An Ounce of Prevention...

A Publication of the
Program on Prevention
In Education & Practice

January 2000 - Volume 1, Number 2

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Happy 2000 to you!

We hope that you and yours had a wonderful holiday season.
We wish you much happiness and success in 2000.

Millennium Moments
Ten Great Public Health Achievements from 1900-1999

Vaccination has resulted in eradication of smallpox; elimination of poliomyelitis in the Americas; and control of measles, rubella, tetanus, diphtheria and Haemophilus influenzae type b.

Improvements in motor vehicle safety (safer highways and vehicles, safety belts, child safety seats) have significantly contributed to a decrease in motor-vehicle-related deaths.

Safer workplaces have reduced the rate of fatal occupational hazards by 40% since 1980.

Clean water and improved sanitation has lead to the control of infectious diseases that were major causes of illness and death in the early 1900's.

A decline in the number of deaths due to coronary heart disease and stroke due to risk factor detection and modification.

Diseases such as rickets, goiter and pellagra have almost been eliminated due to safer and healthier food content and preparation.

Since 1900, infant mortality has decreased 90% and maternal mortality has decreased 99%. This is due in part to better nutrition, hygiene, access to health care and technological advances in care.

Access to family planning and contraception enabled families to space out the births of their children and prevent unwanted pregnancy and sexually transmitted diseases.

Fluoridation of the drinking water has reduced tooth decay 40-70% in children and tooth loss 40-60% in adults.

Recognition of tobacco use as a health hazard has lead to a reduction in smoking-related deaths and a decrease in the prevalence of smoking among adults.

MMWR. April 2, 1999;48(12):241-243.

Newsworthy Notes

Prevention News Around Campus...

SOM Community Service Day Speaker
William Foege, MD, MPH

William Foege, MD, MPH will present "Science in the Service of Humanity" at Community Service Day. Dr. Foege's impressive CV includes Presidential Distinguished Professor of International Health, Emory University; Former Director of the US Centers for Disease Control and Prevention; and former Executive Director of the Carter Center. He will speak January 28, 2000, 5:00-6:00 pm in 103 Berryhill Hall. This will be a wonderful opportunity to hear one of the pioneers in prevention enlighten us with his pearls of wisdom. Dr. Foege is a hero among physicians and we encourage you to mark this presentation on your calendar.

For more information on the accomplishments of Dr. Foege, visit http://www.emory.edu/EUSHC/HSNEWS/PUB/PH/PHFall97/pin.html.

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Publications
Carol Ford, MD of the Department of Pediatrics and Medicine recently published in JAMA results of a study dealing with adolescents who forego health care.

The study looked at over 20,000 adolescents (grades 7-12) to find out how they use the health care system. The findings show that 1 in 5 adolescents who feel they need health care do not receive it. Reasons include, costs, inability to access health care systems, and concerns about privacy. Uninsured teens, older male teens, and minority teens were among those at increased risk of not getting health care. A very important finding is that adolescents who forego care are at increased risk for future physical and mental health problems based on symptoms with common causes of adolescent morbidity and mortality. This means that teens who are foregoing health care may have the most to gain from seeing a doctor or nurse. Future efforts to help adolescents get needed health care must address these factors.

This study was performed as part of the National Longitudinal Study of Adolescent Health Project based at UNC-CH, which is directed by J. Richard Udry, Ph.D.

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US Preventive Services Task Force Update
Faculty at UNC, together with Research Triangle Institute, are collaborating with the 3rd U.S. Preventive Services Task Force to develop reviews for updated recommendations on preventive care. Here is a brief status report.

fMike Pignone, MD is nearing completion of the Systematic Evidence Review on Screening for Lipid Disorders. He is currently seeking comments from peer reviewers.
f Carol Lannon, MD and her team is finishing a draft of the Systematic Evidence Review of Screening kids for Developmental Delay.
fRuss Harris, MD is working on the last stages of a draft of the Systematic Evidence Review of Screening for Type 2 Diabetes. Working with him at present are Eric Baggstrom, MD (renal diseases), Katrina Donahue, MD (harms of screening and accuracy of screening tests), and Saif Rathore (macrovascular risk reduction).
fLinda Kinsinger, MD is finishing a draft of the Systematic Evidence Review of Chemoprophylaxis for Breast Cancer. Working with her are Carmen Lewis, MD, Margaret Wooddell and Russ Harris, MD.
fMerry-K Moos, FNP, MPH, BSN and Neva Edens, MD are working toward completion of a draft of the Systematic Evidence Review on Counseling to Prevention Unintended Pregnancy.
fMike Pignone, MD and Brad Gaynes, MD are nearing completion of a draft of the Systematic Evidence Review of Screening for Depression.
fKathie Harmann, MD is beginning work with a team of people on Cervical Cancer Screening.
fAlex Kemper, MD is beginning the Systematic Evidence Review of Vision Screening in Infants.
fIn the new year, Mike Pignone, MD will begin the Screening for Colorectal Cancer and Russ Harris, MD will begin the Screening for Prostate Cancer sections.
fRuss Harris, MD will also begin the Screening for Gestational Diabetes section. Others will join in on these teams.

If you are interested in joining the Task Force team, call Russ Harris at 966-4065 or e-mail rharris@med.unc.edu

Around the Country...

Healthy People 2010 to be Released
The nation's latest prevention agenda, Health People 2010, will be launched January 25, 2000, by Secretary Donna Shalal and Surgeon General David Satcher at a conference in Washington, DC. Updated every ten years, Health People identifies the most significant preventable threats to health and focuses public and private sector efforts to address them. Healthy People is based on the best scientific knowledge and is used for decision-making and for action.

The previous plan, Health People 2000, set the following three goals:
increase the span of healthy life for Americans,
reduce health disparities among Americans, and
provide access to preventive health services for all Americans.

From these three goals, 319 measurable objectives and 47 "sentinel" indicators were developed. These "sentinel" indicators were written for the general public and non-health care professionals in hopes that measurement of the 47 indicators would allow monitoring of the status of health of the general population.

Evaluation of Healthy People 2000 indicates that 13% of the the 319 objectives reached or superseded the target measures and an additional 43% of the 319 objectives achieved positive progress toward the target measures. Disappointingly, the 47 "sentinel" indicators did not gain attention of the general population, not to mention the health care community. Lack of success is attributed to there being too many indicators.

A committee of the Institute of Medicine looked at three sets of leading health indicators for Health People 2010: health determinants and health outcomes set, life course determinants set and a prevention-oriented set- and 26 focus areas emerged. Three areas were found in all three sets of indicators. These were poverty, disability and tobacco use. The 26 focus areas, their objectives and developmental objectives for each are available by visiting the Healthy People 2010 or the Institute of Medicine websites.

Around the World...

$78 Million Dollar Gift Aids Fight Against Polio
The Bill & Melinda Gates Foundation and the R.E. (Ted) Turner United Nations Foundation have donated $78 million to the World Health Organization, Rotary International and UNICEF in an attempt to eradicate polio by the end of the year 2000. Bill, Melinda and Ted wanted to show an example of how collaboration is needed to eradicate polio.

The Gates Foundation wishes to help improve people's lives through health and learning and in addition to this generous donation the Bill & Melinda Gates Foundation has been involved in immunization and other health care advocacy efforts including:

Development of the Bill & Melinda Gates Children's Vaccine Program which works to deliver vaccines to all the world's children
Development of the Maternal Mortality Reduction Program
$50 million commitment to prevent pregnancy-related deaths of women in developing countries.
$750,000 funding for the Georgia Campaign for Adolescent Pregnancy Prevention
$25 million to the International AIDS Vaccine Initiative for research and development of an AIDS vaccine
$50 million grant to the Alliance for Cervical Cancer Prevention to prevent cervical cancer in developing countries

Check out The Bill & Melinda Gates Foundation for addition information on their contributions to health care research.

Look for our next edition of "An Ounce of Prevention" in March, 2000.
If you have comments or questions about this newsletter or its contents, please e-mail alward@med.unc.edu.

Program Co-Directors: Russ Harris, MD, MPH and Linda Kinsinger, MD, MPH
Editor: Amy L. Ward

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