Category Archives: Access to Health Care
In the 1970s and 80s, residents of the Bronx, one of New York City’s five boroughs, were so anxious to leave the crime-ridden area that many residential and commercial buildings—once majestic and architecturally rich—were torched and empty for decades. Now fifty years later there’s a waiting list of thousands for Via Verde, a new low- and middle-income Bronx housing complex that opened last year. Many features set the complex apart from almost any other housing development in the United States, including an emphasis on greenery from almost every vantage point of the building. This helps create a calming and beautiful atmosphere for the residents, many of whom grew up in crowded housing projects where any nearby parks were usually too dangerous to enjoy.
Why is housing important for health? A lack of affordable rental housing can push more tenants into substandard or overcrowded living situations. Living in unaffordable housing also leaves fewer resources for the things that can keep a family healthy, such as healthy food or preventative health care. Low-income housing also has a reputation for being unhealthy, and for good reason—more than 6 million housing units in the U.S. have deficiencies such as lead paint hazards; allergens, dampness and mold that can trigger asthma; and unsafe structural issues that can cause falls and other injuries. Via Verde and other similar efforts seek to change all that, with housing that is not only affordable but also safe, healthy and even environmentally sound and sustainable (which in turn also saves on costs).
The design for Via Verde was the winner of a 2006 competition hosted by the New York City Department of Housing Preservation and Development; the New York Chapter of the American Institute of Architects; the New York State Energy Research and Development Authority (NYSERDA); and the Enterprise Foundation. It was New York City’s first juried design competition for affordable and sustainable housing.
Women with Midwives Less Likely to Have Complicated, Premature Births
Pregnant women cared for by midwives are less likely to have complicated or premature births, according to a new review of 13 studies by The Cochrane Library. The analysis found that women with midwives were 23 percent less likely have premature births and 19 percent less likely to lose the fetus before 24 weeks. Such pregnancies are also linked to fewer epidurals, episiotomies and the use of instruments such as forceps or vacuums during delivery. Lead author Jane Sandall, professor of social science and women's health in the Division of Women's Health of King's College London, said the next step is to determine exactly why this is the case. "For example, whether it is the model of care itself where midwives are in a position to pick up problems and get the right specialist input as early as possible, or whether a relationship where a women knows and trusts her midwife leads to a better outcome," said Sandall, according to Reuters. Read more on maternal and infant health.
Survey: Large U.S. Employers to Pay 7 Percent More on Health Benefits in 2014
Large U.S. employers estimated the cost of providing health care benefits to their employees will rise 7 percent in 2014, according to a new survey from the National Business Group on Health. The organization is a non-profit association of more than 265 large employers. The survey also found that some employers are interested in the possibility of health insurance exchanges for certain populations, as well as that more companies intend to offer consumer-directed health plans as their only options. This would be the third consecutive year that employers have budgeted for an increase of 7 percent. While this means rates have been kept “stable,” employers are still looking at ways to engage workers in health management and healthy lifestyles that would also help lower costs. “Rising health care costs remain a serious concern for U.S. employers,” said Helen Darling, President and CEO of the National Business Group on Health. Read more on access to health care.
More than 8.5 Million U.S. Adults Use Prescription Sleep Aids
More than 8.5 million U.S. adults took a prescription sleep aid in the past month, according to a new report from the U.S. Centers for Disease Control and Prevention (CDC). As many as 70 million U.S. adults suffer from a sleeping disorder. The report found that the rates of use increases with age, that about 5 percent of women over the age of 20 utilized the medications, that about 3.1 percent of men over the age of 20 utilized the medications and that the higher a person’s level of education, the less likely they were to take the drugs. Report coauthor Yinong Chong, an epidemiologist at the CDC's National Center for Health Statistics, said the rate of usage climbed only about 1 percent from 1999 to 2010. Jordan Josephson, MD, a nasal and endoscopic sinus surgeon at Lenox Hill Hospital in New York City, said the report findings were not surprising. "More accurate diagnosis and better education has led more people to seek treatment for these disorders, which affect them in every aspect of their lives," he said. "For those people who suffer from fatigue and/or daytime somnolence—being tired and feeling sleepy—it is important for them to seek treatment from a board-certified sleep specialist.” However, the U.S. Food and Drug Administration has also lately been taking a closer look at the effects of sleep aids—which recent evidence shows can last into the following day—and plans to have manufacturers perform more extensive tests on the drugs. Read more on prescription drugs.
Kaiser Family Foundation Finds Modest Increase for Family’s Share of Employer-Sponsored Health Insurance
Annual premiums for employer-sponsored family health coverage reached $16,351 this year, up 4 percent from last year, with workers on average paying $4,565 toward the cost of their coverage, according to a new Kaiser Family Foundation survey of more than 2,000 employers. That rise is moderate by historical standards according to the survey; since 2003, premiums have increased 80 percent, nearly three times as fast as wages (31 percent) and inflation (27 percent).
The survey also found that large deductibles of at least $1,000 are common in employer-sponsored plans, especially for employees at smaller firms. This year, 38 percent of all covered workers face such a deductible. At small firms, 58 percent of covered workers now face deductibles of at least $1,000, including nearly a third (31 percent) who face deductibles of at least $2,000, up from 12 percent in 2008.
Additional findings of the survey:
- Nearly all large employers (at least 200 workers) offer at least one wellness program and more than a third (36 percent) of large employers who offer them also provide some kind of financial incentive for workers to participate, such as lower premiums or a lower deductible, receiving a larger contribution to a tax-preferred savings account, or gift cards, cash or other direct financial incentives.
- Among large firms offering health benefits, more than half (55 percent) offer some kind of biometric screenings to measure workers' health risks. Of these, 11 percent reward or penalize workers financially based on whether they achieve specific biometric outcomes.
"This will be an important issue to watch next year, as employers [under the Affordable Care Act can] ask workers to pay more because of their lifestyles and health conditions," said Kaiser Vice President Gary Claxton, the study's lead investigator and director of the Foundation's Health Care Marketplace Project.
Read more on access to health care.
CDC: $75.8M to Help Health Departments Prepare for, Respond to Infectious Diseases
The U.S. Centers for Disease Control and Prevention (CDC) has awarded approximately $75.8 million in grants to help state, territorial and certain local health departments prepare for—and respond quickly to—an array of infectious diseases. The grants are through the Epidemiology and Laboratory Capacity for Infectious Diseases Cooperative Agreement. They will go to such critical areas as surveillance, detection, and outbreak response efforts in infectious disease areas such as foodborne diseases, influenza and healthcare-associated infections. “With many infectious diseases first identified at the local level, this funding ensures that state health departments are able to effectively prevent, detect and respond to such public health threats,” said Beth P. Bell, MD, MPH, director of CDC’s National Center for Emerging and Zoonotic Infectious Diseases.” Read more on infectious diseases.
Study: Quitting Smoking Even After Becoming Pregnant Reduces Risk, Complications of Low Birth Weight
While women who quit smoking right before or right after becoming pregnant will on average gain more pregnancy-related weight, and are also less likely to have babies who are born small, according to a new study in the journal Obstetrics and Gynecology. Low birth weight increases the risk for infections; breathing and respiratory disorders; delayed growth and social development; and learning disabilities. Other studies have also linked smoking during pregnancy to premature birth, birth defects and stillbirth. "The big thing to get out of this study is that quitting early in pregnancy is as helpful in respect to the birth weight of your baby as never having smoked while you were pregnant," said Amber Samuel, MD, a maternal-fetal medicine expert at Emory University School of Medicine in Atlanta. "I think that can be an inspiration to moms who are looking to make a change in their lives." Read more on maternal and infant health.
Malpractice Worries Mean More Tests, Higher Costs for Patients
Concern over malpractice suits increases the number of diagnostic tests ordered by physicians and referrals to emergency rooms, which in turns adds significantly to the costs of health care, according to a new study in the journal Health Affairs. This problem of “defensive medicine” cost the nation approximately $55.6 billion in 2008, or 2.4 percent of all U.S. health care spending. "It's an area where we can chip away at healthcare costs without causing pain to the patient, since these are services ordered not primarily because doctors think they're medically necessary," said Michelle Mello, senior author and professor of law and public health at the Harvard School of Public Health in Boston. Researchers examined the records of approximately 29,000 people who experienced chest pain, lower back pain or headache, but were not later diagnosed with a serious illness related to the complaint. The found that physicians with high levels of concern over malpractice suits ordered additional testing for people with headaches about 11 percent of the time (compared to 6 percent for doctors with low levels of concern) and for patients with lower back pain ordered additional tests about 30 percent of the time (compared to 18 percent). Read more on access to health care.
Poll: 10% of Americans Take Drugs Prescribed for Someone Else
Approximately 1 in 10 Americans has taken prescription drugs prescribed to somebody else, according to a new Reuters/Ipsos poll. About 6 in 10 say they did it for pain relief, while 1 in 5 said it was to sleep or manage stress and anxiety. The poll also found that it was generally not difficult to for people to get their hands on non-prescribed medications, with two-thirds of users saying they were given the drugs by a family member, friend or acquaintance. With prescription drug misuse already the second most abused category of drugs in the United States, this ease of access and casual approach to taking major narcotics is a serious public health issue with severe potential problems. Wilson Compton, MD, a division director at the National Institute on Drug Abuse, said that because prescription drugs are tailored to a person’s particular needs, it can be dangerous for someone else to take them. "Simply because it's a medicine that comes from a pharmacy does not mean it is without risk," he said. "There's a reason they require a prescription." Read more on prescription drugs.
Drug for Enlarged Prostate, Baldness Improves Ability to Identify Prostate Cancer Early
A recently completed study on the effects of a drug used to treat enlarged prostates and male pattern baldness also reduces the risk of prostate cancer by making it easier to identify and treat early, according to a new study in the New England Journal of Medicine. It also refutes concerns that finasteride, found in the prostate drug Proscar and the hair-loss drug Propecia, promotes more virulent prostate cancers."You take Proscar for six months to a year and it halves the size of your prostate, but the cancer inside your prostate does not shrink," said Otis Brawley, MD, chief medical officer for the American Cancer Society. "If I'm performing a biopsy on a smaller prostate, I'm more likely to hit that cancer than if I am sticking into a larger prostate. This drug wasn't causing more prostate cancer. It's causing more prostate cancer to be diagnosed." Approximately 1 in 6 men will be diagnosed with prostate cancer in their lifetime, with 3 to 5 percent dying from the disease. Read more on cancer.
The National Institutes of Health’s Office of Emergency Care Research (OECR), established in 2012, will now be under the leadership of Jeremy Brown, MD. Brown was recently appointed as the first permanent director of OECR, which is housed in NIH’s National Institute of General Medical Sciences.
Before joining NIH, Brown was an associate professor of emergency medicine and chief of the clinical research section in the Department of Emergency Medicine at The George Washington University. Additionally, he served as an attending physician in the emergency department of the Washington, D.C., VA Medical Center. According to the acting director of the National Institute of General Medical Sciences, Judith H. Greenberg, PhD, “Brown brings an impressive mix of clinical expertise, research experience, management abilities and communication skills to this important new position.”
Part of Brown’s research includes how to introduce routine HIV screening—a public health intervention—in hospital emergency departments. Previous studies have found these screenings to be cost-effective and frequently welcomed by patients. This is just one of the many ways in which steps could be taken in the emergency room setting to help improve the data available to assist public health efforts across the country. By using emergency departments as sites for collecting data on the status of the public’s health, more targeted efforts for prevention can be implemented.
NewPublicHealth spoke with Dr. Brown on the evidence that shows support for the collaboration between emergency departments and efforts to improve public health, as well as his new role and what he sees for the future of emergency departments.
NewPublicHealth: How is the transition into this new position going so far and how are you pulling from previous experiences to help with new challenges in this position?
Jeremy Brown: This is the beginning of my fourth week here; it is a new program and a new project really for both me as its first permanent director and for the NIH as well. They’ve never had an office that has addressed this particular part of our nation’s health and I think it’s going to be a learning experience on both sides.
So far, I’ve been really struck by the extremely warm reception that I’ve had from people within institutes and centers with whom I’ve had meetings. Currently, my agenda is really to meet with as many people as possible within NIH whose work touches on emergency medicine and other time sensitive medical issues.
In terms of the latter, I started a brand new HIV screening project from scratch at GW, it hadn’t been done there previously and it really had only been done in a couple of places in the U.S. before. That required the marshaling of a lot of different aspects of both the hospital, the nursing staff, and emergency physicians to get that up and running.
NPH: What other public health initiatives do you think emergency departments can take the lead on to improve public health?
The United Nations Foundation believes that, for the biggest public health obstacles facing the world, it will take all nations and all sectors working toward solutions to succeed. So the Foundation works to make that a reality, bringing together partnerships, growing constituencies, mobilizing resources and advocating policies that can help everyone—in both the developing and developed world.
NewPublicHealth recently spoke with Kathy Calvin, President and Chief Executive Officer of the United Nations Foundation, about the organization’s many efforts to improve health both globally and locally—and how these two goals can support each other.
NewPublicHealth: What changes have you seen in global health during your time in the field?
Kathy Calvin: The number of nonprofits dedicated to health issues has quadrupled it seems, and real progress has been made, which is the most important point—that we’re actually seeing a reduction in maternal deaths and newborn deaths and preventable diseases such as measles and diarrhea and pneumonia. I mean, there’s just been enormous progress, with still much more to happen. But it’s been an exciting time after what I think has been a pretty discouraging period where no amounts of foreign aid seemed to be making a difference. I attribute that partly to some innovations in research and financing, but also to the fact that a lot of governments in Africa actually have prioritized women and prioritized health in some pretty significant ways. And I think we’ve had a very enlightened government in the last five years here, too, in terms of what we’re doing overseas.
So, it’s been exciting to see it. Health is not my background. I’ve really been privileged to see both how serious and significant the challenges are, but also how much good can be done with just a little bit of organized effort.
NPH: When you talk about enlightened government, what are some examples? What is making the difference now?
Calvin: Well ironically it isn’t all that political. In fact, some of the biggest shifts took place under President George W. Bush’s administration with his creation of the President’s Malaria Initiative—until then, there had been zero real depth of interest and progress on malaria—as well as PEPFAR, which some people criticized because it was so bilateral, but it had a huge impact in allowing the current administration to really set some ambitious goals for reducing and eliminating parent-to-child transmission and setting that audacious goal of an AIDS-free generation.
About 40 million U.S. workers don’t receive even a single paid sick day and millions of others can’t utilize sick leave to take care of a sick child. The result is sick kids in school—where they make others sick—and a dramatically increased likelihood of ending up in an emergency room rather than a doctor’s office.
About $1.1 billion in emergency department costs could be saved each year if every U.S. worker had access to paid sick days, according to Vicki Shabo, the Director of Work and Family Programs at the National Partnership for Women & Families. Shabo recently spoke with Grassroots Change about the importance of paid sick leave and the on-the-ground efforts to enact the essential public health initiative at the local level—while also battling government preemption efforts that would take away local ability to improve sick leave policies.
“Unfortunately, we’re seeing a trend,” she said. “It’s sobering and undeniable. There are preemption bills this year that have been introduced in 13 or so states, and several of them have passed. Last year we saw Louisiana pass preemption, and until we alerted some of the local groups on the ground, no one was paying attention to it.”
This and other examples illustrate the critical importance of grassroots efforts to combat preemption and promote improved sick leave policies, which Shabo says benefits workers and their families while having no negative economic impact. With the number of these grassroots advocates growing every day, the next step is improving training and providing more resources to improve policies statewide.
“The takeaway message is that progress is possible, it’s happening, and local grassroots activity is instrumental in the progress that’s been made. As we work federally, grassroots activity will continue to play a central role in future progress. We know that this is not something that we can do from Washington—it has to come from the ground up.”
The Robert Wood Johnson Foundation Human Capital portfolio’s blog, a forum for discussion about the challenges of building a diverse, well-trained health care workforce, features a “Day in the Life” series this week featuring public health nurses. With their own words, these nurses talk not just about what they do, but why they do it—the importance and meaning of their efforts.
For Anneleen Severynen, RN, MN, PHN, of the South King County Mobile Medical Unit for Public Health Seattle and King County in Washington State, it’s about being able to help one person at a time. Anneleen wrote about Charlie, a 60-year-old Native American man who started drinking at the age of 12, bounced around foster homes, returned from service in Vietnam hurting even more, and now calls himself a “lost cause” who expects to drink himself to death.
“As I sat silently, I listened to him grieve the loss of his culture and detail the many kinds of discrimination he has suffered. Though he spoke with the slurred speech of a chronic alcoholic, his eloquence moved me. I noticed tears in his eyes as he described a few happy childhood memories with his father—memories not quite lost to him.”
By helping him to open up she was also able to get Charlie to agree to a few medical tests. He was given a prescription for high blood pressure. She doesn’t know whether he’ll follow through, but she knows that because she took the time to listen, he now has a better chance.
“Every day I get the chance to make a difference in people’s lives, and to help them know that they matter. I can help one person at a time make small choices that will improve their lives and health. As long as there is someone to hear their stories, there are no lost causes.”
Even as the global population continues to grow, technological and societal advances mean that our world is constantly getting smaller. Or at least that we are becoming more interconnected.
Understanding this—that a person in a Midwestern U.S. state is better off when a person on the other side of the world has access to quality health care—the U.S. Department of Health and Human Services’ (HHS) Global Health Strategy is working with partners across the globe to improve the health of everyone.
"Although the chief mission of [HHS] is to enhance the health and well being of Americans, it is critically important that we cooperate with other nations and international organizations to reduce the risks of disease, disability, and premature death throughout the world," said HHS Secretary Kathleen Sebelius.
One of the most powerful initiatives has been the push toward greater immunization rates. Immunizations alone saved 3 million children’s lives in 2011. Over the past decade, premature deaths from measles have been cut by 71 percent and from tetanus by more than 90 percent. And polio is closer and closer to complete eradication.
Still, vaccine-preventable diseases still account for approximately one in four global deaths of children under the age of 5. And of the 22 million children who go without the full benefits of vaccines each year, it is often the poorest that are most affected.
Among the greatest continuing obstacles are the persistent myths surrounding vaccinations, such as the false and repeatedly debunked belief that they cause autism.
“Overcoming these mistaken beliefs has become an integral part of our work towards global vaccine access. Until we reach the day when no lives are lost to vaccine-preventable diseases, we will aggressively continue to develop new and improved vaccines and ensure they are available to everyone in every country.”
>> Read the full “Beyond our borders: Why the U.S. Department of Health and Human Services invests in global efforts” at DefeatDD.org.
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.”