What we did was meaningful. I was drawn to start this publication because it presented an opportunity to break out of the typical crisis-driven flow and ebb of journalism about the field. Harvard wasn’t a publisher, but it was in the business of sharing knowledge, and I thought we could do for public health what Harvard Business Review does for business. I believed there was no public health without the public, and while it took some feints and half-steps to figure out what that meant for our journalism, we eventually settled on assessing every story idea with a simple question: “What would this story change?” Implicit was a corollary question: “And for whom?”

In the meantime, we relaunched the magazine as a digital publication, built out a social media presence, and launched a weekly newsletter. We co-sponsored a well-attended structural racism symposium and special issue, a series on public health data, a Public Health in Action collaboration with The Studio at the Harvard T.H. Chan School, and an event on artificial intelligence with Johns Hopkins Bloomberg’s Global Health Now. We had momentum—visitors to the site almost tripled in last year’s fourth quarter versus the prior year. Almost 15,000 people signed up for Harvard Public Health Weekly, close to 90 percent of them not connected to Harvard.

Readers ate up pieces on processed foods, the health effects of alcohol, and mental health. You also read our beautifully written and photographed narratives like the 10^th anniversary of the Flint water crisis or our look at Christian Happi’s bold aims for African science, and public health’s role in the recent Puerto Rican elections.

Our goal was to publish stories that would help improve health outcomes. That’s hard to measure in three-and-a-half years. But over 40 percent of you opened the newsletter in a typical week. In the last year, readers shared our articles more than 2 million times on social media. We’ve had at least 25 stories republished on other sites and 40 mentions in newsletters. Our stories have been cited in other publications and used in classrooms.

Public health outcomes change slowly, so it’s harder to measure real-world impact. I would love to hear from you about trying an idea you read about in HPH, or even if you just shared the idea with a colleague. Did you use an article from HPH in a class or a meeting? It would be great to hear from you at our inbox, magazine@hsph.harvard.edu. It will be live for a few more months. So will the site, and I encourage you to download articles you found useful.

The pandemic sparked a surge of public health journalism. These are the sites and newsletters I follow closely or scan regularly, and recommend to you:

• Axios Vitals
• Devex CheckUp
• The Examination
• Global Health NOW
• The Harvard Chan Studio
• KFF Health News
• MindSite News
• Public Health Watch
• The Healthiest Goldfish
• Your Local Epidemiologist
• ProPublica
• STAT Morning Rounds
• TradeOffs (podcast)

Also, the new Healthbeat is off to a promising start, focusing for now on Atlanta and New York City.

I have had a long and varied journalism career, much of it spent chronicling the vast impact of high technology. I have never done more meaningful and important work than what we were doing at Harvard Public Health. I am so thankful to the school, colleagues past and present and our fabulous advisory board, everyone who gave me informal counsel, and all the readers who reached out. I rue that we won’t be able to continue. But a wonderful thing about public health is its focus on the public. It is political with a small ‘p,’ rooted in communities.

What’s most important is that you in the public health community (and in the public) stay engaged in doing the good work you do. Keep telling your stories!

Onward,
Michael F. Fitzgerald

The post A farewell to HPH readers appeared first on Harvard Public Health Magazine.

Happy, a Congolese volunteer health care interpreter who requested to share only her first name, helps guide others through a health care system that often feels like a labyrinth. Her experience with the system does not spare her own family from its barriers. [Editor’s note: Harvard Public Health is not citing the full name of Happy and several other interviewees to protect them and their families, due to concern about anti-immigrant sentiment and also cultural norms within some immigrant communities.]

Happy’s younger sister, Nastrinia, has suffered for months from persistent hand tremors and frequent vomiting. Their parents, desperate for answers, have taken her to multiple clinics, only to leave each time with uncertainty. One doctor prescribed nausea medication. Another suggested it might be stress. But no one has given them a clear diagnosis. The language barrier makes every visit more frustrating, given that her parents struggle to communicate their daughter’s symptoms in English. “It’s scary to watch,” Happy says. “And it takes a toll on our family.”

She sees similar struggles play out when she volunteers, watching mothers try to explain their children’s symptoms in broken English, only to be misunderstood repeatedly throughout their appointments. She sees elderly refugees struggle to fill out complex paperwork, their frustration mounting. And she sees the fear in their eyes, the fear that the system will fail them as their hopes for a better life are met with the same hurdles they’ve seen so many others face.

Across Clarkston, which lies about 10 miles northeast of downtown Atlanta, residents face systemic obstacles, language barriers, financial constraints, and a U.S. health care system that often lacks cultural competence. A former medical scribe who requested anonymity to protect his professional and academic standing recalls assisting an Afghan father seeking specialized care for his child. The process required a four-way exchange between the scribe, a Pashto-speaking interpreter, a nurse practitioner, and the family. Despite their best efforts, translation errors led to incorrect appointment details, forcing the family to restart the process. Every mistranslation costs two things many people in Clarkston lack: time and money.

Humaira Shirzai and her husband, both originally from Afghanistan, often skip doctor visits to avoid the upfront appointment fees, and forgo necessary medications due to costs. They don’t have Medicaid, but she says people who do still face barriers—including limited provider acceptance, upfront costs for care, and delayed reimbursements—which can leave them in financial limbo and delay necessary care.

Clarkston’s leaders recognize the urgency of these issues. Mayor Beverly Burks previously worked as a community engagement director at Fulton-Dekalb Hospital Authority, and City Councilwoman Sharifa Adde, who came to the U.S. as a refugee, have spent years advocating for refugee and immigrant families. Both stress that while progress has been made in recent years, the health care system remains difficult to navigate for many. Omar Shekhey, founder of the Somali American Community Center, works to address these barriers by building trust with residents about their health care needs. “Trust means knowing who you can open up to,” he says. “Without it, people hesitate to seek care until it’s too late.”

As Burks, Adde, and Shekhey make their way through Somali Plaza, stopping to speak with residents, it’s clear that immigrants and refugees have developed a rapport with local leaders. That’s not unusual in the U.S. where despite deep distrust of the federal government, about two-thirds of people say they trust local government. Health-related institutions are far more trusted, with 82 percent saying they trust hospitals and 79 percent public health departments. That’s less true for many refugees and recent immigrants, who face a challenge they never encountered in their home countries: barriers to accessing proper health care. Those barriers are even more pronounced in Georgia, where health care access ranks among the worst in the nation.

Language barriers, cultural insensitivity, and systemic obstacles such as lack of insurance and transportation all prevent residents from accessing health care, says Abdi Yusuf, who moved to Clarkston in 1993. Yusuf, originally from Somalia, works as a health care underwriter and sees these challenges play out daily. He says “Many refugees don’t know the language and don’t get the best jobs, which makes access to health care harder.”

Many of the refugees who arrive in the U.S. hold advanced professional jobs in their home countries, but here find themselves relegated to low-wage jobs due to licensing and accreditation barriers, as well as limited English proficiency. Where interpretation services exist, they are often insufficient. The Georgia Department of Public Health’s Refugee Health Program provides interpreters only in Somali, Arabic, Dari, and Pashto. In Clarkston, with its 60+ languages, many residents must rely on other means to navigate the system. Too often these challenges mean they delay or completely avoid medical care.

Some 30 percent of respondents to a 2023 Clarkston Needs assessment conducted by Georgia State University’s Prevention Research Center had not visited a doctor for a regular check-up in the past year, and an equal number delayed medical care due to cost concerns. The rate is almost double Georgia’s overall 15.5 percent of residents who skip medical care due to costs, which is the second-highest percentage in the nation.

In Clarkston, several community-led health care initiatives are working to bridge gaps and provide access to care for those facing financial hardship.

Grace Village Medical Clinic, a free clinic, operates just five times a month, yet in each five-hour clinic session, it serves about 40-50 patients, many suffering from chronic illnesses like diabetes and hypertension. Despite its limited hours, the clinic provides continuity of care to over 2,000 patients annually by leveraging a volunteer staff of physicians, nurse practitioners, and medical students. At its core, Grace strives to serve as a family physician for residents with limited health care options.

Mosaic Health Center, formerly Clarkston Community Health Center, takes a similar approach, helping to reduce financial barriers to health care while reinforcing the importance of trust in medical services. “If equitable solutions can be found in the most diverse square mile, similar models can succeed anywhere in America,” says Jeremy Cole, its executive director. Since 2013, Mosaic has provided free or subsidized care to thousands of uninsured and underinsured patients, with a focus on preventative medicine, chronic disease management, and health education. Its motto is “People care over profit share,” and the clinic aims to give residents facing financial hardship access to care.

While these clinics provide crucial support, they don’t meet demand and still struggle  with systemic barriers, especially translation. Though both organizations lean on local interpreters and language lines to serve their global patient profiles, gaps still occur. “You never know what language we will serve any given day,” says Michael Sorrells, Grace Village’s CEO.

Grace Village and Mosaic are open to any Clarkston resident who needs their services; Ethnē Health, a primary care clinic, moved into the city in 2017 and in 2018 opened a community clinic specifically to serve its international population. Ethnē tries to address barriers faced by refugees and immigrants, by hiring multilingual staff from the community. Like Grace and Mosaic, it utilizes a language access line for real-time translation to support patient needs. It also works to address the connection between health and social conditions, prioritizing immediate needs such as food insecurity, housing, and mental health before shifting to long-term wellness.

“Building trust over time is essential,” says Robert Contino, Ethnē’s CEO. Ethnē has developed partnerships with organizations like MAP International to provide free prescription medications. It also offers free Uber rides for patients without reliable transit. And it coordinates with local hospitals and community organizations to ensure that Clarkston residents receive continuous and culturally competent care. Many residents told us that Ethnē is a trusted option for their health care and praise it for working to serve the community’s evolving needs. Ethnē serves patients with insurance as well as those who are uninsured and underinsured, which has given it flexibility to coordinate available services and to expand its services, as it did in 2023, when it started the first dental clinic in Clarkston for immigrants.

“The need for quality dental care is tremendous,” says Contino, noting that many Clarkston residents have never seen a dentist before arriving in the U.S. But dental services require specialized infrastructure, sterilized equipment, dental chairs, and power tools, all of which are costly to establish and maintain. “Dentistry is harder to provide than primary care because of the infrastructure required,” says Nate Benard of the Christian Medical and Dental Association. “But without access to dental care, small issues quickly escalate into severe problems.” In Clarkston, that lack of routine dental care has led to severe infections, tooth loss, and chronic pain, creating a citywide public health concern.

Sheela Poya, a former refugee from Afghanistan who now works as a case manager at an Afghan refugee support organization, recalls how her family endured severe dental pain for years with no access to affordable treatment. “A $4,000 to $5,000 dental procedure is impossible for someone making $2,500 a month,” she explains through a translator. She says her family opted to use painkillers to deal with dental issues, rather than seek proper care. She wants policymakers to expand Medicaid coverage and increase cost relief for Afghan families and other low-income residents.

Poya’s story is far from unique. A dentistry needs analysis on Clarkston conducted by Georgia State University’s Prevention Research Center found:

• Most community residents do not visit the dentist for preventive care.
• While residents can seek treatment for urgent dental issues, cost and lack of insurance severely limit available services.
• Children receive regular cleanings and checkups, but many parents only visit the dentist when experiencing severe pain or complications.
• There are no in-language educational materials to help residents understand their dental health options.

A college student named Najwa from Sudan, who wished to not be fully identified to protect her family’s privacy, shared how her younger brother’s dental care became a saga of missed opportunities and misinformation. In particular, her mother accidentally switched her brother’s Medicaid plan due to a translation error, causing the family to have a six-month gap in coverage. During this period, his untreated cavities worsened, yet cultural misconceptions about dentistry from the community, such as the belief that it is “just a business” seeking to get you to come back, delayed them from seeking proper care. Instead, they were advised to rely on herbal remedies.

Many of the refugees in Clarkston escaped conflict zones, but they still hold the trauma of war, displacement, and loss. “A lot of people have seen horrible things … walking through forests, seeing people dead. Many are suffering, especially the kids,” says Yusuf, the Somalian health care underwriter. In the U.S., they have to navigate an unfamiliar health care system, which compounds their stress by giving them paperwork they can’t translate and leaving them uncertain about where to turn for help. These factors, financial insecurity, and cultural stigmas make seeking mental health care a challenge.

Some community organizations have worked to become trusted pillars, providing mental health support tailored to the cultural and linguistic needs of Clarkston’s residents.

The Amani Women Center has created safe spaces where women can heal, seek support, and rebuild their sense of agency. It has adopted “sister circles” that allow refugee women to discuss trauma, domestic violence, and health concerns in a culturally sensitive and supportive space. Amani also offers a community ambassador program, which pairs refugees with mentors from their own cultural backgrounds to help them navigate the health care system. “Diversity calls for solutions that are not templates,” says Doris Mukangu, Amani’s founder and executive director. “You must be creative to connect with hard-to-reach communities.”

Amani’s focus on culturally competent care extends to addressing religious nuances, literacy challenges, and social isolation. Previously, this organization has also collaborated with agencies like the Centers for Disease Control and Prevention to tackle sensitive cultural issues such as female genital mutilation (FGM), which many refugee women in Clarkston experienced before arriving in the U.S. These interventions provide critical education and support while fostering trust in medical institutions that many refugees instinctively avoid.

One of Amani’s most impactful initiatives is its sewing program, which began in 2006 with just two women and has since grown to serve over 100 participants from Eritrea, Somalia, Ethiopia, Burma, Afghanistan, and beyond. The program combines economic empowerment with mental health support, giving women skills to achieve financial independence while fostering a sense of belonging. Mukangu says 65 percent of program alumni have started home-based businesses, 70 percent earn a living wage, and 95 percent have opened savings accounts. Clarkston Councilwoman Adde, a graduate of the program, says, “For many women, this was the first time they had an opportunity to achieve self-sufficiency.”

Shekhey, founder of the Somali American Community Center, has spent over 25 years working with refugees, helping them navigate not only the complexities of the health care system but also the deeply ingrained cultural stigmas that prevent many from speaking openly about their struggles. Language barriers compound cultural taboos, since “[feeling unable] to communicate itself is a health issue,” Shekhey says. Mental health is a particular issue, since In the Somali community, terms like mental illness and suicide are rarely spoken aloud. Instead, suffering is often internalized, seen as a private burden rather than something to be treated. Death from any cause is not discussed. “People die, and their families don’t want their friends to know why,” says Shekhey. “They don’t want to be associated with it. It feels like a curse.”

Twice a week, Shekhey conducts informal mental health check-ins for those who cannot afford care or who are afraid to acknowledge the symptoms of a mental health condition. Using post-trauma questions as a guide, he created his own approach to help people open up about their struggles, ranging from daily life challenges to financial stress. He says he sees people suffering quietly, enduring chronic pain and sleepless nights, and others who are slipping into the substance abuse that afflicts the U.S. He listens to families hesitant to even say the word cancer aloud, fearing that naming it might make it real. And he works to connect them with the right support and advocate for their needs.

“Medication alone isn’t enough,” he says. “It’s key to give people your time.” Shekhey says he often spends two to three hours with a single community member, then follows up for weeks to try to ensure issues get addressed. In this way, the center serves as a place where people can discuss what they might not share in a doctor’s office. It’s also a space for correcting misinformation, a role that became critical during the COVID-19 pandemic when false rumors spread through the community, such as the fear that women who took the vaccine would never be able to have children.

Shekhey believes a community’s struggles are shared burdens. “If your neighbor is suffering, you’re suffering too. That’s our culture, that’s how you feel,” he says. It’s why he left a career in the U.S. in mechanical engineering to become a humanitarian. It’s why he believes that traditional surveys and evaluations often fail to capture the reality of immigrant experiences, because without truly knowing the community, the right questions aren’t even being asked.

Clarkston’s leaders recognize that addressing the city’s health care challenges requires more than just medical services, it demands trust, cultural understanding, and a commitment to long-term solutions. Community health workers play a vital role in this effort. Mobilized by organizations like Amani, the Refugee Women’s Network, and Ethnē Health, these workers help residents navigate complex systems, ensuring they receive timely and appropriate care. “Caseworkers are the bridge between residents and resources. They’re essential in breaking down barriers,” says Burks, the city’s mayor.

Burks acknowledges the scale of the challenge. Resources remain limited, and demand often outpaces available support. Achieving true health care equity, she notes, requires long-term investment from all levels of government and the ongoing involvement of community stakeholders.

Clarkston’s approach has been shaped by the belief that the most effective health care solutions come from those who truly understand the community. This philosophy led to higher vaccination rates during the Covid pandemic than in many similar populations, driven through partnerships with organizations like the Amani Women Center and multilingual outreach to address fears and misinformation. The Clarkston Health Equity Coalition (CHEC), created to boost Covid vaccine uptake, has evolved into a citywide network that brings together elected officials, medical professionals, university researchers, and grassroots leaders to tackle systemic health care disparities.

But Clarkston’s commitment to community-driven health care looks likely to face significant challenges due to shifts in federal policy. Proposed Medicaid cuts and uncertain funding for the community-focused Health Center Program could jeopardize care for vulnerable populations, warns Ethnē Health’s Contino, despite these clinics’ proven role in reducing health care costs.

Georgia is one of 10 states that did not expand Medicaid, and Burks fears that any cuts at the federal level will force more low-income and immigrant residents to rely on already overburdened clinics and emergency rooms.

Not everyone sees storms ahead. Grace Village’s Sorrells says, “Our approach to serving Clarkston and the surrounding communities will not change based on what we know today.” In fact, it expects to expand, adding more education and job training services.

But the times are uncertain, and Contino says he sees widespread anxiety among Ethnē’s staff and patients. Most of those patients are here legally via the highly vetted refugee resettlement process. “Even though nearly all have legal status, there is still deep concern about potential targeting from ICE officials,” he says.

If the federal government renounces prior commitments, these leaders say they remain committed to providing and expanding access to culturally competent care across this unique, vibrant community.

Editor’s note: Vngle is a grassroots news and intelligence agency dedicated to amplifying the voices of underrepresented communities. It collaborates with and offers journalism training to members of communities it reports on. Vngle spent nearly a year working with residents of Clarkston, Georgia, for this piece. Vngle’s reporting process is backed by a system of provenance records, ensuring the authenticity and traceability of the stories shared, even with anonymous contributions. This project was initially supported by the Starling Lab for Data Integrity, co-founded by Stanford University and the University of Southern California.

The post For many immigrants, U.S. health care is a maze without a map appeared first on Harvard Public Health Magazine.

College students have to adjust to living with strangers, an exceptionally fertile environment for the common cold and other illnesses, and the all-too-real problem of food insecurity, all while dealing with intense academic expectations. Even the most caring university administrators struggle to meet the health needs of hundreds—or in the case of my school, tens of thousands—of young adults.

Colleges need to learn from students. In particular, more universities should establish student public health director positions.

I served as the student body director of public health last academic year at the University of California, San Diego, and am currently re-applying for the position this year. As an active member of the UCSD student government—the Associated Students of UC San Diego—I applied for the position because I strongly believe that all college students should have access to both health education and the chance to reach their full health potential. At its core, public health has always been a field rooted in service, advocacy, and education. I wanted to increase health awareness among all students on campus, advocate for student needs, and lead public health projects that improved campus health.

My experiences in the role, combined with the student stories I’ve been privileged to hear, have convinced me that these types of positions improve student health and safety on campus.

Student directors of public health serve as a vital bridge between students and university administrators. These student leaders collaborate with campus departments to champion proactive public health practices that meet student needs. Through leading targeted public health initiatives—such as advocating for increasing wheelchair accessibility across campus—they can enhance the overall health and safety of the campus community.

The role’s significance stems from two critical functions: safeguarding students’ long-term health and wellbeing, and ensuring student voices reach university leadership in meaningful ways. Although universities do actively promote student health, their priorities sometimes don’t align with actual student needs.

For example, UCSD students had called on the school for years to fund universal menstrual-product access across campus. However, it wasn’t until two years ago that the first large-scale menstrual project was passed and implemented in all women’s restrooms on campus. When university administrators lack deep insight into student perspectives, this misalignment leads to reduced student engagement with public health measures and preventive practices.

This is where student public health directors can make an impact. Because they are students first, student public health directors both experience and recognize students’ needs. We are well-positioned to let administrators know when they’re not connecting with students.

For instance, UCSD offers a food pantry, mental health counseling, career development centers, and other services meant for students to utilize freely at their convenience. Yet, inadequate publicity for them often means they’re underused. This became clear at a quarterly sit-and-meet with UCSD undergraduate students that I held last year, where many voiced concerns about the lack of awareness of some health resources on campus and difficulty accessing these resources promptly.

One student mentioned she didn’t know UCSD had a free food pantry until her junior year. Another said he wasn’t aware that we had free substance abuse and alcohol counseling available at our student health center. Students who were aware that these programs exist claim that access to these resources can be difficult. A former classmate mentioned that getting mental health support on campus took months for a request to be processed and approved.

Student public health directors can serve as liaisons between students and administration. Their dual perspective allows them to translate student-voiced needs and concerns into targeted public health initiatives, ensuring that university resources align with the community they serve.

Additionally, student public health directors can influence the development of new university policies. On a campus as vast as mine, with more than 45,000 students, student voices often go unheard during policy development. Thoughtful initiatives are crucial for fostering student growth, but how many of these policies genuinely respond to student concerns and experiences? How many emerge from direct student input? In my experience, not many.

Creating student directors of public health positions on more university campuses could help amplify student voices. Since these directors are part of student government, they have access to connections and resources and can directly advocate for students with unmet needs.

As student director of public health, I expanded the role and advocated for equal opportunities for all students to learn and thrive. I launched projects that included partnering with CALPIRG UCSD on a rainwater collection system and lighting staircases to help visually impaired students navigate campus at night. These projects are ongoing, and my experience confirmed how essential this position is for creating a more accessible and equitable campus.

Student directors of public health have the potential to significantly contribute to the betterment of campus health and wellbeing. As the only UC campus to have an established student director of public health role, UCSD serves as a powerful example to others that investment in student leaders can lead to the development of healthier and safer campuses.

Lead image: Lisa5201 / iStock

The post Why every campus should have a student director of public health appeared first on Harvard Public Health Magazine.

—Sarah Muthler

(Study in Nature Medicine, July 2024)

The post The risky side effects of CAR-T therapy appeared first on Harvard Public Health Magazine.

• Cash and Counseling started as a way to let low-income Arkansans living with physical and mental disabilities choose to hire family and friends as caregivers in place of state-appointed caretakers. The program had spectacular results: People who chose it were less likely to go to nursing homes, more satisfied with their care, and reported major gains in their overall satisfaction. Outreach to every important audience was baked in from the start to win support. Eventually, the program was adopted nationally and has made a measurable improvement in quality of life for millions of people in the U.S.
• Adam Zimmerman, a former colleague who became a citizen activist in Montgomery County, Maryland, set out to protect his children from secondhand smoke. His work over a few years mobilized a coalition and led to legislation banning smoking in city parks and restaurants. His most effective tool was not the research papers he assembled, but a Washington Post op-ed, “Keep your secondhand smoke off my nachos, please.”
• Just a few months ago, representatives from 180 countries agreed to rules regarding corporate behavior, as part of a continuing campaign to raise the voices of Indigenous people. The new accord requires companies making products based on digitized genetic information, often gleaned from the traditional knowledge of Indigenous people, to pay into a fund for their communities, which protect some of the world’s most biodiverse areas.

These initiatives have all been hailed for their inventiveness and impact, but in each case, I know that strategic communication was a critical component in turning untested ideas into forces for real change.

The strategy has five steps:

• Identify your audience(s), especially the people who are best positioned to make change happen, as well as the people who influence them.
• Create a message to motivate these people. Avoid the jargon advocates tend to use, and write for the people you want to influence. Meet people where they are. Messaging was key for the three campaigns above. Each of them knew the problem and why it needed solving now, had a proposed solution, and gave a call to action. Those messages were tested with relevant audiences.
• Pick your messenger. When the message is ready, you need to find your messengers. Always include voices from the community (see below). Make sure you have an academic subject-matter expert. And seek out someone unexpected. When conservative Arkansas Governor Mike Huckabee championed Cash and Counseling and went on national TV to advocate for a social program for low-income people, it got people’s attention because he was a counterintuitive messenger.
• Give voice to the community. Community voices make such essential messengers that they need to be their own step in the process. That’s because the people with the lived experience are the best truth-tellers and storytellers. They have the greatest stake in the outcome, whether they’re Indigenous people living in the Amazon or someone with a disability dissatisfied with the status quo. They will be the most authentic messengers for the story.
• Tell your story. Your message tells people what you want. You need stories to show why it matters. Build your message around facts, of course, then wrap it in powerful stories to move people to do something different. As storytelling savant Andy Goodman has said, all success stories can credit a four-letter word called “FEEL.”

Putting the model to work

Once you have a strategy and stories to express it, it’s time to get tactical. Policy audiences won’t read lengthy journal articles, so your research content needs to be translated into engaging visual formats with a clear bottom line.

Media coverage validates the quest for reforms, whether it’s in The New York Times or The Somerville Times, on social media, a podcast, or an influencer’s account. These platforms enable us to amplify the news to share with our targeted audiences. If we can’t attract media interest, we can’t claim that our research or big idea has traction beyond our own personal megaphones. Media is the public validator.

Once we receive media coverage, we are positioned to advocate. Most of the time, advocacy helps drive a changed public dialogue and even specific policies. This was certainly the case with Zimmerman’s anti-tobacco crusade, the changed regulatory guidelines for Cash and Counseling, and the global biodiversity accord. Each largely owes its victory to thoughtful communication strategies and their tactical implementation.

Today’s misinformation miasma means we can’t guarantee results, even with strong evidence and data as our foundation. Still, the campaigns I mentioned at the start of this piece are just some of the many that have worked. I’ve used this strategy to mitigate dangerous adolescent behaviors, spark an emerging national movement to consider gun violence as a public health epidemic, and gain support for introducing a malaria vaccine in Africa.

Public health reformers need better communication tools, and this strategy should be a critical one. Getting this right is not an easy lift. It involves discipline and creativity. But, used wisely, it can be the difference between ideas that become shelfware and those that change people’s lives for the better.

Image: Kent Dayton

The post Public health reformers need better communication tools appeared first on Harvard Public Health Magazine.

—Sarah Muthler

(Study in The Lancet, December 2024)

The post U.S. life expectancy gap widens appeared first on Harvard Public Health Magazine.

Miami Dolphins quarterback Tua Tagovailoa’s third concussion last September elicited calls for his retirement. Weeks later, Hall of Famer Brett Favre revealed that he has Parkinson’s disease due to the many concussions he believes he sustained while playing.

Concussions are mild traumatic brain injuries that can result in a constellation of physical, cognitive, and emotional symptoms. Since 2015, NFL players have logged more than 2,200 concussions in practices and games. It’s harder to get clear numbers in youth football, but we know that each young player sustains about 375 head impacts per season.

Despite the growing concern around concussions and their long-term impact, about 1,700 active NFL players, about 81,000 college students, and two million local youth play football each year.

What will protect these athletes from brain injury and long-term consequences? According to the NFL and companies looking to profit, it’s new protective gear like the Guardian Cap. The problem is that some players, coaches, and football fans conflate the use of this and other gear with brain injury prevention—a feat no piece of equipment can currently achieve in tackle football.

Players are also not required to wear the protective gear. Tagovailoa announced he would not wear one, even after his third concussion.

Concussions in the NFL did decrease this year—182 concussions were diagnosed in NFL players, 17 percent fewer than last year. But football players still experience more concussions than any other athletes, and the risk will never be zero. Safety equipment also cannot prevent the damage associated with repeated head impacts.

CTE is caused by an accumulation of an abnormal protein in the brain from repeated head impacts. Research indicates that lower-grade head impacts are more strongly linked to the disease due to their frequency. CTE symptoms include aggression, memory impairment, and suicidal ideation.

About 90 percent of the 376 deceased former NFL players who donated their brains to Boston University’s CTE lab had CTE. A Harvard study of living former NFL players found that one-third believe they have the condition.

New gear is supposed to alleviate the CTE problem. The Guardian Cap fits over a football helmet and is meant to absorb and spread the force of a hit, purportedly by up to 25 percent. Since 2022, they have been mandated for some players during practices. In 2024, they were approved for use in the regular season.

But only an average of six players wore them each week in the NFL and the Canadian Football League combined, even though Guardian and the NFL claim that concussions are down by over 50 percent in the players who wear them during practice. 

Perhaps the players are aware that at least three independent studies have shown that the caps make no difference. In one study of college football players, lab testing indicated that Guardian Caps reduced head acceleration and the force of impacts, but when the researchers replicated the testing on the field, the caps made no difference at all. Another lab-based study and a third, on-field study confirmed the first study’s field findings.

Also being marketed is the Q-Collar, a Food and Drug Administration-approved piece of equipment meant to minimize the brain’s movement inside the skull. Modeled after the anatomy of woodpeckers, it sits around the neck, applying pressure to the jugular veins to slow blood flow out of the head. Q-Collar creators say this increases blood around the brain, cushioning it and reducing its movement within the skull after impact.

The company that makes the Q-Collar doesn’t claim it prevents concussions and critics note that we don’t know if it actually protects the brain from future harm. And in 2022, scientists found that woodpeckers’ brains are protected from damage simply due to their size and orientation within their skulls.

Like the Guardian Cap, uptake of the Q-Collar among football players is low.

More helpful than the questionable effects of gear would be a better response to head trauma when it happens.

A good first step would be establishing standardized return-to-play protocols across all levels of football. The NFL’s five-step protocol that concussed players must follow before returning to practice doesn’t have guidelines for how long players must spend in each phase of recovery. Yet one study shows that adult men need about 25 days, and women about 35, to recover from a concussion. NFL players typically return to play nine days post-concussion.

Return-to-play protocols are overseen by team physicians who may feel pressure to quickly clear star athletes. Standards could prevent incidents like Tagovailoa’s 2022 event, when he sustained a concussion during a game and was cleared by team doctors to play four days later. He suffered a second concussion during that game and had to be hospitalized.

Other sports have clear rules about required rest. The Australian Football League mandates a 12- to 21-day rest period following concussion. The World Boxing Association requires at least a 60-day suspension for any boxer who gets knocked out from a hit to the head.

Oversight will be needed to make return-to-play protocols effective. Over one-third of American high schools don’t have athletic trainers. As a result, young athletes rely on teammates, coaches, or parents to recognize a concussion and seek appropriate treatment. Without professional support, and a mandated recovery window, many athletes may never seek care and return to play too quickly.

Of course, rest does not reduce the risk of head trauma once a player is back on the field. Whether you’re rooting for star quarterbacks Patrick Mahomes (two confirmed concussions in his career) or Jalen Hurts (concussion in December) this Sunday, know that they along with every player on the field face a hidden threat on every play.

The only sure way to prevent head injuries in football? Don’t play.

Source images: Adobe Stock, iStock

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Ball was part of a 25 percent jump in traffic fatalities in the United States in the past decade, including a surge in 2020 and 2021. Transportation experts attribute the rising number of deaths to factors such as increased speed limits, bigger and heavier vehicles, and the distractions of smartphones. But they also say these deaths are entirely preventable. For instance, Vision Zero, a road safety system widely adopted in Australia, Canada, and the European Union, has helped reduce both fatalities and severe injuries. It uses bike lanes, pedestrian walkways, and other design elements to encourage drivers to slow down in places where they share the roads with cyclists and pedestrians.

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In the U.S., although cities such as Alexandria, Virginia and Hoboken, New Jersey can point to Vision Zero as helping them eliminate traffic deaths, the program has run into roadblocks. The web of federal, state, and local jurisdictions that control decisions about—and funding for—roads is partly to blame. But advocates for safer roads argue that reframing traffic fatalities as a public health crisis would create public awareness and boost support for developing safer infrastructure. They are seeking greater collaboration between transportation engineers and public health experts to change how decisions are made about road design.

“We excuse things that have to do with cars that we don’t with other public health norms,” such as health risks from second-hand smoke, says Tara Goddard, an associate professor in the Department of Landscape Architecture and Urban Planning at Texas A&M University. Goddard’s research shows that an overwhelming majority—almost 84 percent—of respondents think the risk of serious injury is part of driving (less than 40 percent feel the same way about work). At the same time, two-thirds said society should not simply accept the consequences of driving.

A public health approach could help transportation engineers promote and execute Vision Zero as a series of systemic changes that address road safety challenges. “When you design roads, when you design routes, when you design even where a bus stop is located or where a transit center is located, that is public health,” says Sophia Peerzada, a public health expert who specializes in traffic safety but is commenting as a private citizen. “Because [design] directly impacts people’s safety on the roads, and their ability to safely get around.”

Road design shapes driver behavior

The majority of traffic fatalities happen in what transportation researchers call high-injury networks. These are typically locations where people walk or bike on or near roads with speed limits set at 35 to 45 miles per hour, and are where the majority of traffic fatalities occur. “Thirty-five miles per hour is really a sweet spot for killing people,” says Patricia Tice, a transportation researcher and founder of the consulting company ProFound Insights. Tice observes that cyclist and pedestrian deaths often occur in what are called “origin-destination pairs,” where a person has to cross a busy street to reach home, work, or shopping.

Vision Zero policies focus on identifying high-injury networks and making them safer. A major tenet of the approach, which is backed by research, is that the built environment influences driver behavior. It also holds that road design should account for potential human error, so people aren’t killed or severely injured if a crash should happen.

The approach cut traffic fatalities by 36 percent between 2010 and 2020 in European countries where Vision Zero has been implemented, such as Sweden and Denmark. Fatalities in Edmonton, Canada, fell 50 percent in six years, and serious injuries by more than one-third, after the city put Vision Zero into practice in 2015. The U.S., meanwhile, has invested more in public awareness campaigns about the risks of speeding or police officers writing more tickets, say advocates. “We are never going to educate and enforce our way out of this crisis, which is what most of the United States is doing at the city, state, and federal level,” says Amy Cohen, the co-founder of Families for Safe Streets. Cohen started the organization, which advocates for traffic safety legislation and offers support to the families affected by what it calls “traffic violence,” after her son was killed by a car in front of their New York City home.

Certain road features, such as wide lanes, encourage faster driving and increase the risk that cyclists and pedestrians will die in a collision. Further, there is evidence that when drivers can make eye contact with other people while driving, they tend to slow down. Lower speed limits, sidewalks, and crosswalks all encourage eye contact and make streets safer for pedestrians. “If you’re actually laying eyes and interacting with someone one out of every four times you go through a space, you treat that space as a social space, and you’ll go less than 25 miles an hour,” Tice says.

But research also captures a mismatch between what most people feel is safe and what is actually safe. Narrower lanes make drivers slow down, but often make them feel more nervous. “A lot of traffic engineering is counter-intuitive to people who don’t study it,” says Veronica Davis, author of the book Inclusive Transportation: A Manifesto for Repairing Divided Communities, and the director of cities programs at AtkinsRéalis, a design, project management, and engineering company.

Goddard thinks public health professionals can help address this disconnect. “We have more than enough research to know what design makes people safer,” she says. “What we don’t know is how to implement it.”

Systemic change is difficult

Some of the U.S. cities that have passed measures to implement Vision Zero include New York, Chicago, Austin, and Boston, with mixed results. In addition, the National Roadway Safety Strategy from the U.S. Department of Transportation requires states and localities to have a research-backed approach to improving safety to get federal funding for road projects.

“If you don’t have a Vision Zero action plan, there’s this giant pot of money you don’t get to ask for,” says Jay Blazek Crossley, the executive director of the nonprofit Farm&City, which is dedicated to improving transportation and urban planning in Texas. But money by itself is not enough.

Joel Meyer, Austin’s transportation officer, points to several challenges in implementing Vision Zero. The biggest is needing to redesign city streets. “We are making progress where we are making investments,” Meyer says. “It’s really just going to take time and resources to retrofit that environment.”

Austin committed to Vision Zero in 2016, as part of a mobility bond that was approved by voters. But it has only been able to apply these improvements to streets under its jurisdiction. Fatalities on these streets have remained flat. However, Austin does not have jurisdiction over streets that are controlled by the Texas Department of Transportation (TxDOT), and on those streets, fatalities have increased. TxDOT adopted a Vision Zero plan for the state, Road to Zero, in 2019, with the goal of eliminating traffic fatalities by 2050. TxDOT said in a statement that in November 2024 it worked with the Texas Department of Public Safety to share tip cards on safe driving during traffic stops, and it launched a safety initiative in December. It noted that “there’s not one solution, it will take all of us working together to save lives on Texas roads.”

In contrast, the city of Houston, which committed to Vision Zero in 2019, has a new mayor, John Whitmire, who is rolling back many of the implemented safety measures. For example, the city removed a median that had been installed to slow down traffic on a road that had recently been the site of a bicyclist fatality. Whitmire’s rationale, as reported by Texas Monthly, was that the median made it harder for first responders to get through.

The city has also reversed a decision to narrow the car lanes in the planned redesign of another road, which would have slowed traffic, while adding bike lanes. Instead, the plan is to add the bike lanes while keeping the wider car lanes. “The lack of bike lanes is not what is dangerous, the fast cars are what’s dangerous,” says Farm&City’s Blazek Crossley. “They are keeping the fast cars.” He says the rollbacks make Houston an outlier in Texas, as the rest of the state is moving in the direction of implementing evidence-based safe systems design.

Since the rollback started, traffic fatalities in Houston in 2024 set a record, though fatalities combined with severe injuries were down slightly from 2023. At the same time, Harris County outside of Houston, and Texas overall, saw traffic deaths decline. Vision Zero proponents argue Houston’s results point to the need for safer infrastructure.  City officials declined an interview request.

In Decatur, Quanisha Ball’s mother Courtney Thompkins feels her daughter’s death was preventable, and has started volunteering with Families for Safe Streets helping Cohen advocate for Vision Zero. The Georgia Department of Transportation in early 2024 changed the timing of the traffic lights at the intersection where Ball died and, a year earlier, another pedestrian was struck. That change is designed to help make pedestrians more visible to drivers, and Cohen calls it a “modest” improvement.

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Meanwhile, the city of Decatur is developing its own Vision Zero plan through a Safe Streets and Roads for All grant from the U.S. Department of Transportation.

Thompkins, who recently marked the second anniversary of her daughter’s death, sees these changes as headed in the right direction. Still, she considers the challenges ahead to be significant. She hopes her advocacy efforts will make it less likely that other families suffer. “We have to fight to protect other lives,” Thompkins says.

Top image: Marilyn Nieves / iStock
Tara Goddard: Courtesy of Tara Goddard
Amy Cohen: Courtesy of Amy Cohen
Joel Meyer: Austin Transportation and Public Works Department

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—Paul Adepoju

(Study in JAMA Network Open, December 2024)

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