APHA 2015: “Health in All Policies”

Editors note: We are delighted to host a guest contributor blog from Abby Schachter, who was a recipient of a HPSA scholarship to attend the APHA meeting this month. She shares her experiences at the conference below. Thanks, Abby!

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Last week, I attended the American Public Health Association (APHA) Annual Meeting in Chicago. It was a whirlwind event with 13,000 attendees and hundreds of panels, poster sessions, and film screenings. It was difficult to choose which of the dozens of interesting presentations to attend during any given session! The sessions I did attend exemplified the theme of this year’s meeting, Health in All Policies.

Health in All Policies is “an approach to public policies that systematically takes into account health and health systems implications of decisions, seeks synergies and avoids harmful health, in order to improve population health and health equity” (WHO). The opening general session began with a keynote address by U.S. Surgeon General Vivek Murthy, who coupled humorous remarks (e.g., “Keep an eye out for my upcoming report, ‘Why physical activity is overrated’”) with an earnest plea for each of us to begin valuing each other as much as we value ourselves when it comes to protecting and promoting health.

The author (back row, far right, in teal) with other students from the University of Michigan School of Public Health at the conference.

In a clear manifestation of the conference theme, two of the other keynote speakers were not public health professionals at all: Actor and environmentalist Ed Begley Jr. spoke about how he has long advocated for environmental protection due to the inextricable relationships among the natural and built and environments and human health, and renowned educator Dr. Freeman Hrabowski, president of the University of Maryland, Baltimore County, gave a rousing address that exemplified the importance of higher education to foster curious minds, a healthy population, and an equitable society. 

I attended many panel sessions focused on food access and food security, which together highlighted the flip side of the conference theme: not only should all public policies consider health impact, but many different policies also affect any given health issue. A few examples…

• One speaker presented an impact analysis of the “Healthy Happy Meals” bill proposed in New York City on the nutritional content of children’s fast food meals.
• Several presenters focused on how food marketing and labeling can inform or deceive customers when it comes to nutritional quality, and how regulations can guide these practices toward improving consumers’ food choices.
• A talk on food industry donations to academic and health institutions emphasized how requiring disclosures of conflicts of interest can enhance public accountability and trust.
• Multiple speakers spoke of recent efforts to improve food access through urban agriculture and farmers markets, and the challenges they have faced with land use policies and zoning restrictions.
• One panelist talked about how lax antitrust laws have resulted in only a handful of big food companies acquiring many brands, creating an “illusion of choice” when it comes to the grocery store.
• A researcher demonstrated how monthly SNAP (i.e. food stamps) payments lead to cyclical patterns of food insecurity and called for alternate disbursement schedules to eliminate this “SNAP cycle.”

These presentations demonstrate how policies across a wide range of domains can have tremendous impact on food systems, food security, industry, and nutritional quality of the American diet.

The view from the conference's main hall with busy exhibits at APHA 2015.

One of the last panels I attended addressed how the policymaking process relates to another timely topic: vaccinations. Dr. Ross Silverman from Indiana University spoke about the state policy creation process for determining allowable exemptions to required vaccinations. He noted that these decisions are purely political; that is, while medical exemptions are standard, states are not required to allow for religious or “personal belief” exemptions. As we have seen with the Disneyland measles outbreak, these policies are consequential; states with personal belief exemptions have roughly 2.5 times as many opt-outs than states with only religious exemptions. Given the politically charged debates surrounding vaccinations, some states have gone through regulatory rather than legislative processes to eliminate personal belief exemptions in order to strengthen protections against vaccine-preventable diseases.

The APHA Annual Meeting was overwhelming, enlightening, and inspiring. It was reaffirming to be in a place with so many professionals from varied disciplines who are working together toward the same goal, echoing APHA’s mission to make America “the healthiest nation in one generation.” Thank you to the Health Policy Student Association for their support of my attendance to the conference.

By: Abby Schachter, MPH Candidate, University of Michigan School of Public Health, Department of Health Behavior and Health Education

Beyond Obamacare: Life, Death, and Social Policy

A Summary of October’s Book Talk @ The Ford School

“All social policies are health policies.” – James S. House, Professor Emeritus of Survey Research, Public Policy, and Sociology and author of Beyond Obamacare: Life, Death, and Social Policy

This statement was one of the last remarks made by James House to an audience of both seasoned policy professionals and curious Michigan students in the Annenberg Auditorium at the Gerald R. Ford School of Public Policy two weeks ago. Discussion of House’s book “Beyond Obamacare: Life, Death and Social Policy,” included the shift to a demand-side approach to health care (catering to what populations actually need as opposed to what providers want to or can offer) in order to reign in national health care spending and address major social determinants of health that influence population health.

The tone of the event was set by a projection of the book’s cover: an IV bag containing a pile of $100 bills within its therapeutic fluid, as a metaphor that would soon become apparent over the course of the talk.

After a brief introduction, House stepped up to the podium, got right down to business, and began with, “Effective health policy requires effective social policy.” He then outlined problems plaguing the United States health services system dating back to the year 1900, starting with the birth of exclusively supply-side health policy that seemed to work up until 1970 when spending exploded. He referenced how poorly the U.S. performs both relatively and absolutely in life expectancy compared to other developed countries.

His call to action married key ideas when it comes to improving the equity and efficiency of health and health care: a demand-side approach to health care and the social determinants of population health. Some major determinants he cited include environmental exposures, health behaviors, psychosocial stress, psychological disposition, and social roles and productive activities.

House pointed out that the Patient Protection and Affordable Care Act of 2010 is still very much a supply-side policy. Helen Levy, a Professor of Public Policy at Ford, commented that the ACA had two main goals at its inception: to reduce the number of uninsured and to bend the cost curve of burgeoning health care spending. Evidence of accomplishing the former has been clear; the latter presents a greater problem. Professor of Health Management and Policy Richard Lichtenstein added that addressing issues of medical care and insurance, including implementation of pay-for-performance, penalties for hospital-acquired infections and readmissions, and applying the Cadillac tax on lavish plans is not a be-all, end-all solution to the deteriorating health of populations.

Prior to the Q&A, the panel discussion wound down with a “(re)discovery” of social disparities in health such as education, income, occupation, assets, race, and gender. All four panel members – Paula Lantz, Associate Dean for Research and Policy Engagement at the Ford School, in addition to the three aforementioned – emphasized the need for social policies in education at all levels, incomes over people’s lifetimes, employment, civil rights, and housing and neighborhoods in order to redefine and rebuild the health status of populations.

The panel acknowledged the forthcoming challenges in improving population health on a large-scale at the national level. House called for top-down national policy, preferable to policies that struggle to make it from communities upward. Upon the conclusion of the talk, we were left with the realization of the need to move beyond Obamacare and the reformation of health care into the equally, if not more, crucial reformation of the social determinants of health.

By: Peter Chu, MHSA Candidate, University of Michigan School of Public Health, Department of Health Management and Policy