Climate Change & Public Health: So Much More than Drowning Polar Bears
Howard Frumkin, MD, DrPH, and Jonathan Patz, MD, MPH, of the two UWs (respectively University of Washington and University of Wisconsin), instructed, charmed and inspired a standing-room-only crowd at this session. Here are a few random takeaways:
- The dynamics of climate change are anything but simple. Climate change arises from complex, reinforcing feedback loops, and the pace of change is rapidly accelerating.
- Climate change is very regional in how it plays out even though it is a global phenomenon. Yes, sea levels will rise (Please note, those of you who live in lower Manhattan or Brooklyn!) but arid regions such as the US Southwest will become dryer, potentially leading to wild fires and a reduction in arable land.
- Public health practitioners, environmental scientists and climatologists must integrate their data to respond effectively to the effects of climate change. [Could public health laboratories, with their experience in developing laboratory informatics standards and systems be conveners in launching a multidisciplinary approach to data collection?]
- Urban design is public health policy. It’s difficult to exercise in your neighborhood if there are no sidewalks.
- Public health laboratories can mitigate the effects of global warming by greening their facilities. Individually and collectively, such changes do have an impact.
- We must rethink how we communicate with public audiences about the health impacts of climate change. Research demonstrates that, although the public trusts scientists as spokespeople, it is not persuaded by scientific data. What works? Messages from celebrities and discussion of pocket book issues. I know, it’s frustrating. And we can’t use a single set of messages because popular opinion diverges widely on the issue of climate change. We need messages for each audience.
- Climate change could be the greatest public health opportunity we’ve had in over a century. If we respond by eating less, exercising more, changing how we design our cities and reducing carbon emissions – among other interventions – we could create a healthier world.
Newborn Screening: Adding New Tests
Newborn screening (NBS) experts from Wisconsin, New York and a consultant to the Secretary’s Advisory Committee on Heritable Disorders in Newborns and Children (SACHDNC) gave a thorough rundown of the newborn screening process and how new conditions are added. Alex Kemper, MD, MPH, MS gave an overview of the Secretary’s Advisory Committee on Heritable Disorders in Newborns and Children; Dr. Chuck Brokoff, DrPH, director of the Wisconsin State Laboratory of Hygiene, shared their experience expanding newborn screening testing in Wisconsin and beyond; and Dr. Michele Caggana, Sc.D., FACM discussed the Implementation of NBSG tests in New York. From ethical considerations to regulatory hoops, there’s lots to consider when expanding an NBS program. Check out the highlights:
-States choose what to screen for, but it’s informed by the committee’s evidence-based recommendations.
-Anyone can nominate a condition to be evaluated by the committee. Key criteria considered: It should be a well-defined condition, a good screening test must be available, and treatment should lead to better outcomes.
-The committee’s recently recommended conditions, like Severe Combined Immunodeficiency (SCID) and CCHD, all have similar characteristics: well-characterized condition, early intervention leads to benefit, accurate and feasible screening test, diagnosis and treatment is available. (Characteristics of conditions not recommended for addition include: uncertain benefit of early detection, challenges establishing diagnosis, and lack of diagnostic and treatment services.
-Traditional Screening Criteria: Screen for conditions that are an important health problem, the natural history should be understood, detectable at an early stage, a suitable test is available, and risks should be less than benefits.-Wisconsin conducts newborn screening for approximately 68,000 newborns a year in Wisconsin and 15,000 non-Wisconsin newborns.
-Educating parents and health care providers about the NBS process and significance of screening is key to any NBS program.
-Elements of a genetic screening program: Availability to all babies, education of parents, timely follow-up on positive results, appropriate diagnostic workup and treatment, cost-effective assessments, continuous monitoring of program.
-Lab characteristics of a good screening test: Simple, rapid, safe, reliable/precise, accurate
-Ethical Considerations: Should genetic screening be conducted? Should NBS be mandatory? Can screening specimens or DNA be saved for later use?
-Screening for SCID has a high potential for successful treatment. Early intervention leads to better outcomes, more than 97% survival.
-Key considerations when adding a new condition to an NBS panel: input from experts and constituents, consider conducting a pilot study, public and professional education for the public, validation of screening method.
-Wisconsin implemented routine screening of SCID in January 2008 – and later, the Secretary’s committee added it to the core screening panel for all states, Jan 2010.
-How are new tests added? By legislation or commissioner’s signature. The lab’s NBS program puts together a package (the condition, outcomes, cost data, etc), sends to regulatory affairs at the dept of health, and the executive secretary and governor’s office signs off.
- In new York state, on average 1,000 babies born a day.
-New York added Krabbe Disease to their panel: substantial preparation, put together regulatory impact statement/package, conducted feasibility and pilot studies, ensured supplies of reagents for daily testing, and ensured follow-up procedures were in place. They commenced testing in 2006.
-When adding a new condition to a panel, clinical community buy-in early on is key, and they must remain engaged.
Top 5 Tweets
@APHLnews Mary Selecky is singing to us about Washyourhandsington– I’m not even kidding. What a cool Secretary of Health! @wa_deptofhealth #APHL
@MHeintzAPHL Dr. Conti: “everything we do is environmental health.” #APHL
@meganlatshaw For every 1°C increase in temperature, saw 7% increase in diarhheal disease in Peuvian hospital. – Jonathan Patz #APHL
@Go_Vikes PulseNet helped detect at least 8 of 10 of the past decade’s largest national foodborne outbreaks! #APHL
@ShariShea23 Metrics! Metrics! Metrics! They are becoming increasingly important to demonstrating the value of foodborne illness programs. #APHL
See more of the top tweets here!
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