Health and Medical News and Resources

General interest items edited by Janice Flahiff

[Report] Is Violent Radicalisation Associated with Poverty, Migration, Poor Self-Reported Health and Common Mental Disorders?

Originally posted on Full Text Reports...:

Is Violent Radicalisation Associated with Poverty, Migration, Poor Self-Reported Health and Common Mental Disorders?
Source: PLoS ONE

Background
Doctors, lawyers and criminal justice agencies need methods to assess vulnerability to violent radicalization. In synergy, public health interventions aim to prevent the emergence of risk behaviours as well as prevent and treat new illness events. This paper describes a new method of assessing vulnerability to violent radicalization, and then investigates the role of previously reported causes, including poor self-reported health, anxiety and depression, adverse life events, poverty, and migration and socio-political factors. The aim is to identify foci for preventive intervention.

Methods
A cross-sectional survey of a representative population sample of men and women aged 18–45, of Muslim heritage and recruited by quota sampling by age, gender, working status, in two English cities. The main outcomes include self-reported health, symptoms of anxiety and depression (common mental disorders), and vulnerability to violent…

View original 122 more words

May 2, 2014 Posted by | Psychiatry, Psychology, Public Health | , , , , , , | Leave a comment

[Reblog] Social inequality: A blind spot for health reporters

Joe Rojas-Burke

Joe Rojas-Burke is AHCJ’s core topic leader on the social determinants of health. To help journalists broaden the frame of health coverage to include factors such as education, income, neighborhood and social network, Rojas-Burke will hunt for resources, highlight excellent work and moderate discussions with journalists and experts. Send questions or suggestions to joe@healthjournalism.org or tweet to @rojasburke.

Dozens of news stories over the past year have reported on the disturbing data showing that Americans are dying younger than people in other wealthy countries and falling behind in many other measures of population health.

But much of the reporting I’ve seen shies away from covering a crucial part of the story: How social inequality may be the most important reason why the health status of Americans is failing to keep up with progress elsewhere.

Being born into poverty, growing up with curtailed opportunities for education and employment, living in a disadvantaged neighborhood – these social determinants of health are like the cards you’re dealt in a game of poker. It’s hard to win if the deck is stacked against you.

Researchers in sociology and public health have developed a fair amount of evidence that social status (typically measured by income or education) may be the most significant shaper of health, disability and lifespan at the population level. In the picture that is emerging, social status acts through a complicated chain of cause-and-effect. Education equips people with knowledge and skills to adopt healthy behaviors. It improves the chances of securing a job with healthy working conditions, higher wages, and being able to afford housing in a neighborhood secure from violence and pollution. The job security and higher income that tend to come with more education provide a buffer from chronic stress – a corrosive force that undermines health among lesser educated, lower income people. Research consistently shows that more education gives people a greater sense of personal control. Positive beliefs about personal control have a profound impact on how people approach life, make decisions about risky behavior, and cope with illness.

Since 1980, virtually all gains in life expectancy in the U.S. have occurred among highly educated groups. In a revealing analysis published in 2008, researchers looked at long-term changes in infant mortality and adult deaths before age 65 and found a widening gap between haves and have-nots over the past 30 years. If all people in the U.S. population experienced the same health gains as the most advantaged, they found that 14 percent of the premature deaths among whites and 30 percent of premature deaths among people of color would have been prevented.

But news outlets seem almost afraid to dig into questions about social inequality. Take, for example, CNN’s coverage of the Institute Of Medicine’s “Shorter Lives, Poorer Health” report in January. The IOM experts examined many measures in which the United States is lagging behind gains in other nations: infant mortality, disabilities, homicides, teen pregnancy, drug-related deaths, obesity, prevalence of AIDS, and life expectancy.

When the CNN coverage got around to explaining likely causes, it tossed out a range of possibilities, most of them blaming individual behavior. Compared with other wealthy nations we eat too much, spend more time driving than walking, fail to use seat belts, abuse more drugs, and use guns to shoot each other more. In the middle of this laundry list, the CNN report makes a glancing reference to the social determinants of health: “Americans benefit much less from social programs that could negate the effects of poverty.”

In July, a headline-garnering paper in the Journal of the American Medical Association explained how the U.S. lapsed from 20th to 27th among wealthy nations in terms of life expectancy at birth, and from 18th to 27th in terms of premature deaths.

December 8, 2013 Posted by | Public Health | , , , , , , | Leave a comment

[Bread for the World Report] The Push Up Decade: CAADP at 10

Screen Shot 2013-11-03 at 11.59.09 AM

Excerpts from the report

The 2007-2008 food price crisis was a wake-up call for the international community, reigniting the discussion about the need to refocus attention on agricultural development. In sub-Saharan Africa, however, member governments of the African Union (AU) had already been grappling with the issue for several years. In 2001, AU members agreed to establish a process to help spur economic growth and political transformation on the continent. The majority of poor people in Africa— approximately 75 percent—live in rural areas and depend on
agriculture for their livelihood.1 Yet between 1995 and 2003, most African countries spent very little public money on agriculture—well below 1 percent of their Gross Domestic Products (GDP).2

Realizing this contradiction, the AU’s New Partnership for Africa’s Development (NEPAD) launched the Comprehensive Africa Agriculture Development Program (CAADP). African heads of state met in Maputo, Mozambique, in 2003, and agreed in the Maputo Declaration both to begin devoting 10 percent of their national budgets to agriculture by 2008, and to set a goal of achieving an average annual growth rate of 6 percent in the agricultural sector by 2015.3 Nonetheless, donor funding for agriculture was very limited until 2009.

CAADP, an ambitious and comprehensive vision for agricultural reform in Africa, is an example of how initiatives with effective local ownership are making strides toward the U.N. Millennium Development Goals (MDGs).

A good example of what is possible is Tanzania, whose economy has been growing steadily over the past 10 years. On average, the economy expanded by 6.9 percent a year. Five sectors were the source of almost 60 percent of Tanzania’s economic growth between 2008 and 2012:

  • CommunicationGDPalmostdoubledinlessthanfour years, growing on average more than 20 percent a year.
  • Banking and financial services, which has expandedby 11 percent a year since 2008.
  • Retail trade, which increased by almost 40 percentbetween 2008 and 2012.
  • Construction,withaverageannualgrowthof9percentover the same period.
  • Manufacturing, which grew by 8.4 percent annuallyduring the past four years.Agriculture also contributed to Tanzania’s economic growth, but this was a given because it makes up a significant share of GDP, about 25 percent. In fact, during the period 2008-2012, agriculture’s growth rate was consistently below the overall economic growth rate.

Nutrition: Investing in nutrition is extremely cost-effective yet critically underfunded. In fact, of the “10 best buys in development” identified by a group of top economists, five are nutrition interventions.15 But although relatively simple, very affordable interventions to treat malnutrition are available, nutrition remains the “forgotten MDG.” Both overseas development assistance for nutrition, and national budget allocations have been very low.

Since 2009, the United States has worked through its global food security initiative, Feed the Future, to emphasize the urgent need to improve nutrition in the “1,000 Days” window between pregnancy and age 2.16 Because malnutrition in this critical age group causes irreversible physical and cognitive damage, countries with a high proportion of malnourished babies and toddlers pay the price in diminished productivity and economic growth. On the other hand, research shows that $1 invested in nutrition generates as much as $138 in better health and increased productivity.17 In sub-Saharan Africa, an estimated 41 percent of all children younger than 5 are malnourished.18 It is the only world region where the number of child deaths is increasing, and the only one expected to see further increases in food insecurity and absolute poverty.19

In spite of the currently tight budget climate, the United States and other development partners should not back off. Rather, they should press forward to support and help strengthen county-led initiatives such as CAADP. As the African Union prepares for the January 2014 African Union summit, which marks the start of “the Year of Agriculture in Africa,” there is real opportunity for this renewed commitment to have an impact on hunger. On July 1, 2013, African heads of state and government of AU Member States, together with representatives of international organizations, civil society organizations, the private sector, cooperatives, farmers, youths, academia, and other partners unanimously adopted a Declaration to End Hunger in Africa by 2025. This High Level Meeting, Renewed Partnership for a Unified Approach to End Hunger in Africa by 2025 within the CAADP Framework, took place at the initiative of the African Union, FAO, and the Lula Institute along with a broad range of non-state actors.22 With this renewed commitment to end hunger, African countries still have a chance to fulfill their Maputo commitments since that deadline coincides with the MDG deadline, two years away in 2015.

November 3, 2013 Posted by | Nutrition, Public Health | , , , , , | Leave a comment

[Conversation Invitation] Military Interventions in the Broader Middle East: Effects on Nation Building and Education

Why am I posting this?
Because this is a public health issue.

From the Brookings Institution Upcoming Event summary

Events in Afghanistan, Iraq, and Libya have raised questions about the extent to which military intervention promotes nation building. As the prospect of military involvement in Syria seemingly draws inexorably closer, the urgency in accurately framing and seeking answers to this question through robust and frank debate is becoming increasingly clear.

Clear also is the crucial role of quality education in nation building, in combating poverty and promoting peace, social justice, and human rights.

Too frequently overlooked however, are the forms and consequences of military interaction with education when intervention is debated, authorized or takes place. In times of conflict education will suffer – and will do so through a myriad of ways: teachers and students may be killed, injured, imprisoned, or threatened; children may be recruited into the militaries of states and non-state armed groups; and schools and universities damaged or destroyed, deliberately or as collateral damage. Educational premises may, also, be used by military forces as barracks, for storage of munitions or even as firing positions and, in so doing, render them vulnerable to attack by opposition forces. Military support to education through construction of education facilities can sometimes be problematic. Individually and combined, all have the potential not only to harm education specifically, but also to undermine a commonly expressed motivation for military intervention: to facilitate nation building. The protection of education is inseparable from such endeavors.

The Brookings Doha Center – in partnership with the Protect Education in Insecurity and Conflict, a programme of the Education Above All Foundation – is pleased to invite you to a conversation with General Sir David Richards, former Chief of Defense Staff of the British Armed Forces and former principal military advisor to the British Prime Minster from 2010–2013. General Sir David Richards played a leading role in the UK’s military operations in Afghanistan and Libya and throughout his distinguished career at the very top of the UK armed forces and government.

To reserve a place for yourself and/or a guest, please RSVP with the names of those who wish to attend to dohacenter@brookings.edu.

 

For those wishing to view/listen to this event, here’s the email response I rec’d (within 24 hours!) from the Brookings Doha Center.

Please note that the full audio of the event will be made available within 48 hours of the event, the full transcript within 72 hours, and the full video of the event will be up approximately one week after the event. We will also have an event summary that will be posted in a week. All materials can be found on the event’s website page.

EVENT AGENDA

October 29, 2013 Posted by | Public Health | , , , , , , | Leave a comment

Nurturing May Protect Kids from Brain Changes Linked to Poverty

Seems the key is not poverty per se, but parental stress. Not that poverty is OK!
Thinking back to my Peace Corps days in Liberia, West Africa.  Almost all the villagers lived in poverty (according to American standards). Yet I observed very little depression and much resilience in dealing with stress.  I attribute it to the support network  (largely nurturing)  of family, kinship and tribal ties. While there was some behavior that seemed petty to me, there was a strong sense of community where people’s basic needs were largely met.  Don’t have any studies to back me up on this, just personal observation.

An MRI scan highlights the hippocampus (pink) in a child’s brain. Washington University researchers found that poor children with parents who were not very nurturing were likely to have a smaller hippocampus than those raised by more attentive parents. (Credit: Washington University Early Emotional Development Program)

From the 28 October 2013 article at ScienceDaily

Growing up in poverty can have long-lasting, negative consequences for a child. But for poor children raised by parents who lack nurturing skills, the effects may be particularly worrisome, according to a new study at Washington University School of Medicine in St. Louis.

Among children living in poverty, the researchers identified changes in the brain that can lead to lifelong problems like depression, learning difficulties and limitations in the ability to cope with stress. The study showed that the extent of those changes was influenced strongly by whether parents were nurturing.

The good news, according to the researchers, is that a nurturing home life may offset some of the negative changes in brain anatomy among poor children. And the findings suggest that teaching nurturing skills to parents — particularly those living in poverty — may provide a lifetime benefit for their children.

The study is published online Oct. 28 and will appear in the November issue of JAMA Pediatrics.

Using magnetic resonance imaging (MRI), the researchers found that poor children with parents who were not very nurturing were likely to have less gray and white matter in the brain. Gray matter is closely linked to intelligence, while white matter often is linked to the brain’s ability to transmit signals between various cells and structures.

The MRI scans also revealed that two key brain structures were smaller in children who were living in poverty: the amygdala, a key structure in emotional health, and the hippocampus, an area of the brain that is critical to learning and memory.

“We’ve known for many years from behavioral studies that exposure to poverty is one of the most powerful predictors of poor developmental outcomes for children,” said principal investigator Joan L. Luby, MD, a Washington University child psychiatrist at St. Louis Children’s Hospital. “A growing number of neuroscience and brain-imaging studies recently have shown that poverty also has a negative effect on brain development.

“What’s new is that our research shows the effects of poverty on the developing brain, particularly in the hippocampus, are strongly influenced by parenting and life stresses that the children experience.”

..

Luby’s team found that parents living in poverty appeared more stressed and less able to nurture their children during that exercise. In cases where poor parents were rated as good nurturers, the children were less likely to exhibit the same anatomical changes in the brain as poor children with less nurturing parents.

October 29, 2013 Posted by | Medical and Health Research News, Psychiatry | , , | Leave a comment

Study: The Health Care Experiences and Expectations of Low-Income Californians – NPQ – Nonprofit Quarterly

Study: The Health Care Experiences and Expectations of Low-Income Californians – NPQ – Nonprofit Quarterly.

From the 24 October 2013 article BY ANNE EIGEMAN at NonProfit Quarterly

As the most recent update in an ongoing research project that began in 2011, this week, the Blue Shield Foundation of California released a report on the healthcare experiences and expectations of low-income Californians. Two central goals guided the project: 1) to help healthcare facilities—particularly California’s community health centers—successfully navigate the changes brought about by the ACA, and 2) to help community health centers identify the most effective ways of encouraging patients and providers alike to embrace primary care redesign and move closer toward the goal of patient empowerment. As key findings, the study points to the “wide range of positive outcomes” that come from successful communication between patients and providers and the “broad gap” that currently exists between the information patients possess and the information they want.

The study found that only 28 percent of low-income Californians feel they have easily comprehensible health information for decisions about care. In addition, almost 40 percent rely on media sources to address concerns—“a potential problem” according to the study, because “trust in information is much higher when it comes from a medical professional than from other sources.”

A central theme is the value to patients that comes from a strong patient-provider relationship, which can lead to improvement in a patient’s overall sense of being well informed about his or her health, the level of satisfaction with the quality of care at a specific facility, and trust of the information provided by doctors. In light of upcoming structural changes to healthcare systems from the ACA, the study’s note that “alternative communication approaches also show great promise in helping to improve patients’ relationships with their providers.” is significant. Examples of these new approaches include team based care, decision aids, health coaches, and online or smartphone-accessible health sites, all of which were found to “enhance, rather than diminish, the critical connection between patients and their providers.”

The study devotes considerable attention to the effect of the digital divide on healthcare for specific groups of low-income Californians. “While four in ten low-income Californians overall lack Internet access, that soars to 67 percent of Spanish-speakers, 63 percent of non-citizens, 62 percent of Latinas and 59 percent of those in only fair or poor health,” the study reports. In addition, the fact that 59 percent of low-income residents over 50 lack Internet access and 41 percent lack a text-capable phone makes this “vulnerable population particularly hard to reach with technology-based information and communications.”

 

 

Read the entire article here

 

October 26, 2013 Posted by | health care | , , , , , , | Leave a comment

Incentivizing Healthy Behaviors in Low-Income Patient Populations

Incentivizing Healthy Behaviors in Low-Income Patient Populations.

From the 24 October 2013 blog item at Leavitt Partners

What works and 8 lessons other health care organizations learn

Data suggests costs can be better contained if all people are practicing healthy life behaviors.[i] State and Federal leaders, charged with holding down costs without sacrificing access to or quality of care, agree with this principal—and as a health insurance payer with one of the longest histories of serving low-income individuals, state Medicaid programs have explored many approaches to incentivizing positive health-related behaviors in its patient populations.

On January 1 2014, about half of the states will expand their Medicaid programs to newly eligible individuals with income below 133% FPL. Insurance subsidies will also be provided to individuals with income between 100% and 400% FPL, increasing access to commercial insurance to those with low- to moderate-incomes. As health care organizations begin managing the health and wellbeing of these newly insured groups, many will be looking for ways to control long-term costs by incentivizing healthy changes in behaviors.

In order to better understand which approaches are the most effective, Leavitt Partners analyzed case studies and program outcomes to answer the following questions:

What are the most effective approaches to motivate low-income adults to make positive changes in their behavior (for themselves and children)?

What are the most effective approaches to motivate low-i

- See more at: http://leavittpartners.com/2013/10/incentivizing-healthy-behaviors-low-income-patient-populations/#sthash.DyBTYRJG.dpuf

 

 

October 26, 2013 Posted by | health care | , , , , , | Leave a comment

[Repost] Is ‘Patient Capitalism’ The Answer To Poverty?

From the 18 October 2013 NPR story

Part 5 of the TED Radio Hour episode Haves And Have-Nots.

About Jacqueline Novogratz’s TEDTalk

Jacqueline Novogratz, CEO of Acumen Fund, shares stories of how “patient capitalism” can bring sustainable jobs, goods, services and dignity to the world’s poor.

About Jacqueline Novogratz

Jacqueline Novogratz is redefining the way problems of poverty can be solved around the world.

She is a leading proponent of financing enterprises that can bring affordable clean water, housing and health care to poor people so that they no longer depend on traditional charity and aid.

The Acumen Fund, which she founded in 2001, has an ambitious plan: to create a blueprint for alleviating poverty using market-oriented approaches.

Rather than handing out grants, Acumen invests in fledgling companies and organizations that bring products and services to the world’s poor.

Novogratz places a great deal of importance on identifying solutions from within communities rather than imposing them from the outside.

In her bookThe Blue Sweater, she tells stories which emphasize sustainable bottom-up solutions over traditional top-down aid.

 

October 22, 2013 Posted by | Public Health | , , , , , , , , | Leave a comment

[Repost] Household chaos may be hazardous to a child’s health

Remembering that the television was only on for about an hour weekday evening (after homework was done!), and Saturday mornings for cartoons. Also Sunday evenings.  Still  generally stick to this after all these years. Even without homework.
No angel, could be on the Internet less!!

From the 9 October 2013 EurekAlert article

Study links crowding, noise, lack of routine to worse outcomes

COLUMBUS, Ohio – Kindergarten-age children have poorer health if their home life is marked by disorder, noise and a lack of routine and they have a mother who has a chaotic work life, new research suggests.

The results show the importance of order and routine in helping preschoolers stay healthy and develop to the best of their potential, said Claire Kamp Dush, lead author of the study and assistant professor of human sciences at The Ohio State University.

“Children need to have order in their lives,” Kamp Dush said. “When their life is chaotic and not predictable, it can lead to poorer health.”

Kamp Dush said that the study involved mostly low-income families, and the results showed mothers who were more impoverished reported significantly higher levels of chaos.

“I don’t think that the findings would be different in a middle-class sample – chaos is bad for children from any background,” she said.

“But most middle-class families can avoid the same level of chaos that we saw in the most impoverished families. We’re not talking about the chaos of your kids being overinvolved in activities and the parents having to run them from one place to another. This harmful chaos is much more fundamental.”

Kamp Dush conducted the study with Kammi Schmeer, an assistant professor of sociology at Ohio State, and Miles Taylor, assistant professor of sociology at Florida State University. Their results appear online in the journal Social Science & Medicine.

Data came from the Fragile Families and Child Well-being Study, and included 3,288 mothers who were interviewed at their homes by a trained interviewer when their child was 3 and again when he or she was 5 years old. Most of the parents were unmarried and low-income.

The researchers used several measures of household chaos: crowding (more than one person per room), TV background noise (TV was on more than 5 hours a day), lack of regular bedtime for the child, and a home rated as noisy, unclean and cluttered by the interviewer.

The study also included a measure of the mother’s work chaos, which included stress caused by the work schedule, difficulty dealing with child care problems during working hours, lack of flexibility to handle family needs and a constantly changing work schedule.

The children’s health was rated by their mother at ages 3 and 5 as excellent, very good, good, fair or poor.

Results showed that higher levels of household chaos and mothers’ work chaos when their children were age 3 were linked to lower ratings of child health at age 5, even after taking into account initial child health and other factors that may have had an impact.

In addition, the researchers were also able to use a statistical technique to determine if the causality may have been reversed: in other words, if poor child health might lead to more household chaos. “It would be easy to see how having a sick child may make your household more chaotic, but that’s not what we found. We did clearly see, however, that a chaotic household at age 3 was linked to poorer health at age 5,” Kamp Dush said.

The most common source of household chaos was television noise, with more than 60 percent of mothers reporting the television was on more than five hours a day. Between 15 and 20 percent of households reported crowding, noise, and unclean and cluttered rooms.

About a third of the mothers had inflexible work schedules and 11 percent worked multiple jobs.

How does household chaos lead to sicker children? Kamp Dush noted that chaos has been linked to stress, and stress has been shown to lead to poorer health. Women with inflexible work schedules may not be able to take their children to the doctor when needed. And a dirty house may increase exposure to toxins and germs.

Kamp Dush emphasized that the findings shouldn’t be used to suggest that the parents are at fault for the chaos in their households.

“We’re not blaming the victims here – there is a larger system involved,” she said.

“These mothers can’t help it that their jobs don’t give them the flexibility to deal with sick kids. They can’t afford a larger house or apartment to deal with overcrowding. With their work schedules, they often don’t have time to keep a clean home and they don’t have the money to spend on organizational systems or cleaning services used by middle-class families to keep their homes in order.”

What these mothers and fathers need most is jobs that allow them to maintain regular schedules and have the flexibility to deal with sick children, Kamp Dush said. Having to maintain two jobs is also detrimental to keeping households free of chaos.

 

###

 

Kamp Dush received support for this study from the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

 

 

 

 

October 14, 2013 Posted by | Uncategorized | , , , , | Leave a comment

[Reblog] Food prices and public health

From the 10 September post at Groping Towards Bethelem - Economics and Culture in Bite-Size Pieces

The University of Otago announced the results of some research in which I’ve been involved.  The relevant blog post is here. What I really like about the post is the moderate tone:

In the first paper from the SPEND Project, we found that across 20-odd food groups, low-income people and Māori tended to change their consumption of foods more in response to price changes, using New Zealand data.  This is entirely consistent with economic theory – and data about price impacts for other consumer goods such as tobacco.

This suggests – but does not prove for reasons we outline below – that taxes on ‘unhealthy’ foods like those high in saturated fat, salt, and sugar; and subsidies on ‘good’ foods like fruit and vegetables should not only improve diets across the board, but more so among socially disadvantaged groups with worse diets and health to start with.

But the proof is in the pudding, which in this case is the health and economic modelling to see what effect taxes and subsidies will actually have on disease rates.  And due to data limitations our modelling is still only half-baked, no matter which research group’s findings you look at.

The post goes on from there and explains more about the different bits of research.

Of course, there are all the problems with implementing such tax/subsidy programmes, and the philosophical issues with ‘nudges’ and individual welfare. But importantly, we now have better estimates of prices elasticities in order to make better calculations about gains and losses.

 

October 11, 2013 Posted by | Consumer Health, Nutrition | , , , | Leave a comment

[Reblog] The ACA and Medicaid: Where You Live Matters

Screen Shot 2013-09-05 at 4.52.34 AM

From the 4 September 2013 post at HealthCetera – CHMP’s Blog

What a difference a state makes. Ask my friend, a laborer whom I’ll call John.

Some months ago, John realized that a cyst-like lump on his trunk was growing and becoming bothersome. He has no health insurance so he paid out-of-pocket for a physician to examine it. Tests were negative and he was told it was “probably nothing.” The lump continued to grow and became uncomfortable, but John couldn’t afford to have it removed. When he shared this information with me, I told him that he probably qualified for Medicaid in New York State. He looked into it and discovered that he did. He signed up for it and went to a surgeon to remove the lump, now the size of a baseball and causing him increasing discomfort. After the test results came back, the surgeon told John that it was a malignant tumor. Fortunately, there is no evidence of metastasis, and John can proceed with the necessary treatments under Medicaid.

This story would likely have a very different outcome if John lived in Florida, Maine, Idaho, Kentucky or another of the 26 states that have not signed up to expand their Medicaid programs, as called for under the Affordable Care Act (ACA). As of September 2013, only 24 states plus the District of Columbia have committed to expanding their Medicaid programs.

How can this be? The 2012 Supreme Court’s review of the constitutionality of the ACA supported the federal government’s right to require that individuals purchase health insurance (the “individual mandate”), but it struck down a requirement that states expand their Medicaid programs to all adults under the age of 65 years who earn 138% or less of the federal poverty level (FPL) (in 2013, the poverty level is $15,626 for an individual and $32,499 for a family of four). States that failed to do so were to have forfeited their existing Medicaid programs that covered mostly women and children under the FPL. (Children ages 6 to 18 who fall at or under the FPL were covered by the existing Medicaid program; under the ACA, they are now covered up to 138% of the FPL under a separate section of the law that is untouched by the Supreme Court ruling.)

After the Supreme Court ruling, expansion of Medicaid became an option for states rather than a requirement. Why would states not want to do this? One reason is that it would cost the states some additional monies, though not very much. From 2014 to 2016, the federal government would pay 100% of the cost of the expansion. After 2016, it would pay 90% of the costs and the states would pay 10%. Seems like a deal for the states, but politics enters into the equation. The majority of the states opting out of the expansion are “red” states where the governor and/or legislature oppose “Obamacare”. Many of these states are at the bottom of the rankings of key health indicators.

I thought John would have qualified for the new state health insurance exchange that New York is implementing. The exchange will subsidize the cost of insurance for people in all states from 133% of the FPL (139% for people living in states that have adopted the Medicaid expansion) to 400% FPL. But John’s income is under the 139% in New York State, so he qualified for Medicaid.

John may be living a much longer life because New York opted to expand its Medicaid program. What about the unfortunate folks who live in states that didn’t opt in?

Diana J. Mason, PhD, RN, FAAN, Rudin Professor of Nursing

September 5, 2013 Posted by | health care | , , , , | 2 Comments

Poor Concentration: Poverty Reduces Brainpower Needed for Navigating Other Areas of Life

Something I’ve suspected all along…now it seems to be quantified..

From the 29 August 2013 article at Science Daily

Poverty and all its related concerns require so much mental energy that the poor have less remaining brainpower to devote to other areas of life, according to research based at Princeton University. As a result, people of limited means are more likely to make mistakes and bad decisions that may be amplified by — and perpetuate — their financial woes.

Published in the journal Science, the study presents a unique perspective regarding the causes of persistent poverty. The researchers suggest that being poor may keep a person from concentrating on the very avenues that would lead them out of poverty. A person’s cognitive function is diminished by the constant and all-consuming effort of coping with the immediate effects of having little money, such as scrounging to pay bills and cut costs. Thusly, a person is left with fewer “mental resources” to focus on complicated, indirectly related matters such as education, job training and even managing their time.

In a series of experiments, the researchers found that pressing financial concerns had an immediate impact on the ability of low-income individuals to perform on common cognitive and logic tests. On average, a person preoccupied with money problems exhibited a drop in cognitive function similar to a 13-point dip in IQ, or the loss of an entire night’s sleep.

“Stress itself doesn’t predict that people can’t perform well — they may do better up to a point,” Shafir said. “A person in poverty might be at the high part of the performance curve when it comes to a specific task and, in fact, we show that they do well on the problem at hand. But they don’t have leftover bandwidth to devote to other tasks. The poor are often highly effective at focusing on and dealing with pressing problems. It’s the other tasks where they perform poorly.”

The fallout of neglecting other areas of life may loom larger for a person just scraping by, Shafir said. Late fees tacked on to a forgotten rent payment, a job lost because of poor time-management — these make a tight money situation worse. And as people get poorer, they tend to make difficult and often costly decisions that further perpetuate their hardship, Shafir said. He and Mullainathan were co-authors on a 2012 Science paper that reported a higher likelihood of poor people to engage in behaviors that reinforce the conditions of poverty, such as excessive borrowing.

“They can make the same mistakes, but the outcomes of errors are more dear,” Shafir said. “So, if you live in poverty, you’re more error prone and errors cost you more dearly — it’s hard to find a way out.”

The researchers suggest that services for the poor should accommodate the dominance that poverty has on a person’s time and thinking. Such steps would include simpler aid forms and more guidance in receiving assistance, or training and educational programs structured to be more forgiving of unexpected absences, so that a person who has stumbled can more easily try again.

“You want to design a context that is more scarcity proof,” said Shafir, noting that better-off people have access to regular support in their daily lives, be it a computer reminder, a personal assistant, a housecleaner or a babysitter.

“There’s very little you can do with time to get more money, but a lot you can do with money to get more time,” Shafir said. “The poor, who our research suggests are bound to make more mistakes and pay more dearly for errors, inhabit contexts often not designed to help.”

 

Read the entire article here

 

September 3, 2013 Posted by | Medical and Health Research News, Psychiatry, Psychology | , , , , , , , , | Leave a comment

[Repost] Childhood economic status affects substance use among young adults

A NIDA educational pamphlet.

A NIDA educational pamphlet. (Photo credit: Wikipedia)

 

From the 29 July 2013 EurekAlert

 

DURHAM, N.C. – Children who grow up in poverty are more likely than wealthier children to smoke cigarettes, but they are less likely to binge drink and are no more prone to use marijuana, according to researchers at Duke Medicine.

The researchers also found that economic strains in early life – including family worries about paying bills or needing to sell possessions for cash – independently erode a child’s self-control, regardless of strong parenting in adolescence. Lack of self-control often leads to substance use.

The findings, appearing July 30, 2013, in the Journal of Pediatric Psychology, debunk common assumptions about who abuses substances, and provide a basis for better approaches to prevent young people from falling into drug and alcohol addiction.

“Poverty during childhood not only appears to affect child development, but can have lasting effects on the types of health choices made during adolescence and early adulthood, especially as it relates to cigarette smoking,” said senior author Bernard Fuemmeler, Ph.D., MPH, MS, associate professor in Community and Family Medicine at Duke University School of Medicine. “Economic strains may shape an individual’s capacity for self-control by diminishing opportunities for self-regulation, or affecting important brain structures.”

Fuemmeler and colleagues at Duke set out to examine the direct effect of childhood economic strains on smoking, binge drinking, and marijuana use in young adults. They also sought to determine how financial difficulties impact self-control, and how positive parenting might mitigate the tendency to use drugs and alcohol.

The group analyzed data from 1,285 children and caregivers included in a representative sample of U.S. families studied from 1986-2009. Economic status was measured by annual family income, plus a survey with questions about economic problems such as difficulty paying bills or postponing medical care. Additional information was gathered to gauge childhood self-control and parental interactions.

Among the study participants who were transitioning to adulthood, young people who lived in poverty as children were far more likely to become regular cigarette smokers than children who grew up in wealthier households. The impoverished children also scored low on self-control measures.

“Poor self-control may be a product of limited learning resources and opportunities for developing appropriate behaviors,” Fuemmeler said.

Binge drinking, however, was much more common among the wealthier young people. And surprisingly, those who had good self-control as children were more likely to engage in heavy episodic drinking as young adults.

Neither wealth nor poverty appeared to influence marijuana use, although positive parenting did reduce the use of this drug. Parents who were nurturing and accepting, in fact, diminished the likelihood of young people using any of the substances.

The researchers also found no correlation between economic hardship and poor parenting – a contradiction to some other studies.

“We suspected we’d find a relationship between parenting and economic problems – the idea that economic strains may cause parents to have less capacity to deal with their children, but that relationship wasn’t there,” Fuemmeler said. “That means it’s not necessarily poverty that affects the parenting strategy, but poverty that affects the children’s self-control.”

Fuemmeler said the findings are important given the increase in U.S. children living in poverty. The U.S. Census Bureau reported 22 percent of children lived in poverty in 2010, compared to 18 percent in 2000.

“Continued work is needed to better understand how economic strains may influence the development of self-control, as well as to identify other potential mediators between economic strains and substance use outcomes,” Fuemmeler said.

 

###

In addition to Fuemmeler, study authors include Chien-Ti Lee, Joseph McClernon, Scott H. Kollins and Kevin Prybol.

The National Institutes of Health (RO1 DA030487), the National Cancer Institute (K07CA124905) and the National Institute on Drug Abuse (K24DA023464) funded the study.

 

 

July 30, 2013 Posted by | Consumer Health | , , , , , | Leave a comment

U.S. Health in International Perspective: Shorter Lives, Poorer Health

From the summary at the Institute on Medicine

The United States is among the wealthiest nations in the world, but it is far from the healthiest. For many years, Americans have been dying at younger ages than people in almost all other high-income countries. This health disadvantage prevails even though the U.S. spends far more per person on health care than any other nation. To gain a better understanding of this problem, the NIH asked the National Research Council and the IOM to investigate potential reasons for the U.S. health disadvantage and to assess its larger implications. 

 

No single factor can fully explain the U.S. health disadvantage. It likely has multiple causes and involves some combination of inadequate health care, unhealthy behaviors, adverse economic and social conditions, and environmental factors, as well as public policies and social values that shape those conditions. Without action to reverse current trends, the health of Americans will probably continue to fall behind that of people in other high-income countries. The tragedy is not that the U.S. is losing a contest with other countries, but that Americans are dying and suffering from illness and injury at rates that are demonstrably unnecessary.

“The poorer outcomes in the United States are reflected in measures as varied as infant mortality, the rate of teen pregnancy, traffic fatalities, and heart disease. Even those with health insurance, high incomes, college educations, and healthy lifestyles appear to be sicker than their counterparts in other wealthy countries. The U.S. Council on Foreign Relations, a nonpartisan think tank, described the report as “a catalog of horrors.”

Findings that prompted this reaction include the fact that the rate of premature births in the United States is the highest among the comparison countries and more closely resembles those of sub-Saharan Africa. Premature birth is the most frequent cause of infant death in the United States, and the cost to the health care system is estimated to top $26 billion a year.

As distressing as all this is, much less attention has been given to the obvious question: Why is the United States so unwell? The answer, it turns out, is simple and yet deceptively complex: It’s almost everything.

Our health depends on much more than just medical care. Behaviors such as diet, physical activity, and even how fast we drive all have profound effects. So do the environments that expose us to health risks or discourage healthy living, as well as social determinants of health, such as education, income, and poverty.

The United States fares poorly in almost all of these. In addition to many millions of people lacking health insurance, financial barriers to care, and a lack of primary care providers compared with other rich countries, people in the United States consume more calories, are more sedentary, abuse more drugs, and shoot one another more often. The United States also lags behind on many measures of education, has higher child poverty and income inequality, and lower social mobility than most other advanced democracies.

The breadth of these causal factors, and the scope of the U.S. health disadvantage they produce, raises some fundamental questions about U.S. society. As the NRC/IOM report noted, solutions exist for many of these health problems, but there is “limited political support among both the public and policymakers to enact the policies and commit the necessary resources.”

One major impediment is that the United States, which emphasizes self-reliance, individualism, and free markets, is resistant to anything that even appears to hint at socialism. …”

July 22, 2013 Posted by | Public Health | , , , , , , , | Leave a comment

Life Expectancy Shortest In Southern ‘Poverty Belt’ (INFOGRAPHIC)

From the 19 July post at HuffPost

Living in a high-poverty area often means a lifetime of struggle with underperforming public schools, limited job opportunities, higher crime rates, and poor nutrition, health care and housing — all of which can add up to a shorter, sicker retirement.

Americans who live in the South can expect to live fewer healthy years past 65 than those who live in other parts of the country, according to a new report from the CDC. Health disparities among seniors in their final years align closely with profound geographical differences in poverty. The region where more than 30 percent of people live in high-poverty areas — dubbed the “poverty belt” by The Atlantic’s Richard Florida, falls right over the states with the lowest healthy life expectancies. As inequality in the U.S. climbs steadily, this public health crisis may only expand.

From the US Centers for Disease Control and Prevention site

Screen Shot 2013-07-22 at 1.34.43 PM

July 22, 2013 Posted by | Health Statistics | , , , | Leave a comment

The U.S. Health Disadvantage – Part 2: Possible Causes and Solutions

Originally posted on :

by Kirsten Hartil 

“Everyone has the right to a standard of living adequate for the health and well-being of himself and his family, including food, clothing, housing and medical care.”

Image

Reference: Mokdad AH, Marks JS, Stroup DF, Gerberding JL (March 2004). “Actual causes of death in the United States, 2000″. JAMA 291 (10): 1238–45. DOI:10.1001/jama.291.10.1238. PMID 15010446.

At least according to Article 25 of The United Nations Universal Declaration of Human Rights, so why does the United States, one of the wealthiest countries in the world, have some of the poorest health outcomes compared to other high income countries?

My previous blog, adapted from the Institute of Medicine (IOM) report U.S. Health in International Perspective: Shorter Lives, Poorer Health, described how the U.S. compares in causes of mortality and years of life lost with other high income and OECD countries. Here, as outlined in the report, I…

View original 1,347 more words

July 14, 2013 Posted by | Consumer Health, Consumer Safety, Health Statistics, Public Health, statistics | , , , , , , , , , , , , | Leave a comment

Supplemental Nutrition Assistance Program [“Food Stamps”]: Examining the Evidence to Define Benefit Adequacy

English: Logo of the .

English: Logo of the . (Photo credit: Wikipedia)

 

The USDA asked the IOM and the National Research Council to consider whether it is feasible to objectively define the adequacy of SNAP allotments that meet the program goals and, if so, to outline the data and analyses needed to support and evidence-based assessment of SNAP adequacy.

 

Conclusions include:

 

  • The adequacy of SNAP allotments can be defined
  • The adequacy of SNAP allotments is influenced by individual, household,and environmental factors
    •  Unprocessed foods are the cheapest, yet many do not have the time to “cook from scratch”
    • Food prices vary among regions. While SNAP allotments are adjusted, not enough data to show this is working.
    • Nutrition education seems to be working, but evidence is insufficient.
  • The adequacy of SNAP allotments is influenced by program characteristics. The maximum monthly benefit,benefit reduction rate, and net income calculation have important impacts on SNAP allotments.[See this fact sheet for explanations of these terms]

 

And the Recommendations

 

“The committee offers its recommendations in three areas

  • First, it recommends elements that should be included by USDA-FNS in an evidence-based, objective definition and measurement of the adequacy of SNAP allotments.
  • Second, it recommends monitoring and assessment of the adequacy of SNAP allotments that is needed for evaluation and adjustment over time.
  • Third, it recommends additional research and data needed to support an evidence-based definition of allotment adequacy.
  • In addition, the committee describes other research considerations that would further understanding of allotment adequacy.

 

 

 

[This image is basically unreadable if smaller!, it was copied from the summary of the report]
 

Screen Shot 2013-01-24 at 5.03.07 AM

 

From the summary of the report at FullTextReports.com

 

For many Americans who live at or below the poverty threshold, access to healthy foods at a reasonable price is a challenge that often places a strain on already limited resources and may compel them to make food choices that are contrary to current nutritional guidance.

To help alleviate this problem, the U.S. Department of Agriculture (USDA) administers a number of nutrition assistance programs designed to improve access to healthy foods for low-income individuals and households. The largest of these programs is the Supplemental Nutrition Assistance Program (SNAP), formerly called the Food Stamp Program, which today serves more than 46 million Americans with a program cost in excess of $75 billion annually. The goals of SNAP include raising the level of nutrition among low-income households and maintaining adequate levels of nutrition by increasing the food purchasing power of low-income families.

In response to questions about whether there are different ways to define the adequacy of SNAP allotments consistent with the program goals of improving food security and access to a healthy diet, USDA’s Food and Nutrition Service (FNS) asked the Institute of Medicine (IOM) to conduct a study to examine the feasibility of defining the adequacy of SNAP allotments, specifically:

  • the feasibility of establishing an objective, evidence-based, science-driven definition of the adequacy of SNAP allotments consistent with the program goals of improving food security and access to a healthy diet,
  • as well as other relevant dimensions of adequacy;
  • and data and analyses needed to support an evidence-based assessment of the adequacy of SNAP allotments.

 

 

 

January 24, 2013 Posted by | Nutrition | , , , , | Leave a comment

What Does the President’s Oath of Office Have to do with Public Health?

President Obama will take his oath of office today on two bibles, one being that of the late Dr. Martin Luther King, Jr.
Professor Cornell West of Union Theological Seminary in this clip is bothered that the President does not truly honor King’s commitments to justice. These crimes against humanity include Jim Crow, carpet bombing in Vietnam which killed civilians (including children), and poverty.

Dr. King’s reference crimes against humanity are still with us today

–Jim Crow lives on in many areas, including the high percentage of blacks in prisons in numbers disproportionate to the population.

Note the high percentage of incarcerated black males who are from 20 to 49 years old.
While in prison, they are unable to provide for their families and be good role models for their children. Their communities are poorer for not having them in many ways.
“The dismal fact of mass incarceration inflicts widespread and enduring damage by undermining the fair allocation of public resources and political representation, by depriving the children of inmates of their parents’ economic and emotional participation, and, ultimately, by concealing African American disadvantage from public view. (From the book review for Invisible Men)

Screen Shot 2013-01-21 at 5.40.12 AM
The carpet bombing mentality lives on in drone warfare. Some believe that the number of drone civilian deaths have decreased during President Obama’s administration. The use of drone warfare still inflicts psychological terror among civilians who hear them constantly on their surveillance missions.
“The moral damage to the victims must be considered because violence begets more violence and leaves psychic wounds nearly impossible to heal”. And “the costs of drone warfare as an economic choice over alleviating suffering caused by domestic economic challenges have to be weighed. The financial cost of protecting American combatants while killing enemy combatants (and civilians), though steep, are measureable. Measuring the effect of losing those funds for the welfare of the American people suffering most from our economic woes is harder. [From Texas Faith: The morality of drone warfare]
--Poverty rates have not declined appreciably since 1960. There is wide disagreement on the causes and even the definition of poverty. However the gap between the rich and poor is ever widening.
The intentional and unintentional treatment of folks based on their skin color, income, socioeconomic power all exacerbate public health issues. If people are incarcerated unjustly their community suffers. The unjustly incarcerated are not able to contribute to their community in economic and social terms. They are not there to support their families. Drone warfare scars people not only physically but psychologically. And money spent on warfare is not spent on programs and infrastructure for the betterment of all. Poverty disables people in so many ways.  People in poverty are less able to share their God given talents with us all.
 

January 21, 2013 Posted by | Public Health | , , , , , , | Leave a comment

Poorest Miss Out On Benefits, Experience More Material Hardship, Since 1996 Welfare Reform, USA

 

From the 17 September 2011 article at Medical News Today

Although the federal government’s 1996 reform of welfare brought some improvements for the nation’s poor, it also may have made extremely poor Americans worse off, new research shows.

The reforms radically changed cash assistance – what most Americans think of as ‘welfare’ – by imposing lifetime limits on the receipt of aid and requiring recipients to work. About the same time, major social policy reforms during the 1990s raised the benefits of work for low-income families.

In the wake of these changes, millions of previous welfare recipients, largely single mothers, entered the workforce. At the same time, welfare has become more difficult to obtain for families at the very bottom, who often have multiple barriers to work. As a result, in the new welfare system, the working poor may be doing better while the deeply poor are doing worse..

..

“This is the first study to use nationally representative survey data to compare the material hardships of deeply poor households with children to other low-income groups of lower-income households with children, before and after the 1990s welfare reforms,” Ybarra writes. The scholars studied data from the Census Bureau’s Survey of Income and Program Participation from 1992 to 2005 to determine how the deeply poor fared compared to the near poor. They found:

  • While the amount of public aid received by deeply poor households fell dramatically, it increased substantially for near poor families, particularly through expansions of the Earned Income Tax Credit, a benefit that reduces income taxes for certain people with low or moderate wages.
  • Among deeply poor households with children, 48 percent reported in 2005 they did not have enough money to cover most of their essential household expenses, compared with 45 percent in 1992 and 37 percent in 1995.
  • In contrast, among near poor households with children, 30 percent reported in 2005 that they had difficulty meeting their household expenses, down from 37.9 percent in 1992.
  • Even among deeply poor households, 41 percent of household heads were working in 2005. But this is well below the proportion for near poor households, in which 88 percent of household heads work. This may be because household heads among the deeply poor were more likely to report a work-limiting disability.

Among deeply poor households with children, a rising proportion are surviving on virtually no income – $2 a day or less in any given month, according to a companion study released by Shaefer and Kathryn Edin, professor of public policy and management at Harvard University. In fact they found that 1.46 million households with children fall under this metric, used to measure poverty in developing nations….

 

September 17, 2012 Posted by | Public Health | , , , , , , | Leave a comment

Tropical Diseases: The New Plague of Poverty

 

Cover of "The Other America:  Poverty in ...

Cover via Amazon

 

From the 18th August 2012 article at the New York Times

 

IN the United States, 2.8 million children are living in households with incomes of less than $2 per person per day, a benchmark more often applied to developing countries. An additional 20 million Americans live in extreme poverty. In the Gulf Coast states of Louisiana, Mississippi and Alabama, poverty rates are near 20 percent. In some of the poorer counties of Texas, where I live, rates often approach 30 percent. In these places, the Gini coefficient, a measure of inequality, ranks as high as in some sub-Saharan African countries.

Poverty takes many tolls, but in the United States, one of the most tragic has been its tight link with a group of infections known as the neglected tropical diseases, which we ordinarily think of as confined to developing countries.

Most troubling of all, they can even increase the levels of poverty in these areas by slowing the growth and intellectual development of children and impeding productivity in the work force. They are the forgotten diseases of forgotten people, and Texas is emerging as an epicenter.

A key impediment to eliminating neglected tropical diseases in the United States is that they frequently go unrecognized because the disenfranchised people they afflict do not or cannot seek out health care.

..

While immigration is sometimes blamed for introducing neglected tropical diseases into the United States, the real issue is that they are now, to varying degrees, also being transmitted within our borders. Without new interventions, they are here to stay and destined to trap people in poverty for decades to come. Fifty years ago, Michael Harrington’s book “The Other America: Poverty in the United States” became a national best seller. Today more people than ever before live in poverty in this country. We must now turn our attention to the diseases of this Other America.

 

While immigration is sometimes blamed for introducing neglected tropical diseases into the United States, the real issue is that they are now, to varying degrees, also being transmitted within our borders. Without new interventions, they are here to stay and destined to trap people in poverty for decades to come. Fifty years ago, Michael Harrington’s book “The Other America: Poverty in the United States” became a national best seller. Today more people than ever before live in poverty in this country. We must now turn our attention to the diseases of this Other America.

 

 

 

 

September 6, 2012 Posted by | environmental health, Public Health | , , | Leave a comment

‘Burdens Of Place’ Plague Urban Poor; Often Lead To Weight Gain, Obesity

 

From the 12 August Medical News Today article

Most of America’s urban cores were designed for walking but offer little in the way of supermarkets, healthy restaurants and other amenities for residents to walk to, according to a study led by a Michigan State University scholar.

The study is one of the first to show that poor residents living in declining urban neighborhoods want healthy food choices – evidenced by their willingness to travel long distances to find them. Past research has generally assumed that poor people will shop at whatever store is closest.

But compared with suburban residents, the urban poor are more overweight and must travel farther to find healthy food and access personal services, said Igor Vojnovic, associate professor of geography and lead author on the study…

..Other findings included:

  • Fast food restaurants were more plentiful in poor neighborhoods. In addition, residents there reported that 55 percent of all dining-out experiences were at fast food eateries, compared with only 13 percent for those in the suburbs.
  • Poor urban residents had to go nearly twice as far as suburbanites to shop at supermarkets.
  • The urban poor made about five trips per month to convenience stores (which aren’t known for stocking healthy foods) compared with only one trip per month for suburbanites…

..

During the past 30 years, urban planners and business investors have largely ignored poor communities, instead focusing policy, research and investment efforts on wealthier neighborhoods, Vojnovic said. As a result, little is known about resident behaviors in declining communities, even as the number of poor people increases in the United States, he said.

The current study shows that the fundamental principles in city planning and design that have been developed around wealthy communities do not necessarily hold in poor neighborhoods.

Meanwhile, some have advocated an “obesity tax” on unhealthy foods to help pay for the health-care system overhaul or as a policy to curtail obesity. But Vojnovic said such a tax would disproportionately burden the urban poor and noted that this population has little power to influence the location decisions of healthy food suppliers.

Vojnovic said a better option might be for states to give subsidies to major supermarket chains, restaurants serving healthy food and other needed establishments that locate in poor neighborhoods. 

 

August 13, 2012 Posted by | Nutrition, Public Health | , , | Leave a comment

Two postings about proposed state Medicaid expansion (The Health Care Blog)

 

Yes, this is a controversial topic, but thought I’d include these items, the comments for both blogs are interesting.
My thoughts? Health insurance coverage does need revising..because caring for our nation’s health is a shared responsibility…

Why Should You Care Whether or Not Your State Decides to Expand Medicaid Coverage?

By expanding Medicaid, the state-federal partnership that offers health insurance to low-income Americans, the Affordable Care Act set out to cover some 17 million uninsured – or roughly half of the 34 million who are expected to gain coverage under reform. But when the Supreme Court ruled on the Affordable Care Act in June, it struck down a key provision which threatened that if a state refused to co-operate in extending Medicaid to more of its citizens, it could lose the federal funding it now receives for its current Medicaid enrollees…

..

Health care costs, premiums would rise

What these governors ignore is the impact that the loss of those Medicaid dollars will have on insurance rates in their states, says Joe Paduda, editor of Managed Care Matters. Hospitals have been counting on the influx of new Medicaid dollars to reduce the cost of uncompensated care. Today, hospitals spend billions delivering care to patients who are both uninsured and very poor. If more patients have Medicaid, the pile of unpaid bills will shrink.

Assuming that Medicaid will expand, the Affordable Care Act has already trimmed subsidies to hospitals that care for a disproportionate share of impoverished patients. But now, if states turn down the Medicaid funding, the hospitals in these states “are going to have to make up the revenue loss from somewhere,” says Paduda, “and that ‘somewhere’ is going to be from privately-insured patients. That will lead to health insurance costs increasing much faster in ‘non-expansion’ states than in the rest of the country.”

We have been told that in some red states conservatives “hate poor people.” But my guess is that they’ll hate higher premiums more. If premiums go up, governors who turned down federal Medicaid dollars will have to answer to voters…

Now that some states are balking, the Congressional Budget Office estimates that 6 million of the 17 million who were supposed to be covered by the Medicare expansion will be left out of the program. Fortunately, 3 million of those 6 million will be eligible for sliding-scale subsidies that the ACA provides to help low-income and middle-income Americans purchase private insurance – if they earn between 100 percent and 400 percent of the federal poverty level. ($11,170 to $43,320 for an individual).

What is less fortunate is that the CBO estimates that those subsidies will cost Washington $3,000 more per person than if the same people were covered by Medicaid: private health insurance plans have higher administrative costs than Medicaid and also tend to pay providers more.

3 million left out in the cold

The other 3 million will be left out in the cold. The subsidies, which come in the form of tax credits, are earmarked for those who earn between 100 percent and 400 percent of the federal poverty line. Ironically, if a person earns “too little” (less than 100 percent of the FPL), they are not eligible for the subsidy. (The ACA assumed that they would be covered by the new Medicaid.)

At the same time, if they earn “too much” to qualify for Medicaid in a state that limits eligibility to 50 percent of the FPL, they will be shut out of that program as well – leaving them in a no-man’s land where they have no sure access to medical care.

In those cases where they do receive the care they need, the rest of us will wind up covering their unpaid bills as we watch our insurance premiums climb.

The Supreme Court May Have Saved Lives … by Keeping People Off Medicaid

magine that you are the head of a family of three, struggling to get by on an income, say, of $25,000 a year. You’ve signed up for your employer’s health plan because you want your family to get good health care when they need it. But that takes a big bite out of your paycheck — $250 a month.

When you first heard about the president’s health plan, you heard him say that if you like the plan you’re in you can keep it. That was good news. You also believed the whole point of the reform was to help families like yours get health insurance if for some reason you had to seek insurance on your own.

 

Now get ready for some surprises. The first will be an announcement that in another year or so your employer’s health plan will no longer be available to you. The reason: plain economics. People at your income level will qualify for as good or better health insurance in a new health insurance exchange. And almost all the premium will be paid for by the federal government. Most people like you would rather have higher wages than a health plan that duplicates what you can get almost for free, your employer will reason. So in order to compete for labor, your company will have to give prospective employees the compensation package they most want. And your employer will be right.

Then there will be a second surprise. Under the new rules, if you are eligible for Medicaid, you can’t get private insurance in the exchange. Further the health reform law is designed to force the states to raise the income level for Medicaid. If your state complies, someone with your income will be eligible for Medicaid and you won’t be allowed in the exchange!

Now if you were a resident alien, the rules are different. Since they don’t generally qualify for Medicaid, immigrant families at your income level can get subsidized private insurance in the exchange. But alas, you’re a citizen. So this option isn’t open to you.

Now let’s say you are under the impression that Medicaid is second rate insurance and you remember that your employer promised to pay more in wages once your health benefit is gone. What about using the higher wages from your employer to buy private insurance outside the exchange?

Now get ready for the third surprise. There isn’t going to be any market for private insurance outside the exchange — at least not for you. The insurance companies are going away. The brokers are going away. The market is going away.

Now for the final surprise. The only option open to you under the Affordable Care Act is Medicaid! Why should you care? Because your initial impression is correct. Medicaid is second rate insurance.

In most places Medicaid patients have a terrible time finding doctors who will see them and facilities that will admit them. That’s why so many of them turn to community health centers and the emergency rooms of safety net hospitals for basic medical care. Medicaid enrollees turn to emergency rooms for their care twice as often as the privately insured and even the uninsured. In fact, if you’re trying to get a primary care appointment, it appears your chances are better if you say you are uninsured…

..

Here is where is gets little bit tricky, owing to the bizarre structure of ObamaCare. The new health law is trying to get the states to expand Medicaid eligibility to 138% of the federal poverty level ($15,415 for an individual or $26,344 for a family of three). But let’s suppose that, thanks to the Supreme Court, a state doesn’t do anything. It turns out that only people who are between 100% and 138% of poverty can then go into the exchange and get private insurance.

So if your employer does raise your pay and pushes you over that threshold, you qualify. However, while your salary is still only $25,000 you may not be eligible for Medicaid. Here’s the double whammy:  You will not be allowed into the exchange either. You will be in a sort of “no-man’s-land” donut hole. And the only way out will be for you to somehow earn more income. Or, lie about it. This may be one of the very few instances where people will find it their self-interest to tell the IRS their income is higher than it really is!

According to the CBO about two-thirds of the states will not expand eligibility above 100% of the federal poverty level. That’s why 3 million citizens will be liberated and will get private insurance instead. Moreover, the subsidies in the exchange are incredibly generous. The most the family has to pay is 2% of their income.

Further, the private plans in the exchange will pay providers about 50% higher fees that the rock bottom payments they would have gotten from Medicaid. This will be a huge relief for safety net facilities that are scraping by on inadequate resources as it is. And it’s a reason why the CBO may have underestimated how many states will find this option very attractive.

ObamaCare is still a Rube Goldberg contraption that desperately needs repealing and replacing. But in the interim, the Supreme Court has done a lot of families a big favor.

 

August 8, 2012 Posted by | Uncategorized | , , , | Leave a comment

Why doctors should screen for poverty

From the 4 April 2012 blog post by NAHEED DOSANI, MD AND JEREMY PETCH at KevinMD.com

…Bloch points to a growing body of research evidence showing the impact of financial struggle on the risk of a variety of diseases (this research is largely Canadian, so US statistics will differ, though the themes are likely similar):

Cardiovascular disease: there is a 17% higher rate of circulatory conditions among the lowest income quintile versus the average
Diabetes: prevalence among the lowest income quintile is more than double the rate in the highest income quintile
Mental Illness: the suicide-attempt rate of those living on social assistance is 18 times higher than higher-income individuals
Cancer: low-income women are less likely to access screening interventions like mammograms or Pap Smears
Development: infant mortality is 60% higher in the lowest income quintile neighborhoods
Regardless of this compelling evidence, why is there a need to screen for poverty? “Simply because we don’t know which patients live in poverty and if we don’t ask, we won’t find out,” says Dr. Bloch.  Since the recession of 2008, many hard-working people have been squeezed out of the middle class.  A November 2011 report by Wider Opportunities for Women entitled, “Living Below the Line,” highlighted the fact that nearly half of Americans struggle to make ends meet. …

 

April 4, 2012 Posted by | Consumer Health | , , | Leave a comment

Census Bureau Releases New Set of 5-Year American Community Survey Estimates

Logo of the American Community Survey, a proje...

Image via Wikipedia

Estimates Provide Detailed Look at Every Community Nationwide

From the US Census press release

The U.S. Census Bureau today released findings from the American Community Survey — the most relied-on source for detailed, up-to-date socio-economic statistics covering every community in the nation every year — for the combined years from 2006 to 2010.

Consisting of about 11 billion individual estimates and covering more than 670,000 distinct geographies, the five-year estimates give even the smallest communities timely information on more than 40 topics, such as educational attainment, income, occupation, commuting to work, language spoken at home, nativity, ancestry and selected monthly homeowner costs.

Visitors to the Census Bureau website can find their community’s estimates in the <American FactFinder> database.

“These estimates are ideal for public officials to use to make key decisions,” Census Bureau Director Robert Groves said. “School boards will find them helpful in forecasting demand for classroom space, teachers and workforce training programs, and they will be a tremendous asset to planners in identifying traffic concerns and building roads and transit systems to ease commutes. Local governments will also find them useful in forecasting needs for services such as police and fire protection.”

Today’s release is based on completed interviews with almost 2 million housing units each year from 2006 through 2010. By pooling several years of survey responses, the American Community Survey can generate detailed statistical portraits of smaller geographies. The Census Bureau issues new sets of these five-year estimates every year, permitting users to track trends in even the smallest of areas over time.

Two Briefs Using the Five-Year Estimates

In addition to the estimates released in the 940 detailed tables through American FactFinder, the Census Bureau is also releasing today two five-year ACS briefs, which are short, topic-based reports that analyze statistics for a wide range of topics. These new five-year briefs join the series previously only using one-year data and estimates. The five-year briefs take advantage of the very small geography and groups that can only be estimated with five years of data. A complete list of all released Briefs is accessible here: <http://www.census.gov/acs/www/data_documentation/2010_acs_briefs/>.

Native North American Language Speakers Concentrated in a Handful of Counties

Sixty-five percent of Native North American language speakers lived in just three states, Alaska, Arizona and New Mexico. Nine counties within these states contained half the nation’s Native American language speakers. Apache County in Arizona had 37,000 speakers of a Native American language, making it the highest in the nation. McKinley County, N.M., had the second most speakers at 33,000. Together, about 20 percent of all Native American language speakers in the nation lived in these two counties.

The most commonly spoken Native North American language was Navajo, with more than 169,000 people speaking this language nationally. The number of Navajo speakers was nearly nine times larger than the second and third most commonly spoken languages of Yupik and Dakota, with each having about 19,000 speakers. Although the majority of Native North American language speakers resided in an American Indian and Alaska Native area, only 5 percent of people living in an American Indian and Alaska Native area spoke a Native North American language.

More than One-in-Five Live in “Poverty Areas”

People living in poverty tend to be clustered in certain neighborhoods rather than being evenly distributed across geographic areas. About 67 million people across the nation, or 23 percent of the population, lived in “poverty areas” — that is, census tracts with poverty rates of 20 percent or more. Among states, the percentage ranged from 46 percent in Mississippi to 5 percent in New Hampshire. In 15 states and the District of Columbia, more than one-quarter of the population resided in poverty areas.

Of the 10 million people residing in tracts where poverty was especially prevalent (poverty rates of 40 percent or more), 43 percent were white, 38 percent were black, 3 percent were Asian, 11 percent were some other race, and 2 percent reported two or more races.

Individuals residing in tracts with poverty rates of 40 percent or more were less likely to have completed high school, to work year-round, full time and to own a home, and were more likely to be living in a female-householder family and to be receiving food stamps than individuals living in tracts with low poverty rates (poverty rates of less than 13.8 percent).

 

December 9, 2011 Posted by | Public Health | , , , , | Leave a comment

How Human Services Programs and Their Clients Can Benefit from National Health Reform Legislation

urban institute nonprofit social and economic policy research

From the Report Summary (Urban Institute)

Human services programs-the Supplemental Nutrition Assistance Program, Temporary Assistance to Needy Families, subsidized child care, etc.-and their clients can benefit from national health reform. Millions of low-income health coverage applicants can be connected with human services programs, as the latter programs: (a) help health programs efficiently reach eligible consumers; (b) access unprecedented, time-limited federal funding for modernizing eligibility computer systems while limiting risks to current funding; (c) keep social services offices available as an avenue for seeking health coverage; and (d) use a forthcoming Medicaid expansion to accomplish core human services goals related to employment and child development.

 

 

November 17, 2011 Posted by | Public Health | , , , , , , | Leave a comment

Majority Of Homeless People Have Chronic Health Conditions

From the 26 August 2011 Medical News Today article

More than eight out of 10 homeless people surveyed by researchers at St. Michael’s Hospital and elsewhere have at least one chronic health condition and more than half have a mental health problem. People who are “vulnerably housed” – meaning they live in unsafe, unstable or unaffordable housing – had equally poor, and in some cases worse, health, the survey found. The underlying cause for these health issues is poverty, said Dr. Stephen Hwang, the principal investigator of the study and a physician-researcher at the hospital’s Centre for Research on Inner City Health

“Poor housing conditions and poor health are closely linked,” said Dr. Hwang. “We need to treat both problems.” …

Read the article

August 26, 2011 Posted by | Uncategorized | , , , | Leave a comment

Some New Health Related US Demographic Resources

Logo for the 2010 United States Census.

Image via Wikipedia

From a 9 August 2011 Health Information Literacy – For Health and Well Being blog item

First Results from the 2010 Census
http://www.prb.org/pdf11/reports-on-america-2010-census.pdf
Initial report from the 2010 Census identifying population change in rural and metro areas. Includes statistics on the increased diversity and ethnicity in the U.S.

Geography of Need: Identifying Human Service Needs in Rural America
http://www.rupri.org/Forms/HeflinMiller_GeogNeed_June2011.pdf
Uses American Community Survey five year average county-level data to compare the type and degree of human service needs in metropolitan versus non-metropolitan counties.

State of the States
http://frac.org/map/
State profiles of these Federal Food Programs: Demographics, Poverty and Food Insecurity; Federal Nutrition Programs; and State Economic Security Policies.
[Rural Assistance Center Human Services Update]

 

 

August 16, 2011 Posted by | Educational Resources (High School/Early College(, health AND statistics | , , | Leave a comment

About 75 Percent Of Senior Households Have Little Or No Buffer Against Trauma

Roosevelt Signs The Social Security Act: Presi...

Image via Wikipedia

From the 21 July 2011 Medical News Today article

Outliving one’s resources and falling into poverty is an increasingly common experience among today’s senior citizens, according to a new report produced jointly by the Heller School’s Institute on Assets and Social Policy and the public policy research and advocacy organization Demos.

And, researchers say, the situation could deteriorate further if cuts in Social Security are made.

The report, “From Bad to Worse: Senior Economic Insecurity On the Rise,” found that seniors have too few resources and too little time to plan for a fulfilling retirement.

Click here to read the rest of the news article

July 22, 2011 Posted by | Public Health | , | Leave a comment

Urgent Need To Fight Diseases Affecting The World’s Poor

None - This image is in the public domain and ...

Image via Wikipedia

From the 22 June 2011 Medical News Today article 

Despite significant advancements in increasing distribution and development of vaccines against childhood killer diseases – including pneumococcal disease, rotavirus, and Haemophilus influenzae Type B – global efforts to reduce the burden of infection from neglected tropical diseases (NTDs) has greatly lagged, argues Sabin Vaccine Institute (Sabin) President Dr. Peter Hotez in an article for the June edition of Health Affairs.

[Above link is abstract only, for suggestions on how to get this article for free or at low cost, click here]

NTDs, a group of 17 parasitic infections, represent a significant contributor to global poverty, and have well documented chronic and disabling effects. Yet efforts to develop vaccines for NTDs have not benefitted from larger ongoing initiatives to combat major childhood diseases.

In his article, “A Handful of ‘Antipoverty’ Vaccines Exist for Neglected Diseases, But the World’s Poorest Billion People Need More,” Dr. Hotez cites three critical reasons for the lack of interest in “antipoverty” vaccines:

  • Though NTDs disable, they do not typically cause high levels of mortality leading some in the public health community to misleadingly conclude that NTDs are not a significant public health threat;
  • NTDs predominately occur in rural settings and are largely hidden diseases unknown to the public and infrequently documented; and,
  • Pharmaceutical companies are reluctant to make an investment in NTD vaccines because there is no financial incentive.

June 22, 2011 Posted by | Public Health | , , , , , , , | 1 Comment

Number Of Deaths In The US Can Be Linked To Social Factors

From the 16 June 2011 Medical News Today site

Published in the American Journal of Public Health, a new study *** calculates the number of deaths attributable to social factors in the United States, finding a broader way to conceptualize the causes of mortality.

Researchers estimated the number of deaths in the United States attributable to social factors, using a systematic review of the available literature combined with vital statistics data. They conducted a MEDLINE search for all English-language articles published between 1980 and 2007 with estimates of the relation between social factors and adult all-cause mortality. After calculating for the relative risk estimates of mortality, researchers obtained estimates for each social factor. Individual social factors included education, poverty, health insurance status, employment status and jobstress, social support, racism or discrimination, housing conditions and early childhood stressors. Area-level social factors included area-level poverty, income inequality, deteriorating built environment, racial segregation, crime and violence, social capital and availability of open or green spaces.

They found that approximately 245,000 deaths in the United States in 2000 were attributable to low education, 176,000 to racial segregation, 162,000 to low social support, 133,000 to individual-level poverty, 119,000 to income inequality and 39,000 to area-level poverty. …

***For suggestions on how to get this article for free or at low cost, click here

June 20, 2011 Posted by | Public Health | , , , | Leave a comment

Lifelong gap in health between rich and poor set by age 20

 

 

Study by McGill geography professor finds that as people age, the differnce in the health-related quality of life between rich and poor remains constant

From a 8 June 2011 Eureka news alert

 

“We can’t buy our way out of ageing,” says Nancy Ross, a McGill geography professor. “As we get older we start to have vision problems, maybe some hearing loss, maybe lose some mobility – ageing is a kind of a social equalizer.”

Ross is the lead author of a new study about how socio-economic and educational status affects Canadians’ health-related quality of life over the course of a lifetime.

“My research looks at how poverty and social disadvantage affect your health status. Our work was about using social circumstances as a lens to look at how people’s quality of life changes as they age.”

The good news, according to Ross, is that there is no sign of an accelerated ageing process for those who are lower on the social ladder. “The trajectories for declining health as people age look fairly similar across the social spectrum. That surprised me. I thought that there would be a bit more of a difference across social groups.”

But the bad news is that Canadians who are less educated and have a lower income start out less healthy than their wealthier and better-educated compatriots, and remain so over the course of their lives. “What we found, basically, is that people who are more educated and with higher incomes have a better health-related quality of life over their whole lifespan, and that these health “tracks” stay pretty parallel over time.

“The message there is that if you start out with a health-related quality of life deficit through early life experience and a poor educational background, it’s never made up for later on,” says Ross. “Poorer Canadians are in poorer health and they have lower life expectancy than their more affluent counterparts, and by age 20 the pattern for health-related quality of life as people age is already fixed.”

“We might speculate that universal health insurance and other social policies directed to adults and seniors have played a role in preventing accelerated decline in health-related quality of life of the poorer and less educated Canadians. That said, we would need some comparative research in other countries to test this more fully,” she adds. “But this study suggests the need for policies aimed at making sure kids and teens are given the chances early in life to even out socio-economic inequalities that will affect their health as they age.”

 

June 14, 2011 Posted by | Public Health | , , , , , | Leave a comment

America’s Most Distressed Areas, Including The Gulf Coast States And Washington, D.C., Threatened By Emerging Infections Of Poverty

America’s Most Distressed Areas, Including The Gulf Coast States And Washington, D.C., Threatened By Emerging Infections Of Poverty

From the March 29 2011 Medical News Today item

Neglected infections of poverty are the latest threat plaguing the poorest people living in the Gulf Coast states and in Washington, D.C., according to Dr. Peter Hotez, Distinguished Research Professor and Chair of the Department of Microbiology, Immunology, and Tropical Medicine at The George Washington University and President of the Sabin Vaccine Institute, in an editorial published in the open-access journal PLoS Neglected Tropical Diseases on March 29th.

Hotez explains that current post-hurricane conditions in the Gulf coast states coupled with the BP oil disaster and extreme levels of poverty make these areas extremely vulnerable to neglected infections of poverty. Conditions such as dengue hemorrhagic fever and other vector borne neglected infections, like Chagas disease and cutaneous leishmaniasis, as well as non-vector borne neglected infections like trichomoniasis and toxocariasis, are affecting the people living in the region. Additionally, Hotez notes that Washington, D.C. is also among the worst U.S. cities in terms of life expectancy and health index, meaning its residents suffer from the lowest incomes, lowest educational attainment, and shortest life expectancy. Despite the fact that these conditions are triggers for neglected infections of poverty, no surveillance data currently exists to reflect their prevalence. Even trichomonaisis, which is extremely common in Baltimore, MD., has not been tracked.

Because these infections are serious problems that perpetuate poverty, I am extremely concerned about the welfare of the people in these regions. [Editor Flahiff’s emphasis]

Click here for the rest of the news article

Click here for the full text of the journal article written by Dr. Hotez, America’s Most Distressed Areas and Their Neglected Infections: The United States Gulf Coast and the District of Columbia

 

 

March 30, 2011 Posted by | Consumer Health, Consumer Safety, Medical and Health Research News, Public Health | , , , , | Leave a comment

   

Follow

Get every new post delivered to your Inbox.

Join 172 other followers

%d bloggers like this: