Category: Health Policy

An Unlikely Victory in Alabama

Something happened in Alabama this week that has not been seen for quite some time now. Doug Jones became the first Democrat elected to the Senate from Alabama in 25 years on Tuesday night when he beat the controversial Republican former judge Roy Moore. Despite multiple claims against Senator Moore building up over the past weeks he was still favored to remain Senator, thanks to the support of President Trump. However, the state of Alabama made sure its voice was heard.

Thankfully, a stage set to remain central to sexual misconduct has turned to a more empowering story of the power of voter turnout. Senator Doug Jones spoke to those in the state that felt underserved and under-respected, and in return won 95% of the African American voters in the state. While many people saw this election as a lose-lose situation, this is a great example of how elections can change when everyone shows up to the voting polls.

With a history of voter suppression throughout America, it is truly great to see a state empowered to show up at the polls like Alabama did in this election. Hopefully, it will serve as an example to other states of what can happen when everyone is able to participate in our Democracy.

What do you think played the biggest role in the voter turnout in Alabama?

Top 5 “Wins” for Health in 2017

2017 has been one for the books! Our country inaugurated a new president, two major hurricanes swept through the South, the first solar eclipse in a 100 years, the riots in Charlottesville, and most importantly the royal engagement of Prince Harry and Meghan Markle. In the health-related realm there were many notably scientific and policy advances that occurred this year. Here is my top 5 list of these occurrences.

  1. US Federal Court requires tobacco companies to put out corrective statements about harmful health effects of smoking as a consequence for misleading the public about this through advertisements
  2. First diagnosis of CTE in an alive patient (traumatic brain injury typically seen in football players)
  3. First baby born from a uterus transplant
  4. Development of a digital ingestion tracking system. This is a new technology with the ability to monitor drug adherence after the pill has been taken
  5. Decrease in daily consumption of sugary beverages consumed by Americans since 2014

There were many more significant health-related achievements over this year. What is your top 5 list?

 

References:

https://www.nytimes.com/2017/11/14/health/soda-pop-sugary-drinks.html?rref=collection%2Fsectioncollection%2Fhealth&action=click&contentCollection=health&region=stream&module=stream_unit&version=search&contentPlacement=2&pgtype=sectionfront

 

http://abcnews.go.com/US/nfl-player-confirmed-1st-diagnosis-cte-living-patient/story?id=51181721

 

https://www.cbsnews.com/news/first-baby-born-from-a-uterus-transplant-in-the-u-s-delivered-in-texas/

 

http://www.cnn.com/2017/11/14/health/fda-digital-pill-abilify/index.html

 

https://www.tobaccofreekids.org/media/2017/corrective-statements

Health Disparity and Health Difference

The difference between health disparities and health differences lies in inequity and injustice. We might see differences in mobility between elderly individuals and teenagers as a normal difference in age, not related to ageism, though certainly elderly individuals face issues of ageism. However, differences in mortality rates between people of different social classes can be directly related to social and economic inequity. Hence, a health disparity is a health difference that results from inequity and injustice.

Returning to my example of HIV, PrEP, and queer men, we know that queer men have been identified as a high risk group for HIV, which is why targeting PrEP and other interventions at queer men is so important for public health interventions and control of the epidemic. However, we also know that HIV/AIDS was originally considered to be a “gay disease” and limited action was taken at the original outbreak because of the social undesirable position of queer men. This social inequity based on sexuality was stronger at the outbreak of AIDS, but it still persists today. The combination of HIV stigma, poor sexual health education (for everyone, but also specifically for queer individuals), and lacking health care for queer individuals (health care providers are uncomfortable asking about sexual history, don’t ask about sexuality, don’t take necessary precautions, aren’t aware of health needs of queer individuals, etc) directly results in a health disparity resulting in higher rates of HIV among queer men, especially black queer men.

However, public health interventions that continue to target queer men for behavior change seem to push the blame of this health disparity and social inequity on those facing inequity, rather than targeting the providers who are unprepared and improperly educated to effectively care for queer men. We know that providers are less likely to prescribed PrEP to black queer men, compounding on social inequity based on sexuality to add race. This stems directly from racial and gender stereotypes that influence providers and limit their ability to appropriately care for black queer men (Calebrese et al, 2014; 2017). Nonetheless, public health interventions exacerbate the disparity by focusing on queer men adopting different health behaviors instead of educating health care providers and sexual health educators to provide better care for queer men. The root is structural, rather than individual, and ignoring the structural inequity continues to harm queer men, especially black queer men.

Pop Up Museums: Public Health Edition

Pop ups are the newest trend today whether it’s a Game of Thrones bar in Washington D.C. or a boutique clothing pop-up in Chapel Hill. Now the pop-up concept has entered the public health realm in the form of pop up museums. This month in London, there is a pop up museum all about global drug policy. The Museum of Drug Policy is a free museum located in the heart of London that is only open for three days. This exhibit has been featured in other cities such as Montreal and New York City in accordance with the UN Assembly and the Harm Reduction Conference. The museum exhibit is a cultural focus on how drug policies impact local communities and the harmful side effects of these policies. The exhibit has a global focus and will transform you to different parts of the world to understand how drug policies differ based on region and country in the world. While many museums/exhibits leave you feeling negative and powerless, this exhibit is different in terms of learning about new approaches to address this problem that would eliminate the community problems and be more mindful to human rights. London

If you are in the London area this week, check out this exhibit and hopefully we will begin to see this exhibit in future cities and other similar exhibits like this!

Pssht.. it’s time to enroll

It’s November, so you know what that means. Enrollment is now open on HealthCare.gov to sign up for health insurance for 2018. Former President Barack Obama took to Twitter yesterday to promote the Affordable Care Act (ACA) and encouraged Americans to shop around for health insurance.

The enrollment period is only 6 weeks long so there is no time to procrastinate! Okay, you can procrastinate a little bit, take some time to explore the various options on HealthCare.gov, sleep on it, and then take action! There has been a lot of work put into the website to ensure it is as easy to use as possible.

With the scrutiny that has been placed on the ACA by the Trump Administration I was happy to see Barack Obama again spreading word to us Americans about the importance of getting healthcare insurance. This action by the former President is likely due to Trump cutting the advertising budget for the ACA by 90%.

If you haven’t seen the video yet (it’s only 2 mins) hop over to Twitter and check it out. In case you didn’t know, his Twitter handle is @BarackObama and he only tweets high-quality tweets, so he’s worth the follow. Then after you watch it, hop on over to HealthCare.gov and see which plan is best for you!

Health Literacy: The final healthcare barrier?

How can health professionals support and serve our most vulnerable populations? When discussing access to health care, income and location are generally agreed upon barriers to access. Populations who live just above the poverty line often do not qualify for government assistance; however, without it, they often cannot afford coverage. Similarly, populations that live in rural areas often have less lack access to health services. One barrier that accompanies these and is often overlooked is health literacy.

Literacy is not only an education issue it affects access to healthcare as well. When populations have difficulty reading, they may misunderstand health brochures or worse take medication incorrectly. According to Kelly Warnock, Program Manager at the Durham County Health Department, health professionals have a responsibility to reach populations where they are. After working for over 10 years with lower-income, low literacy populations, Ms. Warnock believes that it is possible to increase all communities’ access to healthcare and health information. For health professionals, that means being creative with communication techniques organizing information clearly, using visuals, and non-technical language. If you’re interested in learning more about health literacy and communication, check out this resource from the Food Research and Action Center.

Photo: https://communicatehealth.com/2014/07/frequently-asked-question-can-i-measure-a-patients-health-literacy/

President Trump Declares an Emergency

The opioid crisis is now a National Public Health Emergency under federal law.

For those on the front lines of the opioid epidemic this is great news, but what exactly does it mean? While there is no quick fix to an epidemic of this proportion, the announcement made Thursday by President Trump will make the lives easier for those who have been battling the epidemic.

Trump, through the Public Health Services Act, directed his acting secretary of health and human services to declare a national health emergency, a designation that will not automatically be followed by additional federal funding for the crisis. Instead, the order will expand access to telemedicine in rural areas, instruct agencies to curb bureaucratic delays for dispensing grant money and shift some federal grants towards combating the crisis.

Overall, this is a win for Public Health and the families and communities that have been affected by the opioid epidemic. It is important to note that since the government is not simply throwing funds to states efforts to combat opioids need to be used strategically and effectively. There is still concern this announcement will be used to boost the production of life-saving antidotes only and ignore the need for addiction treatment for those still abusing opioids.

Only time will tell if we as a Nation respond correctly to this emergency, but this is a promising first step to ending the opioid epidemic.

Are You Healthy? (Part 2)

Previously, I discussed changes to our model of health due to randomized control trials and the pharmaceutical industry, as discussed in Joseph Dumit’s Drugs for Life. Here are the three primary models of health as discussed by Donald A. Barr in his book Health Disparities in the United States: Social Class, Race, Ethnicity, & Health. 

The first model is the medical model or physical health model that focuses on the absence of symptoms or other signs of disease or illness. However, Barr mentions several issues with this model of health, noting “that this approach to defining health tells us what the concept of health is not. . .It does not tell us what health is” (2014, pp. 15). He expands on this later:

“What are we to make of a condition that has no abnormal symptoms? An important example of this is high blood pressure, also referred to as hypertension; persons with hypertension develop symptoms only after a number of years. Should we consider a person with somewhat elevated blood pressure to be unhealthy based on our knowledge that his blood pressure will eventually lead to further problems? What might be the consequences of labeling such a person as ‘unhealthy,’ even if he feels fine?” (Barr, 2014, p. 16)

These are the questions that Joe Dumit attempts to answer, looking beyond hypertension to guidelines about pre-hypertension and the prescriptions of statins with no understanding of when patients can stop taking them.

The second model is the sociocultural model or the model of health as functioning at a normal level. Barr looks at it in contrast to the medical model, which looks at absence, because the sociocultural model looks at the presence of an ability to function at a level that has been deemed normal (2014, p. 17). The ability to functional normally is defined in regards to one’s ability to completed five “activities of daily living (ADLs),” which are roughly, (1) eating, (2) bathing, (3) dressing, (4) using the bathroom, and (5) moving on one’s own (2014, p. 17). Of course, the entire premise of “normal functioning” is subjectively predicated on societal ideas of self-sufficiency that might vary from culture to culture or community to community.

The third model is the psychological model or the model of health as a feeling of well-being. In this model, individuals are able to assess themselves and their own health with the help of several developed measures (Barr, 2014, p. 18). However, Barr notes that these tests are often “time-specific” (Barr, 2014, p. 18). I would argue that health is always time specific and temporal. I may be healthy today, but I can quickly develop a health problem or injure myself, perhaps even resulting in a temporary or life-long disability, reaffirming the temporality of both health and disability.

According to Barr, these models can be combined to create a multidimensional model of health that presents a better picture of the health of an individual.

CHIP in or out?

When it comes to healthcare coverage in the US….well, let’s just say it hasn’t had a historically smooth path. Among the political debates have been to whom the government should provide aid, how much, and how for how long…but everyone agrees that children should be have health insurance. Politically speaking, they are an easy group to support.

CHIP, The Children’s Health Insurance Program, was  created in 1997 as part of the Balance Budget Act of 1997. By 2000, every state had enrolled in CHIP-financed coverage. The cost of the program is split between states and the federal government via a formula called the Medicaid Federal Medical Assistance Percentage. But the split is actually more 71-29ish than 50-50, as Congress had also enhanced funding to match 15% more than what a state would cover–basically giving states a bigger incentive to enroll in the program.

Funding for CHIP expired on September 30th. The Affordable Care Act extended CHIP and further enhanced the federal matching rate, which should have continued through September 2019. Many states relied on this in their budgeting, and will face huge shortage if Congress does not extend federal funding.While Congress tries to pass legislation to rescue the program, states like Minnesota and Utah have already applied for emergency funding, and 27 additional states are expected to need more funds by March.

Legislation went through the Senate earlier today, but financial negotiations will need to be sorted across party lines before the vote can pass in the House.

Kaiser Health News  is a reliable source to stay up-to-date on the progress of the bill. It’s unlikely that a final decision will be made before the end of this month, but the bottom line is–nearly 9 million children’s insurance status depends on a successful resolution of this bill.

Trans Youth, Ethics, & Access to Healthcare

There are four primary principles for ethical decision-making in health care (respect for autonomy, 2. justice, beneficence, and non-maleficence); however, these four principles do not necessarily yield the most beneficial results for trans youth or bodies that exist in contradistinction to state controlled modes of life. Medical practice is able to manage the modes of life for trans youth, relying on non-maleficence and a paternalistic notion of future expectations to continually withhold medical intervention.

The duality of beneficence and non-maleficence has often been presented as the double effect, where a single action may have both positive and negative effects that must be weighed against one another (Veach, 2007). A common example is when providing morphine to a dying patient. The patient’s suffering will be limited, causing a beneficial effect; however, the morphine simultaneously slows the respiratory system, causing the patient to die more quickly, the harmful double effect.

In the case of trans youth, this double effect is often used as a way to withhold hormone treatment or other medical intervention because the state and the medical institution see the greater harm if trans youth “change their minds” about their gender. Further, medical professionals discuss the potential harms within a framework of compulsory reproduction. The harm of hormones is seen as an inability to reproduce later in life, which maintains the assumption that biology is destiny (Adkins, 2017).

As we approach these ethical issues, there are difficult power dynamics inherent in the biopolitical state that limits what modes of living are seen as livable. For instance, an inability to reproduce is seen as unlivable or unruly. To provide better care for trans youth, we need to deconstruct current notions about the lack of autonomy for young people broadly, and especially for trans youth.

Adkins, Deanna (2017). “Transgender medicine: A wealth of ethical dilemmas.” Presentation.

Veatch, Robert M. (2007) “How many principles for bioethics?” In R. Ashcroft, A. Dawson, H. Draper, and J. McMillan (Eds.) Principles of Health Care Ethics, Second Edition. Chichester: John Wiley & Sons.