City News

NEW YORK. City hits 22 online e-cigarette retailers with suit for selling products to minors (SILive)

The City of New York has announced a federal lawsuit Wednesday against 22 online e-cigarette vendors that sold their products to New York minors. The complaint alleges online retailers do not have age verification systems in place to screen customers who may be minors and deliberately market their products to minors in violation of city law. Read more here.

SEATTLE. Seattle Has Figured Out How to End the War on Drugs (New York Times)

On gritty streets where heroin, fentanyl and meth stride like Death Eaters, where for decades both drugs and the war on drugs have wrecked lives, the city of Seattle is pioneering a bold approach to narcotics that should be a model for America. Anyone caught here with a small amount of drugs — even heroin — isn’t typically prosecuted. Instead, that person is steered toward social services to get help. Find out more here.

NEW YORK. To Fight The Measles Outbreak, Health Departments Must Balance Civil Liberties With Civic Accountability (Health Affairs)

Eight months ago, it would have been hard to imagine that measles would become the next national public health emergency. Now, we see just how quickly an outbreak can grip the nation. 

In New York City—where measles cases surpassed 550 this week—our response is driven by balancing civil liberties with civic accountability: We believe strongly in the rights of everyone to make an informed decision about their own health and the health of their families. Yet, we are bound by the idea that the responsibility to protect the well-being of New Yorkers extends to every resident of this great city.  Find out more here.

LOS ANGELES. Climate Change, Wildfires, And How Public Health Leaders Can Rise To The Challenge (Health Affairs)

The largest near-term impacts of climate change on society come in the form of weather and climate extremes. Experts estimate that as many as 10,000 people lost their lives from natural disasters in 2018, compared to 50,000 in the prior 30 years combined. In Southern California, the region I call home, drought and warm temperatures recently brought a second year of historic wildfires, where the Thomas, Rye, and Skirball fires burned an area nearly the size of the city of San Antonio, Texas, and the Woolsey fire scorched an area roughly the size of the city of Denver, Colorado. The Woolsey Fire alone destroyed more than 1,500 homes and structures. The blaze forced evacuations of more than 295,000 people and resulted in prolonged power outages for more than 40,000 people. Read more here.

BOSTON. The 123rd Running of the Boston Marathon to Include Expanded Deployment of Everbridge (Business Wire)

The Boston Athletic Association (BAA) has significantly expanded the role of Everbridge’s Critical Event Management (CEM) platform to communicate critical event updates and safety information to all of its volunteers during the 123rd running of the Boston Marathon, taking place Monday, April 15th. This year, the BAA will use Everbridge to provide real-time notifications to its network of nearly 10,000 volunteers preceding the event and during race-day events including start times, route updates or disruptions, and race completion. Additionally, medical tent personnel from local hospitals and the Boston Public Health Commission will be notified of health emergencies via Everbridge-powered text messages. Find out more here.

NATIONAL. How a Measles Quarantine Can Lead to Eviction (The Atlantic)

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.

For the Kansas City families, it quickly became clear that the quarantine would take its toll. As Archer and his colleague Abby Edsall wrote in the November issue of the journal Health Securitythe families received food donations, but these were a mishmash of ingredients that didn’t form complete meals: peanut butter but no bread; a five-pound bag of dried cranberries; boxes of cereal without enough milk.

The health department persuaded the restaurants where the families worked to not fire them, but the families nevertheless faced steep consequences from avoiding work, according to Archer and Edsall. One family missed so many paychecks that they were evicted. Several people had their phones shut off after unpaid bills racked up. Ultimately, the health department had a collection among its own employees to raise money to donate to the quarantined families.

Much of this could have been avoided if the United States had a mandatory-paid-sick-leave policy, Archer and Edsall argue. The Family and Medical Leave Act of 1993 protects the jobs of some workers for up to 12 weeks for medical reasons, but it does not guarantee pay, and it doesn’t cover more than 40 percent of all American workers. Ten states and 33 cities have their own sick-leave policies, but still, 28 percent of American workers lack access to any kind of sick leave. The United States and South Korea are the only countries in the Organization for Economic Cooperation and Development that do not mandate paid sick leave.

The problem in the United States is especially pronounced among low-income workers, many of whom work in service jobs. In one survey, 63 percent of restaurant workers admitted that they cooked and served food while sick. Food-service workers are the source of most norovirus outbreaks. “We’re eating at restaurants where folks can have diarrhea and we don’t even know it,” Archer told me by phone. (In a statement, a National Restaurant Association spokesperson told me that the organization “supports companies having the flexibility they need to set HR policies and procedures that work for their individual businesses.”)

The question is one of growing importance as more and more measles outbreaks occur, and as contagious diseases such as Ebola make their way to the United States by air. About 1,500 excess deaths occurred during the 2010 swine-flu outbreak because people did not stay home from work.

“For residents caught in the crosshairs of an outbreak in a state or locality without paid sick-leave legislation,” Archer and Edsall write, “the cost of compliance can be loss of income, loss of job, loss of home, or the inability to care for and feed family members.”

HOUSTON. Houston earns praise for efforts to combat human trafficking (AP)

By Juan Lozano

Officials from more than 10 U.S. cities convened Tuesday in Houston to learn about its successes combatting human trafficking, a broad approach in which the city’s health department, restaurant inspectors and cab companies all help identify potential victims.

While human trafficking has typically been viewed as a law enforcement issue, the city in 2015 also began focusing on it through a non-law enforcement lens. That garnered praise from federal officials and interest from other cities wanting to mimic the strategies.

“It is a different way of doing things,” said Minal Patel Davis, special advisor to the mayor on human trafficking in Houston.

Officials with New York City, Atlanta, Dallas and San Francisco are among those attending the two-day meeting this week in Houston, which has long been seen as a hub for human trafficking due to its proximity to the U.S.-Mexico border and its diverse and large population.

A 2016 study by the University of Texas at Austin estimates that there are more than 313,000 victims of human trafficking in Texas. More than 234,000 are victims of labor trafficking, and nearly 79,000 are victims of sex trafficking.

At the time Davis was appointed to her job in 2015, it was the first municipal level position of its kind in the United States. Three cities — Atlanta, Chicago and Minneapolis — have since created similar positions through grant funding.

In Houston, Davis began working with the health department — training its inspectors to watch for signs of labor trafficking at the city’s 13,000 food establishments. Inspectors also handed out outreach cards to workers with the phone number for the National Human Trafficking Resource Center.

The city’s health clinics also included human trafficking awareness as part of its screening processes and a human trafficking case manager was placed at Ben Taub Hospital in Houston.

“City departments touch nearly all aspects of life. They are a great set of eyes and ears,” Davis said.

The city has also reached out to the local business and corporate community to raise awareness about human trafficking.

The parent company of Yellow Cab and Taxi Fiesta agreed to notify its drivers by email and text about possible signs of human trafficking with its customers as traffickers often rely on taxis for transportation.

In 2017, Houston passed a city ordinance that implemented a zero-tolerance policy for human trafficking in city service contracts and purchasing. The ordinance requires contractors that work with the city ensure that their supply chains as well as those of their subcontractors adhere with labor laws.

At Tuesday’s meeting, Mayor Sylvester Turner said the success of these various programs in Houston shows the city’s approach is working.

“The reality is, if we are not working to eradicate human trafficking in all cities, in all states and globally, you don’t win,” Turner said.

In October, Secretary of State Mike Pompeo recognized Houston as a national model for building anti-trafficking infrastructure at the municipal level during a meeting in Washington, D.C. of the President’s Interagency Task Force to Monitor and Combat Trafficking in Persons.

“The city now boasts one of the most comprehensive and forward-leaning anti-trafficking programs anywhere in the United States,” Pompeo said.

Ouleye N. Warnock, a senior human trafficking fellow with the city of Atlanta who attended Tuesday’s meeting, said her office is working to develop partnerships with the private sector to offer job opportunities for trafficking victims.

Warnock said she has also had to work to educate the public that human trafficking is not only about sex trafficking about also about forced labor.

Expanding funding to combat human trafficking is something that is being debated during the current Texas legislative session. Lawmakers are discussing providing an additional $60.8 million to establish an anti-gang and an anti-human trafficking task force, providing the Texas Alcoholic Beverage Commission $5.6 million to help spot human trafficking at bars and clubs and $500,000 to the Texas Department of Licensing and Regulation to help identify trafficking at salons and spas.

SEATTLE. ‘Heartless, punitive’: Health officials, immigrant advocates decry Trump proposal to limit access to green cards if using public benefits (The Seattle Times)

By 

Seattle Times staff and  Los Angeles Times

Health officials and advocacy groups are strongly condemning the Trump administration’s proposal to limit legal immigrants’ access to green cards if they use an array of public benefits, including Medicaid, food stamps and federal housing subsidies.

“This is not only bad for the health and well-being of the people most directly affected, it is bad for all of us,” said Dr. Georges Benjamin, head of the American Public Health Association, one of scores of health-care groups to criticize the administration’s proposal.

“We hope that this heartless, punitive public policy will be reversed,” Benjamin said.Among the major groups nationally calling on the Trump administration to withdraw the so-called public charge proposal – posted Wednesday in the Federal Register – are the American Medical Association, the March of Dimes and the American Hospital Association.

Read more.

SEATTLE. King County Wins Sex Ed Funding Case

By Katie Rusch

High fives were common in Seattle & King County Public Health’s Family Planning division this week. On Tuesday, a federal judge ruled the Department of Health and Human Services (HHS) illegally terminated a sex education grant King County was using to study the effectiveness of its FLASH curriculum.

Developed by Seattle & King County Public Health, FLASH has been the primary sex education program used by public schools in King County since it was developed here in the 1980s. Beyond all school districts in King County, the science-based program is used in 44 other states. While, anecdotally, King County program officials have had significant positive public feedback on the curriculum, the organization never had the opportunity to gather data to support their theories that FLASH reduces teen pregnancy and STD rates.


In 2015 that changed. As part of the Teen Pregnancy Prevention Program (TPP), Seattle & King County Public Health was awarded a five-year $5 million grant to study FLASH’s effectiveness. But in 2017, HHS decided to cut King County’s funding two years early, along with the funding to 80 others who received TPP Program grants. Their funding was set to end on June 30.

In February, 10 of those organizations (including King County) filed four seperate lawsuits against the federal government claiming the early termination was illegal.

“We’ve invested three years of taxpayer dollars and resources,” said Heather Maisen, of the Seattle King County Family Planning program. “It would have been three years wasted and promises broken.”

The FLASH curriculum is currently being studied in 20 schools in Minnesota and Georgia. That data could then be used by school boards across the country to help members decide whether or not to use FLASH.

Tuesday’s ruling delivered the fourth and final victory for the organizations suing HHS. Favorable rulings for the other plaintiffs came down in April.

In his ruling issued Tuesday, Judge John Coughenour referenced the three other previous decisions noting that HHS has “attempted to convince multiple courts of their position with no success” while ruling in favor of King County.

“This ruling is such a relief,” said Patty Hayes, the director of Public Health for Seattle & King County. “Our goal with FLASH is to improve the quality of what happens in classrooms across the nation and to protect our most vulnerable youth.”

Judge Coughenour added in his ruling that “HHS failed to articulate a satisfactory explanation for its decision to shorten King County’s project period. In fact, HHS never gave King County an explanation.”

In an August news release, HHS suggested “73 percent [of TPP grantees] either had no impact or had a negative impact on teen behavior,” but provided no proof. HHS has yet to not respond to Seattle Weekly’s repeated requests for comment on the issue.

While Tuesday’s court ruling doesn’t force the federal government to hand over the remainder of King County’s grant, it makes it more difficult for HHS to withhold the money. To end the funding, HHS would have to show King County violated the terms of the grant agreement.

Maisen said she sees no reason the funding won’t come this year calling the victory a “huge hurdle,” but not the “final hurdle.”

This case was just one of the Trump administration’s attempts to remove money from evidence-based sex education programs. Since 2015, funding for sex-education programs that promote abstinence-only or “sexual-risk avoidance” curriculums has increased by $45 million. If HHS succeeds in moving $110 million Teen Pregnancy Prevention Program dollars to these programs—something they alluded to in April—that would more than double the increase.

Maisen knows there is a “long road forward,” but she says this latest legal victory proves King County is on the right path to help the people that FLASH is really all about—the kids. “Our youth in this country are now going to be given access to information that is critical to the outcome of their health and their future goals.”

SAN FRANCISCO. San Francisco will bring anti-addiction medication to users on the streets (Washington Post)

By Lenny Bernstein

San Francisco will begin supplying anti-addiction medication to long-term drug users and homeless people on city streets, an attempt to overcome a formidable obstacle to treatment that has complicated efforts to address the opioid crisis.

The city announced Thursday that its medical providers will offer buprenorphine and naltrexone prescriptions at needle exchanges, in parks and in other places where people with opioid disorders congregate. Users will be able to pick up the medications, which block the craving for opioids and the painful symptoms of withdrawal, at a centrally located city-run pharmacy.

The city is billing the plan as the first of its kind in the United States, though a few other communities have tried similar programs over the years.

“If we’re going to save people’s lives, we can’t wait for addicts to come to us. We have to go to them and engage. And offer. And give support,” said Barbara Garcia, director of health for the city and county of San Francisco.

The United States faces a shortage of drug treatment options of all kinds. Medication-assisted treatment with buprenorphine, methadone and naltrexone is widely considered the most effective way to wean users off opioids, but it is still in short supply and relapses are common, especially among people with the most severe form of opioid use disorder.

Buprenorphine, taken as a film placed on the tongue or in pill form, is generally dispensed by doctors or other providers who must receive eight hours of special training. Typically they give it to users daily or supply them with a few doses at a time. Naltrexone is offered as an injection that lasts a month, but users must be clean for seven to 10 days before it can be administered, which makes it difficult to use on the street.

Buprenorphine also is sold illegally on the street by users seeking to stave off withdrawal symptoms or wean themselves from heroin. Several experts said even intermittent, self-administered use is preferable to the risk of heroin laced with powerful fentanyl that many users now encounter.

Users who live on the street, many of whom also have mental illness, often cannot keep scheduled medical appointments or lack the means to get to them. Others feel reluctant to use the formal medical system. So some cities bring medical and other services to them on the street.

“I think it’s a great idea,” Joshua Sharfstein, a professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health, said of San Francisco’s drug treatment plan. Bringing users into treatment depends on being in the right spot at the right time, when someone feels ready to try, said Sharfstein, an expert in medication-assisted treatment.

Heroin users “will go into withdrawal every eight to 12 hours, so when they’re ready for buprenorphine, you should give it to them right then and there,” said Sharfstein, who is not involved with the San Francisco effort.

The San Francisco program is expensive and labor-intensive. In a year-long pilot program, the city treated 95 people, 22 percent of whom stayed with the program. Twenty-two percent also were still taking buprenorphine at the end of 12 months. More than half the people had chronic medical conditions, two-thirds had psychiatric conditions and 61 percent used methamphetamine as well as heroin, according to the city. There are 7,000 homeless people in the city.

The new program is slated to start in the fall. By next spring, the city hopes to have 250 more people in treatment at an overall cost of $3 million annually.

In Contra Costa County, east of San Francisco, the government runs a less formal attempt to reach hardcore users on the street. There, street medicine teams hand out prescriptions twice a week that users can fill at any local pharmacy. Because some people may not be able to walk to a drugstore, outreach workers sometimes bring buprenorphine to users on the street, said Joe Mega, medical director of the county’s health care for the homeless program.

Mega said he has issued 21 prescriptions and that 11 recipients were continuing to receive buprenorphine after six months.

San Francisco is among a handful of U.S. cities making plans to open supervised drug consumption sites, where users are watched while they smoke or inject drugs by monitors who are ready to administer the overdose antidote naloxone. Such programs are widespread in Canada but against federal law in the United States.

BALTIMORE. Baltimore Asks Trump to Expand Use of Drug for Opioid Overdoses (CQ News)

By Sandhya Raman

Baltimore is making a first-of-its-kind request that the Trump administration use its existing authority to lower the cost of opioid overdose reversal drug naloxone in order to provide it to health care workers and law enforcement.

In a letter sent Thursday to Kellyanne Conway, counselor to the president, the Baltimore City Health Department and Public Citizen outline ways to make the drug more affordable. Other cities may follow suit. 

“Specifically, we ask that the Administration procure naloxone treatments and supply them to local health and law enforcement programs or authorize such programs to procure generic versions of patented naloxone treatments,” the letter reads.

Additionally, the authors ask the administration to “authorize use of any and all patents necessary to allow for the production of generic naloxone treatments and delivery systems to respond to the opioid epidemic.”

Government use authority, according to the groups, would allow the federal government to purchase generic versions of on-patent medicines. While naloxone is generic, Narcan, an easy-to-use form of naloxone that is often available as a nose spray, is under a patent until 2035.

Leana Wen, health commissioner for the Baltimore City Health Department, said at a press conference that the city is currently forced to ration naloxone because it doesn't have the resources to purchase enough of this drug.

“The problem that we have in Baltimore is not the policy. It’s the price,” said Wen.

Currently the Baltimore City Health Department pays $75 per kit for Narcan, Wen said. The cost for the city to provide a kit to every resident would be $46.5 million, or about one-third of the department’s entire budget.

Wen issued a blanket prescription to the city in October of 2015 for individuals to purchase naloxone using their own insurance, but she doesn’t see that as the ultimate solution.

“You are carrying naloxone to save someone else’s life,” she said, drawing a comparison to asking a fireman to buy his own firehose.

The city’s representative in Congress supports the request to the government.

“I commend the Baltimore Health Department and Public Citizen for working to combat the skyrocketing price of naloxone,” said Rep. Elijah E. Cummings, D-Md., in a statement. “The President’s own Opioid Commission recommended that the Trump Administration negotiate directly with drug companies to lower these prices, but President Trump has ignored this recommendation for the better part of a year while communities like Baltimore are forced to ration their supplies."

SAN ANTONIO. After ‘Tobacco 21,’ Metro Health Director Seeks ‘Culture of Health’ for SA (Rivard Report)

By Roseanna Garza

March 28, 2018 (Rivard Report) -- Photographs and awards line the walls and shelves in Colleen Bridger’s office at the San Antonio Metropolitan Health District, mementos from her last job, in Orange County, North Carolina.

“[Before,] a big day for me would be one press conference and two meetings,” Bridger said of her job in Orange County, which has a population of just 135,000. When she took over as San Antonio’s Metro Health Director just over one year ago, she knew she would have to adjust to a much faster pace.

Bridger moved fast and aimed high during her first big push for change, successfully spearheading San Antonio’s effort to become the first city in Texas to raise the age for purchasing tobacco products from 18 to 21. She introduced the idea to City Council in November 2017, and it was passed just three months later.

She called the legislation, known as Tobacco 21, the “most significant public health policy that I will ever be involved with.”

Counterparts from the Big Cities Health Coalition, which comprises leaders of America’s largest metropolitan health departments, called the policy success “remarkable” given that little progress implementing Tobacco 21 has been made in other Texas cities despite overwhelming evidence of the positive health impact.

Read more

BALTIMORE. COMMENTARY: Baltimore city is suing Trump administration over cuts to teen pregnancy prevention education (The Hill)

Baltimore City joined a lawsuit brought by Healthy Teen Network against President Trump, challenging a decision by the U.S. Department of Health and Human Services (HHS) to cut funding from evidence-based teen pregnancy prevention education.

In June 2015, the Baltimore City Health Department (BCHD) was awarded an $8.6 million grant to implement comprehensive, evidence-based teen pregnancy prevention education in all of the City’s more than 120 middle schools and high schools.

 

In July 2017, BCHD received notice from HHS that the grant period would be terminated two years early. This termination amounts to a reduction in overall grant funding to $5.1 million — a funding cut of $3.5 million. Despite multiple phone and written requests for explanation, Baltimore City has not received a response from HHS as to why our program is being terminated.

 

MIAMI. Guns kill about 90 people a day. Is that a public health threat? (Miami Herald)

BY DANIEL CHANG

dchang@miamiherald.com

February 23, 2018 05:55 PM

On the same day that a troubled former student walked onto the campus of Marjory Stoneman Douglas High School in Parkland and murdered 17 people with an assault-style rifle, at least 28 more people died from gunshots elsewhere in the United States.

Some of those gun deaths were matters of self defense or public safety. Some were suicides, which account for nearly two-thirds of all firearm deaths in America, according to the Centers for Disease Control and Prevention.

But even though doctors and public health officials have long considered gun deaths a public health threat — firearms kill as many Americans each year as die in car accidents — the CDC and state agencies responsible for reducing preventable deaths can do little when it comes to guns.

Read more. 

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.