Archive for the ‘Advocacy Process’ Category

The Mexico City Policy: Misunderstood, Misguided, and Malignant for Maternal and Child Health

August 20, 2017

Imagine a woman seeking medical care in the direst of circumstances and a sole health worker prepared to deliver her these services. Now imagine that although the worker’s organization is committed to provide these safe, legal, quality services, a single policy financially incapacitates the care because a minority of citizens in a country thousands of miles away opposes even discussion of certain topics with the patient. This is wasted human spirit. This can mean life or death. And this is the Mexico City Policy, a U.S. federal restriction recently re-enacted and expanded under President Trump as the Protecting Life in Global Health Assistance (PLGHA) policy.

PLGHA requires foreign NGOs to agree not to “perform or actively promote abortion as a method of family planning” as a condition for receiving U.S. government funds NOT ONLY for family planning assistance, as the previous Mexico City Policy declared, but for ALL health programs, including those for HIV/AIDS, maternal and child health, malaria, and global health security, putting billions of annual U.S. aid dollars and, thus lives, at risk. An increase in abortions has previously been found under this intervention and models predict staggering numbers of unintended pregnancies, abortions, and maternal deaths. Not surprisingly, advocates of women’s health around the world from International Planned Parenthood Federation to the United Nations have outlined the deadly consequences of the PLGHA and not only stated their firm opposition to it but have created movements against it.


The clearest course of action for advocates of women’s health and Global Health in general is to promote passage of the U.S. Global Health, Empowerment, and Rights Act (HER Act), introduced by Senator Jeanne Shaheen and Representative Nita Lowey. The HER act would create a permanent, legislative repeal of PLGHA and the Mexico City Policy, allowing NGOs to continue to operate U.S.-supported health programs without being forced to sacrifice the provision of appropriate care. The HER act fights the financial coercion of the PLGHA and may offer the best chance to restore global faith in the U.S. as the leader of Global Health worldwide.









Teen Pregnancy Prevention Program Defunded in Baltimore…and Beyond

August 20, 2017

The teen pregnancy rate in Baltimore is 2-3 times the national average, with rates reaching upwards of 64 pregnant teens for every 1,000 female adolescents in 2009. According to the Center for Disease Control, teen pregnancy costs taxpayers $10 billion annually in health care and foster care costs. On the personal level, unplanned pregnancies significantly reduce life opportunities for teen moms, with the CDC finding that only 50% of teen moms graduating from high school by age 22. This lack of education causes a ripple effect, and teen moms have more chronic health problems and higher rates of incarceration.

Courtesy of the Baltimore Sun

Courtesy of Baltimore Sun

Teen pregnancy in Baltimore has seen a steady decline over the last decade, joining a national downward trend. This comes in no small part to programs such as the Health and Human Services’s Teen Pregnancy Prevention Program (TPPP). With funding from the TPPP, 80 city health departments have been empowered to create science-based prevention programs for teens to understand contraception and sexuality.

Unfortunately, the TPPP was abruptly defunded last week. The Trump administration offered little explanation, leaving pro-abstinence groups such as The Abstinence and Marriage Education Partnership to justify such cuts with claims that abstinence is correlated to lower rates of teen drug abuse.

Here in Maryland, the Baltimore City Health Department expressed frustration at losing $3.5 million out of the $214 milling being cut. Health Commissioner Leana Wen called the cuts “shocking.” The Health Department has joined the Big Cities Health Coalition, comprised of the 80 beneficiary cities of TPPP funds, in decrying the budget cuts. Even the American Academy of Pediatrics has joined the plea, adding a link to its website for pediatricians to contact their congressmen in protest.

There’s good news. The National Campaign to Prevent Teen and Unplanned Pregnancy found that 83% of adults support teen pregnancy prevention programs. Now is the time to tell Congress that the constituency wants the TPPP funded. Call your congressman today!

Michigan Motorcycle Safety: The Need for a Universal Helmet Law

August 20, 2017

(Photo credits: Bridge Magazine,

In 2012, Michigan repealed a universal motorcycle helmet law that had been in place for 35 years, replacing it with a partial law. The American College of Surgeons (ACS) reports that unhelmeted motorcycle riders are significantly more likely to suffer fatal and non-fatal head injuries and that motorcycle riders hospitalized with brain injuries incur nearly double the costs as those without brain injuries, with the public incurring the majority of these costs. According to the ACS, helmets work, stating that “helmeted motorcycle riders have up to an 85 percent reduced incidence of serious, severe, and critical brain injuries compared with unhelmeted riders.”  These general observations have been borne out in Michigan since the repeal.

(Image credit:

Despite this, American Bikers Aiming Toward Education (ABATE) of Michigan continues to be very vocal in their opposition to universal helmet laws on behalf of motorcycle riders, justifying opposition to universal helmet laws by twisting the facts and providing red herring arguments.

In late 2016, Michigan Representative Peter Pettalia, who supported the repeal of the universal helmet law in 2012, died in a motorcycle accident. His death has reinvigorated the discussion of motorcycle safety laws, making now the time to act to make motorcycle riding safer. The American College of Surgeons reports that “when universal helmet laws are enacted, helmet use increases to nearly 100 percent, and fatalities and serious injuries decrease.” The Governors’ Highway Safety Association (GHSA) representing state and territorial highway safety offices and comprised of Governors’ representatives “urges all states to adopt a universal motorcycle helmet law and vigorously enforce existing laws.” I would urge Mike Prince, the Michigan representative to the GHSA, to act on behalf of the GHSA, the Michigan Office of Highway Safety Planning, and the people of Michigan by imploring Governor Rick Snyder to push a legislative agenda that includes a return to a universal motorcycle helmet law in Michigan.

Regulation by Florida of Cancer Treatment Costs for Medicare Beneficiaries

August 20, 2017

Cancer comes with one of the costliest medical expenses. Doctors often diagnose individuals 65+ years old with new cancers, so Medicare and its beneficiaries must pay for the high treatment costs. Medicare requires high-cost sharing among its beneficiaries, which leads to financial distress for example bankruptcy. Florida has one of the largest populations of senior citizens (19.9%), two million of which are Medicare beneficiaries. The high out-of-pocket burden from cancer treatment costs leads Medicare beneficiaries towards decreased medication adherence or medical care postponement. Overall, beneficiaries have poorer cancer treatment outcomes compared to privately insured individuals.


Photo from: NCI Visuals Online

The Florida Department of Health, along with Gov. Rick Scott, should negotiate cancer treatment costs at quality cancer centers in Florida, such as Moffitt Cancer Center, and with pharmaceutical companies like Bristol-Myers Squibb to reduce out-of-pocket expenses for Medicare beneficiaries. The Florida Department of Health should place caps on cancer treatment costs to maintain them at reasonable prices. This political action would test whether cancer treatment cost negotiations at the state level are more effective than federal level negotiations. Biomedical companies can flexibly negotiate cancer treatment prices based on prevalences and morbidities in distinct states.

Florida’s House will not expand Medicaid health insurance coverage, and pharmaceutical companies refuse to negotiate drug prices for Medicare beneficiaries. Placing treatment cost negotiations and caps in the state’s health department’s hands may reduce Medicare beneficiaries’ substantial out-of-pocket cancer treatment expenses. Cancer incidence and morbidity has declined. However, cancer treatment costs and Medicare spending have only risen and are expected to continue growing.

Besides other factors that affect cancer treatment like transportation costs, psychosocial stressors, and reduced quality of life, add stress to a patient’s cancer care experience despite the financial resources provided by organizations like the American Cancer Society.

Supervised Injection Facilities to Mitigate Rhode Island’s Overdose Crisis

August 20, 2017

kitchen floor ODjpg

Rhode Island, the smallest state in the United States, had 336 overdose-related deaths in 2016, double the number of deaths in 2010. Since 2011, illicit drug overdose deaths increased 250% with the crisis expanding to include a 15-fold increase in fentanyl-related deaths.

In August 2015, Governor Gina Raimondo signed an executive order, directing the Department of Health and Department of Behavioral Healthcare, Developmental Disabilities and Hospitals to co-convene an Overdose Prevention and Intervention Task Force with community and stakeholder participation. The Task Force developed an action plan aiming to reduce overdose deaths by one third by 2018.


Source: Rhode Island Department of Health

Because the number of deaths continued to climb, a second executive order was signed in July 2017, calling for community and school-based prevention education, and a directive to explore “a comprehensive harm reduction strategy for intravenous drug users to decrease risk of overdose, infection, and assault.”  

Harm reduction strategies include distribution of clean needles, outreach, peer support, naloxone training, substitution therapy, and supervised injection facilities.  These approaches mitigate the adverse effects of high-risk behaviors associated with drug use by reducing stigma, and legal and social barriers to care.

Vancouver SIF

Source: The Stranger

Supervised injection facilities (SIFs) are an effective public health strategy because their impact is multi-faceted and based in harm reduction. SIFs reduce death from overdose, increase access to services for healthcare and recovery, and improve community safety.

With good results in Canada and campaigns for SIFs in New York and other US locations, Rhode Island is not alone in this crisis. Supervised injection facilities can help stem the exponential increase in deaths and unbearable toll this overdose crisis is taking on individuals, families, and the state.  It is crucial that the Overdose Task Force and Governor Raimondo support local implementation of this evidence-based life-saving strategy.

Closing the gap: Getting it right with the task-sharing policy in Nigeria

August 19, 2017


A visit to a public hospital in Nigeria can be quite a disheartening and depressing experience.  Waiting areas and rooms are filled with patients waiting to be served. In large cities, patients are known to spend the night on hospital grounds in order to secure good spots in a queue, with hopes of being able to be attended to by a doctor. The reason for all of this? There are way more patients than the health personnel can manage.

Nigeria, as a country, has continued to experience an outward migration of its trained health personnel to other countries. Poor salaries and inadequate infrastructure have caused physicians, pharmacists, nurses and others to take up jobs in better developed countries. This poses a challenge in catering to the health needs of the Nigerian people.

According to national records as of December 2012, physician density per 100,000 persons ranged from 50.5 at the highest, to 1.9 at the lowest. For nurses, these numbers ranged from 96.5 per 100,000 to 5.9 per 100,000 persons. Both of these are well below the minimum requirement of 2.28 per 1,000 as set by the WHO.Fig 1: Health worker shortages by region (WHO)

The Task-Sharing and Task-Shifting Policy:

To turn around the situation of health worker shortage, the government of Nigeria has recently instituted a task-sharing policy which is geared towards mobilizing additional resources to help meet the health needs and desired coverage levels to serve the Nigerian people. Auxiliary staff and less-skilled health workers are being trained to assist in providing basic health care needs. The WHO describes task shifting as maximizing human resources by moving tasks around from higher qualified to less-trained health workers with less qualifications.

The introduction of task-shifting and task-sharing policy is a crucial step in the country’s efforts to improve access to essential health services in Nigeria. The policy will permit for some clinical tasks to be provided by less-qualified health workers such as community health workers while freeing up physicians, midwives and others more qualified to attend to more complicated tasks.  Task shifting in health care has been tried in countries such as Malawi, Uganda, Ethiopia, South Africa, Zimbabwe to provide support to health personnel in the management of HIV, malaria, and family planning, among others.

Fig 2: Use of CHWs in providing basic family planning services

(culled from


In as much as the concept of task-sharing is a welcome solution in bridging the health personnel gap, certain considerations needs to be put in place to ensure successful implementation of the policy while also ensuring that the good intentions do not get abused in the long run. Given the opportunity, I would proposed to the stakeholders that:

  1. This policy should be instituted as a temporary measure only. A timeline should be set for initial implementation with a committee setup to monitor activity regularly over time. 3-year intervals would be a reasonable initial timeline for review of the existing policy and to weigh in on the status of the shortage periodically.
  2. Because professional roles are not well-defined and a lot of gray areas exists in terms of what the nurse or pharmacist does relative to the doctor, all representing the various professions (medical, nursing and midwifery, pharmacy) should meet regularly to continue to fine-tune the implementation process and guide what roles are being transitioned to community health workers.
  3. A detailed training curriculum to cover pre- and post- implementation and continuing education, should be set up to ensure quality of care being provided by the CHWs.
  4. The National Primary Healthcare Development Agency should develop a monitoring and evaluation system to keep track of utilization and patient outcomes. Data collected will be very helpful to future assessments of the impact of the policy in bridging the gap.

Conclusion: The task-sharing and task-shifting policy offers significant potential for easing out the challenges of the shortage of personnel experience within the Nigerian health system. However, caution and extensive deliberation is advised as the policy gets implemented across the 36 states of the country. The representing bodies for nurses, physicians and pharmacists must work closely with the other stakeholders to ensure that the policy is rolled out effectively and according to set guidelines.

ACLU: Advocate for the health care needs of Flint adults, too

August 19, 2017

Photo credits – Featured image: The Odyssey Online; Header: Al Jazeera

The Flint water crisis, familiar to many as perhaps the most iconic water-related public health crisis in the US, has only in recent months begun to achieve some level of advancement in necessary legislation for infrastructure and public health initiatives necessary to the city’s recovery. In December 2016, Congress passed the Water Resources Development Act, which included an aid package for the rebuilding of Flint water infrastructure by 2020. Additionally, the bill contained $50 million in provisions for public health initiatives in the area – primarily targeted toward young mothers and children – to address ongoing health concerns related to consumption of the contaminated water supply.

While the public health initiatives included in the Act will be vital for Flint’s recovery, their focus on young mothers and children is, unfortunately, far too narrow to address the widespread, ongoing, and complex health needs of the adult community in Flint – particularly those vulnerable populations of adults with access and functional needs, whose numbers and needs remain substantial. Outside of programs focused on children and young mothers, the primary elements of funding related to adults in the community surround expansion of access to Medicaid and services offered in local Health Systems. As any familiar with Medicaid – and the current political environment, in which levels of access and amounts of coverage provided by Medicaid may continue to remain contested – will attest, the provisions of Medicaid coverage are frequently insufficient to financially provide wholly for preventive and specialized services that may become necessary for many adults facing long-term health consequences as a result of prolonged lead exposure, which can result in a wide range of lifelong and potentially serious health issues in adults as well as in children.

Accordingly, it is necessary that the American Civil Liberties Union (ACLU) add to the focus of their legislative agenda on Flint by advocating for the provision of funds to lifelong specialized health care needs initiatives for all community members, including funding specifically allocated to assist with health care costs for all residents. This should contain special provisional funding for adults with access and functional needs negatively impacted by the water crisis.

While recent legislative action is a step in the right direction, it is only the beginning, and remains insufficient in addressing the ongoing needs of all of Flint’s community. While the children of Flint are its future, its adult community is its present – and it will require just as much attention to health needs caused by the water crisis as its young people.

Raising Fines Saves Lives

August 19, 2017




A May, 2017 report from The Wireless Association (CTIA), states Americans used 14 trillion megabytes of mobile data in 2016; and there are more than 1.2 wireless devices per American. Media distraction while driving is a consequence of this growth and the #1 killer of American Teens, resulting in 11 preventable deaths per year. It is difficult for public health officials to timely design a policy to prevent motor vehicle collisions related to the massive proliferation of mobile technology.

In the United States, distracted driving results in 1.6 million collisions yearly, with an economic burden of 1.5 billion dollars. The actual estimated societal burden is nearly 8 billion dollars. The prevention of a single collision, injury or fatality, would save Maryland millions of dollars yearly and a victim’s lifetime of pain, suffering and disability.

Many teens and adults are addicted to mobile platforms. Maryland bans unlawful cell phone use while driving for teens and adults, imposing a maximum fine of $500.00 for teens and $175.00 for adults. Despite this ban, the District Court reports that 41,833 citations were still issued to adult drivers.  Teens model adults and their behavior. We advocate for more severe fines for adults and support House Bill 242, increasing the maximum fine to $500.00 for adults as well.   Raising the adult fines will help both teens and adults adhere to the law. 

Increased fines will enable positive behavior change.  The budget is approved and local law enforcement support swift implementation of stricter fines. We must have a Senate sponsor to move this bill forward.  One teen life lost is too much!  Please voice your support for more strict  fines and House Bill 242 to Senator James Brochin (R), Lutherville, MD.

The Negative impact of the American Health Care Act of 2017, in the Care of Epilepsy Patients

August 19, 2017


Background: Worldwide movement of care for epilepsy patients

While more than 50 million people worldwide have epilepsy, 80% live in developing countries. With optimal treatment, seizure-free can be attained in 70%. Therefore, access and availability of health care is crucial in the treatment of epilepsy. As such, the Global Campaign against Epilepsy: Out of the Shadows have been established in 1997 as joint projects of the WHO, ILAE, and IBE. In 2012, WHO Programme on Reducing the Epilepsy Treatment Gap has been proposed, and further in 2015, the Epilepsy Resolution was endorsed by the World Health Assembly. All of these efforts strengthen to address the specific needs in the management of epilepsy, and make resources available; making actions toward national health care plans.

American Health Care Act (AHCA)

The AHCA was a Republican health care bill proposed and passed in May, 2017 to repeal the existing Patient Protection and Affordable Care Act (ACA), in scope of the federal budget. Although recently in July 28th, the US Senate closed the debate on repealing the ACA, major changes in provisions would have occurred if AHCA had replaced ACA:

  • End Individual mandate: ACA mandated that all people be covered by health insurance.
  • Let states waive out ACA’s “Essential health benefit requirement”: This was the set of medical services that was required for all insurers to cover; included maternity care and mental health.
  • Let states waive out ACA’s “community rating”: It results in charging sicker people with higher premiums.
  • Tax credits based on age rather than income: It results in benefitting high-income people. (ACA helped the low-income group)
  • Lower health insurance coverage: Estimated 24 million fewer coverage by 2026
  • Falling short on High-risk pools: Estimated 2 to 4 million less for those w/pre-existing chronic conditions.

Public Opinion of the ACA

Recently in the New England Journal of Medicine, a publication regarding public opinion of the ACA was reported. While it revealed different views and attitudes about repeal-and-replace legislation between the Republican and Democrats, there seemed to be an agreement that the number of people covered by Medicaid should not be reduced in any replacement bill. Medicaid is a health insurance program in which people can be qualified for it based on income level or disability. Many Medicaid programs consider epilepsy as a qualifying disabling condition, if having uncontrollable seizures. It provides access and affordable basic health services, and supports millions of Americans, including those with epilepsy.

health insurance coverage


After AHCA was proposed, there has been many objections toward the act. Epilepsy Foundation was one that showed a definite opposition to this. As a result, there were no passage of any act, but I believe that when things like this happen, medical organization should speak up like how Epilepsy Foundation did. This is especially true when movements worldwide have been taking place to reduce the treatment gap, and some act tries to lessen the health care coverage and access. Specific stakeholders that could have taken the role, in terms of relation to the care of epilepsy patients, include ILAE (International League Against Epilepsy), AES (American Epilepsy Society), and NAEC (National Association of Epilepsy Centers).

Improved Access to Naloxone in Ontario’s Fight against Opioid Overdoses:

August 11, 2017



Over the past decade Ontario has seen a steady rise in the number of opioid related deaths and narcotic misuse across all socioeconomic groups in the province. Of particular concern is that despite ongoing provincial initiatives little has been accomplished to prevent the rampant abuse and misuse of narcotic pain medications. The opioid epidemic is a public health crisis of epic proportions. Recently it has been estimated that 1 in 8 deaths in Ontario is related to opioid abuse.

The government has rolled out a variety of initiatives to combat the problem. They have stopped paying for higher-strength narcotic pain medications through the provincial drug benefit payment plan in an effort to reduce the abuse of these agents. The provincial government has also increased funding for addiction services, and set out new guidelines for opioid use in chronic pain. (

These recent policy initiatives from the provincial government to combat the provinces growing opioid crisis are welcome news. The problem represents a complex health issue with potentially devastating consequences for individuals, families and the communities they live in. Unfortunately the crisis continues to grow and these efforts do not go far enough to help prevent the senseless deaths that are occurring every day on the streets of our cities from accidental overdoses.

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Ontario opioid toxicity deaths, by drug – 2002-13. Data from Ontario Coroner.

Historically the use of the lifesaving antidote for an opioid overdose, Naloxone was only available to a select group of healthcare providers like physicians and paramedics. Most recently this past year the provincial government reduced the restrictions on this lifesaving medication making it available in local pharmacies to consumers without requiring a prescription.

This is a welcome policy change that will save lives….unless you live in Grassy Narrows, Attawapiskat, Pikangikum, White Dog, or any of the other remote Northern Ontario First Nation reserves where there are no pharmacies or publicly available free Naloxone kits. You may not find these communities listed on the provincial government website ‘Where to get a free naloxone kit’ but deaths from overdoses are happening here at alarming rates.first nation grassy

While there is strong support for this new policy change, simply removing the legal barriers and improving the availability of this life saving intervention may not equal improved accessibility for some residents of Ontario.


Major health disparities exist amongst remote First Nations communities living in Northern Ontario. These populations are socially marginalized and medically underserviced. Access to healthcare for these populations is limited as is the quality, equity and timeliness of the healthcare they do receive. This results in disproportionately high burdens of disease and poor health outcomes. First Nations youth have higher rates of suicide and an increase prevalence of risk taking behaviours which can all lead to higher rates of alcohol and drug abuse and ultimately death from overdose.


The government’s expansion of initiatives and services which take aim at combating the opioid epidemic in Canada need to target all Canadians and not just those living in urban centers. If the government is serious about broadening access to initiatives like free Naloxone it needs to couple that with initiatives to ensure these initiatives reach the most vulnerable and disadvantaged members of society like the remote First Nation reserves of Northern Ontario. There needs to be a global expansion of healthcare funding for Aboriginal populations that aims to reduce the health disparities that currently exist in these populations.  Otherwise available does not equal accessible.