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Health & Medicine at APHA in Chicago

Health & Medicine Policy Research Group (HMPRG)
December 10, 2015
In November, members of the Health & Medicine staff and board joined health professionals from across the nation for the American Public Health Association’s (APHA) Annual Meeting & Exposition. This year’s conference was held in Chicago and centered on the theme Generation Public Health. The conference was an invaluable opportunity for our staff and other public health professionals convene, learn, network and engage with peers.

Each year, after the conference, the Health & Medicine community comes together to reflect on what they’ve learned. We’d like to share some of those reflections from our staff so you can see some of the thoughts and ideas we found to be most memorable.

Health & Medicine staffers Christine Head, Erica Martinez, and Renae Alvarez at the APHA Health Advocates dinner.

Margie Schaps, Executive Director
I learned so much this year at the APHA conference.  I usually don’t like it when the conference is in Chicago because I am pulled between the conference and “stopping by” the office.  But this year I promised myself I would focus entirely on the conference, and I’m glad I did.  Rather than focus on a particular session of interest to me, I’d like to point out some salient messages I came away with that will infuse the work I do and plan for at Health & Medicine:
  1. CDC is funding 18 states, including Illinois, to do Climate Change Adaptation planning (i.e. understanding that climate change is happening and states must ready themselves for inevitable impacts).  CDC is promoting developing Trauma -Informed Community Building including expansion of solar energy, storm water efficiency, urban gardens, and neighborhood design.  Climate change will have significant impact on health, e.g. rising pediatric asthma cases which are already increasing, and data modeling is showing thousands of excess deaths and instances of disease.  We need to be looking at the impact of climate change on the need for diversification and expansion of the healthcare workforce.
  2. Health and community development are inextricably linked: improvements in child health are most closely correlated with neighborhood support and cohesion and divesting in communities has a direct impact on the safety of those communities.
  3. Community organizers are deeply interested in health but often don’t have the knowledge base needed to act.  Public health leaders need to support and inform the work of community organizers and be informed by organizers as we look for tools to make health policy change.
  4. Increasing data availability to do health disparities geo coding and other mapping is a critical tool in our efforts to mitigate the impacts of inequities.
  5. As we look to address Adverse Childhood Experiences (ACEs), we must have an upstream—poverty and racism—and downstream—addressing immediate present threats—approach.
Renae Alvarez, Policy Analyst
As stated in the “Role of Public Health Data in Advancing Health Equity in All Policies,” by Dr. Mary Bassett, Commissioner of the New York City Department of Health and Mental Hygiene, we must use data to create political urgency around health equity and build coalitions across sectors by making injustice visible.

I attended a couple of sessions on Primary and Mental Health Integration in both pediatric care and adult health systems, and for adults, specifically those who use substances. What I took away from the nuanced view of integrated delivery systems was how pervasive the problem really is with regards to mental health, stigma, and culture.  From pediatrics, we all know that early identification is extremely beneficial and can determine one’s health trajectory. A study of child development and mental health services found that 50% of mental health disorders can be identified by 14 years of age, and 75% can be identified by 24 years of age.

According to Ali, Teich, & Mutters from SAMSHA, the vast majority of all people who were insured, 83% with substance use disorders are not getting treatment. Furthermore, 97.4% of people with and without substance use disorders, regardless of insurance status, did not feel that they needed treatment. The presentation concluded with the need for outreach efforts to raise awareness about the effectives of substance abuse treatment and they are currently looking into reasons why people do not seek treatment (i.e., lack of readiness, treatment not seen as helpful, stigma, access).

Our westernized culture almost champions and endorses the use of alcohol in all major entertainment and media outlets, whereas it stigmatizes those who use other substances such as opioids, and even more so for those who cannot afford prescription opioids, but are stuck in addiction and revert to using substances that they can afford—street drugs. Click here to read more.

Wesley Epplin, Director of Health Equity
During one of the Spirit of 1848 sessions, Dr. Nancy Krieger, a leading social epidemiologist located at Harvard’s T.H. Chan School of Public Health, shared that she had recently had an article accepted for publication that focuses on the idea of health departments and the public health system collecting data related to deaths due to use of force by police, as a matter of public accountability.  This article has since published in PLOS Medicine here.  I had seen Dr. Krieger and others discuss this issue on two panels held at Harvard (view them here and here) that I had viewed online in my preparation for an APHA presentation which focused in part on racist state-sanctioned violence. 

Locally, this is related to the recent release of the dash cam video of Chicago police officer, Jason Van Dyke’s brutal and unjust killing of Laquan McDonald, in which the officer shot McDonald, who was walking away from the officer, 16 times.  The charge of murder in the first degree to the officer and the release of the video happened approximately 400 days after the killing and after a legal battle in which the City of Chicago and Chicago Police Department (CPD) attempted to keep the video out of the public’s eye. The video shows details that conflict with the previously released statements by the CPD about the shooting. 

This instance has again brought to the fore in Chicago the longstanding issues of police violence, racial discrimination in policing, death due to use of police force, and lack of accountability from how police interact with and treat communities of color. Local activists have been active on these issues for decades, and in recent years, with the Black Lives Matter movement growing in Chicago as it has across the U.S.  Structural racism remains a major barrier to health equity, as it disadvantages people of color on the one hand, while privileging whites on the other.  Since achieving health equity and eliminating disparities is one of the overarching national health goals outlined in Healthy People 2020, the field of public health needs to find roles that it can play in helping eliminate structural racism. As health departments are part of government responsible for reducing health hazards, they ought to directly engage with other parts of government whose actions perpetuate racial injustice. Click here to read more.

Christine Head, Community Healthcare Initiative Coordinator and AHEC Administrative Assistant
This year marked my first time attending the annual APHA meeting. Overall, my experience was amazing: I had the opportunity to meet experts from across the United States as well as get a glimpse at groundbreaking research. Most exciting was having the opportunity to see a number of public health professional address racial and ethnic disparities and criminal justice. To read through the conference book and see the subject even brought up was a refreshing step in the right direction. We have a rare opportunity to create some radial change in the criminal justice system, and to see advocates across sector sense the opportunity is sign that we will see victories soon. I was feeling optimistic and proud to be able to even bear witness to what seemed like a turning of tides. But as I attended sessions and connected to other advocates focused on the criminal justice system, a pattern began to emerge.

Though we had all began to use similar language it appeared to me and some of my colleagues that we may not be using the same definition.

When presenters were declaring that “Black lives mattered” in securing health equity and creating a truly just system, it seems that we had different thresholds of success. For Black live to matter, we must move beyond simply asking to be alive. The WHO defines health as “…a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” By the vey principles that guide public health, to not address all of the social determinates of health that institutionalized the health gap between Blacks and other groups in the United States, we have passively declared that Black lives only matter sometimes and in some ways. For Black lives to truly matter, we must be prepared to advocate for not just reducing the number of Black bodies in morgues and in the prison system. We must do more than rattle off stats around obesity and gun violence, as if the experiences of Black people can be narrowed down to those two ailments. We must address the wider system that reduces the options for people to choose a path to thrive. Part of that is being self-reflective and intentional as advocates in how we choose to do our work.

For me, APHA was not just a conference, but affirmation of my rules of engagement in how and why I do the work that I do. It reminded me of the areas I could do better and the areas I should be proud of. It showed the path of where we need to go in order to continue to not only move the needle, but to prevent a retreat down the path of our past failures. But more importantly, it was the fire I needed to take the road towards self-aware advocacy that I hope to continue to build up for years to come.

Erica Martinez, Senior Policy Analyst
Attending this year’s APHA in Chicago made me think about the different approaches policy and research based organizations take when working toward system changes.  One approach presented at APHA is that of community engagement and partnerships on policy. Policy and research based organizations’ activities should be informed by the people who are going to be directly impacted by their work. However many times these organizations do not have the relationships and trust of the community being affected. In order to develop better informed policy proposals, organizations need to create and foster community based partnerships. In one of the sessions, a speaker emphasized how much moving policy and advocacy forward was based on relationships and trust of the partners you are working with. Equally important was while having research and data to support a policy proposal is important, without consideration of the community partners, the effort may not be well received. A couple of thoughts to create and foster better community based partnerships are for organizations to be: 1) intentional about whom they approach; 2) clear about expectations and how each organization will be credited; 3) transparent to some extent about funding and deliverables; 4) have good communication; and 5) set up an evaluation mechanism for the partnership.

Ray Wang, Program Director, Chicago Area Schweitzer Fellows Program
This year’s APHA annual meeting helped to deepen my awareness and knowledge about the social determinants of health and current work that is being done on many fronts to address them.  I was enriched and inspired by the wide ranging presentations about the built environment, climate change, community-based participatory research, progressive pedagogy, and advocacy.

One of the presentations that made the strongest impression upon me was a panel that looked back on the history of Medicare and Social Justice.  I had not realized that the enactment of the Medicare program in 1964 paved the way for the desegregation of hospitals in this country, and quite dramatically.  One of the panelists explained that in the early 1960s – more than 100 years after the introduction  of anesthesia for surgical procedures – African American physicians in the south could not get privileges at hospitals, and patients were systematically and cruelly denied access to many hospitals.  The enactment of Medicare compelled hospitals to desegregate or lose federal funding, and within two years, nearly 6,000 of them did comply by the July 1966 deadline.  The panel really brought home for me how health policy matters, and can be a powerful instrument to bring about change.