Study: Eliminating Mother-to-Child HIV Transmission

Global health agencies and programs, such as the President's Emergency Plan for AIDS Relief (PEPFAR), aim to reduce the number of new HIV infections in children by 90 percent and to reduce the number of AIDS-related maternal deaths by 50 percent. In a new IHI study published today in Health Affairs, authors Dr. Pierre Barker, IHI Senior Vice President, and Dr. Kedar Mate, Country Director for IHI's South Africa Program, explain why eliminating HIV infection from mother to child in countries that are worst affected by the HIV epidemic will require improvements to maternal and child health services. They argue that the success of the ambitious global initiative to decrease infant HIV infections is critically dependent on easy access to routine maternal and child health services. Focusing on nine sub-Saharan African nations and India, the article finds that the clinical interventions needed to reduce new HIV infections in children and to reduce maternal and child mortality are well documented, and most are inexpensive and cost-effective.

California Lawmakers Move Bills To Guarantee Health Coverage

By Pauline Bartolone, Capital Public Radio

June 5th, 2012, 8:30 AM

Pre-existing conditions would not prevent a Californian from buying health insurance on the individual market in 2014, if state lawmakers succeed with a push to make sure the main tenets of the national health law survive in the state – no matter how the U.S. Supreme Court rules later this month.
Last week lawmakers put forth identical bills on pre-existing conditions in both houses of California’s legislature. The bills would also create new rules for setting premium rates. For example, an older person couldn’t be charged more than three times a younger counterpart.
“I feel tremendous responsibility to ensure that California continues to lead the nation, implementing federal reform, and that we serve as a model for the rest of this country,” said Democratic state Senator Ed Hernandez about his bill.
But state Republicans raised concerns about moving forward before the Supreme Court decision.
GOP state Senator Sam Blakeslee argued that if California guarantees insurance, but there’s no requirement to buy it, only sick people would flock to the market. He said their care could drive up costs and cause flight from the insurance pool. That could cause health market changes to “fail, and potentially catastrophically.”
The California insurance industry wants the bills amended to include a mandate.
“Disconnecting the requirement to join the insurance pool from the duty to sell insurance at the same price, doesn’t work,” says Patrick Johnston, CEO of the California Association of Health Plans.
But advocates say the bills would implement important pieces of the federal health system overhaul law. Legislative Director of CALPIRG, Pedro Morillas, says currently, people with pre-existing conditions find themselves uninsurable.
“That is just a bad spot for both the consumers with the condition, and then overall it’s just not the way that the health care marketplace is supposed to work,” says Morillas.
The two identical bills were introduced in both chambers of the California legislature – the Assembly and the Senate. They were passed by a floor vote in their houses of origin and must still pass the other chamber. The two bills could merge, or one could be eliminated before reaching Gov. Jerry Brown’s desk. By then it’s likely the Supreme Court will have had its say.
This story is part of a reporting partnership that includes Capital Public Radio, NPR and Kaiser Health News.

New Study Shows Startling Gap in Cardiovascular Risk Assessment

According to this Wall Street Journal article, doctors are not delving deep enough into family history when assessing their patients' risk of heart disease. This is especially dangerous for women, who  have very different--and sometimes, more subtle--indicators than men.

Seeking Clues to Heart Risk in a Patient's Family Tree

FEBRUARY 21, 2012 

By CHRISTOPHER WEAVER

Doctors often gloss over a key question for assessing a person's risk for coronary heart disease, according to a new study: What is the patient's family history of cardiovascular illness?

The study suggests some doctors may not be capturing the full extent of many patients' chances of developing heart disease. Detailed family information could help doctors better predict who is at risk and more accurately target patients for preventive care that may help avert the disease altogether, according to the study, due to be published Tuesday in the Annals of Internal Medicine. Routinely tracking family history sharply boosted the number of people in the study considered at high risk for heart disease.

A widely used scorecard for measuring heart risk, the Framingham Risk Score, fails to take family history directly into account. And while many doctors currently collect some information about the health of their patients' families, the data often lack the detail to be clinically useful for assessing risk and prescribing care.

"Family history remains one of the most important predictors of an event for an individual," says Donna Arnett, a genetic epidemiologist at the University of Alabama at Birmingham and president-elect of the American Heart Association. Still, "most of the family history that we're collecting is just the presence or the absence of heart disease, not the age of onset or the type of disease," says Dr. Arnett, who wasn't involved in the latest research.

Guidelines for heart-risk screening, issued by the heart association in late 2010, encouraged doctors to take family histories into account. Doctors sometimes make judgment calls to treat people as high risk because of family history, even if it isn't part of the patient's risk score.

The study, funded by the United Kingdom Department of Health, included 748 patients aged 30 to 65. Up to 13% of patients were found to be at high risk of coronary heart disease using traditional assessment tools. After patients filled out enhanced questionnaires that sought more complete information, the percentage considered at high risk jumped to 18%. The traditional assessment could include general information, such as blood pressure, cholesterol level and basic information about whether a family member had a history of heart disease. The enhanced survey would identify, for instance, that a patient's mother had a heart attack at age 50.

"It's a low cost way to target people who are at high risk for cardiovascular disease," says Nadeem Qureshi, the lead researcher and a professor at the University of Nottingham's Faculty of Medicine and Health Sciences in the U.K.

Findings from the U.K.-based study reflect similar use of family history among doctors in the U.S., several U.S.-based physicians say.

Family history has been linked to higher risk for a number of illnesses, including cancer and diabetes. Unlike some other diseases, however, clear genetic markers for coronary heart disease, which accounts for 1 in 6 U.S. deaths, remain elusive. Family histories can be used as a proxy for detailed genetic work that may someday be used to help predict heart-disease risk, researchers say.

Another risk-measurement tool, known as the Reynolds Risk Score, developed by Harvard University researchers in the 1990s, does consider if a patient's parent had a heart attack and at what age. However, many medical practices don't yet use the tool, which became available in 2007.

Using the Reynolds system, the researchers tracked 25,000 initially healthy patients over a decade. They found that a 50-year-old male patient who, among other things, smoked, and had high blood pressure and cholesterol, but no family history of heart disease, had a 12%, or moderate, chance of having a heart attack in the 10-year period. But a similar patient with a parent who had a heart attack before age 60 had a 20% risk, putting that patient at high risk for heart disease. Heart risk wasn't significantly affected in patients with a parent who had a heart attack at the age of 60 or older.

Still, many medical practices continue to rely on the older Framingham Risk Score, which became available in the 1990s. Researchers believed that other factors, including blood pressure and cholesterol levels, provided all the information needed to determine a patient's risk for heart disease.

Doctors use the scoring systems to single out patients who could benefit from counseling about lifestyle changes, such as losing weight and quitting smoking, or from preventive interventions such as low-dose aspirin and cholesterol drugs, says Yul Ejnes, the chairman of the American College of Physicians board of regents. The college publishes the Annals of Internal Medicine.

Primary-care doctors say there are obstacles to gathering family histories from patients, including competing priorities for time in the examination room. And patients often don't know many details about their family members. In the Annals of Internal Medicine study, patients were mailed questionnaires and instructed to gather the material before seeing their doctor.

"It's a little bit of detective work," says Charles Cutler, a primary-care doctor in Norristown, Pa. Patients should make a point of knowing the health histories of their parents, siblings and grandparents, he says. To identify clues about specific diseases, however, Dr. Cutler says he sometimes asks patients questions like: "What do you remember about Grandpop's hospitalization? Were his legs swollen?"

Tamara Barber, a 33-year-old a senior marketing director at a Boston technology firm, says her family history has made her an advocate for her own health. Ms. Barber says she watches her diet and exercises regularly. And although she currently isn't on any heart medication, she regularly pushes her doctor to check thoroughly for signs of developing heart disease.

"I went to the cardiologist and said, 'I may look healthy and my numbers are all good. But my mom had a heart attack when she was 45, and I need to know whether I have any other risk factors that I should be aware of,' " Ms. Barber says.

Write to Christopher Weaver at christopher.weaver@wsj.com


A history of heart disease in the family can have a big impact on your risk of a heart attack. The age when a parent had the attack also affects your risk. Two hypothetical patients:

Patient 1

• Gender: Male
• Age: 55
• Smoking status: No
• Systolic blood pressure: 150 mm/Hg
• Total cholesterol: 300 mg/dL
• HDL (good cholesterol): 30 mg/dL
• Family history: Father had a heart attack at 50 years old
• 10-year risk: 23% (High risk)

Patient 2

• Gender: Male
• Age: 55
• Smoking status: No
• Systolic blood pressure: 150 mm/Hg
• Total cholesterol: 300 mg/dL
• HDL (good cholesterol): 30 mg/dL
• Family history: Father had a heart attack at 70 (too late in life to predict risk)
• 10-year risk: 14% (Moderate risk)

Note: Blood pressure of 140 mm/Hg or above is considered high. Total cholesterol typically ranges from 100 to 400 mg/dL; optimal level is below 160 mg/dL. Ten-year heart-attack risk of 20% or greater is high; moderate risk is 10% to 19%. Source: Reynolds Risk Score

Too Much of a Good Thing...

Doctor exposes the dangers of overtreatment

By Liz Szabo, USA TODAY

ATLANTA – The woman walked quietly into the busy emergency room at Grady Memorial Hospital, Atlanta's safety net hospital for the poor and uninsured. She waited four or five hours to be seen, sitting patiently on a gurney and clutching a plastic bag.

Inside the bag was a moist blue towel. Wrapped inside that towel was her right breast. She was hoping it could be reattached.

Doctors in the United States don't see cancer patients like this every day. A mixture of fear, poverty and lack of paid sick leave had led her to delay cancer treatment for years. Eventually, the tumor grew so large that it cut off the blood supply, causing her right breast to die and fall off, says Otis Brawley, chief medical officer at the American Cancer Society, who saw the woman in the ER that morning in 2003.

• MORE: Excerpt from 'How We Do Harm:' Chapter 10

In his new book, How We Do Harm: A Doctor Breaks Ranks About Being Sick in America, Brawley presents the woman's suffering as a metaphor for a rotting health system that is run, he says, "by the greedy serving the gluttonous."

How much is too much?

Americans often assume that more is better. But supersizing your healthcare -- by getting tests and procedures that you don't really need and which aren't based on sound science -- can kill you, according to a revealing new book by the American Cancer Society's chief medical officer, Otis Brawley.

• Many tests, treatments not necessary Many patients would be surprised to realize how little of the medicine they receive is actually backed by evidence.
• Doctors say he has duty to tell the truth Otis Brawley says he’s not worried about being called a radical.
• Twitter chat with Otis Brawley Chat with Brawley of ACS at 2 p.m. ET Wed. about his new book on overtreatment

A nation of extremes

Brawley uses the book, on sale today (St. Martin's Press, $25.99) and co-written with journalist Paul Goldberg, to show that ours is a nation of extremes, with the poor or uninsured frequently denied even the most basic care while the well-insured often are "overtreated," receiving unproven drugs and procedures that can cause real harm.

"Our medical system fails to provide care when care is needed, and fails to stop expensive, often unnecessary and frequently harmful interventions, even in situations when science proves those interventions are the wrong thing to do," Brawley writes. Too many patients, Brawley writes, get a "wallet biopsy" that decides whether they'll get care. Patients without money or insurance often get no care until they're "sick enough or old enough for government benefits to kick in." Then, patients are welcomed back into the system, "because even at Medicare and Medicaid coverage rates, you can make money on uncontrolled diabetes, kidney failure, heart disease and late-stage cancer.… "

On the other end, he writes, "wealth in America is no protection from getting lousy care.… Wealth can increase your risk of getting lousy care. If you have more money, doctors sell you more of what they sell, and they just might kill you."

Brawley says he doesn't want to ration care or dash the hopes of desperate patients who are willing to gamble on experimental therapies. But he says he's tired of those hopes being exploited by a medical system that's too lazy to insist that care be based on science rather than profit or best guesses.

Patient advocates such as Fran Visco, a breast cancer survivor, welcome Brawley's call to action. "We pour so much money into overtreatment," says Visco, president of the National Breast Cancer Coalition. "All of that could be channeled into getting more people care."

Brawley's message may resonate with policymakers because of his high rank within the cancer society, says Dartmouth Medical School professor Lisa Schwartz, who co-wrote a book last year called Overdiagnosed: Making People Sick in the Pursuit of Health. Brawley's folksy style and sense of humor — his take on medicine is often darkly funny — makes complex issues easy for the public to understand, says Barry Kramer, director of cancer prevention at the National Cancer Institute.

Brawley fills the book with the stories of patients no longer here to speak for themselves.

Consider the woman who died after being given massive doses of an unnecessary but highly profitable anemia-fighting drug that could, studies later showed, sometimes "act like Miracle-Gro for cancer," Brawley says. There's the prostate cancer patient who "died from the cure," after overaggressive treatment of a slow-growing tumor that probably didn't need to be found. And there's the dying lung-cancer patient — responsive only to pain — whose family insists that Brawley, then a young resident, perform one futile invasive procedure after another.

"I'm quite sure Otis remembers the patients who didn't do well, more than the patients who did, because that's the kind of caring individual he is," says Michael Friedman, director of City of Hope cancer center in Duarte, Calif. "It's not that Otis has all the answers, but he's asking all the right questions."

Striding through the halls of Grady Hospital today, Brawley says it was built during the days of segregation, a "monument to racism," to keep black and white patients separate. The health care system today is just as badly designed. "Too often, helping the patient isn't the point," Brawley writes. Perverse economic incentives "can dictate the patient be ground up as expensively as possible with the goal of maximizing the cut of every practitioner who gets involved."

Some point out that doctors aren't deliberately trying to harm their patients.

But doctors may not question the system, either, says Thomas Smith, director of palliative care at Johns Hopkins Medical Institutions in Baltimore. "Most doctors are sleepwalkers, not evildoers," Smith says.

"A lot of people are trying to do their best in a broken system," Schwartz says, adding that it's too simple to say it's all about greed. "It's about how hard it is to come up with a system that gives people what they need."

Making the best decision about care — such as when to provide hospice care, for example, rather than more invasive procedures — can be complicated and doesn't necessarily reflect a doctor's desire to make money, says Smith.

Smith agrees with Brawley that changing the system will require educating patients and families. "This can't come just from doctors and nurses. It will require some changes in society and people, to accept the medical facts," Smith says.

Patients affect care, too

Brawley notes that patients themselves often ask for unproven treatments, even demanding that insurers pay for them. In many cases, however, those extra tests and treatments aren't in patients' best interests. "Prostate-cancer screening and aggressive treatment may save lives," Brawley writes, "but it definitely sells adult diapers."

Standing at the window of Grady's tenth-floor cancer center, in his white doctor's coat, Brawley points out Ebenezer Baptist Church, where Martin Luther King once preached, and the building where the Southern Christian Leadership Conference met. "This is the cradle of the civil rights movement," Brawley says.

And like the civil rights movement, change will have to come from the bottom up, Brawley says, and from patients who have had enough.

"The health care system is dramatically broken," Brawley says. "All of us need to radically change. I'm convinced that health care transformation is a civil rights issue."

Brawley has broken ranks with his peers before, often by saying things on the record — clearly, and in colorful language — that others acknowledge only in private.

While his supervisors at the cancer society have always supported him — Brawley says he was a "known commodity" when hired in 2007 — his unvarnished assessments of cancer drugs and screening tests have often gotten him in hot water with patient advocates, and even cancer society members. While Brawley recommends mammograms, he says doctors should be honest with women about their limitations and risks: "There is this pervasive belief," he says, "that mammography is better than it is."

Prostate cancer advocate Tom Kirk is familiar with Brawley's arguments, and his rhetorical flourishes. "There are a great number of us who have learned to engage with Otis, and it is rare that he says something about prostate cancer where there isn't a chorus of us who respond," says Kirk, president and chief executive officer of the group Us TOO. While Kirk says he appreciates Brawley's efforts to get men to think carefully about health care decisions, he also fears that men could use Brawley's words as an excuse to avoid doctors entirely. Men "have come too far in this country not to play an active role in our health care," Kirk says.

Brawley praises other patient-led efforts, such as the National Breast Cancer Coalition's Project LEAD. The free training program teaches patients and their supporters to understand medical evidence, and advocate for treatments and policies that reflect the best science.

Consumers typically misinterpret any attempt to limit care as a cost-saving scheme, Schwartz says. "Even if we had all the money in the world," Schwartz says, "we would still want to make better decisions about how to make people feel better and live longer."

Some of Brawley's concerns are already being addressed, says John McDonough, a professor at the Harvard School of Public Health.

Beginning next year, Medicare will penalize facilities where patients get a lot of hospital-acquired infections, and where a lot of patients are readmitted shortly after being discharged, McDonough says.

The Affordable Care Act, the healthcare law championed by the Obama administration, also provided funding for a research center that compares existing treatments against each other, something that's not ordinarily done when new drugs are approved, McDonough says.

The Affordable Care Act also creates community groups, called accountable care organizations, through which hospitals can work with local groups to improve community health, says Gerard Anderson, of the Johns Hopkins School of Public Health.

But McDonough also says it's not possible to make the system work perfectly. "The notion that there is a pure, rational way to do something, on which everyone could agree, just doesn't fit reality," McDonough says.

And Anderson says that even the most educated and empowered patients may still have trouble challenging their doctors.

"When your doctor says, 'You need this procedure,' it's really hard to say, 'Really? I don't think I need that,' " Anderson says.

"We just don't have enough information as consumers."

Community Outreach is the Key to Overcoming Healthcare Disparities

Studies like this, while disturbing, can serve as a great motivator. Healthcare providers must step up grassroots efforts to educate at-risk communities on the importance of cancer screening.

CDC Press Release: Study finds racial and ethnic disparities in US cancer screening rate

Study finds racial and ethnic disparities in US cancer screening rates
Screening rates lower among Asian and Hispanic Americans
The percentage of U.S. citizens screened for cancer remains below national targets, with significant disparities among racial and ethnic populations, according to the first federal study to identify cancer screening disparities among Asian and Hispanic groups. The report by the Centers for Disease Control and Prevention<http://www.cdc.gov> and the National Cancer Institute (NCI), part of the National Institutes of Health, was published today in the CDC Morbidity and Mortality Weekly Report<http://www.cdc.gov/mmwr>.

In 2010, breast cancer screening rates were 72.4 percent, below the Healthy People 2020 target of 81 percent; cervical cancer screening was 83 percent, below the target of 93 percent; and colorectal cancer screening was 58.6 percent, below the target of 70.5 percent, according to the study, "Cancer Screening in the United States - 2010."

During Healthcare Uncertainty, the Patient has Few Friends

Although President Obama's healthcare law is gaining acceptance http://gma.yahoo.com/health-reform-law-gaining-wider-acceptance-poll-140405876.html, it is still a hotly contested issue and no doubt will remain so through the 2012 election. As the courts and politicians sort this all out, millions of Americans are caught in healthcare limbo, many of them members of vulnerable populations. The January 29th article from the Rapid City Journal (below) is just one example.  At least there are some healthcare professionals, like Kaiser Permanente, that are trying to bridge the gap. http://www.prnewswire.com/news-releases/kaiser-permanente-leads-nation-in-nine-effectiveness-of-care-measures-for-medicare-136678278.html

State taking wait-and-see approach to healthcare reform
For a time after Congress passed healthcare reform in March 2010, Auralee Nickels thought she might finally get health insurance despite a pre-existing medical condition.
As the months dragged on, "I kinda just gave up on it," she said.
When the Hermosa woman learned last week that a study shows South Dakota to be one of 15 states with very little progress toward implementing the Affordable Care Act, she felt frustrated all over again.
"It's crazy that we have more concern about vehicle insurance in this state than health insurance," she said. "I would gladly pay a higher premium knowing that I'm more in need of it than the guy next to me. I just can't get any."
Earlier this month, Gov. Dennis Daugaard announced that the state would not move forward on creating health insurance exchanges -- one of the mandates of the Affordable Care Act -- until the U.S. Supreme Court rules on the current lawsuit.
South Dakota is one of 26 states involved in the suit, which argues that portions of the ACA are unconstitutional. The Supreme Court will begin hearing arguments beginning in March.
Daugaard said he doesn't want to "waste time and money" on creating an exchange if the act is eventually overturned.
Exchanges are regulated markets that bring together insurance providers and those in need of insurance. The ACA requires states to show progress toward creating exchanges by January 2013. Implementation is targeted for 2014.
If states do not develop their own exchange, the federal government can create and operate exchanges for them.
That's something Daugaard never wants to see.
"I don't want to be forced," he said.
Yet if states don't meet the deadline, that's exactly what could happen, according to Lorez Meinhold with the Colorado governor's office. In the new study by Urban Institute titled "State Progress Toward Health Reform Implementation," Colorado was ranked in Group 1, which means it's a state that has made sufficient progress toward implementing an exchange program.
She believes that states that don't meet the deadlines could get a federal plan instead.
"Our understanding right now ... is by that Jan. 1 (2013) deadline you have to show progress," Meinhold said.
But Rep. Lance Russell, R-Hot Springs, said the state has nothing to worry about.
Russell said problems exist in the wording of the reform legislation that would prevent the federal government from going into states and setting up federal exchanges. As a result, he believes Daugaard's plan to wait is a good one.
"I think it's prudent on his part to hold back on the exchange," he said.
Tony Venhuizen, a senior adviser to Daugaard, said too much is unknown about the healthcare reform act at this point, including what the true deadlines are.
"One of the things about healthcare reform has been that a lot of these deadlines have been subject to change. There's a lot of uncertainty about that. That's one of the reasons we've elected not to go forward at this point," he said.
South Dakota certainly isn't alone in its watch-and-wait approach. According to the Urban Institute study, 14 other states fall into Group 3, indicating that they have not passed any legislation to allow for exchanges, nor have they "demonstrated significant interest in doing so."
In addition to South Dakota, neighbors North Dakota, Wyoming and Montana fall into the Group 3 category.
Meinhold said Colorado, a Group 1 state, has created a non-profit organization and its board has been meeting twice a month since July. The group obtained an initial planning grant -- available to all states -- which allowed it to do technology planning, hire an interim director, develop a board and begin addressing legal matters that surround exchanges.
Meinhold said the process of establishing exchanges has proven to be complex.
While she recognizes that many states like South Dakota are "waiting to see what happens," she's glad Colorado is not one of them.
"We feel pretty crunched even by the timelines," she said. "Even as a state that's made progress, we're worried about making the deadlines."
Daugaard said it's inaccurate to portray South Dakota as a state that has done nothing. With initial grant money, it did a survey to identify the number of uninsured in South Dakota. He said the numbers appear to be about 9 percent. The Kaiser Family Foundation puts the number at 13 percent.
"We've done some planning. We've applied for a grant," he said.
Even if the ACA is upheld, Daugaard believes the state can safely meet the requirements by deadline.
"South Dakota is a very nimble state," he said. "We can get things done much more quickly than most places."
Venhuizen said earlier in the week, however, that, "There would have to be pretty extensive legislation brought to create an exchange."
The debate on when and if South Dakota will enact healthcare reform plays a peripheral role in Nickel's day-to-day life. The 35-year-old was diagnosed as a child with a genetic condition that hinders her liver's ability to clear bad cholesterol from the blood.
Her "pre-existing condition" has lead to two heart attacks - one at the age of 32. She waited three days before seeing a doctor because she didn't have insurance.
Nickels recently paid off her doctor's bills and is debt free for the first time in years. She isn't confident it will last. "I'm one incident from being right back where I was," she said.
Nickels has been told it would be best to see a cardiologist every six months for her condition, but does so only once a year due to the cost constraints. She pays cash for each visit. She gets her medication donated by the manufacturer.
She has purchased insurance in the past, but companies require a 12-month period without a medical incident for those with pre-existing conditions before coverage kicks in. Nickels said she has never been able to reach the 12-month mark. Once, she came within three days, which essentially made the premiums she had paid for the past year a waste, she said.
Even though she has a job and a home, Nickels said the frustration with not being able to get insurance makes her feel like a "second-class citizen."
"It's not like I'm a deadbeat and don't pay my bills," she said. "It's not like I'm in a tax bracket where I need assistance in any other way. I live a pretty good life but I just can't afford healthcare and that's ridiculous."
Daugaard said he understands there are extraordinary situations. "I'm not heartless and I do know that there are people out there who fall through the cracks and yes, the state should look into that," he said. But for the most part, Daugaard said "most people are self-reliant. Most people are finding the means to obtain coverage."
And that should be the goal, he said. "We've got to, at some point in time, say adults must take care of themselves."

Low-Income Schools Are Less Likely to Have Daily Recess

We can no longer afford to ignore the link between schools and our children's health. Obesity is a direct cause of Type II Diabetes and a host of other health problems that will haunt them well into adulthood.

Sandy Slater //Dec. 9, 2011 // 2:20 PM

---

Obesity is a problem in this country that is getting worse. One-third of our children have an elevated risk of serious health problems because of their weight. Our nation’s leading experts agree that we must change our schools and communities to help children eat healthy foods and get more exercise.

Why is it important to focus on schools? Because kids spend about seven hours a day there.
Although there’s much work to be done, schools have made progress in recent years. Since 2006, they’ve started to offer healthier foods and beverages - like fresh fruit, whole grains and low-fat milk - with school lunch meals. They’ve also cut back on some of the less healthy foods, like cookies, pastries and salty snacks.

But they haven’t made any progress in the amount of physical education (PE) or recess offered to elementary students during this same time period.

Here’s what we know:
• Children aged six to 17 should get at least one hour of daily physical activity, yet less than half of kids aged six to 11 get that much exercise. And as kids get older, they’re even less active.
• The National Association of Sport and Physical Education (NASPE) recommends that elementary school students get an average of 50 minutes of activity each school day - at least 150 minutes of PE per week and 20 minutes of daily recess.
• Kids who are more active perform better academically.
As a researcher and a parent, I’m very interested in improving our understanding of how school policies and practices impact kids’ opportunities to be active at school. My colleagues and I recently conducted a study to examine the impact of state laws and school district policies on PE and recess in public elementary schools across the country.
During the 2006 to 2007 and 2008 to 2009 school years, we received surveys from 1,761 school principals in 47 states. We found:
• On average, less than one in five schools offered 150 minutes of PE per week.
• Schools in states with policies that encouraged daily recess were more likely to offer third grade students the recommended 20 minutes of recess daily.
• Schools serving more children at highest risk for obesity (i.e. black and Latino children and those from lower-income families) were less likely to have daily recess than were schools serving predominantly white students and higher-income students.
• Schools that offered 150 minutes of weekly PE were less likely also to offer 20 minutes of daily recess, and vice versa. This suggests that schools are substituting one opportunity for another instead of providing the recommended amount of both.
• Schools with a longer day were more likely to meet the national recommendations for both PE and recess.

So what does this mean?
We need strong state laws and district policies for PE and recess to help more of our youngest students meet the national recommendations for physical activity.

What can be done?
First, Congress should consider making PE a core requirement of the Elementary and Secondary Education Act. This would help ensure that all students get adequate amounts of exercise and that PE classes follow evidence-based guidelines and are taught by certified teachers.

Second, states should adopt and/or strengthen their PE and recess policies so they align with the national recommendations.

Third, school districts should continue to strengthen their policies by requiring time for PE and recess that aligns with the national recommendations.

Finally, given competing time demands and other issues schools face, increasing the amount of time for physical activity during the school day may be challenging. That’s why it’s critical for schools to help kids make the most of the time they do have for physical activity. Schools can do this by increasing the amount of time kids spend in moderate-to-vigorous activity during PE, recess and brief classroom breaks (you can find some resources here and here) and by offering intramural sports and physical activity clubs before or after school.

Sandy Slater, PhD, is a Research Assistant Professor of Health Policy and Administration at the University of Illinois at Chicago School of Public Health, and is the lead author of the study “The Impact of State Laws and District Policies on Physical Education and Recess Practices in a Nationally Representative Sample of U.S. Public Elementary Schools,” published in the Archives of Pediatrics and Adolescent Medicine.

The State of Quality Improvement Science in Health

What do We Know About How to Provide Better Care?

That's a good question. In this new era of healthcare, there is a greater sense of urgency than ever before to improve the level of care we provide. This article illustrates why researchers must become more involved with Quality Improvement, and how they can go about it.  

http://www.rwjf.org/qualityequality/product.jsp?id=73634&cid=XEM_205605

San Francisco Health Improvement Partnerships Tackles Public Health Problems | www.ucsf.edu

This article illustrates the need to build relationships between the healthcare professionals and the communities they serve. San Francisco is certainly taking a step in the right direction!

San Francisco Health Improvement Partnerships Tackles Public Health Problems www.ucsf.edu

Parents Should Not Have to Choose Between Healthy Food and Paying the Rent

Reasonable minds can disagree whether genes or bad parenting is the primary cause of childhood obesity.
http://www.washingtonpost.com/blogs/ezra-klein/post/parents-more-than-parenting-may-be-to-blame-for-obesity/2011/11/28/gIQALOfk4N_blog.html.

But the following article shows that regardless of the cause, obesity is not a partisan issue; neither is it one in which companies must choose between profits and ethics. Parents need to know that they can feed their children healthy food without breaking the bank.


Obesity fight good for profits
By: Bill Frist and Cory Booker
November 28, 2011 09:25 PM EST

We are facing a childhood obesity epidemic so severe that for the first time, America’s children will live sicker, shorter lives than their parents. In the past three decades, the childhood obesity rate has tripled. One in three children is now either obese or overweight.

These trends continue past puberty. In 20 years, half of the U.S. adults are projected to be obese.

But many companies are committed to fighting this epidemic. Our health summit Tuesday focuses on a powerful yet simple idea: If the public and private sectors can come together to effect meaningful, voluntary change, we can end childhood obesity within a generation.

Some companies have already stepped forward. Because of their actions, millions more Americans now have easy access to healthful, affordable foods.

We’ve ensured childcare centers provide the healthiest environment to our children. Major consumer packaged goods companies have reformulated products — decreasing calories, sodium and fat. Restaurants have increased their healthful options — especially for kids. All these new commitments came in 2011 alone.

But their leadership will succeed only if the entire marketplace follows. These companies must show their competitors that by making the healthy choice the easy choice, a company can also make its bottom line healthier.

The good news is this idea is taking root. We have evidence that packaged-food and beverage companies selling a higher percentage of better-for-you products gain better reputations — and a stronger bottom line.

Better-for-you foods and beverages now account for slightly less than 40 percent of sales in grocery, drug and mass merchandisers, but they contributed more than 70 percent of sales growth in the past five years, according to a Hudson Institute study. And companies that expanded their better-for-you products more than traditional ones delivered 2½ times the operating-profit growth.

In addition, returns to shareholders were 1½ times higher for companies selling above-average levels of better-for-you products.

The hard evidence is in, and it’s clear that the private sector can be financially successful in its efforts to help all Americans be healthier.

But the private sector can do more. We say this not with a stick in our hands but with a carrot.

We know consumer demand is there. The private sector merely needs to seize the advantage — as the companies represented at the summit have done.

But we must make meaningful commitments, not empty press releases. In this age of increasing corporate social responsibility, when too many companies attempt to improve reputations by writing checks to causes they believe customers might like, our only counsel to companies looking to change is this: Make it meaningful.

The childhood obesity epidemic is too too dangerous for gimmicks.

Recent actions show that you can succeed by instituting meaningful change. But American consumers are not stupid. They know the difference between real commitments and hollow attempts at PR.

To our private-sector colleagues, remember: There is evidence that consumers will reward you for your efforts — but that does not mean your efforts will be easy.

The opportunity continues at today’s summit. Yet it will involve more than shining a spotlight on important private-sector initiatives to fight childhood obesity. Our real challenge is to carry the momentum these companies create into tomorrow, next month and next year.

Today is just the beginning. It has to be.

Bill Frist is a physician and the former Republican Senate majority leader. Cory Booker is the mayor of Newark, N.J. They are honorary vice chairmen of Partnership for a Healthier America. The group is holding its Building a Healthier Future Summit on Tuesday.

© 2011 POLITICO LLC

Wal-Mart Plans Ambitious Expansion Into Medical Care

This precisely what we should be concerned with as we move into a new era of healthcare. Walmart, best known for undercutting the competition's prices on everything from tires to toilet paper, is now going to offer healthcare services (the quality of which remains to be seen). The corporate giant is clearly trying to grab a piece of the healthcare pie, and preying on vulnerable Americans to do it. At the same time, they have announced that they will not be providing healthcare insurance to their own part-time employees. This is the worst kind of hypocrisy.

Enlarge Eric Risberg/AP A trip to the local Wal-Mart, like this one in Oakland, Calif., could soon mean one less stop at the doctor's office.

Eric Risberg/AP

A trip to the local Wal-Mart, like this one in Oakland, Calif., could soon mean one less stop at the doctor's office.

Updated at 2:52 p.m. ET: Wal-Mart issued a statement Wednesday saying its request for partners to provide primary care services was "overwritten and incorrect." The firm is "not building a national, integrated low-cost primary health care platform," according to the statement by Dr. John Agwunobi, a senior vice president for health and wellness at the retailer.
[For more on the Wal-Mart clarification, see our follow-up post.]

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Wal-Mart wants to be your doctor.
The nation's largest retailer is planning to offer medical services ranging from the management of diabetes to HIV infections, NPR and Kaiser Health News have learned.
In the same week in late October that Wal-Mart said it would stop offering health insurance benefits to new part-time employees, the retailer sent out a request for partners to help it "dramatically ... lower the cost of healthcare ... by becoming the largest provider of primary healthcare services in the nation."
On Tuesday, Wal-Mart spokeswoman Tara Raddohl confirmed the proposal. She declined to elaborate on specifics, calling it simply an effort to determine "strategic next steps."
The 14-page request, which you can read here, asks firms to spell out their expertise in a wide variety of areas, including managing and monitoring patients with chronic, costly health conditions. Partners are to be selected in January.
Analysts said Wal-Mart is likely positioning itself to boost store traffic, possibly by expanding the number of its in-store medical clinics and the services they offer.
The move would also capitalize on growing demand for primary care in 2014, when the federal health law fully kicks in and millions more Americans are expected to have government or private health insurance.
"We have a massive primary care problem that will be made worse by health reform," says Ian Morrison, a Menlo Park, Calif.-based health-care consultant. "Anyone who has a plausible idea on how to solve this should be allowed to play."
In-store medical clinics, such as those offered by Wal-Mart and other retailers, could also be players in another effort in the health law: collaborations between doctors and hospitals to streamline care and lower costs.
Such collaborations, known as accountable care organizations, might contract with in-store medical clinics, says Paul Howard, a senior fellow with the Manhattan Institute for Policy Research. He has studied retail clinics, some of which have recently expanded to offer services beyond simple tests and vaccinations, such as helping monitor patients with diabetes or high blood pressure.
Wal-Mart's request goes even further, asking possible partners to provide information on how they would oversee patients with complicated chronic conditions, including asthma, HIV, arthritis, depression and sleep apnea.
In health care, Wal-Mart has already flexed its super-size muscles when it comes to prescription drugs, says Ed Kaplan, a senior vice president at The Segal Company, an HR benefits firm. The company was the first to offer generic drugs at $4 for a month's supply,and its low-cost pharmacy is popular with employers and seniors. Kaplan says Wal-Mart could bring its massive purchasing power to medical supplies, diabetes test strips, just about anything.
Wal-Mart's efforts to partner with others on health care could help lower costs for some patients and increase access to primary care services. But the approach has detractors.
Family physicians have long been vocal critics of in-store clinics, arguing that patients need a regular source of care from someone who knows their medical history. Glen Stream, president of the American Academy of Family Physicians, says Wal-Mart's proposal takes health care in the wrong direction by further fragmenting care.
Others aren't sure the company's approach can really work. "Maybe Wal-Mart can deliver a lot of this stuff more cheaply because it is an expert at doing this with other types of widgets, but health care is not a widget and managing individual human beings is not nearly as simple as selling commercial products to consumers," says Ann O'Malley, a physician and senior health researcher at the Center for Studying Health System Change, a nonpartisan Washington think tank.
And will it save money? Because primary care services are not the main driver of health care costs in this country, "I would be surprised if this were a model that could truly attack cost problems," says O'Malley.
Whatever it does for health costs, it may also be a way to boost foot traffic and sales in Wal-Mart stores, says Colin McGranahan, a retail analyst for Sanford C. Bernstein & Co. "Their traffic has been declining for over two years and they've been losing market share," McGranahan says. "If you get someone in the door, you can also sell them milk and a shotgun."
Other retailers are ramping up their own medical offerings. CVS Caremark, Walgreens, Kroger, Target and others have recently reinvigorated efforts to open in-store medical clinics.
Until recently, Wal-Mart was the nation's leader in opening such clinics, but has dropped to third place with about 140 of them, well behind CVS Caremark's nearly 550 Minute Clinics and Walgreens' 355 Take Care clinics, according to data tracked by Tom Charland, CEO of Merchant Medicine, a Minnesota-based research and consulting firm. About 1,300 store-based clinics are open nationwide, he says.
They have different business models. Wal-Mart, which has more than 3,500 stores in the U.S., leases space to independent clinic vendors, for example, while CVS owns and staffs its Minute Clinics. While a few centers operated by retailers have doctors on site, most hire nurse practitioners or physician assistants to provide the care. In 2007, Wal-Mart CEO Lee Scott announced the firm would open 400 clinics by 2010.
But early efforts backed by venture capital money faltered and the firm failed to reach that number, says Charland. Wal-Mart then switched strategies and began leasing space to hospital systems, and the clinics began to grow again. Still, last month, the firm appeared to be struggling: Wal-Mart opened three in-store clinics, but closed 10, says Charland.
"This is an industry where people haven't figured out how to make money," he says. Hiring nurses isn't cheap — and business can be seasonal: more people come in during the cold winter months and business can slow to a crawl in the summer. "My guess is the whole purpose of (Wal-Mart's) request for information is to find someone to help them because they've not been able to pull it off."

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This story is part of a reporting partnership that includes KQED, Oregon Public Broadcasting, NPR and Kaiser Health News.
Kristian Foden-Vencil of Oregon Public Broadcasting, and Chris Weaver, Sarah Barr, and Christian Torres of Kaiser Health News contributed to this story.
Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

Twelve Coalitions Receive RWJF Roadmaps to Health Community Grants

State  and Local Efforts Will Work to Create Systems Changes in Areas That Impact  Health, Including Education, Income and Employment, Community Safety and  Social Connectedness

Coalitions in 12 states and localities across the United States have been awarded  Robert Wood Johnson Foundation (RWJF) Roadmaps  to Health Community Grants of up to $200,000 to improve the health  of people living in those communities. The grants, which will support  two-year state and local efforts among policy-makers, business, education,  health care, public health and community organizations, will be managed by  Community Catalyst and are part of the  County Health Rankings & Roadmaps program, a collaboration of RWJF and the  University of Wisconsin Population Health Institute (UWPHI).

The  grantees, selected from more than 300 initial applicants, will build on the  RWJF/UWPHI County Health Rankings model,  which highlights the critical role that factors such as education, jobs and  our environment play in influencing how healthy people are and how long they  live.

In  addition to the Community Grants, the County  Health Rankings & Roadmaps  program will include other efforts to mobilize local communities and national  partners and leaders, including grants to national organizations to activate  local leaders and affiliates to improve health; a prize program to recognize  communities taking action whose promising efforts will lead to better health;  and, tools and resources to help groups working to improve the health of  their communities. Taken together, the Rankings  and Roadmaps to Health are  addressing our nation’s health crisis through the creation of healthier  places to live, learn, work and play.
Read the full press release.
Learn more about each of the 12 grant recipients.

U.S. Herpes Rates Remain High: CDC

JoAnne Allen


WASHINGTON

Tue Mar 9, 2010 3:46pm EST

(Reuters) - About 16 percent of Americans between the ages of 14 and 49 are infected with genital herpes, making it one of the most common sexually transmitted diseases, U.S. health officials said on Tuesday.

Black women had the highest rate of infection at 48 percent and women were nearly twice likely as men to be infected, according to an analysis by the U.S. Centers for Disease Control and Prevention.

About 21 percent of women were infected with genital herpes, compared to only 11.5 percent of men, while 39 percent of blacks were infected compared to about 12 percent for whites, the CDC said.

There is no cure for genital herpes, or herpes simplex virus type 2 (HSV-2), which can cause recurrent and painful genital sores and also increases the likelihood of acquiring and transmitting the AIDS virus. It is related to herpes simplex virus 1, or oral herpes, which causes cold sores.

Several drugs are available to treat herpes symptoms and outbreaks, including acyclovir, which is available generically or under the Zovirax brand name, and valacyclovir, known generically as Valtrex -- both made by GlaxoSmithKline PLC. Ganciclovir, sold as Zirgan, is made by privately-held Sirion Therapeutics, Inc.

The CDC estimates that more than 80 percent of people with genital herpes do not know they are infected.

"The message is herpes is quite common. The symptoms can be often very innocuous," Dr. John Douglas of the CDC said in a teleconference.

"Because herpes is so prevalent it becomes ... a really important reason to use condoms on a consistent and correct basis with all of your partners," Douglas said.

Douglas said the increased rate of infection in blacks is not do to increased risk behavior but likely due to biological factors that make women more susceptible as well as the higher rate of infection within black communities.

The CDC estimates that there are 19 million new sexually transmitted disease infections every year in the United States, costing the health care system about $16 billion annually.