Six members of the Presidential Advisory Council on HIV/AIDS have resigned in frustration with the Trump’s Administration’s apparent lack of interest in “the on-going HIV/AIDS epidemic.”

Since its creation in 1995, the council has sought to craft national policy on the disease, prevent its spread, and promote effective treatment as a cure is developed, according to U.S. News and World Report.

The members of the council who quit began becoming concerned during the 2016 presidential campaign when the Trump team showed little interest in meeting with advocates for those struggling to survive the disease. At that point, while the council noted the Trump camp’s disinterest, they clung to the hope that he could be engaged on the issue once in office, according to U.S. News and World Report.

Things escalated when the White House site “Office of National AIDS Policy” was removed during Trump’s inauguration, said Scott Schoettes, a member of the council since 2014.

The final misstep was when the new American Healthcare Act was passed by the Republican-majority House of Representatives, despite pleas from marginalized communities that it would have disastrous impacts, especially for those with HIV/AIDS.

New HIV infections in America declined 18 percent between 2008 and 2014, according to estimates from the Center for Disease Control. The council worked with the previous administration to create the new healthcare system that provided easier access to diagnosis and treatment. Those who quit the council felt that the new GOP bill would take that away.

Schoettes, and his peers, wanted to provide input for the council, but said that they could no longer stand idly by as the Trump Administration ignored their recommendations. Schoettes wrote in a guest column for Newsweek announcing the resignations:

The Trump Administration has no strategy to address the on-going HIV/AIDS epidemic, seeks zero input from experts to formulate HIV policy, and — most concerning — pushes legislation that will harm people living with HIV and halt or reverse important gains made in the fight against this disease.

Trump has still not appointed anyone to head the White House Office of National AIDS Policy after 150 days, while former President Barack Obama appointed a leader after only 36 days. Schoettes penned the column, but it was cosigned by his partners in resignation Lucy Bradley-Springer, Gina Brown, Ulysses W. Burley III, Grissel Granados, and Michelle Ogle.

While the council can have up to 25 members, it currently has only 15. The council last met in March, at which point the members wrote a letter to Health and Human Services Secretary Tom Price expressing concern about the repeal of the American Healthcare Act and the impact it would have on access to HIV/AIDS treatment. Price responded with an uninspiring, “perfunctory” response, according to Schoettes, which further frustrated the council.

Still, Schoettes says he and his colleagues have a desire to help the community they have worked with for many years. They don’t foresee Trump mustering any more interest than he has shown, but they hope other politicians find it necessary to work on a serious public health issue. The column finished:

We hope the members of Congress who have the power to affect healthcare reform will engage with us and other advocates in a way that the Trump Administration apparently will not.

Josh Schmidt

Josh Schmidt is an editorial intern and is a native of the Washington D.C Metropolitan area. He is working towards a degree in multi-platform journalism with a minor in history at nearby University of Maryland. Contact Josh at staff@LawStreetMedia.com.

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In recent years, scientists have been paying a lot of attention to a striking development: the number of infectious diseases has increased considerably. That rise was not just one or two more diseases each year. In fact, over the last 100 years, the number of new infectious diseases discovered each year has quadrupled and outbreaks have tripled. What explains this dramatic increase in new infectious diseases? Read on to find out the answer to this question, how scientists are working to fight diseases, and what the consequences could be if we continue along this same trajectory.

Infectious Disease on the Rise

To begin to understand the rising levels of infectious disease, it is first imperative to understand the common terminology. Four terms, in particular, are used very frequently and require clarification. These terms are outbreaks, epidemics, pandemics, and endemic. An outbreak occurs when the number of cases of a specific disease in a specific community rises above what would normally be expected. Epidemics are, “a widespread increase in the observed rates of disease in a given population.” Pandemics are basically the multinational form of epidemics in that they encompass worldwide outbreaks beyond a particular population. Endemic is decidedly different than the other terms and essentially means a rate of disease that is consistently higher within a given group. These definitions are particularly important for the people treating an outbreak on the ground, as it helps them tune their methods to the reality of the situation. The following video gives an overview of how disease spreads:

Although that rise sounds troubling it is not all doom and gloom. While individual outbreaks are increasing, they are affecting fewer people now than before. Additionally, only a small variety of infectious diseases are responsible for the majority of outbreaks. Furthermore, of these strands, a little over half are zoonosis–diseases that are passed from animals to humans. Even among zoonosis, there are only a few zoonotic diseases that cause most outbreaks. In other words, outbreaks are on the rise but a decreasing number of diseases–passed from animals to humans–account for that rise. The question then becomes, what is leading to the rise in outbreaks?

Factors Leading to the Rise of Infectious Diseases

There are several reasons for this increase, but it starts with us and the actions we take. Many of the recent outbreaks are not new diseases, only new to us as a species. They have been incubating and traveling all across areas like rainforests for tens of thousands of years. However, with human encroachment in the form of farming, mining, housing, etc. people are starting to come into contact with these diseases more often and the results are not always good.

Other human manipulations of the environment are also leading to the rise of infectious diseases. These include seemingly benign activities such as reforestation, animal farming, and even flooding rice patties. Sometimes it can be a combination of human activity and environmental factors, such as when milder winters that are the result of global warming fail to kill off the usual number of pests. In fact, rising temperatures have the potential to be one of the greatest contributors to the continued rise of infectious diseases in the coming years, while ailments such as Malaria, which prosper in warmer climates, may become much more virulent. The video below details how global warming can increase the risk of infectious disease:

Other trends, like urbanization, may also contribute to the rise of infectious diseases. By clumping closer together, the chances of an infection spreading quickly are much higher. This is particularly true when urbanization occurs in poorer countries without effective public health monitoring and preventions systems. Similarly, more travel between countries and regions can introduce infections to places that have never seen them before and it can increase the likelihood that an epidemic becomes a pandemic. Even technology and modern supply chains can present a risk, as processing consolidation may increase the likelihood that contamination spreads.

Resistance to antibiotics and resulting superbugs are additional issues leading to the rising number of infectious diseases. However, this is also a problem for viral infections for many of the same reasons, including over prescription of certain medicines and prescribing the wrong medication for a specific disease. Viruses are especially problematic because they can evolve so quickly that it is impossible to stay ahead of them. The clearest example of this is influenza or the flu which changes from year to year. Along with antibiotics, many sanitation systems are also proving less useful than before. In this case, the issue has more to do with the lack of upkeep in existing public health systems that has led to outbreaks of old diseases such as cholera.

Efforts to Fight Outbreaks

Given this trend, what is being done to stem the tide? Actually, governments began addressing the rise of infectious diseases several years ago. A response was prompted back in 2014, following the outbreaks of MERS and bird flu. That year, the United States, along with dozens of countries and organizations, announced a plan to respond and treat new outbreaks where they start.

Currently, efforts to fight infectious disease in the United States fall under the authority of the Centers for Disease Control, or CDC. Specifically, many of those efforts are housed in the National Center for Emerging and Zoonotic Infectious Diseases or NCEZID. NCEZID focuses on reducing both illnesses and deaths that are associated with infectious diseases. It also strives to be proactive in protecting against the spread of infectious diseases.

At the international level, there is the World Health Organization (WHO). Much like the CDC in the United States, the WHO also focuses on reacting to and fighting epidemics. The WHO acts more like a clearinghouse encouraging individual countries to improve their own existing systems and work to integrate them internationally so a crisis in one country can be handled as effectively by its neighbor if it crosses international borders. When it comes to the spread of infectious disease, the WHO serves as an international monitor to identify and coordinate a response to outbreaks.

Conclusion

Foreseeing and preventing all outbreaks of infectious disease would be impossible. Just last year, for instance, several people in Russia were infected with Anthrax when frozen strains of the disease were released when permafrost melted. While this could easily lead to discussions about global warming, the truth is that it just as clearly exemplifies that it is impossible to anticipate everything. In fact, in some cases, efforts are even seen as misguided or unwanted.

Many recent efforts have focused on identifying and understanding new diseases, like those deep in the rainforest. However, such methods have also been criticized for spending scarce funding to search out new diseases when funds could instead be used for treating known maladies. Although it seems odd to criticize people for being proactive, that might be a fair critique in a world with finite resources. In fact, it might be fair to wonder why people are really that concerned with infectious diseases at all.

This is because non-communicable diseases, like cancer, which cannot be spread from one person to another, kill far more people each year than infectious diseases. However, those diseases also originate within us and frequently have to do with factors that we are less able to control, such as getting older. Conversely, based on the fact that only a few diseases cause most of the outbreaks, infectious disease can be managed and their threat reduced. Thus counteracting the rise of infectious diseases is likely to continue to be a mainstay of health policy both nationally and globally.

Michael Sliwinski

Michael Sliwinski (@MoneyMike4289) is a 2011 graduate of Ohio University in Athens with a Bachelor’s in History, as well as a 2014 graduate of the University of Georgia with a Master’s in International Policy. In his free time he enjoys writing, reading, and outdoor activites, particularly basketball. Contact Michael at staff@LawStreetMedia.com.

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A recent study found that there has been a rise in insurance claims for obesity-linked illnesses, such as high blood pressure, type 2 diabetes, and sleep apnea. While the results of this study–completed by the nonprofit Fair Health, a national clearinghouse for claims data–is nothing new, it is one of the first to use actual claims data. This is important because claims data shows treatments actually rendered, which can help illustrate the medical costs associated with high obesity rates. Beyond the results of this specific study, though, the fact is that obesity has become a major problem in the United States for people of all ages. Read on to learn more about the American obesity epidemic, what is being done to fight it, and the outlook going forward.

Obesity in America

Obesity is a somewhat mysterious term, so it first bears clarifying. According to the Centers for Disease Control (CDC), a person is obese when his or her Body Mass Index is above 30 percent. BMI is calculated by dividing a person’s height by weight. A BMI above 40 percent is considered extreme or severe obesity. While BMI is a useful tool to help assess health on a basic level, it does not directly measure the amount of body fat a person has.

In 2014, 36 percent of adults in the United States were obese. According to estimates from 2008, obesity cost the nation approximately $147 billion for medical costs. On a more individual level, people who are obese spend $1,429 more on medical costs per year than people of normal weight. Not only does obesity have negative physical effects, but it can also have negative mental effects and lead to depression.

From a demographic perspective, obesity tends to affect certain groups more than others. Non-Hispanic black Americans have the highest age-adjusted rate of obesity, at 48.1 percent. They are followed closely by Hispanics and non-Hispanic whites. The group with the lowest rate of obesity by far is Asian Americans, who have an average obesity rate of just 11.7 percent, which is well below the national average. Additionally, while obesity is on the rise in many demographic groups, middle-aged adults still have higher rates of obesity at 40.2 percent than both older adults and young adults.

Continuing along this same path, for men, there is not much of a correlation between income or education level and obesity. The one exception being that black and Mexican-American men with higher incomes are more likely to be obese than lower income men in the same groups. For women, a more widespread correlation exists–higher income and better-educated women of all races are less likely to be obese than women from the opposite income and education groupings. Geographically, there is a lower prevalence of obesity in states in the West and Northeast of the United States, with those in the Southeast having the highest rates of obesity. The following gives an overview of the facts behind the obesity epidemic:

Factors behind the Obesity Epidemic

So what causes obesity and what led to its rise? While many people may point to a simple lack of self-control to explain the prevalence of obesity, in many cases it is much more complicated than that. One of the major issues is genetics, namely different people absorb, store, and process food differently, which can make them more likely to gain weight.

In the same vein, medical problems that lead to inactivity, such as arthritis, can also contribute to obesity. Similarly, certain medications taken for completely unrelated conditions, such as depression, can cause weight gain. Age and pregnancy can lead to obesity as well, with people’s metabolisms generally slowing down as they get older and some women having difficulty losing weight after giving birth.

In addition to the physical factors, there are also several environmental factors at play. These include access to a place to exercise, knowledge of healthy cooking, and even being able to afford healthy food. Quitting smoking can affect someone’s weight as well, although its potential negative health effects are generally outweighed by its positives. Even a change in sleep patterns can lead to significant weight gain, as they can lead to hormonal changes that affect how food is digested.

Sometimes there are things completely beyond a person’s control, an example being meals at restaurants, which today are four times larger on average than they would have been back in the 1950s. Along with quantity and size, the cost of food also plays an important role in the rate of obesity. Since the 1970s the cost of food as a portion of income has gone down. Nor is all food is created equal, and while all food has gotten relatively cheaper, unhealthy foods tend to cost even less than healthy alternatives such as vegetables. Even if you set aside how healthy cheap food is, the sheer availability of food makes being obese more likely. While factors such as poor diet, family lifestyle, and inactivity can lead to obesity, they are clearly not the only causes.

Efforts to Reduce Obesity

While determining the causes of obesity has been a challenge, actually reducing it has been particularly difficult. However, that failure is not for a lack of trying. The CDC funds programs at the state and local level in an effort to reduce obesity by advocating for a combination of healthy eating habits and an active lifestyle. The CDC’s High Obesity Program provides grants to universities in areas with a high prevalence of obesity that involve a targeted approach to address the issue. Several states and cities have also implemented a range of policies to address health concerns, ranging from taxes on soda and sugary drinks to school nutrition programs.

There are many resources outside the government as well, in the form of non-governmental organizations that are focused on combatting obesity. A number of these organizations–like the Obesity Action Coalition or TOPS Club, inc–echo their government counterparts, preaching that a combination of education, healthy eating, and physical activity is necessary to combat the obesity epidemic.

The accompanying video looks at ways to fight obesity:

Nevertheless, for all the energy these organizations, government and non-government alike, are exerting their efforts seem to be in vain. In fact, despite major efforts in research, clinical care, and the development of various programs to counteract obesity, after more than 30 years there are few signs that suggest the fight against the epidemic is succeeding. While the overall trend has not reversed itself, some targeted efforts have managed to bring about success at the community level.

Going Forward

Obesity is a major factor in predictions that for the first time children growing up today may not outlive their parents. That is because obesity rates and body weights, in general, have skyrocketed over the last 40 to 50 years. From 1962 to 2006 the obesity rate among Americans grew from 13.4 percent to 35.1 percent. The average person today weighs 26 more pounds than he or she would have in the 1950s. A 2005 study found that if obesity trends continue on their current path, the life expectancy gains from the past several decades could flatline or even go in the opposite direction.

This troubling news concerning obesity comes at an especially bad time. With rates already increasing, government programs that target obesity prevention, in particular, could lose federal money. One of the many aspects of the Affordable Care Act involved the creation of a Prevention and Public Health Fund, which provided resources to important prevention programs–including some obesity-related grants–and makes up a sizable portion of the CDC’s total budget. With Congress debating whether or not to repeal the law, such funding could be cut. More than 300 public health organizations signed on to a letter to congressional leaders asking them not to get rid of the fund in January.

Investing in these public health interventions is becoming more important now than ever, as estimates indicate that the obesity epidemic will continue to be a problem in years to come. Two different studies predict that the obesity rate could continue to rise to 42 to 44 percent by 2030.

While this is an American epidemic, and America has the highest percentage of obese people, the United States is not the only place feeling the burden. Roughly 30 percent of the world’s population, or 2.1 billion people, are either overweight or obese. This trend affects both developed and developing countries alike, however, it affects them in different ways. In developed nations, men have higher rates of obesity whereas women in developing countries have higher rates.

Regardless of demographics, though, obesity rates are increasing all over the world much like they are in the United States. Also, like in the United States, preventive measures to reduce obesity have mostly failed. It has gotten to the point now that regions outside of North America and the West actually have the highest rates. Currently, the Middle East and North Africa have the highest adult obesity rates in the world.

Conclusion

While obesity tends to affect certain groups more than others, overall obesity rates have increased significantly in the past several decades. While obesity rates have leveled off among American youth in the past 10 years, they have continued to climb for adults and remain at record highs for both. Unfortunately, many of the attempts to reverse these trends have had little success so far. This is extremely troubling as obesity has gone from a problem to an epidemic.

The impact from rising obesity rates has the potential to be disastrous. Obesity already costs the United States alone hundreds of billions of dollars annually. For nations that cannot afford this level of care, obesity could lead many people to develop obesity-related diseases and complications without any way to treat or address them. While most efforts have failed to reverse the trend, some targeted interventions have been effective. Ultimately, the problem will need to be addressed at a larger scale for rates to decline.

Michael Sliwinski

Michael Sliwinski (@MoneyMike4289) is a 2011 graduate of Ohio University in Athens with a Bachelor’s in History, as well as a 2014 graduate of the University of Georgia with a Master’s in International Policy. In his free time he enjoys writing, reading, and outdoor activites, particularly basketball. Contact Michael at staff@LawStreetMedia.com.

The post The Obesity Epidemic: What’s Behind One of America’s Largest Health Problems? appeared first on Law Street.

Fall has started and along with it comes several long-anticipated events like football season, changing weather, and Thanksgiving. But there’s something else associated with this time of year that no one is looking forward to–flu season. Despite being seemingly innocuous, the flu is one of the greatest scourges in the history of mankind and is still a potent killer. It has also given rise to a billion dollar vaccine industry bent on stopping it.

Read on to find out more about the history of the flu, the flu vaccine, and the business that it has spawned.

The History of the Flu

Human beings have been victims of the flu or influenza for as many as 6,000 years. While no precise date is readily available, it is believed that once humans started to domesticate animals they also started acquiring the flu from them, as many animal species carry flu strains. The name “influenza” originated in eighteenth century Italy where its outbreak was blamed on poor air quality.

Although the existence of the flu has been known for centuries, it is only within the last hundred years that it has been clearly identified. In 1918, a veterinarian actually discovered that a disease found in pigs was similar to one found in humans. In 1928 other researchers proved, through experiments on pigs as well, that the mysterious killer influenza was actually caused by a virus. Still, it was not until 1933 that scientists finally identified the specific virus that caused influenza.

The video below gives an overview of the history of the flu:

Types of Flu

Although the flu is commonly referred to as a monolithic thing, it is actually a combination of related viruses. There are two main types of flu virus: H-types and N-types. These letters correspond with genetic markers for two glycoproteins, hemagglutinin (H) and neuraminidase (N), which are the antigens the host of the virus develops an immunity to. Along with these are three major strains: A, B, and C. The A strain is the one that causes major outbreaks that lead to widespread deaths. There is also a D strain, which primarily infects cattle and is not known to harm humans.

The reason why the flu is so deadly is because of its genetic makeup. Since the genetic code of the influenza virus is made of RNA and not DNA, the viruses replicate very quickly and are more prone to mutations. Thus, viruses can change numerous times before a human, for example, can even build up an immunity to the original virus. This is done through two processes. The first is called antigenic drift, and it occurs when mutations change the virus over time eventually making it so immune systems can no longer recognize it. The second is called antigenetic shift, which involves a dramatic change in the composition of the virus, like combining with an animal subtype, which is often the process that leads to pandemics.

The flu generally hits elderly people, those with asthma, pregnant women, and children the hardest. For anyone who has had the flu before, the symptoms are familiar: fever, chills, coughing, sore throat, achiness, headaches, fatigue, vomiting, and diarrhea. The virus is usually transmitted through the air via respiratory droplets, but can also move through physical contact. Some people who get the flu are asymptomatic meaning, while they have the flu, they do not experience the typical symptoms, yet can still get others sick. The flu also triggers several related complications including, pneumonia and sinus and ear infections. It can worsen existing medical conditions such as chronic pulmonary diseases, or cause heart inflammation.

Deadliest Strains

While the flu is perceived as commonplace and not particularly dangerous today, it is still one of the deadliest viruses in human history. During the 16th and 18th centuries, there were a number of massive and deadly outbreaks. Since 1900 there have been four major flu pandemics. The Asian flu lasted from 1957-1958 and killed one to four million people. The Hong Kong flu circulated from 1967-1968 and killed one million people. The third was the Swine flu, or H1N1, which broke out in 2009. The greatest outbreak by far, though, was the Spanish flu that broke out in 1918, right on the heels of World War I. The epidemic killed as many as 50 million people worldwide, more than the war itself.

The accompanying video looks at the deadly 1918 pandemic:

Aside from these major outbreaks, the flu remains a virulent threat. Although it is hard to pinpoint exactly how many people die each year from the flu, the CDC estimates that more than 55,000 people died from influenza and pneumonia in 2015. But that is an estimate and the numbers often vary. An earlier estimate for the flu alone, by the CDC, put the yearly average somewhere between 23,000 and 33,000. The discrepancy is caused by outliers in yearly totals and different strains that respond to the flu vaccine differently.

The Flu Vaccine

If someone catches the flu there is little that can be done for them. Infected people can take over-the-counter remedies and in certain cases can even be prescribed antiviral medications, although many strains of the virus have grown immune to such treatments. Generally, the only way to consistently ward off the flu is by trying to prevent it in the first place with a flu vaccine.

Developing the flu shot has been a long process and one that is still in progress. The first step was on the heels of two important discoveries–scientists managed to grow the flu virus in eggs for the first time in 1931 and were able to isolate the virus itself in 1933. While Louis Pasteur was the first to actually attempt to make a flu vaccine, it was a Soviet researcher in 1936 who developed the first prototype. While this vaccine was used in the former USSR for 50 more years, it had the drawback of using a live strain of the flu.

However, scientists quickly overcame this by finding a new source of the dead, “inactivated” virus to use in vaccines instead. In 1940 a new problem arose as a second strain of the flu was discovered, leading to the bivalent vaccine in 1942, which targeted one A and B strain. The next major step in the development process occurred in 2007 when the source of the virus for vaccines moved from hen eggs to cell cultures, making reproduction and sterilization easier.

On top of the bivalent vaccine, trivalent and quadrivalent vaccines were developed, containing multiple A and B strains. Vaccines typically change each year because the virus itself mutates from season to season, often making old vaccines ineffective. Strains of the virus are actually monitored all year long, with the Northern Hemisphere monitoring what is circulating in the South and vice versa. When the prevailing strains are identified, a vaccine is tailored to them. Additional vaccines with other strains can also be created in emergencies. This system came about as a result of a WHO recommendation in 1973. Since 1999 WHO has issued two sets of vaccine recommendations each year, one for the Northern Hemisphere in February and one for the Southern Hemisphere in September.

The video below explains how the flu shot works:

The Business Side

Developing a flu vaccine and then redeveloping it each year to fight the different strains of the flu virus has been a long and arduous task. An estimated 171 to 179 million doses of the vaccine were created for the United States in 2015 alone. That amounts to a $1.61 billion industry in the United States and roughly a $4 billion one worldwide.

With an industry this large, it is fair to ask whether the pursuit of profits has overwhelmed the pursuit of health. Roughly 44 percent of Americans received the vaccine in 2015 and the shot is considered the best way to fight the flu. But because of the difficulty of matching the vaccine to the dominant strains, it is only 50 to 60 percent effective. Furthermore, there are different types of vaccines sold depending on how many strains the shot will protect against.

Conclusion

Each year, millions of people are infected with the flu and thousands or even tens of thousands die. It took centuries to identify the virus and much of what we know about the virus was discovered in the last hundred years. Given the nature of the virus and the rate at which it mutates, vaccines often have a hard time keeping up. The international community has developed a sophisticated monitoring system to identify and track new strains of the virus to ensure that vaccines are as effective as possible. But because of the frequent changes, new vaccines must be developed each year, prompting the development of a substantial industry.

Resources

CDC: Deaths and Mortality

CDC: Seasonal Influenza, More Information

WHO: Influenza: Surveillance and Monitoring

NPR: How Many People Die From Flu Each Year? Depends How You Slice The Data

Medical Ecology: Influenza

CNN: Getting a Flu Shot? It may be Better to Wait

The History of Vaccines: Influenza

Medscape: The Evolving History of Influenza Viruses and Influenza Vaccines

CNBC: The $1.6 billion Business of the Flu

Flucelvax: History of the Flu Virus and Influenza Vaccination

Michael Sliwinski

Michael Sliwinski (@MoneyMike4289) is a 2011 graduate of Ohio University in Athens with a Bachelor’s in History, as well as a 2014 graduate of the University of Georgia with a Master’s in International Policy. In his free time he enjoys writing, reading, and outdoor activites, particularly basketball. Contact Michael at staff@LawStreetMedia.com.

The post Feeling Okay? The History of the Flu and Flu Vaccines appeared first on Law Street.

There are many ways to explore and analyze public health. Oftentimes, scientists use a person’s DNA as a method to unlock underlying causes of diseases. However, the best health predictor may not be lying in genetic code, but in one’s ZIP code.

The connection between ZIP codes and human health has long been of interest to researchers desiring to find the best treatment and prevention strategies for some of our deadliest diseases. Land use laws and zoning regulations have transformed some communities and neighborhoods into dumping grounds for industrial plants or undesirable toxic waste. The long-lasting effects of housing segregation and envornmental racism have also had a disparate impact on minorities, reflected in subpar living conditions. Now, some scientists are attempting to explore the importance of ZIP codes as they relate to disease prevention. 

“ZNA”

Dr. Francis Collins, Director of the National Institute of Health, recently noted that our ZIP code at birth is our “ZNA,” “the blueprint for our behavioral and psychosocial make-up.” The air we breathe and the water we drink has just as much of an impact on human health as our genetic code, if not more so. While genetics can inform and shape our health, so too do three other factors: social determinants, community social environments, and physical environments.

Social determinants of health are aspects like income and inequality. Community social environments include crime rates or the particular affluence of a neighborhood. Physical environment means the walkability of a neighborhood or if industrial plants are located near one’s housing. All of these factors overlap each other, influencing one’s health in both direct and indirect manners–some of which may be invisible. Research has indicated that these determinants and influences may have a more powerful impact on health than individual biological differences do.

Housing Patterns and Health Consequences

There are a variety of ways that living in a particular community can affect one’s health. For example, the physical condition of a home can have a profound impact on residents’ health. Building codes in one neighborhood may be more dangerous than in a more affluent one. Disparities in health outcomes across communities are often demonstrated by lead poisoning and asthma. Older homes may have mold or cockroaches, which could also exacerbate underlying health issues.

Land use characteristics, such as residential density, employment opportunities, and walking trails or open spaces, can promote activity and foster a healthy living environment. Zoning also plays a critical role in determining public health. As noted by the Center for Disease Control (CDC), zoning can be instrumental in promoting healthy eating habits and physical activity. Zoning can be utilized to reduce the density of fast food restaurants in a community, incentivize farming in urban areas, and even restrict fast food spots from developing within a specified distance of schools. Additionally, requiring sidewalks, promoting parks and recreation, and widening access to public transportation all play vital roles in increasing physical activity through zoning measures.

Health Mapping

The growth of geographic information science (GIS) and the availability of electronic health records (EHR) now allow for scientists to analyze socioeconomic and environmental factors better than ever before. Health geography has long been an area of medical research that uses geographic techniques to study the impacts of one’s surroundings on their health.

One of the earliest studies employing maps to study dieases was in London, by Dr. John Snow, regarded as one of the fathers of epidemiology. To study the location of cholera outbreaks and deaths in the 1850’s, Dr. Snow used hand-drawn maps showing the location of cholera deaths and then superimposed those with maps of the public water supplies. This allowed him to uncover a cluster of deaths near a particular water pump. His research eventually became an area of study known as disease diffusion mapping, which refers to the spread of disease from a central source, spreading according to environmental patterns and conditions.

GIS utilizes digital software and data sets, along with spatial data, to map multiple aspects of a community. By using and manipulating this geospatial data, researchers are able to thoroughly study the relationship between health, illness, and place. Additionally, EHR can allow scientists to link collected data about the environment with patient medical records. The combination of these powerful tools lends itself well to a broader picture of the interrelationship between ZIP codes, housing conditions and patterns, and human health.

“Not In My Backyard” and Environmental Racism

When development is proposed for a particular community, the most powerful voices can be heard helping to shape the course of the project. “Not In My Backyard” or NIMBY, is a characterization of residents who concede that while a particular project may need to be completed, it should be further away from their community. Projects that could be opposed are practically limitless: any type of housing development, homeless shelters, adult entertainment clubs, and any type of hazardous plants or waste repositories, to simply name a few.

The people who have the power to shape zoning and land use laws in an area tend to be the wealthiest citizens, and usually are white. Thus, more dangerous or undesirable projects are pushed into communities without the bargaining power required to stop them. This type of thinking inevitability promotes environmental racism, utilizing segregated, low-income, minority neighborhoods as the dumping ground for toxic byproducts. This discrimination in land use and zoning policy, particularly fueled by “NIMBY” mindsets, is resulting in increasing health disparities.

What Has Research Uncovered?

Studies have documented that while genetics are an important predictor of health, these other factors have a more powerful impact on health than biology. Income and educational attainment are at least as strongly associated with hypoglycemia in patients with diabetes as particular clinical risk factors. Moreover, those living in areas with less resources for physical activity or healthy food choices have a much higher chance of being diagnosed with type 2 diabetes.

There are dramatic differences in life expectancy rates depending on where one was born in the U.S. In places in the Northeast, populations have a higher life expectancy, while places in the South have the lowest life expectancy rates. These inequalities in mortality rates are intimately tied to housing instability and crowded or subpar housing conditions. In a study of 12,000 New York City households, asthma was more prevalent in Puerto Rican households, immediately followed by other Latino and black households. Moreover, rates of asthma are twice as high in children under the age of 13 in the South Bronx, North/Central Brooklyn, and East/Central Harlem–the three neighborhoods with the highest rates of poverty, morbidity, and mortality in the city.

Additionally, another study utilizing four nationally representative studies noted that worsening economic standing was associated with poor healthcare access, a lack of health insurance, and far higher hospitalization rates. Research has also found that estimated cancer risks associated with ambient air toxics were highest in metropolitan tracts that were highly segregated, and that residential segregation is associated with elevated risks of adult and infant mortality.

The American Housing Survey (AHS) is sponsored by the Department of Housing and Urban Development (HUD) and is considered to be the most comprehensive national housing survey in the U.S. It takes a large representative longitudinal sample of houses on both the state and national level. The most recent survey was completed in 2013, and the results are telling. Data shows that 9.2 percent of non-Latino black homes and 7.2 percent of Latino homes have moderate or severe physical problems, compared with only 3.2 percent of non-Latino White homes.  These numbers are staggering, illustrating a serious issue across the country.

Conclusion

Health-related disparities due to housing can be eliminated if proper measures are taken. For example, childhood blood lead levels have improved by 90 percent since the 1970’s, after effective measures were implemented. Housing conditions continue to be among the greatest determinants of human health, as a large list of highly preventable diseases are intimately tied to poor housing. 

National research and multiple academic reports have continued to affirm that housing access and conditions are among the largest determinants of health, both physical and environmental. There are still numerous roadblocks preventing this issue from being rectified. Significant challenges remain when it comes to legislating and securing meaningful public policies that prevent exposure to physical and environmental hazards, whether it be minimizing indoor pollutants or building high-quality low-income housing. Pervasive housing segregation remains embedded in neighborhoods and cities across the country, adding another layer of difficulty. With the proper focus, combating some of America’s most problematic diseases could be more effective than any other previous attempts.

Resources

Primary

CDC: Zoning to Encourage Healthy Eating

CDC: GIS and Public Health at CDC

Additional

Newsweek: Why Zip Code May Influence Health More Than Genetic Code

Public Health Law Center: Land Use/Zoning

CityLimits.org: Building Justice: Genetic Code, ZIP Code and Housing Code All Affect Health and Equality

CityLimits.org: Builiding Justice: NYC’s Sacrifice Zones and the Environmental Legacy of Racial Injustice

EnvironmentalChemistry.com: Environmental Justice and the NIMBY Principle

GIS Lounge: Overview of Public Health and GIS

Nicole Zub

Nicole is a third-year law student at the University of Kentucky College of Law. She graduated in 2011 from Northeastern University with Bachelor’s in Environmental Science. When she isn’t imbibing copious amounts of caffeine, you can find her with her nose in a book or experimenting in the kitchen. Contact Nicole at Staff@LawStreetMedia.com.

The post ZNA: Could your ZIP Code at Birth Predict Your Health? appeared first on Law Street.

Would you drink this water?

Here’s what Flint, Michigan’s poison lead water looks like. pic.twitter.com/s2g2ml8UL4

— (´・ω・｀) (@_icze4r) January 15, 2016

Many citizens of Flint, Michigan are refusing to–and for good reason. The water supplied by the city of Flint to many residents has been contaminated with poisonous amounts of lead and other toxins for over two years. The safe level for lead content in drinking water, according to the CDC, is absolutely none. That’s why the EPA’s goal for public drinking water is zero parts per billion (ppb), and why 15 ppb is listed as their action level (the concentration at which water authorities are federally required to lower contamination).

So with these regulations from the Safe Drinking Water Act, why are some families reporting 25, 100, and even 200 ppb of lead detected in the tap water from their homes? The answer is shrouded in the intricacies of municipal water supply agreements and water main construction, which are enough to make anyone’s eyes glaze over. So let’s break down just how this ‘man-made disaster‘ began: with a corner-cutting move designed to save money.

It Began With a Plan

Flint, Michigan had been getting its tap water from Detroit for over 50 years. But in 2013, the Karegnondi Water Authority (KWA) began constructing a new pipeline to connect water from Lake Huron to Genessee County, which contains the Flint metropolitan area. This new project would provide water to Genessee and neighboring counties no longer rely on water piped in from Detroit.

A project like this is great news for towns like Flint, which could reduce their public water costs by procuring it locally while also creating jobs to construct and maintain the new system. So construction began on the KWA, and at this point in the story, no public officials or agencies have done anything wrong. That changes.

A Temporary Switch

You see, when this happened, Flint planned to switch to the new KWA pipelines when they finished construction in three years. But in the meantime, they still needed water, and rather than continuing to buy the Detroit water–a pre-treated and sanitary supply from Lake Huron–they switched sources to the Flint River. This switch was estimated to save about $5 million over less than two years.

The trouble was that the water sourced from the Flint River was 19 times more corrosive than the Lake Huron supply. Even after being treated and deemed acceptable, the water eroded the city’s pipes and water lines and accumulated iron, lead, and other metals from the material of the pipes.

By the time the water arrives at neighborhoods, businesses, and schools, the once-drinkable water is tinged brown from the iron, and carrying harmful levels of toxic chemicals. The most dangerous of which is lead.

Flint, Michigan, is suffering a major water crisis. Here’s how you can help. https://t.co/Z01vWiG8JLpic.twitter.com/ecJyIhEtkF

— CNN (@CNN) January 14, 2016

Permanent Health Effects

The presence of lead in drinking water is known to cause kidney problems and related issues in adults, but infants and children are subjected to the worst effects. Lead interferes with development such that children exposed to lead exhibit delays in mental and physical development are often severely impaired by the contaminant’s effects. In September 2015, according to a study performed by the Hurley Medical Center, the proportion of infants and children with above-average levels of lead in their blood nearly doubled since Flint switched its water source.

Given the extent of the problem, residents in Flint have very few options to stay safe. Many homeowners took to boiling large batches of water before bathing their children or giving them water to drink. While that process can help remove some impurities, it actually makes the issue of lead contamination worse. The city issued a ‘Boil Advisory‘ detailing how boiling water just increases the concentration of lead in the tap water.

The only choice left for thousands of residents is to purchase bottled water. The FDA regulates that a bottle of water can have no more than 5 ppb of lead, so bottled water is a safer option for concerned homeowners. For many, this cost is in addition to their water bill, which still may need to use for bathing, and washing dishes. Considering that Flint is often recognized for its poverty (in addition to being among the most dangerous cities in the United States), this burden is especially debilitating.

A Failed Response

After denying that the water in Flint presented a danger to its citizens for nearly two years while residents continuously complained about their water quality, Flint officials finally recognized the contamination problem. When trying to contain a public health epidemic such as this one, it’s important to know the scale of the problem. That seems like a pretty simple task– figure out which homes receive water from pipes made of lead, as those pipes are now corroded and cannot safely transmit water– but as with all things bureaucratic, it wasn’t nearly that simple.

The city government’s data on which houses are serviced by lead water lines was written down on 45,000 index cards stored in a filing cabinet in the city’s public utility building. In October of 2015, transferring this information into a digital spreadsheet was, according to Department of Public Works Director Howard Croft, “on our to-do list,” but only a quarter of the cards had been processed at that time.

Remember that $5 million number? That was the amount Flint expected to save with their water-source switch. The ultimate cost of that “money-saving” maneuver has been estimated at over $1.5 billion dollars by some, as officials evaluate the cost of completely renovating the Flint waterlines with lead-free pipes. That figure also doesn’t take into account any compensation for families and children affected by the contaminated water. The Governor of Michigan, Rick Snyder has now officially appealed to President Obama for a declaration of disaster and federal aid.

Whether Snyder and the state of Michigan receive the declaration and money they are hoping for, the damage to the people of Flint has already been done. Even as the water source is relocated, the lead pipes servicing Flint will still be compromised. A careless decision by local officials snowballed into a public health crisis of unprecedented scale in the area, and the youngest residents of Flint will pay the highest price.

Sean Simon

Sean Simon is an Editorial News Senior Fellow at Law Street, and a senior at The George Washington University, studying Communications and Psychology. In his spare time, he loves exploring D.C. restaurants, solving crossword puzzles, and watching sad foreign films. Contact Sean at SSimon@LawStreetMedia.com.

The post A Call for Help in Flint’s Toxic Water Emergency appeared first on Law Street.

A landmark bill was just passed in California which will make vaccinations necessary for all students, unless they have a medical exemption or the parents choose to homeschool their children. This law eliminates the personal and religious belief exemptions completely, and was met with overwhelming praise, although not without protest. It has been the subject of heated debate for the past few months, although it was finally approved last Tuesday. The Golden State has been forced to take extra precautions after a measles outbreak at Disneyland wreaked havoc on the public, leaving over a hundred people infected.

California Legislature passes mandatory public school vaccination bill #SB277 http://t.co/Rpt3bJvNPI pic.twitter.com/wepXmF011C

— Los Angeles Times (@latimes) June 29, 2015

The bill passed with bipartisan support in the Assembly before it was sent to California Governor Jerry Brown, who hastily signed it, enabling it to finally become a law. Politicians have mixed views on this topic, although it seems that the consensus is that vaccinations are necessary to protect the health of the general public. Recent events have caused numerous bills to be proposed throughout the country, although California’s is one of the first to be set in motion.

Two other states, West Virginia and Mississippi, have already imposed similar laws, and they have proven to very successful so far. California made a wise decision in following the lead of its southern counterparts and given how prominent a state California is, it will likely be a model for other states to follow if all goes well. Many states seem to be interested in implementing similar legislation, and so all eyes will be on California to see just how such actions impact its citizens.

This preventative measure is aimed at schools–both public and private institutions–as well as day care centers. This law also creates clear guidelines for future requirements regarding vaccines so that there are no questions of procedure or exemption. There will now be two vaccination checkpoints for children, one at the kindergarten level, and one in seventh grade. A grandfather clause was also created, which will allow children to wait until the next checkpoint to be vaccinated if they missed the first one due to a personal belief exemption before this change was instituted.

The subject of vaccination has proven to be a very contentious topic in the United States in recent years. But what’s most important is the science behind this decision, and the experts believe that this law is imperative for preventing future outbreaks. Pediatricians in California have high hopes for this new policy, announcing their beliefs that it will most likely increase immunization rates and stop diseases from spreading. The goal is to protect the masses, not only children, but entire communities. So long as the vast majority of people are vaccinated, then the chances of another outbreak are astronomically low. Research has proven that such stringent rules help to create safer environments, so why do so many still have a problem with vaccines?

While the reasons for the opposition to vaccines do merit some recognition, since there is always the microscopic chance of complications, it is obvious that the pros far outweigh the cons in this situation. Many people believe that they can cause disorders such as autism, despite most research debunking this theory. Most other objections are due to personal or religious reasons. Parents used to be able to simply check a box to decide whether or not to inoculate solely based on their beliefs. While this law makes vaccinations mandatory for the majority, there will still be a few opportunities for exemptions. If parents completely refuse to vaccinate their children, then they must pledge to homeschool their children. Medical exemptions will still be available to those with serious health conditions, although this decision will be left up to the professionals. It was also announced that an amendment might be added to the law, and if passed, would make it so that doctors can use family medical histories of patients when evaluating children for medical exemptions.

Actor Jim Carrey made headlines for speaking out in disgust against the new law, even going so far as to call Brown a fascist. In his infamous Twitter rant, he accused the California legislature of being corrupt and knowingly poisoning children by requiring vaccinations. Carrey is only one of many to voice his furor, although it seems that there are far more supporters than protestors for this law.

Numerous groups have also announced their opposition, including the California ProLife Council, California Nurses for Ethical Standards, and the National Vaccine Information Center. Angry parents joined these groups in posting on social media to express their outrage. There have been many disputes between parents regarding this new legislation, and thousands have even stormed the capitol in protest. One major argument that protestors use against this law is that it takes away a parent’s ability to control what goes into their children’s bodies.

No one died during the measles outbreak at Disneyland, although it was still extremely scary for everyone involved and brought much unwanted attention to California. Disneyland is a major tourist destination that attracts millions of visitors a year, and so such a powerful disease infiltrating this popular institution seemed shocking at the time. Such an outbreak in California was upsetting to many after the disease was supposedly eradicated years ago. This was only the latest event in American history to trigger a national debate on the necessity of vaccines. There was also a recent outbreak of whooping cough in a Los Angeles school district where 90 students were infected, although experts believe that this incident could have been prevented. Officials of this district are praising this new law, as they believe that it will definitely help combat future outbreaks.

This law will not take effect until July of 2016, so those who are unhappy have time to move to another state. Some parents find it to be too drastic and have said that they will sue school districts just to get their child admitted without being vaccinated, although it does not seem that they will be triumphant. This law would mandate the entire state to follow through with the law, with very few exceptions. The hope is that given all of the research and findings associated with the benefits of vaccinations, parents will open their minds to the possibility of vaccines benefiting the public.

Toni Keddell

Toni Keddell is a member of the University of Maryland Class of 2017 and a Law Street Media Fellow for the Summer of 2015. Contact Toni at staff@LawStreetMedia.com.

The post Controversy in California: Childhood Vaccines Now Mandatory appeared first on Law Street.

Treating people when they’re already sick is like beating back invaders who have already breached your defenses. In either scenario, prevention through good defense saves money, time, and lives. But when it comes to boosting our nation’s wellness defenses through public health spending, America falls short.

When it comes to health, concerns abound that we’re wasting money, time, and lives by spending too much on treatment and recovery and not enough on prevention. Public health interventions like smoking cessation programs and disaster preparedness initiatives save lives. The more we learn about the power of these interventions, the more experts call to keep them afloat with better funding. Spending a few dollars to get a person to quit smoking makes more sense than spending thousands of dollars to try to treat their lung cancer several years down the road. Preparing for a natural disaster beforehand is preferable to picking up the pieces afterwards.

So what is public health? It’s something that aims to keep you alive as long as possible. From preventing diseases to preparing for disasters, public health programs keep a wary eye out for threats and then help populations avoid or mitigate them. For example, if data shows a high diabetes risk for a certain population, public health programs will target that population with preventative messages about diet and exercise. Public health departments might also help local school systems prepare for potential natural disasters, like Florida does with its Children’s Disaster Preparedness Program.

Read on to learn about public health spending in the United States, and where we might need to invest some more time and money.

Where’s the money?

In April, the Trust for America’s Health (TFAH) released its report Investing in America’s Health: A State-by-State Look at Public Health Funding and Key Health Facts. The report highlights many ways America falls short on public health spending. They say America’s public health system “has been chronically underfunded for decades.” In Why We Don’t Spend Enough on Public Health, author David Hemenway says this is because the benefits of public health spending today aren’t seen until potentially far in the future. Governments and politicians want to see the benefits of their investments in the present day, so they favor spending on medical treatment and other immediately fulfilling initiatives.

Here are some of the key findings:

Public Health Spending is Actually Shrinking

According to TFAH, when you adjust for inflation, public health spending in 2013 has sunk 10 percent from 2009. Many simply don’t see the benefits of spending on public health programs that yield intangible, future benefits when money could be spent on initiatives that produce immediate results like transportation or construction projects.

All States are Not Created Equal

States vary widely in what they spend on public health as funding is determined by the set-up of each state’s unique public health department. Indiana came in at a low of $15.14 per person, while Alaska spends $50.09 per person. This could be why health levels also vary widely from state to state.

Communities Aren’t Prepared for Public Health Emergencies

Public Health Emergency Preparedness (PHEP) Cooperative Agreement Funding helps communities respond to natural disasters, epidemics, and outbreaks. It was backed by $919 million in 2005. In 2013, it was supported by just $643 million.

Hospitals Aren’t Prepared for Public Health Emergencies

The Hospital Preparedness Program (HPP) gives healthcare facilities funding to beef up their preparedness measures. Funding for this program has been slashed by almost half, dropping from $515 million in 2004 to $255 million in 2015.

It’s estimated that 2/3 of all deaths in the United States result from chronic diseases typically linked to behaviors like diet or substance abuse. These diseases could be prevented by well funded intervention programs to decrease the behaviors that eventually lead to chronic diseases. Public health spending could save Americans millions in treatments for preventable diseases. Likewise public health under-spending could be costing us more than we’re saving.

In this video, the American Public Health Association outlines financial returns on every dollar of public health spending for different activities:

The above video states that every dollar spent on fluoride in our water supply could save $40 in dental care costs and that a dollar spent on nutrition education could save $10 in health care costs. The main point? Public health programs make for a smart investment.

The Consequences of Meagre Public Health Budgets

So, America spends too much money on treatment and not enough on prevention. The results aren’t pretty. In Integrating Public Health and Personal Care in a Reformed US Health Care System, authors Chernichovsky and Leibowitz write,

Compared with other developed countries, the United States has an inefficient and expensive health care system with poor outcomes and many citizens who are denied access.

The State of U.S. Health, 1990-2010 report put the U.S. up against other members of the Organization for Economic Cooperation and Development (O.E.C.D.), a program that advocates to improve economic and social outcomes. Since 1990, the U.S. has fallen in rankings for both life expectancy and healthy life expectancy. In 1990, the U.S. stood at the number 20 spot for life expectancy.  By 2010, it was down to number 27.  In 1990, the U.S. also enjoyed the number 14 spot for healthy life expectancy. The year 2010 found us in the 26th spot.

Under-spending in public health doesn’t just lead to generally poor health, it also impedes our ability to respond to emergencies. Assistant professor at the Harvard Business School, Gautam Mukunda, referred to Ebola as a “wake-up call” for the state of U.S. health preparedness. In Ebola as a Wake-Up Call he wrote,

Ebola may serve as a badly needed wake-up call about something the public health and biosecurity community has been banging the drum about for years: the U.S. has massively underinvested in public health.

Mukunda says the Ebola situation highlighted the measly number of extreme disease cases our U.S. hospitals can handle. Hospitals have decreased their capacity for extreme cases to increase their efficiency, only to lose the ability to treat patients when rare diseases strike. Although the need for extreme treatments arises only occasionally, hospitals should always be prepared for them. But with limited funding, it’s hard to be prepared for the unlikely “worst case scenarios.”

How does the future look?

The good news: The Senate finally passed a joint budget resolution after a five year absence of agreement.

The bad news:  Their budget slahes non-defense government spending by about $500 billion over the next 10 years.

The budget cuts spell trouble for discretionary educational public health programs. From disease prevention to health care worker training, programs to promote good health may suffer across the board.

In an APHA press release opposing the measure, Georges Benjamin, executive director of APHA, says,

Simply put, our federal, state and local public health agencies will not be able to do their jobs to protect the health of the American people if these drastic cuts are enacted.

The budget would also annihilate the Affordable Care Act, including the Prevention and Public Health Fund, a program that focused on moving America towards a preventative health model by funding prevention communications, research, surveillance, immunizations, tobacco cessation programs, health-care training, and more.

The resolution isn’t yet a binding law, but indicates a set of collective and alarming priorities that steer America farther from the path of an integrated, preventative public health system. The Appropriations Committee still has to draft the spending bills, so there’s room for opposition. President Obama for one said he’ll veto bills following the restrictive budget.

Evidence to Inform the Future

According to the article, Evidence Links Increases In Public Health Spending To Declines In Preventable Deaths, published in Health Affairs, mortality rates fall anywhere from 1.1 – 6.9 percent for every 10 percent uptick in public health spend. The researchers made observations over thirteen years and found that the localities with the highest upsurges in public health spending had the most significant reductions in preventable deaths. The relationship held true in multiple causes of death and across different demographics. While the study is only a correlation, the linkage presents compelling evidence for the death-decreasing value of public health spending. The researchers believe a lack of substantial evidence for the ROI of public health campaigns may have hindered spending in the past, and their report takes one step towards getting that evidence.

The Trust for America’s Health (TFAH) advocates for an America with increased core public health spending. They also recommend ways to spend the money correctly. They call for a solid public health foundation for all populations in all states so everyone can be healthy no matter where they live. After that’s established, they advise investing in strong, evidence-backed public health programs and efforts to fortify emergency preparedness. Finally, they believe public health expenditures should be completely transparent and accessible to the American public.

Experts at a recent forum of National Public Health Week looked past mere spending to consider the future of public health and consider novel ways of approaching health to make America a healthier nation. The speakers want to stretch health thinking beyond the doctor’s office to focus on environmental and lifestyle factors that promote well-being like employment, housing, education, and even racism.

These experts dream of an improved, 360 degree view of public health. But sadly, their dreams need funding to become reality. If we continue on this path, it will be very hard to become a more healthful nation.

Resources

Primary 

U.S. Department of Health and Human Services: Prevention and Public Health Fund

Additional

American Journal of Public Health: Integrating Public Health and Personal Care in a Reformed US Health Care System

The New Yorker: Why America is Losing the Health Race

Harvard Business School: Ebola as a Wake Up Call

Public Health Newswire: NPHW Forum: Creating Healthiest Nation Requires Addressing Social Determinants of Health

The Trust for America’s Health: Investing in America’s Health

The Washington Post: Senate Passes Budget Even as Impasse on Spending Continues

Public Health Newswire: House Adopts ‘Devastating’ Budget Agreement

Public Health Newswire: Senate Passes Budget that Batters Public Health

American Public Health Association: APHA Calls Budget Agreement Devastating

The Trust for America’s Health: Investing in America’s Health: A State-by-State Look at Public Health Funding & Key Health Facts

Health Affairs: Evidence Links Increases in Public Health Spending to Declines in Preventable Deaths

The National Priorities Project: Military Spending in the United States

New England Journal of Medicine: Why We Don’t Spend Enough on Public Health

Ashley Bell

Ashley Bell communicates about health and wellness every day as a non-profit Program Manager. She has a Bachelor’s degree in Business and Economics from the College of William and Mary, and loves to investigate what changes in healthy policy and research might mean for the future. Contact Ashley at staff@LawStreetMedia.com.

The post Are We Spending Enough on Public Health? appeared first on Law Street.

Heroin addiction is a scary reality for many Americans. It’s often an ongoing roller coaster involving several rehab stints, withdrawal, and lifelong addiction struggles. And it’s unfortunately becoming a more common phenomenon. Today, the drug is no longer an outlier compared to its competitors.  It has been identified by some as the new drug of the upper-middle class. Is this a fair assessment? Here are the facts.

What is heroin?

Heroin received its name from the “hero-like,” invincible effect the drug provides its user. It is also called by other names on the street including: H, Junk, Smack, Big H, Hell Dust, and countless others. Additives can change the color from white (pure heroin) to rose gray, brown, or black. Heroin can be laced with a variety of poisons and/or other drugs. It is injected, smoked, and snorted.

What is the science behind heroin?

From a scientific perspective:

Heroin is an opiate made from the chemical morphine, which is extracted from the dried latex of the opium poppy. Morphine is extracted from the opium latex, and these chemicals are used to make opiates, such as heroin, diamorphine and methadone. Heroin is the 3,6-diacetyl derivative of morphine (hence diacetylmorphine) and is synthesised from it by acetylation.

So what does that mean? Essentially, heroin is an opiate–a drug created from opium that sedates, tranquilizes, and/or depresses the body. It’s similar to a common base in a variety of pain killers–morphine. Opium comes from the cultivation of poppy seeds.

Effects of Heroin                                                     

Heroin users report several effects that differ based on the individual. Heroin can cause a temporary state of euphoria, safety, warmth, and sexual arousal. It can also create a sense of disconnect from other people, causing a dreamlike state and/or sense of floating. It is a depressant, rather than stimulant like cocaine, and it can be used as a self-medicated pain reliever.

Adversely, users can immediately experience vomiting, coughing, constipation, hypothermia, severe itching, and inability to orgasm. Long-term effects include rotten teeth, cold sweats, weakening of the immune system, respiratory illnesses, depression, loss of appetite, insomnia, and tuberculosis. Although this is not a direct effect, the sharing of needles from intravenous injection can often lead to AIDS, Hepatitis C, and other fatal infections.

After the effects wear off, users will start to feel extreme withdrawal symptoms if another dose is not administered. The symptoms of withdrawal can include “restlessness, aches and pains in the bones, diarrhea, vomiting, and severe discomfort.”

How do Americans get heroin?

Afghanistan is the “world’s largest exporter,” producing over 80 percent of the world’s opium. According to the United Nations Office on Drugs and Crime (UNODC), the Afghan poppy cultivation and opium industry amassed $3 billion in 2013, a 50 percent increase from 2012.

Overall, Mexico is the largest drug supplier to the United States. Specifically, Mexico produces Black Tar Heroin, one of the “most dangerous and addictive forms of heroin to date.” This variety looks more similar to hash than powder and can cause sclerosis and severe bacterial infections.

Colombia is the second largest Latin American supplier to the United States. Colombian cartels historically distribute from New York City and are in “full control of the heroin market in the Eastern United States.”

The “Golden Triangle” includes the countries of Burma, Vietnam, Laos, and Thailand. Before the escalation of the Afghan opium market, these southeastern Asian countries reigned over the world’s opium production.

Is it true that middle class heroin use is on the rise?

The Journal of the American Medical Association (JAMA) published a study in 2014 about the changing demographics of heroin users in the last 50 years. Over 2,800 people entering treatment programs participated in self-surveys and extensive interviews.

The results do seem to indicate that heroin is transitioning to the middle class. It is leaving the big cities and becoming more mainstream in the suburbs. Of course, there has been heroin drug use in suburbia before; however, now there is a marked increase.

In the 1960s, the average heroin user was a young man (average age of 16.5) living in a large urban area. Eighty percent of these men’s first experiences with an opioid was heroine. Today, the average heroin user is either a male or female in their twenties (average age of 23). Now, 75.2 percent of these users live in non-urban areas and 75 percent first experienced an opioid through prescription drugs. Almost 90 percent of first-time heroin users in the last ten years were white.

In New York City, doctors and drug counselors report a significant increase in professionals and college students with heroin addictions, while emergency rooms also report an increase in opiate overdoses. In Washington D.C., there has been a 55 percent increase in overdoses since 2010.

Why Heroin?

With all this information readily available through school systems and the internet, why is the educated, middle class turning to heroin? Factors may include increases in depression, exposure to painkillers, and acceptance. The perception of the heroin junkie has changed. A user can snort heroin (bypassing the track marks from injection) and go undetected by those around. It can be a clandestine affair–an appealing notion if the user does want to keep their drug use secret.

Anxiety disorders are the largest mental illness in the United States today, affecting more than 40 million Americans. In a country that loves to self-medicate, heroin offers a false yet accessible reprieve from anxiety and depression.

Prescription drug users also move to heroin. Prescription drugs are expensive and only legally last for the prescribed amount of time. To name a few, these gateway prescriptions drugs come in the forms of hydrocodone (Vicodin), fentanyl (Duragesic), and oxycodone (OxyContin). From 1999-2008, prescription narcotic sales increased 300 percent in the United States. Unlike these expensive prescriptions, a bag with approximately a quarter-sized amount of heroin can be sold for $10 off the streets. The transition isn’t hard to imagine, especially when the desired effects are similar.

Case Study: Understanding Suburban Heroin Use

Young upper-middle class adults are generally perceived as being granted every opportunity and foundation for success. Parents can afford a comfortable lifestyle and access to decent education for their children. So the question continues: why are so many from this walk of life turning to heroin? Through the funding of the Reed Hruby Heroin Prevention Project, the Illinois Consortium on Drug Policy conducted a report Understanding Suburban Heroin Use, to “demonstrate the nuanced nature of risk and protective factors among the heroin interviewees.” A risk factor puts a person in danger of using heroin, while a protective factor reduces the chance of use.

The overriding connection among the interviewees is the “experienced degree of detachment between parent and child and the overall lack of communication.” Contrary to common stereotypes, verbal, physical, and/or earlier drug abuse wasn’t vital in providing a pathway to heroin. A large portion of the answers, proved in these case studies, seem to be the previous emotional health of the users.

Example One

Interviewee one is a 31-year-old male who transitioned from pills to heroin. He is described as athletic, articulate, and candid. He was raised in an upper-middle class Chicago suburb. Although his family was close and intact, he experienced a sense of loneliness. His parents practiced a more hands-off approach to parenting that made him feel like an adult at an early age. His parents didn’t drink or abuse drugs during his childhood. His brother was diagnosed with ADHD, while he was not, although he experienced “restlessness.”

He was caught smoking marijuana at age 14 by his father, quit for a couple months, then resumed. His parents assumed he remained clean because he received good grades and they liked his group of friends. At age 17, he chose to work rather than attend college after graduating high school a semester early. He was earning almost as much income as his father. At 17, he tried his first opioid with a friend whose medical condition allowed easy access to OxyContin. When the prescription ran dry, they turned to heroine. He rationalized the transition thinking if he could handle OxyContin, he could handle heroin. Six months later, he was using approximately $100 worth of heroin daily and eventually moved to violent and illegal actions to sustain his supply. He admitted:

Heroin gave me something. It made me feel the best I have ever felt…Maybe I think love was missing. Like, love. I think. I that, uh, because I always felt like alone. Like even though I had good family, I always felt alone. Different.

Example Two

Interviewee two is a 27-year-old female from the western suburbs of Illinois. She is described as attractive, cheerful, and helpful. She was raised in an educated, wealthy family. She was a cheerleader in high school and earned good grades. There aren’t any psychological or substance abuse problems in her family. She felt disconnected from her siblings as they were much older and felt distant from her parents, as well. Her parents often “bickered” but never had big fights. When she confided in her mother as a child that she might be depressed, her mother seemingly brushed it off.

She started smoking pot in junior high at age 15. Although social, her group of friends was not part of the most popular crowd. This was a constant concern. She maintained a B average and continued with sports, while starting to smoke marijuana every day. An after-school job paid for this habit. When her parents found drug paraphernalia in her room, they didn’t probe the situation and just sent her to her room. Searching for a personal connection, she started dating an older boy. She connected with his parents in a way she could not with her own. During senior year, they both started using cocaine, which became a daily habit. She eventually transitioned to heroin, because as she put it in an answer to one question:

Heroin made me feel real mellow like I had not a care in the world. I had a lot of “what am I doing with my life” and physical pain that I was covering up.

After losing her job, she pawned her belongings with a variety of her parents’ things, and stole from others. She refrained from turning to prostitution, although she heard of other girls going down that road. She finally sought out help after witnessing her boyfriend get pistol-whipped and robbed during a drug exchange.

What does this tell us about heroin use?

There are similarities and differences to all of the case studies in this project. In these two examples, the users come from seemingly sturdy homes and backgrounds. The stereotypes of drug users aren’t present in these cases; however, they both felt distant from the people around them at an early age in life. They also wanted to avoid internal and external pressures. This glimpse into the lives of users offers some potential answers to the question of why relatively well educated, middleclass Americans may turn to heroin.

Fighting Back

In March 2014, the United States Department of Justice and the Attorney General Eric Holder vowed to take action against the “urgent public health crisis” of heroin and prescription opiates. Holder claimed that between 2006-2010, there was a 45 percent increase in heroin overdoses. To start, Holder pushed law enforcement agencies to carry the “overdose-reversal drug” Naloxone and urged the public to watch the educational documentary “The Opiate Effect.” Holder also outlined the DEA plan as follows:

Since 2011, DEA has opened more than 4,500 investigations related to heroin. They’re on track to open many more. And as a result of these aggressive enforcement efforts, the amount of heroin seized along America’s southwest border increased by more than 320 percent between 2008 and 2013…enforcement alone won’t solve the problem. That’s why we are enlisting a variety of partners – including doctors, educators, community leaders, and police officials – to increase our support for education, prevention, and treatment.

Conclusion

Heroin has seen a migration to the middle class. But what can we do to stop it? Many of these new users are already educated on the adverse effects of heroin and know the bottom line. A fear of health concerns isn’t enough. We need to stop it at the source, whether it is gateway prescription drugs or emotional health. Substance abuse is a disease to be cured, not the label of a criminal. The Affordable Care Act and Mental Health Parity and Addiction Equity Act aim to expand behavioral health coverage for 62.5 million people by 2020. Every addict, regardless of demographics, should have the ability and necessary tools to recover.

Resources

Primary

U.S. Justice Department: Attorney General Holder, Calling Rise in Heroin Overdoses ‘Urgent Public Health Crisis,’ Vows Mix of Enforcement, Treatment

JAMA Psychiatry Releases: Demographics of Heroin Users Change in Past 50 Years

Reed Hruby Heroin Prevention Project: Understanding Suburban Heroin Use

Additional

About Health: What Heroin Effects Feel Like

Anxiety and Depression Association of America: Facts & Statistics

The New York Times: The Middle Class Rediscovers Heroin

Original Network of Resources on Heroin: Heroin By Area of Origin

RT: America’s $7.6 Billion War on Afghan Drugs Fails, Opium Production Peaks

Tech Times: Study Profiles New American Heroin Addicts

Foundation For a Drug Free World: The Truth about Heroin

WTOP: Heroin Use Rises in D.C. Among Middle, Upper Class

Jessica McLaughlin

Jessica McLaughlin is a graduate of the University of Maryland with a degree in English Literature and Spanish. She works in the publishing industry and recently moved back to the DC area after living in NYC. Contact Jessica at staff@LawStreetMedia.com.

The post Heroin: The New Drug of the Middle Class? appeared first on Law Street.

It was probably only a matter of time, but vaccination has officially become a political issue. The particular hot topic at the moment is the vaccination of measles. Despite the fact that the virus had been declared “eliminated” from the United States in 2000, there have been approximately 100 cases recently stemming from outbreaks at Disney theme parks–particularly Disneyland in California. Public health officials are encouraging parents to make sure that their children get vaccinated. But that doesn’t mean that it’s not becoming a political conversation–while some politicians like President Barack Obama have encouraged parents to get their children vaccinated, others, like New Jersey Governor Chris Christie have continued to emphasize that it’s an individual choice to be made by parents.

There are plenty of reasons why children don’t get vaccinated–for an in-depth look, check out our issues brief on the topic–but at the most simplistic level, they can get sorted into two camps. The first group are children whose parents choose not to vaccinate them, whether it be because of religious beliefs, concerns about the side effects of vaccines, or whatever other personal reason. The other group is children who physically can’t be vaccinated, usually because they have some sort of allergy to the vaccines, or some illness or condition that would it make it unsafe to be vaccinated. This also includes children who are too young to receive the vaccine–although that’s obviously only a temporary situation. Basically since the measles vaccine became mainstream, those who actually can’t be vaccinated are protected, because those around them can’t get or spread the disease. Unfortunately, as fewer people are vaccinated, that becomes less true, and the spread of measles becomes a legitimate concern.

That being said, it’s not illegal to not vaccinate your child in most places–some states, such as California, are pretty generous when it comes to granting exceptions. Particularly under fire right now are the loopholes that California allows when it comes to its exemption laws, which do require that parents wishing to forego the vaccines undergo “counseling” and get signatures from healthcare professionals. According to Mercury News, those parameters aren’t actually that strict, because:

Counseling can be given by naturopaths, who practice alternative medicine and typically oppose vaccination.

In addition:

People who oppose vaccination because of religious beliefs can skip counseling, a policy change that Gov. Jerry Brown instituted when he signed the updated law.

This has led to a concerning number people in California being unvaccinated–in 2014, 2.5 percent of kindergartners had vaccine exemptions. That doesn’t sound like that many out of context, but that’s pretty much one unvaccinated kid for every other classroom. Children and teens who are unvaccinated are being sent home from school, and there’s a real worry that measles could continue to spread among the unvaccinated population, much of which is clustered into specific schools and neighborhoods.

The CDC put out a statement a few days ago urging any Americans who aren’t vaccinated to do so as soon as possible. President Barack Obama echoed the CDC’s comments on the Today show. However, New Jersey Governor Chris Christie came under fire for a statement he made in response that said that the government should “balance” government and parent interests when it comes to vaccines, saying:

Mary Pat and I have had our children vaccinated and we think that it’s an important part of being sure we protect their health and the public health. I also understand that parents need to have some measure of choice in things as well, so that’s the balance that the government has to decide.

Christie has since clarified that statement, releasing a statement as follows:

The Governor believes vaccines are an important public health protection and with a disease like measles there is no question kids should be vaccinated. At the same time different states require different degrees of vaccination, which is why he was calling for balance in which ones government should mandate.

Obviously this is a clear example of a big difference between Democrats and Republicans–a federal approach vs. a more state-based one is certainly open for debate. That being said, it’s important that our elected officials stay strong and and stand together in encouraging all Americans who are able to get vaccinated or vaccinate their children to do so. There’s a time for politics, but now, with this topic, isn’t it.

Anneliese Mahoney

Anneliese Mahoney is Managing Editor at Law Street and a Connecticut transplant to Washington D.C. She has a Bachelor’s degree in International Affairs from the George Washington University, and a passion for law, politics, and social issues. Contact Anneliese at amahoney@LawStreetMedia.com.

The post Christie, Obama Weigh in on Measles Vaccine appeared first on Law Street.

It seems like all anyone can talk about anymore is Ebola. Especially now that the first case of Ebola has been found in the United States, in Dallas, and the first case transmitted outside Africa reported in Madrid, people seem to be freaking out. One big concern has been that Ebola is going to become an issue in the U.S., which I just want to start by saying is unfounded and unrealistic. The public health infrastructure in the U.S., as well as our ability to isolate the disease make it incredibly unlikely that it becomes an epidemic. You’re still significantly more likely to die of the flu, or a car accident than even go near someone who has Ebola. As of press time, Thomas Eric Duncan — the man in Dallas who had contracted Ebola — has passed away of the disease, and while our thoughts and sympathy are with his family, this development does not change the risk factors in the U.S.

People are losing their minds over it. Seriously, check out #EbolaQandA on Twitter. It makes me terrified — not of Ebola, but at the extent to which our American education system appears to have failed people when it comes to very, very basic concepts of health and geography. Now Ebola is an incredibly important world issue right now, and combating it absolutely deserves our attention, vigilance, and support. That being said, we all need to take a deep breath over here in the U.S., and stop listening to misinformation and conspiracy theories, because this is getting silly. Here’s a helpful flowchart for anyone who’s concerned about the spread of Ebola in America.

Worried about Ebola? Here's a flowchart just for you! #diseases #outbreak #EbolaOutbreak #notenoughwine pic.twitter.com/U6uvQd8MKf

— Melody Butler (@MelodyButler) August 2, 2014

There have been many proposals to try to keep the United States from having Ebola-infected people cross over our borders. One of the most extreme is a “travel ban” aimed at West African countries with high infection rates.

This sounds like a good idea in theory, it really does. But in reality, it’s not something the U.S. will do, or should do. First of all, the best way to make sure that the United States does not experience problems with Ebola is to stop the epidemic. And if we restrict our access and communication with the affected region, it’s just going to get worse. When there’s not a huge risk of Ebola reaching any sort of epidemic levels in the United States, it doesn’t make sense to impede our relief efforts with a ban. A travel ban could mean that relief workers have a harder time going in, or refuse to go at all because they worry that they might not be able to get back.

Also, instituting a travel ban could make it more likely that someone with a case of Ebola makes it into the U.S. If we have a ban in place for countries heavily infected like Sierra Leone, Guinea, and Liberia, people are going to find a way around it. They could go to Senegal, or any other nearby nation where travel is not restricted. Because of the ban they may be incentivized to lie about whether or not they’ve been in contact with an infected person in hopes of not being prevented from getting on a plane. Right now we’re able to track people and examine them at the airport and upon arrival, and we’re going to strengthen our tools for that. We shouldn’t incentivize anything that makes it harder for us to do that.

I’m not an expert in public health; I don’t know what will happen with this epidemic. But what I do know is that panicking is going to do nothing. Educate yourself. Donate to the relief effort. Don’t feed the frenzy. This crisis needs a pragmatic approach, not a reactionary one.

Anneliese Mahoney

Anneliese Mahoney is Managing Editor at Law Street and a Connecticut transplant to Washington D.C. She has a Bachelor’s degree in International Affairs from the George Washington University, and a passion for law, politics, and social issues. Contact Anneliese at amahoney@LawStreetMedia.com.

The post Keep Calm and Carry On: You Don’t Have Ebola appeared first on Law Street.

Trying to get by without a reliable place to stay is difficult. But it becomes nearly impossible when trying to live in a city where it is illegal to sleep in parks, to store belongings, or to stand outside buildings. This is exactly what homeless people are up against in many cities across America. Cities are increasingly turning to laws that criminalize homeless populations by outlawing fundamental human behaviors. With laws banning sleeping and camping in public, where should the homeless turn?

What are the statistics on homelessness?

Homelessness has been a problem for decades, but the root causes of the issue are complex. Homelessness is incredibly difficult to measure, especially since many people are forced into homelessness for only a temporary period of time. According to a one-night head count by the U.S. Department of Housing and Urban Development, more than 610,000 Americans were homeless in January 2013. Sixty-five percent of the nation’s homeless were staying in shelters that night. This means more than one-third were living in unsheltered locations — under bridges, in cars, parks, or abandoned buildings. Nearly a quarter of the homeless were children under the age of 18.

What have cities been doing?

Cities are increasingly passing laws that essentially make it illegal to be homeless. Most of these laws are designed for safety reasons rather than to put more homeless people in jail, but the effects can still be harmful. Numerous U.S. cities have public designs hostile to the homeless, such as benches with a mysterious third bar in the middle to prevent lying down and sleeping. Most cities have unevenly enforced loitering laws as well as laws prohibiting begging.

The National Law Center on Homelessness and Poverty released a report on July 16, 2014, tracking the laws of 187 American. Some of its findings:

• 57 percent of cities prohibit camping in particular public places — “camping” encompasses a wide array of living arrangements
• 27 percent of cities prohibit sleeping in particular public places and 18 percent of cities impose a city-wide ban on sleeping in public
• 76 percent of cities prohibit begging in particular public places
• 65 percent of cities prohibit loitering in specific public places
• 9 percent of cities prohibit sharing food with homeless people
• 74 percent of homeless people do not know a place where it is safe and legal for them to sleep

The problem is that these laws have increased in recent years. Since 2011,

• Citywide bans on camping in public have increased by 60 percent.
• Citywide bans on loitering, loafing, and vagrancy have increased by 35 percent.
• Citywide bans on sitting or lying down in particular public places have increased by 43 percent.
• Bans on sleeping in vehicles have increased by 119 percent.

Watch the video below for more information on the measures taken against the homeless in Clearwater, Florida:

Are these laws constitutional?

City bans targeting the homeless population raise a number of legal questions. While the laws are often ruled unconstitutional, they still thrive in most U.S. cities. Most people take issue with the fact that these laws are discriminatory in targeting the homeless population. Some argue that an activity like begging should be protected as free speech. A similar argument is made that the homeless should be afforded freedom from cruel and unusual punishment and should have the right to due process of law. The U.N. Human Rights Committee found criminalization of homelessness violated the International Covenant on Civil and Political Rights. Other significant rulings:

• In April 2006, the Ninth Circuit Court of Appeals ruled that criminalizing behaviors and acts integral to being homeless was a violation of the 8th and 14th Amendments; however, the opinion was vacated when the two parties settled out of court.
• In August 2012, a federal judge in Philadelphia ruled that laws that prohibited serving food outside to the homeless were unconstitutional.
• On June 19, 2014, a federal appeals court cited issues of discrimination in striking down a Los Angeles law that banned people from living out of their cars.

What are the effects of these laws?

Typically the homeless are encouraged to stay in shelters until they can find affordable housing of their own, but oftentimes it is not that easy. Consider a city like Santa Cruz, California, where 83 percent of homeless people are without housing and shelter options, yet the homeless cannot lie down in public or sleep in vehicles. Or consider El Cajon, California, where 52 percent of homeless people have no access to a shelter, but sleeping in public, camping in public, and begging are criminalized.

Watch the video below to learn more about a law banning homelessness in Columbia, North Carolina:

Incarceration

Violators of these rules face fines or incarceration. As many homeless people cannot afford fines, they end up spending time in jail. With no permanent address, no regular transportation access, no place to store personal records, and few to no financial resources, the homeless targeted for criminal behavior have difficulty paying fines. If they can’t pay fines they often cannot get probation. This means they are incarcerated more often and for longer periods of time. For the homeless, getting into shelters and finding affordable housing is already difficult. But doing so after a previous arrest becomes nearly impossible.

Suspended Benefits

The homeless are typically eligible for a variety of beneficial federal programs, such as Supplemental Security Income (SSI), Social Security Disability Insurance (SSD), and SNAP (food stamps). Many homeless people are unaware of these programs. Since most of the homeless lack an address and application documentation, they have difficulty applying. SNAP has special procedures that give greater assistance to the homeless, such as providing the, with a representative and mailing benefits to homeless shelters. Most cities recognize the obstacles the homeless face in applying for federal benefits and employ outreach teams to connect homeless people to benefits and services. For example, Denver’s “Road Home” plan began in 2005 with the goal of helping homeless people with disabilities. Denver organized all the existing outreach programs in the city and added 20 more outreach workers as well as a program coordinator. In the first 3 years, the program helped 2,000 people in Denver access public benefits and services. Another program in Portland set up training to teach all homeless case workers what major benefit programs are available and how the homeless can apply.

One big problem is that having a criminal record makes people ineligible for certain benefits, such as federal housing subsidies. When disabled individuals are incarcerated, their SSI is suspended. If they are incarcerated for more than a year, SSI benefits are terminated and the person must then submit a new application. The process could take months or even years, meaning an increased chance for homelessness in the meantime.

High Cost

Recent studies show that laws targeting the homeless are not always cost-effective. The Utah Housing and Community Development Division reported that the annual cost of emergency room visits and jail stays for the average homeless person was $16,670. Providing someone an apartment and social worker would only cost $11,000.

A 2013 analysis by the University of New Mexico’s Institute for Social Research examined the costs of providing immediate, permanent, supportive housing to the homeless rather than the more typical transitional housing. Albuquerque’s “Heading Home” Initiative made extensive use of community partnerships to coordinate housing and services. Overall, the study found that housing the homeless is 31 percent cheaper than keeping them homeless, mainly because housed individuals use emergency services less frequently. Their research showed that simply by providing permanent housing, Albuquerque reduced spending on homeless-related jail costs by 64 percent. The costs of emergency room visits also declined 13 percent, while spending on mental health visits increased 34 percent.

Do these laws help protect the homeless?

Very rarely are cities explicitly aiming to make the lives of the homeless even harder by instituting these laws. Many cities see these laws as a way to ensure public safety as well as the safety of the homeless. For instance, laws prohibiting sharing food with the homeless are aimed at protecting the homeless from bad food. Food given illegally could be made with questionable food safety practices or could come from someone with more nefarious intent like poisoning the food. Other cities worry about the effects of public feedings. For instance, a church group may set up in a park next to a school, which would leave many parents upset over the safety of their children. Watch for rationale behind feeding laws below:

Laws outlawing public camping are often a way for the city to push the homeless to stay in safer shelters, especially in dangerously cold weather. Staying in a shelter generally keeps the homeless safe from people who may otherwise harm them on the streets. Shelters can also help cities connect the homeless to other beneficial social service programs. Officials also say these laws help to encourage better pubic hygiene and safety. Other laws target panhandling. Police object to panhandling since it is often done in high-volume, potentially dangerous areas, such as a highway median.

So why can’t the homeless find a place to stay?

More than 12.8 percent of the nation’s supply of low income housing has been permanently lost since 2001. This is largely due to a steady decrease in funding for federal subsidies for standardized housing since the 1970s. There are fewer emergency shelter beds than there are homeless people. The number of shelters in the United States rises each year, but the increased supply of beds does not always correspond to the areas of highest demand. In certain areas where there is a lack of affordable housing, the shelters still do not provide enough beds. Further, waiting lists for subsidized housing in most areas are incredibly long. The city of Los Angeles has only 11,933 shelter beds for a homeless population of 53,798. If cities cannot provide adequate shelter beds, there is no place for the homeless to go but the streets.

Typically shelters are run by non-profit organizations associated with church groups or the federal or state government. Numerous national organizations, such as Salvation Army, United Way, and the National Alliance to End Homelessness, aid in the upkeep of homeless shelters. Most shelters require residents to exit in the morning and go somewhere else for the day before returning at night for a meal and to sleep. Shelters try to offer a variety of services, including job training and rehabilitation programs, but some are criticized for being nothing more than holding facilities. One shelter in Washington, D.C. in particular has dealt with corrupt workers preying on the homeless residents as well as a decaying building, contagious infections, and hazardous bug infestations.

Another significant obstacle is how to find housing for vulnerable populations like the previously incarcerated, the recently hospitalized, and veterans. Once released from jail or prison, many have no place to turn and no money to pay for housing. Those released from hospitals are also more likely to suffer from homelessness and even mental illness.

Housing First models have grown in popularity in recent years as part of the movement to find new ways to help the homeless. One of the first Housing First models was launched in Los Angeles in 1998 by the non-profit PATH Beyond Shelter. The success of the policy led to its spread to a number of U.S. cities. Rather than moving the homeless through different levels of housing, Housing First models move the homeless immediately from the streets or a shelter into their own apartment. The idea is that once housing is obtained, other issues like mental health or addiction can more effectively be addressed. By using a Housing First model, Phoenix became the first city to successfully house all of its chronically homeless veterans.

Watch the video below for more information on the Housing First program:

Libraries and the Homeless

With the homeless finding it increasingly difficult to find someplace to sit outside, libraries are a prime spot to spend their days. As social safety nets shrink, libraries have become more vital than ever to homeless populations. Libraries are free, centrally located, provide numerous books and computers, and allow the homeless to escape from snow or scorching temperatures. Increasingly, libraries have added homeless outreach to their array of programs.

Being a de facto gathering place for homeless populations can often deter use by other patrons. Striking the balance between making the homeless feel welcome and making other visitors feel comfortable is tricky. Naturally libraries deal with complaints regarding homeless people being loud, unclean, mentally ill, monopolizing computer time, and bathing in restrooms. Some libraries institute their own rules to mitigate these problems. For example, rules in Washington, D.C. prohibit alcohol, bare feet, carrying more than two bags, sleeping, or an odor that can be detected six feet away.

Watch the video below to see how a library in Burlington, Vermont, deals with the homeless:

Libraries have not turned a blind eye to the needs of the homeless. In response to problems with the homeless population, the city of San Francisco hired a social worker for its main library. The social worker is aided by five peer counselors, all of whom are formerly homeless. The library even implemented a 12-week “vocational rehabilitation” program. Graduates of the program are then hired to work in the system. Other libraries in Washington, D.C. and Philadelphia have since followed suit to hire social workers.

In Greensboro, North Carolina, libraries offer meals, haircuts, blood pressure screening, and job counseling. Libraries in San Jose, California bring library programs, such as computer classes, to homeless shelters. The central library in Philadelphia even features a cafe staffed by the homeless, who then use the job skills gained to secure other employment. The American Library Association calls for even more programming targeting the homeless, recognizing that libraries should provide training to staff and coordinate programs and activities to benefit that population.

Cities need more affordable housing to help the homeless. Ideally they should seek to confront problems of homelessness and provide solutions rather than criminalize homeless behavior. Naturally many communities do not want to have to deal with the homeless in public areas, but criminalization of homeless behavior is costly, unconstitutional, and hinders a person’s future ability to secure a permanent place to stay.

Resources

Primary

HUD: 2013 Annual Homelessness Assessment Report to Congress

 Additional

No Safe Place: The Criminalization of Homelessness in U.S. Cities

Reuters: U.S. Libraries Become Front Line in Fight Against Homelessness

Huffington Post: More Cities are Basically Making it Illegal to be Homeless

The New York Times: Shunting the Homeless from Sight

USA Today: More Cities Pass Laws that Hurt the Homeless

Wall Street Journal: A Crowdfunding App for the Homeless

Blaze: Top 10 Anti-Homeless Measures Used in the United States

American Library Association: Reducing Homelessness Through Library Engagement

NPR: Urban Libraries Become De Facto Homeless Shelters

MSN: Court Overturns Los Angeles Ban on Living in Cars

ALA Library: Services for the Poor

Arizona Central: Success in Housing for Homeless Veterans in Phoenix

Harvard Civil Rights/Civil Liberties Law Review: Jones v. City of Los Angeles: A Moral Response

NPR: With A Series of Small Bans, Cities Turn Homelessness into a Crime

Alexandra Stembaugh

Alexandra Stembaugh graduated from the University of Notre Dame studying Economics and English. She plans to go on to law school in the future. Her interests include economic policy, criminal justice, and political dramas. Contact Alexandra at staff@LawStreetMedia.com.

The post The Costs of Criminalizing Homelessness appeared first on Law Street.

In recent years, an increasing number of parents decided not to vaccinate their children for a number of diseases. Vaccinations are largely heralded as one of the most effective instruments for public health. Measles, declared eliminated in the United States in 2000, is now back in full force primarily due to lack of vaccination. Here’s what you need to know about the controversy surrounding vaccines, preventable diseases, and what more can be done.

Why are we worried about measles?

It’s true, those pesky measles are back. That contagious respiratory disease characterized by a fever, runny nose, cough, and itchy rash is once more making its way through towns in the United States. Most cases result from foreigners traveling to the United States infecting those who are not vaccinated. In the decade before the measles vaccine was introduced, the Centers for Disease Control and Prevention (CDC) reported an estimated 3 to 4 million people contracted measles each year. The disease caused many cases of chronic disability, hospitalization, and even death. Before the vaccine, the virus affected more than 95 percent of children. Measles kill approximately one in every 1000 cases. About 30 percent of cases develop further complications, including pneumonia, ear infections, or diarrhea. The vaccine for measles, commonly known as the vaccine for Measles Mumps and Rubella (MMR) was introduced in 1967. Following a large measles outbreak from 1989 to 1991, Congress instituted the Vaccines for Children Program to increase vaccination rates. Following, cases of measles rapidly fell. The recent return of measles has largely been blamed on the anti-vaccination movement. Watch below for an overview of the benefits of vaccines:

Why don’t parents want to vaccinate their kids?

Parents are hesitant to trust the government or pharmaceutical companies and have a number of concerns in allowing their children to be vaccinated. The anti-vaccination push began following a 1998 study by researcher Andrew Wakefield in the British journal, The Lancet. The study declared a link between the MMR vaccine and autism. However, the article has since been widely discredited in the scientific community due to conflicts of interest and manipulated evidence. The paper was retracted in 2010 and Wakefield lost his medical license. Despite the following events, many parents are still concerned that the MMR vaccine will cause autism. Watch below for some debate of the study:

Beyond this, the anti-vaccine movement has continued to gain traction for a variety of reasons:

Celebrity Support

Actress, model, and “The View” host Jenny McCarthy has been a vocal opponent of vaccination. McCarthy claims the vaccines have toxins that are generally unsafe, especially as the amount of required vaccines has increased. Scientists point out that vaccines contain a much less amount of toxins than other foods. Other opponents of vaccination include actor Aidan Quinn, who connects his daughter’s autism with the MMR vaccine, and reality star Kristin Cavallari, who opposes the vaccination of her children. Listen to Jenny McCarthy discuss autism and vaccination:

“Vaccine Load”

Some parents are worried about vaccine load, where the child’s immune system may not be able to handle multiple shots at one time. Children now receive up to 28 shots by age 2. Several studies show receiving multiple vaccines on the same day is not associated with increased chances of autism. Further, while the number of vaccines given to children has increased in recent years, the amount of main ingredients in vaccines has decreased. Worries of vaccine load mean many children are not vaccinated in a timely manner. The claim is also made that vaccines cause a permanently depressed immune system. Instead of vaccination, children should be allowed to build up natural immunity over time.

Mercury

Concerned parents cite the mercury-based preservative thimerosal in vaccinations as a cause of potential brain damage. Government officials have deemed thimerosal safe and found no evidence of harm. However, by taking the voluntary precaution to phase the compound out of vaccinations in 1999, the CDC instilled a greater fear of vaccinations.

Religion

Others object to vaccination solely on a religious basis. They claim vaccination interferes with natural law and God’s plan. Others believe the body is sacred and should not receive certain chemicals, blood, and tissue from animals.

Don’t parents have to vaccinate their kids?

In most cases, for a child to attend public school they must have certain vaccinations. However, some states allow exemptions for those with religious or even philosophical opposition to vaccinations. Private schools do not have the same mandate as public schools. Therefore,private schools vaccination rates are as low as 20 percent. The vast majority of parents vaccinate. According to USA Today, vaccination rates for all diseases are about 90 percent, and fewer than one percent  of Americans forgo all vaccinations. However, exemption rates from 2006 to 2011 doubled. Since states have different policies, vaccination rates are not geographically uniform. This leads to outbreaks only in specific areas.

All states allow vaccination exemptions for medical reasons. Nineteen states allow philosophical exemptions for vaccinations. In states with philosophical exemptions like Idaho, Michigan, and Vermont, more than 4.5 percent of kindergarteners last year were unvaccinated for non-medical reasons. These rates are four times the national average and are potential hotspots for outbreaks. Mississippi and West Virginia are the only states to not allow religious exemptions.  So far,  those states have not seen any disease outbreaks. A federal judge recently upheld a New York City policy that unvaccinated students are not allowed to attend school when another student has a vaccine-preventable illness. Ultimately the right to forgo vaccination for religious reasons doesn’t trump the fear that unvaccinated students may contract and spread the disease.

Until 2011, parents in Washington could opt out of vaccinating children simply by signing a form. This system meant up to a quarter of kids in some counties opted out of vaccinations. States that allow non-medical exemptions have seen more parents forgo their children’s vaccines. From 2000 to 2010, non-medical exemptions in California tripled. Watch for a description of a recent measles outbreak:

Has lack of vaccination led to more cases of disease?

The overwhelming majority of current measles infections occur in unvaccinated people. From the beginning of 2014 to June 20, 2014, the CDC declared 514 cases of measles and approximately 16 outbreaks, the most since 1996. Half of these casesare adults age 20 and over. Following a widespread measles outbreak in San Diego in 2008, roughly one in five children were not vaccinated against the disease. Even last year in California, USA Today reported 14,921 children were not vaccinated for philosophical reasons. In Colorado four percent of kindergarteners did not have shots for non-medical reasons. Watch below for information on the recent measles outbreak:

Another vaccine-preventable disease, pertussis, or whooping cough, increased considerably in recent years. In 2012, a fifty-year high of almost 50,000 cases of whooping cough were reported, a stark contrast from the 1980s and early 1990s when rates hovered around 5,000. Through June 16, 2014, almost 10,000 cases of whooping cough were reported, which is a 24 percent increase when compared with the same period in 2013. This is attributed to the anti-vaccination movement as well as weakened antibodies which wane as a person ages.

Should I be worried?

If you are vaccinated and your shots are up to date, probably not. The most vulnerable are infants who are too young to be vaccinated and the elderly who may not have proper boosters. The effects of vaccination deteriorate over time, so adults who have not gotten booster shots can still contract the disease from an unvaccinated person. Unvaccinated people may not even know if they are carrying a disease like measles, but they can still contagious before any symptoms arrive. A recent case study of an individual dubbed “Measles Mary” has even shown it is possible for a vaccinated person to contract measles and then unwittingly pass the disease on to others.

A recent study by the CDC showed routine childhood vaccinations given between 1994 and 2013 will save 732,000 lives while preventing 322 million cases of illness and 21 million hospitalizations over the course of the children’s lifetimes. According to the Washington Post, every $1 spent on vaccines provides $10 benefit to society.

Medical experts agree proper vaccination is extremely important. Having more people vaccinated makes it less likely that anyone in the community will get a disease, a phenomenon known as “herd immunity.” Aiming for vaccination rates higher than 90 percent can help protect the most vulnerable, especially infants who are too young to be vaccinated. Most officials think the best strategy to increase vaccination is a tireless public education campaign to dispel rumors regarding the danger of vaccines. Watch a video below aimed at educating parents:

 Resources

Primary

CDC: Measles Cases and Outbreaks

CDC: Pertussis Outbreak Trends

CDC: Benefits from Immunization During the VCP Era

CDC: Highest Number of U.S. Measles Cases Since 2000

CDC: Measles Vaccination

FDA: Thimerosal in Vaccines

Additional

USA Today: Anti-Vaccine Movement is Giving Diseases a 2nd Life

Newsweek: Anti-Vaccination Movement Strikes Out in Bible Belt States

Washington Post: How the Anti-Vaccine Movement is Endangering Lives

Time: Parents not Vaccinating Kids Contributed to Whooping Cough

Week: The Worrying Rise of the Anti-Vaccination Movement

National Vaccine Information Center: State Law and Vaccine Requirements

Washington Post: Measles Cases are Spreading, Despite High Vaccination Rates

Science: Measles Outbreak Traced to Fully Vaccinated Patient for the First Time

NCSL: Immunization Policy Issues Overview

The New York Times: Judge Upholds Policy Barring Unvaccinated Students

History of Vaccines: Cultural Perspectives on Vaccination

Alexandra Stembaugh

Alexandra Stembaugh graduated from the University of Notre Dame studying Economics and English. She plans to go on to law school in the future. Her interests include economic policy, criminal justice, and political dramas. Contact Alexandra at staff@LawStreetMedia.com.

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