Category Archives: Health promotion and disease prevention
Ending Healthcare Waste, Improving Healthy Lives: Q&A with the L.A. Department of Public Health’s Jonathan Fielding
In a report released last year, the Institute of Medicine found that the United States wastes billions of dollars each year on such unnecessary spending as inefficiently delivered services, excess administrative costs, fraud and missed prevention opportunities. In response, a group of senior public health scholars at the UCLA Fielding School of Public Health, led by Jonathan Fielding, MD, MPH, a professor at the school and the director of the Los Angeles Department of Public Health, published an article in the American Journal of Preventive Medicine on the improvements to population health the country might realize if only the wasted money was devoted instead to the social and environmental determinants of health. If the government could reap 45 percent of the wasted medical care costs, argues Fielding and his co-authors, and invested those resources in sectors such as education, jobs, healthier foods and transportation infrastructure, the health of millions could be markedly improved and society would see additional social benefits.
Jim Marks, Senior Vice President and Director, Health Group at the Robert Wood Johnson Foundation echoed this approach at the recent American Public Health Association (APHA) annual meeting in Boston.
"We know lots about the cost of illness, but very little about the value of health,” he said.
Marks also said that focusing on health as the ultimate goal tends to eclipse some of the social determinants that can have enormous impact on people’s lives. “Most people don’t want good health as their outcome, they want a quality life. They want to travel, take care of grandkids, have a rich family and social life—you can only do that if you’re healthy,” said Marks. “It’s unrelated to good quality medical care. It’s related to education, safe neighborhoods, [and other social factors].”
According to Marks, improving public health isn’t about curing individual diseases or fixing specific injuries. Rather, it’s about everything; the diseases are the end result of the system we live in. And with all the data we have available, we know it’s a system that needs fixing, said Marks.
Marks’ thoughts came at an APHA panel Fielding moderated in a closing day session about the health impact of investment in major social and environmental policies and interventions; information gaps and how they can be filled; and how the discussion of health spending can be re-framed so that U.S. resources can be invested most productively.
NewPublicHealth spoke with Fielding about better uses for the wasted health care spending just before the start of the APHA meeting.
While the U.S. Departments of Health and Human Services, Labor and the Treasury jointly released rules about workplace wellness programs under the Affordable Care Act (ACA) last week, the financial and health improvement value of the programs has not yet been proven, according to several panelists at a briefing late last week co-sponsored by the Alliance for Health Reform and the Robert Wood Johnson Foundation.
How effectively these programs work is especially important now: beginning in 2014, employers will be allowed to charge their workers up to 30 percent more for health insurance premiums if they don't meet certain health goals. Currently, nearly half of large companies offer wellness programs, which can range from smoking cessation programs to penalties for employees who don’t meet employer-defined health targets in such areas such as cholesterol, blood pressure, and Body Mass Index.
To what lengths will hospitals go to make sure their employees are washing their hands? The answer for North Shore University Hospital on Long Island, N.Y., is thousands of miles to India where far-flung employees check their monitors, trained on the hospital floors, to find workers who skip the sinks on their way to the hospital’s intensive care units. According to a recent article in the New York Times, that is just one of many ways hospitals are working to increase hand washing and stop the spread of germs that can kill hospitalized patients. Other methods include free pizza and coffee incentives for frequent hand-washers and embedded chips on hospital employees that emit an alarm when a doctor bypasses a sink outside a patient room.
A March report from the Centers for Disease Control and Prevention (CDC) easily explains the increasing emphasis on hospital hand washing. According to the report, a family of bacteria called Carbapenem-Resistant Enterobacteriaceae, which includes e.coli, have become increasingly resistant to last-resort antibiotics during the past decade, and more hospitalized patients are developing incurable infections. CDC researchers found that during the first half of 2012, 4 percent of hospitals and 18 percent of long-term care facilities treated a patient with this type of infection.
Some hospitals have incentive ideas that employers and families can adopt including buttons that say, “Ask me if I’ve washed my hands?”
>>Read the article.
“We know PSA campaigns can make a big impact; that they can improve people’s lives.”
The Advertising (Ad) Council has just launched a new version of its digital distribution platform, PSA Central, which is geared toward PSA directors and media outlets, but is also valuable for anyone who wants to share the messages including educators and public health practitioners. The site offers easy access to video, print, radio, online, mobile and outdoor media public service advertisements that range from bullying prevention to food safety education.
Public Service Advertisements (PSAs) may actually date back to the civil war when newspapers offered free advertising space to the U.S. government to advertise bonds whose revenues were used to pay for the war effort. These days, PSAs are much more likely to be public safety messages such as a United Kingdom video PSA, downloaded over 2 million times on YouTube, reminding people just why they should buckle up in a car. And more importantly, these efforts are being measured and tracked to show impact on health behavior change and health outcomes, such as the Ad Council’s drunk driving prevention campaign that has encouraged 70 percent of Americans to take action to stop a friend from driving drunk.
NewPublicHealth recently spoke with Peggy Conlon, president and CEO of the Ad Council, about the public health messages PSAs can convey and how new media has expanded their reach.
NewPublicHealth: How have PSAs evolved over the years?
Peggy Conlon: PSAs have evolved quite a bit. The Ad Council is 71 years old and back in the earliest days PSAs were seen in newspapers and heard over the radio. Since then they have been showcased on just about all media platforms. In the 90s we were introduced to the Internet and everything changed forever. The Internet added another new dimension to our ability, in a very tangible and personal way, to engage communities around social issues.
NPH: What are some of the most effective and iconic campaigns in public service advertising?
San Diego County in California has set out to become the nation’s first “heart attack and stroke-free zone.” In a collaborative effort, local hospitals and health care providers are using innovative health information technology and focusing heavily on prevention to achieve this important goal, while the public health community continues to work toward making the county a healthier place to live.
The community was inspired to set this unprecedented public health benchmark when the California Department of Managed Health Care (DMHC) launched the Right Care Initiative in 2008, setting a statewide goal of reaching the 90th percentile nationally for controlling many of the factors which lead to heart attacks and strokes. Prior to 2008, 16 million Californians – about 44 percent of the population – were affected by chronic disease, half of whom suffered from more than one chronic condition.
DMHC has formed key partnerships with California health plans and medical groups, the California Chronic Care Coalition, University of California, American Diabetes Association, American Heart/Stroke Association and community organizations throughout the state. As a result, doctors, patients, and community organizations are saturated with traditional and social media that stress the importance of being proactive.
Communities strive to meet the Right Care Initiative goals through the enhanced practice of patient-centered, evidence-based medicine focusing on the following efforts:
- engaging patients more actively to improve their health with diet and exercise;
- involving pharmacists as part of the patient’s care team; and
- learning proper medication protocol.
Since the Initiative started almost five years ago, eight of the nine largest health plans in California have made overall improvements on heart and diabetes quality measures, 11 groups in California have reached the 90th percentile of clinical control measures, and DMHC has assisted more than one million Californians to resolve their health plan problems.
San Diego is just one community among many waging a battle against chronic disease and the enormous toll it exacts on quality and years of life. Stroke alone takes more than 140,000 lives each year. According to the American Stroke Association, only two-thirds of Americans know at least one of the seven warning signs of stroke. The American Heart Association (AHA) and American Stroke Association (ASA) partnered with the Ad Council to launch their first national multimedia public service campaign to raise awareness in recognizing and responding to the warning signs of stroke by using the acronym: F.A.S.T.
This week in May kicks off the start of Asthma Awareness Month.
According to the National Institutes of Health, asthma impacts 230 million people around the world, and 25 million in the US alone. Studies released today to mark asthma awareness observances include a report that finds that secondhand smoke remains a critical health risk for many children, and that seniors are often under-treated for asthma, putting their health and lives at risk.
There is no way to prevent, or to cure, asthma. Existing treatments focus on preventing or controlling disease symptoms such as wheezing, chest tightness, shortness of breath and coughing. And each year more than half of children and one-third of adults with asthma in the U.S. miss school or work because of the disease. About 17 million people require medical attention because of an asthma episode and more than 3,000 people die of asthma.
There has been progress:
- In March 2012, NIH and other agencies published a report, Asthma Outcomes in Clinical Research, that for the first time pushes for standardization across asthma clinical studies. The report establishes common measures and data-collection methods that will let researchers compare their results more efficiently and could lead to improvements in care.
- In August 2011, NIH held a workshop to identify specific factors that may predict a person’s risk of developing asthma during the first 1,000 days of life, including environmental exposures, genetics and events that occur in pregnancy and early infancy. NIH researchers say understanding the early risk factors for asthma may provide an opportunity to prevent asthma before it begins.
- The Environmental Protection Agency has released a mobile app for iPhones and the Android platform which gives location-specific reports on current air quality and air quality forecasts for both ozone and fine particle pollution to help people with asthma plan their day.
- The American Lung Association has just launched Lungtropolis, an interactive web-based learning game funded by NIH, to help children ages 5-10 control their asthma. Kids become “Asthma Control Agents “as they fight to defeat the “MucusMob.” A recent study found that kids who played the game were better able to manage their asthma than a control group of kids who hadn't tried Lungtropolis.