August's Feature: Profiles in Public Health Law
with Wayne H. Giles, MD, MS, director, CDC’s National Center for
Chronic Disease Prevention and Health Promotion, Division of Population
regulations on community health needs assessments for charitable
hospitals, published by CDC’s Public Health Law Program.
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August 2013 - CDC Public Health Law News
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This Month's Feature Profiles in Public Health Law: Interview with Wayne H. Giles, MD, MS
Wayne H. Giles, MD, MS
CDC Public Health Law News (PHLN): What sparked your interest in public health?
Giles: I had a patient, let’s call her Mrs. M, who had diabetes, high blood pressure, heart disease, diabetes, and arthritis. She was also overweight and one day came into my office and said she wanted to lose some weight. I praised her for wanting to lose weight and suggested she start by walking up and down her neighborhood sidewalks. She mentioned there were no sidewalks in her neighborhood and it was unsafe for her to walk outside.
It was then that I realized that as a physician if my patients were going to be healthy, I needed to be cognizant of the conditions where my patients live, learn, work, and play. This is what led me to a career in public health.
PHLN: Please describe your career path to the Division of Population Health which houses CDC’s School Health Branch.
Giles: Prior to joining CDC in July 1992, in addition to clinical work in internal medicine, my work experience included studies examining the prevalence of hypertension in Africa, clinical trials evaluating the effectiveness of cholesterol-lowering agents, and studies examining racial differences in the incidence of stroke.
As the director of the Division of Population Health, I have the opportunity to work with staff on research and programmatic activities in a number of areas including arthritis, aging, alcohol, chronic obstructive pulmonary disease, prevention research, school health, and epilepsy. This is an exciting time to work with programs that look to improve overall health and specific conditions across the life spectrum, from school-aged children to vibrant senior citizens.
PHLN: Please describe your program and its goals.
Giles: CDC continues its long-standing dedication to improve the health and wellness of students through a number of school-based initiatives. The School Health Program focuses on
The FOA consists of a basic component that funds all 50 states and DC to support a core set of integrated strategies and a competitive component which funds 32 states. The competitive component funds enhanced initiatives for obesity prevention and in the case of school health, also funds initiatives to strengthen policies and practices to improve chronic disease management and care.
The FOA brings together four categorical programs, Heart Disease and Stroke Prevention; Nutrition, Physical Activity, and Obesity; School Health; and Diabetes to develop cross-cutting strategies and expertise to achieve measurable impact. This FOA builds on a trajectory over the last ten years that CDC/NCCDPHP has undertaken to integrate programs that address shared risk factors, better achieve performance objectives, and streamline customer service to grantees.
Through this new joint FOA, CDC will continue to support states by evaluating the most effective practices, providing technical assistance and professional development, developing tools and resources, and collecting data to inform local strategies. With a long history of working across education and public health agencies, CDC brings rich partnerships and expertise for implementing public health practices in schools.
PHLN: Do you consider yourself as working in the area of public health law?
Giles: Certainly, particularly in the education setting, law has always been an effective public health intervention. Historic examples include requiring proof of immunizations for public school enrollment and the impact of Title IX on the participation of girls in high school sports.
Recent legislation that supports and frames our current work includes the Healthy and Hunger-Free Kids Act of 2010 which gave USDA the authority to improve nutritional standards for school meals and regulate the nutritional quality for all foods sold outside of the school meal program during the school day. Much of our school nutrition work in the next few years will support implementation of these two new rules as well as provide guidance to states and locals in adopting even stronger nutrition policies. Laws and policies can provide education and public health leaders with valuable tools to promote programs and strategies that foster an environment where children and adolescents can thrive and learn.
PHLN: Why is health an important aspect of education and how are the two connected?
Giles: The academic success of America’s students is strongly linked with their health—what they eat and how much physical activity they get. For example, eating a healthy breakfast is associated with improved cognitive function (especially memory), reduced absenteeism, and improved mood. In addition, early research is also starting to show that healthy school lunches may help to lower obesity rates. We know that preventing obesity early, in childhood, is easier and makes a big difference.
In the long term, adult health is not only linked to adolescent health outcomes, but also to health literacy. Health literacy is an individual’s capacity to obtain, process, and understand basic health information and services needed to make appropriate health choices. We know that there is a link between limited health literacy and poor health. Nearly nine out of ten adults have difficulty using the everyday health information routinely available in our health care facilities, retail outlets, media, and communities. The school years are the time to improve health literacy to carry those skills into adulthood. Policies that require quality health education and staff professional development are important ways to help increase health literacy skills at a young age.
PHLN: How are physical activity and physical education related to academic performance?
Giles: Increasing the quantity and quality of physical education (PE) and physical activity (PA) in schools is critical for health and can have a positive impact on academic performance. Multiple studies have found one or more positive associations between PE/PA and indicators of cognitive skills and attitudes (e.g., attention or concentration, self-esteem, perception of academic competence), academic behavior (e.g., classroom conduct), and academic achievement.
Recent studies have demonstrated that short durations of intense physical activity have a significant impact on academic performance. There is also increasing evidence that children who get more physical activity in school also perform better in classes and on standardized tests. A comprehensive literature review conducted by CDC found that participating in physical activity is positively related to outcomes including academic achievement, academic behaviors, and indicators of cognitive skills and attitudes, such as concentration, memory, self-esteem, and verbal skills.
Data from the 2009 Youth Risk Behavior Surveillance System (the most recent collection of academic data) shows that teens who earn mostly As were almost twice as likely to be physically active for 60 minutes per day for five or more days per week than students who receive mostly Ds and Fs. Bottom line: kids who perform better in school are more likely to get regular physical activity.
PHLP: Does your program offer guidelines for physical activity in schools?
Giles: Yes, CDC’s School Health Guidelines for Promoting Healthy Eating and Physical Activity. The School Health Program synthesized research and best practices related to promoting healthy eating and physical activity in schools, culminating in nine guidelines. These guidelines are informed by the Dietary Guidelines for Americans, the Physical Activity Guidelines for Americans, and the Healthy People 2020 objectives related to healthy eating and physical activity among children, adolescents, and schools.
The guidelines serve as the foundation for developing, implementing, and evaluating school-based healthy eating and physical activity policies and practices for students. Each of the nine guidelines is accompanied by a set of implementation strategies developed to help schools work toward healthier policies and practices.
In addition, CDC will release A Guide for Developing Comprehensive School Physical Activity Programs (CSPAP) in September. A CSPAP is a multi-component program that includes quality physical education as the foundation; physical activity before, during, and after school; staff involvement; and family and community engagement. In addition to quality physical education, examples of activities that are implemented within a CSPAP are recess, classroom physical activity breaks, intramurals and physical activity clubs, interscholastic sports, walk and bicycle to school initiatives, and joint-use agreements.
PHLN: How does public health law relate to school health?
Giles: Policy and systems change are powerful tools for promoting healthy environments in schools. What is unique to the school setting as compared to other settings for public health work is the issue of “local control.” While there are impactful and important examples of federal and state laws that govern public education, most education policy is developed and adopted at the local district and even school-building level as either codified policies or standard practices. In addition to authoritative binding policies, guidance documents and other non-binding materials help provide a more detailed picture of a state’s or district’s school health policies and activities.
This aspect of “local control” informs how CDC helps state and local agencies apply science to developing and implementing good policies. Whether a specific health-related policy is most appropriate at the state, regional, tribal, school district, or school level depends heavily on jurisdictional traditions, governance structures, and political contexts as well as the particular topic. Regardless of the type and jurisdiction of “policy,” CDC seeks to guide the public health and education sectors in data-driven decision making and implementing evidence- based strategies.
PHLN: What affect will the ACA and new health Marketplaces potentially have on school health and education?
Giles: The potential impact of more affordable health care and preventive services for students includes improved management of chronic conditions, increased establishment of medical homes, a reduction in emergency room visits, earlier detection of health conditions that impede learning, such as hearing and vision problems, and a reduction in absenteeism
Universal healthcare coverage will result in healthier students. Healthy students are more likely to attend school, are better able to focus in class and are ready to learn, ultimately earning better grades and achievingmore in school.
PHLN: How is the new FOA working to support school health in conjunction with the Marketplaces and ACA?
Giles:Chronic diseases account for seven of ten deaths in the United States each year and about three-fourths of the more than $2.5 trillion our nation spends annually on health care. Because this FOA is aimed at preventing and controlling high blood pressure, diabetes, and obesity, the major risk factors for chronic conditions, it is also aimed at lowering healthcare costs In support of chronic disease prevention, this is a timely release because Americans are soon to have access to the new Marketplace to ensure they have affordable health care and access to preventative services.
Collectively, the work conducted through the chronic disease and health promotion framework of this FOA results in a healthier society that delivers healthier students to our schools and early care and education centers, healthier workers to our businesses and employers, and a healthier population to the healthcare system. These types of interventions support and reinforce healthy choices and behaviors and make it easier for Americans to take charge of their health. They have broad reach, sustained health impact, and are a good investment for public health.
PHLN: What interesting projects is your program currently supporting or creating?
Giles: In addition to continuing a focus on obesity prevention in schools, CDC will be funding a new focus area with state health departments for school health—managing chronic conditions in schools. This new programmatic area will improve policies, processes, and protocols to meet the daily management and emergency care needs of students with chronic conditions.
Students spend a majority of their day in schools and as a result schools are responsible for students’ physical health, mental health, and safety during the school day. Because students’ academic success and well-being are intertwined with their physical and mental health and safety, schools have become key providers or liaisons for services to address these needs.
These services may be especially critical to students with chronic conditions, students who lack health insurance, or students who do not regularly see their medical care provider. School staff who provide these services include nurses, physicians, dentists, counselors, psychologists, social workers, and sometimes psychiatrists. CDC will support these efforts with model policies, assessment tools, and guidance documents. For example in fall 2013, CDC will release the Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Programs.
PHLN: What types of illnesses are considered “chronic conditions”?
Giles: CDC’s school health program will mainly focus on asthma, food allergies and anaphylaxis, diabetes, and epilepsy. The main purpose of this initiative is to support practices and policies that improve management for many conditions that impact children daily.
PHLN:What types of interventions might schools implement under the FOA? How are these interventions related to public health law?
Giles: To generalize the answer first, CDC encourages funded partners and stakeholders to invest their efforts and resources in changing the context of their work through institutionalizing health-promoting policies and practices. At some level this involves public health law as public health partners determine the proper jurisdiction and system in which to affect change.
Specifically, state health departments will work with schools to
Giles: Ultimately the goal is promote the health and well-being of children and adolescents, enabling them to become healthy and productive adults. Part of this picture includes preventing and controlling high blood pressure, diabetes and obesity, and also instilling life-long health promoting behaviors such as being active, eating healthy, and practicing health literacy.
PHLN: How can individuals learn more about adolescent and school health programs at CDC?
Giles: Please visit our website at www.cdc.gov/healthyyouth and you can direct kids and youth to check out content developed for them at www.cdc.gov/bam. You may also receive regular school health updates by emailing firstname.lastname@example.org with “Subscribe” in the subject.
PHLN: Have you read any good books lately?
Giles: I’m currently reading the book Let’s Explore Diabetes with Owls by David Sedaris.
PHLN: Is there anything else you'd like to add?
Giles: The Division of Population Health is one of the newest and most diverse divisions at CDC. We have population-focused programs, such as school health and healthy aging, working alongside condition or risk factor specific programs, such as arthritis or the excessive alcohol program. We are also home to the Prevention Research Centers and soon to be home to the Behavior Risk Factor Surveillance Survey, bringing program, policy and research full circle; which makes the work very exciting and rewarding.
In addition to the combined efforts of four CDC divisions under the FOA discussed earlier, our division is at the forefront of creating additional synergies among all of NCCDPHP’s programs with the Coordinated Chronic Disease Program (CCDP). CCDP developed a centralized line of communication from CDC to state chronic disease directors and supports state teams at CDC representing NCCDPHP’s entire portfolio. We’ve asked the states to collaborate and find efficiencies for greater health impact and we’re leading the charge by doing the same at CDC.
Quotation of the Month: Megan Smith, Director of the New Haven Mental Health Outreach Partnership
About Public Health Law NewsThe CDC Public Health Law News is published the third Thursday of each month except holidays, plus special issues when warranted. It is distributed only in electronic form and is free of charge.
The News is published by the CDC Public Health Law Program in the Office for State, Tribal, Local and Territorial Support.