Community Health Centers serve more than 22 million people at more than 9,000 sites located throughout all 50 states and U.S. territories, and have become needed health centers in particular for people newly insured under the Affordable Care Act (ACA) who have not previously had relationships with healthcare providers.
The National Association of Community Health Centers (NACHC) was organized in 1971 and works with a network of state health center and primary care organizations to serve health centers in several ways, including to:
- Provide research-based advocacy for health centers and their clients.
- Educate the public about the mission and value of health centers.
- Train and provide technical assistance to health center staff and boards.
- Develop alliances with private partners and key stakeholders to foster the delivery of primary health care services to communities in need.
Ronald A. Yee, MD, became chief medical officer of the NACHC last year. NewPublicHealth recently spoke with Yee about the mission of health centers and their new roles under the Affordable Care Act.
NewPublicHealth: What field of medicine did you practice before taking on your new role?
Ronald A. Yee: I am a family physician. I worked for 20 years at a community migrant health center in Fresno County. I basically practiced full-scope family medicine including obstetrics, so I was delivering babies up until October of last year when I came to NACHC. So I was on the frontlines doing patient care and I was also the chief medical officer for our health center. I got involved earlier in my career with NACHC on a state and then national level, was on the board and then became chief medical officer.
NPH: Who is most likely to use the services of a community health center?
Yee: Health centers provide about one quarter of all the primary care visits for low-income populations, which include about one in seven people who are uninsured, or one out of every 15 Americans. With the roll out of the Affordable Care Act we’re seeing a big surge in demand among the newly insured, whether that’s through Medicaid expansions or the health insurance exchanges. Many of our patients who previously paid on a sliding scale basis are now covered through the ACA, which is helping us extend the funding we have.
CDC: Reducing High-risk Antibiotic Prescriptions Could Also Reduce Deadly Infections
The most recent Vital Signs report from the U.S. Centers for Disease Control and Prevention (CDC) finds that if prescriptions of high-risk antibiotics in hospitals were reduced by just 30 percent, then there could be as many as 26 fewer cases of deadly diarrhea infections with Clostridium difficile. “Improving antibiotic prescribing can save today’s patients from deadly infections and protect lifesaving antibiotics for tomorrow’s patients,” said CDC Director Tom Frieden, MD, MPH. “Health care facilities are an important part of the solution to drug resistance and every hospital in the country should have a strong antibiotic stewardship program.” As part of its ongoing efforts to improve antibiotic prescribing, the CDC has release a checklist of seven core elements for hospitals:
- Leadership commitment: Dedicate the necessary human, financial, and IT resources.
- Accountability: Appoint a single leader responsible for program outcomes. Physicians have proven successful in this role.
- Drug expertise: Appoint a single pharmacist leader to support improved prescribing.
- Act: Take at least one prescribing improvement action, such as requiring reassessment of prescriptions within 48 hours to check drug choice, dose, and duration.
- Track: Monitor prescribing and antibiotic resistance patterns.
- Report: Regularly report prescribing and resistance information to clinicians.
- Educate: Offer education about antibiotic resistance and improving prescribing practices.
Read more on infectious diseases.
Poorer Women Most Likely to Be Caught in ‘Vicious’ Caregiving, Financial Well-being Cycle
Low-income women are at increased risk of finding themselves caught in a “vicious cycle” of parental caregiving and financial well-being, according to a new study in The Journals of Gerontology. While women of better financial means can afford additional caregiver assistance and better health care for aging parents, poorer women lack those options. "People who had less household income and less financial resources were more likely to take care of their parents so there is this cycle that they cannot get out of—they are poor, then taking care of parents, then being poor and taking care of their parents—there's this kind of cycle," said lead author Yeonjung Lee, a researcher and professor at the Faculty of Social Work at the University of Calgary in Alberta, Canada, according to Reuters. Read more on aging.
Young Skin Cancer Survivors at Heightened Risk for Other Cancers
Younger skin cancer survivors are at increased risk for additional cancer types later in life, according to a new study in the journal Cancer Epidemiology, Biomarkers & Prevention. A review of data of more than 500,000 people with a history of nonmelanoma skin cancer found that while all age groups were at heightened risk for melanoma and other types of cancers, the increase was especially significant for people under the age of 25, who were 23 times more likely to develop cancer than people who had never had nonmelanoma cancer. The risk was 3.5 times higher for nonmelanoma survivors ages 25-44, 1.74 times higher for those ages 45-59 and 1.32 times higher for those older than 60. The types of cancer they are at risk for include melanoma skin cancer, and cancers of the breast, colon, bladder, liver, lung, brain, prostate, stomach and pancreas. Read more on cancer.
A recent report from the Institute of Medicine found that young athletes in the United States face a "culture of resistance" to reporting when they might have a concussion and to complying with treatment decisions. That culture can result in students heading back to school too quickly—when they should be resting their brains to prevent short- and long-term complications.
"The findings of our report justify the concerns about sports concussions in young people," said Robert Graham, chair of the committee and director of the national program office for Aligning Forces for Quality, at George Washington University, Washington, D.C. (Aligning Forces is a program of the Robert Wood Johnson Foundation.) "However,” says Graham, “there are numerous areas in which we need more and better data. Until we have that information, we urge parents, schools, athletic departments, and the public to examine carefully what we do know, as with any decision regarding risk, so they can make more informed decisions about young athletes playing sports."
Recently, Righttime Medical Care, a chain of urgent care centers in Maryland, opened a number of HeadFirst sports injury and concussion centers in the state, staffed with health professionals who can assess injuries for concussions as well as evaluate students for return to play—in consolation with a team of experts who work with HeadFirst staff. HeadFirst will this year be presenting and publishing data on the more than 10,000 youth it has examined and treated for concussion in just the past two years.
NewPublicHealth recently spoke with Robert Graw, MD, head of Righttime and HeadFirst, about the need for better prevention, evaluation and treatment of concussions to prevent long-term health problems and disability.
NewPublicHealth: Why did Righttime add concussion care to the services provided?
Robert Graw: My son is an orthopedic surgeon and talked to me about the number of injuries he was seeing. We decided a few years ago that we’d learn as much as we could about preventing head injury and the consequences of head injury, and then promote that information through Righttime’s call center and through the visits that people made to our sites.
In the process of learning as much as we could we realized that the knowledge base of how people evaluate and manage concussions had changed drastically in the last five years as people have done more research. So, we then gathered together a group of consultant physicians and neuropsychologists to determine best practices. We met with them frequently, and then had them train our provider staff so that all of them became much more informed about what a concussion really is, the best way to evaluate them and the guidelines for management going forward.
Facebook Makes Changes to Combat Illegal Gun Sales
Facing mounting pressure from groups such as Mayors Against Illegal Guns and Mons Demand Action for Gun Sense in America, Facebook yesterday announced plans to remove offers to sell guns without background checks or across state lines. The social media site will being notifying users offering such sales of relevant laws a limit visibility of certain firearm-related posts to users ages 18 and older. Searchers for firearms on Facebook-owned Instagram will also return information on gun laws. The system will rely on users to report violating posts. "We will respond to posts that signal attempts to evade the law so we can delete them," said an AOL spokesman, according to The Wall Street Journal. Read more on violence.
Revamped SAT Designed to Increase Access to College
After only nine years using the “new” format, the College Board has announced changes to the SAT designed to focus the test more on important academic skills and increase access to college. In addition to making the essay section optional—which will put a perfect score back at 1600, from the 2400 of the past few years—the revised test will remove the penalty for incorrect answers or guessing and cut the more obscure vocabulary words. College Board President David Coleman said the changes were needed because the test had “become disconnected from the work of our high schools.” Coleman also announced fee waivers to low-income students who will now be able to apply to four colleges at no charge, according to The New York Times. Read more on education.
HUD Announces Funding to Provide Permanent Housing and Services to Low-Income People with Disabilities
The U.S. Department of Housing and Urban Development (HUD) today announced the availability of approximately $120 million in funding for state housing agencies to provide long term project-based rental assistance to extremely low-income persons with disabilities, many of whom are transitioning out of institutional settings or are at high risk of homelessness. State housing agencies will be working with state Medicaid and Health and Human Service offices to identify, refer and conduct outreach to persons with disabilities who require long-term services and supports to live independently. Read more on housing.
In Shasta County, Calif., the Shasta County Health and Human Services Agency is using a County Rankings & Roadmaps grant to realize the “Shasta Promise,” which helps young people in the community prepare for success in any post-secondary school option so that they can obtain high-skill, high-income jobs that will yield long-term health benefits.
High poverty rates, low educational attainment and lack of employment opportunities are among the factors that make Shasta one of the least healthy counties in California. Only 19.7 percent of Shasta County’s adult population age 25 or older has a bachelor’s degree or higher, compared to 30.2 percent statewide. The goal of Shasta Promise is to increase awareness of and preparedness for post-secondary education. The program provides students in middle school, high school and college with the guidance and support they need to overcome barriers to pursuing higher education, and encourages a culture of college attendance among county residents.
To accomplish this, the county is implementing a newly-established College and Career Readiness Strategic Plan:
- School leaders and counselors are being provided with a training curriculum and sessions to help them get students ready for college.
- Parent focus groups are being convened to inform the development of an engagement plan between the schools and families.
- Written policies are being developed for local colleges to accept all county students who meet enrollment requirement.
- An agreement is being secured from Southern Oregon University to charge in-state tuition for Shasta County students who are admitted.
NewPublicHealth recently spoke with Charlene Ramont, a public health policy and program analyst with the Shasta County Health and Human Services Agency, and Tom Armelino, Shasta County’s Superintendent of Schools, about the Shasta Promise.
NewPublicHealth: What is the mission of the project?
Charlene Ramont: Our aim is to give every student, every option. We want all students, when they graduate from high school, to be prepared for all options post high school. When they graduate, they need to be prepared to join the military if they so choose, they need to be prepared to go to college if they so choose, they need to be prepared to go to a trade school or a certificate program.
Georgia State University College of Law Names Ten Faculty Fellowships to Promote Public Health Law Education
The Georgia State University College of Law and its Center for Law Health & Society have announced ten faculty fellows to participate in the Future of Public Health Law Education: Faculty Fellowship Program. “This fellowship program is an extraordinary opportunity to promote innovative teaching, create a supportive community of practice and share best practices in teaching public health law,” said Charity Scott, JD, MSCM, Catherine C. Henson Professor of Law and director of the Center for Law, Health & Society. “The fellows’ projects will serve as models for innovation in public health law education and the resources developed will be shared with other law and public health faculty nationally.” The program is funded by the Robert Wood Johnson Foundation. Among the five faculty members serving as mentors will be Mary Crossley, JD, professor of law at the University of Pittsburgh School of Law, who NewPublicHealth previously spoke with about her role in the Scholars in Residence program. Read more on public health law.
Study: Better Boundaries, Enforcing Rules Can Improve Kids’ Sleep Health
Parents can improve their children’s sleep habits and overall health by setting boundaries around electronics use, enforcing rules and setting a good example, according to new findings from the National Sleep Foundation’s (NSF) Sleep in America poll. The annual study began in 1991, with the 2014 poll focusing on sleep practices and beliefs of the modern family with school-aged children. “For children, a good night’s sleep is essential to health, development and performance in school,” said Kristen L. Knutson, PhD, University of Chicago. “We found that when parents take action to protect their children’s sleep, their children sleep better.” The NSF recommends that children ages 6-10 get 11 hours of sleep per night, although the poll found that parents estimate their kids in that age group only get about 8.9 hours. The poll also found averages of 8.2 hours for kids ages 11-12, 7.7 hours for ages 13-14 and 7.1 hours ages 15-17; NSF recommends between 8.5 and 9.5 hours for each of those groups. Read more on pediatrics.
Stress of Racism Tied to Obesity in Black Women
Frequent experiences of racism are associated with a higher risk of obesity among African-American women, according to a new study in the American Journal of Epidemiology. Researchers analyzed data from the Black Women's Health Study, a longitudinal study of approximately 59,000 African-American women who were tracked beginning in 1995, finding that the psychosocial stress associated with long-term experience with racism can result in dysregulation of neuroendocrine functions that influence the accumulation of excess body fat. Yvette C. Cozier, DSc, MPH, assistant professor of epidemiology at Boston University who led the analyses, said in a release that work-place- and community-based programs to combat racism and interventions to reduce racism-induced stress could help prevent and combat obesity in high-risk communities. Approximately half of African-American women are obese, which raises their risk factors for cardiovascular diseases, type 2 diabetes, orthopedic problems, and death. Read more on health disparities.
Several leading cancer organizations recently formed a think tank to address health disparities in cancer research with the goal of improving treatment access and outcomes for underserved populations. “Closing the inequality gap will not happen easily, and won’t get done if any of us goes it alone," said Otis W. Brawley, MD, chief medical officer of the American Cancer Society (ACS), one of four groups involved, in addition to the American Association for Cancer Research (AACR); the American Society of Clinical Oncology (ASCO); and the National Cancer Institute (NCI), a branch of the National Institutes of Health (NIH).
“Cancer mortality rates are decreasing for most minorities, but absolute death rates continue to be higher," said NCI Deputy Director Doug Lowy, MD. Lowy adds that it’s important to understand the sources of the disparities in order to reduce them.
The goal of the collaboration is to address the fact that that some racial and ethnic minorities in the United States are more likely to develop cancer, less likely to access high-quality cancer care and more likely to die from cancer when compared to others and to whites. For example, the death rate for cancer among African-American males is 33 percent higher than among white males, and the rate for African-American females is 16 percent higher than it is for white females.
“We must move from describing the problems to more quickly identifying and implementing solutions to address the racial and economic-based disparities that continue to affect many cancer patients and families in the United States,” said ASCO president Clifford A. Hudis, MD.
NewPublicHealth recently spoke with Hudis about the new collaboration.
NewPublicHealth: What key issues help explain—and then overcome—differences in cancer incidence and severity among different populations?
Clifford A. Hudis: We can’t completely disentangle environmental factors, which include nutrition, access to care, general health behaviors, exercise and education, which relates to behaviors such as tobacco use. And of course underlying that is the socioeconomic status. But there also is a burgeoning understanding of the role of genetic variations that may be clustered in various populations and may influence things such as drug metabolism and diseases.
Army, NIH Studies Look at Mental Health Risks, Resilience in U.S. Soldiers
JAMA Psychiatry has released a collection of three articles detailing the findings of a large-scale study of mental health risk and resilience in members of the U.S. Military. Among the findings of The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS):
- The rise in suicide deaths from 2004 to 2009 occurred not only in currently and previously deployed soldiers, but also among soldiers never deployed.
- Nearly half of soldiers who reported suicide attempts indicated their first attempt was prior to enlistment.
- Soldiers reported higher rates of certain mental disorders than civilians, including attention deficit hyperactivity disorder (ADHD), intermittent explosive disorder (recurrent episodes of extreme anger or violence), and substance use disorder.
“These studies provide knowledge on suicide risk and potentially protective factors in a military population that can also help us better understand how to prevent suicide in the public at large,” said National Institute of Mental Health (NIMH) Director Thomas R. Insel, M.D.
The emphasis on mental health in the military comes at the same time as a small group of Vietnam veterans has filed suit against the U.S. government, alleging they received other-than-honorable discharges for violations that the psychiatric community and Army now understand were attributable to post-traumatic stress. The veterans say the government has resisted their attempts to upgrade the discharges. Read more on mental health.
NIH: Allergy Prevalence Consistent Across U.S. Regions, Although Type Varies
Allergy prevalence of allergies is consistent across all regions of the United States in every demographic except for children age 5 years and younger, according to a new study from the U.S. National Institutes of Health (NIH). Researchers analyzed blood serum data from approximately 10,000 Americans between 2005 and 2006. “Before this study, if you would have asked 10 allergy specialists if allergy prevalence varied depending on where people live, all 10 of them would have said yes, because allergen exposures tend to be more common in certain regions of the U.S.,” said Darryl Zeldin, MD, scientific director of the National Institute of Environmental Health Sciences (NIEHS), part of NIH, in a release. “This study suggests that people prone to developing allergies are going to develop an allergy to whatever is in their environment. It’s what people become allergic to that differs.” The comprehensive study also examined and outlined risk factors that would make a person more likely to develop an allergy. Read more on the environment.
Study: SNAP for Just 6 Months Increases Kids’ Food Security Significantly
Children in households that participate in the Supplemental Nutrition Assistance Program (SNAP)—previously known as the Food Stamp Program—for just six months experience significant increases in their “food security,” according to a new study in the journal Pediatrics. Food insecurity—or lack of easy access—is tied to a range of health and developmental problems. The study concluded that “SNAP serves a vital role in improving the health and well-being of low-income children by increasing food security” and that “Future research is needed to determine whether specific groups of children experience differential improvements in food security.” SNAP provided assistance to approximately 47 million people in 2013, with about half of those children. Read more on nutrition.
This month the Johns Hopkins Bloomberg School of Public Health published a special issue of its magazine devoted to food. There weren’t any recipes, unless you count “recipes” for a healthier planet, which can be reached by following some of the recommendations in the supplement.
“Changing what we eat is more complex than it sounds,” writes the school’s dean, Michael Klag, MD, MPH. “It involves not just personal choice but also changing methods of food production and delivery systems so that the right choice becomes the default choice. A new ‘Green Revolution’ that relies on sustainable methods of food production will require partnerships of farmers, agronomists, development agencies and policymakers. Interventions to change the norms of what we eat must be culturally appropriate, and take into account the context of nutritional needs within the population. Such interventions will require partners who understand human and plant biology, behavior, economics and policy. This type of multidisciplinary, population-based effort is a centerpiece of public health...”
Key features of the issue include:
- RX for the Future: How the WIC program got its start
- Planting Health: The seeding of public health
- Photo Gallery: Capturing our relationship with food across the globe
EPA Sets Cleaner Fuel and Car Standards to Cut Air Pollution and Improve Health
The U.S. Environmental Protection Agency (EPA) today finalized emission standards for cars and gasoline to significantly reduce harmful pollution and prevent thousands of premature deaths and illnesses. According to the EPA, the new standards will also create efficiency improvements for cars and trucks. The standards go into effect by 2017.
The new standards cut emissions of a range of harmful pollutants that can cause premature death and respiratory illnesses. By 2030, EPA estimates that up to 2,000 premature deaths; 50,000 cases of respiratory ailments in children; 2,200 hospital admissions and asthma-related emergency room visits; and 1.4 million lost school days, work days and days when activities would be restricted due to air pollution will be prevented. Total health-related benefits in 2030 will be between $6.7 and $19 billion annually.
The program will also reduce exposure to pollution near roads. More than 50 million people live, work, or go to school in close proximity to high-traffic roadways, and the average American spends more than one hour traveling along roads each day. Read more on environment.
Study Finds Many Parents Support Flu Shots at School
Half of parents in the United States would agree to have their children get their flu shots at school, according to a survey from the Brown School of Public Policy at Washington University in St. Louis. Researchers at the school conducted a nationally representative online survey of more than 1,000 parents of school-aged children. Convenience was the chief reason for parents supporting flu shots at school. Thirty two percent of parents surveyed were not sure if they would consent to giving the shots at school and 17 percent said they would not consent. Most likely to support flu shots at school were college-educated parents and parents of uninsured children. The study was published in the journal Vaccine.
Flu season can last in the United States through April, according to the U.S. Centers for Disease Control and Prevention (CDC). This is especially the case in communities where the season started later in the fall or early winter. In a recent report, CDC researchers found that the flu vaccine “offered substantial protection against the flu this [2013-2014] season,” reducing a vaccinated person’s risk of having to go to the doctor for flu illness by about 60 percent across all ages
“We are committed to the development of better flu vaccines, but existing flu vaccines are the best preventive tool available now. This season vaccinated people were substantially better off than people who did not get vaccinated. The season is still ongoing. If you haven’t yet, you should still get vaccinated," said CDC director Tom Frieden, MD, MPH, in a recent release. Read more on flu.
Online Ratings Currently Not Used Much to Choose Physicians
Online ratings that review physicians can influence which doctor a patient chooses, but most patients rank insurance acceptance and distance from home or office as more important, according to a new study in JAMA.
- 9 percent of responders said they consider doctor rating websites “very important” in their search for a physician
- 89 percent of responders ranked “accepts my health insurance” as “very important.”
- 59 percent said a convenient office location very important
The study also found that only five percent of those surveyed have ever posted ratings online, although two-thirds of responders were aware of ranking sites, a higher percentage than found in previous studies.
“These may seem useful, but no one is regulating this ‘crowdsourced’ information about doctors. There’s no way to verify its reliability, so online ratings may not currently be the best resource for patients,” David Hanauer, a primary care pediatrician and clinical associate professor of pediatrics at C.S. Mott Children’s Hospital in Detroit. Read more on community health.