, RN, has served as administrator of the Health Resources and Services Administration in the Department of Health and Human Services since 2009. In that time, she has seen major changes in how Americans see and address their health, from millions of people getting health insurance for the first time to the expansion of health clinics in both rural and urban populations. She also presented at APHA’s 142nd Annual Meeting and Exposition in November in New Orleans. Wakefield spoke with The Nation’s Health about how she hopes public health advocates can take their communities’ health to the next level.

Looking at the future of public health through HRSA — how do you see the public health landscape evolving?

The focus of our work at HRSA is really to support access to quality health care services, primarily for vulnerable populations. Those can be people or families that are financially vulnerable — low-income families, for example. They are folks who are medically vulnerable. There are folks that are geographically vulnerable. That’s a challenge, by the way, not just for some of our rural communities, but a challenge for some of our urban areas, inner-city areas, as well.

In terms of integrating public health, we deploy our resources at HRSA with a close eye on how we can achieve health equity and improve health outcomes. We do that both through investments in primary care, but also in public health. We integrate public health in our work by aligning public health orientation with primary care.

Read the full Q&A with Wakefield in The Nation's Health.

Michael Weahkee

Rear Admiral Michael Weahkee was confirmed April 21 by the U.S. Senate as director of the Indian Health Service, an agency within the U.S. Department of Health and Human Services. He has served in various roles at IHS since 1998, and was appointed principal deputy director in 2017. IHS provides health care services to 2.6 million American Indians and Alaska Natives in hospitals, clinics and other settings. The coronavirus pandemic has created new challenges within American Indian and Alaska Native populations, but health successes point to a hopeful future.

With physical distancing enacted due to the pandemic, how is IHS health care adjusting?

Our challenges with COVID include how we ensure that patients with chronic health conditions continue to get the treatment and the medications they need.

We’ve expanded prescription fills from 30 days to 90 days to help alleviate the need for them to see their physician and spread out the physical in-person meetings as best we can.

We’ve also worked hard to expand telehealth so that patients can connect with their care teams without the requirement to come into the hospital or the health center.

Read the full Q&A with Weahkee in The Nation's Health.

The journeys of Gladney, Foster and Starling are the core of Pulitzer Prize-winner Isabel Wilkerson's book “The Warmth of Other Suns: The Epic Story of America’s Great Migration.” Wilkerson, keynote speaker at the opening general session of APHA’s 142nd Annual Meeting and Exposition in New Orleans, explains why we all should know more about this important slice of U.S. history.

Why is it important for public health workers to have an understanding of this history?

It’s vital that public health workers have an understanding of this history because it’s understanding the history that helps you understand the patient. Every person that comes before anyone seeking help is not just the person they see before them. They are in some ways a compendium of the history of all that’s gone before them and even in succeeding generations. How they appear to themselves up to that moment, how they perceive the possibilities of the treatment, how and whether they are willing to follow the instruction of the health care professional, all has to do with the history that they bring into that room. And the skepticism, the fear, the tentativeness, the wariness — all of those things come into play when a patient is there with the health care professional seeking treatment.

Read the full Q & A in the August Issue of The Nation’s Health.