PI's Weekly Media digest: ACEs and chronic disease, Surgeon General priorities, and more
Violence Prevention and Unintentional Injury
The Guardian reports on a new study by Public Health Wales that found children who endure four or more adverse childhood experiences (ACEs) are more than twice as likely to be diagnosed with a chronic disease in later life compared with those who have experienced none.
Mother Jones reports on a new study from Johns Hopkins University showing that campus carry laws are unlikely to deter rampage shooters and may in fact lead to more injuries and deaths. In an op-ed, VP nominee Tim Kaine states that as a gun owner he supports the Second Amendment, but that that "should never stop us from ensuring our communities are as safe as possible." He also criticized the NRA for opposing all efforts to make the country safer and promote responsible gun ownership. Meanwhile, Surgeon
General Vivek Murthy highlighted his top priorities for the three remaining years of his term: chronic disease, the opioid epidemic, and Americans’ emotional well-being. He also noted, “What I’ve said before is what I believe now — which is gun violence is a public health issue. I won’t shy away from saying that. It makes some people nervous when I say that. Frankly, I don’t care because the truth is the truth."
According to a new analysis by the Department of Public Health, half of all injuries treated at Zuckerberg San Francisco General Hospital are from traffic collisions, which adds up to more than $35 million in medical costs annually (transportation-related severe injuries treated at the hospital’s trauma center from 2012 to 2014 totaled $105.5 million).
Health Equity
Last week, white armed occupiers were acquitted in Oregon while peaceful, unarmed Native-American protesters and allies were tear-gassed in North Dakota. In total, authorities arrested 141 protesters in just a six-hour standoff over the pipeline’s path. More than 200 police officers responded to the demonstrations, many using pepper spray, firing bean bags at protestors (some of whom were children), shooting protesters with rubber bullets, and holding them in dog kennels.
This Alternet piece argues for the creation of “baby bonds” for all American newborns to restore fairness for black citizens who have been held back from economic security by centuries of prejudice. The amount a child receives would depend on the wealth position into which he/she is born (ranging from $2,000 to $50,000), recognizing the structural racism that has generated much inequality. The author notes, “The source of wealth building in America… is less what you save than your capacity to invest in an asset through money given by parents and grandparents.”
A Rewire article details a recent report indicating that the high rates of deaths and severe injuries during pregnancy and childbirth facing New York City Black women may, in part, be due to a legacy of the segregation of the city’s patient population. The report is among a spate of new research highlighting long-established health disparities between Black and white women giving birth in the United States.
The Supreme Court ensured this week that thousands of ballots will be thrown out in Ohio over the smallest of errors — part of a larger trend of voter suppression currently underway. As BMSG notes, “In an opinion piece for the Root, Charles D. Ellison discusses the lack of news coverage that sabotage at the polls has received. Several states have passed laws that are making it more challenging for black voters to access the polls; for example, Florida won't let people register and vote on the same early voting day.”
The Atlantic reports that even though birth control is supposed to be free and easy to access, failure to expand Medicaid has made access to birth control more challenging to access for poor women. One in 10 women remains uninsured, either because coverage is not affordable or because they are undocumented or unaware of the requirement to buy insurance. (via BMSG)
The Brookings Institution documents the growth in concentrated poverty. When more than 30-40 percent of people in a neighborhood are poor, it’s a tipping point for poor health and other social ills. Despite an overall decline in poverty, the number of people living in these extremely poor neighborhoods has increased by 34 percent, from 8.7 million to 13.7 million, since 2009.
New analysis from CAP Action takes a look at how cities fared after minimum wage hikes. In 74 percent of the minimum wage increases in cities from 1993 to the second quarter of 2015, the unemployment rate did not increase in the corresponding city a year after the wage hike. Academic evidence finds that raising the minimum wage has no discernable effect on employment, while reducing poverty and inequality, boosting incomes, and growing the economy.
According to a new study, people in Boston and Seattle with “black-sounding” names were twice as likely to have their Uber rides cancelled than those with white-sounding names. In Seattle, black UberX users had roughly 30% longer wait times than white riders.
California
A new infrastructure report finds that San Francisco, Oakland and Los Angeles have the poorest road conditions of major metro areas in the country, exacting wear and tear on buses and cars.
The SF Public Press reports that soda tax supporters in San Francisco are underestimating the toll diet-related chronic disease takes on the city. A 2013 Budget & Legislative Analyst report calculated that diabetes and obesity resulted in $749 to $945 million lost annually to cover medical care, insurance, and lost productivity, with further indirect costs adding up to an additional $48 to $62 million per year.
Community environments
City Lab reports on community organizing efforts to fight displacement in South Los Angeles: “Nearly all the civic leaders we spoke with—and some of the younger Latinos—lifted up the importance of responding to gentrification and resisting displacement when it comes to the future of South LA. Being strategic about the economic investments to come will be an opportunity for cross-community engagement as the fault lines from gentrification may be not between African Americans and Latinos but rather between homeowners who might gain and renters who are likely to lose. But for both Blacks and Latinos, worries about displacement are not just economic; they worry that the communities and neighborhoods that they have fought so hard to build will be erased… Community organizations have started mobilizing against these forces. They’ve educated residents, rallied council members, employed land banking as a tool to preserve affordable housing, and tried to negotiate community benefit agreements so that any new development brings jobs and benefits to communities on both sides of South L.A., according to Benjamin Torres, president and CEO, Community Development Technologies Center (CDTech).”
UCSF researchers found that, while independently funded research finds strong links between soda consumption and health, soda-industry funded studies on the health impacts of sugary drinks find no link.
Mental health
The New York Times reports that the CDC found that in 2014, more children between 10 and 14 died from suicide than from traffic accidents. This reflects both a spike in suicides and a drop in traffic deaths. Potential reasons for rising suicide rates include shaming through social media, earlier puberty and higher rates of depression.
KQED looks at links between poverty and mental illness, with a focus on stress and other environmental factors, including exposure to violence and lack of access to resources such as healthy food.
Noting there’s substantially more awareness of Adverse Childhood Experiences in recent years, the Center for Youth Wellness focused its 2016 conference on creating an infrastructure to promote changes in policy and practice. Proposals include Robert K. Ross, president and CEO of The California Endowment, made the case for redirecting $3 billion from jails and prisons to investments in healing ACEs. [No explicit mention of community trauma, although there were folks from PI/Making Connections presenting on this.]Speaking at the 2016 Center for Youth Wellness conference, Bryan Stevenson, founder of the Equal Justice Initiative, advocated for moving away from our punishment (incarceration) mindset that heightens trauma that people have already experienced. He argued instead for addressing trauma, for example “having the U.S. Centers for Disease Control and Prevention declare a health crisis in the 200 zip codes in the U.S. where 80 percent of the children are expected to end up in jail because of the dire circumstances they will experience.”
A federal task force convened to ensure parity in mental health and substance use coverage published its final report on October 27. The report recommends increased capacity to audit insurance providers and fines for non-compliance, among other measures. Immediate steps include $9.3 million to help states implement protections and guidance on how to apply parity to coverage for opioid use disorder treatment.
Researchers at the National Institute of Health’s National Center for Complementary and Integrative Health are exploring drug-free pain management options for people with chronic pain. In a review, they examined efficacy and safety evidence in 105 randomized controlled trials conducted between January 1966 and March 2016, and identified several options that appear to have potential, including acupuncture, massage therapy, and relaxation techniques.
Supportive sites are gaining steam in the US as a way to provide drug users a safe place to stay while they're under the influence. Nurses monitor users for signs of an overdose, and the facility can connect drug users to rehab programs. It's the same idea behind needle exchanges and supervised drug injection sites, which are illegal in the US but can be found in Canada, Europe, and Australia. The goal: reduce immediate harm while connecting drug users with the resources they might need to quit. But those facilities have riled up a fair amount of opposition, too.
Health Systems Transformation
In ACA news, a New York Times op-ed makes the case for a public option to help alleviate some of the recent problems with high premiums and lack of competition. The author notes, “… without a public option…insurance competition would dwindle and premiums would skyrocket. Now that they have, it’s time to do now what we should have done then: take the simplest route to a more stable and affordable health care system.” The Los Angeles Times examines one factor rarely mentioned when discussing ACA premium hikes: on average, states that have been hostile to Obamacare are facing the largest premium increases for 2017. Residents in states that have embraced the law will do much better. The article notes, “This points to one indisputable flaw in the law as it was enacted in 2010: The ACA gave the states too much power to implement its provisions….It was only magnified by the decision of Chief Justice John Roberts to transform the law’s mandated expansion of Medicaid to bring insurance to the poorest Americans into a state-level option.” This argument is supported by a new study from Avalere that estimates 1.2 million people living in states that haven't expanded their Medicaid programs could gain coverage if a newly elected governor decides to expand.