The following is a message from Public Health – Seattle & King County’s Health Officer Dr. Jeff Duchin to the agency’s staff. The agency decided to share the message with the public because it thought “the message will resonate with those inside and outside of our agency.”
On Friday, I spent the day with others from Public Health – Seattle & King County and regional local health departments, Washington State Department of Health, and the University of Washington at a conference organized by the Northwest Center for Public Health Practice to help find solutions to the problem of injury and violence in our communities.
It was therefore especially ironic and sickening to hear the news of the Paris terrorist attacks on the car radio as I returned from the meeting.
Many of us, including myself, feel overwhelmed trying to fathom the reasons for, and solutions to, the type of mindless killing that has been routinized by repeated violent terrorist attacks happening around the world, most recently in Paris, Beirut, Nigeria, Somalia, Cameroon, Turkey, Israel and Gaza, Iran, and elsewhere.
Here at home, we are struggling with many incarnations of violence in our own communities and country, including intentional violence from suicide, gun violence, intimate partner and domestic violence, adverse childhood experiences and other emotional trauma, and multiple causes of unintentional injury and death.
As public health professionals we share a common purpose: Improving the health of communities through prevention. Accordingly, we bring our public health approach to addressing the wicked problems of violence and injury.
I sincerely hope that in addition, this most recent abomination in Paris will motivate not only public health professionals but all of us, including governmental, business and community leaders across the country to acknowledge all types of violence – even terrorist violence– as a public health problem – a disease – and treat it accordingly.
Although we will not be able to easily solve the problem of global terrorist violence through our actions here at home, redoubling our efforts to end the ongoing devastation of violence of all types in our communities would be a meaningful start.
I’m optimistic that with the same perseverance, dedication, and intelligence that we used to put a man on the moon, conquer smallpox and polio, and harness the energy of the atom, we can make real progress in reducing violence from all causes in our communities, our country, and the world.
From a string of public suicides in Alaska to assimilation anxiety among young Hispanics in Cleveland, states are faced with the need for more bilingual and culturally sensitive mental health care professionals
By Tim Henderson Stateline
The U.S. is grappling with a severe shortage of mental health professionals. But the situation is particularly dire for some minority communities, where barriers of language and culture can make it hard to seek and get help.
Most good mental health care requires subtle, intimate conversation with patients. But too often, mental health experts say, professionals lack the language skills needed to serve those who struggle with English.
The greatest mental health needs are often in remote, rural areas with scattered populations.
“It’s difficult to trust that translation will capture nuances in the soul-baring process of mental health treatment,” said Sita Diehl, director of state policy at the National Alliance on Mental Illness (NAMI).
The greatest mental health needs are often in remote, rural areas with scattered populations. Continue reading →
Month after month, Natalia Pedroza showed up at the doctor’s office with uncontrolled diabetes and high blood pressure. Her medications never seemed to work, and she kept returning to the emergency room in crisis.
Doctor Janina Morrison speaks with patient Jorge Colorado, 49, and daughter Margarita Lopez about Colorado’s diabetes on Thursday, October 8, 2015 at the Los Angeles County-USC Medical Center (Photo by Heidi de Marco/KHN).
Walfred Lopez, a Los Angeles County community health worker, was determined to figure out why.
Lopez spoke to her in her native Spanish and, little by little, gained her trust. Pedroza, a street vendor living in downtown Los Angeles, shared with him that she was depressed. She didn’t have immigration papers, she told him, and her children still lived in Mexico.
Then she mentioned something she hadn’t told her doctors: She was nearly blind.
Pedroza’s doctor, Janina Morrison, was stunned. For years, Morrison said, “people have been changing her medications and changing her insulin doses, not really realizing that she can’t read the bottles.”
Health officials across the country face a vexing quandary – how do you help the sickest and neediest patients get healthier and prevent their costly visits to emergency rooms? Los Angeles County is testing whether community health workers like Lopez may be one part of the answer.
Lopez is among 25 workers employed by the county to do everything possible to remove obstacles standing in the way of patients’ health. That may mean coaching them about their diseases, ensuring they take their medications or scheduling medical appointments. Their help can extend beyond the clinic walls, too, to such things as finding housing or getting food stamps.
(L) The Los Angeles County-USC Medical Center is the county’s biggest and busiest public hospital. (R) Walfred Lopez, a community health worker at the Los Angeles County-USC Medical Center, sits in small cubicle in the clinic looking over a patient’s health record on Oct. 14, 2015. (Photo by Heidi de Marco/KHN)
The workers don’t necessarily have a medical background. They get several months of county-sponsored training, which includes instruction on different diseases and medications, as well as tips on how to help patients change behavior. They are chosen for their ability to relate to both patients and providers. Many have been doing this job for friends and family for years – just without pay.
“By being from the community, by speaking their language, by having these shared life experiences, they are able to break through and engage patients in ways that we as providers often can’t,” said Dr. Clemens Hong, who is heading the program for the county. “That helps break down barriers.”
For now, they work with about 150 patients, many of whom have mental health issues, substance abuse problems and multiple chronic diseases. The patients haven’t always had the best experience with the county’s massive health care system.
“They tell us, ‘I am just a number on this list,’” Lopez said. “When you call them by name and when you know them one-on-one … they receive that message that I care for you. You are not a number.”
By spring, Hong said he hopes to have hundreds more patients in the program.
Walfred Lopez, a community health worker at the Los Angeles County-USC Medical Center, visits patient Maria Rivera, 48, at her home in La Puente, California, on Friday, October 9, 2015. Rivera says she depends on Lopez to understand what is happening with her health (Photo by Heidi de Marco/KHN).
Community health workers have been used for decades in the U.S. and even longer in other countries. But now officials in various counties and states — including Massachusetts, Pennsylvania and Oregon — are relying on them more as pressure grows to improve health outcomes and reduce Medicaid and other public costs, experts said.
“They are finding a resurgence because of the Affordable Care Act and because health care providers are being held financially accountable for factors that occur outside the clinical walls,” said Dr. Shreya Kangovi, assistant professor of medicine at the University of Pennsylvania and director of the Penn Center for Community Health Workers.
Community health worker Walfred Lopez checks the patient’s medicine to make sure she is up-to-date during a home visit in La Puente, California, on Friday, October 9, 2015 (Photo by Heidi de Marco/KHN).
Kangovi said community health worker programs, however, are likely to fail if they don’t hire the right people, focus too narrowly on certain diseases or operate outside of the medical system. They also need to be guided by the best scientific evidence on what works.
“A lot of people think… they can sort of make it up as they go along, but the reality is that it is really hard,” she said.
Hong, who designed the program based on lessons learned from other models, said Los Angeles County is taking a rigorous approach. It is conducting a study comparing the costs and outcomes of patients in the program against similar patients without assigned workers.
The patients are chosen based on their illnesses, how often they end up in the hospital and whether doctors believe they would benefit.
To Lopez, 43, the work is personal. A former accountant from Guatemala, Lopez has a genetic condition that led to a kidney transplant. Like some of his patients, including Pedroza, he is now on dialysis.
He tries to use his experience and education to get what patients need. But even he runs into snags, he said. One time, he had to argue with a clerk who turned away his patient at an appointment because she didn’t have identification.
Walfred Lopez informs patient Maria Rivera that she is a candidate for bariatric surgery, but needs to lose some weight before the procedure (Photo by Heidi de Marco/KHN).
“The hardest part is the system,” Lopez said. “Trying to navigate it is sometimes even hard for us.”
Lopez and his fellow community health worker, Jessie Cho, sit in small cubicles in the clinic at Los Angeles County-USC Medical Center, the county’s biggest and busiest public hospital.
Throughout the day, they accompany patients to visits and meet with them before and after the doctor does. They also visit patients at home and in the hospital, and give out their cell phone numbers so patients can reach them quickly.
Cho said the patients often can’t believe that somebody is willing to listen to them. “Nobody else on the medical team has it as their job to provide empathy and compassion,” she said.
Morrison, the clinic physician, said both workers have become an essential part of the health team.
“There is just a limited amount I can accomplish in 15 or 20 minutes,” Morrison said. “There are all these mysteries of my patients’ lives that I know are getting in the way of taking care of their chronic medical problems. I either don’t have time to get to the bottom of it or they are never going to really feel that comfortable talking to me about it.”
Natalia Pedroza, who wears a colorful scarf around her head and speaks only Spanish, is a perfect example. Morrison said before Lopez came on board, “I wasn’t getting anywhere with her.”
Initially, Lopez had a hard time helping her understand her health conditions and overcoming her distrust of the system. When they first met, Pedroza believed the dialysis that kept her kidneys functioning was the cause of her health problems. And she didn’t get why Lopez was always around.
But he helped her — by getting her appointments, for instance, and helping arrange for Pedroza to get pre-packaged medications so she wouldn’t have to read the directions. Now Pedroza thinks Lopez is helping her to get better.
On a recent afternoon, Lopez sat down with Pedroza before her medical appointment.
“How are you feeling?” he asked in Spanish.
Pedroza responded that her hair was still falling out and that she still felt sick. She also said she hadn’t been checking her blood sugar because she didn’t know how to use the machine. Lopez calmly demonstrated how the machine worked, and then the two spent several minutes chatting about her job and her neighborhood.
Lopez said he believes he has a made a difference for other patients as well. On a recent Sunday, a 43-year-old patient with chronic pain who initially refused his help texted that he planned to go to the emergency room because of a headache. Lopez reached Morrison, who agreed to squeeze him into the schedule a few days later. And the patient didn’t go to the ER.
Patient Maria Rivera, 48, at her home in La Puente, California, on Friday, October 9, 2015. Rivera is diabetic, dealing with high blood pressure and recently had a tracheotomy (Photo by Heidi de Marco/KHN).
Lopez persuaded another patient, a 56-year-old woman, to take her blood pressure medication before her appointments so that when she arrived, the doctors wouldn’t get worried about her numbers and send her to the hospital.
In one case, his ability to bond with a patient almost undermined his goal of getting the man the help he needed. The patient, who was depressed, said he didn’t want to go see a mental health counselor because he was more comfortable talking to Lopez.
“It was touching,” Lopez said. “I was about to cry.”
Unpaid caregivers and family members spend more than 100 hours a month, on average, assisting elderly people with dementia who live in the community and not in residential care or nursing homes, according to a new study.
As people live longer, the number with dementia will increase, further straining caregiving resources.
The time commitment was significantly higher than for similar caregivers who helped elderly people without dementia, who themselves put in an average 73 hours each month.
Overall, people with dementia make up 10 percent of noninstitutionalized adults age 65 or older, but they account for more than 40 percent of unpaid caregivers’ time. Continue reading →
Johns Hopkins University and the Hopkins health system said the upheaval in Baltimore last April, which revealed the depths of economic misery in the city, lent urgency to the major jobs, contracting and purchasing initiative they announced last month. Other hospitals around the country have also launched anti-poverty efforts.
BALTIMORE—As a child, Bishop Douglas Miles heard the warnings about vans trolling East Baltimore streets, snatching up young African-Americans for medical experiments at nearby Johns Hopkins Hospital.
Whether there was any truth behind those stories—Hopkins has always denied them—hardly mattered. The mythology lived on and, combined with the hospital’s very real development decisions, contributed to a persistent view of Hopkins as an imperious, menacing presence amid the largely poor and African-American neighborhoods surrounding it.
“Hopkins was viewed with a great deal of suspicion and anger,” said Miles, who graduated from the school in 1970 and is the bishop of Koinonia Baptist Church in northeast Baltimore.
But now, Miles says, that perception could be changing. Johns Hopkins University and the Hopkins hospital and health system have launched an ambitious initiative to fill many more jobs with residents from distressed Baltimore neighborhoods, boost the use of minority contractors and vendors from those areas, and require their partners to follow their lead. Continue reading →
Timothy Dick’s office receives all kinds of reports of child abuse and neglect. Perhaps a child has a broken bone, or is underfed, or has been left home alone for too long.
But when caseworkers drive to the child’s home to investigate, they often discover the same root cause. “What we’re finding more and more is that the parents are addicted to opiates. And more often than not, it’s heroin,” said Dick, assistant director of child protective services in Clermont County, Ohio.
In Ohio and other states ravaged by the latest drug epidemic, officials say substance abuse by parents is a major reason for the growing number of children in foster care. In Clermont County, east of Cincinnati, more than half the children placed in foster care this year have parents who are addicted to opiates, Dick said. Continue reading →
In a year when the nation’s overall prison population dropped, the number of older inmates grew rapidly in 2014, continuing a trend that translates into higher federal and state prison health care spending.
New federal data show that from 1999 to 2014, the number of state and federal prisoners age 55 or older increased 250 percent.
This compares to a growth rate of only 8 percent among inmates younger than 55, according to the Bureau of Justice Statistics, which also reported that the U.S. prison population fell in 2014 to its lowest level since 2005.
In 1999, inmates age 55 and above—a common definition of older prisoners—represented just 3 percent of the total population. By 2014, that share had grown to 10 percent. Continue reading →
From the US Department of Health and Human Services and the Indian Health Service
The U.S. Department of Health and Human Services Administration for Children and Families (ACF) and Indian Health Service (IHS) announced Thursday the award of nearly $21 million to support tribal domestic violence victims and organizations in American Indian and Alaska Native communities across the nation.
ACF funding announced today is being awarded under the Family Violence Prevention and Services Act (FVPSA), which is the primary federal funding source dedicated to providing immediate shelter and supportive services for victims of family violence, domestic violence, or dating violence and their dependents.
Grants will be awarded to 136 tribes and tribal organizations serving 274 tribes.
These funds will help to strengthen tribal responses to domestic violence and emphasize public awareness, advocacy, and policy, training, and technical assistance. Continue reading →
CHARLOTTE — Home health agencies are a segment of the medical industry that you may not know about if you or a loved one has never needed one. The companies send therapists and nurses into the homes of Medicare patients to help them recover from an illness or surgery.
This summer the federal government started rating home health agencies – doling out one to five stars – to give consumers a better picture of the job they do. The top grades were elusive: only 239 agencies out of 9,000 nationwide earned five stars, according to a Kaiser Health News analysis.
In North Carolina, Brookdale Home Health Charlotte was one of just two agencies out of more than 170 in the state to earn five stars. How did they manage it? Continue reading →
Students need adequate sleep for their health, safety, and academic success
From the US Centers for Disease Control and Prevention
Fewer than 1 in 5 middle and high schools in the U.S. began the school day at the recommended 8:30 AM start time or later during the 2011-2012 school year, according to data published today in the Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report.
Too-early start times can keep students from getting the sleep they need for health, safety, and academic success, according to the American Academy of Pediatrics.
CDC and U.S. Department of Education researchers reviewed data from the 2011-2012 Schools and Staffing Survey of nearly 40,000 public middle, high, and combined schools to determine school start times.
Schools that have a start time of 8:30 AM or later allow adolescent students the opportunity to get the recommended amount of sleep on school nights: about 8.5 to 9.5 hours. Continue reading →
They walk in front of cars, and into tree limbs and street signs. They fall off curbs and bridges into wet cement and creek beds.
They are distracted walkers who, while calling or texting on mobile phones, have suffered cuts and bruises, sustained serious head injuries or even been killed.
As many cities and states promote walkable neighborhoods, in part to attract more young people, some also are levying fines on distracted walkers and lowering speed limits to make streets gentler for the inattentive.
Pedestrian injuries due to cell phone use are up 35 percent since 2010, according to federal emergency room data reviewed by Stateline, and some researchers blame at least 10 percent of the 78,000 pedestrian injuries in the U.S. in 2012 on mobile device distraction.
The federal Fatality Analysis Reporting system attributes about a half-dozen pedestrians deaths a year to “portable electronic devices,” including phones and music players.
MINNEAPOLIS, Minn.— For years, proposals to raise the minimum wage in Minnesota bogged down over economic concerns: Would a raise impel businesses to leave the state? Would it decrease employment? Would it touch off inflation?
The supporters’ main argument, that raising the minimum wage would put more money into the pockets of low-wage workers and their families, fell short.
This year, proponents seized on a new strategy: They convinced the legislature to ask the Minnesota Department of Health to analyze the health impact of the state’s minimum wage of $6.15 an hour, which is among the lowest in the country.
The department’s subsequent analysis revealed that health and income levels were inextricably linked. Whether it was rates of adequate prenatal care, infant mortality, diabetes, suicide risk, or lack of insurance, the results for poorer Minnesotans were vastly inferior to residents with higher incomes.
In fact, Minnesotans living in the highest income areas of the Twin Cities region lived eight years longer than those living in the poorest.
The report virtually ended the debate. The legislature voted to phase in an increase in the minimum wage to $9.50—one of the highest in the country—with automatic subsequent increases indexed to the rate of inflation.Continue reading →
Nearly half of Americans age 65 and older, totaling about 18 million people, require help with routine daily activities like bathing, handling medications or meals.
A new study in Milbank Quarterly reveals a growing need for improved services and support for older Americans, their spouses, their children and other “informal caregivers.”
While 51 percent of older Americans in the study reported no difficulty with routine tasks, “29 percent reported receiving help with taking care of themselves or getting around in the previous month,” said co-author Vicki A. Freedman, Ph.D., a research professor with the Institute for Social Research at the University of Michigan.
“Another 20 percent reported that they had difficulty carrying out these activities on their own,” she said.
Nearly half of Americans age 65 and older require help with routine daily activities such as bathing, meals or taking medications.
Substantial numbers of older adults living outside of nursing homes experience adverse consequences from unmet care needs.
There is a growing need for improved community-based services and support for older Americans and their caregivers.
SEATTLE — Carlos Romero’s apartment is marked with remnants from his former life: a giant television from his days playing World of Warcraft and a pair of jeans the width of an easy chair. The remnants of that time—when he weighed 437 pounds—mark his body too: loose, hanging skin and stretch marks.
“I lift weights and work out and work hard, but there’s lasting damage,” said Romero.
Yet for all the troubles he had dating when he was obese—all those unanswered requests on dating web sites—shedding weight left him uneasy about how much to reveal.
Romero once weighed 437 pounds. (Photo by Sarah Varney/KHN).
“If you were to say to someone on the first date, ‘I lost 220 pounds,’ you’re indicating that you had a very serious issue at one point and that you may still have that issue,” he said. “So it’s not something I put on a dating profile because I don’t want people to judge me for it.”
Indeed, the stigma of obesity is so strong that it can remain even after the weight is lost. Holly Fee, a sociologist at Bowling Green State University, has conducted some of the only research on dating attitudes toward the formerly obese. In 2012, Fee published her findings in the journal Sociological Inquiry.
She found that potential suitors said they would hesitate to form a romantic relationship with someone who used to be heavy. “The big dragging factor in why they had this hesitation in forming this romantic relationship was that they believed these formerly obese individuals would regain their weight,” Fee said.Continue reading →
Teenage girls who are given access to long-acting contraceptives such as IUDs or hormonal implants at no cost are less likely to become pregnant, according to a study in the New England Journal of Medicine released Wednesday.
The findings come just two days after the American Academy of Pediatrics recommended that health providers should consider IUDs and implants first when discussing contraception choices with teen girls.
Young women with access to these methods at no cost were almost five times less likely to get pregnant, five times less likely to give birth and four times less likely to have an abortion.
Although there are not as many teenage pregnancies as there once were — rates have been cut by more than half since 1991 — they still pose serious public health issues because of the costs associated with child birth and public assistance for young mothers.
These pregnancies can also stunt education and income opportunities for teenage moms.