Category: Health Policy

Africa Vs. Big Tobacco

Lowering tobacco use has been one of the great successes of public health in the past 50 years, and continues to be a focus of research and intervention. This was achieved through policy and health communication. This journey has shown us that it is possible to change the culture and narrative around behavior, despite steady corporate influence. While tobacco is still a significant public health hurdle in the U.S., there is confidence in the direction we’re headed given what we’ve accomplished.

Unfortunately, tobacco companies are infiltrating other countries with less developed infrastructure for tackling this issue. Currently, low and middle income countries represent 80% of the world’s smokers, as well as smoking-related deaths. Africa in particular is falling victim to extremely powerful tobacco marketing campaigns – smoking prevalence in Lesotho rose from 15% to 52% just between 2004 and 2015, and the industry even manipulated public health policy in Nigeria. Big tobacco is no stranger to targeting advertising strategies to vulnerable groups.

In order to reverse this, we need to support strategies that African countries have already begun to administer. Ghana and Madagascar have implemented tobacco advertising bans; several nations have introduced graphic labels on cigarette packs; South Africa has increased tax on tobacco products; and Kenya has implemented a system for tracking and tracing illicit tobacco product sales.

Already having the knowledge of the danger of tobacco will hopefully help other countries prevent the industry’s hold from strengthening. We must support their efforts before it’s too late.

Medicaid Expansion and the Opioid Epidemic in the U.S.

As the United States continues to be embattled in an ongoing opioid overdose epidemic, new research is showing the benefits that Medicaid expansion has had under the Patient Protection and Affordable Care Act (ACA). According to a recent study out of the Center on Budget and Policy Priorities, the rate in which patients who were hospitalized due to opioid-related health issues, who were uninsured dropped in states that expanded Medicaid, from 13.4% in 2013 to 2.9% the following year. The same study also showed that Medicaid expansion had not contributed to the ongoing opioid crisis, showing that opioid-related hospitalizations were higher in states that expanded Medicaid three years before expansion occurred, and that the rates had been steady in expansion and non-expansion states. As we can see, Medicaid expansion has had a profound impact in reducing the rate of uninsured, and in the case of the ongoing Opioid epidemic, Medicaid plays a key and vital role in working to help curb the epidemic. For more information on this study from the Center on Budget and Policy Priorities, please check out the link below.


Center on Budget and Policy Priorities, Medicaid Expansion Dramatically Increased Covered for People with Opioid-Use Disorders, Latest Data Shows –

Corporate Social Responsibility

Customers are threatening companies with boycott if they do not end to their association with the National Rifle Association (NRA).

Lists of companies that offered NRA membership perks were shared on social media, and within 24 hours at least eight companies cut ties. Advocates for reform targeted companies on Twitter and Facebook to engage in this consumer activism—pressuring banks, rental car agencies, airlines, and insurers among others.

According to the Harvard Business Review, moral outrage needs to be the main impetus for a boycott to be successful. As Hannah put it in her post last week, “Each shooting seems to spark the same cycle of outcry among our nation with folks pressuring change from policymakers. Yet each time there is no change from the people in power.”

Are we in a political climate right now that views companies and corporations as more capable of social responsibility than our own legislators? Gun control is a polarizing issue. Companies that don’t cut ties (currently FedEx and Amazon are getting heat) may be boycotted by gun reform advocates, and companies that do cut ties may be boycotted by proponents of the NRA.

“Moral outrage” indeed.



Teens for Gun Reform Make Their White House Appearance

The events that occurred at Marjory Stoneman Douglas High School in Parkside, Florida last week have sparked the gun control debate yet again in the United States. To me the past week has felt a little like déjà vu: Sandy Hook, Route 91 Festival and Pulse nightclub shootings. Thinking even farther back to Columbine shooting in 1997 when a school shooting seemed unthinkable and how that has changed to be almost a predictable occurrence today. Each shooting seems to spark the same cycle of outcry among our nation with folks pressuring change from policymakers. Yet each time there is no change from the people in power. A few weeks go by and there is another story that captives our attention and it is pushed to the back of our minds until the next shooting occurs and the cycle begins again. However one group is attempting to stop this hopeless cycle: Teens for Gun Reform.

Teens for Gun Reform is a student run group that appeared in front of the White House on Monday. They prepared a “silent lie-in” demonstration of 17 members lying down for three minutes in the streets in front of the White House (the amount of time it took the gunman to take the lives of the students and teachers). Around a hundred students and other advocates rallied and protested following the demonstration. These students are standing up for what they believe needs to be changed since policymakers aren’t listening to anyone else. It’s their lives that are in danger and hopefully protests and pressures from this group will lead to change regarding gun control.

To learn more about this group and the protest visit the following sites:

Wearable Health: Who Benefits and Who is Left Out?

By Shazia Manji

There’s no denying the ubiquity of wearable health technology. The global wearables market is expected to grow by more than 15% this year alone, with projected sale of 310.4 million devices worldwide and $30.5 billion generated in revenue. These technologies generate real-time personalized data with the promise to improve individual health by helping to track, manage, incentivize, and improve healthy behaviors and decision making. As wearable tech finds success in the market, it’s important to consider where they can be most effective and where do they face barriers in impact. For example, a device such as a FitBit may be helpful in motivating an individual to make small changes to their diet when they have the necessary resources to make that happen. But what happens if you can’t afford a gym membership and you don’t feel safe running around your neighborhood at night? How well will these devices work for people who live in food swamps, neighborhoods or areas with many fast food and liquor stores but few places to buy healthy foods such as fresh fruits and vegetables?

The overall efficacy and effectiveness of wearable tech is still being determined. A 2015 study published in the Journal of the American Medical Association noted that while these kinds of tracking devices were increasing in popularity, there has been little evidence to show that they are successful in actually changing behavior. Still another suggested that wearables are more likely to be purchased by those who already live a relatively healthy lifestyle, and are less in use by those who might most benefit from a shift in physical activity, or by those with an existing and related health condition. Few studies or initiatives have looked at connecting these mobile health technologies with lower-income individuals in the US or at increasing their prevalence across socioeconomic status. This is largely in part because cost can be prohibitive for those at the lower end of the spectrum. Low-income populations are most at risk for diabetic complications, and may be less likely to have easy access to a physician, but the tools to help improve compliance and self-care have not been made with them in mind. The digital divide in healthcare technology is yet another example of how opportunities and resources for health are inequitably distributed. If we truly want to increase the effectiveness and relevance of wearable health tech, there needs to be a shift in their development and distribution.

A great first step to reducing the cost barrier would be working to get more health tech to be covered by insurers – and not just more robust private or employer-provided insurance plans, but by the insurance plans used by targeted populations, including Medicare and Medicaid. Tech companies could forge partnerships with community-based initiatives working to understand and shift the more structural barriers to health in low-income neighborhoods as part of potential multi-level interventions that go beyond individual behavior change. Wearable health tech used in research studies could combine the tracking technology with forms of interviewing or survey collection aimed at better understanding the barriers to behavior change in the most vulnerable populations, to help collect participant data that can in turn inform chronic disease prevention efforts. At the very least, developers could recognize that tech developed and marketed towards more affluent populations will differ from tech tailored for the most vulnerable.

Perhaps most importantly, I think it’s important to approach investment in and development of wearable health technologies with caution. Investment in digital health technologies is rising tremendously – but it’s crucial to understand who benefits from these technologies and who is left out, and then work proactively toward decreasing the digital divide. Investment in new tech should not trump investment in people and investment in improving the places and conditions in which people live, the conditions which shape and constrain quality of life and health behaviors.

Image: Koolme, Andri. “Fitbit Blaze activity tracker / wristwatch / smartband / smartwatch / smartphone.” 16 July 2016. Licensed under Creative Commons Attribution 2.0 Generic (CC BY 2.0). Accessed 31 Jan 2018.

Curbing Food Waste in Schools

Perhaps one of the best-known pieces of legislation that the Obama administration passed was the Health Hunger-Free Kids Act [1]. This set of laws which increased the number of children who were eligible for free and reduced lunch also modified the nutrition standards for meals served by schools that receive federal reimbursement for school lunches. The food requirements include providing whole grains, fruit, vegetable, protein, and dairy at every meal. There are also restrictions on trans fat, sugar and calorie content.

While this act has reduced the risk of hunger among vulnerable children and provided children with healthier options, it is not without scrutiny. In recent years, both this legislation and the National School Lunch Program have been criticized for their association with food waste. Many say that when children are forced to take standard food items, they may simply throw the foods they don’t like away. Some believe that the required fruits and vegetables that school meals must now include could end up in the trash. This issue could highlight challenges in our efforts to make school lunches healthier, but they could also highlight a larger issue in this country surrounding food waste.

In the US, it is estimated that 31% of all food is wasted. This applies to school lunches, grocery stores, etc. Food items are found in the trash due to spoilage before consumption, dislike for the products among many other reasons. According to new research from Ohio State University, the secret to reducing food waste could be eating at home and choosing your own food items.

Researchers from Ohio State University found that individuals waste less food when they eat at home. This could be due to increased control over food choices and the amount of food that makes it to their plates. This is not the case in restaurants and school environments where many foods and amounts served come standardized for everyone regardless of age, need, or personal preference.

Perhaps the key to reducing food waste and helping children eat healthier at school involves allowing them more interaction with food production processes at an early age. Children might be more likely to select fruits and vegetables if they have opportunities to see where their foods come from and see the adults they look up to eating them. While serving healthier lunch might be part of the solution to increasing obesity rates in our country, we must also teach children to make healthy choices. Only then will they have learned the necessary tools that will last into adulthood.

SNAPFresh Without the Fresh

This week the Trump administration released their proposed change to the longstanding SNAP (Supplemental Nutrition Assistance Program) which some would equate to delivery meal services such as HelloFresh, Blue Apron and Purple Carrot. These new delivery meal services have been tremendously popular and my first reaction was this might actually be a good idea. This type of service is more convenient and having groceries delivered without the hassle of going to a grocery store would be a nice perk for program shoppers. I further explored the details of this program and my mind quickly changed when I read about what was included in the boxes and more importantly what was not. These boxes would not contain fresh foods (milk, eggs, fruits and vegetables) and instead would provide canned fruits and vegetables and shelf milk. To be honest I had to do a quick web search to see what was actually shelf milk. Additionally, these Americans would have little to no say over what is included in the boxes versus the current program where they are issued a card and can purchase what they choose to at participating stores. While I could see benefit in this type of service as an OPTION for SNAP shoppers there is a lot of improvements that should be made before bringing this proposed idea into actual implementation particularly thinking about the foods included and would this truly be something that current SNAP shoppers find feasible and/or pragmatic.


Funding AMR Research Straight from the Source: Agriculture

By Raj Topiwala

Alexander Fleming’s discovery of Penicillin in 1928 is undoubtedly one of history’s crowning achievements in medicine. In the 89 years that have since followed, antibiotics have saved countless lives and reduced once fatal maladies to easily treatable diseases. However, with the list of antimicrobial resistant pathogens growing at an alarming rate, we risk soon encountering diseases that are resistant to every available method of treatment, regressing us back into the pre-antibiotic age (and its diminished life outcomes).

With that in mind, one would expect research and development (R&D) into antimicrobial resistance (AMR) to be a major objective in the pharmaceutical industry. However, it turns out that AMR innovation is a rather unattractive option for pharmaceutical firms. Because patents for new pharmaceuticals expire quickly, there is a narrow window of time for firms to make up the massive costs of R&D and turn a profit, a near-impossible task for new antibiotics. With the plethora of inexpensive generics already on the market, why would a consumer choose the new expensive antibiotic when they could get a generic for nearly free? To offset this lack of profitability, a prize-system that rewards new AMR innovation has been proposed. In searching for a way to fund the prize, I propose we focus our gaze on what is arguably the biggest contributor to AMR there is: the agriculture industry.

The largest consumer – and waster – of antibiotics is the agriculture industry. More drugs are used for animals that produce food than the people that eat them (CDC, 2013) and an estimated 75-90% of antibiotics used in feed is excreted from livestock completely unmetabolized (O’neil 2016). The industry is routinely exposing pathogens to antibiotics without killing them – directly fostering the development of drug resistance. Taxing this practice presents a win-win scenario for the health sector. If the industry opts to continue using antibiotics at such

a dangerous rate, the tax revenue generated would be more than sufficient to fund the prize. If instead, the industry responds to the tax by decreasing antibiotic use in feed, then an entirely different, but equally beneficial, victory in reducing the dangerous practice will have been achieved. On some level, it is fitting to have the very practices that are creating AMR enable to solving of it. Though the agriculture industry is clearly unequipped to “clean up their own mess” in this case, having them pay for the AMR prize comes in at a close second – one that is both feasible and effective.

Works Cited

CDC: Centers for Disease Control and Prevention. (2013). Antibiotic / Antimicrobial Resistance. Retrieved November 19, 2017, from

O’Neil, J. (May 2016). Tackling Drug-Resistant Infections Globally: Final Report and Recommendations. The Review on Antimicrobial Resistance.

STOP Act: Implementation and Effects on the Opioid Epidemic in North Carolina

The rise of the opioid epidemic nationwide has led to an increase of attention from both media and policy makers. Here in North Carolina, a recently passed policy is the Strengthen Opioid Misuse Prevention, or STOP Act, which aims to reduce the amount of Opioids prescribed a one approach to tackle the epidemic. The STOP Act was signed into law by Governor Roy Cooper on June 29, 2017, and since then its four stage implementation has been put into effect, which will continue until 2020.

The first step of implementation occurred almost immediately after the law’s passage, on July 1st 2017, requiring Physician Assistants (PAs) and Nurse Practitioners (NPs) to personally consult with a supervising physician. This applied to Pas and NPs at facilities that primarily engage in treating pain, and the prescription will, or is expected to, last longer than 30 days. Additionally, PAs and NPs have to consult with a supervising physician every 90 days for patients for are continuously prescribed opioids.  Providers are also required to provide information on the disposal of controlled substances, both written and orally, when a patient concludes a course of treatment. The second aspect, implemented on September 1st, 2017, requires that pharmacies report targeted prescriptions to the North Carolina Controlled Substance Reporting System within a day of the prescription is dispensed.

The most recent aspect of the STOP Act was implemented on January 1st, 2018, and limits the amount of opioids prescribed for acute pain. Practitioners are not able to prescribe more than five days’ worth of any Schedule II or III Opioid or Narcotic, with an exception to things like pain after surgery, where the prescription cannot for longer than seven days. The final part of the law will be implemented on January 1st, 2020, and will require practitioners to electronically prescribed targeted controlled substances, with a few exceptions.

While it is still unclear what impact the law will have on overdose deaths in the state, it appears that the State government is attempting to address this issue. While more resources could be devoted to mental health services, naloxone access and syringe exchanges, and more programs geared toward injecting drug users rather than only those who use prescription drugs, it’s commendable that a joint effort was reached to combat this ongoing epidemic.



New! Summary of NC’s new opioids law, the STOP Act: North Carolina Medical Board –

FAQs: The STOP Act of 2017: North Carolina Medical Board –

STOP Act Provision Takes Effect Jan. 1, Will Limit Opioid Prescriptions: NC Governor Roy Cooper –

STOP Act Bill Summary: North Carolina Medical Board –


Health Disparity in Alameda County

By Elleni Hailu

In Alameda county, African Americans have the lowest life expectancy, compared to all other racial groups [1]. This trend in adverse health outcomes is also correlated with income levels, as individuals with lower incomes have higher morbidity and mortality rates, not only in the U.S. but also everywhere in the world. Combined with biologic and behavioral factors, ensuring health care access can reduce health disparities. However, having access to a health care professional and adequate medical care is simply not enough for many individuals, as they are not able to follow through with their doctor’s recommendations to improve their health and to prevent adverse outcomes. This is because there are a number of underlying factors besides access to care that affect a person’s well being such as neighborhood effects (i.e. access to fresh produce and parks). Here in the Alameda county alone, 23% of the Black population lives in poverty, compared to 8% of White residents who live in poverty [1]. This gap in income is what affects the health status of many Americans and their ability to maintain their health. Hence, creating ways to ensure income equality, such as passing bills that encourage public and private sector partnerships to build more affordable housing, would be instrumental in promoting healthy living.


[1] Lee, T. (2017, September). Epidemiology as a Tool for Social Justice. Lecture presented at Seminar for MPH Students in UC Berkeley.