Prevention Matters

The passage of the Affordable Care Act created a renewed emphasis on community prevention and population health. With the Prevention and Public Health Fund and the Community Transformation Grants, resources are now available to improve the health of communities around the country. But how do you know how healthy your community is?

On Wednesday, the Robert Wood Johnson Foundation (http://www.rwjf.org/) and the University of Wisconsin Population Health Institute (http://uwphi.pophealth.wisc.edu/) released the 2011 County Health Rankings (http://www.countyhealthrankings.org/). The County Health Rankings are a key component of the Mobilizing Action Toward Community Health (MATCH) project—a nationwide call to action for improving community health—first released last year. The rankings generate 50 state reports, ranking each county within the 50 states according to its health outcomes and the multiple health factors that determine a county’s health. The four different types of health factors are health behaviors, clinical care, social and economic factors, and the physical environment. Specific county-level data (as well as state benchmarks) are also available. The Rankings are built on America’s Health Rankings, an annual comprehensive assessment of the nation’s health on a state-by-state analysis, which is published jointly by United Health Foundation, the American Public Health Association and Partnership for Prevention.

Many counties around the country have used the Rankings to implement strategies and initiate interventions to positively influence health factors and improve their health outcomes. One specific example is Wyandotte County, Kansas, where Mayor Joe Reardon worked with other local stakeholders to create a Healthy Communities initiative after seeing his state’s low rank in last year’s County Health Rankings report.

A new development with this year’s Rankings is the launch of an innovative tool, the County Health Calculator (http://chc.humanneeds.vcu.edu/). The calculator is a new interactive online application that simulates the affect of higher levels of education and income on health in a county. It was developed by Center of Human Needs at Virginia Commonwealth University (http://humanneeds.vcu.edu/) with funding by Robert Wood Johnson Foundation.

Read more on Partnership’s community prevention efforts here.

Only one year after the landmark legislation was signed, the Affordable Care Act (ACA) is already improving women’s access to high quality, affordable health care. When the law is fully implemented in 2014, it will signify the greatest leap forward for American women’s health in decades.

New protections for women under the ACA include:

• Improved Access to Affordable Coverage: Under the ACA, adolescents and young adults up to age 26 may now remain on their families’ plans. Due to substantial new tax credits, more small businesses are now offering health care coverage to their employees. And beginning in 2014, expanded Medicaid eligibility means improved access to healthcare coverage for lower income women and families.
• Free Preventive Care: Under the ACA, women receive recommended preventive services without copayments or deductibles. This includes U.S. Preventive Services Task Force A- and B-rated services such as mammograms, screenings for cervical cancer and chlamydia, prenatal care and more.
• The End of Gender-Based Discrimination: Before the ACA, women could be charged higher premiums than men for the same insurance policy. Beginning in 2014, it will be illegal for insurance companies to charge women higher premiums on the basis of gender.
• Being a Woman is No Longer a Pre-Existing Condition: Before the ACA became law, insurers could deny women coverage for “pre-existing conditions” such as pregnancy, Cesarean sections, and breast cancer. Beginning in 2014, insurers cannot deny coverage to anyone based on pre-existing conditions. Already under the ACA, children cannot be denied coverage because of pre-existing conditions.
• The End of Lifetime Limits: Under the ACA, insurance companies cannot place a lifetime limit on the amount of coverage an individual receives. Beginning in 2014, annual limits are banned as well.

For more information about the important rights and benefits the ACA provides for women and their families, see healthcare.gov’s new page on Women and the Affordable Care Act.

The U.S. Food and Drug Administration Tobacco Products Scientific Advisory Committee (TPSAC) recently concluded that the “removal of menthol cigarettes from the marketplace would benefit public health in the United States.”  This recommendation to the FDA is based on prevailing science surrounding menthol cigarettes.  Although menthol cigarettes do not contain more toxins, they increase the number of young people who try cigarettes and the number of children who become regular smokers, increasing overall youth smoking.  Menthol cigarettes have also been found to be more appealing to African-Americans and therefore contribute to higher smoking rates and decreased cessation among this population.

The TPSAC final report is set to go through a systematic review by experts from the FDA Center for Tobacco Products.  They are to take into account menthol cigarettes’ risks and benefits to the population, effects on overall smoking initiation and cessation rates, achievability, and consequential effects that may arise, such as demand for contraband.  The FDA intends to provide its first progress report on the review in about 90 days.

Partnership for Prevention supports the TPSAC’s recommendations and urges the FDA to take action to ban menthol to curb the uptake of smoking by youth and promote cessation among other high-risk groups.  The tobacco industry’s incessant marketing of menthol cigarettes to youth, African Americans and other communities are threats to the public’s health.  We are hopeful that the FDA will recognize the harmful impact of menthol cigarettes on the health of the nation and employ the committee’s advice.

Harmeet Singh
Tobacco Control Team

The Affordable Care Act (ACA) will celebrate its one year anniversary March 23, 2011. Signed into law last year, the ACA puts into place comprehensive health insurance reforms designed to lower health care costs by enhancing the quality of health for all Americans.

The ACA’s small business provisions focus on finding ways for business owners to reduce their heath care costs by ensuring their employees have access to quality, affordable health insurance.

Small business provisions include:

• Small Businesses with fewer than 25 full time employees may qualify for the business tax credit.
• Employer-based health plans that provide health insurance to retirees aged 55-65 can get financial help through the Early Retiree Reinsurance Program.
• Insurance companies will no longer be able to deny individuals with a pre-existing condition, who may now be eligible to join the Pre-Existing Condition Insurance Plan.
• Employees can receive recommended preventive services like mammograms and flu shots without any additional cost to the employee.
• Insurance companies are prohibited from capping the dollar amount of care an employee can receive in a lifetime, or dropping coverage due to a mistake on your application when you get sick.
• Insurance companies must spend at least 80% of premium dollars on healthcare.

Currently four million small business owners have been able to claim a tax credit up to 35% of their health insurance costs. But tax credits are not the only benefit for small business owners. By 2014, small businesses will be able to increase their buying power through state-based health insurance marketplaces. Employers will be able to identify health insurance plans that better meet their needs. The ACA has allowed small business employers to provide health benefits to their employees.

Throughout this week the Small Business Majority will host a series of roundtables and webinars designed to better understand what the ACA has meant to small businesses. Today, the Secretary of the U.S. Dept of Health and Human Services, Kathleen Sebelius will kick off the series in Ohio. The Secretary will join The Consortium of African American Organizations and the National Policy Director of the Small Business Majority. 

Healthy People 2020, the U.S. Department of Health and Human Services' master plan for improving the health of the American population over the next decade, covers 42 topics and nearly 600 objectives.  A new report from the Institute of Medicine singles out 12 indicators as immediate, major health concerns that should be monitored and 24 objectives that warrant priority attention in the plan's implementation. 

The report updates and expands on the 10 leading health indicators that served as priorities for Healthy People 2010.  The recommendations on what should be the priorities for the latest version of this decadal health plan reflect the consensus of a committee comprising population health experts, epidemiologists, health statisticians, and others.  Indicators provide yardsticks that health experts and policymakers can use to measure progress, and objectives set out clear, concrete goals for improvements. 

The 12 recommended indicators include measures of access to care and quality of health care services, healthy behaviors, injury, physical and social environments, chronic disease, mental health, responsible sexual behavior, substance abuse, tobacco use, and healthy births.

The 24 objectives that the committee identified are:

•      Increase educational achievement of adolescents and young adults.
•      Increase the proportion of people with health insurance.
•      Increase the proportion of people with a usual primary care provider.
•      Increase the proportion of people who receive appropriate evidence-based clinical preventive services.
•      Reduce the overall cancer death rate.
•      Reduce the number of days the Air Quality Index exceeds 100.
•      Increase the proportion of children who are ready for school in all five domains of healthy development: physical development, social-emotional development, language, cognitive development, and approaches to learning.
•      Reduce pregnancy rates among adolescents.
•      Reduce central-line-associated bloodstream infections.
•      Improve the health literacy of the population.
•      Reduce coronary heart disease deaths.
•      Reduce the proportion of people with hypertension.
•      Increase the proportion of sexually active people who use condoms.
•      Reduce fatal and nonfatal injuries.
•      Reduce the proportion of people who experience major depressive episodes.
•      Reduce low birth weight and very low birth weight.
•      Reduce the proportion of obese children and adolescents.
•      Reduce consumption of calories from solid fats and added sugars by people age 2 and older.
•      Increase the proportion of adults who meet current federal guidelines for aerobic physical activity and for muscle-strengthening activity.
•      Reduce the proportion of people engaging in binge drinking of alcoholic beverages.
•      Reduce past-month use of illicit substances.
•      Increase the proportion of adults who get sufficient sleep.
•      Reduce tobacco use by adults.
•      Reduce the initiation of tobacco use among children, adolescents, and young adults.

Partnership for Prevention is pleased to learn that in only two months over 150,000 Medicare beneficiaries have received the annual wellness visit authorized in the Affordable Care Act (ACA). This good news comes on the heels of an HHS report earlier this week indicating that those over 65 are not getting the preventive services they need.  Click here for HHS news release.

The ACA requires a health risk assessment (HRA) for Medicare beneficiaries to assist in developing personalized prevention plans. Partnership has been working with the Centers for Disease Control and Prevention (CDC) and the Centers for Medicaid and Medicare Services (CMS) to develop guidance for implementing this important tool. Specifically, Partnership organized and helped lead a Public Forum meeting in response to a Federal Register Notice for public comments and submitted, with Thomson Reuters, a report that CDC will use to inform CMS on the development of guidance for the HRA.

For additional information about Partnership’s work on the annual wellness visit and HRA, please click here or contact Jason M.M. Spangler, MD, MPH, FACPM, Chief Medical Officer, Partnership for Prevention, jspangler@prevent.org.

Adults over the age of 65 are not getting the preventive services that they need, according to a report released by the Department of Health and Human Services on Monday. The report found that preventive services, including vaccinations, tobacco cessation, and screening for cancer, diabetes, lipid disorders, and osteoporosis are underutilized. The report emphasizes that adults over 65 should be taking advantage of preventive services on a regular basis, and notes that many beneficiaries don’t know what services are covered by Medicare.

As a provision of the Affordable Care Act, certain USPSTF A and B recommended preventive services are covered without cost sharing by Medicare patients. In order to promote uptake of preventive services, including those services that are currently underutilized, Medicare has instituted an annual wellness visit. The wellness visit will allow Medicare beneficiaries access to preventive services on a regular and continued basis. It will be based on a detailed Health Risk Assessment (HRA), which allows patients and providers to create a personalized prevention plan. Partnership for Prevention, along with the CDC, has assisted the Centers for Medicare and Medicaid Services (CMS) in the effort to design and implement the HRA by interviewing and convening a group of HRA experts.

Medicare coverage, along with outreach and education for the annual wellness visit, will help to bring awareness to the need for and use of preventive services for those over the age of 65.


Rebecca Doigan, MPH
Research Fellow and Program Associate

As one of the most popular sports in the United States, baseball is a highly integral and influential part of American culture today. Unfortunately, tobacco companies thrive on Major League Baseball players, who are the most prominent spokesmen for smokeless tobacco. The very heroes that many people, especially young kids, look up to are conveying a dangerous message that promotes a behavior that leads to mouth diseases, cancers, and heart attacks.

Despite the sufferings of Babe Ruth and Tony Gwynn with cancer, MLB players, coaches, and managers continue to chew tobacco all season long. It doesn’t seem like a coincidence that smokeless tobacco use among high school boys has increased by 36% in the past seven years.

In a January article in the Washington Post, Washington Nationals superstar pitcher Stephen Strasberg recalls how he began using smokeless tobacco as a teenager to better emulate the ballplayers he idolized. Strasberg is attempting to quit tobacco and his goal was to be tobacco free by spring training. Not only is Strasberg quitting because of the many health risks associated with tobacco use, but he also doesn't want kids who want to be like him to see him chewing.

The Campaign for Tobacco Free Kids and nine supporting organizations are calling upon MLB and the Players Association to ban all tobacco use on the field and in the dugout in their upcoming contract negotiations. The contract to be signed will be in place for five seasons, so taking action now is crucial.

Tobacco use has already been banned in the minors, the NCAA and the National Hockey League. It is time that MLB does the same.

Join the Campaign’s efforts to Knock Tobacco Out of the Park by sending a message to Major League Baseball denouncing smokeless tobacco.


Harmeet Singh
Tobacco Control Team

"Best and Worst News for Prevention” is based on a purposive sample consisting of expert staff members who each week choose to share their opinions on the best and worst news for prevention.

BEST

Doctors Urge Indoor Tanning Ban for Minors

U.S. tanning salons should close their doors to minors to protect them from skin cancer, a group of 60,000 pediatricians said Monday in a new policy statement. With the move, the American Academy of Pediatrics joins the World Health Organization (WHO), the American Academy of Dermatology and other groups that are already pushing for a ban. Since 2009, the International Agency for Research on Cancer, a part of the WHO, has classified tanning beds as cancer-causing. Research shows people who start going to tanning salons before age 35 have a 75-percent increase in their chances of developing melanoma, the deadliest type of skin cancer.

WORST

Smoking Linked to Infant Heart Defects


A pregnant woman who smokes in her first trimester is much more likely to have an infant with a congenital heart defect, U.S. health officials say.  A study by the Centers for Disease Control and Prevention in Atlanta found tobacco exposure is associated with a 20 percent to 70 percent increased risk of certain types of defects such as those that obstruct the flow of blood from the right side of the heart into the lungs and openings between the upper chambers of the heart.


The “Best and Worst” awards are announced each week in “Prevention Matters,” the blog of Partnership for Prevention. "Best and Worst News for Prevention” is based on a purposive sample of expert staff members who each week choose to share their opinions on the best and worst news for prevention. More information is available at http://www.prevent.org/.