Category Archives: Recommended Reading
Recommended Reading: Life Expectancy Gains Threatened When Older Americans Have Multiple Medical Conditions
A new study from the Johns Hopkins Bloomberg School of Public Health finds that nearly four in five older Americans are living with multiple chronic medical conditions. That’s very concerning, say the researchers, because their work shows that the more ailments a person has after retirement age, the shorter their life expectancy. The researchers say the new study is one of the first to look at the burden of multiple chronic conditions on life expectancy among the elderly and may help explain why increases in life expectancy among older Americans are slowing.
“Living with multiple chronic diseases such as diabetes, kidney disease and heart failure is now the norm and not the exception in the United States,” said Eva H. DuGoff, PhD, a researcher at the school of public health and the lead author of the new study. “The medical advances that have allowed sick people to live longer may not be able to keep up with the growing burden of chronic disease. It is becoming very clear that preventing the development of additional chronic conditions in the elderly could be the only way to continue to improve life expectancy.”
The study found that a 75-year-old American woman with no chronic conditions will live to be an average of 92, but a 75-year-old woman with five chronic conditions will only live to an average age of 87 and a 75-year-old woman with 10 or more chronic conditions will only live to the age of 80. Women continue to live longer than men and white people live longer than black people, based on data from annual U.S. surveys.
On average, life expectancy is reduced by 1.8 years with each additional chronic condition, the researchers found. But while the first disease shaves off just a fraction of a year off life expectancy for older people, the impact grows as the diseases add up. The study is based on an analysis of the records of 1.4 million Medicare enrollees and was published in the journal Medical Care.
Other groups are also beginning to look at this issue. Healthy aging will be this year’s focus of the President’s Initiative of the Association of State and Territorial Health Officers. A year-long focus on healthy aging will begin during the association’s annual conference in September.
Read the full study.
The public comment period for rules regulating the sale and use of e-cigarettes proposed in April by the U.S. Food and Drug Administration (FDA) ends on August 8, after which the agency is expected to release final rules governing the products. Experts say the timing is critical because sales of the products—which weren’t even on the market a decade ago—are heating up, with revenues approaching $1 billion a year, according to Forbes Magazine.
Last week, Health Affairs and the Robert Wood Johnson Foundation (RWJF) released a health policy brief about e-cigarettes that sets out key issues concerning the products and provides important background, particularly for people poised to comment on the FDA’s proposed rules.
Among the issues the policy brief addresses are e-cigarette safety; whether the devices ought to be regulated as a medical (smoking cessation) device or as a cigarette; and whether e-cigarettes pose a risk as a “gateway” drug to tobacco products. It notes that the FDA is currently funding close to 40 studies on e-cigarettes.
The issue is especially critical because sales to kids and teens are increasing, and there is still insufficient information on whether the vapor emitted by the devices pose a cancer risk. A 2013 study of 40,000 middle and high school students around the country by researchers at UC San Francisco found that e-cigarette use in that group doubled between 2011 and 2012, from 3.1 percent to 6.5 percent.
Read the policy brief from Health Affairs and RWJF.
>>Bonus Link: Read a NewPublicHealth post on initiatives by major cities to regulate the sale and use of e-cigarettes.
There are an estimated 7,350 homeless people living in San Francisco, yet there are only eight facilities in the city at which the homeless can shower. At each of these facilities, there are at most two shower stalls—meaning that there is at most one shower for every 460 homeless people.
Lava Mae developed a mobile approach to target this public health issue.
The refurbished San Francisco MUNI bus outfitted with two full-service bathrooms successfully made its first rounds on June 28. The bus will travel around the city providing the homeless with mobile public utilities and giving them much-needed access to clean water and sanitation. Without the limitations of stationary locations, Lava Mae is able to aide people across the city while also staying free from high real estate prices, rising rent and potential eviction.
"For at least a decade, bathrooms have stood in for the city's anxieties about homelessness, public utilities, and the changing economy," wrote Rachel Swan in a piece on public bathrooms in SF Weekly. Lava Mae founder Doniece Sandoval hopes that the program will take big steps in improving the health of the homeless and public sanitation by increasing the number and scope of available public restrooms.
The relationship between the health and wellbeing of the homeless population correlates directly with the health of the community as a whole. As the homeless population strives for a better quality of life, so does the community—one shower at a time.
Read the full story, “A Refurbished Bus Will Bring Showers to the Homeless in San Francisco.”
Last month the Washington Post held a live event, Health Beyond Health Care, that brought together doctors, bankers, architects, teachers and others to focus on health beyond the doctor’s office. The goal of the Washington, D.C., event—which was co-sponsored by the Robert Wood Johnson Foundation (RWJF) and others—was to showcase examples of novel places that are working to create cultures of health, such as a newly designed school that promotes physical activity and healthy eating in Virginia, and free outdoor exercise classes in Detroit.
Videos from the Post event are now online and include conversations with:
- Dan Nissenbaum, managing director in the Goldman Sachs Urban Investment Group, about community development.
- Brookings Institution fellow Alice Rivlin about the RWJF Commission to Build a Healthier America, which released its report Beyond Health Care in January.
- Chris Allen, CEO of the Detroit Wayne County Health Authority, about moving the community from a focus on sick care to a focus on prevention and wellness.
The Post's continuing coverage also includes articles about how city design can open up new opportunities for health; how greenways and complete streets can get people moving; and how workplaces can get a makeover for healthier employees.
Over the next few days, NewPublicHealth will report on additional efforts across the country to promote a culture of health across neighborhoods, schools, homes and workplaces.
Explore the Post’s special report on “Health Beyond Health Care” here.
An American Academy of Pediatrics symposium earlier this week focused on ways to prevent “toxic stress” in children and families, including addressing mental health education and treatment early in a child’s life. In a comprehensive interview during May’s Mental Health Awareness Month, David Shern, PhD, senior science advisor at Mental Health America and a member of American Public Health Association’s Mental Health Section, addressed the importance of this approach.
“[W]e can develop strong mental health which gives us increased resilience to deal with the adversities that we experience in life, to concentrate better, to be more productive, to be more emotionally well balanced,” he said. “So it’s important that when we think about the overall health of our population, we think not only about preventing illness, which of course is critically important, but also promoting strength and well being.”
Read the full interview with the American Public Health Association.
“At 10 a.m. on any given morning, the kids at low-income San Francisco schools are starting to fidget. Their teachers report they’re having trouble concentrating, asking how long ‘til they eat...Then the snacks arrive, delivered by volunteers from the San Francisco-Marin Food Bank. They serve string cheese one week; baby carrots, mandarin oranges or apple slices the next.”
Because of this and other programs, Marin County, Calif. tops the U.S. News & World Report’s new rankings of “America’s 50 Healthiest Counties for Kids,” part of its annual guide on the nation’s Best Children’s Hospitals. The new rankings, for children 18 and younger, are calculated in cooperation with the University of Wisconsin Population Health Institute, which also evaluates health data for the U.S. population as part of its County Health Rankings & Roadmaps program, a collaboration with the Robert Wood Johnson Foundation (RWJF).
The rankings analyze U.S. counties according to several key measures, including:
- Infant deaths
- Low birth weight babies
- Deaths from injuries
- Teen births
- Children in poverty
- Percentage of children without health insurance
- Air quality in most states
- Rates of adult smoking and adult obesity
- Access to physicians
- Exercise opportunities
In addition to the rankings, the U.S. News story also highlights six communities that have made significant advancements toward improving the health of their kids, including:
- Santa Clara, Calif., where a policy stipulates that 50 percent of food and beverages sold in countywide vending machines must meet nutrition guidelines.
- Washington County, R.I., where the policy organization Kids Count is dedicated to improving children’s health, education, economic well-being and safety.
- Middlesex County, Mass., which includes the city of Cambridge—one of RWJF’s Culture of Health Prize winners last year—and where fun physical education classes keep kids active while healthy school meals celebrate cultural diversity.
Read the full story, “America's 50 Healthiest Counties for Kids.”
Far too many older people in generally good health find themselves without purpose—which is itself at cross purposes with the natural makeup of humans, according to Linda P. Fried, MD, MPH, an expert on aging and the dean of the Mailman School of Public Health at Columbia University.
“We are a species wired to feel needed, respected, and purposeful,” she wrote in the latest issue of The Atlantic. “The absence of those qualities is actually harmful to our health.”
The new article discusses the current research on the benefits of older people engaging in work that they are good at and enjoy. One example, Experience Corps—which Fried cofounded and which is now hosted by the AARP—seeks to leverage “the investments in one age group in order to benefit many stakeholders.”
Another example is the World Health Organization’s Global Network of Age-Friendly Cities and Communities, which provides a model for developing public-private partnerships. In New York City, the Age-Friendly NYC Commission was established in 2010 in partnership with the New York City Council and The New York Academy of Medicine. The underlying premise, according to Fried, was that the active participation of older residents in all aspects of city life is essential to the growth and health of the city, and that creating the conditions to achieve this is an important investment in public health.
Read the full story from The Atlantic, “Making Aging Positive.”
>>Bonus Link: Read a previous NewPublicHealth post on the Age-Friendly NYC Commission.
Recent decisions by a number of states to legalize, or consider legalizing, marijuana has prompted the National Institute on Drug Abuse (NIDA) to update two guides: Marijuana Facts for Teens and Marijuana: Facts Parents Need to Know.
According to NIDA, marijuana remains the most abused illegal substance among young adults. By the time they graduate high school, about 46 percent of U.S. teens will have tried marijuana at least once. And although marijuana use among teens dropped dramatically in the last ten years, use of the drug is on the upswing again. Approximately 12.4 percent of students reported use in the month before being surveyed in 2007; in 2013, nearly 23 percent of high school seniors reported current marijuana use and 6.5 percent used marijuana daily.
NIDA’s annual Monitoring the Future survey, which has been tracking teen attitudes and drug use since 1975, shows that use of marijuana over time is directly related to how safe teens perceive the drug to be. The most recent survey shows that the number of teens who think marijuana users risk harming themselves is declining, even though studies have shown that the impacts of marijuana use can include a permanently lower IQ, poor school performance, psychosis, panic and impaired driving. A study earlier this month in JAMA Pediatrics found that college-age men dispute the idea that marijuana can impact their driving.
“The subject of marijuana use has become increasingly difficult to talk about—in part, because of the mixed messages being conveyed by the passage of medical marijuana laws and legalization of marijuana in some states,” said NIDA director Nora Volk. “In addition, many parents of today’s teens may have used marijuana when they were younger, which could make talking openly and setting definitive rules about its use more difficult.”
“Sometimes,” he added, “just beginning the conversation is the hardest part. I hope these booklets can help.”
The updated booklets include new data on marijuana use; new evidence-based information on the potential harms of marijuana; and information on the highly dangerous and even lethal K2/Spice, also referred to as synthetic marijuana.
Marijuana Facts for Teens is also available in print; Marijuana: Facts Parents Need to Know will be available in print soon.
>>Bonus Link: Read an interview with Alexander Wagenaar, PhD, a Professor in the Institute for Child Health Policy at the University of Florida, who recently moderated a webinar on the public health perspectives of legalizing marijuana.
Hurricane season—which officially starts in two weeks—has become a time of year for individuals, communities and organizations to assess their state of readiness for withstanding and surviving a disaster.
A recent Atlantic Cities article profiled a model to follow: the Providence Baptist Church in the Bayview community of San Francisco. Led by local pastor GL Hodge, who has both big box retail and crisis experience, the church has monthly resiliency meetings to establish a local response, and has provided CPR and disaster training to church members through the American Red Cross. The church has also worked to develop community trust by providing after school programs, weekly dinners, a weekly food bank and a shelter on the church grounds that sleeps more than 100 people every night.
Steps to help try to prevent large scale death and injury if an earthquake or other disaster hits include distribution of plastic bags to seniors to store their medicines and ID if they need to evacuate; placards that fit on door knobs indicating if they’re OK or need help in the event of a disaster; and a proposal that would use community development funds to train young men how to strengthen the foundations of senior’s homes, which would improve the chance that the structures would survive a disaster.
“We’re preparing a culture of preparedness,” says Hodge.
Read the full story here.
>>Bonus Link: Read a previous NewPublicHealth interview with Irwin Redlener, MD, director of the National Center for Disaster Preparedness at Columbia University’s Mailman School of Public Health.
After decades of studies demonstrating that poor people and minorities are more likely than their white counterparts to live near health hazards such as toxic waste sites, landfills and congested highways, a new study in the journal PLOS One took a more refined look at a particular aspect in the area of “environmental injustice”: exposure to nitrogen dioxide. The pollutant—which is produced by cars, construction equipment and industrial sources—is linked to higher risk of both asthma and heart attack.
Using data from the 2000 Census, researchers determined that minorities are on average exposed to 38 percent higher levels of outdoor nitrogen dioxide. The gap varies depending where in the country they live, with the upper Midwest and the Northeast seeing the greatest disparities, as well as major cities. All told the disparity accounts for an additional 7,000 deaths due to heart disease annually.
"The biggest finding is that we have this national picture of environmental injustice and how it varies by state and by city," said Julian Marshall, a professor of environmental engineering at the University of Minnesota and one of the authors of the study, according to The Washington Post. "The levels of disparity that we see here are large and likely have health implications."
There are a number of possibilities to account for the disparities. For example, according to The Post, many “urban highways...were originally routed through minority communities that were politically easier to uproot than middle-class white neighborhoods” and “highways and landfills also depress nearby property values, meaning that people who can afford to live elsewhere do, while those who can't remain within their influence.”
Read the full story from The New York Times here.
>>Bonus Link: April is National Minority Health Awareness month. Read more of NewPublicHealth’s coverage of the annual event here.