It's National Public Health Week!

We are halfway through National Public Health Week, which runs from April 5th-11th!! I thought I better get a quick post in to promote public health myself!

So what does Public Health do? Click here to find out!

Click here to view the Statement by Assistant Secretary for Health Howard Koh, MD, MPH.

Health Reform Makes History - What Does it Mean?

The House voted late Sunday March 21, 2010 (219-212 vote) in favor of sending the Health Reform Bill to President Obama. In addition, the House Democrats made some changes to the Senate's health reform bill (220-211 vote) which now goes back to the Senate. They must pass word-for-word reconciliation. As I post this blog entry, Obama is signing this long-awaited bill for the health of our nation.

32 million uninsured will now have health insurance. Excluded in this number are: illegal immigrants (who are also banned from purchasing in the health insurance exchanges), those eligible for Medicaid who won't enroll until they seek care, and those choosing to pay the fine instead of purchasing health insurance.

Here is a breakdown of (some of) what is included in this historical piece of health legislation.

Effective Immediately up to 6 Months From Now:
1) Insurers can't deny coverage to sick children (due to preexisting health conditions)
2) Free preventive care--screenings and preventive care must be excluded from annual deductibles on any new plans (all other plans affected in 2018)
3) No caps on lifetime benefits and restrictions on annual limits on coverage
4) Young adults allowed to stay on parent's insurance until the age 0f 26
5) Medicare Advantage (Medicare benefits delivered by private firms) gets cuts in spending in 2011
6) Children on Medicaid or state CHIP can't be dropped from now until 2019
7) Excise tax on tanning beds (10%)--"sin" tax
8) Individuals without coverage because of preexisting conditions can purchase it from high-risk pools (to be combined into exchanges in 2014)
9) Rebate of $250 for Medicare seniors in the "donut hole" for prescription drug benefits. First of incremental steps to close the hole (half-closed next year)

Effective in (or just prior to) 2014:

1) Individual Mandate--Everyone must purchase health insurance or pay annual fine of $95 (rises to $695 in 2016) unless they can prove financial hardship.

2) State health insurance exchanges--marketplace of insurance plans--goes into effect
3) Insurers can't deny coverage to adults with preexisting health conditions
4) Insurers required to cover maternity care same as medical procedures
5) Tax credits will start helping pay premiums for working families with incomes up to $88,000 per year
6) Medicaid expanded to cover more low-income people, up to 133% of federal poverty level
7) Medicare payroll tax increase of 1% for individuals making >$200k and couples making >$250k
8) New Medicare tax on unearned income of 3.8% (in 2013)
9) "Donut Hole" closing--Medicare Part D prescription drug coverage gap to be fully closed by 2020

Other items:

In 2018, "Cadillac health plans" are taxed 40% of value of the plan above thresholds (of $10,200 per individual or $27,500 per family)

The bill maintains longstanding federal funding restrictions (known as Hyde Amendment) on abortions. The exception would be in cases of rape or incest, or when the life of the woman would be endangered.

It is estimated by the nonpartisan Congressional Budget Office to cut federal deficits by $143 billion over the next decade. This bill is a landmark piece of legislation to improve the health of our nation's people. In my eyes, this is an incremental step (and focused on health insurance reform), but an amazing step nonetheless.

What are your thoughts about this this historical event, the passing of health reform?

Grass-Fed Beef: Health Effects for You And the Environment

The provocative documentary, Food, Inc., brings to light some of the environmental and ethical issues with the way we eat. One of the many issues in this Academy Award-nominated documentary, deals with is the farm industry. Cows raised in pastures are raised more humanely and are usually not given hormones or antibiotics. Additionally, the diet for grass-fed cows uses less fossil fuels than corn/soy-fed cows on a feedlot. Grass-fed cows do their own fertilizing and harvesting. Also, although grass-fed cows create more methane, they compensate in a number of ways. Most importantly, pastures reduce greenhouse gas through "carbon sequestration," or carbon capture and storage. They also use less fossil fuels in production and don't emit as much ammonia as feedlots do. The net result, as determined by the Institute for Environmental Research and Education (IERE) is a reduction in greenhouse gases for pastures and significant increases in greenhouse gases for feedlots. See more detail and other environmental benefits of grassfarming at EatWild.

A new report published this week by California researchers in Nutrition Journal shows that meat from grass-fed cows is nutritionally healthier for you too. The article discusses years have research which have shown that grass-fed diets can significantly increase the amount of cancer-fighting antioxidants, Vitamin A and E, and fatty acids in beef. Grass-fed beef is also lower in dietary cholesterol. In sum, grass-fed beef is healthier for your cardiovascular health and lowers your risk of diabetes and other health problems, like obesity as compared to corn/grain-fed cows. However, it's important to note two things. One, the omega-3 fatty acid levels in grass-fed beef are still much lower than in fish, especially salmon. Two, in order to reap the health benefits, you still need to ensure that you choose lean cuts of the beef. The Mayo Clinic has created a guide to the leanest cuts of beef.

For consumers, there are some other issues of interest here. Because the nutrient content is different between the types of beef, the taste is also different, tasting "grassier." Whether that is a good or bad thing is up to you. To read more about the taste difference, check out this article from the NY Times, "There's More to Like About Grass-Fed Beef." Additionally, the cost of grass-fed beef costs more, nearly 3x as much as grain-fed.

Grass-fed beef is sold primarily at local farms and online. If you're interested in purchasing grass-fed meats, EatWild, has a great State-by-State Directory of Farms. You can also take a look at Tallgrass Beef (Kansas), Burgundy Pasture Beef (Texas), and Hedgeapple Farm (Maryland). When shopping in regular grocery stores, be careful of the food labels. Oftentimes, the label will say "grass-fed" when the cows were only fed on grass for the first 6 or 12 months, then transferred to a feedlot. Check out Mother Earth's article, "The Label Says Grass-Fed, but is it?" for more information. As they suggest, the best label to look for is the American Grassfed Association (AGA).

Do you eat beef? If so, what type of beef do you eat? Are you more intrigued by the environmental or the health issues related to beef? Will this information change your behaviors?

Health Reform Passes. Now, The Real Work Begins.

Well, as I'm sure you're well aware, Health Reform has passed both Houses of Congress. The House of Representatives passed their version on November 7th, 2009 with a vote of 220-215. The Senate passed their version of the health care bill on December 24th, 2009 with a clear 60-39 party-line vote. A clear victory for health-reform advocates (and a nice Christmas gift for those advocates whom celebrate the holiday), the battle is far from over.

Step 1 of the battle was passing the bill. Step 2 now is compromising the two forms and agreeing on the bill's provisions, which is no small task. A number of provisions will be hammered out: 1) national versus state health exchanges (no more public option), 2) definition of, and possible taxing of, "Cadillac" health plans, and 3) how to pay for this health care overhaul. Democrats are focusing on some provisions appealing to all consumers, such as: 1) the cutoff age for children to be on their parents' health plan moved to 26, 2) eliminated co-payments for preventive services, and 3) no more denying coverage to children under the age of 18 with preexisting conditions. However, that doesn't mean Republicans are done fighting. As stated by Minority Leader Mitch McConnell (R-KY), "My colleagues [Republicans] and I will work to stop this bill from becoming law."

I think Adam Zyglis' (from the Buffalo News) Charlie Brown cartoon (above) says it all for our next steps. How far will the compromises go and what will our final version of health care reform look like? Will it be enough?

Health Efficiency

It's a fact. The United States is not a "leader" in health information technology. But we are trying to say "goodbye" to our old ways of paper records (see photo). We may be able to learn a lot of Denmark, a country that started using electronic health records (EHRs) a year ago. Telemedicine is also greatly utilized in Denmark (an example of Telemedicine can be found here). If the US wants to focus on efficiency in our health care system (we do), then perhaps we should follow our Scandinavian friends' example (Sweden and Norway are also using EHRs).

To quote the 2008 report by the Healthcare Information and Management Systems Society (HIMSS), "healthcare information technology (IT) is a sleeping giant." On top of that, healthcare IT is significantly behind most other sectors (e.g. banking and telecommunications). The report also mentions that Denmark was able to save roughly $120 million per year by using electronic medical records. The Commonwealth Fund will also be publishing a study later this month, which concludes the Danish information system is the most efficient in the world.

US policymakers are studying the Danish system and seeing if it is possible to follow their example as we overhaul our current healthcare system. Although it is used in some US hospitals and clinics, EHRs only exist in the minority of hospitals--about 10%, or about 17% of physicians use EHRs. Compatibility across and within systems needs significant improvement in the US though. However, last week, two large health systems and users of EHRs--Kaiser Permanente and the Department of Veterans' Affairs--announced communication is possible across the two systems (hooray!).

Of course, electronic health records (EHR) aren't without some concerns. Privacy is one of them. Even though the majority of physicians think EHRS will save time and money while improving patient care, many are still worried about possible security breaches. This is one area HIT policymakers will have to focus on while moving forward with the United States' journey to advanced HIT and EHR.

What do you think about the United States and its expanding role into electronic health records using health information technology? I must say that I, for one, am looking forward to the day that I do not have to fill out my prior medical history (AGAIN) at every doctor's appointment I ever make. Have it all in one electronic record would sure be nice.

Health Nuts & Pregnancy Nuts

Oh nuts. Many people don't fully appreciate all the health benefits we get from them. Nuts are excellent for our heart health by: lowering our LDL (bad) cholesterol, reducing risk of blood clots, and reducing risk of coronary heart disease. They do this by providing a Power 12 List: 1) Omega-3 Fatty Acids, 2) L-arginine, 3) Fiber, 4) Vitamin E, 5) Plant Sterols, 6) Unsaturated Fats, 7) Vitamin K, 8) Vitamin B6, 9) Folate, 10) Vegetable Protein, 11) Calcium, & 12) Magnesium.

In addition to heart health, nuts contribute to health in other ways. They can reduce your risk of diabetes, Parkinson's disease and dementia, macular degeneration, and improve your mood (e.g. walnuts improve serotonin levels in your brain, similar to antidepressant medications).

The best nuts: walnuts, hazlenuts, almonds, cashews, pistachios, pecans, and even peanuts (although not really a nut, but rather a legume). Also, the way in which you eat them matters. Raw or dry-roasted are the best ways and offer equal nutritional value. Oil-roasted nuts have more fat and calories. Try to avoid nuts made with salt--or at minimum, make sure sea salt instead of regular salt is used. If you are a food pyramid follower, nuts belong in the "meat" group.

The nut craze doesn't come without precaution. Please don't go nuts (pun intended) eating these, as just a handful is approximately 200 calories. Everything in moderation. The reason they are so calorically dense is because of nuts' high fat content. These fats are the healthy ones though, polyunsaturated and monounsaturated.

Pregnancy nuts: there is debate about whether consumption of peanuts and other nuts during pregnancy increases the risk that a child will develop a nut allergy or asthma OR conversely, exposure protects a child from developing an allergy or asthma. Be sure to read scientific sources of literature and look at the date of publication. A lot of press came out after the July 15, 2008 article I referenced above and here, but more recent science says the opposite. Be sure to consult with your physician on this.

*photo courtesy of nuthealth.org

Stop Typing, Start Talking

Take a look around you the next time you're in a mall, on the street, at the zoo or park, or anywhere where you can see a mother with her child. Is she talking to him/her or is she busy on the phone texting/emailing? Technology has its downfalls and teaching communication to our children could be one of them.

Infants learn speech by hearing it, so parents should be sure to talk to their children as much as possible. Identify objects, point out colors, animals, and expose them to a second language. Even if they aren't able to talk back to you yet, those babies are like little sponges, soaking up the information (well, it seeps in anyway). The point here is to try to stop the texts and emails on our Blackberries and iPhones and to remember to talk to your infants. Plus, you're enriching their cognition, and who doesn't want a smart kid?

This is also important, as we know that our ability to acquire new languages is best at very young ages and declines rapidly around puberty. See Steven Pinker's book, The Language Instinct, for more information on that. Also, read about Noam Chomsky, one of the fathers of linguistics. So, teach your children as much vocabulary as you can early and expose them to other languages early. Second-language exposure in junior high is too late for a child to be able to speak with phonetic "nativity."

Finally, to increase communication with your child, try teaching them sign language at a very young age, before they are able to talk. My sister-in-law did this with her children before they could communicate with her verbally and sure enough, the screaming outbursts of frustration were reduced, and the kids communicated more easily with her when wanting "more" or when they were "tired." Not only does communication then increase, but it's suggested they have an increase in cognition, early literacy, and spatial reasoning.

So, start talking to your kids and create some little Einsteins and Beethovens...or Chomskys.

Monkeys, Music, & Health Reform

Apologies for the absenteeism. Summer has been filled with passing my PhD Comps (hooray), traveling (e.g. Costa Rica & Panama), and working at AHRQ. No excuses really, but I give them nonetheless...

Here are some of my favorite recent stories from the Summer of 2009:

Eat Less and Live Longer. A team at the University of Wisconsin found that caloric restriction in monkeys was associated with reduced diabetes, cancer, and heart and brain disease. How did they do it? Reduce caloric restriction by 30%, and add a vitamin and mineral supplement to ensure adequate nutrition.

Internet Therapy. A recent study published in the Lancet says internet-based psychotherapy for depression works. Specifically, the used cognitive-behavioural therapy (CBT) in real time via the web. Will insurers pay for this type of therapy? Although recent trends say a push in therapy trends for depression is heavy on pharmacotherapy, psychotherapy may be more effective or less costly for those receiving treatment.

Pleasure from Music? Not for Depressed. It appears that the lack of interest and pleasure in depressed individuals is actually visible in neural brain activity. Functional magnetic resonance imaging (fMRI) shows that individuals with depression have less neural activity than non-depressed, even for simple activities like listening to music.

US Life Expectancy at All-Time High. The CDC's Center for Health Statistics revealed new mortality stats in their National Vital Stat Report. The United States life expectancy is now 78, all all-time national high (Japan, Australia, Italy, Canada all still live longer than us). Women are still living longer (life expec is 80.4 yrs) than mean (75.3 years), but the gap is narrowing. Deaths due to the 8/15 leading causes of death have dropped (e.g. flu, heart disease, stroke, diabetes), but raised for Alzheimer's, Parkinson's, and liver disease. Not to play devil's advocate to public health and prevention of disease (i.e. promotion of longer lives), but does prevention actually cost us more money in the long run?

Health Reform. Will it occur this year? Questions? Check the facts and falsities behind the bills and debates here.

5 Months Until Health Reform?

I took a quick look today at Kaiser Health News (KHN), the new nonprofit news organization devoted to health care policy and politics.  They just rolled out today, June 1st, 2009.  I added a quick link in my bookmarks also.  KHN will be a great, high-quality resource for stories on things like health reform, health care costs, insurance, aging, health IT, and quality and delivery of care issues.  I urge you to take a look.

Regarding the title of this post, "5 Months Until Health Reform?," an interview was done with White House health care czar, Nancy-Ann DeParle and she estimates that Obama will have a health reform bill on his desk by Thanksgiving.   DaPerle is asked about her thoughts on financing, and the answere appear unclear, although she does state her opinion that health reform will not be funded primarily with taxes and that a scaled back version of health reform (e.g. scaling uninsured number to half) is not an option right now.  Full reform is the focus.  Also see the KHN article, "Big, Small or Nothing At All? Three Scenarios For Health Reform."  

What are your thoughts on health reform?  What about Kaiser's new health news, KHN?

You can view the press releases for KHN here:  11-19-2008 and today's roll-out 6-1-2009.