The US is far behind peer nations in aligning policies with her public’s health. [Reblog]
The future of public health in the United States is difficult to predict, but the challenges public health has yet to overcome are much more certain. As Keck, Scutchfield, and Holsinger point out i…
Source: The US is far behind peer nations in aligning policies with her public’s health.
coding answers
From the 7 January 2015 Medical Economics article
The new year brings changes to many evaluation and management codes physicians use, including chronic care management and advanced planning
Poll finds US public sees ill health as resulting from a broad range of causes
Good study. However I would like to see how this compares with what researchers believe are causes/correlations of ill health and how best to address the causes/correlations.
From the 2 March 2015 Harvard School of Public Health press release
Many believe their health has been impacted by negative childhood experiences
A new NPR/Robert Wood Johnson Foundation/Harvard T.H. Chan School of Public Health poll finds that more than six in ten people living in the U.S. (62%) are concerned about their future health. Nearly four in ten (39%) said that they had one or more negative childhood experiences that they believe had a harmful impact on their adult health.
Causes of ill health
“When the public thinks about the causes of ill health, it’s not just about germs. They also see access to medical care, personal behavior, stress, andpollution as affecting health,” said Robert J. Blendon, Richard L. Menschel Professor of Health Policy and Political Analysis at Harvard T.H. Chan School of Public Health.
When given a list of 14 factors that might cause ill health, the top five causes cited by the public as extremely important are lack of access to high-quality medical care (42%), personal behavior (40%), viruses or bacteria (40%), high stress (37%), and exposure to air, water, or chemical pollution (35%).
Those rankings diverge, however, among ethnic groups.
…
Actions to improve health
Given the wide range of reasons given for why ill health occurs, it is not surprising that people in the U.S. have a very broad view of the actions that could be taken to improve people’s health. The top five things (from a list of 16) that the public believes would improve people’s health a great deal are: improving access to affordable healthy food (57%), reducing illegal drug use (54%), reducing air, water, or chemical pollution (52%), increasing access to high-quality health care (52%), and improving the economy and the availability of jobs (49%).
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[Press release] US needs harm-reduction approach to drug use, researcher says
US needs harm-reduction approach to drug use, researcher says
From the 14 January 2015 Rice University press release
Neill: Approach minimizes harm associated with drug use for the individual and society
HOUSTON – (Jan. 14, 2015) – The United States’ law-and-order approach to reducing the supply of drugs and punishing sellers and users has impeded the development of a public health model that views drug addiction as a disease that is preventable and treatable. A new policy paper from Rice University’s Baker Institute for Public Policy advocates that a harm-reduction approach would more effectively reduce the negative individual and societal consequences of drug use.
According to the paper’s author, Katharine Neill, the rate of federal inmates incarcerated for drug offenses hovered at just under 50 percent in 2011, and in 2013 the Obama administration’s budget asked for $25.6 billion to fight the drug war, $15 billion of which was directed toward law enforcement. In addition, by some estimates, state and local governments spend a combined total of $51 billion per year on drug-related law enforcement efforts, which suggests they have a lot to gain by investing in treatment options, Neill said.
“That law enforcement efforts continue to dominate drug policy highlights the need to reframe the discourse on drug use and addiction,” said Neill, the Baker Institute’s Alfred C. Glassell III Postdoctoral Fellow in Drug Policy. “While emphasizing the cost-saving benefits of treatment is important, this should be coupled with more public conversations focusing on drug addiction as a disease requiring medical treatment, not politically based solutions. Reframing the issue in this way should increase the likelihood that a public health approach to drug policy will be adopted for the long term.”
The paper, “Tough on Drugs: Law and Order Dominance and the Neglect of Public Health in U.S. Drug Policy,” is published in the journal World Medical and Health Policy.
Emphasizing harm reduction is a popular public health approach to drugs, Neill said. “A harm-reduction approach recognizes the permanence of drugs in society and, instead of trying to eradicate drug use, focuses on minimizing harm associated with drug use for the individual and society,” she said. “This encompasses a variety of objectives, including preventing individuals from using drugs, treating individuals who want to stop using drugs, preventing drug use where it increases the chances of negative outcomes such as driving while on drugs, and helping individuals who want to continue using drugs do so in a way that does not further compromise their health or the health of others.” This last objective is often achieved through needle-exchange programs intended to prevent the spread of HIV and hepatitis C and is more controversial than other policies, Neill said.
Harm reduction is multidimensional and can include contradictory objectives, she said. For example, some proponents wish to decriminalize drug use and focus on helping drug users get the resources they need for treatment or to continue to use drugs safely, while others accept the illegality of drug use so long as treatment is more available. Others argue that distinctions should be made between drugs according to the risks they pose to the user and society and that policy should be based on these distinctions. “Still, most advocates of harm reduction agree on some basic tenets, including the view that addiction is a disease requiring medical assistance, the desire to minimize risky behavior without requiring abstinence and the need to protect the public from the consequences of drug use, which includes punishing individuals who commit acts that harm others,” Neill said.
– See more at: http://news.rice.edu/2015/01/14/us-needs-harm-reduction-approach-to-drug-use-baker-institute-researcher-says/#sthash.2OCJoKRU.dpuf
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[Press release] Penn Medicine Bioethicists Call for Return to Asylums for Long-Term Psychiatric Care
Bioethicists call for return to asylums for long-term psychiatric care
From the 20 January 2015 Penn Medicine press release
JAMA Viewpoint Characterizes Current Model for Treating Mentally Ill as “Ethically Unacceptable and Financially Costly”
PHILADELPHIA — As the United States population has doubled since 1955, the number of inpatient psychiatric beds in the United States has been cut by nearly 95 percent to just 45,000, a wholly inadequate equation when considering that there are currently 10 million U.S. residents with serious mental illness. A new viewpoint in JAMA,written by Dominic Sisti, PhD, Andrea Segal, MS, and Ezekiel Emanuel, MD, PhD, of the department of Medical Ethics and Health Policy in the Perelman School of Medicine at theUniversity of Pennsylvania, looks at the evolution away from inpatient psychiatric beds, evaluates the current system for housing and treating the mentally ill, and then suggests a modern approach to institutionalized mental health care as a solution.
English: Pilgrim Psychiatric Center (Photo credit: Wikipedia)
“For the past 60 years or more, social, political and economic forces coalesced to move severely mentally ill patients out of psychiatric hospitals,” write the authors. They say the civil rights movement propelled deinstitutionalization, reports of hospital abuse offended public consciousness, and new drugs gave patients independence. In addition, economics and federal policies accelerated the transformation because outpatient therapy and drug treatment were less expensive than inpatient care, and the federal legislation like the Community Mental Health Centers Act and Medicaid led to states closing or limiting the size of so-called institutions for mental diseases.
However, the authors write, “deinstitutionalization has really been transinstitutionalization.” Some patients with chronic psychiatric diseases were moved to nursing homes or hospitals. Others became homeless, utilizing hospital emergency departments for both care and housing. But “most disturbingly, U.S. jails and prisons have become the nation’s largest mental health care facilities. Half of all inmates have a mental illness or substance abuse disorder; 15 percent of state inmates are diagnosed with a psychotic disorder.” According to the authors, “this results in a vicious cycle whereby mentally ill patients move between crisis hospitalization, homelessness and incarceration.”
Instead, the authors suggest that a better option for the severely and chronically mentally ill, and the most “financially sensible and morally appropriate way forward includes a return to psychiatric asylums that are safe, modern and humane.” They argue that the term ‘aslyum’ should be understood in its original sense — a place of safety, sanctuary and healing.
“Asylums are a necessary, but not sufficient component of a reformed spectrum of psychiatric services,” write the authors. Reforms need to expand the role of these institutions to address a full range of integrated psychiatric treatment services — from providing care to patients who cannot live alone or are a danger to themselves and others, to providing care to patients with milder forms of mental illness who can thrive with high-quality outpatient care. These fully-integrated, patient-centered facilities do exist in the U.S. today, but more are needed to provide 21st century care to patients with chronic, serious mental illness.
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[Press release] Equation helps identify global disparities in cancer screening and treatment | EurekAlert! Science News
From the 20 January 2015 press release
Disparities in cancer screening, incidence, treatment, and survival are worsening globally. In a new study on colorectal cancer, researchers found that the
Age-standardised death rates from Colon and rectum cancers by country (per 100,000 inhabitants). (Photo credit: Wikipedia)
mortality-to-incidence ratio (MIR) can help identify whether a country has a higher mortality than might be expected based on cancer incidence. Countries with lower-than-expected MIRs have strong national health systems characterized by formal colorectal cancer screening programs. Conversely, countries with higher-than-expected MIRs are more likely to lack such screening programs.
The findings suggest that the MIR has potential as an indicator of the long-term success of global cancer surveillance programs. “The MIR appears to be a promising method to help identify global populations at risk for screenable cancers. In this capacity, it is potentially a useful tool for monitoring an important cancer outcome that informs and improves health policy at a national and international level,” said Dr. Vasu Sunkara, lead author of the Cancerstudy. Senior author Dr. James Hébert, who had used the MIR previously at the state and national level within the US, added that the use of the MIR internationally opens new possibilities for testing the relationship between this important indicator of cancer outcome and characteristics of countries’ health care delivery systems.
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[News article]NerdWallet Health Study: Medical Debt Crisis Worsening Despite Policy Advances – Health
NerdWallet Health Study: Medical Debt Crisis Worsening Despite Policy Advances – Health.
From the 8 October 2014 article
Despite recent advances in health care policy, American households continue to struggle with medical debt, and it’s only getting worse. Americans are putting more of their take-home pay toward medical costs than ever before.
- NerdWallet Health has found that Americans pay three times more in third-party collections of medical debt each year than they pay for bank and credit card debt combined. In 2014, roughly one in five American adults will be contacted by a debt collection agency about medical bills, but they may be overpaying – NerdWallet found rampant hospital billing errors resulting in overcharges of up to 26%.
- NerdWallet found 63% of American adults indicate they have received medical bills that cost more than they expected. At the same time, 73% of consumers agree they could make better health decisions if they knew the cost of medical care before receiving it.
- Between 2010 and 2013, American households lost $2,300 in median income, but their health care expenses increased by $1,814.[1] Out-of-pocket spending is expected to accelerate to a 5.5% annual growth rate by 2023 – double the growth of real GDP.
In a follow-up to last year’s study that found medical debt is the largest cause of personal bankruptcy, NerdWallet Health investigated the mounting financial obstacles facing the American patient.
[News article] Corruption of health care delivery system? — ScienceDaily
Corruption of health care delivery system? — ScienceDaily.
From the 14 October 2014 article
he foundation of evidence-based research has eroded and the trend must be reversed so patients and clinicians can make wise shared decisions about their health, say Dartmouth researchers in the journal Circulation: Cardiovascular Quality and Outcomes.
Drs. Glyn Elwyn and Elliott Fisher of The Dartmouth Institute for Health Policy & Clinical Practice are authors of the report in which they highlight five major problems set against a backdrop of “obvious corruption.” There is a dearth of transparent research and a low quality of evidence synthesis. The difficulty of obtaining research funding for comparative effectiveness studies is directly related to the prominence of industry-supported trials: “finance dictates the activity.”
The pharmaceutical industry has influenced medical research in its favor by selective reporting, targeted educational efforts, and incentivizing prescriber behavior that influences how medicine is practiced, the researchers say. The pharmaceutical industry has also spent billions of dollars in direct-to-consumer advertising and has created new disease labels, so-called disease-mongering, and by promoting the use of drugs to address spurious predictions.
Another problem with such studies is publication bias, where results of trials that fail to demonstrate an effect remain unpublished, but trials where the results are demonstrated are quickly published and promoted.
…
English: Example of promotional “freebies” given to physicians by pharmaceutical companies (Photo credit: Wikipedia)
The authors offer possible solutions:
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Explore how changing nursing home culture affects care
From the 28 January 2014 article at Covering Health
Any journalist who covers nursing homes should check out this month’s special supplement in The Gerontologist, the Gerontological Society of America’s journal. It focuses on the two-decade long effort to change nursing home culture and many of the articles and studies raise important questions about whether enough progress has been shown.
English: Nursing Home in Goldthorn Hill. This area of Wolverhampton has a cluster of nursing homes. (Photo credit: Wikipedia)
For example, this study finds that nursing homes that are considered culture change adopters show a nearly 15 percent decrease in health-related survey deficiency citations relative to comparable nonadopting homes. This study looks at what is meant by nursing home culture change – the nature and scope of interventions, measurement, adherence and outcomes. Harvard health policy expert David Grabowski and colleagues take a closer look at some of the key innovators in nursing home care and what it might mean for health policy – particularly in light of the Affordable Care Act’s directive to provide more home and community-based care. Other articles look at the THRIVE study, mouth care, workplace practices, Medicaid reimbursement, and more policy implications.
Any of these studies — or several taken together — can serve as a jumping off point for local coverage. Are there nursing homes in your community that are doing things differently? Have any instituted policies or processes that show improvements in care coordination, outcomes, quality, or other key measures? Are there homes that are resisting change? Why? Which one(s) best exemplify person-centered care? How do these changes affect the workforce?
Nursing Home Compare from CMS provides the data behind complaints, violations, quality, and cost, among other metrics. This article in The Philadelphia Inquirer is a great example of interweaving research with personal narrative. Another approach might be to look at trends in the city, state, or region. How are nursing homes marketing themselves to consumers? To referral sources? Have their business models changed?
Experts on all sides have been talking about culture change for more than a decade. And in 2008, a Commonwealth Fund report explored culture change in nursing homes. Has the time finally come, for real?
Unfortunately, the articles referred to are subscription based only.
For information on how to get them for free or low cost, click here.
-
Transforming Nursing Home Culture: Evidence for Practice and Policy
- What Does the Evidence Really Say About Culture Change in Nursing Homes?
- A “Recipe” for Culture Change? Findings From the THRIVE Survey of Culture Change Adopters
- High-Performance Workplace Practices in Nursing Homes: An Economic Perspective
- Medicaid Capital Reimbursement Policy and Environmental Artifacts of Nursing Home Culture Change
- Building a State Coalition for Nursing Home Excellence
-
Implications for Policy: The Nursing Home as Least Restrictive Setting
Related articles
NYTimes: Rethinking Our ‘Rights’ to Dangerous Behaviors
Related articles (Presented for informational purposes only, a diversity of views)
“What we need,” Freudenberg said to me, “is to return to the public sector the right to set health policy and to limit corporations’ freedom to profit at the expense of public health.”
Bittman contributes to the ongoing discussion here at NobodyisFlyingthePlane about how certain industries deflect public discourse from what is best for our citizens to what makes the most profit, no matter the consequences.
The author he quotes poses a series of questions which get at the heart of the matter.
“Shouldn’t science and technology be used to improve human well-being, not to advance business goals that harm health?”
Similarly, we need to be asking not “Do junk food companies have the right to market to children?” but “Do children have the right to a healthy diet?”
Essentially its a PR game. Do we let whole industries spin how the conversation is framed or do we let the…
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Resources from the Association of Health Care Journalists
The Association of Health Care Journalists offers a wide range of resources – many of which are available exclusively to members.
AHCJ publications include our newsletter, HealthBeat, as well as several guides to covering specific aspects of health and health care.
Members share ideas and ask questions of fellow members on the AHCJ electronic mailing list. Tip sheets are prepared for our conferences and workshops, often offering sources and information about covering specific stories.
Contest entries are from the Awards for Excellence in Health Care Journalism, recognizing the best health reporting in print, broadcast and online media. We have links to past winners and information culled from questionnaires submitted with the entries about how each story was researched and written.
We include links to some recent reports and studies of interest to our membership, as well as links to Web sites relevant to health care.
Members and other journalists write articles specifically for AHCJ about how they have reported a story, issues that our members are likely to cover and other important topics.
- AHCJ Articles
- Tip Sheets
- Health Data
- HospitalInspections.org
- Covering Health blog
- Global Health Coverage
- AHCJ Reporting Guides
- AHCJ Publications
- Electronic Discussion List
- Webcasts
- Contest Entries
- Latest Reports/Studies
- Websites
- Health-related Newsletters
- Freelancer’s Corner
- Advanced Search
Health ReformRelated articles
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- Donor Dilemma receives national recognition (andrewcconte.wordpress.com)
The U.S. Health Disadvantage – Part 2: Possible Causes and Solutions
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.”
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 explore some of the social determinants of health that may explain this. Social determinants of health, as opposed to biological determinants (biology and genetics), describe the…
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The Guide to Community Preventive Services: What Works to Promote Health
The Guide to Community Preventive Services is a great resource for what methods and interventions work well to improve public health. It is geared towards public health officials, researchers, and policy makers. However, it is also a good aid for anyone looking for the best way(s) to address issues touching family members and friends. The information can be used to promote or advocate for changes in policies and laws at local or national levels. They can be used to positively influence changes for the better in schools, workplaces, public health departments, and more.
A good way to start is through the Topics link at the top of the page. It includes links to issues as asthma, cancer, diabetes, nutrition, obesity, vaccines, and violence. Each topic includes links to more information on the topic and related topics.
Many topics have summaries of recommendations and findings. For example the topic Diabetes includes recommendations for certain disease management programs but insufficient evidence for self management programs in school settings or worksites.
All information on the interventions for a specific topic (as violence, diabetes, alcoholism) is carefully reviewed through a standardized step by step process. systematic reviews. Each reviews includes summarized results of all related evidence. These unbiased evidence-based reviews are also called systematic reviews.
[Click here for a good explanation of the systematic review process]
Each topic in this community guide answer questions such as: c
- What interventions have and have not worked?
- In which populations and settings has the intervention worked or not worked?
- What might the intervention cost? What should I expect for my investment?
- Does the intervention lead to any other benefits or harms?
- What interventions need more research before we know if they work or not?
Click on these tabs at the top of the home page for additional information
- Use the community guide for an overview, listing of topics, and subscribing to email updates
- Methods for explanations of systematic and economic reviews
- Resources as
- Publications by and about this task force
- Slides to help tell others about this guide
- Outreach materials as a flyer, a bookmark and a table tent
- A glossary
- News and a comprehensive About Us sections
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- Systematic review / synthesis of qualitative evidence – issues (phtwitjc.wordpress.com)
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Nimble Medicine | The Health Care Blog
Nimble Medicine | The Health Care Blog
This is an interesting blog posting on business models (old) and technologies (new) in health care delivery.
The author writes on why this is not working.
Specifically the author is advocating decentralization of health care delivery to reduce costs and reduce time in treating people at the onset of health problems (before and during treatment).
The author does provide a disclaimer, he is employed by a health care technology company.
Still, an interesting view of what health care industry trends.
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New Thinking: Medical Hot Spots (Lowering Medical Costs by Giving Neediest Patients Better Care)
From the 2 August 2011 blog posting at Medical-Lee Speaking
Atul Gawande, associate professor of surgery and public health at Harvard and one of our most prolific contemporary physician-writers, adapts his New Yorker piece [full text of the article The Hotspotters] surveying innovative attempts to lower healthcare costs by better serving those patients with greatest need to a 13 minute PBS FRONTLINE report focused on one such program, the Camden Coalition of Healthcare Providers in Camden, New Jersey, led by Dr. Jeffrey Brenner, that is having unprecedented success.
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IOM Report: Government Should Consider Public Health Implications Of All Major Legislation
A new report by the Institute of Medicine (IOM) says that strong evidence indicates that policies beyond the health sector have substantial effects on people’s health, and recommends that all levels of U.S. government adopt a structured approach to considering the health effects of any major legislation or regulation.
Excerpts from the report brief
Good health is not merely the result of good medical care but the result of what we do as a society to create the conditions in which people can be healthy. Public policy can be one of the most effective approaches to protecting and improving the health of the population. Unlike the one-on-one care provided by clinicians, laws, regulations, and other policies can affect the health of millions. This makes “healthy” public policy particularly important in a time of scarce resources, because it can diminish or preclude the need for other, more costly and potentially less efficient interventions.
The IOM report addresses three categories of law and public policy pertinent to health:
1. Laws that establish the structure, function, and authority of government public health agencies at the federal, state, and local levels.
2. Statutes and other policies that are designed to achieve specific health objectives, for example, taxing tobacco products and requiring immunization for school entry.
3. Policies in other areas of government, such as education, transportation, land use planning, and agriculture, that have health effects. In this area, intersectoral strategies are necessary—non-health agencies can contribute to improving health by considering the health implications of their policies. vices as the standard of practice in public health.
The report makes recommendations in these areas
- Laws and policies should be updated to reflect current science, practice, socioeconomic conditions, and goals such as the CDC’s 10 essential public health services***
- Legal and policy tools should be more effectively used, including regulations, taxation, and modification of the environment (as bicycle paths).
- Inclusion of all health policy stakeholders should be encouraged to prevent unintended negative consequences of health policy and legislation. Examples includeThese stakeholders are potential allies in addressing related issues outside of the health sector, as housing, employment, and education arenas.
***From the US Centers for Disease Control and Prevention site
he Essential Public Health Services provide the fundamental framework for the NPHPSP instruments, by describing the public health activities that should be undertaken in all communities.
The Core Public Health Functions Steering Committee developed the framework for the Essential Services in 1994. This steering committee included representatives from US Public Health Service agencies and other major public health organizations.
The Essential Services provide a working definition of public health and a guiding framework for the responsibilities of local public health systems.
- Monitor health status to identify and solve community health problems.
- Diagnose and investigate health problems and health hazards in the community.
- Inform, educate, and empower people about health issues.
- Mobilize community partnerships and action to identify and solve health problems.
- Develop policies and plans that support individual and community health efforts.
- Enforce laws and regulations that protect health and ensure safety.
- Link people to needed personal health services and assure the provision of health care when otherwise unavailable.
- Assure competent public and personal health care workforce.
- Evaluate effectiveness, accessibility, and quality of personal and population-based health services.
- Research for new insights and innovative solutions to health problems.
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- A Seattle doctor speaks out on public health and paid sick leave (seattlehealthyworkforce.org)
About
This blog presents a sampling of health and medical news and resources for all. Selected articles and resources will hopefully be of general interest but will also encourage further reading through posted references and other links. Currently I am focusing on public health, basic and applied research and very broadly on disease and healthy lifestyle topics.
Several times a month I will post items on international and global health issues. My Peace Corps Liberia experience (1980-81) has formed me as a global citizen in many ways and has challenged me to think of health and other topics in a more holistic manner.
Do you have an informational question in the health/medical area?
Email me at jmflahiff@yahoo.com
I will reply within 48 hours.
This blog is a companion site to my Health and Medical News and Resources Web site with…
- Great places to start (locating health information)
- Links to help from others (as health care providers and support groups)
- Interactive tools (as health calculators and apps)
- Select related news sites and blogs
My professional work experience and education includes over 15 years experience as a medical librarian and a Master’s in Library Science. In my most recent position I enjoyed contributing to our library’s blog, performing in depth literature searches, and collaborating with faculty, staff, students, and the general public.
While I will never be be able to keep up with the universe of current health/medical news, I subscribe to the following to glean entries for this blog.
- Science Daily – Your source for the latest research news
- MedlinePlus email updates from the US National Institutes of Health
- Partners in Information Access for the Public Health Workforce – a collaboration of U.S. government agencies, public health organizations and health sciences libraries
- US Agency for Healthcare Research and Quality (AHRQ) news now with updates on the agency’s efforts to “improve the quality, safety, efficiency, and effectiveness of health care for all Americans”
- Research Buzz, “news about search engines, digital archives, online museums, databases, and other Internet information collections since 1998”
- Scout Report, a “weekly publication offering a selection of new and newly discovered Internet resources of interest to researchers and educators”
- KevinMD.com -“Social Media’s leading physician voice”
- EurekAlert-Medicine and Health
Health and Medical News and Resources 