Posts Tagged ‘Health Policy’

Toxic Stress in Children of Immigrant Detainees

August 6, 2017

kids of deported parentsPediatricians are sounding the alarm on the health effects of children traumatically separated from detained immigrant parents. Responding to the Executive Order expanding deportation, American Academy of Pediatrics (AAP) President Fernando Stein stated

The executive orders signed today are harmful to immigrant children and families throughout our country.they deserve to be healthy and safe.”

Nonetheless, on June 15 the Secretary of Homeland Security rescinded the  Deferred Action for Parents of Americans and Lawful Permanent Residents (DAPA) which protected undocumented parents of US citizen children from deportation.

5 million children who are US citizens have at least one undocumented parent. 660,000 children were separated from parents due to deportation between 1998 and 2012. By May, non-criminal immigration arrests increased by 150%.

Pediatricians warn that constant fear of parental deportation results in feeding, sleep and learning problems, depression, and illness and toxic stress, which can hinder brain development. Adverse experiences in childhood predispose individuals to heart disease, diabetes, and cancer.

Even before Trump’s actions, immigrant and American-born Hispanic mothers in Iowa were 24 percent more likely to have low-birthweight babies after a federal immigration raid. Delays in preventive care and medical treatment followed Arizona immigration legislation. Parents, even those with children with disabilities, hear of a single parent of a child with cerebral palsy being deported to Colombia, and stay home foregoing medical care due to fear of detainment.

Pediatricians are raising their voices, lobbying for protection of community sanctuary status, designing emergency care documents for immigrant families, and writing letters supporting parental care for special health needs.

Homeland Security must immediately limit arrests to immigrants with a documented criminal record, and provide agency assistance in creating family care plans before detention. Until federal raids are halted, states must defend the sovereignty of sanctuary communities for immigrants. Children must be put first.

foster care deported image


Controlling gun violence: Maryland’s 2013 Firearm Safety Act

March 12, 2017

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.

Kiribati Trying to Keep Its Head Above Water

March 11, 2017


Kiribati, a small Pacific island nation, could disappear under water in a few decades due to climate trends. Former President Anote Tong led initiatives to address climate change effects, such as the Kiribati Adaptation Program . This World Bank-funded program helped to provide education and infrastructure support to help the country manage the threat of climate change but only through 2016.  It is now crucial for the current Kiribati administration to continue this progress and introduce a formal policy to mitigate the effects of climate change and preserve this beautiful country.

Key stakeholders support efforts to curtail climate change. The United Nations has increased international attention on climate change effects in Kiribati.  International businesses such as Sunlabob Renewable Energy  and Kiribati Fish Ltd. are using natural resources to create training and economic opportunities. There is grassroots support for environment protection from NGOs such as the Kiribati Climate Action Network.  However, skepticism exists among various entities.  Current President Taneti Maamau places lower priority on climate change than the former president did . Even the pastor with the Kiribati Uniting Church, serving almost half of the country’s population, does not fully believe in these effects.  

There should be no doubt that climate change can affect the wellbeing of all Kiribati people.  We must petition Parliament to introduce a bill that shifts funding toward climate change mitigation programs focusing on international advocacy, education, and local economic support with signature of President Maamau. Tebao Awerika, Minister of Environment, Lands, and Agricultural Development, and Dr. Teuea Taotu, Minister of Finance and Economic Development, can provide testimony to Parliament and strengthen our advocacy efforts.  This government must be a part of actionable change to save lives and maintain the wellbeing of Kiribati citizens.

Why California voters should uphold Senate Bill 277

August 14, 2015
Girl getting immunization: Getty Images

Getty Images

On June 30th, 2015, Governor Jerry Brown signed Senate Bill 277 into law. SB277 amended the vaccine requirements for California school children by banning religious and personal belief exemptions of childhood vaccinations. Starting January 1, 2016, students attending California schools must receive all childhood vaccinations as recommended by the AAP and CDC unless they have a medical exemption signed by a physician. The California State PTA and the California Department of Public Health supported this legislature in light of a recent measles outbreak that began in California’s Disneyland. The outbreak was perpetuated by low inoculation rates that decreased herd immunity and led to cases across 24 states and the District of Columbia.

While side effects exist for all medications, the risk of vaccination is highly outweighed by the benefit of eliminating suffering and death from vaccine preventable diseases. Serious allergic reaction to the Measles Mumps and Rubella vaccine has been reported in less than 1 out of a million doses given. In contrast, 1 to 2 out of every 1,000 children who get measles will die. In addition, research has thoroughly discredited any connection between childhood vaccinations and neurodevelopmental disorders such as autism.

Despite the fact that research has clearly proven childhood vaccines are both safe and effective, former assemblyman Tim Donnelly filed a referendum to oppose SB277. Opponents of the bill, such as anti-vaccine group the California Coalition for Vaccine Choice, need to collect 365,880 valid referendum signatures in order to delay the implementation of SB277 by bringing the bill to a vote in November of 2016, after the start of the school year.

Young children and persons who are chronically ill or immunocompromised are at increased risk for contracting diseases such as measles and suffering more severe sequelae of such diseases. The California government has the responsibility to protect these individuals, and to do so vaccination rates must be increased to levels sufficient for herd immunity. SB277 is an evidence-based policy that supports the public health of all Californians. California voters need to unite in favor of protecting their neighbors and fellow citizens and uphold SB277.

Renewing the debate for an HPV school-entry vaccination mandate in Maryland

August 14, 2015

HPV vaccine being administered (JOE RAEDLE / GETTY IMAGES)

In 2007, a human papillomavirus (HPV) school-entry vaccination mandate was introduced and then withdrawn in the Maryland legislature.  The major concerns at the time was that the vaccine was too new, it was too costly, and that it was intended to prevent a sexually transmitted disease.

Since then, no substantial action has been taken and there has been no formal deliberation about re-introducing an HPV vaccine mandate in Maryland.  In the years since the mandate was introduced, cervical cancer has continued to rise in Maryland with nearly 200 new cases per year according to the most recent data from the Maryland Department of Health.

It is unanimous among the scientific community that nearly all cervical cancer cases are caused by HPV.  It is understandable that the public was apprehensive of the HPV vaccine in the past, but now we know that:

  • The vaccine has been administered for nearly 10 years and is proven to be safe
  • The vaccine is very effective and can prevent thousands of deaths from cervical cancer
  • There is no evidence that the HPV vaccine increases the chances of risky sexual behavior
  • Insurance plans are required to cover the cost of the vaccine under the ACA and it is also available at no cost through Medicaid’s Vaccines for Children Program

Virginia, the District of Columbia, and recently Rhode Island have enacted school-entry mandates for HPV vaccination.  DC passed the law in 2007 and as a result, they are now a national leader in HPV vaccination coverage.

It has been eight years since the HPV vaccine mandate was first debated in Maryland and it is time to renew that debate.  If Maryland is serious about preventing a deadly form of cancer, they should follow their neighbors’ lead and enact a school-entry HPV vaccination mandate.

Increase access to pharmacists’ patient-care services: recognize pharmacists as providers under Federal Law and pass H.R 592 and S. 314

August 14, 2015


Pharmacists provide an array of patient-care activities that have shown through numerous studies, to improve patient outcomes. The most comprehensive report coming in the form of a 2011 report to the U.S. Surgeon General, “Improving Patient and Health System Outcomes through Advanced Pharmacy Practice”. Several states have Clinical Pharmacists who provide direct patient care through a variety of services, such as managing a patient’s medication regimen, ordering labs, and adjusting mediation dosages. The ability of a pharmacist to perform these expanded patient care duties are largely due to Pharmacist Collaborative Practice Agreements (CPA) with providers, which differs from state to state. Even with the ability of pharmacists to have expanded scope of practice, they are still not recognized as Providers under Medicare Part B and the Social Security Act. This inhibits pharmacists from fully being integrated within the healthcare team, as they are not being reimbursed for the services they are providing. By seeking provider status, pharmacists are seeking recognition for reimbursement. Once reimbursement is uniform for the array of services pharmacists can provide, it can increase patient access to pharmacist care. Although there are 34 states that recognize pharmacists as providers, third party reimbursement is highly variable and even non-existent in some states. The American Pharmacists Association state that “because Medicaid and private payers often follow precedents set by Medicare, federal provider status for pharmacists within the Social Security Act (SSA) would likely make coverage for pharmacists’ patient care services easier and more widespread”.

Essentially, pharmacists need to be utilized to the top of their ability in order to promote positive patient outcomes. A way to do this is by recognizing pharmacists as providers by Medicare Part B within the Social Security Act. Once national precedent is set, then Medicaid and other private payers will most likely follow. Support from the general public and by various healthcare professions are needed to support the Pharmacist Provider Status Legislation, called the Pharmacy and Medically Underserved Areas Enhancement Act (H.R. 592 and S. 314).

Adopt the 2014 bill SBP 7028, the “Florida Telemedicine Act”

March 6, 2015

For the past two years, there has been a heated debate on legislature surrounding the adoption of telehealth technology in the state of Florida. Telemedicine has been shown to be a cost-saving benefit by leveraging technology to provide more effective and efficient systems of care. blog pic 1Florida currently has a higher ratio of patients to primary care providers when compared to the national average and is projected to have an increasing shortage of physicians over the next 10 to 15 years. The reasons cited for these projections include a growth in the population, increased use of medical services due to an aging population and an increased number in the insured due to the mandated 2010 Affordable Care Act (ACA). Another major benefit to facilitating telemedicine in the state is rural health care coverage. The Florida Department of Health reports ten of Florida’s 30 rural counties currently lack a rural hospital which continue to be the primary and focal point of care for these areas.

SBP 7028 would seek to “create licensure and registration requirements; provide health insurer and health plan reimbursement requirements for telemedicine; and provide requirements for reimbursement of telemedicine services under the Medicaid program, etc.” Telemedicine in Florida is supported by independent groups such as Florida TaxWatch and Florida Partnership for Teleheath. This bill has been met with most resistance from the Florida Medical Association specifically due to concerns of accountability, physician licensure, certification process to provide telemedicine services and potential abuse or misuse of such technology by out of state providers.

Twenty-two states are facing proposed legislature related to adopting telehealth technologies while others are expanding these to meet a growing need. One year and several amendments later, it is time to vote on this bill for telemedicine across the state of Florida.

End of Life Care

March 10, 2014

Last year, Medicare paid 55 BILLION dollars to cover the expenses generated during the last two months of people’s lives! Studies estimate that this accounts for about 25% of the entire Medicare budget. At a time when budgets are being cut and necessary projects are being delayed due to insufficient funds, we as a society have to ask ourselves if spending this much money on end of life care is worth it and what are other alternatives?

One alternative which can decrease costs, and – more importantly – improve quality of life for dying people is palliative or hospice care. However, in order to take advantage of this care, it requires people to think about exactly how they want to die and what medical treatments they are willing to accept. Are they willing to be ventilated if they have trouble breathing, or do they want to be resuscitated if their heart stops?

While they are still relatively healthy, people with terminal disease should get an advance directive and appoint a power of attorney. Thinking about these issues prior to the finals days will not only prevent patients from having to endure procedures which they would not have wanted, but it will also save billions of dollars. The final days of a person’s life should be made as comfortable as possible, and not everybody wants to use the incredible advances of modern medicine just to squeeze out a few extra days.