Category Archives: Health policy
Ahead of the annual pilgrimage of Muslims to Mecca and Medina in Saudi Arabia this October, the Saudi health ministry is limiting the number of foreign and local pilgrims in order to lower the risk of the spread of H7N9, a new form of avian flu identified several months ago in China, and MERS, or Middle East respiratory syndrome corona virus (MERS/MERS-CoV), a potentially fatal virus that emerged last year. The largest numbers of cases of the virus—and deaths—have been in Saudi Arabia. According to a recent post on the Network for Public Health Law’s (NPHL) blog by Daniel G. Orenstein, JD, deputy director of NPHL’s Western Region, so far neither the U.S. Centers for Disease Control and Prevention nor the World Health Organization have issued travel restrictions about the Hajj.
However, the post does note that the emergence of the two viruses has prompted the U.S. Food and Drug Administration (FDA) to take action under its legal authority to increase U.S. readiness to treat potential outbreaks of H7N9 and MERS. Under the Pandemic and All Hazards Preparedness Reauthorization Act of 2013 (PAHPRA), the FDA recently issued Emergency Use Authorizations (EUAs) for diagnostic tests for both viruses. EUAs enable the FDA to temporarily allow use of unapproved medical products such as antibiotics, vaccines and diagnostic tests needed during emergencies.
Orenstein says that “issuing the EUAs illustrates the flexibility and adaptability of FDA authority as clarified under PAHPRA. As epidemiologic research develops further on these viruses, FDA will be able to respond quickly, hopefully mitigating the impact on population health.”
>>Read more: Read the full post on the Network for Public Health Law’s blog.
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.
In 2012, the American Institute of Architects (AIA) established the Decade of Design initiative to research and develop architectural design approaches for urban infrastructure and to implement solutions to ensure the effective use of natural, economic and human resources that promote public health.
NewPublicHealth recently spoke with Brooks Rainwater, the AIA’s director of public policy, about the initiative and the impact it can have on public health.
NewPublicHealth: How did the Decade of Design project come about and what are the goals?
Brooks Rainwater: The Decade of Design global urban solutions challenge is our Clinton Global Initiative commitment to action. CGI convenes global leaders to create and implement innovative solutions to the world's most pressing challenges. We put together a 10-year AIA pledge with a focus on documenting, envisioning and implementing solutions related to the design of the urban built environment in the interest of public health, and effective use of natural economic and human resources. In order to do this, the AIA is working with partner organizations—including the Association of Collegiate Schools of Architecture and the MIT Center for Advanced Urbanism—to leverage design thinking in order to effect meaningful change in urban environment through research, community participation, design frameworks and active implementation of innovative solutions.
We started in 2012 by giving research grants to three architecture programs at Texas A&M University, the University of Arkansas and the University of New Mexico.
At Texas A&M, they focused on evaluating the health benefits of livable communities and creating a toolkit for measuring the health impacts of walkable communities as they’re being developed in Texas.
Researchers at the University of Arkansas have a plan called Fayetteville 2030. The city is slated to double in population in the next two decades, so they have brought together community leaders to develop a long-range plan to focus on local food production, including urban farming to help prepare for the large population growth.
At the University of New Mexico, they're establishing an interdisciplinary public health and architecture curriculum. Over the next three years they want to create joint courses on some of the translation issues that come up between the professions, making sure that architects can speak the public health language and public health professionals can also understand the built environment in a new and different way.
Last week, a lunch briefing hosted by Women’s Policy, Inc., a national nonprofit that focuses on women’s issues, brought together a packed house of policymakers, public health leaders, academics, and legislative staff in key Congressional offices to discuss how data can inform action around women's and population health.
The briefing focused on the County Health Rankings & Roadmaps, a collaboration between the Robert Wood Johnson Foundation (RWJF) and the University of Wisconsin Population Health Institute that measures the health of every county in the United States and provides tools to help create solutions that make it easier for people to be healthy in their own communities. Measuring health outcomes like length and quality of life along with health factors like education, income, and obesity rates, the Rankings provide an annual snapshot of where counties are doing well and where they can improve.
In turn, the Roadmaps to Health program helps counties partner with other local leaders to use that data to improve the health of residents. One of the featured speakers at the briefing was Claude-Alix Jacob, Chief Public Health Officer of Cambridge, Mass., one of six inaugural winners of RWJF’s Roadmaps to Health Prize.
Jacob pointed out the value of having data to work with determining where to put resources in order to improve community health. Women’s health data points of in Cambridge include:
- Girls reported slightly higher rates of smoking and binge drinking than boys
- Girls reported rates three times higher than boys of verbal abuse.
- Girls reported being three times more likely to hurt themselves than boys
- 87 percent of eligible women have had Pap smears, and 85.5 have had mammograms
- One-third of single mothers live in poverty
One key program that Jacob pointed to that Cambridge has begun is Baby University, a free 16-week innovate program designed for parents with children from birth to age 3. The goal is to increase parents’ knowledge about child-rearing topics, strengthen parent-child relationships and connect parents to community resources. “While the first few cycles have largely included only moms,” said Jacob, “ the two most recent cycles have included more dads.”
The program includes childcare and transportation costs for enrolled parents, as well as home visits by professional staff. Parents who complete the program become part of an alumni association that continues the relationship between the parents and the program staff. So far, the program has had 140 graduates.
>>Read more about the briefing from the County Health Rankings blog.
>>Bonus Link: Among the resources for improving community health discussed at the Women Policy Inc. briefing was the “Town Hall Meeting in a Box” to help facilitate community conversations. The toolkit includes invitation samples, venue ideas and presentation documents. See more County Health Rankings & Roadmaps resources here.
As scholars together at the Columbia Mailman School of Public Health in New York City, public health researchers Kimberley Roussin Isett, PhD, and Miriam Laugesen, PhD, watched major policy changes unfold across the city over the past several years. They decided to look at New York City as a model for improving public health that other cities could replicate. “Things were happening in New York City rapidly, and in a health-focused way that really not seen before,” says Isett. Since then, other cities across the country have enacted similar, comprehensive smoke-free policies. Voluntary calorie postings on restaurant menus were also integrated as a requirement in the Affordable Care Act. The researchers decided to look at New York City as a model for improving public health that other cities could replicate. NewPublicHealth recently spoke with Drs. Isett and Laugesen about their research. Dr. Isett recently took a new position as an Associate Professor in the School of Public Policy at the Georgia Institute of Technology in Atlanta, and Dr. Laugesen is an Assistant Professor of Health Policy and Management at Mailman and a former Robert Wood Johnson Foundation Health & Society Scholar.
NewPublicHealth: Because of its large budget and powerful public leaders, New York City isn’t always seen as a model for other, particularly smaller, health departments. But your work shows some of their efforts to be important, maybe critical for other departments to study and replicate. How did you come to that conclusion?
Miriam Laugesen: In our research, one theme that kept coming across again and again was the scientific basis—the amount of research and data—that the Bloomberg administration and staff had collected to justify and design their policies. That was a very big component, we thought, of many of their policies and that New York City had many innovative, interesting examples of how policymakers can base their policies on evidence.
The Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts, recently announced eight new grant recipients that will receive funding to conduct health impact assessments (HIAs). The projects will bring health considerations into upcoming decisions on topics including education, sanitation infrastructure, and energy.
“Our new grantees will use health impact assessments to uncover opportunities to improve health in a wide range of policy decisions, as well as to identify and avoid potential unintended consequences,” said Aaron Wernham, MD, director of the Health Impact Project. “These eight HIAs are the latest in a fast-growing field, as more cities and states find them a useful way to bring health into decisions in other sectors.”
By the end of 2007, there were 27 completed HIAs in the United States. There are now more than 225 completed or in progress, according to the Health Impact Project map of HIA activity in the United States.
Funding for some of the new proposals was also provided by the Blue Cross and Blue Shield of Minnesota Foundation and The California Endowment.
Some of the new HIAs that have received funding include:
- Partners for a Healthier Community, Inc. will undertake an HIA to inform decisions about a proposed casino in western Massachusetts. Decision-makers—including the state gaming commission, local government officials, and voters—will consider siting options as well as licensing, regulation, design and development of the casino. The HIA will examine health risks that might be linked to gambling—including substance abuse, mental health, and injury—and potential health benefits related to employment opportunity, access to health insurance, and community revenues.
- The University of Texas at El Paso, will conduct an HIA on the impacts of proposed water and sanitation improvement projects on the town of Vinton, Texas. Vinton primarily relies on failing septic tanks and cesspools for wastewater removal and domestic wells with poor water quality. Poor water and sanitation are associated with gastrointestinal illnesses and other serious health conditions such as hepatitis, dysentery, and dehydration. Improved systems could not only improve public health but also support economic development and long-term sustainability of local businesses and industry.
- An HIA by the Kentucky Environmental Foundation, in collaboration with the Purchase District Health Department, will examine the potential health benefits and risks of the retrofit or retirement of the Shawnee coal plant in Paducah, KY, operated by the Tennessee Valley Authority. The HIA will analyze environmental health concerns associated with air and water pollution from the plant and the effects of its closure on the community including employment, individual income, and revenue for local services important to health.
NewPublicHealth recently spoke with two of the researchers conducting the Shawnee coal plant HIA, Elizabeth Crowe, executive director of the Kentucky Environmental Foundation, and Deborah Payne, energy and health coordinator for the Foundation.
NewPublicHealth: What is the scope of the HIA you’re conducting?
Nearly 40 percent of private-sector employees in the United States do not have access to paid sick days, making it difficult for them to miss work when they are ill or have a doctor’s appointment. Those who do stay home often suffer lost wages and risk being fired from their jobs. To avoid financial insecurity, employees often go to work while sick, according to the Network for Public Health Law.
Paid sick days, on the other hand, allow employees to stay home or seek preventive care without risking a family’s income or endangering the health of co-workers, customers and others. In fact, one study found that 7 million workers were infected with H1N1 in 2009 because their co-workers came to work sick. To combat this trend, some U.S. cities and one state (Connecticut) have enacted laws requiring employers to provide paid sick days, which was a topic explored in a webinar earlier this year from the Network for Public Health Law.
But as some cities are making moves toward paid sick leave, some state-level legislation is cropping up that could prevent cities and counties from passing their own paid sick days standards and enacting other workplace protections. Such preemption laws are being considered in at least six states, according to a post by Vicki Shabo, Director of Work and Family Programs, for the National Partnership for Women and Families.
"No matter where you live or work, no one should have to choose between job and family because he or she cannot earn paid sick days," said Shabo in the post.
Past Decade's Poor Economy Drove Health Declines
More than a decade of research points to the negative impact of the austerity that accompanies a flagging economy on the population's health, according to Reuters. The studies will be detailed in a new book to be released by an interesting research pairing including a political economist from Oxford University and a professor of medicine and epidemiology at Standford University. the researchers say more than 10,000 suicides and up to a million cases of depression have been diagnosed during what they call the "Great Recession" and its accompanying austerity across Europe and North America. For example, more than five million Americans have lost access to health care during the latest recession. Researchers also tie cuts in governmental public health programs to excess disease rates. "In Greece, moves like cutting HIV prevention budgets have coincided with rates of the AIDS-causing virus rising by more than 200 percent since 2011—driven in part by increasing drug abuse in the context of a 50 percent youth unemployment rate," according to the Reuters article. Read more on poverty and health.
What Influences Kids to Smoke (or Not to) Changes Over Time
Peer pressure may have a bigger influence on middle school-aged kids in starting to smoke, but that influence may wane as they get older. On the other hand, researchers said parents seem to remain influential over their children's smoking behavior throughout high school, as reported by HealthDay. Researchers looked at data from the Midwestern Prevention Project, the longest-running substance abuse prevention, randomized controlled trial in the United States, which includes 1,000 teens. Read more on tobacco use.
Facebook Could Help Predict, Track and Map Obesity
The higher the percentage of people in a city, town or neighborhood with Facebook interests suggesting a healthy, active lifestyle, the lower that area's obesity rate, according to a new study. At the same time, areas with a large percentage of Facebook users with television-related interests tend to have higher rates of obesity. The study was conducted by Boston Children's Hospital researchers comparing geotagged Facebook user data with data from national and New York City-focused health surveys.
"Online social networks like Facebook represent a new high-value, low-cost data stream for looking at health at a population level," said study author John Brownstein, PhD, from the Boston Children's Hospital Informatics Program. "The tight correlation between Facebook users' interests and obesity data suggest that this kind of social network analysis could help generate real-time estimates of obesity levels in an area, help target public health campaigns that would promote healthy behavior change, and assess the success of those campaigns." The study was published in PLOS ONE. Read more on obesity.
Do we need an endgame strategy to finally end the devastating hold tobacco has on its users? Scholars, scientists and policy experts grapple with endgame proposals in a special supplement to the journal Tobacco Control. Some of the articles are based on a workshop held last year at the University of Michigan, with financial support from the Robert Wood Johnson Foundation and the American Legacy Foundation. The workshop was hosted by Kenneth Warner, PhD, a former dean at the University of Michigan School of Public Health and now a professor at the School.
Although smoking has declined significantly in most developed nations in the last half-century, due to policy changes and increased education about the health hazards, says Warner, too many people continue to die from the most preventable cause of premature death and illness. It's estimated that worldwide six million people a year die from illnesses caused by cigarettes, including more than 400,000 in the U.S. alone."There is a newfound interest in discussing the idea of an endgame strategy. The fact that we can talk about it openly reflects a sea change,” says Warner.
>>Read the articles in the tobacco endgame supplement.
Some of the strategies in the supplement include:
- Requiring manufacturers to reduce nicotine content sufficiently to make cigarettes nonaddictive.
- A "sinking lid" strategy that would call for quotas on sales and imports of tobacco, which would reduce supply and drive up price to deter tobacco purchases.
- A "tobacco-free generation" proposal calling for laws that would prevent the sale of tobacco to those born after a given year, usually cited as 2000, to keep young people from starting to smoke; or ban the sale of cigarettes altogether.
"What we are doing today is not enough," says Warner. "Even if we do very well with tobacco control, as we have for several decades now, we'll have a huge number of smokers for years to come, and smoking will continue to cause millions of deaths.”
NewPublicHealth recently spoke with Dr. Warner about some of the strategies proposed for ending tobacco use.
NewPublicHealth: Why is there a need for novel, even radical, endgame strategy?
Ken Warner: While a lot of people have quit smoking, if you look at the rate at which people are quitting in the United States, in the last few years it may actually have declined. In Canada, there is some concern that their very low rates of smoking may actually have gone up. In Singapore, which had the lowest smoking prevalence among developed nations, the smoking rate went up from 12.6 percent to 14.3 percent between 2004 and 2010. So what we're observing is that in some of the countries that have had pretty good success with tobacco control, smoking is now being reduced somewhat more slowly, or possibly even increasing. And if we stay at the current rate of smoking, or even if the smoking rate continues to decline slowly, smoking will remain the leading cause of preventable premature death for many years to come.
NPH: What are some of the reasons that we’re seeing a plateau in the reduction of tobacco use?
Jill Birnbaum is an advocate for nutrition policy, tobacco control, and health care reform who has worked at the federal, state, and local levels. Her work began in Minnesota, and she now oversees state advocacy for the American Heart Association. Her grassroots experience, combined with her national role, gives her unique insights into public health policy at all levels of government.
This is the first in a two-part interview conducted by Grassroots Change: Connecting for Better Health, a project of the Robert Wood Johnson Foundation Health Group. In part one, Jill shares her perspective on grassroots movements and the threat of preemption in the obesity prevention arena. Preemption can take away the ability of states and local communities to adopt innovative solutions to their own public health problems in a way that responds to each community’s unique needs.
Grassroots Change: What do you see as the impact of preemption in public health, especially in obesity prevention?
Jill Birnbaum: [Preemption] slows or even ends grassroots movements before they begin. It also drains our resources for future advocacy efforts. We leave it to the next generation of public health advocates to undo policy compromises that we make today. We’re still seeing that in a few states with tobacco, and anticipating the fights both at the federal and state levels that we might have to undo someday [in obesity prevention].
Preemption stifles innovation, and it also makes some assumptions that can be wrong. It assumes that we know everything today and that there’s nothing more that we have to learn tomorrow. That’s especially true in nutrition policy where science continues to evolve and policy needs to evolve along with the science.
Preemption also has the effect of dividing the [public health] community when a small group of people, in some cases even a single individual or organization, negotiates away something that other people really want.
GC: Are the concerns about preemption in obesity prevention mostly about nutrition policy? There doesn’t seem to be a major effort to preempt local physical activity policies.