Cross posted at Daily Kos.
I know, it seems shocking. Look at the health statistics in the city of Baltimore - fifth highest overall mortality rate, second highest homicide rate, fourth highest infant mortality rate, third in low birth weight rankings... and the clincher: second highest AIDS and HIV rates, at a whopping 40.4% and 50.5%, respectively. Oh, and years of neglect and corruption in the City Health Department. How could the Baltimore City Health Commissioner be improving the situation?
Well, he is. Josh Sharfstein, M.D. is currently the Health Commissioner of Baltimore, and he has a pretty impossible job. He is tasked with improving the public health of a city that has such serious epidemics - the spread of HIV, heroin addiction, asthma among children, infant mortality...the list goes on. And he has to deal with Mayor Sheila Dixon and the Baltimore City Council - no easy feat.
But Sharfstein has proposed some interesting strategies for combating these problems. For tackling the spread of HIV and heroin addiction among Baltimoreans, he supports buprenorphine. Buprenorphine is an alternative to methadone, the controversial heroin substitute. Health professionals are divided on the benefits on buprenorphine. Some say it is over-prescribed and an inadequate substitute to counseling services. Others say it provides the benefits of methadone without being as highly addictive.
But the best part of bupenorphine is that regular doctors can describe it (after a number of hours of training). Methadone has to be distributed at special methadone clinics. No one wants methadone clinics in their communities, so it becomes more difficult to build them. Bupenorphine could help produce the safer consumption of heroin substitutes in Baltimore, and ultimately lead to a drop in the HIV rates among users.
Sharfstein has also committed to targeting other urban policy issues that affect public health. For example, high school dropout rates can turn into a public health nightmare - they can lead to increased rates of teen pregnancy and drug use, among other things. However, studies have shown that providing families with books will increase the likelihood that their kids will stay in school. So, the Commissioner came up with a plan for Baltimore City to give books to pediatricians, who would in turn give them to their patients so they would have something to read - simple, but effective.
Baltimore has also begun its "Safe Streets" program - a copy of Chicago's Ceasefire Program to lower gun violence in the city. There is no greater risk to public health than the murder rate, and it is not only the police commissioner who needs to get involved in such programs, the health commissioner must as well.
However, the greatest achievement Sharfstein has made is establishing a shift to community based health provision in Baltimore. For too long, the city has suffered a health budget that was too small to get anything done (thanks in large part to inadequate federal funding). However, community organizations can do more with less - they have more devoted staff, a knowledge of the local needs of their target area, and a relationship with the people that need access to services. All of these things allow community based organizations to provide primary care better than the City can. Thus, instead of wasting money on inadequate health services, the Health Commissioner has invested in community based primary care initiatives. However, the City still needs to do its part, and has maintained clinics and health centers that still fulfill a need.
Republicans constantly talk about the need to increase efficiency in our health care system - but they only know how to do that by cutting services. The services are still needed, we just need to change how we provide them. Supporting health care can take many forms, but two things is clear: government still needs to maintain a role in health care provision through funding local services, and we need more health commissioners like Josh Sharfstein in the country.
Wednesday, September 17, 2008
Thursday, September 11, 2008
New Problems With HIV Risk
Cross posted at Daily Kos.
It is ludicrous to think that, almost 30 years after the AIDS epidemic swept through the country, the U.S. government could still let people at risk for HIV, and people who are newly infected with HIV, fall through the cracks. Unfortunately, this does seem to be the case.
An article in The New York Times calls attention to the new Centers for Disease Control and Prevention study on HIV risk among Americans. The study found that the groups that make up the majority of new HIV cases are gay or bisexual men and blacks. Infections among gay or bisexual white men occurred mostly in their 30s or 40s, whereas cases among gay or bisexual black men occurred mostly in their teens and 20s.
Furthermore, the study showed that these groups are severely at risk for not getting the treatment they need:
To say that this poses a public health risk barely skims the surface of the problem. People are who at risk for a disease as serious as AIDS should have access to the health care that they need, but sadly, this is not the case.
Those who do not have access to infection prevention services, or basic birth control or safe sex education programs, end up becoming at risk for AIDS.
(By the way, I think we can all think of a certain 17 year old from Alaska who might have benefited from some access to birth control and basic sex education programs...but that's neither here nor there).
These people often live in areas where these services are underfunded (especially when the federal government only promotes abstinence only education programs). And these people are hit again when they don't have access to the necessary treatment medications or programs.
This is a problem of people lacking, or having inadequate, insurance. This is also a problem of our health care services not targeting those who need them most. People need to wake up to these health disparities, as they create public health problems for the whole country. If they don't, things will only get worse.
It is ludicrous to think that, almost 30 years after the AIDS epidemic swept through the country, the U.S. government could still let people at risk for HIV, and people who are newly infected with HIV, fall through the cracks. Unfortunately, this does seem to be the case.
An article in The New York Times calls attention to the new Centers for Disease Control and Prevention study on HIV risk among Americans. The study found that the groups that make up the majority of new HIV cases are gay or bisexual men and blacks. Infections among gay or bisexual white men occurred mostly in their 30s or 40s, whereas cases among gay or bisexual black men occurred mostly in their teens and 20s.
Furthermore, the study showed that these groups are severely at risk for not getting the treatment they need:
In one of the most dismal statistics provided by the centers, researchers said that 80 percent of those found to be newly infected by the disease had not been reached by prevention efforts, which are often sponsored by federal, state and local health officials.
To say that this poses a public health risk barely skims the surface of the problem. People are who at risk for a disease as serious as AIDS should have access to the health care that they need, but sadly, this is not the case.
Those who do not have access to infection prevention services, or basic birth control or safe sex education programs, end up becoming at risk for AIDS.
(By the way, I think we can all think of a certain 17 year old from Alaska who might have benefited from some access to birth control and basic sex education programs...but that's neither here nor there).
These people often live in areas where these services are underfunded (especially when the federal government only promotes abstinence only education programs). And these people are hit again when they don't have access to the necessary treatment medications or programs.
This is a problem of people lacking, or having inadequate, insurance. This is also a problem of our health care services not targeting those who need them most. People need to wake up to these health disparities, as they create public health problems for the whole country. If they don't, things will only get worse.
Tuesday, September 9, 2008
Where Is Discussion of Access to Health Care?
Cross posted at Daily Kos.
Inadequate access to health care is a problem plaguing this nation's communities. In light of that fact, it was discouraging that no keynote speakers at the DNC or RNC managed to discuss this problem in a meaningful way in their speeches. Those at the DNC do get some credit for discussing the problem of inadequate health insurance coverage in the U.S., but that is only the tip of the iceberg. Where is the discussion of inadequate access to care, and the health disparities that follow from it, among our country's leaders?
Health Beat has started a series titled, "Americans Who Have Insurance — But Still No Access To Care." The first posting went up Tuesday, and discussed various problems plaguing the 56 million Americans that do not have regular access to health care. But it is important to note that this is not only a problem of people lacking health insurance - many of these 56 million Americans have insurance, but still do not have the access to care that they need.
The problem of inadequate access to care is even more evident in poor communities. The shortage of primary care physicians is most severe in those communities, and the effects are enormous. Health disparities in the U.S. still plague low-income areas, areas that are often populated largely by communities of color.
It is also important to note that this inadequate access to care is not only a problem for those seeking primary care. This week's Kaiser Health Disparities Report links to a study that shows minority single women and teenagers are less likely than others to receive proper prenatal care:
When these individuals do not have access to prenatal care, their children become subject to a host of potential health problems early in life, including ones as severe as infant mortality:
The Kaiser report also links to a study examining the causes of massive rates of obesity in Native American communities. The problems are most severe among youths:
Without access to health care, parents cannot teach their children about proper nutrition and dieting. Therefore, this cycle of bad health continues generation after generation.
We need our political leaders to talk about this issues if we want anything done. The conventions were a missed opportunity for both parties, but it wasn't the only one that will appear in this election cycle. Hopefully, next time we can expect more.
Inadequate access to health care is a problem plaguing this nation's communities. In light of that fact, it was discouraging that no keynote speakers at the DNC or RNC managed to discuss this problem in a meaningful way in their speeches. Those at the DNC do get some credit for discussing the problem of inadequate health insurance coverage in the U.S., but that is only the tip of the iceberg. Where is the discussion of inadequate access to care, and the health disparities that follow from it, among our country's leaders?
Health Beat has started a series titled, "Americans Who Have Insurance — But Still No Access To Care." The first posting went up Tuesday, and discussed various problems plaguing the 56 million Americans that do not have regular access to health care. But it is important to note that this is not only a problem of people lacking health insurance - many of these 56 million Americans have insurance, but still do not have the access to care that they need.
The problem of inadequate access to care is even more evident in poor communities. The shortage of primary care physicians is most severe in those communities, and the effects are enormous. Health disparities in the U.S. still plague low-income areas, areas that are often populated largely by communities of color.
It is also important to note that this inadequate access to care is not only a problem for those seeking primary care. This week's Kaiser Health Disparities Report links to a study that shows minority single women and teenagers are less likely than others to receive proper prenatal care:
The task force report, based on data from 1990 to 2004, found that across all racial and ethnic groups, uninsured women had the lowest rate of trimester prenatal care at 73% and that women with private insurance had the highest rate at 96%. The overall average for prenatal care was 89%.
When these individuals do not have access to prenatal care, their children become subject to a host of potential health problems early in life, including ones as severe as infant mortality:
The task force recommended increased preconception health awareness, promotion of equity in birth outcomes and assurance of availability of early prenatal services for women living in areas with hospital closures or reductions in obstetrical services.
The Kaiser report also links to a study examining the causes of massive rates of obesity in Native American communities. The problems are most severe among youths:
Forty-three percent of boys and 39% of girls were considered overweight, according to the study.
Without access to health care, parents cannot teach their children about proper nutrition and dieting. Therefore, this cycle of bad health continues generation after generation.
We need our political leaders to talk about this issues if we want anything done. The conventions were a missed opportunity for both parties, but it wasn't the only one that will appear in this election cycle. Hopefully, next time we can expect more.
Series Two - Health Care: Introduction
The next series on this blog will focus on health care in the United States. It will cover a range of issues that are not focused on in the mainstream political arena, particularly the unequal access to health care, the inadequate quality of health care and the health disparities that exist in the U.S. I will look at how these issues are discussed (or not discussed) in politics in general and in the upcoming election.
When politicians do address health care, they mainly talk about lowering costs, improving efficiency in spending and getting more people covered. While the uninsured population is a huge concern in the U.S. and should be discussed, there are many other issues in our health care system that do not get the same kind of focus. These issues can be just as bad, or even worse, than lacking insurance.
The series will also look at the U.S.'s health care system in the context of the other countries' health care systems. There are other countries that our leaders could learn a lot from (good and bad) when seeking to improve the U.S.'s health care system.
Also, many of these postings will be cross posted on two other blogs - the Daily Kos and Scoop08. Please look at those if you get a chance.
When politicians do address health care, they mainly talk about lowering costs, improving efficiency in spending and getting more people covered. While the uninsured population is a huge concern in the U.S. and should be discussed, there are many other issues in our health care system that do not get the same kind of focus. These issues can be just as bad, or even worse, than lacking insurance.
The series will also look at the U.S.'s health care system in the context of the other countries' health care systems. There are other countries that our leaders could learn a lot from (good and bad) when seeking to improve the U.S.'s health care system.
Also, many of these postings will be cross posted on two other blogs - the Daily Kos and Scoop08. Please look at those if you get a chance.
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