Category Archives: Health Care Workforce
Oral health received some recent attention with the passage of a law in California that allows dental hygienists to perform some procedures under the supervision of a remote dentist checking in via video screen. The goal is to improve the oral health of kids in that state. Other states are watching the rollout in the hopes of implementing similar programs.
With that same goal in mind, the Ad Council and dozens of partners have just launched a new series of quirky public service announcements (PSAs) aimed at getting kids to brush their teeth twice a day, two minutes each time. The PSAs highlight how teaching kids to brush their teeth is far easier than other lessons parents impart, including cooking, manners and getting dressed.
The PSAs will appear as television, radio, print, outdoor and digital ads, and can also be found online. Campaign partners include the American Dental Association and the American Academy of Pediatrics. Ad Council spokeswoman Ellyn Fisher said the campaign is timed to coincide with Halloween—“as kids get ready to dig into their candy bags.”
A recent Ad Council survey found that three quarters of parents said their kids often forget to brush their teeth. The survey also found that while it’s estimated that children miss more than 51 million school hours each year due to dental-related illnesses, parents rank their children’s dental health as a low priority relative to other health issues, such as nutrition or cold and flu season.
The new PSAs are available in both English and Spanish and direct viewers to the campaign’s website, where parents and children can watch the videos—all 2 minutes in length, or the exact amount of time they should spend brushing their teeth. More than 1.7 million people have visited the website since its launch in 2012. A 2013 Ad Council survey showed that in one year, English-speaking parents reported that their children were significantly more likely to brush twice a day (55 percent in 2013, up from 48 percent in 2012) and significantly more likely to brush for two minutes each time (64 percent in 2013, up from 60 percent in 2012). Spanish-speaking parents also saw significant increases in brushing twice a day, from 63 percent in 2012 to 66 percent in 2013; 77 percent reported kids brushed for the recommended two minutes 2013, up from 69 percent in 2012.
“We’ve had some extraordinary success with this campaign so far,” said Fisher, “But we have a long way to go to make brushing for 2 minutes, twice a day a social norm.”
Recent data out of California has shown that close to 90,000 children go to the emergency room for dental care each year. Although the cost of those visits is tens of millions of dollars, often little more is done than prescribing antibiotics to control infections. While that is important, after such a visit a child’s teeth remain decayed, posing significant risks for adult dental health problems, which can lead to illnesses, deaths, huge out of pocket costs and reduced job opportunities if teeth are noticeably missing.
But California is now also the first state in the nation to permit dentists to take care of underserved kids and adults virtually. A law passed at the end of September vastly expands the Virtual Dental Home, a demonstration project that uses telehealth technology to bring dental services directly to patients in community settings, such as preschools, elementary schools and nursing homes.
Under the program, dental hygienists and assistants perform preventive care and provide patient information electronically for review by an off-site dentist. Under the direction of the dentist, the providers can also place temporary fillings—no drilling required—which can last for years, according to Jenny Kattlove, an oral health policy analyst for The Children’s Partnership, a children’s advocacy group. Patients who need more advanced care are referred to a dentist, and often they’re the dentist who worked with their technician.
A recent Pew study examined how the Virtual Dental Home worked at an elementary school in Sacramento, where the program provided cost-effective services to low-income children who did not have a regular source of dental care. Care under the Virtual Dental Home is paid for under California’s Medicaid program.
According to research by the University of the Pacific Arthur A. Dugoni School of Dentistry, which operates the Virtual Dental Home pilot program, more than 30 percent of Californians are unable to meet their oral health needs through the traditional dental care system. More than half of California’s Medicaid-enrolled children received no dental care in 2012 and even fewer received preventive care services.
NewPublicHealth recently spoke with Kattlove about the new law and its potential as a model for dental care for low income individuals across the country.
NewPublicHealth: What is the most significant advantage of the Virtual Dental Home?
Jenny Kattlove: The Virtual Dental Home is a way to diversify or disperse the workforce so that all the professionals are working at the top of their skills and expertise. By putting dental hygienists in a community setting and having them take care of the majority of the care that the child needs, the dentist can be in the clinic or in their dental office taking care of the more complex needs and supervising the hygienist.
The Bipartisan Policy Center (BPC) in Washington, D.C., and nine CEOs from leading U.S. companies issued a report yesterday that lays out their ideas for improving individual and community health while reducing health care costs. The report, Building Better Health: Innovative Strategies from America's Business Leaders, shares strategies from all the companies and makes several recommendations:
- Implement and track the outcomes of corporate health and wellness programs
- Collaborate on the implementation of community-based programs
- Improve the health care system by supporting the movement toward transparency and payment and delivery models that are based on outcomes rather than on volume
The CEOs are members of the BPC’s CEO Council and collectively employ more than one million people and provide coverage for over 150 million people. Council participants include McKinsey & Company, Aetna, Johnson & Johnson, The Coca-Cola Company, Verizon Communications, Bank of America, Blue Cross Blue Shield Association and Walgreens Co.
In addition to the report, the council released an interactive website with examples of initiatives the companies have taken to improve individual and community health. Some examples also improve the corporations’ bottom lines, such as Verizon’s partnerships with university research centers to test wireless health monitors that individuals or companies can download and buy through the technology company. However, David Erickson, director of the Center for Community Development Investments at the Federal Reserve Bank of San Francisco, points out that no for-profit company can afford the investments required for improving public health without also being able to see an impact on their own bottom line. Examples include increased sales and greater efficiencies in delivering health care.
For example, Walgreens has increased its share of flu shots given from fewer than one million in 2009 to more than seven million in 2013. While that represents improved income for the company, Walgreens—which has stores within three miles of 63 percent of Americans, 75 percent of African-Americans and 78 percent of Latinos—has also worked with state and federal health officials to publicize and increase immunization initiatives. It has also worked with many third-party payers so that patients are often fully or largely covered for the vaccines, with little or no copayment required. Retail clinics such as those at many Walgreen stores also often improve on current health care delivery, such as being open 365 days a year, unlike most doctors’ offices.
The first federal minimum wage was set in 1938 by the U.S. Fair Labor Standards Act. It was 25 cents per hour. Twenty-two subsequent increases now put the wage at $7.25—that equates to about $15,000 per year for a person who works a standard 40-hour workweek.
A new interactive dataset from Public Health Law Research (PHLR) enables researchers, policymakers, media and others to track these and other changes in both the federal and state minimum wages. PHLR is a national program of the Robert Wood Johnson Foundation and Temple University dedicated to building the evidence base for laws that improve public health
“By tracking the changes to the rates and the law’s characteristics over time, we have laid the ground work for researchers and others to study the effects of minimum wage laws on many factors, such as housing, education, and health and well-being,” said Sarah Happy, JD, the PHLR program’s Director of Policy Surveillance, in a release.
Why does income impact health? A good paying job makes it easier for workers to live in healthier neighborhoods, provide quality education for their children, secure child care services and buy more nutritious food—all of which affect health.
Among the facts and trends revealed by the interactive dataset:
- Forty-five states and Washington, D.C., have minimum wage laws. The only states that do not are Alabama, Louisiana, Mississippi, South Carolina and Tennessee.
- In many states, the recent trend has been to increase the minimum wage above the federal rate and adjust it yearly for inflation. Currently, Washington, D.C., has the highest state minimum wage rate at $9.50 an hour.
- Arkansas, Georgia, Minnesota and Wyoming all have lower minimum wages than the federal wage, meaning their residents would receive the federal minimum, in most cases.
- Alaska and Connecticut are the only two states that have had a minimum wage consistently higher than the federal minimum wage rate since 1980.
PHLR’s “Minimum Wage Laws Map joins more than 25 other maps on the PHLR LawAtlas.org website tracking laws across states and over time in more than ten public health issue areas, including chronic disease; injury and violence prevention; and environmental health.
>>Read more on the impact of income and jobs on health.
The Prince George's County, Maryland Place Matters team is addressing food inequity by establishing a Food Policy Council and working with the county's recreation department to design and implement after-school healthy eating and active-living programs.
The project is beginning with the waterfront towns of Bladensburg, Colmar Manor, Cottage City and Edmonston, which have drafted a Community Action Plan with strategies on how to reduce chronic disease in Prince George's County. Partners on the Community Action Plan included Kaiser Permanente, the Consumer Health Foundation, United Way of the National Capital Area and the Meyer Foundation. Place Matters plans to replicate the initiative in other county municipalities.
Prince George's County is the most diverse in Maryland; 80 percent of the population is made up of minority groups. According to the 2010 Census, 8 percent of households live below the poverty line, but some of the towns have higher rates of poverty. Cottage City has a 21 percent poverty level, Bladensburg has a poverty level of 12 percent and Edmonston has a poverty rate of 9 percent.
Key Team Objectives:
- Improve healthy food access and wellness for all through food policy and action.
- Create reliable public transit, bike and pedestrian access to schools and recreational facilities.
- Enhance community capacity to lead and support the Community Action Plan.
“What we decided to do was instead of trying to address the full county is to build a model which the county could replicate,” said team co-leader David Harrington. Harrington said the project, which started seven years ago, has “had some good success in helping to address some policy issues and system change issues.”
Place Matters is building a team around stakeholders called the Community Implementation Team and a countywide team called the Policy Development Team, which consists of the county agencies that influence policy and can provide support for help in doing the community work. They were engaged early in the conversation “so that they would consider administrative and other policies that will help them buttress the community work, and then the community work would help then influence their work, so this becomes a supportive concentric circle of activity that helps systems change, as well as change at the community level,” said Harrington.
Beginning later next year, more than a million workers in New York City will have a brand new, health-promoting benefit: paid sick leave days that guarantee wages on a set number of days when they or a family member they care for is ill.
The new law, passed last June by the New York City Council and overriding an earlier veto by the mayor, begins to go into effect in April 2014. New York now joins San Francisco, Calif., Washington, D.C., Seattle, Wash., Portland, Ore., and the state of Connecticut in adopting at least some sick leave provisions.
Not every employee in New York City will get paid sick leave under the new law. The bill that passed the City Council initially applies only to businesses with 20 or more employees, who will be required to provide five paid sick days a year; that extends to companies with 15 or more employees beginning October 1, 2015. Smaller businesses and manufacturing firms are exempt from the paid leave provisions for now, though these workers will gain five days of unpaid sick leave, so they can take time off without fear of losing their jobs. Advocates hope to extend paid leave to cover those workers before long.
Advocates say paid sick leave is critical for smaller businesses, and especially for low wage earners. A survey by the Community Service Society (CSS) of New York found that half of low-income respondents said they have less than $500 to fall back on in case of an emergency, and according to CSS, without compensation for sick days, people are often forced to choose between caring for themselves or a loved one and heading to work.
A 2012 study in the American Journal of Public Health shows why the measure that is critical to individuals and families is equally crucial to society as a whole. The study found that lack of certain workplace policies, including paid sick leave, led to an additional 5 million cases of adult H1N1 (swine flu) during the 2009 outbreak.
Funding for much of CSS’s advocacy came through a County Health Rankings & Roadmaps grant to focus on four areas in two New York City boroughs, the Bronx and Brooklyn, that have very poor health rankings. The goal was to build support among small businesses, faith-based organizations and low-wage workers for passage of the ordinance through grassroots events, town halls, story collection and media coverage, as well as by encouraging partners and allies to include this policy as part of their policy agendas. The grant runs through November 2014 and CSS will be focusing its efforts, now that legislation has passed, on creating awareness and implementation of the new law.
NewPublicHealth recently spoke with Nancy Rankin, vice president for policy, research and advocacy at CSS about the new law and its impact.
NewPublicHealth: Key components of the legislation you advocated for passed. What’s next in your efforts on paid sick leave?
Nancy Rankin: We are continuing to work on this issue because we recognize that having a law pass is not the end of the story. We now need to do outreach to inform workers about their new rights and employers about their new requirements, because a new law requires compliance and it requires people to be aware of its provisions.
A new article published by the Association of American Medical Colleges highlights the important work of medical-legal partnerships. These efforts improve the health and well-being of low-income and other vulnerable populations by addressing unmet legal needs that can impact health, such as substandard housing and difficulty accessing public assistance programs.
According to the article, the partnerships integrate law students and lawyers into the health care team to provide direct legal assistance to patients, develop and align legal strategies develop and help change policies so that underserved people can get and stay healthy.
There are now more than 100 medical-legal partnerships around the U.S. that serve more than 50,000 patients each year at 275-plus health institutions.
Anne Ryan, JD, founder and director of the Tucson Family Advocacy Program based at the University of Arizona Medical Center-Alvernon Family Medicine Clinic, says her cases have included helping patients who were denied disability benefits, food stamps and Medicaid assistance as well as denied coverage by their insurer.
>>Learn more about the partnerships from the National Center for Medical-Legal Partnership, which is based at the George Washington University School of Public Health and Health Policy and supported in part by the Robert Wood Johnson Foundation.
Citric acid-based drinks have been linked to devastating tooth erosion, especially in Central Appalachia where the drinks are widely consumed by people of all ages. The issue was selected for a five-minute “Critical Opportunities” presentation that garnered more votes than any other issue in the session at the most recent Public Health Law Conference. This year, the issue has moved to a general session on the main day of the Public Health Law Research (PHLR) Annual Meeting, as an emerging issue in public health law. Priscilla Harris, JD, an associate professor with the Appalachian School of Law in Grundy, Va., will present “Finding Legal Interventions to Impact Purchase and Consumption of Sugar-Sweetened Beverages and Citric Acid Drinks: Trying to undo the damage of the Dew.”
According to the American Dental Association, 65 percent of West Virginia's children ages three through seven suffer from tooth decay—and near-constant sipping of Mountain Dew and other citric acid-based drinks plays a role. Harris, together with Dana Singer, JD, a program developer and researcher at the Mid-Ohio Valley Health Department and Mary Beth Shea, a dental hygienist with the health department, spoke at an information session to the Mid-Ohio Valley Board of Health a few weeks ago to present the research they have worked on to show the damaging health effects of the beverages for the people of the region. NewPublicHealth spoke with the three public health professionals just before the PHLR annual meeting began.
NewPublicHealth: What research are you working on to look at the impact of citric acid on tooth health?
Priscilla Norwood Harris: We conducted surveys to determine purchase and consumption patterns for sugar-sweetened beverages and citric acid drinks. We also interviewed and sent surveys to dentists in Central Appalachia about their perceptions of oral health problems in the region. We also went to five clinics that offer medical, dental and vision care to low-income people, and asked patients about these drinks. In addition, have almost 2,000 surveys of students in grades K through 12. We have also reviewed journal articles, many from Europe, that examine the issue of dental erosion. While it’s under the radar here in America, the studies we’ve reviewed are making the connection between dental erosion and the citric acid in drinks.
A lot of the attention in the U.S. has been focused on the sugar in these drinks and their contribution to obesity as well as the sugar with regard to oral health and cavities. Unfortunately, the acids in these drinks and the connection to dental erosion have been almost ignored. “Mountain Dew Mouth,” a term used in Central Appalachia for severely damaged teeth, involves the acids in these drinks, which can take away the tooth’s enamel.
Mary Beth Shea: From a dental health professionals’ perspective, we see a high number of adults who have said they didn’t have a clue that the beverages they’re consuming are causing the damage in their mouth and they haven’t had money for dental care.
Economic constraints cause many Latinos to settle in low-income neighborhoods that have limited access to affordable healthy food options, playgrounds and parks, and pedestrian and bike-friendly streets. Instead, these neighborhoods have fast food restaurants that offer primarily nutrient poor food and, limited resources for recreation which limit physical activity options.
“Latinos will tell you it’s too hard to get fruits and vegetables,” Said Dr. George R. Flores, MD, MPH, Board of Directors, Latino Coalition for a Healthy California at APHA 2012. “Inequality in the social and physical environments in Latino communities contributes to the obesity epidemic by failing to provide opportunities for healthy eating and physical activity.”
Latino populations on average have some of the highest rates of obesity, which can have the severe consequence of type 2 diabetes. The diets of Latino children are higher in fat and lower in fruits and vegetables.
To follow is an excerpt of a blog post by Myra Parker, JD, PhD, is acting instructor at the Center for the Study of Health and Risk Behaviors at the University of Washington and a Robert Wood Johnson Foundation (RWJF) New Connections grantee, about her experiences at the APHA Annual Meeting.
I took my seven-year-old daughter to help me pick up my registration materials at the Moscone Center. I was thrilled to map the American Indian, Alaska Native and Native Hawaiian (AI/AN/NH) sessions and discover they are located in one of the central buildings this year! It’s terrific to be able to attend the general sessions AND those specific to my community, which has not always been the case with AI/AN/NH sessions held in off-site hotels last year in Washington, D.C.
I was excited to see the diversity of attendees across many different professional backgrounds and ethnic/cultural communities.
My first session, since I am working on an evaluation of a tribal home visitation grant funded under the Affordable Care Act through the Administration for Children and Families, was Protecting the Health of Our Children and Families – Examples of Maternal and Child Health in Indigenous Communities. It was standing room only!! The first presenter focused on a national campaign to raise awareness about Sudden Infant Death Syndrome within AI/AN communities, entitled: Lessons from designing a campaign to address infant mortality among urban American Indians and Alaska Natives, by Shira P. Rutman, MPH and Crystal Tetrick, MPH. Being in Seattle and being Native, of course I am aware of the groundbreaking work done at the Urban Indian Health Institute based at the Seattle Indian Heallth Center. It was a treat to hear about one of their efforts and you can learn more here: http://www.uihi.org.
>>Read the full post over on RWJF's Human Capital blog.