It was about 10 years ago that the Institute of Medicine Committee on Assuring the Health of the Public in the 21st Century's released a report calling for an accreditation process for the nation’s public health departments. That recommendation led to the creation of the Public Health Accreditation Board (PHAB), which earlier this year named the first eleven departments to receive accreditation.
Writing in a special issue of the Journal of Public Health Management and Practice that is dedicated to public health accreditation, Kaye Bender, PhD, RN, FAAN, and Carole Moehrle, BSN, RN, looked back on the first year, how the inaugural departments were selected and how they see accreditation changing the public health landscape moving forward. Both are on PHAB’s Board of Directors.
“The first year of realizing the goal of accredited health departments has been outstanding, not only from the standpoint of reaching that goal but also from the perspective of experiencing firsthand what the public health community across this country can do when we all work together on a common goal,” they wrote in the article, PHAB: Reflections From the First Year of Accreditation. “As the next years unfold and accreditation changes with the inevitable changes in the public health practice environment, these initial days will long be remembered for establishing a sound foundation upon which to build.
Writing in the same issue, Pamela Russo, MD, MPH, and Paul Kuehnert, DNP, RN, in their commentary, Accreditation: A Lever for Transformation of Public Health Practice, discussed the role that the Robert Wood Johnson Foundation and other organizations played in making accreditation a success. Accreditation, they wrote, is a way for a public health department to demonstrate to its community that it’s committed to accountable, transparent and quality care.
“Those who have perceived health departments as simply administrative sites for a collection of miscellaneous services are beginning to recognize that accredited health departments are mission-driven organizations of excellence that are implementing strategic plans to improve and protect the health of their communities,” wrote Russo and Kuehnert. “Accreditation is rapidly proving itself to be a powerful lever for the transformation of public health practice.”
>>Bonus content: RWJF Senior Program Officer Pamela Russo recently sat down for an interview on the National Association of County & City Health Officials (NACCHO) podcast. Listen to Russo discuss how local partnerships can contribute to and improve community health.
Unemployment and poverty top the reasons why homelessness and hunger continue to grow in the U.S., according to the U.S. Conference of Mayors 31st Hunger and Homelessness Survey, released yesterday. “There’s no question that the nation’s economy is on the mend, but there’s also no question that the slow pace of recovery is making it difficult and, for many, impossible, to respond to the growing needs of the hungry and the homeless,” said Tom Cochran, executive director of the Conference of Mayors during a conference call with reporters yesterday about the report.
The new report is based on surveys of city officials in the 25 cities that make up the Conference’s task force on Hunger and Homelessness, and all but one of the participating cities said requests for help had either gone up or stayed the same as the previous year.
Additional findings of the report include:
- The number of families and individuals experiencing homelessness increased across the survey cities by an average of 4 percent.
- More than one in five people needing assistance did not receive it because of insufficient city and donated funds.
- Because of the increase in requests many emergency kitchens and food pantries in the 25 cities surveyed had to reduce the amount of food provided to individuals or families.
One positive note in this year’s report was an increase in aid provided to homeless veterans because of targeted efforts by cities, the Department of Housing and Urban Development and the Veterans Administration. Eighty percent of the survey cities were able to find stable housing for some previously homeless veterans.
Many of the 25 survey cities addressed homelessness and hunger problems by adopting innovative programs specific to their communities to address and improve the situation. The Conference of Mayors report includes many examples both to highlight innovation and to serve as models for other cities working to improve the housing and food security conditions of their citizens:
Telehealth Technology Could Help Obese Youth Get Better Treatment, Lose Weight
Telehealth technology—a secure computer system that enables patients to speak “face-to-face” with doctors who are far away—could be an effective strategy to help obese youth who are trying to lose weight, according to new research from UCLA. With a multidisciplinary approach often the prescribed for treating obesity, telehealth services would reduce travel time while giving patients access to expertise that might not be available in their area. This would be especially helpful for low-income families. The UCLA study linked UCLA health care providers with patients at their local health clinics, finding that 80 percent of the 45 study subjects were happy with the technology and would use it again. "One surprise was how natural it was to talk with each other through the telehealth system, even though we never met the patients in person," said lead author Wendy Slusser, MD, medical director of the Fit for Healthy Weight program at Mattel Children's Hospital UCLA and director of pediatric wellness programs at the Venice Family Clinic. "The interaction was very much like being in the same room together. Some kids even thought it was fun to see themselves on the screen." Read more on access to health care.
Study: Psychiatrists Less Likely than Other Doctors to Accept Insurance
Psychiatrists are less likely than other doctors to accept private insurance, according to a new study in JAMA Psychiatry. Researchers analyzed government data from 2005 to 2010, which surveyed approximately 1,250 doctors each year, finding that from 2005 to 2010 the percentage of psychiatrists who accepted private insurance dropped from 72 percent to 55 percent. In comparison, over that same time the rate for doctors in other areas only dropped from 93 percent to 89 percent. While the study does not explain the vast difference, Jeffrey Lieberman, MD, president of the American Psychiatric Association, said reimbursement is a major concern, according to Reuters. "Many doctors can't afford to accept insurance because (insurance companies) don't pay them for the time," he said. "It involves taking more time with the patient and often treating them with psychotherapy.” Read more on mental health.
Even Mild Hits to the Head Can Cause Brain Damage
Even mild hits to the head that don’t cause concussion can still lead to problems with memory and thinking, according to a new study in the journal Neurology. Researchers equipped 80 football and ice hockey players with special helmets that gathered data on mild hits; while none of the players were diagnosed with a concussion, they still showed signs of deficits in thinking after the season. "This suggests that concussion is not the only thing we need to pay attention to," said Tom McAllister, MD, chairman of the department of psychiatry at the Indiana University School of Medicine. "These athletes didn't have a concussion diagnosis in the year we studied them ... and there is a subsample of them who are perhaps more vulnerable to impact. We need to learn more about how long these changes last and whether the changes are permanent." Read more on injury prevention.
Recommended Reading: ‘Retweet This’—Researchers See Rise in Use of Twitter to Share Scientific Journal Articles
The top two tweeted peer-reviewed science articles between 2010 and 2012 were about the effect of radiation on humans, according to a study published in the Journal of the Association for Information Science and Technology. Researchers reviewed 1.4 million articles to determine the most tweeted studies. Runners up in the top 15 of the most tweeted articles included studies on acne in teenagers and the link between physical activity and mortality rates. Nature, a highly regarded journal, received the most tweets: 13,430 Twitter mentions of 1,083 papers.
However, the researchers found that a retweet rate doesn’t necessarily correlate with a high rate of citations for an article in other studies, which is a standard measurement of significance for a scientific study. The most tweeted study—on genetic changes during radiation exposure—was tweeted 963 times but was cited in journals only nine times.
"The most popular scientific articles on Twitter stress health implications or have a humorous or surprising component. This suggests that articles having the broadest scientific impact do not have the widest distribution," said Stefanie Haustein, of the University of Montreal School of Library and Information Science, and a co-author of the study.
Still, the researchers say the increase in tweets that include a link or description of scientific studies is important even if the rates don’t correlate with journal citations. For one thing, the number of scientific researchers on Twitter is still low and “the fact that more and more articles are tweeted [at all] is good news because it helps scientific communication [and] regardless of whether non-scientists are sending this information, it proves that science is an aspect of general culture,” said Vincent Larivière, PHD, a co-author of the study and professor at the University of Montreal, who holds the Canada Research Chair on the Transformation of Academic Communication.
Read the full study.
2013 America’s Health Rankings Finds Significant Progress in National Health
The new 2013 America’s Health Rankings from the United Health Foundation finds that while there is still much progress to be made, over the past year Americans improved in the majority of the measures that the Rankings use to rate public health. The improved areas include smoking rates, which fell to 19.6 percent of the adult population, from 21.2 percent the previous year, as well as physical inactivity, which fell to 22.9 percent from 26.2 percent. Also, for the first time since 1998 the obesity rate did not rise. With low rates of uninsured people, high rates of childhood immunization and low rates of health issues such as obesity and smoking, Hawaii ranked as the healthiest state in the country. Read more on community health.
FDA to Phase Out Use of Certain Antimicrobials in Food Animals
The U.S. Food and Drug Administration (FDA) is moving forward with a plan to combat the spread of antibacterial resistance by prohibiting the use of medically important antimicrobials in food animals for food production purposes, while also adding veterinary oversight to therapeutic use of the drugs in animals. Antimicrobials can be used in the food and drinking water of cattle, poultry and other food animals to encourage weight gain. However, these same antimicrobials are used to treat infections in humans, and their availability in the food supply increases the possibility of the development of antimicrobial resistance. The FDA is giving companies three months to sign on to the strategy, then three years to transition. “This action promotes the judicious use of important antimicrobials to protect public health while ensuring that sick and at-risk animals receive the therapy they need,” said Bernadette Dunham, DVM, PhD, director of the FDA’s Center for Veterinary Medicine. “We realize that these steps represent changes for veterinarians and animal producers, and we have been working—and will continue to work—to make this transition as seamless as possible.” Read more on food safety.
HHS: 365,000 Enrolled Under Affordable Care Act in October, November
The official numbers are in, with almost 365,000 people selecting plans in the Health Insurance Marketplace in October and November, according to the U.S. Department of Health and Human Services. About 1.9 million people have gone through the online process, but have just not yet selected a plan, while more than 800,000 were determined eligible for Medicaid or the Children’s Health Insurance Program (CHIP). The site went live at the beginning of October, but extensive bugs and glitches meant only about 27,000 people were able to sign up in that first month. Last week a reconfigured HealthCare.gov was launched after about five weeks of work spent addressing the problems, and 29,000 people were able to sign up during the first two days alone. Thirty-six states use HealthCare.gov, with fourteen states and Washington, D.C. maintaining their own sites. Read more on the Affordable Care Act.
Fifteen Years after Tobacco Settlement, States Falling Short in Funding Tobacco Prevention: Q&A with Danny McGoldrick
On November 23, 1998, 46 states settled their lawsuits against the nation’s major tobacco companies to recover tobacco-related health care costs, joining four states—Mississippi, Texas, Florida and Minnesota—that had reached earlier, individual settlements.
These settlements require the tobacco companies to make annual payments to the states in perpetuity, with total payments estimated at $246 billion over the first 25 years.
Yesterday a coalition of health advocacy groups released the latest edition of A Broken Promise to Our Kids, an annual report on state use of tobacco funds for tobacco prevention and cessation efforts. As in years past, the report finds that most states fall short in the amount of money they allocate to prevent kids from smoking and to help current smokers quit.
The groups that jointly issued the report include the Campaign for Tobacco-Free Kids, the American Heart Association, American Cancer Society Cancer Action Network, the American Lung Association, the Robert Wood Johnson Foundation and Americans for Nonsmokers’ Rights.
Key findings of the 2013 report include:
- Over the past 15 years, states have spent just 2.3 percent of their total tobacco-generated revenue on tobacco prevention and cessation programs.
- The states this year will collect $25 billion from the tobacco settlement and tobacco taxes, but will spend just 1.9 percent of it—$481.2 million—on tobacco prevention programs. This means the states are spending less than two cents of every dollar in tobacco revenue to fight tobacco use.
- States are falling short of the U.S. Centers for Disease Control and Prevention’s (CDC) recommended funding levels for tobacco prevention programs. Altogether, the states have budgeted just 13 percent of the $3.7 billion the CDC recommends.
- Only two states—Alaska and North Dakota—currently fund tobacco prevention programs at the CDC-recommended level.
To discuss the ramifications of the latest edition of the Broken Promises report, NewPublicHealth recently spoke with Danny McGoldrick, vice president of research at the Campaign for Tobacco-Free Kids.
NewPublicHealth: Can you give us some background on the Tobacco Master Settlement Agreement?
Danny McGoldrick: This is the 15th anniversary of the Tobacco Master Settlement Agreement, when 46 states and the District of Columbia settled their lawsuits against the tobacco companies mostly to recover the costs that they’d incurred treating smoking-caused disease in their states. Four other states had settled individually with the tobacco companies prior to the Master Settlement Agreement, and so this provided for some restrictions on tobacco company marketing; they promised never to market to kids again, which is ironic, but it also resulted in the tobacco companies sending about $250 billion over just the first 25 years of the settlement for the states to spend as they saw fit. They left that to the province of the state legislators and governors to decide how those funds should be spent.
Study: Strong State Laws Can Help Curb Binge Drinking
Strong state laws can help curb binge drinking, according to a new study in the American Journal of Preventive Medicine. Binge drinking, defined as more than four or five alcoholic drinks in a two-hour period, is a factor in about half of the 80,000 alcohol-related deaths each year. Researchers analyzed and graded 29 alcohol control policies across the United States, finding that those with the better policies were one-fourth as likely as those with poorest scores to have binge drinking rates in the top 25 percent of states. They also found that rates were 33 percent higher in states in the bottom quarter of grades than those in the top quarter. "Unfortunately, most states have not taken advantage of these policies to help drinkers consume responsibly, and to protect innocent citizens from the devastating secondhand effects and economic costs from excessive drinking," said study senior author Tim Naimi, MD, an associate professor of medicine at Boston University Schools of Medicine and attending physician at Boston Medical Center. "The bottom line is that this study adds an important dimension to a large body of research demonstrating that alcohol policies matter—and matter a great deal—for reducing and preventing the fundamental building block of alcohol-related problems." Laws and policies that can help prevent binge drinking include limiting hours of sale, increasing alcohol taxes and holding those who sell alcohol legally responsible for harm inflicted by consumers who recently consumed alcohol, according to the U.S. Centers for Disease Control and Prevention. Read more on alcohol.
VP to Announce $100M to Improve Access to Mental Health Services
Vice President Joe Biden will today announce $100 million to improve access to mental health services across the country. The plan comes a year after the school shooting in Newtown, Connecticut, and Biden will make the announcement at a meeting of the families of the victims of the tragedy and mental health advocates. The U.S. Department of Health and Human Services (HHS) and the U.S. Department of Agriculture (USDA) will provide the funding. "HHS will soon issue a $50 million funding opportunity to help Community Health Centers establish or expand behavioral health services for people living with mental illness or addiction," said a White House official, according to Reuters. "Additionally, USDA has set a goal of financing $50 million for the construction, expansion, or improvement of mental health facilities in rural areas over the next three years." Read more on mental health.
Kids Who Watch Violent Movies Also Exposed to Other Risky Behaviors
Exposing kids to violent movies can also expose them to other examples of potentially harmful behavior, according to a new study in the journal Pediatrics. "Parents should be aware that youth who watch PG-13 movies will be exposed to characters whose violence is linked to other more common behaviors, such as alcohol and sex, and that they should consider whether they want their children exposed to that influence," said study lead author Amy Bleakley, a policy research scientist at the University of Pennsylvania's Annenberg Public Policy Center. The study analyzed nearly 400 top-grossing movies released from 1985 to 2010, finding that 90 percent included at least one act of violence that involved a main character, and that a main character used tobacco, consumed alcohol or engaged in sexual behavior in 77 percent of the films. Read more on violence.
NewPublicHealth Q&A: John Auerbach and Cheryl Bartlett on the Massachusetts Prevention and Wellness Trust
The Massachusetts Prevention and Wellness Trust is a four-year, $60 million project designed to support prevention and health-promotion activities in the state. The first project of its kind in the United States will fund six to 12 collaborative initiatives, and partners on the initiative will include municipalities, community-based organizations, health care providers, regional agencies and health plans. Information on the Trust is detailed in a new report prepared by the Institute on Urban Health Research and Practice at Northeastern University and funded by the Robert Wood Johnson Foundation.
The vision behind the creation of the project is to give all Massachusetts residents the opportunity to live in communities that promote health, as well as seamless access to all community and clinical services needed to prevent and control chronic diseases. It was created because while there is access to health insurance and health care in Massachusetts, health costs continue to rise. The goals of the project include:
- Reducing the rate of the state’s most costly preventable health conditions
- Reducing health disparities
- Increasing healthy behaviors
- Increasing the adoption of workplace wellness programs
- Developing a strong evidence base of effective prevention programs
In order to implement these goals, the Massachusetts Department of Public Health identified four priority areas: tobacco use, childhood asthma, hypertension and elder falls prevention—all of which should be considered closely when working to reduce health disparities and co-occurring mental health conditions in these areas.
A new infographic created for the Prevention and Wellness Trust’s inauguration perfectly illustrates how community links work together to improve health under the principles of the Trust. For example, a diagnosis of hypertension would need a provider to prescribe medications, but the obesity and exercise needs that would also improve the condition for many patients requires input from other community entities, including:
- Classes in exercise, medication and stress reduction by community agencies
- Chronic disease self management classes and home visits for medication use instruction by a community agency
- A neighborhood policy that provides support for transportation changes to encourage walking or biking and zoning for healthy food stores
- A neighborhood policy that provides support for more accessible recreation options in parks and city centers for increased stress reduction
- Workplace policies that provide support for workplace wellness programs that help provide and encourage exercise, healthy foods and stress reduction
NewPublicHealth recently spoke with John Auerbach, a Professor at Northeastern University and the primary author of a report on the Trust, and Cheryl Bartlett, public health commissioner of Massachusetts and the lead person charged with its implementation.
Improved Prevention and Treatment Decrease U.S. Stroke Deaths
Stroke deaths in the United States have declined dramatically in the last few decades because of improved prevention and treatment, according to a scientific statement published in Stroke, published by the American Heart Association. “The decline in stroke deaths is one of the greatest public health achievements of the 20th and 21st centuries,” said Daniel T. Lackland, DrPH, chair of the statement writing committee and professor of epidemiology at the Medical University of South Carolina, in Charleston, S.C. “The decline is real, not a statistical fluke or the result of more people dying of lung disease, the third leading cause of death,” said Lackland, who added that “although all groups showed improvement, there are still great racial and geographic disparities with stroke risks as well many people having strokes at young ages [and] we need to keep doing what works and to better target these programs to groups at higher risk.” Public health efforts that have helped lower stroke rates include hypertension control that started in the 1970s; smoking cessation programs; improved control of diabetes and high cholesterol levels; and improved stroke treatment options. Read more on prevention.
NHTSA Announces New Safety Efforts for Older Drivers
The National Highway Traffic Safety Administration (NHTSA) has announced a new strategic plan to help ensure the safety of older drivers and passengers. In 2012, according to NHTSA, more than 5,560 people over the age of 65 died, and 214,000 were injured in motor vehicle crashes. That’s a three percent increase in the number of fatalities and a 16 percent increase in the number of injuries from the previous year. In addition, since 2003 the population of older adults—defined as age 65 and older—has increased by 20 percent and the number of licensed older drivers increased by 21 percent, to 35 million licensed older drivers in 2012.
NHTSA has several new efforts in place to reduce these deaths and injuries:
- The agency is researching advanced vehicle technologies, including vehicle-to-vehicle communications, collision avoidance and crashworthiness that could help reduce the risk of death or injury to older occupants in the event of a crash. It is also considering adding a “silver” rating system, meaning cars with certain technologies might be preferable for older drivers.
- NHTSA will conduct studies to better understand the effects of age-related medical conditions, including dementia.
- NHTSA will continue public education efforts on functional changes that can impact driving, including vision, strength, flexibility and cognition.
Read more on transportation.
Poll: Parents Concerned Over Lack of Physical Activity During School Day
A recent poll conducted by the Harvard School of Public Health, National Public Radio and the Robert Wood Johnson Foundation found that many parents are concerned about inadequate levels of physical education at schools. More than 1,300 parents of public school students were polled on a range of issues concerning education and health in the their child’s school, and one in four parents (25 percent) said their child’s school gives too little emphasis to physical education, compared with one in seven who say the same thing about reading and writing (14 percent) or math (15 percent). About three in 10 parents (28 percent) give a low grade (C, D or F) to their child’s school on providing enough time for physical education, while almost seven in 10 parents (68 percent) report that their child’s school does not provide daily physical education classes, a recommendation included in U.S. Centers for Disease Control and Prevention guidelines for schools. “In a period with a significant public debate about the content of educational reform, it is significant that many parents feel that more physical education is needed in the schools,” said Robert Blendon, ScD, Richard L. Menschel professor of Health Policy and Political Analysis at Harvard. Read more on education.
The Alliance for Health Reform will hold a briefing today in Washington, D.C. on an increasing trend at hospitals of "observing"—instead of admitting—Medicare beneficiaries to hospitals. The briefing follows an AARP report issued earlier this month, Rapid Growth in Medicare Hospital Observation Services: What’s Going On?. The report found that a key reason for the rise in hospital observations among Medicare beneficiaries is that under the Affordable Care Act hospitals can face penalties of 2 percent of hospital charges for patients readmitted to the hospital before thirty days after discharge—which don’t apply if the patient is observed rather than admitted.
Observation status is a long-standing one. For decades it has allowed emergency room staff to determine whether it’s safe for the patient to be sent home. But patients may face higher charges in the emergency room than they would as an inpatient, and may not qualify for Medicare-covered nursing home care after their hospital stay if they were observed and not admitted.
The AARP report analyzed the frequency and duration of the use of observation status for Medicare beneficiaries between 2001 and 2009. It found more than 100 percent growth over nine years, and an even greater percentage increase in the length of time spent in observation, with visits longer than 48 hours increasing the most.
“The dramatic increase in the use of observation status for Medicare patients deserves a closer look,” said Debra Whitman, AARP Executive Vice President for Policy, Strategy and International Affairs. “The clinical benefit of long-term observation remains questionable. And for Medicare patients who remain in the hospital under observation, they may not realize the high out-of-pocket costs they'll have to pay.”
Bipartisan legislation has been introduced in both the House and Senate to count the time spent in observation toward the three-day stay requirement.
>>Bonus Link: The focus of this month’s issue of Health Affairs is the future of emergency medicine.
>>Bonus Content: Follow the briefing on Twitter: #ObservationStatus