A Minute of Health (0:59)
A Cup of Health (3:36)
This week's podcast from the Center's for Disease Control and Prevention's (CDC) Morbidity and Mortality Weekly Report (MMWR) focuses on safety concerns and precautions for children in vehicles. Use the links below to listen to a brief overview or a more in-depth discussion.
A Minute of Health (0:59)
A Cup of Health (3:36)
By: Leah Howard
In the upcoming 2016 election, one of the big-ticket topics is health insurance and the continuance of President Obama’s Affordable Care Act (ACA). Presidential candidate Donald Trump has talked about plans to repeal the bill and replace it with his own proposals in which individuals could deduct their premiums from their taxable income, which would mostly benefit the affluent, but be disadvantageous to poor and working class Americans. According to policy journalist Max Ehrenfreund, if this law were to pass, as many as 22 million people in poverty would go without health insurance. However, presidential candidate Hillary Clinton's plan could allow as many as 9.6 million people to gain access to health insurance by providing a tax credit to help families pay for their premiums, co-insurance, and deductibles.
Regardless of what happens next month, health insurance is getting harder to pay for, and to keep causing major issues. “Gap plans” are becoming the new expense in the health insurance world. These plans are used to cover out-of-pocket expenses, such as high deductibles, and are caused by the rising price of insurance. Because of the higher costs of insurance, people are opting for cheaper, high-deductible plans. Just this year, over 90% of plans offered in the Affordable Care Act Marketplace had a deductible of $3,000 or more. Prices like these may deter consumers because if they are unable to qualify for a subsidy, then they have to pay the majority of that cost. Luckily, 80% of people who enroll in healthcare under the ACA qualify for some sort of subsidy. However, the situation is not the same for businesses, and for smaller businesses, gap plans make sense, allowing the out-of-pocket expenses for employees to be smaller.
Although the ACA is a big topic of the election, healthcare costs are still a concern for those individuals outside of the marketplace. The rising cost of healthcare deductibles for Americans who qualify for insurance via their place of employment is also an issue. This increase is not a product of the ACA, but rather began years before its passage in 2010. The rise of deductibles in 2016 was 12%, greatly affecting small businesses where almost 65% or employees of businesses with less than 200 workers have high deductible plans. The deductible is rising 6 times more than the rate of the average wage.
However, plans such as these are not a terrible option for some consumers. For those who are in good health, these plans are viable possibilities. On the other hand, they can leave individuals with chronic diseases and needs, or a lower income more vulnerable. In general, high deductible plans can also be a problem when there are large increases in the price of certain drugs, like those of the EpiPen. However, employers and the ACA can help cover some of the out-of-pocket costs for a lot of insurance plans. If you’re in the market for health insurance, do your research, and know which plans would work best for you. Most of all, keep in mind that this could all change on Tuesday, November 8th.
By: Taylor Eisenstein
Health literacy is defined by the Patient Protection and Affordable Care Act of 2010, Title V, as the “degree to which an individual has the capacity to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions.” Health literacy is not the same as ordinary literacy, although the two are related. A person who can adequately read and write still may not have the tools to comprehend the health information he or she is reading; conversely, a person’s limited literacy can affect his or her ability to comprehend health information. According to the Centers for Disease Control and Prevention (CDC), health literacy can affect one’s ability to navigate the healthcare system, participate in self-care, understand mathematical ideas, and share information. Numeracy—the ability to comprehend and work with numbers—is an important component of health literacy. Numeracy plays a large role in various health behaviors, including calculating blood sugar levels and understanding nutrition labels.
Health literacy skills can vary. The highest skill level is proficient, followed by intermediate, basic, and below basic. In the United States, according to results from the 2003 National Assessment of Adult Literacy, 53% of participants had intermediate health literacy. However, only 12% of adults possessed proficient health literacy. Many adults had lower skill levels of health literacy; 22% possessed basic health literacy and 14% of participants had below basic health literacy. Adults ages 65 and older had poorer average health literacy than younger adults.
Furthermore, inadequate health literacy can have detrimental repercussions for those individuals. Individuals with limited health literacy can have less knowledge, especially in regard to their own health conditions. Studies have illustrated that patients with less literacy are less likely to have knowledge related to managing chronic conditions such as asthma, diabetes, or hypertension.[2,3] For instance, an asthmatic person with inadequate literacy may not be able to properly utilize an inhaler. Patients with lower health literacy are also more likely to self-report poorer health and they are more likely to be hospitalized more frequently, which can have costly financial consequences.
Many literacy tests can assess health literacy through a variety of means. The Rapid Estimate of Adult Literacy in Medicine (REALM) assesses individuals on reading and pronunciation of various words, but it does not test comprehension. In contrast, the Test of Functional Health Literacy in Adults (TOFHLA) further assesses comprehension. For instance, it might ask individuals to interpret certain medical instructions. However, many individuals with low literacy may feel ashamed or embarrassed when their literacy status is disclosed through these tests.
Inadequate health literacy can have disastrous consequences for patients. The National Action Plan to Improve Health Literacy was introduced in May 2010 by the U.S. Department of Health and Human Services as a united effort to combat health literacy struggles. The plan consists of seven goals that culminate in the plan’s primary vision, which aims to create a society that “provides everyone access to accurate, actionable health information; delivers person-centered health information and services; and supports life-long learning and skills to promote good health.” Similarly, the Plain Writing Act of 2010, practiced by the CDC, was established to ensure that federal agencies communicate using language that is understandable to the general public. Further plans or potential screening strategies must be implemented to identify, educate, and assist patients with low health literacy, so that adverse outcomes can be prevented.
1. Kutner, M., Greenburg, E., Jin, Y., & Paulsen, C. (2006). The Health Literacy of America's Adults: Results from the 2003 National Assessment of Adult Literacy. NCES 2006-483. National Center for Education Statistics.
2. Williams, M. V., Baker, D. W., Honig, E. G., Lee, T. M., & Nowlan, A. (1998).
Inadequate literacy is a barrier to asthma knowledge and self-care. Chest, 114(4), 1008-1015.
3. Williams, M. V., Baker, D. W., Parker, R. M., & Nurss, J. R. (1998b).
Relationship of functional health literacy to patients' knowledge of their chronic disease: a study of patients with hypertension and diabetes. Archives of internal medicine, 158(2), 166-172.
4. Baker, D. W., Parker, R. M., Williams, M. V., Clark, W. S., & Nurss, J. (1997). The relationship of patient reading ability to self-reported health and use of health services. American journal of public health, 87(6), 1027-1030.
By: Hannah Heitz
Mental healthcare services are most commonly delivered through the public sector. Since policy changes of the 1960’s, there has been a shift away from a centralized system of mental healthcare provision. There are four major service sectors that provide mental healthcare services: specialty mental health, general medicine, human services, and complementary and alternative medicine. Human services take on mental health care services indirectly through a systems that typically provide disjointed care through referrals and support services. General medicine is the main source of mental healthcare, which is partially due to the increased frequency with which general practitioners are seen compared to mental health specialists. Unfortunately, this also means that individuals who lack specialty psychiatry training are making psychiatric care evaluations—ranging from determining who needs specialty care to making psychiatric drug decisions.
Mental health is culturally viewed as secondary to physical health, and mental healthcare equality only became an expectation for insurance plans following the Parity Act of 1996. Mental illness and substance abuse issues are stigmatized and often not treated as seriously as physical illnesses. Diagnosis in mental health is often less definitive and requires care beyond the basic physical healthcare options that address acute, chronic, and severe illness offered in general medicine. The difficulty in diagnosis stems from the lack of objective measures associated with mental illness and guidelines in the Diagnostic and Statistical Manual of Mental Disorders (DSM) that are somewhat open to interpretation and difficult to utilize in practice, especially when dealing with comorbidity, the presence of one or more co-occuring disorders. An additional issue stems from the fact that providers range from social workers to psychiatrists and individuals receive care at numerous access points from these varied professionals. In the mental healthcare field, there is no standardized system of communication and there are fewer standardized measures of quality of treatment.
Many of the supports put in place for those with disabilities prioritize physical disability and, as a result, many individuals with severe mental illness do not receive adequate benefits or support. Mental health coverage is more limited and frequently includes higher co-pays than physical healthcare coverage, despite mounting evidence that mental and physical health and intrinsically connected. For general medical care, services are provided in a cohesive, centralized format with fewer options. Mental health services used to function similarly and relied heavily on public state mental hospitals, but the services have since shifted to community-based care. This shift initially began after the deinstitutionalization, also known as transhospitilization, that started in 1965 when the creation of Medicaid put greater financial incentive on community-based treatment. However, community-based mental health care services are underfunded and, thus, individuals who are most impacted by mental illness often slip through the cracks.
A great deal of mental health coverage is delivered through the public sector, which means that consumers have less choice and decreased ability to propagate change or improvement in quality of care. Compared to physical health care, mental healthcare services are decentralized, which makes it more difficult to monitor and assess quality. An individual typically has one primary healthcare provider to monitor physical health, but there are numerous professionals who might meet his or her mental healthcare needs. Different professionals take different approaches in providing treatment, with wide variation in therapeutic style and medication preference, which makes quality assessment difficult since each case is unique.
Although the public sector does strive to improve quality of care, there is less pressure from the consumer than there is in the private sector. In order to improve quality, there must be improvement in measurement tools that assess progress. In order to improve quality of care for patients, while also getting increased value from the federal and state budget spent on mental healthcare, a standardized system of care and better monitoring of quality is necessary. There is a shift to patient-centered care in the medical field; policies that support a similar shift for mental healthcare would be highly beneficial. This includes increased information sharing (with obvious respect to confidentiality), patient communication, and coordination across care access points, such as social workers, psychotherapists, and primary care physicians. Patient-centered care empowers individuals to make choices in their own healthcare. Research has shown that in this system, patient self-report ratings of care quality increases.
1: Wang, PS, et al. Twelve-Month Use of Mental Health Services in the United States Results From the National Comorbidity Survey Replication Arch Gen Psychiatry. 2005;62:629-640.
2: Barry CL, Goldman HH, Huskamp HA. Health Aff. Federal Parity In The Evolving Mental Health And Addiction Care Landscape.2016Jun1;35(6):1009-16. doi:10.1377/hlthaff.2015.1653.
3: Druss, BG and Walker, E. Mental disorders and medical comorbidity. Robert Wood Johnson Evidence Synthesis, February 2011.
4: Epstein, R. M., Fiscella, K., Lesser, C. S., & Stange, K. C. (2010). Why the nation needs a policy push on patient-centered health care. Health Affairs,29(8), 1489-1495.
A summary of important health news from the past week.
Seven gonorrhea patients in Hawaii were treated and cured using antibiotics. However, laboratory tests showed that their gonorrheal infections were not as susceptible to the antibiotics as they have been previously. This increased resistance shows that antibiotics might not be as effective in the future.
Double Dose of Pesticides Stops Zika Mosquitoes, CDC Says
By: Maggie Fox and Samuel Sarmiento
The Zika outbreak was declared over in the Wynwood neighborhood of Miami. Florida Health officials explain that ground and arial pesticide spraying was key to stopping the spread. As of now, there have been 105 confirmed cases of Zika in Florida.
Smoking leaves 30-year legacy on your DNA
By: Meera Senthilingam
An analysis of almost 16,000 blood samples from smokers, former smokers and nonsmokers found that tobacco smoke leaves a lasting legacy of people's addiction on the surface of their DNA. Studies have showed that smoking causes surfaces changes to DNA, but the new study identifies the diversity of affected genes and the persistence of smoking-related DNA alternations. Also, the study highlights prevention as a key solution to health risks induced by smoking.
Researchers at the University of California, San Diego have found evidence suggesting that concussions can increase one's risk of developing Post-Traumatic Stress Syndrome (PTSD). The study involved assessing more than 1,600 service members before and after deployments to Iraq or Afghanistan. Military members who experienced a traumatic brain injury (TBI), including concussions, were twice as likely to develop PTSD.
By: Maggie Cherneff
This May, the U.S. Food and Drug Administration (FDA) enacted a new rule expanding their authority to monitor a wider range of tobacco related products including e-cigarettes and other vaporized nicotine devices. In light of this new policy, the tobacco industry has launched aggressive new efforts in Washington D.C. to block the FDA in order to ensure E- cigarettes remain securely on the market. Spearheaded by The Altria Group, which oversees the tobacco powerhouse Philip Morris, this initiative now involves over 75 lobbyists from both major political parties. This new rule, which was set to go into effect last month, enacts the first federal law prohibiting any sale, including online sales, of e-cigarettes to anyone under the age of 18.
According to the American Lung Association, the term e-cigarettes refers to a range of electronic smoking devices that deliver nicotine via an aerosol. These products have been a growing cause for concern as the Centers for Disease Control and Prevention (CDC) found that the percent of high school aged teenagers that use these products has jumped by over 14 percentage points in the last 6 years. The American Lung Association has voiced its concerns that these products are being inappropriately marketed towards children and young adults. E-cigarettes and other vaporized nicotine products come as small battery-operated devices, are offered in a wide range of flavors, including candy-like flavors, and are easily accessible for online purchase. Safety information about these products is still unclear. Some studies have found that, in addition to the nicotine, e-cigarettes contain trace amounts of diethylene glycol, a toxic chemical found in anti-freeze and other known carcinogens. Additionally, it seems as though there is a significant amount of unconfirmed or incorrect information circulating about these products. Theories that e-cigarettes help regular smokers quit are highly contested and there is little concrete evidence confirming that these devices are safer than traditional smoking methods.
Regardless of the health concerns, e-cigarettes sales have developed into a booming industry that was valued at around 3.7 billion dollars in 2015. However, some estimate that it will cost the e-cigarette companies over 2 million dollars to properly comply with the new FDA regulations. Opponents of the new FDA rule argue that these new regulations will result in larger companies that can afford these types of costs will come to dominate the market, while smaller companies will be forced to close, leaving people unemployed. In an article featured in the Wisconsin State Journal, Christian Berkey, C.E.O. of Johnson Creek Enterprises, an e-liquid manufacturing company, stated he feared “close to a million jobs could vanish and nearly 30,000 businesses could close.”
Tobacco companies are hardly strangers to Washington D.C. It has not yet been 20 years since the Master Settlement Agreement of 1998 in which the major tobacco companies were ordered to pay significant amounts money as reparations for the harm their products caused on the American public. These recent lobbying efforts mark the industry’s latest backlash against lawmakers and public health officials. This current tension is a reflection of the constant intersection between government, industry and public health. To find out more about the latest FDA rules regarding e-cigarettes, or for more information about nicotine safety, Destination Health EU recommends you visit fda.gov.
 Singh T, Arrazola RA, Corey CG, et al. Tobacco Use Among Middle and High School Students — United States, 2011–2015. MMWR Morb Mortal
 Christoph, Meike Paschke, Svetlana Kruschinski, Frank Henkler, Jürgen Hahn, and Andreas Luch. "Chemical Hazards Present in Liquids and Vapors of Electronic Cigarettes." Archives of Toxicology Arch Toxicol 88.7 (2014): 1295-308. Web.
A summary of important health news from the past week.
Brain Cancer Is Now the Leading Cancer Killer of Kids
Who We Are
The Center is the hub of the science of human health for students, faculty, and staff at Emory University.