PHILADELPHIA. Mayor wants all landlords with pre-1978 housing to prove rentals are safe from lead. (The Philadelphia Inquirer)

By Barbara Laker & Wendy Ruderman 

The current law, passed in 2012, requires landlords to certify their rentals as lead-safe only if they rent to families with children who are 6 and younger.

But landlords largely have ignored the law, and the city has failed to hold them to account, an Inquirer and Daily News investigation found last October as part of the “Toxic City” series.

Shortly thereafter, Kenney formed the Philadelphia Childhood Lead Poisoning Prevention Advisory Group to find ways to reduce the numbers of children exposed to lead.

On Tuesday, Kenney and other city officials released the group’s report, which also recommended that the city financially help owners remove lead paint from their homes.

The Centers for Disease Control and Prevention says public health and pediatricians should intervene when children have a blood lead level of 5 micrograms per deciliter. The Health Department investigates only when a child hits a level of 10.

Last year, 341 children tested had a blood lead level above 10 — a new low, City Health Commissioner Thomas Farley said.

“We’ve made an awful lot of progress in lead over the years, but we still have far too many children who are being exposed to lead,” Farley said Tuesday. “This report represents a shift towards primary prevention, preventing kids from having exposure to lead in the first place, rather than just testing them and finding out later on.”

The city said it had struggled to enforce the current law because it was difficult to discern which rentals had young children. With an all-inclusive law, the city could deny a rental license to those landlords who don’t certify their rentals as lead-safe.

Read more.

NEW YORK CITY. Officials identify likely culprit in deadly Legionnaires outbreak (CBS News)

By CBS News Staff

New York City health officials say water vapor spread through the air from a building's cooling tower likely caused the deadly Legionnaires outbreak in the Lenox Hill area on the east side of Manhattan.

At least one person has died and at least six others have been infected by the outbreak, which took place in the past two weeks.

Officials held an information session on Monday in response to the outbreak and City Health Commissioner Dr. Mary Bassett fielded questions from about 100 neighborhood residents, CBS New York reports.

"It's not spread by one person coughing, and another person getting it. It spreads through water mist," she said. Inhaling mist contaminated with Legionella bacteria can cause the illness, a severe form of pneumonia that mostly affects older people and those with weakened immune systems.

Read more.

NATIONAL. Zika remains a serious threat. Federal funding cuts will make the problem even worse. (ScienceBlogs: The Pump Handle)

By Kim Krisberg

Last year’s emergency Zika funding is about to run out and there’s no new money in the pipeline. It’s emblematic of the kind of short-term, reactive policymaking that public health officials have been warning us about for years. Now, as we head into summer, public health again faces a dangerous, highly complex threat along with an enormous funding gap.

“The Zika threat will get worse,” said Claude Jacob, chief public health officer at the Cambridge Public Health Department in Massachusetts and president of the National Association of County & City Health Officials (NACCHO). “And the consequences for women and their babies are very serious.”

Jacob spoke during a May 31 press briefing on the 2017 Zika threat organized by NACCHO, March of Dimes, and the Big Cities Health Coalition (a forum for the nation’s largest metropolitan health departments). Speakers discussed the state of the Zika outbreak — there are now nearly 5,300 Zika cases reported in the U.S., including more than 1,800 pregnant women — as well as evolving research on the virus’ health effects. But the overarching message was clear: keeping the Zika virus at relative bay will require continued and sustained investment. Gaps in funding, they said, will have an especially acute impact at the community level, where local public health agencies serve as a frontline defense against the mosquito-borne virus.

“Local health departments need that sustained investment — they can’t wait for Congress to take months to act,” said Oscar Alleyne, senior advisor for public health programs at NACCHO, referring to Congress’ months-long delay in authorizing the 2016 Zika funding. “We can’t wait until there’s a fire to want to go out and buy a fire truck.”

Read more.

DALLAS. Risk of the Zika virus growing in the U.S. (The Dallas Examiner)

By DENISHA McKNIGHT

As the seasons change from warm to hot, residents should be very cautious of not only the heat but also the rising health risks, such as the Zika virus.

“With summer coming, the Zika threat will get worse,” said Claude Jacob, president of the National Association of County and City Health Officials during a press conference discussing the Zika threat May 31.

Many people are at risk of contracting the virus through a mosquito bite this summer, particularly people who live close to the Gulf Coast and pregnant women. Last year, there were 5,300 Zika cases reported in the U.S. Furthermore, 250 pregnant women were confirmed to have Zika and, of those, 10 percent delivered babies with Zika-related birth defects, according to the Centers for Disease Control.

Reports haven’t been broken down racially yet, but researchers have considered several social variables.

“They are taking it into consideration. Social determinants are important,” said Oscar Alleyne, NACCHO senior adviser. “People who work outside have a higher risk, and people whose housing is less safe such as lack of air conditioning and screens are at higher risk as well. People who are lower on the socio-economic gradient [also] are more at risk.”

Read more.

NATIONAL. Public health officials fear Trump budget cuts in fight against Zika virus (USA Today)

Kate Covington and Jayne O'Donnell

Spending cuts in the Trump administration's proposed budget for 2018 will hit the agencies dedicated to fighting the Zika virus as the season for the mosquito-borne illness is starting and when the demand for higher spending is needed, city and county health officials say.

Members of the National Association of County and City Health Officials (NACCHO) and the March of Dimes are lobbying Congress for more funding that covers a longer period of time to combat Zika, but say they are trying to develop a bigger coalition to make their case.

"We cannot wait until there’s a fire to want to go out and buy a fire a truck,” says Oscar Alleyne, NACCHO’s senior adviser for public health programs.

President Trump's budget proposed huge cuts to the agencies dedicated to — and most effective at —  fighting Zika at the Centers for Disease Control and Prevention and other public health services, said NACCHO President Claude Jacob.

Public health officials have been down this road before. Congress took 233 days to respond to the Zika outbreak last year, but a portion of the $1.1 billion lawmakers appropriated went to local health departments "to fund their work on the front lines of the outbreak," says Chrissie Juliano, director of NACCHO's Big Cities Health Coalition.

Health departments shifted around "scarce dollars" last summer and  provided education on how to protect against Zika and targeted expectant parents and those who traveled to infected regions of other countries, she added.

"We are working hard this year to ensure this sort of long delay in the federal response to a rapidly spreading disease outbreak does not occur again," says Juliano.

A hiring freeze at the Department of Health and Human Services poses a threat along with the $838 million that will be cut from the National Institute of Allergy and Infectious Diseases, the organization that oversees vaccine development, Kaiser Health News reported recently.

CDC says about 5,300 cases of Zika have been reported in the United States as of May 31, with 224 acquired from local mosquitoes and 5,206 in people who traveled to affected areas. Over 36,000 cases have been reported in U.S territories, CDC statistics show.

Read more.

NATIONAL. Zika: What to Expect this Year (WebMD)

By Kathleen Doheny

The Zika virus, spread by the bite of infected mosquitoes and other means, is here to stay, and with it the potential for serious birth defects, public health experts warned today.

From January 2015 to May 31, 2017, 5,285 cases of Zika have been reported on the U.S. mainland, said Oscar Alleyne, PhD, senior adviser for public health programs for the National Association of County and City Health Officials. The group hosted a Zika virus update during a press conference co-sponsored by the Big Cities Health Coalition and the March of Dimes.

In addition, more than 36,000 confirmed Zika cases have happened in U.S. territories. Of the 250 pregnant U.S. women confirmed with Zika infection in 2016, 10% delivered a baby with Zika-related birth defects, Alleyne said.

With government funding possibly expiring for some Zika-related programs, consumers need to stay vigilant and educated more than ever, the experts said.

"Zika is real," said Paul Jarris, MD, chief medical officer for the March of Dimes, at the press conference. "Protect yourself. Know before you go (if the virus is present at your destination)," he warned travelers. If it is present, travelers should consider postponing their trip, especially if you are trying to get pregnant.

Read more.

NATIONAL. Zika's Set to Return to Mainland U.S., But Budget Cuts Threaten Response (HealthDay News)

By Dennis Thompson

The Zika virus will strike the continental United States again this summer, and looming federal budget cuts will make it hard for local officials to curb its spread, public health experts said Wednesday.

The experts believe it's a foregone conclusion that more local Zika outbreaks will occur on the U.S. mainland in the coming months, much like what happened in Miami and Brownsville, Texas, last summer.

"We can virtually guarantee there will be activity, particularly along the Gulf region," said Michael Osterholm. He directs the University of Minnesota's Center for Infectious Disease Research and Policy.

Local health departments will shoulder the burden of any response to a local Zika outbreak, infection control experts said during a media briefing hosted by the National Association of County & City Health Officials (NACCHO).

NATIONAL. Federal Budget Cuts Could Be 'Catastrophic' for Zika Control (Medscape)

By Megan Brooks

With summer around the corner, public health officials in the United States are gearing up to combat the threat posed by the Zika virus.

In the coming months, the threat of Zika "will get worse, and the consequences of inaction are very real for pregnant women and their babies," Claude Jacob, president of the National Association of County and City Health Officials (NACCHO), warned today during a media briefing.

NACCHO, along with the Big Cities Health Coalition (BCHC) and the March of Dimes, held the briefing to discuss the threat posed by the Zika virus this summer.

Zika infections continue to be "widespread in Puerto Rico and the US Virgin Islands, and of course we had outbreaks in Miami and Brownsville, Texas, last year, and we expect more local outbreaks of Zika in this country, the mainland as well as other territories," said Paul Jarris, MD, chief medical officer of the March of Dimes. The Southern and Gulf Coast regions in the United States are particularly vulnerable to Zika outbreaks.

When it comes to Zika, "we absolutely need to maintain vigilance and funding for Zika as it spreads and we learn more about the effects on pregnancy and newborns," said Dr Jarris.

Read more.

NATIONAL. Proposed funding cuts may increase Zika threat: Health officials (Business Insurance)

By Gloria Gonzalez

The budget proposed by President Donald Trump combined with a bill to repeal President Barack Obama’s signature health care law could worsen the threat Zika poses to the United States this year, according to local and national health care experts.

As of May 24, 5,300 cases of Zika have been reported on the U.S. mainland, according to the U.S. Centers for Disease Control and Prevention.

“With summer coming, the Zika threat will get worse,” Claude Jacob, president of the National Association of County and City Health Officials and chief public health officer, Cambridge Public Health Department in Cambridge, Massachusetts, said during a webinar on Wednesday.

Despite the Zika threat, Congress took 233 days last year to provide emergency funding to address the disease, he said.

“The president’s proposed budget continues to threaten our ability to address Zika and other public health challenges,” Mr. Jacob said, citing the proposal to reduce the CDC budget by $1.2 billion, as well as a potential $40 million reduction to the Epidemiology and Laboratory Capacity for Infectious Diseases program and a $109 million proposed reduction to the Public Health Emergency Preparedness Program.

“A cut of $1.2 billion to that agency would be dire because so much of CDC’s money goes to state and local departments to support their public health activities such as preparing for and responding to Zika,” said Laura Hanen, interim executive director and chief of government affairs of NACCHO. “You need to have sustained federal funding over time to deal with the day-to-day emergencies that health departments are facing. And then when something like Ebola or Zika comes along that has unique circumstances and needs additional funding from the federal government, then you can go to Congress and ask for supplemental funds.”

Read more.

NATIONAL. House Democrats blast Trump's leaked contraception rule (Politico)

By DAN DIAMOND

ZIKA VIRUS

Advocates warn that Congressional funding is sorely needed. Congressional inaction on committing additional funding to combat the Zika virus, along with proposed budget cuts to federal health agencies, could increase the risk for virus outbreaks this summer, public health experts from Big Cities Health Coalition, the National Association of County and City Health Officials and the March of Dimes told reporters on Wednesday.

“Failing to fund this system will be catastrophic,” said Dr. Oscar Alleyne, NACCHO's senior advisor for public health programs. The $1.1 billion that Congress allocated toward fighting Zika is expected to run out in September and the White House’s initial budget proposes more than $1 billion in cuts to the CDC budget.

… NACCHO's Laura Hanen said that the Trump administration’s proposed CDC budget cuts, along with funding cuts to epidemiology and lab services, will limit the ability of local and state health departments to track the disease and contain outbreaks.

“The fact that the President’s budget would present such a deep cut when we are dealing with emergencies,” she said, “would have a deleterious impact on Zika.”

Read more.

KANSAS CITY. West Nile investigated in boy’s death, which would be Missouri’s earliest fatal case (Kansas City Star)

BY ANDY MARSO

“Mosquito populations as a whole tend to spike in June, July and August, but we mostly see mosquitoes carrying West Nile (at the) end of July through September,” Rogers said. “They’re more prone to carrying it later in the year.”

Rogers said “it’s uncommon” to see cases in May in this region.

But with milder winters and wetter springs the last few years, mosquito season is coming earlier. KDHE put out a news release last year on June 10 warning that mosquito counts, including those of the Culex species that carry West Nile, were already high in Sedgwick County.

Until this year that was the only county the Kansas Biological Survey examined. But this year Rogers said the University of Kansas department is expanding mosquito surveillance to a few more locations and will continue to add more counties if it gets more funding.

Health officials say the best ways to prevent mosquito-borne diseases are to wear long sleeves and pants, use window screens to keep mosquitoes out of the home and apply insect repellant before going outside.

The Kansas Biological Survey is also studying the range of the mosquito species that carry the Zika virus, the Aedes aegypti and Aedes albopictus. Those species have been found in some parts of Kansas and Missouri, but the only confirmed cases of Zika in the area so far have been in people who traveled to other countries and imported it.

Zika is a relatively mild illness except when it occurs during pregnancy, when it can cause the birth defect microcephaly. A study of almost 1,500 pregnant women with Zika in the continental United States found that it caused birth defects in about 5 percent of cases.

There were about 5,000 confirmed cases of Zika in the continental United States last year, according to the Centers for Disease Control. But only 224 were believed to be from local mosquitoes and all of those cases were in Florida or Texas.

There’s been no confirmed cases of locally acquired Zika in the continental United States yet this year. But Claude-Alix Jacob, the president of the National Association of County and City Health Officials, said local health officials should stay wary.

“With summer coming, the Zika threat will get worse,” Jacob said.

Read more.

MIAMI. Public health officials prep for Zika (Naples Daily News)

By Liz Freeman

Deep funding cuts to the Centers for Disease Control and Prevention would severely undermine response to a renewed Zika threat that’s expected as the summer mosquito season ramps up, a panel of public health officials said Wednesday.

The consequences of a $1.2 billion cut, which is one-eighth of the CDC’s entire budget, would trickle down to county health departments in Florida and Texas that were hard hit by Zika last summer.

The county agencies relied on federal support for laboratory testing and ground-level surveillance.

President Trump’s budget proposal also includes cutting $109 million to the public health emergency preparedness program and another $40 million to the epidemiology and laboratory capacity program, according to Laura Hanen, interim executive director and chief of government affairs for the National Association of County and City Health Officials.

Hanen was part of a press briefing Wednesday about the status of Zika and how Trump’s proposed cuts would come on top of one-time Zika funding last year that expires shortly.

Congress allocated $1.1 billion for a Zika response in 2016.

There is no more money coming behind that unless Congress recommends a comprehensive approach,” she said.

What’s really needed is a permanent public health emergency fund so there isn’t a scramble to secure money to react each time there’s a public health threat, said Dr. Paul Jarris, chief medical officer with the March of Dimes.

“That is not how FEMA operates,” Jarris said, referring to the Federal Emergency Management Agency that responds to hurricanes and other natural disasters.

Read more.

PHILADELPHIA. 'Heroin in pill form': Philly targets prescription painkillers to curtail fatal ODs

By Sam Wood

There were 907 fatal overdoses in Philadelphia last year. Opioids — heroin and prescription painkillers — were implicated in 729 of them. 

Many of those killed by heroin began their addictions with prescription opioids, so the city is launching a TV and social media campaign labeling legal painkillers as “heroin in pill form.” The aim of the $182,000 campaign, announced by the Health Department Monday at City Hall, is to save lives.

Read more

SEATTLE. Four ways we are measuring Affordable Care Act proposals (Public Health Insider)

By Patty Hayes, Director, Public Health—Seattle & King County

This post originally appeared in Public Health Insider

As various proposals to replace the Affordable Care Act continue to circulate, here is the yardstick Public Health—Seattle & King County will use to measure any proposals and the potential impacts.

Any reform or replacement for the Affordable Care Act should help people lead healthier lives. We believe that’s the underlying purpose for health care reform (while acknowledging that there are economic and other reasons to reform, as well). We’re tracking four key areas that help us measure each proposal. Read more. 

NATIONAL. More than the ACA: We Can’t Stop Fighting Now. (Huffington Post)

By Dr. Oxiris Barbot, First Deputy Commissioner, NYC Health Department

Since the start of the new presidential administration, the onslaught of policies and executive orders have been met with outcries from communities, organizations and elected officials. In the medical community, there was an almost unprecedented bipartisan opposition to the White House’s proposed American Health Care Act. To some, the protection of the Affordable Care Act has given us a rare time to celebrate, rest and regroup.

Now is not that time.

Not one of us should have the delusion that an insurance card will be a game changer when it comes to addressing longstanding and dire health inequities. If we truly want to ensure America’s health, activists, physicians and medical organizations can’t just mobilize for preservation of the Affordable Care Act. We must respond with equal vigor to immigration reform, housing quality and segregation, civil rights and other policies that could shape the nation for generations. When 80 percent of health is determined by the context of our lives, confining advocacy to access to medical care is reckless and irresponsible.

In a brave new world, here’s how we move forward:

#1 Collect Data for Action

Medicine and health rely on facts. There can be no alternatives. The need to collect robust data and shape the narrative of health has never been more urgent. By quantifying the human toll of defunding Planned Parenthood, reducing SNAP benefits through the Farm Bill and block-granting Medicaid, we proactively treat more patients than a doctor could during a shift in the ER, or an entire career. Read more. 

DETROIT. Detroit’s new top doctor making an impact (Detroit News)

Karen Bouffard, The Detroit News

Dr. Joneigh S. Khaldun took the top job at the Detroit Health Department a little over a month ago, and has already launched two public health initiatives with others in the works.

SisterFriends, announced by Detroit Mayor Mike Duggan in his State of the City address, is an attempt to combat preterm births and infant mortality by matching young moms with volunteer mentors. The other initiative, Lead Safe Detroit, launched earlier this month, created a central clearinghouse for all of the city’s lead-related activities at detroitmi.gov/leadsafedetroit.

Joining the city’s Health Department as medical director last July was a dream come true for Khaldun, 36. She became Detroit’s top doctor on Feb. 17, when she was named executive director and health officer.

Read more. 

CHICAGO. Chicago health commissioner: The ACA saves lives and we shouldn't abandon it (The Hill)

Op-ed by Julie Morita, Commissioner, Chicago Department of Public Health

For many people, the signature accomplishment of the Affordable Care Act (ACA) is the 20 million additional Americans that gained access to health insurance.

But what is less recognized is the ACA's transformation of the entire health system. These changes included a sharper focus on preventive care, a departure from the fee for service payment models that incentivize procedures, and the adoption of payment to quality, not quantity, of care.

While we are hopeful that much of this remains in place regardless of what the future of ACA looks like, one key lever must be retained to continue the progress made toward prevention of many serious and costly diseases: the Prevention and Public Health Fund (PPHF).

This fund directs federal dollars to state and local public health agencies to conduct vital prevention initiatives ranging from preventing lead poisoning in homes, to detecting and controlling infectious disease outbreaks before they can spread.

These funds have played a critical role in combating a little recognized public health threat known as Human Papillomavirus (HPV) here in Chicago. Guided by the Centers for Disease Control and Prevention (CDC), our nation’s leading public health agency, recommendation that young girls and boys receive the first dose of the life-saving, cancer-preventing HPV vaccine at age eleven, Chicago has taken steps to protect our children from HPV-induced cancers. And we could not have done it without the PPHF funding that we received in 2013. Read more. 

BALTIMORE. I'm Pregnant. What Would Happen If I Couldn't Afford Health Care? (NPR Shots)

By Dr. Leana Wen

On Christmas Day, I found out that I was pregnant. It was the best present I could have hoped for. My husband and I have wanted to start a family for years, and we could not wait to share the news with our loved ones.

But my initial exhilaration quickly turned to anxiety. As a physician, I knew many of the things that could go wrong. I wanted to do everything I could do to have a healthy baby.

I found an obstetrician and made an appointment for my first prenatal visit. I was so relieved when I saw the baby's heartbeat on the ultrasound. My blood was drawn to check for anemia and thyroid problems. I had the rest of my recommended first trimester tests, including a Pap smear and testing for HIV and sexually-transmitted infections.

The appointment also provided other valuable information. I talked to my doctor and his nurse practitioner about combating morning sickness and eating nutritious meals. I don't smoke, but if I did (as 1 in 10 pregnant women do), they would have counseled on why and how to quit. My providers asked additional questions to assess for domestic violence, a concern for up to 1 in 6 pregnant women.

Even though I'm a relatively healthy 34-year-old, I have several medical conditions that call for more frequent monitoring. My doctor recommended that I return every two weeks for a physical exam and ultrasound. Closer to delivery, I should plan to see him every week.

I didn't hesitate to follow my doctor's recommendations. I have excellent health insurance with no copay for doctor's visits and a minimal cost for tests.

But what would I have done if I didn't have insurance?

One obstetrician visit would cost $150. With an ultrasound each time, it would be $400. A Pap smear would cost $53. One set of blood tests would add another $300. All told, my prenatal care with all visits and tests included would be over $10,000. This is not counting labor and delivery, which in my area is estimated to be up to $30,000 for a vaginal birth and $50,000 for a cesarean section.

Facing these astronomical costs, would I be forced to pick and choose care based on my ability to pay, rather than the best available medical evidence? What services would I forgo, and with what consequences?

These are not hypothetical questions.

The Republican proposal to replace the Affordable Care Act would drastically cut Medicaid, which provides health coverage for women, children, seniors, and individuals with disabilities. In Baltimore, where I serve as the health commissioner, the majority of pregnant women are insured through Medicaid. Thousands of low-income women could lose coverage and have to pay out-of-pocket for services; others who have insurance may only be able to afford bare-minimum plans that don't cover needed services. Read more. 

PHOENIX. GOP health bill would cut nearly $47 million in Arizona public health funds (The Arizona Republic)

By Ken Alltucker

Arizona could lose $46.8 million in federal public health funding over the next five years via a cut included in the House Republican health bill, likely forcing local health departments to reduce or cut public health programs.

While debate over the GOP's American Health Care Act largely focuses on how the bill seeks to remake private-sector insurance and the Medicaid program for low-income and disabled people, a less-publicized provision would eliminate a Centers for Disease Control and Prevention fund of nearly $1 billion that sustains public health programs nationwide.

The Arizona Department of Health Services received $9.3 million this fiscal year from the Prevention and Public Health Fund. The money is included in the Affordable Care Act, but the GOP plan that cleared two House committees last week would discontinue funding next fiscal year.

The fund pays for program such as providing childhood immunizations and counteracting emerging public health threats such as the Zika and Ebola viruses. It also helps pay for efforts to curb childhood lead poisoning, fight heart disease, manage diabetes, promote skin-cancer awareness and smoking cessation.

"This funding is in danger," said Dr. Cara Christ, director of the Arizona Department of Health Services. "There is no guarantee these programs would continue." Read more.