Prevention Matters

This podcast features an interview with Danny McGoldrick, Vice President for Research at the Campaign for Tobacco-Free Kids. His organization recently teamed up with Partnership for Prevention and the United Health Foundation to launch an initiative aimed at American businesses. At a time of deep economic decline, this team is working to show businesses some proven ways to improve their bottom lines – by adopting tobacco-free policies in the workplace and by supporting tobacco-free policies in their communities. Listen by clicking on the media player below.

President Obama's nomination of Dr. Howard Koh to serve as the Assistant Secretary for Health should get enthusiastic support from the public health and prevention communities.

As Commissioner of Public Health for the Commonwealth of Massachusetts from 1997-2003, Dr. Koh oversaw four public health hospitals and a staff of over 3000 professionals. In this capacity, he emphasized the power of prevention and strengthened the state’s commitment to eliminating health disparities. He was involved in establishing and then overseeing the groundbreaking Massachusetts Tobacco Control Program.

Dr. Koh is currently the Harvey V. Fineberg Professor of the Practice of Public Health, Associate Dean for Public Health Practice, and Director of the Division of Public Health Practice at the Harvard School of Public Health. A major focus of his research has been on community-based strategies to reduce cancer disparities and promote cancer prevention and early detection. As Director of the Harvard School of Public Health Center for Public Health Preparedness (HSPH-CPHP), he has promoted education about bioterrorism, pandemic influenza, and other emerging health threats.

“Howard Koh is a world-renowned expert on public health and cancer, and his tenure as commissioner of public health for the Commonwealth of Massachusetts gives him the hands-on experience needed to address the challenges facing those on the front lines of our private and public health care systems,” said Dr. Corinne G. Husten, interim president of Partnership for Prevention. “Partnership for Prevention enthusiastically supports Dr. Koh’s nomination and we look forward to working with him to make prevention a focal point of efforts to reform our health system.”

Robert Laszewski says l have produced the tremors that could re-open the fault lines along the road to health reform. ast week’s estimates by the CBO on the proposed Obama budget. The CBO said the budget would produce a nearly $9.3 trillion deficit over the next decade and increase budget deficits to more than 4% of GDP each year over the next decade.

"Still stunned from that report, and under immense pressure from moderates in the Democratic party to cut spending, both the House and Senate Budget chairs have made it clear they intend to reduce the Obama budget and see the Congress proceed with health care reform following the pay-go rules.," Laskewski writes. "That would mean any new health care reform spending over the next ten years needs to be offset with either cuts to existing spending or with new revenue."

The Indiana University Center for Health Policy has issued findings from a comprehensive review of existing research about the health and economic impact of smokefree workplace laws. It's designed to clear up some of the confusion created by contradictory studies that flood the offices of lawmakers and policymakers. Among the findings:

• While secondhand smoke has been definitively linked to many kinds of health problems, the most significant health consequence related to secondhand smoke is death
• Smokefree workplace laws do not have a negative economic impact on restaurants and bars
• Smokefree workplaces save employers money.
• Servers, bartenders, dealers and other workers in restaurants, bars and casinos may regularly be exposed to high levels of secondhand smoke.

The recent controversy over the pope's declaration that condoms could make the AIDS epidemic worse, not better, in Africa, prompted RTI Chief Scientist Douglas Kamerow to take a stab at closing the chasm between Catholic orthodoxy and public health science.

"One possible approach to the seemingly irresolvable conflict between condoms and religious dictums might be to separate the disease prevention attributes of condoms from their contraceptive effect," Kamerow, a former assistant surgeon general, writes in BMJ.

"There is precedent for this, at least in the United States: many Catholic hospitals and doctors here prescribe oral contraceptives to women not to prevent pregnancy but instead to prevent heavy, painful periods," he continues. "So it wouldn’t be too much of a stretch to imagine the Catholic church tacitly condoning condom use as part of an overall disease prevention programme to decrease the spread of HIV, even if only within marriages."

Kamerow notes that much of the spread of the AIDS epidemic in Africa occurs within marriage, making the pope's encouragement of abstinence a moot point in such cases.

"If condoms are not available, these women are forced to make the impossible choice between refusing to have sex with their husbands (and risking abuse) or consenting to sex (and risking HIV infection)," he concluded.

Princeton economics professor Uwe E. Reinhardt offers some interesting views in the New York Times' Economix blog about the use of Quality of Additional Life Years as a mechanism to gauge the cost-effectiveness of medical interventions.

"A medical intervention yielding a given number of additional life-years in perfect health makes a greater contribution to human well-being than an intervention that yields the same number of life-years in less-than-perfect health," Reinhardt writes. "QALYs are used to adjust for that difference in a patient’s quality of life."

That would appear to make a case for prevention measures aimed at keeping people healthier throughout the life span.

"Cheap interventions might be immunization for infectious diseases, which might save a large number of QALYs at relatively low cost," he wrote. "...Expensive interventions might involve new biological specialty drugs costing $100,000 or more per treatment that might add only a month or two to a terminally ill person’s life, or even low-cost diagnostic tests that do not detect much illness because they are applied to low-risk populations.

Ultimately, he says, reformers face two vexing questions: "Is there a maximum price per quality-adjusted life year (or life-month or life-day) beyond which society will not buy additional QALYs from the health system?" and "If there is a maximum price, should it be the same for all members of society – rich or poor, prominent or not...?"

Sen. Tom Harkin, D-Iowa, used a White House regional forum on health reform this week to make a strong case for prevention and wellness initiatives and then elaborated on his plans in a meeting with editors for the Des Moines Register.

Harkin, who is helping write wellness portions of the Senate version of the health-reform bill, said at the Iowa forum that the government should provide better foods in schools and should build walking paths to encourage exercise. He also said doctors should be rewarded for keeping their patients well, as opposed to the current system in which they are paid mainly for treating them after they become sick.

In a meeting Monday with Register editors and reporters, Harkin added that he would favor charging higher health-insurance premiums to people who smoke or are obese. Such people also ought to receive help and encouragement to improve their habits, he said: "I think there ought to be both a carrot and stick."

"Harkin brushed aside reports questioning whether wellness programs would provide savings to the system," the Register reported. He acknowledged that his proposals would add some costs, but he predicted savings would start quickly: "'I don't mean in 10 years, I mean in the next two or three years, we'll see this start to decline.'"

Over at Nieman Reports, the Health News Review's Gary Schwitzer notes that his organization's ongoing review of health journalism has detected a troubling trend in reporting about screening tests.

"In many news reports—including some done by major news organizations—a crusading advocacy seems to exist when it comes to promoting screening tests," Schweitzer writes. "And this happens even when such guidance conflicts with the best medical evidence."

Schweitzer, an associate professor at the University of Minnesota School of Journalism & Mass Communication, says such reporting may be well-intentioned, but can do more harm than good.

"These pro-screening crusades often promote costly approaches, such as CT scans of the heart or of the lungs or of the full body, which convince many new “worried well” people to enter the health care system, costing them and all of us dearly," he says.

President Obama's announcement of steps to improve food safety was named Best Prevention Idea of the Week, while Pope Benedict XVI's admonition to Africans that condoms won't help - and could make worse - the continent's problem with AIDS was named Worst Prevention Idea of the Week.

The Best/Worst honors are a regular feature of Prevention Matters (http://www.preventionmatters.blogspot.com/), the blog of Partnership for Prevention. Each week, Partnership for Prevention's staff will choose the designees based on nominations of items in the previous week’s news submitted by members, staff and the public at large. To submit a nomination or for more information, contact Damon Thompson at dthompson@prevent.org .


BEST IDEA

In his weekly address to the nation, President Obama said he is forming a Food Safety Working Group to "upgrade our food safety laws for the 21st century," He said he also will ask Congress for $1 billion in new funds to add inspectors and modernize laboratories, and announced that the Agriculture Department is moving ahead with a rule change banning all sick or disabled cattle from entering the food supply.


WORST IDEA

Pope Benedict XVI said condoms are not the answer to the AIDS epidemic in Africa and can make the problem worse, setting off criticism Tuesday as he began a weeklong trip to the continent where some 22 million people are living with HIV. It was Benedict's first statement on an issue that has divided even Catholic clergy working with AIDS patients.

Aspirin not only relieves aches and pains, but it can also help prevent heart attacks and strokes. There is some confusion over exactly who should use aspirin to help their hearts and how they should use it. The U.S.Preventive Services Task Force has issued new recommendations to help doctors and consumers. Discussing these recommendations is Dr. Nieca Goldberg, associate professor of medicine at New York University and a member of Partnership for Prevention's Task Force for Appropriate Aspirin Use. Click on the media player directly below to listen to the podcast.

The Business Roundtable report that compared U.S. health care expenditures and benefits with those of other countries concluded with a couple of recommendations worth noting.

The report recommended “engaging all Americans in taking an active role in their health care. First, this means placing an obligation on all Americans to obtain health insurance either through their employer or the private market. Second, we must encourage all Americans to participate in employer- or community-based prevention, wellness and chronic care programs.”

These happen to be two of the Healthy Workforce 2010 recommendations that are included in Healthy Workforce 2010: The Essential Health Promotion Sourcebook for Employers, Large and Small published by Partnership for Prevention published in 2001.

A new report from the Business Roundtable, which represents CEOs of major companies, says America's health care system has become a liability in a global economy. The report says Americans in 2006 spent $1,928 per capita on health care, at least two-and-a-half times more per person than any other advanced country.

The report added a new wrinkle by taking those those costs and factoring benefits into the equation. It compares statistics on life expectancy, death rates and even cholesterol readings and blood pressures. The health measures are factored together with costs into a 100-point "value" scale. That hasn't been done before, the authors said.

The results - the United States is 23 points behind five leading economic competitors: Canada, Japan, Germany, the United Kingdom and France. The five nations cover all their citizens, and though their systems differ, in each country the government plays a much larger role than in the U.S.
The cost-benefit disparity is even wider — 46 points — when the U.S. is compared with emerging competitors: China, Brazil and India.

Former House Speaker Newt Gingrich told Michigan legislators this week that their efforts to improve the health care system should start with a focus on reforming behavior, like a ban on smoking in the workplace and mandatory exercise for school children.

Gingrich, who now heads the Center for Health Transformation, said policymakers, the public and the media often make the mistake of viewing health care reform primarily as a financial challenge, rather than a complex mix of individual behavior, cultural influence and uneven quality.

“If all you do is try to figure out how to finance the current system, you’ll go broke,” he told the state Senate Health Policy Committee. “The current system is stunningly wasteful.”

He said government can encourage healthier eating and living by providing financial and tax incentives, such as providing a food stamp bonus to recipients who purchase more fruits and vegetables, he said.

Wal-Mart continues to show how it can be a change-maker in the health world by virtue of its ability to distribute products at a high-volume for low prices. The New York Times says the world's largest retailer, which already has introduced $4 generic prescriptions and over-the-counter tobacco cessation kits priced below $10, is now working to provide electronic health records technology that will be affordable for physicians working in small offices.

"The company plans to team its Sam’s Club division with Dell for computers and eClinicalWorks, a fast-growing private company, for software," writes the Times' Steve Lohr. "...The Sam’s Club offering, to be made available this spring, will be under $25,000 for the first physician in a practice, and about $10,000 for each additional doctor. After the installation and training, continuing annual costs for maintenance and support will be $4,000 to $6,500 a year, the company estimates."

The Obama administration's plan provides financial incentives of more than $40,000 per physician over a few years, to install and use electronic health records. Only about 17 percent of the nation’s physicians currently use computerized patient records. About 200,000 health care providers, mostly doctors, are among Sam Club’s 47 million members.

A healthier workforce and a healthier community is smart business, because it makes for a healthier bottom line. That’s why Partnership for Prevention, the Campaign for Tobacco-Free Kids and United Health Foundation collaborated to develop a new resource to help businesses lower their costs by reducing the use of tobacco in the workplace.

The “toolkit,” entitled “Investing in A Tobacco-Free Future: How it Benefits Your Bottom Line & Community,” highlights the many gains from implementing tobacco control programs and policies. You can download the toolkit and get more information at www.prevent.org/tobaccofreefuture.

A multi-pronged approach is a win-win that works. Adopting a tobacco-free workplace policy not only improves the health of all workers exposed to secondhand smoke, but also cuts business expenses related to fire and property insurance costs. Providing health benefits that include access to services to help people quit their tobacco use is cost effective to implement and yields healthier employees who spend less on health care. Comprehensive tobacco-use treatment generally includes three components – screening by health professionals, counseling that can be in-person or via phone quitlines and pharmacy support that can include over-the-counter and prescription medication.

It’s also smart business to support proven state and local public policy solutions to drive down smoking rates and increase community well-being and health. Initiatives like smoke-free workplace laws, higher tobacco taxes and well-funded tobacco prevention and cessation programs are all effective strategies to save lives and reduce health care costs – a worthy goal for all.

In 2008, states received $17.60 per person on average from the U.S. Centers for Disease Control and Prevention (CDC) to spend on disease prevention and health promotion. But a new report from the Trust for America's Health and the Robert Wood Johnson Foundation shows that the difference in funding to individual states differed by as much as $40 per resident.

Alaska received the most funding from CDC of any state at $52.78 per person in FY 2008, while Indiana received the least at $12.74. The report shows that Midwestern and Southern states received less funding from the federal government than Northeastern and Western states.

Thirty years ago, the Carter Administration set standards to ensure that foods sold in schools had at least 5% of an essential nutrient, like protein, Vitamin C or calcium. But the standards, still in effect, do nothing to limit fat, calories or sodium.

But that could change this year, as Congress must reauthorize the Child Nutrition Act with an amendment by U.S. Rep. Lynn Woolsey, D-Calif., and support from the Obama administration, 88 other members of Congress and a host of public health organizations including Partnership for Prevention. The new legislation would have the U.S. Department of Agriculture update the nutrition standards for foods sold alongside school meals in cafeterias, vending machines, school stores, and elsewhere. Those standards would apply throughout the school day, and everywhere on campus.

A creative contest that helped pay for a New England high school’s prom in return for student’s pledges not to tan for it was named the Best Prevention Idea of the Week, while an amendment passed by the U.S. Senate gutting the District of Columbia’s ability to restrict the use of firearms was named the Worst Prevention Idea of the Week.

The Best/Worst honors are a regular feature of Prevention Matters. Each week, Partnership for Prevention's staff will choose the designees based on nominations of items in the previous week’s news submitted by members, staff and the public at large. To submit a nomination or for more information, contact Damon Thompson at dthompson@prevent.org.

BEST IDEA

High School Wins $1,000 for Not Tanning

Over 500 Waltham, MA, High School students promised not to tan for this year's prom - and it paid off. As part of the Your Skin is In contest, the school won $1,000 from the Melanoma Foundation of New England to use toward the spring dance. The nonprofit, dedicated to education about early detection and prevention of melanoma, asked students across New England to sign a no-tanning pledge. Schools that got at least 70 percent of their prom-going class to sign the pledge were entered into a raffle with a chance to win $1,000 or $500 in prizes and tickets to Six Flags New England. Over 5,500 students across New England signed the pledge. Schools that got at least 70 percent of their prom-going class to sign the pledge were entered into a raffle with a chance to win $1,000 or $500 in prizes and tickets to Six Flags New England. Over 5,500 students across New England signed the pledge.


WORST IDEA

Senate approves amendment gutting DC gun restrictions

District of Columbia residents would have far greater access to firearms, including semiautomatic weapons, under a measure approved recently by the U.S. Senate. The 62-36 vote was a victory for the pro-gun lobby which has waged a lengthy battle against the tough antigun laws imposed by the district on its residents. Sen. John Ensign, R-Nev., offered the measure as an amendment to legislation giving the district a vote in the House of Representatives. The Brady Campaign to Prevent Gun Violence, in protesting the amendment, said it would allow D.C. residents to cross state lines to buy handguns in neighboring states and would repeal the district's ban on military-style weapons, including sniper rifles that can pierce armor plating. It would lower from 21 to the federal limit of 18 the age when people can possess handguns and ease the district's registration requirements.