Issue Category: Child and School Health

Trust for America’s Health Releases “Blueprint for a Healthier America” Report Featuring High-Impact Policies for the Next Administration and Congress

Washington, D.C., October 19, 2016 – Today, the Trust for America’s Health (TFAH) released Blueprint for a Healthier America 2016: Policy Priorities for the Next Administration and Congress which calls for a new approach to health – prioritizing improving health and addressing major epidemics in the United States.

“It’s time for a sea change from our current sick care system to a true health system, where we focus on preventing disease and improving quality of life,” said Richard Hamburg, Interim CEO and President of TFAH.  “In the Blueprint, we highlight high-impact policies that could help spare millions of Americans from preventable health problems and save billions in avoidable healthcare costs – if we make them a priority.” 

The report highlights pressing crises and how investments could yield positive returns on investment by adopting proven health strategies.  For instance:

  • Investing $1 in substance use prevention to realize as much as $34 in return.  Deaths from prescription painkiller use have more than quadrupled in the last 15 years and deaths from heroin have tripled since 2010, contributing to higher death rates among middle-aged Whites.  Five of the strongest school-based substance use prevention strategies have returns on investment ranging from $3.8:1 to $34:1.
  • Saving more than $16 billion through a more active and healthy population. One in three children will develop type 2 diabetes in their lifetime and one in four young adults are not healthy enough to join the military.  An investment of $10 per person in proven, evidence-based community prevention programs to increase physical activity, improve nutrition and reduce tobacco use could save the country more than $16 billion annually – a $5.60:1 return.
  • Connecting health and social services to cut billions in costs.  Health and social service coordinating systems that address gaps between medical care and effective social service programs – by connecting patients in need with programs ranging from supportive housing to food assistance – could yield between $15 billion and $72 billion in healthcare savings a year within 10 years, according to a new analysis by TFAH and Healthsperien.
  • Reducing the $120 billion spent annually on preventable infectious diseases.  Fifteen years after 9/11 and 11 years after Hurricane Katrina, when health crises such as new infectious diseases arise, the country still scrambles to implement emergency plans and secure funding.  Preventable infectious diseases cost the country more than $120 billion annually – and that cost is exponentially compounded when new diseases emerge.
  • Realizing a 7-10 percent annual return by investing in early childhood education. More than half of U.S. children – across the economic spectrum – experience adverse experiences, such as physical or sexual abuse, and more than 20 percent live below the poverty line, which increases their risk for “toxic stress” – living under a constant state of stressful conditions – that can contribute to a range of physical, mental and behavioral health issues.  Investments in early childhood education can help mitigate against impact of these risks and increase resilience, while also providing an annual return of 7 to 10 percent per year, and supportive nurse-family home visits for high-risk families show a return of $5.70:1. 

The Blueprint highlights leading evidence-based strategies for improving health and policy – and models to help bring them to scale across the country. These include:

  • Supporting Better Health in Every Community:  Federal, state and local public health programs and policies should support place-based health improvement partnerships. Doing so will help identify and elevate a local community’s top priorities and bring key partners and assets together – from public health, healthcare, social services, philanthropies, education, businesses and faith and community groups – for a greater collective impact.  A network of expert institutes in each state should provide technical assistance to these multisector collaborative partnerships.  In addition, the Prevention and Public Health Fund and other community-based health improvement programs should be protected and fully funded.
  • Modernizing the Public Health System to Be Prepared for Emergencies:  The public health system must be modernized – and sufficiently funded – so that it can handle ongoing threats and new emergencies. Too often the country has been caught off guard when a new crisis emerges, diverting attention and resources.  There should be 1) greater investment to improve baseline foundational capabilities in communities around the country; 2) a standing Public Health Emergency Fund to provide additional surge funds when needed; 3) improved federal leadership, such as through a Special Assistant to the President for Health Security; and 4) upgrades to out-of-date technology and surveillance systems.
  • Incentivizing Health Care vs. Sick Care:  There should be increased incentives and mechanisms for healthcare insurers, nonprofit hospital community benefit programs and social investment funds to support health improvement strategies.  Efforts such as healthcare investment in community-wide health improvement programs, “navigator plus support” health and social service integration (such as Accountable Health Communities), Community Development Financial Institutions for Health (strategic planning and financing intermediaries) and pay-for-outcome approaches should be expanded.

The report also includes a set of policy recommendations to address priority health problems that require urgent action, some highlight areas include:

  • Stopping the Prescription Painkiller and Heroin Epidemics
  • Renewing Efforts to Prevent Obesity, Diabetes and Tobacco Use
  • Highlighting Prevention in the National Cancer Moonshot Initiative
  • Ending the HIV/AIDS Epidemic
  • Stopping Superbugs and Antibiotic Resistance
  • Lowering the Rising Death Rates Among Middle-Aged Whites
  • Achieving Health Equity

The Blueprint was supported by grants from the Robert Wood Johnson Foundation, the W.K. Kellogg Foundation, The California Endowment and The Kresge Foundation.

Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.

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Trust for America’s Health Announces New President and CEO, John Auerbach

Washington, D.C., October 7, 2016–Today, Trust for America’s Health (TFAH) announced the selection of John Auerbach, MBA, as its new President and CEO.

Auerbach brings more than 35 years of experience as a leader in the public health field – including serving as the Commissioner of the Massachusetts Department of Health, Executive Director of the Boston Public Health Commission, and, most recently, Associate Director for Policy and Acting Director of the Office for State, Tribal, Local and Territorial Support at the Centers for Disease Control and Prevention (CDC).

“John is a true innovator in public health and we cannot be more pleased to have him as the new head of TFAH,” said Gail Christopher, board chair of TFAH and vice president for policy and senior advisor at the W.K. Kellogg Foundation. “His work embodies a transformative approach to improving health – thinking beyond medical care to support opportunities for better health in our daily lives. We share a vision where every American has the chance to be as healthy as they can be.”

At CDC, Auerbach has focused on promotion of public health and prevention as components of healthcare and payment reform and health system transformation. He also oversees key activities and technical assistance that support the nation’s health departments and the public health system.

Previously, he was, from 2012 to 2014, a distinguished professor of practice in health sciences and director of the Institute on Urban Health Research and Practice at Northeastern University.  From 2007 to 2012, he was the commissioner of public health for the Commonwealth of Massachusetts. Under his leadership, the department developed innovative programs to address racial and ethnic disparities, promote wellness, combat chronic disease, and support the successful implementation of the state’s early healthcare reform initiative.  He served as the President of the Association of State and Territorial Health Officials (ASTHO) in 2010-2011.

Prior to that, Auerbach was the executive director of the Boston Public Health Commission for nine years during which health equity, emergency preparedness, and tobacco prevention became priorities. In addition to Boston’s public health programs, he oversaw its emergency medical, homeless, and substance abuse services.  Throughout his tenure as the city commissioner, Auerbach served as a member of the Board of Directors at the National Association of County and City Health Officials (NACCHO).

Earlier in his career Auerbach worked at the state health department for a decade, first as chief of staff and later as an assistant commissioner overseeing the HIV/AIDS Bureau during the early years of the epidemic.  He was a founding member and the second president of the National Association of State and Territorial AIDS Directors (NASTAD).

“I’ve had a lifelong commitment to health and social justice, from the start of my career as a community health worker in one of the earliest community health centers to having the privilege of managing city, state and federal efforts,” said Auerbach.  “We’re in a unique moment to define the next generation of health and healthcare – and I am excited to be joining TFAH and being at the leading edge of efforts to advance the mission of creating a healthier America.”

Auerbach will start in his role January 1, 2017.  TFAH’s previous executive director, Jeffrey Levi, PhD, is now serving as Professor of Health Policy and Management at the Milken Institute School of Public Health at the George Washington University.

Richard Hamburg, who has been Interim President and CEO at TFAH, will be assuming the position of Executive Vice President and Chief Operating Officer.

 

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Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.

Trust for America’s Health Conducts Social Media Awareness Campaign in Support of Emergency Funding for Zika Prevention and Response

September 12, 2016

Washington, D.C., September 12, 2016 –Trust for America’s Health (TFAH) has released the first in a series of creative cartoons and editorials in support of emergency funding to prevent, mitigate and respond to the disastrous effects of Zika.

The first editorial details the price of inaction, concluding that “with broad support from the American people, it’s time for our leaders to decide whether to heed the warnings and invest in solutions now, or leave the country with a devastating bill later.” The first image is available for anyone to use on Facebook, Twitter or other social media platforms.

“Unfortunately, considerable Zika-related damage has already been done to our nation—and it is likely irreversible,” said Richard Hamburg, interim president and CEO of TFAH. “Our nation’s failure to act severely hampers the full response that is greatly needed. However, the sooner we do act, the sooner we can prevent further damage and destruction to our nation’s most vulnerable: our newborns.”

During the next few weeks, TFAH will release additional editorials and cartoons to underscore the urgent need for the nation to provide support for communities to prevent, control and mitigate complications arising from Zika.

“Without additional support, health departments and communities are on their own. Either resources will be shifted from other pressing needs or communities will have insufficient means to perform mosquito testing, infection prevention, disease tracking and other actions to protect against this devastating virus,” said Hamburg.

Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority. www.healthyamericans.org

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Trust for America’s Health Statement on Bipartisan Senate Agriculture Committee Compromise on Child Nutrition Reauthorization

Washington, D.C., January 19, 2016 – The following is a statement from Richard Hamburg, interim president and CEO of the Trust for America’s Health (TFAH), on the bipartisan compromise legislation introduced earlier this week by Senate Agriculture Committee Chairman Pat Roberts (R-KS) and Ranking Member Debbie Stabenow (D-MI).

“The Improving Child Nutrition Integrity and Access Act of 2016 is an important step toward ensuring healthier nutrition for all of the nation’s children.  We applaud the committee leadership and staff for their hard work in achieving a compromise that will build on the important accomplishments that were made in the Healthy, Hunger-Free Kids Act of 2010.

Around 15.5 million children experience food insecurity each year, with their access to adequate food and nutrition limited due to cost, proximity and/or other resources. At the same time, 17 percent of children are obese.  There’s clearly still a lot of work to do to ensure this generation of children receive the support they need to thrive.  In our annual State of Obesity report, TFAH highlights programs and policies at the U.S. Department of Agriculture, U.S. Department of Health and Human Services and in states and localities that can help ensure all children have the chance to grow up with good nutrition.  We know what works – but we need to keep moving forward and increasing support to realize the promise of these efforts.

This bill advances some important improvements by increasing investments in school kitchen equipment, Farm-to-School programs and other programs that help feed kids outside of traditional school settings. Unfortunately, there are some provisions in the bill that are not ideal and deviate from the evidence-base, such as not requiring 100 percent whole grains in school meals. But, on balance, the bill represents continued progress in the right direction.

We urge members of Congress to move forward with markup and embrace the spirit of compromise embodied in this legislation. TFAH stands ready to work with policymakers and partners to help ensure reauthorization legislation is best able to support our children, their families and schools.”

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Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.

TFAH Applauds the Obama Administration for Showing Strong Support for Increased Collaboration between the Health and Education Sectors

Washington, D.C., January 15, 2016 – Trust for America’s Health (TFAH) applauds the Obama Administration for showing strong support for increased collaboration and coordination between the health and education sectors. The following is a statement from Richard Hamburg, interim president and CEO, TFAH and co-chair of the National Collaborative for Education and Health.

“The release of the Healthy Students, Promising Futures toolkit and joint letter from the U.S. Department of Health and Human Services and U.S. Department of Education is an important step in ensuring all of the nation’s children can succeed in school and life.

Healthy children are more prepared to learn, and academic success puts children on track for healthier and more productive lives.  The toolkit importantly recognizes the inextricable link between health and education — and provides communities with ways to take action to help this generation of children thrive.

TFAH, as a co-founder with Healthy Schools Campaign of the National Collaborative for Education and Health, is excited to see real, high-impact opportunities to improve joint outcomes – including through:

  • Ensuring children have health coverage;
  • Expanding reimbursable health services available in schools;
  • Supporting wrap-around case management for at-risk students–including addressing health conditions and exposure to violence or trauma and toxic stress–to remove barriers to learning;
  • Promoting nutrition, physical activity and health education; and
  • Improved assessments of local community needs and building of partnerships across schools, hospitals, public health departments and others to provide services and programs that can better meet those needs.

We look forward to working with the Administration and state and local communities to support greater adoption and implementation of the Healthy Students, Promising Futures opportunities – and continuing to build toward a vision of healthy schools and communities for our children.”

 

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Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.

Report Finds Major Gaps in Country’s Ability to Prevent and Control Infectious Disease Outbreaks

28 States and Washington, D.C. Reach Half or Fewer of Key Indicators

Washington, D.C., December 17, 2015 – A new report released today found that more than half (28) of states score a five or lower out of 10 key indicators related to preventing, detecting, diagnosing and responding to outbreaks. The report, from Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF), concluded that the United States must redouble efforts to better protect the country from new infectious disease threats, such as MERS-CoV and antibiotic-resistant superbugs, and resurging illnesses like whooping cough, tuberculosis and gonorrhea.

Five states—Delaware, Kentucky, Maine, New York and Virginia—tied for the top score, achieving eight out of 10 indicators. Seven states—Idaho, Kansas, Michigan, Ohio, Oklahoma, Oregon and Utah—tied for the lowest score at three out of 10.

“The overuse of antibiotics and underuse of vaccinations along with unstable and insufficient funding have left major gaps in our country’s ability to prepare for infectious disease threats,” said Jeffrey Levi, PhD, executive director of TFAH. “We cannot afford to continue to be complacent. Infectious diseases – which are largely preventable – disrupt the lives of millions of Americans and contribute to billions of dollars in unnecessary healthcare costs each year.”

Some key findings from the Outbreaks: Protecting Americans from Infectious Diseases report include:

  • Healthcare-associated Infections: Around one out of every 25 people who are hospitalized each year contracts a healthcare-associated infection, leading to some 75,000 deaths a year.
    • Only nine states reduced the standardized infection ratio (SIR) for central line-associated blood stream infections (CLABSI) between 2012 and 2013.
  • Childhood Vaccinations: In 2014, there were more than 600 cases of measles and nearly 33,000 cases of whooping cough reported. While more than 90 percent of all U.S. kindergarteners receive all recommended vaccinations, rates are lower in a number of communities and states. More than 28 percent of preschoolers do not receive all recommended vaccinations.
    • 20 states have laws that either exclude philosophical exemptions entirely or require a parental notarization or affidavit to achieve a religious or philosophical exemption for school attendance.
  • Flu Vaccinations: Based on the severity of the strain, the flu can cause 3,000 to 49,000 deaths a year, more than $10 billion in direct medical expenses and more than $16 billion in lost earnings.
    • 18 states vaccinated at least half of their population (ages 6 months and older) for the seasonal flu from Fall 2014 to Spring 2015. The national average is 47.1 percent. Rates are lowest among young and middle age adults (only 38 percent of 18- to 64-year-olds are vaccinated).
  • Hepatitis C and HIV/AIDS: Of the more than 1.2 million Americans living with HIV, almost one in eight do not know they are infected. Hepatitis C infections—related to a rise in heroin and injection drug use from people transitioning from prescription painkillers—increased more than 150 percent from 2010 to 2013.
    • 16 states and Washington, D.C. explicitly authorize syringe exchange programs.
    • 43 states and Washington, D.C. require reporting all (detectable and undetectable) CD4 cell count (a type of white blood cell) and HIV viral load data to their state HIV surveillance program, as of July 2013.
  • Food Safety: Around 48 million Americans get sick from a foodborne illness each year.
    • 39 states met the national performance target of testing 90 percent of E.coli O157 cases within four days (in 2013).
  • Preparing for Emerging Threats: Significant advances have been made in preparing for public health emergencies, including potential bioterror or natural disease outbreaks, since the September 11, 2001 and anthrax attacks. Gaps remain, however, and have been exacerbated as resources have been cut.
    • 36 states have a biosafety professional in their state public health laboratories – which are responsible for helping detect, diagnose and contain disease outbreaks.
    • 15 states have completed climate change adaption plans that include the impact on human health.
  • Superbugs: More than two million Americans contract antibiotic-resistant infections each year, leading in excess of 23,000 deaths, $20 billion in direct medical costs and more than $35 billion in lost productivity.

“America’s investments in infectious disease prevention ebb and flow, leaving our nation challenged to sufficiently address persistent problems,” said Paul Kuehnert, a Robert Wood Johnson Foundation director. “We need to reboot our approach so we support the health of every community by being ready when new infectious threats emerge.”

The Outbreaks report features priority recommendations, including:

  • Increase resources to ensure every state can maintain and modernize basic capabilities – such as epidemiology and laboratory abilities – that are needed to respond to new and ongoing outbreaks;
  • Update disease surveillance to be real-time and interoperable across communities and health systems to better detect, track and contain disease threats;
  • Incentivize the development of new medicines and vaccines, and ensure systems are in place to effectively distribute them when needed;
  • Decrease antibiotic overuse and increase vaccination rates;
  • Improve and maintain the ability of the health system to be prepared for a range of potential threats – such as an influx of patients during a widespread outbreak or the containment of a novel, highly infectious organism that requires specialty care;
  • Strengthen efforts and policies to reduce healthcare-associated infections;
  • Take strong measures to contain the rising hepatitis C epidemic and other sexually transmitted infections, particularly among young adults; and
  • Adopt modern strategies to end AIDS in every state and city.

The indicators represent examples of important capabilities, policies and trends, and were selected in consultation with leading public health and healthcare officials.

Score Summary: 

A full list of all of the indicators and scores and the full report are available on TFAH’s website. For the state-by-state scoring, states received one point for achieving an indicator or zero points if they did not achieve the indicator, with zero the lowest possible overall score and 10 the highest. The data for the indicators are from publicly available sources or were provided from public officials.

8 out of 10: Delaware, Kentucky, Maine, New York and Virginia

7 out of 10: Alaska, California, Maryland, Massachusetts, Minnesota and Nebraska

6 out of 10: Arkansas, Illinois, Iowa, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Vermont, West Virginia and Wisconsin

5 out of 10: Arizona, Colorado, Connecticut, Georgia, Hawaii, Mississippi, Missouri, Montana, Pennsylvania, Rhode Island, Texas and Washington

4 out of 10: Alabama, District of Columbia, Florida, Indiana, Louisiana, Nevada, South Carolina, South Dakota, Tennessee and Wyoming

3 out of 10: Idaho, Kansas, Michigan, Ohio, Oklahoma, Oregon and Utah

 

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Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.

For more than 40 years the Robert Wood Johnson Foundation has worked to improve health and health care. We are striving to build a national Culture of Health that will enable all to live longer, healthier lives now and for generations to come. For more information, visit www.rwjf.org. Follow the Foundation on Twitter at www.rwjf.org/twitter or on Facebook at www.rwjf.org/facebook.

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How an Entire Community Can Come Together to Help Control Asthma

By Karen Meyerson, MSN, APRN, NP-C, AE-C, Manager, Asthma Network of West Michigan

In 1994, a group of concerned health professionals in West Michigan recognized the alarming rise in pediatric asthma morbidity and mortality, locally as well as nationally. Significant disparities are also associated with asthma. For example, asthma deaths in Michigan occur six times more frequently in Black children than in White children. In response, the Asthma Network of West Michigan (ANWM) was formed as a grass-roots coalition with initial funding from the (then) three acute care hospitals and two local foundations.

To reach and improve the lives of the nearly 100,000 people in Western Michigan—24 percent of whom are children—who have asthma, ANWM created a direct service arm of its coalition and implemented a home-based asthma case management program for school-aged children who had uncontrolled asthma. ANWM, believed to be the first grassroots asthma coalition in the nation to receive reimbursement for asthma education and case management services from health insurance plans,  has since expanded its services to adults as well as children under the age of 5.

Our model relies on a few core components: home visits, care conferences and school/daycare visits and social worker services.

Home Visits

Research and common sense says that the environment around a child, particularly the home, is an important factor in preventing and controlling asthma. Consequently, a home visit provides the ideal setting to educate, review medication plans, and help families identify environmental factors that may contribute to the severity of asthma. If there are issues in the home that are triggering asthma attacks, we connect the family to our partner, the Healthy Homes Coalition, that provides environmental remediation.

To help educate families, we send a certified asthma educator—a nurse (at the RN level) or respiratory therapist (at the RRT level)—into the homes of patients for up to a year to perform environmental assessments and teach them about asthma attack trigger identification and avoidance/reduction, medications, proper use of devices and other self-management techniques. The asthma educator’s home visits are typically biweekly for the first three months and then monthly thereafter, as necessary, to provide a continuum of care.

Care Conferences and School/Daycare Visits

Care conferences—which are reimbursable visits—are held with the primary care physician and, if indicated, the asthma specialist soon after a new patient enters the program. These conferences tackle issues surrounding adherence, including psychosocial barriers to asthma management and access to care, and elicit a written asthma action plan, if none exists. If necessary, we provide spacers, a device to use with inhalers, to all patients who do not have them.

School/daycare visits – also reimbursable visits – are conducted in order to educate those caring for the children throughout the day about asthma and the child’s asthma in particular. We share the asthma action plan with staff and discuss asthma triggers in those settings.

Social Work Services

Lastly, we connect patients to our Licensed Masters-level Social Worker’s services (LMSW), which help families link the clinical recommendations they receive in the hospital or at the doctor’s office with the social services in their community. This is a vital service because many of our patients and families typically have multiple stressors, ranging from environmental to financial to socio-legal and LMSWs are uniquely capable of identifying and assisting with this range of problems. By blending social support with clinical support, ANWM makes the appropriate referrals or contacts to financial resources, mental health agencies, food banks, hospitals, landlords and others.

Successes

With this type of intensive, personal care, we have had demonstrated success in controlling asthma and reducing healthcare utilization (including emergency department visits and hospital admissions due to asthma).  Patients often “graduate” from our program after just 6 to 12 months when their asthma control has improved.

When reviewing data over the past 19 years, we find that there have been significant reductions (64 percent) in the number of hospitalizations, days hospitalized for children and emergency department visits (from 60 percent to 35 percent). And, for low-income children with moderate to severe asthma who remained in the original case management study for at least 1 year, we saw an estimated average savings of $1,625 in hospital charges per patient. In total, we estimate the program results in approximately $800 in net healthcare savings per child per year, with a return to society—over two years—of $1.53 for every $1 invested.

We also hear from those we serve. The mother of a 5-year old boy with asthma told us that, “working with the Asthma Network has really made a big difference – his asthma is controlled now.  They gave me education and made sure that I understood what asthma meant…they made me feel like no one was judging me.” Mom added, “I thought he had asthma ONLY when he got sick so I didn’t give him his inhaler until he had symptoms. If I had never had that education, who knows how many more asthma attacks or emergency room visits he would have?”

Another important, but perhaps overlooked success, is merely being paid for our services by health insurance plans. Most similar programs aren’t so lucky to receive reimbursement for their hard work. We get reimbursed by Medicaid managed care plans, Medicare and other commercial insurers. We have also been successful in raising grant funds and community benefit funds from local hospitals.  It takes a lot of different funding streams, braided and blended together, to support our program, even with the insurance reimbursement. The funding is out there, you just need to spend the time to find it and combine the various streams to succeed.

ANWM owes our success to intentional collaborations with local health insurance plans, hospitals and schools, the people and entities helping patients (public health nurses, physician practices, community clinics, and our local healthcare HUB, Health Net of West Michigan) and our unique ability to blend different funding sources

Because of our success, other Michigan coalitions have formed and begun replicating our model—and they have also been successful in securing payment for similar services in their respective communities.

For more than 20 years we’ve worked hard to prevent adverse asthma events among our most vulnerable populations. We wouldn’t have been successful without the network of community resources and funding we’ve been able to marshal – and the ability, through home visits and social work services, to connect families to those services. Asthma cannot be cured, but it can be controlled. Individuals with asthma should expect nothing less.