State Category: District of Columbia
COVID-19 School Closures Put 30 Million Children at Risk of Hunger
Many States with High COVID-19 Infection Rates Also Have Highest School-Meal Programs Participation Rates
(Washington, DC – July 16, 2020) – As COVID-19 infection rates continue to increase in states across the country, many of those jurisdictions are facing the complex dilemma of high infections rates complicating school re-openings and thereby limiting students’ access to school-based meal programs. Among the states with spiking infection rates and a high percentage of students participating in school-based meal programs are Arizona, Florida, Louisiana, Mississippi and South Carolina.
In March schools across the country began closing to stop the spread of the COVID-19 virus. In response, and recognizing the important source of nutrition school-based meals were to millions of American children, the U.S. Department of Agriculture’s Food and Nutrition Service began approving nationwide waivers to provide school systems flexibility in how meals were provided to students. For example, these waivers enable schools to serve meals in non-congregate settings and outside of standard mealtimes, serve afterschool snacks and meals outside of structured environments, and waive requirements that students be present when meals are picked up.
Over half of all students in elementary and secondary schools across the country depend on the National School Lunch Program, and 12.5 million of those students also participate in the School Breakfast Program. As the COVID-19 pandemic closed schools this spring, these students were placed at risk of not having enough to eat.
A new policy brief, Beyond School Walls: How Federal, State and Local Entities are Adapting Policies to Ensure Student Access to Healthy Meals During the COVID-19 Pandemic, released today by Trust for America’s Health, reviews steps the federal and state governments have taken to ensure students’ access to healthy meals when schools are closed and what needs to be done to ensure continued meal access as all school systems face uncertainties about how to safely reopen for the 2020-2021 school year.
“School meal programs are the most important source of nutritious food for millions of American children. To the degree possible, school systems, with financial and regulatory relief from the federal government, should continue to be innovative about how to deliver meals to students and should strive to meet or exceed federal nutrition standards for these meals despite product shortages created by the pandemic,” said Adam Lustig, Project Manager at Trust for America’s Health and the brief’s author.
Due to the economic impact the pandemic has had on millions of American families and the numerous uncertainties about how to safely re-open schools, the currently in place program waivers should be extended through the summer and may need to be kept in place during the 2020–2021 school year, the brief says.
Many of the states hardest hit by COVID also have highest school meal programs participation rates
States with some of the highest rates of COVID-19 infections also have high percentages of students who depend on school meals for much of their nutrition. States in which both COVID-19 infection rates are above national medians and school meals program enrollment is high include Arizona, Florida, Georgia, Louisiana, Mississippi, and South Carolina.
States in which more than half of students are enrolled in school-meals programs are:
Percentage of students enrolled in school meal programs
D.C. 76.4%
Mississippi 75.0%
New Mexico 71.4%
South Carolina 67.0%
Arkansas 63.6%
Louisiana 63.0%
Oklahoma 62.5%
Georgia 62.0%
Nevada 60.8%
Kentucky 58.7%
California 58.1%
Florida 58.1%
Arizona 57.0%
Missouri 52.7%
New York 52.6%
Illinois 50.2%
Alabama 51.6%
Oregon 50.5%
Hunger, poor nutrition and food insecurity can increase a child’s risk of developing a range of physical, mental, behavioral, emotional, and learning problems. Hungry children also get sick more often and are more likely to be hospitalized. Maintaining children’s access to nutritious meals despite school closures not only ensure they do not go hungry, but also promotes children’s health.
“State and federal guidelines waivers have allowed school systems to provide meals to students during the pandemic response, keeping them in place this summer and into the 2020-2021 school year will be the difference between kids who have enough to eat and kids who go hungry,” Lustig said.
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Trust for America’s Health is a nonprofit, nonpartisan organization that promotes optimal health for every person and community and makes the prevention of illness and injury a national priority. Twitter:@HealthyAmerica1
Newly Announced Order for Hospitals to Bypass CDC and Send Coronavirus Patient Information Directly to Washington Database Likely to Worsen Pandemic Response Rather than Improve It
(Washington, DC – July 15, 2020) — The U.S. Centers for Disease Control and Prevention (CDC), as the nation’s lead public health agency, is uniquely qualified to collect, analyze and disseminate information regarding infectious diseases. It has been serving in that role since its creation and, in close collaboration with U.S. healthcare facilities nationwide, has developed a health statistics infrastructure that is the gold standard worldwide.
The problems with regard to the COVID-19 data collection have largely been a result of the decentralized and fragmented nature of both healthcare and public health in the United States. Furthermore, hospital data is only one aspect of what we need to know to fight the pandemic. A key role of health departments at all levels of government is to aggregate data to produce a detailed picture of a health problem at the national, state and local levels. Inadequate funding for data infrastructure, at CDC and at the local, state, tribal and territorial levels, is also a contributing factor. That underfunding should be corrected rather than bypassed.
In the midst of the worst public health crisis in a century, it is counter-productive to create a new mechanism which will be extremely complicated to build and implement. Another area of concern is that the planning for this new approach did not substantively involve officials at the local, state, tribal and/or territorial levels. This is a time to support the public health system not take actions which may undermine its authority and critical role.
Americans must have confidence in the integrity of health data and its insulation from even the suggestion of political interference. Sending these sensitive data to a newly created entity overseen directly by the White House will not eliminate such concerns, it will increase them.
John Auerbach, President and CEO, Trust for America’s Health
Dr. Tom Frieden, President and CEO, Resolve to Save Lives
Lori T. Freeman, Chief Executive Officer, National Association of County and City Health Officials
Dr. Georges C. Benjamin, Executive Director, American Public Health Association
Thomas M. File, Jr., M.D., MSc, FIDSA; President, Infectious Disease Society of America
Chrissie Juliano, MPP, Executive Director, Big Cities Health Coalition
William H. Dietz, MD, PhD, Chair, Redstone Center for Prevention and Wellness, George Washington University
Nearly 350 Public Health Organizations Implore HHS Secretary Azar to Support CDC’s Critical Role in the COVID-19 Pandemic Response
Letter calls on Secretary Azar to “speak up” and be an advocate for CDC and public health
(Washington, DC – July 7, 2020) – The expertise of the U.S. Centers for Disease Control and Prevention (CDC) and all public health agencies is critical to protecting Americans’ health during the COVID-19 crisis, said a letter to Health and Human Services Secretary Alex Azar from 347 health and public health organizations released today.
The authoring organizations, including the American Public Health Association, Association of State and Territorial Health Officials, Big Cities Health Coalition, National Association of County and City Health Officials and Trust for America’s Health, expressed “deep concern” about increasing reports of resistance to evidence-based public health messages and threats to public health leaders and agencies, and called on the Secretary to be an advocate for public health.
At this sentinel moment, during the worst public health emergency in over a century, all of the nation’s leaders must resist any efforts that would undermine the critical role of the CDC to respond to the pandemic and must be an advocate for increased investment in public health, said the letter signatories.
“Secretary Azar, we urge you to speak up and amplify the critical role of CDC and that of all public health agencies during this monumental crisis,” the letter said.
The public health community’s work to respond to the pandemic, via the federal government, including within the CDC, and at the state, local, territorial and tribal levels, has been tireless but has been hamstrung by shrunken programs and inadequate technology; the result of decades of underfunding.
Public health leaders are calling attention to the need for CDC to play a central role as the nation’s navigates the COVID-19 pandemic, including:
“CDC is the world’s premier public health institution and should be treated as such during this pandemic. It must be appropriately funded and allowed to speak based on the best available science and with an unfettered voice,” said John Auerbach, President and CEO of Trust for America’s Health.
“When you look at the global response to the COVID-19 pandemic, countries that listen to and prioritize public health fare best,” said Dr. Tom Frieden, former director of the CDC, President and CEO of Resolve to Save Lives, an initiative of Vital Strategies. “Trying to fight this pandemic without daily, public guidance from the CDC is like fighting with one hand tied behind your back.”
“There’s no federal agency better suited to lead the response to this unprecedented pandemic. CDC has experts who have studied and helped control coronaviruses and other viral threats for decades, and can help our country emerge from this crisis,” said Dr. Julie Gerberding, former director of the CDC, Co-Chair CSIS Commission on Strengthening America’s Health Security.
The COVID-19 crisis has also illuminated the ways in which racial inequities impact health. Higher rates of COVID-19 deaths within communities of color illustrate the importance of all of CDC’s work, including its focus on chronic disease prevention. It is not possible to effectively meet the needs of the American people if that scope is narrowed.
The letter furthermore calls on Secretary Azar to be an advocate for increased funding for CDC’s core budget. While emergency supplemental funding has been critical to begin to address the immediate COVID-19 response needs, robust, sustained, and predictable funding for its full public health mission is essential to sustain its public health activities and to prevent the next emergency. Increasing the federal investment in public health will be particularly important, as state and local government budgets are likely to be severely hampered in the coming fiscal year due to tax revenue losses during the COVID-19 related economic shutdown.
Today’s laser focus should be on preventing further deaths and disruptions due to the pandemic and the CDC, as the world’s premier public health institution, should be at the helm of that effort, the letter said. Once the pandemic is controlled, the CDC, other federal agencies, state and local leaders and the public health community should collaboratively evaluate their performance and must acknowledge and address shortcomings of the response in order to be better prepared for the next public health emergency.
Signing the letter were:
1,000 Days
Academic Health Resource
Academy for Eating Disorders
Action on Smoking and Health
Advocates for Better Children’s Diets
AES Consulting
AFSCME
AIDS Alliance for Women, Infants, Children, Youth & Families
AIDS United
AlohaCare
Alzheimer’s and Dementia Alliance of WI
Alzheimer’s Association
Alzheimer’s Impact Movement (AIM)
Alzheimer’s of Central Alabama
Alzheimer’s Orange County
American Academy of Family Physicians
American Academy of Pediatrics
American Academy of Pediatrics, California
American Association for Clinical Chemistry
American Association for Dental Research
American Association for the Study of Liver Diseases
American Association of Colleges of Pharmacy
American Association on Health and Disability
American Cancer Society Cancer Action Network (ACS CAN)
American College Health Association
American College of Clinical Pharmacy
American College of Clinical Pharmacy (ACCP)
American College of Obstetricians and Gynecologists
American College of Physicians
American College of Preventive Medicine
American Council on Exercise
American Dental Association
American Foundation for Suicide Prevention
American Geriatrics Society
American Heart Association
American Kidney Fund
American Lung Association
American Medical Women’s Association
American Organization for Nursing Leadership
American Public Health Association
American School Health Association
American Sexual Health Association
American Society for Clinical Pathology
American Society for Microbiology
American Society of Hematology
American Society of Pediatric Nephrology
American Society of Tropical Medicine & Hygiene
American Thoracic Society
American University Department of Health Studies
APLA Health
Arizona Community Health Workers Association
Arizona Public Health Association
Art & Science of Health Promotion Institute
Asian Health Coalition
Asian Health Services
Association for Prevention Teaching and Research
Association for Professionals in Infection Control and Epidemiology
Association of American Cancer Institutes
Association of American Medical Colleges
Association of Asian Pacific Community Health Organizations (AAPCHO)
Association of Departments of Family Medicine
Association of Family Medicine Residency Directors
Association of Food and Drug Officials
Association of Immunization Managers
Association of Maternal & Child Health Programs
Association of Minority Health Professions Schools
Association of Ohio Health Commissioners
Association of Population Centers
Association of Public Health Laboratories
Association of Schools and Programs of Public Health
Association of SNAP Nutrition Education Administrators
Association of State and Territorial Health Officials
Association of State Public Health Nutritionists
Autistic Self Advocacy Network
Big Cities Health Coalition
Bipartisan Policy Center
Black AIDS Institute
Black Men’s Health Initiative
Boston Public Health Commission
Bristol Health Equity Zone
Bronx Health REACH
California Coalition for Children’s Safety and Health
California Immunization Coalition
California Pan-Ethnic Health Network
California School Nurses Organization
Cambridge Public Health Department
Campaign for Tobacco-Free Kids
Cancer Council of the Pacific Islands
Caring Ambassadors Program
Cascade AIDS Project
Center for Community Resilience
Center for Health and Learning
Center for Law and Social Policy (CLASP)
CenterLink: The Community of LGBT Centers
Ceres Community Project
ChangeLab Solutions
Child Welfare League of America
Children’s Environmental Health Network
Children’s Mental Health Network
Christian Council of Delmarva
City of Houston Health Department
City of Milwaukee of Health Department
Climate for Health, ecoAmerica
Coalition for a Tobacco Free Arkansas
Coalition of National Health Education Organizations
Cohen Veterans Bioscience
Colorado Association of Local Public Health Officials
Colorado Public Health Association
Colorado Public Health Nursing Leaders
Community Access National Network
Community Education Group
Connecticut Public Health Association
Cooley’s Anemia Foundation
Council of State and Territorial Epidemiologists
Counter Tools
County Health Executives Association of California
Cuyahoga County Board of Health
Cystic Fibrosis Foundation
Delaware Academy of Medicine
Delaware Academy of Medicine / Delaware Public Health Association
Delaware Academy of Medicine and the Delaware Public Health Association
East Shore District Health Dept.
Eating Disorders Coalition for Research, Policy & Action
Education Development Center
Element Health, Inc.
Endocrine Society
Enlace Chicago
Epilepsy Alliance America
Epilepsy Foundation
Equality California
Eta Sigma Gamma
Families USA
Family Voices
Fetal Alcohol Syndrome Information Network
FHI 360
FIRST Family Service Center
Fletcher Group, Inc.
Florida Institute for Health Innovation
Florida Public Health Association
Foundation for Healthy Generations
Galaxy Aviation Corp
Gateway Region YMCA
George Mason University Center for Climate Change Communication
GLMA: Health Professionals Advancing LGBTQ Equality
Global Alliance for Behavioral Health and Social Justice
Global Health Council
Global Health Technologies Coalition (GHTC)
Global Healthy Living Foundation
Global Liver Institute
Grand Traverse County Health Department
Green & Healthy Homes Initiative
Harm Reduction Michigan
Hawaii Public Health Association
Hawaii State Dept of Health, Office of Primary Care and Rural Health
Health by Design
Health Care Improvement Foundation
Health Enhancement Research Organization (HERO)
Health Resources in Action
Healthcare Foundation Northern Sonoma County
Healthcare Ready
HealthHIV
HealthPartners Institute
Healthy Schools Campaign
Healthy Weight Partnership Inc.
Heartland Alliance
Hep B United
Hepatitis B Foundation
HIV Medicine Association
Hogg Foundation for Mental Health
Hope and Help Center of Central Florida, Inc.
Idaho Public Health Association
Immunization Action Coalition
Immunize Nevada
Impetus – Let’s Get Started LLC
Indiana Public Health Association
Infectious Diseases Society of America
Institute for Family Health
Interdisciplinary Association for Population Health Science (IAPHS)
International Association of Emergency Managers
International Association of Fire Chiefs
IWC Resources, LP
Jeffrey Modell Foundation
Journal of Public Health Management and Practice
Jump IN for Healthy Kids
Kaplan Health Innovations
Kentucky Health Departments Association
KidsAndCars.org
L.A. Care Health Plan
Lakeshore Foundation
League of American Bicyclists
Linn County Public Health
Louisiana Community Health Worker Outreach Network
Louisiana Public Health Association
Lupus and Allied Diseases Association, Inc.
Macoupin County Public Health Department
Maine Public Health Association
March of Dimes
MaryCatherine Jones Consulting, LLC
Maryland Association of County Health Officers (MACHO)
Maryland Office of Minority Health
Massachusetts Public Health Association
Medicago
MEND Foundation
Metropolitan Group
Michigan Association for Local Public Health
MindWise Innovations
Minneapolis Health Department
Mississippi Public Health Institute
Montana Public Health Association
Monterey County Health Department
Morehouse School of Medicine
MountainCare
Multnomah County Health Department
NAACP
NAPHSIS
NASTAD
National Adult Day Services Association
National Association of Chronic Disease Directors
National Association of Community Health Workers
National Association of County and City Health Officials
National Association of Pediatric Nurse Practitioners
National Association of School Nurses
National Athletic Trainers’ Association
National Birth Equity Collaborative
National Center for Disaster Preparedness, Columbia University
National Center for Healthy Housing
National Coalition for LGBT Health
National Coalition for the Homeless
National Coalition of STD Directors
National Environmental Health Association (NEHA)
National Forum for Heart Disease & Stroke Prevention
National Hemophilia Foundation
National Kidney Foundation
National Lipid Association
National Medical Association (NMA)
National Network of Public Health Institutes
National Nurse-Led Care Consortium
National Prevention Science Coalition to Improve Lives
National REACH Coalition
National Safety Council
National Viral Hepatitis Roundtable
National WIC Association
Nebraska Association of Local Health Directors
Network for Environmental & Economic Responsibility of United Church of Christ
Nevada Public Health Organization
Nevada Rural Hospital Partners
New Jersey Association of County and City Health Officials
New Jersey Public Health Association
New York State Public Health Association
North American Primary Care Research Group
North Carolina Healthcare Foundation
Northwest Center for Public Health Practice
NYU Grossman School of Medicine
NYU School of Global Public Health
Ohio Public Health Association
Onyx Strategic Consulting LLC
Pacific Island Health Officers Association
Partnering for Community Transformation Inc
Partnership to Fight Chronic Disease
Partnership to Fight Infectious Disease
PATH
Patrick Risha CTE Awareness Foundation
Pawtucket Central Falls Health Equity Zone
Peggy Lillis Foundation
Pennsylvania Public Health Association
PFLAG National
Population Association of America
Population Health Alliance
Prevent Blindness
Prevent Child Abuse America
Prevention Institute
Preventive Cardiovascular Nurses Association
Public Health Advocates
Public Health Alliance of Southern California
Public Health Foundation
Public Health Institute
Public Health Law Center
Public Health Solutions
Puerto Rico Public Health Association
Pulmonary Hypertension Association
Redstone Global Center for Prevention and Wellness GWU
Research!America
Residential Eating Disorders Consortium
RESOLVE
Resolve to Save Lives, an initiative of Vital Strategies
Respiratory Health Association
Rhode Island Department of Health
RiverStone Health
Rural Health Association of Tennessee
Rural Health Association of Utah
Safe Routes Partnership
Safe States Alliance
Samueli Integrative Health Programs
SANIPLAN
School-Based Health Alliance
SF Hep B Free – Bay Area
SHAPE America – Society of Health and Physical Educators
Shoals Community Clinic
Silver State Equality-Nevada
Smoke Free St. Joe
Society for Advancement of Violence and Injury Research
Society for Maternal-Fetal Medicine
Society for Public Health Education
Society of State Leaders of Health and Physical Education
Society of Teachers of Family Medicine
Southern California Public Health Association
Southwick BOH
Stanislaus County Medical Society
Susan G. Komen
Tennessee Justice Center
Tennessee Public Health Association
Texas Public Health Association
The AIDS Institute
The Broussard Company
The Center for Community Resilience, George Washington University
The Consortium
The Foundation for Sustainable Communities
The George Washington University (GW) Cancer Center
The Gerontological Society of America
The Immunization Partnership
The John A. Hartford Foundation
The Kennedy Forum
The Los Angeles Trust for Children’s Health
The National Commission for Health Education Credentialing, Inc
The Nourished Principles, LLC
The Permanente Medical Group
Thomas Jefferson University
Training Resources Network, Inc.
Treatment Action Group
Trillium Health
Trust for America’s Health
Truth Initiative
U.S. Breastfeeding Committee
UCLA Fielding School of Public Health
UNC Gillings School of Global Public Health
United Ostomy Associations of America
United Way of Greenwood and Abbeville Counties
University of Washington Department of Global Health
University of Washington School of Nursing
University of Washington School of Public Health
University of Wisconsin Population Health Institute
USAgainstAlzheimer’s
Vaccinate Your Family
Washington State Association of Local Health Officials
Washington State Department of Health
Washington State Public Health Association
WelCore Health, LLC
West Valley Neighborhoods Coalition
Whitefoord
Winer Family Foundation
Wisconsin Public Health Association
Women Of A Certain Age
WomenHeart: The National Coalition for Women with Heart Disease
Women’s Resource Center
Woodhull Freedom Foundation
Xavier University for Population Health
YMCA of the USA
Zell Community Health Strategies
The ACA is Critical to the Health of all Americans, Particularly as the Nation Struggles to Contain the Coronavirus
(Washington D.C. – June 29, 2020)
The Trump Administration’s efforts to dismantle the Affordable Care Act (ACA), including urging the Supreme Court to overturn the act, is ill-conceived and puts the health of millions of Americans at risk during the worst public health crisis in over a century.
While always a bad idea, overturning the ACA as COVID-19 infection rates hit new highs in five states, would be catastrophic and could result in excess deaths. The loss of the ACA would also exacerbate the racial inequities that exist in healthcare access, adding to the disproportionate deaths of Blacks and other people of color due to the pandemic.
The ACA has been the law of the land for over a decade and millions of people rely on it for essential health services. If the act was overturned, more than 20 million Americans who gained access to healthcare through the ACA created marketplace and Medicaid expansion would lose that coverage, including vital protections related to pre-existing conditions. Plus, the nearly 30 million Americans who have lost their healthcare due to COVID-19 layoffs would lose access to the critical back-up source for health coverage provided by the ACA marketplace.
There are also major implications for public health. If the law is overturned, it would gut the nation’s investment in public health by eliminating over $15 billion over the next 10 years (FY2021-FY2030) for the Centers for Disease Control and Prevention (CDC) and other public health agencies. The Prevention and Public Health Fund, a dedicated funding stream created by the ACA and specifically designated for public health and prevention, funds approximately 11 percent of the CDC’s budget. These funds are put to work in every state to expand immunizations, prevent suicide, modernize laboratory and epidemiology services to detect and contain disease outbreaks, prevent childhood lead poisoning, and prevent diabetes and other chronic conditions.
Also at risk is the requirement that insurers cover recommended clinical preventive services without cost-sharing. These provisions have meant that an estimated additional 71 million Americans now have access to vaccines, tobacco cessation services, blood pressure and diabetes screenings and other life-saving services previously inaccessible to them.
Public Health Needs Our Support
(Washington D.C. – June 23)
John Auerbach, President and CEO of Trust for America’s Health, issued the following statement:
“As our nation struggles to manage the continued surge of COVID-19 cases, we need to strengthen the public health response. Resistance to public health messages and threats to public health leaders and agencies undermine the efforts to protect the health and wellbeing of America’s residents. We need to support the leadership of Centers for Disease Control and Prevention (CDC) and state, local, tribal, and territorial public health agencies in the efforts to re-open safely.
CDC, state, local, tribal, and territorial public health staff have been working around the clock for months to respond to the pandemic and protect the public, while often relying on overworked staff and inadequate systems that are the result of decades of underfunding.
CDC is a scientific agency that must be able to function in an apolitical manner. We must amplify the unfettered voice of CDC, not stifle it.
The broad scope of CDC’s work – from chronic disease to injury prevention to environmental health to emergency preparedness to infectious disease – is critical. It isn’t possible to effectively meet the needs of the American people if the scope is narrowed. The COVID-19 pandemic demonstrates that the underlying health of Americans – including, for example, obesity, heart disease and diabetes – has a direct impact on the risk of serious illness and death. And the pandemic has also starkly highlighted the unacceptable health disparities related to racism and discrimination which can only be addressed with a sweeping health focus.
The mission of the CDC is clear and replicated in every state and local community’s public health department: save lives through sound public health. Now more than ever we need them to accomplish their mission.”
Addressing the Crisis of Black Youth Suicide: Interview with Dr. Michael A. Lindsey
Dr. Lindsey is the executive director of the McSilver Institute for Poverty Policy and Research at New York University. He also leads the working group of experts supporting the Congressional Black Caucus Emergency Task Force on Black Youth Suicide and Mental Health. The Task Force report, Ring the Alarm: The Crisis of Black Youth Suicide, released in December 2019, is a comprehensive examination of the alarming rise in suicide rates for Black youth over the past generation; a survey of available data and evidence; and a call for policymakers and communities to take action to better understand and to reverse this emergent trend.[1]
TFAH: Please describe your work at the McSilver Institute.
Dr. Lindsey: We focus on the social determinants of mental health, as well as trauma and treatment disparities, all of which intersect with intergenerational poverty. If you are experiencing inequality related to, for example, food insecurity or underemployment, that has a psychological impact. We are looking for ways to break that cycle. We are committed to studying intergenerational poverty, not only to understand its consequences, but to also do something about it.
TFAH: Where does your passion for your work come from?
Dr. Lindsey: I’ve always been interested in mental health treatment disparities, particularly the lack of treatment access for serious mental health issues among Black people. I know the consequences of lack of mental health treatment. My passion derives from growing up in the Southeast section of Washington, D.C., where I saw the effects of drug use and undiagnosed, untreated addiction and mental health issues. I want to bridge that gap to make sure kids and families are connected to treatment in meaningful ways.
TFAH: If you could recommend to policymakers one or two actions that would make a real difference on the social determinants of mental health, what would they be?
Dr. Lindsey: Let’s focus that a bit. And that’s a key point. Whatever we design as an intervention has to speak to the unique issues that are experienced by a specific group. For example, looking at the rising rates of suicide among Black youth. We need to have mental health professionals in schools, proportionate to the number of kids in that school. We can’t have one provider trying to serve 500 kids or even 100 kids; that’s too many. We also need to see more federal research dollars, specifically, for studying the increasing rate of Black youth suicide. The data are clearly telling us that Black youth are at high risk.
TFAH: Does the research you are calling for need to be population-focused?
Dr. Lindsey: No question, it does. The research also needs to be gender-sensitive and culturally appropriate. We need to understand how families of color, in this case, Black families, resolve mental health challenges. For example, do we need to involve clergy in the intervention programs? Do we need services in non-traditional settings? Do we need to provide services in places other than those that the community believes are where “crazy people” go? Setting up services from the consumer perspective will help us establish services that are going to be meaningful.
TFAH: What’s the impact of the school environment on the lives of Black children? Are you concerned about school disciplinary policies that have unintended consequences for students who end up in trouble with the juvenile justice system?
Dr. Lindsey: This is something I’m particularly concerned about. For students of color, there’s implicit bias in how their behaviors are interpreted. If you have a White kid and a Black kid and a Latino kid—if the Black or Latino kid aggresses toward someone, the reaction is that kid is a bad kid, one who should be removed from school. But if a White kid acts up, he is perceived as having emotional challenges. The White kid is not suspended, he’s offered mental health services. It happens a lot.
When Black kids are suspended from school, they can be wayward in the community, they’re not engaged, their behavior comes to the attention of law enforcement—it’s a vicious cycle. It’s also tough for those same kids who are suspended from school to return to school because those school communities often don’t want them back. The largest number of students who have this lack of school engagement tend to be Black and Brown.
If we had intervened on those behaviors early on and gotten those kids to mental health treatment and associated services, we could have averted that later suspension from school. It’s a matter of how we interpret the behavioral presentations of kids. It happens to be that Black and Brown students are the ones who are not getting the requisite services surrounding their mental health.
TFAH: What has been the impact of zero-tolerance policies in schools on students of color?
Dr. Lindsey: Zero-tolerance has had a big impact on what I would call school persistence and staying connected to school among Black and Brown kids. Zero-tolerance policies do not work, and they disadvantage low-income kids and kids of color.
TFAH: McSilver’s Step Up program is established in two New York City high schools. Can you tell us more about it?
Dr. Lindsey: Step Up is focused on positive youth development. What we do is take students who are at risk for truancy or school dropout, and we wrap-around services to support them. It includes peer support—so a lot of peer-based mentoring—as well as professionally led activities to help kids stay on a positive course. The program has an 85 percent graduation rate; that’s about 10 percent higher than the general graduation rate in New York City. Programs like Step Up or school mental health services that can be offered to kids who are struggling can be very important to ensure that these kids stay connected.
TFAH: You led the expert working group that helped inform the work of the Congressional Black Caucus Emergency Task Force on Black Youth Suicide and Mental Health. What did the task force find and what did it recommend?
Dr. Lindsey: Black youth suicide and suicidal behaviors are rising. Black boys (ages 5 to 12 years old) are twice as likely to die by suicide as compared with their White peers. We led a study at the McSilver Institute that found that the self-reported suicide attempt rate for Black youth increased by 73 percent between 1991 and 2017; meanwhile, self-reported suicide attempt rates fell for White and Latino kids and for Asian and American Indian/Alaska Native kids during the same period.
What needs to be done is many of things we’ve talked about. We’re calling for mental health professionals in every school and for more National Institutes of Health funding. We’re calling for Mental Health First Aid to be widely implemented in schools. All the professionals in schools should be well-versed in the presentation of mental health issues, the signs that a student may be having trouble and how to get that student connected to supportive treatment.
We are also calling for more demonstration projects, programs that would implement evidence-based and best practices for clinicians and teachers and anyone who interacts with Black youth. We are calling for investment in demonstration projects to identify exemplars and then implement those programs at scale.
TFAH: What is required to scale up promising programs?
Dr. Lindsey: We have a program called Making Connections. In this program, we are targeting kids who have depression. The program works to reduce stigma. It is designed to help families understand what mental health treatment is all about and to address any concerns they might have about it. It’s a promising program I’d like to see delivered at scale. In order to do that, we are going to have to invest dollars in understanding how this program works. We are currently funded by NIMH [National Institute of Mental Health], but we are going to need increased funding to be able to do this in other places. If we are going to deliver these programs at scale, we are going to have to engage in the research to take them to scale. That means establishing the efficacy of programs like Making Connections, but also determining how best to implement programs like it at scale.
TFAH: Anything else you want to share?
Dr. Lindsey: I’m reminded of the power of storytelling. We need to demonstrate how implicit bias is impacting Black and Brown kids, bias that is potentially an underlying feature of why we are seeing the rising suicide trends. We need to tell the story of implicit bias in compelling ways. I believe that will challenge folks to action. It’s also important to recognize the role that stigma and mistrust play in the disconnection from services. They play a huge role in terms of the disconnection from mental health treatment. We need to work on bridging those gaps between need and use of treatment.
[1] Watson Coleman B. Ring the Alarm: The Crisis of Black Youth Suicide in America. Washington, D.C.: Congressional Black Caucus Emergency TaskForce on Black Youth Suicide and Mental Health, December 2019. https://watsoncoleman.house.gov/uploadedfiles/full_taskforce_report.pdf (accessed April 30, 2020).
TFAH’s Statement on Racism and Health and Well Being in America
Trust for America’s Health (TFAH) stands in solidarity with those opposing racism and seeking racial justice. The recent horrific deaths of George Floyd, Breonna Taylor, and Ahmaud Arbery further expose the persistence of racism and racial violence in American society. We must remember the lives of so many Black people taken by such violence. We keep the families in our minds and hearts.
Systemic racism undermines equity and opportunity and is far-reaching – in health, education, economic opportunity, employment, housing, transportation, and criminal justice, only to name a few examples. The toll from racism on the lives and health of Black people and other people of color is vast. It is seen in the impact of the disinvestment in and marginalization of communities of color, the unhealthy social, economic, and environmental conditions, and the lack of opportunities within community, work and school settings, which result in deaths at earlier ages and high rates of chronic and infectious diseases. It is seen in the impact of racial violence as well as daily instances of prejudice and racial discrimination that result in adverse mental and physical health effects such as stress, trauma, and elevated blood pressure. The recent cases of violence against Black people and the disproportionate impact of the COVID-19 pandemic on people of color have highlighted once again the importance of combating racism as a public health imperative.
At Trust for America’s Health, we envision a nation that values the health and well-being of all, where equity is foundational to policymaking at all levels of society. Together with all justice-seeking people in America, we remain steadfast in advocating for policy solutions to achieve equity so that everyone has a fair and just opportunity for optimal health.
COVID-19 Policy Response Brief
Las muertes anuales debidas al alcohol, las drogas o el suicidio excedieron los 150,000 según los datos más recientes, y podrían empeorar debido a COVID-19
A pesar de las disminuciones en las muertes por sobredosis de opioides en general, las muertes por opioides sintéticos, cocaína y otros psicoestimulantes aumentaron bruscamente y las muertes por alcohol y suicidio también aumentaron
(Washington, DC y Oakland, CA – 21 de mayo de 2020) – Los datos recientemente publicados muestran que 151,964 estadounidenses murieron debido al alcohol, las drogas o el suicidio en el 2018. Esta tasa nacional de mortalidad por alcohol, drogas y muertes por suicidio fue solo muy ligeramente inferior a lo que había sido en el 2017 a pesar del progreso en la reducción de algunos tipos de sobredosis de opioides, según un nuevo estudio realizado por Trust for America’s Health (TFAH) y Well Being Trust (WBT).
Por el año, las muertes por alcohol aumentaron un 4 por ciento y las muertes por suicidio aumentaron un 2 por ciento. Los nuevos datos también muestran un cambio continuo dentro de la crisis de opioides con reducciones en las muertes por sobredosis de opioides recetados, pero aumentan las muertes que involucran opioides sintéticos, incluido el fentanilo.
Las tasas de mortalidad de todos los opioides disminuyeron un 2 por ciento, pero la tasa de mortalidad de los opioides sintéticos aumentó un 10 por ciento. Además, las muertes por sobredosis con heroína fueron menores, pero las muertes por cocaína y otros psicoestimulantes, como la metanfetamina, el éxtasis, la anfetamina y los estimulantes recetados, fueron mayores.
Aunque todavía es inquietantemente alto, los datos del 2018 son la primera vez desde 1999, cuando comenzó la recopilación de datos actual, que no ha habido un aumento considerable en el alcohol, las drogas y las muertes por suicidio por una tasa de 100,000. Sin embargo, esta estabilización en la tasa de mortalidad no fue uniforme. Algunos lugares y grupos de población están experimentando tasas de mortalidad estables o decrecientes, mientras que las tasas entre otros grupos o en otros lugares continúan aumentando.
“Estos datos son un llamado a la acción”, dijo John Auerbach, presidente y CEO de Trust for America’s Health. “Sabemos lo que funciona para abordar las muertes por desesperación, pero el progreso ha sido desigual y las tasas de mortalidad continúan aumentando, con comunidades de color que experimentan tasas más altas de aumentos en las muertes inducidas por drogas y alcohol. Y hay otra preocupación inmediata: la crisis de COVID-19 ha aumentado las cargas sanitarias y las presiones económicas en muchas comunidades de color “.
Los indios americanos, asiáticos, negros, latinos y adultos mayores experimentaron aumentos en las muertes inducidas por drogas entre 2017 y 2018. Los negros y los indios estadounidenses tuvieron el mayor aumento absoluto. Los negros ahora tienen tasas más altas de sobredosis de opioides sintéticos (10.7 por 100,000), tasas de sobredosis de cocaína (8.8 por 100,000) y casi la misma tasa general de mortalidad inducida por drogas (21.8 por 100,000) que los blancos, después de décadas de tener tasas sustancialmente más bajas.
Los grupos de población que experimentaron tasas de mortalidad más bajas inducidas por drogas en el 2018 incluyeron adultos de 18 a 54 años y blancos.
“Simplemente, muchos estadounidenses están muriendo por causas prevenibles. Las profundas disparidades raciales de salud observadas en estos datos muestran que muchos grupos de minorías étnicas se están quedando atrás en nuestros esfuerzos de respuesta “, dijo Benjamin F. Miller, PsyD, director de estrategia de Well Being Trust. “La nación necesita un marco integral para la excelencia en la salud mental y el bienestar, uno que intencionalmente brinde soluciones para los indios americanos, negros, asiáticos y latinos. Con todas las demás inversiones relacionadas con COVID-19, es hora de que el gobierno federal invierta completamente en salud mental ahora y que todos los estados tomen medidas “.
La reducción de ciertas muertes por opioides sugiere que las políticas y los programas dirigidos a la epidemia de opioides pueden estar afianzándose en algunas poblaciones, pero muchos grupos raciales y étnicos no están viendo el mismo progreso que los blancos. La nación debe basarse en el pequeño grado de éxito y llevar el mismo enfoque a las poblaciones que están en mayor riesgo, especialmente los negros, los latinos y los indios estadounidenses.
Las recomendaciones de política descritas en el informe incluyen:
o Invertir en prevención abordando los factores importantes que crean las condiciones que mejoran los resultados. Numerosos factores contribuyen al bienestar o la falta de este, incluida la pobreza intergeneracional, el racismo sistémico, la discriminación étnica y la homofobia / transfobia se encuentran entre los factores sociales, económicos y ambientales que elevan el riesgo. Las agencias gubernamentales a todos los niveles deben tomar medidas para promover la equidad racial y combatir el racismo y la discriminación.
o Reducir los factores de riesgo y promover la resiliencia en niños, familias y comunidades. Apoyo de políticas y programas equitativos que reduzcan las experiencias traumáticas y adversas, como la exposición a la violencia, la vivienda inestable, la discriminación racial y étnica y el sesgo implícito, que tienen profundos impactos a largo plazo en el uso posterior de sustancias y la salud mental.
o Integrar, aumentar el acceso y mejorar la atención médica al involucrar a todos los sectores de la sociedad para abordar los trastornos de salud mental y uso de sustancias. Las escuelas, los lugares de trabajo, los centros comunitarios, las bibliotecas y los programas públicos deben incorporar formas de abordar los problemas de salud mental y adicciones, desde aumentar la conciencia y reducir el estigma, hasta proporcionar capacitación en intervenciones de crisis y facilitar referencias, e incluso integrar la atención médica en su programación donde sea posible.
o Limitar el acceso a medios letales de suicidio. Promover el almacenamiento seguro de medicamentos y armas de fuego proporcionando educación pública; restringir el acceso a armas de fuego a niños y personas en crisis o en riesgo de suicidio; y la creación de protocolos para proveedores de atención médica, consejeros y personal de primera respuesta sobre cómo interactuar y aconsejar a los pacientes y sus familias para crear entornos seguros. Implementar verificaciones de antecedentes universales para la compra de armas y órdenes de protección de riesgo extremo en todo el país, y ampliar los programas para involucrar a las partes interesadas, como el Proyecto Gun Shop, que educa al personal de las tiendas de armas sobre la prevención del suicidio.
Resumen de datos de 2018
Muertes por tipos de drogas
Muertes por sobredosis de opioides sintéticos: en el 2018, 31,355 estadounidenses murieron por sobredosis de opioides sintéticos; un aumento del 10 por ciento desde el 2017. En total, la tasa de mortalidad por sobredosis con opioides sintéticos ha aumentado casi 10 veces desde el 2013.
Muertes por sobredosis de cocaína: en el 2018, 14,666 estadounidenses murieron por sobredosis relacionadas con la cocaína; hasta un 5 por ciento desde el 2017. La tasa general de mortalidad por sobredosis de cocaína ha aumentado en un 187 por ciento desde el 2013.
Otras muertes por sobredosis de psicoestimulantes: en el 2018, 12,676 estadounidenses murieron por sobredosis de psicoestimulantes y 52,279 murieron en la última década debido al abuso de psicoestimulantes. La tasa de mortalidad por sobredosis de psicoestimulantes en el 2018 fue un 22 por ciento más alta que en el 2017.
Muertes inducidas por alcohol
En el 2018, 37,329 estadounidenses murieron debido a causas inducidas por el alcohol; La tasa de muertes inducidas por el alcohol en el 2018 fue un 4 por ciento más alta que el año anterior.
Las muertes inducidas por el alcohol son más altas entre los indios americanos (30.0 por 100,000) y adultos de 55 a 74 años (27.6 por 100,000). Todos los grupos de población tuvieron tasas más altas de muertes por alcohol en 2018 en comparación con el año anterior, excepto los jóvenes de 0 a 17 años, cuya tasa se mantuvo estable.
Muertes por suicidios
En el 2018, 48,344 estadounidenses murieron como resultado del suicidio. A nivel nacional, la tasa de suicidios de 2018 fue dos por ciento más alta que el año anterior (después de un aumento de cuatro por ciento en 2017). Las tasas de suicidio aumentaron en todos los datos demográficos, excepto en adultos de 18 a 54 años cuya tasa se mantuvo estable. Además, todos los grupos minoritarios raciales y étnicos experimentaron cambios proporcionales mayores en las tasas de suicidio que los blancos.
La muerte por suicidio en el 2018 fue más alta entre los hombres (23.4 por ciento por 100,000), aquellos que viven en áreas rurales (19.7 por 100,000), blancos (16.8 por 100,000) y nativos de los indios americanos / Alaska (14.1 por 100,000).
Tendencias estatales
Entre 2017 y 2018, 27 estados experimentaron tasas más altas (por encima del 0,04%) de muertes por alcohol, drogas y suicidio. Veintitrés estados y el Distrito de Columbia tuvieron menos muertes por alcohol, drogas y suicidio durante el mismo período.
Los estados con las tasas más altas de mortalidad por alcohol, drogas y suicidio en el 2018 fueron: West Virginia (84.9 por 100,000), Nuevo México (82.8 por 100,000), New Hampshire (68.2 por 100,000) y Alaska (67.8 por 100,000).
Los estados con las tasas más bajas de alcohol, drogas y suicidio en 2018 fueron: Texas (31.7 por 100,000), Mississippi (31.7 por 100,000) y Hawaii (34.6 por 100,000).
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Trust for America’s Health es una organización sin fines de lucro y no partidista que promueve la salud óptima para cada persona y comunidad y hace de la prevención de enfermedades y lesiones una prioridad nacional. www.tfah.org. Twitter: @HealthyAmerica1
Well Being Trust es una fundación nacional dedicada a promover la salud mental, social y espiritual de la nación. Creado para incluir la participación de organizaciones de todos los sectores y perspectivas, Well Being Trust se compromete a innovar y abordar los desafíos de salud mental más críticos que enfrenta Estados Unidos, y a transformar el bienestar individual y comunitario. www.wellbeingtrust.org. Twitter: @WellBeingTrust