Category Archives: Access to Health Care
Up to 80 percent of family physicians are expected to use electronic health records (EHRs) by the end of this year, and experts across the country are talking about ways to leverage this influx of data to inform better health. A pre-conference workshop at the National Association of County and City Health Officials (NACCHO) Annual Meeting focused on Beacon Communities, which are part of a pilot to demonstrate how meaningful use of EHRs can lead to better health and better health care at a lower cost. The HHS Office of the National Coordinator for Health IT is providing $250 million over three years to 17 selected communities throughout the United States where numerous institutions are sharing data to inform quality improvement and other data-informed efforts.
The NACCHO meeting highlighted Beacon communities that are partnering with public health in different ways to forge data-informed population health activities.
Health departments in North Carolina have been required to do community assessments since 2002 as part of a statewide health department accreditation program and are very experienced with working with this data, whereas hospitals are just now beginning to be required to do similar assessments under the affordable care act, according to John Graham, PhD, PMP, Senior Investigator for the NC Institute for Public Health at the Gillings School for Global Public Health, which plays an integral role in the Southern Piedmont Beacon Community.
“Health assessment planning and communication are tools that can be leveraged to foster more collaboration,” said Graham. “We really try to coordinate public health prevention and health care. We can do a lot with clinical interventions, looking at it from a population health perspective.”
Even Insured Low-income Immigrants Less Likely to Visit Doctors
About 47 percent of insured and uninsured low-income immigrant children saw a doctor in 2010, compared about 60 percent for U.S.-born children, according to a new study from the Migration Policy Institute (MPI). The report also found that immigrant adults are less likely (8 percent) than native-born adults (13 percent) to visit emergency rooms. As immigrants are generally not eligible for coverage under the Affordable Care Act, their care will in many cases fall to health departments. Read more on access to care.
Exercise Alone Won’t Lower Weight; Lifestyle Changes Also Required
Exercise alone is good for maintaining a healthy weight, but should be combined with other lifestyle changes if a person expects to lose weight and then keep it off. People also negate the positive effects of exercise by overindulging in their post-workout rewards. "There's a war between exercise and nutrition in our heads," said American Council on Exercise spokesperson Jonathan Ross. "People tend to overestimate the amount of physical activity they get. They work out a little bit and treat themselves a lot." Between 250 and 300 minutes of exercise each week is necessary for weight loss, according to Joseph E. Donnelly, MD, an exercise physiologist with the American College of Sports Medicine; the government’s recommendation of 150 minutes of moderate-intensity is for cardiovascular fitness. A single pound of fat is about 3,500 calories. Read more on physical activity.
Soda Company to Stop Adding, Promoting Antioxidants in Some 7UP Drinks
The Dr. Pepper Snapple Group has agreed to stop fortifying certain of its 7UP soft drinks with vitamins and will no longer claim the product has antioxidants. The agreement ends a class action lawsuit against the company. 7UP’s regular and diet Cherry Antioxidant, Mixed Berry Antioxidant and Pomegranate Antioxidant varieties had small amounts of vitamin E added at the time of the lawsuit. According to the complaint, the pictures of cherries, blackberries, cranberries, raspberries and pomegranates on various 7UP labels gave the impression that the antioxidants might have come from fruit, but there is no fruit juice of any kind in any variety of 7UP. And last week a federal magistrate ruled that a separate lawsuit against Coca-Cola, for what the Center for Science in the Public Interest says is deceptive marketing of its vitaminwater line of soft drinks, may proceed as a class action suit. Read more on nutrition.
With just 83 days to go until health insurance marketplaces open up to allow otherwise uninsured Americans to sign up for health coverage under the Affordable Care Act (ACA), NACCHO Annual has a good number of plenary and other sessions focused on the role of public health in implementing the law.
>>Read more NewPublicHealth coverage of NACCHO Annual.
In his address to the 1,000 plus attendees at this year’s NACCHO conference, Centers for Disease Control and Prevention Director Tom Frieden, MD, MPH, talked about what local health departments can do to support ACA. “This is an all hands on deck situation,” said Frieden. “We want to do a lot with improving quality of care, but first we’ve got to get people signed up.”
Frieden ticked off actions that local health departments can take to help support enrollment, including:
- Provide resources to the community on getting insured & the benefits of being insured, including free preventive care.
- Educate every resident served by the department, such as immunization, tuberculosis and STD clinic patients, on how they can enroll.
- Educate every organization that the health departments connects with, such as schools, courts and businesses, on how stakeholders can enroll.
“Public health will always be local. But we will always need to adapt and evolve to continue to be relevant and effective,” said Thomas Frieden, MD, MPH, Director of the Centers for Disease Control and Prevention (CDC) to the packed crowd of local health department leaders at the opening session of this year’s National Association of County and City Health Officials (NACCHO) Annual Meeting. That means leveraging what’s working well, and keeping a finger on the pulse of what will work even better in the future, according to panelists at yesterday’s session, which was moderated by Dr. Swannie Jett, DrPH, MSc, Health Officer for the Florida Department of Health in Seminole County and included presentations by a number of federal-level public health officials.
>>Follow ongoing NewPublicHealth coverage of NACCHO Annual, including session recaps, interviews with speakers and more.
Jett alluded to a rapid transformation in public health that will change what it means to ensure the health of a nation or a county.
“Public health needs to be at the forefront,” said Jett. “We need to take the lead in our communities. We need to reach out to community partners, and to health officers in other counties and states. We need to bring everyone into the fold in this conversation.”
These kinds of cross-cutting partnerships, with public health playing a central role, were also the subject of a recent op-ed by Frieden on the Huffington Post, sharing success stories from the 2013 Annual Status Report of the National Prevention Strategy. The Strategy envisions a prevention-oriented society where all sectors recognize the value of health for individuals, families, and society, working together to achieve better health for all Americans. Frieden shared some examples of efforts to create healthier places to live happening across the country:
Employer Mandate to Provide Health Insurance for Workers Delayed One Year
The U.S. Department of the Treasury announced yesterday that implementation of the rule under the Affordable Care Act requiring employers with more than fifty workers to provide health insurance or pay penalties beginning January 1, 2014, will be delayed by one year. Read more on access to health care.
Pharmacist-guided Home Hypertension Monitoring Shows Significant Results
Home blood pressure monitoring augmented by partnering with a pharmacist can lead to greater improvements in hypertension than the traditional treatments, according to a new study in the Journal of the American Medical Association. People in the study intervention group received a home blood pressure monitor, training and lifestyle advice. The monitor automatically sent updates to the pharmacists, who could adjust treatment accordingly. About 72 percent of the study participants who underwent the new care combination had their hypertension under control after six months, compared to 45 percent for the participants who underwent the usual care. This control also persisted months after the interventions. “The reason that only about half of people with [high] blood pressure have it under control is that usual care isn't working. We combined two interventions that we thought would be very powerful together—home monitoring and pharmacist managements—and this is one system that we've shown works very well for blood pressure control," said senior investigator Karen Margolis, MD, from the HealthPartners Institute for Education and Research in Minneapolis. About 30 percent of U.S. adults suffer from high blood pressure. Read more on heart health.
HHS Issues Final Plan on Improving Patient Care Utilizing Health IT
The Department of Health and Human Services (HHS) has issued its final “Health IT Patient Safety Action and Surveillance Plan” to utilize health information technology (IT) to better protect patients and improve the quality of care. “When implemented and used properly, health IT is an important tool in finding and avoiding medical errors and protecting patients,” said National Coordinator for Health IT Farzad Mostashari, MD. “This Plan will help us make sure that these new technologies are used to make health care safer.” The Office of National Coordinator for Health IT plan outlines the responsibilities of both HHS and the private sector. It includes making it easier to report health IT-related incidents and hazards using certified electronic health record technology; encouraging reports to Patient Safety Organizations and updating standardized reporting forms; encouraging the use of standardized reporting forms in hospital incident reporting systems; and training on how to use the forms to identify safe and unsafe health IT practices. Read more on technology.
HHS Launches HealthCare.gov to Help Americans Prepare for New Coverage Opportunities
The U.S. Department of Health and Human Services (HHS) has launched the new HealthCare.gov to help Americans prepare for new coverage opportunities through the Affordable Care Act. Open enrollment in the Health Insurance Marketplace begins in just a few months, on October 1. The website (also available in Spanish) includes social media integration, sharable content and engagement destinations, and will later incorporate web chat functionality. “The new website and toll-free number have a simple mission: to make sure every American who needs health coverage has the information they need to make choices that are right for themselves and their families—or their businesses,” said HHS Secretary Kathleen Sebelius. Read more on access to health care.
USPSTF Recommends Hep C Screenings for All ‘Baby Boomers’
All “Baby Boomers”—Americans born between 1945 and 1965—should be screened for hepatitis C, according to new final recommendations from the U.S. Preventive Services Task Force (USPSTF). Earlier recommendations in November had only suggested that doctors consider screening. The new recommendations appear in the Annals of Internal Medicine. Researchers concluded that even the “moderate” net benefit made screening worthwhile; they also recommended screening for people at higher risk, such as injection drug users. "New evidence came out since the draft recommendation, which gave us greater confidence in the linkage between a sustained viral response and important outcomes," said Albert Siu, MD, co-vice chair of the task force, to Reuters. The majority of the 3 million Americans who have hepatitis C are Baby Boomers, according to the U.S. Centers for Disease Control and Prevention. Read more on aging.
Study: Diet, Exercise Don’t Decrease Heart Health Risk for People with Diabetes
While the weight loss associated with diet and exercise does not necessarily improve heart health for people with type 2 diabetes, the positive lifestyle changes can decrease the chances of kidney failure and eye damage, according to a new study in the New England Journal of Medicine. "Intensive lifestyle intervention reduced the risk of chronic kidney disease by 31 percent," said study author Rena Wing. "So we had a very, very marked effect on the development of high-risk chronic kidney disease. We also showed a benefit in terms of self-reported eye disease." Researchers said one possibility for the lack of heart health improvement was the relatively small weight losses of both of the study groups—the one that incorporated exercise, and the one that did not. Frank Sacks, MD a professor of cardiovascular disease prevention at the Harvard School of Public Health who saw the study but did not participate, said he believed it was “stopped too soon,” which affected the results. Read more on diabetes and heart health.
RWJF ‘Commission to Build a Healthier America’ Reconvenes to Focus on Early Childhood and Improving Community Health
What do the needs of children in early childhood and improving community health have to do with each other? Everything, according to a group of panelists who addressed the Robert Wood Johnson Foundation (RWJF) Commission to Build a Healthier America at a public meeting in Washington, D.C. yesterday.
Early childhood education and other interventions early in life, particularly for low-income children, can set kids on a path to better jobs, increased income and less toxic stressors such as violence and food insecurity, according to testimony at the today’s meeting. And that in turn creates more stable and healthier communities. Those two issues are the focus of the Commission, which plans to release actionable recommendations in September.
Yesterday’s event marks the first time the Commission is reconvening since it issued recommendations for improving health for all Americans in 2009. It will be co-chaired again by Mark McClellan, MD, PhD, director of the Engelberg Center for Health Care Reform at The Brookings Institution and former Administrator of the Centers for Medicare & Medicaid Services, and Alice M. Rivlin, PhD, senior economist at The Brookings Institution and former director of the Office of Management and Budget.
“Although we have seen progress since the Commission issued its recommendations in 2009, we still have a long way to go before America achieves its full health potential,” said RWJF President and CEO Risa Lavizzo-Mourey, MD, MBA at the Commission’s public meeting in Washington. “We know what works: giving children a healthy start with quality child care and early childhood development programs, and building healthy communities where everyone has an opportunity to make healthy choices. That is why RWJF is reconvening the Commission, to concentrate on these two critical areas.”
Last week, efforts to add a ten year old with cystic fibrosis to the list of adult patients waiting to get donated lungs, increasing her chances of a transplant, made big news. NewPublicHealth had planned to write about the urgent need for citizens to step up and sign on to become organ donors and help whittle down the long lists of patients desperately waiting for hearts, lungs, kidneys and other organs. But our colleagues at the The Public’s Health, a well-worth-reading public health blog hosted by the Philadelphia Inquirer, beat us to it. We urge you to read the post by Michael Yudell, one of the blog’s writers as well as an associate professor at the Drexel University School of Public Health.
"…The demand for organs in the United States far outpaces the supply. There are currently 75,650 active candidates (meaning they are medically suitable for a transplant) waiting for organs in the United States. But 18 people die every day, on average, waiting for an organ transplant."
New ‘Health Affairs’ Brief Looks at Novel Coverage Idea under the Affordable Care Act
A number of states that have decided against implementing the Medicaid expansion program under the Affordable Care Act, which would give Medicaid benefits to many low-income adults who currently don’t have health insurance, may have another idea for coverage. The states are considering providing people eligible for the Medicaid funds with vouchers to purchase private insurance on their state health insurance exchanges. The exchanges, also known as marketplaces, open October 1, 2013 for health insurance that begins January 1, 2014. A new policy brief from Health Affairs and the Robert Wood Johnson Foundation looks at whether that option can be cost-effective and still provide benefits equal to those provided by the traditional Medicaid program. Read more on access to health care.
Teen Dating Violence Persists Despite Prevention Efforts
Two recent studies by the University of Maryland School of Public Health examine physical dating violence (PDV) among teens found it persists despite decades of national and local prevention efforts. The research showed that PDV rates have remained consistent for girls since 1999 and that rates for boys' PDV have increased. The study on trends in girls, published in the Journal of School Health, found that approximately one in 10 girls experience PDV annually. Teenage girls who reported being physically abused by a girlfriend or boyfriend were also more likely to report feeling sad and hopeless and have suicidal thoughts, violence-related behaviors and engage in sexually risky behavior. A second study, published in the International Quarterly of Community Health Education, found that the prevalence of male PDV victims increased about 30 percent between 1999 and 2009, and according to the study by 2009 almost one in eight high school males reported having been hit, slapped, or physically hurt on purpose by a boyfriend or girlfriend within the past year. The study also found feelings of hopelessness, physical fighting, multiple sex partners and lack of condom use among male victims of PDV. Read more on violence.
USDA, EPA Launch U.S. Food Waste Challenge
The U.S. Department of Agriculture (USDA), and the U.S. Environmental Protection Agency (EPA) have launched the U.S. Food Waste Challenge, which calls on food producers, processors, manufacturers, retailers, communities and government agencies to reduce, recover and recycle food waste. Food waste in the United States is estimated at between 30 to 40 percent of the food supply. In 2010, an estimated 133 billion pounds of food from U.S. retail food stores, restaurants and homes was never consumed. In 2010, the financial value of food waste was pegged at close to $400 for every U.S. consumer. As part of the food challenge, USDA is initiating activities to reduce waste in the school meals program, educate consumers about food waste and food storage, and develop new technologies to reduce food waste. To join the Challenge visit here. Read more on nutrition.
Smoking Cessation, Three Other Simple Lifestyle Behaviors Dramatically Improve Overall Health
Utilizing four simple lifestyle behaviors can reduce the risk of both heart disease in particular and death in general, according to a new study in the American Journal of Epidemiology. Researchers from the Johns Hopkins University School of Medicine identified regular exercise, eating healthy, maintaining a healthy weight and—in particular—quitting smoking as the four keys. "Of all the lifestyle factors, we found that smoking avoidance played the largest role in reducing the risk of coronary heart disease and mortality," said study senior author Roger Blumenthal, MD, a cardiologist and professor of medicine at Hopkins and director of the Ciccarone Center for the Prevention of Heart Disease at Johns Hopkins. "In fact, smokers who adopted two or more of the healthy behaviors still had lower survival rates after 7.6 years than did nonsmokers who were sedentary and obese." The researchers said the findings support American Heart Association recommendations regarding health and illustrate that there are many health factors that people can control. Read more on tobacco.
TSA Abandons Plans to Allow Small Knives, Sports Equipment on Planes
The Transportation Security Administration (TSA) has dropped its plans to allow passengers to carry knives and certain sports equipment on planes amid loud protests from lawmakers, the airline industry, labor unions and law enforcement, according to the Associated Press. TSA first announced its intentions back in March; 145 members of the U.S. Congress recently signed a letter requesting the prohibitions to stay in place and the House was nearing passage of legislation that would counter TSA’s plans to loosen regulations. "After getting the input from all these different constituents, I realized there was not across-the-board support that would serve us well in moving forward," TSA Administrator John Pistole. "It is a recognition that, yes, these items could be used as weapons, but I want our folks to focus on those things that, again, are the most concern given the current intelligence.” Read more on safety.
California Law Reduces Payments for Millions of Uninsured Patients
California’s Hospital Fair Pricing Act is successfully helping low-income populations by limiting exactly how much hospitals can collect from uninsured patients and can serve as a diagram for how other states can address the public health issue, according to a new study from the Robert Wood Johnson Foundation appearing in the journal Health Affairs. The law was passed in 2006. There are more than 6.8 million people in the state without insurance; 97 percent of California hospitals offered free care to such patients with incomes at or below the federal poverty level. Read more on access to health care.