Public Health

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Smoking Prevention in China

August 30, 2011 in Books, Public Health | 1 comment

“All tobacco companies are state-owned, and the industry provides signifiant revenue; it also directly employs more than half a million people. From the government’s perspective, smoking is important to stability, both economic and social.  Some cigarettes are even subsidized–the cheapest brands cost as little as thirty cents a pack, because officials fear that farmers will become unhappy if they can’t afford to smoke.”

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Medicare Patient Safety Monitoring System (MPSMS)

August 4, 2011 in Public Health | No comments

The Medicare Patient Safety Monitoring System (MPSMS) is a national surveillance project aimed at identifying the rates of specific adverse events within the Medicare population.  It is administered by the Quality Improvement Group (QIG) in the Office of Clinical Standards and Quality (OCSQ).  The goal of the project is not to monitor physicians for best practices or determine physician errors.  Instead, the project is limited solely to detecting harm which comes to patients from the fault of the physician.

To identify patients who experience harm, the MPSMS system uses hospital records from over 40,000 hospital discharges.  Whereas AHRQ’s Patient Safety Indicators (PSI) relies exclusively on claims data to identify patient safety problems, the MPSMS sends medical records from these 40,000 discharges for review at one of two Clinical Data Abstraction Centers (CDAC). Using medical records has the advantage of being able to access more data than is available in the claim; using medical record data, however, is expensive, time-consuming, and relies on providers entering information into the patient’s chart in an honest fashion.

The safety measures cover these topics.  Any adverse medical event selected for monitoring must met the following criteria:

  • The adverse event can be found.
  • The adverse event is common
  • The adverse event is likely to be associated with exposure to a specific process of care
  • The adverse event is responsible for serious morbidity/mortality
  • The adverse event is preventable or repairable

Examples of the events monitored include adverse events associated with hip/knee replacement and post-operative pneumonia (the second most frequent postoperative complication after major surgery).  The most frequent postoperative complication after major surgery is wound infection, but it was not selected as a topic because the wound infection often appears during post-acute care, and thus many wound infections are missed in the data.

One drawback of the MPSMS program is that it is simply a monitoring program.  If MPSMS detects that a provider is harming a large number of patient, no action is taken since MPSMS’s mandate is simply to monitor trends in harm to patient.  Additionally, MPSMS is much more expensive to administer than a safety monitoring program relying on claims data.  Further, even if a harmful provider were identified, the delay caused by medical record review may mean that the provider has corrected his action or no longer practices.

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U.S. Began Providing Socialized Health Care in 1798

July 13, 2011 in Health Reform, Public Health | No comments

While walking around in San Francisco’s Presidio, I noticed a refurbished building which happened to be a former Public Health Service Hospital.  After investigating its origins, I dug up the following information regarding one of the United States’ first efforts to provide an individual health insurance mandate:

“In July of 1798, Congress passed – and President John Adams signed - “An Act for the Relief of Sick and Disabled Seamen.” The law authorized the creation of a government operated marine hospital service and mandated that privately employed sailors be required to purchase health care insurance…First, it created the Marine Hospital Service, a series of hospitals built and operated by the federal government to treat injured and ailing privately employed sailors. This government provided healthcare service was to be paid for by a mandatory tax on the maritime sailors (a little more than 1% of a sailor’s wages), the same to be withheld from a sailor’s pay and turned over to the government by the ship’s owner. The payment of this tax for health care was not optional. If a sailor wanted to work, he had to pay up.”

 

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Drinking in College is “Largely Positive”?

May 24, 2011 in Public Health | 3 comments

According to Marshall Poe, drinking in college has more positives than negatives.

“Rowdy drinking is not the problem. It is an essential, ineradicable, and largely positive element of American college culture. The problem is students who cannot or will not engage in rowdy drinking safely, for they often harm themselves and others.”

How is drinking a positive?  According to Poe, it fosters community at the University of Iowa and many other American universities.

“For most students and alumni, rowdy drinking is considered essential to becoming a Hawkeye. …It may well constitute some of the glue that holds said package together. At Iowa and in American colleges throughout the nation, getting tight and acting silly with your classmates is a rite of passage. It is self-imposed hazing writ large. Like any initiation ritual, it comes at a price…In the vast majority of cases, however, that price is low: hangovers, poor grades, and fines. If you make it through — and almost everyone does — then you will have become a different person and be welcomed into a vast, eternal community. You will have earned the right to reminisce about your eventful days in Iowa City, to warn your children with a wink not to do the things you did, and to bask in the glory of being a Hawkeye.”

Drinking in college is certainly a risky behavior.  Public health offical should examine their efforts to stop college drinking in two parts: 1) what is the net impact of college drinking, and 2) will public health officials/college administrators be able to stop it.  On the first count, public health officials generally only focus on the cot of drinking and not the benefits (i.e., hedonistic pleasure, comradery).  On the second count, it seems like health efforts will only have a marginal effect on drinking.

Instead of demonizing college drinking, let’s focus on helping those who truly have a drinking problem, and let college kids who drink (relatively) responsibly have their fun.

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Foreclosures: Bad for your health

August 1, 2010 in Public Health | No comments

According to a recent study by Pollack and Lynch (2009), having your house foreclosed is bad for your health.  The Penn Gazette summarizes the paper’s findings as follows:

“[the authors]  presented sobering findings culled from a survey of 250 Philadelphians who had sought credit counseling for home mortgage foreclosure.  More than one-third of the study participants met screening criteria for major depression, and after adjusting for demographic and financial factors, people undergoing foreclosure had significantly higher rates of hypertension and heart disease than others in the community.”

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Health dangers for active couch potatoes

July 18, 2010 in Public Health | 1 comment

In my job, I spend nearly my entire day staring at a computer screen.  Whether this is writing computer code, compiling a report, reading papers, or checking my email, I am constantly in a seated position.  I do, however, exercise six mornings per week.  Does this mean that I am an active, healthy person since I exercise religiously or that I am a health risk since I spend so much time sitting?

The N.Y. Times Well blog describes a May 2010 paper which found the following:

“Men who spent more than 23 hours a week watching TV and sitting in their cars (as passengers or as drivers) had a 64 percent greater chance of dying from heart disease than those who sat for 11 hours a week or less. What was unexpected was that many of the men who sat long hours and developed heart problems also exercised. Quite a few of them said they did so regularly and led active lifestyles. The men worked out, then sat in cars and in front of televisions for hours, and their risk of heart disease soared, despite the exercise. Their workouts did not counteract the ill effects of sitting.”

The extremeness of our sedentary lifestyle is to blame.  Doing things such as cooking and cleaning is not heavy exercise, but it does burn some calories and get your heart moving much more than just sitting in front of the T.V.  Chasing after toddlers after work–while potentially a stressful activity–could also help improve your heart’s condition.

The article recommends decreasing the amount of extreme physical inactivity in your day.  For instance, stand up more and sit less.  Pace around your office.  Do housework while you are watching T.V. Read your favorite blog on a mobile device while going for a walk.  Your heart will thank you.

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Smoking’s Impact on Longevity across the World

June 3, 2010 in Public Health | 3 comments

One measure of longevity that may better reflect the quality of a medical care in a country is life expectancy at age 50.  According to a recent article in the Penn SAS Magazine (p. 16-p.17) life expectancy in the U.S. for non-smokers is 84.9 for females and 81.2 for males.  These figures rank 7th and 9th among all developed nations.

Longevity for smokers is significantly shorter.  In the U.S., the longevity is 82.3 for females and 78.5 for men.  These figures rank 17th and 14th among developed nations.

The observation that the life expectancy for smokers is shorter is not surprising.  However, why does the U.S. rank so much worse for life expectancy for smokers than non-smokers?  Is the U.S. medical treatment for smokers so much worse than that of other developed countries?  I would guess not.

The likely cause of the ranking change is due to the selection of people into the smoking group.  It many be the case that smokers in the U.S., are poorer, less educated and more likely to be obese than non-smokers.  Thus, because the group of smokers is at a socioeconomic disadvantage, this can explain why the U.S. longevity ranking is lower for smokers than non-smokers.

Many people stereotype that in France, smoking may be more respectable in high class society and smoking may not be as concentrated in poorer individuals.  In fact, we observe that France ranks 4th in female life expectancy for non-smokers but 3rd in female life expectancy for smokers.  A similar phenomenon may exist in Spain; the life expectancy for non-smoking females ranks 11th, but the life expectancy  for smokers is 5th in the world.  However, these trends are not as strong for differences in male life expectancy between smokers and non-smokers.

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Do Economists Support FDA Pre-approval of Drugs?

May 9, 2010 in Pharmaceuticals, Public Health, Regulation | No comments

Conventional wisdom holds that economists advocate for reducing regulation on most policy arenas.  Regulation imposes costs and businesses and is often ineffective.  Further, as technology and market conditions change, regulations which were originally welfare enhancing can now become archane.

The public generally views the FDA’s pre-approval as a worthwhile endeavor.  The goal of FDA pre-approval is to protect consumers against unsafe and/or ineffective drugs.  In the world of neo-classical economics, agents have perfect information about drug quality and the role for the FDA disappears.  Even if information is not perfectly observed, the FDA’s ability to restrict the entry of potentially useful drugs into the market can be welfare destroying.  Certifying drugs as safe rather than prohibiting them through regulations may be a preferable form of spreading information.

In a recent survey of 44 leading economists, 23 support or strongly support pre-market approval of new pharmaceuticals and devices while 15 where opposed or strongly opposed (6 were neutral).  The key rationale behind the support of pre-market approval was the problem of imperfect information and also the public goods aspect of knowledge.  Fewer economists supported the notion that the government has superior ability to assure safety and  efficacy.

The majority of economists also believe:

  • the effect of pre-market approval in suppressing would-have-been benefits is often or typically overstated in public discourse.
  • doctors do not systematically error when prescribing medicines.
  • replacing the current FDA system with a simple physician prescription requirement for new drugs and devices is a bad idea
  • The current FDA system increase the amount of knowledge available on new drugs.

Economists were split as to whether drugs approved by European, Japanese, and Canadian authorities should automatically be approved for use in the U.S.

This survey shows that economists do not have a clear consensus answer to the question of whether there is “a sound market-failure rationale for the banned-till-permitted policy for drugs and devices.“

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Eligibility Requirement for California Government Health Insurance Programs

January 19, 2010 in Medicaid/Medicare, Public Health, Public Policy | No comments

The California HealthCare Foundation has an almanac entry on Children’s Health Coverage Facts and Figures.  Eligibility requirements for these programs is described in this table.  Other key findings include:

  • The proportion of children without health insurance continued to decline through 2007, though the pace of improvement has slowed.
  • Nearly 80 percent of California’s uninsured children are eligible for coverage under either Medi-Cal, Healthy families, or Healthy Kids.
  • Medi-Cal and Healthy families are key sources of coverage for children in low-income households that together have closed the coverage gap among families with incomes up to 250 percent of the federal poverty level.
  • Healthy Kids programs are also important for children’s coverage. twenty-four counties operate Healthy Kids programs and four others rely on California Kids.
  • Children are less likely to have employment-based coverage than adults and are more likely to be enrolled in public programs in California.

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H1N1: Do I have it? Do I need a vaccine?

October 20, 2009 in Contagious Disease, Public Health | No comments

Two weeks ago, the U.S. government released its H1N1 vaccine to the public.  Many people have had a number of questions about whether or not they should get the vaccine.  The CDC website has a list of Key Facts and a Q&A section that is helpful.  

There are five major groups who should have priority of getting the vaccine:

  • pregnant women,
  • people who live with or provide care for infants younger than 6 months (e.g., parents, siblings, and day care providers),
  • health care and emergency medical services personnel,
  • people 6 months through 24 years of age, and,
  • people 25 years through 64 years of age who have certain medical conditions that put them at higher risk for influenza-related complications.

There are a number of people who should NOT get the vaccine.

  • People who have a severe allergy to chicken eggs.
  • People who have had a severe reaction to an influenza vaccination.
  • People who developed Guillain-Barré syndrome (GBS) within 6 weeks of getting an influenza vaccine previously.
  • Children younger than 6 months of age (influenza vaccine is not approved for this age group), and
  • People who have a moderate-to-severe illness with a fever (they should wait until they recover to get vaccinated.)

The H1N1 vaccine is prepared using the same method as used for the seasonal flu.  However, because the H1N1 vaccine was developed too late, it could not be added to the seasonal flu vaccine.  Thus there are two flu shots available now, one for the seasonal flu and one for H1N1. 

If you think you have the H1N1 illness, you can use this self assessment tool to verify whether or not you should see a doctor.

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