The Baltimore Day of Dignity is a one-stop shop that nurtures the individual’s personal, physical and spiritual needs. The goal is not to just hand out things. Rather it is to uplift, to help pave the road to self-sufficiency. But to help individuals become self-sufficient, our society needs to do more. Read the full story here.
The Big Cities Health Coalition (BCHC) provided "mini-grants" to graduate students for work related to the Big Cities Health Inventory (BCHI) Data Platform. The research undertaken by Michael Benusic, MD, CCFP, Master of Public Health Student at Johns Hopkins Bloomberg School of Public Health looked at the relationship between obesity and income - his research was published in the Oxford Journal of Public Health.
By Shefali Luthra
In an almost uniform response to the impending exit of Food and Drug Administration Commissioner Scott Gottlieb, city and county public health officials are urging the Trump administration to go bigger in its response to adolescents' growing use of e-cigarettes.
The issue, they say, is reaching crisis levels and many worry the FDA's much-touted efforts are falling short.
By Olga Khazan
In June 2014, Rex Archer, the director of health in Kansas City, Missouri, quarantined five families during a measles outbreak because several of the families’ members had contracted measles. The residents were told to stay in their home and avoid returning to work for several days.
Quarantine is a necessary, though difficult, measure that public-health officials sometimes take for people who are unvaccinated or at high risk of contracting a very contagious illness. In the case of measles, quarantine can last three weeks. Breaking quarantine can be a crime—one Wisconsin man was recently charged with a misdemeanor for going to the gym when he was supposed to be confined to his home.
By Melina Druga
More than 80 local, state, and territorial health officials met Wednesday with Congress members with the goal of advocating for public health funding.
The officials told Congress members that investing in public health agencies is critical to protect and promote health. Federal investment in public health has not matched the rate of inflation, the officials said, nor has it matched the health challenges affecting the United States.
Challenges include the opioid epidemic, improving immunization rates, infectious disease outbreaks, the need for more resources and employees at the local level, public health emergencies and extreme weather events.
The officials also are urging Congress to increase funding for the Centers for Disease
Control and Prevention (CDC) by 22 percent by fiscal year 2022.
Annually, $3.5 trillion is spent on health care, according to the Trust for America’s Health, but 3 percent is directed to public health.
The health officials included representatives from the Association of State and Territorial Health Officials, the Big Cities Health Coalition, the National Association of Local Boards of Health, and the National Association of County and City Health Officials (NACCHO).
NACCHO’s board of directors also met with CDC Director Robert Redfield and Robert Kadlec, assistant secretary for preparedness and response.
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.
By Don Ward Hackett
A coalition of national organizations representing public health, healthcare providers, biotechnology companies, and researchers urged congressional leaders on December 6, 2018, to swiftly approve the Pandemic and All-Hazards Preparedness and Advancing Innovation (PAHPAI) Act of 2018.
The PAHPAI clarifies the role of the U.S. Centers for Disease Control and Prevention (CDC) in preparing public health departments for disasters.
And, this legislation delivers the tools to the CDC to improve biosurveillance capabilities to better detect new threats to Americans.
And, taking lessons learned from Ebola cases, the bill helps develop specialized hospitals that are capable of responding to extraordinary outbreaks.
“This bill is a great step forward, but I hope we don’t restrict this legislation to perceived pandemic threats,” said Peter Jay Hotez, M.D., Ph.D., Dean for the National School of Tropical Medicine, Baylor College of Medicine.
“Any new bill should include efforts to address and help the 12 million Americans I estimate living in poverty with neglected tropical diseases,” Dr. Hotez said, the author of Blue Marble Health: An Innovative Plan to Fight Diseases of the Poor amid Wealth.
The bipartisan reauthorization bill, H.R. 6378/S. 2852, would strengthen America’s defense, preparedness and response to chemical, biological, radiological or nuclear (CBRN) attacks, natural disasters, and emerging infectious diseases.
The groups added that “it would be a setback for our national health security to delay reauthorization until 2019.”
“We believe that time is of the essence in reauthorizing these important authorities,” wrote members of AABB (formerly known as American Association of Blood Banks); AFSCME; the Alliance for Biosecurity; the American Academy of Pediatrics; the American Association on Health and Disability; the American Hospital Association; American Public Health Association; American Society for Microbiology; America’s Blood Centers; the Association of American Medical Colleges; the Association of Maternal and Child Health Programs; the Association of Public Health Laboratories; the Association of State and Territorial Health Officials; Big Cities Health Coalition (BCHC); the Biotechnology Innovation Organization (BIO); California Life Sciences Association; the Chicago Department of Public Health; the Council of State and Territorial Epidemiologists; Healthcare Ready; Health Industry Distributors Association; Infectious Diseases Society of America; the International Safety Equipment Association; Johns Hopkins Center for Health Security; Los Angeles County Department of Public Health; March of Dimes; the National Association of County and City Health Officials; the New York City Department of Health and Mental Hygiene; the TB Alliance; and Trust for America’s Health.
H.R. 6378 and S. 2852 are under consideration in the U.S. Senate Health, Education, Labor, and Pensions Committee.
By Kim Riley
A coalition of national organizations representing public health, healthcare providers, biotechnology companies, and researchers this week urged congressional leaders to swiftly approve the Pandemic and All-Hazards Preparedness and Advancing Innovation (PAHPAI) Act of 2018 before Congress adjourns for the year.
The bipartisan reauthorization bill, H.R. 6378/S. 2852, would strengthen America’s defense, preparedness and response to chemical, biological, radiological or nuclear (CBRN) attacks, natural disasters and emerging infectious diseases. The U.S. House on Sept. 25 passed H.R. 6378 and sent it to the U.S. Senate, which has been reconciling the bill with its version, the same-named S. 2852.
By Gloria Gonzalez
The U.S. Food and Drug Administration has proposed new steps to limit access to flavored e-cigarettes by those under the age of 18 and ban menthol in cigarettes and cigars.
Technologies such as electronic nicotine delivery systems were developed as an alternative to cigarettes for adults, but new research from the U.S. Centers for Disease Control and Prevention show that e-cigarette use among youngsters is significantly increasing, FDA Commissioner Scott Gottlieb said in a statement on Thursday. From 2017 to 2018, there was a 78% increase in current e-cigarette use among high school students and a 48% increase among middle school students, with the total number of middle and high school students currently using e-cigarettes rising to 3.6 million, meaning 1.5 million more students are using these products than in the previous year, according to the new CDC research.
In response, the FDA’s Center for Tobacco Products will revisit its compliance policy as it applies to electronic nicotine delivery systems, including all flavors other than tobacco, mint and menthol, with a proposal to have these products sold in age-restricted, in-person locations and, if sold online, under heightened practices for age verification, according to the FDA’s statement.
“FDA Commissioner Scott Gottlieb got it right when he called e-cigarette use among youth an ‘epidemic’,” Chrissie Juliano, director of the Big Cities Health Coalition in Washington, D.C., said in a statement on Thursday. “And their action today is a step in the right direction. Most drug stores and gas station retailers will no longer be allowed to sell flavored e-cigarettes and additional restrictions regarding online sales should also help to stem the tide. This is a good start, but opportunities remain. These flavors are still available for sale on the internet to those over the age of 18, and brick-and-mortar specialty retailers will continue to sell highly addictive, traditionally flavored e-cigarettes to those ‘of age.’ Further, menthol and mint vaping products will also still be available.”
The agency will also put forth a notice of proposed rule making that would seek to ban menthol in combustible tobacco products, including cigarettes and cigars, according to the FDA’s statement.
“This closes a major regulatory loophole in the Tobacco Control Act and is long overdue,” Ms. Juliano said in the statement.
However, Gregory Conley, president of the American Vaping Association in Washington, said in a statement on Thursday: “No youth should vape and there is room for more rigorous enforcement to ensure youth are not accessing these products. However, this move by Commissioner Gottlieb will only serve to make it harder for adult smokers to switch to a far less harmful alternative.”
Written by Mackenzie Bean
October 23, 2018
Many major cities in the U.S. staff fewer epidemiologists than recommended by state staffing ratios, according to a survey from the Big Cities Health Coalition and the Council of State and Territorial Epidemiologists.
BCHC comprises leaders from the country's largest metropolitan health departments who share strategies to promote the health and safety of more than 55 million people, or 17 percent of the U.S. population.
The survey includes responses from 27 of the group's 30 participating health department leaders recorded from October to December 2017.
Here are four survey findings to know:
1. About 18 percent of health departments do not have a dedicated leader to oversee epidemiology activities. A majority (78 percent) employ generalist epidemiologists who support a few or all public health program areas.
2. Every health department had an infectious disease and emergency preparedness program, but only 33 percent had a mental health program and 19 percent had an occupational health program. Lead epidemiologists were most likely to oversee infectious disease programs (85 percent), followed by maternal and child health programs (74 percent), and vital statistics programs (67 percent).
3. The 27 participating health departments employ a total 1,091 full-time epidemiologists. Overall, the departments would need to increase epidemiology staff by 40 percent to reach full capacity.
4. When asked to rate their department's capacity to conduct essential public health services related to epidemiology, leaders said they were most capable of monitoring health status (93 percent) and identifying and investigating community health hazards (78 percent). However, only 33 percent of leaders said their departments were capable of researching innovative solutions to health problems, and 41 percent said their departments could thoroughly evaluate population-based health services.
"Some cities are woefully under-resourced," the authors wrote. "Even in well-staffed departments, there is a perceived need for a significant increase in capacity."
October 22, 2018
Local officials raise alarm about shortage of epidemiologists. Local health departments will need to grow their epidemiology staffs by 40 percent to meet public health emergencies, according to a report published Friday by the Big Cities Health Coalition and Council of State and Territorial Epidemiologists. A shortage of “disease detectives” would be particularly concerning amid the opioid crisis and the latest spread of paralysis-inducing acute flaccid myelitis.
By Megan Thielking
The FDA is expanding its investigation into how e-cigarette businesses might be illegally marketing their products. The FDA fired off letters to 21 e-cigarette companies — both manufacturers and importers — seeking information about about whether their products were on sale before August 8, 2016. That's the date when the FDA started requiring new or modified products to receive clearance before hitting the market. Meanwhile, leaders of more than two dozen urban health departments — from Austin to Boston — just sent a letter to FDA Commissioner Scott Gottlieb urging him to ban flavors in e-cigs and vapes.
By Tomas Aragon and Derek Smith
The FDA recently announced that it considers a new surge in teen e-cigarette use to be an epidemic, and will give e-cigarette manufacturers 60 days to prove that they are not marketing to kids. This is a very welcome move for those of us who have been pushing to prevent teen tobacco use. Our city recently took on the makers of e-cigarettes and won. The FDA should take San Francisco's lead and do everything it can to protect kids from Big Tobacco. Read the full article
The Baltimore City Health Department has just been named "Local Health Department of the Year" by the National Association of County and City Health Officials. City Health Commissioner Dr. Leana Wen talks about the recent award, the sugary drinks ban on kid's menus in city resteraunts and other topics.
By Jan Hoffman
Despite a $12 million ad blizzard by a giant tobacco company, voters in San Francisco resoundingly supported a new ban on the selling of flavored tobacco products, including vaping liquids packaged as candies and juice boxes, and menthol cigarettes.
The measure, known as Proposition E, is said to be the most restrictive in the country, and health groups predicted it could serve as a model for other communities.
The vote had been expected to be close, but the final tally was 68 percent to 32 percent in support of the ban. Those results reflected a big miscalculation by R. J. Reynolds Tobacco Company, which had saturated the city with multimedia ads in four languages, likening the ban to Prohibition and invoking a black market crime wave.
By Dr. Julie Morita, Commissioner, Chicago Department of Public Health
The U.S. Food and Drug Administration recently announced a crackdown on e-cigarette sales to minors, but before then, the city of Chicago had already taken matters into its own hands. The City Council passed an ordinance to require tobacco dealers to post warning signs at their doors about the health risks of e-cigarettes and other tobacco products. These signs, once designed and distributed, will also contain quit-line numbers to help our residents beat a nicotine addiction.
The ordinance, introduced by Mayor Rahm Emanuel, reflects the nation’s growing understanding that e-cigarettes, also known as vaping products, are the latest effort by Big Tobacco to get our kids hooked on a risky and potentially deadly habit.
To be sure, our country has made strides fighting tobacco use, with declining rates of smoking and lung cancer deaths. In Chicago, we have reduced cigarette smoking rates by high school students from 13.6 percent in 2011 to 6.0 percent today, a record low.
Yet, according to the Centers for Disease Control and Prevention Youth Risk Behaviors Survey the rate of cigar smoking (7.2 percent) and e-cigarette use (6.6 percent) is now higher than cigarettes among Chicago high school students. Even more concerning, 14.5 percent of students report tobacco use of any kind. Tobacco remains the leading cause of preventable disease, disability and death in the United States.
E-cigarettes hit the market in 2004 and since then we’ve seen their use rise dramatically. Nearly all e-cigarettes use flavored liquids that attract young people with names like Gummy Bear, Cherry Crush and Crème Brulee. Most e-cigarettes contain nicotine and harmful toxins, making them addictive and dangerous to youth, whose developing brains are more susceptible to addiction. Other tobacco products such as cigarillos and dip, which are known to cause cancer, also come in flavors that entice youth.
Big Tobacco knows that marketing that focuses on flavors is effective at getting youth to start using. Such marketing, as well as tactics like cheap prices, coupons and a barrage of misleading messages, have led the public, especially young people, to vastly underestimate the health and addiction risks of these products.
This misconception must be taken seriously, as tobacco use almost always begins in adolescence and young adulthood. The problem is worsened by the fact that some of today’s most popular vaping products, like JUUL, are designed to look like USB flash drives, making them easy for youth to conceal.
Unfortunately, the research is now clear that the use of e-cigarettes by youth is associated with an increased likelihood of progressing to cigarettes. For young people, tobacco use begets more tobacco use.
In Chicago, knowing that prevention will save lives for generations, we have confronted Big Tobacco’s ever-evolving tactics through a robust suite of policies. Prior to our recent warning sign ordinance, we raised the purchasing age from 18 to 21, made cigarette prices among the highest in the nation, banned tobacco discounts and required that clerks ringing up tobacco sales be at least 21.
We have targeted vaping by banning the use of e-cigarettes in public facilities, prohibiting the sale of flavored tobacco (including menthol) within 500 feet of high schools and becoming the first big city to impose our own e-cigarette tax.
Cities and states across the country should follow suit. And, the FDA should act immediately to ban youth-attracting flavors in all tobacco products, prohibit e-cigarette marketing to youth and reverse its 2017 decision to delay vaping regulation and allow risky products to remain on the market without undergoing agency review.
The fight against Big Tobacco isn’t over, despite our nation’s gains. Every level of government must enact bold, transformative solutions to meet the emerging threats to public health and equip young people to reject tobacco, once and for all.
By Dr. Mary T. Bassett, Laura McQuade, Lisa David and Dr. Mitchell Katz
MAY 21, 2018
Any day now, the Trump administration is expected to propose a new rule designed to make it impossible for patients to get birth control or preventive care from reproductive health care providers like Planned Parenthood and organizations that provide complete, high quality, medically appropriate sexual and reproductive health care services.
This is an attack on all women, and especially on communities of color and those with low incomes. All people deserve the right to access quality, compassionate, affordable health care.
The federal Title X family planning program serves 4 million people annually and exists to help ensure that every person — regardless of where they live, their income, their background and whether or not they have health insurance — has access to basic preventive and reproductive health care, like birth control, cancer screenings, testing and treatment for sexually transmitted infections, and annual health exams.
As public health leaders committed to ensuring access to quality, compassionate health care in New York City and beyond, we condemn this outrageous attack on the health and safety of our communities. Undermining the basic health care relied on by millions of people is wrong, and it is a threat to our city's public health.
Under this anticipated rule, doctors, nurses, hospitals, and community health centers across the United States would be forced to choose between receiving federal family planning funding, or freely providing the full range of options that patients deserve, including abortion services, referrals to safe, legal abortion providers, and complete and accurate information about care options.
For nearly two decades, Title X law has been clear: health care providers cannot withhold information from patients about pregnancy options, including abortion. This proposed new rule ends that protection.
Major medical associations, including the American College of Obstetricians and Gynecologists, the American College of Physicians, oppose this rule. In fact, when a similar version of this rule was introduced in the 1980s, it was met with tremendous outcry and opposition from the medical community, and was ultimately, and rightly, shelved.
In New York State, more than 300,000 people receive care annually at Title X-funded health centers. In New York City alone, 150,000 people rely on Title X for their sexual and reproductive health care. More than half of the people who rely on the Title X program nationwide are people of color: 21 percent of all Title X clients identify as Black or African American, and 32 percent identify as Hispanic or Latino. Twenty-two New York City health care providers receive Title X funding, including Planned Parenthood of New York City, 10 NYC Health + Hospital sites, and other community-based providers.
Since day one, the Trump administration has pushed policy after policy to take away our basic health care, rights and freedoms. In addition to trying to eliminate the Teen Pregnancy Prevention Program, it has already sabotaged protections for survivors of sexual assault on campus; attempted to kick millions of people off their health insurance; implemented a rule that would allow employers to decide whether or not their employees' birth control is covered by insurance; and tried time and time again to prevent patients from coming to Planned Parenthood and other health care providers that offer evidence-based sexual and reproductive health care.
New Yorkers — and Americans — won't stop until every woman, person of color, immigrant, LGBTQ person, and others being targeted by the Trump-Pence administration can control our bodies and our lives. We stand with you, we will fight for you, and we are more committed than ever to ensuring that health care is never a victim of political warfare.
Bassett is New York City Health Commissioner. McQuade is president and CEO of Planned Parenthood of New York City. David is president and CEO of Public Health Solutions. Katz is the president and CEO of NYC Health + Hospitals.
By Joneigh S. Khaldun, MD, MPH, FACEP
Director and Health Officer, Detroit Health Department
I am a black woman, an emergency-department physician, and the director of the Detroit Health Department. I am also the survivor of a life-threatening postpartum complication — a brain bleed (bilateral subdural hematomas) that was delayed in diagnosis, three weeks after I delivered my first child 11 years ago.
I originally had planned a natural labor and enlisted a doula, but after a day and a half of labor, I failed to progress and ended up having a C-section. After the delivery, I had excruciating headaches and told both my OB and my anesthesiologist several times. I felt brushed off and did not know what to do. It was not until I told one of my fellow residents about the pain I was experiencing that I went into my own ER where I worked and received a CT scan that diagnosed my life-threatening brain bleed.
I ended up having an urgent surgery on a Sunday afternoon to save my life. This experience has made me a better physician, and it is why I have committed myself to improving the lives of mothers and babies in my work in Detroit.
The Big Cities Health Coalition (BCHC) held a webinar - you can listen to a recording here - today featuring Patty Hayes, the Director of Public Health – Seattle & King County to discuss how Teen Pregnancy Prevention programs contributed to a dramatic decrease in teen pregnancy rates in her county, why Congress must act to fund them and why her county is suing HHS to protect them.
Last summer, the U. S. Department of Health and Human Services (HHS) announced it would abruptly end grants totaling $200 million to 81 adolescent health projects across the country, which collectively serve 1.2 million young Americans. These projects are funded through the Teen Pregnancy Prevention Program (TPPP), a federal grant program grounded in evidence-based research, which provides important funding to diverse organizations working to prevent teen pregnancy in the U.S.
Officials in Seattle & King County in Washington State are challenging this decision in court and have filed a lawsuit to block HHS from ending these programs. The programs are slated to be cancelled at the end of June 2018, rather than the original date, June 2020. Congressional action by March 23 is necessary to preserve the progress that the program has made in improving adolescent health.
By Dennis Thompson
MONDAY, March 5, 2018 (HealthDay News) -- Debate over the value of tough state gun control laws has reached a fever pitch following last month's deadly shooting of 17 people at a Florida high school.
Now, results from a new study indicate that such laws are potentially so effective they can prevent firearm-related murders on a regional basis, with the benefits extending into other nearby states that have more lax laws on the books.
States with strong firearm laws have overall lower rates of gun-related murder and suicide, according to the county-by-county analysis.
But counties in states with weak gun laws also appear to gain some protection from gun violence if they are located next to states with stronger laws, researchers reported.