August 4-10, 2005
city beat
TEMPERATURE RISING: As soon as Joanne Godley assumed her new position at the Health Department, the heat was on. Photo By: Manuel Dominguez Jr  |
|
Joanne Godley, Philly's new health commissioner, wants Philly to open up and say aah.
On July 23, Dr. Joanne Godley, M.D., M.P.H., became acting commissioner of the Philadelphia Department of Public Health, replacing the retiring John Domzalski. Prior to her appointment, Godley served as medical director for PDPH, and before that, worked as an administrator for the Peace Corps in Africa. We asked the new commissioner about her time overseas, as well as what her plans are for some of the health risks facing Philadelphians — including one you may not be aware of.
City Paper: For three years, you oversaw the health care of Peace Corps volunteers stationed [in Africa]. Some of them were trying to administer health care or encourage health care for Africans. Did that affect how they thought about getting health care themselves?
Joanne Godley: [The volunteers] lived at the level of the community, so they were usually based in villages, and ate the same food. They lived on the level of a person that they would be expected to be working with. What tended to happen over a period of about 6 to 12 months is that they tended to view themselves as more like the villagers than like Americans, so they were less inclined to take prevention methods, to use condoms, to purify their water, or to take their malaria prophylaxis.
CP: You're not going to bring in the next class of volunteers if 80 percent of the previous class got malaria.
Godley: Right. But it was a constant dynamic, because they'd look at their African counterparts and say well, he doesn't take daily malaria prophylaxis, and he seems to be fine.
CP: Was there also an element of guilt involved?
Godley: On some level I think that's probably true, although I don't think that was explicitly articulated.
CP: Are there lessons from your experience there that apply to Philadelphia?
Godley: Oh, surely. Prevention — trying to get people to buy into prevention — is the same no matter what population of people you're talking about.
CP: You took over the Health Department, essentially, in the middle of a heat wave.
Godley: I would not use the words "take over." I assumed my position in the middle of the hottest days of the summer thus far, that is true.
CP: Do you have any sense of how well the department's response worked? What can you do better next time?
Godley: One thing that we did notice is that there is an increase in calls to [our] heat line that seems to be directly correlated with how the TV stations broadcast that the heat line is activated. Now, [the stations] are doing a ticker tape scrolling across the TV, with other counties' heat line numbers. Philadelphia's sort of gets merged in with everyone else's. Our ideal would be to have the heat line number be something that everyone is aware of. We're going to work on that for next year.
CP: What's the number?
Godley: 215-765-9040.
CP: Is that something you might consider changing? Does the number spell anything? Is there a mnemonic device?
Godley: That's a good question. We'll credit you with the idea. Something like 215-GO-HEAT or something.
CP: In 1999, Philadelphia was one of six cities with better than 80 percent immunization rates for children. Are we still doing well?
Godley: We're way past that. Our goal is 85 percent by fiscal year '06, and 90 percent by fiscal year '10, which we think is very doable. One of our initiatives that we think has contributed to the success has been partnering with community-based organizations to get to those communities where the rates have been lower in the past.
CP: Who's still not getting immunized, and why?
Godley: It usually relates to families that have not established an ongoing relationship with a particular physician or clinic. And so what the community-based organizations are doing is actually linking a particular family with a particular neighborhood clinic. It ends up benefiting not just the vaccine rates but also the family.
CP: About a year ago, the Health Department came under fire for its position on co-sleeping [the practice of a parent sleeping in the same bed with an infant]. You went on record saying that co-sleeping wasn't a danger, that it was a matter of cultural preference, and that the department should leave it alone. The department eventually modified its position to advise against co-sleeping.
Godley: That's not exactly what I said. My position and the department's position is that there is a risk of rolling over onto an infant when one co-sleeps. There have been a number of roll-over deaths. The number should be zero, because that is a preventable type of death. In order to get that number to zero, we have a challenge of educating people about co-sleeping.
CP: What does it mean to educate them?
Godley: The American Academy of Pediatrics recommends that the safest place for an infant to sleep is face up in a crib.
CP: Where do you stand on the smoking ban proposed by Councilman Nutter?
Godley: I am in support of no smoking, as a physician and as a public health person. I think that politicians have a challenge in terms of working out how a public smoking ban gets implemented.
CP: You've spent some time studying racial disparities in health outcomes. In addition to socioeconomic disparities, you've argued that the stress of experiencing racism can be detrimental to one's health.
Godley: The stress of undergoing chronic, recurring confrontations with racism can have an impact on a person's health. For example, there's a study that was presented at the American Heart Association meeting in Chicago in March which showed that there was a correlation between women who reported having frequent episodes of racial situations and the amount of atherosclerotic heart disease in those individuals. Racism is thought to be a stressor, and with chronic stress, there are serum-cortisol levels that go up. Cortisol is the stress hormone that's elevated when you have a fight-or-flight situation.
CP: Is racism distinct from other stressors in having that effect?
Godley: There are some studies that are ongoing to try to tease out poor environmental living situations, the amount of violence in one's neighborhood, so it is difficult to piece out one particular social event.
CP: We're going to give you space to get a message out. What's it going to be?
Godley: Goodness, I hope I've been giving out messages all along. One of the things I hope to ratchet up is more of an emphasis on primary prevention. We have other programs that handle secondary prevention. Our lead paint approach (prosecuting delinquent landlords) is secondary prevention. It's been extremely successful and we plan to continue our efforts. But we also want to emphasize primary prevention, which is going into the home and doing a lead wipe before a baby is able to crawl on the floor and ingest the dust and lead chips, so that things are remedied before there's a problem.
-- Respond to this article in our Forums -- click to jump there
