Trump admin moves on immigration, abortion, climate change; new study finds diabetes lurks behind more deaths

Health equity

On Wednesday, Trump signed two executive orders regarding immigration – one directing the Department of Homeland Security to construct a wall along the US-Mexico border and to step up enforcement of the border in the interim (detaining everyone who crosses the border, including families and asylum-seekers), the other to make it easier for immigration agents to detain and deport people who lack documentation. Trump also announced a plan to strip sanctuary cities (including Los Angeles and San Francisco) of federal funding, as well as pledging to publish a list of alleged crimes committed by undocumented immigrants each week.

Like every incoming Republican administration since Ronald Reagan, the Trump administration reinstated the so-called global gag rule, a policy restricting US aid money to family-planning providers on the condition that they not discuss – much less provide – abortion care (regardless of how abortion care is funded). Vox reports that Trump radically expanded the policy “to include not just family planning organizations but all global health organizations that receive US government funding. This means organizations that address everything from malaria, tuberculosis, and HIV/AIDS to tropical diseases and vaccinations — the list goes on — will now risk losing funding if they even mention abortion. “It is not only chilling effect on family planning,” Dr. Mengistu Asnake, the Ethiopia country representative for Pathfinder International, a global family planning organization, tells me via Skype from Addis Ababa. “It will create a chilling effect on every health program.”’

Donald Trump effectively resurrected the Keystone XL and Dakota Access Pipeline projects this week in an executive order and presidential memorandum, inviting TransCanada to reapply for approval on Keystone XL and urging the Army Corps of Engineers to reconsider its December decision to halt construction on the Dakota Access Pipeline.

Jennifer-Epps Addison of the Center for Popular Democracy holds up the #FightFor15 movement as a model for grassroots political action in the Trump era (via Berkeley Media Studies Group).

Community environments

Employees at the Environmental Protection Agency – as well as other health-related agencies – have been ordered by the Trump administration not to speak to the press or update public communication channels. The administration has also frozen new grants and contracts. The Centers for Disease Control and Prevention cancelled an upcoming conference on climate change and health (it was announced Thursday that another conference on climate and health will be held during the same time period, hosted by Al Gore, the APHA, the Harvard Global Health Institute, and other health/enviro groups). The administration announced Thursday that all EPA studies and data be reviewed by political appointees before release to the public.

The American Lung Association’s annual “State of Tobacco Control” report, which grades state and federal government policies to prevent and reduce tobacco use, “finds that much more needs to be done to prevent our nation’s youth from a lifetime of tobacco addiction. The report shows that some key actions were taken at the federal and state levels to prevent and reduce tobacco use in 2016, but much more must be done to protect the public from the harms of tobacco use and secondhand smoke.”

Progress in cutting consumption of sugary drinks has stalled – after falling for the last decade – according to a new CDC report. The Washington Post quotes Rachel Johnson, University of Vermont professor of nutrition: “The amount of sugar that children in particular consume is still astounding… We recommend that children drink soda once a week or less. We’re seeing that two-thirds drink it on a daily basis.”

A new study published in PLoS One dug deeper into death certificates to see if diabetes was contributing to more deaths than those that were strictly identified as caused by diabetes. The researchers found that while death certificates typically cite 3.5% of deaths as caused by diabetes, a closer examination reveals the real number is closer to 12%. 

California

In his State of the State address this week, Governor Jerry Brown excoriated Trump’s lies and policy agenda. According to Mother Jones, “expanding upon recent vows to counter Trump's agenda, Brown took aim at the administration's "bald assertion of 'alternative facts'" and "blatant attacks on science." He lamented that the "familiar signposts of our democracy—truth, civility, working together—have been swept aside." But he maintained that California could serve as a powerful bulwark: "We must prepare for uncertain times and reaffirm the basic principles that have made California the Great Exception that it is."

Violence and injury prevention

The Milwaukee Independent featured Prevention Institute’s work with the City of Milwaukee to reduce violence and address community trauma.

The National Rifle Association is renewing its push to silence one of guns’ “most important safety features”: the sound of gunfire, by making silencers easier to acquire. Currently, federal law requires background checks and registration for gun silencer purchases.

Mental Health

The City of Flint, Michigan is working with partners to address potential behavioral health impacts stemming from the city’s crisis with lead-tainted water, East Village magazine reports. The work is part of a Resiliency in Communities After Stress and Trauma (ReCAST) grant the city received from the Substance Abuse and Mental Health Services Administration (SAMHSA). The grant is designed to promote resilience, community empowerment, and long-term well-being for families and youth, particularly in cities exposed to trauma through natural and manmade disasters or civil disturbances. Grants also were awarded to Ferguson, MO; Baltimore, Milwaukee, Chicago, Oakland, San Antonio and Minneapolis.

STAT reports on cities and counties around the U.S. that are suing drug makers for flooding their markets with pain pills through drug rings, fueling the opioid crisis.

The federal hiring freeze may leave the Department of Veterans Affairs ill-equipped to meet the needs of veterans who could turn to the VA for services after losing access to other sources of health care that may become unavailable if Affordable Care Act, NPR reports.

Most people support treating rather than arresting those who misuse prescription drugs, according to a poll conducted by the Office of Public Policy Outreach in the Center for Public Policy at the L. Douglas Wilder School of Government and Public Affairs at Virginia Commonwealth University in Richmond. Researchers polled 1,000 residents of Virginia, where State Health Commissioner Marissa Levine has declared a public health emergency  in response to a rise in opioid abuse, according to WRIC.

Health systems

New research shows that communities with high numbers of uninsured experience less cohesion and trust. The lead researcher writes in RealClearHealth: “People living in communities with lower levels of insurance are less likely to feel connected to and trust their neighbors, even after controlling for several other neighborhood and individual factors that might affect people’s perceptions of and engagement with their communities.” Likewise, she writes: “…people’s perceptions of their neighbors and communities improve as more people gain access to insurance in their community.”

A new study finds repealing the ACA will kill more than 43,000 people a year, The Washington Post reports. The study was covered widely in the mainstream media. The study found that for every 355 people who gained coverage across several states, one life was saved per year. If the ACA is repealed, an estimated 20 million people will lose coverage, yielding a death rate of 43,956 deaths annually. And, as for the financial case against repeal, Kaiser Health News reports 59% of individuals contacted by collection agencies have medical debt—this problem will worsen if people lose coverage. Unlike other kinds of debt, medical debt spanned income levels and ages.  

The New England Journal of Medicine reports that just 38% of primary care doctors who voted for Trump want Obamacare repealed. Of all primary care doctors, just 15% want repeal.

An op-ed in the Austin American-Statesman by an infectious disease epidemiologist argues for keeping the Prevention and Public Health Fund, noting it has given Texas $124 million to fight Ebola, prevent lead poisoning, and curb tobacco use. Meanwhile, two doctors wrote an op-ed in Stat arguing that medical education needs to embrace prevention (albeit a focus on individual-patient and/or secondary prevention).

Kaiser Health News has a helpful article on potential consequences of moving to Medicaid block grants.