Ohio’s Opioid Crisis Impacts Communities, Families

Photo by World News

We can no longer debate the harsh reality. The opioid crisis is real. Fentanyl and heroin overdoses continue to rise at an alarming rate. From 2003-2015 2,590 people unintentionally overdosed from opioids in the state of Ohio.  This is 84.9% of all accidental overdoses recorded over that time. Recovery supports are becoming more and more important with each passing day. Now more than ever, we need to build out the continuum of care and invest in recovery support services. Whether it’s the language we use, the way in which we view substance use disorders (SUD) in the court of law, or the gaps that we begin to fill, changes need to be made. 89% of people who need treatment are not getting the help they need. Work continues to be done on educating society on one simple message; recovery is possible.

Recovery language is vital to shifting the tides at work. What we say and how we say it has the power to help or hurt. This disease will continue to be viewed through a criminal justice lens as long as we continue to talk about it as such. Derogatory terms like “addict”, “drunk” and “junkie” have negative connotations that have been engrained in us for decades. We see this as criminal behavior because that is what we were taught. If we continue the work of shifting towards proper recovery language then together we can shift the culture towards healing our communities.

“People suffering from a SUD are not bad people trying to get good, they are sick people trying to get well.” Words that echo through recovery circles and treatment centers across the country. Yet incarceration still seems to be the go to for government spending. Studies show that if just 10% of drug related incarcerations were differed to treatment, lifetime societal net benefits reflect $8.5 billion relative to baseline. And if that percentage climbs to the still reasonable 40%, we could see net benefits of $22.5 billion dollars. Treatment is not only cheaper, it is also more effective. In New York state, they saw a 21% decrease in reconviction rates when people received a treatment alternative! While treatment is effective and results in cost savings, it isn’t the end of the continuum.

What we do after initial treatment is paramount to providing those with SUD a continuum of care. Studies show that the change of returning to use rates diminish the longer the individual maintains their recovery. After just five years of remission, return to use rates drop below 15%. The goal here is to ensure that individuals have access to a continuum of care and ongoing recovery supports so they can reach this critical five year mark. There are many ways to foster and develop SUD recovery. Whether its outpatient treatment programs, medically-assisted treatment (MAT) or collegiate recovery programs (CRP), all of these fall on the continuum of care for SUD, and all have been proven effective. Programs like the Higher Education Center for Alcohol and Drug Misuse Prevention and Recovery (HECAOD) and CRPs across the country look to foster an environment that promotes the expansion to the continuum of care for people recovering from SUD.

While this crisis may seem daunting, there are things we can do right now to make an impact. Firstly, we should incorporate recovery language in our lives in order to help destigmatize the jaded view of SUD. Treatment is not only more humane than incarceration, it’s more effective. Additionally, look to support legislation that encourages treatment over incarceration and taking a public health approach to ending this epidemic rather than a criminal justice approach. Lastly, we need to continue investing in recovery supports! Programs all across the country are making an impact into the opioid crisis. A SUD is a not a character problem, it’s a community problem. We rise and fall as one, and if we take the proper steps we can all recover, together.

Rob Schilder, Ohio State Collegiate Recovery Community Student Assistant

Sarah Nerad, Higher Education Center for Alcohol and Drug Misuse Prevention and Recovery, Director of Recovery

Imagine Not Knowing…

Imagine Not Knowing … that there are 1.2 million people in the United States that are living with HIV.

Imagine Not Knowing …that 1 in 8 people living with HIV do not know their status.

Imagine Not Knowing…that YOU can make a difference in these numbers.


Project INK, or “Project: Imagine Not Knowing…” is a comprehensive HIV prevention program designed to educate, and provide access to care for the community. Project INK strives to enable the community through opportunities to receive testing, counseling, linkage to care services, and other resources for health. We use a peer advocacy strategy, in which community members are empowered to take charge of their status, their lives, and their health by sharing “role model stories”. These stories are disbursed through members of the focus community that we serve and through our various pages. Our specific focus is on testing men who have sex with other men between the ages of 17-39, as this community has the highest rates of HIV transmission disparities throughout the nation.

Project INK is a CDC funded and evidence-based program, which means these strategies have been proven to improve health outcomes for those who are HIV negative by increasing testing, linking to PrEP (the once daily pill that is over 90% effective at preventing HIV transmission), and has been proven to have positive, powerful impacts for those living with HIV by linking them to care, and increasing medical adherence.

Our program is just one of many avenues that people in Columbus can navigate to learn more about HIV and advocate for their health, and the health of those around them. Programs like this, make the end of HIV a foreseeable and realistic goal. However, in order to end HIV transmission we must continue to advocate for those who are living with HIV and continue to provide education and preventative measures to those most at risk. Even if you find yourself outside of the “high –risk” population there are still ways to support the movement; learning about HIV and HIV transmission helps reduce stigma, which plays a large part in the way our society interacts with HIV, and ending the stigma surrounding the virus plays an essential part in us finding a cure.

If you couldn’t “Imagine Not Knowing… the feeling of making a difference,” then help support Project INK. Showing support can be as simple as liking us on Facebook and Instagram. Or if you or anyone you know are interested in getting involved then email: projectinkcolumbus@equitashealth.com for more information.

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Facebook: www.facebook.com/projectinkcolumbus

IG: project_ink_columbus

 

#SuicidePreventionMonth – What You Need to Know

Suicide is the tenth leading cause of death in the United States (Drapeau & McIntosh, 2015), as well as one of the leading causes of death for college-age students (Suicide Prevention Resource Center, 2014).  In a representative year, over 42,000 people die by suicide, which equates to approximately 115 each day.  Not only is this a tragic loss of life, but research indicates that the ripple effect on campuses and communities can be equally devastating.  Consider that for every suicide there are approximately 147 people who are exposed to the death, including 18 who experience a major disruption as a result of the suicide (Drapeau & McIntosh, 2015).   When the impact of each suicide is considered in this way — approximately 750,000 people deeply impacted each year, as well as 6.3 million exposed in a year — it is no wonder why suicide is considered a significant public health problem among campuses and communities across the country.

In spite of the magnitude of this problem, suicide is preventable.  In fact, the state of Ohio recently invested in statewide prevention efforts beginning with House Bill 28, which requires all public institutions of higher education to provide suicide prevention programming on their campuses.  The best suicide prevention practices occur when campuses align strategies to identify at-risk students, increase help-seeking behavior, provide mental health services, promote social connectedness, and develop sound policies related to crisis management and restricting access to lethal means (The Jed Foundation, 2016).  When administrators, staff, faculty, and students possess a shared vision to prevent suicide by promoting mental health and eliminating stigma around help-seeking, the likelihood of preventing suicide increases markedly.

The Ohio State University is one of a select number of campuses nationwide to house a standalone suicide prevention program.  The OSU Suicide Prevention Program was originally founded through a grant from the Substance Abuse and Mental Health Services Administration (SAMHSA), and it is currently funded through a partnership between the College of Education and Human Ecology and the Office of Student Life.  The program works closely with other offices on campus to ensure that the mental health needs of our entire campus community are prioritized.  We have collaborated on initiatives to improve the mental health and well-being of groups with an elevated risk of suicide, including male students, graduate and professional students, international students, and student veterans.

We believe that preventing suicide is a responsibility shared by the entire campus community.  If you are interested in learning more about how to prevent suicide on campus and within our local community, consider attending a REACH training.  REACH is an educational training in which participants learn how to Recognize warning signs, Engage a distressed individual with empathy, Ask directly about suicide, Communicate hope, and Help the individual access mental health resources.  Nearly 10,000 individuals have been trained in REACH.  To sign up, visit reach.osu.edu.

To learn more about what we are doing at OSU, or if you would like to get involved in other ways, please visit our website (suicideprevention.osu.edu) or email us at osusuicideprevention@osu.edu.  You can also follow us on Twitter (@OSUREACH).


 

Matthew Fullen, M.A., M.Div., LPCC is an independently licensed counselor and doctoral candidate at The Ohio State University.  He serves as Program Manager of The Ohio State University Suicide Prevention Program, which is now in its 10th year.  Matthew has presented and published on community suicide prevention efforts for people of various ages.  He can be reached at fullen.33@osu.edu.

Let’s talk about (Sexual) Health, Baby

Did you know that half of all sexually active young people will get a sexually transmitted infection (STI) before their 25? Or if current HIV rates continue, about 1 in 2 black men who have sex with men (MSM) and 1 in 4 Latino MSM in the United States will be diagnosed with HIV during their lifetime? Ohio is absolutely not immune to these statistics. Since 2013, the number of cases of chlamydia, gonorrhea, and syphilis have continuously increased throughout the state.

At the Ohio HIV/STI Hotline, anyone can call or chat (http://ohiv.org/) with us about general sexual health, HIV, STIs, condoms, birth control, etc. As a fairly easy option to better protect against HIV and STIs, we often recommend using condoms in all sexual activity. Unfortunately, we frequently hear that people are uncomfortable buying condoms or taking them from a health center, don’t know where to get them, or don’t know what size they may need. This of course got us here at the Ohio HIV/STI Hotline thinking… how can we reduce as many barriers to this one safer sex tool as possible?

With much excitement, the Free Condom Project was launched in May 2016! A month’s supply of free condoms will be discreetly mailed to anyone in Ohio (aged 16+) who orders from the Ohio HIV/STI Hotline website. We currently have a great variety of condoms, including flavored, sensitive, colored, thin, and XL. Inside each package will also be information about nearby HIV/STI test sites, how to properly use a condom, and information about the Ohio HIV/STI Hotline and other local resources.

Our theory is that reducing barriers and increasing accessibility to safe sex products like condoms and dental dams will assist in decreasing in the incidence of STI, HIV, and unwanted pregnancy rates throughout Ohio. When other programs like this have been done on a much smaller scale, participants have reported that they were more likely to correctly use contraceptives. We feel confident that if people have easy access to condoms, they will use them. The Free Condom Project is the first to attempt this on a state level, and since its launch has distributed over 25,000 condoms across Ohio.

Since incidence data on HIV, STIs, and unwanted pregnancy won’t be available until next year, we have been measuring our success in community feedback. So far, it has been incredibly positive! Community feedback has highlighted a lot of things that we already knew: there still is a stigma surrounding sex especially for women and members of the LGBTQ community, condoms are expensive, people don’t always know where to go to get tested, etc. And a lot of other barriers came to our attention that our team hadn’t initially even thought of, like, the fear of being “outed” just from the act of buying/picking up condoms. Here at the Ohio HIV/STI Hotline, we feel like we have been succeeding in our main mission – to remove barriers that were preventing people from engaging in safer sex. We are looking forward to serving even more Ohioans and ensuring everyone has access to safer sex products.

If you or a friend are interested in ordering condoms, please visit the Ohio HIV/STI Hotline at www.ohiv.org to fill out the simple order form. A completely free variety pack of condoms will then be shipped to your desired address shortly!

FCP Variety Mix

The Ohio HIV/STI Hotline is a program of Equitas Health and is supported by funding from the Ohio Department of Health.


 

Editor’s Note:  Check out the Ohio HIV/STI Hotline’s calendar of events by clicking here.  If you need to talk to someone regarding HIV, STIs, sexual health, and more, call the Hotline at 800-332-2437.  They are here to help!

Breaking Barriers for Latino Children

 

From our country to our community, we are experiencing demographic changes that will alter how we serve our people and how we relate to each other. It is projected that by 2035, one in three children will be Latino. Currently, 51% of Latino children in Franklin County live in distressed (low-opportunity) neighborhoods. Therefore, we chose to acknowledge these changes by focusing the 2016 Champion of Children Report: Voices of Latino Boys on their experiences here in central Ohio. How we respond to these changes today will determine how many opportunities lie ahead and how successful these boys are tomorrow.

Key challenges noted in the report include:

  • Limited time and resources available to help parents prepare for the future;
  • Language barriers at home and in the community; and
  • Documentation status and the stress that goes with it.

Parents want more for their children than they themselves had. Many are working multiple jobs and long hours to support their family. Ironically, it was the boys that we spoke with that called for more resources and support for their parents. Additionally, the boys described how having positive influences, mentors, would help their peers “make better choices and not go down the wrong path.”

Language barriers present several challenges. Boys noted the difficulty in switching back and forth from one language at home to another at school. We heard about long appointment wait times for translators to become available. Additionally, overcoming the assumption that Spanish is the universal language of Latinos is a barrier for those needing to access their native language.

The fear of deportation can be subtle but powerful, regardless of actual legal status. Latino boys in our community are acutely aware of how delicate this situation could be. Many expressed anxiety over deportation and immigration issues for their family and friends. Estimating a number of immigrants in central Ohio, or even the U.S., without documentation is challenging for several reasons. However, we do know that in 2009, nearly 60% of Latino children in the U.S. lived in families in which at least one parent is an immigrant.

While describing challenges faced by our Latino boys the report simultaneously showcases their resilience and determination. They described great cultural pride and many credit their parents for their achievements. Latinos show strength in social ties to faith, family and friends and leverage each to support one another.

As a community, we can contribute to the future success our Latino boys. These recommendations are your call to action.

  • Create a diverse teacher pipeline to match the demographic pipeline.
  • Promote emotionally and culturally intelligent practices within the classroom.
  • Support dedicated advocates. From guides to help parents better navigate our systems to mentors to provide a positive influence in these boys’ lives.
  • Provide a dedicated place where affordable resources are available for parents and children. For children, the space would a safe place with educational and constructive activities. Resources for parents include job assistance, legal assistance, English classes, etc.

To download a copy of the report, go here

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Delilah Lopez is the Director of Champion of Children for United Way of Central Ohio (UWCO). She develops and executes funding strategies to expand public awareness and education around issues impacting children in our community. Through branded events and communication, she engages and mobilizes the community around these critical issues. Throughout her 15-year career, Delilah has successfully demonstrated her ability to educate, mobilize and raise funds that have been invested in strategies to reduce poverty in the community, protect the environment, and fund medical research. Delilah’s UWCO career began in April 2011 as a member of the Corporate Resource Development team. During this time she raised more than $40 million by managing external year-round relationships with current and prospective donors, volunteers and advocates through community engagement, education, and workplace campaigns. She continues to co-lead United Way’s strategy for engaging the central Ohio Latino community. Delilah’s community involvement includes membership in the Women’s Leadership Council (WLC) and E3 Initiative mentor. She also volunteers for and attends events benefiting women’s and children’s issues, animal welfare, and the environment. Delilah attended Bowling Green State University, majoring in Recreation and Tourism, with a focus in Commercial Tourism.  A native of Toledo, Ohio, Delilah has resided in Columbus since 2003.

 

Know Your Biases: Behavioral Health across Cultures

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July is recognized as National Minority Mental Health Awareness Month and provides an opportunity to highlight the critical need to ensure diverse populations receive equitable behavioral health services. There is much improvement to be made in Ohio to reduce pervasive health disparities. Social determinants are crucial contributing factors, but an overall lack of cultural competence in the field is also to blame.

With innovative approaches such as the Affordable Care Act (ACA) aimed at improving access to care, the focus has now shifted to ensuring services are cognizant and respectful of cultural beliefs and practices. This is the foundation of providing culturally competent care. The catalyst for this change was the realization that disparities exist beyond socioeconomic status and are directly linked to racial, ethnic, and cultural background. For example, a child born to an African American woman in Ohio with a PhD is less likely to reach their first birthday than a child born to a Caucasian woman with no high school diploma.

Oftentimes it is assumed that a one size fits all approach is the most impartial; research on implicit bias has disproven this as it relates to health. Providers retain biases that impact their delivery of care resulting in disparate outcomes. In behavioral health, many providers have a higher propensity to diagnose diverse consumers as being schizophrenic or bipolar while their counterparts are thought to have a less severe anxiety disorders. Frequent misdiagnoses are also tied to prevalent over-prescribing tendencies that have afflicted minority communities.

Behavioral health services in Ohio must be tailored to meet the needs of all cultural and ethnic backgrounds. Franklin County continues to see significant growth in immigrant communities, namely the Somali and Bhutanese/Nepalese populations. Similarly, the Latino population is increasing in Northeast Ohio. New Americans face unique challenges related to behavioral health; many suffer disproportionately with trauma related disorders. The rapid diversification of the state underscores the urgency needed to implement practices rooted in cultural competence.

What are some actionable next steps? Conducting cultural audits and other self-assessments of systems and agencies must be the first step to improving the delivery of care to diverse communities. Implementation of the National Enhanced CLAS (Culturally and Linguistically Appropriate Service) Standards is also essential as they provide much needed framework. Standards listed under Theme II, Communication and Language Assistance, are federally mandated.

The Multiethnic Advocates for Cultural Competence (MACC) remains committed to providing the support necessary for behavioral health providers, agencies and systems to successfully incorporate best practices. Together with our partners and members across the state, MACC remains steadfast in the fruition of our mission- “Enhance the quality of care in Ohio’s health care system and incorporate culturally competent models of practice into the systems and organizations that provide services to Ohio’s diverse populations”.

Editor’s Note:  We encourage our readers to check out MACC’s upcoming 2016 Statewide Training Conference taking place October 6th and October 7th at the Columbus State Community College’s Center for Workforce Development.  For more information, please click here.


Simone Crawley currently serves as the Executive Director for the Multiethnic Advocates for Cultural Competence, Inc. (MACC). Throughout her career at The Ohio State University, Simone served as a Page in the Ohio House of Representatives. She earned her degree in Political Science. Expanding her public policy background, she served as an aide to Assistant Minority Leader Charleta B. Tavares for three years. During her time at the Ohio Senate, Simone was also elected President of the Ohio Young Black Democrats where she aided in the successful campaigns of several legislative candidates. In January 2015, Simone began working to ensure cultural proficiency and improved health outcomes in Ohio as the Program Coordinator for the Multiethnic Advocates for Cultural Competence, Inc (MACC). She has served as the Executive Director since March 2016.

Pure Peace=Pure Water

Oftentimes the relationship between peace and public health can be a murky route to navigate. Both can be perceived to be influenced by alternative forces, where in reality, public health could often be looked at as one part of how peace is defined. In fact, Ashley Bersani put it best, “Public Health and Peace­ they go together like peas and carrots”. In her article highlighting the relationship between peace and public health, she argued that in order to have a peaceful society, members in this society must have their basic needs met. With that, and and understanding of basic human needs, we know the most quintessential basic need to survive is, water.

But what specifically does water have to do with peace? How do we solve this problem?

All around the world, water is distributed and consumed in various ways. For many of us, we wake up in the morning take a shower, brush our teeth, and drink a glass of water. However, we know that everywhere that is not the case. Each and everyday the lack of clean water creates many problems for those on the other end. When clean water is scarce, it creates tension and conflict simply because many people are vying for a limited supply. As water consumption continues to increase this problem will only continue to spread internationally. In fact the struggles experienced by these circumstances have developed what many have deemed, “The Global Water Crisis”. In fact, the World Economic Forum determined that this Crisis is the most severe Societal Global risk today.

Fortunately, there are many organizations working towards creating easier access to clean water for areas around the world. However, roughly 50% of clean water interventions fail. Why does this occur though? Many of the interventions that organizations take on are ill fit for the communities they are working with. To solve any issue it is important to gauge the political, economic, and cultural climates of the areas an organization may work with to ensure sustainable solutions to clean water access. In fact, one such company working towards this is a Columbus based company, the Pure Water Access Project (PWAP).

PWAP was created in response to the circumstances of “The Global Water Crisis” and aims to resolve common issues it incurs around the globe. The aim of this company is to promote the sustainability of pure water access initiatives, and to help educate about the issues associated with promoting this. PWAP works toward these goals through a combination of physical support and consultation with organizations and people that have already established networks within the regions we aim to, or are already working in. U​sing key data analysis and research skills PWAP is able to have a broad reach with the help of the interconnected nature of the world it interacts in.

PWAP’s founding by Ohio State students paved the way for its Fellowship program that employs undergraduate students to coordinate the company’s projects and initiatives. PWAP has worked in major projects in El Salvador, Nicaragua, and Ghana, with plans to begin work in Sri Lanka and Peru as well. In El Salvador and Nicaragua, PWAP assessed the effectiveness of different water filters, and worked to help construct major filters in the communities they visited, while maintaining contact with locals to ensure their sustainability. Additionally, PWAP evaluated the community’s behaviors and attitudes towards common WASH (Water and Sanitation Hygiene) practices to determine the impact that was having on issues with water access in the communities it worked in. In Ghana, PWAP worked in a similar capacity, through consulting “Global Brigades” in researching and determining the most practical filters for it to implement in the communities it worked in.

PWAP’s future involves maintaining the strategies it has implemented in its current projects, and applying the same practices to its work in Peru and Sri Lanka. PWAP hopes to also expand its work locally and have a greater presence within communities in the midwest and through the U.S.. Through implementing successful strategies from the past, while cultivating the innovation that new Fellows and Partners will bring, PWAP’s future is bright in helping address the Global Water Crisis one step at a time.

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Trisha Barnett is a third-year business student, specializing in Operations Management at The Ohio State University’s Max. M. Fisher College of Business. She has passion for social entrepreneurship and loves the idea of using business practices to make an impact. Aside from her work in PWAP she is involved in Alleviating Poverty Through Entrepreneurship, Delta Sigma Pi, and Politics, Society, and Law Scholars. Upon graduation, she plans on pursuing a dual MPP/MBA degree.

Public Health and Peace? No, really, they go together likes peas & carrots

National Public Health Week: April 4-10, 2016 | Healthiest Nation by 2030

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What is public health? Why are we talking about it in relation to peace?

According to the Center for Disease Control and Prevention (CDC), “Public health is the science of protecting and improving the health of families and communities through the promotion of healthy lifestyles, research for disease and injury prevention and detection and control of infectious diseases. Overall, public health is concerned with protecting the health of entire populations.”[1]

Most public health practitioners and those in related disciplines such as medical anthropology, epidemiology, and health policy would tell you that physical health is directly related to something called the social determinants of health. Basically, that’s fancy talk for knowing that being poor is a health risk. So is being African American, or Hispanic if you live in the U.S.

Riiiiight, but how is that related to peace?

Well, social determinants of health traditionally include things like educational attainment, housing, transportation options, and neighborhood safety. But some argue that peace, or more often the absence of conflict, should be included in this list as well.

That brings us to 1986, when Canada hosted a World Health Organization (WHO) conference that produced the Ottawa Charter for Health Promotion, in which “peace, shelter, education, food, income, a stable eco-system, sustainable resources, social justice and equity” were listed as the prerequisites for health. Peace is often overlooked when we discuss social determinants of health, perhaps because the focus tends to be on domestic policy change. But when one considers the absence of peace, be it through armed conflict or structural violence, the danger to the health of all in a society becomes clear.[2]

Okay, now let’s bring that all back to National Public Health Week in the U.S. (April 4-10, 2016) and a Peace Festival in Columbus, Ohio (June 6-14, 2016).

Here’s the main thing: a peaceful society exists when individuals have their basic needs met, and when social justice and equity is perceived. Coincidentally, this is also the basic requirement for a healthy society.

What happens when those criteria are not met?

To get a little meta on you, in Chinese medicine it is believed that when the qi of the liver is stagnant due to external stressors (e.g. poverty) people become physically ill, which oftentimes manifests as mood disorders and emotional management issues, particularly anger.[3]  There’s a connection between the external environment/society, physical wellbeing, and mental health.

This non-allopathic viewpoint is sometime dismissed as folkloric, relegating public health and traditional medicinal practices to the banal relics of miasmas.

Until, ooops, this little big-deal study published in The American Journal of Psychiatry in 2015 found that growing up in poverty alters brain connectivity in two critical areas: the hippocampus — responsible for memory and learning — and the amygdala, which regulates emotions and stress. This leaves impoverished children at an increased risk of poor academic performance as well as mental disorders such as depression, even before they are teenagers.[4]

That sure sounds like a recipe for conflict.

So, you can see that public health is a form of preventive public service (like promoting equity and social justice), when you consider the non-health actors like housing and neighborhood safety, which absolutely impact health outcomes.

And maybe you can also see that peace studies are sort of like a form of preventive medicine that you partake in (akin to a vitamin) so that you don’t get sick (or start a war.)

Peace promotion and public health are challenging to implement, mainly because we can’t always neatly quantify the positive impact of prevention, but we do recognize when it fails (e.g. the Vietnam War and the recent Ebola Virus crisis.)

Access to quality education and affordable health care are aspects of public health, but they’re also foundational for a peaceful society.

Give health a chance – just like you give peace a chance.

If you’d like to get involved with National Public Health Week #nphw (April 4-10, 2016) activities sponsored by The Ohio State University have a look here for some options.

 

About the author: Ashley M. Bersani, MPH, CPH is a global health advocacy and policy consultant that focuses on vector-borne diseases and humanitarian issues related to women and children. She received three degrees from The Ohio State University, created an international NGO with partners in West Africa, and actively contributes to the arts community in Columbus, Ohio. Ms. Bersani resides in Victorian Village with her partner, Jon-Pau d’Aversa, and two children.

 

 

[1] http://www.cdcfoundation.org/content/what-public-health

[2] http://www.thinkupstream.net/give_health_a_chance_peace_as_sdoh

[3] http://www.simonlaucentre.co.uk/blog/2010/07/27/qi-stagnation/

[4] http://aplus.com/a/poverty-changes-childrens-brains