Category Archives: Diabetes
Obstetricians and gynecologists should screen all patients for intimate partner violence, including during prenatal visits, according to new recommendations from the American College of Obstetricians and Gynecologists. Read more on violence and health.
The rate of leg and foot amputations among U.S. adults aged 40 and older with diagnosed diabetes declined by 65 percent between 1996 and 2008, according to a study funded by the Centers for Disease Control and Prevention and published in the journal Diabetes Care. The study also found that among people with diagnosed diabetes in 2008, men, blacks and adults aged 75 years and older had the highest rates of leg and foot amputations. The study authors say that that improvements in blood sugar control, foot care and diabetes management, along with declines in cardiovascular disease likely contributed to the decline in amputations. Get more diabetes news.
A recent study in the American Journal of Public Health found that smokers with lower socioeconomic status had less success quitting smoking than more affluent counterparts in the same cessation program.
The researchers examined socioeconomic disparities in a community-based tobacco dependence treatment program. Both behavioral therapy and nicotine patches were provided to 2,739 smokers. The researchers found that the probability of not smoking three months after treatment among study participants was 55 percent greater for the highest socioeconomic status than for the lowest socioeconomic status smokers at three months, and 2.5 times greater at six months. Researchers also found that the less affluent participants had fewer resources and less environmental support to help them keep from smoking. Get the latest tobacco news updates.
A new study in the journal Health Affairs has found that young people with diabetes are more likely to drop out of high school and could expect to earn about $160,000 less than those without diabetes over their lifetimes. That’s on top of medical expenses that can average $6,000 per year for medicine, testing equipment and physician visits. The Health Affairs article used data from the U.S. National Longitudinal Study of Adolescent Health to look at the non-medical costs associated with diabetes.
NewPublicHealth spoke with Michael R. Richards, a co-author of the study and a graduate student in health economics in the Division of Health Policy and Administration at the Yale School of Public Health. Richards says the study is important because often the urgency that is associated with diabetes focuses on long-term health consequences—outcomes that happen later in life.
“Our work suggests that urgency should be brought forward earlier. We need to be looking at long- and short-term consequences—including educational attainment and income levels. Richards says not enough is known yet to help formalize policies on how to deal with short-term issues, but that the next step in the research by the study authors is to uncover the mechanisms that are driving these outcomes. “Once we know the mechanisms,” says Richards, “it will be easier to plan next steps.”
>>Read the Health Affairs article here.
Patients treated for acute heart attacks in the United States are readmitted to the hospital within 30 days of their initial discharge more often than in other countries, according to a new study published in the Journal of the American Medical Association. The study found that 60 percent of severe heart attack patients admitted to U.S. hospitals were discharged in three days or less, yet 14.5 percent of the U.S. patients required another stay within a month. By comparison, 54 percent of study participants in other countries spent at least six days in the hospital and only 10 percent were readmitted to the hospital within thirty days. Read more on heart health.
A new tool from the National Diabetes Education Program offers users the chance to declare resolutions, such as losing weight and exercising more, and share the resolutions through social media. The site offers information and tools to bolster efforts to be healthier in 2012. Get more updates on new technology and apps to support better health.
The Department of Transportation has announced proposed improvements to Passenger Train Emergency System regulations for emergency passenger and crew evacuations. The proposed regulations include improvements to compartment doors, emergency lighting, signage and markings for emergency entrance and exit, and rescue access. The agency also recommends stronger requirements for debriefing passengers and crews after emergency situations and simulations. The comment period for the proposal closes March 5, 2012. Read more on transportation and health.
The Department of Health and Human Services has released more than $845 million to states to help low-income households with their heating and home energy costs under the Low Income Home Energy Assistance Program.
Hepatitis B vaccination is recommended for all unvaccinated adults with type 1 and type 2 diabetes aged 19 to 59, according to new guidelines from the U.S. Advisory Committee on Immunization Practices. The committee made it recommendation based on findings that show that people with diabetes are at increased risk for Hepatitis B, which can be transmitted through minute amounts of blood from an infected person. For example, the virus can be transmitted if finger-stick devices or blood glucose monitors are shared and used by an infected person.
The Department of Housing and Urban Development has launched the HUD Language Line, a telephone language service pilot program that will offer live, one-on-one interpretation services in more than 175 languages. The program will be accessible throughout the US and will help HUD staff better communicate with individuals and families with limited English skills about HUD programs and services. The pilot program will run through September 2012.
Where you live—your zip code, your neighborhood, and even your home—may have just as much or more impact on your health as what goes on in the doctor’s office. “You can predict the life expectancy of a child by the zip code in which they grow up. This is wrong,” said U.S. Department of Housing and Urban Development (HUD) Secretary Shaun Donovan (as quoted in an opinion piece in today’s Roll Call and in a recent commentary, together with U.S. Department of Health and Human Services Secretary Kathleen Sebelius, “How Housing Matters”).
Recent research on a HUD demonstration project found that poor women who were given the opportunity to live in safer, more affluent neighborhoods had lower rates of obesity, diabetes, psychological distress, and major depression. The Roll Call opinion piece, jointly authored by Raphael Bostic, PhD, Assistant Secretary, Policy Development and Research at HUD and Risa Lavizzo-Mourey, MD, MBA, President and CEO of the Robert Wood Johnson Foundation, looks at the role of housing in health, and new collaborations across sectors that recognize that providing healthier, more affordable housing can lead to significant health outcomes.
NewPublicHealth caught up with Raphael Bostic to get his take on changes at HUD to integrate health in all policies, some of the innovative housing programs from the field and how the health field can better support this work. Bostic addressed similar topics a recent conference hosted by the Federal Reserve Bank of San Francisco, RWJF and The Pew Charitable Trusts.
NewPublicHealth: Why is HUD looking at health and how does this fit with HUD’s more central mission?
Raphael Bostic: One of the things that has really been interesting for us as we’ve looked at our programs and our activities is the intersection between housing and a whole host of other areas—health care, school performance, job attachment—they all seem to be pretty closely linked to how well people were housed. We started down this route to pay specific attention to those intersections, and have that as a central platform in our strategic plan.
We’ve been running a demonstration project called Moving to Opportunity, and some of preliminary results of that study, which started in the early 1990s, suggested that health benefits were going to emerge as one of the biggest benefits of people getting housed well. The experimental research really did guide us in a significant way.
NPH: Did this Moving to Opportunity study represent a turning point in how HUD thought about health and housing?
Raphael Bostic: There’s always been some intuition in this building that housing played a role in health, but the experimental results made it concrete and something that we could act on. It also made it easier for us for us to talk to our partners, our stakeholders and grantees to let them know they should be thinking about health, and to think about how the programs they’re designing affect health. That’s been a good conversation to be able to have and point to real findings that say when people get housed better, they wind up healthier.
We’re starting to see some other efforts in this area as well. Asthma is a huge problem, and a costly problem, especially for young people. The quality of housing and how well the housing is built and kept plays a huge role in the incidence of asthma. There are a number of efforts to have joint interventions where health organizations use their resources to do interventions to get housing up to better quality standards, which will then save them money because they don’t have to treat uncontrolled asthma. That really falls in line with the idea that we have that housing policy is health policy.
NPH: How is HUD’s outlook different now than in the past?
Raphael Bostic: One, we’re thinking much more broadly about what success for our program looks like. It used to be success for us was that someone had a voucher and was in a house. We didn’t look much beyond that to say are other parts of their quality of life changing significantly. This has allowed us to focus much more broadly on what success means.
It has also made us be more proactive in finding partnerships with our sister agencies in the federal government. Our partnership with the Department of Health and Human Services has been significantly strengthened and deepened. Similarly, we’re working closely with Department of Education around educational outcomes—it’s really allowed us to be much more integrated, hopefully to get a holistically better set of outcomes.
NPH: What are some of the innovative programs that are working?
Raphael Bostic: Some of our most basic programs have a viewpoint on health embedded in them. There’s Choice Neighborhoods, which is a program where we take some of the worst of our public housing and we convert it into higher-quality, mixed-income, mixed-tenure (rental and ownership) developments. We take those places where we know health is as bad as it’s going to be from a housing perspective and convert them into places where there’s much healthier lifestyles—you have sidewalks, you have walkable neighborhoods, you have amenities and the like. That’s one where I think we will see significant improvements in health because of the housing policy.
Another initiative is the Sustainable Communities Planning Grant. What we’re trying to do is facilitate and incentivize regional planning and more coordinated development of housing that is more sustainable, more walkable, closer to jobs and helps to make living easier, which should translate into real health benefits.
Our basic programs, including support through the Housing Choice Voucher program, where we help people have some mobility to choose the neighborhood they live in, has allowed people to get away from the neighborhoods that were a source of stress and lack of safety—so we’re seeing significant psychological benefits.
And our Housing Opportunities for Persons With AIDS program has been extremely beneficial. One of the most sobering statistics I heard at our conference in September was that for people with HIV/AIDS, if you had 100 people and didn’t get them quality housing, only 25 were still alive five years later. If you got them housing, 95 of them were still alive three to five years later. Talk about an “aha moment.”
NPH: What challenges does HUD face in looking at health-related effects of its work?
Raphael Bostic: Health is a very specialized field. A lot of the housers aren’t aware of what good interventions look like and they don’t really know who to talk to in getting that information. You wind up with a very siloed atmosphere. I think that’s the biggest challenge, is getting the experts to talk to people beyond the usual suspects and get them to understand that we need to be a broader and more integrated community. We’re trying to start facilitating those conversations about health and housing.
NPH: What can the health sector do to help and to work together?
Raphael Bostic: Figure out what sorts of activities are going on in communities that could be informed by health considerations. There’s a movement afoot where people are trying to get health professionals on planning commissions and on code boards so that when zoning decisions come up, we think about them in terms of their health impact. I think that’s an interesting way to make sure health is thought about in all the situations where it’s relevant.
The partnerships we’ve formed with HHS and other agencies here have been extremely positive—it’s really my hope that those collaborations happening on a national level will eventually diffuse down. If we integrate health and housing policies at all levels, that will be very exciting.
NPH: What other organizations or sectors need to be involved in these collaborations to really make an impact on health?
Raphael Bostic: Community development organizations have become increasingly interested, particularly in minority and low-income areas, in the health of their communities. If there are ways to improve health, it improves employability and a whole host of things. How communities are constructed, how neighborhoods are laid out, and how we plan for new, transit-oriented developments—those are all broader community development concerns that have real positive implications, if done well, for how people are housed. A number of community development professionals get this already. There’s a lot of work to be done. Some studies have showed that how communities are zoned and constructed can have direct impacts on obesity, diabetes, hypertension and other health issues. I think there’s more research to be done to better understand those relationships.
>>Read more on the link between housing and health.
NewPublicHealth spoke with Yvette Roubideaux, MD, MPH, director of the Indian Health Service (IHS) and a member of the Rosebud Sioux tribe, about innovative efforts to improve the health of Native Americans.
NewPublicHealth: What is significant to you about the observance of Native American Heritage Month?
Dr. Roubideaux: Each year it’s a celebration of the richness and the strength of Native American cultures. It’s a great opportunity to be reminded of the great cultures and traditions of American Indians and Alaska Natives and how that relates to overall health and well-being.
NPH: For 2012, what are some of the key projects and issues that are on the front burner with regard to Native American health in the U.S.?
Dr. Roubideaux: Well certainly one of the biggest issues relates to the disparities that this population experiences compared to the U.S. general population and the significant burden of disease that’s causing lots of illness for the population, including chronic diseases and obesity. Trying to narrow that gap in disparities, trying to improve access to care are major efforts of what we’re doing with the Indian Health Service. For example, the mortality rates on diabetes are almost three times the U.S. population rates. We know that obesity is higher in American Indians and American Indian children. We know that, for example, alcohol-related mortality is almost six times greater in American Indians and Alaska Natives.
NPH: In what ways might Native Americans approach health and well-being differently than other Americans?
Dr. Roubideaux: Well, I think that there’s a general understanding among American Indian and Alaska Natives that the culture and their traditions promote health, and so a lot of the prevention efforts and community-based health initiatives are really starting to focus more on what we can learn from our traditions. How can we learn to be healthy and live in balance and seek wellness? It comes from the fact that for American Indians and Alaska Natives, there’s a recognition that over a hundred years ago we didn’t have the illnesses that we have now, we didn’t have diabetes, we didn’t have obesity, and so they must have been doing something right and what can we take from the lessons of our ancestors and our traditions to be healthier. And, of course, it’s eating healthy and making healthy food choices, more physical activityand living a life in balance—in balance in general and in balance with nature.
Many programs are focused on returning to traditional ways. Some of those are reintroducing gardening and growing traditional plants and some are returning to traditional games and physical activity that the tribes did. Some tribes, they were runners, and so they’re doing more runs, and lacrosse is a traditional Native game and they’re reviving that for the kids. Many tribes are looking at their past to find answers to the health problems that are plaguing them today. Healthy eating practices of Indian people included eating very lean meats, berries and greens—foods from nature. And they had to have enough food for the whole group so they didn’t over-indulge and had to prepare for famines, and so they were very cautious about what they ate.
NPH: How can accreditation benefit tribal public health departments and the communities they serve? What are some of the greatest opportunities and challenges that accreditation presents?
“It’s not easy but it’s worth it,” is the very important message from the National Diabetes Education Program (NDEP), a partnership between the Centers for Disease Control and Prevention and the National Institutes of Health. The Partnership is promoting that message and a very useful library of resources in observance of National Diabetes Awareness Month in November. The critical need to get people to manage or prevent diabetes grows each year. Currently, 26 million Americans have diabetes and 79 million are at risk of developing the disease.
The NDEP resource library has numerous entry points including age, diabetes status and ethnicity, which link site users to targeted materials that address their specific needs and concerns. It also has entry points for community health workers, community organizations and teachers with resources such as a variety of toolkits for diabetes outreach.
Recommendations on the site help make managing or preventing diabetes more manageable for many people:
- Think about what is important to you and your health.
- What changes are you willing and able to make?
- Decide what steps will help you reach your health goals.
- Choose one goal to work on first. Start this week. Pick one change you can start to make immediately.
- Don't give up. It's common to run into some problems along the way. If things don’t go as planned, think about other ways to reach your goal.
Read more on diabetes prevention and other diabetes news here.
In the last few years the Department of Housing and Urban Development (HUD) has launched a number of initiatives focused on making homes and communities healthier while also helping to reduce health disparities and promote health equity—a focus of several presentations at the recent annual meeting of the American Public Health Association. NewPublicHealth spoke with Erika Poethig, Deputy Assistant Secretary for Policy Development, about the role of HUD in helping improve the health of Americans.
NewPublicHealth: What’s the relationship between the Department of Housing and Urban Development and the nation’s health?
Erika Poethig: For probably a hundred years we’ve understood that housing quality has a relationship to health outcomes. That’s why zoning laws were changed to reduce crowding and major housing reforms were advanced to improve the quality of housing mid-century. More recently, in the last 10 years, a group of scientists including physicians have really focused on the connection between socioeconomic status and health.
Health outcomes can be really affected by people’s environments, and that includes the housing unit but it also includes the neighborhoods in which people live. Most recently we have had a major 15-year social experiment called Moving to Opportunity. The project tested the impact of giving people who live in public housing the opportunity to move to lower-poverty communities.
At the time the hoped-for result was around labor attachment and labor force outcomes and better education. These were the theories that people had about why it was important for people to move to low poverty communities. But with the partnership of other federal agencies and the MacArthur Foundation, for the first time we included biomarker data collection to really get rigorous measurement of the markers for diabetes. The main finding is that for low-income women, moving from high-poverty neighborhoods to lower-poverty neighborhoods is associated with reductions in both extreme obesity and diabetes of about 20 percent.
NPH: What’s the chief significance of the study’s findings?
Erika Poethig: In conversations with people in the medical field on the issues of socioeconomic status and health they said we feel like we’ve met the limits of what we can do on the behavior side and possibly through medication. So, this opens up a whole new way for us to think about how we really affect these health conditions, which disproportionately affect minority populations and costs our healthcare system about $5,000 per person per year.
NPH: How does that play out in the real world?
A new, first-ever state level report on suicide, released by the Centers for Disease Control and Prevention, finds that in the United States someone considers taking their own life every 15 minutes. Serious thoughts of suicide range from about 1 in 50 adults in Georgia (2.1 percent) to 1 in 15 in Utah (6.8 percent). “Most people are uncomfortable talking about suicide, but this is not a problem to shroud in secrecy,” says CDC Director Thomas Frieden, MD, MPH. “We need to work together to raise awareness about suicide and learn more about interventions that work to prevent this public health problem.” Read more mental health news.
A Danish study on more than 350,000 people published in the British Medical Journal says cell phones do not pose a brain tumor risk for users. Expect the debate to continue—a study earlier this year by the World Health Organization (WHO) suggested cell phones do increase the risk. The authors of the new study say continued monitoring is needed. Read more about the WHO study with contradictory findings.
The National Institutes of Health has just introduced Go4Life, an exercise and physical activity campaign aimed at helping older adults fit exercise and physical activity into daily life. A public-private partnership including several government organizations, community organizations such as the YMCA, health insurance companies, elder care organizations and professional organizations such as the Gerontological Society of America will work to bring the campaign into communities across the United States. Find more news on older adult health.
A study in the journal Diabetes Care find that women with newly diagnosed diabetes may be more likely than women not diagnosed with the disease to also find out they have breast cancer. The researchers speculate that once doctors confirm diabetes they are likely to order more tests for other medical conditions and so detect the breast cancer as well. Read more cancer news.
Thomas Frieden, MD, MPH, director of the Centers for Disease Control and Prevention (CDC), spoke at the Opening Session of the Association of State and Territorial Health Officials (ASTHO) Annual Meeting yesterday, with a focus on a vision for the public health of the future. NewPublicHealth caught up with Frieden to talk about the CDC’s efforts to move public health into the future, despite economic constraints.
NewPublicHealth: The theme of the ASTHO opening session is a vision for the "new" public health. What does this mean to you and the CDC?
Thomas Frieden: Public health has to consistently and newly demonstrate our value to society, both through the traditional efforts in communicable diseases and environmental health as well as the newer challenges of dealing with cancer, heart disease, stroke and diabetes. What we’ve tried to do is to identify Winnable Battles where we can save a lot of lives and save a lot of money with a big impact on health. We can succeed at these by getting many different parts of society working together. We’re encouraging stories from around the country of getting everything from school boards to housing projects to workplaces to WIC [Women, Infants and Children] programs involved in promoting health.
NPH: This year CDC and other partners launched the Million Hearts initiative to prevent 1 million heart attacks and strokes over the next five years. What are the strategies for accomplishing this goal?
Frieden: Million Hearts is, I think, an incredibly exciting initiative, and I’m confident that within five years, this initiative will prevent one million heart attacks and strokes. It will do that by reducing the number of people who need treatment and improving the quality of care for those who do need treatment. It will reduce the number of people who need treatment through tobacco control and improved nutrition, particularly reducing artificial trans-fats and excess sodium intake.
And it will improve the quality of care by addressing the ABCS – Aspirin, Blood Pressure, Cholesterol and Smoking Cessation. Currently the U.S. does very poorly on the ABCS. Less than half of the people who should be on aspirin are on it, less than half of the people with high blood pressure have it under control, only a third of people with high cholesterol have it under control and less than a quarter of smokers who see their doctor get advice to quit. Now what we know is that highly performing systems can do dramatically better. They can do that by focusing on key outcomes like using health information technology and getting all members of the healthcare team to be used to their fullest potential.
NPH: What will be happening at the community level to meet these goals?