Saturday, April 19, 2014
Inquirer Daily News

Nan Feyler

POSTED: Friday, March 14, 2014, 6:30 AM
Filed Under: Kids | Nan Feyler | Violence
What if the doctor counseled this? (

Gun control in the United States is among the most polarizing issues we face. Strong feelings prevail, with few areas of agreement on either side of the issues. But blocking a physician’s opportunity to counsel a family against leaving a gun and ammunition where curious hands can cause terrible tragedies is in no one’s interest. Unfortunately, that’s exactly what at least one state is trying to do.

It's widely understood that physicians play an essential role in counseling patients to reduce their risk of death, illness or injury, whether from smoking, alcohol abuse, unhealthy eating or unsafe sex. Doctors routinely counsel families about car seats, bike helmets, and how to store medicines and cleaning supplies to keep children safe.

The National Rifle Association sponsors the Eagle Eddie Gun Safe Program to promote the protection and safety of children in schools and community groups across the country. According to the NRA website, “The purpose of the Eddie Eagle Program isn't to teach whether guns are good or bad, but rather to promote the protection and safety of children. Like swimming pools, electrical outlets, matchbooks and household poison, they're treated simply as a fact of everyday life. With firearms found in about half of all American households, it's a stance that makes sense.”

POSTED: Thursday, February 20, 2014, 6:30 AM
Filed Under: Kids | Nan Feyler | Race
People who work in public health often see the glass as half empty. Troubling health reports remind us where public health strategies have failed to take hold to prevent lost lives or injuries. Grim health statistics often underscore the number of people living with diseases that could have been prevented with early screening, prompt medical care or lifestyle changes, and injuries that could have been prevented with better safety precautions.

But public health has its share of accomplishments. Vaccination campaigns have eradicated smallpox; clean water and sanitation improvements have dramatically reduced infectious diseases like typhoid and cholera; and anti-smoking ad campaigns, smoke-free laws and tobacco taxes have reduced rates of cigarette smoking to their lowest level, saving thousands of lives each year.

And improvements in motor-vehicle safety through engineering of safer cars and highways and successful efforts to change driving and passenger behavior have contributed to large reductions in motor-vehicle-related deaths.

POSTED: Tuesday, July 16, 2013, 6:30 AM
Filed Under: Ethics | Nan Feyler | Obesity

At its recent annual meeting, American Medical Association (AMA) delegates rejected the advice of their own Committee on Science and Public Health and voted to reclassify obesity as a disease rather than a condition or disease risk factor. 

Proponents believe that this reclassification by the nation’s largest physician organization will improve medical providers’ attitudes toward obesity, increase funding for research and treatment and improve patient care.  A substantial body of research has found overweight and obesity are associated with many serious health problems including: type 2 diabetes, coronary heart disease, and cancer.  Rather than seen as a personal failure, obesity will be seen as a disease resulting in greater attention paid to its medical consequences by the medical profession

Others are concerned this will increase unnecessary and costly pharmacological and surgical treatments and will lead to overtreatment of people based on their Body Mass Index (BMI) rather than objective health indicators.  While co-morbidities generally increase with increased BMI, there are many healthy overweight and obese individuals, who in some cases fare better than their lower weight counterparts.  For example, in a study  looking at cardiovascular risk based on BMI in 5,440 U.S. adults,  23.5 percent of normal-weight adults had cardiovascular abnormalities, while 51.3 percent of overweight adults and 31.7 percent of obese adults were metabolically healthy.  Some critics are concerned that the disease label will further stigmatize a group of people who already face pervasive discrimination and will result in physicians overlooking other serious health conditions unrelated to a patient’s weight.

POSTED: Tuesday, April 9, 2013, 6:30 AM

In just a few weeks, the City of Brotherly Love will welcome the third annual Philadelphia Science Festival — a 10-day-long, citywide celebration of science that features lectures, debates, hands-on activities, special exhibits, and a host of other science-related programming coming to a museum, bar, or random space near you.

We here at The Public’s Health will be participating in two events this year. On Friday, April 19 at 6 p.m. we will be hosting a discussion called Blogging and Beer: Public Health in Philadelphia. Our editor at the Inquirer, Don Sapatkin, will be joining us, as will some of our regular contributors. We expect to have a lively conversation at  Rembrandt’s Restaurant in Fairmount. If you want to participate and enjoy good food and drink, please come! There is no cover charge.

On Thursday, April 25 at 7 p.m. I will also be participating in a wacky evening that is appropriately titled Sounds Made  Up: Tales  from the History of Science.   It brings historians and comedians together at The Chemical Heritage Foundation at the edge of Old City to dramatize, in the silliest way possible,  absurdities from the histories of science, medicine and public health. Last year’s rather risque event —  the video above is from the year before — saw discussions of a medieval women birthing a cat, zombies, the history of the banana, and a discussion of Alfred Kinsey’s toothbrush.

POSTED: Tuesday, April 2, 2013, 6:30 AM
Filed Under: Food | Kids | Nan Feyler | Nutrition | Obesity

In the wake of the New York State Supreme Court striking down New York City’s ban on sodas larger than 16 ounces, a surprising op-ed appeared in the New York Times. The essay encouraged New York City, despite the ruling, not to give up trying to limit the aggressive marketing tactics of big food companies and the soda industry. The surprise, however, was not the sentiment – after all, many public health leaders applaud Mayor Bloomberg’s latest effort to address obesity by regulating sales of super-sized sodas.

The op-ed, it turns out, was written by a former food industry insider, Kraft Foods executive Michael Mudd. Mudd had left the industry when he could no longer accept, as he called it, “a business model that put profits over public health.” Mudd argues that it is big food processors and soft drink companies who are the most culpable for the growth in obesity. “Over the years, relentless efforts were made to increase the number of eating occasions people indulged in and the amount of food they consumed at each. Even as awareness grew of the health consequences of obesity, the industry continued to emphasize cheap and often unhealthful ingredients that maximized taste, shelf life and profits,” he wrote.

Selling food and beverages to kids is big business. According to a recent Federal Trade Commission report, the food and beverage industry, including fast food restaurants, spent 1.79 billion dollars in 2009 to sell products mostly low in nutrition and high in calories, sugars, salt and fats to America’s children. Seventy-two percent of this was spent on fast food restaurants, carbonated beverages and breakfast cereals.

POSTED: Friday, January 4, 2013, 6:30 AM
Filed Under: Environment | Funding | Kids | Nan Feyler
Click here to print coloring book illustrating lead-safe work practices on a home with lead paint.

Nan Feyler is chief of staff for the Philadelphia Department of Public Health.

By Nan Feyler

Lead poisoning of children continues to be a serious health problem – and one that science has linked to lower and lower levels of exposure even as government has opted for greater and greater cuts in prevention programs.

POSTED: Wednesday, November 28, 2012, 6:30 AM
Filed Under: Kids | Nan Feyler | Smoking

Nan Feyler is chief of staff for the Philadelphia Department of Public Health.

By Nan Feyler

Exposure to secondhand smoke is dangerous, especially to infants and children. Secondhand smoke can impact children’s lung growth and pulmonary functions. It can cause sudden infant death syndrome (SIDS), respiratory illnesses, ear infections and more frequent and severe asthma attacks.

Smoke-free laws have significantly reduced exposure to secondhand smoke. Philadelphia’s Clean Indoor Air Worker Protection Law banned smoking in Philadelphia’s restaurants, bars and workplaces in 2007. Last year, Philadelphia implemented a 100 percent smoke-free policy for all city recreation centers, pools and playgrounds. A handful of other places have followed suit, including Cherry Hill this week.
But what about homes? The home is now becoming the predominant location in the United States where children as well as adults are exposed to secondhand smoke. A recent survey conducted by the Annenberg Public Policy Center (not yet published) found that slightly more than half of Philadelphia households with a smoker and a child under 13 allowed smoking in the home. Another study, of low income children with asthma in Baltimore, found evidence of significant exposure to secondhand smoke in younger children, children with a higher number of household smokers, and homes without complete smoking bans (as well as homes where a caregiver reported symptoms of depression and there were more than moderate levels of daily stress).
Families face practical barriers to enforcing a smoke-free household rule. Tobacco is an addiction, and smokers struggle with limiting or curtailing their habit; when the weather makes smoking outdoors uncomfortable, or if there are no good or safe places to smoke outside, they will do it in the house. A caretaker who smokes may be deterred from going outside where he or she cannot supervise the children, or would need to bundle them up to leave the house together. People report reluctance to engage in conflict with smokers who live in the house or visit. Living in a home owned by a relative who smokes can make a smoke-free rule impossible to enforce.
It may come as no surprise that heads of households who overcome these barriers credit their own motivation and commitment. In one study, participants who were able to establish smoke-free homes said they were motivated foremost by concern for the health of their children. Quitting smoking, contemplating quitting, and smoking less often went along with their decision to prohibit indoor smoking for others. Some changed their habits to increase the amount of smoking they did outdoors, ended a relationship with a smoker, or moved out in order to establish a smoke-free household.
Determining the best strategy to reduce the health risks associated with secondhand smoke at home raises complex issues. What should be the government’s role in reducing smoking in private homes or cars, especially when children’s health is at stake? Increasingly, evidence shows a health threat from smoking in an adjacent housing unit, like an apartment, where toxins from secondhand smoke seep through walls, ductwork, windows, and ventilation systems. Should smoke-free laws be extended to include multiunit private housing? Should smoking in a car be banned when children are present?
Alternatively, what kind of encouragement would help people voluntarily ban smoking on their own? Given the challenges of adopting a smoke-free home, is there value in supporting families who take a gradual, more incremental approach – starting small, say, by not smoking in front of children or establishing a single smoke-free room – as worthwhile steps on the path to going entirely smoke-free? Or does this confuse the message because only a total ban on secondhand smoke will protect children’s health?
For specific suggestions, download the New York City Department of Health pamphlet, "How to Make Your Home Smoke-Free.
Public education is critical. In the U.S. and elsewhere, media campaigns focused on secondhand smoke have successfully reduced exposure to secondhand smoke and promoting quitting among adult smokers. Pediatricians can also play an important role in helping parents understand the risks – to their children’s health – of their own habit.
It’s worth taking a moment to applaud the recent news that smoking among adults in Philadelphia decreased from 27.3 percent in 2008 to 23.5 percent in 2012,a drop that works out to 15 percent – and 40,000 fewer smokers. While the rate of smoking in in the city is still well above the19.3 percent national average, this is real progress and everyone who has successfully quit smoking should be congratulated. (Rates vary significantly from neighborhood to neighborhood, as shown in this interactive map of smoking rates in the city and Pennsylvania suburbs.) As every former smoker knows, quitting is not easy – but success is possible.
If you are a smoker, the single best way to protect your family from secondhand smoke is to quit. For help, call the Pennsylvania Free Quit Line at 1-800-QUIT-NOW, or go to,where there are a range of services to help smokers stop once and for all. In the meantime, enforcing smoke-free policies at home will protect the health of other adults and children living there. And smokers who have instituted smoke-free home rules are significantly more likely to quit or to smoke fewer cigarettes per day. Restricting smoking also sends an important antismoking message to your children.
So, while policymakers grapple with the public health goal of reducing secondhand smoke exposure, there is a clear role for the smokers, too: Keep trying to quit! You can do it. And while you’re thinking about it, do what you can to avoid exposing others – especially children – to your cigarette smoke. For inspiration, check out this video.

POSTED: Tuesday, October 30, 2012, 6:30 AM
Filed Under: Ethics | Funding | Nan Feyler
Staples Pink Ribbon Stapler

Nan Feyler, chief of staff for the Philadelphia Department of Public Healthis a member of an expert panel intended to expand the breadth of The Public’s Health.

By Nan Feyler

Since 1985, October has been designated a month to promote breast cancer awareness, share information on the disease, and provide greater access to related services. For some, it is a time to reflect on family members and friends who have died from  breast cancer; an opportunity to raise money for breast cancer research and treatment, or a chance to join in solidarity in the fight against breast cancer. For others it is a month of endless pink – pink water in public fountains, buildings awash in soft pink lighting, pink-adorned cheerleaders with pink pom poms and lots of merchandise emblazoned with a pink ribbon – that they see as evidence of the commercialization of a disease that science is still struggling to understand, and is far from preventing.

About this blog

What is public health — and why does it matter?

Through prevention, education, and intervention, public health practitioners - epidemiologists, health policy experts, municipal workers, environmental health scientists - work to keep us healthy.

It’s not always easy. Michael Yudell, Jonathan Purtle, and other contributors tell you why.

Michael Yudell, PhD, MPH Associate Professor, Drexel University School of Public Health
Jonathan Purtle, MPH Doctoral candidate and Research Associate, Center for Nonviolence and Social Justice, Drexel University
Janet Golden, PhD Professor of history, Rutgers University-Camden
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