“emerging activities in rural areas” richard f. hamman, md, drph dean
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“Emerging Activities in Rural Areas” Richard F. Hamman, MD, DrPH Dean. Overview. Northern Colorado. Introduction Rural activities Training Joint degrees Questions. Colorado State. UC Denver AMC Campus. What is Public Health?. - PowerPoint PPT PresentationTRANSCRIPT
University of Colorado Denver | Colorado State University | University of Northern Colorado
“Emerging Activities in Rural Areas”
Richard F. Hamman, MD, DrPHDean
University of Colorado Denver | Colorado State University | University of Northern Colorado
Overview• Introduction• Rural activities • Training• Joint degrees• Questions
Colorado State
3
What is Public Health?
Public Health is the science and art of protecting and improving the health of communities through
education, promotion of healthy lifestyles, and
research for disease and injury prevention.
University of Colorado Denver | Colorado State University | University of Northern Colorado4
““Health Care is vital to all of us Health Care is vital to all of us
some of the time but some of the time but
public healthpublic health
is vital to all of us all of the time”is vital to all of us all of the time”
C. Everett KoopFormer Surgeon General
University of Colorado Denver | Colorado State University | University of Northern Colorado
Association of Schools of Public Health (ASPH) Report“Confronting the Public Health Workforce Crisis”KEY FACTS: • ASPH estimates that 250,000 more public health
workers will be needed by 2020. • The public health workforce is diminishing over time
(there were 50,000 fewer public health workers in 2000 than in 1980), forcing public health workers to do more for more people with fewer resources.
University of Colorado Denver | Colorado State University | University of Northern Colorado
ASPH Report“Confronting the Public Health Workforce Crisis”
• 23% of the current workforce – almost 110,000 workers – are eligible to retire by 2012.
• Documented and forecasted shortages of – – public health physicians– public health nurses– epidemiologists – health care educators– administrators
University of Colorado Denver | Colorado State University | University of Northern Colorado
ASPH Report“Confronting the Public Health Workforce Crisis”• To replenish the workforce and avert the crisis,
schools of public health will have to train three times the current number of graduates over the next 12 years
(Note, this doesn’t even include the massive need to provide continuing, career long training to those already in the workforce)
In the news
Viral disease sickens hundreds in ChinaThe Associated Press May 19, 2007
BEIJING- An outbreak of a viral disease common in children has sickened almost 900 people in eastern Chinabut the outbreak has been contained, state mediasaid Saturday.
Quarantine laws need strengthening in light of TB case, health official says By KEVIN FREKING Associated Press Writer June 9,2007Plague found in Park Hill critters
Jeremy P. Meyer Denver Post Staff Writer April 28,2007
Five squirrels and one rabbit found dead in the Park Hill neighborhood tested positive for plague, leading health officials to caution the public against handling dead animals.
Chan: Bird flu huge global health threatELIANE ENGELER Associated Press Writer May16.2007
GENEVA- “The U.N. health chief on Wednesday harshly criticized countries that do not share their H5N1virus samples, accusing them of crippling the worldin the fight against a possible flu pandemic.”
New resistant bird-flu strainstrikes Asian fowl, peopleRandolph E. Schmid Associated Press
E. coli triggers ground beef recall Two sickened by bacterium The Denver Post June 4,2007Denver - The Consumer Protection Division of the Colorado Department of Public Health and Environment suggested that Coloradans who purchased certain packages of Moran's ground beef at local Albertsons stores check to make sure it hasn't been recalled due to possible contamination with E. coli.
Moose test positive for Chronic Wasting DiseaseJeremy P. Meyer Denver Post Staff Writer Nov 9, 2006
Two bull moose legally harvested by hunters last month in northern Colorado tested positive for chronic wasting disease, the Colorado Division of Wildlife said today.
Grand Junction woman dies of West NileThe Associated Press Oct 21,2006
Colorado mercury emissions higher?Kim McGuire Denver Post Staff Writer Dec10, 2006
Front Range on brink of clean-air violationsKim McGuire Denver Post Staff Writer Nov 12, 2006
Front Range on brink of clean-air violationsKim McGuire Denver Post Staff Writer Nov 12, 2006
Contaminated pet food fed to hogs in 5 statesThe Associated Press Apr 25, 2007
Too many kids pudgy by preschoolStudy finds Latino children most at risk; using a bottle at age 3 a clueLauran Neergaard Associated Press Dec 28, 2006
Washington - Too many kids are fat by preschool, and Latino youngsters are most at risk, says new research that's among the first to focus on children in poverty. Seventeen percent of U.S. youngsters are obese, and millions more are overweight.
Wednesday, February 4, 2009
Vitamin Cottage recalls ground peanut butter amid salmonella outbreakDenver Business Journal
We need a well trained public health workforce!
We need a well trained public health workforce!
University of Colorado Denver | Colorado State University | University of Northern Colorado
• University of Colorado Denver• Colorado State University• University of Northern Colorado
together with• CDPHE & Local Health Departments
The Colorado School of Public Health is a collaboration of :
University of Colorado Denver | Colorado State University | University of Northern Colorado
MissionThe mission of the Colorado School of Public Health is to promote the physical, mental, social and environmental health of people and communities in the Rocky Mountain Region and globally.
The mission will be accomplished through collaborations in education, population-based research, and community service that bring together institutions, agencies and diverse populations.
University of Colorado Denver | Colorado State University | University of Northern Colorado
Schools of Public Health: July 1, 2008
University of Colorado Denver | Colorado State University | University of Northern Colorado
UC DenverMedicineNursingDentistryPharmacyGraduateBusiness
Public AffairsLiberal Arts and SciencesArchitecture and Planning
Engineering
CSUVeterinary Medicine
& Biomedical Sciences Agricultural Sciences
Applied Human Sciences Natural Sciences
UNCEducation & Behavioral Sciences
Natural & Health Sciences
Academic
Future Partners: Regional Universities, State and Community Colleges and Private Institutions
Departments and AgenciesCO Dept of Public Health & Environment
Local Health DepartmentsCommunity Agencies
Affiliated Health Care & Environmental OrganizationsAnd others
University Linked Organizations Area Health Education Centers-UCD
CSU Cooperative Extension
Colorado School of Public Health
Center for Public Health Practice
Rocky Mountain Prevention Research CenterNIOSH MAP ERC
Colorado Injury Control Research Center
Center for Global HealthCenter for Native American /
Alaskan Native Health
UCDAltitude Research Center • Barbara
Davis Center for Childhood Diabetes • Center for Health Services & Policy Research • Colorado Comprehensive
Cancer Center
UCB, CU SystemColeman Institute • Institute of
Behavioral Sciences •
CSUArthropod-Borne & Infectious
Disease Laboratory • Center for Environmental Toxicology &
Technology • Tri-Ethnic Center for Prevention Research • Center on Aging • High Plains Intermountain Center for Agricultural Health and
Safety
UNC• Center for Applied Gerontology
Research • Center for Social Science Research •
Collaborative•Bio-Defense & Emerging Infectious Diseases • Consortium for Human
Nutrition •And others
Research
Community
Collaborations
University of Colorado Denver | Colorado State University | University of Northern Colorado
Educational Programs• Goal: Create effective educational programs
characterized by collaborative, multidisciplinary approaches to educate and train highly competent and committed public health professionals and research scientists.
University of Colorado Denver | Colorado State University | University of Northern Colorado
MPH concentrations• UC Denver
o Applied Biostatisticso Community & Behavioral Healtho Environmental & Occupational Healtho Epidemiologyo Health Systems Management & Policyo Generalist
• CSUo Generalist
Focus areas in: Epidemiology, Environmental & Occupational Health, Global Health & Health Disparities, Health and Exercise, Health Communication, Public Health Nutrition
• UNCo Community Health Education
University of Colorado Denver | Colorado State University | University of Northern Colorado
Doctoral programs
• UC Denvero MS/PhD in Biostatisticso PhD in Epidemiologyo PhD in Health Services Researcho DrPH (under development)
• CSUo MS/PhD in Environmental & Occupational
Health
University of Colorado Denver | Colorado State University | University of Northern Colorado
Current Enrollment (Fall 2008)
• MPH 150 (50 new)– Includes 35 in MSPH – 4 DVM/MPH at CSU– 1 MPH at CSU– Will add about 25-30 from UNC in spring
• Certificate Students 60 (35 new)• PhD 53 (10 new)
– Bioinformatics 10 – Biostatistics 12– Epidemiology 21– Health Services Research 10
• MS Biostatistics 23• Preventive Medicine Residents 6• Occupational Medicine Residents 5
• TOTAL 297
University of Colorado Denver | Colorado State University | University of Northern Colorado
FacultyArea Primary 2nd/Affil Total
Biostatistics 23 38 61
Community & Behavioral Health 50 32 82
Environmental & Occupational Health 16 22 38
Epidemiology 24 22 46
Health Systems, Mgmt & Policy 7 21 28
Total 120 135 255
University of Colorado Denver | Colorado State University | University of Northern Colorado
Center for Public Health Practice• Goal: Create a Center for Public Health
Practice to bridge academic public health with state and local health agencies, healthcare providers, and community based organizations.
Community Outreach Continuing Education Service Opportunities Research in Public Health Practice
University of Colorado Denver | Colorado State University | University of Northern Colorado
Research• Goal: Advance the scientific basis for the
practice of public health with research that addresses the important public health issues in Colorado and the Rocky Mountain region.
University of Colorado Denver | Colorado State University | University of Northern Colorado
Current Research - overview• Biostatistical / Informatics
methods• Clinical trials methods• Disease etiology and prevention
– Cancer, Diabetes (Type I, II), COPD, CVD, Injury, Autism, Skin cancer, Obesity, Depression
• Genetic epidemiology– Diabetes, COPD, CVD, Cystic
fibrosis• Lifecourse epidemiology
– Obesity, CVD risk, Asthma, Autism, Diabetes, Birth defects, Behavioral interventions
• Community participatory research
– School policy, nutrition, physical activity, obesity prevention
• PH practice research network• Environmental health
– Built environment, air pollution• Occupational health
– Beryllium, methamphetamine labs, radiation workers
• Health services research– Medicare, Medicaid, costs of
prevention• Health Policy
University of Colorado Denver | Colorado State University | University of Northern Colorado
Facilities Fitzsimons Army HospitalBuilding 500 – 3rd Floor
Colorado State
University of Colorado Denver | Colorado State University | University of Northern Colorado
Timelines
2006 2007 2008 2009 2010 2011 2012 2013 2014
DevelopmentOperational
Phase IIOperationalAccreditedAccredited
Today
First class admitted
Accreditation site visit Spring 2010 Accreditation Fall 2010Self Study
Applicant status for accreditation Spring 2008
University of Colorado Denver | Colorado State University | University of Northern Colorado
Rural Activities• San Luis Valley Programs• School Programs• HICHAS - High Plains Intermountain Center for
Agricultural Health and Safety (CSU)• Community Exposures and the Oil and Gas Industry• Colorado Injury Control Research Center• Colorado Colorectal Cancer Screening Program• Public Health Practice-based Research Network• American Indian Alaskan Native Research (CAIANH)• Training
University of Colorado Denver | Colorado State University | University of Northern Colorado
Family-Based Prevention of Type 2 Diabetes
& its Complications
Principal Investigator: Julie A. Marshall, PhD
Rocky Mountain Prevention Research Center
of the San Luis Valley Health StudiesUniversity of Colorado at Denver
Rocky Mountain
Prevention Research Center
University of Colorado Denver | Colorado State University | University of Northern Colorado
SLV Healthy Family Project*funded by the National Institutes of Health
• Purpose: – Prevention of type 2 diabetes and its complications– Translation of DPP findings
• Population: Families at risk for developing type 2 diabetes and/or its complications– Primary, secondary and tertiary prevention– Social & physical factors support healthy behaviors
• Design:– Randomized control trial of 250 families in SLV
• Randomization ratio 2:1
University of Colorado Denver | Colorado State University | University of Northern Colorado
Diabetes Prevention Program*Percent reduction in diabetes risk by race-ethnicity compared with placebo
-80
-60
-40
-20
0
Caucasian(n=1768)
AfricanAmerican(n=645)
Hispanic(n=508)
AmericanIndian (n=171) Asian (n=142)
%
University of Colorado Denver | Colorado State University | University of Northern Colorado
Intervention Goals
• Improve Diet• Increase physical activity• Achieve and maintain healthy weight• Improve disease management• Increase use of community resources
Healthy FamilyHealthy FamilyProjectProject
NatureWalk
Realization thatwalking can be
good qualitytime with family
Realization thatwalking trailsare close by
Realization that evenwhen feeling tired,still can find energy
to go for a walk
Increase physical activityRealization that
walking doesn’tcost money
Intervention Activity Mediating Factors Outcome
University of Colorado Denver | Colorado State University | University of Northern Colorado
Family LifestyleCoach
Community Resources
•Family•Home
•Worksite•Community
•School
Health CareSystem
Healthy FamilyHealthy FamilyProjectProject
University of Colorado Denver | Colorado State University | University of Northern Colorado
SLVHFP Intervention
• Family Lifestyle Coach trained in behavior change strategies using Motivational Interviewing
• Choose target behaviors and develop individualized action plan
• Receive 12-16 home visits over a 4-8 month period
Healthy FamilyHealthy FamilyProjectProject
University of Colorado Denver | Colorado State University | University of Northern Colorado
Outcomes
• Weight loss, reduced weight gain• Biochemical markers of insulin
resistance• Nutrition and physical activity
changes• Use of community resources• Mediators of change
Healthy FamilyHealthy FamilyProjectProject
University of Colorado Denver | Colorado State University | University of Northern Colorado
School-based programs• School Environment Project (San Luis Valley - 10 schools - CDC)
– intervention to increase opportunities for physical activity and healthy eating through school environment and policy change
• SLV Physical Education Collaborative (CCTSI)– planning grant to form a collaborative that will identify the current state
of physical education in the SLV and barriers/facilitators to increasing quality and quantity of PE
• Integrated Nutrition Education Program– 8 schools in the SLV (joint with Pediatrics)
• What’s Working Project (45 rural low income elementary schools - RWJF)
– evaluation study to understand the initial impact of federally mandated local wellness policy on school environment (nutrition and activity)
University of Colorado Denver | Colorado State University | University of Northern Colorado
Local School Policy Evaluation (“What’s Working Project”)• Described the initial impact of the US federally
mandated Local Wellness Policy in rural, low-income elementary schools located in Colorado.
• Random sample of 45 rural elementary schools (40+% of students qualified for free or reduced-cost lunch)
• Opportunities for physical activity did not change after the policy went into effect:
– time in physical education increased by 14 min per week (P=0.10), but time for recess decreased by roughly 19 min per week (P=0.10)
– Policies supporting student participation in physical education and recess did not change.
• Local Wellness Policies were weakly worded and resulted in minimal impact
• Barriers: (1) competing pressures facing school districts; (2) lack of resources devoted to the Local Wellness Policy; (3) principals’ lack of knowledge about the policy, and (4) lack of accountability mechanisms to ensure policy implementation
University of Colorado Denver | Colorado State University | University of Northern Colorado
High Plains Intermountain Center for Agricultural Health and Safety• Mission: to reduce illness, injury,
and fatalities in agriculture• Major areas:
– organic dust lung disease in multiple regional settings– development of novel and user friendly biomarkers for
pesticides– Engineering research related to development and
retrofitting of tractor rollover protection structures• Strong emphasis on the large Hispanic workforce in
the region and on children
University of Colorado Denver | Colorado State University | University of Northern Colorado
High Plains Intermountain Center for Agricultural Health and Safety (HICAHS)• Current research
– An intervention to improve the design of milking parlors at dairies to reduce injuries and long-term degenerative diseases
– impact of exposure to dust, ammonia and bacterial endotoxins on respiratory disease rates of dairy workers
– development of an educational CD about health and safety for 4-H programs
– evaluating the effectiveness of health and safety information to agricultural workers
University of Colorado Denver | Colorado State University | University of Northern Colorado
Potential Human Health Effects of Oil and Gas Development in Rural Colorado• Exposure to oil and gas activity and chemicals associated with it can adversely
impact human health:– increased risk of cancers, pulmonary, cardiovascular, neurological, and
other diseases; adverse birth outcomes and children’s health• Major gaps in the past assessment of air quality related to oil and gas
development on the Western Slope• Garfield County air quality studies indicate that potential exposures to
hazardous emissions exist • Acute problem with toxic emissions of uncertain proportions and a possible
emergent problem for the health of the citizens of Garfield County due to unmeasured or under-measured toxics in Garfield County, despite the increase in oil and gas development known to produce these chemicals
• Health Impact Assessment of oil and gas development in Colorado should be done
Testimony to Colorado Air Quality Commission, October 2008
Garfield County
Colorado
Potential Exposure-Related Human Health Effects of Oil and Gas Development:Witter R, Stinson K, Sackett H, Putter S, Kinney G,Teitelbaum D,
Newman L
University of Colorado Denver | Colorado State University | University of Northern Colorado
Adverse health outcomesGarfield County, CO
• Garfield County higher (vs. other West Slope counties)– Children hospitalized for seizures and headache,
bronchitis, asthma, respiratory infection– Birth and pregnancy outcome disorders– Alcohol and drug disorders
• 2000-2005:– Violent crime rates increased (per 10,000 residents):
8.5 to 19.7• (Rape/other sex crimes, robbery, aggravated assault)
– Drug violations increased: 19.4 to 39.7Saccomano study 2000-2007
University of Colorado Denver | Colorado State University | University of Northern Colorado
Colorado Injury Control Research CenterCSU-UC Denver collaborative Center• Drug use and risky behavior among rural youth • Laboratory based research
– survival of sensory and motor neurons after injury– protective factors against brain injury
• Motor vehicle mortality in rural and urban areas• Rehabilitation care for individuals suffering traumatic brain
injuries• Risk communication for injuries• Community based traumatic brain injury prevention• Injury among disabled individuals• Alcohol-impaired Driving: Register of Controlled Studies
University of Colorado Denver | Colorado State University | University of Northern Colorado
Colorado Injury Control Research Center
• Marketing Fall Prevention Classes to Older Adults in Faith-Based Congregations: Cluster Randomized Controlled Trial
• Focused on Grand Junction and regional rural populations
• Aims to increase use of fall prevention classes that are known to be effective among rural elderly through social marketing
University of Colorado Denver | Colorado State University | University of Northern Colorado
Colorado Injury Control Research Center – Community Initiated Grant Program
• Salud Family and Health Centers– Provide bicycle helmets & car seats to migrant families at two health
fairs in Northern Colorado• Larimer County Department of Health and Environment - Newborn,
Infant and Toddler Safety Project– Provide home environment safety training and equipment to prevent
early childhood injuries• Centennial BOCES –Migrant Education Program, Greeley, CO Injury
Prevention and Education for Migrant and Homeless Families– Provide migrant and homeless families with information, skills and
resources to prevent and control intentional and unintentional injuries
University of Colorado Denver | Colorado State University | University of Northern Colorado
Colorado Colorectal Cancer Screening Program
• Funded by the tobacco tax revenues competitive grants program
• Goal: Increase colorectal screening rates among Coloradans ages 50 and older to 75% by 2010.
– Provide endoscopic colorectal screening to persons without health insurance who are under 250% Federal Poverty Level and who need screening
– Encourage all Coloradans ages 50 and older to get screened
• Began in January 2006, expanded statewide in November 2006
• Over 6500 patients screened to date – 24% had adenomas removed (most
likely to progress to cancer)– 1% were diagnosed with cancer
A partnership between the University of Colorado Cancer Center, community clinics and their screening partners
University of Colorado Denver | Colorado State University | University of Northern Colorado
Local Public Health Agencies• 54 local public health
agencies that serve 64 counties in Colorado– 15 organized health
departments– 39 public health nursing
services• Serve populations
ranging in size from less than 1000 to over 1.2 million Organized health departments (color)
Nursing services (white)
University of Colorado Denver | Colorado State University | University of Northern Colorado
Colorado Public Health Practice-Based Research Network
• Partnership between The Public Health Alliance of Colorado and CSPH
• Develop network infrastructure to support communication, decision-making, training and priority setting
• Develop data system infrastructure: performance measures, data on environmental health determinants; population-based health status and health behavior measures
• Identify high priority research questions• Identify strategies and resources to institutionalize research
as an integrated component of the public health system• Study the impact of SB08-194
University of Colorado Denver | Colorado State University | University of Northern Colorado
Colorado Public Health Reauthorization ActSenate Bill 08-194
• Passed in June 2008 to address outdated laws • Define public health and core public health services• Require each local public health agency to have a county
or district board of health• Expand powers and duties of the State Board of Health• Expand powers and duties of county/district boards of
health• Outline powers and duties of local public health agencies
and directors• Require a public health planning process to further develop
the new model of public health service delivery and to address related workforce and funding issues
University of Colorado Denver | Colorado State University | University of Northern Colorado
Center for American Indian Alaskan Native Health (CAIANH)
• The CAIANH works in AI/AN communities across the nation
• AI/AN populations remains one of the most rural in the US, though increasingly urbanized
• AI/AN population is a relatively small proportion of the US population and, in urban areas, tends not to live in ethnic enclaves
• Health research with AI/AN often takes place on or near reservations (or villages in Alaska)
University of Colorado Denver | Colorado State University | University of Northern Colorado
Center for American Indian Alaskan Native Health (CAIANH)
University of Colorado Denver | Colorado State University | University of Northern Colorado
Center for American Indian Alaskan Native Health (CAIANH)
University of Colorado Denver | Colorado State University | University of Northern Colorado
Center for American Indian Alaskan Native Health (CAIANH)
University of Colorado Denver | Colorado State University | University of Northern Colorado
Training in rural areas• MPH students
– Practicum; capstone project; electives– Community Health Assessment class
• Preventive Medicine Residents– Training grant has focus on medically underserved
communities: Salud FHC; Health District of Northern Larimer County; AHEC
– Elective courses; visiting faculty• Other health sciences students interested in public
health
University of Colorado Denver | Colorado State University | University of Northern Colorado
Joint Degree Programs• MD/MPH
– Proposed to start July 2009– In the approval process– 5 year program; 42 credit hours– 9 elective credits from MD curriculum + MSA
• DVM/MPH– Collaborative with CSU Veterinary Medicine– 5 students/year; 4 year history
• Discussing MSN/MPH, others
University of Colorado Denver | Colorado State University | University of Northern Colorado
Website: http://publichealth.ucdenver.edu
University of Colorado Denver | Colorado State University | University of Northern Colorado
Questions?