PI's Weekly Media digest: Tax proposal would dramatically affect public health/healthcare; CHIP funds running out in 11 states; mental health supports needed post-Maria in Puerto Rico

Vox’s Sarah Kliff describes the GOP tax proposal as “really a health care bill with major implications for more than 100 million Americans who rely on the federal government for their health insurance,” which would affect Medicaid, Medicare, and the Affordable Care Act exchanges, as well as potentially triggering PAYGO cuts that could zero out the Prevention and Public Health Fund.

A CDC study of emergency room visits published in JAMA shows that self-inflicted injuries among girls between 10 and 14 years old nearly tripled between 2009 and 2015. The trend is consistent with a rise in depression and deaths by suicide among youth, especially young girls. Mental health experts suggest the rise may be related to bullying on social media, substance misuse, and economic stress, according to the Associated Press. They said the findings highlight the need to promote connection and other supports for preventing isolation and coping with stress. The study of emergency room visits from youth between 10 and 25 years old from 2001-2015 showed no significant increase in visits for self-harm until 2009, when rates began to climb, particularly among girls ages 10-14, for whom rates rose from about 110 per 100,000 in 2009 to 318 per 100,000 in 2015. The study’s authors noted that the rates are likely an underestimate since not all instances of self-harm result in emergency department visits.

Since the Children’s Health Insurance Program has still not been renewed, many states are beginning to reach out to families and warn that their children may lose healthcare coverage as early as January. New York Magazine reports that some states have “stopped pushing eligible families to sign up for the program, a development that could lead to many more low-income children going without coverage, even if the program gets reauthorized in December.” The threat of children losing coverage will also undermine faith in the program, which could further depress children’s healthcare coverage, even if CHIP is renewed soon.

Mother Jones reports on the pervasiveness and severity of harassment, sexual violence, and other sex-based inequities in agriculture and food service. “According to a 2016 report from the Food Chain Workers Alliance and the Solidarity Research Cooperative, food and farm workers make a median wage of $16,000 a year, or about $10 an hour. About a third of these workers are women, and they make even less than those paltry averages—less than half of what their male counterparts make… In these low-wage, low-visibility jobs, sexual harassment—and worse—flourishes. In a 2014 survey by Restaurant Opportunities Center United, 66 percent of female restaurant workers reported “high levels of harassing behaviors” from their managers, 80 percent reported it from co-workers, and 78 percent from customers. A 2012 Human Rights Watch report found sexual harassment and violence a common theme of life for women who work in US farm fields, “fostered by a severe imbalance of power between employers and supervisors and their low-wage, immigrant workers.”’

Public health officials are concerned that a mental health crisis is building as Puerto Rico continues to struggle to recover from Hurricane Maria, The New York Times reports. Along with traumatic memories of the hurricane, residents are dealing with lost jobs and homes, and limited access to basics like water, electricity, and cell phone service. Calls to psychiatric hotlines have surged, hospitalizations and deaths by suicide have increased, and clinicians are calling on colleagues from other regions to help manage the growing demand for mental health supports.

New research published in PLOS Biology last week finds that the sugar industry has known for 50 years that its products are linked to heart disease, based on self-funded research that the industry kept under wraps while attempting to shift the public blame for rising rates of heart disease from sugar to fat.

After 11 years of appeals, tobacco companies will finally run print and television ads in which they will admit that smoking kills and that they purposely manipulated their products to make them more addictive.

In an opinion piece in STAT, John Auerbach of Trust for America’s Health and Benjamin F. Miller of Well Being Trust call for bold action in the form of a “National Resilience Strategy” to reduce what have become known as deaths from despair. A study their organizations commissioned from the Berkeley Research group predicts that such deaths, typically from suicide and drug and alcohol misuse, could climb to 1.6 million between 2016 and 2025, a 60% increase over the previous decade. To prevent this surge, they have mapped a range of strategies that focus on identifying and addressing issues early, and providing effective treatment. These approaches include taking steps to reduce risk factors such as exposure to trauma in communities and families;  providing social-emotional learning and violence prevention programs in schools; and enacting policies to prevent alcohol misuse, such as increasing pricing and limiting the hours and density of outlets that sell alcohol.

In a piece exploring the range of experiences that can contribute to post-traumatic stress disorder, National Public Radio features a former social worker who worked for 13 years investigating foster care cases. After leaving the position, he discovered that the trauma of navigating potentially dangerous situations and working with children who had experienced abuse would resurface in certain circumstances. Sandro Galea of the Boston University School of Public Health said: “We know now that the lifetime experience before the trauma, the nature of the trauma itself, and what happens to you after the trauma — even though unrelated to trauma — all matter for whether you are going to get PTSD."

STAT profiles Michael Bischoff, a man with a brain tumor who is among the subjects researchers are observing to determine whether storytelling can improve health. Researchers from the Health Story Collaborative are looking at the mental and physical health benefits of personal narratives, particularly those that feature resilience and connections. Bischoff says the process of crafting his own narrative has helped him to recognize that he wants to focus on his connections with family and friends, not just on fighting his disease.  “Having people gather and listen in a loving way to my story helped me understand that. It’s about purpose; it’s about love. And I need to keep doing that over and over again to reorient myself away from the anxious grasping, and toward the love and purpose.”