Prevention Matters

The Pan American Health Organization (PAHO) is encouraging nations to require graphic images on all tobacco products depicting the sickness and suffering caused by tobacco use. They urged countries to follow the lead of Brazil, Canada, Chile, Panama, Uruguay and Venezuela

Smoke-related health risks are notable among all smokers, but one group of people - infants - has an exceptionally high risk for smoking-related health issues despite the fact they can't even smoke. The CDC says 174,000 deaths each year, including 776 infant deaths, are attributed to women’s smoking habits.

“Smoking during pregnancy is one behavior known to result in infant morbidity and mortality and for which effective cessation interventions exist,” the CDC says. One in five women smoke for three months before becoming pregnant and may attempt to quit, but many start smoking shortly after the baby has been delivered. In 2005, the lowest prevalence was in New York City with 5.2% and the highest in West Virginia with 35.7%. The Healthy People 2010 goal is to reduce prenatal smoking to less than 1%.

Many of the dangers infants face associated with maternal smoking include low birth weight, preterm infants, and complications during pregnancy. And, the risks don’t end after pregnancy. Instead, secondhand smoke can cause respiratory infections, ear infections, and an increased likelihood of SIDS, Sudden Infant Death Syndrome. Smoking before conception can delay pregnancy and reduce fertility, but maternal smoking also costs the mother much more than the price of cigarettes. The CDC cites serious economic concerns when both the mother and child inevitably suffer the consequences of the mother’s smoking habits.

Amy Himmelstein
Tobacco Policy and Program Intern
Partnership for Prevention

H.L. Mencken famously wrote: "For every problem, there is a solution that is simple, neat, and wrong." It's still true. A recent case in point: an item on Insureblog that expressed exasperation that more people aren’t practicing wellness.

“...wellness and health care include what we can do for ourselves, to keep ourselves . . . healthy,” the author posits. “We can exercise (free). We can get adequate sleep (free). We can steer clear of substance abuse of all kinds (free). We can keep a reasonable diet (free). We can always wash our hands (free). We can hold it down to 85 on the Interstate (free). We can stop smoking or never start (better than free). To a great extent we already have free health care in the U.S.

“Why, I wonder, aren’t more people taking advantage of free health care? Free is affordable. What's the problem?”

Gosh, where do we start? Let’s just take them one-by-one.

• It’s not so easy to exercise in a high-crime neighborhood where there’s no safe, convenient place to be physically active. And when there are no sidewalks in a neighborhood, more people will drive instead of walk and fewer kids can safely walk to school.
• Adequate sleep can be hampered by inadequately regulated neighborhood noise, or by chronic diseases that are increasing in incidence across the country and which more people cannot afford to have treated.
• A reasonable diet isn’t so easy in a neighborhood where there’s a fast food restaurant on every corner but purchasing fresh fruit and vegetables requires a one-hour bus ride.
• We can always wash our hands only when facilities to do so are easily accessible.
• Where enforcement isn’t present, some people simply aren’t going to “hold it to 85 on the interstate,” whether I choose to do so or not.
• Most people have to try numerous times before they successfully quit smoking. But many of them can’t afford or aren’t aware of the drugs, patches and other tools that could help them succeed, or they aren’t covered by their health insurance. And stopping smoking isn’t so easy when the tobacco industry is allowed to manipulate the nicotine content in their products to make them even more addictive. Even if they succeed, they are often subjected to second-hand smoke from other smokers. Meanwhile, keeping people from starting smoking is made more difficult when tobacco companies can engage in sophisticated marketing efforts targeting our most vulnerable populations.

The number of US adults following a healthy lifestyle has fallen in the last two decades despite health campaigns, a study shows. Levels of exercise also fell, as did consumption of fruit and vegetables. The American Journal of Medicine study found the number of people exercising three times a week or more fell from 53% to 43%, while the number of people eating five portions of fruit and vegetables a day fell by nearly 40%. Overall, researchers found, the number of people adhering to five "healthy habits" - including maintaining a healthy weight and stopping smoking - decreased from 15% to 8%.

The governor of the nation's largest tobacco-producing state has signed into law a statewide ban on smoking in bars and restaurants. The North Carolina ban doesn’t take effect until Jan. 2, 2010. The bill's chief backer in the legislature left open the possibility that he would try in the future to broaden the new smoking ban in order to cover businesses beyond restaurants and bars.

Unmet contraceptive needs and unsafe sex both figure in the top 20 risk factors for mortality and burden of disease, says an editorial in PLoS Medicine.

The editors, whose publication is produced by Public Library of Science, call for political and religious leaders to redouble their efforts to realign research and policy making to promote better sexual health for all, and provide the support that is necessary to enable medical research to fulfill its role in promoting sexual health. The editors said these matters have been included in PLoS Medicine's recently announced priority areas for publication.

'There are 19 million new cases of STDs each year in the United States, at an estimated cost of US$15.9 billion annually to the US health care system," the editors write.

Private well water should be tested yearly, and in some cases more often, according to new guidance offered by the American Academy of Pediatrics (AAP). The recommendations call for annual well testing, especially for nitrate and microorganisms such as coliform bacteria, which can indicate that sewage has contaminated the well. The recommendations point out circumstances when additional testing should occur, including testing when there is a new infant in the house or if the well is subjected to structural damage.

This from The New York Times' Lesley Alderman:

"According to a January survey by the benefits consulting firm Hewitt Associates, nearly two-thirds of large employers planned to transfer more costs to employees. At the same time, one-third planned to put greater emphasis on wellness plans — programs that encourage employees to adopt healthier lifestyles. "

Economic Inquiry has some interesting articles on the vices of drinking and smoking:

• Nationwide adoption of a minimum legal drinking age (MLDA) appears to have had only a minor impact on teen drinking and traffic fatalities. Even in early-adopting states, the impact of the MLDA did not persist much past the year of adoption.
• Fraternity membership significantly increases drinking intensity, frequency, and recency, as well as the prevalence of many deleterious drinking consequences that potentially carry negative externalities.
• Rising cigarette taxes have not significantly contributed to rising obesity rates.

A Vermont congressman’s proposal to measure Medicare health outcomes on the value of the services provided rather than the volume was named Partnership for Prevention's "Best Prevention Idea of the Week," while the recent trend of American food processors to shift responsibility for food safety to consumers was named the "Worst Prevention Idea of the week."

The Best/Worst Idea awards are a regular feature of Prevention Matters, 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

Congressman proposes Medicare reimbursement based on value, not volume, of care

http://www.burlingtonfreepress.com/article/20090519/NEWS03/90518029/-1/NEWS05

U.S. Rep. Peter Welch, D-Vt., says he plans to introduce a bill that would allow for an alternative, voluntary payment system under Medicare that allowed doctors to create accountable care organizations that measure health outcomes and receive reimbursement based on the value rather than the volume of the care they deliver. Welch’s proposal is based on research at the Dartmouth Institute for Health Policy and Clinical Practice that suggests payment should be based on the value of the health care, not the volume of patients seen and procedures carried out.


WORST

Food companies shift the onus for safety to consumers

http://www.thespec.com/News/article/566815

The New York Times News Service’s Michael Moss reports that corporations that supply Americans with processed foods are increasingly shifting responsibility for the safety of their products to the consumer because they are unable to guarantee the safety of their ingredients.

More employers are willing to pay their employees for staying healthy. The percentage of companies paying people to ditch bad habits (especially eating junk food and not exercising enough) has gone from 53% in 2008 to 61% this year, according to a new study from human-resources consultant Watson Wyatt and the National Business Group on Health (NBGH). Nearly 6 in 10 (58%) now offer wellness programs, up from fewer than half (43%) in 2007.

Seventy-one percent of American workers admit they go to work when they are ill because they fear losing their jobs or are too busy to take a break, a national online poll conducted by job-search Web site Monster.com has found. It's a statistic that gives one pause at a time when Americans are worried about a flu pandemic.

That concern is compounded by a separate report from the Center for Economic and Policy Research showing that, unlike most every developed country, America doesn't guarantee its workers paid sick days. "The U.S. is the only country among 22 countries ranked highly in terms of conomic and human development that does not guarantee that workers receive paid sick days or paid sick leave," write the authors. "Under current U.S. labor law, employers are not required to provide short-term paid sick days or longer-term paid sick leave."

Chris Norwood, the founder and Executive Director of Health People: Community Preventive Health Institute in the South Bronx, has a column in the Huffington Post in which she stakes a strong claim for community-based prevention as part of health reform.

"For the United States, health reform without a clear plan to mobilize community groups nationwide to put proven prevention programs right in place where they are most needed, will not be "reform", but a continuing disaster in which people are simply more equal in being able to obtain expensive medical "care" for dehabilitating conditions that often could have been prevented," she writes.

"We will be able to judge both the real intent of the medical industrial complex - and the Obama Administration and the Senate and Congress - by their support for community-based prevention," she continues. "Right now, it is still routine to read in discussions of healthcare reform that "real" reductions in our overwhelming rates of chronic disease aren't possible---and that it just not true. What analysts who say that are not admitting is that while the ordinary ways of the health care system--drugs, "treatments", surgery, etc.---cannot reduce chronic disease rates, getting prevention out of the health care system, itself, can."

In 2005, Norwood was one of 1,000 women from around the world chosen for a groundbreaking Nobel Peace Prize nomination honoring women’s local work.

The Wall Street Journal's Anna Wilde Mathews reports that coding errors on health care provider bills are increasingly providing an unwelcome surprise to patients who try to take advantage of preventive screening that is covered by their employers' health plans.

The Senate Health, Education, Labor and Pensions Committee approved a bill that gives the Food and Drug Administration the authority to regulate tobacco. Fifteen senators - 12 Democrats and three Republicans - voted for the bill, while eight voted against it. The bill now will be sent to the full Senate for consideration.

A new study suggests that comprehensive clean indoor air policies do not lead to a reduction in hospitality jobs, and that exempting bars from community smoking bans makes no economic difference in terms of preserving bar employment.

The research, published in the June issue of the journal Prevention Science, this is the first analysis to compare the economic effects of different levels of clean indoor air policies in multiple cities. The study, led by Elizabeth Klein, assistant professor of health behavior and health promotion at Ohio State University, examined employment trends over three years in eight Minnesota cities with different types of clean indoor air policies and two cities with no laws restricting smoking.

An Australian obesity expert who heads a World Health Organization center on obesity has advised his country to take up a hardline campaign against like those used against cigarettes and drink driving.

Deakin University’s Professor Boyd Swinburn says such tactics would include advertising bans, taxes on unhealthy products and junk food-free zones. Swinburn is the Director of the World Health Organisation Collaborating Centre for Obesity Prevention.

Republicans are using prevention to help frame their approach to health reform. The Senate Republican Conference and the Republican Policy Committee will hold a May 21 hearing on Capitol Hill to discuss "wellness and prevention through healthy behavior as a key to health care reform."

"This hearing will explore solutions that can help keep Americans healthier and truly bend the cost curve in the right direction," said a hearing announcement.

The wording of the witness list suggests the hearing will focus heavily upon the notion of personal responsibility.

It describes former Arkansas Governor Mike Huckabee as a person "whose efforts to improve his own health after being diagnosed with Type II diabetes have received national attention." There is no mention of the many state programs Huckabee actually put in place to help combat childhood obesity, like mandatory BMI measurements of every public school student and restrictions on junk food on school campuses.

Steve Burd, CEO of Safeway, Inc., is touted for his "consumer-driven health care program that could serve as a template for addressing the national health care crisis." "Consumer-driven" would appear to be an alternative to "government program."

In his forward to the 2002 "Call to Action" on obesity and overweight, Surgeon General David Satcher said: "Many people believe that dealing with overweight and obesity is a personal responsibility. To some degree they are right, but it is also a community responsibility." He went on to explain that personal responsibility can only exist in a community where healthy choices are readily available. Where there are no safe places to play or exercise, where healthy food choices are either scarce or unaffordable, and where environments are unhealthy, personal responsibility can have a hard time taking root.

TIME reports that, if the H1N1 virus reaches full-fledged pandemic proportions, there won't be enough face masks to go around. The Department of Health and Human Services (HHS) says the nation would need more than 30 billion masks. But the Centers for Disease Control and Prevention (CDC) Strategic National Stockpile currently contains only 119 million masks - less than 1% of the goal health officials set in 2007.

The U.S. has one mask for every three Americans (masks are not supposed to be shared), while Australia has 2.5 masks per resident and Great Britain boasts six. And 90% of masks sold in the U.S. now come from Mexico or China, who would would be unlikely to export their supplies to meet a huge U.S. order before making sure their own populations were fully protected.

Only about 200 people have joined an ambitious Howard County, MD, program to provide low-cost preventive medical care to uninsured residents, prompting local officials to consider cutting funds for the program.

Healthy Howard is a network of local doctors who charge members between $50 and $115 monthly for comprehensive medical coverage. The program uses health coaches to improve residents' overall health and seeks to lower costs related to emergency care over time. The intital goal was to have 2,000 enrolees in the first year, which began in October 2008. That prediction has been revised to 980 enrolees by July 2010.

County council member Greg Fox questioned if the enrollment level justifies a second county outlay of $500,000 for the program in fiscal year 2010, adding that he supports cutting county funding in half for the program in that year. Supporters of the program, however, say it needs more time and money in order to succeed, noting that enrollees have been seeing doctors through the program only since January. Commonwealth Fund President Karen Davis notes that the program has also helped 2,500 county residents - including children - find coverage through state and federal insurance programs.

There's been some buzz on Capitol Hill of late about increasing alcohol taxes to help pay for health care reform. The Marin Institute, and alcohol industry watchdog group, has developed an online calculator that allows you to calculate the new revenues that could be earned in anyindividual state through an increase in alcohol taxes or fees.

People tend to associate immunizations with children, but there are a number of cost-effective immunizations that not only can help keep older Americans healthy, but can also save their lives. For example, an additional 12,000 lives could be saved each year if the adult influenza immunization rate could be increased to 90%. Dr. Litjen 'L.J.' Tan, the American Medical Association's Director of Medicine and Public Health, says the value of adult immunizations is underappreciated, and he talks with us about how policymakers can help change that. To listen to this podcast, click on the media player below. If there is not media player below, click here.

The Senate on Monday night confirmed Margaret A. "Peggy" Hamburg as the head of the Food and Drug Administration. Hamburg, who was confirmed by a voice vote. once headed New York City’s public health department and developed the federal government’s pandemic disease response plan.

Meanwhile the Senate Health, Education, Labor and Pensions Committee has begun a two-day markup of legislation to give Hamburg's agency the power to regulate tobacco.

An Ohio insurance company’s program to make fresh produce available to its customers was named Partnership for Prevention's "Best Prevention Idea of the Week," while a Chinese governmental order that civil servants smoke 230,000 packs of cigarettes a year was named the "Worst Prevention Idea of the week."

The Best/Worst Idea awards are a regular feature of Prevention Matters, 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

Ohio Insurance Company Provides Fresh Produce to Members

http://www.cleveland.com/healthfit/index.ssf/2009/05/medical_mutual_customers_can_g.html

Medical Mutual of Ohio has worked out an agreement that allows its 1.6 million Ohio customers to receive regular shipments from Chef's Garden, a 225-acre farm that otherwise grows food exclusively for some of the finest eateries in America, for $25 a box. All customers have to do is go to the insurance company's Web site, log onto "My Health Plan" and follow the Chef's Garden instructions.



WORST

Chinese county orders officials to smoke

http://www.oxha.org/alliance-alert/2009-q2-april-june/alert.2009-05-05.1352397291

The government in Gong’an county, China, has ordered local officials (civil servants and even teachers) to smoke 230,000 packs of cigarettes a year. This is an attempt to raise tax revenues, as the cigarettes have to be of the local, Hubei, brand. Those who do not smoke enough, or who smoke other brands, face a fine – or even the sack.

White House Budget Director Peter Orszag says prevention programs are one of four steps needed in health reform to produce cheaper, better health care.

"How can we move toward a high-quality, lower-cost system?" Orszag asks in a May 15 Wall Street Journal op-ed. "There are four key steps: 1) health information technology, because we can't improve what we don't measure; 2) more research into what works and what doesn't, so doctors don't recommend treatments that don't improve health; 3) prevention and wellness, so that people do the things that keep them healthy and avoid costs associated with health risks such as smoking and obesity; and 4) changes in financial incentives for providers so that they are incentivized rather than penalized for delivering high-quality care."

Meanwhile, The New Republic's Jonathan Cohn reveals some preliminary cost estimates from the Congressional Budget Office and says, "according to several sources familiar with the estimates, the news isn't quite what Obama and his allies were hoping to hear."

President Obama has proposed adding 404 full-time staff members to work on food inspection at the Food and Drug Administration (FDA). David W.K. Acheson, associate commissioner for foods, told a congressional committee that it would be a “retrograde step for public health” if food inspection responsibility was removed from the FDA. Consumer advocacy groups long have complained that federal government attempts to track and regulate food safety are lacking and dispersed among too many agencies, including both the FDA and the U.S. Department of Agriculture (USDA).

President Obama has named Dr. Thomas Frieden, currently commissioner of the New York City Health Department, to head the Centers for Disease Control and Prevention. Frieden, who will start his new job in June, has run one of the nation's largest public health agencies, in New York, since January 2002. Frieden served at the CDC from 1990 to 2002, at one point investigating issues such as a spread of drug-resistant tuberculosis.

In New York City, Frieden oversaw the implementation of smoke-free laws and rules requiring national restaurant chains to post calorie information on their menu boards. He co-authored an April 30 "Perspective" piece in the New England Journal of Medicine that reviewed the experience of places that have enacted soda taxes. The study showed that every 10% increase in soft drink prices results in a 7.8% drop in consumption. The White House credited Friedman with leading efforts to reduce smoking, increase cancer screening and combat AIDS.

Dr. Rich Besser, who has served as acting CDC director, will stay to run the Office for Terrorism Preparedness and Emergency Response, which he has overseen for four years. Health and Human Services Secretary Kathleen Sebelius and the president both praised Besser for his handling of the H1N1 flu epidemic, which during his interim status spread from 20 known cases inside the United States to 4,298 confirmed or probable cases, but only three deaths.

Dr. Steven H. Woolf attracted national attention in February with a commentary he wrote in JAMA about the value of prevention in the health reform debate. That commentary synthesized a scholarly paper Woolf and others prepared for Partnership for Prevention rebutting critics who have downplayed prevention's place in the debate on the grouds that it did not save money.

Woolf, a professor of family medicine at Virginia Commonwealth University, has now been invited to address the America's Health Insurance Plans (AHIP) Institute 2009 about his work. He will speak at a session on "The Economics of Disease Prevention" that is scheduled for for 11:40 am Thursday, June 4, at the San Diego Convention Center.

"Your recent article in JAMA and your work with the Partnership for Prevention are very important to health care reform and for stakeholders wrestling to balance cost and quality in a struggling economy," Stephanie Lentz Dougherty, AHIP's Senior Director of Professional Education, said in her invitation to Woolf.

AHIP's Institute is the nation's leading conference for the health insurance industry attended by more than 3,000 health care leaders. The educational content at this year's conference has an emphasis on health care reform.

Do consumers notice it when restaurant chains post calorie counts on their menu boards? Data from New York City suggest that they do.

Citing information from the NYC Department of Health, the Boston Globe reports that two-thirds of New Yorkers who dined at chains such as McDonald's or Starbucks said they look at the calorie listings. And about 1 in every 4 diners who paid attention said the information influenced what they ordered.

For a year now, New York City has required restaurant chains to post calorie totals for menu items. Massachusetts is considering doing the same thing.

Kudos to Wisconsin and North Carolina for becoming the latest states to act to protect their citizens from the dangers of secondhand smoke. On May 13, both state legislatures gave final approval to bills calling for smoke-free workplaces, restaurants and bars.

As one might expect, Wisconsin’s law is much stronger – calls for 100 percent smoke free workplaces, restaurants, bars and hotel rooms. As with most state laws, certain exemptions are provided – in this case, for cigar bars and tobacco retail shops. And, as often is the case, some preemption language “slipped in.” The state allows certain businesses to designate outdoor smoking areas on privately-owned property – local municipalities are preempted from passing stronger laws affecting private property, like bar or restaurant patios. However, local communities CAN pass stronger indoor and outdoor restrictions on publicly-owned property. The governor is expected to sign the bill early next week.

Now for North Carolina – a big applause for bucking the odds and passing a statewide law. Remember, this is the state that gave us Winston and Salem cigarette brands and still feels significant pressure from “big tobacco.” While all workers won’t be protected from dangerous secondhand smoke, an important group – restaurant and bar employees, as well as their patrons, will be able to breathe easier. Governor Beverly Perdue is expected to sign the bill, which would go into effect January 2, 2010. We appreciate the efforts of the North Carolina Alliance for Health and NC Prevention Partners who pressed for stronger protections and who will continue to fight for the health of all North Carolinians.


Diane M. Canova
Managing Senior Fellow
& Senior Program Officer

Three companies that are members of Partnership for Prevention’s "Leading by Example" initiative were among the businesses honored at a White House ceremony for their commitment to aggressive workplace health programs.

Johnson & Johnson CEO William Weldon, Safeway CEO Steve Burd and Pitney Bowes CEO Murray Martin were among a handful of executives praised by President Obama for reining in skyrocketing health care costs through programs designed to make their workforces healthier.

Obama saluted the firms for encouraging their employees to exercise, lose weight and quit smoking—and for offering innovations such as physician house calls aimed at keeping patients out of the emergency room. “All this [is] designed to save taxpayers money, save businesses money and ultimately make the American people healthier and happier [and] make sure we’re getting a bigger bang for our health care dollars,” the president said.

Through the Leading by Example initiative, CEOs who have incorporated new, successful approaches to employee health and productivity share their experiences and knowledge with other CEOs.

The Partnership for Prevention website has more information on programs and initiativces at the three employers.

Medicare officials have decided not to pay for "virtual" colonoscopies, concluding that "the evidence is not sufficient to conclude that screening CT colonography improves health benefits for asymptomatic, average risk Medicare beneficiaries."

Gary Schwitzer calls the decision "a bold move," given the intense industry pressure to approve such payments. In response, he says, the industry is already ratcheting up the rhetoric about socialized medicine and rationing of care.

"I wish news stories and press releases would skip the rhetoric and explain the evidence," Schwitzer says. "Otherwise the rationing rhetoric is bound to continue - without advancing true public understanding of the issues at play. It's another early bellwether of what any true comparative effectiveness research effort will be up against."

"Having Rick Scott as your spokesman against health care reform is like having an E. Coli bacterium as your spokesman against handwashing."

- MSNBC's Rachel Maddow

The National Treasury Employees Union says it won't oppose the closing of smoking lounges in Federal Communications Commission buildings. NTEU had negotiated such lounges as part of its union contracts. But a General Services Administration decision to ban smoking lounges after June 19 in the 1,500 federal buildings it manages has put the NTEU in a sticky situation when it comes to federal office buildings not owned by the GSA. Union leaders contend those decisions will be made on a case-by-case basis.

Providing preventive care is still possible, but it means navigating through a maze of declining reimbursement and increasing patient loads, says an article in Physicians Practice.

Michael Parkinson, primary-care physician and past president of the American College of Preventive Medicine, contends the answer isn’t finding a way to spend more time per patient, but rather properly utilizing the time that is available.

“The evidence is that patients aren’t really looking for an hour-long lecture from a doctor about nutrition, exercise, or whatever," says Parkinson. "They’re looking for brief interventions that show the physician cares, that they listen to what [the patient] says, and then follow up. It may be just a matter of increasing pre-exam organization, sticking to what’s been proven, and then referring patients to specially trained nonphysician providers for more detailed counseling."

Sending personalized nutrition education materials through the mail is an inexpensive way to help low-income, ethnically diverse people eat better, says a study from Brown University. The $2-million Your Health/Su Vida Saludable study funded by the National Cancer Institute showed so much promise that the research team is in the middle of disseminating the program to local community agencies, funded by a $1.3-million grant from the Centers for Disease Control and Prevention.

A coalition of more than 100 groups representing women, immigrants, and public health and reproductive rights advocates are hoping CDC will repeal its rule requiring female immigrants seeking U.S. citizenship to receive the human papillomavirus vaccine. CDC has been conducting an ongoing review of the requirement, and the public comment period ended on Friday.

Currently, female immigrants ages 11 to 26 must receive Gardasil to be eligible for a green card. The CDC advisory committee recommends the vaccine for U.S. residents, but the agency has proposed changing the criteria used to decide which vaccines should be required for immigrants. Critics say many young women are faced with the choice of getting the vaccine or waiting until they reach age 27 to acquire a green card. The vaccination is a three-shot series that costs between $400 and $1,000, which can add to financial strain for immigrants who already pay more than $1,000 in form fees and hundreds of dollars for mandatory medical exams.

The UCLA Medal, the university's highest honor, has been awarded to Dr. Jonathan Fielding, the director of the Los Angeles County Department of Public Health, a county health officer and a professor at the UCLA School of Public Health, for his work as an innovator, leader and public health visionary. Fielding is chairman of Partnership for Prevention's Board of Directors.

The Senate Health, Education, Labor and Pensions Committee has been delayed by a week a meeting to mark up a bill that would give the Food and Drug Administration authority to regulate tobacco products. The meeting is now scheduled for May 19

Secretary of Health and Human Services Kathleen Sebelius today announced the establishment of the Department of Health and Human Services’ (HHS) Office of Health Reform. This office will spearhead the department’s efforts to pass urgently needed health reform this year and coordinate closely with the White House Office of Health Reform. Jeanne Lambrew, Ph.D., will direct the office.

A Senate committee takes up a bill this week that would allow the Food and Drug Administration (FDA) to regulate tobacco. The House has already approved the legislation, and the Washington Post's Lyndsey Layton reports that both advocates and opponents of the bill "say they believe Congress is finally ready to regulate tobacco. Even so, skeptics are not comforted by the fact that tobacco manufacturer Altria supports the bill and spent $4.29 million on lobbying in the first quarter of 2009.

Representatives of major health trade associations will present a plan to President Obama to reduce the growth of health costs for the next 10 years, which — if effective — could save the nation $2 trillion or more, White House officials estimate. The proposal, which was brokered by Service Employees International Union, will be laid out at a White House meeting between Obama and associations representing health insurers, hospitals, drug companies, doctors and medical device makers.

The New York Times' Robert Pear reported over the weekend that Congress is planning to put language in the health reform bill to give employers "sweeping new authority to reward employees for healthy behavior, including better diet, more exercise, weight loss and smoking cessation."

Senate Finance Committee Chairman Max Baucus, D-MT, and Sen. Tom Harkin, D-IA, are taking the lead in devising such incentives. Harkin recently re-introduced his legislation to provide tax credits or other subsidies to employers who offer wellness programs that meet federal criteria. In addition, Pear reports, "lawmakers said they would make it easier for employers to use financial rewards or penalties to promote healthy behavior among employees."

A Chicago project for homeless people shows strong results from a program that uses social workers find them housing and secure medical services, Judith Graham writes in Triage.

Chicago researchers reported in JAMA that an 18-month study showed that homeless people who got assistance had 24 percent fewer emergency department visits and 29 percent fewer hospitalizations than homeless people who received “usual care”—discharge to a homeless shelter or the city’s only respite center for the homeless.

"Put another way, the study shows that for every 100 homeless adults offered assistance, expected benefits include 49 fewer hospitalizations, 270 fewer hospital days and 116 fewer emergency department visits," Graham writes.

Republican message-meister Frank Luntz was invited to Capitol Hill this week to advise House Republicans on how to best frame their views on health reform. However, CQ reports, his urging of members to focus on healthy lifestyles and wellness wasn't exactly a home run.

“I don’t want to live that kind of life,” responded Louie Gohmert, R-Texas.

“You don’t want to live that kind of life?” Luntz asked.

“Yeah, you’re eating your BBQ. Clearly you don’t want to live that kind of life,” he went on, to some laughter.

“Hey, ribs are a food group,” an unidentified member called out, to which Luntz responded: “His ribs could actually get up and walk out of the office.”

Google Health is trying to apply lessons learned from one of its users to improve the accuracy of medical records. An item on the Google blog tells how the user, whom they call "e-patient Dave," found that data was imported into his Google Health Account from his hospital in Boston that included "diagnoses that were both alarming and wrong."

The data came from the billing codes and associated descriptions used by the hopsital to fillout Dave's insurance forms.

"These descriptions, from the International Classification of Diseases (ICD-9), often do not accurately describe a patient because the right ICD-9 code may not exist," says Roni Zeiger, M.D., Product Manager of Google Health. "So the doctor or hospital administrator chooses something that is 'close enough' for billing purposes. In other cases, the assigned code is precisely what the doctor is trying to rule out, and if the patient turns out not to have that often scary diagnosis, it is still associated with their record."

Google Health and Dave met with hospital officials, and they worked out a plan to address the situation. The hospital agreed to stop sending ICD-9 billing codes and will instead only send to Google Health the free text descriptions entered by doctors. The hospital is also working with the National Library of Medicine (NLM) to associate those free text descriptions with a more clinically useful coding system called SNOMED-CT.

"The result will be more accurate and useful information in patients' Google Health profiles," Zeiger says.

Ad Age gives the CDC kudos on its communication work on the H1N1 epidemic and how it is "managing the conversational airwaves."

"It is neither sexy nor flashy, but it's highly effective -- and critically timely," Pete Blackshaw writes. "Moreover, the approach is building credibility. The agency has added nearly 15,000 Twitter followers in the past two days, bringing the total to 40,000. Data from my employer, Nielsen Online, also suggest the CDC website is generating unprecedented links and references, including from Wikipedia, across all dimensions of this issue.

The article lists 10 specific communications lessons to be learned from the CDC experience. It's worth a read.

A penny-per-ounce excise tax could reduce consumption of sugared beverages by more than 10%, Dr. Kelly Brownell, Director of the Rudd Center for Food Policy and Obesity at Yale University and Dr. Thomas Frieden, Health Commissioner for the City of New York, suggest in an April 30 "Perspective" piece in the New England Journal of Medicine. Brownell and Frieden say a review of places that have enacted soda taxes shows that every 10% increase in the price results in a drop in consumption by 7.8%.

They say sugar-sweetened beverages may be the "single largest driver of the obesity epidemic," and that proposals to tax sugared beverages gain support from the general public if the revenue is used for programs to prevent childhood obesity, such as media campaigns, physical activity facilities, and healthier food in schools. A poll of New York residents found that 52% supported a "soda tax," but the number increased to 72% when respondents were told that the revenue would be used for obesity prevention.

The Associated Press reported last week on a study showing that the drug Avodart lowered the chances of a prostate cancer diagnosis by 23 percent after four years of use. Health News Review's Gary Schwitzer dug a little further and found some figures that may take the bloom off that rose.

"The story said that 'to prevent a single case of cancer, 71 men would have to take finasteride [a similar drug] for 7 years." But it didn't then do the math. The story says Avodart is $3 per pill, so---

"71 men x 365 days/yr. x 7 yrs. x $3/pill = $544,215 to prevent a single case of prostate cancer."

"How can these kinds of numbers be left out of stories?" Schwitzer asks.

The Harvard School of Public Health has released a new survey of Americans and their family members are doing to try to avoid the flu epidemic. Here’s what they say:

59% have washed their hands or used hand sanitizer more frequently
25% have avoided crowded places such as sporting events, malls or public transportation
20% have avoided people they thought may have recently visited Mexico
17% have avoided Mexican restaurants or grocery stores
8% have worn a face mask
5% have purchased a face mask
5% have talked with their doctor about health issues related to swine flu
1% have gotten a prescription for or purchased antivirals

Some of these approaches - like hand-washing - are evidence-based, while others - like avoiding crowdedplaces and Mexcan restaurants - are not. But it's an interesting list.

"An overwhelming majority of Americans believe that they can get the current swine flu from being in close contact with someone who has it (83%), and few believe that they can get the disease from eating pork (13%)," the study says. "Some Americans also believe that they can get the swine flu from being near, but not in close contact with, someone with swine flu (29%), or from being in contact with pigs (34%). "

A Colorado congresswoman's efforts to determine a "Prevention Dividend" for taxpayers was named Partnership for Prevention's Best Prevention Idea of the Week, while a North Dakota legislator's efforts to undo a voter-mandated tobacco initiative was named the Worst Prevention Idea of the week.

The Best/Worst Idea awards are a regular feature of Prevention Matters, 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

Congresswoman Developing Metric for “Prevention Dividend”

U.S. Rep. Diana DeGette, D-CO, says she’s exploring a new way to calculate not simply the costs of preventative care, but the long-term benefits — what she calls the "prevention dividend." “We need to put a new emphasis on preventative care — anti-smoking efforts, cancer screening and pre-natal care, where every dollar spent saves four dollars in long-term care,” she says.


WORST

North Dakota State Sen. John Andrist, R-Crosby, introduced legislation asking the state's voters to undo their approval last November of an initiative that mandated millions of dollars for anti-tobacco efforts. The measure by Andrist, who says he doesn’t think voters fully understood what they were voting on, would divert and dilute funding that the voters directed to prevention and cessation program. UPDATE: The Senate approved the measure April 29 by a 24-23 vote, but a House committee gutted the measure a day later.