Steve Sartino – Page 5 – Lister Hill Center for Health Policy

Birmingham Policy Surveillance Initiative

February 28, 2020, by Tessa Graham (Program Coordinator II, Office of Public Health Practice) and Sean McMahon (LHC Outreach Coordinator)

Two Ambitious Projects…

Policy Surveillance Project

While much public health policy is enacted at the state or federal level, US cities play a crucial role in implementing programs and polices that impact population health. Despite playing this role, there are few systems that track and seek to understand practices at this level. In 2017, the Urban Health Collaborative at the Drexel University Dornsife School of Public Health initiated a Policy Surveillance Project (UHC PSP) that focused on urban centers with active policy debate.

Drexel Live HealthSmart

Live HealthSmart Alabama

According to America’s Health Rankings, Alabama ranks 46th in obesity, 48th in diabetes, and 49th in high blood pressure, among other poor health ranking metrics. This was the impetus for the winner of UAB’s Grand Challenge: Live HealthSmart Alabama. This initiative, led by Dr. Mona Fouad (Director, Minority Health & Health Disparities Research Center), works “with businesses, schools, faith-based organizations, and non-profits in order to make changes to policies, systems, and build environment impacting the health of Alabamians.” Dr. Lisa McCormick (Associate Dean of Public Health Practice, UAB School of Public Health) is a collaborator on the Live HealthSmart team and assists them in their goals of transforming Alabama’s health and moving us out of the bottom ten in national health rankings. Live HealthSmart has chosen a team of collaborators from disciplines all across campus, allowing them to assess complex factors detrimental to the health of Alabamians.

A Big Week for the LHC

Last week was a big one for the Lister Hill Center (hence, the delayed blog post). We sent one member of the team to Washington, DC while the rest stayed in Birmingham for the long-awaited seminar/workshop from the Alan Alda Center for Communicating Science. On top of all this, we teamed up with Undergraduate Student Government Association and the Graduate School to host a voter registration drive! Use the tabs below to navigate between the different undertakings of LHC staff last week:

Why Are You Yelling? – The Significance of Protests

January 31, 2020 by Sara Harper, LHC Student Intern

Intro

Last Saturday, January 25th, I participated in an anti-war protest, organized by the Birmingham chapter of the Party for Socialism & Liberation, in response to political strife over the assassination of Iranian General Qasem Soleimani. As the rally ended a passerby approached to question the group’s intentions. He commented, “I just think there are better ways to get your message across, because this,” he motioned to the group surrounding him, “is going to burn out.” His comments weren’t unfounded; social movements can fizzle without a strong group organizing and keeping advocates accountable. Regardless of the outcomes, protests have been essential to the formation and vast changes America has undergone throughout history.

It Isn’t Just Yelling

Sure, people who protest seem pretty angry. We are! Protesting is the most outward and public way that advocates can voice opinions on the platforms they feel passionately about. However, public protests are only one tool in the advocacy kit. Protesting is by no means the end-all-be-all to any movement; it just happens to be the loudest and most visible form of advocacy. It’s easy to overlook the organizing power behind rallying a large group of people who are willing to stand in solidarity against whatever they believe to be unjust. Protests are the metaphorical tip of the iceberg for advocates who spend the majority of their time planning, recruiting, and participating in hands-on work related to their movement.

Legislative Significance

The right to protest is not explicitly mentioned within the first amendment but has historically been covered by the right to assembly and the right to free speech. The first amendment gives American citizens the legal protection needed to organize and publicly voice their grievances. The broad nature of the first amendment protects all forms of voicing dissent, including hate speech such as the antisemetic chants heard at the 2017 Unite the Right Rally in Charlottesville, VA. While these views are not generally accepted, they are still legal to express in a public forum per the first amendment.

The first amendment usually supplies protections to more vulnerable populations who choose to speak out against injustices. The right to protest has been exercised by a myriad of labor unions and other workers’ groups who withhold their labor in order to force management to implement changes in wages, safety laws, or equality in the workplace. Major advancements in civil rights, women’s rights, and LGBT+ rights – and the laws now in place – have only happened because of large scale movements, organized by the people within these communities.

Social Significance

Protesting is a socially significant route to spread information and increase general awareness on topics, not only in America but beyond our borders as well. Protests typically garner media attention which, in turn, exposes a higher percentage of the population to said topics. Media can bolster a movement to numbers the organizers never expected. However, large movements can be seen as aggressive to the local governments who funnel resources towards dismantling the movement organizers. An example of this includes the FBI’s involvement with targeting prominent members of the civil rights movement, including (but definitely not limited to) Martin Luther King Jr. and Malcom X. Government involvement in the dismantling of social movements has a history of escalating situations like the Kent State Massacre in 1970, when authorities opened fire on students protesting the Vietnam war. The shootings resulted in four deaths, nine injuries, and an increased sense of distrust between the government and distressed citizens. Relations between police and protestors were escalated in 2014 during the Ferguson Unrest following the police shooting of Michael Brown. As we move forward, protests have become the forefront of fighting for social justice and voicing dissent against oppression. However, those in power who would rather maintain the status quo retaliate in their own way. This is the ultimate caveat of protests: Rarely does progress happen without fighting against a forceful hand.

Movements and Momentum

The United States will likely never be protest-free; the only reason we exist as a country is because we protested an imperial power and won. The last four years have seen some of the largest protests in American history, with some estimates showing 4.6 million people participating in the 2017 Women’s March! As long as we continue to recognize (and subsequently utilize) the power of organizing and the power of protests, we will continue our American tradition for generations.

AL Public Service Commission Hearing for Solar Reform

December 2, 2019 by Sara Harper, LHC Student Intern

Thursday, November 21, I attended the Alabama Public Service Commission’s public rate hearing on Alabama Power’s fee on solar producers. Alabama Power charges solar users who are plugged into the “grid” $5 per kW of energy they produce. The idea behind the fee is to cover the costs of solar-users who draw supplementary power from the grid during non-productive hours. However, the fees erase most savings that solar producers would be getting from switching to renewables and make recovering the cost of installation difficult. GASP, represented by the Southern Environmental Law Center, and Energy Alabama requested the hearing, testifying that the stand-by fee is unnecessary, discriminatory, and has impeded upon Alabama’s solar progress for years.

IMG_7036 (1).jpg The inside of the courtroom was representative of the greater issue we were there to discuss. People of all ages and races filed in until the space became standing room only. Supporters of the cause sported a sticker reading “Let it Shine” emblazoned with a bright yellow sun. Once the stickers were passed out to those willing, it was easy to discern there was a greater majority of “pro” than “against”. Advocates of all demographics exemplified that Alabama Power’s monopoly is a bipartisan issue that concerns all of Alabama’s residents.

On the other hand, the current public service commission seems entirely partisan, all three of its members being part of the Republican Party, and was moderated by an agitated Administrative Law Judge John Garner. Alabama power was represented by one lawyer and Team Leader of Regulatory Costing, Natalie Dean. The whole scene conveyed that Alabama Power was not intimidated by their challengers and the legislators were annoyed to be pulled into work so early in the morning (the hearing was scheduled at 9AM to deter public engagement).

Alabama Power, backed by the Public Service Commission, continues to force Alabamians to pay some of the highest solar rates in the US. Throughout the course of the day it was easy to AL PSC.png tell that the Public Service Commission was not interested in the minutia of the hearing: one example of this being Judge Garner and Commission chair Chip Beeker exchanging phones and giggling to themselves on the stand while the SELC was cross examining Natalie Dean. A blatant example of misuse of power was displayed when Judge Garner disrupted a testimony to order the bailiff to remove anyone filming the hearing from the courtroom. Several audience members, all adorned with sunshine stickers, were removed from the courtroom; most notably Kari Powell, who has run for a Public Service Commission seat in the past. This removal was unconstitutional and those several who were removed were prepared to show the bailiff the exact legislation that defended the legality of their recording. The recordings were an attempt to make the “public” hearing accessible and keep Alabama Power and the Public Service Commission accountable for what was discussed, despite the two entities being involved in controversial a smear campaign a few years prior.

An official decision on the fees was not made on the 21st. Both parties have until December 20th to submit their final orders and a decision will be made after that. The odds seem stacked against the Alabama advocates for solar energy; however, an appeal of the case could be sent to the United States Supreme Court.

Built Environment Symposium Re-Cap: Four Perspectives

November 21, 2019 by the LHC Team

Each Fall and Spring semester we focus in on a public health topic to encourage policy action among our stakeholders. We call this our Semester Spotlight program. This Fall was our first semester rolling out this program; we decided to start with the Built Environment. As our city continues to grow and re-develop, we hope to spark conversations about how the environment we build affects the public’s health.

Are there Dental Access Issues in Alabama?

November 4, 2019 by Conan Davis, DMD MPH

Do we have any issues to be concerned about regarding access to dental care in Alabama? Everyone has a dentist who can see them on short notice if they need, right? Wrong.

If you live in Birmingham or in one of the larger cities in Alabama, you might not have a problem being seen on short notice – particularly if you have dental insurance or out of pocket cash for treatment, but if you live in smaller towns or rural areas in our state, you might not be so lucky.

Alabama currently has only one county without a dentist: Greene County. However, about 80 percent of all the dentists practicing in Alabama practice in the 13 most urban counties. The other 20 percent practice in the 54 non-urban counties of Alabama; many of these smaller counties only have between one and three dentists. This translates to about one dentist for every 1800 people in the urban areas, versus one dentist for every 4100 people in the non-urban areas – a big difference.

This is the subject of a paper Dr. Stuart Lockwood and I are developing and hope to publish with the Lister Hill Center for al dentists.png Health Policy in the next few months. Dr. Lockwood and I are both former State Dental Directors with the Alabama Department of Public Health. We both have examined the teeth of thousands of children in Alabama to assess the state of dental decay and to make referrals to local dentists. We have seen many with excellent dental care and many without any need for treatment. However, we have also seen the evidence of neglected dental needs in many children. An even larger concern we have seen is the lack of access afforded to low-income adults with no dental insurance and no public dental coverage in Alabama. We will cover that connected subject perhaps in another post.

Dr. Lockwood and I have been engaged in studying the underlying issues for our widening gap between urban and non-urban areas concerning dental care access for many years. We developed a partnership between UAB School of Dentistry and the Alabama Dental Association to develop a strategy to correct the disparities we found in the more rural areas of the state.

Through this partnership, we wrote and were awarded a grant to do several things in this area. One was to take the available data on dental practices in Alabama and with the help of the UAB School of Public Health develop a GIS map detailing where all dentists’ practices are located in Alabama. The grant also allowed for rotation experiences in rural areas for dental students as a way to allow them to see dental practice life in these areas. We also provided significant financial awards to a few graduating dentists who agreed to practice in a rural area and also agreed to see a certain percentage of Medicaid patients for a specified number of years. Graduating dental students can have very significant school debt, and this was designed to assist them with that debt and help them establish a practice. The grants were planned to help “plant” dental offices in nine rural areas needing a dentist. Nine such practices came about through this grant program and they have successfully continued in those areas to this day.

I’ve worked with Dr. Lockwood and the state dental association on language presented to the state legislature and the Governor’s office for consideration of a similar state-based financial incentive program for new dentists willing to locate in a rural area. We hoped this would also encourage young dentists to choose a smaller town or rural area in which to practice. While all our legislators were favorable to the concept, funding has not been significant just yet. We continue pursuing this possibility.

Another issue regarding distribution of dentists involves the current ages of dentists in the rural areas. We will discuss these findings in some detail in our upcoming paper.

So – to answer the question, “Is it easy to find a dentist to see you on short notice anywhere in Alabama?” – no. However, many of us are engaged about this concern and working towards positive solutions for all Alabamians. We hope to be able to answer my question in the affirmative in the near future!

Conan Davis recently retired from his position as Assistant Dean for Community Collaborations and Public Health at the UAB School of Dentistry. He continues to research the inequities in access to dental care across Alabama.

Environmental Justice: Lois Gibbs

October 24, 2019 by Sean McMahon and Sara Harper

A few weeks ago the Lister Hill Center for Health Policy co-sponsored a visit from Lois Gibbs, often called the Mother of the Superfund. She guest-lectured in a few classes and met with community members in Birmingham. We had the wonderful opportunity to sit down and chat with Ms. Gibbs over lunch at Lucy’s. We were able to get to know her a bit more and hear about her 40 years of Environmental Justice (EJ) work.

If you missed her, you can listen to the podcast she recorded with the Office of Public Health Practice. You can view Ms. Gibbs’s lecture here.

Ag-Gag: Big Agriculture fighting back

October 11, 2019 by Sara Harper, LHC Student Intern

Three years ago, I got obsessed with where meat comes from. Kip Anderson’s exposé “Cowspiracy”had come out a few years prior and, while sensationalized, it gave me a passion for something that enveloped environment, policy, and justice. Since then, I’ve written several academic pieces on the factory farming industry and adjusted my purchasing habits away from supporting industrialized farms. Do I sound like PETA yet? Throughout my research I’ve consistently addressed the issue from a human and environmental health point of view, with animal rights being a positive outcome of the latter. My reasoning for this is to steer my point away from sensationalizing the animal cruelty involved, in favor of a health-based approach to this problematic industry.

Quick background: Factory farming, or intensive livestock farming, is a sector of the Agriculture industry that relies on overcrowding animals and assembly-line style production in order to maximize meat output. These facilities have large negative impacts on the surrounding environment including: Water source contamination, greenhouse gas production, and deforestation, and so many other issues.

Okay now you’re caught up. These things are bad, right? So, who’s fighting the good fight? Well…

In the past two decades, “Big Ag” has proposed laws in states across the country that criminalize the efforts of whistleblowers in the industry. These laws have been coined “Ag-Gags” because, by nature, they silence those who intend to call out the harm done by intensive livestock farms. Alabama passed their own Ag-Gag bill in 2002, which makes it a felony offense to obtain access to a property “by false pretenses” and to possess records obtained by deception. This law was directly related to an increase in environmental advocates performing undercover investigations on factory farms under the pretense of employment.

So why is this important? The agricultural industry in America is a high grossing source of income and production but is, by all accounts, necessary. However, powerful, money intensive industries like factory farming have little government oversight when it comes to their environmental health impacts. These production facilities are known to under-report incidents like waste spills and romanticize the idea of their farms to consumers. In this industry, whistle blowers in the media and advocacy groups are the only people holding these companies accountable for their actions. Ag-Gag bills seek to make it virtually impossible to report on factory farms in order to reduce the amount of incriminating information leaking out of their facilities.

I know what you’re thinking… “What can I do?” As consumers, it’s up to us to consume responsibly. Using your purchasing power to opt for humanely farmed meat shows that you do not condone the actions of this negligent polluting industry. All in all, the future for defeating Ag-Gags looks bright. As of June 2019, 3 states have declared Ag-Gag policies unconstitutional, ruling that the laws infringe upon freedom of speech and freedom of the press. Seventeen other states have blocked such bills from ever being passed.

Suicide Prevention

September 11, 2019 by Sean McMahon, LHC Outreach Coordinator

September is National Suicide Prevention Month, and specifically this week is National Suicide Prevention Week. A friend of mine recently died by suicide, and since then I’ve been diving into national statistic and prevention strategies.

A month ago, I was at my desk, stumped about what to share on the Lister Hill Center’s Facebook page. This is always an involved process. I’d like to share the new Healthcare Triage video each week, but that would be redundant. I’d like to make another post about Medicaid policy changes, but I’d already made a few that month. Still deciding, I logged on and the first this I saw was a post from a former pastor of mine, someone my family has kept in touch with for nearly two decades.

Normally, when I log into Facebook to interact as the Lister Hill Center, I quickly navigate away from the home page so that I don’t bring my personal life to my work desk. However, when you see the words “my oldest son has passed away,” your heart jumps a little bit and you have to take a moment to investigate. Almost immediately I received a text from my sister to tell me the news. She was with the family. She was with them shortly after they were told that their son had taken his own life.

After a week of going through the motions, I went to be with my family and friends. We had an informal memorial; a funeral wasn’t possible just yet. After another week of going through the motions, I went back for the formal funeral service.

Just two months before my friend took his own life, I was taking a policy advocacy course at Johns Hopkins University, crafting a mock proposal (similar to UAB’s annual Global Health Case Competition) for an advocacy plan to decrease suicide rates in India. And now I’m dealing with the very real occurrence of suicide happening within my circle of friends.

NSPL Logo 2 Nationwide, a staggering 47,173 people died by suicide in 2017. After adjusting for age, that’s a mortality rate of 14 per 100,000 population. If that doesn’t sound like much to you, just remember that intentional self-harm was the 10^th leading cause of death that year. Alabama’s rate (16.2) is higher than the national average.

As for policies enacted to prevent suicide, include: restricting the means (tighter gun control, regulating certain medications, etc.); integrating mental health with primary care; and of mental health services. Someday we’ll find the perfect combination of policies to keep the suicide rate down, but until then there are things we can all do at the individual level to prevent suicides.

If you’re having thoughts of suicide, please take the time to call the National Suicide Prevention Hotline at 1-(800)-273-8255. To learn more about how the Lifeline operates, join this webinar on September 18.

If you want to get involved with prevention efforts, you can volunteer with the Crisis Center right here in Birmingham.

If someone reaches out to you about having suicidal thoughts, listen to them and help guide them towards seeking help. Don’t tell them everything will be fine, and don’t promise to keep it a secret. This fact sheet from the Alabama Department of Public Health has more information about how to help.

Reflections on Jury Duty and Civic Obligations

September 26, 2019 by Suzanne Judd, LHC Director

A few weeks ago, I had that wonderful American privilege of being selected for jury duty to the 10th Judicial Circuit Court of Jefferson County, Alabama. I say “wonderful” tongue-in-cheek since, like most of the people I was chatting with in the Jury Assembly Room, I had no desire to be there. Parking was a nightmare. They simply don’t have enough spots for the 400 jurors that were summoned to downtown Birmingham for the shot at being selected to sit on a jury. This was my second time in three months coming on a Monday morning to wait to see if I would be selected for a jury. Three months prior, I was dismissed because I had not lived in Jefferson County continuously for a year due to a six-month commitment in France. The disqualification didn’t make sense to me. Luckily, I was back 90 days later to try again. And this time, it was even better because Law & Order was on the television to keep me entertained while waiting. No lie!

Before jury selection began, we sat through a 30-minute explanation of what a great honor it is to be selected as a juror. The judge described how unique we are as Americans to be allowed to serve as jurors. In most countries, citizens do not decide the fate of other citizens. He described the jury selection process in Alabama, which is basically tied to being a registered voter. Really? Given all we know about voter suppression in Alabama, one can only assume the same factors affect the juror selection process. This was a fact that was tough for this former Michigander to digest since Michigan uses driver’s license lists to generate juror pools.

As I sat looking around the room, I wondered why I can’t, as a voter, be randomly selected to sit down with lawmakers for a week to express ways to improve society rather than sitting here waiting to be selected for a jury. My registering to vote enables me to sit on a jury to decide another human’s fate but does not provide me with the random chance to meet with the people for whom I voted? Honestly, I would rather sit down with one of my elected officials for one week. Nevertheless, I suppose jury service is important even if that means sitting and waiting.

Since I spent hours waiting, I began to meditate on the process for influencing elected officials to create and implement policies. At times it can seem like citizens don’t have much input. We can call, write, or email our representatives but that always seems so impersonal. Layers of bureaucracy obscure the tangible results of those efforts. If we want to occupy the same space as a candidate, there are town halls and debates but often those feel staged, lacking a real human connection between you and the candidate or elected official.

So where does that leave the average American who wants to be more involved? Advocacy is one of the key tools to ensure the laws our elected officials pass and the ways in which they spend our collective money are more representative of what we want as a people. Beyond simply contacting elected officials, an individual can advocate for their opinion by signing petitions, funding advocacy groups, and constantly pursuing information to stay educated about a variety of topics that face society. Advocating can lead to policies that mold society into something that is more reflective of what the majority of people would like to see.

On the upside, jury duty begrudgingly provided me with needed time and space away from the daily grind to think my own role in influencing laws and policies. I also began to wonder what was on the mind of others. So, in the absence of a random lottery system that grants me access to my elected officials, here are some areas of health policy that seem quite timely:

What are you doing? Let us know; we would love to hear from you.