Wednesday, April 16, 2014
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POSTED: Friday, January 31, 2014, 6:30 AM

When Pennsylvania and 24 other states opted out of—or delayed opting into—the Medicaid expansion, they put a lot of lives on the line. Hundreds of thousands of Pennsylvanians would have gained health insurance on Jan. 1 had the state accepted the federal money offered under the Affordable Care Act. Instead, less than a month earlier, Gov. Corbett proposed an alternative plan using federal dollars to subsidize commercial insurance plans that is so complex and requires so many waivers of federal law that even the governor didn’t project it could start until Jan. 1, 2015. Approval of the draft form that was released to the public is extremely unlikely.

Now comes a study, published on the Health Affairs blog,that reveals the consequences. “We estimate the number of deaths attributable to the lack of Medicaid expansion in opt-out states at between 7,115 and 17,104,” the authors write. In Pennsylvania, the annual estimated death toll ranges from 398 to 1,491. That’s right. We have rejected the chance to save lives and health. That is immoral.

It is also fiscally stupid. Medicaid expansion would be entirely paid for by the federal government for three years–2014, 2015, and 2016, so Pennsylvania will get no more than two of them–and phasing down to 90 percent in 2020. And it saves money for the states.

POSTED: Wednesday, January 22, 2014, 2:34 PM

Pennsylvania is one of 11 states that subsidized 93 percent of recent top-grossing movies featuring characters who smoke, according to researchers at the University of California, San Francisco–and one of seven states that gave  more money to those movies than it spent on tobacco prevention.

According to an ad placed in State Legislatures magazine by SmokeFreeMovies, a project of UCSF professor Stanton Glantz, Pennsylvania subsidized production of 24 movies between 2008 and 2012, of which 16 included smoking. It says the industry got $18 million a year in subsidies from the commonwealth for movies that included smoking, and spent $14 million in 2012 on smoking prevention.

“Seven states are now spending more subsidizing movies that promote smoking to kids than they are spending fighting smoking,” writes Glantz, director of UCSF’s Center for Tobacco Control Research and Education, in a new post on his blog.

Ad running in the magazine of the National Conference of State Legislatures.
POSTED: Tuesday, November 12, 2013, 5:30 AM
Filed Under: Funding | Poverty
A resident surveys damage wrought by Typhoon Haiyan in the central Philippines city of Tacloban. Friday's storm has displaced an estimated 600,000 people. AARON FAVILA / AP

The devastation in the Philippines following Typhoon Haiyan is enormous.  Over 10,000 are dead.  Survivors are without water, food, and shelter.  Disease outbreaks have begun.  International relief efforts are hampered by continuing storms and by devastating conditions.  UNICEF estimates that up to 4 million children may be affected by this disaster.  UNICEF along with governments and charities around the world have begun relief efforts to which you can donate.  We all need to step up and help.

As we pause to consider the enormous destruction and horrific loss of life overseas we are reminded that we need to prepare for such events closer to home.  It was just about a year ago that Superstorm Sandy hit our shores.  We remember the damage and loss of life following Hurricane Katrina a few years ago.   And this is not the first time we have watched from afar disasters overseas.  We recall the Haitian earthquake that took 85,000 lives and the 2004 tsunami deaths that took nearly 230,000 lives and displaced nearly 1.5 million. 

On November 1, President Obama signed an Executive Order “Preparing the United States for the Impacts of Climate Change,” following the recommendation of the Intragency Climate Change Adaptation Task Force. Federal, state, and local governments must be prepared for disasters and severe weather emergencies and they need plans that can be implemented quickly and knowledgably. 

POSTED: Monday, October 21, 2013, 6:30 AM
Filed Under: Food | Funding | Janet Golden

The recent government shutdown brought a halt to most of the work of two agencies overseeing food safety. (Meat and poultry inspection continued under the auspices of the U.S. Department of Agriculture). The Food and Drug Administration (FDA), part of the Department of Health and Human Services, is responsible for protecting the public health by assuring the safety, effectiveness, quality, and security of human and veterinary drugs, vaccines and other biological products, medical devices, most of our nation’s food supply, all cosmetics, dietary supplements, and products that give off radiation and for regulating tobacco products. Outbreaks of food-borne illness are monitored by the Centers for Disease Control and Prevention (CDC). This is a critical public health task. As the CDC notes, in 2012, it monitored between 16 and 57 potential food poisoning clusters each week (emphasis mine).

While critics often rail about big government regulation, the fact is that laws providing for the safety of our food, drugs, cosmetics and medical devices resulted from public uproar following exposes and tragedies. Over the past century, Americans have demanded more regulation, not less. And the result has been to make us safer and healthier.

Government oversight of our food, drugs, cosmetics and medical devices came as the result of public insistence on cleanliness, safety, and honest labeling. Muckraking journalists, public health advocates and progressive women’s organizations together helped to secure passage of 1906 Pure Food and Drug Act that was signed into law by President Theodore Roosevelt. Many credit Upton Sinclair’s horrifyingly graphic novel about the stockyards, The Jungle, published in 1906, for prompting public outrage that persuaded lawmakers to take action. As a result of this law, meat inspection began, the manufacture, transport and sale of adulterated food products and poisonous patent medicines was forbidden, and habit-forming drugs (among them cocaine and heroin) were required to have accurate labeling.

POSTED: Monday, October 7, 2013, 6:30 AM
The vaccine is here, but will we know when the flu arrives?

This is the second in a series of posts about the government shutdown’s impact on the nation’s health.

Whatever your politics, you should be afraid. Very afraid. Not only are radical Republicans—a term that once referred to the GOPs principled opponents to slavery and now simply means reckless—holding our government hostage in the hopes of delaying President Obama’s flagship health insurance program, but in the process they are harming us all. They are not only harming the government workers and their families who have been furloughed in the wake of this foolishness, but their actions have led to the suspension of essential programs that protect the public’s health.

Last week we wrote of the impending post-shutdown calamity as funding runs out for the Supplemental Nutrition Assistance Program for Women, Infants, and Children (known as WIC), putting almost 9 million WIC beneficiaries at risk. The low-income women and their babies who rely on WIC to receive infant formula are likely to be the most severely harmed should the shutdown not end quickly (how does that make you feel Speaker Boehner?!?).

POSTED: Thursday, October 3, 2013, 6:30 AM
Filed Under: Funding | Janet Golden | Kids | Nutrition | Poverty

Update Oct. 4: In a news release on October 2, the Pennsylvania Department of Health outlined the steps being taken to maintain the WIC program during the current federal government shutdown. By using funds from the previous year and harboring administrative funds they hope to sustain operations for “a few weeks” and they are working with federal and state officials to “minimize service disruptions as much as possible.”

This announcement follows the issuance of new guidelines by the Food and Nutrition Service of the US Department of Agriculture, allowing states to tap into additional funds but warning of funding shortfalls in fiscal year 2014.

You might think that a party so deeply opposed to women’s reproductive rights would be a party in favor of helping pregnant women and babies. 

POSTED: Wednesday, September 11, 2013, 3:02 AM
Filed Under: Food | Funding | History | Michael Yudell

In his 1938 book, My America, Louis Adamic wrote about answering the doorbell one morning during the Great Depression to be confronted by hungry children on their way to school. A girl spoke to him:“ Excuse me, Mister…but we have no eats in our house and my mother said I should take my brother before we go to school and ring a doorbell in some house…and ask you to give us something to eat.”

The following year, after having distributed some surplus commodities, through the Federal Surplus Relief Corporation, the United States Department of Agriculture (USDA) created an experimental food stamp program that lasted until 1943. Food insecurity was a problem then and it is today. A recent report found that 22 percent of Philadelphians were food insecure, lacking enough food for an active, healthy life. Yet the nation is in the midst of a congressional debate about the Supplemental Nutrition Assistance Program (SNAP), the descendent of the 1964 Food Stamp Act. A Robert Wood Johnson Foundation study of the impact of the cuts that some in Congress proposed found they would lead to greater poverty and food insecurity, with as many as 1.2 million children losing eligibility for free or reduced price school meals.

Opponents of the SNAP program claim it suffers from problems of fraud. That is not true; the rate is low and falling. Others claim that too many are eligible for SNAP. That is the result of our current recession, which began in 2007. Some wonder what people buy with SNAP. The answer is food—but no food that will be eaten in the store and no hot food. You cannot buy alcohol or tobacco products with SNAP.

POSTED: Friday, May 31, 2013, 6:30 AM
Janet Brown puts drops in the eyes of her 12-year-old son, Ronnie, at their home in North Philadelphia. Both of them suffer from asthma, exacerbated by roaches, a common scenario in impoverished communities. ( TOM GRALISH / Staff Photographer )

Today’s piece, the fourth in our ongoing race and health series, is by Janet Golden, a historian of medicine and public health. She writes about the teaching of race and health, and connections between past and present.

- Michael Yudell

As a medical historian, I find the subject of race and health to be both the easiest and the hardest to present to my students. It’s easy because there is so much data to analyze, from W.E.B. DuBois’ Philadelphia Negro (1899) to more recent work from the National Institute on Minority Health and Health Disparities. This agency, which is part of the National Institutes of Health, has been around in one form or another since 1990, and today has the mission of leading “scientific research to improve minority health and eliminate health disparities.” That is the challenge.

About this blog

What is public health — and why does it matter?

Through prevention, education, and intervention, public health practitioners - epidemiologists, health policy experts, municipal workers, environmental health scientists - work to keep us healthy.

It’s not always easy. Michael Yudell, Jonathan Purtle, and other contributors tell you why.

Michael Yudell, PhD, MPH Associate Professor, Drexel University School of Public Health
Jonathan Purtle, MPH Doctoral candidate and Research Associate, Center for Nonviolence and Social Justice, Drexel University
Janet Golden, PhD Professor of history, Rutgers University-Camden
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