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THE MAGAZINE FOR DREXEL UNIVERSITY’S SCHOOL OF PUBLIC HEALTH
20
VOL / 2 0 DornsifeSPH Facing this Challenge
MAGAZINE
As COVID-19 continues to
disrupt global health, Dornsife
remains focused and committed
to being part of a meaningful
and effective response.
20
FOREWORD IN PHOTOGRAPHS VOL / 20 Photographer Jeff Fusco 01
March
2020
During the last two weeks
of March, shortly after
stay-at-home orders were
issued, noted Philadelphia
photographer Jeff Fusco
(safely) visited campus and
traveled around the city to
see what was going on.
From University City cam-
pus to neighboring West
Philadelphia to Citizens
Bank Park to Chinatown,
here’s what the city of
Philadelphia looked like.
-Alissa Falcone
Members of the
Dornsife School of
Public Health faculty
and staff assisted
in the planning of a
COVID-19 drive-thru
testing facility at
Citizens Bank Park in
South Philadelphia.
Several students
and faculty also
volunteered at the
site, which served
vulnerable individuals
over the age of 50.
20
02 FOREWORD IN PHOTOGRAPHS VOL / 20 03
As the pandemic
evolved and Drexel
University shut its
doors in early spring,
33rd and Market, an
intersection typically
bustling with students,
staff, faculty, and
community members,
is seen empty.
A lone pedestrian
crosses at 34th and
Market, another in-
tersection previously
packed with people
and food trucks.
20
04 FOREWORD IN PHOTOGRAPHS VOL / 20 05
Neighboring Drexel
University, 30th
Street Station,
which houses the
third-busiest Amtrak
station in the U.S., is
photographed with
very few commuters
and travelers.
2 02 0
06 DEAN’S MESSAGE
Ana V. Diez Roux, MD, PhD, MPH
Dean and Distinguished University Professor, Epidemiology, Dornsife School of Public Health 2 02 0
V O L V/ O L / STREET SCENE 07
a public health measure; air pollution and greenhouse gas
emissions dropped precipitously across the globe; many
cities became more walkable and cycling soared. At the
same time the pandemic has made more visible than ever
the unfairness and injustice inherent in our society: like so
many other diseases the virus hit the poor, the marginalized
and those affected by a long history of structural racism the
hardest. The epidemiology of the pandemic became a mir-
ror in which we can see our society reflected.
The last eight months And then in June, the murder of George Floyd launched
hundreds of thousands into the streets, fed up with inaction,
calling for an end to a long, long history of racism against
have been frightening, Black people in all its multiple manifestations. Health, of
course, is in many ways a barometer of social justice. Martin
Luther King Jr. said as much in his famous words, “Of all
remarkable, revealing, the forms of inequality, injustice in health is the most shock-
ing and the most inhuman.” A growing movement coalesced
discouraging, and
in support of Black Lives Matter, a movement that many of
us feel (and hope) will be sustained and powerful and that
will generate real reckoning and real change. Across the
motivating all at once.
United States, counties and cities have begun to declare rac-
ism the public health threat and the public health crisis that
it is and that it has been for so long. The long tradition of
public health scholarship (much of it by Black scholars and
The world has faced a pandemic, something scholars of color) that has named racism as a cause of health
that public health experts have been talking inequities and documented its impacts is at last receiving
about and even preparing for a long time, and the recognition and visibility it deserves.
yet I venture to guess that few expected that Over the past eight months the Dornsife School of Public
it would actually happen in our lifetimes. As Health community has come together in many ways. We
cases and deaths increased in different places have continued to teach by pivoting quickly to remote deliv-
and at different times, we struggled (and still ery and have prepared for an unprecedented new academic
struggle) to get the right data and to lever- year. Our research has not only continued but also ex-
age the public health infrastructure to choose panded to encompass work on COVID-19 and especially
the right policies and evaluate their impacts. inequities in COVID-19. Our faculty, staff and students
Epidemiology has become an everyday word, have continued to support our health department and com-
and epidemiologic concepts are discussed at munity groups all over Philadelphia as they deal with the
length in the press, but at the same time we many implications of the pandemic. We have come together
have seen science being questioned and ma- building on Dornsife’s historical commitment to health as a
nipulated for political gain. human right and to diversity and inclusion to develop and
The pandemic has already killed over a mil- implement an anti-racism action plan and support the vital
lion people worldwide, and this number is scholarship, training and advocacy that we need to advance
likely an underestimate and will continue to an anti-racist agenda.
Before COVID
increase. Many more have been hospitalized In the midst of all this universities like ours struggled to
struck, Dean Diez
Roux prepares to
with severe disease. Many millions, especial- identify the best path forward on issues ranging from the
announce the win- ly the poor across the globe, have suffered the practical and mundane to the transformative: Should stu-
ners of Dornsife’s dire consequences not only of the infection it- dents return to campus? How can masking be enforced? Is
first Case Compe- self but also the loss of their livelihoods. And periodic testing feasible and useful? How can we begin to
tition which was yet in the midst of all this glimmers of hope dismantle structures that reinforce social injustice and be-
one of the School’s have emerged: in a remarkable show of col- come fully anti-racist in our practices and policies? There is
last large in-person lective response to protect population health, much uncertainty and we are only at the beginning of what
gatherings on activities across the world shut down to pre- will be a long and difficult path. But what I have seen in 4.2.20 One of the unanticipated and surprising consequences of the pandemic is that I have gotten to know the streets of my city, Philadelphia,
campus in 2020.
vent transmission; societies came together to our students, in our staff and in our faculty over the course like never before. At the height of the pandemic, I took long walks through the city. I wore a mask and avoided other pedestrians as much as
provide payments for those left without jobs; of these last eight months gives me hope. I know that after possible, crossing the street or stopping to let them pass by, a sad routine that has become a hallmark of our social interactions, something
the CDC issued an order halting evictions as reading these pages you will agree. that none of us would ever have imagined that we would be doing a year ago. —Ana V. Diez Roux, MD, PhD, MPH
4
20
08 ISSUE NUMBER VOL / 20 CONTENTS 09
:
Number of Philly-based artists DEPARTMENTS
featured in this redesign issue 01 F O R E W O R D I N P H O T O G R A P H S
For the inaugural issue of the redesigned
Dornsife SPH Magazine, we collaborated 06 D E A N ’ S M E S S A G E
with several local artists, including award-
winning illustrator Jon Krause, to help bring
these pages to life. “I was incredibly excited
to be asked to collaborate on the relaunch
10 Urban Health Report
of Dornsife SPH Magazine. It’s always an Partnering with the Big Cities Health Coalition,
honor to illustrate for one of my hometown/ Dornsife program expansions, heat and mor-
city 6 schools, especially considering the tality in cities, urban health in Latin America,
importance of the subject matter being cov- cancer health disparities in Philadelphia
ered,” Krause said.
COVER STORY 16 F O C U S Global
Inequality in Latin America, new health and
Jeff Fusco
photographer / jefffusco.biz
FOREWORD IN PHOTOGRAPHS
38 All Hands on Deck
Through service, outreach, research, and advocacy,
human rights journal partnership, working
with global agencies
Dornsife faculty, staff, and students are taking 20 F O C U S Policy
unprecedented action amid the coronavirus pandemic. Restrictions on public housing after incar-
Jon Krause ceration, public trust in government, tracking
illustrator / jonkrause.com
place-based policies in distressed communities
COVER STORY
FEATURED
26 F O C U S Community
Natalie Hope McDonald
32 Social Leveraging Reversing opioid overdoses at the community
Educating parents about HPV through the power level, reducing food insecurity by empower-
illustrator / nataliehopemcdonaldillustration.com
of social media ing parents, strengthening an overwhelmed
P O R T R A I T I L L U S T R AT I O N S I L LU S T R AT I O N B Y J O N K R A U S E EMS safety net
34 Gender Identification 30 Q&A
Transgender adults holding gender-affirming IDs
James Olstein have better mental health Can taking vitamin D help prevent my child
illustrator / jamesolstein.com
from developing autism?
U R B A N H E A LT H R E P O R T F E AT U R E S T O R Y
36 HIV in Africa
Pathways to reducing HIV risk in Africa 48 D O R N S I F E Highlights
Urban Health Report
11
To learn more about the estimated hospitalizations
avoided and lives saved by stay-at-home orders visit
bigcitieshealth.org/stayhomeimpact.
20
10 VOL / 20
P R O G R A M E X PA N S I O N S
Urban Health Training
IN THIS EDITION
Continues to Expand at
New partnership for
more equitable cities I N O C T O B E R 2 0 1 9 , the Dornsife Dornsife
_ School of Public Health, through By 2050, more than 65 percent
its Urban Health Collaborative of the world’s population will
Dornsife Program (UHC), joined in a new partner- live in cities. This shift in de-
Expansions “Through this partnership, BCHC mographics means that cities
_ ship with the Big Cities Health
present complex, large-scale
Coalition (BCHC) to support the and UHC will enhance their ability health challenges, but also offer
Heat and Mortality Coalition’s vision of healthy, more to meet their shared vision of im- one-of-a-kind opportunities to
in Cities equitable cities through big city proving the health of people living in translate public health solutions
_ innovation and leadership. New to communities of all sizes.
our nation’s largest cities.” Programs
A powerful voice for public In order to adapt to public
Urban Health in Latin health departments in the nation’s cities, and residents began to face the loss of at health professionals’ specific
America Dornsife needs, the Dornsife School of
_ largest, most urban cities, this not only life, but livelihoods as well. Despite
new partnership with UHC is ad- the many challenges of implementing stay- Public Health has introduced a
Bachelor of new online degree and online
In Philadelphia: Cancer vancing BCHC’s work by bringing at-home orders, they proved to be extremely Arts in Global certificate focused specifically
Health Disparities faculty, expertise, and resources in crucial in slowing the spread of COVID-19. Health on urban health — the Master of
_ policy, planning, and evaluation, With the BCHC, estimates were released in Urban Health (MPH) and Graduate
as well as data knowledge and March that showed that early actions by Online MPH in Certificate in Urban Health.
infrastructure. Most importantly, its members, leaders from America’s largest Epidemiology
Addressing the health challenges
the partnership is enhancing and metropolitan health departments, to get the created by urban living but also
Online MPH
supporting BCHC’s strong com- public to stay home led to an estimated 2.1 mil- in Global capitalizing on the health-promoting
mitment to evidence-based urban lion hospitalizations avoided and more than Health features of cities is critical to pro-
moting population health worldwide.
health practice. 200,000 lives saved.
Big
Online MPH “Even in the time of COVID-19
For the UHC, the partnership These projections were covered widely by cities provide many opportunities
in Urban
is an opportunity to advance its the media nationally at a time when stay-at- Health to promote both health and en-
commitment to urban health lo- home order fatigue was felt by the public. vironmental sustainability. Today
Partnership
cally and globally, leveraging the “Some communities struggle with seeing the Online Master more than ever we need to figure
School’s historic expertise in public value of staying at home. And it is a privilege of Science in out ways to design, manage and
Global Health govern cities so that they promote
health practice in urban settings. to be able to stay at home and not work, or
“This partnership is at the core work remotely,” said Amy Carroll-Scott, PhD, health and health equity,” said Ana
Online V. Diez Roux, MD, PhD, MPH, dean
of the UHC’s mission and com- MPH, assistant professor in the department of Graduate
Partnering with the Big Cities Health Coalition and distinguished university pro-
mitment to research, training, and Community Health and Prevention at Dornsife Certificate
in Infectious fessor of epidemiology at Dornsife.
policy translation in urban health and the UHC. “Messaging is important.” Students in the new online
Disease
locally and globally,” said Jennifer These estimates, based on 45-day stay-at- Prevention Master of Urban Health (MPH) will
Kolker, MPH, clinical profes- home orders, were calculated by the UHC using and Control train in the foundational principles
sor in the department of Health a model published by The New York Times. of urban health practice. Rooted in
Management and Policy, associate Another way that the UHC is harnessing the Online the concept of health as a human
dean for public health practice and power of data is by creating a platform that Graduate right, this MPH teaches students
Certificate in to develop programs, policies, and
external relations, and co-lead of tracks COVID-19 outcomes and inequalities Urban Health solutions to contemporary urban
the UHC’s Policy and Community across major cities. Funding from the Robert health challenges that leverage
Engagement Core. “Through this Wood Johnson Foundation has enabled the policy and interventions on built
partnership, BCHC and UHC will development of this data platform that will
…
physical and social environments to
enhance their ability to meet their provide timely comparisons of key COVID-19 promote health and health equity.
shared vision of improving the indicators, as well as indicators of inequities in The Graduate Certificate in Urban
To read
health of people living in our na- health outcomes, across BCHC cities over time. Health provides an introduction to
more about
tion’s largest cities.” While similar platforms exist at the state urban health practice techniques,
the UHC’s
COVID-19 which help students build founda-
Shortly after this partnership and county level, this platform will be the first
initiatives, tional knowledge in the field. The
began, cities around the world city-level platform which enables city health courses are built to benefit pro-
see “All
were faced with the COVID-19 officials, policymakers, and other partners to Hands on fessionals in areas like community
pandemic. Stay-at-home orders analyze data within and across large cities in Deck” on health, health education, and urban
were issued for almost all large the United States. page 38. and regional planning.
I L LU S T R AT I O N B Y J A M E S O L S T E I N
12 Urban Health Report VOL /
20
20 For updates on work regarding heat and mortality in
13
urban areas, visit, bit.ly/UHCheat20.
P R O G R A M E X PA N S I O N S
The Fifth Annual
Urban Health Summer
Institute Goes Virtual
For the first time, the Urban Health I N M A Y 2 0 2 0 , the Pan American Health Org-
Summer Institute hosted by the anization (PAHO) and the Dornsife School of
Dornsife School of Public Health’s Public Health established a formal agreement to
Urban Health Collaborative (UHC) collaborate on efforts to promote urban health
was fully online. Midway through throughout Latin America.
the planning process, the UHC met The agreement facilitates ongoing collabo-
the challenge to rethink how the
Heat and Mortality
ration between the Salud Urbana en América Heat vulnerability is of
event could continue during the particular concern in
pandemic. Despite the different Latina (“Urban Health in Latin America”)
cities, due to the urban
in Cities
format, more than 100 attendees or SALURBAL project, led by the Urban heat island effect, which
from across the country gathered Health Collaborative at Dornsife, and the is attributable to the
online to engage in trainings. Since the Health Promotion and Social Determinants large amounts of concrete
Attendees included faculty, stu- inception of Unit at the Regional office of PAHO/WHO in and asphalt and lack of
dents, and staff from universities the Urban Each year, more than 600 people in the United vegetation.
Washington, D.C.
such as NC State, Colorado State Health States are killed by extreme heat, according to
Summer With the joint goal of promoting urban
University, University of Pittsburgh, the Centers for Disease Control and Prevention
Institute in health, the two groups will continue efforts (CDC). In addition to measures of public
University of Puerto Rico, and
2016, the to coordinate research and policy priorities, safety surrounding the coronavirus pandemic,
many others. Participants included Physiologically,
UHC has leverage regional contacts and engagement op-
professionals from organizations temperatures in Philadelphia soared above infants have less
trained
across Philadelphia and the portunities throughout policy processes, and 90 degrees on multiple days during July 2020, developed regulating
U.S., such as the Philadelphia more than identify ways to improve the capacities of the causing the city to declare several heat health body systems, high
Department of Public Health, Pew
Charitable Trusts, Detroit Health 325 local governments throughout the region.
T h e t e a m s h av e w o r k e d t o g e t h e r o n
emergencies with various relief and safety
measures taken.
metabolic rates,
higher heart rates
36
Department, U.S. Department of participants Lower socioeconomic and racial or ethnic than adults, and low
multiple initiatives in recent years. PAHO rep-
Housing and Urban Development, through this minority groups are particularly vulnerable to whole-body sweating
resentatives have played a key role in providing both heat and coronavirus. Heat vulnerability is
Fox Chase Cancer Center, New program. rates. Because of their
Jersey Department of Health, feedback and insights about the SALURBAL of particular concern in cities, due to the urban newness to the world,
and the Children’s Hospital of research project and relevance for local actors Number heat island effect, which is attributable to the there is little oppor-
throughout the region. of days of large amounts of concrete and asphalt and lack tunity for their bodies
Philadelphia.
90+ degree of vegetation. Within cities, variation in built en-
This year, the event included In October 2019, Ana V. Diez Roux, MD, to acclimate. The
temperatures
seven different courses from June vironment and land cover characteristics, such association between
Promoting
PhD, MPH, dean and distinguished university recorded in
22-26, 2020. From introduction professor of epidemiology at Dornsife, joined Philadelphia as vegetation and tree canopy, creates different heat and infant mor-
courses in urban health research from Jun 1 microclimates. Such characteristics may also tality is understudied
Gerry Eijkemans, chief of PAHO’s Health
to pivoting to the challenges of the through Aug vary along sociodemographic lines. because infants are
Promotion and Social Determinants Unit, and These concurrent public health threats
Urban
pandemic, a range of courses of- 31, 2020. not always recognized
fered attendees the opportunity to mayors from across the Americas at the third caused new challenges for the city. Because of as a heat-sensitive
gain skills in tools, evaluation, and meeting of the Health Municipalities, Cities The long- coronavirus safety precautions, the usual areas subpopulation.
data analysis methods for public and Communities Movement. The meeting term average for respite from the heat such as public pools In addition to
Health
and urban health research. took place in Paipa, Colombia and marked the is 21 days. or air-conditioned spaces like public libraries the need for more
In the exit survey and social official launch of a policy brief on “Health in All were not open. To keep residents of the city research on infants’
media posts, participants remarked safe from the heat, public health officials had susceptibility to
Urban Policies,” which was co-produced by the
on just how much they learned to execute new solutions like utilizing SEPTA heat, her team notes
SALURBAL and PAHO teams.
Throughout
from these condensed courses. buses with air-conditioning as cooling stations. that the elderly and
Participants appreciated that it
Promoting healthy and sustainable cities “We all feel and complain about the heat, but those with underlying
was offered online and that the requires concrete guidance, experience, and col- let’s also remember this is an important public medical conditions
content from the courses was very laboration across many sectors to address the health issue, and one that is most severe for are among the most
Latin
useful for their daily work. They determinants of urban health. In today’s context those who are also most COVID-vulnerable,” vulnerable to heat. As
thought that the courses were of uncertainty and global challenges, PAHO said Leah Schinasi, PhD, assistant research temperatures con-
helpful and that the instructors and Dornsife remain committed to the goals professor at the Dornsife School of Public tinue to rise globally,
were knowledgeable and engaging. Health and the Urban Health Collaborative public health leaders
America
of supporting development to improve health,
Participants remarked upon how (UHC). Schinasi studies the impact of heat in must continue to fill
equity, and environmental sustainability. Now cities and what it means for health.
they will use the skills that they this gap in knowledge
learned in their research and on the more than ever, urban inequalities need to be From 2016-2019, Schinasi led a pilot study out on optimal ways to
job to improve their programs and addressed to better respond to emergencies like of the UHC on the associations between tem- adapt to earth’s rising
bring new perspective to their work. By Katy Indvik and Fernanda Lanzagorta the COVID-19 pandemic. perature and infant mortality in Philadelphia. temperatures.
20
14 EXCERPT VOL / 20 15
URBAN PUBLIC HEALTH: A RESEARCH TOOLKIT FOR PRACTICE AND IMPACT
Cancer Health
“An increasing majority of the P R O G R A M E X PA N S I O N S
New Dornsife Disparities in
human population resides in urban Course Further
Examines Health Philadelphia
areas, and residents are affected Inequities in
Cities A NEW REPORT RELEASED in September 2020 by the
in multiple ways by these settings. At the start of 2020,
Sharrelle Barber,
ScD, MPH, assis-
Urban Health Collaborative at the Dornsife
School of Public Health, the Philadelphia
Department of Public Health, and Fox Chase
CANCER DEATHS BY RACE/ETHNICITY AND INCOME
IN PHILADELPHIA, 2016
Our lives and our health are shaped A new book, Urban Public Health:
A Research Toolkit for Practice
tant professor in
the department of
Epidemiology and
Cancer Center uses existing data on cancer
rates in Philadelphia to give a thorough look at
how cancer and its risk factors have changed
by the design of buildings and
Biostatistics at the
and Impact edited by Diez Roux, Dornsife School of over the past decade and how they vary by so-
Gina Lovasi, PhD, MPH, UHC Public Health and cioeconomic factors and race.
co-director, and Jennifer Kolker, the Urban Health The comprehensive report, which is the first
transportation systems, access MPH, clinical professor in the de-
partment of Health Management
and Policy, associate dean for
Collaborative, led
a newly designed
course that examines
of its kind, outlines key analysis for public health
agencies, policymakers, and healthcare provid-
ers to better serve people and make informed
to improved sanitation and public health practice and exter- the differences in life choices on resource allocation. Alongside the
expectancy and other
nal relations, and co-lead of the report, the researchers have also developed a
markers of morbidity
UHC’s Policy and Community and mortality that community brief and an interactive dashboard. higher for Blacks than for other races and eth-
early childhood education, the Engagement Core, tackles a wide
range of urban health topics.
The overall progress of urban
exist within small dis-
tances in urban areas
across the United
RACIAL
DISPARITIES
Cancer
The dashboard is a comprehensive interactive
site to explore information from the report on
cancer incidence, screening, and mortality data
nic groups and is also higher in neighborhoods
with relatively lower levels of education.
People with lower education have signifi-
availability of food stores and health is measured and monitored
by the constant support and care
of all people who live within urban
States and around the
world. This course is
now a core class in
mortality is
higher
in Philadelphia by race/ethnicity and sex for
different cancer types.
Researchers used data from the 2000-2016
cantly higher levels of cancer risk factors than
those with higher education. Some cancer risk
factors have improved in recent years, but rates
recreational spaces, and by a
the online Masters in for Blacks than
landscapes, no matter someone’s Pennsylvania Department of Health Cancer of obesity, diabetes, and binge drinking have in-
Urban Health (MPH) for other race
social position or health status. at Dornsife. and ethnic Registry and the Vital Statistics Registry from creased, and fruit and vegetable consumption
This book articulates perspectives Students enrolled groups the Pennsylvania Department of Health’s remain low. Philadelphia residents, including
wide range of local policies from and baseline knowledge crucial to
the field of urban health, and the
research and partnership strate-
in the course will
examine the root
causes of differences
Bureau of Health Statistics & Registries. For
statistics on the cancer screening and risk
factors, such as race and education level, the
Black men and women, reported high rates of
screening for most common cancers.
Researchers call for programs and policies
housing to health care access. gies which can guide cities toward in health like resi- report draws from nine surveys conducted that reduce disparities by promoting healthy
dential segregation,
better population health and between 2000 and 2018 by the Southeastern lifestyles — lowering rates of smoking and obe-
gentrification and
health equity outcomes. Examples displacement, and
Pennsylvania Household Health Survey from sity and encouraging access to healthy fruits
Urban health can be conceptualized
and expertise are shared through- racialized violence. the Public Health Management Corporation. and vegetables and exercise — as well as ini-
out the book from contributors at These issues will be While incidence and mortality rates for tiatives that provide universal access to cancer
the UHC and across its network studied through an many cancers have been steadily decreasing screening and treatment.
as an object, a goal, and an area of
of Philadelphia-based and global explicit structural over the past few years, the fight is far from This research was supported by the Lazarex
partner organizations. racism lens. over. Liver cancer incidence and mortality have Cancer Foundation as part of the Community
This book is tailored for building In addition to identi- increased in both men and women. Breast can- IMPACT project. The goal of Community
fying these inequities,
scholarship and practice.”
capacity for emerging profession- cer incidence and lung cancer incidence have IMPACT, a collaboration between the Dornsife
students will explore
als in public health, though there public health inter- increased in Black women as well. School of Public Health, Drexel College of
is also clear relevance to urban ventions and models Similar to the health disparities seen in the Nursing and Health Professions and Lazarex is
planning, social sciences, policy for action to improve coronavirus pandemic, racial and socioeco- to improve understanding and awareness of the
creation, and more. health. nomic disparities persist. Cancer mortality is burden of cancer on patients.
20
Global
16 FOCUS VOL / 20 Writing Greg Richter 17
Our Common
Ground
What lessons can Philadelphia learn from inequality
observed in Latin American cities?
influence the health of the 80 percent of Latin
Americans who reside in cities.
The team looked at six Latin American cit-
ies that are collectively home to more than 60
million people – Buenos Aires, Argentina; Belo
I N L A T E 2 0 1 9 , a Dornsife School Horizonte, Brazil; Santiago, Chile; San Jose,
of Public Health study found Costa Rica; Mexico City, Mexico; and Panama
wide-ranging differences in lifes- City in Panama – and found broad contrasts in
pan in six major Latin American life expectancy when comparing specific areas
cities. The findings — which may located within these six metropolitan locations.
be the first to give comprehen- The researchers mined each country’s census
sive, standardized data about life and vital registration data for stats on socioeco-
expectancy at birth within nomic status measures, death rates, gender and
small areas of the cities — help other population metrics, and did the heavy
researchers pinpoint what forces lifting of standardizing the data for all areas
are linked to these disparities and that make up these cities. The researchers then
what lessons can be learned by calculated life expectancy at birth by gender for
Philadelphia and other cities ex- each of the areas in the six locations.
periencing similar issues. The group found higher differences in life
The findings, published in The expectancy at birth within cities than among
Lancet Planetary Health from re- cities. For example, the largest difference was
searchers at the Salud Urbana en found within Panama City, where residents of
América Latina (SALURBAL), or the areas with the highest life expectancy live 18
Urban Health in Latin America years longer, on average, than residents of areas
project at Drexel University’s with the lowest life expectancy. Meanwhile the
Dornsife School of Public Health, difference between the city with the highest
are the latest among growing ef- overall life expectancy (Panama City) and the
forts by the group to evaluate how lowest life expectancy (Mexico City) was much
environment and public policies lower — seven years for men and 11 for women.18 FOCUS Global To learn more visit hhrjournal.org.
VOL /
20
20 19
Global Impact
in Practice The United Nations
Development Program
As countries work
Working with Global Agencies
towards universal
health coverage, they
THE DORNSIFE SCHOOL of Public Health is dedicated to strength- are transforming their
of Public Health, measures were health systems to take
By comprehensively studying ening public health systems and the public health workforce including Suruchi opportunistic, some advantage of digital
life expectancy in these areas, the not only locally, but also globally. Through its Office of Sood, PhD, asso- restricted free- tools, approaches, and
researchers uncovered some of the Global Health, Dornsife works closely with ministries of ciate professor of dom of speech and big data. The use of
earliest data used in pinpointing health, NGOs, academic institutions and low- and mid- Community Health expression, including digital technologies in
the determinants, or factors, that dle-income country partners to develop mutually beneficial and Prevention, devel- whistleblowers, and HIV-related programs
capacity building, training, and research collaborations in oped this framework some—while seeking provides opportunities
influence health for residents.
regions such as Asia, Africa, Europe, Latin America, and the in partnership with to enforce social for improved access to
“These stark differences in Jonathan Mann the United Nations distancing, curfew or quality health services
health across neighborhoods arise Caribbean Islands.
speaks at the United Fund for Population quarantine orders— at lower costs but also
from differences in social circum- Nations General Strengthening partnerships with health and human rights Activities (UNFPA) may have increased raises new issues
stances and physical environments Assembly in 1987. organizations throughout the world enables the School to and the United risk of transmission related to human rights,
that can be addressed through maximize impact. Below are a few key partnerships: Nations International and disproportionately especially the rights to
policy,” said SALURBAL princi- Children’s Emergency impacted vulnerable information and privacy.
pal investigator Ana V. Diez Roux, announced yet another result of The Global Fund The Dornsife School Fund (UNICEF), in con- populations and mar- Achievement of health
In 2017, the Global of Public Health, with sultation with experts ginalized communities. equity in the use of
MD, PhD, dean and distinguished Mann’s valuable legacy – a new
Fund against HIV/ the leadership of Joe around the world. Recognizing that digital technologies is
university professor of epidemiol- relationship with the Health and
AIDS, tuberculosis Amon, PhD, MSPH, According to there is no global also a key consideration,
ogy at Dornsife. “They highlight Human Rights Journal (HHR), a
(TB), and malaria clinical professor and UNICEF, an estimated consensus on the use particularly as digital
publication of the François-Xavier
Continued
how health is affected by much launched an initiative director of the Office 3 million girls in var- of criminal law or
Bagnoud (FXB) Center for Health approaches vary across
more than health care.” and Human Rights (where Mann called Breaking Down of Global Health, and ious parts of Africa, other punitive mea- contexts.
Action to fix disproportionate Barriers (BDB), with Nina Sun, JD, assis- the Middle East, and sures in public health The United Nations
was the first director) at the
Legacy
wealth and improve population the aim of strength- tant clinical professor, Asia continue to be emergencies (despite Development Program
Harvard T.H. Chan School of Public
health cannot begin without data. ening communities both in the depart- subjected to FGM and decades of attention (UNDP) contracted
Health and Dornsife.
28
and scaling up pro- ment of Community 200 million girls and to criminal law in Dornsife to support the
In a strategic plan published in “For the twenty-fifth year of
grams to remove Health and Prevention women worldwide the HIV response), development of practical
October 2019, the Pan American the publication of the Health and
human rights-related at Dornsife, is leading have been affected by this project, funded guidance to countries
Health Organization acknowl- New Health and Human Rights Journal, it is fitting
barriers to HIV, TB, the mid-term assess- FGM. The tools and by The Joint United on how to incorporate
that the FXB Center and Dornsife
edged that equity is “at the heart of Human Rights are announcing this partnership,” and malaria services ment of the project, Number of methods provided in Nations Programme attention to human
health,” but progress is limited by evaluating accom- countries the framework can on HIV/AIDS (UNAIDS)
Journal Partnership said Joe Amon, PhD, MSPH, clinical and expand access,
plishments to date in which be adapted to local
rights and equity in the
a “lack of consistent disaggregated professor and director of the Office uptake, and retention and led by Amon and development of their
and the achievement Dornsife contexts. Once the
data to track and reveal disparities.” of Global Health at Dornsife. “The in prevention and Sun, will summa- national digital health
of comprehensive currently has data from Guinea and
Similar data from the U.S. To the world, Jonathan Mann, Health and Human Rights Journal, treatment services in partnerships rize scholarship on strategy.
MD, MPH, was the first head of 20 countries. national human rights Ethiopia is validated criminal law and HIV Amon and Sun
Centers for Disease Control and from its start, helped to advance through its
HIV programs at the World Health The initiative programming. and additional expert and track examples worked closely with
Prevention and the Associated scholarship on the right to health Office of
Organization and an international and to examine how health rights funds programs that consultation takes of how criminal UNDP to prepare the
Press reveal even broader dispar- Global Health
champion of human rights. To the can be operationalized and how address stigma and The United Nations place, researchers sanctions and other guidance and solic-
ities in life expectancy in Greater grateful faculty, staff, and students discrimination, train International Children’s hope to share the ACT punitive measures it input from across
they can promote accountability.
PHOTO COURTESY UN/DPI PHOTO BY SAW LWIN
Philadelphia. Residents in near- of the Dornsife School of Public I’m looking forward to a close part- health care provid- Emergency Fund Framework globally. are being used to the United Nations,
by Lower Merion Township in Health, he is also fondly remem- nership with the FXB Center and ers on human rights In March 2020, a enforce public health government officials,
Montgomery County have an av- bered as the founding dean. the opportunity to be a part of the and medical ethics, new framework that The Joint United measures in re- academia, and civil
erage life expectancy of 92 years, A visionary scholar, advocate, next phase of the Journal’s history.” sensitize lawmakers measures, tracks, and Nations Programme sponse to COVID-19. society to discuss the
while life expectancy a few miles and scientist, the hallmark of This partnership not only and law enforcement evaluates changes in on HIV/AIDS Dornsife will critical areas of gover-
away in Philadelphia’s Strawberry Mann’s career was the degree to celebrates the shared history of agents, reduce dis- social norms related to The emergence of work with UNAIDS nance and support to
which he highlighted and advanced the two schools, but is also an crimination against female genital mutila- COVID-19 was marked to prepare a docu- countries on the policies
Mansion section is at 64 years.
knowledge about the critical link opportunity for both institutions to women, promote tion (FGM), known as by widespread use ment outlining key and regulations needed
Where you live can have a ma- between public health and human to guide effective
communicate, through the journal, legal literacy, expand the ACT Framework, of criminal law as principles on public
jor impact on your lifespan, both rights in the United States and and to have important discussions access to legal was implemented in well as more broadly health, human rights, scale up and equitable
in Philadelphia and its suburbs. around the world. about health and human rights, services, and monitor Guinea and Ethiopia. punitive approach- and criminal law application of digital
This can also be said for much of On Human Right’s Day, while furthering Mann’s original and reform laws, reg- Researchers from es that restricted during public health technologies in HIV-
Latin America. December 10, 2019, Dornsife mission for the journal. ulations, and policies. the Dornsife School rights. Some of these emergencies. related interventions.20
Policy
20 FOCUS VOL / 20 Writing Karyn L. Feiden 21
After
Incarceration
Restrictive public housing policies generate health inequity
to trace these connections. An an associate
professor of health management and policy at
the Dornsife School of Public Health—and an
alumnus who earned both of his graduate de-
grees there—Purtle’s expertise centers on the
dissemination and implementation of policies
that influence mental health and health equity.
Recognizing his skill at analyzing policy doc-
uments, Kim Blankenship, PhD, a colleague
GOVERNMENT-FUNDED rental assistance at American University, asked him to get in-
represents one of the few sources volved in a slice of a major study funded by the
of affordable housing available to National Institute of Mental Health. The larger
low-income families and individu- study, “The Justice, Housing and Health Study,”
als in the United States. But many represents a collaboration between Dornsife,
local authorities have restricted American University, and Yale School of Public
individuals with criminal justice his- Health and examines how mass incarceration
tories from public housing. Because and housing vulnerabilities intersect to create
Black people are significantly more health risk, with a focus on HIV. Although Purtle
likely to have been incarcerated, they had not previously conducted much research on
are therefore also more likely to be housing or criminal justice, he seized the oppor-
excluded from subsidized housing. tunity to do both.
And because stable housing has “There is an emerging field of legal epide-
well-established health benefits, miology that looks at the association between
restrictive policies can drive inequi- different laws and health outcomes,” he ex-
table health outcomes. plained. “Part of that is doing a content analysis
Jonathan Purtle, DrPH, MPH, on legal text or policies.” For the smaller study,
MSc, was lead author of an article his team measured policy variations across local
recently published in the American public housing authorities related to involve-
Journal of Public Health that starts ment with the criminal justice system.22 FOCUS Policy VOL /
20
20 EXCERPT 23
“Individuals face numerous barriers to reintegration after
The ultimate goal was to elucidate the line from criminal
incarceration, and housing poses a particular challenge.
justice involvement to stable housing to health outcomes,
Purtle said. “You can do that with more sensitivity and pre- Upon leaving prison, they simultaneously face financial
cision if you have a continuous variable that captures what
you are interested in along a continuum, as opposed to a
dichotomous variable that is just ‘yes’ or ‘no.’”
challenges—45 percent of re-entrants do not earn any
Variation in Restrictions
Although the analysis uncovered substantial variations,
income in the first year after incarceration—and a severe
local housing policies were generally more restrictive than
federal law requires. Significantly, most authorities retain
affordable housing crisis. Across the United States, fair market
Innovative Study Design
A unique aspect of the study was
its use of a methodology known as
substantial discretion to decide who gets housing and who
does not on the basis of their criminal justice history.
“That creates a lot of room for bias to enter an equation,”
rents have increased faster than wages such that there is
factor analysis, which allowed the
researchers to create a restrictive-
said Purtle, stepping back to reflect on the larger aims of
the study. “Let’s say our goal is to write the least restrictive currently no state where full-time minimum-wage work is
ness score based on a composite of policy. That does not look like giving policy implementers
policy provisions.
In a more traditional design,
a lot of leeway, it looks like being very clear and concrete in
terms of whether, or under what conditions, criminal justice
sufficient to rent an unsubsidized fair-market 2-bedroom unit.
a city’s public housing policies
would have been tracked with
simple “yes/no” responses — does
restrictions are imposed.”
And why would few or no restrictions be a goal? “That
is where research and advocacy and values come in,” said
Government rental assistance programs are one of the few
this city have that restriction, does
it have this one? But that approach
Purtle. “All of us on the research team feel that no restrictions
would be best. That is our personal ideological perspec-
sources of affordable housing available to low-income renters,
particularly for Blacks—who are the head of household (i.e.,
would not uncover the insights tive, but also moving away from our own perspective, the
that emerged by aggregating research evidence shows that housing is an extremely im-
multiple factors, said co-author portant social determinant of health. If you want to remove
JONATHAN PURTLE,
Luwam Gebrekristos, who earned
her MPH at Dornsife in 2016 and
health inequities, you want to remove policies that have dis-
parate impact on communities of color.” leaseholder) of approximately 44 percent of the public housing
DrPH, MPH, MSc enters the school’s PhD program “Given that stable housing is a critical social determinant
Associate professor,
Dornsife School of
Public Health
in biostatistics in the fall of 2020.
As she explains, “It is not a single
of health and given the disproportionate representation of
Blacks in the criminal justice system, these polices could
units in the United States. Recent research suggests positive
policy within the local housing
authority that intersects with the
criminal justice system. Creating
contribute to health inequities.” (Purtle et al., American
Journal of Public Health, 2020)
Committed to moving evidence into action, the re-
effects of rental assistance on psychological well-being,
a single variable that encompasses
all those policies tells us more.”
searchers continue to examine the health implications of
restrictive public hous-
overall self-rated health, and access to health care. However,
The scale used in this research
public policies impose restrictions on the ability of people with
ing policies. Applying the
was based on a cluster of eight
“Given that stable
methodological tools that
provisions that were key in deter- housing is a critical proved so incisive in this
mining whether an individual with
a criminal justice history could be
social determinant of
health and given the
study, they will look next
at whether restrictiveness criminal justice histories to access rental housing assistance
admitted into public housing and disproportionate rep- is associated with a higher
permitted to remain there. Among
the policies included in the restric-
resentation of Blacks
in the criminal justice
incidence of HIV and
sexually transmitted dis-
and achieve housing security.”
tiveness measure were those that eases. The hypothesis, said
explicitly considered mitigating
system, these polices Purtle, is that restrictive PURTLE ET AL., AMERICAN JOURNAL OF PUBLIC HEALTH, 2020
circumstances, family impact, and could contribute to policies will prove to be a
proof of good tenancy. health inequities.” pathway to health inequity.
P O R T R A I T S B Y N ATA L I E H O P E M C D O N A L D24 FOCUS Policy Writing Greg Richter VOL /
20
20 25
prevalence of all unhealthy behav-
iors, except binge drinking, was
higher in QOZs. The paper also
provided results by state and with-
in an interactive app to facilitate
evaluation of QOZ by local stake-
holders.
Evaluating the effects of QOZs
2. Legislators’ opinions about the
Health
on health is critical. Previous
effects of childhood trauma vary research linking place-based poli-
along party lines. cies like QOZ to health is limited,
In a study published in July 2019
in the journal Psychiatric Services,
Purtle and colleagues surveyed
state legislators about adverse
and Home and QOZs will most benefit dis-
tressed communities if investors,
local governments, and commu-
childhood experiences, such as Tracking Place-Based Policies in nity organizations have the data
physical or mental abuse, and Distressed Communities they need to guide investment
how experiencing this trauma can and shape how this policy is im-
influence behavioral health prob- I N J A N U A R Y 2 0 2 0 , Jana A. Hirsch, PhD, MES, plemented. Public health can and
lems as an adult. assistant research professor in the depart- should be part of that discussion.
Despite clear evidence from
ment of Epidemiology and Biostatistics at the There are a few key strategies
the 1998 Adverse Childhood
Experiences Study and subse- Dornsife School of Public Health, along public health officials could engage
quent research demonstrating with the Dornsife Urban Health Collaborative in to maximize health benefits
that abuse, neglect, and witness- team, released a report on living conditions in in QOZs. Enacting policies that
1. The public wants legislators ing violence during childhood
JANA A. federally qualified opportunity zones (QOZs) would increase affordable hous-
to use more ‘evidence’ in making all increase risk for behavioral HIRSCH, PHD, and how they may impact health. ing in these zones could have the
health policy. health problems as an adult, just MES The federal government implemented QOZs potential to reduce displacement
A brief report Purtle published over half of those identifying as assistant through the Tax Cuts and Jobs Act of 2017. This and its subsequent health impacts.
in June 2019 in Translational liberals and less than a third of research
professor in the legislation was intended to incentivize private Public health practitioners should
Behavioral Medicine exposed a their conservative colleagues said
that witnessing domestic violence
department of investment in distressed communities through also collaborate with local urban
wide gap between what Americans Epidemiology
can be a risk factor. Additionally, and Biostatistics tax breaks, with the hope that they will have a planning departments to imple-
say they want out of lawmakers
and what they perceive they’re men were far less informed than positive and dramatic effect on American ment zoning that could encourage
getting. their female colleagues: female Hirsch’s study, neighborhoods and the health of residents who health-promoting businesses in
In a 2018 public opinion survey, legislators were significantly more “Health and live within them. QOZs. Similarly, larger benefits
532 Americans were asked to what accurate at identifying these types Health- Neighborhoods with a QOZ designation have may emerge by pairing public and
extent six factors “should have” of childhood experiences as risk Related
Resources
the potential to see economic development that private investments that impact
and “currently have” influence factors than their male counter-
parts were. in Newly changes the retail and physical environment. health, including new or improved
on health policy decisions made
Designated New neighborhood resources could promote parks or pedestrian infrastructure.
by members of the United States
Federally healthy behaviors, such as increased physical Public health may play a key role
Congress, including industry inter- 3. Sometimes legislators get it right. Qualified
Health officials testify ests, evidence and budget costs. Vaccine-preventable disease activity and enhanced diet quality, to ultimate- in ensuring that future evaluations
Opportunity
during a House Oversight The result? Despite political (VPD) outbreaks are increasing Zones: United ly improve cardiovascular and other chronic assess impacts on health dispari-
Committee Hearing on division between Democrats and in frequency in the United States, States, 2012– health outcomes. ties. Finally, QOZ designation
Unhealthy
Coronavirus prepared- No matter who is in elected office, Republicans, members of both but legislation aimed at increas- 2016,” was However, QOZs could also have less ben- may offer public health officials an
ness and response on citizens may agree or disagree with parties supported greater use of ing childhood vaccination rates is published in eficial or unequal effects through changes in opportunity to engage locally and
Capitol Hill in Washing- specific policies, positions, action ‘evidence’ – information based also rising in places where those the American population, shifts in social engagement among mobilize residents around neigh-
Outlook
ton, DC. A recent study or inaction, but public trust in our on reliable data and produced by epidemics occurred, according to Journal of
Public Health. neighbors, gentrification, and displacement of borhoods’ impacts on health.
showed that members elected representatives is at a mere statistical methods – in develop- findings published in November
17 percent, according to a Pew ment of health policy. Although 2019 in JAMA Pediatrics from vulnerable populations. In collaboration with other ex-
of both political parties
supported greater use Research Center report released 59 percent of respondents said Neal Goldstein, PhD, an assis- Compared to non-QOZ communities, on perts aiming to understand the
of ‘evidence’ — informa- Americans’ trust in their in 2019. So, what accounts for this that evidence should have “a lot of tant professor in Epidemiology average QOZs had fewer people, a younger social, economic, or business out-
low level of trust? What do citizens influence” on policy, only 11 per- & Biostatistics in the School of population, and lower proportions of non-His- comes of this federal legislation,
tion based on reliable government is low. want, and could using scientific cent said that evidence currently Public Health, Purtle, and col-
data and produced by panic White residents. QOZ tracts had lower public health has a key role to play.
statistical methods — Is that fair? evidence to pass bills in citizens’ has “a lot of influence” on those leagues. economic status and substantially lower density “We must work to ensure that the
in development of interest help restore that trust? decisions. Sometimes politicians get of physical activity resources. QOZs also had a health impacts of this place-based
health policy. Takeaways from three papers Purtle noted in the paper that it right and sometimes they
higher density of walkable destinations for daily policy are not just tracked across
by Jonathan Purtle, DrPH, MPH, U.S. Congress members might be simply fall short. The more we
MSc, an assistant professor in the held more accountable by encour- understand about the motivations living, food stores, social destinations, and so- time but also used to advance
Dornsife School of Public Health, aging efforts to disclose evidence behind policies, the more trust can cial services than tracts that were eligible for the health equity across communities,”
and colleagues, offer some insights. behind policy decisions. be restored in our elected officials. program but were not designated. In addition, said Hirsch. —Sarah Greer20
Community
26 FOCUS VOL / 20 Writing Greg Richter 27
Rapid
Response
Reversing opioid overdoses at the community level
additional 52 overdose emergencies, the par-
ticipants who witnessed the overdose signaled
an alert with the app and then administered
Naloxone themselves. A successful reversal was
reported in 95.9 percent (71/74) of cases. In over
half of these events (59.5 percent), study partic-
ipants administered Naloxone more than five
minutes faster than Emergency Medical Services
(EMS) were able to arrive on scene.
EQUIPPED WITH NALOXONE and a smart- During the yearlong observational study
phone app, community members that concluded in February 2020, 112 adult
can save lives in the fight against Philadelphians, 57 of whom use opioids reported
America’s opioid crisis, accord- 291 suspected overdoses and alerted nearby vol-
ing to a paper from researchers unteers using the UnityPhilly app.
at the Dornsife School of Public All study participants were trained in how
Health and colleagues published in to administer Naloxone, use the app and give
August 2020 in The Lancet journal rescue breathing, and were then provided with
EClinicalMedicine. two doses of Naloxone. Every time an alert was
During a pilot study, researchers signaled by pressing an “SOS” button in the app,
found that enrolled participants it also alerted EMS via 911, which allowed them
were able to signal and respond to to follow up with their protocol, regardless of
opioid overdoses using a smart- whether a layperson responded.
phone app, called UnityPhilly, “We know that the lay public is effective at
developed by the Dornsife team. administering Naloxone, but now we know that
During 22 overdose emergencies, an app can help laypersons provide Naloxone
a participant received an over- faster when every second counts,” said senior
dose alert on the UnityPhilly app, author Stephen Lankenau, PhD, a professor
traveled to the location and then and associate dean for research at the Dornsife
administered Naloxone to the School of Public Health, who co-led the study
overdose victim at the scene. In an with David Schwartz of Bar-≠Ilan University,You can also read
