City News

SAN DIEGO. California Today: A Deadly Outbreak Stalks San Diego. (The New York TImes)

By Mike McPhate

In a typical year, San Diego County might see a few dozen cases of hepatitis A.

So far this year? More than 400, with 15 people now killed by the liver disease.

“This is an outbreak like none other that we’ve ever had,” said Dr. Wilma Wooten, the region’s public health officer. Dr. Wooten said the response has been complicated by the infection’s nebulous spread.

Whereas past outbreaks have commonly been traced to a single food source, allowing the threat to be swiftly contained, this one is passing person to person. San Diego’s homeless population has been hit hardest by the virus, which stalks its victims more readily in areas of poor sanitation.

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SEATTLE. US Cuts Funds Aimed at Reducing Teen Births. (The Skanner)

by Melanie Sevcenko

Just two years into the federally-funded Teen Pregnancy Prevention Program (TPPP), the U.S. Department of Health & Human Services has announced it plans to pull the plug on funding in June of next year.

That’s two years shy of the five years of funding the program promised.

Moreover, the announcement to shorten the TPPP funds, issued by the Office of Adolescent Health on Jul. 6, came with no warning, explanation or alternative.

The lack of dollars, say Big Cities Health Coalition (BCHC) – a forum for the leaders of America’s largest metropolitan health departments – will severely impact evidence-based programs, services, and research for reducing teen pregnancies.

According to the Centers for Disease Control and Prevention, one in four teens will become pregnant by age 20.

In protest to the funding cut, 37 Democratic senators sent a letter to U.S. Department of Health and Human Services Secretary Tom Price, questioning why crucial funding is being yanked out of public health departments across the U.S, two years too soon.  

Days later, the BCHC sent its own letter to Price, signed by 20 health commissioners and echoing the sentiment of the senators.

The health advocates argue that the TPPP has made unprecedented progress in reducing teen pregnancies. 

Read more.

SEATTLE. King County Health Officials Protest Early End Of Sex Ed Grant (KNKX)

By Ed Ronco

The public health department is in year three of a five-year grant from the U.S. Department of Health and Human Services. The $5 million pays for sexual health education curriculum, teacher training, and efforts to reduce teen pregnancy. It also funds research into how well the curriculum is working.

“One key principle for our work in public health is that we act based on science and evidence,” said Patty Hayes, director of public health in King County. “We need the evidence that a new system or rule or intervention is necessary – and that it’s effective.”

King County and other urban public health agencies have filed a formal protest with the Trump administration. They’re organized by the Big Cities Health Coalition, which calls the early termination of the grant “highly disruptive to work already underway.”

Read more.

NEW YORK CITY. How the Senate's Obamacare repeal bill would wallop the urban poor (NY Daily News)

If there was any hope that Senate Republicans could bring some sanity into the national discussion around the future of our health care system, such hope completely vanished on Thursday. Like the House's health care bill, the Senate's proposal is nothing less than an all-out attack on public health and our public hospital system, and its consequences will be devastating for New York City and the country.

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.

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.

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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. 

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. 

BALTIMORE. Six reasons to fight the ACA replacement plan (Baltimore Sun)

By Dr. Leana Wen

For months, I have received questions from concerned residents about how repeal of the Affordable Care Act (ACA) would impact their health. My patients were worried about whether they could still get medications to treat their heart disease and diabetes, whether they would they lose coverage for mental health and addiction services, and whether they would continue to get basic preventive services such as mammogram, pap smears and blood pressure screenings.

This week, House Republicans issued their proposed replacement. There are six particularly concerning provisions with drastic consequences to Baltimore's health:

First, the bill punishes those with lower wages by eliminating subsidies to help pay for insurance coverage based on a person's income. As a physician who has practiced medicine before and after the ACA, I have seen patients forced to make the impossible choice between basic needs, including food and housing, and critical medications. I have seen patients forgo paying for insurance coverage because it is too expensive. I have seen the consequences when people are forced to pay for this "choice" with their lives.

The policy also drives more people to use emergency departments as a source of primary care. As an emergency physician, I am proud to deliver excellent care when people need it — but this is an inappropriate safety. Studies have shown that patients without health insurance put off their medical needs until they become so severe that they can no longer be pushed aside. At that point, when patients are very ill, their care becomes unnecessarily expensive.

Second, the bill places a cap on Medicaid spending, which limits the amount states can pay per person. This leads to inevitable cuts in coverage and will hurt those who are the most vulnerable — including seniors, women, children, people with low incomes and individuals with disabilities. These are already populations who face a disproportionate share of health disparities, which will worsen if the Medicaid safety net is weakened. Read more.

SACRAMENTO. GOP Obamacare repeal plan could hurt fight against Zika, hepatitis, other health problems (The Sacramento Bee)

By Sammy Caiola

A multibillion dollar federal fund that helps prevent disease outbreaks and fights chronic conditions may disappear with a Republican plan to revamp the Affordable Care Act, worrying local physicians and county officials who say they rely on the money to sustain community health.

The GOP legislation, as it was released Monday, proposes cutting a piece of the Affordable Care Act called the Prevention and Public Health Fund – a store of federal money created to bolster immunization rates, disease surveillance, workforce training and community health education, among other programs. If the replacement legislation passes, county and state agencies throughout California will lose millions of dollars they relied on for public health efforts. Those governments also used the grants to prepare for emergencies such as Ebola and Zika virus outbreaks, health officials said.

The Prevention and Public Health Fund has provided more than $4 billion nationally and about $290 million to California since its launch, including $4 million directly to groups in the Sacramento area. That money goes to government agencies such as the U.S. Centers for Disease Control and Prevention and the Administration for Community Living, who then distribute it to state and local health departments as well as hospitals, universities and nonprofit groups.

In the Sacramento area, the fund has supported major public health projects including:

▪ A $98,950 UC Davis effort to prevent the spread of viral hepatitis through early identification.

▪ A $101,999 project at Sierra College in Rocklin to fight suicide among college students.

▪ A $484,389 initiative from the California Center for Public Health Advocacy in Davis to reduce chronic disease in diverse communities.

▪ A $2,661,141 effort by the California Rural Indian Health Board in Sacramento to prevent diabetes among American Indians. In 2017, the fund will award more than $900 million to programs throughout the U.S. addressing Alzheimer’s disease, immunizationbreastfeedinglead poisoningyouth suicide and more.

The Republican plan proposes discontinuing the fund starting in fiscal year 2019. The Affordable Care Act, which went into effect in 2010, not only expanded insurance coverage but also started initiatives to address a range of health issues, such as high hospital readmission rates, electronic medical record adoption and rising drug prices for Medicare enrollees. Read more

PHILADELPHIA. Berkeley, nonprofits & more call big beverage's soda tax lawsuit 'absurd' (Philadelphia Business Journal)

By Alison Burdo

The city of Philadelphia apparently has some friends of its own – at least two dozen nonprofits and the city of Berkeley, Calif., – filed six separate amicus briefs Friday that support the administration in its legal battle over the city's beverage tax by saying the beverage industry, which "does not lose gracefully," is putting forth "absurd" arguments.

"[The plaintiffs] legal theory would invalidate not only this tax, but potentially many other taxes and nontax initiatives that further public health and welfare by encouraging citizens to reduce their consumption of unhealthy products," according to an amicus brief filed on behalf of the American Heart Association, the American Medical Association, the National Alliance for Hispanic Health, the Public Health Law Center and 10 other organizations. Read more

PHILADELPHIA. Fifteen health organizations file in Philadelphia’s sugary drink tax (AHA News)

Fifteen health organizations filed a friend-of-the-court brief Friday in hopes that the beverage industry’s appeal of a sugar tax will fall flat.

Philadelphia’s 1.5-cent-an-ounce tax on sweetened drinks survived a major challenge in December from the beverage industry, after a city judge dismissed the group’s lawsuit. The beverage industry filed an appeal last month.

The health groups’ brief was filed by the Public Health Law Center on behalf of the American Heart Association and 14 leading public health and medical organizations, including the American Medical Association and the American Cancer Society Cancer Action Network. The science-based filing outlines support for taxing sugary drinks in Philadelphia, which has some of the highest rates of heart disease, Type 2 diabetes and obesity among large cities.

While the tax is said to have a public health impact through reduced consumption, the AHA says the revenue raised by the tax will be used in a way that has a significant impact.

The tax will be levied on distributors, not consumers. It is expected to bring in about $91 million annually, which the city plans to use to expand pre-kindergarten programs, improve parks and offer tax credits for businesses that sell healthy beverages. Read more

PHILADELPHIA. Philly beverage tax is working (Philadelphia Inquirer)

By Thomas A. Farley

In the publicity about the first month's revenue from the Philadelphia beverage tax and the howls from the soda industry, the key point has been missing: The tax is working.

Children are getting educated in prekindergarten. The city is taking the first steps toward a massive rebuilding of parks, recreation centers, and libraries. Nine community schools are helping students and their families. The city is meeting its revenue projections, and the soda industry says sugary drinks sales have declined.

Mayor Kenney predicted that all of these things would happen. And opponents, at one time or another, claimed that none of them would.

The primary goal of the beverage tax was to pay for these investments in our city's children, families, and neighborhoods. And a secondary goal was to do it in a way that battled back the city's still-growing twin epidemics of obesity and diabetes.

Critics said that you couldn't do both. If people stopped drinking soda, they said, the city wouldn't have sufficient revenue for its programs or, alternatively, if revenue came in at projections, then people weren't significantly reducing their soda consumption.

But with the city's first revenue collections on track to meet annual projections and soda sellers reporting declines, the industry's predictions have been proved wrong, and so they are now shifting to fear mongering on job loss. Read more.

NEW YORK CITY. Trump Victory Underscores the Important Role of Cities (Governing)

By William Fulton

In the middle of the most important urban renaissance in a century, the people of the United States have elected a president who lives in a 58-story mixed-use building in midtown Manhattan. Whatever you think of him, the president-elect is a man who ought to understand cities. He has lived in America’s largest city his entire life. He comes from a family that has developed and managed urban real estate for three generations. The glitziness of major cities -- New York, Chicago, Los Angeles, even Pennsylvania Avenue in Washington, D.C. -- has always had a magnetic appeal for him.

And yet Donald Trump’s election may be the most anti-urban act on the American political stage since the nomination of William Jennings Bryan 120 years ago, when the populist Nebraskan railed against New York bankers in a fiery speech at the Democratic convention. Trump’s political base is anything but urban. It is white, older, exurban and rural, and angry. His supporters are nothing like the Manhattan social elite he has always aspired to be part of. (He lost his home county 82 percent to 9 percent) They are more like the Archie Bunkers he lived among -- admittedly, as a rich kid -- growing up in Queens.

 

Read more.

 

NEW YORK CITY. Why Congress drags its feet on Zika: New York City's health commissioner blames racism (NY Daily News)

The public health community is watching in astonishment as Congress continues to drag its feet on funding to fight Zika, a disease that threatens one of the most basic human functions — the ability to produce healthy babies.

The usual political gridlock is playing a role, but there’s something else that few people acknowledge: Zika is perceived as a disease of the south, mostly affecting people of color. The media have bombarded us with images of brown babies with microcephaly who live in the Caribbean and Latin America. Our Congress, which is dominated by an increasingly anti-immigrant party, may not feel a sense of urgency to respond to this evolving tragedy.

Read more.