At the opening general session of the American Public Health Association’s annual meeting, I learned a few things about Philadelphia, where this year’s meeting is happening. Philadelphia opened the nation’s first public hospital, nursing school, and medical school, and it boasts the highest childhood immunization rate in the nation and the greatest proportion of workers who walk to work. Also, given that water is the theme for this year’s meeting, it’s fitting to note that Philly was the home of the nation’s first municipal waterworks.
Speakers at the opening session set the tone for an ambitious and optimistic meeting (with some of that optimism probably due to the House’s passage of healthcare legislation last night):
Dr. Mirta Roses Periago, director of the Pan-American Health Organization, reminded us why accesss to clean water, sanitation, and hygiene is so crucial: each year, 1.4 million children die from preventable cases of diarrhea. No public health intervention has greater impact, she told us, than improving water, sanitation, and hygiene. Without water-related improvements, the world jeopardizes its achievement of the Millennium Development Goals; conversely, investments in these improvements yield enormous returns.
Recently confirmed US Surgeon General Regina Benjamin, MD spoke about some of the experiences that have informed her practice as a doctor and will inform her work as the nation’s doctor. One of her patients, a middle-aged African-American woman who had insurance through her job as a school janitor, delayed filling a much-needed prescription for pain medication because she couldn’t afford her prescription co-pay until payday. Dr. Benjamin arranged to get the prescription filled, and was surprised to find her patient upset to receive the medication. She realized that she had taken her patient’s dignity, and that “you can have the same race as a person but still be culturally incompetent.” (Dr. Benjamin addressed the situation by telling her patient that the prescription money came from a fund set up for just such situations, and that she could make a donation to it once she received her paycheck.) In addition to serving as a lesson on the importance of cultural understanding, Dr. Benjamin noted that this story highlights the widespread problem of underinsurance.
EPA Administrator Lisa Jackson also touched on the role of race and culture as she emphasized the Obama Administration’s commitment to broadening the conversation on the environment and reaching out to racial minorities and low-income communities that have been underrepresented in the environmental movement. After touching on some of the environmental issues – particularly air and water pollution – that directly affect human health, she focused on the importance of reforming chemical management, particularly the Toxic Substances Control Act. Jackson discussed EPA’s six principles for reforming chemical management legislation, which include placing the responsibility for demonstrating safety on industry (rather than EPA) and giving the agency clear authority for conducting safety reviews. Jackson also reminded the audience that “environmental protection is public health protection.”
Like Regina Benjamin, filmmaker Celine Cousteau learned important lessons in culture, communication, and helping people through her experiences with indigenous communities in the Amazon. After becoming engaged in the health issues in that area, Cousteau approached a tribal leader about getting access to his village to make a movie. When he asked her what she would do for them in exchange for access and guidance, she “naively said, ‘I’m making this big international film.” But the tribal leader told her that researchers studying medicinal plants and anthropology had come in the past to get information from the tribe, but had failed to make good on their promises to help. This, Cousteau said, taught her the best lesson of her adult life: “Great intentions are not enough.”
Cousteau ended up learning about a nonprofit group called Amazon Promise, which sends medical teams to remote Amazon villages to provide healthcare, train local people to provide healthcare services, and educate community members about prevention. In exchange for getting brought along on their trips, Cousteau serves as aone-woman film production crew and donates the resulting films to the group to use in fundraising. She also drew an important lesson from the organization’s director, Patty Webster, when she asked Webster how she manages to avoid getting discouraged given the enormous gap between what communities need and what Amazon Promise can provide. Webster’s response was, “At least I’m doing something” — and maybe it only makes a difference for one person, or 30, or 300, but that’s something.
Here at APHA, everyone is doing something to make the world a healthier place. If you’re here in Philly, let us know in the comments about what you’ve seen or heard that’s interested you. Also check out the APHA Annual Meeting Blog for posts about several of the different sessions going on.