Prevention Matters

Few would argue the importance of increasing funding for community prevention. That’s the reason prevention advocates were so delighted Congress established a Prevention and Public Health Fund to “provide for expanded and sustained national investment in prevention and public health programs to improve health and help restrain the rate of growth in private and public sector health care costs.” The fund makes available $500 million in new spending in FY2010; the fiscal year ending September 30. There is a tough decision ahead to spend a great deal of money in a short period of time.

There are many worthy ideas vying for DHHS Secretary Kathleen Sebelius’ attention. She is the official charged by the new law in allocating the funds “for prevention, wellness and public health activities…”

How should the Secretary make the initial trust fund allocation given that so many deserving programs are asking for a slice from the pie?

In an Op Ed (“The Prevention Dilemma”) written for Kaiser Health News, Partnership for Prevention CEO, Dr. Robert Gould, answers the tough question.

“There will never be enough federal money to address every prevention need. What the secretary needs to decide is whether there is sufficient political courage to concentrate early prevention funding to deliver a knockout blow to the leading cause of premature death in the country? … The criteria for prioritizing this specific funding should be simple: what are the evidence-based programs that are primed and ready to go, that are proven to work, that we know will move us toward a healthier society and that we can be sure will deliver a large, measurable return on investment? By these criteria, the top priority for prevention spending should be tobacco control.”

Gould recommends DHHS focus their resources on three well tested, evidence-based components::

1) Nationwide public education campaign modeled on the highly successful Truth® campaign that dissuades thousands of young people from initiating tobacco use and encourages smoking cessation;

2) Fully funding quit lines that provide direct cessation services and significantly improve quit rates efficiently and effectively, especially among disadvantaged populations served by Medicaid; and

3) Support for existing state and community-based tobacco control programs that reach people where they live, work, play and worship.”

The Partnership leader believes the goal of this potentially historic investment is simple and most important, achievable.. Gould concludes:

“If community-based tobacco control programs could be brought to scale nationally, we have a genuine opportunity to drive smoking rates into single digits. The rapid and enduring payoff, in lives and money saved, is there for the taking. It’s a rare opportunity. I urge Secretary Sebelius to seize it.”

Sounds like good advice. Do you agree?

Ripley Forbes
Director, Government Affairs
Partnership for Prevention

The Environmental and Energy Study Institute, (EESI) held a Congressional briefing on May 24, 2010 that highlighted the important health choice Congress will need to consider as it debates a pending, multiyear reauthorization of Federal transportation spending. The briefing featured a presentation by Jonathan Patz, MD, MPH, professor and director of Global Environmental Health, University of Wisconsin, who spoke of the direct impact on public health that results from climate change; specifically the role that transportation policy plays in healthy/unhealthy air and lifestyles. While its well known that air pollution can cause respiratory diseases such as chronic obstructive pulmonary disease and asthma, Patz told congressional staffers that poorly planned transportation policies have a morbidity and mortality rate significantly higher than the conventional associations with automobile and pedestrian accidents.

In addition to extensive health consequences resulting from air pollution, Patz argued that transportation decisions are significant factors contributing to the nation’s obesity epidemic due to community designs that foster inactivity and chronic disease. Chronic diseases, such as diabetes, obesity, heart disease and cancer, are an inevitable result of a unhealthy lifestyle. Patz noted that nearly half of all car trips are less than two miles long, and a significant number could be reduced through investments and incentives in alternative transportation methods; especially investments such as mass transit, community design and other policies that reduce reliance on private automobiles and increase walking and other forms of physical activity. Whats the bottom line? While organizations like the American Public Health Association have persuasively argued that “climate change is a public health issue” Dr. Patz's presentation included a powerful image (see below) illustrating how simple policies can hinder or enhance a physically active lifestyle.

Dr. Jonathan Patz's complete presentation is available on the Environmental and Energy Study Institute website.

Amy Himmelstein
Policy and Program Intern
Partnership for Prevention

Food companies committing to take 1.5 trillion calories out of their products by 2015 was named the “Best Prevention Idea of the Week,” while teens mistaking smokeless tobacco products for candy was named the “Worst Prevention Idea of the Week."

The “Best/Worst” awards are announced each week in “Prevention Matters,” the blog of Partnership for Prevention. Nominees are submitted by Partnership staff as well as the general public, and are voted on by the staff. Partnership for Prevention is a nonpartisan organization of business, nonprofit and government leaders who are working to make evidence-based disease prevention and health promotion a national priority. More information is available at http://www.prevent.org/.

BEST

Food makers to trim 1.5 trillion calories

Several of the nation's largest food companies say they will take 1.5 trillion calories out of their products by 2015 in an effort to reduce childhood obesity.

The companies made the announcement through the Healthy Weight Commitment Foundation, a coalition of retailers, food and beverage manufacturers and industry trade associations. They pledged to reduce the calories as part of an agreement with a group of nonprofit organizations concerned with childhood obesity, first lady Michelle Obama said last Monday.

WORST

One out of Three Teens Mistook Smokeless Tobacco Products for Candy


According to a survey administered by the Virginia Foundation for Healthy Youth, one out of three teenagers younger than 18 mistakenly identified a new type of smokeless tobacco product as candy or gum. The survey of about 1,400 Virginia residents, including 728 younger than 18, asked them to identify package images for several types of new, smokeless tobacco products, as well as package images of mints and gums. About 39 percent of the respondents younger than 18 identified Camel Orbs, an oral tobacco product that dissolves in the mouth and delivers nicotine to the user, as mints or gum. Of the teenagers younger than 18 surveyed who do not currently use tobacco, 27 percent said they would try Camel Orbs based on packaging alone.

Why do people fighting against schizophrenia die so much earlier than the population at large? The answer may surprise you. And it’s related to tobacco cessation.

In a study published this month in the journal Addiction, researchers have determined that treatment for smoking dependence is as effective among people with severe mental illnesses as it is for the general population. Historically, the problem has been that many in the medical community have opted not to treat tobacco addiction in this population for fear of worsening their patients’ mental health. However, this study concluded that offering such treatments does not appear to cause deterioration in mental health. It also found that pharmaceutical and behavioral treatments doubled the probability of quitting among these patients, whose smoking rates are two to three times higher than average.

Professor Simon Gilbody from the University of York & Hull York Medical School, who co-authored the review, commented that “schizophrenia is a devastating condition which causes people to die 25 years earlier than the rest of the population. This is a huge health inequality, and it is largely due to smoking-related illness rather than schizophrenia itself.”

Dr Lindsay Banham, who led the review, added “what this review suggests is that quit-smoking treatments like nicotine replacement therapy may work just as well for people with disorders like schizophrenia. Smoking by those with severe mental illness has largely been ignored and people with schizophrenia are not consistently offered treatment or services. We found evidence that smoking cessation treatments are effective and safe. We hope our research leads to better services for this neglected population.”

David A. Zauche
Senior Program Officer
Partnership for Prevention

The Department of Health and Human Services’ Office of Inspector General (IG) has just released a new report (OEI-05-08-00520) concluding that “Most children in nine selected States are not fully benefiting from Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) comprehensive screening services.”

For anyone concerned about the importance of expanding coverage for clinical preventive services under health reform, this report is a reminder that coverage alone isn’t enough to assure access.

The EPSDT program provides “a comprehensive and preventive child health program for children under the age of 21. Every State Medicaid program must offer the EPSDT benefit…In 2007, 31.5 million children were eligible for EPSDT…Services provided under the EPSDT benefit are intended to screen, diagnose, and treat children eligible for EPSDT services at early, regular intervals to avoid or minimize childhood illness. The EPSDT services cover four health-related areas: medical, vision, hearing, and dental. This study focused on medical, vision, and hearing screenings. Only medical screenings have components specifically required by the statute. Complete medical screenings under the EPSDT benefit must include the following five age-appropriate components: a comprehensive health and developmental history, a comprehensive unclothed physical examination, appropriate immunizations according to age and health history, appropriate laboratory tests, and health education.

States selected for the review included Arkansas, Florida, Idaho, Illinois, Missouri, North Carolina, Texas, Vermont and West Virginia.

The IG found that two primary factors contributed to children not receiving required screenings.

First, children did not receive the correct number of each type of screening. Second, when children received medical screenings, the screenings were often incomplete. These two factors taken together indicate that very few children received the correct number of complete screenings required by law.

Seventy-six percent of children, or 2.7 million children, in the States selected for the review did not receive all of the required number of medical, vision, and hearing screenings. Forty-one percent of children did not receive any required medical screenings. In addition, more than half of children did not receive any required vision or hearing screenings.

Fifty-five percent of children in the nine States received a medical screening during the study period. Of these children, 59 percent lacked at least one component of a complete medical screening. The component that children were missing most often was appropriate laboratory tests.

Officials from all nine selected States identified strategies to improve participation in the EPSDT and the completeness of medical screenings. The disconnection between States’ efforts to improve the EPSDT program and the low number of children receiving required screenings is difficult to account for, but it indicates that additional efforts are required.

Based on these findings, the IG recommended that CMS: (1) require States to report vision and hearing screenings, (2) collaborate with States and providers to develop effective strategies to encourage beneficiary participation in EPSDT screenings, (3) collaborate with States and providers to develop education and incentives for providers to encourage complete medical screenings, and (4) identify and disseminate promising State practices for increasing children’s participation in EPSDT screenings and providers’ delivery of complete medical screenings.

New requirements under Health Reform will require expanded coverage of clinical prevention services under Medicare and new individual and group private plans. To realize the benefits of these services it is essential the Administration require that new coverage be accompanied by effective strategies and resources to encourage participation.

E Ripley Forbes
Director, Government Affairs
Partnership for Prevention

On May 20th, Partnership for Prevention’s work on the National Chlamydia Coalition (NCC) was showcased as part of the Center for Disease Control and Prevention’s (CDC) monthly Public Health Grand Rounds series. The session, entitled "Chlamydia Prevention: Challenges and Strategies for Reducing Disease Burden," featured presentations from active NCC members Dr. Gail Bolan, State STD Director for California and Dr. Gale Burstein, a pediatrician representing the Society of Adolescent Health and Medicine. Dr. Burstein’s presentation highlighted two of the NCC’s publications and outlined our activities aimed to increase chlamydia screening. The CDC’s Dr. Raul Romaguera’s presentation listed the NCC as one of four key partners working with the CDC to reduce chlamydia rates.

Alana Ward
Program Associate
Partnership for Prevention

A policy statement released by the Committee on Substance Abuse for the American Academy of Pediatrics recommends that doctors screen all of their young patients, beginning in middle school, about their use of alcohol.

"A remarkable amount of brain development is still occurring for young people through their 20s," said report lead author Patricia Kokotailo of the University of Wisconsin School of Medicine and Public Health. "This policy statement provides better evidence about how alcohol affects the brains of young people and why it is important to screen children."

The revised policy states that "pediatricians should be knowledgeable about substance abuse to be able to recognize risk factors for alcohol and other substance abuse among youth, screen for use, provide appropriate brief interventions, and refer to treatment."

Committee chair Janet Williams of the University of Texas Health Science Center at San Antonio said that most doctors don't routinely ask about youth alcohol use, and need to know how to provide prevention guidance and where to refer young drinkers to treatment.

Christianne Johnson
Program Manager
Partnership for Prevention