In the Spotlight
The Lerner Center for Public Health Advocacy's In the Spotlight series features stories highlighting notable advocates from Johns Hopkins Bloomberg School of Public Health.
Co-Founders of the Center for Public Health Advocacy - August 2020
Student Initiative uses Federal Register to Advocate for Change on Rule Depriving Asylum Seekers of Humanitarian Protection in the U.S.
Using the Federal Register, students from the Johns Hopkins Bloomberg School of Public Health and School of Nursing are pushing back on a proposed regulation that would bar asylum seekers from humanitarian protections in the U.S., purportedly to protect public health during the pandemic.
The Rule, entitled ‘Security Bars’, would grant the U.S. Department of Homeland Security and the Department of Justice -- security agencies that have no clinical or public health mandate or expertise -- the authority to assess whether individual migrants or asylum-seekers present a threat to national security on the grounds of their health. It would give these agencies sweeping powers to deport people seeking protection using vague criteria and is in violation of national and international legal obligations.
The Rule would bar asylum seekers who were exposed or infected with COVID-19 from the U.S. This could lead to the deportation of people who contracted the illness in crowded, unhygienic detention facilities and, potentially, the removal of migrant health professionals working to end the COVID-19 pandemic in the U.S.
This Rule is disproportionate to the threat posed and discriminatory, and not written with public health principles in mind. In response, Johns Hopkins Bloomberg School of Public Health professors Leonard Rubenstein, Paul Spiegel, and Joshua Sharfstein worked with students to draft and submit comments to the Federal Register, a platform where feedback on the Rules of federal agencies is shared before they become policy.
Students participating in this effort attended a preparatory webinar and workshop, reviewed relevant scientific literature, and drafted and submitted comments to the Federal Register. The students were among more than 5,000 other individuals and groups who submitted comments on the ‘Security Bars’ rule. Their comments contributed to a broader effort by clinicians, public health practitioners, and rights advocates alike who aimed to see this regulation withdrawn.
At a November webinar hosted by the Bloomberg School of Public Health Office of Public Health Practice, “The Who, What, and How of Submitting Comments to the Federal Register”, students shared insights from this experience and explored different ways to use evidence to drive advocacy with fellow public health students and professionals.
“It was encouraging to see such a large turnout for this webinar. This experience really highlighted the diversity of individuals who are eager to make an impact in public health,” said Karen Lin, a Doctor of Nursing Practice student at the Johns Hopkins School of Nursing who was one of the three students presenting on the panel. “It also showcases the need for interprofessional collaboration across disciplines to address public health challenges. I hope there will be more opportunities for students of different disciplines to work together to tackle public health issues locally and abroad.”
“At the heart of public health is a concern for equity and justice; in contrast, this proposed rule uses public health as a pretext to deprive asylum seekers of their rights,” says Sandra Smiley, a Master of Public Health student involved in this initiative. “It’s important that we, as public health and health care professionals, are equipped to identify discriminatory policies that misuse or ignore public health science and use evidence to push back.”
On December 23, 2020 the Rule was finalized with only a few minor changes. The Rule was originally intended to take effect on January 22, 2021 and was delayed until March 22, 2021 to allow President Biden’s appointees time to review it. As U.S. migration policies are reviewed and revised in the Biden Administration’s early days, public health professionals will continue to advocate for approaches that are ethical, equitable, and grounded in science.
Translation of Research to Policy: Virginia Firefighter Disease Presumption Laws
A policy analysis by researchers from the Johns Hopkins Bloomberg School of Public Health helped inform legislative changes in the 2020 Virginia General Assembly session by revising Virginia’s fire fighter compensation system, including disease presumptions. Under worker’s compensation policies, ‘disease presumptions’ attribute the development of certain conditions or diseases to an individual’s employment.
First responders, including firefighters, are critical to protecting the public’s health and safety during fires, natural disasters, and emergency situations; thus, protecting the health of first responders is imperative. However, Virginia's workers' compensation policies and case laws placed undue burdens on firefighters including documentation requirements of carcinogenic chemical exposures and requiring 12 years of continuous service to be eligible for workers’ compensation.
Under contract with Virginia’s Join Legislative Audit and Review Commission, researchers assessed Virgina’s occupational disease presumption policies-- policies that place responsibility on the worker to prove their health condition is a result of occupational exposures instead of the employer to prove working conditions were not a contributing factor to the health condition. They assembled and interpreted the scientific literature on first responder health and disease risk to inform revisions to Virginia’s worker compensation laws and reviewed health outcomes and worker’s compensation requirements for firefighters to claim cancer presumption. As a result, two major bills were passed into Virginia state law:
Changes to cancer presumption including:
- Added colon, brain, and testicular cancers to the list of cancers presumed to be caused by firefighting.
- Removes the toxic exposure requirement (that required firefighters show the specific substance to which they were exposed that could have caused their particular cancer).
- Reduced the years of service requirement from 12 years to five years.
- Removed the requirement that the years of service be continuous.
Changes to cardiovascular disease presumption:
- Added a 5-year service requirement to be eligible for the cardiovascular disease presumption.
- Made PTSD a compensable injury under the Virginia Workers' Compensation Act if it meets certain conditions.
The team of Bloomberg School researchers included faculty Mary Fox, Wendy Shields, Beth Resnick and Thomas Burke from the Department of Health Policy and Management and doctoral candidate, Kelsey Babik, from the Department of Environmental Health and Engineering.
Co-Founders of the Center for Public Health Advocacy
Jose “Oying” Rimon II and Beth Fredrick, the Co-Founders, and original co-directors of the Center for Public Health Advocacy built the center with a strong vision: to train public health professionals to be as skilled in advocacy as they are in science and research. They saw that few academic institutions incorporated advocacy research, training, and practice into their curricula in a systematic way and many were not meeting the demand for the skills and knowledge needed to engage in strategic public health advocacy.
The Johns Hopkins Bloomberg School of Public Health launched the Center for Public Health Advocacy in December 2016 after years spent building support and laying the groundwork for this unique, interdisciplinary initiative. The creation of the center helped to elevate the importance and visibility of advocacy across the school. Under Rimon and Fredrick’s leadership, the center introduced the Certificate in Public Health Advocacy and graduated 15 students from the program. The center also led a Distinguished Speaker Series, featuring high-level advocates and leaders including, retired U.S. Senator Barbara Mikulski, the longest-serving woman in the history of Congress, and Mark Suzman, the CEO of the Bill & Melinda Gates Foundation.
Rimon and Fredrick still serve as valued advisors to the center. Rimon is the Director of the Bill & Melinda Gates Institute for Population and Reproductive Health at JHSPH. He is also a senior scientist with the Department of Population, Family and Reproductive Health. An internationally recognized leader in behavior change, Rimon has more than 30 years of leadership experience in public health. From 2008 to 2012, he was a senior officer in the Global Health Policy and Advocacy group of the Bill & Melinda Gates Foundation leading the policy and advocacy portfolio on family planning, maternal, neonatal and child health and nutrition. Prior to joining the Gates Foundation, he was a founding member and the senior deputy director of the Bloomberg School's Center for Communication Programs where he led health behavior and knowledge management programs in more than 50 countries in Asia, Africa, and the Near East. He was also director of the Health Communication Partnership, USAID’s $200M flagship health and behavior global program.
Fredrick is a lifelong advocate. For over three decades she has worked to advance sexual and reproductive health and rights in the United States and globally. She is the executive director and co-principal investigator of the multi-country Advance Family Planning advocacy initiative with the Bill & Melinda Gates Institute on Population and Reproductive Health with the School. For 11 years the initiative has supported evidence-based, locally driven advocacy, working in partnership with African and Asian governments and corporations. She serves on the faculty of the Department of Population, Family and Reproductive Health, teaching and lecturing on abortion and family planning advocacy. She has held leadership positions and supported advocacy efforts within the Center for Communications Programs, the International Women’s Health Coalition, and for 21 years, the Guttmacher Institute. Fredrick has spearheaded numerous initiatives to support sexual and reproductive health and rights advocacy in the United States and internationally. She was a Bell Fellow with Harvard University and adjunct faculty with the New York University Robert F. Wagner Graduate School of Public Service. She has served on the boards of Ibis Reproductive Health and ScenariosUSA, and now serves on the board of EMpower, a grant-making organization which supports youth programs in emerging markets, and the U.S. board of the Asian-Pacific Resource and Research Centre for Women.