Implementation of the Affordable Care Act—and keeping future generations of Americans healthy or even healthy enough—will rely on an adequate supply of primary care physicians. That includes family physicians, pediatricians and internists who can help steer patients toward healthier lifestyles and effective treatments for chronic illnesses to help avoid both unnecessary complications and costs. However, the Association of American Medical Colleges predicts a shortfall of about 45,000 primary care doctors in the next decade, according to The Wall Street Journal. Many medical students have traditionally avoided primary care training in favor of specializing in fields such as dermatology and radiology because the pay is generally far higher. That matters especially these days, when many medical students leave school owing more than $150,000 for their training.
According to the article, in an effort to increase the number of doctors specializing in primary care, a number of medical schools have strengthened their primary care programs and at least 17 new medical schools have opened since 2005—some that have only primary care training programs. And some of the schools have been able to recruit effectively by building loan repayment programs into the program, especially if students commit to practicing in underserved areas following their training.
Colleen Christmas, director of the internal residency program at Johns Hopkins Bayview Medical Center, who is interviewed in the article, points out that a strategy of increasing the number of primary care doctors makes economic as well as population health sense. According to Christmas, a recent study by Johns Hopkins researchers showed that with each 1 percent increase in the proportion of primary-care physicians, an average city will have 503 fewer hospital admissions, almost 3,000 fewer emergency-room visits and 512 fewer surgeries annually.
Read the full story in The Wall Street Journal.
>>Bonus Link: Four months after Surgeon General Regina Benjamin left her post to return to academia and a medical practice, the White House has nominated Vivek Hallegere Murthy, co-founder and president of Doctors for America and a Boston-area physician, to take up that post.
Bithlo, Fla. is a town of 8,000 that is just 30 minutes outside Orlando and not much farther from the “happiest place on Earth” — but is beset by poverty, illiteracy, unemployment and toxic dumps that have infiltrated the drinking water. The water is so bad that it has eroded many residents’ teeth, making it that much harder for them to find jobs. Streets filled with trash, frequent road deaths and injuries from a lack of transportation options and safe places to walk, and dropping out before 10th grade were all the norm.
In just a short time, a collection of partners and volunteers have begun to reverse some of the decades-old problems Bithlo has faced. And earlier this week, the town that had been forgotten for almost a century was the scene of a hubbub of activity as hundreds of volunteers descended on the town to continue work on “Transformation Village,” Bithlo’s future main street, which will sport a combination library/coffee shop, schools, shops and many other services, all long missing from Bithlo.
Over the last few months, NewPublicHealth has reported on initiatives of the participating members of Stakeholder Health, formerly known as the Health Systems Learning Group. Stakeholder Health is a learning collaborative made up of 43 organizations, including 36 nonprofit health systems, that share innovative practices aimed at improving health and economic viability of communities.
>>Read more on the Stakeholder Health effort to leverage health care systems to improve community health.
One of the Stakeholder Health members is the Adventist Health System, a not-for-profit health care system that has hospitals across the country. Recently, Adventist’s flagship health care provider, Florida Hospital in Orlando, began supporting United Global Outreach (UGO), a non-profit group aimed at building up communities in need, in their four-year-long effort to transform the town of Bithlo.
NewPublicHealth recently spoke with Tim McKinney, executive vice president of United Global Outreach, and Verbelee Neilsen-Swanson, vice president of community impact at Florida Hospital, about the partnerships and commitment that have gone into Bithlo’s transformation into a town that is looking forward to new housing stock, jobs, stores, better education and improved health outcomes for the its citizens.
Kids Today Slower, Less Fit than Their Parents as Kids
An average child in 1975 in a one-mile race with an average child today would win by an average of a minute and a half, according to new research. Kids today are also about 15 percent less aerobically fit, with heart endurance falling an average of 6 percent per decade from 1970 to 2000. That means today’s kids are more likely to be unhealthy in adulthood, with weaker hearts, thinner bones and overall lower quality of life. Grant Tomkinson, a senior lecturer in the University of South Australia's School of Health Sciences, pointed to a number of factors, including communities designed to discourage walking, bicycling and backyard play; reduced or even completely absent physical education in schools; and the prevalence of television, computer, tablet and smartphone screens that keep kids indoors. "We all live in an environment that's toxic for exercise, and our children are paying the price," Tomkinson said. Tomkinson said in order to reverse this trend, kids need at least 60 minutes of serious physical exercise a day, such as running, swimming or cycling. "You want exercise to be fun, but there needs to be some huff and puff there as well," he said. "It needs to make them somewhat tired." Read more on physical activity.
Study: Symptoms of ‘Sudden’ Cardiac Arrest Can Be Seen Up to a Month Earlier
Symptoms of “sudden” cardiac arrest can be seen up to a month beforehand in middle-age men, according to new findings presented this week at the annual scientific sessions of the American Heart Association, held this year in Dallas. Researchers looked at the medical records of 567 men, ages 35-65, who had out-of-hospital heart attacks, finding that approximately 53 percent showed symptoms beforehand. They included chest pain (56 percent); shortness of breath (13 percent); and dizziness, fainting or palpitations (4 percent). Sumeet Chugh, senior author of the study and associate director for genomic cardiology at the Cedars-Sinai Heart Institute in Los Angeles, said the “entirely unexpected” findings show that people may be able to prevent heart attacks if they seek treatment earlier for these symptoms. "The findings were entirely unexpected," said "We never thought more than half of these middle-aged men would have had warning signs so long before their cardiac arrests,” Chugh said. “Previously we thought most people don't have symptoms so we can't do anything about it." Read more on heart health.
ACS Tips on Quitting Tobacco for Tomorrow’s ‘Great American Smokeout’
Tomorrow is the American Cancer Society (ACS) Great American Smokeout, held every year on the third Thursday of November. The annual event was founded to encourage people to quit using tobacco—perhaps to stop smoking on that day, or to make a plan on how to quit at a later date—and to provide the tools and resources that can help the decision stick. According to ACS, research shows that people are most successful at quitting tobacco when they have support, and recommends combing two or more of the following tactics to improve the odds:
- Telephone smoking-cessation hotlines
- Stop-smoking groups
- Online quit groups
- Nicotine replacement products
- Prescription medicine to lessen cravings
- Guide books
- Encouragement and support from friends and family members
>>NewPublicHealth continues a new series to highlight some of the best public health education and outreach campaigns every month. Submit your ideas for Public Health Campaign of the Month to info@newPublichealth.org.
Glass thermometers. Compact fluorescent light (CFL) bulbs. Medical equipment. Gauges and other science equipment. Thermostats, switches and other electrical devices.
Mercury lives in all of these devices—and all can be found in schools. While it may be common, mercury is also incredibly dangerous. Mercury poisoning can negatively impact the nervous system, lungs and kidneys. It can even lead to brain damage or death.
Often mercury poisoning is the result of a kid thinking it’s “cool”— taking it, playing with, passing it around to friends. Metallic mercury easily vaporizes into a colorless, odorless, hazardous gas.
The Agency for Toxic Substances and Disease Registry (ATSDR), part of the U.S. Centers for Disease Control and Prevention (CDC), has released a new website that brings together a suite of tools to educate kids, teachers, school administrators and parents about the dangers of mercury poisoning. They include an interactive human body illustration and facts sheets, as well as a 30-second “Don’t Mess With Mercury” animated video to raise awareness about the dangers of mercury.
BSR: More and More, Private Sector Being Asked to Improve Population Health
Traditionally, health efforts fall under the purview of human resources—not corporate social responsibility (CSR)—in the business world. However, companies are playing an increasingly important role in not only health improvement efforts for their own employees, but also in population health for their larger communities. Increasingly, consumers are demanding this from companies to support their CSR work, as reported by Fast Company. That's also the subject of a BSR report, A New CSR Frontier: Business and Population Health. The report looked at the role of businesses in overall public health for more than 350 major companies, including Coca-Cola, Walmart, Microsoft, Chevron, and General Mills. The report found three major trends:
- Society expects companies to play a bigger role in population health
- Companies are responding to those expectations, but primarily with employees and customers
- Health and wellness are still largely the domain of human resources, even though departments such as philanthropy, marketing and research & development should be involved
"The pullback of government as an influence for population health has created gaps and stakeholders are expecting more from the private sector," said Mark Little, director of health care advisory services at BSR. "The overarching single headline is that business now has new responsibilities that are recognized by stakeholders. We do believe there is a new frontier for CSR."
Support for this report was provided by a grant from the Robert Wood Johnson Foundation. Read more on business.
AAP Offers New Guidelines to Reduce Risk of Antibiotic Resistance
This week is “Get Smart About Antibiotics Week,” and the American Academy of Pediatrics (AAP) has released new guidance that would limit the over-prescription of antibiotics that is contributing to the growing public health issue of antibiotic resistance. The guidance, formulated in collaboration with the U.S. Centers for Disease Control and Prevention (CDC), focuses on the three common upper respiratory tract infections in children that are unlikely to be helped by antibiotics: ear infections, sinus infections and sore throats. The report includes clinical criteria to help physicians determine whether an upper respiratory tract infection is viral or bacterial, which will improve care while limiting opportunities for bacteria to become resistant to antibiotics. “Our medicine cabinet is nearly empty of antibiotics to treat some infections,” said CDC Director Tom Frieden, MD, MPH. “If doctors prescribe antibiotics carefully and patients take them as prescribed we can preserve these lifesaving drugs and avoid entering a post-antibiotic era.” Read more on prescription drugs.
Study: Half of Teens with Mental Disorders Receive No Treatment
Despite ever-increasing knowledge about psychiatric conditions and their links to other health issues, more than half of American teenagers with psychiatric disorders do not receive treatment, according to a new study in the journal Psychiatric Services. The study found that treatment rates varied by disorder. For example, adolescents with ADHD received care more than 70 percent of the time, while adolescents with phobias or anxiety disorders were the least likely to receive mental health care. The analysis also found racial disparities, with white youths far more likely to receive care than black youths. The lack of qualified child mental health professionals also hinders access to care, with pediatricians, school counselors and probation officers being asked to provide care for which they are not actually trained, according to E. Jane Costello, a Duke University professor of psychology and epidemiology and associate director of the Duke Center for Child and Family Policy. "We need to train more child psychiatrists in this country," she said. “And those individuals need to be used strategically, as consultants to the school counselors and others who do the lion's share of the work." The study included data from the National Comorbidity Survey Adolescent Supplement, as well as a survey of more than 10,000 U.S. teenagers. Read more on mental health.
Atlantic Cities recently reported on a ride sharing program called Lyft, which requires riders to join up and input credit card information to be eligible for the carpool-like rides. Lyft’s licensed drivers are pinged to pick up passengers whom the system tracks as headed in the same direction as other riders already in the car.
The article focuses on the "cool" factor, and the potential for building social relationships, making it a great solution for college kids or young adults looking for a safe way to get home on nights out—a critical public health service, particularly when research released earlier this year found that more than one-third of designated drivers end up drinking.
But another potential future use could be to help alleviate massive transportation challenges in rural areas, particularly for those with limited income or no access to a car for other reasons. One Department of Transportation study found, "Close to 40 percent of all rural counties are not served by rural transit, while another 28 percent have limited service. And, nearly 57 percent of the rural poor do not own a car, while 1 in every 14 households in rural America has no vehicle." In the future, perhaps ride sharing programs could catch on as a viable transportation option in rural towns far away from the neon lights.
>>Bonus Link: A second transportation article in Atlantic Cities this week finds that despite the growth in ridership of bike share programs across the country, PBSC, a Montreal-based major supplier of city bikeshare equipment and software faces major transportation woes. PBSC bike share customers include London, D.C. and Chicago, the city with the largest bike-share program in the nation.
Six Killed, Dozens Injured as Tornados Sweep Across the U.S. Midwest
At least six people were killed and dozens left injured after a flurry of tornados swept through the American Midwest yesterday. Tornado watches were announced for Illinois, Indiana, Iowa, Michigan, Missouri, Ohio and Wisconsin; by the end of the day, an estimated 77 had touched down, mostly in Illinois, according to the National Weather Service. The severe weather left thousands without power (approximately 89,000 in Northern Illinois alone) and leveled entire neighborhoods. “I went over there immediately after the tornado, walking through the neighborhoods, and I couldn’t even tell what street I was on,” said Tyler Gee, an alderman on the Chicago City Council, to radio station WBBM in Chicago. “It just completely flattened some of the neighborhoods here in town, hundreds of homes.” Read more on disasters.
NHTSA: 2012 Highway Fatalities Up for the First Time Since 2005
While highway traffic fatalities continue to hover around historic lows, the total number of deaths increased by 1,082 from 2011 to 2012, to a total of 33,561, the first increase since 2005. The findings are part of the U.S. Department of Transportation's National Highway Traffic Safety Administration’s (NHTSA) 2012 Fatality Analysis Reporting System (FARS) data. "Highway deaths claim more than 30,000 lives each year and while we've made substantial progress over the past 50 years, it's clear that we have much more work to do," said U.S. Transportation Secretary Anthony Foxx. "As we look to the future, we must focus our efforts to tackle persistent and emerging issues that threaten the safety of motorists, cyclists and pedestrians across the nation." Read more on safety.
Heart Groups’ New Risk Guidelines, Calculator Apparently Flawed
The risk guidelines and calculator released last week by the American Heart Association and the American College of Cardiology, meant to improve the assessment of potential cardiovascular disease, could possibly instead greatly overestimate the risk and as built could lead to millions of unnecessary statin prescriptions. The potential problems, first identified by two Harvard Medical School professors, will be published today in The Lancet. One possible explanation for the problem is that the system relies on old data, while populations and their behaviors have changed. Steven Nissen, MD, chief of cardiovascular medicine at the Cleveland Clinic and a past president of the American College of Cardiology, called the findings “stunning,” adding “We need a pause to further evaluate this approach before it is implemented on a widespread basis.” However, after emergency meetings at the American Heart Association’s annual meeting this weekend in Dallas, both organizations said despite the apparent flaws the guidelines are still a major step forward, noting that patients are also advised to speak with their doctors, and not simply follow the results of the calculator. Read more on heart health.
CDC: Emerging Tobacco Products Gaining Popularity among Middle and High School Students
A new report from the U.S. Centers for Disease Control and Prevention (CDC) finds that emerging tobacco products such as e-cigarettes and hookahs are quickly gaining popularity among middle- and high-school students, but with no significant decline in students’ cigarette smoking or overall tobacco use. The new report was culled from data in the 2012 National Youth Tobacco Survey, which shows that electronic cigarette use rose among middle school students from 0.6 percent in 2011 to 1.1 percent in 2012 and among high school students from 1.5 percent to 2.8 percent. Hookah use among high school students rose from 4.1 percent to 5.4 percent from 2011 to 2012.
The study authors say the increase in the use of electronic cigarettes and hookahs could be due to an increase in marketing, availability and visibility of the products, as well as the perception that they may be safer alternatives to cigarettes. While electronic cigarettes, hookahs, cigars and certain other new types of tobacco products are not currently subject to regulation by the U.S. Food and Drug Administration, the agency has said recently that it plans to issue a proposed rule that would deem products meeting the statutory definition of a "tobacco product" to be subject to the Federal Food, Drug, and Cosmetic Act—as cigarettes are.
The researchers say cigar use in young adults is of particular concern. During 2011-2012, cigar use increased dramatically among non-Hispanic black high school students from 11.7 percent to 16.7 percent, and has more than doubled since 2009, and similar to the rate of cigarette use among high school males (16.3 percent). Read more on tobacco.
Earlier this week, the Robert Wood Johnson Foundation held its first ever “Culture of Health Hangout,” a new series meant to explore what communities across the country are doing to advance and transform public health. This first foray looked at how public health departments have evolved in recent years, and are continuing to evolve to meet the changing needs of the communities they serve. The panel was moderated by Paul Kuehnert, RWJF senior program officer and Public Health team director.
According to Muntu Davis, Public Health Director and County Health Officer of Alameda County, the core role of public health hasn’t really changed—public health departments and officials continue to gather and analyze data to explain what’s happening to the health of a community. However, what has changed is where they put their focus. Now, in health departments across the country, the focus is not simply on individual decisions, but on social and economic factors that dictate which options are truly available.
“Although it does boil down to an individual choice, if there’s no opportunity there for communities, then ‘health’ is definitely not an easy choice to make,” said Davis.
One of the more innovative approaches his health department has undertaken is utilizing maternal and child health workers to provide, in addition to their traditional work, financial coaching to people who may be of lower incomes. “Studies have shown link between income, wealth and life expectancy,” said Davis, and that’s what makes it important for public health to help support not just the immediate health need but also “the full picture of what might be shaping their health.” These workers are able to provide education and assistance, while also linking them to financial coaching and tools that can help them manage the money they have.
Karen DeSalvo, City of New Orleans Health Commissioner, spoke extensively on the importance of community partnerships when it comes to advancing community health. She said Hurricane Katrina was, in a way, a “catalyst for change” that enabled the entire community to hit the reset button, assess where they were and determine how best to move forward together. One of the first realizations was that the city simply did not have a strong enough local health department.
“It allowed us to begin planning, and to decide to move away from an expensive, hospital-based system to one that was more about prevention and primary care,” she said. “And over the course of years, once we stabilized that infrastructure at the frontline of primary care and moved more toward prevention, the glaring need to have a strong public health department became obvious.”
White House Announces Modification to Affordable Care Act Aimed at Letting Many Keep their Current Health Insurance Coverage
The White House announced on Thursday that health insurance companies will now be permitted to renew many previously cancelled health insurance plans for the upcoming coverage year. The plans had been cancelled by insurers in the last few weeks because they did not include a menu of preventive services—for example, some immunizations provided without a patient co-pay—that are required under the Affordable Care Act (ACA) for health plans that cover people in the United States beginning January 1, 2014. Insurers are allowed, but not required, to reinstate the cancelled plans and will not have to include free preventive services in the renewed plans for 2014.
The roll out of health insurance under the ACA has seen numerous glitches, including difficulty even logging into the health insurance marketplace website. On Thursday, Kaiser Health News posted a very informative FAQ aimed at answering some of the many questions consumers and health experts have right now about signing up for health insurance for 2014.
>>Bonus Link: Read about the Affordable Care Act on RWJF.org.
Study: State Car Seat, Seatbelt Laws Leave Children Vulnerable to Injury, Death
Many state laws on car seats and seatbelts are not current with regards to modern research or are inconsistent from state to state, leaving children vulnerable to injuries or even death, according to a new study in the journal Social Science and Medicine. Researchers look at child passenger safety laws from 1978-2010 across all 50 states [Editor’s note: Go here for an interactive map]. “These laws do not keep up with the published evidence, and even when they do, there are some cases where the laws are unclear,” said Jin Yung Bae, JD, MPH, the study’s lead author, and associate research scientist at the Steinhardt School of Culture, Education and Human Development at New York University. Approximately 250,000 children are injured and 2,000 are killed each year in the United States because of vehicle crashes, which many of these preventable, according to the study authors. The study was conducted by a team from New York University in collaboration with Temple University, and supported by the Robert Wood Johnson Foundation through its Public Health Law Research. The National Institutes of Health’s National Institute on Alcohol Abuse and Alcoholism also funded the study. Read more on injury prevention.
USDA Announces Grants to Improve Rural Housing
The U.S. Department of Agriculture (USDA) has announced that organizations in 45 states, the Western Pacific and the Commonwealth of Puerto Rico will receive grants to make housing repairs and improve housing conditions for limited-income rural residents. The funding is through the USDA Rural Development's Housing Preservation Grant program and will be provided to intermediaries such as local governments; public agencies; federally-recognized Indian Tribes; and non-profit, faith-based and community organizations. The organizations distribute the grants to homeowners and owners of multi-family rental properties or cooperative dwellings who rent to low- and very-low-income residents. Grants may be used to make general repairs, such as installing or improving plumbing, providing or enhancing access to people with disabilities and making homes more energy efficient. Read more on housing.
CDC’s Emergency Management Program Receives Full EMAP Accreditation
The U.S. Centers for Disease Control and Prevention (CDC) has become the first federal agency to achieve full accreditation of its emergency management program from the Emergency Management Accreditation Program (EMAP). “Accreditation is a serious accomplishment for CDC and the emergency management community we support,” said Ali S. Khan, MD, MPH, director of the Office of Public Health Preparedness and Response. “Preparing for and responding to emergencies of any kind—natural disasters, bioterrorism events, chemical terrorism or pandemics—is a core function of public health. Everyone at CDC has a hand, at one point in time, in emergency management and execution.” EMAP’s six steps to accreditation are subscription, self assessment, application, on-site assessment, committee review and accreditation decision. Thirty one states; the District of Columbia; and 14 U.S. cities and counties are accredited. Read more on preparedness and accreditation.