NATIONAL. Big-City Health Officials Talk Opioid, Measles Epidemics (MedPage Today)

March 13, 2019

By Joyce Frieden

WASHINGTON -- The opioid epidemic, the measles epidemic, and the unintended consequences of marijuana legalization were some of the topics on the minds of big-city health commissioners as they convened here this week.

Like many other big cities, Columbus, Ohio has been hit hard by the opioid epidemic, Mysheika Roberts, MD, health commissioner of Columbus, Ohio, said at an event here sponsored by the Big Cities Health Coalition. "In Franklin County [where Columbus is located], we had a 581% increase in opiate overdose deaths from 2003 to 2017," she said, adding that about 450 people die from it every year. "The city has funded a comprehensive harm reduction program, conducted by one of our federally qualified health clinics; we provide naloxone training, HIV and hepatitis C testing, treatment referrals, and wound care."

Two of the city's more unusual efforts include several safe needle disposal boxes located throughout the city, which has reduced the number of needles discarded in parks and other public places, and a "surge notification system," under which the coroner's office, emergency medical services, police departments, and emergency departments alert other agencies via a conference call if they notice an unusually high number of people dying from overdoses or being transported to the hospital for overdose treatment.

"This helps us identify a concentrated area of overdoses," Roberts said. Two years ago, the notification system alerted officials to a high number of overdoses in a particular African-American community in Columbus. "We found a cocaine batch that had [been] contaminated by carfentanyl ... We were able to get on top of that quickly and made sure that people [in that community] had access to Narcan."

But funding such efforts continues to be a challenge, she added. "I know I'm not alone in that. We're going to continue to see more deaths in the community if we don't do something drastic to change things ... One area where we see a lot of [funds] draining is children's services; many children are becoming orphans" because their parents have died from drug overdoses.

The measles epidemic is weighing heavily on the mind of Rachel Banks, MPA, public health director of Multnomah County, Oregon, where Portland is located. "We're really focused on the measles vaccine exemption rate," specifically, the rate of "non-medical" exemptions where people seek exemptions for religious or philosophical reasons, she said, noting that the county is on its fifth recent measles outbreak.

In Oregon overall, 5.2% of children are unvaccinated due to a non-medical exemption; in Multnomah County, the rate is 6.1%. Similarly, Oregon has a statement measles vaccine exemption rate of 3.9%, compared with 4.3% for the county, she said, adding that the area's recent measles outbreak has increased vaccine uptake.

"We are concerned with disease spread and the impact on the healthcare system," said Banks. The county health system and the providers have used a joint plan to mitigate community exposures; that model has worked well. For example, "we had one outbreak in July 2018 -- we had three cases with no additional exposures after the first case, and stopped the subsequent spread, but it was very expensive and involved a highly skilled and trained staff."

There are two cost-related issues with the outbreak, Banks continued -- one is the cost of educating families seeking exemptions about the possible consequences, and the other is the cost of the outbreaks themselves. The policy solutions are clear: officials should take a balanced approach by supporting vaccines, while also working with affected families to convince them to take precautions to avoid spreading the disease.

Tomás Aragón, MD, MPH, public health officer for San Francisco, discussed the unintended consequences of marijuana legalization in his state. "In California, you can't consume cannabis in public, so people create consumption places," he explained. However, right now the prevalence of [cigarette] smoking is very low through decreasing demand and also through "de-normalization" -- making smoking not considered the cool thing to do. "So we don't want smoking to now start taking off, because they'll probably go beyond cannabis" and smoke tobacco too.

Clean indoor air and worker safety also could be affected by marijuana legalization, Aragón added, noting that under current state law, "workers are protected from second-hand smoke."

He is also concerned about the high potency of the marijuana being sold, some of which has a 90% level of its main ingredient, tetrahydrocannabinol (THC). "I feel like we're in the Wild West [of marijuana] ... I went to one retail place where the owner himself consumes cannabis 24/7 -- but only at a 25% THC level," said Aragón. Of the cannabis with 100% THC, the owner told Aragón, "I sell this stuff but I would never touch it."

Other health department heads discussed some of their successes. Virginia Caine, MD, director of the Marion County (Indiana) Health Department, where Indianapolis is located, said she recently testified before the Indianapolis City Council in support of a needle exchange program for the city. The day she appeared, Indiana's Attorney General, Curtis Hill, gave a press conference saying that needle exchange programs "enable drug addicts and make this a terrible epidemic for the young generation." Despite Hill's remarks, all 24 council members voted unanimously in favor of the program, Caine said.

SAN JOSE. Federal budget cuts put Californians’ health at risk (The Mercury News)

By the Mercury News & East Bay Times Editorial Boards

Congress does have a doctor in the House. Fifteen of them, to be exact. And another physician in the Senate. So there’s no excuse for the appalling attack on health care in the budget deal passed by Congress on Friday and signed by President Trump.

Congress did fund the Children’s Health Insurance Program for 10 years. That’s the good news for 200,000 kids in the Bay Area who rely on it to meet their basic health care needs. But Congress came up with the funding for CHIP by grabbing $1.35 billion from the Centers for Disease Control’s Prevention and Public Health Fund.

“Pitting prevention against care and treatment is really a false choice,” said Dr. Sara Cody, Santa Clara County’s public health officer. “Nobody knows for sure how much the CDC will cut from California and Bay Area county budgets. But once again the importance of prevention is being short-changed.”

Public health keeps people, not surprisingly, healthier and out of the hospital. It’s as simple as that. Controlling outbreaks before they become widespread is an essential component of basic health care strategy. The CDC’s prevention budget supports vaccine coverage, enables states and counties to respond to infectious outbreaks, such as Ebola or Zika, and fights chronic problems, including diabetes, cancer, stroke and heart disease.

This winter’s flu outbreak demonstrates the importance of  public health funding. About 40 percent of Californians fail to get flu shots every year, and more than 160 under the age of 65 have died during the current flu season.

The value of the CDC funding became obvious in January 2016, after Santa Clara University student Bradley Sheffield contracted meningitis from an unknown source. The outbreak put the entire campus at risk.

The university’s quick action and the support of local public health officials stopped the disease in its tracks by providing thousands of students with emergency vaccinations. Sheffield recovered and was able to return to classes in the spring.

“The only reason we were able to be so nimble in response was because of the federally funded vaccines allowing the state to keep an emergency supply on hand,” said Cody. “It was 48 hours from the time we heard about the outbreak to the first shot in the arm.”

It’s an open question with the reduction in funding whether the state will be able to maintain a supply of emergency vaccinations for various outbreaks.

The CDC prevention and public health funding also provides crucial support in the East Bay. In 2016, Alameda County received a $500,000 grant to fight chronic disease, another $204,000 for smoking prevention programs and $65,000 to support its immunization program.

Benjamin Franklin was actually talking about fire safety when he said an ounce of prevention is worth a pound of cure. It shouldn’t be too much to ask Congress to be smart enough to know how foolish it is to stop protecting Americans from devastating outbreaks and diseases.

MINNEAPOLIS. Repeal of ACA would imperil a little-known part with a huge impact (Minneapolis Star Tribune)

February 17, 2017

The debate about the future of the Affordable Care Act (ACA) is in full swing, and many know that repealing the ACA would leave almost 20 million Americans without health care coverage. This is of great concern.

But the fact that repealing the law would also decimate the already-fragile public health system in America is not known to many policymakers or members of the public.

This part of the law, which benefits every American, helps to keep all healthy and safe; it will essentially be undone with the repeal of the ACA. If there is no comparable replacement, communities across the nation are poised to lose $3 billion in federal funds over the next five years through a mechanism called the Prevention and Public Health Fund, which is currently a component of the ACA.

The Prevention and Public Health Fund was designed as an important, complementary component to the promise of insurance coverage for most Americans. It was meant to help us prevent disease instead of just treating it when it strikes, and to address many of the other factors that make us ill and cause our health care costs to keep rising.

Researchers have found that our ZIP code is actually a greater predictor of our health than our genetic code. Strategies supported by the fund are aimed at addressing our nation’s sky-high rate of chronic disease, in particular diabetes, obesity, cancer, asthma, and heart disease. These health problems now touch almost every family in every community.

The resources that flow from the ACA are now being used to backfill funding cuts to support core public health programs by funding a large portion of the Centers for Disease Control and Prevention (CDC), the part of the federal government that works 24/7 to protect America from health, safety and security threats. It is responsible for ensuring access to vaccines to protect against flu and other diseases; supporting local and state first responders in mitigating the effects of outbreaks like Zika or Ebola; and preparing for and responding to natural disasters like hurricanes and earthquakes. The CDC works to protect every American, every single day. Without the funding provided by the Affordable Care Act, its reach will be dramatically reduced.

Read more.