Category Archives: Access to Health Care
The Robert Wood Johnson Foundation Human Capital portfolio’s blog, a forum for discussion about the challenges of building a diverse, well-trained health care workforce, features a “Day in the Life” series this week featuring public health nurses. With their own words, these nurses talk not just about what they do, but why they do it—the importance and meaning of their efforts.
For Anneleen Severynen, RN, MN, PHN, of the South King County Mobile Medical Unit for Public Health Seattle and King County in Washington State, it’s about being able to help one person at a time. Anneleen wrote about Charlie, a 60-year-old Native American man who started drinking at the age of 12, bounced around foster homes, returned from service in Vietnam hurting even more, and now calls himself a “lost cause” who expects to drink himself to death.
“As I sat silently, I listened to him grieve the loss of his culture and detail the many kinds of discrimination he has suffered. Though he spoke with the slurred speech of a chronic alcoholic, his eloquence moved me. I noticed tears in his eyes as he described a few happy childhood memories with his father—memories not quite lost to him.”
By helping him to open up she was also able to get Charlie to agree to a few medical tests. He was given a prescription for high blood pressure. She doesn’t know whether he’ll follow through, but she knows that because she took the time to listen, he now has a better chance.
“Every day I get the chance to make a difference in people’s lives, and to help them know that they matter. I can help one person at a time make small choices that will improve their lives and health. As long as there is someone to hear their stories, there are no lost causes.”
Even as the global population continues to grow, technological and societal advances mean that our world is constantly getting smaller. Or at least that we are becoming more interconnected.
Understanding this—that a person in a Midwestern U.S. state is better off when a person on the other side of the world has access to quality health care—the U.S. Department of Health and Human Services’ (HHS) Global Health Strategy is working with partners across the globe to improve the health of everyone.
"Although the chief mission of [HHS] is to enhance the health and well being of Americans, it is critically important that we cooperate with other nations and international organizations to reduce the risks of disease, disability, and premature death throughout the world," said HHS Secretary Kathleen Sebelius.
One of the most powerful initiatives has been the push toward greater immunization rates. Immunizations alone saved 3 million children’s lives in 2011. Over the past decade, premature deaths from measles have been cut by 71 percent and from tetanus by more than 90 percent. And polio is closer and closer to complete eradication.
Still, vaccine-preventable diseases still account for approximately one in four global deaths of children under the age of 5. And of the 22 million children who go without the full benefits of vaccines each year, it is often the poorest that are most affected.
Among the greatest continuing obstacles are the persistent myths surrounding vaccinations, such as the false and repeatedly debunked belief that they cause autism.
“Overcoming these mistaken beliefs has become an integral part of our work towards global vaccine access. Until we reach the day when no lives are lost to vaccine-preventable diseases, we will aggressively continue to develop new and improved vaccines and ensure they are available to everyone in every country.”
>> Read the full “Beyond our borders: Why the U.S. Department of Health and Human Services invests in global efforts” at DefeatDD.org.
Up to 80 percent of family physicians are expected to use electronic health records (EHRs) by the end of this year, and experts across the country are talking about ways to leverage this influx of data to inform better health. A pre-conference workshop at the National Association of County and City Health Officials (NACCHO) Annual Meeting focused on Beacon Communities, which are part of a pilot to demonstrate how meaningful use of EHRs can lead to better health and better health care at a lower cost. The HHS Office of the National Coordinator for Health IT is providing $250 million over three years to 17 selected communities throughout the United States where numerous institutions are sharing data to inform quality improvement and other data-informed efforts.
The NACCHO meeting highlighted Beacon communities that are partnering with public health in different ways to forge data-informed population health activities.
Health departments in North Carolina have been required to do community assessments since 2002 as part of a statewide health department accreditation program and are very experienced with working with this data, whereas hospitals are just now beginning to be required to do similar assessments under the affordable care act, according to John Graham, PhD, PMP, Senior Investigator for the NC Institute for Public Health at the Gillings School for Global Public Health, which plays an integral role in the Southern Piedmont Beacon Community.
“Health assessment planning and communication are tools that can be leveraged to foster more collaboration,” said Graham. “We really try to coordinate public health prevention and health care. We can do a lot with clinical interventions, looking at it from a population health perspective.”
Even Insured Low-income Immigrants Less Likely to Visit Doctors
About 47 percent of insured and uninsured low-income immigrant children saw a doctor in 2010, compared about 60 percent for U.S.-born children, according to a new study from the Migration Policy Institute (MPI). The report also found that immigrant adults are less likely (8 percent) than native-born adults (13 percent) to visit emergency rooms. As immigrants are generally not eligible for coverage under the Affordable Care Act, their care will in many cases fall to health departments. Read more on access to care.
Exercise Alone Won’t Lower Weight; Lifestyle Changes Also Required
Exercise alone is good for maintaining a healthy weight, but should be combined with other lifestyle changes if a person expects to lose weight and then keep it off. People also negate the positive effects of exercise by overindulging in their post-workout rewards. "There's a war between exercise and nutrition in our heads," said American Council on Exercise spokesperson Jonathan Ross. "People tend to overestimate the amount of physical activity they get. They work out a little bit and treat themselves a lot." Between 250 and 300 minutes of exercise each week is necessary for weight loss, according to Joseph E. Donnelly, MD, an exercise physiologist with the American College of Sports Medicine; the government’s recommendation of 150 minutes of moderate-intensity is for cardiovascular fitness. A single pound of fat is about 3,500 calories. Read more on physical activity.
Soda Company to Stop Adding, Promoting Antioxidants in Some 7UP Drinks
The Dr. Pepper Snapple Group has agreed to stop fortifying certain of its 7UP soft drinks with vitamins and will no longer claim the product has antioxidants. The agreement ends a class action lawsuit against the company. 7UP’s regular and diet Cherry Antioxidant, Mixed Berry Antioxidant and Pomegranate Antioxidant varieties had small amounts of vitamin E added at the time of the lawsuit. According to the complaint, the pictures of cherries, blackberries, cranberries, raspberries and pomegranates on various 7UP labels gave the impression that the antioxidants might have come from fruit, but there is no fruit juice of any kind in any variety of 7UP. And last week a federal magistrate ruled that a separate lawsuit against Coca-Cola, for what the Center for Science in the Public Interest says is deceptive marketing of its vitaminwater line of soft drinks, may proceed as a class action suit. Read more on nutrition.
With just 83 days to go until health insurance marketplaces open up to allow otherwise uninsured Americans to sign up for health coverage under the Affordable Care Act (ACA), NACCHO Annual has a good number of plenary and other sessions focused on the role of public health in implementing the law.
>>Read more NewPublicHealth coverage of NACCHO Annual.
In his address to the 1,000 plus attendees at this year’s NACCHO conference, Centers for Disease Control and Prevention Director Tom Frieden, MD, MPH, talked about what local health departments can do to support ACA. “This is an all hands on deck situation,” said Frieden. “We want to do a lot with improving quality of care, but first we’ve got to get people signed up.”
Frieden ticked off actions that local health departments can take to help support enrollment, including:
- Provide resources to the community on getting insured & the benefits of being insured, including free preventive care.
- Educate every resident served by the department, such as immunization, tuberculosis and STD clinic patients, on how they can enroll.
- Educate every organization that the health departments connects with, such as schools, courts and businesses, on how stakeholders can enroll.
“Public health will always be local. But we will always need to adapt and evolve to continue to be relevant and effective,” said Thomas Frieden, MD, MPH, Director of the Centers for Disease Control and Prevention (CDC) to the packed crowd of local health department leaders at the opening session of this year’s National Association of County and City Health Officials (NACCHO) Annual Meeting. That means leveraging what’s working well, and keeping a finger on the pulse of what will work even better in the future, according to panelists at yesterday’s session, which was moderated by Dr. Swannie Jett, DrPH, MSc, Health Officer for the Florida Department of Health in Seminole County and included presentations by a number of federal-level public health officials.
>>Follow ongoing NewPublicHealth coverage of NACCHO Annual, including session recaps, interviews with speakers and more.
Jett alluded to a rapid transformation in public health that will change what it means to ensure the health of a nation or a county.
“Public health needs to be at the forefront,” said Jett. “We need to take the lead in our communities. We need to reach out to community partners, and to health officers in other counties and states. We need to bring everyone into the fold in this conversation.”
These kinds of cross-cutting partnerships, with public health playing a central role, were also the subject of a recent op-ed by Frieden on the Huffington Post, sharing success stories from the 2013 Annual Status Report of the National Prevention Strategy. The Strategy envisions a prevention-oriented society where all sectors recognize the value of health for individuals, families, and society, working together to achieve better health for all Americans. Frieden shared some examples of efforts to create healthier places to live happening across the country:
Employer Mandate to Provide Health Insurance for Workers Delayed One Year
The U.S. Department of the Treasury announced yesterday that implementation of the rule under the Affordable Care Act requiring employers with more than fifty workers to provide health insurance or pay penalties beginning January 1, 2014, will be delayed by one year. Read more on access to health care.
Pharmacist-guided Home Hypertension Monitoring Shows Significant Results
Home blood pressure monitoring augmented by partnering with a pharmacist can lead to greater improvements in hypertension than the traditional treatments, according to a new study in the Journal of the American Medical Association. People in the study intervention group received a home blood pressure monitor, training and lifestyle advice. The monitor automatically sent updates to the pharmacists, who could adjust treatment accordingly. About 72 percent of the study participants who underwent the new care combination had their hypertension under control after six months, compared to 45 percent for the participants who underwent the usual care. This control also persisted months after the interventions. “The reason that only about half of people with [high] blood pressure have it under control is that usual care isn't working. We combined two interventions that we thought would be very powerful together—home monitoring and pharmacist managements—and this is one system that we've shown works very well for blood pressure control," said senior investigator Karen Margolis, MD, from the HealthPartners Institute for Education and Research in Minneapolis. About 30 percent of U.S. adults suffer from high blood pressure. Read more on heart health.
HHS Issues Final Plan on Improving Patient Care Utilizing Health IT
The Department of Health and Human Services (HHS) has issued its final “Health IT Patient Safety Action and Surveillance Plan” to utilize health information technology (IT) to better protect patients and improve the quality of care. “When implemented and used properly, health IT is an important tool in finding and avoiding medical errors and protecting patients,” said National Coordinator for Health IT Farzad Mostashari, MD. “This Plan will help us make sure that these new technologies are used to make health care safer.” The Office of National Coordinator for Health IT plan outlines the responsibilities of both HHS and the private sector. It includes making it easier to report health IT-related incidents and hazards using certified electronic health record technology; encouraging reports to Patient Safety Organizations and updating standardized reporting forms; encouraging the use of standardized reporting forms in hospital incident reporting systems; and training on how to use the forms to identify safe and unsafe health IT practices. Read more on technology.
HHS Launches HealthCare.gov to Help Americans Prepare for New Coverage Opportunities
The U.S. Department of Health and Human Services (HHS) has launched the new HealthCare.gov to help Americans prepare for new coverage opportunities through the Affordable Care Act. Open enrollment in the Health Insurance Marketplace begins in just a few months, on October 1. The website (also available in Spanish) includes social media integration, sharable content and engagement destinations, and will later incorporate web chat functionality. “The new website and toll-free number have a simple mission: to make sure every American who needs health coverage has the information they need to make choices that are right for themselves and their families—or their businesses,” said HHS Secretary Kathleen Sebelius. Read more on access to health care.
USPSTF Recommends Hep C Screenings for All ‘Baby Boomers’
All “Baby Boomers”—Americans born between 1945 and 1965—should be screened for hepatitis C, according to new final recommendations from the U.S. Preventive Services Task Force (USPSTF). Earlier recommendations in November had only suggested that doctors consider screening. The new recommendations appear in the Annals of Internal Medicine. Researchers concluded that even the “moderate” net benefit made screening worthwhile; they also recommended screening for people at higher risk, such as injection drug users. "New evidence came out since the draft recommendation, which gave us greater confidence in the linkage between a sustained viral response and important outcomes," said Albert Siu, MD, co-vice chair of the task force, to Reuters. The majority of the 3 million Americans who have hepatitis C are Baby Boomers, according to the U.S. Centers for Disease Control and Prevention. Read more on aging.
Study: Diet, Exercise Don’t Decrease Heart Health Risk for People with Diabetes
While the weight loss associated with diet and exercise does not necessarily improve heart health for people with type 2 diabetes, the positive lifestyle changes can decrease the chances of kidney failure and eye damage, according to a new study in the New England Journal of Medicine. "Intensive lifestyle intervention reduced the risk of chronic kidney disease by 31 percent," said study author Rena Wing. "So we had a very, very marked effect on the development of high-risk chronic kidney disease. We also showed a benefit in terms of self-reported eye disease." Researchers said one possibility for the lack of heart health improvement was the relatively small weight losses of both of the study groups—the one that incorporated exercise, and the one that did not. Frank Sacks, MD a professor of cardiovascular disease prevention at the Harvard School of Public Health who saw the study but did not participate, said he believed it was “stopped too soon,” which affected the results. Read more on diabetes and heart health.
RWJF ‘Commission to Build a Healthier America’ Reconvenes to Focus on Early Childhood and Improving Community Health
What do the needs of children in early childhood and improving community health have to do with each other? Everything, according to a group of panelists who addressed the Robert Wood Johnson Foundation (RWJF) Commission to Build a Healthier America at a public meeting in Washington, D.C. yesterday.
Early childhood education and other interventions early in life, particularly for low-income children, can set kids on a path to better jobs, increased income and less toxic stressors such as violence and food insecurity, according to testimony at the today’s meeting. And that in turn creates more stable and healthier communities. Those two issues are the focus of the Commission, which plans to release actionable recommendations in September.
Yesterday’s event marks the first time the Commission is reconvening since it issued recommendations for improving health for all Americans in 2009. It will be co-chaired again by Mark McClellan, MD, PhD, director of the Engelberg Center for Health Care Reform at The Brookings Institution and former Administrator of the Centers for Medicare & Medicaid Services, and Alice M. Rivlin, PhD, senior economist at The Brookings Institution and former director of the Office of Management and Budget.
“Although we have seen progress since the Commission issued its recommendations in 2009, we still have a long way to go before America achieves its full health potential,” said RWJF President and CEO Risa Lavizzo-Mourey, MD, MBA at the Commission’s public meeting in Washington. “We know what works: giving children a healthy start with quality child care and early childhood development programs, and building healthy communities where everyone has an opportunity to make healthy choices. That is why RWJF is reconvening the Commission, to concentrate on these two critical areas.”
Last week, efforts to add a ten year old with cystic fibrosis to the list of adult patients waiting to get donated lungs, increasing her chances of a transplant, made big news. NewPublicHealth had planned to write about the urgent need for citizens to step up and sign on to become organ donors and help whittle down the long lists of patients desperately waiting for hearts, lungs, kidneys and other organs. But our colleagues at the The Public’s Health, a well-worth-reading public health blog hosted by the Philadelphia Inquirer, beat us to it. We urge you to read the post by Michael Yudell, one of the blog’s writers as well as an associate professor at the Drexel University School of Public Health.
"…The demand for organs in the United States far outpaces the supply. There are currently 75,650 active candidates (meaning they are medically suitable for a transplant) waiting for organs in the United States. But 18 people die every day, on average, waiting for an organ transplant."