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Probe
THE

Quarterly Newsletter of the Oregon Public Health Association Spring 2004

President's message for Public Health Week


Public health outcomes ask personal commitment
Portland, to exhibit efforts to eliminate ment in health status occurs. Change and
BY YOLANDA RUSSELL
health disparities. improvement occur at the individual

C ause, origin, root cause ... stress,


obesity, tobacco ... social justice,
environmental justice, health literacy,
The more things change, the more they
stay the same – almost. When I look at
public health information in documents
level, and if enough individual people in
a group change their behavior to the
better, then the health outcomes for the
racism, otherism. As the Oregon Public like Healthy People 2010, and the group improve.
Health Association celebrates 60 years of American Public Health Association's In the thirty years that I have worked
public service this year, what legacy will in educational institutions and health
we create for the next generation of public organizations; worked with groups,
health professionals?
How great it would be to actually
eliminate a public health problem like
violence or drug abuse. Or to be the first
state to increase life expectancy and
I wonder where the
magic wand is that

turns knowledge into


populations, and communities; the things
that I have seen work are relationships,
and investment of time and personal
commitment. These are also the things
that brought many of us to public service.
eliminate health disparities in diabetes or I want to challenge each of us to take
HIV. This is a discussion that started at up the call from APHA to “Leave No One
our conference last fall and will continue behavioral change. Behind” – to make a commitment this
throughout this year, in April during year to bring all populations and commu-
Public Health Week, throughout the Public Health Week fact sheets, I wonder nities to the highest level of health
spring and summer at our regional what is missing. Why are so many health outcome currently enjoyed by a few. Take
member meetings, in the fall at our annual outcomes not improving? Why am I up the call that was presented at our fall
members meeting, and at our next reading what seems like the same statis- conference to take a stand for health and
conference during Public Health Week tics that I have read for several years? I wellness in each of our communities.
2005. wonder where the magic wand is that Let’s meet or beat the measurements in
This year, Public Health Week runs turns knowledge into behavioral change. Healthy People 2010.
April 5-11. OPHA will celebrate with a I understand that public health is We know what to do. Our communi-
morning gathering on Wednesday, April based on the health of groups of people, ties have told us what they need to be
7, at the Oregon State Building in on identifiable populations, but that is not healthy. We have but to do it. Let’s make
where behavioral change and improve- solutions, not statistics our legacy.
OPHA Mission
• Protect and promote the INSIDE: Diversity in the health workforce ™
health of all Oregon residents
• Educate and support public Health information infrastructure ™ Immorality
health workers of abstinence ™ OPHA leadership roster ™
• Advocate for just and Health impact assessment ™ And more ...
equitable health policies
2 The Probe

Health awareness campaigns


short on responsive solutions You can help us
spread the word
W ith the panoply of new
appreciation days, and weeks,
months, even years and decades dedi-
contacts: in Portland, Thomas Novick
(tnovick@mrsspdx.com); and in the
Rogue River Valley, MaureenO'Brien
Please consider distributing
The Probe to colleagues
cated to some cause or special group, (maureen.obrien@gmmb.com).
conscientious social activists must be Portland is listed by CTUW organizers and friends interested in
worn out by changing buttons so fre- as one of 17 target communities this year. Oregon public health. With
quently to mount each new campaign. The honor leaves it unspecified whether office technology, the best
Scanning the list of activities in various this means we get more information than
states for Public Health Week, April 5- anyone else, or we end up fully insured way to achieve a magazine
11, shows a multitude of declarations, by June. format is by double-sided
dissemination of printed information, and In February, the office of Oregon copying, with two auto-
events for talking heads, but few activities Health Policy & Research published an
with discernible outcomes. issue brief on "Gaps in Health Insurance," mated staples on the side.
The website for the American Public mostly advancing the definitive treatment
Health Association (www.apha.org) in the Institute of Medicine's six volumes
shows two events in Oregon: a gathering on the topic over the past few years,

Probe
THE
for presentations to colleagues on health concluding in January with a final volume
disparities, including James Mason, of principles and recommendations.
newly appointed administrator of the Kaiser Family Foundation (www.kff.org)
Office of Multicultural Health in the gives us continuous data updates. In a
Oregon Department of Human Services; systematic review of the literature last TERRY HAMMOND Editor
and a gathering to honor public health year, Jack Hadley recommended that we LESLEY RUSH Assistant Editor
heroes. know enough already. The point is to act. EVA RIPPETEAU Illustration
Few states show much more. In In this light, one has to appreciate the LAURA BRENNAN Editorial support
Pennsylvania, a full schedule of fairs and mission statement of the collaborative
meetings also includes several healthy organization Connecting for Health, DANA KAYE Communication chair
walking tours. Other states sometimes, mentioned in the article in this issue on KATE KARLSON Webmaster
but rarely, include free preventive health health information:
screenings, bike-helmet education with "The purpose of the Collaborative is News published in The Probe aims to
children, and occasional convocations neither to report nor exhort. It is, simply, provide information. Views expressed
with policymakers to advance specific to catalyze specific actions on a national
in this newsletter do not necessarily
projects. Otherwise, there are many basis that will rapidly clear the way for
posters, speakers, awards and intro- an interconnected, electronic national represent the views of OPHA members
ductions. Under the rubric of "real health information infrastructure." or its board of directors.
community solutions," APHA lists four This statement reflects the current
accomplishments in 2003, all related to
minorities, one to low income, and only
theme of Public Health Week – moving
from statistics to solutions. According to
Give us your news!
We invite you to send stories, news
two with actual outcomes. the statistics on solutions so far, we have and graphics. Submission dates:
Compare these results to the proposed a long way to go.
target. Healthy People 2010 has 28 focus – TERRY HAMMOND ISSUE STORY DEADLINE
areas and 467 objectives; the average Winter Dec 21
number of health indicators tracked by Spring Mar 21
states is 113. Multiply these numbers by Alert! The Probe Summer Jun 21
Fall Sep 21
50 states, or 3,082 counties, or 40,000 seeks section reports for publication on the 10th of
zip codes, and the recorded number of
Current activities in the nursing, nutrition,
activities appears decidedly dismal. Jan., April, July, and Dec.
health promotion, and adolescent risky
Will we see more for Cover the
behavior sections deserve regular
Uninsured Week, May 10-16? Today, the Contact Terry at terryh@pdx.edu
attention. Section leaders – please
agenda in Oregon includes a staged press Oregon Public Health Association,
consider writing a brief news story for
release and a public forum. The official
each issue of The Probe (see page 7). 818 SW 3rd Ave, #1201, Ptd 97204
website for the event names two local
Spring 2004 3
IOM book review

Diversity initiatives could improve health


care for those with presently limited Educational institutions rely heavily
BY LESLEY RUSH
access. In this way, diversity initiatives on quantitative data to make admission

F ollowing the recent Supreme Court’s


decision in the Grutter v. Bollinger
case – upholding the University of
could help close the gaps for some health
disparities.
In its recommendations to support
selections. Due to research that shows that
minority populations perform lower than
white students on standardized tests, the
Michigan Law School’s admissions underrepresented minority groups and committee proposes the integration of
policies, and also maintaining that greater their involvement in health professions, qualitative factors in the admissions
diversity promotes educational experience the committee proposes that educational process, including the attributes that each
– diversity initiatives in the health institutions develop mission statements candidate could contribute, and compati-
professions obtained a new significance. that recognize diversity. In the commit- bility with the mission of the institution.
In response to population changes in Additionally, the selection committees
the United States, showing the number of #%
"
 &



for academic programs should include
$
 

persons in minority groups increasing, the representatives from various culture





 




"
#% &
  
Institute of Medicine in February pub- 
 

 
groups. Conducting training programs


lished, In the Nation’s Compelling about the importance of diversity in the
Interest: Ensuring Diversity in the Health educational sector should be included in
  
 #$$! !%$  "   "$  #%# %"%

Care Workforce. The report addresses the the selection committee's responsibilities.
potential for institutional and policy-level This training should extend to include
strategies to increase underrepresented students, faculty, and administrative
minority participation in the health bodies, so that the climate for diversity is
professions. In great detail regarding supported on every level.
processes for diversifying the healthcare The first step in this process involves
professions, the report focuses on the accreditation bodies, which ultimately
!"#$$   

overarching question: What benefits does control policy at educational institutions.


diversity contribute to the larger society? The U.S. Department of Education and
!"#$$   

The IOM report makes a number of accreditation bodies at educational


recommendations to integrate minority institutions should enforce standards of
groups into health profession educational diversity in enrollment and curriculum.
institutions, and incisively connects these This is intended to have a ripple effect. A
recommendations to the assertion that a diverse academic setting will promote
greater number of perspectives and appreciation and understanding of the
approaches is beneficial, both in academic value of diversity in professional settings,
and professional settings, working with tee's view, this acknowledgment makes and further, in society.
coworkers and patients alike. The commit- a good start on improving the value of The committee believes that all of its
tee that produced the report hopes that healthcare education. recommendations should be developed
introducing a stronger minority presence The effectiveness of each program’s with a concern for health and social
in academic settings will not only improve mission, and efforts to increase diversity values. Focusing on outcomes, each
opportunities for disadvantaged groups, should be assessed. Are the programs institution’s diversity initiatives should
but also allow nonminority students to gain attracting diverse applicants? Are the consistently emerge as part of the overall
a better understanding of the many minority students progressing and goal of bettering the healthcare profes-
differences in people and cultures in our completing the programs? sions, resulting in higher-quality care.
society. Also, Congress should be involved, Although disparities are not the focus
Another expressed benefit of these encouraging diversity by increasing of the report, the committee believes that
initiatives is a possible increase in care for funding under the Public Health Service diversity initiatives should be designed
marginalized groups. When minority Act, Titles VII and VIII, which deal with to target disparities in health care.
students go into the workforce, they are a wide span of issues in education and Defining disparities involves not only
more likely than white students to work training of health professionals – and racial and ethnic minorities, but also
with underprivileged groups in dis- already recognize the value of racial and financial and nonfinancial barriers to
advantaged areas. In effect, putting more ethnic diversity. Locally, communities access and quality care experienced by
diversity in the education system will may provide additional support to other people, identified by need rather
improve opportunities for professional encourage diversity. than color or language.
4 The Probe

National leaders in health information


Consumers are typically not the primary Quality Chasm. Advocacy for consumer
BY TERRY HAMMOND
choice remains a prominent feature in
purchasers. Short of destroying insurance

I n a nation with one-fourth of the entirely, they are never likely to be.
population functionally illiterate, and
another one-fourth semi-literate (and in
Still, when we do want to know the
ingredients, or comparison shop, then we
FACCT, but counting this a rhetorical
failure does not detract from the organiza-
tion’s notable achievements in applied
terms of health care also functionally information technology.
have to appreciate the laws and organiza-
illiterate), the goal of consumer-choice tions that make that information available. FACCT stakes its fame on providing
advocates to provide information online This is more in line with FACCT’s actualreliable, scientifically based data on
achievements, and fits with Lansky’s
to facilitate smart shopping in health care clinical healthcare quality, marketing a
is not likely to transform the system more immediate point, also quoted in thevariety of survey instruments designed to
toward market efficiency. interview: capture quality data, and also packaging
Paul Ellwood, a founder of managed “Individuals should have access to data in interactive report cards designed
care, managed competition and consumer tools that enable them to make decisionsfor easy use by consumers. Milestones
choice – and also co-founder of the about their future.” recorded on its website (www.facct.org),
Foundation for Accountability include adoption of in-
(FACCT) based in Portland – struments by the National
admitted last year: Committee for Quality
“Exaggerated assumptions
about the power of consumer
financial choices to permanent-
ly change provider behavior or
the health system’s structure
have undermined everyone’s
FACCT FOUNDATION FOR ACCOUNTABILITY
Assurance, by dozens of
states and top companies,
and a 2001 endorsement by
IOM.
The newest FACCT
tool – Compare Your Care
including our attempts at health – allows patients to compare
system reform.” This narrower purpose is a more their care to several standards: an ideal
This marks an important new direc- realistic goal, corresponding to the core clinical guideline, and regional and
tion. Further evidence of circumspection value of patient-centered care from the national benchmarks. Users can also
appears in the lead article by Len Nichols Institute of Medicine’s Crossing the access elementary information about
et al. in the new March/April Health their health needs (see demonstration at
Affairs: “Waning confidence in health www.compareyourcare.org).
market forces?” The authors use data
E xaggerated assumptions Additional FACCT projects are
from the long-running Community underway with Johns Hopkins University
Tracking Study to reveal increasing favor about the power of consumer for a schizophrenia tool, and with
among stakeholders for government purchasing groups like Leapfrog and
intervention in a “market,” which despite financial choices to “Fortune 100” companies for tools that
valiant efforts to the contrary, remains assist prudent purchasing based on
disorganized and inefficient.
In an interview a few years ago,
permanently change provider quality. On the frontier, FACCT is also
FACCT President David Lansky said the working with a number of associations
organization’s long-term future involves behavior or the health and foundations in the development of a
getting healthcare consumers to think personal health record. Achieving any
differently about their role in the care they system’s structure have kind of electronic medical record is the
receive. Probably this statement is too typical goal, but FACCT and partners are
ambitious. As consumers, we are unlikely most concerned to assure interoperability
to want anyone to tell us how to shop for
undermined everyone’s with the patient – so the patient owns the
groceries or anything else. Relying on record – thus the distinction between a
presently unpopular “paternalistic” including our attempts at PHR and an EMR.
authority, or word of mouth, or plain Kris Gowen, FACCT’s senior re-
negligence to save time are all good health system reform. search associate, lists the organization's
options. Really, only our willingness to current activities with assurance up to the
lay out the cash matters – which is another – PAUL ELLWOOD point of the personal health record, where
problem with consumer-choice theory. she sighs, confronted by a daunting image
Spring 2004 5

share agenda from Portland offices


of endless details and challenges. In 2003, New York City, WebMD also operates viability. Contrary to this view, Kris
Healthcare Information and Management Medscape, the most popular information Gowen at FACCT emphasizes her organi-
Systems Society released a starting model website for physicians. Survey results zation’s reputation for solid research
for a standard electronic medical record, reported in the Jan. 23 issue of Medical skills, placing that character first, and
just as the federal government announced Economics show half the responding “questions how much advocacy we want
the same initiative. Further development physicians use Medscape – many times to do.”
of the model is on the agenda of the more than any other resource. The similarity of FACCT and WebMD
HIMSS summer conference in Las Vegas, WebMD also uses its electronic skills was recognized by the Markle Foun-
June 14-15 (see www.himss.org). to transfer claims from providers to dation, which made them the primary
purchasers, standardizing the platform for partners in a television and internet
Neighbors unite a few cents per claim. According to an feature called “Life on the Line,” using
A comparison of FACCT to WebMD insider, the service earns millions of information modules from both organiza-
appears inevitable by the intersection of dollars. Presumably, this amount is tions. The television program aired on
content related to quality health care, and figured in to the estimated cost savings Oxygen Network last October. The on-
expertise in electronic informa- line feature is still available
tion systems. Coincidentally, (www.lifeontheline.webmd.com).
these two nationally recognized The Markle Founda-
health information specialists tion is dedicated to advancing
also share the same neighbor-
hood, with offices hardly more
than a stone’s throw away from
each other, near Old Town.
Unlike FACCT, WebMD is
a for-profit organization, with
WebMD information technology, and
sponsors a public/private
collaboration – Connecting
for Health (dot org) – which
energetically addresses "the
challenges of mobilizing
information focused more on health of $86.8 billion each year, plus significant information to improve quality, conduct
promotion and management as a saleable quality improvement, once we achieve a timely research, empower patients to
product to large companies. The report- standardized electronic health infor- become full participants in their care, and
card strategy advanced by FACCT is not mation infrastructure, as calculated bolster the public health infrastructure."
included. Evidently, simply giving recently by the Center for Information Developing a standardized informa-
employees access to health information Technology Leadership. tion infrastructure is critical to the
saves money for self-insured companies, David Rowe, local WebMD vice advancement of public health as well as
regardless of provider profiles for quality president for product marketing, distin- health care. The good news here is that
selection. guishes FACCT as an advocacy group, we have two information champions,
With additional offices in Atlanta and and emphasizes his product’s commercial working for the future, onsite.

Task force questions structure of health authority


I n response to a house bill in the 2003
legislative session that languished in
committee upon adjournment, a task force
Other state functions (like the Em-
ployment Department), have been moved
to independent status in the past, and other
Rep. Greenlick summarized the first
meeting with three questions for further
action: (1) Does organizational structure
chaired by Reps. Mitch Greenlick and Jeff states have made an independent health matter to state workers in public health?
Kruse is investigating the question authority (like Washington). Practical (2) Does it matter to county health
whether public health should be moved matters discussed at the meeting included workers? (3) What are the results in other
to an independent department, with a the comment that without proper funding, states, and what states are models?
director appointed by the governor. The organization hardly matters one way or Ultimately, these questions refer to
first meeting of the work group at the state the other; and Cindy Becker of Admini- outcomes relative to essential public
capital building, on March 8, was strative Services gave an insightful health services, and to the public's health.
facilitated by Bruce Goldberg, Oregon presentation on challenges to efficiency, Anecdotal input is welcome at this point.
Health Policy & Research administrator, observing the fragmentation in electronic You can send your answers to Rick
and included an array of state and county data platforms. Reorganization involves Berkobien, legislative committee ad-
officials. information as well as services. ministrator (rick.berkobien@state.or.us).
6 The Probe

New DHS report documents


NEWS BITES initimate partner violence
against women in Oregon
Terror threatens world health formerly separate databases serving Ten percent of Oregon women ages 20 to
Among the online resources new or Oregonians and state agencies seeking 55 years have experienced physical or
discovered since last issue, the most employment opportunities, social sup- sexual violence at the hands of their
profound is Third World Traveler port, and public health services. intimate partner during the past five years,
(www.thirdworldtraveler.com), featuring a new state Department of Human
a wealth of essays and information “about Prayer seeks AIDS healing Services report reveals.
the state of democracy in America, and Publication timing missed the date, but “Intimate partner violence is a signifi-
about the impact of the policies of the this national event with support from a cant public health problem,” state
United States government, transnational number of local churches reappears epidemiologist Mel Kohn said. “It takes
corporations, international trade and annually. Christian churches with a focus a physical and emotional toll on the
financial institutions, and the corporate on black communities join in prayer to women who are harmed, and can have a
media, on war and peace, democracy, “break the silence,” and bring awareness profound negative effect on children who
civil liberties, free speech, human rights, and a higher power into the fight against witness these acts of violence. It
and social and economic justice in the HIV/AIDS (see www.balmingilead.org/ undermines the social fabric of our
Third World, and in the United States.” programs/weekofprayer2004/ communities.”
As 9/11 showed us, confrontation with founder.asp). The report is based on a survey of
grave reality is eventually unavoidable. 2,962 Oregon women. The prevalence of
We need to acknowledge the truth that Conference speaks out for violence is likely to be higher than the
the biggest threat to world health today report shows, Kohn said, because women
and in the past half century is heavy
sexual minorities
were not asked about their experience
bombing, military operations, military A free conference in Shoreline, Wash., on
over a lifetime.
hardware, torture and subversion driven June 4 – called "Saying It Out Loud" –
addresses “alcohol, tobacco, other drugs, • At least 1 in 10 Oregon women, aged
by the U.S. government in scores of 20-55 – more than 85,000 women – have
nations – amounting collectively to a mental health and other health issues
facing the gay, lesbian, bisexual, trans- experienced intimate partner violence in
campaign of genocide to secure the “free the past five years, with nearly one-third
world” – intent on suppressing move- gender and questioning communities.”
Keynote speaker: Kate Bornstein. For of the instances in the past 12 months.
ments for democracy, social justice, and • Intimate partner violence results in
national sovereignty. We as public health more information, contact Ira Stallsworth
at 206-272-2190 or stallsi@dshs.wa.gov serious physical injury. Injuries included
advocates need to get it straight and pass
broken bones, internal injuries, head
the word to our neighbors. The face of
Audioconference features injuries, and lacerations or knife wounds.
terror is us.
William Blum – author of Killing CV disease in women • Less than two-fifths of seriously
Hope and Rogue State, both documenting George Mensah, MD, and Suzanne injured women received medical care.
the incredible extent of U.S. terror Haynes, MD, will give an audioconfer- • Women who experienced intimate
operations – introduces the many quota- ence on April 14, 10-11 a.m., with online partner violence in the past five years
tions on the site, saying: “No matter how slides and telephone audio, dealing with reported poorer mental and physical
paranoid or conspiracy-minded you are, cardiovascular disease in women. More health than other women. They also
what the government is actually doing is women than men die from CV disease, experienced higher rates of depression,
worse than you imagine.” and women are 10 times more likely to anxiety, post-traumatic stress disorder,
If we are looking to end health die from CV disease than from breast suicidal thoughts, and alcohol and drug
disparities, a principal choice for attention cancer. Registration required at the use.
should be the fate of millions around the National Conference of State Legislatures • Children witnessed 33 percent of
world who have been maimed, sickened, website (“meetings” at www.ncsl.org). intimate partner physical assaults, and 20
and killed through our funding and percent of sexual assaults.
support as citizens. This site helps to raise Activist girls show nerve Kohn said that medical providers are
awareness of today’s world crisis. The Girls' Initiative Network, represented an important part of the solution, but
on a recent OPHA panel on adolescent comprehensive, vigorous community
Resource directory launched risky behavior, announce an upcoming involvement is also needed.
The Oregon Community Resource article in the online magazine Nervy Girl, The report is available online
Directory (www.OregonCRD.org) puts a focusing on the topic of "teen pressures" (www.dhs.state.or.us/publichealth/ipv/
new user-friendly face on a handful of (www.girlsinitiativenetwork.org). index.cfm), or by calling 503-731-4024.
Spring 2004 7

Abstinence threatens moral fiber of youth


L ast week, I was handed a copy of an
abstinence education catalog. After
perusing the merchandise, I discovered a
These programs do not address
alternatives to abstinence. Apparently you
get married or never experience sex – a
because it is morally not supposed to
exist.
As the new generation of children
summary chart from Section 510 of Title view that is not only unrealistic, but also reaches school age – and more children
V in the Social Security Act, established blatantly discriminatory. have only one parent – it is important to
in 1998. Abstinence education programs Even married couples need to be not make them feel like burdens to their
receive special funding from the U.S. informed about birth control and sexually families and society. Their challenges
government if they follow mandated transmitted diseases. If contraception is should be addressed in a way that
regulations as outlined in the act. included in the curriculum, then students encourages them to succeed, and also
Abstinence education programs are will be doubly prepared to make good encourages pride and responsibility in
intended to teach adolescents of the health decisions; they will know that sexual their parents.
gains – psychological, social, and activity should be reserved for committed Students should learn about critical
physical – of abstinence. The overarching relationships, while also being aware of thinking and decisionmaking in school.
theme of these programs contends that their choices should they find themselves The goal of education should be to equip
sexual activity outside the context of ready for a sexual relationship on other students with the information and skills
marriage is harmful and detrimental to terms. to go into the world and make sound
individuals and society. The United States has the highest teen choices. By neglecting to provide students
It is tacit knowledge that the only way pregnancy rate in the industrialized world. with the vast amount of information and
to avoid sexually transmitted disease and Title V Section 510 states that “bearing perspectives available about healthy
pregnancy is to avoid sexual activity; but children out-of-wedlock is likely to have sexuality, these programs hurt students,
these programs seem to be doing more harmful consequences for the child, the not only because they present a single side
than teaching that abstaining from sexual child’s parents, and society.” Yet this is to a controversy, but also because they
activity is a healthy choice. They are primarily due to the lack of social services neglect to give students the full range of
advocating a moral choice as well. and networks to support people in perspectives on moral responsibility, to
The materials in the catalog echo this disadvantaged situations. Abstinence decide for themselves the appropriate
moral choice. Nearly every item for sale education puts an additional stigma on the person, time, and way to engage in a
includes a theme such as “true love waits struggles that arise for single parents, sexual relationship.
for marriage” or “best sex is in marriage.” – LESLEY RUSH
Abstinence education programs expand
on the belief that every adult will or
should get married, and after the vows
Adolescent Risky Behavior section
have been exchanged, sexual activity is
perfect and acceptable.
becomes active part of OPHA
Stating that sexual activity should be
reserved for committed, monogamous
relationships seems like a fine idea, but
I n summer 2003, the proposed
Adolescent Risky Behavior section
received enough members to be recog-
prevent such behavior. Out of these
discussions, section members decided to
pursue a varied action agenda for the year.
insisting on the “for marriage” clause nized as an official section of OPHA. The Subsequent meetings have featured
seems a divisive aside for sex education section sponsored two sessions at the discussions of (a) a pilot project where
programs. In a nation where the right for OPHA fall conference. youth help adults to communicate better
same-sex couples to be married is in One session focused on background with their adolescent children, (b) a policy
question, and "marriage" constitutes information regarding patterns of risky on adolescent risky behavior to submit
many different things to different people, behavior, including results from the for APHA approval, and (c) updating the
the abstinence education programs pose annual Oregon Youth Health Survey, plus Adolescent Risky Behavior Legislative
problems. data on adolescent access to care, risk Handbook to distribute in time for the
In my mind, if the goal of these factors for youth living with disabilities, 2005 Oregon legislative session.
programs is to encourage students to learning disabilities of youth who engage The section meets on the second
value sexual activity as something we in juvenile-delinquent acts, and access to Monday of each month, 4-5 p.m., in the
should share only with a most trusted, health care for youth in custody of the State Office Building. Interested persons
committed partner, then let’s start thinking Oregon Youth Authority. are invited to contact section chair, Katie
about what constitutes healthy rela- The second session featured a panel Riley (katieriley@comcast.net) to receive
tionships and healthy sexuality, and start by 12 high school students discussing meeting notices and minutes. All are
teaching that to students. their views on risky behavior and how to invited to attend.
8 The Probe

Nexus: OPHA announces leadership for 2004


T he new OPHA leadership roster
is now available, good through 2004.
Some positions continue into later years.
Co-representatives to the board
Hilton Levias
10040 N Lombard
Secretary/Treasurer
Robin Stanton
19188 SE Tilstrom Rd
Publishing the names and contact Portland OR 97230 Boring OR 97009
information for persons in the four 503-901-1022 503-731-4594
sections, and the board of directors, may hilton.b.levias@co.multnomah.or.us robin.w.stanton@state.or.us
facilitate participation and networking for
our coming year of accomplishments. Betty Graham
Excelsior. 14333 SE Mill Ct Committees
Portland OR 97233
503-257-8338 Bylaws
Sections betjgraham@aol.com
Chair
Nursing Connie Guist
Adolescent Risky Behavior 426 SW Stark St, 8th Flr
Chair Portland OR 97204
Chair/Representative to the board
Tom Engle 503-988-3056 ext 22972#
Katie Riley
15555 NW Norwich St connie.l.guist@co.multnomah.or.us
250 NE Hillwood Dr
Beaverton OR 97006
Hillsborro OR 97124
503-731-4017 Communication
503-640-8689
tengle@teleport.com
katieriley@comcast.net Chair
tom.r.engle@state.or.us
Secretary Dana Kaye
Secretary
Catherine Fleischman 1845 SW Roth St
Maria Grumm
451 NW 1st Corvallis OR 97333
2516 SE Cora St
Gresham OR 97030 541-740-1972
Portland OR 97202
503-669-8350 x231 dana_kaye@comcast.net
503-731-4655
Catherine.fleischman@providence.org Newsletter editor
maria.l.grumm@state.or.us
Treasurer Terry Hammond
Treasurer
Carol Elliott 5734 NE 27th Ave #3
Renee Menkens
800 NE Oregon St, Ste 850 Portland OR 97211
4050 NW Carlton Ct
Portland OR 97232 503-282-1242
Portland OR 97229-2944
503-731-4363 terryh@pdx.edu
503-494-7893
carol.j.elliott@state.or.us Editorial support
menkensr@ohsu.edu
Representative to the board Laura Brennan
Community Health Promotion Dianna Pickett (see board roster for info)
& Health Education 783 NW Naito Pkwy #207 Webmaster
Portland OR 97209 Kate Karlson
Co-chair 503-241-0234 PO Box 1718
Rosa Martinez dianna.l.pickett@state.or.us White Salmon WA 98672
9000 N Lombard 541-296-4636 x312
Portland OR 97203 karlsonk@earthlink.net
Nutrition
503-988-3366
rosa.e.martinez@co.multnomah.or.us Chair/Representative to the board
Co-chair Joan Ottinger Membership
Lois Criss 3948 NE 20th Ave
2800 N Vancouver Ste 100 Portland OR 97230 Chair
Portland OR 97227 503-731-4708 Lesli Uebel
503-413-1850 joan.m.ottinger@state.or.us 800 NE Oregon St, Ste 850
loisc@aahc-portland.org Portland OR 97232
Secretary/Treasurer 503-731-4632
Marcela Dixon lesli.l.uebel@state.or.us
(no info posted)
Spring 2004 9
agaddie@ci.portland.or.us doraa@aahc-portland.org
President-elect Director at large 9
Nominating
Kimberly Nemeth Robert Gassner
Chair 85 N 12th St 1403 NE Thompson St #4
Tracy Gratto Cornelius OR 97113 Portland OR 97212-4269
6127 SE Gladstone 503-359-8513 or 503-286-1345 503-282-7825 (H) 503-888-2031 (cell)
Portland OR 97206 knemeth@chno.org robertgassner@hotmail.com
503-788-3315 Director at large 1 Director at large 10
Member Rafael Arellano-Barrera Crista Whittington
Dan Peddycord 214 NE 20th Ave (see Policy for info)
2577 NE Courtney Dr Portland OR 97232 Affiliate representative to the
Bend OR 97701 503-238-5790 governing council
541-388-6616 educateya@qwest.net Mitchell Haas
DanP@deschutes.org Director at large 2 2900 NE 132nd Ave
Member Ronald P. Dowd Portland OR 97230
Maria Michalczyk 19322 SW Laurelhurst Way 503-251-5728
1635 Cinnamon Hill Drive Bend OR 97702 mhaas@wschiro.edu
Salem OR 97306 541-318-5774 Section representatives
503-362-7258 rdowd@bendcable.com Katie Riley
cmichalc@pcc.edu Director at large 3 Hilton Levias
Larry Hill Betty Graham
Policy 800 NE Oregon St, Ste 1105 Dianna Pickett
Portland OR 97232 Joan Ottinger
Co-chair 503-731-4665 Region 1 representative
Michael Sorensen larry.d.hill@state.or.us (Multnomah County)
3639 NE Rodney Director at large 4 Laura Brennan
Portland OR 97212 Marjorie McGee 800 NE Oregon St, Ste 903
503-756-2314 800 NE Oregon St, Ste 730 Portland OR 97232
michael.e.sorensen@co.multnomah.or.us Portland OR 97232 503-731-4002 x306
Co-chair 503-731-4273 x448 laura.j.brennan@state.or.us
Crista Whittington marjoriemcgee@msn.com laurajeanbrennan@comcast.net
PO Box 549 marjorie.g.mcgee@state.or.us Region 2 representative
Siletz OR 97380 Director at large 5 (Southwest Oregon)
800-600-5599 x267 (W) 541-270-2602 Elizabeth Rink Vacant
(cell) 530 NW 27th Street/PO Box 579 Region 3 representative
cjwhittington@highstream.net Corvallis OR 97339-0579 (Northwest Oregon)
541-766-6657 John E. Robinson
elizabeth.l.rink@co.benton.or.us 801 Pacific Ave/PO Box 489
Board of Directors Director at large 6/Treasurer Tillamook OR 97141
President Akiko Berkman 800-528-2938; 503-842-3922
Yolanda A. Russell 18080 Sarah Hill Lane jrobinso@co.tillamook.or.us
PO Box 3647 Lake Oswego OR 97035 Region 4 representative
Portland OR 97208-3647 503-639-1414 (Eastern Oregon)
503-784-6711 amberkman@msn.com Jerry Street
yolandarussell@earthlink.net Director at large 7 715 SW 4th St, Ste C
Past president Kerri Lopez Madras OR 97741
Amalia Alarcon-Gaddie 520 SW Harrison St, Ste 335 541-475-4456
1900 SW 4th Ave, Ste 40 Portland OR 97201-5258 Jerry_Street@class.oregonvos.net
Portland OR 97204 503-228-4185 Region 5 representative/Secretary
503-823-5542 klopez@npaihb.org (Valley)
Director at large 8 Dana Kaye
Dora Asana (see Communication for info)
2800 N Vancouver Ave, Ste 100
Portland OR 97227
503-413-1850
10 The Probe
World report
Health impact assessment targets inequalities
Community policies and activities." bibliography and review of the literature
BY TERRY HAMMOND
HIA is also strong in Thailand. In its online, indicating interest in the topic.

H ealth impact assessment is a new


concept, derived from earlier ex-
perience with environmental impact
agenda for health system reform since
2000, the Thai government is concentra-
ting on health promotion rather than
Iintersectoral relationships with stake-
holders, and cooperation among state
agencies are both essential. Community
assessments; and also derived from the medical care. About 20 HIA case studies participation is often promoted by activist
growing attention to health promotion have already been conducted. researchers, but it is too expensive and
through evidence-based public policy. The coincidence of HIA with the time-consuming for rapid assessment
British Columbia gave the concept its first recent enactment of national health schedules. In the policy process, timing
governmental endorsement in 1991. insurance in Thailand reflects the experi- is of utmost importance. Community
The practice of HIA is now wide- ence in other countries. Evidently, the participation is appropriate when there is
spread in Canada. Other Commonwealth government only truly has a vested a direct and personal community interest.
countries (United Kingdom, Australia, interest in public health once it takes The movement for health indicators
New Zealand) quickly adopted it. responsibility to pay for medical care. (as in Healthy People 2010) is different,
In 1998, the Acheson Report in the HIA is virtually absent in the USA. representing policy activism with a
UK made its principal recommendation The Minnesota Department of Public “health needs assessment.” Community
to the national government "that as part Health provides an excellent annotated participation there is important to
of health impact assessment, all policies prioritize choices for action.
likely to have a direct or indirect effect 2004 Health Disparities HIA analysts must closely monitor
on health should be evaluated in terms Symposium, April 15-16 policy developments and be prepared to
of their impact on health inequalities, and "Neighborhood and Place" respond rapidly. Ideal timing in HIA
should be formulated in such a way that relies upon monitoring, networking,
by favouring the less well off they will, Keynote address: authority to intervene, and access to
wherever possible, reduce such inequali- George Kaplan, president, Society policymakers during the window of
ties." This statement recognizes health for Epidemiologic Research opportunity between vague ideas, definite
impact as a standard for public policy. Plenary session: proposals, and official draft.
HIA was officially adopted in the Ana Diez-Roux, an expert on The best incremental strategy for
European Union through the Amsterdam neighborhood research instituting HIA probably involves piggy-
Treaty, taking effect in 1999, with Article Location: University of Washington backing on established procedures for
152 stating: "A high level of human health campus, Seattle, rooms TBA. environmental impact assessment, and
protection shall be ensured in the For more information, contact Syd combining social dimensions into a
definition and implementation of all Fredrickson (sydf@u.washington.edu). concept of "human impact."

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