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Public Health Prism

(Peter Beilenson, MD, MPH) -- In this inaugural column of the Public Health Prism, I thought I would briefly highlight my initial impressions upon moving from the public health environment of Baltimore City to that of Howard County, and then describe our first major initiative.

As some may know, for the past thirteen years, I was Baltimore’s Health Commissioner, where most of my time was spent dealing with what might be called acute or reactive public health issues:  outbreaks of syphilis or hepatitis, drug addiction and HIV/AIDS, juvenile violence, lead paint poisoning or teen pregnancy, to name just a few.  We were so busy responding to these myriad public health threats that we were often not able to take the time to work on primary prevention efforts on the leading causes of death in the city---heart disease, stroke, cancer and diabetes.

In March of this year, after I lost a close race for Congress in 2006, County Executive Ken Ulman appointed me as Howard County Health Officer, with the charge of making Howard a model public health community for the country.  My new office, in Columbia Gateway, is only 12 minutes from my office in the City, yet in those few minutes I traverse different worlds:  I went from serving the fifth poorest city in the country to serving the fourth wealthiest county in the country.  Howard County certainly has its share of health concerns--a higher rate than the rest of the state of overweight adults, a growing senior population with a dearth of available geriatricians, a large undocumented immigrant population in need of services, over ten thousand uninsured residents—however, the magnitude of acute public health issues is significantly less than in Baltimore City. Thus, I have the “luxury” of being able to devote most of my time to proactive efforts to improve the health and wellness of all of Howard’s residents.  To that end, our first major effort is the Healthy Howard Initiative (funded, in part, by the Horizon Foundation).

Healthy Howard came about as a response to the generally poor results of the federal government’s Healthy People 2000 program.  That initiative tracked hundreds of health outcomes, for everything from obesity rates to the use of bike helmets.  Strategies were proposed to improve these outcomes (such as increasing physical activity and eating healthy foods to reduce obesity rates), and although there were some successes, so few of the goals were reached that a new guide, Healthy People 2010 was produced.  The results of this program demonstrate once again that knowledge of what needs to be done to improve health does not equal behavior change.  To combat that fact, the premise of the Healthy Howard Initiative is to get institutions important in people’s everyday lives (e.g. restaurants, schools, workplaces) to inculcate healthy activities or healthy products into their daily operations, so that just by attending these institutions citizens are more likely to participate in healthy behaviors.

The first phase of Healthy Howard to be announced was Healthy Restaurants.  Rather than simply try to ban trans fat from restaurants in the County (as some other jurisdictions have tried to do), we took a more comprehensive approach.  We set five broad criteria for restaurants to meet in order to be deemed a Healthy Howard Restaurant:  a) be completely trans fat free; b) have healthy alternatives on their menu (defined by portion size, calories and total and saturated fat content); c) provide the nutritional content of these alternatives to all patrons; d) have no validated complaints about failing to enforce the County smoking ban; and e) have excellent food inspections for the entire year.  By not expending all of our efforts on a legislative effort to solely ban trans fats (which, due to market pressures, I am convinced, will cease to be available in the next couple of years anyway) I think that this holistic approach will actually result in much more healthy dining for Howard Countians.  As we will be publicizing restaurants which attain Healthy Howard status, we think that restaurateurs will see this as an economic incentive, as well as the right thing to do—and the dozens of restaurants currently in the application process supports this thesis.  

In the fall we will be announcing the next major phase of the Healthy Howard Initiative—Healthy Schools--where we will recognize schools that meet certain criteria, including: increasing students’ physical activity; improving nutritional content of the food offered to students both in cafeterias and vending machines; maintaining healthy physical environments; and providing mental health services.

I am honored to be working in Howard County and appreciate the support of so many who are concerned about improving the health of its citizens, particularly Dr. Rich Krieg and the Horizon Foundation.