Archive for March, 2016

A Patient Navigator’s Support for the New York State Breast Cancer Initiative’s 4-Hour Leave for Breast Cancer Screening

March 8, 2016

Breast cancer is the most common cancer among women in New York State,[1] and mammography has been shown to be effective at detecting tumors at earlier stages of development than clinical breast exam.[2]

breastcancer_stat_paperworkSource: https://www.ny.gov/programs/new-york-state-breast-cancer-programs

 

All eligible New York State public employees are currently entitled to one annual 4-hour leave from work in order to undergo mammography for early detection of breast cancer. Governor Cuomo wants to expand this policy to cover the private sector, so that all New Yorkers will have the right to life-saving screening without putting their employment status in jeopardy.

As a patient navigator in a cancer center in East Harlem, I believe that this policy will be instrumental in saving lives. Many of the patients we see would be classified as “working poor” – despite often holding two jobs and working constantly, they still live in a state of poverty. Even one day’s lost wages could upset the extremely delicate balance they live and cast them into a state of catastrophe. As a result, many people will often choose the work they need to put food on the table over getting a screening that has little apparent immediate benefit. Unfortunately, this often results in the women who do develop breast cancer only finding out they have the disease at a later stage, making it much more difficult to treat.

Numerous private sector businesses, including M&T Bank and Amneal Pharmaceuticals, have indicated their support for the policy. This is not to say that everyone is on board – there are those organizations[3] who believe that even the state employees’ guaranteed leave for screening is s superfluous use of New York State citizens’ tax dollars. I, however, would disagree – increased screening coverage would not only save lives, but it would also save the state money in the long run. Treating late stage breast cancer is extremely expensive compared to early stage cancer. Since screening should ensure that most breast cancers are caught and treated early, this will reduce the burden on the economy,[4] and especially on the state’s budget by reducing costs for Medicaid and Medicare Services, which insure a great deal of the people who would benefit from the new policy.

References

[1] https://www.ny.gov/new-york-state-breast-cancer-programs/new-york-state-breast-cancer-services

[2] http://www.cancer.org/healthy/toolsandcalculators/remind-me?_ga=1.268218890.549704867.1457131056

[3] http://www.stopthetaxshift.org/employee-relations/29-paid-leave-for-cancer-screenings-

[4] Mandelblatt, Jeanne, Harold Freeman, Deidre Winczewski, Kate Cagney, Sterling Williams, Reynold Trowers, Jian Tang, and Jon Kerner. “Implementation of a Breast and Cervical Cancer Screening Program in a Public Hospital Emergency Department.” Annals of Emergency Medicine 28, no. 5 (November 1996): 493–98. doi:10.1016/S0196-0644(96)70111-7.

 

Advertisements

The Case for a Carbon Tax

March 4, 2016

As people start to come to terms with the serious health impacts of climate change, there is a strong push for climate change mitigation through policy. The carbon tax is one such policy intervention that holds promise for reducing the amount of greenhouse gases in Earth’s atmosphere by putting a direct price on carbon. By putting a price on carbon, we can improve the economy, reduce health impacts from global warming, and reduce pollution that results in global warming.

scientists-clues-print

Effects of  global warming (courtesy of the EPA)

climate_change_health_impacts600w.jpg

Health Impacts courtesy of the CDC

A federal carbon tax in the US would put a price on each tonne of CO2 emitted and provide financial incentives to businesses, governments, communities, and individuals to use less carbon, and a financial penalty for those who use more. The tax would include hidden carbon costs of a service or product (e.g. transportation costs) as well as direct costs involved in production or service delivery.

Many other countries already have a version of a carbon tax in place, including British Columbia, Chile, Costa Rica, Denmark, Finland, France, Iceland, Ireland, Japan, Mexico, Norway, South Africa, Sweden, Switzerland, and the United Kingdom. Now it is time for the US to become a leader in the climate change fight and join the rest of the world to reduce our carbon emissions!

While groups such as the Citizens’ Climate Lobby, Physicians for Social Responsibility, the US Environmental Protection Agency, and even oil and gas companies such as Exxon Mobil  have come out in support of taxing carbon, there are still some groups who are against it, such as many individuals and business with ties to the oil, coal, and gas sectors; as they stand to pay more penalties for producing carbon-based products. Some organizations; such as the Union for Concerned Scientists, are against the tax- not because they think it is a bad idea, but because they support the idea of a cap and trade system (where there is a mandatory limit on emissions, but businesses can have flexibility about how they comply) instead.

Climate change has been highly polarized in US politics with many conservatives arguing against the tax while many liberals support the tax, but even some conservatives such as Jerry Taylor (Libertarian) advocate for the tax and give strong arguments for  conservative support (read it here). Currently, there is a proposal to pass a carbon tax in Washington, making it the first state to adopt a carbon tax. Although opponents claim that a carbon tax may hurt the economy, this has not been shown to be the case in countries that have already adopted a carbon tax. For example, British Columbia has used the revenue from the carbon tax to help strengthen their economy. As you can see below, petrol sales also have gone down since the tax was introduced in 2008.

chart-2-sales-of-refined-petroleum-producs-per-capita-in-bc-and-canada

 

If you want to show your support for the carbon tax:

  • Vote for representatives who support the carbon tax and other related climate change policies
  • Support organizations who show support for the tax
  • If your state happens to draft carbon tax legislation, call your congressperson or start a petition to show your support
  • Let others know about why this issue is important

Together we can make a difference and make our voices heard!

your-vote-counts.jpg

 

 

 

The Mental Health Reform Act

March 4, 2016

Mental health policy and advocacy has come a long way since the days of asylums, padded rooms and shackles in the 1900’s. Though we have made great progress in the services and care provided to individuals with mental disorders and their families, we still have work to do; here at home and around the world.

The mental health burden is the USA is high. Nearly 1 in 5 adults experiences a mental illness in any given year, this equates to approximately 43 million Americans. Of all the mental health disorders, major depressive disorder carries the heaviest burden, accounting for approximately 3.7% of all US disability adjusted life years (DALYs). The biggest  flaw in US health care is the inadequacy of mental health care and services, with approximately 5.1 million adults having unmet mental health care needs. Mental disorders may not be curable but they are treatable and with consistent case management and initiation of mental health care in the primary setting, mental illnesses can be effectively controlled and highly prevented.

Currently, many mental health issues have been at the forefront of policy maker agendas. One of particular interest is the Mental Health Reform Act. The act calls for the following: (1) integration of mental health into primary care, designating an Assistant Secretary for Mental Health, (2) development of an Interagency Mental Illness Coordinating Committee, (3) establishment of grant programs for early intervention and (4)  strengthening services within Medicare/ Medicaid. To date, the bill is being considered in Congress and has many influential organizations in favor of it, including: NAMI, who states “As the nation’s largest organization representing people living with serious mental illness and their families, NAMI is proud to offer our support.”

By providing much needed infrastructure for the diagnosis and management of mental illness, the Mental Health Reform act will finally give millions of struggling Americans the opportunity to live their lives free from the shadow of undiagnosed and untreated mental health issues.

Capitol Storm

UNITED STATES – JULY 30: A severe thunderstorm passes over the U.S. Capitol on Thursday, July 30, 2015. (Photo By Bill Clark/CQ Roll Call)

Menu Labeling: Positive for Consumers and Industry

March 4, 2016
chipotlemenu05182015getty-1

Photo credit: Getty Images

In 2010, President Obama signed the Affordable Care Act. Part of this law, was the Nutrition Labeling of Standard Menu Items which required calorie information on menus. Restaurants that are covered must: “(1) be part of a chain of 20 or more locations, (2) doing business under the same name, (3) offering for sale substantially the same menu items”(FDA). The final rules also covered establishments that sell “restaurant-type food”, such as prepared foods at grocery stores and movie theaters, which was met with hostility.

Why would this rule need to be made in the first place? Some estimates place say that Americans eat as much as 43% of their food outside the home. The reality is that more food is being eaten outside the home, and Americans continue to be  overweight or obese.

While it’s impossible to say that these two are directly related, FDA feels that consumers should have access to information about food they are eating, so they can make more informed decisions, such as consuming less calories. They are not alone. The American Heart Association emphasizes the importance of helping consumers make better choices, and the Academy of Nutrition and Dietetics says the law will help consumers “make informed, healthful choices” when eating outside the home.

FDA-Menu-Labeling-Infographic

Photo credit: FDA

From an industry standpoint, the law is helpful. Many states and local governments responded to obesity by passing labeling laws. By having one federal standard,  a single menu can be made across multiple states, and as the National Restaurant Association said, help “avoid a patchwork of differing state and local requirements.”

While some companies continue to argue about the law, most see the positives. Consumers want this information and will see positive health outcomes, industry gets a standard way of providing the information, and everyone benefits in the end.

Adoption of a federal mandate for Universal Health Care in India

March 4, 2016

Universal healthcare is a topic that is increasingly being considered for adoption in India, and there have been a numbers of papers written on whether it is a utopian vision, and what it would look like when implemented with a view to efficiency, equity and quality.

At the present time, health expenditure in India is 5% of its GDP, which is more than other South Asian countries, but public spending is only 19% of that. That leaves around 70% of healthcare expenditure being paid for out-of-pocket by consumers, and has 25% of all those being hospitalized pushed below the poverty line because of health-related expenses.

As is the case with many low and middle income countries, India is also facing a epidemiologic transition, with a triple burden of infectious disease, non-communicable disease and injuries. It is estimated that 60% of premature loss of life is due to non-communicable illnesses, and that the loss in productivity to the Indian economy from non-communicable illnesses will exceed the GDP if there is no intervention in current trends.

IJCM-37-142-g002

 

In India, health is overseen by the centre and the states. Increasingly, states are receiving a greater proportion of tax monies from the center, but this leaves them with a greater responsibility for planning, financing and implementing health related spending, which requires systems strengthening and political will to implement some of these measures.

There is a need for nationally mandated provision of universal health coverage with a basic basket of health services, which need to be determined based on burden of disease, cost effectiveness, financial constraints and standard of care. This would require extensive reform of systems of administration, governance, data collection and surveillance of health, but would greatly improve health outcomes and productivity of India’s large population which currently has very poor access to healthcare.

The broad use of genetically modified organisms (GMOs) is a public health threat for which policy is outdated.

March 4, 2016

UntitledA federal Biotechnology Policy written in 1992, and currently supported by the Food and Drug Administration (FDA), states that GMOs are not materially different from other products and propose there is a lack of consensus on whether or not GMOs cause harm to health sufficient to support a change to the policy.

For a bit of background, in 1994, the FDA approved the first genetically engineered food for sale, a tomato with a longer shelf life than conventional tomatoes. The economic advantage was undeniable: farmers could raise bacteria, draught and infestation resistant crops; pressure eased in transportation time to ensure freshness; grocery stores could make the product available to consumers for a longer period of time without rot.

NonGMOPressure is mounting by consumer groups such as the Organic Consumers Association (OCA) and lawmakers Rep. Diana Urban, D-North Stonington, and Sen. Dante Bartolomeo, D-Meriden, co-chairwomen of the legislature’s children’s committee to label GMO foods, and to ensure that children’s food in particular, such as baby formula and snack for young children, are GMO-free. January 7, 2016, Cambell’s Soup Company announced their support for mandatory national labeling laws – the first major American company to do so. Proponent claim that GMOs have been linked to increased cancer rates, heart disease, rare allergies and contributed to US antibiotic resistance. GMO crops such as soy and corn are the foundation of our nation: derivatives of these two products are in literally everything. Here is a 4 page list of corn derivatives alone! Consumers have a right to know what is in their food.

A1Yet backlash against labeling and use of GMOs is high. In fact, 4 of the 20 members of the U.S. Senate Committee on Agriculture confirmed that they work for Monsanto
,
a company that produces “round up ready” products such as seeds that grow their own pesticides. Monsanto has dominated the seed market, making purchase of non-GMO seeds prohibitively expensive for farmers. Food and industry groups say they would be harmed by mandatory labeling requirements, which could be costly to impose and cast GMOs, present in more than 80 percent of the nation’s food, in a negative light. Yet, the OCA cited statements signed by 300 scientists and doctors saying
that there is “no scientific consensus on GMO safety”.

All of this hits a little too close to home. My son, from birth, vomited profusely after nursing. It continued until at 7 months, we nearly lost him as we could not find what was triggering this allergic reaction which was causing severe malnutrition.  As his mother, I finally realized I had to find  something that was in everything: corn. Specialists were stumped, however we confirmed my son’s allergy to trace amounts of corn. What I found through my research is a growing community of the corn and soy allergic. However many of these people have less or no reaction to non-GMO foods.

If Congress can pass policy supporting mandatory food labeling, perhaps we can spare another generation from the impact of genetically modified food and related negative health outcomes.

LARC: Reducing Colorado’s Teenage Pregnancy Rate

March 4, 2016

infographic-b_970px

Although teenage pregnancy rates have declined over the last twenty years, teenagers in the US are far more likely to give birth than teenagers in other industrialized countries.

However, between 2009-2013, Colorado decreased the number of teenage births by 40% and the number of abortions by 35%; the Colorado Family Planning Initiative used an anonymous grant to provide free, or reduced-priced, IUD implants to over 30,000 individuals. Despite the fact that this was a substantial drop, GOP lawmakers refused to provide taxpayer dollars to further this program. As a result, state officials are still looking for continued funding.

 

Planned Parenthood (PP) and NARAL Pro-Choice America are two stakeholders that will advocate for additional funding, as their organizations advocate for policies that ensure access to reproductive and complementary healthcare services. These organizations advocate for LARC methods, including the IUD, as they are the most effective forms of reversible birth control and last for years.

The Catholic Church and Colorado Family Action (CFA) are two stakeholders that will advocate against providing funding. CFA opposes state funding as they don’t believe tax dollars should be used to “insert the government between teens and their parents”. The Catholic Church will join CFA in opposing funding on moral grounds, as they oppose any form of birth control other than natural family planning.

Providing IUDs have had a substantial impact on birth and abortion rates for Colorado teenagers; Colorado must take action by working with supportive stakeholders to secure funding to ensure the success of this program. PP, for instance, spent over $1.3 million in 2015 lobbying for various health policies and funding. Their support, in terms of finances and lobbying, for additional funding would be extremely beneficial, as they have the knowledge and experience with how to best advocate for this additional funding.

 

Right to die with dignity

March 4, 2016

Individuals facing a terminal illness should have the right to die with dignity, whether that means choosing to live until the very end or choosing to take medications to end their lives on their own terms. The End of Life Option Act, which is currently up for debate in the Maryland legislature, would allow physicians to legally prescribe lethal medicine to mentally competent individuals with less than 6 months to live. The law empowers individuals to make a choice at end-of-life that best fits with their personal views, ethics, and morality and to have autonomy in their own bodies.

death1.png

Maryland would join Vermont, Oregon, and three other states with aid-in-dying legislations. Oregon’s aid in dying legislation is seen as the model for other states, with research showing that Oregon’s legislation has led to improved end-of-life care in general, including improved pain management, psychiatric treatment and palliative care. Furthermore, Oregon tracks these requests and has not seen any coercion or abuse in the 20 years the provision has been legal. The Maryland law reflects similar safeguards aimed at protecting vulnerable populations, with patients required to be mentally competent, to administer the medication themselves and to request the prescription at least three times.

ca_map_update.png

Individuals facing immense suffering at the end of a terminal illness do not have much power to make decisions. They did not choose to have these illnesses or prognoses, and they did not choose to experience increasing pain and decreasing ability to manage daily tasks. But with the End of Life Option Act, individuals can choose what they want to happen at the end of life.

a

Increasing Sugar-Sweetened Beverage Taxes to Combat the Obesity Epidemic

March 4, 2016

Childhood obesity is an epidemic in the US. Today, nearly one-third of all children and adolescents in the country are overweight or obese. Children with obesity demonstrate lower performance at school and are at increased risk of having low self-esteem. Additionally, they have a higher chance of being obese as an adult, putting them at greater risk for heart disease, type 2 diabetes and other serious obesity-related diseases.

Although the cause of obesity is multi-factorial, research has shown that the rising consumption of sugar sweetened beverages (SSBs) are a major contributor to the obesity epidemic. SSBs include not only soda drinks, but also sports and energy drinks, fruit punch, lemonade, sweetened powder drinks, and even some fruit juices. It is often difficult for consumers to understand the deleterious effects of SSBs due to a lack of information, a lack of affordable alternatives, and strong advertising and marketing influences of the beverage industry. Rising obesity rates have spurred policymakers into considering policies that will improve access to affordable, healthy foods and increase physical activity in schools and communities. Despite these policies, more needs to be done to target the consumption of SSBs.

Picture1.png

To reduce consumption of unhealthy beverages, promote public health, and generate revenue to be funneled back into obesity prevention programs, as of January 1, 2014, 34 states and the District of Columbia (D.C.) applied sales taxes to regular, sugar-sweetened soda sold through food stores. Unfortunately, the average tax rate in these states have been modest at best, averaging only 5.2 percent, resulting in little impact on consumption or weight. Research has shown that relatively large increases in taxes can be effective in reducing consumption on cigarettes and tobacco products. Furthermore, some studies have shown that significant differences in the relative prices of healthier beverages compared with less healthier ones could help to reduce BMI and the prevalence of obesity

Screen Shot 2016-03-04 at 9.42.16 PM.png

Given the ever-increasing rate of obesity in the US, it is imperative that US Congress act now by acknowledging the link between SSBs and obesity and implementing a federal law to increase taxes on SSBs as a public health intervention to reduce SSB consumption and combat the obesity epidemic.

http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2009/rwjf43487

The Agony of Ecstasy: Amend the Illicit Drug Anti-proliferation Act

March 4, 2016

By refusing to amend the Illicit Drug Anti-Proliferation Act, Congress continues to stand in the way of harm-reduction services as the number of drug-related deaths continues to mount in the night life and music communities.

What is the Illicit Drug Anti-Proliferation Act?

In 2003, the Illicit Drug Anti-Proliferation Act (Read the full text here.) was passed by Congress in an effort to combat deaths due to ‘club’ drugs, such as MDMA. This act states that organizers of an event where controlled substances are suspected to be present can be charged with a felony for contributing to drug use, punishable by up to 20 years imprisonment, a fine of up to $500,000, and can have their venue seized by law enforcement.

What are the effects of this act?

This act has proven to be ineffective as stories of deaths at music events due to drug use continue to emerge. The Drug Abuse Warning network recently reported that national ED visits due to MDMA toxicity increased 120% between 2004 and 2011 while levels of MDMA use have remained relatively constant.

ecstasy graph

Past Month Ecstasy Use among People Aged 12 or Older, by Age Group: Percentages, 2002-2014. Figure produced by 2014 Drug Use report sponsored by HHS
Source: http://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.htm

 

One victim of this act was 19 year-old Shelly Goldsmith, a student at the University of Virginia, who died of dehydration and heatstroke after consuming MDMA at a rave in Washington D.C. Shelley collapsed while attempting to make her way through the hot, crowded venue to the bar to buy a bottle of water.  The current act discourages venues from distributing free water to prevent heat stroke or any other harm-reduction services, else they face federal prosecution for suspicion of contributing to drug use.

shelley-biden01

Shelley Goldsmith died at 19 years old from heatstroke after ingesting MDMA at an Electronic Dance Music concert where no free water was available, is seen here posing with Vice President Joe Biden, who authored the Anti Illicit Drug Proliferation Act
Source: https://www.amendtheraveact.org/

Advocates such as Shelley’s mother, Dede Goldsmith, have spoken to Congress on the importance of harm reduction and educating the public on safe drug use.  Senator Tim Kaine has recently announced that he intends to propose an amendment to current law which will allow venues to provide harm-reduction services without bearing the risk of legal consequences.

Unfortunately, the bill is unlikely to easily pass. Most members of Congress are nervous about appearing ‘soft’ on drug policies and will need to be shown that harm-reduction is the will of the people and that passing this amendment will save lives.

What can we do to show Congress how important this amendment is?

  • Sign the Petition! Send Congress a message that the American people want to stop the unnecessary deaths: Petition: https://www.amendtheraveact.org/sign-the-petition/
  • Donate! The organization, ATRA (AmendTheRaveAct.org) creates and distributes campaign materials to educate the public on the harms caused by this amendment
  • Speak out! By explaining the benefit of harm reduction, and the differences between harm-reduction and the promotion of drug use, you can help turn the tide of public opinion against using an abstinence only strategy to reduce drug related-deaths.

.