Public Health Issues

Abstract

The subject of public health conjures up myriad issues. In this paper, some of the most salient issues are addressed. First, there is a growing crisis in America over the issue of healthy weight. Americans are also increasingly concerned about the problem of environmental change—toxins in air, water, and foods; climate change affecting weather patterns; the threat of secondhand smoke; and buildings that are so toxic, they are called "sick buildings." In addition to these concerns, superbugs and pandemics that can potentially threaten the health of millions have begun to appear. These diseases can also be spread through another contemporary threat—bioterrorism. The concern is how much is known about this threat and what can be done about it. In the end, it may come down to effective health education—educating Americans about what's out there, how to keep healthy, and what to do in the case of health threats.

Overview

Public Health Issues. There are numerous issues that could be included in an overview of public health. This paper presents some of the most pressing issues facing the American public. The existence of so many health issues is due to the complexity of the lives we lead and the changes taking place in our environment. The interconnection between environmental changes and human health problems are making it difficult for governments and policy makers to come up with effective solutions. In order to address these issues, the environmental problems must be effectively dealt with, but at the same time, there must be practical and appropriate measures to protect the public's health.

In addition to environmental problems, Americans are facing an enormous problem with the growing threat of obesity. Not only adults but children are gaining weight in record numbers. The use of sugar and fats in a wide range of products means that people ingest far too much of this combination of ingredients.

The final part of the picture is health education and the ways the public can learn to adopt healthy behaviors and healthy lifestyles.

Obesity. There is a growing threat from obesity in America. A startling number of both adults and children are not just overweight but dangerously obese. The lifestyle we lead is increasingly sedentary. Fewer kids walk to school; they are driven by their parents, or they take the bus. At school, they sit all day and eat during lunchtime. When they return home, they sit in front of the television or a computer. For adults, it is very much the same. Many people spend an enormous amount of the day sitting at desks with little opportunity for exercise.

According to Oliver & Lee, health policy experts have recently sounded the warning about the severe health and economic consequences of America's growing rates of obesity. This concern appears to resonate with much of the American public. In 2006, the Pew Research Center found that 8 percent of surveyed American adults were dieting, 40 percent were exercising to lose weight, and 17 percent were attempting to do both. Of those who reported being overweight, 47 percent were then dieting and 53 percent were exercising. Despite this, respondents also indicated ongoing dissatisfaction with their weight and many reported needing to get more physical activity (Pew Research Center, 2006).

The problem, unfortunately, goes far deeper than overeating and too little exercise. It is also a result of the ways foods are manufactured, with far too much sugar and unhealthy fats, and data from a study by Gearhardt, Grilo, DiLeone, Brownell, and Potenza (2011) suggests that certain “hyperpalatable” foods may even have addictive qualities. Obesity is gaining recognition as a serious problem, although it has been building for a long time. Additional factors include lack of public education as to reading and understanding ingredients and labeling of foods and the fact that healthy foods tend to be more expensive and there are populations of people who do not have access to healthy foods (e.g., the urban poor, the homeless).

Perhaps even more disturbing is the growing trend in obesity in kids. With obesity comes a long list of health problems including heart disease, diabetes, musculoskeletal problems, cancer, and the possibility of a decreased life span. According to the US Centers for Disease Control and Prevention (CDC), 36.5 percent of American adults and 17 percent of children and teens were obese in 2011–2014 (Ogden, Carroll, Fryar & Flegal, 2015). The CDC and state governments have implemented a variety of programs and initiatives to promote fruit and vegetable consumption, physical activity, and breastfeeding, and to discourage the consumption of sugary drinks and high-calorie foods, especially in schools and workplaces (National Center for Chronic Disease Prevention and Health Promotion, 2011). Such efforts may be having a positive impact, as the rate of obesity among low-income preschoolers declined in nineteen states of forty-three surveyed states between 2008 and 2011 (National Center for Chronic Disease Prevention and Health Promotion, 2013). However, much work still needs to be done.

Social Effects. Obesity costs the United States billions of dollars in health care costs. It is connected to myriad health problems, and these problems, in turn, must be dealt with. The question is: what do we do about the problem of obesity in America? The Pew Research Center for the People and the Press (2013) found that a slight majority (54 percent) of surveyed Americans disfavor government intervention in the fight against childhood obesity, although 69 percent agree that obesity is a major health concern and 61 percent believe that government policies can reduce obesity. Americans are supportive of some sanctions and unsupportive of others. The Pew findings show widespread support for requiring restaurant chains to list calorie counts on menus (67 percent) and banning commercials for unhealthy foods during children’s television programming (55 percent), but trans fat prohibitions in restaurants met 52 percent opposition; taxing snacks and soft drinks, 64 percent; and limiting soft drink sizes in retail establishments, 31 percent. It is entirely possible that stringent measures and tougher policies are going to have to be instituted in order to help the country combat the epidemic of obesity that threatens its adults and children.

The Environment & Public Health. It might seem obvious that the environment could pose potential health problems to the public. After all, the subject of pollution and the decreasing ozone layer are nothing new. However, the growing specter of climate change must be added to the mix, as well as a relatively new phenomenon—sick building syndrome. Another concern is toxins in our drinking water. That water we take for granted that pours out of our kitchen faucet might be more dangerous to our health than we realize.

Poor Drinking Water. Research has begun to appear about the concern for pharmaceuticals, chemicals from personal care products, pesticides, and hormones, among other chemicals in our drinking water. While steps have been taken for some time to improve the quality of our drinking water, not all municipal water treatment facilities have the capability to removal these contaminants of emerging concern (CECs), as the Environmental Protection Agency (EPA) terms them. The EPA reports that “treated drinking water is disinfected to inactivate and/or remove pathogens. Like municipal wastewater treatment plants, although drinking water treatment plants are not designed to remove CECs; however, removals do occur. The extent of removal varies with the specific CEC and type of drinking water treatment” (2010, p. 2). Marhaba notes that "such compounds . . . may accumulate in the environment. Although the concentrations of these compounds in drinking water are low today, their eventual impact on public health should not be ignored" (2008, p. 20).

Public concerns over the safety of drinking water has led to a boom in the business of bottled water. Yet some suggest that even bottled water is not necessarily safe; all bottled water is not equal. Marhaba (2008) warns that bottled water could be even less healthy than tap water: "Be very careful about drinking bottled water. First, purchase only bottled water from deep aquifers not impacted by pharmaceuticals. Not all bottled water comes from deep aquifers, so read the small print carefully" (p. 20).

Climate Changes. A host of environmental problems connected to climate change or global warming will not only affect water but many other aspects of our lives as well. There is generally a scientific consensus that the world's climates are changing. Of course, climate has affected human existence for millennia:

Weather and climate have been known to affect human health since the time of Hippocrates. Heat causes hyperthermia, cold causes hypothermia and droughts cause famine. Injuries, displacement, and death result from floods, hurricanes, tornadoes and forest fires. An entire category of diseases—the tropical diseases—is named for a particular climate; climate and weather affect the distribution and risk of many vector-borne diseases, such as malaria (Frumkin et al., 2008, p. 435).

The international media is reporting life-altering droughts in places such as Australia, where the weather has been predicted to steadily worsen. There have also been reports of the loss of ice in Antarctica, where the ecosystem is undergoing a radical change. As the earth's climate changes, we will have to respond, but in the meantime, there may be consequences to public health that could be next to impossible to cope with. There could be large-scale famines and loss of animal and plant life, not to mention the continued rising cost of food.

The effects of greenhouse gas emissions on the earth's climate have been debated for some time; more recently, the concern over what we can do has set in. As difficult as it is to accept, these climactic changes will spell long-term difficulties for the public's health. Frumkin et al. report that "changes in the patterns of pests, parasites, and pathogens affecting wildlife, livestock, agriculture, forests, and coastal marine organisms can alter ecosystem composition and functions, and changes in these life-support systems carry implications for human health" (Frumkin et al., 2008, p. 435).

These climactic changes create the necessity for public health preparedness. The federal and state governments must develop protocols in order to deal with the ramifications of these massive changes. For example, longer, hotter summers may sound nice to some who live in cold climates. But they can be difficult too. Many people do not cope well with heat, and it also changes the cycles of local flora and fauna. One of the strategies that Frumkin et al. (2008) suggest is a public impact assessment. Governments should study how these long-term weather changes will affect people and the environment. They point out that even one environmental change can have huge results for public health. For example, if we can reduce greenhouse gases, we can improve air quality, thus reducing respiratory disorders.

In 1994, the American Public Health Association developed the 10 Essential Services of Public Health in order to coordinate local, state, and federal responsibilities to cope with serious health care issues (Frumkin et al., 2008). However, one problem with climate change is that it will continue to take place over a long period of time. Even if we are able to respond effectively in the present, it may not be enough to stem all of the changes that may (or may not) take place.

Bioterrorism. While some would suggest that the events of September 11, 2001, aroused our fear and concern around possible acts of terrorism, the fact is the world's population has been living with terrorist acts for a very long time. The difference is in the weaponry available and the reasons for committing acts of terrorism. Historically, terrorism has been used to subdue cultures and enslave people. In the twentieth and twenty-first centuries, it seems to be almost exclusively to incite fear. Certainly, the specter of September 11 hangs over the heads of Americans every day. Yet, while the thought of such a large-scale attack is frightening, an even more damaging attack could take place using biological or chemical weapons. It is not only the weapons that are at issue here, but the seemingly increased preponderance for violence in our world. Some see it as a response to the rising tensions of a world with too many people and too few answers for how to address everyone's problems. In some cultures, a person is defined as a terrorist abroad, but at home he or she is hailed as a hero and a freedom fighter. It can be difficult to gain perspective on this highly complex issue. Nevertheless, the threat of bioterrorism is real, and it could truly be dangerous to public health.

The first issue that relates to public health is preparedness. How prepared are the cities in America for a bioterrorist attack? To be prepared means to have a solid plan in place that will mitigate the ramifications of such an attack. This means that first responders (professionals who work in emergency services) have to be thoroughly trained and have the necessary equipment. It also implies that vaccines and other treatments should be available, and there needs to be way to get them to the people who need them as quickly as possible.

Bioterrorism is still a relatively new concept and as such "our lack of experience with biological attacks leaves considerable room for controversy regarding the magnitude of their threat…" (Epstein, 2008, p. 357). Bioterrorism would not exist if it were not for the continued development of new and exciting technologies meant to benefit humankind. Unfortunately, like nuclear energy, which can also be used in a positive or negative way, such technology has devastating negative applications as well.

Hellmich and Redig (2007) believe that a bioterrorist attack may be inevitable. However, understanding the ways in which terrorist organizations work and the ideology behind their acts may help us to ward off these attacks and to be more prepared in case they do occur. From a public health perspective, bioterrorism is the kind of health threat that would have enormous ramifications. Therefore, we must develop a greater understanding of the ways in which various biological organisms function and how they can possibly be used in such a fashion. There must also be tight controls on the professionals who work with these substances in order to prevent people from selling the scientific data and components that can make such an attack possible.

Viewpoints

Public Health & Education. One of the keys to coping with these critical issues is to provide ongoing, effective public health education. However, the ability to provide that education is an ongoing issue. First, there are financial considerations—updating websites, writing, printing, publishing, and disseminating literature, and providing ongoing education for health care professionals and community services costs a great deal of money. Second, there are continually new public health issues to deal with. Fee and Bu remind us,

Global public health in the beginning of the 21st century has been threatened by SARS, avian influenza, wars and bioterrorism, to name but a few dangers. To deal effectively with new as well as existing public health challenges would seem to require an international army of qualified public health workers, as well as an educated public mobilized to deal with health hazards (2007, p. 977).

Another issue in public health education is the socioeconomic gap between rich and poor. Not everyone is capable of accessing the same array of information on an equitable basis. Public health is not only about responding to crises, but also about promoting health and healthy practices such as proper hygiene, nutrition, and exercise. How prepared are we to provide the public health education necessary to address the complicated issues of contemporary society? "The challenge is to scale up the production of public health professionals with appropriate skills and competencies" (Petrakova & Sadana, 2007, p. 964).

In 1997, the Partners in Information Access for the Public Health Workforce was formed to aid in the training of workers and the necessary dissemination of health information. Some of the key issues they have worked on include responses to HIV/AIDS, children's environmental health, creating 'e-learning' solutions (wired communities), public health outreach projects, and the Healthy People 2010 Initiative (Cahn et al., 2007). As new health concerns arise, as well as to address some long-standing health concerns, there is always a need to update the public. Without this information, people can make incorrect assumptions about what to do with respect to a specific health concern. The public must always have access to credible, up-to-date information in a meaningful and user-friendly way (Cahn et al., 2007).

A key element to keeping the public informed is to continually update the training and skills of the nation's health care professionals. New training modules (and models) as well as publications must be continually developed and disseminated in order to provide them with the training they require. "A secondary goal is to build collaborative relationships among health librarians and health education specialists to improve planning, implementing, and evaluating disease prevention or health promotion programs in their regions" (Cahn et al., 2007, p. 305).

To promote healthy lifestyles, proper nutrition, maintaining a healthy weight, communicate how to deal with a health crisis, and address other key issues, there must be a considerable effort devoted to developing and maintaining the resources that can support people in these endeavors. One goal is to provide the critical information, but this must be balanced with the support services to help make these goals a reality. Public health education requires vision and balance. Both of these will be necessary to keep America healthy and informed through the twenty-first century.

Conclusion

There is probably no age in human history that has not witnessed its own worries over public health issues. In the Middle Ages, it was the bubonic plague. Later, diseases such as polio, cancer, multiple sclerosis, and many others have presented. While there is still no cure for many of these conditions, we manage them better and research is progressing. In many ways, humanity has become its own biggest health threat. We have overpopulated the planet, depleted resources, hunted animals to extinction, poisoned our waters with pharmaceuticals and other toxins, and, many believe, created almost irreversible damage through global warming and climate change.

Public health education is not as straightforward or simplistic as it used to be. It is no longer about simply washing one’s hands, eating one’s basic diet, and getting a good night's sleep. While these three concepts remain important, the complexity of our lives must be matched by public health education that can address these issues on a practical level that people can understand.

Terms & Concepts

Bioterrorism: The term for terrorism through the use of a biological agent such as bacteria or a virus.

Flora and Fauna Flora are plants that are all of the same region or period considered part of a group. Fauna are animals of a region or period that are considered part of a group.

Global Climate Change: In its simplest definition, the changes in the earth’s climate patterns generally considered to be a result of gradual increasing temperatures of the earth’s air and water. The extent to which human activity contributes to global warming and climate change remains the subject of much debate.

Greenhouse Gases: Gases that are in the earth's atmosphere and that prevent the venting of heat into space. They affect global temperature in what is called the greenhouse effect.

Obesity: When a person accumulates excess fat to the point that his or her health may become negatively affected. This is a clinical condition and a public health issue.

Pathogens: An infectious agent; a biological agent that causes disease to its infected host.

Trans Fats: The common name for unsaturated trans fatty acids, which have a trans, or opposing, arrangement of functional groups. They may be monounsaturated or polyunsaturated and generally are created during hydrogenation or partial hydrogenation of vegetable oils. According to the American Heart Association, consumption of trans fats has been associated with higher levels of LDL cholesterol and increased risk of cardiovascular disease, stroke, and diabetes.

Bibliography

Almeida, C. (2011). Health and foreign policy: The threat from health securitisation. Australian & New Zealand Journal of Public Health, 35, 312. Retrieved November 18, 2013 from EBSCO online database SocINDEX with Full Text. http://search.ebscohost.com/login.aspx?direct=true&db=sih&AN=63848541

Cahn, M. A., et al. (2007). The partners in information access for the public health workforce: A collaboration to improve and protect the public's health, 1995–2006. Journal of the Medical Library Association, 95, 301–309. Retrieved July 13, 2008 from EBSCO online database Academic Search Premier: http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=26019305&site=ehost-live

Chatwood, S., Bjerregaard, P., & Young, T. (2012). Global health—A circumpolar perspective. American Journal of Public Health, 102, 1246–1249. Retrieved November 18, 2013 from EBSCO online database SocINDEX with Full Text. http://search.ebscohost.com/login.aspx?direct=true&db=sih&AN=77378911

De Senarciens, P. (1984). Population and security. International Social Science Journal, 46, 439. Retrieved July 11, 2008 from EBSCO online database Academic Search Premier: http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=9504100944&site=ehost-live

Ellingson, K., McCormick, K., Sinkowitz-Cochran, R., Woodard, T., Jernigan, J., Srinivasan, A., & Rask, K. (2014). Enhancement of health department capacity for health care-associated infection prevention through Recovery Act-funded programs. American Journal of Public Health, 104, e27–e33. Retrieved January 13, 2015, from EBSCO online database SocINDEX with Full Text. http://search.ebscohost.com/login.aspx?direct=true&db=sih&AN=94898645&site=ehost-live&scope=site

Environmental Protection Agency. (2010, August). Treating contaminants of emerging concern: A literature review database. Retrieved November 18, 2013, from: http://water.epa.gov/scitech/swguidance/ppcp/upload/cecliterature.pdf

Epstein, G. L. (2008). Whither bioscience? Benevolence or bioviolence? Bioscience, 58, 357–359. Retrieved July 11, 2008 from EBSCO online database Academic Search Premier: http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=31660541&site=ehost-live

Fee, E., & Bu, L. (2007). Models of public health education: Choices for the future? Bulletin of the World Health Organization, 85, 977–979. Retrieved July 11, 2008 from EBSCO online database Academic Search Premier: http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=27746676&site=ehost-live

Finkelstein, E. A., & Trogdon, J. E. (2008). Health interventions for addressing childhood overweight: Analysis of the business case. American Journal of Public Health, 98, 411–415. Retrieved July 11, 2008 from EBSCO online database Academic Search Premier: http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=31286393&site=ehost-live

Frumkin, H., Hess, J., Luber, G., Malilay, J., & McGreehin, M. (2008). Climate change: The public health response. American Journal of Public Health, 98, 435–445. Retrieved July 11, 2008 from EBSCO online database Academic Search Premier: http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=31286396&site=ehost-live

Gearhardt, A. N., Grilo, C. M., DiLeone, R. J., Brownell, K. D., & Potenza, M. N. (2011). Can food be addictive? Public health and policy implications. Addiction, 106, 1208–1212. Retrieved November 18, 2013 from EBSCO online database SocINDEX with Full Text. http://search.ebscohost.com/login.aspx?direct=true&db=sih&AN=60975236

Gerst-Emerson, K., & Jayawardhana, J. (2015). Research and practice: Loneliness as a public health issue: The impact of loneliness on health care utilization among older adults. American Journal of Public Health, 105(5), 1013–1019. Retrieved January 26, 2016, from EBSCO Online Database SocINDEX with Full Text. http://search.ebscohost.com/login.aspx?direct=true&db=sih&AN=102611129&site=ehost-live&scope=site

Hellmich, C., & Redig, J. A. (2007). The question is when: The ideology of Al Qaeda and the reality of bioterrorism. Studies in Conflict & Terrorism, 30, 396. Retrieved July 11, 2008 from EBSCO online database SocINDEX with Full Text: http://search.ebscohost.com/login.aspx?direct=true&db=sih&AN=96208185&site=ehost-live&scope=site

Hruby, A., Manson, J. E., Lu, Q., Malik, V. S., Rimm, E. B., Qi, S., & ... Hu, F. B. (2016). Determinants and consequences of obesity. American Journal of Public Health, 106(9), 1656–1662. doi:10.2105/AJPH.2016.303326. Retrieved December 22, 2016, from EBSCO online database Sociology Source Ultimate. http://search.ebscohost.com/login.aspx?direct=true&db=sxi&AN=117367925&site=ehost-live&scope=site

Leider, J. P., Resnick, B., Kass, N., Sellers, K., Young, J., Bernet, P., & Jarris, P. (2014). Budget- and priority-setting criteria at state health agencies in times of austerity: A mixed-methods study. American Journal of Public Health, 104, 1092–1099. Retrieved January 13, 2015, from EBSCO online database SocINDEX with Full Text. http://search.ebscohost.com/login.aspx?direct=true&db=bwh&AN=31906352&site=ehost-live

Marhaba, T. H. (2008). Dangerous pharmaceutical compounds in water cannot be ignored any longer. NJBIZ, 21, 20. Retrieved July 11, 2008 from EBSCO online database Regional Business News: http://search.ebscohost.com/login.aspx?direct=true&db=bwh&AN=31906352&site=ehost-live

National Center for Chronic Disease Prevention and Health Promotion. (2011). Obesity: Halting the epidemic by making health easier—At a glance 2011. Atlanta, GA: Centers for Disease Control and Prevention. Retrieved November 18, 2013, from: http://www.cdc.gov/chronicdisease/resources/publications/aag/pdf/2011/obesity%5Faag%5Fweb%5F508.pdf

National Center for Chronic Disease Prevention and Health Promotion. (2013, August 6). Progress on childhood obesity. Retrieved November 18, 2013, from Centers for Disease Control and Prevention website: http://www.cdc.gov/VitalSigns/ChildhoodObesity

Ogden, C. L., Carroll, M. D., Fryar, C. D., Flegal, K. M. (2015, November). Prevalence of obesity in the United States, 2011–2014 (NCHS Data Brief no. 219). Retrieved December 22, 2016, from: https://www.cdc.gov/nchs/data/databriefs/db219.pdf

Oliver, J. E., & Taeku, L. (2005). Public opinion and the politics of obesity in America. Journal of Health Politics, Policy & Law, 30, 923–954. Retrieved July 11, 2008 from EBSCO online database Academic Search Premier: http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=18773378&site=ehost-live

Petrakova, A., & Sadana, R. (2007). Problems and progress in public health education. Bulletin of the World Health Organization, 85, 963–970. Retrieved July 13, 2008 from EBSCO online database Academic Search Premier: http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=27746665&site=ehost-live

Pew Research Center. (2006, April 25). In the battle of the bulge, more soldiers than success. Washington, DC: Author. Retrieved November 18, 2013, from: http://www.pewsocialtrends.org/files/2010/11/Exercise.pdf

Pew Research Center. (2013, November 12). Public agrees on obesity’s impact, not government’s role. Washington, DC: Author. Retrieved November 18, 2013, from: http://www.people-press.org/files/legacy-pdf/11-12-13%20Obesity%20Release.pdf

VanDerslice, J. (2011). Drinking water infrastructure and environmental disparities: Evidence and methodological considerations. American Journal of Public Health, 101(S1), S109–S114. Retrieved November 18, 2013 from EBSCO online database SocINDEX with Full Text. http://search.ebscohost.com/login.aspx?direct=true&db=sih&AN=74988062

Suggested Reading

Batra, R., Strecher, V. J., & Keller, P. (2011). Leveraging consumer psychology for effective health communications: The obesity challenge. Armonk, NY: M.E. Sharpe. Retrieved November 18, 2013 from EBSCO online database eBook Academic Collection (EBSCOhost). http://search.ebscohost.com/login.aspx?direct=true&db=e000xna&AN=356310&site=ehost-live

Camargo, K., Jr., & Grant, R. (2015). Public health, science, and policy debate: Being right is not enough. American Journal of Public Health, 105(2), 232–235. doi:10.2105/AJPH.2014.302241. Retrieved December 22, 2016, from EBSCO online database Source Ultimate. http://search.ebscohost.com/login.aspx?direct=true&db=sxi&AN=100375771&site=ehost-live&scope=site

Figert, A. (2014). Governing how we care: Contesting community and defining difference in US public health programs. American Journal of Sociology, 119, 1780–1781. Retrieved January 13, 2015, from EBSCO online database SocINDEX. http://search.ebscohost.com/login.aspx?direct=true&db=sih&AN=97175313&site=ehost-live&scope=site

Henderson, D. A., O'Toole, T., & Inglesby, T. V. (2002). Bioterrorism: Guidelines for medical and public health management. Chicago, IL: American Medical Association.

Kessel, A. (2006). Air the environment and public health. New York, NY: Oxford University Press.

Laverack, G. (2015). A–Z of public health. New York, NY: Palgrave.

McKee, M., & Sim, F. (2011). Issues in public health (2nd ed.). Maidenhead, England: McGraw-Hill/Open University Press. Retrieved November 18, 2013 from EBSCO online database eBook Academic Collection (EBSCOhost). http://search.ebscohost.com/login.aspx?direct=true&db=e000xna&AN=405329&site=ehost-live

Oliver, J. E. (2006). Fat politics: The real story behind America's fat epidemic. New York, NY: Oxford University Press.

Smith, J. (2005). Integration of public health with adaptation to climate change: Lessons learned and new directions. Leiden, Netherlands: Aa Balkema.

Turnock, B.J. (2007). Public health: What it is and how it works. Sudbury, MA: Jones and Bartlett Publishers.