Replacing the Affordable Care Act

March 12, 2017 by

Lab 5 Blog

The Affordable Care Act was put into place by President Obama to help insure millions of American’s by expanding Medicaid to cover more low-income Americans. The Affordable Care Act also made it so that insurance companies could not refuse people because of pre-existing conditions and made birth control free, along with many other preventative services.

The current pressing issue around the ACA is that the Republican majority congress has stated that they will repeal and replace the ACA. Until earlier this week, congress had not presented an option for replacement of the ACA. Many stakeholders are against the repeal of the ACA without a replacement that they deem to be reasonable, which means the new proposal will be under much scrutiny.

There are already many negative reactions to the proposed replacement, not only from those against repealing, but also some that are for it. Many House and Senate Republicans, who support repealing the ACA, have stated that the replacement would negatively effect the Medicaid expansion put into place by the ACA and will hurt many of their states citizens. While others, who are more conservative, feel that the replacement is simply “ObamaCare-lite” and is not a good enough solution to the problems they see in the ACA.

While Republicans are torn about the proposed replacement, House and Senate Democrats are presenting a firm stance against repealing and replacing the ACA. This split in support will make it very difficult for the suggested replacement, as it stands, to be passed through Congress. If the Republican majority wants to replace the ACA, they will have to find a more agreeable suggestion with which to do so.

Stop Fracking: Education and Advocacy

March 12, 2017 by

A fight is raging in the middle of Pennsylvania over a process called hydraulic fracturing, commonly known as “fracking.” Shale gas will comprise 45% of all natural “dry” gas used in the United States by 2035 (shown in Figure 1).[1] This estimates to trillions of dollars for gas companies.  But not only the gas companies benefit. These profits extend to private-owners. Business Insider has suggested that in 2010, $21 billion has been paid to landowners across the country. Specifically, a pay-out of $1.2 billion has been given to Pennsylvania land-owners in 2012.[2]

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However, environmental scientists have shown that one of the largest problems is the leakage of fracking products that contaminate watersheds and aquifers that people use for potable water.[3] [4] [5] Drinking contaminated drinking water with the inputs and outputs of fracking will cause significant health effects.

A large reason for aquifer contamination is that cement is the only barrier that prevents byproducts from reaching ground-soil. Similarly, storage of fracking wastewater isnot well-disposed or handled after fracking [6]. After years of weathering and neglect, these concrete structures can fall away and allow for free-water flow into the ground.


There are many organizations that have stake in proposing regulation and policy-briefs about fracking, including Green-Peace and Earth-Justice.[7] Earth-justice, among others have issued initiatives to prevent fracking in public and private lands.[8] We need to support these advocacy groups AND educate people in Pennsylvania about the deleterious effects of fracking. Similarly, Advocacy journalism and advocacy social media play significant roles in reaching out to policy-makers and gas-companies. These actions, will promote public outcry.

Enough public outcry can promote a systemic change in how fracking is managed and regulated. We must educate people, promote initiatives, and demonstrate why companies need to responsible for both cleaning up their waste-water and maintaining the integrity of abandoned fracking wells.

CCMDD: A vehicle towards universal access to Anti Retrovirals and other chronic medicines in South Africa.

March 12, 2017 by

Over the past decade, South Africa has experienced an unprecedented growth in patients requiring access to long-term therapies. Not only has South Africa introduced universal access to antiretroviral therapy (ART) for patients living with HIV and AIDS, but there has also been a steady increase in the number of patients with non-communicable diseases (NCDs), requiring chronic therapy.  gapminder_hiv_chart_feb09_a

Slide1South Africa’s changing epidemiological profile has led to an over-extension of public sector healthcare facilities including primary health care (PHC) clinics. This has placed enormous strain on available resources and has contributed towards medicine shortages and declining quality of care.

South African government response to this and other health disparities was the introduction of the new policy called  National Health Insurance (NHI) which “seeks to transform the South African Healthcare system with emphasis on the promotion of health and the prevention of diseases. It also seeks to provide access to quality and affordable healthcare services for all South Africans based on their health needs irrespective of their socio-economic status”, according to the South African Government website.

To improve patient access to needed medicines, especially for patients on chronic medication, as well as to assist with decongesting public clinics, the Department implemented the Centralised Chronic Medication Dispensing and DistributiSlide1on (CCMDD) policy. This is comprised of two programme components, Central Chronic Medicine Dispensing and Distribution (CCMDD) and Pick-Up Points (PuPs).

This system will lead to shorter waiting times at facilities – patients would collect their medicine from an alternative pick-up point; patients would be able collect medicines from places closer to their homes and work. There will be improved retention of patients on treatment and follow-up on defaulters.  I strongly support this policy and advocate for more funding as it is currently underfunded by at least R 800 million to be fully implemented in the whole country (Gray A et al, 2015).



Controlling gun violence: Maryland’s 2013 Firearm Safety Act

March 12, 2017 by

Gun violence is an urgent public health issue in the United States. Many states, including Maryland, struggle with increasing numbers of firearm-related homicides. In 2016, Baltimore had 275 gun-related homicides despite increased arrests for gun crimes. This is a 44% increase from 2014 when 191 homicides occurred in the city.

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Among the 50 states, Maryland has been at the forefront of leading the gun safety movement in the country. In 2013, Maryland passed the Firearm Safety Act that bans the sale of commonly owned high-capacity firearms and magazines in the state. However, this law has been quite controversial.

Maryland Shall Issue, a gun store, and four Maryland residents filed a lawsuit against the Firearm Safety Act with the support of the Maryland State Rifle & Pistol Association. Initially, the U.S. District Court judge in Baltimore stated the law was constitutional and upheld the law. However, in 2016 the U.S. Court of Appeals for the Fourth Circuit overruled this reasoning by 2-1 vote, stating that high-capacity guns included in the ban were in common use.

Former Maryland Governor Martin O’Malley who led the passing of the 2013 law, as well as community groups such as Marylanders to Prevent Gun Violence, have lobbied other states to enact similar policies, believing that this law led to a reduction in gun-related homicides.

Despite the ongoing debate regarding the policy, the Maryland Department of Health and the Maryland State Police have not formally stated their positions with regard to the Firearm Safety Act. In order for the State of Maryland to protect the community from gun violence, it is important for the Maryland Department of Health and the Maryland State Police to release an evidence-based statement of their organizations’ positions. Furthermore, they should do this in a timely manner, before the case’s upcoming court proceedings.

Adoption of New TB Drugs

March 12, 2017 by

TB is an airborne infection that, if untreated, causes coughing blood, wasting away, and an inevitable slow death. In 2012, an estimated 8.6 million people developed TB, and 1.3 million people died from it. TB continues to cause a huge amount of sickness and death since it evolves into drug-resistant TB (DR-TB) resulting in a lower probability of cure.

  • According to WHO estimates, in 2012, there were 450,000 new cases of MDR-TB among detected TB cases and nearly half as many remained undetected
  • Pakistan has the fifth highest number of MDR-TB cases in the world
  • MDR-TB is 3.5% among new TB cases and 32% among previously treated cases

Some challenges for treatment of DR-TB are:

  • Low cure rates due to poor activity of second line drugs to treat MDR-TB
  • Treatment requires 4 to 5 “effective” second line drugs and most of these drugs were invented decades ago. These drugs fell out of use due to weak sterilising activity or severe side effects 

    After 50 years, there’s a ray of hope, as two new drugs (i.e. bedaquiline & delaminid) have been developed and approved by the Food & Drug Administration and the European Medicines Agency. Due to lack of sufficient data and evidence on safety and efficacy, the governments are reluctant to adopt these drugs in their national TB programmes.

    Up till October 2016, only 5,700 patients had received bedaquiline globally, and only 405 had access to delaminid. World Health Organization (WHO) estimates that 580,000 people were eligible for MDR-TB treatment in 2015.

    International stakeholders such as the WHO Task Force for New Drug Policy Development and Stop TB Partnership are for the adoption of these two drugs in Pakistan. Moreover, the Infectious Diseases Committee in Pakistan also realises the benefits and is for the use of these drugs. However, the National TB Control Program, Pakistan is still not committed since it is assessing the costs incurred, logistics of procuring and disbursing these drugs and the risks of administering these drugs.



Need for Sustainable Financing of Long Term Services for United States Seniors

March 12, 2017 by

According to the United States Department of Health and Human Services’ Administration on Aging, in 2014, there were 46.2 million people 65 years and older in the U.S. This number is expected to grow to 98 million by 2060, with a significant proportion requiring long term services and supports (LTSS) to help with activities of daily living (such as bathing, dressing, eating) and instrumental activities of daily living (such as medication management, financial management, and housecleaning) due to physical, developmental or cognitive impairments.


LTSS are provided by skilled nursing facilities, assisted living facilities, senior living communities, community senior agencies, home aide agencies and family/friend caregivers. Unfortunately, Medicare does not pay for these services. Currently, the methods of financing these services are Medicaid, private long term insurance policies, private pay services, and unpaid caregivers. The challenge is that none of these methods alone is sustainable, affordable, or  available to a socioeconomically diverse aging population.

그림3.pngThe U.S. Congress has made various efforts to promote community and social program support for the aging population, however, it has been unable to pass comprehensive legislation that would allow for public funding of LTSS  due to lack of bipartisan support and the diversity of needs that must be met. Several non-governmental senior and public policy advocacy groups, such as the National Council on Aging, the Bipartisan Policy Center (BPC), The Convergence Center for Policy Resolution and Leading Age have recognized that a multipronged approach to sustainably financing LTSS which includes expanding Medicaid options for community and home based services, making private long term insurance more affordable, and creating a plan to finance LTSS for high utilizers is needed.

Continued collaboration between governmental health agencies (federal and states), advocacy groups, LTSS providers, private insurance companies and seniors is required to create actionable proposals to present to Congress in the next 2-5 years.

Written by Aruna Josyula, Euijae Kim

The FDA should immediately introduce new graphic warning labels on tobacco products

March 12, 2017 by

Graphic warning labels on tobacco products have been proven to deter individuals from smoking. In the United States, cigarettes and other tobacco products are required to contain text warning labels. However, tobacco labeling in the U.S. has not been updated for over 30 years. Currently, the size, location, and content of warning labels on tobacco packaging are inadequate, particularly when compared to the evidence on effective tobacco labeling and the warning labels used in other countries.

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In 2009 the Family Smoking Prevention and Tobacco Control Act was passed, which required the FDA to establish and enforce new regulations for graphic warning labels on all tobacco products. However, tobacco companies succeeded in halting the FDA from implementing the new rule requiring graphic warning labels in 2012 by winning lawsuits, claiming that it violated their First Amendment rights. These legal cases left the FDA to come up with new rules for graphic warning labels, but no action has been taken for the four years since this court ruling. After waiting more than seven years since the legislation of the Tobacco Control Act, eight public health and professional organizations filed a lawsuit requesting the court to compel the FDA to comply with the agency’s statutory duty to propose lawful graphic warning labels. They claimed that over three million Americans, including minors, have begun to smoke during that time.

Given the high stakes for the health of the American public and the abundant evidence demonstrating the effectiveness of graphic warning labels in reducing smoking, the FDA cannot afford to delay graphic warning label requirements any longer. The FDA must do everything in its power to immediately design and require pictorial warning labels on tobacco product that meet federal and international standards.

Antimicrobial Resistance: The Role of Food Animal Production

March 12, 2017 by

Picture1Antimicrobial resistance (AMR) can arise from inappropriate use of antimicrobial medications (AMMs).  In the United States, more than 80% of all AMMs are used in food animal production, including classes of medications that are on the WHO list of critically important AMMs. Prior to 2017, many AMMs for food animal production could be purchased and used without a prescription and for purposes such as “growth promotion,” rather than for treating a documented infection.

In 2012 and 2013, the FDA released Guidance for Industry, which sought to define judicious use of AMMs in food production, as well as to recommend that the animal pharmaceutical industry voluntarily change their labeling of critically important AMMs used in food production. In short, the FDA recommended that certain AMMs should no longer be used without veterinary oversight or solely for “growth promotion.” Using these medications against their labelled purposes would then constitute a violation of the Federal Food, Drug, and Cosmetic Act.

Picture2Despite pushback from industry groups such as the National Pork Producers Council and the National Turkey Federation, which argue that there is no firm science supporting the concept that AMMs in animal production result in AMR in humans, the FDA has shown some early successes of their new guidelines. According to reports published this year, the pharmaceutical industry voluntarily either changed all new drug applications to require veterinary oversight or withdrew    the applications from consideration by January 2017.                     Credit:

However, there is more work to be done. Further guidance from the FDA should tighten controls on the use of AMMs in food production for disease prevention purposes. Currently, use of AMMs for disease prevention can include prophylactic administration of subtherapeutic doses for prolonged periods, dosed imprecisely in feed or water, to entire herds or flocks. Additionally, organizations focused on veterinary medicine and animal care, such as the USDA, should be made part of the Transatlantic Task Force on Antimicrobial Resistance (TATFAR). Finally, improved animal husbandry in food production facilities (decreased crowding, improved sanitation) would lead to less infectious disease.



Firearms and Public Health: Misguided Mental Health Crisis

March 12, 2017 by

The Mental Health and Safe Communities Act (S.2002) was introduced in 2015 in response to multiple high-profile gun violence incidents. The bill sought to increase awareness and treatment of mentally ill offenders by law enforcement officers.  However, the bill also liberalized gun ownership by removing the permanent prohibition of gun purchase or ownership by any person who has been involuntarily committed for psychiatric treatment or adjudicated to be mentally ill and restores their gun rights immediately after their involuntary commitment order expires.



Furthermore, it also justifies gun possession by emergency care providers, such as paramedics, Emergency Room clinicians, and crisis intervention specialists as a protection during their work hours thus leading to criminalization and labeling of the mentally ill as a population that we need armed protection against.

President Trump also signed an executive order on February 28, 2017 overriding the Obama administration rule requiring the Social Security Administration to input records of mentally disabled people into the FBI database (National Instant Criminal Background Check System) which is used to determine whether someone can purchase a firearm. This order further erodes our ability to identify individuals that should not have access to firearms on the basis of mental illness.

We strongly oppose the justification of gun use to protect the public, the labeling of the mentally ill as a dangerous population that we need to arm ourselves against and the easier access to firearms that the bill affords.

guns-health-care-82880109353Increased availability and access to guns in our community will not improve our safety. In order to prevent mentally ill members from committing criminal acts, we have to improve awareness of mental illness among law enforcement officers, adequate training in lieu of armed forces, and better access to mental health care.



Written by Tomoyo Kasuya and Shakirat Oyetunji

National Health Reform in Mexico

March 12, 2017 by

Photo credit: The Yucatan Times via google


In 2003, Mexico legalized a health reform policy that endorsed the introduction a health insurance mechanism called Seguro Popular de Salud (SPS).   SPS was designed to secure universal health coverage (UHC) for all citizens.

Dr. Julio Frenk, who was then the secretary of the health, led the team of reformers who drew upon years of accrued evidence to build support at the federal level through successful lobbying efforts and by sidelining opponents in the executive and legislature.  Their efforts proved successful at ensuring the program’s adoption into policy.

However, one issue of fragmentation in health services provision was not adequately addressed. Prior to the policy’s adoption, formal workers received services through either the Social Security Institute (IMSS) or the Institute for Social Security and Services for Civil Servants (ISSSTE).  Informal workers received health services under public assistance or from the private sector, with no financial protections. 

Frenk and his team pushed for a nationally integrated insurance scheme through the  Family Health Insurance Scheme (FHI) run by the IMSS that would be independent from a competitive market for services provision.  Threatened by Frenk’s competitive model , the IMSS and Ministry of Health providers resisted. So, rather than becoming a national insurance scheme, SPS was left to function as a subsidy service for the poor.

SPS has recorded notable successes in increasing coverage for mostly informal workers and for the poor. However, the program can ensure greater coverage and financial protection through risk sharing across the entire Mexican population. Additionally, the introduction of consumer choice through competition will ensure greater efficiency in service provision. To achieve these, the federal government must secure buy-in from the IMSS and MOH unions  to pass a nationally integrated insurance scheme that ensures a maximal pool and adequate competition among providers.