Thoughts on year two: what’s next?

With less than four weeks ‘til graduation, second year MCH students like yours truly are busy playing the waiting game—waiting to hear about fellowships abroad, jobs the next county over, or doctoral programs right here on campus. It’s a difficult time, especially for those of us who aren’t quite sure what’s next (disclaimer: as I write this I’m waiting at the airport, preparing to fly out for an interview I could not have even considered two years ago. Honestly, I never thought that sitting around could make me so anxious).

This kind of waiting, whether it happens at an airport or a bus stop or a post office—if you aren’t careful, it’ll put you in a contemplative mood. And that’s where I’m at: trying to figure out what’s next, busy doing my own kind of reflective practice, but with a community of virtual readers.

Over the past two years, I’ve had the pleasure to learn from all kinds of people—both within the classroom and elsewhere. Last May, when I drove into Minneapolis for a talk with our Program Director, I was overwhelmed with the potential of it all—what classes would I take? Where would I live? Would I have any friends? Three months later I returned and began to find some answers. Most were comforting (yes, I found friends), some less so (my first apartment in town had at least 9 public health and safety violations). I’d be lying if I said I figured everything out: there’s still a lot to learn.

The good news is that I’ve gotten more comfortable with this feeling: the never-quite-knowing-ness. In fact, it’s starting to feel like reality. If you work at an agency that is supported by federal funding—particularly Title X funding—I guess you know what I’m talking about. The truth is, you never quite know where you’ll land next. It’s okay not to know.  Even better if you have a window seat.

(Statisticians, by the way, have a hefty term for random-ness. They call it “stochasticity.” Try saying it out loud, and then go listen to this wonderful Radiolab podcast on the subject: http://www.radiolab.org/2009/jun/15/

Affordable Access to the HPV Vaccine for All Adolescent Females

Guest Blogger: Amanda Eastwood

While suggested or even mandatory Human Papilloma Virus (HPV) vaccines for young girls in the United States has been a highly controversial topic over the past few years, the risk of HPV among females in developing countries is a topic of equally important value but receives little publicity within the United States. While I don’t argue that the HPV vaccine should be mandatory for all young females anywhere, I do believe that it should be made available at little to no cost to young females, not only in the United States and other developed countries, but also in developing countries where cervical cancer screening is less common and often less effective.

The World Health Organization holds a similar stance to my own on the topic by recommending that:

“…routine HPV vaccination should be included in national immunization programmes, provided that: prevention of cervical cancer or other HPV-related diseases, or both, constitutes a public health priority; vaccine introduction is programmatically feasible; sustainable financing can be secured; and the cost effectiveness of vaccination strategies in the country or region is considered¹.”

Further emphasizing that all young women should have affordable access to the HPV vaccine, Part Two of the 25^th Article of the Universal Declaration of Human Rights states that, “Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection².”  As an upcoming public health professional with a deep-rooted desire for advocating for women’s reproductive health, I believe that cervical cancer is a threat to the livelihood of women, families, and entire communities and that access to the HPV vaccine can help to protect this right.

Cervical cancer, caused by HPV in almost all cases, is the leading cause of cancer deaths among women worldwide.  Often referred to as a disease of the poor, of the roughly 500,000 annual cervical cancer deaths worldwide, approximately 80 percent are in developing countries where it should be most considered a public health priority meeting one of the criterion of the WHO stance on including it as part of a country’s vaccination programme³. One positive aspect of cervical cancer is that it is extremely slow to progress allowing time to detect it in its early stages. When un-detected in its most preventable states, it often presents during a woman’s years of greatest productivity from her 30s to 50s. The good news is that cervical cancer can be prevented quite feasibly and easily through the prevention of HPV and through the early detection of pre-cancerous cells through cervical cancer screening³. The downside is that in many low-resource settings adequate screening and treatment services are generally sub-par which is why so many women in these settings perish at such a young age to a preventable cancer.

GlaxoSmithKline’s (GSK’s) Cervarix® and Merck’s Gardasil® are the two leading HPV vaccines consisting of a three-series shot administered to prevent the four main cancer causing strands of HPV. The vaccine, consisting of a series of three doses, averages $10 to $25 U.S. dollars per shot to all recipients unless their country of residence is considered an “extremely poor” country by the standards of the pharmaceutical company. Protection rates are highest (90 to 100 percent in clinical trials) after the administration of all three doses but the vaccine still shows high rates of efficacy after as little as one dose¹. The cost is a seemingly small amount by American standards, however, an impossibly large sum to many poor women in country’s not considered to be “poor enough”. The problem is that many developing countries are comprised of a large, very poor population with a very small middle class and an even smaller but very rich upper class. Therefore, the economic status of such countries is skewed by the small population with extreme wealth and not considered “poor enough” to receive discounted vaccines.

There are several avenues one could take to approaching the issue of availability due to prohibitive pricing. One would be to demand that pharmaceutical companies consider vaccine rates on a more region or community specific level as opposed to a country-wide assessment. A second option is to tap into external sources that provide funding for vaccines in low-resource countries. Frankly, I would prefer to see the pharmaceutical companies reevaluate their current system of assigning countries an economic category or even consider the donation of vaccines to extremely impoverished settings. However, I don’t see this as extremely likely so will err toward the option that is already in place and functioning.

The GAVI Alliance is a source of external funding for vaccines in countries with a Gross National Income of less than $1,000 U.S. dollars per capita. Approximately 54 percent of cervical cancer cases are found in qualifying countries which could indicate huge strides in lowering both cervical cancer rates and deaths!  Achieving success, however, will require some work on behalf of qualifying countries. Countries must apply to the GAVI Alliance and the Alliance does reserve the right to approve or deny applications. Nevertheless, once approved, countries are asked to contribute a maximum of 30 cents U.S. per vaccine depending on the Gross National Income of the country, and the GAVI Alliance will cover the rest⁴. Not only does this option reduce the financial burden to vaccine recipients, it also meets the WHO criterion of the security of sustainable funding. When looking at this from a cost-benefit approach, spending 30 cents U.S. now to prevent cervical cancer is a great deal less than the costs associated with trying to treat a very lethal cancer thereby making the vaccine a good long-term investment. I will not address the WHO criterion regarding the feasibility of programme introduction within this reaction but do want to acknowledge the importance it.

The fact that cervical cancer is the leading cancer killer among women worldwide should indicate its status as a public health priority.  What’s more is that there is a known method which demonstrates high levels of efficacy in the prevention of HPV.  As public health professionals, there is a level of accountability in making it available to women worldwide but particularly in low-resource settings where incidence rates of cervical cancer are highest. As many as 500,000 women worldwide die each year; each of them mothers, daughters, sisters, friends, wives, and companions in the peak of their lives³. The prevention of HPV among young women of this generation paired with effective cervical cancer screening among all women makes the fight against cervical cancer is one that we can win.

*Amanda Eastwood is a graduate student in the Maternal and Child Health Program at the University of Minnesota

References

1. (April 10, 2009). Human Papillomavirus Vaccine WHO Position Paper. Weekly Epidemiological Record. No. 15, 2009, 84, 117–132. Retrieved from http://www.rho.org/file /WHO_WER_HPV_vaccine_position_paper_2009.pdf.
2. (December 10, 1948). Universal Declaration of Human Rights. Article 25, Part 2. Retrieved on February 12, 2011 from: http://www.un.org/en/documents/udhr/index.shtml.(2007).
3. Cervical Cancer, Human Papillomavirus (HPV), and HPV Vaccines; Key Points for Policy-makers and Health Professionals. WHO Press. Ref WHO/RHR/08.14. Retrieved from  http://whqlibdoc.who.int/hq/2008/WHO_RHR_08.14_eng.pdf.(2007).
4. Making Cervical Cancer Vaccines Widely Available In Developing Countries: Cost and Financing Issues. Retrieved from http://screening.iarc.fr/doc/IAVI_PATH_HPV_financing_brief.pdf

Guest Post: MCH Student Andrea Aga – Reflections on AMCHP

This year, I was sponsored by the Center for Leadership Education in Maternal

University of Minnesota MCH student, Andrea Aga

and Child Public Health at the University of Minnesota to attend the 2011 AMCHP Annual Conference in Washington, DC. As a master’s student nearing the completion of my MPH training, I knew the conference would offer four days of intensive learning opportunities, but I came away from the experience with much more than even I expected.

As a social service provider with years of experience working with at-risk youth, I am passionate about the policies that impact these populations. However, aside from the occasional email or phone call to a representative’s office, my legislative advocacy efforts have been quite minimal. I definitely see this competency as one of my biggest areas for growth, so when I noticed the skill-building session Can You Hear Me Now? Influencing Policymakers to Hear Your Call for Increased Support was being offered, I jumped at the chance to attend.

The room was filled with professionals, all with varying levels of policy and advocacy experience, and overall, I found their personal stories regarding their interactions with policymakers to be quite poignant. Many spoke of the need to change their messages and their approaches with each election cycle and within an ever-evolving political climate. Their dedication and their ability to work with diverse communities and systems was not only inspiring, but showed incredible creativity. The session emphasized crafting messages that influence policymakers, and it quickly became evident that their stories, some positive and some defeating, played an integral role in advancing the objectives of their organizations. These stories put a human face on MCH issues and can have a strong impact on legislators.

But stories alone are not often enough to persuade policymakers. It is essential to establish yourself as an expert, not just an advocate, and there are a variety of ways to accomplish that, such as presenting the negatives of your argument along with the positives and being prepared to discuss what works in other areas or states. The most important theme of the session was that of relationship building – finding common connections with policymakers, meeting them and establishing a rapport before you make a request, and staying in touch with legislators, not just contacting them when you need something. This session was effective because it not only gave me the tools to approach law makers, but also the confidence to advocate effectively on behalf of issues that I feel so strongly about.

In addition to the variety of skill-building sessions and workshops offered, I was also able to attend a professional coaching session. This individual, 40-minute session allowed me to speak one-on-one with Dr. Kris Risley, a trained and certified leadership coach regarding my career plans. As I near graduation and become more apprehensive about available employment opportunities and the potential need to relocate, it was incredibly helpful to speak with someone with an outside perspective. While I sometimes feel that my future aspirations lack focus, Dr. Risley was able to reassure me that I am able to clearly articulate my interest areas and my relevant experience, as well as offer advice on remaining in contact with the professional network I have made in the Twin Cities area, even if relocation becomes necessary.

As a student attending the AMCHP Conference, I was provided with invaluable professional development and offered a glimpse into the changing scope of the field during these strained financial times. Not only did I gain additional insight about Title V nationally, it was also invigorating to connect with MCH leaders across the country who are working so diligently to develop creative solutions to protect the health and well-being of women, children, and families. The opportunity further validated my decision to pursue my MPH in maternal and child health, and I look forward to joining the ranks of these dedicated professionals.

Public Health Symposium – May 2011

The Center for Leadership in Maternal and Child Public Health, in partnership with the Center for Excellence in Children’s Mental Health, the Human Capital Research Collaborative and the Minnesota Community Foundation Project for Babies, is pleased to announce the 2011 Public Health Symposium on Promoting Early Childhood Mental Health:  Translating the science of early experiences into culturally-informed policy and practice

May 26-27, 2011
at the Earle Brown Heritage Center in Brooklyn Center, Minnesota
Registration for both days: $95.00

Keynote speakers include:

Robert Anda, MD, MS, Centers for Disease Control and  Prevention
Atum Azzahir, Powderhorn/Phillips Cultural Wellness Center
Diane Benjamin, MPH, FrameWorks Institute
Megan Gunnar, PhD, University of Minnesota, Institute of Child Development
Jim Koppel, MSW, Children’s Defense Fund
Tony LookingElk, City of Minneapolis Department of Health Urban Health Advisory Committee
Art Rolnick, PhD,  Human Capital Research Collaborative, University of Minnesota
Don Warne, MPH, MD,  Office of Native Health for Sanford Health System

This symposium will bring together researchers, policymakers and practitioners to address the critical question of how we translate the science of early brain development into messages that effectively communicate the evidence across disciplines, communities, and cultures. Speakers will emphasize and explore culturally relevant strategies for identifying and addressing the social emotional needs of young children across different cultures and different economic circumstances.

Scholarships and student discounts are available. To register, or for more information, visit http://mch2011symposium.eventbrite.com/ Early bird registration specials are available through Friday, April 22, 2011.

Guest Post: MCH Student Reflects on Professional Development

As a master’s student in the Maternal and Child Health program at the University of Minnesota’s School of Public Health, my graduate training has been generously supported by the Center for Leadership in Maternal and Child Public Health for the past two years. This February, the Center sponsored an additional training opportunity for Minnesota’s MCH students: an invitation to attend the annual Association of Maternal and Child Health Professionals (AMCHP) conference in Washington, DC. Along with five other students, I applied for a scholarship and was lucky enough to be accepted.

I say “lucky,” because my experience at AMCHP was inspiring and invigorating, and in multiple ways. This was a chance to extend my understanding of MCH competencies in the company of articulate and knowledgeable professionals from both state and national public health agencies. On Saturday I found myself discussing data collection with a PRAMS coordinator from Wisconsin; on Sunday I was immersed in conversation about bicycle helmet policy with a family advocate from Colorado. These women and men are deeply invested in the health and safety of all Americans, particularly our most vulnerable populations, and their passion was encouraging—particularly as I ready myself for a new career in public health.

Although all the sessions I attended were stimulating, a training workshop moderated by Georgia’s MCH program and Title V director was especially enlightening. Brian Castrucci clearly demonstrated the importance of data in advocacy work with state policymakers. His emphasis on translating data into messages that can be used by diverse constituencies was a powerful lesson for me. My own focus on health communications will certainly benefit from the strategies outlined in this session, as well as others I attended throughout the four-day conference.

AMCHP sharpened my focus and my sense of purpose, bringing me closer to the professionals who will soon be my colleagues.  I look forward to attending additional professional training workshops like this one after graduation. In short, it was a tremendous gift, and a valuable reminder, of the important work ahead.

Laura Andersen is a graduate student in the Maternal and Child Health program at the University of Minnesota