Archive for the ‘Funding’ Category

Minnesota Needs the Clean Power Plan.

August 20, 2017

The Clean Power Plan enacted in 2015 aimed to reduce greenhouse emissions from the energy sector, which account for almost 40% of the U.S. carbon dioxide emissions, necessary to halt the predicted destructive impact climate change will have globally.  In March 2017, President Trump signed the Executive Order for Energy Independence, which sent the policy for review by the EPA to either withdraw or rewrite the plan, a lengthy process which will halt the policy’s regulation of power plant emissions.

The Clean Power Plan and all other actions to reduce climate change are necessary for all countries and individuals globally.  Coastal cities, such as Miami, are already dealing with flooding due to the sea level increasing.

Many Americans and Minnesotans may think climate change will have minimal effect on their wellbeing and daily Screen Shot 2017-08-20 at 6.57.48 PM.pngactivities.  The impact of climate change in Minnesota has been predicted and witnessed, as tornados, storms, and floods become more devastating and irregular.  Erratic changes in temperatures and precipitation will affect livestock and crop yields.

 

Individually, people should care for their health.  Energy production from coal leads to air pollution and climate change creating or worsening respiratory problems such as asthma, bronchitis, emphysema, and lung cancer, as well as increasing the risk of heart attack, heart failure, and stroke.  The length of allergy seasons has already increased, for example the ragweed season is 21 days longer than in 1995.

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Minnesota itself has not hit the emission targets set to reduce the impact of climate change, while the rest of the country has variable progressions.  In Minnesota, we need to be advocates for our health and wellbeing, and to do so, we must encourage others to support the Clean Power Plan and other efforts to combat climate change and turn our focus and investment to more efficient or cleaner forms of energy.

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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!

Expanding Medicare’s Immunosuppressive Drug Coverage to All Kidney Transplant Recipients

August 20, 2017
The high cost of necessary transplant medicines can lead to some kidney transplant recipients losing their new kidneys.

The high cost of necessary transplant medicines can lead to some kidney transplant recipients losing their new kidneys.

As of January 2016, about 660,000 individuals in the United States are being treated for kidney failure. While dialysis can be an effective solution for some individuals, the current best care for renal failure is a kidney transplant, which offers better health outcomes and is less expensive long term than dialysis. While the initial transplant costs about $90,000 and required post-transplant medicines cost $16,000 per year, dialysis costs about $44,000 per year; most transplants pay for themselves and become cheaper than dialysis after 2 to 3 years. Kidney transplant recipients must take expensive immunosuppressive medications to keep their transplants healthy and working. Medicare currently pays for dialysis and kidney transplants as needed for everyone in the United States. However, while Medicare will cover the cost of transplant medications indefinitely for those 65 and older or disabled, Medicare will only cover transplant medications for 36 months for those under 65. After 36 months, many transplant recipients are not able to afford their medication and stop taking it; many then lose their transplant and have to go back on dialysis.

A doctor preparing a donated kidney for transport.

A doctor preparing a donated kidney for transport.

Multiple professional, patient-centered, and nonprofit groups support changing the law to expand Medicare’s indefinite immunosuppressive drug coverage to anyone in the United States with a kidney transplant. While bills have been introduced multiple times in Congress to address this issue, none have yet passed. A proposal put forward in 2009 was blocked by a major industry coalition who opposed plans to generate cost-savings from dialysis care to pay for the new coverage.  Subsequent proposals have failed to make it to a vote, due both to a Congress unwilling to address more health legislation in the wake of the Affordable Care Act and to real concerns about continued funding for Medicare. While the long term savings will be high, initial funding for such a measure may be difficult to find. Nevertheless, expanding post-transplant drug coverage in this way has substantial advantages both in increased quality of life for patients and in long-term savings for Medicare. Patients, health care professionals, and kidney-focused nonprofit groups should continue to contact their legislators through both private communication and public statements to urge them to expand transplant drug coverage.

 

Give Thailand’s Migrants their Health Insurance (MHI)

August 20, 2017

In 2011, Thailand was estimated to have 3.7 million migrant workers. They form 5% of the total labour workforce and are estimated to contribute to 6.2% of the Thai national gross domestic product (GDP), or US $ 2 billion dollars in 2005. The majority of these migrants may be displaced, illegal or undocumented. Hence, they do not enjoy health protection through the Social Health Insurance (SHI) private employees provide to workers with a permit. In 2013, the MHI was expanded to include coverage for undocumented workers and other services for a yearly fee of 2100 baht (approximately US $60). Human rights groups applauded Thailand as it became a global leader in universal healthcare for non-citizens. However, reports have surfaced on the refusal of hospitals to register undocumented workers under the MHI, especially in the greater Bangkok metropolitan area.

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Figure 1. Proportion of Non-Thai Citizens in 2011 (adapted from the International Health Policy Program Foundation)

Migrants smuggled to Thailand UN

Figure 2. The UN Office of Drugs and Crime reports Thailand as a destination country for migrant smuggling and labour trafficking

Displaced people due to civil war or poor economic conditions in neighbouring countries, the trafficked, smuggled and asylum seekers all need the MHI to have access to healthcare. Yet, hospitals are given discretion in their interpretation of the policy and face no penalty for refusing migrant workers. A hospital’s refusal to allow a migrant healthcare because they do not have documentation is a violation of the policy and the human right to a standard of living adequate for health and the well-being of a person and his family according to the Universal Declaration of Human Rights 1948 Article 25. Sadly, they are motivated to do so for fiscal survival in fear of the migrant workers over-burdening their resources.

Cambodian migrant worker

Figure 3. Yum, 29, was sold from Cambodia to a Thai fishing boat. He sailed for days at sea before knowing he was sold. After nine months at sea, he escaped. Now with a wife and newborn baby, he is hoping to find work in Thailand again. – The Guardian.

The health ministry must enforce the MHI for undocumented migrants to protect the community against communicable disease and increase pooled funds. It is a moral imperative to allow the people who make significant contributions to the nation’s economy access to healthcare.

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

August 19, 2017

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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.

The Global Gag Rule, a harmful human rights violation

March 12, 2017

The Global Gag Rule (GGR) is harmful to women and families and violates human rights. Originally known as the “Mexico City Policy” because it was enacted by Ronald Reagan in 1984 at a conference in Mexico City, the policy is more commonly known as the Global Gag Rule because of how it silences NGOs and health care workers. Specifically, the original policy dictated that no USAID family planning funds could be awarded to organizations that performed or promoted abortion and therefore prohibited them from even speaking about abortion.

The GGR is highly partisan- every Democrat president since Reagan has rescinded the policy and every Republican has reinstated it. The current administration, however, has not only reinstated the GGR but has dramatically expanded the funds that are affected.

Reagan’s version applied to USAID family planning funds; G.W. Bush’s version limited the GGR by exempting USAID HIV/AIDs related work. The latest iteration, however, greatly expands the affected funds to cover all foreign aid arising from any agency or department. The current version restricts up to $9.5 billion in aid, or 16x the amount of funds that would have been affected by previous versions.

Worse yet, beyond being a clear example of religious overreach in US politics and a violation of human rights, evidence suggests that the policy reduces sex education and contraception use while increasing both abortions and the proportion of abortions that result in health complications- maternal, family, and child health all suffer. There is a large coalition of organizations that oppose the GGR. You can take action today by learning more information about the GGR and volunteering or donating to organizations like IPPF, PAI, and the Bill and Melinda Gates Foundation who, together with UN member countries, are attempting to counteract the extreme funding deficit.

Rescind the Mexico City Policy

March 12, 2017

In 1984, President Reagan instituted what has been referred to as the “Mexico City” Policy. This policy prohibits any federal funds going to NGOs that provide family planning advice related to abortion. Its intent was to ensure that no U.S. taxpayer money was spent on any abortion related services. Depending on which political party is in power, the policy is periodically reinstated and then rescinded again. Recently, President Trump reinstated the Mexico City Policy. Reinstatement of this policy is often applauded by pro-life groups and religious institutions such as the Catholic Church. Other groups, such as Planned Parenthood and Doctors Without Borders, have come out strongly against reinstating the policy.

Although this policy is intended to reduce the number of abortions by not allowing funding to go toward organizations that advise women on abortion and other family planning services, evidence indicates that the policy results in an increase in the number of abortions over time. For instance, a study cited in The Economist indicated that Sub-Saharan countries with high exposure to this policy saw dramatic increase in abortions over time after it was reinstated by the Bush Administration in 2001 (see figure below).  Since this policy explicitly deprives organizations of all funding because they provide abortions or abortion related advice, it can also reduce the amount of funding available for contraceptives, HIV testing, and prenatal care.

Credit: The Economist

In summary, The Mexico City policy is counterproductive to reducing abortion and improving women’s health services as evidence has indicated the policy results in an increase the number of abortions when federal funding for NGO’s is reduced. Therefore, it would be better for women’s health and many pro-life groups if the policy is rescinded as it deprives funding for NGOs that provide other important services like contraception and STI testing.

Rescinding the Mexico City Policy

March 12, 2017

The Mexico City Policy, also commonly known as the “Global Gag Rule,” was first introduced in 1985 during the Reagan administration and has been rescinded by most Democratic presidents and reinstated by most Republican presidents since then. This policy was most recently reinstated by President Trump, and prohibits foreign NGOs that receive US government funding from performing abortions, providing counseling and information on abortions as a method of family planning, or promoting any changes in a country’s legislation regarding abortion. The Trump administration’s reinstatement, however, does not apply only to family planning assistance. It expands to limit all U.S. global health funding, including global HIV and maternal child health (MCH) assistance.

Many organizations, including Marie Stopes International, Doctors Without Borders, Population Action International, and International Planned Parenthood Federation, have released statements in opposition to the Global Gag Rule. Foreign governments have also stepped forward, with some creating international funds or pledging money in an effort to fill the funding gap. While these are a good start, we need greater mobilization to fight for women’s health and empowerment.

Unsafe abortion is one of the main causes of maternal mortality worldwide, and disproportionately affects women in low- and middle-income countries and in vulnerable contexts such as refugee camps and conflict zones. Research has shown that policies preventing providers from educating women about abortion and family planning methods lead to more unwanted pregnancies, more unsafe abortions, and higher rates of STIs. This policy also threatens progress on many other fronts, such as HIV, child malaria, tuberculosis, and immunizations. Healthcare providers, public health professionals, and all concerned citizens need to speak out for global reproductive rights, support international aid organizations, and push Trump and US Congress for the repeal of the Mexico City Policy.

South Africa’s Never Ending Struggle with Mental Health Care

March 12, 2017

x1461868764808.jpg.pagespeed.ic.I8dCKVYwxTImage Credit: The Rand Blog

In February of 2017, over 94 mental health patients under the Gauteng Department of Health’s care perished after being subjected to  neglect and abuse. Patients were severely malnourished and had been subjected to conditions likened to living in a concentration camp. These findings highlight the extensive work that remains to be done in regards to mental health care in South Africa.

Although national statistics estimate that  30.3% of South African adults suffer from a mental illness during their lifetimes, mental health remains a taboo subject in the nation. Cape Mental Health attributes this stigma to traditional beliefs and a lack of knowledge on what mental health care entails. 

In 2002, South Africa enacted the Mental Health Care Act  which was meant to:

  • Prohibit the unfair discrimination of those suffering from mental health disorders.
  • Ensure the dignity and privacy of patients during treatment.
  • Support mental health care services that promote the well-being of its users.

Although supported by many stakeholders, the Act has largely failed to achieve its goals due to the stigmatization of mental patients by health professionals, improper training, and a lack of resources in mental health care facilities.

As such, it is imperative that the South African government increases the funding and stresses the implementation of the Mental Health Care Act of 2002. The government should increase the funding of mental health care facilities so that they are able to expand their resources. Workshops and training programs on mental health care should be made mandatory for health care personnel, and programs that educate patients on coping strategies should also be enacted.

South Africa’s problem isn’t a faulty policy initiative, it is faulty implementation. By expanding on the resources available to mental health centers, the nation will be able to ensure that the events of February 2017 are never repeated.

A proposed modification to Brazil’s Public Expenditure Ceiling 55 (PEC 55)

March 11, 2017

 

Anti-government demonstrators clash with riot-policemen during a protest against the constitutional amendment PEC 55, which limits public spending, in front of Brazil's National Congress in Brasilia

Photo credit: Anti-government demonstrators clash with riot-policemen during a protest against the constitutional amendment PEC 55, which limits public spending, in front of Brazil’s National Congress in Brasilia, Brazil. REUTERS/Adriano Machado

In December 2016, the Brazilian Senate approved a cap for federal spending for the next 20 years through a constitutional amendment. Controversial President Michel Temer proposed austerity measures, known as PEC 55 (Public Expenditure Ceiling 55) to lift Brazil out of its worst economic recession ever documented. These measures include cuts to healthcare spending.

Created out of social and political unrest, the 1988 Brazilian Constitution declared health as a human right, an idea borrowed from the Declaration of Alma Ata. The Constitution authorized free public healthcare for all citizens through the Unified Health System. This system provides decentralized, comprehensive, universal health care and community-based primary healthcare services for Brazilians. About 80% of Brazilians solely use the public system for their healthcare needs.

Brazil’s Institute of Applied Economic Research estimated that the accumulated, 20-year loss to the public healthcare system due to these cuts could be a total of 654 billion Brazilian reais. The cuts will most hurt the poorest and most vulnerable populations. The cuts are expected to decrease preventative and health promotion services and also increase inequities in access to health care. The opposing majority, protesters, health experts and economic experts are raising their concerns because cuts to health and education under PEC 55 will disproportionately harm vulnerable populations such as racial minorities, the poor and the elderly. And, opponents decry PEC 55 because it will cause detrimental setbacks in education and health.

Health is not a sector in which governments should cut corners. The long-term costs and predicted increase in demand for healthcare services should outweigh the estimated budget savings. The Brazilian Senate should create an exemption in PEC 55 to allow for flexibility in healthcare spending. The spending cap should not apply to healthcare.

In this case, saving dollars just doesn’t make sense.