Archive for the ‘Advocacy Process’ Category

Housing, Not Handcuffs: The Criminalization of Homelessness in Colorado

March 12, 2018

From Durango to the Front Range, many Coloradans in 2018 are struggling to find affordable housing in a state experiencing one of the greatest housing crises in the US. In 2014, a Denver resident needed to make $35/hour to afford median rent, more than triple the state’s minimum wage. The reality is much worse for families with very low income, who could affordably access just 7.5% of housing units across Colorado in 2016, a staggering drop from 32% in 2010.


In such a context, it is no surprise that our population experiencing homelessness has risen, and housing solutions have not kept pace. In 2017, Denver had a homeless population of over 5100, but only 1800 shelter beds. Yet even with such obvious barriers to housing, Colorado continues with aggressive criminalization efforts, with over 350 laws across the state that penalize acts associated with homelessness.


One category of such laws is urban camping bans, which punish basic survival acts such as sleeping in a car or covering with a blanket while resting in public. Just six months after Denver enacted an urban camping ban in 2012, 83% of survey respondents reported having been “asked by police to “move along,” without being offered alternative services”, and 66% reported sleeping in less safe locations. Boulder’s even stricter enforcement resulted in over 1700 citations for unauthorized camping from 2010-2014.


Camping bans are expensive to enforce and can have multiple negative effects on health, well-being, and opportunities for those experiencing homelessness. Police “sweeps” of homeless encampments displace people to unsafe areas away from service providers and may deprive people of their personal property, including medications. Citations, arrests, failure to pay fines and jail time may disqualify residents from future housing and employment opportunities, perpetuating the cycle of poverty.

Colorado needs to stop spending tax dollars on ineffective policies that punish the poor and unhoused,  and focus on workable solutions. Denver Homeless Out Loud and a large coalition of supporters have fought since 2015 to pass the Right to Rest Act, HB18-1067, which would prohibit legislation that criminalizes resting, sleeping, covering oneself, or sharing food in public spaces.  Call your representative in the local government committee. Tell him/her that Coloradans need housing, not handcuffs.


Glocality and harmful consumption of alcohol: The SDG target 3.5 and the Alto Tâmega and Barroso region

March 11, 2018

In 2015, the United Nations General Assembly approved the 17 Sustainable Development Goals (SDGs). One of the targets (3.5) of the SDG 3, underlined the importance of “Strengthen the prevention and treatment of substance abuse, including (…) harmful use of alcohol”.  However, several of the targets don’t apply to all the communities. While the epidemics of AIDS is a major concern in several communities, in others the harmful consumption of alcohol is a priority. Taking that into account, there is need to push forward the creation of local policies targeting alcohol abuse that are also related with global policies – the creation of glocal policies.


Portugal isn’t an exception. According to the Institute for Health Metrics and Evaluation (IHME), alcohol is the major component that hinders the health development in Portugal. According to SICAD (General Directorate for Intervention on Addictive Behaviors and Dependencies), this harmful habit starts at young age, with almost 50% of the men aged 18 years old registering an episode of drunkenness in the previous 12 months.


Since the majority of our behaviors are developed inside of our households and in our communities, it is important to tackle this problem locally. As an example, the Alto Tâmega and Barroso region has the third highest number of patients with the diagnose of Chronic Abuse of Alcohol in north of Portugal. According to the North Health Observatory, Chronic Liver disease and Cirrhosis are the principal specific cause of mortality that leads to potential years of life lost in this region – 396.3/1000000. Although this is a major health concern and the existence of Local and National Plans, there is the need to support the creation and funding of specific strategies developed by local health departments that target this problem.

By 2020, the Ministry of Health (MoH) should give more autonomy and funding for local diagonal health programs for the reduction of harmful consumption of alcohol. The national guidelines’ development to support these programs is essential. The MoH, the Directorate-General of Health and the SICAD should serve as advisers and monitors of the implementation of those strategies at local level, as the UN is to Portugal, at national level. The national agencies should support the implementation of international decisions by focusing on the local problems. Only by then, we will be able to achieve the SDGs and the reduction of alcohol consumption.

The Opioid Epidemic: Decriminalization, legalization, or offer of treatment as an alternative to criminal justice penalties for nonviolent users of opioids

March 11, 2018

Every day, more than 100 Americans die from drug overdose. This epidemic has lowered American life expectancy in 2015 and 2016 for the first time in decades, with drug overdose now the leading cause of death for Americans under age 50.

opioid epidemics by numbers


The use of illicit drugs is a drain on the nation’s financial resources. In 2007, the cost of illicit drug use was estimated to be about $200 billion related to lost productivity, health care and law enforcement ($11 billion annually). The medical complications of untreated substance use disorder also drive health care system costs. Hospitalizations for opioid use disorder rose from nearly 302 000 to more than 520 000 from 2002 to 2012, and costs for such care quadrupled to $15 billion in 2012. Charges for hospitalization for opioid use disorder with serious infections also quadrupled over the same period to $700 million.

Over the past 40 years, many jurisdictions established rigid punishments for nonviolent drug offenses, including mandatory incarceration. However, there has been growing support from health care professionals, public health authorities and patient advocacy groups for the idea that public policy should be reoriented to emphasize prevention and treatment of substance use disorders through public and individual health interventions rather than excessive reliance on criminalization and incarceration.

Health Care National Organizations new focus is to ensure guidelines are followed in management of chronic pain, pharmacists are establishing prescription drug monitoring programs at state and national level, addiction medicine specialists recently released a scientific guideline on how to treat opioid dependance, even top 16 health care payers came together to announce new reimbursement policies that will promote and reward substance use disorder treatments that aligns with principles of care, while the patient advocacy groups are trying to remove the stigma surrounding addiction and promoting medication-assisted treatment: all pointing towards the new trend in academia, industry and general public to treat opioid addiction like any other disease.

Now is the time that our justice department, the key player in war on drugs, moves beyond deploying criminal law enforcement tools on patients and embrace alternative approaches such as providing treatment, counseling and mental health services to the addicts that have proven to be a success in other countries.

Why 21 to Purchase Tobacco Products?

March 11, 2018

The Master Settlement Agreement of 1999 imposed major restrictions on tobacco industries, proved to be a victory for public health workers in the United States and their efforts in tackling the tobacco epidemic.

However, the rise of the use of electronic cigarettes prove to be yet another strategy with tobacco companies in promoting tobacco use. The NIH defines electronic cigarettes, or e-cigs, as battery operated devices that contain aerosol flavorings and other chemicals that mixes with health, producing a vapor.

Due to its’ lack of long term consequences and it’s gateway to adult smoking, I support the bill for increasing tobacco sales from 18 to 21 years old in Washington state.

According to Washington21, 17, 800 Washington kids try smoking for the first time each year, 3, 900 kids become daily smokers with a third of them dying prematurely. The marketing of flavors for electronic cigarettes makes this product more appealing, with majority of teens not knowing exactly what is even in these e-cigs which makes e-cigs all the more dangerous in this population. The IOM Report in 2013 reported that there would be a 25% reduction in 15-17 year olds smoking tobacco and a 10% decrease in smoking related deaths if the age was raised to 21.

Like the effects of increasing the drinking age to 21, I believe that we would see similar effects when raising the age of 21 in purchasing tobacco in Washington, including e-cigs. By supporting the Washington21 campaign we are able to prevent further use of tobacco products among teens and also reduce health related tobacco issues such as cardiovascular/lung diseases, and cancer Participating in advocacy campaigns will also help with providing advocacy tools that can be used at your own state to enact policies to save lives.

On March 8, 2018, Washington house has passed SB 6048  raising the age to buy tobacco products to 21.Given this victory, it is promising that Washington state’s bill will hopefully pass the Washington senate! To support this cause and to protect the health of the youth, contact your district legislator and vote for Tobacco 21!

It’s Time for PrEP in Mecklenburg County

March 11, 2018

Source: Men’s Lifestyle Clinic

Mecklenburg County, home to the city of Charlotte in North Carolina, is one of the fastest-growing metropolitan areas in the Southeast and has one of the highest HIV infection rates in the nation. According to the latest State of the County Health Report (SOTCH), Mecklenburg saw 27.9 new HIV infections per 100,000 population in 2015. That’s over twice the state average of 13.4 and more than double the national average of 12.3. Statewide, blacks are disproportionately affected with six times the case rate compared to white males and fourteen times the case rate of white females.

What is Prep


Unlike other counties across America, Mecklenburg does not directly distribute PrEP, a drug approved by the FDA that can help prevent and stop the spread of HIV. Public awareness campaigns to promote use of the drug are virtually nonexistent.  Distribution of PrEP by county health clinics is still hotly contested within the elected Board of County Commissioners who oversee the county budget. In mid-2017 the County Commissioners approved $248,000 to help expand the use of PrEP, but the Health Department failed to act until very recently when they approved a pilot to distribute PrEP in a select number of county health clinics. For populations at risk of HIV infection, these actions are too little, too late.

Mecklenburg County’s community of public health professionals and activist groups like RAIN must continue putting pressure on policy makers and administrators in the County Health Department to urgently scale up PrEP distribution to slow down and ultimately stop new HIV infections. We are calling on county officials to fund public awareness campaigns to drum up patient demand for PrEP. On the supply side, county medical providers should receive training on PrEP and ensure patients are aware. The drug manufacturer, Gilead, has committed to cover the cost of PrEP. Now, it is up to Mecklenburg County authorities and medical providers to seize this opportunity to join counties around the nation in stopping the spread of HIV through promotion and provision of PrEP and related services, starting today.


Could Biology Explain Racial Health Inequalities?

March 10, 2018

The consistently greater risk for infections and cancer among men of African ancestry compared to all other ethnic groups in the world suggests fundamental biologic causes that supersede social and geographic influences. One of the most popular arguments for the notion that race is a “social construct” is derived from the point made by the geneticist Richard Lewontin, to the effect that intra-racial genetic similarity among individuals classed within any given “race” typically accounts for only about 7% of genetic similarity. Lewontin concluded from this that racial classification is “meaningless.” While his data concerning intra-racial vs. interracial genetic similarity were correct, the inference from this data that racial classification is meaningless is widely referred to by evolutionary biologists today as “Lewontin’s fallacy.” Indeed, 7% of the genetic material consists of several thousand genetic loci, which is quite an impressive amount of genetic material.

Random studies have found higher Testosterone levels in African American men and higher Testosterone and Estrogen levels among African American women together with low Dehydroepiandrosterone levels (DHEA) compared to their racial counterparts, could explain the health inequality. DHEA levels decrease with old age and low levels are said to reduce body’s immunity against diseases increase the risk for infections and cancer; DHEA levels have been found to be particularly low in African Americans, increasing their vulnerability to diseases. This understanding is key to prioritizing health services to this community. We need policies to address early childhood education including health education; access to healthy food and eating right, and performing work and out of work activities according to your biological capabilities. We need to help people understand their biology and how it affects their health and behaviour and they can take advantage of their differences.racial differences

I advocate for health education and services to reach out to African American communities in their homes, work, schools, and churches. Early screening of African American women, for Breast cancer, Endometrial cancer, and Ovarian cancer and earlier screening of Lung cancer Prostate cancer and other common cancers among African American men; after reaching the age 40.

Featured picture by KANGSTAR

The Deadly Combination of Guns and Domestic Violence: New Mexico’s Need for New Legislation

March 9, 2018

PHC Blog Photo 1

Domestic violence is a significant contributor to intimate partner homicide (IPH). In fact, between 40-50% of all U.S. female homicides are due to IPH. A perpetrator’s access to firearms increases the risk for homicide more than five-fold. Current federal law prohibits the “purchase and possession of firearms and ammunition by people who have been convicted in any court of a ‘misdemeanor crime of domestic violence’, and/or who are subject to certain domestic violence protective orders”. However, New Mexico state government has failed to implement this federal law.  In New Mexico, state law does NOT:

  • Prohibit individuals convicted of domestic violence misdemeanors from purchasing or possessing firearms or ammunition (unlike federal law);
  • Prohibit individuals subject to domestic violence protective orders from possessing firearms or ammunition (unlike federal law);
  • Require the surrender of firearms or ammunition by domestic abusers who have become prohibited from possessing firearms or ammunition under federal law);

Thus, it is no surprise that New Mexico leads the country in homicide rates against women. In fact, in New Mexico, “men murder women at the third highest rate in the country…”. Most recent data in 2015 shows that “the homicide rate among females murdered by males in New Mexico was 1.52 per 100,000”. Many studies have shown that restricting perpetrators access to firearms, such as through the use of domestic violence restraining orders (DVROs), has been associated with as much as a 25% reduction in IPHs. However, the National Rifle Association (NRA) proposes that rather than focusing on imposing restrictions around perpetrators access to guns, to instead arm domestic violence victims. In fact, the NRA has a history of encouraging domestic violence victims to purchase firearms and sign up for NRA training courses. Such actions not only fail to address firearm related IPHs, but they also put domestic violence victims at increased risk of harm.

In 2017, the New Mexicans to Prevent Gun Violence (NMPGV) organization worked to pass SB259, “legislation [that] would have prohibited misdemeanor domestic violence offenders under protect orders from being able to possess firearms”. While this bill passed in both the Senate and the House, state Governor Martinez vetoed it. This year, Governor Martinez should not only reconsider, but also work with the NMPGV to implement evidenced-based DVRO legislation around the purchasing, possession, and surrender of firearms, as this legislation acts as a critical first step in reducing firearm-related IPHs in New Mexico.


Where Have All the Medicare Doctors Gone – When Will Medicare Ever Learn – When Will They Ever Learn?

March 9, 2018

In 2017, CMS began requiring all eligible clinicians to comply with burdensome quality reporting requirements to receive Medicare reimbursements.  The requirements stemmed from the legislation for merit-based payments  MIPS-MACRA.  Many clinicians complained about the burdens associated with reporting but more importantly clinicians, especially small and specialty practices, complained that the measures that are available for reporting are meaningless and small clinician practices and specialties are considering dropping Medicare patients.

no medicare

One doctor’s painful letter about no longer being able to take care of Medicare patients struck a note for many patients and providers My Dear Medicare Patients.


walk away


In trying to address the problem, CMS included additional exclusion criteria so that some small practices would not have to report.  However, the answer is not to find ways to eliminate clinicians from the program but rather make it less burdensome and more meaningful so that they can participate – especially since many reports show small practices can provide same or better quality of care to patients National StudyCan Small Physician Practices Survive.  A better solution is for CMS to facilitate and incent collaboration across clinical communities to begin identifying more meaningful measures and remove barriers related to additional measure endorsement requirements NQF.

Medical societies and trade associations are key stakeholders, especially those that represent family practices AAFP.  Some specialty providers are already working with their specialty providers to begin identifying these more meaningful measures American College of Rheumatology.   Patients are also a critical stakeholder who stand to lose access to care, as well as major patient advocacy groups such as AARP and PAF.  However, EHR and Health IT providers stand to gain a lot of money from providers by charging for additional services to support clinician quality reporting.

Actionable Next Steps

If you are a clinician ask your medical society to provide feedback to CMS at QPP urging them to incentivize medical societies and associations to work with their providers to identify meaningful measures.

If you are a patient or caregiver, let your clinician know what is meaningful to you for tracking quality of care.



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!