APHA members T. Bella Dinh-Zarr, PhD, MPH, and Robert Zarr, MD, MPH, personify “Health in All Policies.” The former was sworn into office of the National Transportation Safety Board in March, designated by U.S. President Barack Obama as vice chairman of the board — and becoming the first public health professional to be nominated and confirmed to the position. The latter is a pediatrician at Unity Health Care in Washington, D.C., and a physician champion of DC Parks Rx, which The Washington Post recently described as “an innovative community health program committed to combating the woes of urban living by prescribing time outdoors.”

Both presented at APHA’s Annual Meeting in Chicago — Dinh Zarr on the intersection of drug use and transportation and Zarr on connecting patients to parks to prevent chronic disease , the latter of which was chronicled in APHA’s Storify recap — and joined Public Health Newswire for a conversation of their lives uniquely dedicated to public health.

Q: Transportation and medical care are not commonly thought of as similar professions but Health in All Policies looks at both as forces that help keep us healthy. What does HiAP mean to you?

BDZ: People often think our professions are so different and really they’re the same. Really, it’s all about the continuum of public health. Everything about transportation is about your health. It’s your mobility, it’s your environment, it’s how you get around and it’s things ranging from walking and biking to driving to getting in an airplane, when you’re on a ship or train. It’s all the different modes of transportation and all of those things can all affect our health and how we choose to get around. And of course there’s the safety side of being safe when you get around.

For Robert’s side, a lot of what he does is relevant because he’s seeing firsthand the patients — but then also going beyond that and looking at how he can prevent some of their illnesses through nature. A lot of my work in the past has been just policy-oriented … now I get to actually see it firsthand. At NTSB, we investigate crashes so I get to see the people who are affected by these different kinds of events and then make recommendations on how we could prevent these crashes from happening. I like that part; it’s terrible to see what people have to go through but it’s important to see the firsthand experience and then to help change policy to prevent that.

Editor’s note: Dinh-Zarr discussed Health in All Policies at APHA’s Annual Meeting in Chicago, as seen on YouTube.

Robert Zarr, MD, MPH, is president of Physicians for a National Health Program and a longtime APHA Medical Care Section member. Photo by Robert Zarr.

Robert Zarr, MD, MPH, is president of Physicians for a National Health Program and a longtime APHA Medical Care Section member. Photo by Robert Zarr.

RZ: I first got interested in prescribing parks — and by the way this is not my idea and originated in Australia through their parks system. And the U.S. National Park Service adopted it essentially in almost its same format. It’s called Healthy Parks, Healthy People. A piece of that is the park prescription or Park Rx.

And that’s really what I clung onto as a great idea for so many reasons. Because I’m a doctor and I know doctors and I know the daily grind and all the other sorts of priorities that take over that patient-doctor encounter, I realized very early on it had to be done really easily and efficiently because there’s just only so much real estate during that 15-minute office visit. We’re dealing with a lot of things; patients come in with their own agenda of what they want to accomplish during that visit and we have our agenda to make sure that they step out of that office with everything that they need, and also the things feel they should get, during that visit. Now that includes the importance of asking that question of physical activity outside because it affects so much of the work we do and so many of the conditions they suffer from.

It’s so important for us to ask that question now. We need to start asking questions like the ones we’ve been asking about alcohol, driving while intoxicated, wearing your seat belt. If you go back 30 years these are questions we weren’t asking before, even with smoking. In my field of medicine we’re starting to realize we need to incorporate these questions into our daily visits. But this had to be easy to do. So I came back from a conference in 2010 committed to working with anybody who wanted to work with me from local, regional, national organizations to rate all the (park) space in D.C., to map it and to rate it.

As president of Physicians for a National Health Program I can tell you we’re focused primarily on this issue of universal access: affordable, comprehensive, lifetime access. And I try to figure out the best way and most efficient way to connect people to parks or green space — using existing resources that are underutilized, especially for our vulnerable population that’s poor, of color and suffering disproportionately from chronic disease.

Editor’s note: Physicians for a National Health Program authors were featured in an American Journal of Public Health study, “Access to Care and Chronic Disease Outcomes Among Medicaid-Insured Persons Versus the Uninsured,” which published online ahead of print.

Q: Both of you are longtime APHA members and public health advocates. How have your careers intersected?

BDZ: We were in public health school together. We went to University of Texas School of Public Health and that’s when we started dating. I was getting my MPH.

RZ: Medical school and public health; it wasn’t a joint program at the time. I started medical school at the Baylor College of Medicine but I withdrew for a year so I could get my MPH.

T. Bella Dinh-Zarr, PhD, MPH, presented earlier this month at APHA's Annual Meeting in Chicago. Photo by Michele Late/The Nation’s Health/APHA

T. Bella Dinh-Zarr, PhD, MPH, presented earlier this month at APHA’s Annual Meeting in Chicago. Photo by Michele Late/The Nation’s Health/APHA

BDZ: I was originally doing some violence work and then I started getting more interested in transportation. My master’s was in interventions to decrease injuries from alcohol. So obviously a big one was motor vehicle injuries, so then I got more and more into transportation.

We’re a public health family. I was chair of the Injury Control and Emergency Health Services Section at APHA four years ago, the same time he was president of the American Academy of Pediatrics D.C. chapter. We were both elected, same year, two different things. We go to APHA (Annual Meetings) together, in Boston, Denver, San Diego, D.C., now Chicago. We’ve been to World Federation of Public Health Associations meetings. And actually my dad encouraged Robert to join PNHP and now he’s president.

I think that’s something we share; we’re passionate about public health. There are a lot of ways to address different issues but one thing both of us is we believe is that addressing the most vulnerable populations is a way to improve our overall health.

RZ: That’s a great question. And I would say that just like for Bella, when she’s at a crash site and seeing the damage, for me it’s in the health center — that intersection is seeing the results of the lack of infrastructure, or the overwhelming poverty or the poor housing that my patients suffer from. When I see that on a daily basis I’m actually seeing the end result of what happens when we don’t have a super public health infrastructure in this country.

I think my colleagues get it. Most don’t have an MPH or DrPH but they get it and they’re there for a mission: They’re there because they want to be there. These are colleagues of mine who graduated from top-notch programs, Ivy League schools, they’re very well-trained. But that’s not enough. To work where I work you have to have something else, something that drives you to put you in an environment where on a daily basis you’re bombarded with (challenges) like the things I’ve mentioned, and figuring out — OK, what can you do in 15 minutes? And beyond that, what you can do when you’re not seeing patients to save lives. And that’s where the public health comes in for me.

For me that really nicely complements the work I do and gives me the connection to the larger projects that are population-centered or community-centered. It’s addressing the social determinants of health — of which parks and green space plays a very important role — as well as access to medical care. And those happen to be the two areas that I have devoted most of my time in my advocacy.

Q: What are some of the challenges — and success stories — in your fields today?

BDZ: I look at motor vehicle crashes that used to kill 50,000 people per year and now it’s 30,000, and it’s within my professional life where we’ve seen it go down. So I’m constantly thinking about what can I do in this short three-and-a-half years with NTSB, because it can happen in a relatively short time. On the vision side, ultimately I would like people to be able to get around however they want to in the safest way possible. We need to have such a strong safety culture that people don’t even think about not wearing their seat belt whether it’s the back seat or the front seat. People wouldn’t even dream of being impaired while they were driving. In the old days it was just alcohol. Now it’s drugs, synthetic drugs, a lot of other new things. People wouldn’t even think of being distracted.

T. Bella Dinh-Zarr (left) was confirmed by the U.S. Senate as a National Transportation Safety Board member in March. Photo by Fia Foundation

T. Bella Dinh-Zarr (left) was confirmed by the U.S. Senate as a National Transportation Safety Board member in March. Photo by NTSB

The impact of technology on transportation is one area that’s particularly (emerging). People have so much technology, which is so useful in so many ways, but in another way it’s disconnecting us from the world, from nature, from our environment and also causing us to be more at risk of being in crashes — not only for drivers but people who are operators of trains and pilots and ships. This technology is great in one way but also a distraction in other ways.

RZ: What is it you say about multitasking?

BDZ: I always say multitasking is a myth. Really, we are just selectively attending to different things in series. When you are driving or piloting a ship you are already attending to a very complex task with your instruments, any other vehicles that are in place, the weather. So you are already having a complex interaction in your brain and then you’re adding another distraction? And there’s great technology for transportation: automatic braking. There’s a lot of things about transportation that’s been aided by technology because it’s often making the machine safer but we have to know when to use it and when not to. And that’s the same in life in general.

RZ: And actually, when thinking about the intersection of our careers, I think technology is the link between what we do. In the medical field we talk about the phrase: “judicious use of technology.” You often hear that term, “judicious,” with antibiotics or medications. But I use it now with technology.

Every day I see someone crossing the street in a crosswalk on their phones completely zoned out, with cars or bicycles flying by. I (see it) in patient rooms every day. For example, today I noticed a mother and a son who are both on their cell phones quietly. And when I walk in, they sort of have to come out of that zone almost reluctantly to leave whatever it was that they were doing. And it begs the question: What was happening at that moment and how does that juxtapose with what’s about to happen? Your doctor is coming in who you may only see once a year sometimes for 15 minutes. Wouldn’t it be a better use of time to have a list of things you want to talk about?

So I’m a bit obsessed with the integration of technology into our lives. And technology is not a bad thing. I’m using technology to connect people to parks. Our next generation of this project with DC Parks Rx is creating an app, on iPhones, on Androids and all sorts of devices so people can immediately match the best park with the best activity in that instant of time, wherever they are geographically. That’s what technology can do. But it’s not what we’re using it for. So I sort of think of Park Rx as the Yelp of parks but it’s more thinking about how we can use technology appropriately, judiciously.

BDZ: I think people use (technology) because it’s there. Just because we have it doesn’t mean we need to use it all the time.

RZ: What Bella’s talking about is a very fundamental concept of access. If you have ice cream in your freezer you’re more likely to eat it. If you have soda in your fridge you’re more likely to drink it. If you have a cell phone in your pocket you’re more likely to use it — even when you don’t need it. And that’s where public health professionals can play a really important role: to educate us as individuals and communities and as a nation, as to how we can best use the tools around us.

BDZ: In the healthiest way possible!