I recently saw a great presentation from the American Public Health Association describing what public health does. generationpublichealth.org

An excellent  explanation of  the value  of public health in promoting healthy lifestyles.

The Virginia General Assembly has finally banned smoking in bars and restaurants and the bill goes  to  Governor Kaine who will almost certainly sign it with ” the quickest drying ink he can find.“  After weeks of debate the legislation passed despite the opposition of Phillip Morris, the nation’s largest cigarette producer, headquartered in Richmond.

There are a few exceptions to the ban such as:

1. Any outdoor area of a restaurant

2. Any portion of a restaurant that has a door and is separately vented to prevent the recirculation of air

3. Any portion of a restaurant that is used exclusively for private functions and those portions  of the restaurant are separately vented and have a door

4. private clubs

One of the more important sections of the bill says “No individual who is wait staff or bus staff in a restaurant shall be required by the proprietor to work in an area of the restaurant where smoking may be permitted without the consent of such individual.“

Finally, the staff can avoid the health effects of second hand smoke.  In June 2006 the U.S.Surgeon General reported that there is no safe level of exposure to second hand smoke.

At last, health wins over big tobacco  in Virginia.

I recently saw the movie Super Size Me and was once again reminded that the U.S population is fat and getting fatter.   What are the causes of the obesity epidemic ?  Certainly the availability of cheap calorie and fat laden fast food  contributes to the problem.  How many times a week does the average family eat out?  If children are not getting meals  at  home where do they learn to  prepare food?  Where do children learn about diet and nutrition?

My sons are excellent cooks, are not obese, and understand nutrition.  I am not the best cook (famous for my rubber chicken)  but we ate most meals at home.  My husband and I encouraged our sons  to cook meals for the family.  They learned that food comes from the grocery store and not the drive through.  They also learned that home cooked food tastes better and is more nutritious than burgers and fries.

My suggestion to help combat the obestity epidemic is to introduce children to cooking  and keep family meals at home.

Google.org recently launched a new source for flu data called Google Flu Trends.  Flu activity is estimated by the number of Internet  searches  for flu information.  This may correlate with the number of people  having flu like illness.  CDC and states now  collect data from outpatient visits for  flu like illness, laboratory reports of specimens testing positive for influenza, as well as reported outbreaks of influenza.

According to Google.org, they were able to estimate the 2007-2008 flu activity 1-2 weeks faster than CDC published reports.  Some states monitor daily influenza like illness activity through  syndromic surveillance which may be more timely than the published CDC reports.  Also some state health departments  are  looking at  data on over the counter medication sales.

Early warning allows state and local health officials to put into effect prevention and control activities as well as help people take appropriate precautions if flu is in their area.

The unique aspect of the Google flu surveillance is that it looks at the both the population that is seen by a clinician and those that are not seen by a clinician  for their symptoms.

Google.org adds to the growing sources of  innovative sources of health data such as ProMED-mail and Healthmap and I applaud their efforts. It will be interesting to follow this  data through the coming flu season and determine how it can be used to benefit health.

The Kaiser Family Foundation has a new resource on its health08.org web site detailing Sen. John McCain’s and Sen. Barack Obama’s positions on key health care issues.  The side by side comparison focuses on issues not necessarily addressed in their health care reform proposals compiled from the candidates’ web sites, speeches and campaign debates.  These issues include:

• Biomedical Research
• Care Coordination and Prevention
• Health Care Reform
• Health Information and Technology
• HIV/AIDS/Global Health
• Long-Term Care
• Medicaid and SCHIP
• Medical Malpractice
• Medicare
• Mental Health Parity
• Prescription Drugs
• Racial and Ethnic Disparities
• Transparency and Comparative Effectiveness
• Veterans’ Health
• Women’s Health

Under the heading of Prevention, Senator McCain

“believes individuals should do everything possible to prevent expensive, chronic diseases, and that parents have a moral obligation to educate their children on healthy lifestyles.”

I would like to know how he plans to accomplish these goals.  Other than advocating that businesses and insurance companies  promote the availability of smoking cessation programs and funding research on chronic illness prevention, he has little to say about how individuals and families can accomplish disease prevention.

Senator Obama, on the other hand, would require federally supported health plans to cover essential preventive services such as cancer screening and smoking cessation programs so individuals and families can have access to these services. He  would increase funding to expand community based preventive interventions. He  would work with schools to create more healthful environments for children with  school based health screening programs and clinical services as well as  increased support for physical education and educational programs for students.  His plan supports expanding and rewarding work site health promotion and prevention.  I see his plan as more than just  hoping that “individuals do everything possible to prevent chronic diseases”.

Jonathan Oberlander, Ph.D. has written an excellent review of the candidates plans for healthcare reform in the recent New England Journal of Medicine. The article includes a succinct comprehensive summary of both candidates’ key elements for health care reform. His main criticism of the McCain plan is

” its reliance on the individual insurance market.”

“In contrast to John McCain’s emphasis on markets and deregulation, Barack Obama’s reform plan relies on an employer mandate, new public and private insurance programs, and insurance market regulation.”

Health care reform will be an important issue in the coming election and this article is a must read.

After a recent cycling trip , I decided to update my blog on bike helmet safety. While cycling with a group in the Netherlands, we suddenly encountered a terrific thunderstorm with marble sized hail lasting what seemed like 30 minutes. We were all wearing bike helmets which protected our heads from the ice pellets. We huddled together and received numerous bruises on our backs and extremities but our heads were protected.

Our helmets had ventilation holes so a few pellets got through but for the most part, our heads were saved from the constant pelting. Wikipedia describes head injuries from large hail and I can believe it.

I now will add protection from hail as another good reason to wear a helmet while cycling.

My youngest son recently reminded me how difficult it was to grow up in the home of an emergency physician. All activities were ranked on a scale of 1-10 with 1 being almost no risk of injury, such as finger painting with non toxic paint to 10 being a good chance of injury, such as riding behind a neighbor’s car on a sled. There was always the reminder that high ranking injury activities would bring them into my ED on a stretcher. I was constantly telling them that the leading cause of death in children from 1-18 was unintentional injury and that injuries were not “accidents”.

Before the birth of my first child, I had childproofed the house with plugs in all outlets and no poisons in lower cabinets. I had posted the number for poison control on the refrigerator and removed all toxic houseplants. Bike riding was helmets only and when in a boat life preservers were mandatory. As they reached adolescence we had a driving contract which prohibited driving after dark for the first year. Since I had seen my share of underage drinking in patients, they were not allowed to stay with friends whose parents were not at home.

Did they have injuries…sure. Two anterior cruciate ligament injuries from team sports, a cut tendon from a knife, a smashed thumb caught in a car door ( A Volvo, of course) and an unavoidable auto crash ( in a 1990 Volvo).

So now that they are adults, I hope they remember the 1-10 injury grading scale when they are making their own decisions. We recently went swimming at a quarry with my oldest son and he was remarking how dangerous it was to dive off the rocks. I think he remembered.

I have finally found what I consider the ultimate healthy diet in Michael Pollan’s book “In Defense of Food”. He states it very simply:

“Eat food, Not too much, Mostly plants“

I have tried multiple diets including the “Diet for a Small Planet” approach by Fances Moore Lappe to eat complementary combinations of food. I have tried the low carbohydrate diet, the low fat diet, the no red meat diet and even the grapefruit diet. I scanned labels in the grocery store to learn the nutritional content of foods and to figure out the science of eating a healthy diet.

After reading this book, I buy mostly produce which comes with no packaging and no labels to confuse me with nutritional content. I am liberated by the statement “eat food, not too much, mostly plants.” It is so easy!

Health care will be a top priority in the next presidential campaign. As the candidates consider affordable heath care for every American, I hope they do not lose sight of public health and the huge achievements that have improved the health and extended the life expectancy of persons in the United States.

According to Senator McCain in response to an set of ten questions posed by the AMA to the candidates about their health care reform proposals.

“The most important players in health care; however, are the patient and their health care provider-as everyone else merely plays a support role”

I would like to remind Senator McCain of the Ten Great Public Health Achievements in the U. S. -1900 to 1999 which include:

• Vaccination
• Motor-vehicle safety
• Safer workplaces
• Control of infectious diseases
• Decline in deaths from coronary heart disease and stroke
• Safer and healthier foods
• Healthier mothers and babies
• Family planning
• Fluoridation of drinking water
• Recognition of tobacco use as a health hazard

Public health is a major contributor to the health of Americans and not “merely a support role”. Public health at the federal, state, and local level plays a critical role in disease prevention and health promotion.