Category Archives: Health disparities

Apr 18 2014
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Faces of Public Health: Esther Chernak, Drexel University School of Public Health

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The Center for Public Health Readiness and Communication (CPHRC) at the Drexel University School of Public Health in Philadelphia recently re-launched DiversityPreparedness.org, a clearinghouse of resources and an information exchange portal to facilitate communication, networking and collaboration to improve preparedness, build resilience and eliminate disparities for culturally diverse communities across all phases of an emergency. The site had originally been developed by Dennis Andrulis, now at the Texas Health Institute, and Jonathan Purtle, who co-writes a blog on public health for the Philadelphia Inquirer.

>>Bonus Links:

NewPublicHealth recently spoke with Esther Chernak, MD, MPH, the head of CPHRC, about the re-launched site and her work in preparedness.

NewPublicHealth: Tell us a little bit about your background and how you came to lead the Center for Public Health Readiness and Communication.

Esther Chernak: I’m an infectious disease physician by training and pretty much have been working in public health since I finished my infectious disease fellowship in 1991 at the University of Pennsylvania. I started working in the Philadelphia Department of Public Health in its city clinic system doing HIV/AIDS care, and then became the Clinical Director of HIV Clinical Programs for the health centers back in the early ’90s when the epidemic was obviously very different. I then moved to working in infectious disease epidemiology as a staff doctor in the acute communicable disease control program and was involved in infectious disease surveillance and outbreak investigations for a number of years.

Then in 1999, I took a job with the City Health Department in what was then called bioterrorism preparedness. That was the time when major cities in the country were just beginning to be funded to do bioterrorism response plans. Groups that were involved in bioterrorism preparedness recognized relatively quickly that despite the fact that we were dealing with planning for novel strains of influenza and pandemic preparedness and SARS and smallpox, we were also dealing with many, many really significant infectious disease outbreaks, and then ultimately non-infectious disease related issues that had huge impacts on public health, such as earthquakes and hurricanes. Those links helped prepare me for my role at the Center.

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Apr 17 2014
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Recommended Reading: ‘Pollution is Segregated, Too’

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After decades of studies demonstrating that poor people and minorities are more likely than their white counterparts to live near health hazards such as toxic waste sites, landfills and congested highways, a new study in the journal PLOS One took a more refined look at a particular aspect in the area of “environmental injustice”: exposure to nitrogen dioxide. The pollutant—which is produced by cars, construction equipment and industrial sources—is linked to higher risk of both asthma and heart attack.

Using data from the 2000 Census, researchers determined that minorities are on average exposed to 38 percent higher levels of outdoor nitrogen dioxide. The gap varies depending where in the country they live, with the upper Midwest and the Northeast seeing the greatest disparities, as well as major cities. All told the disparity accounts for an additional 7,000 deaths due to heart disease annually.

"The biggest finding is that we have this national picture of environmental injustice and how it varies by state and by city," said Julian Marshall, a professor of environmental engineering at the University of Minnesota and one of the authors of the study, according to The Washington Post. "The levels of disparity that we see here are large and likely have health implications."

There are a number of possibilities to account for the disparities. For example, according to The Post, many “urban highways...were originally routed through minority communities that were politically easier to uproot than middle-class white neighborhoods” and “highways and landfills also depress nearby property values, meaning that people who can afford to live elsewhere do, while those who can't remain within their influence.”

Read the full story from The New York Times here.

>>Bonus Link: April is National Minority Health Awareness month. Read more of NewPublicHealth’s coverage of the annual event here.

Apr 9 2014
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National Minority Health Awareness Month: Roundup of NewPublicHealth Coverage on Health Disparities

April is National Minority Health Awareness Month. A look back at NewPublicHealth’s coverage of health disparities so far this year shows significant steps being taken to both identify and rectify the public health problem. From understanding why certain demographics are at greater risk for cancer, to how income gaps and ethnicity can collide, to how racism can affect overall health, here’s a review of some of the key stories we’ve reported on health disparities in 2014.

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.

Black, Latina Breast Cancer Patients More Likely to Struggle with Health Care-Related Debt
Black and Latina breast cancer patients are far more likely than their white counterparts to have medical debt as a result of treatment or to skip treatments due to costs

Faces of Public Health: Louis W. Sullivan, MD
Louis W. Sullivan, MD, former U.S. Secretary of Health and Human Services under President George H.W. Bush, recently wrote a memoir, Breaking Ground: My Life in Medicine, that offers a wide view of Sullivan’s experiences as a medical student in Boston, the founding dean of the Morehouse School of Medicine in Atlanta and as the country’s chief health officer. NewPublicHealth recently sat down with Sullivan to discuss the book and his thoughts on the history and future of improving the nation’s health.

Study: Many Chronically Ill Adults Forced to Decide Between Medicine, Food
Chronically ill adults who, due to financial instability, lack consistent access to food are far more likely to underuse or even skip their medications completely, according to a new study in The American Journal of Medicine. Researchers analyzed data of 9,696 adults with chronic illness who participated in the National Health Interview Survey, finding that 23.4 percent reported cost-related medication underuse, while 18.8% percent reported food insecurity and 11 percent reported both. Hispanic and non-Hispanic blacks were at the highest risk.

Free to Be You and Me @ 40
Free to Be You and Me, a blockbuster hit album of the 70s and beyond, is still widely available on most music platforms. The television special, filled with skits on gender neutrality, is still a popular kids’ birthday gift, in part because many of the issues it speaks to—especially advancement opportunities and equality—are still being grappled with today.

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Apr 2 2014
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Public Health News Roundup: April 2

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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.

Mar 26 2014
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Public Health News Roundup: March 26

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Study: ‘White Coat Effect’ on Blood Pressure is Real
The “White Coat Effect” is real, according to a new study in the British Journal of General Practice. The effect, wherein a person’s blood pressure is higher when taken by a doctor than when taken by a nurse, has long been assumed, but this is the first study to confirm it. The study analyzed the results of more than 1,000 people who had their blood pressure taken by both a physician and a nurse, finding the results of the physician-administered tests were noticeably higher. "Doctors should continue to measure blood pressure as part of the assessment of an ill patient or a routine check-up, but not where clinical decisions on blood pressure treatment depend on the outcome,” said Christopher Clark, MD, of the University of Exeter Medical School, in a release. “The difference we noted is enough to tip some patients over the threshold for treatment for high blood pressure, and unnecessary medication can lead to unwanted side-effects.” Clark also noted that researchers should also take these findings into account when performing studies on topics such as hypertension. Read more on heart health.

Black, Latina Breast Cancer Patients More Likely to Struggle with Health Care-Related Debt
Black and Latina breast cancer patients are far more likely than their white counterparts to have medical debt as a result of treatment or to skip treatments due to costs, according to a new study in the Journal of Clinical Oncology. In a survey of 1,502 patients, researchers determined that 9 percent of whites, 15 percent of blacks, 17 percent of English-speaking Latinas and 10 percent of Spanish-speaking Latinas reported medical-related debt four years post diagnosis. The study said the findings should “motivate efforts to control costs and ensure communication between patients and providers regarding financial distress, particularly for vulnerable subgroups.” Read more on health disparities.

Lawsuit Challenges New York City’s Ban on E-Cigarettes
A “smoker’s rights” group called New York City Citizens Lobbying Against Smoker Harassment has filed a legal challenge to the city’s ban on electronic cigarettes—or e-cigarettes—in restaurants, parks and certain other public places. The group contends that since e-cigarettes do not contain tobacco or produce smoke, they should not be subject to New York City’s Smoke-Free Air Act. The city council expanding regulations to include e-cigarettes last year and the U.S. Food and Drug Administration has announced its intention to propose government regulations over their use. In the lawsuit, the group wrote that "E-Cig regulation is, even in the Council's words, at best, tangentially related to the subject of smoking, in much the same way that toy water guns are at best tangentially related to authentic firearms.” However, city council spokeswoman Robin Levine said by email to Reuters that "Our legislation ensures the goals of the Smoke-Free Air Act are not undermined and protects the public against these unregulated substances.” Read more on tobacco.

Mar 21 2014
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Faces of Public Health: Louis W. Sullivan, MD

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Louis W. Sullivan, MD, former U.S. Secretary of Health and Human Services under President George H.W. Bush, recently wrote a memoir, Breaking Ground: My Life in Medicine, that offers a wide view of Sullivan’s experiences as a medical student in Boston, the founding dean of the Morehouse School of Medicine in Atlanta and as the country’s chief health officer. NewPublicHealth recently sat down with Sullivan to discuss the book and his thoughts on the history and future of improving the nation’s health.

NewPublicHealth: Looking back, what can you share about the highlights of your career in medicine and health promotion?

Louis Sullivan: Highlights would certainly include my time at the Boston University School of Medicine. That had many significant points. It was my first time living in an integrated environment because up until that time I spent all of my life in the South. Working in an environment without concerns about discrimination and bias, that was a great experience; my classmates and the faculty at Boston University were all welcoming.

Another highlight was later when I was a research fellow in hematology in the Harvard unit at Boston City Hospital. I had a paper accepted for presentation at a major research conference in Atlantic City. It was a paper showing that heavy drinking suppressed the production of red blood cells by the bone marrow.

And of course a tremendous highlight was going back to Morehouse College, my alma mater, to start the Morehouse School of Medicine. I was returning home in a sense. I had gained experience as a faculty member at Boston University, had been steeped in medicine and now I was in the process of establishing a new institution to train young people for the future.

NewPublicHealth: What changes have you created and supported to improve population health.

Sullivan: Well, certainly becoming Secretary of Health and Human Services was indeed an honor and a great opportunity for me, and it was also a very challenging experience.

In the late ‘80s, when I became Secretary, AIDS was a new disease. There were many demonstrations by various advocacy groups, groups that didn’t trust the government, and we had to work to develop a relationship with them. I convinced President Bush to put $1.6 billion in his budget to be used for research on this new disease, to develop mechanisms for treating the disease and to educate the public. And as a result of that initial investment and ones that followed, this disease has been transformed from a virtual death sentence to a chronic disease which is controlled by medication. And people, rather than living a few months, which was the case once the diagnosis was made in 1989, are now living for decades with the virus suppressed on medication, raising their families, working, earning wages, paying taxes. So that has been really a very satisfying outcome from that experience. And we hopefully are close to finding a cure for this disease as well.

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Mar 21 2014
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Public Health News Roundup: March 21

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Study Finds Dramatic Increase in Opioid Prescriptions by Emergency Rooms
The past decade has seen a dramatic increase in opioid analgesic prescriptions by emergency rooms, despite only a modest increase in pain-related complaints, according to a new study in the journal Academic Emergency Medicine. Using data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2001 and 2010, researchers found that there was a 49 percent increase in prescriptions for potentially addictive narcotic painkillers such as OxyContin, Percocet and Vicodin. Approximately 12 million Americans abused prescription painkillers in 2010 and approximately 15,000 die annually due to overdoses, according to the U.S. Centers for Disease Control and Prevention. Read more on prescription drugs.

Study: Many Chronically Ill Adults Forced to Decide Between Medicine, Food
Chronically ill adults who due to financial instability lack consistent access to food are far more likely to underuse or even skip their medications completely, according to a new study in The American Journal of Medicine. Researchers analyzed data of 9,696 adults with chronic illness who participated in the National Health Interview Survey (NHIS), finding that 23.4 percent reported cost-related medication underuse, while 18.8% percent reported food insecurity and 11 percent reported both. Hispanic and non-Hispanic blacks were at the highest risk. "The high overall prevalence of food insecurity and cost-related medication underuse highlights how difficult successful chronic disease management in the current social environment is," said lead investigator Seth A. Berkowitz, MD, Division of General Internal Medicine, Massachusetts General Hospital and Harvard Medical School, in a release. "These findings suggest residual unmet needs for food-insecure participants and thus have clear implications for health policy." Read more on health disparities.

FDA Approves Implantable Device for Adults with a Certain Type of Hearing Loss
The U.S. Food and Drug Administration (FDA) has approved the first implantable hearing device for adults with severe or profound sensorineural hearing loss of high-frequency sounds in both ears, but who can still hear low-frequency sounds with or without a hearing aid. Sensorineural hearing loss is the most common form of hearing loss and can be caused by aging, heredity, exposure to loud noise, drugs that are toxic to the inner ear and certain other illnesses. “Hearing loss greatly impacts the education, employment, and well-being of many Americans,” said Christy Foreman, director of the Office of Device Evaluation at the FDA’s Center for Devices and Radiological Health, in a release. “This device may provide improved speech recognition for people with this kind of hearing loss, who have limited treatment options.” Read more on technology.

Mar 20 2014
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Free to Be You and Me @ 40

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Don’t judge a change agent by its vinyl. Free to Be You and Me, a blockbuster hit album of the 70s and beyond, and still widely available on most music platforms, was the "Born This Way" by Lady Gaga of its time, with songs, stories and ideas that told kids they could be whoever they wanted.

Stars who recorded songs for the album included Mel Brooks and Diana Ross. Songs included “Parents are People,” about the many professions open to men and women and sung by album creators Marlo Thomas and Harry Belafonte, as well as “It’s Alright to Cry” sung by football player Rosie Grier.

“We wanted to let children know that their wildest dreams were not just OK, but wonderful—and completely achievable,” said Thomas at a recent anniversary celebration for the album at the Paley Center for Media in New York City.

The television special, filled with skits on gender neutrality, is still a popular kids’ birthday gift, in part because many of the issues it speaks to—especially advancement opportunities and equality—are still being grappled with today:

  • According to a recent Institute of Medicine report, African Americans live, on average, five years less than other Americans.
  • According to the Society for Women’s Health Research, in some cases critical data on sex, age, race and ethnicity does not exist for new drugs, biologics and devices. For instance, women made up less than one-third of the participants in clinical trials on three different coronary stents (which open up blockages), even though 43 percent of patients with coronary heart disease are women.
  • According to the Institute for Women’s Policy Research, in 2012 female full-time workers made only 77 cents for every dollar earned by men, a gender wage gap of 23 percent.

>>Bonus Link: Watch a panel discussion among several of the original Free to Be You and Me stars filmed earlier this month at the Paley Center.

Mar 10 2014
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Public Health News Roundup: March 10

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Majority of Youth C. Difficile Infections Linked to Doctor Visits
Antibiotics prescribed in a doctor’s office for other conditions are associated with the majority of Clostridium difficile infections, according to a new study in the journal Pediatrics. Researchers from the U.S. Centers for Disease Control and Prevention (CDC) determined that 71 percent of the cases for youth ages 1-17 were linked to the visits, rather than to overnight stays in health care facilities; two-thirds of adult cases are linked to hospital stays. The findings raise the profile of ongoing efforts to reduce unnecessary prescriptions. “Improved antibiotic prescribing is critical to protect the health of our nation’s children,” said CDC Director Tom Frieden, MD, MPH. “When antibiotics are prescribed incorrectly, our children are needlessly put at risk for health problems including C. difficile infection and dangerous antibiotic resistant infections.” Read more on prescription drugs.

Study: Even Slightly Elevated Blood Pressure Can Do Cardiovascular Damage Over Time
Even slightly elevated blood pressure that does not rise to the clinical definition of hypertension can do cardiovascular damage over time, according to a new study in the Journal of the American Medical Association. Researchers at the University of Oklahoma Health Sciences Center analyzed blood pressure data on more than 4,600 participants, all of whom had their readings tracked over 25 years from young adulthood to middle age. They placed the participants in five blood pressure trajectory categories:

  • Low-stable: blood pressure that starts low and stays low
  • Moderate-stable: blood pressure that begins only slightly elevated and stays that way
  • Moderate-increasing: blood pressure begins only slightly elevated and increases over time
  • Elevated-stable: blood pressure that starts at elevated levels, but does not increase
  • Elevated-increasing: blood pressure that begins elevated and increases over time

The study determined that participants in the moderate-stable group were 44 percent more likely to have coronary artery calcification than those in the low-stable group. Read more on heart health.

Study: Men Die Earlier in More Patriarchal Societies
Gender differences when it comes to mortality rates are higher in more patriarchal societies, meaning women’s rights are good for men’s health, according to a new study in the American Psychological Association’s Evolutionary Behavioral Sciences. Utilized sociodemographic and mortality data from the World Health Organization, researchers from the University of Michigan (UM) School of Public Health found that men living in the top 25 percent most-patriarchal societies were 31 percent more likely to die than men in the least patriarchal quartile, compared to mortality rates for women. Researchers noted that the study only included societies with infrastructures capable of providing reliable data, so the difference could be even more pronounced. Possible explanations include:

  • Males in societies where they are more socially dominant tend to engage in riskier behaviors that can lead to death.
  • These societies tend to have more resources and social status concentrated in a smaller group of elite men, and men with greater control of resources and social status historically have had more reproductive success.
  • In their quest for social dominance, men will go up against other men to gain power and engage in forms of competitive, and sometimes dangerous, behavior.

"Gender inequality is inherently related to inequality in general, and this is bad for both men and women's health, though especially harmful to men in increasing the risk of death," said UM researcher Daniel Kruger. Read more on health disparities.

Mar 5 2014
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Public Health News Roundup: March 5

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Georgia State University College of Law Names Ten Faculty Fellowships to Promote Public Health Law Education
The Georgia State University College of Law and its Center for Law Health & Society have announced ten faculty fellows to participate in the Future of Public Health Law Education: Faculty Fellowship Program. “This fellowship program is an extraordinary opportunity to promote innovative teaching, create a supportive community of practice and share best practices in teaching public health law,” said Charity Scott, JD, MSCM, Catherine C. Henson Professor of Law and director of the Center for Law, Health & Society. “The fellows’ projects will serve as models for innovation in public health law education and the resources developed will be shared with other law and public health faculty nationally.” The program is funded by the Robert Wood Johnson Foundation. Among the five faculty members serving as mentors will be Mary Crossley, JD, professor of law at the University of Pittsburgh School of Law, who NewPublicHealth previously spoke with about her role in the Scholars in Residence program. Read more on public health law.

Study: Better Boundaries, Enforcing Rules Can Improve Kids’ Sleep Health
Parents can improve their children’s sleep habits and overall health by setting boundaries around electronics use, enforcing rules and setting a good example, according to new findings from the National Sleep Foundation’s (NSF) Sleep in America poll. The annual study began in 1991, with the 2014 poll focusing on sleep practices and beliefs of the modern family with school-aged children. “For children, a good night’s sleep is essential to health, development and performance in school,” said Kristen L. Knutson, PhD, University of Chicago. “We found that when parents take action to protect their children’s sleep, their children sleep better.” The NSF recommends that children ages 6-10 get 11 hours of sleep per night, although the poll found that parents estimate their kids in that age group only get about 8.9 hours. The poll also found averages of 8.2 hours for kids ages 11-12, 7.7 hours for ages 13-14 and 7.1 hours ages 15-17; NSF recommends between 8.5 and 9.5 hours for each of those groups. Read more on pediatrics.

Stress of Racism Tied to Obesity in Black Women
Frequent experiences of racism are associated with a higher risk of obesity among African-American women, according to a new study in the American Journal of Epidemiology. Researchers analyzed data from the Black Women's Health Study, a longitudinal study of approximately 59,000 African-American women who were tracked beginning in 1995, finding that the psychosocial stress associated with long-term experience with racism can result in dysregulation of neuroendocrine functions that influence the accumulation of excess body fat. Yvette C. Cozier, DSc, MPH, assistant professor of epidemiology at Boston University who led the analyses, said in a release that work-place- and community-based programs to combat racism and interventions to reduce racism-induced stress could help prevent and combat obesity in high-risk communities. Approximately half of African-American women are obese, which raises their risk factors for cardiovascular diseases, type 2 diabetes, orthopedic problems, and death. Read more on health disparities.