Category Archives: Community Health
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.
Help for Keeping Those New Year’s Resolutions from the Federal Government
Losing weight, helping others and quitting smoking are among the top New Year’s resolutions of the American people, according to the General Services Administration (GSA), the agency that oversees the business of the federal government. Links on the GSA site offer strategies, websites and help lines for 2014 resolutions. Click on the quit smoking link on the GSA resolution list for example, and you’ll find yourself at smokefree.gov, which offers tools you can access immediately, even before 2014 begins. Read more on community health.
NIH to Fund Research on Workforce Diversity Programs
The National Institutes of Health (NIH) will establish a national consortium to develop, implement and evaluate approaches to encourage individuals of all backgrounds to start and stay in biomedical research careers. “There is a compelling need to promote diversity in the biomedical research workforce,” said NIH Director Francis S. Collins MD, PhD. “A lack of diversity jeopardizes our ability to carry out the NIH mission because innovation and problem solving require diverse perspectives. The future of biomedical research rests on engaging highly talented researchers from all groups and preparing them to be successful in the NIH-funded workforce.” Read a new JAMA study that finds that minority physicians care for the majority of underserved patients in the United States. Read more on health disparities.
Twenty Percent of Drivers Admit They Often Drive Too Fast
A recent survey by the National Highway Traffic Safety Administration (NHTSA) finds that twenty percent of drivers say they “try to get where I am going as fast as I can." According to NHTSA, speeding-related deaths nationwide account for nearly a third of all traffic fatalities each year, taking close to 10,000 lives. And despite acknowledging the safety benefits of speed limits and reasons drivers should follow them, more than a quarter of those surveyed admitted "speeding is something I do without thinking" and "I enjoy the feeling of driving fast." And sixteen percent felt that "driving over the speed limit is not dangerous for skilled drivers." Most alarming, drivers with the least experience behind the wheel—those 16-20 years old—admitted to speeding more frequently than any other age group. And more than one in ten drivers ages 16-20 reported at least one speeding-related crash in the past five years, compared to 4 percent for the population as a whole. Read more on injury prevention.
2013 America’s Health Rankings Finds Significant Progress in National Health
The new 2013 America’s Health Rankings from the United Health Foundation finds that while there is still much progress to be made, over the past year Americans improved in the majority of the measures that the Rankings use to rate public health. The improved areas include smoking rates, which fell to 19.6 percent of the adult population, from 21.2 percent the previous year, as well as physical inactivity, which fell to 22.9 percent from 26.2 percent. Also, for the first time since 1998 the obesity rate did not rise. With low rates of uninsured people, high rates of childhood immunization and low rates of health issues such as obesity and smoking, Hawaii ranked as the healthiest state in the country. Read more on community health.
FDA to Phase Out Use of Certain Antimicrobials in Food Animals
The U.S. Food and Drug Administration (FDA) is moving forward with a plan to combat the spread of antibacterial resistance by prohibiting the use of medically important antimicrobials in food animals for food production purposes, while also adding veterinary oversight to therapeutic use of the drugs in animals. Antimicrobials can be used in the food and drinking water of cattle, poultry and other food animals to encourage weight gain. However, these same antimicrobials are used to treat infections in humans, and their availability in the food supply increases the possibility of the development of antimicrobial resistance. The FDA is giving companies three months to sign on to the strategy, then three years to transition. “This action promotes the judicious use of important antimicrobials to protect public health while ensuring that sick and at-risk animals receive the therapy they need,” said Bernadette Dunham, DVM, PhD, director of the FDA’s Center for Veterinary Medicine. “We realize that these steps represent changes for veterinarians and animal producers, and we have been working—and will continue to work—to make this transition as seamless as possible.” Read more on food safety.
HHS: 365,000 Enrolled Under Affordable Care Act in October, November
The official numbers are in, with almost 365,000 people selecting plans in the Health Insurance Marketplace in October and November, according to the U.S. Department of Health and Human Services. About 1.9 million people have gone through the online process, but have just not yet selected a plan, while more than 800,000 were determined eligible for Medicaid or the Children’s Health Insurance Program (CHIP). The site went live at the beginning of October, but extensive bugs and glitches meant only about 27,000 people were able to sign up in that first month. Last week a reconfigured HealthCare.gov was launched after about five weeks of work spent addressing the problems, and 29,000 people were able to sign up during the first two days alone. Thirty-six states use HealthCare.gov, with fourteen states and Washington, D.C. maintaining their own sites. Read more on the Affordable Care Act.
NewPublicHealth Q&A: John Auerbach and Cheryl Bartlett on the Massachusetts Prevention and Wellness Trust
The Massachusetts Prevention and Wellness Trust is a four-year, $60 million project designed to support prevention and health-promotion activities in the state. The first project of its kind in the United States will fund six to 12 collaborative initiatives, and partners on the initiative will include municipalities, community-based organizations, health care providers, regional agencies and health plans. Information on the Trust is detailed in a new report prepared by the Institute on Urban Health Research and Practice at Northeastern University and funded by the Robert Wood Johnson Foundation.
The vision behind the creation of the project is to give all Massachusetts residents the opportunity to live in communities that promote health, as well as seamless access to all community and clinical services needed to prevent and control chronic diseases. It was created because while there is access to health insurance and health care in Massachusetts, health costs continue to rise. The goals of the project include:
- Reducing the rate of the state’s most costly preventable health conditions
- Reducing health disparities
- Increasing healthy behaviors
- Increasing the adoption of workplace wellness programs
- Developing a strong evidence base of effective prevention programs
In order to implement these goals, the Massachusetts Department of Public Health identified four priority areas: tobacco use, childhood asthma, hypertension and elder falls prevention—all of which should be considered closely when working to reduce health disparities and co-occurring mental health conditions in these areas.
A new infographic created for the Prevention and Wellness Trust’s inauguration perfectly illustrates how community links work together to improve health under the principles of the Trust. For example, a diagnosis of hypertension would need a provider to prescribe medications, but the obesity and exercise needs that would also improve the condition for many patients requires input from other community entities, including:
- Classes in exercise, medication and stress reduction by community agencies
- Chronic disease self management classes and home visits for medication use instruction by a community agency
- A neighborhood policy that provides support for transportation changes to encourage walking or biking and zoning for healthy food stores
- A neighborhood policy that provides support for more accessible recreation options in parks and city centers for increased stress reduction
- Workplace policies that provide support for workplace wellness programs that help provide and encourage exercise, healthy foods and stress reduction
NewPublicHealth recently spoke with John Auerbach, a Professor at Northeastern University and the primary author of a report on the Trust, and Cheryl Bartlett, public health commissioner of Massachusetts and the lead person charged with its implementation.