Category Archives: Access and barriers to care
The American Heart Association (AHA) is working with dozens of state legislatures this year to develop laws that would add cardiopulmonary resuscitation (CPR) classes to middle or high school curricula. Nineteen states require in-school training for high school students, and more are expected to consider or implement the training in the next few years. In Virginia, for example, Gwyneth’s Law—named for a little girl who went into cardiac arrest and died waiting for an ambulance with no one with CPR training able to step forward to try to help—goes into effect in two years and makes CPR mandatory for high school graduation, unless students are specifically exempted.
The AHA says that by graduating young adults with the knowledge to perform CPR—now taught as a hands-only skill, with no mouth-to-mouth resuscitation so as to keep the emphasis on chest compressions—they can vastly reduce the number of Americans, currently 420,000, who die of cardiac arrest outside a hospital each year. The numbers are highest among Latinos and African-Americans, according to the AHA, largely because too many members of those communities have not been taught CPR. AHA surveys find that people who live in lower-income, African-American neighborhoods are 50 percent less likely to have CPR performed.
New AHA grants are helping fund the training in underserved areas. A 2013 study in Circulation: Cardiovascular Quality and Outcomes studied several underserved, high-risk neighborhoods to learn about CPR barriers. The researchers found that the biggest challenges for minorities in urban communities are cost (including child care and travel costs), fear and lack of information.
“Our continued research shows disparities exist in learning and performing CPR, and we are ready to move beyond documenting gaps to finding solutions to fix them,” said Dianne Atkins, MD, professor of Pediatrics at the University of Iowa. “School is a great equalizer, which is why CPR in schools is an integral part of the solution and will help increase bystander CPR across all communities and save more lives.”
The AHA has received funding from Ross, the national clothing store chain, for a program called CPR in Schools, which teaches hands-free CPR to seventh and eighth graders. As a way to increase training for minority students, AHA is partnering local Ross stores with nearby public schools where at least 50 percent of students receive free or reduced lunches.
- Read a NewPublicHealth story about a pilot kiosk CPR trainer to teach hands-free CPR in the Dallas/Fort Worth Airport. The pilot program will expand to other locations in 2015.
- Watch hands-only CPR training videos from the American Heart Association. Tip: First learn to hum “Staying Alive” by the Bee Gees. The beat is almost precisely the rhythm needed for effective CPR chest compressions.
Recommended Reading: Some Drugs—Especially Oncology Medicines—Have Been in Short Supply for Too Many Years
Health Affairs and the Robert Wood Johnson Foundation recently released an issue brief on the continuing shortages of certain drugs, most frequently injectable drugs for cancer treatment. According to the issue brief, there have been fewer reports of newly unavailable drugs in the last few years, but problems remain, forcing many patients to skip some treatments or sometimes opt for a less-effective drug. U.S. Food and Drug Administration (FDA) updates on drug shortages in just the first two weeks of September found sixteen injectable drugs in short supply, two of them new to the list.
Recent Government Accountability Office reports have found several reasons for the shortages, including:
- Difficulty acquiring raw materials
- Manufacturing problems
- A loss of drug products when factories are updated and modernized
- Low reimbursement by Medicare and other government payment programs
- FDA regulations that may slow down new drug approvals
The authors of the issue brief say that it is unlikely that Congress will act, and that the industry has and will make changes likely to help bolster some supplies. Also, thorough reviews such as the current issue brief help remind policymakers that some drug shortages remain.
Read the full issue brief.
A new Kaiser Health News (KHN) article describes the challenges of helping people who have never had health insurance sign up for coverage. The KHN profile looks at the Arab Community Center for Economic & Social Services (ACCESS) a nonprofit agency that is helping the large Arab-American population in Dearborn, Mich., sign up for coverage and access care.
The group has found that many of the people they are helping are immigrants who know little to nothing about health insurance concepts such as enrollment, copays and deductibles—an issue that also applies to millions of other people new to health insurance across the country. Immigrant and uninsured populations all over the country face cultural and language barriers to understanding and adopting U.S. insurance practices.
Ten million non-citizens living legally in the U.S. are expected to gain health insurance under the Affordable Care Act, according to KHN. The navigators at ACCESS are also trained to teach immigrants about free public health screenings for conditions such as breast cancer, which requires specialized training and conversations because of cultural stigmas associated with cancer.. At the ACCESS center in Dearborn, for example, women coming for free mammograms enter through an unmarked door.
Read the Kaiser Health News article.
- Kaiser Health News recently reported that, on average, premiums will decline in 16 major cities for the 2015 coverage year.
- Advertising for health insurance plans has already started across the country. Sign up for the 2015 coverage year begins October 15, 2014 and ends February 15, 2015, a period that is roughly three months shorter than last year’s enrollment period. Find information at healthcare.gov.
Recently NewPublicHealth shared an interview from AlleyWatch, a Silicon Valley technology blog about SenseHealth, a new medical technology firm that has created a text message platform that health care providers can use to communicate with patients. In May, SenseHealth was picked to be part of the New York Digital Health Accelerator, which gives up to $100,000 in funding to companies developing digital health solutions for patients and providers. The accelerator is run by the Partnership Fund for New York City and the New York eHealth Collaborative. SenseHealth engaged in a clinical trial last year that used the technology to help providers engage with patients who are Medicaid beneficiaries.
Health conditions supported by the SenseHealth platform range from diabetes to mental health diagnoses, while the messaging options include more than 20 customizable care plans, such as medicine or blood pressure monitoring reminders. There are also more than 1,000 supportive messages, such as a congratulatory text when a patient lets the provider know they’ve filled a prescription or completed lab work. The platform couples the content with a built-in algorithm that can sense when a user has logged information or responded to a provider, and providers are able to set specific messages for specific patients. Early assessments show that the technology has helped patient manage their conditions, with data showing more SenseHealth patients adhered to treatment plans and showed up for appointments than patients who didn’t receive the text program.
We received strong feedback on the post, including a question from a reader about whether Medicaid beneficiaries lose contact with their providers if they disconnect their cell phones or change their numbers, a common occurrence among low-income individuals who often have to prioritize monthly bills. To learn more about SenseHealth and its texting platform, NewPublicHealth recently spoke with the company’s CEO and founder, Stan Berkow.
NewPublicHealth: How did SenseHealth get its start?
Stan Berkow: We got started about two to two-and-a-half years ago. I met one of the other founders while I was working at the Columbia University Medical Center in New York City. We were both clinical trial coordinators and were seeing—first hand—the difficulties in getting participants in our studies to actually follow through on all the exercise and nutritional changes they needed to make in order to complete the research project. That led us to step back and look at the bigger health care picture and recognize the challenges for providers to help patients manage chronic conditions, and recognizing that there’s a huge time limitation on the providers. That pushed us toward finding a way through technology to help those providers help the patients they work with more effectively to prevent and manage chronic conditions.
It’s no secret that kids perform better in school when they are healthy and feel motivated to learn. But not all kids have access to the quality health care that can help them get healthy, stay healthy or treat any chronic health conditions they have. That’s where school-based health centers come in.
School-based health centers are partnerships between schools and community health organizations. They help students get the preventive care they need—including flu shots, annual physicals, dental exams, vision exams and mental health counseling—right where they spend most of their daytime hours: On school grounds. There are currently more than 2,000 school-based health centers across the country. Besides removing barriers to health care that many families face, school-based health centers help reduce inappropriate visits to emergency departments by up to 57 percent, research has found. They also help lower Medicaid expenditures, decrease student absences from school and do a better job of getting students with mental health issues the services they need.
Moreover, with growing recognition that health disparities affect academic achievement, school-based health clinics help close the gap by providing crucial access to health care for students who might not otherwise get it. A study by researchers at the University of Washington, Seattle, found that high school students who used school-based health centers experienced greater academic improvements over the course of five semesters than students who didn’t use these centers; the effect was especially pronounced among those who took advantage of mental-health services. Another study found that high school students who were moderate users of school-based health centers had a 33 percent lower dropout rate in an urban setting that has a high dropout rate.
The exact services offered by these centers vary by community. At Santa Maria High School in Santa Maria, Calif., the health center’s offerings include crisis intervention sessions; a grief group for students dealing with loss; and ongoing opportunities for students to build important social skills and skills that will help them maintain a healthy lifestyle. In Oakland, Calif., the Native American Health Center offered at a middle school and a high school provides medical care, dental care, mental health services and a peer health education program in one setting. At the Maranacook Health Center in central Maine, kids can get support for chronic health problems (such as asthma, diabetes, or seizures), medications they need, counseling or other mental-health evaluations and services.
The ultimate goal behind these centers is for all children to enjoy and benefit from good health and school success.
“Children and adolescents are at the heart of the mission,” said John Schlitt, president of the School-Based Health Alliance, based in Washington, D.C. But the “scope of the health center’s influence extends beyond the clinic walls to the entire school, its inhabitants, climate, curriculum, and policies. The school is transformed as a hub for community health improvement.”
The U.S. Department of Labor’s Office of Disability Employment Policy (ODEP) and the National Council on Disability (NCD) have established a virtual town hall conversation to examine the accessibility barriers of social media for individuals with disabilities. The town hall, which will continue through Friday, April 4, is the first in a series of three online events on the topic of social media accessibility that will take place over the next three months.
Social media is a critical tool for engaging customers, employees, jobseekers and stakeholders. When it is inaccessible to people with disabilities, a large portion of the population is excluded from important conversations. Advancing Accessibility and Inclusion in Social Media—The User Experience aims to identify the barriers to social media use and develop solutions to help ensure that all people can reap the benefits of social media and digital services.
Town hall participants are able to discuss personal social media experiences; submit comments and ideas; and vote on suggested solutions to accessibility barriers. Participants have shared feedback regarding a variety of social media platforms: Calling for captioning on government-produced Vine videos, seeking recommendations for using social media to find employment and suggesting increased accessibility training for social media developers. ODEP and NCD will use insights gleaned from the town halls to work with the social media industry to improve experiences for Americans with disabilities.
"We anticipate that this online discussion will present new and exciting opportunities for Americans with disabilities and people around the world,” said Janni Lehrer-Stein, chairperson of access and integration for NCD. “Social media opens up a new marketplace of ideas and access for everyone, including people with disabilities, adding value and providing new opportunities through inclusive engagement in the virtual world."
To participate, register at ODEP’s ePolicyWorks town hall and submit your feedback.
The fifth edition of the County Health Rankings, released today, continues to show that where we live matters to our health. The 2014 edition of the County Health Rankings finds that large gaps remain between the least healthy and the healthiest counties.
>>View the webcast of the 12:30 p.m. ET release of the new rankings here.
The County Health Rankings, first released in 2010, are a collaboration between the Robert Wood Johnson Foundation (RWJF) and the University Of Wisconsin Population Health Institute. They allow each state to see how its counties compare on 29 factors that impact health, including smoking, high school graduation rates, unemployment, physical inactivity and access to healthy foods.
“The Robert Wood Johnson Foundation’s vision for a culture of health is one where everyone has the opportunity to be healthy,” said Risa Lavizzo-Mourey, MD, RWJF president and CEO. “The County Health Rankings are a starting point for change, helping communities come together, identify priorities and create solutions that will help all in our diverse society live healthier lives now and for generations to come.”
This year’s County Health Rankings report shows some important trends, including:
- Teen birth rates have decreased about 25 percent since 2007.
- The rate of preventable hospital stays decreased about 20 percent from 2003 to 2011.
- Smoking rates dropped from 21 percent in 2005 to 18 percent in 2012.
- Completion of at least some college attendance increased slightly from 59 percent in 2005 to 64 percent in 2012.
This year’s report also features several new measures:
- Housing: Almost 1 in 5 households are overcrowded, pose a severe cost burden, or lack adequate facilities to cook, clean, or bathe. These problems are greatest on the East and West coasts, in Alaska, and in parts of the South.
- Transportation: More than three-quarters of workers drive to work alone and among them 33 percent drive longer than a half hour each way. Driving contributes to physical inactivity, obesity and air pollution.
- Food Environment: People in many parts of the country face food insecurity (or the threat of hunger) and limited access to healthy foods, especially in counties in the Southwest, across parts of the South and in the Western United States.
- Mental Health: Amid growing attention to mental health care, the availability of mental health providers in the healthiest counties in each state is 1.3 times higher than in the least healthy counties. The west and northeast regions of the country have the best access to mental health providers.
- Injury-Related Deaths: The third-leading cause of death in the United States, injury death rates are 1.7 times higher in the least healthy counties than in the healthiest counties. These rates are particularly high in the Southwest, part of the Northwest (including Alaska) and in the East South Central and Appalachian regions.
- Exercise Opportunities: Access to parks or recreational facilities in the healthiest counties is 1.4 times higher than in the least healthy counties.
“The County Health Rankings show us how health is influenced by our everyday surroundings—where we live, learn, work and play,” said Bridget Caitlin, PhD, MHSA, director of the County Health Rankings. “The County Health Rankings often provide the spark for business, community planners, policy-makers, public health, parents and others to work together for better health.”
- The County Health Rankings is part of the County Health Rankings & Roadmaps, which includes the Roadmaps to Health Action Center which provides local leaders with tools, guides and stories to help communities identify and implement solutions that make it easier for people to live healthy lives
- The County Health Rankings & Roadmaps also includes the annual RWJF Culture of Health Prize, which celebrates communities that are harnessing the collective power of leaders, partners and stakeholders to build cultures of health.
The 2014 RWJF Culture of Health Prize winners and the call for 2014-2015 prize applications will be announced in June at the Aspen Ideas Festival, Spotlight: Health.
A recent essay by columnist Nicholas Kristof of The New York Times looked at a critical problem faced by jails across the country, which often double as behavioral health treatment centers. For many inmates, mental health problems have been the significant factor in committing a crime, with some even purposely flouting the law in the hopes of getting into jail where they can get free treatment. As a result, the United States has a national inmate population where half of all male inmates and three quarters of all female inmates have a behavioral health condition.
Solutions are beginning to emerge, though critical problems remain. At a recent health initiatives forum convened by the National Association of Counties and held in San Diego, county health officials talked about the promise of the Affordable Care Act, which will allow jail health specialists to help enroll inmates in coverage in advance of their discharge to help continue care—behavioral and physical—outside of jail.
Read the full column here.
>>Bonus Link: Read NewPublicHealth’s coverage of the recent NACo Health Initiatives Forum.
It’s been more than forty years since a U.S. vice presidential candidate, Senator Thomas Eagleton, was forced to withdraw his name from the ticket after it was revealed he’d been treated for depression. Medical science and understanding have come a long way since then. Still, for many there is still a stigma surrounding mental illness—a stigma that can leave people, already hurting, feeling even more alone.
This is a clear and major public health issue which dramatically reduces the likelihood that someone with a mental health condition will seek out and have access to effective health care and social services. In fact, only 38 percent of U.S. adults with diagnosable mental illnesses receive the treatment they need. The numbers are even worse for children and adolescents, with less than 20 percent getting treatment.
September is Suicide Prevention Month and Sept. 10 is the 11th-annual World Suicide Prevention Day. This year’s theme is “Stigma: A Major Barrier for Suicide Prevention.” Suicide is one of the top ten leading causes of death in the United States—with more than 38,000 deaths each year—and many of those people suffered in silence rather than reaching out to loved ones and available avenues of help.
As part of the collective effort to combat this barrier to full and compassionate care, the American Psychiatric Association (APA) is working to raise awareness so that people with mental illnesses and substance use disorders can feel more confident in seeking treatment, just as anyone with most any other medical concern would be.
APA’s new Public Service Advertisements (PSAs) series, called “A Healthy Minds Minute,” features a number of celebrities and prominent figures calling for equal access to quality care and insurance coverage for people with mental illness and substance use disorders. Below is a video with Former Congressman Patrick Kennedy.
>>Watch the APA’s “A Healthy Minds Minute” online video series.
A recent Opinionator column in The New York Times by Nancy DiTomaso, vice dean for faculty and research at Rutgers Business School in New Jersey, suggests that some of the reason for the 13 percent unemployment rate among African-Americans—double the rate for whites—may stem from the fact that whites are more able to rely on their social networks for an edge when finding out about and applying for higher-wage jobs.
“Getting an inside edge by using help from family and friends is a powerful, hidden force driving inequality in the United States,” says DiTomaso, who adds that whites helping other whites is not the same as discrimination, and it is not illegal, “yet it may have a powerful effect on the access that African-Americans and other minorities have to good jobs, or even to the job market itself.”
Income—and lack of it—impact every aspect of health, from being able to afford safe housing to being able to purchase nutritious food to accessing high-quality healthcare. A study published in the British Medical Journal earlier this year found that there were nearly 40,000 extra hospital readmissions over a three-year period in states with the greatest income inequality.
NewPublicHealth illustrated the link between jobs and health in a recent infographic.
>> Read the post from The New York Times.