www.oregonpublichealth.

org

Probe
THE

Quarterly Newsletter of the Oregon Public Health Association Fall 2004

OPHA 60th Anniversary

Founders demonstrate commitment to health
BY SUSANNA LAI The founding members decided to call The association has served as a venue to
the organization Oregon Association of solve problems and integrate programs and

T he Oregon Public Health Association

has been a force behind numerous
efforts in disease prevention and health
Public Health Workers. The present name
was adopted in 1968. The founders in-
cluded Dr. Frederick D. Stricker, state
activities. One of the main interests of the
original organization remains true today –
seeking to actively participative as an
promotion for over half a century. health officer; Dr. Samuel B. Osgood, interested party in health-related legislation
Affiliated with the American Public Josephine County health officer; Harold that affects Oregonians.
Health Association, the oldest and largest M. Erickson, assistant state health officer; In the last 60 years, OPHA has been
organization for public health profes- and Mrs. Saidie Orr Dunbar, executive involved in a wide range of medical,
sionals in the world, OPHA was founded secretary of the Oregon Tuberculosis political and social issues. Numerous
in 1944, in the anxious period when Association. resolutions have been presented to the
worldwide conflict was teetering to a governor, to the senate president and
climx. Agenda targets policy leaders house speaker in the state Legislative
It all began at a public health confer- OPHA has helped to galvanize the Assembly, and to members of the
ence and exhibit held under the auspices public health community with a common Committee on Medicine, Pharmacy and
of various health services and nonprofit purpose and a commitment to united effort. (continued on page 3)
organizations in Portland during the
month of May, when the end of war was
at last coming dimly into view. Attendees Most notable events in the association’s history
included a team of APHA executives and 1954 Promulgated the necessity of sanitary dairy products in disease
directors. The enthusiasm generated from prevention.
this conference prompted a number of
1966 Recommended reorganization of the Public Health Service and
prominent lay and professional public
passage of a bill before Congress to render control to governors
health workers to form an organization
over health problems and planning in the states.
where they could speak a common
language – to act and promote public 1967 Lobbied for legislation to require fluoridation of drinking water statewide
health for the common good and welfare to curtail cavities and improve dental health.
of the people in the state.
1969 Acknowledged the obesity issue, advocated environmental health
and workplace safety, and correlated nutrition with children’s mental
OPHA Mission development.
• Protect and promote the health
1972 Approved a series of resolutions ranging from administrative plans,
of all Oregon residents like placing the Oregon Department of Environmental Quality in the
• Educate and support public Health Affairs Division under the Department of Human Resources,
health workers to direct action, like requiring immunization for specific diseases
before a child enters school.
• Advocate for just and equitable
health policies 1999 Sponsored the breastfeeding “Welcome Tea.”
2 The Probe

Section addresses adolescent issues You can help us

D o you work with youth? Do you
have tips to share on working with
adolescents? Do you have ideas to
tobacco use. We plan to have teens
deliver the handbooks with section
members and other OPHA volunteers.
spread the word
combat adolescent risky behavior? If yes, Other planned activities focus on Please consider distributing
then join the newest section of OPHA, addressing adult/teen communication. The Probe to colleagues and
the Adolescent Risky Behavior Section, We are pursuing grants to study how to
friends interested in Oregon
and share your ideas while working on improve communication between parents
several projects with section members! and teens. We also hope to develop public health. With office
Activities planned for the year are trainings to improve clinic staff communi- technology, the best way to
focused on advocacy for adolescents and cation with difficult teen clients. In
achieve a magazine format is
helping teens and parents improve addition, we would also like to prepare
communication with each other. Break- “cheat sheets” with tips for parents on by double-sided copying, with
out sessions will be held for the OPHA how to communicate with their teens. two automated staples on the
conference and a booth or breakout The members of the Adolescent Risky
left side.
session will be planned for the Girls Behavior (ARB) Section of OPHA invite
Initiative Network conference. you to join in their discussions and
In January, the section plans to activities. If this topic interests you, please
distribute a Legislative Handbook to state fill out the OPHA membership form on

Probe
THE

legislators at the beginning of the the back page, check the ARB Section box,
legislative session. The Adolescent Risky and send in the form. If you are not already
Behavior Legislative Handbook contains a member of another section, it doesn’t cost
pertinent facts about Oregon adolescents you anything more than your normal
TERRY HAMMOND Editor
and recommends legislative actions to OPHA dues. If you are a member of
help prevent or intervene early in another section, the cost is an additional Dana Kaye Communication Chair
negative behavior. Topics range from $10. If you have questions, please contact HELENA WOLFE Design
alcohol use and abuse through obesity to Katie Riley at [email protected]
KATE KARLSON Webmaster

OPHA is in CRISIS
Marjorie McGee Web Apprentice

The Oregon Public Health Association Executive Committee is calling News published in The Probe aims to
an emergency meeting for members, friends, and supporters of OPHA. provide information. Views expressed in
Topic: Recommendation to dissolve OPHA. this newsletter do not necessarily
December 3, 3-5 p.m. represent the views of OPHA members
Kaiser Town Hall (next to Kaiser Center for Health Research) or its board of directors.
3800 N Interstate
Vote to continue or abolish OPHA Give us your news!
• Declining membership • Declining member participation
• Declining board attendance • Two of four sections not operational We invite you to send stories, news
• Less than 10% of members active • Officers contribute personal funds and graphics. Submission dates:
• No funds to replace operations manager
ISSUE STORY DEADLINE
Celebration event cancelled Winter Dec 21
Spring Mar 21
The Health of Multnomah County 2004 Summer
Fall
Jun 21
Sep 21
Now available for publication on the 10th of
Includes data on Maternal and Infant Health, Children’s Health, Adolescent January, April, July, and December
Health, Adult Health, Health of Older Adults, Communicable Disease,
Unintentional Injury and Violence, and Leading Causes of Death Contact Terry at [email protected]
or
Find the report on the Multnomah County Health Department website Oregon Public Health Association,
http://www.co.multnomah.or.us/health/
818 SW 3rd Ave, #1201, Ptd 97204
Hard copy is available on request: (503) 988-3674 x28185
Fall 2004 3

Achievement frozen in present organization

(from page 1)
Dentistry. Also, each year like clockwork, OPHA needs to develop and maintain a strong
during early fall and around annual board
meetings, members contributed stories on coalition with state government at all levels
health topics of regional and national
importance to appear in local print media.
Despite OPHA’s many accomplish- original and traditional public health
ments, interest and enrollment has professionals – such as clinicians, middle
declined in recent years. managers, and government officials – to
Rumors of precarious sustainability today’s community activists and outreach
are challenging the association’s exis- or health promoters. According to
tence. Even the OPHA website appears Hennrich, while today’s leaders represent
frozen in time, with the exception of the a critical aspect of the organization, a
quarterly distribution of The Probe. “different sense of diversity,” as she puts
Mary Lou Hennrich, executive director it, needs to be integrated into the mix. She
of Community Health Partnership, former recommends the inclusion of diverse public
CEO of CareOregon, one-time board health professions and perspectives.
member and lifetime member of OPHA, Hennrich also urges professionals in
Inertia challenges enthusiasm expresses concern with the recent the medical sector to become actively
To boost enthusiasm within the organi- stagnation in activities, and how this might involved, particularly those working in
zation, annual awards have been regularly affect the association’s viability as a state clinical/medical and academic research
announced and presented to prominent affiliate with APHA. Hennrich advises and fields. Such members could re-energize a
health officials in recognition of their work calls for organizational restructuring. sustainable infrastructure by using the
and contributions. Today, however, In the last decade, leadership roles association to draw federal, state, and
something more appears to be required. within OPHA have shifted from the private funding.
Time to polish the diamond
A beautiful list of Internet resources related to public Most importantly, according to
health is available on the website of the Hennrich, OPHA needs to develop and
UC Berkeley Center for Family and Community Health maintain a strong coalition with state
government at all levels: in departmental
(dated Sept. 14, 2004)
affairs, at the cabinet level in the
http://socrates.berkeley.edu/~jmm716/ governor’s office, and in legislation and
Internet_Resources.html policy development.
As OPHA officially celebrates its
covering the following topics diamond anniversary in November, this
Aging Health statistics is a good time to reflect on the extra-
Alcohol and drugs HIV/AIDS ordinary contributions and progressive
Biostatistics Infectious disease health reforms of the past, and measure
Cancer Lung disease how far we have come since the organiza-
Cardiovascular health Minority health tion’s inception. And still, how far yet to
Children, youth and family Nutrition go. With perseverance and the combined
Data sources Occupational health vision of past and current members,
Diabetes Oral health OPHA remains a valuable tool for public
Employment & internship opportunities Physical activity health professionals to network and
Environmental health Public health address issues with a positive impact on
Epidemiology Public health agencies/organizations the health of all Oregonians.
Global health Research funding, implementation, Consider this anniversary year a key
Health news and publishing moment to get more involved. Oregon,
Health policy Tobacco control and the nation, needs leadership for
Health promotion & disease prevention UC Berkeley health more than ever as we face a new
Health sciences Women’s health era crippled by the shadow of war.
 ART
4 The Probe

NW Public Health Leadership Institute offers

collaborative leadership opportunity Ford Diversity Fellows
I ncrease collaborative leadership skills in this yearlong onsite
and distance learning opportunity, guided by practice-based
faculty. The curriculum comprises five content modules:
F ord Foundation Diversity Fellowships are designed to
increase the diversity of the nation’s college and university
faculties. Approx. 60 predoctoral, 35 dissertation, and 20
postdoctoral fellowships are available, sponsored by the Ford
• Challenges to public health
Foundation and administered by the National Research Council
• Leadership skills assessment and development of the National Academies.
• Crisis leadership Eligibility. U.S. citizen or national; planning a career in teaching
and research at the college or university level.
• Collaborative leadership and community building
Awards. Predoctoral $17,000 and institutional allowance $5,000,
• Developing leadership in staff, volunteers, and others for 3 years. Dissertation $21,000 for 1 year. Postdoctoral $40,000
Qualifications. Participating scholars must have at least 5 years for 1 year, plus employing institution $1,500 to be matched by
of professional experience in a field related to public health, at employing institution. All awardees have expenses paid to
least 1 year in present position; must be in a leadership position attend one Conference of Ford Fellows.
or have demonstrated leadership interest and ability. There is Application deadlines. PREDOCTORAL, Nov. 17, 2004;
no minimum educational standard. DISSERTATION, Dec. 1, 2004; POSTDOCTORAL, Dec. 15, 2004.
Application deadline. Dec. 17, 2004 Contact. More information and applications available online:
Tuition to be determined. http://national-academies.org/fellowships
Contact. Applications and more information available online:: FELLOWSHIPS OFFICE, GR 346A, 500 Fifth Street, NW,
http://nwcphp.org/nwphli/ Washington DC 20001. Phone: (202) 334–2872; Fax: (202) 334–
Northwest Public Health Leadership Institute, School of Public 3419; E-mail: [email protected]
Health and Community Medicine, University of Washington, Train at CDC
Box 3548409, Seattle WA 98195-4809. Fax: (206) 616-9415; Phone:
(206) 616-2986; Email: [email protected]
T he Centers for Disease Control and Prevention (CDC) invites
applications for the Public Health Prevention Service
Wellstone Fellowship (PHPS), a 3-year national training and service program for
masters-level health professionals. The ninth class of 25

for Social Justice participants is scheduled to begin in September 2005.

The PHPS program focuses on public health program

F amilies USA, a national nonprofit, nonpartisan organization

dedicated to the achievement of high-quality, affordable
health care for all Americans, is accepting applications for the
management and provides prevention specialists with
experience in program planning, implementation, and evaluation
through specialized hands-on training and mentorship at CDC
Wellstone Fellowship for Social Justice. and state and local health agencies. Formal instruction is
The fellowship is a yearlong, full-time, salaried position in health provided in program management, epidemiology, surveillance,
care advocacy work at Families USA in Washington, DC. Fellows emergency response, and project evaluation.
will learn about Medicare, Medicaid, efforts to achieve universal Eligibility. Professionals with a strong interest in a career in
coverage, and other national health-policy issues. Specifically, public health, a master’s degree related to public health, and
the fellow will be engaged in outreach to communities of color, U.S. citizenship; at least 1 year of public health work experience
developing techniques of grassroots organizing and mobilization. may include an internship or a thesis project in a community
The fellowship provides a unique opportunity to honor the setting.
memory of the late Senator Paul D. Wellstone. Starting salary. Approx. $41,000 with annual increases and
Term begins. August 2005 benefits.
Qualifications. All academic disciplines are welcome, preferably Application deadline. Jan. 15, 2005
with a college degree as of August 2005. Contact. More information and application available online:
Contact. More information and application available online: http://www.cdc.gov/epo/dapht/phps.htm
h t t p : / / w w w. f a m i l i e s u s a . o r g / s i t e / P a g e S e r v e r ? Public Health Prevention Service, Division of Applied Public
pagename=Wellstone_Fellowship Health Training, Epidemiology Program Office, Centers for
Or contact Melissa Rosenblatt, Director, Internship and Disease Control and Prevention, 1600 Clifton Road, NE, MS E-
Fellowship Program, Families USA. PHONE: 202-628-3030; 92, Atlanta GA 30333; Phone: Everett Exposé 404.498.6164; e-
EMAIL: [email protected] mail: [email protected]
Fall 2004 5

Stem-cell advances merit expanded funding

Research touches sensitive The center at OHSU was founded in
BY LESLEY RUSH January 2004, with a three-year grant of
issues in many countries $4.5 million from Oregon Opportunity,

A dvanced treatments and cures for

cancer, diabetes, Parkinson’s disease,
and birth defects are on the way. Slowly.
Outside the USA, other countries are
also establishing regulations and allow-
ances in stem-cell research. Moral
an intergovernmental collaboration that
draws in federal funding. Research at
OHSU focuses on adult stem cells,
Stem cells, both embryonic (cultivated considerations guide many of their aiming for applications in pancreas and
from fertility treatment residuals) and adult decisions as well, and countries with liver diseases.
(from a source like bone marrow), are the greater religious influences have more The Stem Cell Center’s director, Dr.
hope of future medical treatments. In time, restrictions in the lab. Markus Grompe, believes that funding for
doctors may be able to regenerate healthy In the European Union, each country stem-cell research has increased over the
tissues from a patient’s own bone marrow is responsible for outlining its own last four years as a result of a growing
to treat heart-attack victims and liver- policies for stem-cell research. The Czech presence in scientific and public spheres.
disease sufferers, thus avoiding the risk Republic is drafting regulations that limit He proposes that a change in White House
of transplant rejection. power will lead to greater federal funding
Stem cells are also the source of hot for stem-cell research, but also suggests
debate during this election year. Medical The moral implications that citizens who are compelled should
aspirations will take greater support and independently donate to the research.
time to transpire, but with raised aware-
of stem-cell research Other centers for stem-cell research
ness and understanding of the U.S. invariably complicate in the country include the University of
position, these hopeful developments California system, Columbia, Duke,
could be realized more quickly. the activities of Harvard, Michigan, Stanford, and
research programs Washington University in St. Louis.
Private funds need
public boost Moral divide threatens life
In 2001, the president authorized research to residual embryos from fertility The moral implications of stem-cell
federal funding for the 60 stem cells treatment; and has already used adult research invariably complicate the
already cultivated for research. Yet fewer stem cells to treat patients following heart activities of research programs. In the
than 20 proved useful in the lab. The attack. France maintains a similar position, USA, moral divisiveness fundamentally
funding policy restricts the use or allowing research on fertilized embryos, limits research and progress toward
creation of further stem cell lines. but bans cloning. advanced treatments using stem cells that
President Bush called the decision a The UK is by far the most liberal, could add years of life to people through-
compromise. The allocation of $25 allowing cloning in order to obtain stem out the world.
million dollars for embryonic research, cells. A South Korean team pioneered the Current U.S. policy was established
however, was inadequate. Research cloning of stem cells for research. China as a tool to garner support from pro-life
centers must seek out additional funding is the sole country that implants stem cells enthusiasts. Labeling stem-cell research
from private sources, or look for research in patients with amyotrophic lateral a moral issue forces individuals to rank
opportunities in other countries, where sclerosis (ALS), in order to slow and the stages of life, and the result presently
access to and support for stem cells is prevent further muscular degeneration. appears to favor the stage of cell life over
more readily available. a breathing human being.
John Kerry promises to lift the ban OHSU pursues applications The challenge here is to avoid moral
established by the president and provide Currently, all of the government divisions, and reach a consensus on the
federal funding for all types of stem-cell funded embryonic cells are housed at the worthy long-term aims of stem-cell
research, and make access to new cell University of Wisconsin-Madison. Only research: increased efficacy of health care
lines. Scientists would be allowed to one research center in the country has treatments, improved lifestyles for both
make the ethical decisions in research access to these versatile cells. Other the ill and the healthy, and a positive
with embryonic stem cells. Kerry insists universities across the country are collaboration with the international
that the restrictions in place now have participating in stem-cell research pro- healthcare community. Current advances
made it difficult for U.S. scientists to hold grams, but most, like the Oregon Stem Cell in stem-cell research throughout the
a competitive edge, and have slowed the Center at Oregon Health and Science world are promising. With patience and
progress toward advanced treatment for University, are not receiving full funding wider support, many of these hopes will
some of the most devastating diseases. from the government. become actualized.
 p p
6 The Probe

A potheosis of the
BY TERRY HAMMOND
Fiscal parent drains resolve
olicy aradigm
seriously discuss personal civil and
criminal liability for individual executives

V isiting Michael Heumann in his

office in the annex across the street
from the Oregon state office building in
In the lap of fiscal federalism, Oregon
had to beg Uncle Sam for the Oregon
Health Plan. Parentally subsidized, the
responsible for corporate conduct that
results in “manslaughter” – as is presently
underway in Canada and the UK.
Portland brings one into contact with a state general fund covers only about 25
maze of acronyms, moving from familiar percent of OHP costs. Likewise, most
Stop the killing – Now!
ones like DEQ, EPA, BLS and CDC, to attention in public health dances to the Similarly, if Nuremberg criminal penal-
progressively more complex concoctions tune of what Sam approves. ties were applied to U.S. officials, perhaps
like NIOSH, SHINE, ATSDR, CSTE, PARC, Most of the ideas Oregonians take we would see a more sincere effort to clean
EPHT network, and particularly interesting pride in really originate elsewhere. Much up Hanford, instead of producing yet
– bear with me – ROSH codes. Like most good work is accomplished, but the more nuclear waste; and outside the
of us wrapped in our cocoons at work, shifting of funds and ideas from far away country, perhaps we would see more

DEQ
Heumann (pronounced “human”) – attenuates accountability. concern for the uranium ammunition

BLS
manager of the Environmental and

RO
NIOSH
Occupational Epidemiology program,

D
under the Office of Disease Prevention
and Epidemiology in the Oregon Dept

SH
of Human Services – appears largely

ATS
PARC
unaware of his alphabet armor.

DR
A small part of the language derives
from local state initiatives, like the
interagency Pesticide Analytical and SHINE
Response Center, which has made
pesticide poisoning a sentinel event in In fact, with the feds working on a strewn over Afghanistan and Iraq, which
Oregon. Another small part derives from credit card, it almost appears like no one is causing nationwide birth defects,
interstate cooperative endeavors, like really has to pay for efforts to clean up disease, and death. In addition to this
the Council of State and Territorial pollution from private companies deposit- grave health hazard we have exported,
Epidemiologists, which helps to prioritize ing chromium and lead in the drinking oddly, no one in the USA seems very
health indicators in line with available water around Corvallis, uranium in the concerned about the one million children
data, and supports the interface of public Fremont Forest, lead oxide in Lake in Iraq at risk of death “in the event of a
health research and practice. Oswego, aluminum in Troutdale and The crisis,” as reported in The Probe (Spring
Mostly, though, state officials learn Dalles, asbestos in Klamath Falls, a soup 2003) before the war, drawn from a report
their ABCs from the feds. Heumann’s EOE of chemicals in the Portland harbor, and publicized by a team of physicians who
program is 95 percent funded by grants so on and so on. Heumann and others visited the country. Clearly, it is not our
from the federal government and private are helping communities with these sites, prosperity and way of life these people
foundations. Most other public health tracking hazards, exposures, and health resent. Killing babies is one sure way to
programs in the state show the same outcomes through Oregon’s Superfund induce hatred and terrific resistance, just
dependence. Heumann estimates only 10 Health Investigation and Education as the world rose up in revulsion at the
percent of Oregon’s public health infra- program, funded by the Agency for Toxic crimes of the Nazis.
structure is supported by the state’s Substances and Disease Registry, under
general fund. The Oregon State Public the Centers for Disease Control and
Pay to save Oregon
Health Laboratory, along with an ever- Prevention, in the U.S. Department of Lack of accountability is painting a
growing share of government services, Health and Human Services. more dramatic picture in distant lands,
subsists on fees. Even PARC, a home- Corporations may be fined or taken to but the problem is also evident here.
grown achievement, has been drawn into court to help pay (or wriggle away) for Incrementally, our homeland security is
the orbit of funding from the Department damage and clean up, but one wonders, being destroyed. Heumann reports there
of Agriculture and the Environmental if Oregon had to pay directly, perhaps are at least 1100 priority hazardous waste
Protection Agency. local leaders and citizens would begin to (continued on page 7)
Fall 2004 7

Epidemiology applies insurance claims data

(from page 6) to prevent them from proliferating, cruising the seas of China and India, and
sites in Oregon, with only a dozen or so morbidity and mortality will mount, and outer space, and our national leaders
under investigation. With the same the pressures on the healthcare system would find the wherewithal to work harder
negligence, about 400 cases of pesticide will increase. Paying is the likeliest way for friendship and peace. By this reason-
poisoning are reported each year, but to get us to think about accountability, ing, it appears public health will only
since 2003 only occupational cases are and the sustainability of our environment, succeed once the public rises to the
investigated, funded by the National our economy, and our lives. challenge to take charge, and stops
Institute for Occupational Safety and On a larger scale, if we really had to charging the account to others. This
Health (also under CDC). pay for it, we would likely reconsider the simple market logic ought to appeal to all
So long as Oregon refuses to tax itself present profligate commitment to an sides of the political spectrum.
to meet these hazards and find ways allegedly invincible military machine, now

Solving the mystery of data translation saw the nature of the problem, involving
poison oak, he found another firm that

T he diatribe above, opposing fiscal

federalism is not the theme
elaborated by Heumann in our cordial
(see James Robinson, May 19, Health
Affairs Web Exclusives); but applying
that knowledge requires a sense of
produced a protective lotion, acquired
free samples, and gained permission to
test the product on one team of workers.
meeting, and should not be attributed enterprise most insurers lack, partic- It worked. The workers in the field were
to him. Rather, he more plainly re- ularly now that managed care has been the first to benefit. Then the owner of
counted his success at bridging the gap so thoroughly discredited. In other the firm saw the benefit of fewer sick
between research and practice, and areas, too, like product liability, insurers days and better productivity, and
showed in a story the characteristics of have historically shown a strange inertia purchased the lotion for all workers
science in a policy paradigm. The clear in regard to using data to change client nationwide. The product manufacturer
victory of reason inspires a vision of behavior in ways that could ultimately made a profit off the initial free sample.
what public health researchers might do, save them money. This is where the Finally, Liberty Northwest saw the
if given a mandate by the people to enterprise of Heumann as an result in the elimination of a whole block
perform in their behalf. epidemiologist paid off – for everyone. of claims.
Data is very often scarce, unstan- In consequence, Heumann’s role as
dardized, or unreliable, which the ROSH codes come to life a friend of insurers with access to claims
ambitious effort toward indicators and The Liberty Northwest tower, one data became assured. With other
minimum datasets in the 1990s has of Oregon’s primary insurers for researchers, he is now working with
worked hard to remedy, with notable Workers’ Compensation, is just visible Kaiser Northwest, looking for patterns
progress. In the last few years, discour- from Heumann’s office. Five years ago, in various chronic diseases.
agement set in, once it became generally with a grant directing him to address The lesson here for public health
recognized that information by itself is dermatitis, Heumann went to Liberty suggests more than the typical combi-
simply not enough to make anything and made an arrangement to look at their nation of quantitative and qualitative
change. Systematic reviews, like those claims data. In 1996, WC claims coders data, favored by forward-thinking
provided by the Evidence-based began using the Redesigned academicians. Neither one in itself, nor
Practice Center at OHSU, for example, Occupational Safety and Health Survey both together, is a paradigm. Just tools.
condense data, but no one follows coding system to identify “nature, part, Heumann’s example shows various
through to translate the letters into event, and sources of injury.” ROSH stages of communication and persua-
words into language into speakers to allowed Heumann to detect patterns sion are necessary all through the
get the message to the field. Physicians that pointed to a particular company process, bound together by a constant
in the UK have long complained about with an unusual number of claims for initiative until the job demonstrates
the mute quality of Cochrane dermatitis. He wrote a report and gave results. Dynamic human connections
Collaboration reviews. Pure science, it to Liberty to distribute. Job done. and a final appeal to interests on all
like pure mathematics, is pointless if it But really, the job was not done. sides define the policy paradigm. The
never touches the ground. He found that Liberty needed further example emphasizes the innovative role
Larger insurers in the USA are prompting. Carefully, he asked the of epidemiology and health research in
gradually learning to mine their claims insurer if he could make contact with real life, beyond the penumbra of the
data for clues on health improvement the problem firm in the field. Once he computer screen.
8 The Probe

Oregon team responds to Healthy Start questions

BYBETH GREEN PHD, JULIETTE MACKIN regression, odds ratios, repeated meas- can be reached and provided with home-
PHD, AND JEROD TARTE MA ures analysis of variance, and other visiting services, but not the quality of
statistical techniques, but we agree the the services. In an ongoing effort to

T he Oregon Commission on Children

and Families, and NPC Research, the
independent evaluator for Oregon’s
report relies heavily on straightforward
reporting of easy-to-understand outcome
figures. The major audiences for this
maintain this effective program model,
Oregon’s Healthy Start has been working
on a Quality Assurance Protocol (since
Healthy Start evaluation, are pleased to report, state legislators and Healthy Start 2002), and is currently in the process of
see so much thoughtful discussion about program staff, are not typically statisti- applying for national accreditation
the impact of Healthy Start in Oregon. cians or researchers. Our main goal is to through Healthy Families America.
Below, we respond to the concerns raised report findings that are accessible for Edmonds leads the reader to believe
by Joyce Edmonds (The Probe, Summer counties and policymakers to use in their that Oregon’s Healthy Start program has
2004), and offer additional information. ongoing work related to this program. been receiving annual increases in
Further, key questions raised by funding, when the reverse is true. Budget
Issues of Random Assignment readers are usually straightforward: How cuts over the last two years have signifi-
and Scientific Rigor many families did you serve this year? cantly decreased Healthy Start funding
First, the article makes the argument for sites. Funding levels for service have
that Healthy Start would be best served declined from 80% of first births in
by an evaluation using a randomized Our main goal is participating counties, to only 47% of first
study design. Randomized designs are births. Despite such a drastic reduction
often touted as the “gold standard” for to report findings that in funding, Healthy Start continues to
evaluation research, though this point has demonstrate strong program implementa-
been widely debated (cf., McCall & Green, are accessible for tion and positive family outcomes.
2004; Patton, 2004). Most professional
evaluators would agree that evaluation counties to use in their Child Maltreatment Data
methods, measures, and statistical Edmonds charges the Healthy Start
approaches must be tailored to fit the ongoing commitment report with using “an inflated denominator
needs of the program and interested for its maltreatment statistics.” She also
stakeholders, and that appropriate to the program asserts that families provided with
methods vary widely depending upon the universal basic services are not an
purpose of the evaluation. Randomized What percentage of your clients received appropriate part of the Healthy Start
evaluation approaches are often not the substance abuse treatment? To what program group, and only families receiving
best choice for providing data aimed at degree did parents improve their parent- intensive-service home visiting should be
improving program performance, which child interactions? These kinds of ques- used to evaluate maltreatment outcomes.
is one of the primary goals of Oregon’s tions are best answered, and understood, Actually, the status report does report
Healthy Start evaluation. with simple numbers. maltreatment rates for families who
Healthy Start’s legislatively mandated Child maltreatment data are admittedly received basic vs. intensive services (the
goal to provide universal services for all more complex, and readers of the annual “logical group” Edmonds suggested we
first-birth families makes a randomized evaluation report will notice that we report identify – see Healthy Start of Oregon
comparison group infeasible. Instead, maltreatment incidence based on popula- 2001-2002 Status Report, p.137, Table 22).
state policymakers have opted for a tion norming – a commonly accepted Additionally, the report includes child
performance-measurement approach, method for comparing incidence rates in abuse and neglect statistics for several
which provides data over time about large populations – along with logistic other groups, including higher-risk
participating families, and information for regression, and a repeated-measures parents who did not meet eligibility
continuous program improvement. design to examine longitudinal data. requirements for intensive services, and
lower-risk families.
Use of Appropriate Funding Issues Child maltreatment data is available
Statistical Approaches Although we understand Edmonds’ for the general population, but com-
Edmonds suggests that one weakness concern about programs trying to parisons to Healthy Start subgroups are
of the evaluation is its reliance on “raw “squeeze their services to fit available inappropriate, because families in general
numbers, percentages, and frequencies.” funding,” Healthy Start follows a model include both high and low risks. By
The Healthy Start annual evaluation program of services. Thus, funding including basic-service families in the
report does, in fact, include logistic shortfalls affect the number of families that (continued on page 9)
Fall 2004 9

(from page 8) Healthy Start children who are also first- social service field, and a number are
analyses, we assure that we are not just births. The status report mentions this public health nurses.
comparing high-risk, high-stress Healthy variation as a caution in interpreting the In closing, we welcome opportunities
Start families to the general nonserved study results. to discuss our state’s Healthy Start
population. Some Healthy Start programs do serve program and its evaluation. No evaluation
subsequent births, and these families are is perfect, and we certainly would not
Universal Prevention included in the Healthy Start service argue that this one is any exception.
A universal approach to child abuse group in the analysis of maltreatment However, we firmly believe the Healthy
prevention is supported in a recent rates. It is worth noting however, that Start evaluation, and its associated
research report on preventing child there are few studies on the influence of reports, are grounded in solid research
maltreatment (NCIPC, 2004), which states, birth order on maltreatment rates, and this methodology, produce useful and under-
“a universal program potentially benefits literature tends to focus on specific standable information for stakeholders,
all parents through multiple levels of populations (e.g., teen moms). More and continue to show that the Healthy
intervention tailored to parents who consistent in the maltreatment literature Start program is successful in helping to
experience a range of problems” (p. 1). is the finding that the highest rates of reduce the risk for and incidence of child
Levels of intervention can range from abuse and neglect involve young child- abuse and neglect among participating
basic parenting information, like Healthy ren, specifically those under age 3 families.
Start’s basic services, to more intensive (NCCANI, 2002). For this reason, the
services for families with more problems. focus on abuse rates for this population References
Not all families receive long-term is appropriate. Center for Law and Social Policy. (1998). More
intensive services, because not all fami- than one: Teen mothers and subsequent
lies need it. In times of limited funding,
Other Issues childbearing. Authors.
targeting intensive, costly services to Two additional assertions warrant Green BL, Mackin JR, Tarte J, Cole RTM &
those most at risk makes good sense. At comment. First, the evaluation of Brekhus J. (2003). Healthy Start of Oregon
the same time, recognizing that all new Oregon’s Healthy Start program is 2001 – 2002 Status Report. A report to the
parents need support, Healthy Start conducted by a disinterested party. NPC Oregon Commission on Children and
implements a standardized protocol to Research is a private, professional Families.
make decisions about the level of support evaluation firm and we take considerable McCall RB & Green B. (2004). Beyond the
most appropriate for each family. pride in our ability to provide timely, gold standards in developmental research:
Edmonds challenges Healthy Start’s useful, and objective information to our Considerations for policy and practice. The
intensive service, stating that “only 9% clients. We adhere strictly to American Society for Research in Child Development’s
Social Policy Report, 18(2), p. 3-12.
of first-birth families received service.” In Evaluation Association standards of
fact, of the 4,620 first birth families who practice (Newmann et al., 1994), which National Center for Injury Prevention and
consented to Healthy Start services and include systematic inquiry using the most Control. (2004). Using evidence-based
parenting programs to advance CDC
sharing their data with DHS and the appropriate technical standards, along
efforts in child maltreatment prevention
evaluation team, 1,574 of those families with standards to avoid bias, including research activities. Centers for Disease
(34%) received intensive service. disclosure of conflicts of interest and full Control and Prevention.
disclosure of findings.
Maltreatment and Birth Order Second, Edmonds mistakenly inter-
National Clearinghouse on Child Abuse and
Neglect Information. (2004). Child mal-
Edmonds raises the concern that prets articles in the June 2004 issue of treatment 2002: Summary of key findings.
Healthy Start’s evaluation compares rates Child Abuse and Neglect as indicating Authors.
of maltreatment for Healthy Start families that Healthy Start, in general, shows little Newmann D, Scheier MA, Shadish W &
(primarily first births) to the general evidence of positive effects. That article Nye C. (1994). Guiding principles for
population of 0-2 year olds (which series, conducted on a home-visiting evaluators: A report from the AEA task
includes subsequent births). A few program in Hawaii, is a single-site force on guiding principles for evaluators.
articles have found maltreatment rates to evaluation, with uncertain applicability American Evaluation Association.
be higher in families with more children elsewhere. The Hawaii program is dif- Patton MQ. (2004). http://videocast.nih.gov/
(Zuravin, 1988; Center for Law and Social ferent from Oregon Healthy Start in ppt/nci_patton091404.ppt
Policy, 1998). From data made available several ways, perhaps most significantly Zuravin S. (1988). Fertility patterns: Their
through the Department of Human by relying on paraprofessional home relationship to child physical abuse and
Services, the evaluation team was unable visitors. Many Oregon program staff child neglect. Journal of Marriage and the
to identify a comparison group of non- have at least a bachelor’s degree in a Family,50(4), 983-993.
10 The Probe

Health benefit costs hammer U.S. nonprofits

FROM THELISTENING POST PROJECT impact has been even greater on Services for the Aging, another Listening
CENTER FOR CIVIL SOCIETY STUDIES nonprofit organizations, and this has a Post Project partner organization.
JOHNS HOPKINS UNIVERSITY serious ripple effect on the quality ”We need to be more inventive if we want
of community life,” said Audrey Alvarado, to fashion policy approaches that

N onprofit organizations in the USA

are being especially hard hit by
escalating health-benefit costs, according
executive director of the National
Council of Nonprofit Associations, a
Listening Post Project partner..
can effectively shield nonprofit organi-
zations and those they serve from the
crippling effects of continued health
to a new report by the Center for Civil ”Recent proposals to fix the health insurance cost increases.”
Society Studies. Looking at a nationwide insurance crisis by offering tax breaks
sample of over 250 nonprofit agencies to small businesses provide no relief to The Listening Post Project Health
that serve children, the elderly, community nonprofit organizations,” observed Benefits Report is available online at
development, and the arts, the Johns Larry Minnix, president and CEO of the www.jhu.edu/listeningpost/news
Hopkins survey documents for the first American Association of Homes and

Massachusetts legislature moves to

time the impact of exploding health
benefit costs on U.S. charitable
organizations.
Determined to avoid negative impacts
make health care a constitutional right
on those they serve and unable to In July, a Kaiser Family Foundation passed financed health insurance coverage for
raise additional funds, nonprofits found in its daily health policy news that the all medically necessary preventive, acute
it necessary to shift more costs Massachusetts house and senate in a and chronic health care and mental health
onto their employees, who already make joint session voted 153-41 to approve a care services, prescription drugs and
less than private-sector workers. proposed state constitutional amendment devices.”
Escalating health-benefit costs are that would make “comprehensive and The proposed amendment was initi-
particularly damaging to nonprofit affordable health care” a right. The ated after more than 70,000 registered
organizations because health benefits are amendment states that it “shall be the voters in the state signed a petition in its
one of the most important attractions of obligation and duty of the Legislature and favor. By state law, the amendment must
nonprofit employment. executive officials ... to enact and imple- be approved a second time by the
”While much has been written about ment such laws as will ensure that no legislature in its 2005-2006 legislative
the impact of rising health benefit costs Massachusetts resident lacks com- session in order to reach the ballot in
on small businesses, the fact is that the prehensive, affordable and equitably 2006.

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