City News

BOSTON. Providing A Safe Space And Medical Monitoring To Prevent Overdose Deaths (Health Affairs Blog)

Jessie GaetaBarry Bock, and Mary Takach

August 31, 2016

According to the Centers for Disease Control and Prevention (CDC), more people died from drug overdoses in 2014 than in any year on record. Most of these deaths—78 every day—involved an opioid. Closer to home in Boston, deaths from opioid overdoses increased by 50 percent from 2014 to 2015 (Note 1). In our practice, Boston Health Care for the Homeless Program (BHCHP), based on the corner of Massachusetts Avenue and Albany Street (the epicenter of Boston’s drug activity), opioid overdoses have become the leading cause of death among our patients.

Overdoses were happening multiple times each week in our lobby, clinic bathrooms, and on the sidewalks and alleys adjacent to our building. Despite significant existing services aimed at the prevention and treatment of substance use disorders (SUD), we were not effectively engaging some of the highest-risk people with SUD. There was recognition among our staff, board of directors, and patients that in addition to improving screening for SUD, expanding access to opioid agonist therapy, broadly distributing naloxone (the rescue drug to reverse opioid overdoses), improving opioid prescribing practices, and expanding housing opportunities, we also needed to reduce the harms associated with ongoing drug use and provide a safe alternative to the street for people who are over sedated. Our goals are to respond with a new service that:

  1. Prevents fatal overdose;
  2. More effectively connects highest-risk individuals with addiction treatment; and,
  3. Addresses the impact of SUD on our patients, our organization, and our neighborhood.

Read more

MIAMI & HOUSTON. New Zika Cases in Florida Show U.S. Cities' Struggle Without Federal Funding (Governing)

After Congress left cities to fend for themselves, four new cases -- possibly the first to be contracted by mosquitoes in the U.S. -- suggest how difficult it is for them to combat the virus on their own.

BY MATTIE QUINN 

Congressional inaction on Zika funds has hampered efforts on the local level to stop the spread of the disease. That was more or less proven Friday when Florida Department of Health officials said it's highly likely that four new cases in Miami were the first to be contracted by infected mosquitoes in the U.S.

To date, there have been 1,658 cases of Zika in the continental United States. But so far, they've all involved someone who had traveled to a foreign country or had sex with someone who had recently been to a Zika-affected country.

President Obama in May proposed $1.9 billion to help combat the spread of the virus. Congress, however, was unable to agree on that number and left for recess without allocating any extra money for state and local governments.

Even if Congress does allocate Zika funding, local officials say they may already have missed an important window for combatting the virus.

“The real tragedy is that now is the time when you need the extra money and resources: July and August is mosquito control time all across the U.S.,” said Peter Hotez, dean of the National School of Tropical Medicine at the Baylor College of Medicine. “Everything from here on out is just going to be damage control.”

In the absence of federal funding, localities have been left to fend for themselves.

“The Centers for Disease Control is not going to fight this disease. This is going to be a fight almost exclusively at the local level,” said Hotez.

Beyond mosquito control, which is hardest in the summer months, Hotez says local health centers must start being constantly on the lookout for possible cases.

Read more.

HOUSTON. Troisi, Williams: Public health approach can stem gun violence Accidental shootings prompt experts to apply familiar safety measures (Houston Chronicle)

By Catherine Troisi and Stephen Williams

We have heard the statistics: Every year in the U.S., an estimated 30,000 persons die from injuries involving guns, including heartbreakingly, 1,500 children. Here in Harris County, gun accidents are now the second cause of accidental death among children. Regardless of where you stand on the role of guns in society, we would all agree that we need to decrease these numbers. We believe that taking a public health approach, similar to that successfully used to decrease deaths from automobiles, is the method we need to use to do this. According to a review of major achievements of public health done by the U.S. Centers for Disease Control and Prevention, six times as many people drove in 2000 as in 1925, and the number of cars increased by eleven­fold with the number of miles driven 10 times higher. One might therefore anticipate that more people are dying in motor­ vehicle­ related crashes ­ and yet the data show otherwise. The annual death rate (calculated per vehicle miles traveled) has declined by an incredible 90 percent. What improvements led to remarkable achievement? This decrease in motor­ vehicle fatalities is due in large part to the work of a physician, Dr. William Haddon, who applied standard public health methods to this problem. Public health workers/leaders/advocates took a three­pronged approach to increasing road safety targeting cars, roads and drivers through both technological advances and policies.

The 1966 Highway Safety Act set standards for both safer motor vehicles and highways. Car design was improved to afford better protection to occupants in case of a crash. New car safety features such as safety belts, shatter­ resistant windshields, head rests, etc., increased the likelihood that persons involved in a crash would survive and would suffer fewer or less severe injuries. Roads were redesigned ­ road reflectors, center stripes, breakaway sign and utility poles, improved lighting and guard rails were added to advance safety. While these changes led to rapid decreases in motor ­vehicle deaths, these were not the only improvements. Driver and passenger behavior changed due to a combination of laws, policy, and education, as well as changes in social acceptability of certain behaviors.

There was greater enforcement of laws against driving while intoxicated, underage drinking, open containers and requirements for safety­ belt and child­ safety seats. Graduated licensing laws aimed at beginning drivers enacted policies that make the process of learning to drive safer. Groups such as Mothers Against Drunk Driving helped change the social acceptability of DWI while other groups focused on the importance of using child safety seats. Other policies that have contributed to motor vehicle safety include car safety inspections, speed limit changes and traffic regulations. Preventing motor ­vehicle related injuries took the application of a public health approach using technology, policies and behavior change and the collaboration of specialists in these areas. According to Dr. Georges Benjamin, executive director of the American Public Health Association, "Time and again, a public health approach to solving health threats is a proven, evidence­ based approach to improving health and preventing injury.

Read more.

MIAMI. Zika “active transmission area” in Miami, health department says (Miami Herald)

BY DAVID J. NEAL dneal@miamiherald.com

Florida’s Department of Health announced there’s a “high likelihood” of four locally-transmitted cases of the Zika virus in Miami-Dade and Broward County, the first locally-transmitted cases in the United States, and “believes there’s an active transmission area” that includes Wynwood, Midtown and the Design District areas of Miami.

The department defined the transmission area’s boundaries as U.S. 1 (Biscayne Boulevard) to the east; Northwest Fifth Avenue to the west; 20th Street on the south; and 38th Street on the north.

“While no mosquitoes trapped tested positive for the Zika virus, the department believes these cases were likely transmitted through infected mosquitoes in this area,” the department declared in a news release.

“The department is actively conducting door-to-door outreach and urine sample collection in the impacted area and will share more details as they become available. The results from these efforts will help department determine the number of people affected. These local cases were identified by clinicians who brought them to the attention of the department. In addition, blood banks in the area are currently excluding donations from impacted areas until screening protocols are in place.”
 

Read more.

NATIONAL. Gun Violence Is a Public Health Crisis (Huffington Post)

By Dr. Mary Bassett, New York City’s Health Commissioner

For far too long, far too many lives have been cut short by the plague of gun violence in the places we live, work, play and love. We can’t wait for Congress to act on gun control; it’s time for the rest of us to take responsibility. For me, it means addressing gun violence as the public health emergency it is.

The mission of public health is to protect and promote the health, safety and wellbeing of entire populations. When public health professionals notice a troubling trend, we can’t sit on the sidelines. We must take action. When we saw that thousands of people were dying before their time due to smoking each year, we aggressively disseminated information about the harms of smoking, implemented new treatment tools and collaborated with lawmakers to raise taxes and ban smoking in public places. Our multipronged approach worked - the adult smoking rate in New York City declined by 35% between 2002 and 2014, and the youth smoking rate fell by 53% from 2001 to 2013.

There’s no reason our country can’t take a similar multipronged approach to prevent gun violence. Community-based interventions like Cure Violence, a program started in Chicago by Dr. Gary Slutkin, are part of this effort. In New York City, Cure Violence aims to reduce gun violence in 17 neighborhoods that account for more than half of the city’s shootings through a collaborative of community organizations and government partners delivering wraparound behavioral and social support services which have been shown to reduce violence.

Read more.

NATIONAL. Inside A Secret Government Warehouse Prepped For Health Catastrophes (National Public Radio)

June 27, 20164:56 AM ET

Heard on Morning Edition

When Greg Burel tells people he's in charge of some secret government warehouses, he often gets asked if they're like the one at the end of Raiders of the Lost Ark, where the Ark of the Covenant gets packed away in a crate and hidden forever.

"Well, no, not really," says Burel, director of a program called the Strategic National Stockpile at the Centers for Disease Control and Prevention.

Thousands of lives might someday depend on this stockpile, which holds all kinds of medical supplies that the officials would need in the wake of a terrorist attack with a chemical, biological or nuclear weapon.

The location of these warehouses is secret. How many there are is secret. (Although a former government official recently said at a public meeting that there are six.) And exactly what's in them is secret.

"If everybody knows exactly what we have, then you know exactly what you can do to us that we can't fix," says Burel. "And we just don't want that to happen."

Read more. 

 

CHICAGO. Chicago Passes Paid Sick Leave (Next City)

BY JEN KINNEY | JUNE 23, 2016

This week Chicago’s city council approved a paid sick leave ordinance, ensuring that nearly every Windy City worker will have the right to earn up to five days of paid sick leave. The city joins over two dozen others in the U.S., including New York and Los Angeles, in requiring employees to provide that protection. When the legislation goes into effect next year, it will extend the right to more than 460,000 workers. Construction workers were excluded, reports the Chicago Tribune, because they tend to work for more than one employer over the course of a year.

Mayor Rahm Emanuel characterized the ordinance as “earned sick leave,” because employees will accrue one hour of paid sick leave for every 40 hours labored. “You have to earn it, you don’t just get it, by the amount of hours you put in,” he said.

Even though numerous studies have shown that paid sick leave has a minimal negative impact on employer expenses and a significant positive impact on employee productivity and morale, Chicago’s business community opposed the ordinance. “It’s unfortunate the City Council refuses to consider the overall effects of the litany of new rules, regulations and costs they place on employers,” said Chicagoland Chamber President Theresa Mintle in a statement. “Businesses don’t operate in silos, and this mandated paid sick leave is another cost neighborhood businesses will have to absorb at a time when they can least afford it.”

Read more. 

NATIONAL. Can We Curb Gun Violence by Treating It Like a Disease? (TIME)

Josh Sanburn @joshsanburn

June 23, 2016

In 2014, a week before Thanksgiving, a 56-year-old man was shot in the Crown Heights neighborhood of Brooklyn. Within hours, several of his family members gathered at the crime scene, discussing retribution. They had suffered; now, they wanted others to pay for their pain.

That’s when David Gaskin showed up. He gently probed the family, asking how they were feeling and why they might retaliate. He offered sympathy and counsel, informed by his experiences in prison and as a former gang member. And he repeatedly asked for verbal commitments that they wouldn’t strike back, at least not then. Some agreed–and he promised to follow up.

Gaskin, 34, isn’t a police officer or a psychologist; he’s an outreach worker for a nonprofit initiative, Save Our Streets (SOS). But he and others like him may well be instrumental in curbing America’s gun-violence epidemic on a local level, especially as Congress keeps declining to pass federal gun control.

The key is their unorthodox approach. Unlike cops, who arrest criminals, or coalitions, which raise money to change laws, programs like SOS–now in Oakland, Calif., New Orleans and at least 20 other major U.S. cities–approach gun violence like doctors approach disease: as a contagious bug that must be diagnosed, contained and treated. “Hurt people hurt people,” explains Yvette Simpson, who is spearheading an SOS-like initiative in Cincinnati. And at a time when the American Medical Association (AMA) is calling gun violence a public health crisis, these groups say it’s paramount to manage that pain. It just might prevent the next local shooting, or even the next Orlando.

Read more.

HOUSTON. Commentary: We can stem gun deaths the same way we lowered auto deaths (Austin-American Statesman)

By Cathy Troisi and Stephen Williams - Special to the American-Statesman

The news from Orlando has broken our hearts yet again. This was the largest mass murder in US history, but every year in the U.S., an estimated 30,000 persons die from injuries involving guns, including unbearably, 1,500 children. Regardless of where you stand on the role of guns in society, we would all agree that we need to decrease these numbers. We believe that taking a public health approach, similar to that successfully used to decrease deaths from automobiles is the method we need to use to do this.

Six times as many people drove in 2000 as in 1925 and the number of cars increased by eleven-fold with the number of miles driven 10 times higher. One might therefore anticipate that more people are dying in motor-vehicle-related crashes — and yet the data show otherwise. The annual death rate, calculated per vehicle miles traveled, has declined by an incredible 90 percent. What improvements led to remarkable achievement?

This decrease in motor-vehicle fatalities is due in large part to the work of a public health physician, William Haddon, who applied standard public health methods to this problem. Public health workers, leaders and advocates took a three-pronged approach to increase road safety targeting cars, roads, and drivers through both technological advances and policies.

The 1966 Highway Safety Act and the National Traffic and Motor Vehicle Safety Act set standards for both safer motor vehicles and highways. Car design was improved to afford better protection to occupants in case of a crash. New car safety features such as safety belts, shatter-resistant windshields, heads rests, etc., increased the likelihood that persons involved in a crash would survive and would suffer fewer or less severe injuries. Roads were redesigned – road reflectors, center stripes, breakaway sign and utility poles, improved lighting, guard rails were added to advance safety.

While these changes led to rapid decreases in motor-vehicle deaths, these were not the only improvements. Driver behavior changed due to a combination of laws and education as well as changes in social acceptability of certain behaviors. There was greater enforcement of laws against driving while intoxicated, underage drinking, open containers and requirements for safety-belt and child-safety seats. Graduated licensing laws aimed at beginning drivers made the process of learning to drive safer. Groups such as Mothers Against Drunk Driving changed the social acceptability of DWI while other groups educated about the importance of using child safety seats. Other policies that have contributed to motor-vehicle safety include car safety inspections, speed limit changes, and traffic regulations.

Preventing motor-vehicle related injuries required a public health approach using technology, policies, and behavior change. We need to use these tools to stem the tide of gun-related injuries. We need data about what works and doesn’t work which requires lifting the ban on research dollars to study this. We need to work with the gun industry to design safer “smart” guns just as we have safer cars. We need an understanding of which policies work, and which don’t, to protect people from injuries caused by guns. We need research into understanding and addressing violent behaviors including suicide prevention.

According to a statement by Dr. Georges Benjamin, executive director of the American Public Health Association, “health epidemics don’t end unless we intervene taking the best science about what does and does not work and using it. The epidemic of intentional gun violence can be reversed with a science-based approach. It happened with Ebola, it worked for automobile crashes and it can absolutely reduce gun violence.” To accomplish this, it’s time to reduce the rhetoric and have open conversations about this epidemic, agree on a common goal, and work together to reduce these preventable injuries and deaths. No more Orlandos.

Catherine Troisi is an epidemiologist and chair-designate of the American Public Health Action Board. Stephen Williams is director of the Houston Health Department.

PHILADELPHIA. Philly Wants To Tax Soda To Raise Money For Schools (National Public Radio)

Philadelphia's new mayor wants to do something few American cities have done: pass a tax on soda and other sugary drinks.

So far, Berkeley, Calif., has been the only U.S. city to approve such a tax. That measure was aimed at reducing soda consumption (and the negative health effects that go along with drinking too much of it).

But in Philly, the tax isn't being promoted as a scheme to bring down the city's high rates of obesity or diabetes. Mayor Jim Kenney says he wants to use the revenue for projects that benefit residents in a city with a 26 percent poverty rate, the highest of America's largest cities. He argues soda companies make big money and often market their products to low-income people.

"What we're looking to do is to take some of that profit, to put it back into the neighborhoods that have been their biggest customers, to improve the lives and opportunities for the people who live there," he said at a rally promoting the tax last month.

Read more. 

NATIONAL. Health Departments Cut Programs While Awaiting Zika Funding (National Public Radio)

While Congress fidgets over whether and how to pay for the fight against the Zika virus, state and local health departments are scrambling and slimming down.

That's because these front-line public health agencies have already seen their budgets chopped because of the debate.

The Centers for Disease Control and Prevention in April cut $44 million from its fund that helps state and local governments prepare for public health emergencies. It was part of the $589 million the White House moved from other programs – mostly money allocated for domestic and international responses to the Ebola virus – to combat Zika as it awaited action on Capitol Hill.

New York City's health department lost $1.1 million in the deal.

Marisa Raphael, the deputy commissioner in New York's Office of Emergency Preparedness and Response, says she expects to have to cut jobs.

"We depend on this grant to create an infrastructure for our preparedness and our response," Raphael tells Shots. "That's everything from our lab staff to our surveillance staff, so when we have this cut, that does immediately impact our capabilities."

Read more.

SAN FRANCISCO. Judge upholds SF’s pioneering law on sugary beverage ads (SF Gate)

San Francisco’s first-in-the-nation law requiring display ads for sugary drinks to carry warnings of increased risks of obesity, diabetes and tooth decay can take effect in July as scheduled, a federal judge ruled Tuesday in rejecting a challenge by the beverage industry.

“The warning required by the city ordinance is factual and accurate,” and is a “legitimate action to protect public health and safety,” said U.S. District Judge Edward Chen, who turned aside industry arguments that the advertising message is misleading and violates free speech.

The American Beverage Association, the California Retailers Association and the California State Outdoor Advertising Association sought the injunction against the requirement.

The ordinance, passed unanimously by the Board of Supervisors last year and due to take effect July 25, requires publicly displayed advertising for sugar-sweetened beverages to display a warning label that takes up 20 percent of their advertising space, attributing the message to the city. It doesn’t apply to ads in newspapers, magazines, television, menus or product labels.

Read more.

DETROIT. In the poorest city in America, he's bringing the health department back to life (STAT)

DETROIT — Dr. Abdul El-Sayed knew he had to come home.

Last summer, the university professor and former Rhodes scholar was in New York, having already earned a doctorate in public health at Oxford and a medical degree at Columbia. At 31, he was a rising star in the study of how social factors affect public health.

But then, as El-Sayed recalls it, he decided he wanted something more. He was tired of simply studying public health problems. He wanted to help solve them. “I think I want to be the health commissioner for Detroit,” he told a mentor.

Read more.

NATIONAL. Social service shortfalls hinder health, boost medical spending (USA Today)

BERKELEY SPRINGS, W.Va. — States that spend more money on social services and public health programs relative to medical care have much healthier residents than states that don’t, a study out today by a prominent public health researcher found.

The study comes as the Obama administration prepares to fund its own research to support the idea that higher social service spending can improve health and lower health care costs. Last week, the Department of Health and Human Services proposed a long-awaited rule that will pave the way for more doctors and hospitals to work closely with social services providers to keep people healthier, such as with home visits or help with housing.

Health care and social services experts in West Virginia, where jobs and access to health care can be hard to come by, cite daily reminders of how improved services can save money later. Their challenge is expanding the reach of the programs they do have. "There's always more need than resources," says Audrey Morris. director of the non-profit Starting Points of Morgan County here.

The new study is the first to compare state spending on social services — which are generally less expensive than medical costs — to spending on Medicare and Medicaidand to residents' health. Many state officials, including those here, say Medicaid claims are busting their budgets and federal officials struggle to rein in Medicare spending on drugs and medical treatments, especially for chronic disease.

Politicians from both parties say health care spending increases,  although slowing, are unsustainable, but they disagree often vehemently over how to address the problem. Yale University public health professor Elizabeth Bradley, lead author of the study,  is urging more efficient — not more — government spending.

Bradley and her co-authors found that for every dollar of Medicare and Medicaid spending for residents of the average state, an additional $3 was spent on social services and public health between 2000 and 2009, the latest available. Washington, D.C., and states including Colorado and Nevada had the highest ratios of social service and public health spending relative to medical costs - about $5 for every dollar of medical treatment — and were much healthier.

New York and Massachusetts joined traditionally poor-health states including West Virginia, Kentucky and Louisiana with the lowest ratios of social services to medical spending, averaging about $2.30 on social services for every medical dollar spent. People in these states also tend to have higher rates of heart attacks, lung cancer, mental illness and obesity, the study showed.

Read more.

SEATTLE. It’s time for Congress to step up and stop the spread of Zika virus (Seattle Times)

By Seattle Times Editorial Board

CONGRESS must act quickly to help stop the spread of the Zika virus.

As of April 20, the Centers for Disease Control and Prevention reported nearly 400 cases throughout the U.S., including two in Washington, and infections in 33 pregnant women.

Lawmakers should grant President Obama’s $1.9 billion emergency funding request to control Zika-carrying mosquitoes, develop a vaccine and assist countries dealing with much higher rates of infection.

Dr. William Dobyns, a Zika expert and pediatric neurologist at Seattle Children’s who is tracking its spread, showed The Seattle Times jarring photos of babies born to mothers infected with the virus. Some will never walk or talk.

Read more.

DALLAS. Dallas County getting head start on fight against mosquito season (Dallas Morning News)

by Chris Siron

Officials are warning Dallas County residents of the dangers of mosquito-transmitted diseases – even though mosquito season hasn’t started yet.

Zac Thompson, the county’s director of the Health and Human Services Department, wants people to focus on preventing the spread of the Zika and West Nile viruses before mosquito season starts the first week of May.

“The impact … [Zika] could have on pregnant women is dramatic, so we think our personal mission is to ensure that we get information out to all … [Dallas County] residents,” he said. “But we don’t want to lose sight of public enemy number one: West Nile virus.”

Read more. 

NEW YORK CITY. Dr. Thomas Farley Takes on Big Food and Big Tobacco (The New York Times Well Blog)

A century ago, most local health departments concentrated their efforts on fighting infectious diseases like cholera, polio and tuberculosis. But today, many health departments have a very different focus: cancer, heart disease and Type 2 diabetes, some of America’s leading killers. Fighting these diseases often means promoting changes in lifestyle and behavior, and no health department has done that more aggressively than New York City’s.

Under former Mayor Michael R. Bloomberg, New York’s health commissioners — first Dr. Thomas R. Frieden, and then Dr. Thomas A. Farley — took on smoking, sugary drinks, sodium, trans fats and binge drinking. Those battles weren’t always successful. A state court struck downthe city’s controversial soda tax initiative, and critics complained that New York City was becoming a “nanny” state.

But Dr. Farley, who served as New York’s health commissioner from 2009 to 2014, says the city’s efforts helped demonstrate that the key to eradicating lifestyle-related diseases is by changing environments — making bad choices harder and good ones easier. He makes a case for this approach in his latest book, “Saving Gotham: Billionaire Mayor, Activist Doctors, and the Fight for Eight Million Lives,” which shares the behind-the-scenes story of the Bloomberg administration’s radical approach to fighting chronic disease.

http://well.blogs.nytimes.com/2016/04/20/dr-thomas-farley-takes-on-big-food-and-big-tobacco/?smid=tw-share&_r=0

HOUSTON. Feds hold back state funds to fight Zika (Houston Chronicle)

Texas to lose nearly $3.6 million of slated aid to help pay for national response to virus

By Markian Hawryluk

April 4, 2016

Texas will lose nearly $3.6 million in public health emergency preparedness funding this year, after federal health officials held back $44.2 million for the national response to the emerging threat of the Zika virus.

The cut represents 9.6 percent of the $37.7 million Texas would have received. Based on percentage, the reduction is the largest of any state. However, Texas health officials say they will use federal funding left over from 2015 to minimize the effect on county and city health departments.

"You're shifting the dollars over to make health departments whole, which is good, but you still have a hole for what you were going to use those dollars from a state standpoint," said Dr. Umair Shah, executive director of the Harris County Public Health & Environmental Services.

The leftover money would have been used to pay for a series of public health programs throughout the state, but the specific projects had not yet been determined.

With the reduction, Texas will receive $34.1 million in health emergency preparedness funds in 2016 from the Centers for Disease Control and Prevention. Of that, the state plans to pass on $20.4 million to local health departments to help prepare for public health emergencies such as infectious disease outbreaks or natural disasters.

"The challenge will be if there are further reductions announced or if this reduction is ongoing," said Carrie Williams, a Department of State Health Services spokeswoman.

Per capita cuts

The money shifting started when the Obama administration asked Congress in February for $1.9 billion in emergency Zika funding. U.S. lawmakers adjourned on March 23 for their spring recess without approving the request. That left the CDC scrambling to find money for Zika preparation and response efforts that could not wait until Congress returns on April 12.

The state funding cuts were implemented according to the formula mandated by Congress, which provides a base amount to each state with additional per capita payments, a CDC spokesman said. As a result, states with larger populations absorbed a higher percentage cut.

Many state health departments still have not recovered from a 20 percent cut in public health emergency funds in 2013, which led to the elimination of more than 4,300 public health jobs nationwide that year. Many worry the latest cuts could hamper state and local health departments nationwide as they prepare for a potential Zika virus outbreak.

"It does not make much sense," said Dr. Oscar Alleyne, senior advisor for public health programs at the National Association of County & City Health Officials. "There will be a reduced ability to respond to the needs of our communities."

Congressional leaders suggested the CDC could shift funds allocated for the Ebola virus response to Zika needs. But CDC officials said the Ebola funds were allocated in part to improve the infrastructure in Africa to prevent future outbreaks. And a new case of Ebola last week in Liberia suggests the outbreak is not over.

Spending millions locally

Meanwhile, last week Houston Mayor Sylvester Turner sent a letter to the region's congressional delegation urging them to pass the $1.9 billion emergency appropriation the president requested for mosquito-transmitted Zika.

"We must not overlook the threat to Houston and other areas along the Gulf Coast," Turner said.

The mayor said the city expects to spend $3.6 million this year to clear illegal dumping and other trash that could facilitate mosquito breeding, and the Houston Health Department has implemented extra surveillance for Zika at a cost of $540,000 to $750,000. Those costs would increase significantly, he said, if the virus begins to circulate locally.

Texas has had 27 confirmed cases of Zika, although 26 of those were travelers returning from Latin America or the Caribbean where active transmission of the virus by mosquito is occurring. The remaining case was a women who was diagnosed after having sexual contact with someone infected abroad. Harris County and Houston Health Department reported a combined 12 confirmed cases.

Harris County spends more than $4 million a year on its mosquito abatement program, but 98 percent of those funds come from county tax dollars. Shah said Harris County could spend up to $3 million this year responding to Zika.

http://www.houstonchronicle.com/news/houston-texas/houston/article/Feds-hold-back-state-funds-to-fight-Zika-7227934.php

CLEVELAND. Flint Is in the News, but Lead Poisoning Is Even Worse in Cleveland (New York Times)

By MICHAEL WINES

MARCH 3, 2016

CLEVELAND — One hundred fifty miles northwest of here, the residents of Flint, Mich., are still reeling from the drinking water debacle that more than doubled the share of children with elevated levels of lead in their blood — to a peak, in mid-2014, of 7 percent of all children tested.

Clevelanders can only sympathize. The comparable number here is 14.2 percent.

The poisoning of Flint’s children outraged the nation. But too much lead in children’s blood has long been an everyday fact in Cleveland and scores of other cities — not because of bungled decisions about drinking water, but largely because a decades-long attack on lead in household paint has faltered. It is a tragic reminder that one of the great public health crusades of the 20th century remains unfinished.

http://mobile.nytimes.com/2016/03/04/us/lead-paint-contamination-persists-in-many-cities-as-cleanup-falters.html?emc=edit_th_20160304&nl=todaysheadlines&nlid=61752073&_r=2&referer=

BALTIMORE. Baltimore's Leana Wen: A Doctor For The City (National Public Radio)

It's only March, but Baltimore City Health Commissioner Leana Wen already has an embarrassingly full calendar.

She's put together the city's plan for dealing with the Zika virus, launched a campaign against soda and other sugary beverages and overseen an investigation into why so many people in the city are overdosing on fentanyl.

Trained in emergency medicine, Wen, 33, says running the health department in Baltimore is the fastest-paced job she's had.

http://www.npr.org/sections/health-shots/2016/03/02/468893616/baltimore-s-leana-wen-a-doctor-for-the-city