Category Archives: Community Health
Mistrust, Perceived Discrimination Affect Young Adult Latinos’ Satisfaction with Health Care
Mistrust of the medical community and perceived discrimination can affect how satisfied young adult Latinos are with their health care, which in turn can influence health outcomes, affect participation in health care programs under the Affordable Care Act and contribute to disparities in health care access, according to a new study in The Journal of Rural Health. Researchers surveyed 387 young adult Latinos, ages 18-25, finding that approximately 73 percent were moderately or very satisfied with their health care, but among those who were not, medical mistrust and perceived discrimination were found to be factors. The researchers recommend improving “cultural competency” among health care providers—from the doctors to the receptionists to the lab technicians—to help ensure Latinos are treated with respect and dignity, and also that a bilingual/bicultural workforce may be more effective at building trust. “Trust is huge; it allows patients to disclose concerns and be honest,” said study co-author S. Marie Harvey, associate dean and professor of public health at Oregon State University in a release. Read more on health disparities.
FDA Approves First Sublingual Home Treatment for Hay Fever
The U.S. Food and Drug Administration (FDA) has approved the first sublingual—or under the tongue—allergen extract for use in the United States. Designed to treat hay fever with or without conjunctivitis that results from exposure to certain grass pollens in people ages 10-65, the first dose is administered in a health care providers office so that the patient can be observed for any adverse reactions, but can then be taken at home. Approximately 30 million Americans and 500 million people worldwide are affected by hay fever, also known as allergic rhinitis, which can cause repetitive sneezing; nasal itching; runny nose; nasal congestion; and itchy and watery eyes. “While there is no cure for grass pollen allergies, they can be managed through treatment and avoiding exposure to the pollen,” said Karen Midthun, MD, director of the FDA’s Center for Biologics Evaluation and Research, in a release. “The approval of Oralair provides an alternative to allergy shots that must be given in a health care provider’s office.” Read more on the FDA.
New Report Analyzes Link Between Metro Areas and Overall Health
People who live in compact, connected metropolitan regions are more likely to see their incomes rise, have lower household costs, have more transportation options and live longer, safer and healthier lives, according to Measuring Sprawl 2014, a new report from Smart Growth America and the University of Utah’s Metropolitan Research Center. The report looks at 221 major U.S. metropolitan areas, ranking them based on how sprawling or compact they are as well as examining how sprawl relates to factors such as economic mobility; the cost of housing and transportation; life expectancy; obesity; chronic disease and safety. “Smart growth strategies are about making life better for everyone in a community,” said Geoff Anderson, President and CEO of Smart Growth America. “If policymakers are looking for ways to lower costs for their constituents, improve public health and support their broader economy, they need to be thinking about how to improve their development.” Read more on community health.
EPA Sets Cleaner Fuel and Car Standards to Cut Air Pollution and Improve Health
The U.S. Environmental Protection Agency (EPA) today finalized emission standards for cars and gasoline to significantly reduce harmful pollution and prevent thousands of premature deaths and illnesses. According to the EPA, the new standards will also create efficiency improvements for cars and trucks. The standards go into effect by 2017.
The new standards cut emissions of a range of harmful pollutants that can cause premature death and respiratory illnesses. By 2030, EPA estimates that up to 2,000 premature deaths; 50,000 cases of respiratory ailments in children; 2,200 hospital admissions and asthma-related emergency room visits; and 1.4 million lost school days, work days and days when activities would be restricted due to air pollution will be prevented. Total health-related benefits in 2030 will be between $6.7 and $19 billion annually.
The program will also reduce exposure to pollution near roads. More than 50 million people live, work, or go to school in close proximity to high-traffic roadways, and the average American spends more than one hour traveling along roads each day. Read more on environment.
Study Finds Many Parents Support Flu Shots at School
Half of parents in the United States would agree to have their children get their flu shots at school, according to a survey from the Brown School of Public Policy at Washington University in St. Louis. Researchers at the school conducted a nationally representative online survey of more than 1,000 parents of school-aged children. Convenience was the chief reason for parents supporting flu shots at school. Thirty two percent of parents surveyed were not sure if they would consent to giving the shots at school and 17 percent said they would not consent. Most likely to support flu shots at school were college-educated parents and parents of uninsured children. The study was published in the journal Vaccine.
Flu season can last in the United States through April, according to the U.S. Centers for Disease Control and Prevention (CDC). This is especially the case in communities where the season started later in the fall or early winter. In a recent report, CDC researchers found that the flu vaccine “offered substantial protection against the flu this [2013-2014] season,” reducing a vaccinated person’s risk of having to go to the doctor for flu illness by about 60 percent across all ages
“We are committed to the development of better flu vaccines, but existing flu vaccines are the best preventive tool available now. This season vaccinated people were substantially better off than people who did not get vaccinated. The season is still ongoing. If you haven’t yet, you should still get vaccinated," said CDC director Tom Frieden, MD, MPH, in a recent release. Read more on flu.
Online Ratings Currently Not Used Much to Choose Physicians
Online ratings that review physicians can influence which doctor a patient chooses, but most patients rank insurance acceptance and distance from home or office as more important, according to a new study in JAMA.
- 9 percent of responders said they consider doctor rating websites “very important” in their search for a physician
- 89 percent of responders ranked “accepts my health insurance” as “very important.”
- 59 percent said a convenient office location very important
The study also found that only five percent of those surveyed have ever posted ratings online, although two-thirds of responders were aware of ranking sites, a higher percentage than found in previous studies.
“These may seem useful, but no one is regulating this ‘crowdsourced’ information about doctors. There’s no way to verify its reliability, so online ratings may not currently be the best resource for patients,” David Hanauer, a primary care pediatrician and clinical associate professor of pediatrics at C.S. Mott Children’s Hospital in Detroit. Read more on community health.
Labor Department Announces Grants to help Adults Transition from Prison to Workforce
The U.S. Department of Labor has announced close to $30 million in grants to help men and women participating in state or local prison work-release programs get the job skills needed for “in demand” jobs. Grants will be awarded to implementing partners that provide qualifying services in areas with high-poverty and high-crime rates, including communities that have a large proportion of returning citizens that typically experience higher rates of recidivism. Read more on community health.
Combining Online Games, Betting and Social Interaction Can Help People Lose Weight
A study by researchers at the Miriam Hospital in Providence, Rhode Island finds that a web-based commercial weight loss program that pairs financial incentives with social influence resulted in significant weight loss for many of the study participants. The results were published in JMIR Serious Games.
Players joined a game to lose weight while betting money on themselves and had four weeks to lose four percent of their starting weight. At the end of week four, all players who lost at least four percent of their initial body weight were deemed winners and split the pool of money collected at the start of the game. The researchers studied nearly 40,000 players over seven months and found that winners lost an average of 4.9 percent of their initial body weight and won an average of $59 in four weeks. Factors associated with winning the game included betting more money, sharing on Facebook, completing more weigh-ins, and engaging in more social interactions with the other players. Read more on obesity.
New SAMHSA Guide Provides Resources to Help Families Support Their LGBT Children
The Substance Abuse and Mental Health Services Administration (SAMHSA) has released a Resource Guide to help health care and social service practitioners provide guidance to families on how to support their children who are coming out or identifying themselves as lesbian, gay, bisexual and transgender (LGBT). According to SAMHSA, with greater access to more information about sexual orientation, gender identity and LGBT resources through the internet and other media, more young people have been coming out than ever before and at younger ages, and the family-oriented approach offered by the guide can provide useful information during a critical period. Read more on pediatrics.
A key session at the National Association of Counties (NACo) Health Initiatives Forum held last week in San Diego focused on the opportunities and implementation challenges of the Affordable Care Act for inmates of county jails.
Most county jail inmates are there awaiting trial because they can’t afford bail, and a large percentage have physical and/or mental health problems. While in jail, the cost for their health care falls to the county; Medicaid and other benefits inmates have in the community end once they enter the jail system, and many have no benefits. Typically, the care inmates received in jail ends on release since there is generally no entity to help them transition to community benefits and care.
And benefits under the Affordable Care Act are generally elusive for inmates—and counties—desperate for care and a break on the high cost of health care for inmates. While just about all inmates would qualify for coverage under the Affordable Care Act either through health insurance marketplaces or Medicaid expansions in those states that have changed their Medicaid rules under the health law—expanding Medicaid benefits to those without children who qualify financially because of low incomes—current laws do not permit inmates to be covered for health care costs under Medicaid while in jail, except for hospitalizations while they’re incarcerated.
Many counties in states that have expanded Medicaid to include low-income adults without children have petitioned their state Medicaid offices to amend current rules and allow coverage for health care under Medicaid during incarceration.
However, counties are taking initiative to help inmates sign up for coverage that will kick in on their release, reducing the chance for recidivism and improving the chance for healthier and more productive lives. For example, last week in San Francisco the city sheriff sent a bill to the city’s Board of Supervisors that would make the sheriff’s office responsible for helping inmates sign up for the Affordable Care Act.
At the NACo meeting, Farrah McDaid Ting, Associate Legislative Representative for Health and Human Services at the California State Association of Counties, said a key issue both for county budgets and for the health of people released from jail into the community is that without benefits and a transition to care, often care was only sought afterward and delivered when there is a crisis. Ting says among the requests being made in California is to have Medicaid suspended rather than terminated for people in jail under a year, which would allow a person to transition back to care immediately on release.
Another critical need in jail is technology infrastructure to allow inmates to be signed up. Some counties in California, according to Ting, are using outside nonprofit groups to sign up eligible inmates before release.
“What we want to reduce is that person ending up back in jail,” said Ting.
Many of the sessions at the National Association of Counties (NACo) Health Initiatives Forum meeting in San Diego this week have been moderated by Nick Macchione, director of San Diego’s Health and Human Services Agency and vice chair of the Healthy Counties Initiative Advisory Board. Macchione is a key architect of Live Well San Diego, a program voted in by the San Diego Board of Supervisors that is a long term, comprehensive and innovative strategy on wellness with a goal of helping all San Diego County residents become healthy, safe and thriving.
NewPublicHealth spoke with Nick Macchione ahead of the forum. Senior Policy Advisor Julie Howell and Dale Fleming, director of strategic planning and operational support, joined the conversation.
NewPublicHealth: The buzz about San Diego is that you’re working hard toward population health improvement.
Nick Macchione: I think the excitement about San Diego is that we have earned a reputation as a health innovation zone by having a collective impact on health and wellness. Our deeds demonstrate our words because over the past decade there have been five major broad-based population health improvements: reduction of heart disease and stroke; reduction of cancer rates; reduction of childhood obesity; reduction of infant mortality; and reduction of children in foster care. That reduction is extremely important to population health because we also look at the social determinants of health and not just pure health care.
We've taken an ecological approach to population health—working with partners across all sectors and coming together not just from traditional health care but beyond that to public health, social services, business, community, schools and the faith community.
And we’ve done that in the context of optimizing existing resources to improve outcomes. We’ve been blessed with a lot of competitive federal grants and philanthropy investments, but really the framework is how we leverage and optimize what we have first before we go and seek to augment with other resources. That has worked exceptionally well and that’s earned us that innovation zone reputation.
NPH: Tell us about Live Well San Diego.
Macchione: Live Well San Diego is a comprehensive public health initiative that involves widespread community partnerships to address the root causes of illness and rising health care costs. The tagline is healthy, safe and thriving. We think it’s a great template that communities can use, it’s transferable because San Diego has every imaginable bio-climate except a tropical rainforest. So we have desert towns, we have rural communities, we have mountain villages, we have beach towns and everything in between urban core. We also call it Project 1 Percent because 1 percent of San Diego represents the nation both in its diversity and its population. So, if we can achieve what we're achieving on advancing population based health in a broad scale it can be demonstrated throughout the country.
This week the National Association of Counties (NACo) will hold the fourth Healthy Communities Initiative Forum, in San Diego, bringing together county health directors and staff to share best practices to improve community health. The NACo Healthy Counties Initiative supports innovative public-private partnerships to enhance community health.
Ahead of the conference, NewPublicHealth spoke with Linda Langston, president of NACo and Supervisor of Linn County, Iowa, who will be attending and presenting at the conference.
NewPublicHealth: Tell us about the Healthy Counties Initiative.
Linda Langston: I was the first chair of the initiative when it came into being four years ago. We modeled it after what we had done with our Green Government initiative—we had local government elected officials and staff connected to various areas of health, and then we also populated the committee with some of our corporate sponsors that were ultimately working toward very similar kinds of goals and trying to figure out how we could work affectively together.
We're also helping people understand upcoming issues and ideas they may know about.
NPH: What are the key health issues that counties face in 2014 and how is NACo generally helping counties with those issues?
Langston: Many counties are responsible for safety-net services and virtually every county in the nation has a jail. We’ve learned that many people, including many federal legislators, don’t understand the difference between jails and prisons. Jails are unique to local government, at the county level, and are often where people who have been arrested but can’t afford bail wait until their trial dates. Our challenges include providing health care in the jails, as well as connecting those released to health services in the community, with a goal of continuity for such services as mental health care and treatment for substance abuse.
We are also employers and very often, particularly in small-to-medium-sized counties, we are the largest employer in the area. So we have a lot of employees who need our best efforts, such as looking at how to incentivize people to make good decisions about their own health. And, of course, we also have the community public health responsibility. So we're pretty effectively placed to deal with all things related to health.
New Report by RWJF Commission to Build a Healthier America Calls for Funding Changes to Help Improve the Health of the Nation
Recommendations released by the Robert Wood Johnson Foundation’s Commission to Build a Healthier America yesterday call for three areas of change essential to improving the nation's health:
- Increasing access to early childhood development programs;
- Revitalizing low-income neighborhoods;
- Broadening the mission of health care providers beyond medical treatment to include the social problems their patients face that keep them from living healthy lives.
The Commission, which reconvened last June after four years, deliberated over the past several months and determined that these areas have the greatest potential for improving the health of the population, especially for low-income families.
The independent, non-partisan Commission was chaired by Alice M. Rivlin, PhD, former director of the Office of Management and Budget, and Mark McClellan, MD, PhD, the former head of the Centers for Medicare & Medicaid Services. Commission members included journalists, physicians, academics, policymakers, public health experts and people engaged in community development.
The new recommendations are part of a new report, Time to Act: Investing in the Health of Our Children and Communities.
“We cannot improve health by putting more resources into health care alone," McClellan said. "We must find ways to help more Americans stay healthy and reduce the health care costs that are crowding out other national priorities."
"To achieve a healthier America, we must change our approach to investing in health to affect the actual determinants of health, not just the consequences of ill-health," said Rivlin. "If carried out, these recommendations will build a foundation of lifelong health for generations to come."
Speaking at the release of the recommendations in Washington, D.C., yesterday RWJF President and CEO Risa Lavizzo-Mourey, MD, MBA, said, “we must join forces to foster a culture of health in which everyone—regardless of where they live, their race or ethnicity, or how poor or wealthy they may be—has the opportunity to lead a healthy life."
The Commission’s members all spoke about the findings and recommendations during panel discussions at an event at the Newseum to release the report. Suggested next steps include engaging both citizens and policymakers to advance the issues. “Often aspiring policymakers are looking for an issue and we’re trying to hand them one,” said Rivin. Anne Warhover, a member of the Commission and president and CEO of the Colorado Health Foundation, pointed out that turning the recommendations into successful actions will include helping each community determine both what it needs and what it can do, and realizing that “one size does not fit all” when it comes to these changes.
The Robert Wood Johnson Foundation, said Lavizzo-Mourey, “will make the [Commission’s report] our compass going forward to allow everyone to live a healthy life. It’s not going to stay on the shelf. We’re going to use this every day.”
- Resources created to accompany the release of the recommendations of the Commission to Build a Healthier America include video interviews with key leaders who are already helping to change the health of their communities.
U.S. Lung Cancer Rates Dropping for Both Men and Women
The rate of new lung cancer cases decreased among men and women in the United States from 2005 to 2009, according to a new report from the U.S. Centers for Disease Control and Prevention (CDC), with the fastest drop among adults aged 35-44 years. The rate of decrease has been 6.5 percent per year among men and 5.8 percent per year among women. Lung cancer incidence rates decreased more rapidly among men than among women in all age groups. “These dramatic declines in the number of young adults with lung cancer show that tobacco prevention and control programs work—when they are applied,” said CDC Director Tom Frieden, MD, MPH. Lung cancer is the leading cause of cancer death and the second most commonly diagnosed cancer among both men and women in the United States, with most lung cancers attributable to cigarette smoking and secondhand smoke. Because smoking behaviors among women are now similar to those among men, women are now experiencing the same risk of lung cancer as men, according to the CDC. Read more on tobacco.
DOT to Fund New Low or No Emission Buses
The U.S. Department of Transportation (DOT) has announced funding of close to $25 million to help fund non-polluting buses in communities across the country. The funds will be awarded competitively to transit agencies and state transportation departments working either independently or jointly with bus manufacturers already making low- and zero-emission buses. According to the DOT, in addition to the environmental benefits, the new buses will also save money for transportation agencies because they can more than double the fuel economy of buses that run on diesel and other fuels. Read more on transportation.
Assistance for Paying Heat Costs
The polar vortex deep freeze much of the country experienced this past week is ending, but there are still many more weeks left of winter. People having trouble paying for heating costs can contact the National Energy Assistance Referral project at: 1-866-674-6327, e-mail email@example.com or access the LIHEAP website to find out where to apply for help to pay for heating costs. Read more on community health.
Late last year the Grand Rounds program of the U.S. Centers for Disease Control and Prevention (CDC) held a webinar on water fluoridation, a public health intervention that has been a priority in the United States for nearly seventy years.
Fluoridation, which has been shown to significantly reduce cavities in children, has been recognized by the CDC as one of 10 great public health achievements of the 20th century. Despite the benefits such as cost savings, however, CDC says there are ongoing challenges in promoting and expanding fluoridation.
NewPublicHealth recently spoke with Barbara Gooch, DMD, MPH, Associate Director for Science in the Division of Oral Health at CDC’s National Center for Chronic Disease Prevention and Health Promotion, about the challenges and benefits of water fluoridation and other emerging oral health improvement opportunities.
NewPublicHealth: What has been the historical impact of fluoridating water in the United States?
Dr. Barbara Gooch: All water generally contains fluoride, but usually at a level too low to prevent tooth decay, so community water fluoridation is a controlled adjustment of fluoride in a public water supply to an optimum concentration for the prevention of tooth decay.
That optimal concentration has historically been set at about 1 milligram (mg) of fluoride per liter of water, or 1 part per million. Fluoride was first introduced in the United States in Grand Rapids, Mich., in 1945. For cities that implemented community water fluoridation in the 1940s and 1950s, there was a dramatic reduction in tooth decay among children. Sometimes that reduction was greater than 50 percent. It has really been a major factor leading to the improvement in U.S. oral health.
When we compare the National Health and Nutrition Examination Survey done in the early 1970s with one conducted from 1999 to 2004, we found that the percentage of adolescents with one or more decayed teeth decreased from 90 percent in the early 1970s to 60 percent in the ’99-’04 National Survey. And while the number of teeth affected by tooth decay was an average of six in the 1970s survey, the instance was reduced to fewer than three in the later survey.
NPH: There are other sources of fluoride now, such as toothpaste. Is community water fluoridation still important?
Gooch: Current studies indicate that community water fluoridation increases the prevention of tooth decay by an additional 25 percent despite other sources. But the other very important factor about community water fluoridation is in order to receive its benefits, if you live in a fluoridated community. all you have to do is drink the tap water. And we can also show cost savings. One study estimates that for every dollar spent on community water fluoridation, you save about $38 in dental treatment costs.
Infographics, public health news and innovative efforts to improve community health were the topics of the most widely read posts on NewPublicHealth this year.
Take a look back at our most popular posts:
- The Robert Wood Johnson Foundation’s Commission to Build a Healthier America will release new recommendations on early childhood education and improving community health on Monday January 13. Earlier this year, new city maps to illustrate the dramatic disparity between the life expectancies of communities mere miles away from each other. Where we live, learn, work and play can have a greater impact on our health than we realize.
- Three of the infographics created for the NewPublicHealth series on the National Prevention Strategy, a cross-federal agency emphasis on public health priorities, were among the most popular posts of 2013. Stable Jobs = Healthier Lives, the most widely viewed NPH infographic, tells a visual story about the role of employment in the health of our communities. One example: Laid-off workers are 54 percent more likely to have fair or poor health and 83 percent more likely to develop a stress-related health condition.
- Better Transportation =Healthier Lives, another 2013 infographic, tells a visual story about the role of transportation in the health of our communities. Consider this important piece of the infographic as we head into 2014: The risk of obesity increases 6 percent with every additional mile spent in the car, and decreases 5 percent with every kilometer walked.
- Top Five Things You Didn’t Know Could Spread Disease was the best read of the very well read stories on NewPublicHealth during Outbreak Week—an original series created by NPH to accompany the release in late December of Outbreaks: Protecting Americans from Infectious Disease, a pivotal report released by the Robert Wood Johnson Foundation and Trust for America’s Health.
- Better Education=Healthier Lives, another widely viewed—and shared—infographic on NewPublicHealth, shared the critical information that more education increases life span, decreases health risks such as heart disease and—for mothers who receive more years in school—increases the chance that her baby will die in infancy.
- How Healthy is Your County? In 2014 the Robert Wood Johnson Foundation will release the fifth County Health Rankings, a data set more and more communities rely on to see improvements—and room for change—in the health of their citizens. NewPublicHealth’s 2013 coverage of the County Health Rankings & Roadmaps included posts on the six communities that won the inaugural RWJF Roadmaps to Health Prize for their innovative strategies to create a culture of health by partnering across sectors in their communities.
- The Five Deadliest Outbreaks and Pandemics in History, was our seventh best read post of the year. Read it again and ask: Are we prepared as a nation for the next big outbreak?
- What does architecture have to do with public health? Visit the Apple Store in New York City’s SoHo neighborhood, Texas’ Red Swing project, or....view our post from earlier this year.
- Less than a month after the shootings in late 2012 at Sandy Hook elementary school in Connecticut, the Harvard School of Public Health held a live webcast town hall meeting on gun violence on the legal, political, and public health factors that could influence efforts to prevent gun massacres. And toward the end of 2013, NewPublicHealth sat down with former Surgeon General David Satcher, MD, MPH, to talk about the role of research in preventing gun violence.
- NewPublicHealth covered the release of a report by Trust for America’s Health that found that most states are not implementing enough proven strategies to prevent prescription drug abuse. But the year ended with some better news on the critical public health issue. An NPH news roundup post reported on a study funded by the National Institutes of Health which found that rates of prescription drug abuse by high school students have dropped slightly.
Close runners up included How Do You Transform a Community After a Century of Neglect?, which looked at how Bithlo, Fla. is working to bring much-needed services to its main street through the “Transformation Village” initiative, as well as ‘Unprecedented Destruction’: Ocean County Public Health Continues to Respond to Hurricane Sandy, which brought together a NewPublicHealth video and a Q&A to illustrate how public health officials and departments worked together to help their regions recover from the devastating superstorm. Also in the top 20 for year was an interview with New York State Health Commissioner Nirav R. Shah, MD, MPH, on the release of the 2013-17 Prevention Agenda: New York State’s Health Improvement Plan—a statewide, five-year plan to improve the health and quality of life for everyone who lives in New York State.