Category Archives: Access to Health Care
Even Low Levels of Air Pollution Tied to Low Birth Weights
Even low levels of pollution can increase the risk of low-birth weight babies, according to a new study in The Lancet Respiratory Medicine. Researchers analyzed data on more than 74,000 women in 12 European countries, finding that all types of air pollution were linked to both increased risk of low birth weights and smaller average head circumference at birth. The determined that every increase of 5 micrograms per cubic meter (mcg/m3) of fine particulate matter also increases the risk of low birth weight by 18 percent. The European Union’s current regulations call for a limit of 25 mcg/m3, but the study found the risk is still there at limits below this threshold; lowering it to the World Health Organization's guideline of 10 mcg/m3 could prevent as many as 22 percent of the cases. "Our findings suggest that a substantial proportion of cases of low birth weight at term could be prevented in Europe if urban air pollution—particularly fine particulate matter—was reduced," said lead author Marie Pedersen, MD, from the Centre for Research in Environmental Epidemiology in Barcelona, Spain. Read more on infant and maternal health.
Regular Exercise Can Boost Sperm Count, Improve Odds of Conception
Regular exercise—especially done outdoors—may boost a man’s sperm count and improve the odds of conception, according to a new study to be presented at the International Federation of Fertility Societies and the American Society for Reproductive Medicine in Boston. Researchers found that men who spent about an hour a day exercising had a 48 percent higher concentration than men who spent less than one hour a week exercising. The study also found clear associations between higher sperm counts and time spent either outdoors or lifting weights. Possible explanations include higher vitamin D levels in men who spent time outdoors in the sunshine and the increased testosterone levels and insulin sensitivity that come with lifting weights. Also, contradicting popular conceptions, the study found no link between caffeine and alcohol and decreased fertility. Read more on sexual health.
Study: Hospital CEO Salaries Tied to Patient Satisfaction, Not Quality of Care
Hospital CEO salaries tend to be higher at hospitals with high patient satisfaction ratings, and does not seem on average to be linked to either their quality of care nor the benefits they offer to their communities, according to a new study in JAMA Internal Medicine. "I was hoping I'd see even some modest relationship with quality performance," said lead researcher Ashish Jha, MD. "I think we were a little disappointed." Researchers at the Harvard School of Public Health analyzed data on 1,877 CEOs from 2,681 private, non-profit hospitals across the country, finding an average salary of $596,000; those in the lowest 10 percent earned about $118,000 and those in the highest earned about $1.7 million. While many different factors account for the wide range, Jha said the growing emphasis on improving quality measures suggests that the quality of care should be a factor when determining executive salaries. "If you're going to ask doctors and nurses to be accountable, if you're going to ask patients to be accountable…then I think we should make sure that everybody's in, and that senior managers of hospitals also have a stake in insuring high-quality care." Read more on access to health care.
Average Monthly Cost of Mid-tier Insurance Under Affordable Care Act Estimated at $328
The average monthly cost of a mid-tier health insurance plan under the Affordable Care Act will be $328, and government subsidies will also help reduce that cost for most Americans, according to a new report from the U.S. Department of Health and Human Services. The health exchanges open for enrollment next week and the federal government hopes to enroll as many as 7 million people within the first year. The cost varies from state to state, with Minnesota projected to have the least expensive plan at $192 per month and Wyoming projected to have the highest at $516. Read more on access to health care.
NIH Initiative Will Help Move Science from the Laboratories to the Commercial Sector
The U.S. National Institutes of Health (NIH) has awarded $31.5 million in grants to establish three inaugural NIH Centers for Accelerated Innovations that will work to improve how basic science discoveries move from laboratories to commercial products. The Centers are funded by NIH’s National Heart, Lung and Blood Institute (NHLBI) and will focus on technologies to improve the diagnosis, treatment, management and prevention of heart, lung, blood and sleep disorders and diseases. “These centers essentially will offer a one-stop shop to accelerate the translation of early-stage technologies for further development by the private sector and ultimate commercialization,” said Gary H. Gibbons, MD, director of NHLBI. As a result, the public will gain access sooner to new biomedical products that improve human health while also benefiting from the economic growth associated with the creation of new companies and the expansion of existing ones.” Read more on research.
‘Cycling’ Drugs Could Help Combat Antibiotic-resistant Bacteria
“Cycling” between antibiotics may extend their life and effectiveness, while also enabling doctors to stay ahead of drug-resistant bacteria, according to a new study in the journal Science Translational Medicine. "You cycle between drugs that have reciprocal sensitivities," said study co-author Morten Sommer, a lead researcher with the Novo Nordisk Foundation Center for Biosustainability at the Technical University of Denmark. "If you become resistant to drug A, you will become more sensitive to drug B. That way, you can cycle between drug A and drug B without increasing resistance in the long term.” With the increased use—and overuse—of antibiotics, antibiotic-resistant bacteria are becoming an increasingly serious public health problem, leading researchers and health care professionals in search of new ways to combat the problem. More than 2 million people are made ill and more than 23,000 people die every year in the United States due to antibiotic-resistant infections, according to the U.S. Centers for Disease Control and Prevention. Read more on prescription drugs.
Confusing ‘Sell-by’ and ‘Best-before’ Labeling Leads to Billions of Pounds of Wasted Food
Inconsistent “sell-by” and “best-before” dates on package labels lead Americans to needlessly discard billions of pounds of food every year, according to a new study by Harvard Law School and the Natural Resources Defense Council. The labels are meant to inform retailers about a food product’s peak freshness. "The labeling system is aimed at helping consumers understand freshness, but it fails—they think it's about safety. And (consumers) are wasting money and wasting food because of this misunderstanding," said co-author Emily Broad Lieb, who led the report from the Harvard Law School's Food Law and Policy Clinic. The study recommends that “sell-by” dates be reconfigured so as to be invisible to consumers, that a uniform label system is created and that technology-based “smart labels” be used more often. "Under the current patchwork of state and federal laws, consumers are left in the lurch, forced to decipher the differences between 'sell-by' and 'best if used by,' and too often food is either thrown out prematurely, or families wind up consuming dangerous or spoiled food," said Congresswoman Nita Lowey (D-NY), in a release. Read more on food safety.
Study: Hospitals that Perform the Most Surgeries Also Have Lowest Readmission Rates
A new study from the New England Journal of Medicine indicates that the higher quality of care during a surgical procedure, the lower the likelihood of the patient being readmitted for additional surgery. It also found that hospitals that performed the most procedures also, on average, delivered a higher quality of care. In a review of about 480,000 patients discharged from more than 3,000 U.S. hospitals, the researchers found that one in seven were readmitted within 30 days, with the hospitals that did the most procedures having both the lowest readmission rates and the lowest death rates. Hospitals with the most surgeries had readmission rates of about 12.7 percent, compared to 16.8 percent for hospitals with the fewest procedures. "If hospitals performing very few surgeries do not have the volume required to create highly reliable care systems despite their best quality-improvement efforts, perhaps they should not be performing them," said Don Goldmann, MD, chief medical and scientific officer of the Institute for Healthcare Improvement in Boston, who was not involved in the study. "This is a provocative suggestion and deserves careful consideration before being implemented." Read more on access to health care.
HHS ‘Meaningful Consent’ Website to Help Providers, Patients Understands EHR Sharing
As electronic health records (EHRs) become more common, a new website from the U.S. Department of Health and Human Services (HHS) will help health care providers and patients determine exactly how they want their electronic patient health information shared. Meaningful Consent will address issues such as the laws and policies related to the health information exchange (HIE). It also includes strategies and tools for providers, certain health information organizations and other implementers of health information technology. The site also provides background, lessons learned, videos and customizable tools from the HHS Office of the National Coordinator for Health Information Technology’s eConsent pilot project, which tested the use of tablet computers to provide patients with better information on EHRs. Read more on technology.
U.S. Youth Exercise, Diet Improved Over Past Decade
Exercise and dietary habits of U.S. kids and teenagers seems to have improved over the past decade, according to a new study in the journal Pediatrics. The study found that from 2001-2002 to 2009-2010, the average number of days per week being physically active for at least 60 minutes for sixth through tenth graders climbed from 4.3 to 4.5; the days eating breakfast before school climbed from 3 to 3.3; and hours per day watching television dropped from 3.1 to 2.4. The findings suggest that it takes time for public health efforts to translate into behavioral changes. "I would like to believe that all the public health efforts focusing on increasing physical activity and increasing fruit and vegetable consumption are having an effect, because that seems to be a pattern," said Ronald Iannotti, study author from the University of Massachusetts Boston. "The fact that (obesity) is leveling off, that's a surprise and a major change from the steady increase that we've seen over time.” Read more on pediatrics.
Study: Kids of Same-sex Couples Less Likely to Have Private Health Insurance
Children of same-sex parents are less likely to have private health insurance, although the rates improve in states that recognize same-sex marriages or unions, according to a new study in the journal Pediatrics. Approximately two-thirds of U.S. youth with same-sex parents have private health insurance, compared to approximately 78 percent of U.S. youth with married heterosexual parents. When accounting for additional factors such as parental incomes and education level, researchers determined that youth living with same-sex parents were as much as 45 percent less likely to have private health insurance than were youth living with married heterosexual parents. The findings indicate yet another public health benefit of same-sex marriage, as access to health insurance directly affects a child’s health; previous studies have shown a connection between legal unions and improved mental health for gay and lesbian adults. A likely cause for the disparity is the fact that employers have not had to extend coverage to an employee’s same-sex partner or that employee’s children. "I think we are going to see more and more research like this that shows how marriage-equality laws have far-reaching health consequences," said Richard Wight, a researcher at the University of California, Los Angeles, who was not a part of the study. Read more on LGBT issues.
HHS: $67M for Expanded Preventive and Primary Care for 130,000 Americans
The U.S. Department of Health and Human Services (HHS) has awarded approximately $67 million for the creation of 32 new health service delivery sites to expand access to individuals, families and communities across the country. The sites will provide improved preventive and primary health care to more than 130,000 people. Another $48 million will go toward the approximately 1,200 existing centers. “Health centers have a proven track record of success in providing high quality health care to those who need it most,” said HHS Secretary Kathleen Sebelius. “New health center sites in some of the neediest communities in the country will provide access to health care for individuals and families who otherwise may have lacked access to high quality, affordable and comprehensive primary care services.” Read more on access to health care.
Have you heard the story about the Prevention and Public Health Fund? A “no” wouldn’t be surprising.
Have you heard the story about the almost 200,000 preventable deaths in the United States each year due to heart disease and stroke? Probably so.
The latter was big news last week, inspiring headlines and handwringing across the country. Men are twice as likely as women to die of preventable cardiovascular disease. Blacks are twice as likely as whites. Southerners are at far greater risk.
Most of the stories emphasized how all this unhealthy living is the result of unhealthy lifestyle choices. But is that the whole story?
“Largely absent from most of the stories covering the study was context—a hard look at the social and environmental conditions that help explain the findings—as well as some explanation of what it might take to really change things and prevent large numbers of needless deaths.” They also tended to suggest “that poor health is essentially a personal moral failing, while ignoring the vastly different realities that exist in different communities in this country.”
That’s the thesis of a recent Forbes opinion piece, which looks past the round number of “200,000” and other statistics detailed by the U.S. Centers for Disease Control and Prevention (CDC), and points attention to the very real obstacles to healthy living that far too many people face.
The CDC study also discussed the importance of addressing the economic and social determinants that influence the health of individuals and communities (though this went largely unacknowledged in most media accounts, according to the Forbes piece). The CDC pointed out strategies that help create conditions for healthier living, including policy changes that increase access to health care, that give people healthy local food options and that build walkable communities—changes that can only be made by communities, not individuals.
That brings us back to the Prevention and Public Health Fund. Created by the Affordable Care Act, the Fund’s grantees have spent the past three years doing all these things—helping states, cities and tribes create safer, healthier communities.
“That’s a story that needs to be told, with context.”
>>Read the full piece, “200,000 Preventable Deaths A Year: Numbers That Cry Out For Action -- And Better Reporting.”
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?