Transcript of the Healthy People 2010 Regional
Meeting
New Orleans, Louisiana
October 21-22, 1998
U.S. Department of Health and Human Services
Office of Disease Prevention and Health Promotion
Session I:
Promoting Healthy Behaviors and Safe Communities
MR. HAGEBAK: Good morning, everyone. I am Beaumont Hagebak. My friends call me Ace. This is session number one, public comment on promoting healthy behaviors and healthy and safe communities. We will be hearing comments on chapters one through nine here.
To help assure a fair opportunity for everyone to participate in today's hearing, we will be using the same procedures as were used in the opening session.
First, each oral statement will be limited to three minutes, so that we can hear from the greatest number of participants.
The light will turn yellow when one minute remains and red when your time has ended.
Dr. Cynthia Piltch, who is a consultant to the department for this program, and who is a qualitative and quantitative researcher on the faculty of Tufts University and Boston University School of Public Health, will be monitoring that device for us. She is a very strong person.
Second, each individual and organization will be limited to one oral statement for each of the focus areas.
Third, we will allow up to 20 minutes of comments for each focus area. Then, if time permits, at the end of the overall session, the floor will be open for general comment.
I will ask each of you to introduce yourself by name and state of residence. Also, please let us know if you are commenting on behalf of an organization as opposed to individual comments.
We will begin by hearing comments on the first focus area, focus area one, physical activity and fitness.
The federal representative for this area is Christine Spain, of the President's Council on Physical Fitness and Sports, and Carol Macera from the CDC. Christine Spain is a member of the Healthy People steering committee and work group coordinator for this focus area.
We will begin. Just queue up at the microphone.
MR. STEWART: Just to make one comment.
MR. HAGEBAK: Your name, sir, and state?
MR. STEWART: Larry Stewart, a biology professor here in New Orleans. Just one general comment. I am happy that the emphasis is not solely on our children. It appears that when we are talking about health, we are talking about the children. We have to be aware of the children. We have to do this and that for our children.
It completely ignores the teenagers, the young adults and the old adults and people of other ages. I am happy that there is stress made for people of all ages in this. Thank you.
MR. MARTIN: My name is Jim Martin. I am the executive director of USET, United South and Eastern Tribes. USET is an inter-tribal organization made up of 23 federally recognized tribes in 12 different states.
On the area of physical activity and fitness, our tribe strongly endorses that concept. Each of our tribes run health services, providing health services to their tribal membership.
What our tribes are learning is that they are changing the emphasis on treating the results of a bad lifestyle to influence a healthy lifestyle.
I think an initiative on a national level, to put more emphasis on physical fitness through the improvement of recreational facilities, ball parks, gymnasiums, in the communities, will go a long way in promoting a healthier lifestyle and also as a deterrent, as we can see, to violence, drug abuse, substance abuse and those types of things.
We strongly endorse the concept of looking at the community holistically and certainly an emphasis on the physical fitness of a community.
MR. HAGEBAK: If, after you would speak, you would be kind enough to drop back at the table in the back and give her your name and identifying information, that would be appreciated.
Others on physical activity and fitness?
MS. BACON: I am Janice Bacon with G.A. Carmichael Health Center in Canton, Mississippi. It is a community health center. I just want to make one comment with reference to the issue of physical activity and fitness. Make sure that the focus is to take existing programs, such as Head Start, if there are school based clinics in the various schools, if there are school nurses, and to sort of piggy back on what was said earlier, that at the beginning of the school year or when the plans are made for that particular organization, that prevention from the standpoint of physical activity is included.
So, to utilize existing services and integrate that into those.
MR. HAGEBAK: Thank you. Other?
Okay, there will be, if there is time at the end of the entire morning, then others who wish to comment on this area can.
Our second focus area is the area of nutrition. Van Hubbard of NIH is our person in the front of the room, to respond to issues and questions should there be such.
Van Hubbard is the work group coordinator for this focus area. If you would queue up at the microphone please? Nutrition.
MS. WHITING: I am Hazel Whiting from G.A. Carmichael Family Health Center headquartered in Canton, Mississippi. I am a finance officer. On the nutrition area, I would like to make one general comment. To me, on nutrition, it is more of a change that needs to occur, and I don't know how it will take place.
I know I grew up in the south, and in the south people are trained to cook a certain way. A lot of the things that I ate as a child growing up are considered bad foods for you.
My mother, you know -- you know, to me a lot of it is not really educating a person because you know the foods are not good for you or have high fat content or what have you. It is more of a cultural thing that I guess has been kind of instilled in you as you grow up.
I find myself, if I return home to my mother's house and she has cooked -- God forbid -- chitterlings or neck bones or something of that nature, you find yourself, you will eat it, because that is what has been instilled in you growing up.
I really don't know what the answer is nutrition-wise. Even as people become educated, it is almost like taking their cultural background away from them, when they have to walk away from the things they grew up eating. The other aspect of it is, in educating older people like my mother, even though they are educated, they still will not change their dietary intake of food or the way they prepare food.
I think a lot of that is due to religion also, because she feels that she is going to live until God gets ready for her to die. I guess the thing there is quality of life. You may live as long as God intended for you to live, but what will your quality of life be. Will you have diabetes. Will you have high blood pressure. Will you have all these different diseases that you have to manage.
Therefore, I don't know what the answer is or how you get people to change their lifestyle or their cultural upbringing to change their nutritional or dietary intake.
A lot of it is not that you are not educated, because you do know things that are high in fat content, high in sodium, frying foods versus baking foods.
So, you know a lot of that. You already are educated. How does that person actually change, I guess, is the thing that needs to be dealt with.
MR. HAGEBAK: We thank you very much for your comments. I guess the solution is not to visit our mothers. [Laughter.]
The next topic area is tobacco use. Dana Silverman from the CDC, Centers for Disease Control and Prevention, is here to assist us in this area should we need it. Tobacco use.
MS. WILLIAMS: My name is Shawn Williams. I work for the Louisiana Office of Public Health Youth Tobacco Prevention Program. I sat down with Dana last night and made several comments.
Most of my comments are based on how we link tobacco use and our racial and ethnic disparities focus.
They are doing some things dealing with counter-advertising but they are not doing enough. Especially like Indian communities, they are so much not available in Indian, Native American and Asian populations. Why is it not available?
Those communities, they see tobacco as a medicinal thing. So, what exactly are we doing. We have a minority health council and how is that happening? How are they getting reached. If so, what are the statistics. If not, why not.
Also, with the high-risk areas in like inner cities and African American neighborhoods. They have a cigarette ad right here and a malt liquor billboard right here, you know, but where is the anti-smoking ads in these areas.
Right now they have started in the healthy babies to try to get the unwed mothers and stuff like that to try to go for prenatal. Are they trying to get these people to stop smoking?
The media, TV, especially movies, now they are focusing on African American males with cigars. People like Will Smith have, you know, their stogies.
He is a real good person. He is clean cut, the guy has money, he is not a nasty rapper; he is a good rapper. He is just a good guy.
So, now what has happened is a lot of these young African American males are -- in New Orleans, we have Master Pete, which is somebody who came from the ghetto and now they are like a millionaire.
These young black men see this and they don't need tobacco. They have enough with, you know, violence and unemployment and all this other stuff. So, who is trying to reach these men.
MR. HAGEBAK: Thank you. The topic is tobacco.
MS. BACON: My name is Janice Bacon. I work at G.A. Carmichael in Canton, Mississippi and I am a pediatrician. I just want to make one comment with reference to tobacco.
In the book it talks about adolescent use of tobacco. One thing I want to make sure about in the adolescent population, I have had young kids -- and I mean nine-year-old kids -- who are smoking.
I want to make sure that it is not just looking at high school children or high school aged kids.
The other concern that I have is the issue with reference to where convenience stores are located. I realize that they are there to make money.
If you are located by a high school, more than likely kids are going to come in to get drinks and snacks or whatever. Really, I think that makes it a lot easier for them to get cigarettes and cigars.
The other concern that I have -- and this has happened quite a bit -- is even though the owners will not sell it to that teenager, what the teenager usually will do is stop an adult going in and have the adult buy it for them. I would make sure that issue is addressed as well.
MR. HAGEBAK: If you would, give your name back there so that it is in order. Tobacco.
MR. STEWART: Back again, Larry Stewart from Holy Cross College here in New Orleans. I would like to see a resurrection of some beautiful old advertisements.
I remember when I was growing up, would you kiss an ashtray was one particular ad, or something along the lines of providing the American public about the odors associated with smoking.
Smokers completely have lost their sense of both taste and smell. When non-smokers object, smokers have no basis on which to judge what we non-smokers are upset about.
What I would love to see is either the CDC or this particular organization provide some shock advertising, to bring it back to the American public.
MS. GIMARC: I am Jerry Dell Gimarc from South Carolina, and I am representing myself.
This is a data kind of question.
I would just like to make sure this time around that the BRFS and the youth risk behavior
survey, that the questions are the same so that there is a continuity of the information
across age groups.
I know that in our state we really look at the key health indicators by age group. As we were putting things together, there was a discontinuity in how the questions were asked in youth risk behavior and BRFS.
For us to understand that although the tobacco use among adults in our state seems to be steady or going down, when we begin to look at the youth risk behavior, it is like here is this tidal wave out there about to get us.
We weren't connecting those data sets. I would just like to make sure that they are connected.
MR. HAGEBAK: Thank you. The topic is tobacco use.
Other commentary on tobacco use?
All right, hearing none, our fourth focus area this morning is educational and community-based programs. Katherine Hutsell of the Centers for Disease Control and Prevention is with us this morning to assist with this topic area. Dr. Hutsell is a work group coordinator for this focus area.
MS. BOBBITT-COOKE: My name is Mary Bobbitt-Cooke and I am the director of the Office of Healthy Carolinians in the Department of Health and Human Services in North Carolina.
I wanted to speak to this chapter. I think it is innovative and very progressive and looks toward the communities. I work with communities, so I was glad to see this here.
I really appreciate the first objective, which talks about children dropping out of school and said, let's get all of our kids through school and get them with a high school degree.
While that was a good bold step forward, I would like to encourage Healthy People to go even further.
The determinants of health really lie in poverty. What we need in our communities is sustainable economic growth, where people have quality jobs that are not going to rape the environment, where they are not going to be sequestered to the great big company that comes in like Swang Industries.
We have these in North Carolina, which destroy the environment and keep people in very inferior jobs. We need better sustainable growth for a healthy nation.
We also need to have portable and adequate housing if we want healthy people. We also need to have adequate child care before school, preschool as well as after school for our teenagers and middle school children as well. We also need to have adequate transportation.
All these things are building blocks to health and they are not in this rather large book. So, I would encourage the authors and the people who are putting this together, to just take a few more steps down the road and just to look at the very basic fundamentals of life that determine what our health status is.
Poverty is a great link to health. If we can do something about poverty, we have done an awful lot. I would encourage us all to look at that.
MR. HAGEBAK: Thank you.
MS. VAN LOON: My name is Susan Van Loon. I am from New Orleans. I am a professor at Our Lady of Holy Cross College and also a doctoral student at the Tulane School of Public Health.
This comment is not so much about specific objectives in this book as a proposal for something that we could do with all of the objectives.
My proposal is that we develop a healthy people report card, a simple report card of health indicators that can be used by organizations, schools, businesses, various community groups, any place where you have a population of people gathered that would show the indicators of health within that population.
For example, the percentage of people within your group who fall within the normal weight range, the percentage of non-smokers, percentage who exercise regularly.
If the report card were implemented and could be done on a yearly basis, it is entirely possible that it could be tied into health insurance rates, which would certainly be an incentive for communities, companies, businesses, schools, et cetera, implementing that.
MR. HAGEBAK: Thank you.
MS. GIMARC: I am Jerry Dell Gimarc, South Carolina, the Department of Health. I would like to propose consideration of a related objective to the high school graduation, and that would be school readiness at school entry.
Certainly in our state and other states around, there is a great interest in that particular kind of measurement, which goes back to early brain development, adequate care. Adequate child care is rolled up into that.
Certainly both the public and private sector in our state and I think in others, through maybe the leadership of the United Ways and their success by six programs, are very much involved in the school readiness issue.
I think that that one combines a lot of those direct health care health issues that we are interested in, as well as many of these other factors. That, I think, would be a good objective to consider.
MR. HAGEBAK: Thank you. The topic is educational and community based programs.
MS. WHITING: I am Hazel Whiting from G.A. Carmichael Family Health Center in Canton, Mississippi.
In the area of education and community based programs there is one objective, I believe, on school nurses saying to increase the school nurses, I guess throughout the nation.
We do have some school based clinics in a few schools in our area. They have been very effective, I guess you could say, in educating teenagers to be more health conscious, I guess you could say.
Not only that, we provide other things to the students as well, other than just health education. This brings their level of awareness up and basically, in our school-based clinics, we have nurse practitioners.
The reason we choose to put nurse practitioners there is because they can handle a wide variety of things that a nurse cannot do.
In Mississippi a nurse can only do certain things and I am sure that is true in all states. Basically, they can not only educate them, healthwise, but they can see the patients within the school-based clinic and provide them medical services.
I guess if more funding is going to be made available to place medical personnel in school, we would like for it to be more of a full-fledged school-based clinic atmosphere.
MS. ROMALEWSKI: I am Christine Romalewski, Office of Public Health here in Louisiana, but I am speaking for myself.
The thrust of this whole thing, it seems to me, is for communities to be able to take charge of the direction that they are going in.
The other day I read a snippet in an article where a priest went into a new neighborhood; he was assigned to a new parish. He was walking the streets. It was a poor neighborhood.
He made connections with some drug dealers on the streets. He asked them, why are you reaching the young people and we are not.
The drug dealer said, when they go to the store to get bread for their mother, I am here. You are not.
That really hit home with me. In order for a community to be able to have an impact on itself, a community has to have involvement.
I think it would be helpful for the communities to be able to measure the degree of the community's involvement in what is happening in the community.
I don't really have any specifics, but it seems to me that there are boy scout troops, there are affiliations with churches, there are things that are happening in each community that the community itself, if the community could grab a handle on it, it would empower the community.
The community could say, okay, we have got this many Cub Scout troops and the parents are involved in these troops, or we have youth organizations through our churches.
I am not being specific at all, but communities have a lot going on right now. I think that if communities had a way of realizing what they have going on, and also realizing that there are programs that are tracked nationally -- for example, the scout -- that they can implement themselves, that parents and the older teenagers can get involved in this, if there would be a way to grab onto the number, a count or a percent participation among young people, these are things that would be difficult to track, but they are trackable.
It would give the community some sense of power over themselves. That is all.
MR. HAGEBAK: Thank you very much. Are there other comments on educational and community-based programs?
Hearing none, we will move on to our fifth area, environmental health. Gibson Parrish of the Centers for Disease Control and Prevention is with us this morning to respond to issues or questions as needed. Gib Parrish is the work group coordinator for this focus area.
We are open to comments on environmental health.
MS. GIMARC: Jerry Dell Gimarc, South Carolina. We have the EPA delegated authority in our agency. I know that there was early discussion from EPA that they were developing goals and objectives for EPA programs.
My question is, have those been developed. If so, are we having the same goals as EPA or the programs under EPA. I would like to make sure that when I go back that we are talking the same language, the same goals. Would you respond to that? I just don't know where that is.
MR. PARRISH: I will give you a very brief response and I would be happy to talk with you more afterwards. There has been some effort at coordination between Healthy People 2010 and the EPA goal development.
They have, in fact, published their strategic plan in the last year, and that is also available to the public, both through the Internet and in print.
MS. GIMARC: Is it looking like the same?
MR. PARRISH: There is some overlap, but let me discuss that with you a bit more later. There have been some difficulties in terms of that coordination.
MS. BACON: Janice Bacon with G.A. Carmichael in Canton, Mississippi. As a pediatrician, my focus is one with reference to lead levels.
I know we have made a lot of progress with reference to that, but two concerns. For those kids that I have who have lead levels that are higher than 15 and we are constantly re-evaluating those kids and then they are reported and assessments are made of the homes and the environment, recommendations are made to remove the carpet or basically some to get them out of the house.
They never leave that environment. Something to be done to help those poor folks who really can't do anything about their given situation, that is one thing.
The other thing is, once we started getting into the issue of lead levels, we realized, for example, that we have a Head Start facility that was built before 1940 or whatever.
So, the kids going to school at that facility are constantly at risk for elevated lead levels, because we do have a significant number of children with lead levels above 15. So, that component I wondered about being addressed.
The other thing was that we actually have some area agencies that, for Head Start, for example, they were only testing kids that were on Medicaid for a while.
They were telling us that they could not afford the cost of actually having the test done for the non-Medicaid children.
MR. HAGEBAK: Thank you. If there are no additional comments in the area of environmental health, the sixth area, the sixth focus area is food safety. Darlene Tollestrup of the Food and Drug Administration will respond, should there be issues that require that involvement. Thank you. The floor is open.
Are there any comments in the area of food safety this morning?
Hearing none, we will move on to focus area seven, injury and violence and prevention. Tim Groza of CDC is with us in this area. Tim Groza is work group coordinator for this focus area. This area deals with unintentional injury, violence and abuse, and cross cutting areas.
MR. TODD: My name is Knox Todd. I teach at Emery University in Atlanta, Georgia. Today I am speaking on behalf of the Society for Academic Emergency Medicine.
In representing the society, I would like to make some specific recommendations with regard to objective 7 and 32 of chapter 7.
Objective 7 speaks to injury prevention education in public and private schools. The way it is written currently it does not address the importance of training health professionals.
We recommend revising objective seven to promote injury prevention training not only for grades K-12, but also in schools of medicine, nursing and allied health.
The CDC and the National Highway Traffic Safety Administration recommend injury prevention training as part of the core curriculum of medical schools and as part of a standardized national EMS curriculum.
Today, less than half of U.S. medical schools include injury prevention in their required curricula.
With my colleagues at Emery, we recently tested 635 fourth year students at six U.S. medical schools. We found tremendous gaps in their understanding of even basic injury prevention concepts. This was published in Academic Medicine a couple of months ago.
Most important, they, like many lay persons, tended to view injuries as unpreventable events. If we don't teach health professionals the principles of injury control, they cannot and will not incorporate them in practice.
Moving to objective 32, this promotes injury prevention counseling for children during routine medical and dental visits.
The society, in addition, supports age appropriate counseling in the emergency department and the pre-hospital setting for patients of all ages.
We suggest revising objective 32 to include these goals.
If injury prevention counseling is to have an impact, we must go where the money is. Victims of injury are at known risk, high risk, for future injuries.
Thus, secondary prevention efforts are particularly relevant for injured patients we see in the emergency department and pre-hospital setting.
The atmosphere of the emergency setting, particularly when treating an injury or a near-injury can truly be a teachable moment.
Within this setting, patients and loved ones are more receptive to injury prevention efforts, particularly when they are made by credible and knowledgeable emergency physicians, nurses and health professionals.
In addition, while we agree that childhood injuries are important, injuries are an important cause of morbidity and mortality throughout the life span.
As just one example, the emergency department is a critical site for identifying the elderly at risk for falling. Falls are a tremendous public health burden.
Every day we treat thousands of elderly patients with minor fall-related injuries. We can exploit this window of opportunity to intervene and prevent what is often a predictable downward spiral.
Remember the over 70 million baby boomers born between 1946 and 1964 turn 65 in the year 2010. Thank you.
MR. HAGEBAK: Thank you. Other comments in the area of injury and violence prevention.
MR. MARTIN: Jim Martin, executive director of the United South and Eastern Tribes. Injury prevention for American Indian communities is within the top five productive life lost and years life lost.
If memory serves me correctly, it is like number three and it is totally not health related. Injury prevention is one of the least costly ways that we can provide an influence on the communities.
A general comment on data collection in general. American Indian communities, with their connection with the Indian Health Service, the major provider of the health services, have already a lot of data facilities.
So, a general comment is, let's not reinvent the wheel. I would prefer utilizing and expanding the already data gathering structure that is in place for the communities that have them now, and then to expand it to collect the other ones.
I hear a lot of people talking about the specific book. I do have a criticism of it, because I was only given this book yesterday.
Also, a criticism of, if this is supposedly a public forum, I think you should have done a better outreach to be able to get more community-based organizations.
I was really disturbed at not seeing more Indian tribes here talking about it, because this will influence them greatly.
I do think you need to do a better job of disseminating your information earlier so people can review it, and also get the cross public spectrum to be able to comment on this.
Also, on your data collection on this, I think you need to narrow them down. I would hate for more money to go to just studying them, and take away money from actually going out and preventing things from happening.
MR. STEWART: Larry Stewart, Our Lady of Holy Cross College here in New Orleans. I am a long distance bicyclist. I noticed objective number 25, 26 and 27 simply relate to the increased use of helmets among children, 14 years of age and younger, ninth and twelfth grade students who ride bicycles.
One annoyance for me is seeing parents out with enough sense to have their child on a bicycle with a helmet and they do not even wear a helmet themselves.
I don't know why you are, once again -- my pet peeve -- directing all this attention to the youth. Get the adults. Let us practice what the heck we preach.
I am a member of a bicycling organization here in New Orleans. I have taken part in a big bicycle ride in July every year up in Iowa called Ragride. About 8,000 cyclists pedal across and they urge everybody to wear a helmet.
A colleague and I have got into the habit of seeing some of the people have enough sense to buy a helmet, but it is too hot to wear it. So, they have it tied onto the bike seat or somewhere in the back.
Tom and I make snide comments about, we sure hope that helmet saves your butt if you fall.
I would appreciate rewriting these particular objectives along the lines of, hey, let's get everybody. Why pick on just the poor youth. It is the adults that need the education. Thank you.
MR. FALCON: Hello. My name is Adolphe Falcon and I am vice president for policy and research at the National Coalition of Hispanic Human Health and Services Organization, known as COSSMHO.
In terms of the area of injury prevention, I would like to point out two items. One is that not all areas include Hispanic data breakouts.
Number two, a number of the areas, with regard to youth, focus on surveys that rely on school based surveying. For Hispanic communities, out-of-school youth are a major concern for our population.
By the time of 10th through 12th grade, a significant percentage of our youth are indeed out-of-school youth and we often find are our youth at risk for a number of the not only injuries, but other conditions that we are trying to prevent in Healthy People 2010.
In my three minutes, I also just wanted to comment on a few other areas, since I had some cross cutting comments. I thought I would join them together.
One is in the area of physical activity and fitness, again, most of the data is based on school-based surveys. We need to find a way to look at out-of-school youth.
In the area of nutrition, I would urge that we also look at nutrition with regard to new immigrants. We have a lot to learn from new immigrants as their nutritional status often is better than that of folks who reside in the United States for a long time.
There seems to be some kind of McDonald's factor going on that is decreasing our nutritional status.
In the area of tobacco, once again I would comment that race and ethnic data is not consistent throughout, and we really need to look at how we are using school based surveys and what the situation is for out-of-school youth.
With regard to environmental health, I would strongly urge that we look at the area of mercury and how mercury is playing out among children in the Hispanic community.
Finally, with regard to educational and community based programs, I would like to strongly support objective 11 under that area, that calls for states to develop culturally competent programs and plans, and that that area be changed slightly to include incorporation -- the states make plans to fully incorporate community based organizations as participants in their programs. Thanks.
MR. HAGEBAK: Thank you. We will, of course, open up at the end of all the focus groups for general comments. We are on injury and violence prevention.
MS. SMITH: I am Luberida Smith, G.A. Carmichael Family Health Center in Canton, Mississippi. I would like to comment on the youth violence, 39, 40 and 41.
We operate three school based clinics and the community health center that I am employed. We do have a school based clinic in the middle school.
During the summer months we have what is called school camp for summer enrichment. We teach conflict resolution and violence prevention.
That is only a small segment of the population that we are reaching. We see children that the law enforcement come on campus, arrest these students and take them to wherever.
I think that violence prevention, conflict resolution, should be integrated into the school curriculum in some form, in order to curtail the rise in violence that is witnessed by adolescents and even younger kids. That is my comment.
MR. HAGEBAK: Thank you.
DR. AIKEN: My name is Dr. James Aiken. I am faculty with LSU Emergency Medicine. A major part of my responsibility is staffing the local trauma center.
I have two issues I want to discuss very briefly. One relates to item 7-15. I don't know how the percentages or how the goals are obtained.
I want to say very quickly my appreciation for including emergency medicine in these proceedings. But I notice the goal for 7-15 is 93 percent of motor vehicle occupants using safety belts in children.
I would like to suggest that we put down 100 percent for that. It is one thing to legislate behavior in adults. It is another thing to take responsibility for our children.
Again, if there is procedural or other reason that it can't be 100 percent, I would certainly go along with that. For me to accept the fact or even go along with a policy that somehow condones, by the fact that we put down 93 percent instead of 100 percent for the use of safety devices for children in vehicles, I think is sending out a message that we might not want to.
As you well know, restraints or the lack of the use of restraints is a major reason for the morbidity and mortality in vehicular related trauma.
I would make a strong recommendation that we increase that percentage to 100 percent, if nothing else than to send a message out that we can't do enough for our children.
It was also brought to my attention that there was a goal in the 2000 recommendations that we encourage -- again, I will be frank with you, I didn't see it, but it was brought to my attention -- the development and prevalence of child protected firearms.
If that is the case, I would very much like to know why that was deleted from the book this year. Unfortunately, New Orleans is a major knife and gun club in the country. We are very frustrated in trauma medicine.
Anything that can be done, anything that is remotely reasonable, remotely realistic in the restrictions or even the use of firearms, whether it is preventing the children, I think would be very, very useful.
I would urge that in the 2020 proceedings that we look and reinstate that goal. Thank you.
MR. HAGEBAK: Thank you.
MS. BACON: Janice Bacon with G.A. Carmichael in Canton, Mississippi. I want to address the issue with respect to the lack of baselines in dealing with sexual assault, victims and victims of partner violence.
What I would like to see is a way to investigate when you do have women there for their routine OB/GYN examinations or mammograms or whatever, if that would be a way to try to do a routine screening.
What we have found, for those who we have as domestic violence victims, if you get them when they are not in the acute situation and try to find out about it earlier, sometimes you can get information.
So, maybe utilize when they come in for something else, such as OB/GYN care or when they come in for mammograms, versus when you have them in the emergency room in a bad situation, to try to get some baseline information.
MR. BENN: Good morning. My name is Clyde Benn. I am the minority health director for the state of Oklahoma. I would just like to make some general comments regarding male responsibility and male health.
I think that we need to specifically put in the Healthy People 2010 objectives some type of coordinated information regarding male educators and individuals that work with males.
I think we also need to start including beyond just the clergy, individuals such as our coaches and various state coaching organizations, vocational educators and male fraternal organizations. Thank you.
MR. HAGEBAK: Other comments on injury and violence prevention?
Hearing none, our focus area -- I am sorry.
MS. GIMARC: I am sorry, just one more time. Research shows that violence and poor impulse control are related to low levels of brain serotonin, and the lower the level of brain serotonin, the more violent the violence.
Research also shows that exercise and sports activity elevate brain serotonin. I think if we can put those programs back in the school, we will see school violence diminish greatly. Thanks.
MR. HAGEBAK: Other comments in this area? Hearing none, we will move to focus area number eight, occupational safety and health.
Chuck Gollmar from the Centers for Disease Control and Prevention is with us on this topic. Chuck is a member of the Healthy People steering committee. The floor is open.
For those of you who have come in late, we will be opening the floor to comments on all areas before we conclude the session this morning.
Are there any additional comments, or comments, on occupational safety and health.
Hearing none, we will move to focus area number nine, oral health. Van Hubbard, with the National Institutes of Health, is with us on this topic this morning. Oral health.
MS. WILLIAMS: My name is Shawn Williams again. I am with the Louisiana Office of Public Health Youth Tobacco Prevention Program.
My question is, what are dentists or anybody in oral health doing anything about explaining smokeless tobacco to their patients and how smokeless tobacco affects your oral health.
A lot of people see smokeless tobacco as harmless compared to cigarettes. In actuality, it does more harm than smoking a cigarette.
I wonder, do you have any statistics on the prevalence of them asking if they chew or whatever, and do you do education on it. That is my question.
MR. HUBBARD: I am not sure I can adequately answer all your questions other than personal experience on that. When you go for a dental visit, those questions are asked as part of a questionnaire that you fill out while in the waiting room.
I would anticipate that to be taught in the dental schools. I would have to take that back to the oral health group to get further information.
MR. HAGEBAK: Thank you. Other comments?
MS. BACON: My name is Janice Bacon, G.A. Carmichael, Canton, Mississippi. The issue of children who are on Medicaid and who are part of the EPSTD program, so they actually have a funding source to pay for their dental services, but a good proportion of them are not receiving dental services.
Is there a way to provide some type of incentive or mandate or whatever to make sure they get it, because it is really a waste when they do have something that will pay for dental services and they are not receiving it, if that can be addressed. I would appreciate that.
MR. HAGEBAK: Other comments in the area of oral health? Hearing none, then, I would like to open the floor generally, to any comments that anyone would care to make in the area of promoting healthy behaviors and healthy and safe communities. That is our topic area in session one. Anyone at all, particularly latecomers?
MS. SFAKIANAKI: Good morning. My name is Eleni Sfakianaki. I am the medical director of the Miami/Dade County Health Department, and I am also on the faculty of the Miami University School of Medicine, where I teach public health courses.
I really would like to thank you all for allowing us the opportunity to express our opinions. I commend you for the process.
I was coming here with the hope that I would listen to public comments. I would like to share the concern that was expressed earlier today with you.
I feel very privileged that I am participating in this process, and I was happy to hear comments from all in this room. I really would have liked to see the communities to be represented, and the public to be able to express their opinions and their concerns.
It is their health, after all, that we are concerned with. Perhaps at some point in the process you would like to invite people from the general public and the communities that we care for. Thank you.
MR. HAGEBAK: Ma'am, if you would give your name at the back of the room? Thank you.
MR. TODD: I am Knox Todd again. I am an emergency physician from Atlanta, Georgia. In this case I would like to speak to injury prevention but speak from a personal perspective.
Despite the obvious importance of education and enforcement, our major advances in the area of injury control have come from engineering innovations.
We build better roads, we build better cars. They have had a major impact on motor vehicle crash mortality. This is a tremendous public health success story.
As an emergency physician, however, I treat large numbers of handgun injuries. I was troubled, on seeing the draft last week, to see that an objective regarding development of a child safe hand gun that was present in Healthy People 2000 has been removed from Healthy People 2010.
In fact, the term hand gun seems to have been completely removed from the draft that I read.
I am originally from Texas. I have nothing against long guns. I actually grew up in a hunting culture, as you can imagine.
For Healthy People 2010 to strategically remove this term seems to me to be counterproductive, particularly with regard to the promise of engineering a child safe firearm.
I think that in removing this objective, I think we have lost a great deal in terms of the leadership that the Healthy People process can provide. Thank you.
MR. HAGEBAK: Thank you.
MS. CARROLL: Hi. I am Alice Carroll. I am a registered dietitian and I am just representing myself.
I would like to see a little more cross referencing in the nutrition section with the educational community based programs.
Some of the objectives are particularly related to nutrition education. Objectives 14, 15 and 16, out of context they seem a little odd, but put in context with a total educational program, it makes a lot more sense.
I would also like to know what does better than the best mean.
MR. HAGEBAK: Thank you.
MR. MARTIN: Jim Martin, executive director of USET. I want to commend the group in one thing as far as I see the different categories, and I hope that I am perceiving it correctly, that you are looking at the communities holistically.
That is something that our tribes are now looking at, is treating the whole person. As one of the previous ones, I think you need to marry a lot of the areas, the community-based educational with nutrition and injury prevention.
The ones that by sheer fact are similar should be married together in looking at it holistically, particularly like for community based organization and education and the area of elderly and nutrition and injury prevention.
One of the things we found in our clinics was the doctors would write prescriptions for elderly people. They would go home but they would forget how to take their medicine correctly.
So, it is not only that you did not get the person well, you actually created an injury. You see that person back in for over dosage.
That could be worked through the senior citizens programs, the community based programs for senior citizens, meals on wheels, congregate meal sites, of how to -- they are already going.
You do not have to reinvent the wheel. I would hate to see this overall project create new organizations. The infrastructure for most communities to be able to disseminate and address these issues are in there.
For the ones that it is not, then go into those new ones. The ones that are there already, expand them. Give them the necessary funds to do it.
They can tell you, and are already trying to address a lot of these issues anyway. It is simply that they do not have enough funding to do it adequately.
MR. STEWART: Larry Cross, Our Lady of Holy Cross College here in New Orleans. I would like to second what the young lady said before, about smokeless tobacco.
There appeared to be nothing specifically identifying it in the oral health section. Looking in the tobacco use, it appears there is a slight mention in objective 1-B, on page 3-8, that says, reduce smokeless tobacco use among male military personnel aged 18 to 24, to no more than 11 percent.
Why single out only these men in the military, between 18 and 24? We certainly have quite a few other people that use it.
Then over on objective three it says, reduce the proportion of young people in grades nine through 12 who have used tobacco products.
Once again, we are taking a specific young group and we want to reduce the smokeless tobacco use per month from 9.3 percent down to two percent.
I would urge you to develop an objective on smokeless tobacco for the entire American population, rather than just men in the military between 18 and 24, or the young people grades nine through 12. It is too narrow. Please. Thank you.
MR. GRANT: Hello. My name is Andre Grant, G.A. Carmichael Family Health Center, Canton, Mississippi.
I presently work at a school-based clinic. We have three school based clinics in Canton. One of the most important things that the school based clinics have helped there in Canton was that parents normally have to get up at 3:00 o'clock, 4:00 o'clock and go to work.
That way, they get home late and the child wouldn't normally see any health care. Since G.A. Carmichael has taken on the responsibility of putting school-based clinics on campus, that has helped tremendously that the parents don't have to worry.
There are some kids come in asthmatic, the kids come in with various complaints. Normally the parent has to leave work that is about 20 or 30 miles away and come and try to see about the child, or an elder, a grandmother, had to come see about the child.
Focus more on school-based clinics. It has helped tremendously there as far as parents who really don't have the money, nor can't afford to get off work, don't make enough money on the job they are at, but yet instead they are trying to do their best.
School based clinics have covered a gap and I feel that we have tremendously helped the community there in Canton. Also, many parents have come and talked about how greatly they appreciate what we are doing there.
I think especially in some of those deprived areas, that school based clinics, it is a full clinic on campus, not a school nurse but a school based clinic, that you will be able to treat a child and send him back to help.
Also, what it has helped, it has helped tremendously on attendance, that normally a child would miss school or have to go home. Now the child can be treated. If it is not severe, he or she can go back to class. Thank you.
MR. HAGEBAK: Thank you.
MR. TUBRE: Good morning. My name is Charles Tubre. I am the director of advocacy and community relations for a local community-based organization which provides services to people with disabilities.
I am a later comer. I have not had a chance to read your 2010 statement. I am familiar with 2000, Healthy 2000. In the late 1980s, I worked for the Office of Public Health Disability Prevention Program here in Louisiana.
One of the things that we did, in addition to establishing a registry for collecting information about head injury and spinal cord injury, was to look at secondary conditions attendant to those two disabilities.
While we made some proposals as to how a health department could be involved in understanding the data, translating that into some prevention strategies and, subsequently, how we might reduce the incidence of secondary conditions. Nothing ever came of that.
As a staff person now of a local community-based organization, an independent living center, one of 320 across the country, I think it would be useful for us to think in terms of how independent living centers can become a community base for education on prevention to the disability population that we serve.
One of the things that we do now, as we intake and provide services to people with disabilities, is help them know where medical services are.
It seems logical to me that if monies were available for such centers as ours and others around the country, that we could be a forum for teaching people with disabilities how to prevent and minimize secondary conditions, such as skin conditions, ulcers, urinary tract infections, depression, et cetera, substance abuse.
I would ask that you consider putting that into your plan for the future, as a way of providing an education opportunity for people with disabilities. Coming to such centers now for services, it would be a natural place for an extension of that education.
The other thing is, for long-term care, right now in many states the only option for long-term care, if you can't get it in the community through some sort of subsidy funding for attendant care, is to end up in a nursing home.
I would ask that you include in the long-term care prevention of secondary conditions by the provision of funding such as what is being proposed by MICASA.
If you don't know, that is just a strategy for using Medicaid funds to enable people with disabilities to live at the community level rather than in nursing homes.
This, indeed, using trained personnel would help us prevent some of the secondary conditions that we deal with on a daily basis. Thank you very much.
MR. HAGEBAK: Thank you, sir.
Ladies and gentlemen, it is 10:00 o'clock. We have had an interesting morning here. The Marines have a slogan that goes semper fidelis, which means always faithful.
We in the Public Health Service have one that goes semper gumby. It means, always flexible. You know Gumby, and we are going to try to be flexible here.
What we would like to suggest to you is, since the other two groups have ended already, and this room is too small to contain everyone who would like to come into it, that perhaps we could adjourn back to the ballroom on the 16th floor for a break.
Then Dr. Clinton will open the floor to everyone on all topics, not only on this one, so that we can be assured that all will have an opportunity to speak to the issues they wish.
I would like to thank the expert panel here, who received such very short introductions for such very skilled people, really, and it was a thrill to meet most all of them.
I would like to thank my colleague here, for running the clock, and thank you for your testimony here this morning. Thank you all very much. We will see you in the ballroom.
[Whereupon, at 10:00 a.m., the session was adjourned]