Tuesday, June 30, 2009

The signing of a law giving the Food and Drug Administration authority to regulate tobacco was named Partnership for Prevention's "Best Prevention Idea of the Week," while the national trend of people waiting too long to be tested for HIV/AIDS 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.


Obama Signs Tobacco Regulation Bill into Law http://news.yahoo.com/s/mcclatchy/20090622/pl_mcclatchy/3257729
President Barack Obama , who still struggles with his own addiction to cigarettes, on Monday signed into law the most sweeping federal anti-tobacco legislation to pass Congress in decades.
The law gives the Food and Drug Administration broad authority to regulate the marketing and manufacture of tobacco products. It bans fruit- and spice-flavored cigarettes, slaps expansive new warnings on packages and gets rid of the monikers "light" and "low-tar."

It also allows the FDA to order manufacturers to reduce — though not eliminate — the amount of the addictive chemical nicotine that's in cigarettes.


An analysis of data from 34 states suggests that many people still do not undergo HIV testing until late into the course of infection, when treatments may have limited effectiveness. In a study of subjects who were diagnosed with HIV from 1996 to 2005, researchers from the Centers for Disease Control and Prevention found that 45 percent had a diagnosis of AIDS within 3 years: 38.3 percent within 1 year of their initial HIV diagnosis and another 6.7 percent in the next 2 years.

The Centers for Disease Control and Prevention recently unveiled LEAN Works! (Leading Employees to Activity and Nutrition), a free web site designed to help businesses address obesity. CDC’s LEAN Works! can help employers calculate the cost of obesity for their organization and develop a tailored approach to help control these costs through nutrition and physical activity interventions.

Garry M. Lindsay, Managing Senior Fellow and Senior Program Officer at Partnership for Prevention, was a member of an Expert Panel on Worksite Obesity Prevention convened by CDC in 2006 and 2007 that provided initial input into the development of the Website.

Silent STD causes infertility

I know that an untreated chlamydia infection can result in infertility, but many young women do not know. In today's Wall Street Journal, consumer health writer, Melinda Beck, addresses the facts about chlamydia infections and the challenges to getting young women screened routinely. In developing the article Melinda interviewed several members of the National Chlamydia Coalition (www.prevent.org/NCC) which is convened and operated by Partnership for Prevention, in conjunction with the Centers for Disease Control and Prevention.

Susan Maloney
Senior Program Manager
Partnership for Prevention

URL to link to

WASHINGTON - Prevention was one of six priority areas cited by a federal panel in its recommendations as to how the Secretary of Health and Human Services should spend $400 million in stimulus-bill funding for comparative effectiveness research. The Federal Coordinating Council for Comparative Effectiveness Research (CER) issued its findings in a report issued today. Partnership for Prevention testified before the Council at a May 13 field hearing in Chicago and urged that prevention be made a priority in the recommendations.

"Many effective interventions for improving health are likely to involve prevention and community intervention, but these areas are currently understudied," the council concluded. "For example, behavioral change and prevention have the potential to decrease obesity, decrease smoking rates, increase adherence to medical therapies, and improve many other factors that determine health."

The high-priority interventions cited by the council were medical and assistive devices, procedures/surgery, behavioral change, prevention, and delivery systems.

"Due to astonishing achievements in biomedical science, clinicians and patients often have a plethora of choices when making decisions about diagnosis, treatment, and prevention, but it is frequently unclear which therapeutic choice works best for whom, when, and in what circumstances," the council said. It said CER "should identify interventions that yield the most health improvement and represent the best value wherever and however the interventions are delivered."

Partnership for Prevention President Robert J. Gould expressed appreciation to the council for making prevention a priority and for encouraging Partnership's participation in their listening sessions.

"The council's decision is an important step in giving prevention the footing it needs to take its rightful place in the spectrum of health-care decisionmaking," Gould said. "Everyone wins when consumers and health professionals can make informed decision based upon science-based comparisons that show how we can get the most health benefits for the dollars spent."

"We hope HHS Secretary Katherine Sebelius will follow this blueprint when she makes her final decisions on the federal investment in CER," he said.

The council's report was mandated by the American Recovery and Reinvestment Act, is designed to help the HHS Secretary and lawmakers improve the quality of care for patients, and provide patients and doctors the best information possible to make decisions about health care. The report is available at www.hhs.gov/recovery/programs/cer.

Thursday, June 25, 2009

Harkin Talks Up Prevention and Wellness

Sen. Tom Harkin, D-Iowa, wrote a column for Yahoo.com in which he made a strong call for the inclusion of prevention and wellness services as part of health reform.

"It’s not enough to talk about how to extend insurance coverage and how to pay for health care – as important as those things are," Harkin said. "It makes no sense just to figure out a better way to pay the bills for a system that is dysfunctional, ineffective, and broken. We also have to change the health care system itself, beginning with a sharp new emphasis on prevention and public health.

"We also have to realize that wellness and prevention must be truly comprehensive. It is not only about what goes on in a doctor’s office. It encompasses workplace wellness programs, community-wide wellness programs, building bike paths and walking trails, getting junk food out of our schools, making school breakfasts and lunches more nutritious, increasing the amount of physical activity our children get, and so much more."

Wednesday, June 24, 2009

Screening and brief intervention programs can spot addiction and mental health problems among elderly patients that traditional healthcare interactions may miss, findings from a new Florida study indicate.

Reuters reported June 12 that researchers screened more than 3,000 elderly Florida residents during a three-year study, using a tool called BRITE to assess subjects for six risk factors. The study authors found that 10 percent of those screened had problems with alcohol misuse, 26 percent had problems with prescription and over-the-counter (OTC) medication, 64 percent suffered from depression, and 2 percent were at risk for suicide.

A new study in the Archives of Internal Medicine shows that an average of one out of every 14 patients with clinically significant abnormal results don't get this information from their doctors. Failure to disclose such results can put a patient's health at serious risk.

Doctors' offices without clear procedures for handling test results dropped the ball for as many as one in every four patients; those with standard procedures did so very infrequently or not at all.

The study recommends that patients call for results after a certain period of time if they haven't heard from their doctor. Every responsible physician should get a copy of lab result, sign it, and inform patients directly of the results or ask staff to do so, the authors say. Also, staff should document that a patient has been informed of a test result each time this occurs.

Atul Gawande, the doctor whose recent New Yorker piece piece comparing the medical systems of El Paso and McAllen, Tex. has caused a major stir in health policy circles, says a greater focus on prevention could help reduce costs in McAllen "overnight."

"...We have not been thinking hard enough about how we control costs and make a better system," in an interview with the Washington Post's Ezra Klein. "I think it's achievable in about 10 to15 years, and maybe even faster. I can tell you three things that will transform McAllen overnight. But CBO doesn't score them."

Gawande said McAllen's average $15,000 annual expenditure per Medicare beneficiary could be reduced to $10,000 through a reduction in home visits, an increase in the use of hospice care vs. ambulance rides, and "work on basic cardiac prevention like getting people statin drugs."

"Most studies have shown you'll lower the cardiovascular disease rate by 25 percent and lower the number of procedures ordered," he said. "This was done in by Kaiser of Northern California, and they became the first community I've ever heard of where heart disease stopped being the leading cause of death."

Tuesday, June 23, 2009

WSJ - They're Just Not That Into Prevention

Has anybody seen the Wall Street Journal column praising the benefits of prevention? Neither have we, and we're starting to suspect such a column doesn't exist. But we sure have seen their columns that take the opposite tack. In the last dozen or so days, in fact, the WSJ has published two columns and two blog postings dismissing prevention as part of health reform.

Was it something we said?

First, there was a June 12 print piece by Janet Adamy entitled "Prevention Efforts Provide No Panacea on Health Costs." On the same date, WSJ printed a blog post by Shirley S. Wang entitled "Does Preventing Disease Really Save Money?" (Her answer: probably not, and it may not even improve health); and a blog post by Peter Landers entitled "Disease Prevention in Germany Is Mostly Good for Doctors." Then there was Abraham Verghese's June 20 column on entitled "The Myth of Prevention."

C'mon, folks, how do you really feel?

The logic employed in these pieces is simplistic - preventive services aren't worth investing in because not all of them save money. But that's concentrating on the hole, not the doughnut.

The fact is that some preventive services DO save money. We reviewed 25 procedures approved by the US Preventive Services Task Force and found that six of them actually saved money while 12 of them were highly cost-effective. We also found five preventive clinical servces that are currently underused that could save an additional 100,000 lives a year if they were broadly utilized. Three of those services save money, while the other two are highly cost-effective.

Which raises another problem with the logic in the WSJ columns. A preventive service doesn't have to save money to provide value to the health care system. Many of the procedures that don't save money still deliver significant health benefits for the dollars spent.

Using logic like that employed in the WSJ columns, the owners of Major League Baseball teams wouldn't invest in hitters, because even the best of them get a hit less than a third of the time they go to the plate. In reality, of course, those owners look not at the hits the players don't get, but at the hits they DO get - how many homers they hit, how many runs they drive in, how many put people in scoring position - and they invest in the players that give them the most bang for the buck.

Perhaps there's a lesson there for health care... and for the WSJ.

Obama "95% Cured" of Tobacco Addiction

President Obama said today he's "95% cured" of tobacco addiction, but admits to falling off the wagon on occasion.

"I've said before that as a former smoker I constantly struggle with it," the president said at a press conference. "Have I fallen off the wagon sometimes? Yes. Am I a daily smoker, a constant smoker? No." "I would say that I am 95 percent cured, but there are times where, there are times where I mess up," he added.

The president, who this week signed legislation into law giving the Food and Drug Administration the power to regulate tobacco products, said that he does not smoke in front of his kids or the rest of his family, and compared his situation to that of a recovering alcoholic.

"I don't know what to tell you, other than the fact that, you know, like folks who go to A.A., you know, once you've gone down this path, then, you know, it's something you continually struggle with, which is precisely why the legislation we signed was so important, because what we don't want is kids going down that path in the first place," he said.

Monday, June 22, 2009

A school-based prevention program that cut risky behaviors in half was named Partnership for Prevention's "Best Prevention Idea of the Week," while a congressman’s contention that tobacco is no more dangerous than lettuce 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.


School-Based Prevention Program Reduces Problem Behaviors by Half


A study suggests that a school-based prevention program begun in elementary school can significantly reduce problem behaviors in students. Fifth graders who participated in Positive Action (PA), a comprehensive interactive school prevention program, for one to four years were about half as likely to engage in substance abuse, violent behavior, or sexual activity as those who did not take part in the program. The study, supported by the National Institute on Drug Abuse (NIDA), a component of the National Institutes of Health, will appear in the August 2009 print issue of the American Journal of Public Health.


Congressman: "Smoking lettuce same as cigarettes"


Rep. Steve Buyer, R-Ind., said smoking lettuce is the same as smoking cigarettes. He says it's not the nicotine that kills, it's the smoke. In a House floor speech opposing a bill allowing the FDA to regulate tobacco Buyer said, “It's not the nicotine that kills. It's the smoke that kills. So it's the inhalation of the smoke. That's what causes and is responsible for the pandemic of cancers, of heart disease, respiratory disease, and other disease. It's the smoke." No word as to whether Buyer thinks that eating lettuce would be as bad as chewing tobacco.

Podcast #15 - Calculating Prevention's ROI

How do you prove the value of disease prevention and health promotion? A research team at Harvard Medical School thinks they may have an answer. They have developed a calculator that allows them to estimate the return on investment of prevention services. Dr. Nancy Oriol, dean of students at Harvard Medical School and a leader of the research team, explains how this new tool operates. She also discusses "The Family Van," a mobile clinic program she has helped to operate in the Boston area that inspired their efforts to develop the calculator. To listen to this podcast, click on the media player below. If you don't see a media player below, click here.

Friday, June 19, 2009

The three committees in the U.S. House of Representatives that are crafting a health reform bill today released a "discussion draft" of the legislation they are about to propose. The 852- page discussion draft is designed to provide “quality affordable health care for all Americans and controls health care cost growth." In brief, provisions in the discussion draft would:

  • Expand the capacity of two independent, advisory task forces — the U.S. Preventive Services Task Force (USPSTF) and the Task Force on Community Preventive Services (TFCPS) — to undertake rigorous, systematic reviews of existing science to recommend the adoption of proven and effective services.
  • Provide new investments in the science of prevention to further expand the base of information available for evaluation by the task forces.
  • Deliver clinical preventive services by including USPSTF‐recommended services in Medicaid and insurance available in the Health Insurance Exchange.
  • Eliminate cost‐sharing on recommended preventive services delivered by Medicare, Medicaid, and insurance available in the Health Insurance Exchange.
  • Deliver community preventive services by investing in state, territorial, and local public health infrastructure andby providing grants to implement TFCPS‐recommended services.

Meanwhile, here's a more detailed rundown of provisions within Title III, which covers the creation of the Prevention and Wellness Trust Fund and program allocations. The key provisions include:

(Section 2301; page 797) Establishes Prevention and Wellness Trust funded at $2.4 Billion in FY2010 and rising to $3.5 Billion in FY2014. The trust makes funding available for the following areas:

  • $30 million in each of FY 2010-2014 to fund the activities of the Clinical and Community Preventive Services Task Force.
  • $100 million in FY 2010 for prevention and wellness research and rising to $300 million in FY2014.
  • $1.1 billion in FY 2010 for community-based prevention and wellness services and rising to $1.6 billion in FY2014.
  • $800 million in FY2010 for core public health infrastructure and activities for state and local health departments rising to $1.3 Billion in FY2014.
  • $350 million in each of FY2010-2014 for core public health infrastructure and activities for CDC.

(Section 3121; Page 800) Prevention and Wellness Strategy. A national strategy to improve the Nation’s health through evidenced-based clinical and community-based prevention and wellness activities, including core public health infrastructure improvement activities. Strategy will work to address unmet prevention and wellness needs AND unanswered research questions on prevention and wellness.

(Section 3131, page 802) Task Force on Clinical Preventive Services. Revises and strengthens the Task Force under the authority of the Agency for Healthcare Research and Quality. Authority will include a clinical prevention stakeholders board to advise the Task Force on developing, updating, publishing, and disseminating evidence-based recommendations on the use of clinical preventive services.

(Section 3132, page 807) Task Force on Community Preventive Services. Codifies in Federal statute, under the CDC, a permanent task force to review scientific evidence related to the benefits, effectiveness, appropriateness, and costs of community preventive services for the purpose of developing, updating, publishing, and disseminating evidence-based recommendations on the use of community preventive services. A community prevention stakeholders board is established to advise the Task Force on developing, updating, publishing, and disseminating evidence-based recommendations on the use of community preventive services

Subtitle D – Prevention and Wellness Research

(Section 3141, page 813) Requires that prevention and wellness research undertaken by CDC and NIH be informed by the national prevention strategy and the Task Force (Preventive/Community)recommendations.

(Section 3142, page 813) Authorizes CDC to make prevention and wellness research grants.

(Section 3151, page 814) Authorizes CDC to make community-based prevention and wellness services grants. 50% of funding is reserved for services “whose primary purpose is to achieve a measurable reduction in one or more health disparities.”

(Section 3161, page 818) Authorizes a new program of Core Public Health Infrastructure and activities for State and local health departments.

(Section 3162, page 822) Authorizes a program of Core Public Health Infrastructure and Activities for the CDC.

On June 18, I took part in a discussion at the White House billed as a "Stakeholder Meeting with Physicians.” We discussed health reform, with an emphasis on prevention and health cost savings. The meeting was chaired by Michael Hash, Senior Adviser in the White House Office of Health Reforman and attended by Dr. Zeke Emanuel from the Office of Management and Budget, Dr. Bob Kocher from the National Economic Council, Dr. Kavita Patel from the Office of Public Engagement, and Dr. Dora Hughes from the Department of Health and Human Services.

There is strong commitment by the President to disease prevention and health promotion in health reform, with a good appreciation that this encompasses clinical prevention, community preventive services, and creating healthier communities.

There was widespread consensus among the participants that multiple strategies are needed, including reimbursing for clinical preventive services, creating financial incentives that reward primary care and prevention more and high tech procedures less, expanding the primary care and public health workforce, creating a sufficient and sustained funding source for our public health system and community preventive services, assessing the health impact of our non-health policies (transportation, food), increasing prevention research, and fostering better integration between Federal agencies and between clinicians and community resources.

There was also widespread agreement that there needs to be a focus on reducing tobacco and obesity if we are to reduce chronic disease rates and control future health care costs.

Corinne G. Husten, MD, MPH
Executive Vice President &
Chief Policy & Program Officer
Partnership for Prevention

Wednesday, June 17, 2009

Partnership for Prevention today applauded a health reform proposal crafted by four former Senate majority leaders — Howard Baker, Tom Daschle, Bob Dole and George Mitchell. The “Crossing Our Lines” report called for the establishment of a 10-year, $50 billion public health and wellness fund that would, among other things, invest in the elimination of co-payments and deductibles for high-value preventive services and provide tax credits for workplace wellness programs.

“In this report, noted leaders from both political parties have laid out a common-sense plan that would increase the nation’s focus on clinical and population-based prevention,” said Partnership President Robert J. Gould. “Partnership for Prevention urges members of Congress to take a close look at this report and use it as a guide to assure that real health reform starts with prevention.”

In the report, the former Senate leaders noted that “a large and growing proportion of our health spending” is currently going toward chronic diseases that are attributable to “clear, changeable patient behaviors.”

“However, traditional approaches to health care, which pay more for treating illnesses after they develop, do not support these lifestyle changes,” they said. The report called for a focus on school, workplace and community-based programs that “effectively encourage more responsible health choices.”

The leaders proposed using the $50 billion public health and wellness fund to:

  • invest $500 million in innovative school and community-based programs to provide direct preventive and primary health care services, including exercise, nutrition, and wellness education;
  • eliminate deductibles and co-payments under Medicare for “A” and “B” rated preventive services that the U.S. Preventive Services Task Force has deemed appropriate;
  • provide a 50 percent tax credit for certified employer-based wellness programs for small- and medium-sized firms;
  • invest $2.5 billion to support community health teams to provide preventive wellness and coordinated preventive health services.

Tuesday, June 16, 2009

Dr. Jason Spangler, managing senior fellow at Partnership for Prevention, recently participated in a conference on "The Dollars and Sense of Prevention" that was sponsored by the Center for Studying Health System Change. He was joined by Dr. A. Mark Fendrick, Professor of Internal Medicine and Health Management and Policy at the University of Michigan and Dr. Steven H. Woolf, Professor of Family Medicine at Virginia Commonwealth University. A transcript of that conference - including Powerpoint presentations - is available online by clicking here.

Monday, June 15, 2009

The development of technology to calculate prevention’s return on investment was named Partnership for Prevention's "Best Prevention Idea of the Week," while hospital budget cuts to infection-control efforts 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.


Harvard Researchers Develop Tool to Calculate Prevention's ROI


Researchers from Harvard Medical School have led the development of a prototype "return on investment calculator" that can measure the value of prevention services. Using a Boston-based mobile health program called the "Family Van" to test the tool, the team found that for the services provided in 2008, this program, in the long run, will return $36 for every dollar invested.


Hospitals cutting Infection-control efforts


In a survey of 2,000 infection preventionists—conducted by the Association for Professionals in Infection Control and Epidemiology—41 percent reported cuts in funding for infection-prevention efforts in the past 18 months due partly to the struggling economy.

Podcast # 14 - National Poll on Prevention

The American people overwhelmingly believe that investing more in disease prevention will save money. Even more importantly, they believe overwhelmingly that we should invest more in prevention, even if it doesn't save money. In this podcast we talk with Richard Hamburg, Director of Government Relations for the Trust for America’s Health (TFAH). His organization has conducted an extensive survey of Americans to find out how they feel about disease prevention and health promotion, as well as how big of a priority they think it should be as Congress tries to reform the health care system.

To listen to this podcast, click on the media player below. If you do not see a media player below, click here.

In his "last stand" speech against legislation to let FDA regulate tobacco, Rep. Steve Buyer, R-Ind., said smoking lettuce is the same as smoking cigarettes. He says it's not the nicotine that kills, it's the smoke. Of course, using that logic, chewing on tobacco as if it were a salad wouldn't cause throat or gum cancer. Buyer beware, indeed! Fortunately, the bill passed and is on its way to the White House for a signature.

View a video of Buyer's remarks by clicking on the player below. If you don't see a player below, click here.

Friday, June 12, 2009

FDA Tobacco Bill Clears Congress

The House of Representatives today approved the Senate version of a bill to give the FDA broad authority to regulate tobacco products. The 307-97 vote sends the bill to President Obama for signature. Speaking from the White House, Obama said he will sign it, adding that broad bipartisan passage of the bill "truly defines a change in Washington."

Safeway CEO Stephen Burd says well-designed health-care reform, utilizing market-based solutions, "can ultimately reduce our nation's health-care bill by 40%."

In an op-ed in today's Wall Street Journal, Burd says Safeway implemented such a plan for its workers in 2005. Since then, he says "we have kept our per capita health-care costs flat (that includes both the employee and the employer portion), while most American companies' costs have increased 38% over the same four years."

"The key to achieving these savings is health-care plans that reward healthy behavior," he says. Burd is a member of Partnership for Prevention's "Leading by Example" initiative.

A new study finds that in sharp contrast to the overall declining rates of colorectal cancer in the United States, incidence rates among adults younger than age 50 years are increasing. The authors theorize that these increases may be related to rising rates of obesity and changes in dietary patterns, including increased consumption of fast food.

States Vary Widely in Tobacco-Control Efforts

A new study shows that most states still aren't making good use of tobacco control tools that have been proven to work.

According to the report - Cigarette Smoking Prevalence and Policies in the 50 States: An Era of Change -- the Robert Wood Johnson Foundation ImpacTeen Tobacco Chart Book -says a combination of outreach programs, legislation, cigarette price increases and coverage for and access to stop-smoking treatments has been proven effective in reducing smoking rates and protect nonsmokers. Even so, there is wide variation in cigarette smoking prevalence across states and a clear relationship between smoking prevalence and the rate of mortality that can be attributed to smoking.

For example, approximately 27 percent of adult Medicaid recipients were smokers in 2006 - significantly higher than the 17 percent rate among adults with private insurance. But in that same year, Medicaid programs in a dozen states still did not provide coverage for proven tobacco treatment to their clients who smoked.

Thursday, June 11, 2009

Sen. Jud Gregg, R-NH, touted prevention as a cornerstone of his alternative proposal to reform the nation's health system. Gregg, the ranking Republican on the Senate Budget Committee, explained his "CPR" proposal - standing for "Coverage, Prevention, Reform" - in an op-ed on the Yahoo!News website.

"This proposal... aggressively focuses on the need for more robust preventive care and creates incentives for people and businesses to work toward better health sooner, rather than later when such measures may not work and crisis treatment is much more costly," Gregg says.

"By offering first-dollar coverage for early health screenings and immunizations, this program will create the foundation for healthy lifestyles and reduce the need for later treatments," he says. "Further, by rewarding employees for taking part in employer-sponsored programs, which often include programs to help people quit smoking, fitness club membership options, and affordable access to programs like Weight Watchers, CPR creates incentives that will motivate Americans to take control of and improve their personal health.

The U.S. Senate passed the FDA bill by an overwhelming 79-17 vote.

AMA Opposes Public Health Insurance Plan

The American Medical Association says it will oppose creation of a government-sponsored insurance plan. The opposition of America’s largest physician organization could be a major hurdle for advocates of a public insurance plan. President Obama is scheduled to speak to the 250,000 member group on Monday in Chicago.

Restaurant Association Backs Menu Labeling

The National Restaurant Association has agreed to support legislation that would require them to disclose calories on their menus. Chain restaurants with 20 or more locations would have to list on their menus the number of calories per item and would also have to make available upon request other nutritional information such as the amount of sugar, salt or cholesterol. The menu labeling law could be included in health reform legislation expected to be discussed in Congress during the next few weeks.

Anyone who doubted Senator Kennedy’s ability to introduce a comprehensive health reform bill this Congress, looked on with embarrassment Tuesday as the majority members of Kennedy’s Senate Health, Education, Labor, and Pensions Committee introduced a 615-page bill detailing the Committee’s plan to reform America’s health system.

The Affordable Health Choices Act details the ins-and-outs of the Committee’s plan and includes mechanisms to ensure quality, affordable health care for all Americans by improving the quality and efficiency of health care and preventing fraud and abuse, bettering the health care workforce, improving access to innovative medical therapies, and last but certainly not least, provisions to increase our emphasis on prevention.

Last year, Kennedy asked Senator Tom Harkin to help lead the prevention and public health aspects of health reform and there is no doubt that Title III of the bill, “Improving the Health of the American People,” is an answer to that charge.

This Title includes several provisions that, if enacted, would greatly increase our health system’s emphasis on health promotion and disease prevention. A number of the policies closely resemble those found in “Real Health Reform Starts with Prevention” (the song book Partnership for Prevention has been singing from for the past two years.)

The wellness and prevention policies include:

  • Creating the National Prevention, Health Promotion and Public Health Council – The interagency council would provide coordinating and leadership at the Federal level with respect to prevention, wellness, and health promotion practices, the public health system, and integrative health care in the United States.*
  • Establishing a Prevention and Public Health Investment Fund – The fund would provide an expanded and sustained national investment in prevention and public health programs for no less than $10 billion for each fiscal year*
  • Expanding the charge of the U.S. Preventive Services Task Force – Under the bill, the Task Force would be responsible for developing additional top areas of new recommendations and interventions including those for specific sub-populations, updating all recommendations every 5 years if not sooner, improving integration with the Federal Government, increasing the dissemination of their recommendations, and submitting annual reports to Congress. The bill also calls for increased coordinating with the Community Preventive Services Task Force and the Advisory Committee on Immunization Practices.*
  • Authorizing and expanding the Community Preventive Services Task Force – Authorize the Task Force and expand it’s scope similar to the U.S. Preventive Services Task Force.*
  • Establishing an education and outreach campaign regarding preventive benefits.*
  • Enacting the “Right Choices Program” – This Program was first introduced in the Senate Finance Committee’s, “Reforming America’s Health Care System: A Call to Action.” The Program would provide low-income, uninsured Americans with a risk-stratified care plan and referral for treatment for any diagnosed illnesses.
  • Awarding community transformation grants – Secretary would award competitive grants to promote individual and community health and prevent the incidence of chronic disease.
  • Promoting healthy aging, living well for the pre-Medicare population (55-64 years of age)
  • The Centers for Disease Control and Prevention would award grants for 5-year pilot programs to provide public health community interventions, screenings, and clinical referrals where necessary.
  • Increasing the use of immunizations – States would have the authority to purchase recommended vaccines for adults through government contracts and CDC would establish a demonstration project to improve immunization coverage by implementing evidence-based interventions*
  • Requiring nutrition labeling of standard menu items at Chain Restaurants and of articles of food sold from vending machines*
  • Increasing research on optimizing the delivery of public health services and providing an annual report to Congress on the research findings *
  • Support health impact assessments - Establishing a program at CDC to support the development and of health impact assessments and dissemination of best practices related to health impact assessments.*
  • Promoting employer-based wellness programs – CDC will study and evaluate best employer-based wellness practices and educate and provide technical assistance to employers.*

* Denotes policy options promoted in Partnership for Prevention’s “Real Health Reform Starts with Prevention” campaign, which includes policy recommendations, policy papers, and model legislative language.

While health reform is far from being complete, the Affordable Health Choices Act is an encouraging starting point for prevention and public health advocates.

A public hearing is scheduled for Thursday, June 11 at 3 p.m. in 430 Dirksen Senate Office Building. The HELP Committee will begin mark-up on Tuesday, June 16 at 2:30 p.m. in 325 Russell Senate Office Building.

For more information on the bill see the Committee’s press release on the bill. Click here for section by section narrative of the bill and click here for a copy of the bill http://help.senate.gov/BAI09A84_xml.pdf.

Tracie Bryant
Congressional Liaison
Partnership for Prevention

The Senate voted 67-30 yesterday to limit debate on a bill to give the Food and Drug Administration authority to regulate tobacco. The final vote has been scheduled for 2:30 p.m. Eastern time today.

Wednesday, June 10, 2009

Despite strong recommendations that all sexually active young women age 25 and younger receive a screening test each year for chlamydia, many websites offering health information fail to mention the importance of chlamydia screening. Health websites providing information to the public often discuss chlamydia infections, symptoms and treatment. But the vast majority of young women with chlamydia have no symptoms so making screening a routine part of medical care is strongly recommended.

Chlamydia screening is recommended by the US Preventive Services Task Force, Centers for Disease Control and Prevention, and many leading medical associations including the American Academy of Pediatrics, American College of Obstetricians and Gynecologists, and the American Medical Association. The consequences of untreated chlamydia infections include pelvic inflammatory disease, which may lead to infertility, chronic pelvic pain, and pregnancy complications. Chlamydia can be detected with a urine test and treated with common antibiotics.

The National Chlamydia Coalition, convened by the Partnership for Prevention and the Centers for Disease Control and Prevention, has begun to reach out to health websites urging them to update their entries on chlamydia to make it clear to sexually active young women that chlamydia screening should be a routine part of their medical care. The coalition is pleased to have worked with the National Women’s Health Resource Center to update its chlamydia information to include screening. The article can be accessed at http://www.healthywomen.org/healthtopics/chlamydia. The National Chlamydia Coalition offers additional resources, including where to locate confidential STD screening services, at www.prevent.org/NCC.

Susan K. Maloney, MHS
Managing Senior Fellow & Senior Program Officer
Partnership for Prevention

CHRISTUS St. Frances Cabrini Hospital, one of the 10 largest top 10 Catholic health systems in the United States, is launching an international competition aimed at ending diabetes. They're inviting inventors, entrepreneurs, and researchers from around the world to develop and submit a proposal for a program that will aid in the evaluation, diagnosis and treatment of diabetes in a rural area such as central Louisiana. The program must be able to track results and outcomes within a budget of $200,000.00. The first place winner(s) will be awarded a cash prize of $20,000 The second place winner will receive a cash prize of $15,000 and the third place winner will win a cash prize of $5,000.

There have been a couple of really good items this week on how efforts to prevent hospital infections are being inadvertantly undermined here and abroad, even though they cause 10,000 deaths a year in the U.S. and add $20 billion to the country's health care bill.

Laura Landro over at WSJ's "Health Blog" cites a poll by the Association for Professionals in Infection Control in which 41% of nearly 2,000 professionals reported cuts in their budgets, including money for technology, staff, education, products and equipment. Of those, nearly 40% had layoffs or reduced hours, and a third experienced hiring freezes. Nurses who staff many of the departments say they are being asked to take on extra duties that distract them from infection control.

Meanwhile, the BBC reports on a British Medical Association report that says infection control practices there have been damaged by overcrowding and understaffing in NHS facilities. "...the BMA says polices promoting higher patient throughput "have led to many services constantly operating close to full capacity. This has led to overcrowding, understaffing, higher bed occupancy, and increased movement of patients between hospital wards. All of these factors have made it difficult to implement measures such as hand washing, and screening of at-risk patients."

Carmona Advises Balance to New CDC Director

Former Surgeon General Richard Carmona suggests over at the Health Affairs blog that some of new CDC Director Tom Frieden's health initiatives in New York City might be seen by some as overreaching and intrusive if applied at the federal level. He calls for a careful balance between public health and personal freedoms.

The American public and business community "get it" when it comes to the value of using disease prevention and health promotion to help reform the country's health care system, Partnership for Prevention President Robert J. Gould, PhD, said at a recent press conference on Capitol Hill.

Gould made the remarks at an event discussing a new survey that shows that public considers prevention the top priority in health reform. The survey, commissioned by Trust for America's Health and the Robert Wood Johnson Foundation, showed 72 percent support increased support for prevention programs, even if they don't save money.

"The public gets it, and business executives get it," said Gould. "Addressing the worsening health status of workers is critical to controlling future health care spending... And the polling data released today confirms the American public's support."

Gould said Partnership's "Leading by Example" initiative has helped CEOs at more than 40 American companies - including many Fortune 500 corporations - promote and implement effective worksite wellness programs.

"Increasingly, corporate executives are not just speaking out on the high cost of health care," he said. "They are creating compelling models to produce a healthier workforce."

Gould noted that President Obama last month held a roundtable discussion wtih business executives who were praised for their corporate efforts to contain health care costs. The dozen or so executives in attendance included those from three "Leading by Example" companies - Johnson & Johnson, Safeway, and Pitney Bowes.

Another "Leading by Example" company, Dow Chemical Co., recently testified on Capitol Hill that its worksite wellness programs last year saved 9,000 employee absentee days and yielded a return on investment equal to seven cents per share of company stock.

"Employer wellness programs are a win-win proposition for both the employee and the employer," he said. Even so, he said, many businesses - particularly small businesses - could use tax incentives to help them establish such programs.

To view a video recording of Gould's remarks, click here.

Tuesday, June 9, 2009

By Jeff Levi, PhD, Executive Director of Trust for America's Health (TFAH)

Americans rank prevention as the most important health care reform priority, and overwhelmingly support increasing funding for prevention programs to reduce disease and keep people healthy.

In a new public opinion poll released today by the Trust for America’s Health and the Robert Wood Johnson Foundation, we found that Americans from coast to coast and across the political spectrum are overwhelmingly in favor of investing in disease prevention. They clearly see the value of prevention for reducing disease, improving quality of life, and lowering health care costs.

In the poll, conducted by Greenberg Quinlan Rosner Research and Public Opinion Strategies in May of 2009, 70 percent of Americans ranked investing in prevention between an eight and 10 on a scale of zero to ten, where zero means not at all an important health care priority and 10 means very important. Forty-six percent rated prevention as a 10 out of 10. Overall, prevention was rated higher than all other proposals tested, including providing tax credits to small businesses and prohibiting health insurers from denying coverage based on health status.

More than three-quarters of Americans (76 percent) said that they support increasing funding for prevention programs that provide people with information and resources and creating policies that help people make healthier choices. Investing in prevention is popular across the political spectrum, with 86 percent of Democrats, 71 percent of Republicans, and 70 percent of Independents supporting investing more in prevention.

For too long, health care has focused on treating people after they become sick instead of trying to help them stay healthy in the first place. This poll shows the American public strongly believes it’s time we shift from a sick care system to a true health care system that stresses disease prevention.

While Americans believe that prevention will save money (77 percent agree with the statement that “prevention will save us money”), they strongly support prevention regardless of its impact on costs. Rather, they point clearly to keeping people healthy as the best reason to invest in prevention, with 72 percent agreeing with the statement that “investing in prevention is worth it even if it doesn’t save us money, because it will prevent disease and save lives.” Additionally, 57 percent agree more with the statement “we should invest in prevention to keep people healthier and improve quality of life” than the statement “we should invest in prevention to lower health care costs” (21 percent agree).

Americans clearly see the value of the prevention for both saving money and reducing disease rates. And the research supports their belief. We know that strategic investments in disease prevention programs in communities can result in a big payoff in a short time -- reducing health care costs, increasing the productivity of the nation’s workforce, and helping people lead healthier lives.

According to the CDC, a vast majority of chronic diseases could be prevented through lifestyle and environmental changes. A study we did at the Trust for America’s Health last summer, entitled Prevention for a Healthier America: Investments in Disease Prevention Yield Significant Savings, Stronger Communities, found that for an investment in $10 per year per person in proven community-based programs to increase physical activity, improve nutrition, and prevent smoking and other tobacco use – which help make it easier for individuals to make healthy choices -- the country could save more than $16 billion annually within five years. This is a return of $5.60 for every $1 spent.

But, to get the returns that prevention offers, we need to make the investment. This includes creating a reliable, stable funding stream for public health, including providing enough resources for community-based disease prevention programs, ensuring that people have access to preventive health care benefits, and developing and implementing a national prevention strategy, so we make sure that resources are being well spent and are delivering real results toward improving our health.

Right now, high rates of chronic diseases are among the biggest drivers of U.S. health care costs. What this means in real terms is that Americans are not as healthy as they could be or should be – and that is translating into huge growth in health costs. And our workforce is less productive than it could be or should be to compete with the rest of the world.

It’s time to invest in keeping the country healthier and promote prevention – to make our country healthier, to make our health care system more cost-effective, and to make our economy more competitive.

More information about the poll can be found on the Trust for America’s Health Web site at: http://www.healthyamericans.org/.

A new survey shows that Americans overwhelmingly support increasing prevention funding, even if it doesn't save money. The survey, commissioned by Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation (RWJF) found that 72 percent of those surveyed agree with the statement that "investing in prevention is worth it even if it doesn't save us money, because it will prevent disease and save lives."

Poll participants ranked prevention as the most important health care reform priority. Seventy percent ranked it between an eight and 10 on a scale of zero to ten, where zero means not at all an important health care priority and 10 means very important. Forty-six percent rated prevention as a 10 out of 10. Overall, prevention was rated higher than all other proposals, including providing tax credits to small businesses and prohibiting health insurers from denying coverage based on health status.

The poll, conducted by Greenberg Quinlan Rosner Research and Public Opinion Strategies, found that 86 percent of Democrats, 71 percent of Republicans, and 70 percent of Independents supporting investing more in prevention. It also found that 77 percent of Americans agreed with the statement that "prevention will save us money."

Partnership for Prevention President Robert J. Gould took part in a press conference with TFAH yesterday to say the results are consistent with Partnership's experience working with corporations to establish worksite wellness programs.

"The public gets it and CEOS are getting it," Gould said. "One of the most hopeful trends in disease prevention and health promotion over the past several years has been the movement among corporations to promote health and wellness through worksite-based programs. More companies "are taking proactive measures to improve the physical health of their employees and the fiscal health of their organizations," he said.

To view video of Gould's remarks, click on the media player below. If you don't see a media player, click here.

Monday, June 8, 2009

In this podcast, we talk with Dr. Douglas Kamerow, Chief Scientist for Health, Social and Economics Research at RTI International. Doug, who’s also a professor of clinical family medicine at Georgetown University in Washington, was part of a group of national prevention experts who prepared policy papers for Partnership for Prevention on how to incorporate disease prevention and health promotion into the health reform legislation being developed by Congress. In one of those papers, he offered an analysis of how we can modernize Medicare’s prevention policies. With the health reform debate about to reach full throttle, we discuss those recommendations. To listen to this podcast, click on the media player below; if you dont' see a media player below, click here.

Soap-sniffing technology that makes sure hospital employees wash their hands was named Partnership for Prevention's "Best Prevention Idea of the Week," while a trend whereby people are cutting back on health care spending to save money 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.


Soap-sniffing technology encourages hospital staff to wash hands

Using sensors capable of detecting drugs in breath, new technology developed at University of Florida monitors health-care workers' hand hygiene by detecting sanitizer or soap fumes given off from their hands. By reminding workers to clean their hands to remove disease-causing organisms such as the bacteria MRSA, the system could help reduce hospital-acquired infections and save millions of dollars now spent to treat them.


More people skimping on health care to save money

In a recent survey, 73 percent of doctors said more patients are cutting prescription dosages to save money, while 60 percent say they have seen more health problems caused by patients skipping preventive care and 58 percent report more canceled appointments.

As Congress tackles health reform, a new public education campaign by Partnership for Prevention notes that more than 100,000 lives could be saved every year by investing in five basic preventive services. That includes 45,000 deaths that would be prevented each year if people who could benefit were advised by their doctors to take a daily dose of aspirin to prevent heart disease and 42,000 lives that could be saved a year if doctors offered tobacco cessation counseling.

A print ad in Roll Call, a popular Capitol Hill newspaper, this week asks members of Congress - “If You Could Save 100,000 Lives, Would You Do It?” It spells out how increasing the widespread use of just five services available through a doctor’s office – aspirin counseling, tobacco cessation counseling, adult influenza immunization, colorectal screening, and breast cancer screening - would save an estimated 117,600 additional lives a year.

More information is available online at www.prevent.org/healthreform . Partnership has also launched a "How to Save 100,000 Lives" interactive quiz for Facebook at http://tinyurl.com/100kquiz.

Friday, June 5, 2009

Researchers from Harvard Medical School have led the development of a prototype "return on investment calculator" that can measure the value of prevention services. Using a Boston-based mobile health program called the "Family Van" to test the tool, the team found that for the services provided in 2008, this program, in the long run, will return $36 for every dollar invested.

The researchers used published data from Partnership for Prevention's National Commission on Prevention Priorities (NCPP), which assigns values to a broad array of preventative practices, as well as published data on the cost-savings of preventing avoidable emergency room visits, the team developed an algorithm that "calculates" a return on investment ratio, thereby quantifying the value of mobile health care to the overall health care system.

Lessons from the Pandemic Flu Outbreak

Trust for America’s Health (TFAH), has released a report detailing 10 early lessons from the recent H1N1 outbreak, as well as 10 core areas that must be addressed to strengthen U.S. preparedness for future potential flu outbreaks and other national health emergencies.

The World Health Organization recommended on Friday that oral rotavirus vaccines be included in all national immunization programs to avert half a million diarrhoeal deaths and 2 million hospitalizations a year.

CNN reports that Blockbuster movies are less likely to portray smokers than they have in the past, according to a new study. What's more, this decline in on-screen smoking may have occurred in tandem with a drop in the number of adolescents who have lit up in real life.

Prenatal Visits to Family Physicians Declining

Of 244.5 million prenatal visits made between 1995 and 2004, the percentage made to family physicians decreased from 11.6 percent in 1995-96 to 6.1 percent in 2003-04, says a recent study published in the Annals of Family Medicine. The percentage of visits made to FPs in rural areas fell even more drastically during that period, from 38.6 percent to 12.9 percent.

Tuesday, June 2, 2009

Senate to Move on Health Reform "Within Weeks"

CQ reports that President Obama told Democratic members of the two Senate committees in charge of health care legislation that completing an overhaul of health care is “not a luxury” and that the period from now to August is the “make or break period.”

With that in mind, CQ says, Senate Democrats intend to move a single health care bill to the floor within weeks.

For the first time in our nation’s history, today’s generation of children may well live sicker, shorter lives than their parents. To improve America’s health, we need to understand why, across social boundaries and in every community, so many Americans are getting sick in the first place.

To answer that question, the Robert Wood Johnson Foundation Commission to Build a Healthier America spent the last year and a half investigating the powerful influence that factors beyond health care – where we live, learn, work and play – have on our health. As staff director, I had the privilege of joining the diverse group of commissioners in talking with experts, leaders and citizens across the country as the commission developed its recommendations.

We have good news: From business to government and at all levels of society, leaders and citizens are collaborating to remove obstacles that prevent people from making healthy choices. Where communities have mobilized to improve their health, we found grocery stores well-stocked with nutritious food, streets that were safe to walk, housing that was maintained, workplaces that promoted wellness, and a commitment among schools, child-care centers and parents to give all children in the community a chance to grow up healthy.

The commission released its recommendations in April to highlight these local successes. But the commission did not stop at identifying programs and policies and learning why they work. As Partnership for Prevention understands well, great ideas will go nowhere without equal efforts to educate decision-makers and engage stakeholders towards action. To that end, the commission is actively facilitating collaboration across communities, businesses, unions, philanthropies, and local, state and federal governments to help bring the recommendations to life.

Specifically, the commission recommends:

  • Making education and high-quality child care a national priority

  • Banning junk food in schools. Federal funds should be used exclusively for healthful meals

  • Getting kids moving. All schools (K-12) should include at least 30 minutes every day for children to be physically active

  • Eliminating so-called food deserts. Create public-private partnerships to open grocery stores in communities without access to healthful foods

  • Creating incentives for healthy, safe development by assigning a health impact rating to housing and infrastructure projects

  • Providing employees opportunities to make healthy choices in the workplace

  • Protecting us all from tobacco smoke. Eliminating smoking remains one of the most important contributors to longer, healthier lives

You can read all the recommendations and learn more about model programs at commissiononhealth.org.

Building a healthier America is feasible in years, not decades, if we collaborate and act on what is making a difference. I encourage you to read the commission’s recommendations and to do your part to make America’s health a place of progress once again.

Dr. David R. Williams is a Professor of Public Health at the Harvard School of Public Health and the Staff Director for the Robert Wood Johnson Foundation Commission to Build a Healthier America.

Atul Gawande has an incisive piece in The New Yorker on what accounts for the vast differences in per capita Medicare spending in different parts of the country. He focuses on McAllen, Texas, where the average annual Medicare expenditure per patient exceeds the average annual income and is double that of Medicare spending in El Paso County, Texas - even though the demographics and treatement facilities are roughly equal and the quality of health care is ranked lower in McAllen than in El Paso County.

Basically, Gawande concludes that the situation in McAllen and many areas with extremely high costs is attributable to an "across-the-board overuse of medicine" fueled by a local economic culture that "came to treat patients the way subprime-mortgage lenders treated home buyers: as profit centers."

At the same time, he says, "patients in high-cost areas were actually less likely to receive low-cost preventive services, such as flu and pneumonia vaccines, faced longer waits at doctor and emergency-room visits, and were less likely to have a primary-care physician. They got more of the stuff that cost more, but not more of what they needed."

Monday, June 1, 2009

NEWSWEEK Slams the Oprah Effect

NEWSWEEK delivers a scathing assessment of much of the health advice delivered on Oprah Winfrey's megapopular talk show. The TV diva's influence is such that she can drive millions of women to pursue better health, but Weston Kosova and Pat Wingert write that "...the truth is, some of what Oprah promotes isn't good, and a lot of the advice her guests dispense on the show is just bad."

"Some of the many experts who cross her stage offer interesting and useful information... Others gush nonsense," they write. "Oprah, who holds up her guests as prophets, can't seem to tell the difference. She has the power to summon the most learned authorities on any subject; who would refuse her? Instead, all too often Oprah winds up putting herself and her trusting audience in the hands of celebrity authors and pop-science artists pitching wonder cures and miracle treatments that are questionable or flat-out wrong, and sometimes dangerous."'

Kosova and Wingert single out for criticism recent appearances on Oprah's show by actress Suzanne Somers to hawk hormone replacement therapy and by Playboy pinup Jenny McCarthy to denounce child vaccines as a cause of autism.

NYT Blasts Tobacco as "Rogue Industry"

The New York Times didn't mince words in an editorial over the weekend urging Senate passage of a bill giving the FDA the power to regulate tobacco. It declared tobacco manufacturers "a rogue industry," a judgment it said is borne out by a recent court of appeals ruling against those manufacturers.

"The decision makes it clear that the tobacco companies have engaged in deceitful and harmful behavior for many decades and cannot be trusted to reform on their own," the editorial declared. "Regulatory oversight is the best chance to rein them in."

The signing of a smokefree law in America's "tobacco capital" was named Partnership for Prevention's "Best Prevention Idea of the Week," while a New York bottle bill that would reward makers of noncarbonated beverages containing sugar 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.


Smoke-Free Law Signed in Tobacco Capital


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. Fortunately, a federal judge has delayed implementation of the law until April 1, 2010.


NY Bottle Bill Bites


Instead of requiring deposits for all new beverage categories, New York's new bottle law covers bottled water only, and exempts all noncarbonated beverages that contain added sugar. That means it will encourage millions of New Yorkers, and especially price-sensitive populations like the poor and children, to consume sugar-spiked beverages like teas and sports drinks instead of water.

The more than 2,600 YMCAs of the USA are not only the largest not-for-profit community service organizations in the United States; they also are collectively the nation’s largest providers of health and well-being programs, serving 21 million children and adults of all ages, races, faiths, backgrounds, abilities and income levels. The YMCAs have committed themselves to providing community preventive services that encourage healthy lifestyles. In some cases, they've proven an ability to deliver those services effectively at a fraction of the normal cost. On this show, we’re discussing their programs with Katie Clarke Adamson, Director of Health Partnerships and Policy for YMCA of the USA. To listen the podcast, click on the media player below; if you do not see a media player, click here.