Category Archives: Disability
The final plenary session at this year’s NACCHO Annual included a talk by Christopher Murray, MD, DPhil, director of the Institute for Health Metrics and Evaluation at the University of Washington on how data is used to measure health, evaluate interventions and find ways to maximize health system impact. Dr. Murray was a lead author on three pivotal studies published last week that used data to assess the state of health in the United States compared with 34 other countries and county level data on diet and exercise. One of the key findings is that Americans are living longer, but not necessarily better—half of healthy life years are now lost to disability instead of mortality; and dietary risks are the leading cause of U.S. disease burden.
NewPublicHealth spoke with Dr. Murray about the study findings, their impact and upcoming research that can add to the data public health needs to improve the health of all Americans.
NewPublicHealth: Tell us about the three studies that were published this week using the Institute’s research.
Dr. Murray: The study in JAMA [Journal of the American Medical Association] is an analysis of a comprehensive look at the health of the United States in comparison to the 34 OECD [Organisation for Economic Co-operation and Development] countries. The study looks at both causes of death and premature mortality through over 290 different diseases and puts them all together in a comprehensive analysis of what the contributors are to lost healthy life. That study also looks at the contribution to patterns of health in the U.S., from major environmental, behavioral, and metabolic risk factors. In each of those categories, there are important findings:
- The U.S. spends the most on healthcare but has pretty mediocre outcomes and ranks about 27th for life expectancy among its peer countries.
- For many large, important causes of premature death, the U.S. does pretty poorly. And we also see a big shift towards more and more individuals having major disability—from mental disorders, substance abuse, and bone and joint disease.
- On the risk factor front, the big surprise is that diet is the leading risk factor in the U.S. It is bigger than tobacco, which is second and then followed by obesity, high blood pressure, high blood sugar, and physical inactivity. Diet in this study is made up of 14 subcomponents, each analyzed separately and then put together.
“Death is an inevitable part of life. But death from preventable causes like cervical cancer, early heart disease, or gun violence is a tragedy. Whether expressed in dry, cold numbers or by the images of first graders smiling at the camera for their school picture, these tragedies will continue to motivate us to use both left-brain science and right-brain passion to improve human health and prevent unnecessary death.”
That paragraph is from the foreword by Michael Klag, MD, MPH, dean of the Johns Hopkins Bloomberg School of Public Health (JHSPH) in the current issue of the school’s magazine. The issue is devoted to how public health researchers and practitioners probe, investigate, understand and fight death.
The full issue is well worth reading. A few notable pieces include:
- An interview with Vladimir Canuda Romo, PhD, a demographer and assistant professor at the school who says his research shows American life expectancy is on the rise.
- A critical article on making palliative care a public health issue.
- A summary of a recent forum at the school on dealing with gun violence.
- A piece on prescription drug abuse, which the author calls the “biggest public health issue you’ve never heard of."
Perhaps most poignant are a collection of essays by JHSPH alumni including a thoughtful look at the last minutes of a deer.
>>Bonus Link: In a new book, Happier Endings , Erica Brown, PhD, the scholar in residence at the Jewish Federation of Greater Washington, tells her readers: “we are all going to die, but some of us will die better.” The book, which Dr. Brown calls “a meditation on life and death,” looks at the deaths of several people and shares intimate details of last months, last weeks, last seconds—sometimes peaceful, sometimes not. It’s an important reminder that communities and populations, the building blocks of public health, are made up of individuals who are loved, and missed when they pass away, and that death is indeed a public health issue worth attention.
Study: No Link Between Hospital Deaths, Readmission Rates
Hospital readmission rates—which Medicare can use to penalize health care providers—and death rates are not linked, according to a new study in the Journal of the American Medical Association. Researchers, who looked at rates for heart attack and pneumonia patients, say this means hospitals can still keep the number of returning patients down without increasing the number who die. "The concern was that their performance in one area is going to compromise their performance in another," said Harlan Krumholz, MD, lead author from the Yale University School of Medicine in New Haven, Connecticut. The U.S. Centers for Medicare and Medicaid Services reduces payments to hospitals with high readmission rates. Read more on access to health care.
HUD, HHS Grants to Provide Housing for Low-income People with Disabilities
The U.S. Department of Housing and Urban Development (HUD) and the U.S. Department of Health and Human Services (HHS) is granting approximately $98 million in funding to help prevent homelessness and unnecessary institutionalization of extremely low-income people with disabilities. Thirteen state housing agencies will use the grants to provide rental assistance. “By working together, HUD and HHS are helping states to offer permanent housing and critically needed supportive services to offer real and lasting assistance to persons who might otherwise be institutionalized or living on our streets,” said HUD Secretary Shaun Donovan in a release. “We’re helping states reduce health care costs, improving quality of life for persons with disabilities, and ending homelessness as we know it.” Read more on housing and disability.
High-calcium Diets, Supplements May Increase Death from Heart Disease for Women
High-calcium diets and supplements may increase the risk of death by heart disease for women, according to a new study in BMJ. Another recent study found a similar link among men. Calcium supplements are taken to prevent bone loss and had been speculated to also improve cardiovascular health. Instead, researchers found diets very low or very high in calcium can causes changes in blood level. Most adults should intake 1,000 to 1,200 milligrams of calcium daily, according to the U.S. Office of Dietary Supplements. Read more on heart health.
Disabled Adults Have Very High Rates of Emergency Room Use
A review of medical expenditure data by researchers at the National Institutes of Health finds that disabled adults account for a disproportionately high amount of annual emergency room (ER) visits.
The study found that despite representing 17 percent of the working age U.S. population, adults with disabilities accounted for 39.2 percent of total emergency room visits. The researchers say the higher ER use is a problem not just because of the higher costs, but also because many disabled adults have non-urgent needs that are not met by the ER visits.
Recommendations to improve care for disabled adults include prevention and chronic condition management programs tailored for the functional limitations and service needs of people with disabilities, wider use of coordinated care systems for the disabled that provide case management, integration of psychosocial care and 24/7 access to medical assistance.
Read more on disability.
Change in Color of their Pills Keeps Some Patients from Taking Generic Drugs
A new study in JAMA Internal Medicine finds that some people stop taking their medicines when a generic becomes available if the color of the dispensed generic drug is different than the brand name drug they received previously.
The authors say the study shows the need for a reconsideration of the FDA’s current regulations that allow wide variation in the appearance of generic drugs.
Read more news about the Food and Drug Administration.
Mental Health Disorders Increase the Risk of Becoming a Victim of Domestic Violence
People diagnosed with mental illness are more likely than those who are not to be victims of domestic violence, according to a new study in PLoS One.
The researchers say the causality may run in both directions. Domestic violence can result in mental health problems and people with mental health problems are more likely to experience domestic violence. The researchers say studies they reviewed show that the link between domestic violence and mental health problems is a concern for both men and women.
Read more on mental health.
Last year, a new center to help promote physical activity among individuals with disabilities opened at the University of Alabama at Birmingham. NewPublicHealth spoke with James Rimmer, PhD, the center’s director, who has spent decades promoting the importance of people who are disabled engaging in physical activity for both their health and for fun.
NewPublicHealth: Tell us about the new center.
Rimmer: When I moved here from the University of Illinois/Chicago, there was a large donation made to support the needs of people with disabilities in all areas of physical activity, sport and recreation, by the Lakeshore Foundation, a non-profit organization that provides health and fitness services to people with disabilities. They brought me in to build an enterprise between the University of Alabama at Birmingham and the foundation, which is called the UAB Lakeshore Research Collaborative. Subsumed under that are two national centers that have been funded by the Centers for Disease Control and Prevention and the National Institute on Disability and Rehabilitation Research. The first center is the National Center Health, Physical Activity and Disability. The second center is the Rehabilitation Engineering Research Center.
NPH: You have been working in this field for decades. What will be new about your initiatives and efforts in 2013?
Non-profit Achilles International connects physically and mentally disabled individuals with able-bodied amateur athletes to help build physical strength and confidence through their sense of accomplishment, which often impacts other parts of their lives. Since its start in the 1970′s, Achilles has also added training programs for children and disabled veterans. Achilles Kids provides training, racing opportunities, and an in-school program for children with disabilities; the Freedom Team of Wounded Veterans program brings running programs and marathon opportunities to disabled veterans returning from Iraq and Afghanistan.
Richard Traum, Achilles’ founder, says sports are simply the tool for accomplishing the group’s main objective: to bring hope, inspiration and the joys of achievement to people with disabilities.
NewPublicHealth recently spoke with Richard Traum about the organization and its accomplishments over the years.
NewPublicHealth: How did Achilles get started?
Richard Traum: In 1976, as an above the knee amputee, I ran in the New York City Marathon on my artificial leg. I didn’t know it at that time, but I became the first amputee to run that kind of a distance. In 1982 we started the Achilles Track Club, which was an eight week course to encourage people with disabilities to participate in long distance running and after the eight week program was over, the question was what do we do next? And the thought was move it from a course to a track club and that’s how Achilles got started, which was in January of 1983.
NPH: Tell us a bit about the mission.
Richard Traum: Well, the mission is really to help people with all types of disabilities to participate in sports with a particular focus on running in the mainstream environment. What we do most is have disabled people participate in marathons. I’ve always felt that it was very important for people with disabilities to integrate with people who aren’t disabled. One reason is that if you are disabled, it makes you feel more comfortable in the able-bodied community, but it also works in the other direction—people who are not disabled increase their comfort level by seeing folks who are disabled competing with them in a sport.
NPH: What are some of the successes?
Richard Traum: Well, one is Donald Arthur. Donald had a heart transplant and he joined us shortly thereafter. He started to work out and he built up to doing a marathon and as he progressed, he would send the t-shirts to his doctor who would then send them to the family of the heart donor. He eventually did the marathon, sent his medal to the family and told them that their son’s heart had just done a marathon. The next year, Donald ran with a brother of the donor and during the last several years, Donald has done several marathons a year in different states; to focus awareness on organ donation.
A new analysis of mortality data from the University of Washington School of Public Health has found that the life span for women in the United States is improving at a much slower rate than men’s. Researchers analyzed population data by gender, race and county from 1989 to 2009 and found that in 661 counties, primarily in the southeast, the life spans of women had stopped increasing or actually decreased. There are about 3,000 U.S. counties in total.
According to the review, men on average now live to 76.2 years while women live to 81.3 years. That was a gain of 4.6 years for men over the last 20 years, but a gain of only 2.7 years for women. Factors cited by the researchers for the reported changes include high blood pressure, high cholesterol, obesity and tobacco and alcohol use. Read about related county-level data from the County Health Rankings, which ranks the health of nearly every county in the nation and shows that much of what affects health occurs outside of the doctor’s office.
The Campaign for Disability Employment, a collaborative of disability and business organizations, has selected the winners in a contest that called for videos to showcase skills offered by people with disabilities, and common misconceptions about disability employment. Among the winners: a video about a disabled school cafeteria employee, Margaret, who helped a child who was choking. Watch the videos and vote for your favorites. The two top winners receive $250 each. Read more on disability.
Poison centers throughout the nation are reporting an uptick in calls about young children swallowing single-use packets of laundry detergent. Some children have become very ill and required hospitalization. “The rapid onset of significant symptoms is pretty scary,” said Dr. Michael Beuhler, medical director of the Carolinas Poison Center. “Other laundry detergent [products] cause only mild stomach upset or even no symptoms at all. Although we aren't certain what in the product is making the children sick, we urge all parents and caregivers to make sure laundry detergent packs are not accessible to young kids.”
- Read a fact sheet from the Association of Poison Control Centers on the growing concern, which includes a photo of the packaging.
- Read a use guide on the single-use products, including several warnings, from a laundry product trade association.
Read more on product safety.
Missed the Reelabilities Film Festival in New York, Washington or Philadelphia? The festival, which features invited films showing the lives, loves, triumphs and challenges of individuals and artists with different disabilities, is on the road with festivals planned for Chicago in April and Richmond in May, along with other cities later this year.
The three-year old festival grew out of a meeting of agencies in New York City that serve people with disabilities to help “widen the definition of community and broaden the notion of inclusion,” says Anita Altman, founder of the festival, and Deputy Managing Director, Department of Government and External Affairs of UJA-Federation, an umbrella group in New York City for services to the Jewish and greater community. Altman is also founder of the organization’s Task Force on People with Disabilities. At that meeting, says Altman, the group realized it could be a change agent for society and chose film as the vehicle.
Altman says a key goal of the festival is a greater acceptance and understanding in society of people with disabilities, says Altman. A key element of the festival is that the goal goes far beyond simply screening films. Each showing includes a “talkback” about the film and its lessons learned. “It’s about helping to raise consciousness,” says Altman.
Hearing loss may be a risk factor for falls, according to a new study in the Archives of Internal Medicine. Researchers, including Frank Lin, MD, PHD, of the Johns Hopkins School of Medicine, looked at data from the National Health Examination Survey and found that for about 2,000 participants ages 40 to 69, those with a 25-decibel (mild) hearing loss were nearly three times more likely than those without hearing loss to have a history of falling. The researchers found that for every additional 10-decibels of hearing loss, the chances of falling rose by 1.4 fold.
And research published earlier this month by Dr. Lin found that although an estimated 26.7 million Americans age 50 and older have hearing loss, only about one in seven uses a hearing aid. Read more on the health of older adults.
The current issue of Pediatrics looks at three important issues:
- A revised policy statement from the American Academy of Pediatrics recommends prevention of baseball and softball throwing injuries by instructing kids on proper throwing mechanics, training and conditioning, and encouraging kids to stop playing and seek treatment when signs of overuse injuries arise.
- A second revised policy statement on HPV Vaccine Recommendations recommends use of the HPV vaccine in both males and females at 11 to 12 years of age.
- Children who were given active video games were not more physically active than those given inactive games, according to a new study in Pediatrics. Providing explicit instructions to use the active games did seem to lead to increased physical activity, however.
Read more children's health news.
A new influenza A virus discovered in fruit bats in Guatemala doesn't appear to pose a current threat to humans, but should be studied as a potential source for human influenza, according to a study in Proceedings of the National Academy of Sciences from scientists at the Centers for Disease Control and Prevention. Catch up on this year's flu news.
The U.S. Department of Housing and Urban Development (HUD) today announced that it is charging Bank of America with discriminating against home buyers with disabilities. HUD alleges that Bank of America imposed unnecessary and burdensome requirements on borrowers who relied on disability income to qualify for their home loans and required some disabled borrowers to provide physician statements to qualify for home mortgage loans. Read more on disability.
NewPublicHealth writers are on the road a lot, so we appreciated a recent column in The New York Times, that offered helpful ideas for older flyers. Truth is, many of the tips—carts to speed you to your gate, ordering a wheel chair from an airline, small fees for early boarding and storage room—are available to anyone who flies, and may also be beneficial to disabled travelers.
Bonus Travel Tips:
- Many more airports than listed in the article have golf carts to get you to the gate; stay to the side of the corridors and flag one down. You’ll need to show a ticket for a flight that day.
- No mobility problems? For some extra physical activity, skip the tram or train and walk to the gate. At some airports, that can get you a walk of a quarter mile or more.