Issue Category: Obesity/Chronic Disease

New Report Places 25 States and DC in High Performance Tier on 10 Public Health Emergency Preparedness Measures

As Threats Increase, Annual Assessment Finds States’ Level of Readiness for Health Emergencies is Improving in Some Areas but Stalled in Others

February 5, 2020

(Washington, DC) – Twenty-five states and the District of Columbia were high-performers on a three-tier measure of states’ preparedness to protect the public’s health during an  emergency, according to a new report released today by Trust for America’s Health (TFAH). The annual report, Ready or Not 2020: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism, found year-over-year improvement among 10 emergency readiness measures, but also notes areas in need of improvement. Last year, 17 states ranked in the report’s top tier.

For 2020, 12 states placed in the middle performance tier, down from 20 states and the District of Columbia in the middle tier last year, and 13 placed in the low performance tier, the same number as last year.

The report found that states’ level of preparedness has improved in key areas, including public health funding, participation in healthcare coalitions and compacts, hospital safety, and seasonal flu vaccination. However, other key health security measures, including ensuring a safe water supply and access to paid time off, stalled or lost ground.

Performance Tier States Number of States
High Tier AL, CO, CT, DC, DE, IA, ID, IL, KS, MA, MD, ME, MO,
MS, NC, NE, NJ, NM, OK, PA, TN, UT, VA, VT, WA, WI		 25 states and DC
Middle Tier AZ, CA, FL, GA, KY, LA, MI, MN, ND, OR, RI, TX 12 states
Low Tier AK, AR, HI, IN, MT, NH, NV, NY, OH, SC, SD, WV, WY 13 states

 

The report measures states’ performance on an annual basis using 10 indicators that, taken together, provide a checklist of a jurisdiction’s level of preparedness to prevent and respond to threats to its residents’ health during an emergency. The indicators are:

Preparedness Indicators 
1 Incident Management: Adoption of the Nurse Licensure Compact. 6 Water Security: Percentage of the population who used a community water system that failed to meet all applicable health-based standards.
2 Cross-Sector Community collaboration: Percentage of hospitals participating in healthcare coalitions. 7 Workforce Resiliency and Infection Control: Percentage of employed population with paid time off.
3 Institutional Quality: Accreditation by the Public Health Accreditation Board. 8 Countermeasure Utilization: Percentage of people ages 6 months or older who received a seasonal flu vaccination.
4 Institutional Quality: Accreditation by the Emergency Management Accreditation Program. 9 Patient Safety: Percentage of hospitals with a top-quality ranking (“A” grade) on the Leapfrog Hospital Safety Grade.
5 Institutional Quality: Size of the state public health budget, compared with the past year. 10 Health Security Surveillance: The public health laboratory has a plan for a six-to eight-week surge in testing capacity.

Four states (Delaware, Pennsylvania, Tennessee, and Utah) moved from the low performance tier in last year’s report to the high tier in this year’s report. Six states (Illinois, Iowa, Maine, New Mexico, Oklahoma, Vermont) and the District of Columbia moved up from the middle tier to the high tier. No state fell from the high to the low tier but six moved from the middle to the low tier. Hawaii, Montana, Nevada, New Hampshire, South Carolina, and West Virginia.

“The increasing number of threats to Americans’ health in 2019, from floods to wildfires to vaping, demonstrate the critical importance of a robust public health system. Being prepared is often the difference between harm or no harm during health emergencies and requires four things: planning, dedicated funding, interagency and jurisdictional cooperation, and a skilled public health workforce,” said John Auerbach, President and CEO of Trust for America’s Health.

“While this year’s report shows that, as a nation, we are more prepared to deal with public health emergencies, we’re still not as prepared as we should be. More planning and investment are necessary to saves lives,” Auerbach said.

TFAH’s analysis found that:

  • A majority of states have plans in place to expand healthcare capacity in an emergency through programs such as the Nurse Licensure Compact or other healthcare coalitions. Thirty-two states participated in the Nurse Licensure Compact, which allows licensed nurses to practice in multiple jurisdictions during an emergency. Furthermore, 89 percent of hospitals nationally participated in a healthcare coalition, and 17 states and the District of Columbia have universal participation meaning every hospital in the state (+DC)  participated in a coalition. In addition, 48 states and DC had a plan to surge public health laboratory capacity during an emergency.
  • Most states are accredited in the areas of public health, emergency management, or both. Such accreditation helps ensure that necessary emergency prevention and response systems are in place and staffed by qualified personnel.
  • Most people who got their household water through a community water system had access to safe water. Based on 2018 data, on average, just 7 percent of state residents got their household water from a community water system that did not meet applicable health standards, up slightly from 6 percent in 2017.
  • Seasonal flu vaccination rates improved but are still too low. The seasonal flu vaccination rate among Americans ages 6 months and older rose from 42 percent during the 2017-2018 flu season to 49 percent during the 2018-2019 season, but vaccination rates are still well below the 70 percent target established by Healthy People 2020.
  • In 2019, only 55 percent of employed people had access to paid time off, the same percentage as in 2018. The absence of paid time off has been shown to exacerbate some infectious disease outbreaks . It can also prevent people from getting preventive care.
  • Only 30 percent of hospitals, on average, earned top patient safety grades, up slightly from 28 percent in 2018. Hospital safety scores measure performance on such issues as healthcare associated infection rates, intensive-care capacity and an overall culture of error prevention. Such measures are critical to patient safety during infectious disease outbreaks and are also a measure of a hospital’s ability to perform well during an emergency.

The report includes recommended policy actions that the federal government, states and the healthcare sector  should take to improve the nation’s ability to protect the public’s health during emergencies.

Other sections of the report describe how the public health system was critical to the vaping crisis response, how health inequities put some communities at greater risk during an emergency, and the needs of people with disabilities during an emergency.

Read the full text report

The State of Obesity 2019 Congressional Briefing: Better Policies for a Healthier America

On November 18th, 2019, Trust for America’s Health held a briefing for congressional staff and partners that reviewed the latest obesity rates and trends, the role of public health and other stakeholders in preventing, treating and responding to obesity and its comorbidities, highlighted promising approaches to ensure healthy communities, and offered evidence-based policy recommendations that could help all Americans lead healthier lives.

Briefing speakers included:

  • John Auerbach, MBA, President and CEO, Trust for America’s Health
  • Devita Davison, Executive Director, FoodLab Detroit
  • Martha Halko, MS, RD, LD, Deputy Director of Prevention & Wellness, Cuyahoga County (Ohio) Board of Health
  • Ruth Petersen, MD, MPH, Director, Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control & Prevention (CDC)

Briefing materials:

  • Panelists biographies
  • Presentation slides
  • CDC Division of Nutrition, Physical Activity, and Obesity At A Glance fact sheet
  • CDC Division of Nutrition, Physical Activity, and Obesity’s Work in Healthcare Settings to Reduce Childhood Obesity fact sheet
  • TFAH’s State of Obesity 2019 Report
  • TFAH’s State of Obesity 2019 report fact sheet
  • Robert Wood Johnson Foundation’s (RWJF) 2019 Obesity Report

For more information, please contact Daphne Delgado, TFAH Senior Government Relations Manager at [email protected]

 

Produce Rx: Using Prescriptions to Improve Affordability of Healthy Foods

Healthy eating among families and communities promotes optimal health and well-being. However, approximately three-fourths of Americans do not consume the recommended amounts of healthy foods, such as fruits and vegetables, set by the 2015-2020 Dietary Guidelines for Americans.

A healthy daily diet is linked to reduced risk for obesity, diabetes, hypertension, and other preventable chronic illnesses. But, despite efforts to promote healthy eating, communities across the U.S. continue to face barriers to accessing healthy foods.

Produce Rx

In 2012, DC Greens, a food justice non-profit located in Washington, DC, launched a pilot program called Produce Rx which began as a small-scale partnership between health care clinics and local farmer’s markets. The vision, like that of similar efforts across the country, was to increase patients’ access to fresh produce and empower them to make healthier food choices in order to manage and improve their health.

A sample prescription a doctor might provide for Produce Rx.

As part of the program, patients facing food insecurity and living with diet-related chronic disease enrolled in a six-month group nutrition class at a local health clinic, where they received monthly nutrition education and seasonal recipe demonstrations and had a check-in with a healthcare provider. Additionally, they received a “prescription” in the form of a voucher from the healthcare provider to purchase fresh produce from their local farmer’s market.

Community members who participated in the Produce Rx program showed significant improvements in health outcomes, such as lower BMI among 50 percent of the participants. In addition, 85 percent of the program participants reported improved patient-provider relationships.

Expansion and Growth

In March 2019, DC Greens, with funding support from the DC Department of Health and AmeriHealth Caritas, the largest Medicaid managed care organization in the District with more than 100,000 members, established a new partnership with Giant Food – the only grocery store located in D.C.’s Ward 8. The Ward 8 neighborhood has some of the highest income, educational, health, and racial and ethnic disparities among all of the District’s 8 wards – creating an opportunity to support D.C. residents with the greatest need through a new expanded model of the Produce Rx program.

D.C.’s Ward 8 is known as a “food desert” due to the limited number of retailers selling fresh, affordable produce, and the fact that the community faces disproportionate rates of people with diet-related chronic conditions. Moreover, Ward 8 has the highest rates of death due to diabetes and heart disease within the city.

“There is a myth that people living in poverty don’t want healthy food. We know this isn’t true,” says Lauren Shweder Biel, Executive Director of DC Greens. “people simply lack the resources to get the healthy foods that they want and that they need. With Produce Rx, we’ve been able to give patients a way to follow their doctors’ medical advice.”

“Giant Food is excited about the positive impact the Produce Rx program has had at our Alabama Avenue store,” said Ira Kress, interim President at Giant Food. ” As a food retailer, with roots in Washington, D.C. dating back 83 years, we recognize the important role we can play in the access to healthy foods and health education in our community, and this program has been a natural fit.”

With the new partnership Produce Rx participants will have access to fresh fruit and vegetables year-round. The program will expand its services to 500 AmeriHealth Medicaid participants who will receive a $20 voucher every week to purchase produce at their neighborhood Giant.

Produce Rx patient Adrienne Dove exchanges her prescription for a voucher for produce from Giant Food Pharmacy Manager Adaoma Chinweuba.

“AmeriHealth Caritas DC is committed to helping our members, especially those with chronic health conditions, improve their overall health by adding more fruits and vegetables to their daily diet,” said Keith Maccannon, Director of Community Relations and Outreach at AmeriHealth Caritas DC. “Collaboration with community-based organizations and businesses like DC Greens and Giant Food are a key component of our strategy in this area.”

Participants in this program will also have access to personal-level nutrition education at their health clinic and through Giant’s in-store nutritionist and AmeriHealth’s nutrition and wellness programs.

“Pairing nutrition education with produce access is essential for helping our customers unlock the power of produce,” said Jillian Griffith, Giant Food in-store nutritionist. “It is one thing to be instructed by a medical provider to eat more fruits and vegetables, but it’s another to have an in-store nutritionist available to share plant-based recipe ideas or new produce pairings for traditional family favorites. I am so grateful for the opportunity to teach Produce Rx participants the role food plays in their overall health while empowering them with the “produce tools” needed to meet dietary recommendations.”

Through these services, Produce Rx is making healthy food options more affordable and accessible for both individuals and their families.

“The program has impacted me and my family because we found we are eating healthier, losing more weight, and needing less medication than we used to,” said Adrienne Dove, a participant in the program. “I count my spending to make sure I don’t go over on food, but now I can buy healthier options, like spinach and broccoli, that my son wants to try, from the grocery store right around the corner.”

Next Steps

This next iteration of Produce Rx will run for a year, allowing DC Greens to conduct a robust evaluation of its effectiveness by measuring key behavior changes, health outcomes, and tracking health care costs among program participants. Currently, DC Greens administers Produce Rx but with this evaluation they hope to build the case for scalable and sustainable investments in these programs by the healthcare system.

(From left to right) Kevin O’Donnell (Giant Food District Pharmacy Manager), Adaoma Chinweuba (Giant Food Pharmacy Manager), Adrienne Dove (Produce Rx Patient) Samir Balile (Giant Food Clinical Programs Specialist).

“We are working to integrate ‘food as medicine’ as a key component of clinical care, but we know that the only way to truly scale a program like this is to prove a return on investment for the healthcare system,” says Biel. “With AmeriHealth Caritas and DC Health at our side, we believe this program is poised to demonstrate the impact that ‘food as medicine’ can have on individual health and patient utilization of the healthcare system.”

More Investment in Policies and Programs to Support Food Access and Healthy Choices is Needed

Continued investments in local, state, and federal policies and programs are critical for improving nutrition and health, especially among low-income and underserved communities that face limited access to affordable, fresh produce. More research is needed to definitively demonstrate the impact that DC Greens Produce Rx and other innovative programs are having on health and healthcare services usage. But the preliminary findings are promising.

“With the obesity crisis getting worse, we need to have a comprehensive and multi-faceted approach to changing the conditions that make it difficult for people to eat a healthful diet. Such an approach includes initiatives like DC Produce Rx with its focus on reducing the financial barriers to accessing healthy foods as well as providing culturally and linguistically tailored educational information,” said John Auerbach, President and CEO of Trust for America’s Health.

From community-based programs that test new strategies like Produce Rx to federal programs such as the Supplemental Nutrition Assistance Program for Woman, Infants, and Children (WIC) access to nutritious, affordable foods can help communities live healthier lives. As the nation experiences growing rates of obesity and other chronic diseases, it’s important for policymakers to continue supporting innovative solutions that address the root causes of preventable disease.