Research

Pollution: not “an unavoidable consequence” of development

cmonforton — Fri, 20 Oct 2017 13:09:52 +0000

Pollution: not “an unavoidable consequence” of development

The headlines are grabbing people's attention:

CBC News: "Pollution causing more deaths worldwide than war or smoking"; CNN: "Pollution linked to 9 million deaths worldwide in 2015, study says"; BBC: "Pollution linked to one in six deaths"; Associated Press: "Pollution killing more people every year than wars, disaster and hunger, study says"; The Independent: "Pollution is killing millions of people a year and the world is reaching 'crisis point', experts warn."

News outlets are referring to a report released yesterday by The Lancet Commission on Pollution and Health. The report’s authors---an international team of nearly 50 public health scientists---spent nearly two years synthesizing data on the human health effects and economic costs of toxic substances in the air, soil, and water.

Their definition of pollution comes from the European Union:

"unwanted, often dangerous, material that is introduced into the Earth’s environment as the result of human activity, that threatens human health, and that harms ecosystems."

The headlines whet my appetite for more of the numbers and the report delivers. For example, the committee's analysis indicates:

An estimated 9 million deaths in 2015 can be attributed to air, water, and soil pollution. This compares to an estimated 4 million deaths from obesity, 2.3 million from alcohol, and 1.4 million on roadways.
Pollution related deaths are responsible for three times as many deaths from AIDs, TB, and malaria combined.
Pollution related deaths are responsible for nearly 15 times as many deaths as those from wars and all forms of violence.

The report, however, goes much deeper than calculations and point estimates. Laced throughout the report---explicit and implicit---is a message that governments, foundations, medical societies, and research institutions pay too little attention to the impact of pollution on health. The authors call out political actors, international development and health organizations for ignoring pollution in their agendas. The authors write:

“Although more than 70% of the diseases caused by pollution are non-communicable diseases, interventions against pollution are barely mentioned in the [World Health Organization’s] Global Action Plan for the Prevention and Control of Non-Communicable Diseases.”

The identify several factors for the neglect:

“… A persistent impediment has been the flawed conventional wisdom that pollution and disease are the unavoidable consequences of economic development, the so-called ‘environmental Kuznets hypothesis.’ This Commission vigorously challenges that claim as a flawed and obsolete notion formulated decades ago when populations and urban centres were much smaller than they are today, the nature, sources, and health effects of pollution were very different, and cleaner fuels and modern production technologies were not yet available.

The authors do not shy away from articulating a path forward to address pollution. I agree with their assessment that sustainable long-term solutions will require a fundamental economic shift. We must move away from the "resource-intensive, and inherently wasteful, linear take-make-use-dispose economic paradigm." (It's a mouthful but sums it up well.) We must embrace and adopt a new economic system that the authors describe as one in which:

"pollution is reduced through the creation of durable, long-lasting products, the reduction of waste by large-scale recycling, reuse, and repair, the removal of distorting subsidies, the replacement of hazardous materials with safer alternatives, and strict enforcement of pollution taxes. ...[An economy that] conserves and increases resources, rather than taking and depleting them."

The Lancet Commission's report generated some eye catching headlines. I'm glad I took the time to read it. I hope many others do too.

cmonforton Fri, 10/20/2017 - 09:09

Categories

Environment

10/19/2017
With widely announced reports of casualties from world pollution being so exceedingly great; the worth of clean air, water and contaminant free soils and foods becomes further emphasized and the need underscored. This also infers that ground water, being tained by chemically laden ashes from homes and towns that have burned to the ground; homes Containing plastics, household chemicals, electronics casings. industrial solvents etc. that yet need be better prevented from contaminating; and doing so by wise planning and construction and forestry management. Further actual value can be derived from societal pursuits that do not increase or require daily polluting commuting, breathing lingering wildfire smoke, and the equally dangerous fumes from detonated weaponry being used worldwide by peoples not realizing the after effects of lingering barbarism and refusal to rather nurture mutual regard also for the planet's life sustaining land foliage -plants, trees-and other wildlife, long preceding human presence onthe planet.

Further value can be derived from not only abandoning the long adversely ramifying death dealing sado-masochistic world 'cults of mayhem, injury,decimation and death' but rather seeking and actually both pursuing and accepting whatever actually leads toward greater global safety and stabiity; and especially when such more optimal outcomes can and do present evidences of sure achievement and attainment, however unprecedented.

Among such novel occurrences are those widely seen successful demonstrations during the past three decades; of difficult to access wildfires being more quickly suppressed without chemicals and costly air flights, in over two countries and three states. The modes the advanced collaborative modes introduced, saved benefitting states and countries billions in firefighting, restoration & medical expenditures, yet were largely disparaged and likely deemed coincidental. This too underscores how humankind -even when shown better provenances to pursue, are prone to disregard and devalue the implications;, preferring the more risky costly familiar pursuits.

During the early AM hours of 10/21/2017 while dreaming; twice during the same dream sequence, I saw a volcano -seemingly nearby and somewhat blue and yellow in color-. when actually enabled to I look at it for a sustained period. During that second time;he second time -the first time it was more fleeting- I saw dark clouds moving slowly and , spreading overhead too. Whenever ever in the past when a dream is suddenly interrupted twice like that -and wit brilliant colors-, I've learned it's more than a dream and deserves attention of others. In fact I heard other voices also shouting in alarming tones when the volcanoes were seen..

It's very possible we all need be readied for more than just reckless human induced consequences, as heat from growing radioactive 'waste' is also adversely impacting the global environs . Long accumulating protective moderating elements have also been dangerously degraded, resulting in residual intensifications. And likely also enabling deeper tropospheric penetration of solar X-rays, high energy UV and cosmic rays..

CDC: Vaccination rates among kindergartners remain stable

kkrisberg — Tue, 17 Oct 2017 20:05:49 +0000

CDC: Vaccination rates among kindergartners remain stable

In more encouraging public health news, the Centers for Disease Control and Prevention reports that vaccination rates among kindergarteners have remained stable, with the median vaccine exemption rate at 2 percent. Some states even reported an increase in immunization rates.

In a study published last week in CDC’s Morbidity and Mortality Weekly Report, researchers examined 2016-2017 data from 49 states regarding coverage of three vaccines: measles, mumps and rubella (MMR); diphtheria, tetanus and acellular pertussis (DTaP); and varicella, more commonly known as chickenpox. Researchers also examined exemption numbers from all 50 states as well as data on kindergartners in 27 states who were provisionally enrolled in school or were within a vaccine grace period. They found median vaccination coverage was at 94.5 percent for state-required doses of DTaP; at 94 percent for two doses of MMR, which is what the Advisory Committee on Immunization Practices recommends; and at 93.8 percent for two doses of varicella, also what the committee recommends.

Overall, it means rates of vaccine coverage and vaccine exemption have been “relatively consistent” since 2011-2012. According to researchers: “Vaccination coverage remains consistently high and exemptions low at state and national levels.”

Getting into the particulars, the study reported that MMR vaccine coverage ranged from more than 85 percent in Washington, D.C., to more than 99 percent in Mississippi, with 20 states reporting coverage at 95 percent or higher. Among the 48 states that reported DTaP data, coverage ranged from about 82 percent in Washington, D.C., to nearly 100 percent in Maryland, with 23 states at 95 percent or higher. On chickenpox, 42 states reported coverage ranging from more than 84 percent in D.C. to more than 99 percent in Mississippi, with 15 states reporting coverage rates of 95 percent or above.

Among 46 states reporting data, the median percentage of kindergartners exempted from one or more vaccines was 2 percent. That rate ranged from less than 1 percent in Mississippi to nearly 7 percent in Alaska. Exemption rates were lower than 1 percent in four states: Alabama, Louisiana, Mississippi and West Virginia. Between the 2015-2016 and 2016-2017 school years, the exemption rate decreased in California and Vermont and slightly increased in Alaska, Georgia, Nevada, New Hampshire, New Mexico, North Carolina and Wisconsin. The median percentage of kindergartners in school with a provisional enrollment or during a grace period was at 2 percent.

The study found that four states — California, New York, North Dakota and Tennessee — reported increased coverage rates for all three vaccines. Researchers said the increases could be due to policy changes as well as efforts to educate school personnel on vaccine requirements. For example, California eliminated nonmedical exemptions for kindergartners at public and private schools. And in North Dakota, educating school superintendents on the importance of vaccines prompted most school districts to more strictly enforce vaccine requirements, which led to coverage increases of more than 3 percentage points for each of the three vaccines.

Researchers concluded the study by pointing to the importance of local data in guiding public health immunization efforts. Co-authors Ranee Seither, Kayla Calhoun, Erica Street, Jenelle Mellerson, Cynthia Knighton, Ashley Tippins and J. Michael Underwood write:

However, clusters of low vaccination coverage continue to serve as opportunities for outbreaks of vaccine-preventable diseases. Because vaccination coverage and exemption levels are clustered locally, availability of local-level vaccination data can help immunization programs identify schools that might be vulnerable in an outbreak. CDC is working with programs to improve collection and use of grace period and provisional enrollment data to understand contributing factors for reported under-vaccination and identify programmatic actions that might increase vaccination coverage among kindergartners.

Proposals at the federal level could impact vaccine rates as well. For example, lawmakers are looking to raid billions from the Affordable Care Act’s Prevention and Public Health Fund (PPHF) to keep the Children’s Health Insurance Program running — leaders in Congress let funds for the vital safety net program expire in September. However, monies from the PPHF already go to support other essential health programs, such as CDC’s Section 317 Immunization Program, which provides vaccines to underinsured children and uninsured adults. Fifty-three percent of the 317 funding now comes from the PPHF.

Advocates are calling on Congress to pass a “clean” bill that extends CHIP funding without pitting critical health programs against each other.

For a copy of the new vaccine study, visit MMWR.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years. Follow me on Twitter — @kkrisberg.

kkrisberg Tue, 10/17/2017 - 16:05

Gun control laws can impact death rates. But we need more research to find what works.

kkrisberg — Thu, 05 Oct 2017 16:30:31 +0000

Gun control laws can impact death rates. But we need more research to find what works.

Guns are the third leading cause of injury-related death in the country. Every year, nearly 12,000 gun homicides happen in the U.S., and for every person killed, two more are injured. Whether Congress will do anything about this violence is a whole other (depressing) article. But there is evidence that change is possible.

Last year, a study published in Epidemiologic Reviews “systematically” reviewed studies examining the links between gun laws and gun-related homicides, suicides and unintentional injuries and deaths. Researchers eventually gathered evidence from 130 studies in 10 countries, finding that in certain places, gun restrictions are associated with declines in gun deaths. For instance, laws that restrict gun purchasing, such as background checks, are associated with lower rates of intimate partner homicide; while laws addressing access to guns, such as safe storage policies, are associated with lower rates of unintentional gun deaths among children. Study co-authors Julian Santaella-Tenorio, Magdalena Cerdá, Andrés Villaveces and Sandro Galea write:

This heterogeneity in approaches and implementation methods makes it critical to identify approaches that are less likely to be effective and to identify which strategies, looking forward, may be more likely to work. In addition, examining the associations between specific policies and firearm-related deaths across countries can improve our understanding about which types of laws are more likely to be successful in reducing firearm mortality rates in similar contexts or within diverse legal frameworks.

The study’s findings are a mixed bag — some of the gun laws studied seemed to reduce gun deaths, while others seemed to make no difference or increase deaths. For example, a number of studies examined found no association between concealed carry laws and gun homicides in the U.S. However, one study using injury data from southern Arizona found higher proportions of firearm injuries and deaths associated with concealed carry. Yet another study in Colombia examined the effects of laws banning the carrying of guns during weekends after paydays, holidays and elections days in two Colombian cities, Cali and Bogota. That study found a 14 percent reduction in homicide rates in Cali during no-carry days and a 13 percent reduction in Bogota.

Studies on background checks and waiting periods came in mixed as well. For example, one study cited found no association between waiting periods and homicides and suicides. On the other hand, researchers have found that gun purchase bans for people with certain mental health conditions were associated with fewer homicides. One study found more stringent background checks were linked with fewer gun homicides. States with laws banning people with domestic violence restraining orders from owning and purchasing a gun also experienced reductions in intimate partner homicide. But one study found no homicide effect for laws that restricted gun access among those convicted of domestic violence.

Two cross-sectional studies analyzed found that gun permits and licenses were associated with lower rates of gun suicide. In Missouri, researchers studied the effect of repealing requirements that people need a valid license to buy a gun, finding the repeal was associated with a 25 percent increase in homicide rates. On laws regulating gun storage, one study found that such child access prevention laws were associated with fewer unintentional gun deaths among children younger than 15, but not among older teens. Another found child access laws were linked to a reduction in all suicides among people ages 14 to 17. A study using hospital discharge data found that such storage laws were associated with lower nonfatal gun injuries among those younger than 18.

The Epidemiologic Reviews study included research on particular laws as well. For example, a study on the U.S. Gun Control Act of 1968 — which restricted the sale of so-called Saturday night specials, among many other measures — did not find associated changes in homicide rates. But a study on Washington, D.C.’s 1976 law banning ownership of automatic and semiautomatic firearms and handguns found an “abrupt” reduction in homicide and suicide rates. Globally, Australia’s 1996 National Firearms Agreement, which banned certain kinds of firearms, was linked with a significant reduction in gun death rates. In addition, Australia has not experienced a mass shooting since the law was enacted. Control gun laws in Brazil, Austria and South Africa were also associated with fewer gun deaths.

Overall, researchers were able to identify some “general observations” in combing through the 130 studies — most notably finding that the simultaneous enactment of laws targeting multiple gun regulations were associated with fewer gun deaths in certain countries. Another big finding: we simply need more research to understand what works and what doesn’t to prevent gun deaths. The researchers also noted that few studies have delved into the impact of gun safety laws on particular populations or whether such laws affect social attitudes, norms and behaviors. The authors write:

To conclude, we have provided an overview of national and international studies on the association between firearm-related laws and firearm injuries/deaths. High-quality research overcoming limitations of existing studies in this field would lead to a better understanding of what interventions are more likely to work given local contexts. This information is key for policy development aiming at reducing the burden posed to populations worldwide by violent and unintentional firearm injuries.

In more recent gun research, a study published this month in Health Affairs set out to quantify the clinical and economic burden associated with emergency room visits for gun-related injuries in the U.S. Researchers examined data from the Nationwide Emergency Department Sample, identifying 150,930 people between 2006 and 2014 who showed up to an ER alive, but with a gun-related injury. That number represents a weighted estimate (that’s a fancy term for adjusting data to represent the greater population) of 704,916 patients.

ER visits for gun injuries was lowest among those younger than 10 and highest among ages 15 to 29. Incidence of gun injury was about nine-fold higher for male patients — among men ages 20 to 24, more than 152 patients per 100,000 visited the ER for a gun injury. Most of the patients had been injured in an assault or unintentionally. The proportion injured in an attempted suicide was more than two-fold higher among Medicare beneficiaries. Handguns were the most common cause of the injury, followed by shotguns and hunting rifles.

Among the more than 150,000 cases of gun injury at the ER, 48 percent were discharged home, 7.7 percent were discharged to other care facilities, about 37 percent were admitted to the hospital and just more than 5 percent died during their ER visits. Overall, 8.3 percent of the gun injury patients either died in the ER or as an inpatient. The average charge for gun injury in the ER was about $5,250; the average charge for those admitted was more than $95,000. Over the entire study period, gun-related injuries cost $2.9 billion in ER charges and $22 billion in inpatient care.

Authors of the Health Affairs study also pointed out the need for more research, citing a 1996 federal measure known as the Dickey Amendment that said injury research funds at the Centers for Disease Control and Prevention could not be used to advocate or promote gun control. Co-authors Faiz Gani, Joseph Sakran and Joseph Canner write:

Researchers, politicians and government officials must work together to ensure that research funds are allocated to promote the understanding of the complex interplay between social, economic and medical factors associated with firearm-related injuries. Only through the adoption of an evidence-based public health approach can the resulting substantial medical and financial burden be reduced.

To request a full copy of the ER study, visit Health Affairs. For a copy of the gun policy study, visit Epidemiologic Reviews.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years. Follow me on Twitter — @kkrisberg.

kkrisberg Thu, 10/05/2017 - 12:30

Categories

Medicine

Graham-Cassidy isn't a health care solution. It's a blueprint for less access, less value and less coverage.

kkrisberg — Mon, 25 Sep 2017 17:35:06 +0000

Graham-Cassidy isn't a health care solution. It's a blueprint for less access, less value and less coverage.

In yet another attempt to repeal and replace the Affordable Care Act, much of the GOP justification boils down to one argument: that the ACA isn’t working. Never mind that we don’t really know what constitutes a “working” health care system for Republicans.

For a while, Republicans said the ACA wasn’t working because some U.S. counties didn’t have an insurer. Today, no county is without an insurer. Then there’s the argument that ACA premiums are too high. However, the research shows that while premiums have gone up, the rise in premiums has been slower under the ACA than it was before the ACA. Other health policy experts have pointed out that average premiums dropped fairly significantly early in the ACA’s implementation, even as many people were receiving much more comprehensive and valuable health coverage.

It's true that premiums did rise — sometimes dramatically and it’s an issue that lawmakers in both parties agree needs to be addressed. But on the other hand, policy experts and lawmakers knew it would take insurers time to adjust to the ACA’s new rules and protections and settle on premium rates that matched the new marketplace. That’s why ACA designers included measures like the “risk corridor” program to protect insurers from too much loss and ensure their continued participation in the ACA. Plus, ACA subsides generally shield marketplace customers from premium hikes.

Now, the GOP argument is that block granting the health care system and handing over (dramatically reduced) funds to states is a magic panacea for all of our health care woes. It's an argument that falls apart once you remember that 19 states chose not to expand their Medicaid programs, even though nearly all of the costs of expansion were picked up by the federal government. That decision — made by state lawmakers — left millions of Americans in a completely preventable health insurance gap.

The Graham-Cassidy bill isn’t a new health care system — it’s the old health care system. (Except likely even worse since it devastates Medicaid funding.) The Graham-Cassidy plan strips American consumers of guaranteed health protections and puts coverage decisions back in the hands of the free market and the political whims of ever-changing state governments. We already did that — before the ACA. That old system delivered higher and higher uninsurance rates every year, higher premiums every year, no guarantee to basic health services, discrimination based on pre-existing conditions and bankruptcy-inducing lifetime limits. Graham-Cassidy threatens to do the same thing. It isn’t innovative; it’s a relic of the past.

The real story is that the ACA isn’t perfect, but it’s ushered in some extremely positive changes that deserve more attention and credit in the health care debate. Premium rates can’t be the only way we define success or failure in a health care system. We should also be focused on how well a health care system is working to broaden access to care, create affordability and improve health metrics. In that vein, let’s take a look at just a few recent studies on the impacts of the ACA — gains we risk losing under the GOP plan as well as under pressure of constant uncertainty coming from the White House.

In a study published this month in Health Affairs, researchers examined data from the Urban Institute’s 2017 Health Reform Monitoring Survey to assess recent gains in coverage, access and affordability under the ACA. They found that the gains made in the early days of ACA implementation have persisted into 2017, with adults in all parts of the country, of all ages and of all income groups benefiting from gains in the U.S. insurance rate. In particular, just 10.2 percent of nonelderly U.S. adults are now uninsured, compared to nearly 41 percent before ACA implementation. Adults with low and moderate incomes experienced the greatest reductions in uninsurance. For example, among adults with family incomes at or below 138 percent of federal poverty, uninsurance decreased by more than 42 percent following ACA implementation; among adults between 139 and 399 percent of poverty, uninsurance decreased by more than 49 percent. The study also found that the share of adults without a usual source of care decreased, the share without a routine check-up in the last year decreased, and fewer adults reported unmet medical needs due to cost.

This study, recently published in Medical Care Research and Review, analyzed credit bureau data to get a clearer picture of how the ACA Medicaid expansion impacted people’s finances. In states that decided to expand Medicaid, researchers found financial improvements as measured by: improved credit scores; reduced balances past due as a percent of total debt; reduced probability of a medical collection balance of $1,000 or more; reduced probability of having one or more recent medical bills go to a collection agency; reduction in the probability of experiencing a new negative balance of any type; and a reduced probability of a new bankruptcy filing. The study states: “This work demonstrates how the ACA Medicaid expansions have improved economic well-being of low-income Americans, which at the same time has implications for providers and payers of medical services.”

A new study published in the journal Drug and Alcohol Dependence examined the impact of the ACA on opioid addiction treatment. (FYI: Another recent study found that the opioid overdose epidemic has become so bad in the U.S. that it’s contributed to a decline in overall life expectancy.) The ACA study analyzed data from the National Survey on Drug Use and Health on more than 4,000 people with an opioid use disorder between 2008 and 2004. The researcher found that the odds of insurance coverage increased by 72 percent for people with an opioid use disorder between 2008 and 2014. In addition, the odds of not receiving addiction treatment due to financial concerns dropped by 50 percent. After ACA implementation, the study found, the odds of receiving opioid addiction treatment increased by 158 percent, with the odds of a person’s insurance paying for the care going up by 213 percent. (The Graham-Cassidy bill would allow states to waive essential health benefits, such as substance abuse treatment.)

A 2017 study from the Commonwealth Fund, based on data from the National Health Interview Survey and the Behavioral Risk Factor Surveillance System, found that ACA expansions decreased the probability of not receiving medical care by between 21 percent and 25 percent. It also found that gaining insurance coverage increased the probability of having a usual source of care by up to 86 percent. Before the ACA, about 47 percent of uninsured people reported they were unable to get medical care because of cost. Gaining health insurance cut that number by half.

Graham-Cassidy isn’t the future of health care — it’s not a bill informed by evidence-based ways of improving people’s health and lives. It’s a bill based on political calculations, not medical ones.

Yes, the ACA isn’t perfect. But it’s making real progress that lawmakers should be working to improve upon, not tear down. If you’d like to voice your opinion on Graham-Cassidy, the American Public Health Association has an easy-to-use template to help you reach your representatives in Congress.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years. Follow me on Twitter — @kkrisberg.

kkrisberg Mon, 09/25/2017 - 13:35

Surveys of safety net providers find worsening rates of burnout, professional satisfaction

kkrisberg — Fri, 01 Sep 2017 16:50:53 +0000

Surveys of safety net providers find worsening rates of burnout, professional satisfaction

Across the country, federally qualified health centers provide a critical safety net, delivering needed medical care regardless of a person’s ability to pay. And so it’s worrisome when researchers document a sharp increase in dissatisfaction among the clinicians and staff who make those centers run.

“We’re not sure why we saw things getting worse in the centers,” said Mark Friedberg, a senior natural scientist at Rand Corporation and director of their Boston office. “The best takeaway from this study is we need to track this. We need to get to the bottom of it because it is alarming.”

Friedberg and his colleagues surveyed FQHC staff in 2013 and 2014 as part of a larger evaluation of the FQHC Advanced Primary Care Practice Demonstration at the Centers for Medicare & Medicaid Services (CMS), which focused on patient-centered medical homes. To conduct the study, researchers sampled all 503 FQHC sites participating in the demonstration project, ultimately receiving survey responses from more than 1,200 clinicians and staff in 2013, representing 440 FQHC sites. A follow-up survey in 2014 gained responses from more than 500 clinicians and staff who had also participated in the baseline survey and represented nearly 300 FQHC sites. The results were published in the August issue of Health Affairs.

Researchers found that even though the survey took place only about 15 months apart, responses “worsened significantly over time.” Between surveys, overall satisfaction rates declined from 84.2 percent to 74.4 percent, while rates of burnout increased from 23 percent to 31.5 percent. The proportion of survey respondents who said they were likely to leave their practices within two years rose from about 29 percent to more than 38 percent.

Also, 12 of 13 practice culture measures worsened over the two-survey period, with the greatest declines related to teamwork and facilitative leadership. Other workplace environment measures that worsened over time included work control as well as working in a hectic or chaotic practice atmosphere.

While the surveys didn’t tease out the specific reasons for increasing dissatisfaction, the researchers did offer some guesses. Friedberg and co-authors Rachel Reid, Justin Timbie, Claude Setodji, Aaron Kofner, Beverly Weidmer and Katherine Kahn write:

For example, rapid adoption of new electronic health records (which can disrupt practice workflow and distract from face-to-face care), expansion of coverage under the Affordable Care Act (which may have caused a demand surge for many clinics), and medical home transformation (whether spurred by the CMS FQHC Advanced Primary Care Practice Demonstration or other initiatives) all could have stressed FQHC clinicians and staff members.

“I was surprised to see that big of a change in such a short period of time,” Friedberg told me. “If you look at measures of physician satisfaction over time, by and large across the country, it’s remarkably stable. So with that as a prior finding, this was a surprise.”

On the other hand, Friedberg said FQHCs, which typically care for patients with complicated health, behavioral and social needs, often do experience staff turnovers every few years. With that in mind, he said the survey results could also simply be reflecting the challenging environments inside FQHCs — or as Friedberg said, “it could be all we’re seeing is two points in time in their natural histories.” Still, he said neither explanation is very reassuring, especially considering the critical importance of FQHCs in caring for the nation’s most vulnerable populations.

“I hope that more work is done to confirm, update and better understand the causes of what we reported,” Friedberg said. “The best possible thing would be that someone fails to confirm what we found. I’d love to be not correct on this because I do worry that this is a leading indicator of the sustainability of our safety net. …How long can you run a system in which things are getting worse for the workforce?”

To request a copy of the study, visit Health Affairs.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years. Follow me on Twitter — @kkrisberg.

kkrisberg Fri, 09/01/2017 - 12:50

Tags

government

healthcare

Occupational Health & Safety

Public Health - General

Research

federally qualified health centers

Occupational health

physician burnout

professional satisfaction

Categories

Another new study finds the Affordable Care Act is not a 'job killer'

kkrisberg — Wed, 30 Aug 2017 15:09:52 +0000

Another new study finds the Affordable Care Act is not a 'job killer'

The idea that the Affordable Care Act is a job killer is one of those regularly debunked talking points that won’t disappear. So, here’s yet more evidence that the ACA has had very little impact on the labor market.

In a new study from the National Bureau of Economic Research, a team of Stanford University economists found that even though different regions experienced varying labor market effects likely related to the ACA, the overall impact to jobs numbers was insignificant. In particular, researchers wrote: “Our findings indicate that the average labor supply effects of the ACA were close to zero but that this average masks important heterogeneity in its effects.”

The study addresses estimates from the Congressional Budget Office released before ACA implementation that said the health reform law — which made it possible for most Americans to access affordable health care regardless of employment status — could reduce the size of the labor force by up to 2 percent by 2024. However, since key provisions of the ACA went into effect in 2014, the Stanford researchers found that differing labor market effects across the nation essentially cancelled each other out.

“The idea that the ACA is a job killer — we don’t see that actually happening,” study co-author Gopi Shah Goda, deputy director and senior fellow at the Stanford Institute for Economic Policy Research, told me.

To conduct the study, Goda and colleagues investigated whether regions with bigger ACA-related coverage gains also experienced larger changes in their labor markets. The study did come with a big challenge however — because the ACA covered the entire nation and became effective for everyone at the same time, researchers didn’t have an obvious or natural control group.

To make up for that, researchers teased out regions where labor market changes would likely be unrelated to the ACA — those would end up being the control group — so they could more clearly isolate which impacts were actually associated with the health reform law. Here’s how Goda explained it: Say there’s one region home to a low rate of uninsured people who would be eligible for Medicaid expansion and another region with a high rate of uninsured people eligible for Medicaid. If labor market changes occurred within the first region, researchers could reasonably assume those changes would have happened anyway; however, if changes were only documented in the second region, researchers could reasonably associate the changes with the ACA.

“We’re trying to understand the causal impact of the ACA on the labor market,” Goda said. “So we had to find a way to create a control group so we could understand the effects of the ACA relative to what would have happened without the ACA.”

Goda, along with colleagues Mark Duggan and Emilie Jackson, found that in areas with a high share of people who were uninsured and eligible for private insurance subsidies, labor force participation fell significantly. On the other hand, in areas with a high share of uninsured people but with incomes too low to qualify for marketplace subsidies, labor force participation went up significantly. They write: “These changes suggest that middle-income individuals reduced their labor supply due to the additional tax on earnings while lower income individuals worked more in order to qualify for private insurance. In the aggregate, these countervailing effects approximately balance.”

The study also found “little evidence” that the ACA impacted part-time employment, self-employment and hours worked. Also of note, states that expanded their Medicaid programs typically experienced larger average decreases in unemployment. Overall, however, the aggregate labor market effects both in states that did expand Medicaid and those that didn’t were relatively small.

While the study doesn’t tease out the precise reasons for the labor market changes, Goda had some hunches. For example, she said it’s possible that people eligible for Medicaid decided to make job changes that would allow them to qualify for marketplace subsidies and therefore gain private insurance coverage. Or it could be that Medicaid enrollment led to some people becoming healthier and increasing their labor force participation.

Goda, who said she and colleagues hope to continue this line of research as more ACA data comes out, said it’s fair to use the study’s findings to refute claims that the ACA is a job killer.

“We hope these findings are taken into consideration whenever discussions of the ACA or changes to the ACA are being made,” she told me. “I think because the impacts of the ACA over the last few years have been different than what was predicted, it makes sense to consider these labor market non-effects whenever considering changes to the law.”

In more good ACA news released this month, the Centers for Disease Control and Prevention’s National Center for Health Statistics reported that in the first three months of 2017, 28.1 million people of all ages were uninsured — that’s half a million fewer uninsured people than in 2016 and 20.5 million fewer uninsured people than in 2010. Overall, from 1997 through 2013, the percentage of adults ages 18 to 64 who were uninsured generally increased. However, more recently, rates of uninsured adults have gone down each year, from more than 20 percent in 2013 to about 12 percent in the first quarter of 2017.

For a copy of the new ACA labor market study, visit the National Bureau of Economic Research.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years. Follow me on Twitter — @kkrisberg.

kkrisberg Wed, 08/30/2017 - 11:09

Tags

Affordable Care Act

government

healthcare

Public Health - General

Public health officials call on HHS to restore grant funding for preventing teen pregnancies

kkrisberg — Tue, 22 Aug 2017 16:19:42 +0000

Public health officials call on HHS to restore grant funding for preventing teen pregnancies

In July, public health departments across the country got a letter from the Trump administration abruptly cutting off funding for teen pregnancy prevention efforts in the middle of the program’s grant cycle. The move means that many teens will miss out on receiving an education that could — quite literally — change the trajectory of their lives.

The abrupt funding cut — which came down without reason or explanation, according to grantees — also cuts off research efforts right at the evaluation stage. That’s the stage when public health practitioners rigorously assess a program’s outcomes, gather evidence of its effectiveness, and determine what works and what doesn’t. That’s exactly what we should want from our public investments — evidence, not anecdotes — and it’s exactly how you tackle a problem as complex and as costly as teen pregnancy. Teasing out the evidence is how we sort the aspirational from the effectual.

And determining what works to prevent and reduce teen pregnancy is a worthy endeavor. According to the Centers for Disease Control and Prevention, while the U.S. teen birth rate recently hit a record low — the birth rate among young women ages 15 to 19 dropped 8 percent between 2014 and 2015 — the U.S. is still home to one of the highest teen pregnancy rates in the industrialized world. And that rate comes with impacts, including upping the risk that teen girls won’t graduate from high school, which has a generational domino effect in and of itself, as well as racking up billions in societal costs related to health care, foster care and lost tax revenue. Plus, nearly all teen pregnancies are unplanned, which makes investing in their prevention sound public policy.

At a news conference held earlier this month and hosted by the Big Cities Health Coalition (BCHC), health officials from cities on opposite coasts — Baltimore and Seattle — spoke about the importance of preventing teen pregnancy in their communities and the on-the-ground impact of abruptly losing federal funding that had already been awarded and appropriated. Both the Baltimore City Health Department as well as Public Health — Seattle & King County are among the 81 grantees who received a letter from the U.S. Department of Health and Human Services (HHS) in July saying the five-year grant they’d already been awarded through the agency’s Teen Pregnancy Prevention Program would be ending two years early, in 2018 instead of 2020.

Both Leana Wen, Baltimore’s health commissioner, and Patty Hayes, director of Public Health — Seattle & King County, said there was no dialogue, discussion or explanation for the funding cut. The announcement didn’t even come in a special notice. Instead, both health officials found out about the cut when they received their usual, yearly notice-of-award letter in which the end date had been pushed up by two years. Hayes said Seattle’s program manager quickly reached out to HHS for an explanation and was basically told the agency was moving on to implement the cuts.

“It’s just an arbitrary decision that we’re trying to appeal,” Hayes said during the BCHC news conference.

Hayes and Wen are among 20 public health officials from around the country who signed onto a BCHC letter to HHS Secretary Tom Price asking him to reconsider the cuts. Also, in July, Democratic senators wrote to Price asking him to explain his plan to “unilaterally” cut the teen pregnancy prevention grants short. The letter states:

Since the start of the grant projects and prior to the recent notification of early termination, (the HHS Office of Adolescent Health) has ensured the program includes high quality implementation, rigorous evaluation, innovation and learning from results. The pace of progress has accelerated dramatically since the federal investments in evidence-based teen pregnancy prevention began. Since 2010, pregnancy rates among 15- to 19-year-olds has declined by 41 percent nationwide — more than double the decline in any other six-year period since rates peaked in 1991 — and is at a historic low. Seventy-five percent of pregnancies among this population remain unintended. The (Teen Pregnancy Prevention) Program has been proven to support young people in delaying sexual initiation and adopting sexual health behaviors that help them avoid unintended pregnancy.

In Baltimore, the grant termination means a cut of $3.5 million, which means 20,000 students in grades seven through nine will lose access to comprehensive reproductive health education, Wen said. The funding cut also means the agency won’t have the resources to continue training teachers or members of a local youth advisory council that does peer-to-peer education.

Wen said Baltimore has made huge progress in reducing its teen birth rate — it fell by 44 percent between 2009 and 2015. She’s worried that losing any ground on that front will only lead to fewer educational and economic opportunities for Baltimore youth, fewer young women graduating from high school and greater public costs to the community.

“We should be doing everything we can to empower youth to succeed and thrive,” Wen said during the BCHC news conference. “We see the impact in our cities, and we urge the federal government and HHS to reconsider this drastic cut, taking into account the future of all of our youth across the country.”

In Seattle and King County, where teen pregnancy rates have gone down by more than half since 2008, public health officials were using their $5 million Teen Pregnancy Prevention grant to evaluate the effectiveness of a sexual health curriculum they recently updated called FLASH, which includes a variety of strategies to help reduce teen pregnancy, sexually transmitted diseases and sexual violence. During the BCHC news conference, Hayes said FLASH has been used all over the U.S. and the world, with about 80,000 FLASH lessons downloaded in the span of just one year. She noted that the curriculum is designed to be inclusive of LGBT students and is just as relevant for young people who decide to abstain from sex as it is for those who don’t.

However, Public Health — Seattle & King County hadn’t had the chance to rigorously evaluate the curriculum to tease out its exact impacts, such as whether it increased the number of students who delay sex or the number of young people who practice safe sex. That’s what it was using its HHS grant funding for – to measure the effectiveness of the curriculum. The public health agency had already recruited more than two-dozen schools in multiple states to take part in the evaluation; thousands of students participated in the FLASH curriculum and an independent evaluator was hired to analyze the outcomes.

But now that HHS has shut down the grant funding early, that data will be lost. Hayes said she believed there was a “good chance” the evaluation would have shown that FLASH does, indeed, make a positive difference in young people’s lives. Without such evidence, however, it may become more difficult to persuade schools to adopt the curriculum. Hayes said her agency has filed an administrative appeal with the HHS Office of Adolescent Health in the hopes of getting the funding restored.

Hayes said she believes the funding cut is due to both across-the-board budget cuts, but also to an ideological shift on how to address teen pregnancy.

Beyond the particular efforts that the HHS grants were supporting, the abrupt funding cuts also impact both agencies’ overall capacity to prevent teen pregnancy in their communities. In Baltimore, Wen said the funding gap will “create a huge hole in our ability to deliver services.” At Public Health — Seattle & King County, Hayes said the grant supported a significant portion of the agency’s teen pregnancy prevention efforts.

“It does shrink our program,” Hayes said, “and so it’s not without great implications.”

Visit CDC to learn more about the benefits of investing in teen pregnancy prevention.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years. Follow me on Twitter — @kkrisberg.

kkrisberg Tue, 08/22/2017 - 12:19

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Everyday I read a heartbreaking report from this Whitehouse. The ignorance is dumbfounding and down right scary.

Study: Trust in science spiked after media coverage of Zika vaccine trial

kkrisberg — Thu, 03 Aug 2017 20:26:49 +0000

Study: Trust in science spiked after media coverage of Zika vaccine trial

Public trust in science is a fickle creature. Surveys show a clear majority of Americans believe science has positively impacted society, and they’re more likely to trust scientists on issues like climate change and vaccines. On the other hand, surveys also find that factors like politics, religion, age and race can greatly impact the degree of that trust. It presents a delicate challenge for agencies that depend on trust in science to do their jobs.

“Trust in science is high, but it’s not unanimous and it’s not completely unquestioned — and nor necessarily should it be,” Joseph Hilgard, an assistant professor of social psychology at Illinois State University, told me. “We assume that people don’t trust us because they don’t know what (scientists) know, but that’s not really the case. You have ideology, perspective, values — all these different lenses coming into play and that’s a great challenge for science communication.”

Hilgard is the co-author of a new study that provides some interesting insights into possible ways to improve public trust in science. The study, published in the August issue of Science Communication, is based on data collected via the Annenberg Science Knowledge survey, which began in 2016 and conducts nationwide bilingual telephone surveys on a weekly basis. Last August, the survey enhanced its ongoing data collection on Zika knowledge and attitudes, adding in another 500 people from the high-risk state of Florida. In examining the Zika data, researchers detected a noteworthy trend: following media coverage of a potential Zika vaccine, respondents reported greater trust in science for providing solutions to problems.

Hilgard, who at the time was a postdoctoral fellow at the Annenberg Public Policy Center, cautioned right off the bat that the findings are correlational and it’s difficult to draw any generalized implications, especially since Zika doesn’t have the polarizing effect of some other scientific issues. And unlike other Zika solutions — like aerial spraying and genetically modified mosquitoes — a vaccine is relatively uncontroversial. Still, the findings could suggest that particular circumstances are conducive to facilitating trust in science.

Hilgard and co-author Kathleen Hall Jamieson write:

A Zika vaccine has clear benefits, improving human health by preventing birth disorders, and vaccination does not conflict with mainstream public values or cultural norms. Additionally, media coverage of the Zika virus has established Zika prevention as a matter of public concern and general importance. These attributes make this news cycle a useful opportunity to observe the relationship between news of scientific progress and public attitudes toward science.

In examining answers from more than 34,000 survey responses, researchers found that in the weeks following news that a Zika vaccine had entered its first human trial, people paid more attention to Zika news and public trust in science went up. In particular, that trust bump followed increases in Google searches for “Zika vaccine” as well as news reports featuring Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, and Tom Frieden, then-director of the Centers for Disease Control and Prevention. The heightened trust lasted only two weeks, but greater attention to Zika overall lasted for six weeks.

However, the increased trust in science didn’t extend to the federal agencies tasked with Zika response and research. Within the same period of Zika vaccine news, opinions of both the National Institutes of Health and CDC remained the same. The vaccine news also had no effect on whether people felt the federal government was prepared to deal with a Zika outbreak in their community — those opinions stayed stable throughout the study period as well. Hilgard and Jamieson write:

This finding opens the possibility that confidence in science could be bolstered in a more sustained fashion by regularized communication about advances made by science. These communications may be particularly effective when they provide potential solutions to problems placed by media on the national agenda. However, such effects are likely to be relatively brief even under the best of circumstances. Additionally, such communications may backfire if the public feels that a problem or its solution is overstated for the personal benefit of scientists, politicians, or the media, although further empirical research is needed.

“This may seem like a surprise given the struggle that we sometimes have in expressing the safety of this or that treatment,” Hilgard said of the findings. “But I think it speaks to the idea that it’s not that people dislike science; it’s that they dislike certain science.”

So, what exactly fueled the heightened trust following media reports of the Zika vaccine? The study doesn’t tease those specifics out, but Hilgard had some guesses. First, while vaccine safety can be a sensitive topic, Hilgard said the actual gap in vaccine safety attitudes between scientists and the public probably isn’t as wide as we sometimes fear. Secondly, he said Zika isn’t “morally aligned.” In other words, it doesn’t lend itself to the type of morality discussions that erupted with the advent of the HPV vaccine, which prevents a sexually transmitted disease.

“Zika has very serious health implications and people are afraid of it,” he told me. “You put together fear of Zika, the acceptability of the product and the fact that there’s no real moral element to protecting yourself against Zika, and it leads to a scientific advance that, by and large, people feel good about.”

Because of such factors, Hilgard said it’s difficult to draw any generalized tips for communicating better on other scientific topics. But he did say the study suggests that keeping the public informed on new and promising scientific advances — while staying accurate and not exaggerating — could help nourish public trust.

“Science has always enjoyed a respected place in society, but it’s not unconditional love,” he said. “People want to see science earning its keep — they want know, ‘what have you done for me lately?’”

For a copy of the new study, visit Science Communication.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years. Follow me on Twitter — @kkrisberg.

kkrisberg Thu, 08/03/2017 - 16:26

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Report: U.S. funding for global health research saves lives and creates American jobs

kkrisberg — Wed, 02 Aug 2017 12:19:14 +0000

Report: U.S. funding for global health research saves lives and creates American jobs

U.S. investments in global health research have saved millions of lives and prevented immeasurable suffering. And by working to detect, treat and eventually eliminate infectious diseases worldwide, we’re protecting our own country too. That cliché about diseases knowing no borders is unfortunately very true. All that alone should be enough to remain committed to the cause.

But a couple weeks ago, a new report from the Global Health Technologies Coalition (GHTC) offered another persuasive reason: U.S. funding for global health research and development (R&D) is good for the American economy. The report, “Return on Innovation,” found that in 2015, 89 cents of every U.S. public dollar directed to global health R&D was invested right here at home. Between 2007 and 2015, that investment injected $12 billion into the U.S. economy, creating an estimated 200,000 new jobs and generating an additional $33 billion in economic output. Every $1 that the National Institutes of Health spends on basic research is estimated to generate more than $8 of industry investments over the next eight years.

“We want policymakers to know that (global health funding) affects their constituents,” Jamie Bay Nishi, director of GHTC, told me. “Part of the interesting story here is the catalytic power of U.S. government investment in terms of incentivizing private investment.”

Nishi said work on the new report began last fall — before the presidential election — and wasn’t initially intended as a response to global health cuts now being proposed by the Trump administration. With U.S. funding for global health R&D either stagnant or declining since 2009 (with the exception of emergency funds for Ebola and Zika), Nishi said the report was written to help “change that trend line regardless of administration.” According to the report, the U.S. invested $1.7 billion in global health R&D in 2015, which represented less than one-tenth of 1 percent of U.S. gross domestic product. The 2015 budget for global health R&D was already a quarter-billion dollars less than 2012 funding levels.

President Trump’s fiscal year 2018 proposal doesn’t look much better. Among its many recommended cuts to global health: A 50 percent cut to USAID global health programs, including a zeroing out of its HIV programs; a $25 million cut to neglected tropical diseases; a $65 million cut to maternal and child health; a $1.1 billion cut to the National Institute of Allergy and Infectious Diseases, which leads critical infectious disease research; and a $70 million cut to the CDC’s National Center for Emerging and Zoonotic Infectious Diseases. There’s more than that, but fortunately no one — including Nishi — thinks Trump’s budget will make it out of Congress in one piece. Like many other advocates working in Washington, D.C., she called it “dead on arrival.”

The budget proposal from House looks better for global health — it increases the NIH budget and saves its global health center, though it still recommends sizeable cuts to USAID and CDC. The House proposal may be an improvement over Trump’s, but Nishi said “there’s still too many variables out there for us to feel that global health funding for R&D is safe.”

Enter the new GHTC report, which provides a trove of information on the benefits and returns we yield with investments in global health R&D. Its authors write:

Not only does U.S. government investment play an essential and catalytic role in developing new drugs, vaccines, diagnostics, and other urgently-needed tools for neglected diseases and health conditions, but it also delivers tangible economic and security returns for Americans. This is a win-win from a humanitarian and strategic perspective – these investments save and improve lives in vulnerable populations around the world, while at the same time advancing American leadership in science and innovation, creating jobs and economic growth at home, supporting public-private partnerships, and protecting American and health security.

First, the lives saved. According to the GHTC report, all 42 new drugs, diagnostics, vaccines and reproductive health technologies created since 2000 with U.S. investment have made a positive difference. For instance, a 50-cent meningitis A vaccine, developed with U.S. global health R&D funding support, prevented 673,000 cases of disease, 378,000 deaths and 63,000 cases of lifelong disability. By the end of this decade, this one vaccine will have saved $9 billion in health care spending. Other examples include a new pediatric malaria treatment estimated to have saved 750,000 children, and a late-stage HIV vaccine candidate now being tested that could cut the number of new HIV infections in half in just 10 years.

Global health R&D is good for America’s health and economy too. Since 2007, global health R&D investment has created about 200,000 U.S. jobs and generated more than $30 billion in economic output as it cycles its way through the American economy. For example, the U.S. invested $192 million in global health R&D monies into U.S.-based pharmaceutical companies in 2015. That investment, according to the report, encouraged those companies to invest another $294 million, with the majority of that money spent domestically. In other words, “US government investment in global health R&D has a stimulative effect” that not only encourages additional private investment in the U.S. economy, but investment in disease research that benefits the world’s poorest people.

Plus, upfront investments now could help avert much higher spending in the future. For example, the growing problem of antimicrobial resistance — a problem often described as a looming public health crisis — is expected to cause 10 million deaths by 2050 and cost the global economy upwards of $100 trillion. However, according to the GHTC report, investing $2 billion annually in anti-microbial R&D could lead to the kinds of tools needed to combat the problem. Global R&D investments also prepare us for the next novel disease outbreak. The report notes:

The US government spent nearly $600 million to improve domestic preparedness for Ebola within the United States during the recent outbreak, and an additional $2.4 billion on efforts to combat and contain the Ebola outbreak at its source. If a point-of-care diagnostic and vaccine against Ebola had been available at the start, the 2014 West African Ebola outbreak would never have grown into the global health emergency it became. Not only would thousands of deaths have been prevented, but the US government would also have saved billions of dollars.

Nishi said the coalition hopes to follow its new report with one that breaks down the impact of global health R&D at the state level — “we really want to connect those dots for policymakers so they understand why they should care about this,” she said.

“First and foremost, it’s about saving millions of lives,” Nishi said. “The U.S. has an incredible history of being a leader in technology and innovation and that should hold true when it comes to (global health R&D) as well.”

She added: “Sometimes it does seem like these are distant problems and it’s hard to see the connections. …But it can’t be U.S. health versus global health — U.S. health is global health.”

For a copy of the “Return on Innovation” report, visit GHTC.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years. Follow me on Twitter — @kkrisberg.

kkrisberg Wed, 08/02/2017 - 08:19

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Anything that saves lives is ok with me.

Study: Small drop in measles vaccination rate could cost public sector millions of dollars

kkrisberg — Fri, 28 Jul 2017 16:28:30 +0000

Study: Small drop in measles vaccination rate could cost public sector millions of dollars

Another day, another study that underscores the societal benefits of vaccines and the consequences we’d face without them.

In a study published earlier this week in JAMA Pediatrics, researchers took on the issue of vaccine hesitancy by estimating the disease burden and economic costs associated with declines in the measles-mumps-rubella (MMR) vaccination rate. They noted that while overall childhood vaccine rates remain high in the U.S., there are areas where nonmedical exemption policies are materializing into declining immunization coverage.

For example, this 2016 article in PLOS Medicine — authored by one of the researchers on the new JAMA Pediatrics study — noted that in Texas in 2016, there were almost 45,000 children with nonmedical vaccine exemptions, which is near double the exemptions given in 2010 and a 19-fold increase from 2003. Those numbers mean that some Texas counties are at risk of having their measles vaccination rate drop below 95 percent, which is the threshold scientists say we need to ensure herd immunity and prevent outbreaks. Right now, 18 states allow “personal belief” exemptions for childhood vaccines.

So, what would a relatively minor decrease in measles immunization look like in the U.S.? To find out, researchers used vaccine data from the Centers for Disease Control and Prevention to simulate county-level MMR vaccine coverage for children ages 2 to 11. They then used a mathematical model to estimate the impacts of decreasing vaccination rates, simulating thousands of situations in which measles is introduced by a traveler into the U.S. (This is the kind of scenario that’s happened in recent real-life measles outbreaks.) They found that a 5 percent decline in MMR vaccine coverage among U.S. children would result in a three-fold increase in national measles cases, or 150 cases and an additional $2.1 million in economic costs to the public sector. That’s $20,000 per case of measles.

The researchers noted that their findings were conservative, as they only accounted for children ages 2 to 11 and not for infants, adolescents and adults who are unvaccinated against measles. Study co-authors Nathan Lo and Peter Hotez write:

The results of our study find substantial public health and economic consequences with even minor reductions in MMR coverage due to vaccine hesitancy and directly confront the notion that measles is no longer a threat in the United States. Removal of the nonmedical personal belief exemptions for childhood vaccination may mitigate these consequences.

In a news release on the study, Hotez, dean of the National School of Tropical Medicine at Baylor University in Texas, added: "I think our study is a wake-up call for what we can expect in the coming months and years as vaccine coverage rates continue to decline in the 18 states that now allow non-medical or philosophical belief exemptions.”

Even though measles was declared eliminated in the U.S. in 2000, outbreaks have recently began occurring on a yearly basis. According to CDC, recent case counts have ranged from a low of 55 in 2012 to a high of 667 in 2014, which represented the greatest number of measles cases since the disease was announced eliminated in the U.S. The agency also noted that the majority of residents who caught the disease were unvaccinated. In the most recent measles outbreak in Minnesota earlier this year, 79 cases were confirmed, the vast majority of which were among unvaccinated children. Research has shown that vaccine refusals do indeed fuel preventable disease outbreaks.

Unfortunately, the anti-vaccine movement got a boost earlier this year when word got out that President Trump wanted to create a “vaccine safety commission” led by Robert Kennedy Jr., who’s known for spreading debunked information about vaccine safety. So far, this idea hasn’t panned out. Let’s hope it never does.

For a copy of the new measles vaccine study, visit JAMA Pediatrics.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years. Follow me on Twitter — @kkrisberg.

kkrisberg Fri, 07/28/2017 - 12:28