Tuesday, June 28, 2011

Clearing the Air: Addressing Asthma Disparities in Maryland

This morning I had the pleasure of addressing a group of health care professionals at the Asthma and Allergy Foundation’s Clearing the Air: Addressing Asthma Disparities in Maryland conference in Linthicum, Md.

In Baltimore City, over 60,000 adults and nearly 20,000 children have been diagnosed with asthma at some point in their lives. There are considerable disparities in the burden of asthma by age, race, ethnicity, and geography. Young children, African-Americans, those with low income, and urban residents carry a disproportionate burden of asthma in Maryland. Access to quality care is thought to be a significant factor contributing to disparities. Disparate populations may lack insurance, asthma education, or access to quality primary or specialty care providers. These and other barriers to quality care have significant impacts on asthma morbidity and mortality.

One of the key ways that the Health Department is addressing asthma disparities in Baltimore is through Healthy Baltimore 2015, our comprehensive health policy agenda. This agenda aims to explore the root causes that drive health inequities, break down silos between various sectors of our society. To this end we’ve created an interagency task force to examine potential health implications of policy decisions.

To date, the asthma home visiting programs have reached over 500 children and have documented significant reductions in asthma symptoms, roach and mouse infestations, and school absences. Among a sample of 94 clients, 94.7% had a reduction in emergency department visits and 100% had a reduction in hospitalizations after completing three home visits. School-age participants also reported an increased attendance rate.

To address asthma disparities in Baltimore City Schools, we are working with the state to implement the Asthma Friendly School Initiative. More than 30 Baltimore City Schools that are Asthma Friendly. This Initiative requires schools to meet a set of criteria to be considered Asthma Friendly including:

    • Identifying and tracking students with asthma;
    • Maximizing asthma management through the use of asthma action plans and case management;
    • Coordination of asthma management with parents/guardians and health care providers;
    • Supportive policies regarding access to asthma medication;
    • Proactive maintenance of buildings and school facilities to reduce asthma triggers and improve indoor and outdoor air quality; and
    • Asthma education for students and staff

Additionally, the Health Department’s EPA-funded Healthy Environments Healthy Kids program will provide training of and direct services to community-based partners engaged in improving environmental health for children in Baltimore. Through this grant, the BCHD will improve child health outcomes in Baltimore through:

o   inspecting and training for city-based Head Start Programs and child care providers focused on environmental and health hazards in those settings;
o   training of key home visit staff (e.g., community health workers and nurses, Healthy Start staff) on healthy home fundamentals;
o   training for WIC and other community-based partners; and
o   integrating healthy homes and community principals into training and certification programs for licensed child care providers.

BCHD will continue to collaborate with its partners to improve asthma disparities, working toward our goal of turning Baltimore into a city where all residents realize their full health potential.

I’m curious to hear what other public health workers are doing around asthma and schools. What are some of your success stories?

Tuesday, June 21, 2011

Cigarettes Get Graphic New Warning Labels

Today the FDA announced a major leap forward in the ongoing struggle of educating the public about the dangers of smoking. 

Beginning in September 2012, every pack of cigarettes will be required to have a graphic warning label reminding the public about the real life consequences of smoking.  Thanks to the Family Smoking Prevention and Tobacco Control Act signed into law in June of 2009, each pack of cigarettes will contain one of the following images:
One of the FDA's new warning labels.

  • A mouth full of gross teeth with a lip ulcer - early signs of oral cancer
  • Before and after picture of lungs exposed to smoking
  • A cute baby about to be engulfed by a cloud of poisonous tobacco smoke
  • A gentleman smoking through a hole in his throat
  • An overweight man on oxygen presumably having a heart attack – a consequence of smoking
  • A cartoon of a premature infant – prematurity a consequence of smoking during pregnancy
  • A distraught woman next to the caption “WARNING: Tobacco smoke causes fatal lung disease in nonsmokers.” 
  • A corpse with his chest sewn up
  • A dude proudly sticking his chest out with an “I Quit” logo on his shirt

These images range from the gross to the sentimental to the uplifting.  I applaud this effort because we need all the help we can get when it comes to helping people stop smoking. 

Cigarettes have been designed to be one of the most efficient ways to deliver one of the most addictive substances on this planet – nicotine.  Packaged with slick advertising cigarettes have worked their way to being the number one cause of PREVENTABLE death.  Regrettably, I don’t think there’s a graphic for that.

In Baltimore City, smoking rates are as high as they are in states such as Kentucky, one of the highest producers of tobacco plants.  There are no safe tobacco products, nor is there a risk-free exposure level for adults, children or pregnant women. Tobacco is a major contributor to early heart attacks, strokes, chronic lung diseases and cancers. There is also compelling evidence of the harmful impact of secondhand smoke to nonsmokers and children who suffer from respiratory infections. Smoking is also associated with preterm births, still­births, and low birth weight.

That’s why Healthy Baltimore 2015 identifies tobacco as a priority area for action. Over the course of the coming year, we will collaborate with partners across the city to help our residents stop smoking, or better yet – never start.  One of our most important resources is 1-800-QUIT-NOW.

Which graphic do you prefer?

Take Care Baltimore!

Thursday, June 16, 2011

National Prevention Strategy mirrors efforts in Baltimore to improve health outcomes, eliminate disparities

Today I had the pleasure of taking part in a stakeholder panel discussion as part of the release of the National Prevention Strategy. I was representing the National Association of County and City Health Officials (NACCHO), the group that represents the nation’s more than 2,800 local public health departments.
These city, county, metropolitan, district and tribal departments work every day to protect and promote the health and well-being of all people in their communities.

Local health departments are essential to seeing that the strategic directions and priorities of this Strategy result in improved health outcomes. The central role for local health departments will be to do what we do best: Emphasize preventive and quality health care, expand access to care for all populations and engage communities.

In Baltimore City there is a 20 year gap in life expectancy between 2 neighborhoods less than 5 miles apart. Statistics like these give great urgency to the work we do to improve the health of our city, our neighborhoods and our residents. That’s why in April, Mayor Stephanie Rawlings-Blake and I released Healthy Baltimore 2015, an aggressive plan for improving health outcomes and eliminating health disparities.

Healthy Baltimore 2015 highlights 10 priority areas for action that account for the greatest morbidity and mortality in Baltimore City.  These priority areas mirror the National Prevention Strategy. Within each of the 10 areas, we identified aggressive benchmarks for improvement because they help to set the level of urgency in addressing ongoing disparities and inequities. 

In addition to reporting citywide data for each of the leading indicators, we include the greatest subgroup disparities.  In some indicators this is based on race, but in other indicators the greatest disparities are based on gender, educational attainment or income.

Our leading indicators go beyond traditional health measures and explore the root causes that tend to drive health inequities such as access to healthy foods, liquor outlet density and vacant building density.

We’re adopting a health in all policies approach because it’s clear that addressing these long-standing inequities can no longer be accomplished via traditional medical models or even traditional public health models. We’ve convened a cross-agency health task force that has senior level representation from all city agencies. 

Our job will be to look at what each agency is currently doing in service of HB2015 and what we can do above and beyond. We’re working with Hopkins School of Public Health to develop evaluation metrics to determine what difference this process makes on the ground.

We’ve also convened a similar group for our clinical providers.

Lastly, we have an innovative private public partnership aimed at reducing disparities in access to healthy foods. It’s our virtual supermarket known as Baltimarket.

The National Prevention Strategy represents an unprecedented commitment by the Obama Administration to the idea that prevention of illness and disease should be a national goal, not just for those of us in the health field, but for every sector of society that touches people’s lives. I stand with other local health departments in applauding federal government leaders represented here today for recognizing that improving the quality of life for all Americans needs to incorporate the influences of where we live, learn, work and play.

Have you had a chance to look at the Strategy? What are your initial thoughts? How can we all work together more efficiently to achieve these goals?

Wednesday, June 15, 2011

Health Department Testing Reveals Items of Children’s Jewelry With Excess Lead

Many parents are aware of the health risks associated with lead poisoning. The federal government limits the amount of lead in children’s toys. But what they may not know is our inspectors continue to find some products – especially children’s jewelry – with off-the-charts lead content being sold in Baltimore City retail stores.

Lead is toxic to the nervous system. It can cause severe illness and even death at high doses and cognitive impairment and other neurological problems at lower doses. These health risks are the reason the Baltimore City Health Department tests products for lead levels every month. This morning, we issued violations to three businesses selling items of children’s jewelry that contained dangerous levels of lead. Lead contents below 300 parts per million (ppm) are considered safe. However, these items tested by an independent certified laboratory for as much as 280,000 ppm of lead.

Perhaps the most disturbing aspect of these test results is that one of the products was labeled “lead compliant,” and yet it contained 18,000 ppm of lead – that is 6 times the regulated limit.

All products of the same style and manufacturer to these items are being considered a nuisance to public health. These products may not be offered for retail sale in Baltimore City. Please be on the lookout for these products:

Item: 4pc Pink & Rhinestone Flower Set (Rhinestone flower clip on earrings)
Total Lead Content: 18,000 ppm

Item: Strawberry Charm Bracelet (Big Strawberry Charm)
Total Lead Content: 180,000 ppm

Item: 3 piece Pearl Set (Pearl Necklace)
Total Lead Content: Clasp – 3,800 ppm; Chain – 280,000 ppm

This and other recent toy recalls due to unsafe lead levels should serve as an important reminder for parents to remain vigilant. Dangerous lead levels have recently been found in a Toy Story 3 bowling set, an American Girl’s craft kit, even articles of children’s clothing.  In fact, a quick glance at the CPSC’s toy hazard recalls will illustrate that the sale of children’s items containing high levels of lead remains a stubbornly difficult problem to combat.

For more information on Baltimore’s regulation on lead in children’s jewelry, visit our website.

Friday, June 3, 2011

Goodbye Food Pyramid, Hello MyPlate

First Lady Michelle Obama has been a powerful advocate for ending childhood obesity. Her Let’s Move campaign is aimed at raising a generation of American youth who are healthier and more active than those before them.  While her initiatives are directed at kids, Mrs. Obama’s message is an important one for all of us.

We live in a time when two-thirds of Americans are overweight or obese. In Baltimore City, 1 in 3 children is overweight. Additionally, 37% of Baltimore City high school students are overweight, compared to 29% of their counterparts in Maryland.

As we all know, obesity is associated with numerous health problems, including heart disease, stroke, and diabetes. And while sedentary lifestyles play a significant role in the country’s obesity epidemic, so too do poor food choices.

Enter MyPlate. This new tool from the USDA replaces the outdated food pyramid. MyPlate provides a clean visual representation of how our meals should look: half of the plate is fruits and vegetables, with the other half split between grains and protein. Dairy sits in a saucer on the side. This is a far more logical symbol for consumers to make food choices than a pyramid – what could be simpler than a plate?

The old food pyramid primarily instructed consumers to eat a certain number of servings from each food group. However, what constituted a “serving” was not especially easy or convenient for people to figure out. As the First Lady said, "We can't be expected to measure three ounces of chicken or look up a portion size of rice or broccoli." In contrast, MyPlate places a much higher emphasis on portion size and proportion.

It is important to know that MyPlate will not single-handedly end the obesity epidemic – it does not encourage physical activity; explicitly decry slathering vegetables in butter; or address the fact that in many households and restaurants, plates can be the size of small dinner tables. However, news outlets, nutritionists, foodies, and academics agree that MyPlate is a great first step toward educating consumers about smart food choices in a relatable, common-sense way. And just like its predecessor the pyramid, people are encouraged to visit www.choosemyplate.gov for more in-depth information on nutritional food choices.

If we are to meet the aggressive goals we set in Healthy Baltimore 2015 for combating obesity, we must utilize a variety of approaches to educate and change the behavior of our residents. Common-sense tools such as MyPlate can be an important resource for the average family looking to improve their food choices.

What do you think? How does MyPlate compare to the food pyramid? Do you think it will succeed in getting people to eat healthier?