It is only fitting that the American Public Health Association’s (APHA’s) 142^nd Annual Meeting and Exposition last month was held in New Orleans, a city which suffered a major catastrophe from Hurricane Katrina almost a decade ago. This year’s theme – “Healthography” – emphasized the significance of how where we live impacts our health and well-being.

The city and its people have recovered remarkably well and are an example of how effective response really takes teamwork, contributed to by voluntary agencies, resources, and the government. APHA itself depicted the extraordinary determination of individuals to work together to control infectious disease, to reduce chronic disease, prevent injuries, ensure food and water safety, improve the environment and reduce health disparities around the world.

Having returned from New Orleans where I learned of a number of inspiring and successful programs that are improving the health of our communities, I hope that BMC Public Health can be a part of this success by contributing to the dissemination of important work in this area.

Ebola – what is APHA doing?

The current Ebola outbreak in West Africa – the largest in history – has sparked an international public health response. Since the first report of Ebola in March, the World Health Organization has confirmed 1,603 cases and 887 deaths resulting from the virus in Guinea, Liberia, Sierra Leone and Nigeria. The outbreak is unprecedented in numbers of cases, deaths as well as geographic scope. The public is unfortunately seeing ill-advised quarantine decisions and plans of action that stray from science-based responses proven to be effective. APHA’s Get Ready campaign has produced an Ebola fact sheet to help the public easily understand the risks of Ebola and how to stay safe.

APHA is also offering the Ebola-Marburg virus chapter from the Control of Communicable Diseases Manual free of charge and has issued an action alert about the importance of public health funding in the wake of the outbreak.

The Ebola Epidemic session at the meeting focused on the current epidemic and public health response. Timothy Roberton, Johns Hopkins University, interviewed Red Cross volunteers who were working in Guinea to educate local residents about Ebola, initiate behavior change and help stop its spread.

Volunteers reported resistant villages and individuals who were in disbelief of the current situation, unwilling to change cultural or religious norms in order to adopt protective behaviors.

Burial customs in these villages meant that people did not understand that they needed to stay away from the deceased and allow for the disinfection of bodies; family-led body preparation and religious rituals in these regions require direct contact with the corpse.

Seeing as Ebola victims are most contagious after they’ve died, the burial problems in West Africa are especially concerning. Dr Roberton’s research indicates that, as stopping the spread of Ebola requires community members to adopt protective behaviors and behavior change has broad implications for families, there is a need to build trust within the most impacted areas. To achieve this, there needs to be face-to-face communication and peer education from volunteers who require proper training and supervision.

Emmanuel d’Harcourt, physician and senior advisor of the International Rescue Committee, promoted a new report called “A Different Kind of Army” that outlines what fighting Ebola effectively should look like. He stated that there is a great misrepresentation of what the problem is and that the myths of Ebola are distracting from the reality of the outbreak. An example of this lies in the lack of rationale behind putting people in quarantine. Although the focus is on treatment, this should be on prevention and there is also a need to handle any disconnect between the people and their governments.

Jide Idris, commissioner of health for the Lagos state, gave the example of Nigeria which, on October 20^th this year, was certified Ebola-free. Although faced by many challenges including doctors going on strike, delays in securing health care workers and the hostility of contacts, the country deployed a vigorous public health response which was strengthened by the commitment of the government and a number of different stakeholders, political will and good leadership.

“Ebola is not the problem in West Africa – Ebola is revealing the problem in West Africa,” said session presenter Kim Kargbo, president and CEO of Women of Hope International. The outbreak has brought to light numerous underlying issues in the region such as inadequate health care facilities and health care systems, corruption, broken educational systems, lack of infrastructure such as poor support systems, poor hygiene and sanitation. Kim Kargbo said, and I quote: “Ebola requires outside-of-the-box thinking. It’s also an all-hands-on-deck situation. ”

Food Access

APHA has long been active on food system issues and on promoting access to varied, healthy, and affordable foods important to the public’s health. Kala Mayer, Frances Hardin-Fanning, Elizabeth Reifsnider and Katie Huffling all came together in an interesting session examining the health impact of food, from a full service grocery to the home. Social support provision is a large determinant of food security and community kitchens, where people come together to collectively obtain, prepare and eat food, provide an example of environments in which social support can be facilitated.

More than 47 million American households rely on Supplemental Nutrition Assistance Program (SNAP) funds to help meet their nutritional needs. The media has propagated a baseless claim that poverty and receipt of SNAP funds are associated with the likelihood to purchase unhealthy foods.

Few studies have looked at the impact of vouchers on food purchasing and interesting research carried out by Frances Hardin-Fanning examined associations of income, age, gender and education with purchasing of healthy foods via a grocery voucher in a rural, impoverished Appalachian county.

The study’s findings indicate that adequately funding SNAP programs would not result in more unhealthy food purchases and contribute to poor dietary habit. Furthermore, that point of purchase strategies in community grocery stores may be effective in increasing consumption of foods associated with decreased risk of cardiovascular disorders.

Improving air and water quality

In terms of disability-adjusted life years, household air pollution (HAP) is the second most important risk factor for women and girls and is the most important risk factor for men and women in South East Asia and Sub-Saharan Africa, making it a huge public health problem. Over 3 billion people worldwide rely on biomass such as firewood, charcoal, or dung for their cooking needs and it is estimated that household air pollution causes 3.5 million premature deaths annually.

Megan Graham, Georgia State University, explored the use of ethanol cooking fuel in Madagascar to reduce exposure to HAP and related illness and shared her findings in the ‘Public Health Intervention and Response to Improving Air and Water Quality’ session.

As part of a three year World Bank funded study, two communities in Madagascar (coastal and highland) were provided ethanol cookstoves. Following the intervention, ethanol cookstoves significantly reduced women’s exposure to carbon monoxide in both regions and children’s exposure by 60% in the highland location.

Households with ethanol stoves saw a significant reduction of headaches and eye irritation among women and a significant reduction in adult and child burns. Most importantly, modeling future uptake of ethanol stoves and pollutant reduction demonstrated a relative risk reduction for acute lower respiratory infections among children, chronic obstructive pulmonary disease among adults, and ischemic heart disease.

In an equally intriguing talk, Leigh-Anne Krometis discussed the associations between homeowner perceptions of water quality and measures of contamination in private drinking water supplies. A recent CDC report states that the proportion of waterborne outbreaks associated with privately supplied household drinking systems has increased over the past three decades and is of concern.

Almost a third of outbreaks associated with drinking water in the United States between 1971 and 2008 were associated with untreated groundwater systems. Not many studies have been carried out on private drinking water systems which made this talk particularly interesting. Previous studies indicate that, even among those well-educated in environmental health, homeowners generally forego water quality testing or technical assistance unless they perceive a water quality problem at the point of use.

Leigh-Anne Krometis’ work comprises of the analysis of a unique historical dataset of almost 15,000 household water samples collected from privately supplied systems via a Virginia Cooperative Extension Program. It was found that contamination with fecal indicator bacteria is the most prevalent cause of contamination in Virginia private systems and findings indicate that human perception is not always a reliable indicator of water quality issues. More research is needed to understand barriers to private system stewardship.

APHA 2015

With numerous exciting sessions to select from and not enough time to attend them all, BMC Public Health can’t wait to explore more of these at APHA in Chicago next year. We look forward to seeing you there!