[Reblog] Incarceration’s contribution to infant mortality (and related note to a local “no to war on drugs event”/ Mexican Caravan For Peace)

Yesterday I participated in a walk drawing attention to the failures in the US and Mexico’s failed drug policies.
The participants (about 100) were mainly folks from the Caravan For Peace Campaign which is winding its way from
Tijuana through the US and ending up in Washington DC.
[See related news stories, blog items, and photos below]***

It was heartbreaking to talk a bit with the Mexicans, many who held small signs with pictures of their murdered family members/friends. Most had just disappeared…all because of drug related violence.

I’ve always believed our (US) War on Drugs is failing miserably, our skyrocketing incarceration rate is not solving anything.
In fact, it is having terrible consequences, including adverse health effects including greater susceptibility to disease, stress, and increased risk for infant mortality.

To be honest, I am not sure what the answer is.
Prohibition isn’t working, but I am very unsure about legalization.
Perhaps a fresh new way to address this as a health issue and not a criminal issue.
When I walked and listened to these people, I know that somehow, some way, I just have to get involved.
These people, too, are my community.

From the 27 August 2012 blog post at Family Inequality

A recent study in the journal Social Problems by sociologist Chistopher Wildemanshows that America’s practice of mass incarceration may be exacerbating both infant mortality in general and stubborn racial inequality in infant mortality in particular.

Drawing on recent literature by himself and others, Wildeman spells out the case for incarceration’s negative effect on family economies, including: lost earnings and financial contributions from fathers, the expensive burden of maintaining the relationship with an incarcerated parent, and the lost value of the incarcerated parent’s unpaid labor. All of those costs may take a toll on mothers’ health, which is the primary cause of infant mortality.

In addition, family members of incarcerated parents may contract infectious diseases, experience significant stress, and lose support networks — all taking an additional health toll.

Sure enough, his analysis of data from the Pregnancy Risk Assessment Monitoring System confirms that children born into families in which a parent has been incarcerated are more likely to die in the first year of life. The association may not be causal, but it holds with a lot of important control variables.

Does this increase racial inequality? Probably, because parental incarceration is so concentrated among Black families, as Wildeman and Bruce Western reported previously (my graph of their numbers):

To make the connection to racial inequality explicit, Wildeman moves to compare states over time, on the suspicion that incarceration could increase infant mortality rates, and racial inequality in infant mortality rates. That could be because concentrated incarceration undermines community support and income, people with felony records often are disenfranchised (so the political system can ignore their needs), and the costs of incarceration crowd out more beneficial spending that could improve community health.

The results of a lot of fancy statistical models comparing states show that:

the imprisonment rate is positively and significantly associated with the total infant mortality rate, the black infant mortality rate, and the black-white gap in the infant mortality rate.

It’s an impressive article on an important subject, one that thankfully is attracting more attention from good scholars.

I previously reported on Wildeman’s work on how the drug war affect families, here.

***

• [Photos of event from a colleague] https://www.facebook.com/media/set/?set=a.10151046490842135.424853.679937134&type=1
• Mexico ‘Peace Caravan’ Stops in Toledo, Seeks Help in Stopping Drug Wars(ToledoFavs.com)
• Caravan For Peace (official Web site)
  • The Route (Tijuana–>SW US–>SE US–>NE US
  • About Page

Related articles

• The U.S. Drug Policy Landscape — Insights and Opportunities for Improving the View

  Discussions about reducing the harms associated with drug use and antidrug policies are often politicized, infused with questionable data, and unproductive. This paper provides a nonpartisan primer that should be of interest to those who are new to the field of drug policy, as well as those who have been working in the trenches. It begins with an overview of problems and policies related to illegal drugs in the United States, including the nonmedical use of prescription drugs. It then discusses the efficacy of U.S. drug policies and programs, including long-standing issues that deserve additional attention. Next, the paper lists the major funders of research and analysis in the area and describes their priorities. By highlighting the issues that receive most of the funding, this discussion identifies where gaps remain. Comparing these needs, old and new, to the current funding patterns suggests eight opportunities to improve understanding of drug problems and drug policies in the United States: (1) sponsor young scholars and strengthen the infrastructure of the field, (2) accelerate the diffusion of good ideas and reliable information to decisionmakers, (3) replicate and evaluate cutting-edge programs in an expedited fashion, (4) support nonpartisan research on marijuana policy, (5) investigate ways to reduce drug-related violence in Mexico and Central America, (6) improve understanding of the markets for diverted pharmaceuticals, (7) help build and sustain comprehensive community prevention efforts, and (8) develop more sensible sentencing policies that reduce the excessive levels of incarceration for drug offenses and address the extreme racial disparities. The document offers some specific suggestions for researchers and potential research funders in each of the eight areas.

  From Family Inequality: Incarceration’s contribution to infant mortality (drhiphop85.com)

• Incarceration’s contribution to infant mortality (familyinequality.wordpress.com)
• September Is Infant Mortality Awareness Month (midwivesofcolor.wordpress.com)
• U.S. infant mortality, preterm birth drop (upi.com)
• Infant mortality rates increase among blacks in Arkansas (thegrio.com)
• Drug Wars: Caravan for Peace Raises the Voices of Drug War Victims (ionglobaltrends.com)
• Drug caravan to visit more than 20 US cities (utsandiego.com)
• Mexican Caravan for Peace demands change to U.S. drug policy (wagingnonviolence.org)
• Street Gang Shootings In Chicagoland Are Proxy War For Mexican Drug Cartels (bitterqueen.typepad.com)
• Drug caravan to visit more than 20 US cities (miamiherald.com)

[Reblog] Clustering of unhealthy behaviours over time Implications for policy and practice

 

From The Kings Fund (UK site)

Summary

People’s lifestyles – whether they smoke, how much they drink, what they eat, whether they take regular exercise – affect their health and mortality. It is well known that each of these lifestyle risk factors is unequally distributed in the population.

Less is known about how these behaviours co-occur or cluster in the population and about how these patterns of multiple lifestyle risk have been evolving over time. This paper considers this in the context of the English population and sets out the implications for public health policy and practice that flow from the findings.

It reviews the current evidence on multiple lifestyle risks and analyses data from the Health Survey for England on the distribution of these risks in the adult population and how this is changing over time.

You can also download the supporting methodology and data appendices (98 kb) 

Key points

• The overall proportion of the English population that engages in three or four unhealthy behaviours has declined significantly, from around 33 per cent of the population in 2003, to 25 per cent in 2008.
• These reductions have been seen mainly among those in higher socio-economic and educational groups: people with no qualifications were more than five times as likely as those with higher education to engage in all four poor behaviours in 2008, compared with only three times as likely in 2003.
• The health of the overall population will improve as a result of the decline in these behaviours, but the poorest and those with least education will benefit least, leading to widening inequalities and avoidable pressure on the NHS.

Policy implications

More effective ways must be found to help people in lower socio-economic groups and those with the least education to improve their health behaviours.

This requires a more holistic approach to policy and practice, addressing lifestyles that encompass multiple rather than individual unhealthy behaviours.

In addition, behaviour change should be linked more closely to inequalities policy and be focused more directly on improving the health of the poorest.

More research and better use of the data already available is key. In particular, it would be helpful to know whether it is easier or harder to change the behaviour of those with multiple risks, whether it is more effective to tackle the risks in sequence or in tandem, what the most cost-effective approaches are and what we can learn from other areas of care.

• Listen to David Buck talk through the key findings of the report in his audio-slideshow
• Read David’s blog: Improving the health of the poorest, fastest: why clusters of lifestyle behaviours matter
• See our press release on the findings

Related articles

• Smoking, drinking and bad diets down among the young (but only among the wealthiest) (standard.co.uk)
• Class divide in health widens, says thinktank (guardian.co.uk)
• Lifestyle, social factors, and survival after age 75: population based study (bespacific.com)
• Singapore named healthiest country (todayonline.com)

 

Tropical Diseases: The New Plague of Poverty

 

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.

 

 

 

Related articles

• Hurricanes, Poverty, and Neglected Infections (blogs.scientificamerican.com)
• Obstetric fistula as a neglected tropical disease [Aetiology] (scienceblogs.com)
• US: Tropical diseases and poverty (crofsblogs.typepad.com)
• America’s Descent into Poverty (sott.net)
• Global neglected disease research ‘rapidly expanding’ (scidev.net)
• Key tropical diseases ‘suffering funding neglect’ (scidev.net)
• How to Help End Seven Tropical Diseases (mombloggersforsocialgood.com)
• Free exchange: The geography of poverty | The Economist (policyabcs.wordpress.com)
• New study maps hotspots of human-animal infectious diseases and emerging disease outbreaks (eurekalert.org)
• Oregon man recovering from rare case of the plague (guardian.co.uk)

 

[Reblog] Ethics of commercial screening tests: choice should be informed by evidence, not advertising claims

 

From the 28 August 2012 post at HealthNewsReview.org

An opinion piece in the Annals of Internal Medicine, “Ethics of Commercial Screening Tests,” makes a strong, clear statement about the problems with many screening test campaigns offered by commercial companies in partnerships with churches, pharmacies, shopping malls or trusted medical organizations. Excerpts:

“Particular concerns about “the use of ultrasonography (for example, ultrasonography of the carotid arteries to assess for plaques and stenosis, ultrasonography of the heel to assess for osteoporosis, and echocardiography) in the direct-to-consumer screening market as a driver of expensive and unnecessary care.

…

When screenings are provided in a church and sponsored by a trusted medical organization, consumers may have a false sense of trust in the quality and appropriateness of services provided. Consumers are generally unaware of the potential harms of screening.

Because of a lack of counseling by these companies about the potential risks of an “abnormal” test result, the consumer is initially unaware that this may open a Pandora’s box of referrals and additional testing to monitor or treat these abnormal findings. Our medical system and society bear the cost of poor coordination of care and additional testing and treatment to follow up on unnecessary “abnormal” screening test results.  That most of these tests are not medically indicated in the first place is left undisclosed to the consumer, nor is there a discussion of potential adverse consequences or additional costs.

…

Advocates of widespread screening may argue that if patients know that they have disease, they will be more likely to engage in behavior modification. However, evidence does not support this hypothesis.

…

We respect patients’ autonomy to make their own medical decisions. However, choices should be informed by evidence, not such advertising claims as, “the ultrasound screenings that we offer can help save your life.” Patients can be coerced through unsubstantiated, misleading statements or omission of factual information into obtaining tests where the actual risk may outweigh the proven benefit. In direct-to-consumer advertising of pharmaceuticals, companies are required to disclose the potential risks of taking a medication. We believe that commercial screening companies should also be obligated to disclose from published guidelines the recommended indications and benefits of testing, as well as the potential risks and harms.”

 

I’ve written about these commercial screening campaigns in the past.

One year ago at this time – the time of the annual Minnesota State Fair – I wrote about how a local TV station co-sponsored a prostate cancer screening campaign.  This year, it does not appear that the prostate screens are being done.  But ultrasounds of the heel to check for osteoporosis – one of the very specific issues highlighted as a special cause for concern in the journal editorial cited above, continue.  KARE-11 TV of Minneapolis states on its website:

“Put your best foot forward and find out your bone density.  Health Strategies will be providing heel scan ultrasound bone density screenings at the fair.”

The TV station promotes this as “Know Your Numbers.”  Maybe they should know the evidence (or lack thereof) for some of what they’re promoting.

Other related past posts:

• Free Throat, Head, Neck Cancer Screenings Promoted Without Full Info

• In the BMJ: “What companies don’t tell you about screening” and “Routine testicular self examination: it’s time to stop”

• Local TV report questions LifeLine Screening tests

 

Related articles

• Annals of Internal Medicine tip sheet for Aug. 28, 2012 (eurekalert.org)
• Question of the Week: STD’s – Test or Just Treat? (jailmedicine.com)
• Prenatal testing: Is it right for you? (zedie.wordpress.com)

 

[Reblog] Use of patient decision aids may lead to “sharply lower hip/knee surgery rates & costs”

From the 4 September 2012 blog post at HealthNewsReview.org

4 COMMENTS

Photo credit: Cindy Funk via Flickr

A paper in Health Affairs (subscription required for access) shows what can be done with decision aids in clinical practice in what the authors describe as “the largest (observational study) to date of the implementation of patient decision aids in the context of quality improvement for elective surgery.”

A team from Group Health Cooperative in Seattle reports:

“Decision aids are evidence-based sources of health information that can help patients make informed treatment decisions. However, little is known about how decision aids affect health care use when they are implemented outside of randomized controlled clinical trials. We conducted an observational study to examine the associations between introducing decision aids for hip and knee osteoarthritis and rates of joint replacement surgery and costs in a large health system in Washington State. Consistent with prior randomized trials, our introduction of decision aids was associated with 26 percent fewer hip replacement surgeries, 38 percent fewer knee replacements, and 12–21 percent lower costs over six months. These findings support the concept that patient decision aids for some health conditions, for which treatment decisions are highly sensitive to both patients’ and physicians’ preferences, may reduce rates of elective surgery and lower costs.”

Group Health says it has distributed more decision aids than any other single health care organization in the world. More than 25,000 Group Health patients have received decision aids, and is now distributing at the rate of about 900 more each month.

It should also be noted that 5 years ago, Washington passed the first state legislation recognizing the use of patient decision aids and “shared decision making” as a higher standard of informed consent.

The study was funded by the Commonwealth Fund. The implementation of decision aids was funded in part by the Informed Medical Decisions Foundation, which has been the sole supporter of this website for its entire existence.  However, no one at that Foundation influences what I publish on this site.  First author Dr. David Arterburn has also reviewed stories for HealthNewsReview.org.

Related Resources

• Comparing Medical Treatments – guides for a number of diseases/conditions(US Agency for Healthcare Research and Quality)
• MedlinePlus – search by disease/condition
• eMedicine Health – search by disease/condition
• MayoClinic.gov -Diseases and Conditions

[reblog]Journal editorials this week: the magic asterisk and transparency in clinical trials

From the 30 August 2012 blog posting at HealthNewsReview

Two journal editorials touching on different health care reform issues caught our eye.

Harold DeMonaco, MS, one of our story reviewers on HealthNewsReview.org, thought that an editorial in the New England Journal of Medicine by editor Jeffrey Drazen, MD, deserves some news attention.  DeMonaco wrote me:

“Over the past five years or so, there has been a gradual increase in the registration of clinical trials into a single database.  Although it would be nice to believe that the pharmaceutical industry has embraced the concept of transparency, it is more likely that the FDA Amendments Act of 2007 forced their hand.  Without registration of the clinical trial and reporting of the results, the FDA would not consider the data for submission for a New Drug Application.

As Dr. Drazen notes, there are some holes in the existing legislation.  Not all studies need be registered.  A newly introduced bill into the US House of Representatives would close the loopholes and provide ‘real transparency.’  There are always two sides to every story and the pharmaceutical industry has legitimate proprietary concerns that no doubt will be voiced loudly to members of the House and to the media.  It seems to me that this issue represents a wonderful opportunity for the media to inform and educate the public on this important piece of legislation for both sides on the issue.”

 

And in the JAMA Forum, David Cutler, PhD, of Harvard and the Institute of Medicine suggests that journalists and the public pay more attention to “the magic asterisk” in health policy discussions.