Sunday, February 22, 2015

The Advocacy Challenge...

This blogger has been too busy to blog for a while.  Now, I'm back.

To say that there has been a lot happening in the world of health policy lately is putting it mildly.  Nationally, there has been another ACA marketplace insurance enrollment period, with all of the accompanying education and outreach.  CHIP, the Children's Health Insurance Program that provides comprehensive, affordable coverage for children and families whose incomes are too high for Medicaid but too low to pay for private insurance, needs to be reauthorized by Congress this fall if it is to continue.  In Wisconsin, the state where I'm a resident and a public health professional, there has also been a lot bubbling up.  (Namely our Governor's proposed budget, which I won't get into).  Aside from that, given that our state has not yet accepted federal funds to expand Medicaid, some legislators have introduced compromise legislation aimed at expanding BadgerCare to childless adults.

Who makes health policy changes become reality?  Government is definitely involved.  The feds, and the states with state-based exchanges, have to implement the policies and procedures around ACA enrollment, and maintain the website.  Congress will ultimately have to vote whether to reauthorize CHIP.  In our state, legislators and the Governor will make the final decisions on Medicaid/BadgerCare expansion.  But behind these decisions, constantly moving and shaking, are advocates.  Interested individual citizens,  non-profit organizations and health professional organizations, health-minded politicians, and more.  People and organizations that care about health policy issues and are willing to speak out.

As I have watched and listened to the advocates in Wisconsin these past few weeks, I'm proud to call some of them public health colleagues and friends.  I am impressed by how articulate and passionate they are, with loud voices (and powerful pens).  They went all out around ACA enrollment, and speak up frequently on any number of public health and health policy issues. I feel fortunate to live and work in a state with such skilled and dedicated advocates helping to shape our health policy.

These advocates set the bar really high for the rest of us, in terms of our public health and health policy advocacy.  Their examples challenge all of us to do some kind--any kind--of health advocacy.  I hope we--myself included--can live up to this challenge.

Tuesday, February 3, 2015

In Poor Health...

1 in 4 American kids are growing up in poverty. 

That number is astonishing.  And appalling.  And really unhealthy for our country. 

Yes, I  spent my evening watching Episode 2 of The Path Appears (based on Nicholas Kristof's and Sheryl WuDunn's incredible book), which focuses on poverty.  Since the weather precluded my spending the evening volunteering at a program that serves families in poverty, I watched poverty  instead.  I saw the family living in the Appalachian trailer park--a mom struggling to overcome a tumultuous childhood, raise her child, and attend school. I saw Haiti--urban slums and poor rural areas.  I saw Colombia--and a program for impoverished pregnant teens.  And I started thinking about my experiences working with children and families in poverty.

I was born and raised in a town with a high poverty rate.  Yes, I knew of the poverty  But I really didn't know much about poverty until later.  As a senior in college, on a medical mission trip to Guatemala, I saw extreme poverty for the first time.  The dump where the poorest of the poor scavenged.  Children begging on streets.  Tiny shack houses.  Patients with horrible tooth decay.  A rural hospital without basic medical supplies in different sizes.

During my MPH years, we learned about the social determinants of health, and poverty was part of the conversation.  But it was after grad school that my real lessons on American poverty commenced.  I returned to my hometown, where I worked as an elementary teacher and a medical Spanish interpreter.  Enter...students without any books at home. Students whose parents were unemployed and laid off.  Students who took their school crayons home to color with because they didn't have other crayons.  Enter...uninsured Latino patients who self-paid, and who skipped specialist appointments because they couldn't afford them.  Patients who didn't get tests done because they couldn't pay.  Patients who couldn't afford glasses for their children. 

Fast forward til now, when poverty and associated problems are increasingly recognized as contributors to toxic stress, and we know that toxic stress early in life can contribute to health problems years later.  The MPH in me cringes at the thought that my former students may be at higher risk for obesity, heart disease, and other poverty-associated conditions when they're adults--just because they grew up in poverty.  The MPH in me wonders if my uninsured Latino patients will suffer long-term consequences of untreated chronic conditions because they couldn't afford needed care.

For those who live in poverty now, how poor will their health be in the future as a result?

Sunday, January 25, 2015

Vaccination Communications

Vaccinations, immunizations, shots...whatever you want to call them, they've been in the news a lot lately.  Because of the measles issue at Disneyland, there has been an abundance of media coverage.  Some factual.  Some quite logical and persuasive.  Some, like the Onion's, meant to be funny. There has also been a fair amount of news coverage related to the flu vaccine, which is not proving as effective against this year's strain as it was hoped--but which people are still encouraged to get.  And that doesn't even get into the anti-vaccine stuff, which I admit I have not bothered to read.

Bottom line:  there are a lot of vaccination communications floating around the Internet, TV, and newspapers now.  Many are well-done.

As a public health person, I am glad to see all the news media coverage around immunizations.  Aside from the fact that immunizations are among public health's great triumphs and it's nice to see them get some good primetime attention, I'm happy about the coverage for another reason.  There's no hope that it will convince the diehard antivaxers to vaccinate themselves or their kids, but maybe just maybe the attention and coverage will convince those who are on the fence, those who are debating, those who are pondering, to get immunized and/or to get their kids immunized.

I am young enough that I've never seen measles, mumps, or polio in action (chicken pox is another story--I am just old enough that I actually had it).  And I hope that in my public health career, I never do. Dealing with vaccine-preventable diseases is one thing I can do without, thank you very much.  In terms of influenza, which is different than the others because it tends to rear its ugly head each year, I have not only seen it in other people, but I have had it myself.  Suffice it to say that having it once is enough to make anyone a convert to getting the flu shot yearly for the rest of one's life (and to make one very thankful for Tamiful!).

With media coverage continuing regarding the Disneyland situation and the flu season, there are stories and columns and factual pieces aplenty that will reach lots of Americans.  I hope that people are reading and listening, considering the facts and thinking critically...and baring their arms and their kids' arms--for the shots that can save lives.  I hope that some of the carefully crafted vaccination communications are having a positive public health impact.

Monday, January 19, 2015

A Sign of Trust...

A medical/health newspaper article hasn't ticked me off for a while, but today one did.  My rant would have been too long for a Facebook post, so a blog post it will be.

Abigail Zuger MD wrote an article in the New York Times entitled Too Close to a Patient for Comfort.  The gist of the article, that sometimes physicians treat family/friends/celebrities and have difficulty remaining objective, is legit.  The example she gives in the article, however, is not.

Zuger writes about how the CEO of her clinic announced that he would be getting his medical care from one of the doctors in the clinic, and about how this made her and her colleagues uncomfortable.

I completely and totally disagree with the CEO example.  First of all, if a CEO doesn't get care from providers in his/her clinic, hospital, or health system...what a demeaning sign to those providers: that the CEO doesn't trust their clinical skills and judgment enough to see them for medical care, to let one of the doctors listen to his/her heart, diagnose and treat high cholesterol, or remove a gallbladder.  The CEO may have had something to do with hiring these doctors, and yet he/she doesn't trust them enough to see them for care?!?  And an equally demeaning sign to clinic/hospital/health system staff:  that the CEO doesn't trust the nurses, radiology techs, and phlebotomists enough to let them take blood pressures, insert IV needles, perform ultrasounds, etc.  If community members and outsiders know that the CEO doesn't get care at his/her own clinic/practice/health system, it becomes more than just a demeaning sign to providers and staff, it becomes really bad PR.

I don't disagree with Zuger's general premise about physician objectivity.  I have multiple doctors in my family, who--depending on the situation, may or may not be objective.  Which is why I have actual regular doctors, people who are more objective and whose clinical skills and judgment I trust.  But as a child of two doctors who was born and raised amidst community medicine, I think Zuger's CEO example is off base.  Zuger and her colleagues should be more than a little annoyed and upset that the CEO wasn't seeing one of them for care in the first place.  In fact, they should expect that he/she would see one of them as a basic sign of trust in the health care that they provide. 

Thursday, January 15, 2015

Deja Vu

I feel like I am back in public health grad school. In Health Policy and Managed Care class.

I just started reading Ezekiel Emanuel's new book Reinventing American Health Care.  Yes, this is the quintessential health policy nerd book.  A few nights ago I went bookstore browsing, planning to buy something light and mindless, and then I saw this.  So much for light and mindless.

I've only read a little of the book thus far, but thus far it brings back memories of classes long ago.  Emanuel's pages are filled with all of the acronyms and terms I knew and loved back then.  Flexner Report, Hill-Burton--all of my old friends appear in this book.  And Emanuel himself is familiar--I know that we read some of his health policy journal articles in grad school, because that's where I first learned his name and his importance.

In other words, Health Policy and Managed Care classes repeated.

But there's something very different now.  The ACA.  It wasn't around when I was in grad school.  Meaning that we didn't get to dissect its parts in Health Policy class, to analyze the impact on the number of uninsured, to think about the difference preventive health care benefits would make.  Wed didn't get to learn the ins and outs of this law, because it simply didn't exist.

Now, as a public health professional who continues to be fascinated with health policy, I'm discovering that I want and need to know more about the ACA. I need to go back into MPH student mode and delve into the policy details, the intricacies, the  historical issues.  My advocacy friends' Internet resources and social media posts are excellent sources of information, but the ACA is one complicated law and I want to actually see more of the writing on the page.

Hence snatching this book off the shelf. And hence feeling like once again, I am a MPH Health Policy student--a feeling I honestly didn't think would ever be repeated.  I'm glad that the ACA, as it has entered the scene and completely changed the landscape, has proven me wrong and is taking me back to my health policy roots.