April is National Minority Health Awareness Month

MinorityHealth

The theme for this years National Minority Health Awareness Month is “30 Years of Advancing Health Equity; The Heckler Report: A Force for Ending Health Disparities in America,” This year marks the 30 year anniversary of the release of the “Report of the Secretary’s Task Force on Black and Minority Health.” For years, former secretary of Health and Human Services, Margret Heckler observed that blacks and other minority populations had more health problems than their white counterparts. In 1984, she decided to organizes a powerful task force to investigate the reasons for these disparities and and to give recommendations to the federal government on how to fix the problem. The report, now known as the “Heckler Report” was first released in 1985. The Heckler Report has been a driving force for the monumental changes in research, policies, programs and legislation to advance health equity.

Although 30 years of research and policy changes has helped the health disparities among whites and non-whites, the fact is that these disparities still exist and they need to be taken seriously. All minorities are at a higher risk for many diseases than whites, however the disparity is the greatest between non-Hispanic African Americans and non-Hispanic whites.

In 2012, it was reported that African Americans were 20 times more likely to have asthma than whites and in 2013 it was reported that they were three times more likely to die from an asthma related cause. Between 2003 and 2005, African American children were 7 times more likely than white children to die from an asthma related condition and were three times more likely to be admitted into a hospital for asthma.

African Americans have the highest mortality rate of any racial and ethnic group for all cancers combined and for most major cancers including stomach, lung, colon, pancreatic, prostate, and breast cancer. Statistics from 2009 show that African American women were 10% more likely to develop breast cancer than white women, yet were 40% more likely to die from it.

Among African Americans, chronic liver disease is a leading cause of death. African American men are 70% more likely to have liver and IBD cancer than white men and African American women are 1.4 times more likely to die from this than white women. The cause is not always known, some cases can be initiated by conditions such as chronic alcoholism, obesity, and exposure to Hepatitis B and C viruses (African Americans were twice as likely to develop Hepatitis B, in 2011, than the White population and had the highest rate of Hep B than any other ethnic group.)

African Americans are twice as likely to be diagnosed with diabetes as whites, and African American Adults are 70% more likely to be diagnosed with diabetes by a physician than whites. They are also more likely to suffer complications from diabetes, such as end-stage renal failure and amputations. Although African Americans have the same or lower rate of high cholesterol as their non-Hispanic white counterparts, they are also more likely to have high blood pressure.

In fact, African Americans are 40% more likely to have High Blood pressure and are 30% more likely to die from it than whites.

HIV/AIDS is extremely disproportionate in the African American Community. Men have 7.8 times the AIDS rate as white males, and women had 23 times the AIDS rate as white females.African American children are twice as likely to be born with HIV as opposed to white children. And both men and women are more likely to die from AIDS/HIV related complications than whites.

There is also a disparity in immunizations and flu vaccines for African Americans over the age of 65, as compared to whites. However, African American children age 19-35 months has comparable vaccination rates compared to white children.

African Americans have 2.3 times the infant mortality rate as whites. They are almost four times as likely to die as infants due to complications related to low birth weight as compared to white infants. Death from SIDS was 2 times higher from African American  infants in 2009 and were 2.3 times more likely to not begin prenatal care until the third trimester.

African Americans are also more likely to suffer from mental disorders. African Americans are 20% more likely to report having serious psychological distress than whites. However, whites are twice as likely to receive a prescription for anti-depressants. And suicide rates for African Americans is actually 60% lower than whites.

African American women have the highest rates of being overweight or obese compared to other groups in the U.S. About four out of five African American women are overweight or obese. In 2011, African Americans were 1.5 times as likely to be obese as whites.

African Americans make up the largest group of minorities in need of an organ transplant.The number of organ transplants performed on African Americans in 2012 was only 14% of the number of African Americans currently waiting for a transplant. The number of transplants performed on White Americans was 27% of the number currently waiting.While 29% of the total candidates currently waiting for transplants are Black American, they comprised 14% of organ donors in 2012. Although the total number of white Americans on organ transplant waiting lists is about 1.5 times greater than that of Black Americans, the number of candidates waiting for a kidney transplant is almost the same between Blacks and Whites.Black Americans have higher rates of diabetes and high blood pressure than White Americans. These conditions are known to put the patient at risk for organ failures.

African American adults are twice as likely to have a stroke as their white adult counterparts. Further, black men are 60% more likely to die from a stroke than their White adult counterparts.

With all of these health disparities that still exist between whites and minorities, it is extremely important to spread awareness about the diseases, what can cause them, and what can prevent them. This is a battle the Health and Human Services and the Center for Disease Control and Prevention have been fighting for 30 years. This is a battle they will continue to fight, and we should all continue to fight, until all heath is equal, despite race or ethnicity. Knowledge is power, and in this case knowledge is life. If you have not already, please take some time out and visit your primary care physician for a yearly check up, make healthy food choices, stay active, limit alcohol and stay tobacco and drug free!

Lethal Injection Drugs are Running Out

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The primary method used by state and federal correctional facilities when executing criminals sentenced to death is lethal injection. Lethal injection gained popularity because it was thought to be the most humane and painless method of putting a criminal to death. During this process, the prisoner is injected with a lethal does of the lethal injection drug(s). States in the past have used single drugs, or cocktails of two or three drugs to make the lethal concoction.These drugs normally act to paralyze the prisoner, put the prisoner to sleep and then stop their heart.

Activists against the death penalty were already pressuring pharmaceutical companies to place more restrictions on supplying the drugs used for lethal injections.This was only maximized  when news of many botched lethal injection executions, namely in Oklahoma and Ohio, surfaced. Pharmaceutical companies both in America and abroad are now refusing to supply the lethal drugs to state and federal correctional facilities because they no longer wish to take part in the executions and fear backlash from the activists. Because pharmaceutical companies are refusing to provide the drugs, states are running out of the drugs they need to enforce the death penalty. This is causing some states to use older, alternative methods such as the electric chair, firing squads, and nitrogen gas.

Attorney General, and longer term opponent of the death penalty, Eric Holder, is suggesting all states hold off executions until the Supreme Court decided Glossip v. Gross, which it will hear on April 29, 2015. This case is a challenge to Oklahoma’s lethal injection procedure, and particularly the use of the drug midazolam that was used in 3 botched executions in the state in 2014. The issues presented before the court include “(1) Whether it is constitutionally permissible for a state to carry out an execution using a three-drug protocol where (a) there is a well-established scientific consensus that the first drug has no pain relieving properties and cannot reliably produce deep, coma-like unconsciousness, and (b) it is undisputed that there is a substantial, constitutionally unacceptable risk of pain and suffering from the administration of the second and third drugs when a prisoner is conscious; (2) whether the plurality stay standard of Baze v. Rees applies when states are not using a protocol substantially similar to the one that this Court considered in Baze; and (3) whether a prisoner must establish the availability of an alternative drug formula even if the state’s lethal-injection protocol, as properly administered, will violate the Eighth Amendment.”

This case will likely be decided by June, but until then, states like Texas, Tennessee, Utah, and even Oklahoma are actively looking for other methods to get the job done.

A Little Empathy Can Go a Long Way

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Have you ever went for a doctors visit and you feel like they keep you waiting for two hours just to see the doctor for two minutes? And during that time, did the doctor actually talk to you or did he talk at you? Did he even make eye contact? Did you leave feeling less than satisfied? Did you have a good idea of your diagnosis or the treatment? Did you trust the doctors opinion? Did you feel like the doctor cared about your health at all? Or did you just feel like an item on a factory line?

Doctors in the past, and some still currently, focus everything on medical knowledge and technical skills. In the past, doctors have been trained to just spew out information without much regard for the patients feelings. Doctors tend to spit out facts as quick as they can and then move on to the next patient. One study shows that doctors, on average, interrupt their patients within the first 18 seconds of speaking with them. This makes patients feel small, unimportant, and even angry.This lack of emotion and know it all attitude comes off as cold and heartless, especially when people are dealing with serious illnesses such as cancer. This however is changing due to economics and demographics. The baby boomer generation refuses to see a doctor who is arrogant or inapproachable. This, as well as many other factors, has caused the Affordable Care Act and the accountability for health improvement to raise the importance of the doctor patient relationship. Especially when it comes to getting patients to actually follow the doctors treatment plan, which in turn improves health care outcomes.

In order to create a better doctor patient relationship, Empathetics courses have been recommended to medical students. Although they are not required, the interest in the Empathetics courses are growing. These courses teach physicians clinical empathy. They literally teach physicians how to put themselves in the patients shoes and how to feel “sorry” for a person. It teaches them how to read a patients body language and how to comfort the patient appropriately by relating to him or her. Some of the things taught in the course are so simple, but often over looked, such as: “Make eye contact with the patient, not the computer. Don’t stand over a hospitalized patient, pull up a chair. Don’t conduct a monologue in off-putting medicalese. Pay attention to tone of voice, which can be more important than what is said. When delivering bad news, schedule the patient for the end of the day and do not allow interruptions. Find out what the patient is most concerned about and figure out how best to address that.”

Not only does an empathetic physician make the patient feel more comfortable and more satisfied, studies have also linked physician empathy to  better treatment outcomes, decreased physician burnout and a lower risk of malpractice suits and errors. At least one major malpractice insurer, MMIC, is recommending physicians take this course. Furthermore, patient satisfaction scores are being used to calculate Medicare reimbursements  under the ACA and more than 70% of hospitals and health networks in the US are using patient satisfaction scores in physician compensation decisions.

One study of 100 doctors shows that those who have taken the Empathetics courses were judged by patients as “significantly better at understanding their concerns and making them feel at ease than residents who had not undergone the training.” Even still some doctors argue that too much empathy wastes time, however the physicians that actually do take the extra time out with the patients say it actually saves time, energy, and money, and is emotionally fulfilling. Empathy not only helps the patient, it helps the doctors too. So take some time out and spread a little love!

France Moving One step Closer to Legalizing Euthanasia

Euthanasia and physician assisted suicide are currently illegal in France. In 2005 though, the French Parliament unanimously voted on a law, known as the “right to be left to die” laws which allows physicians to “limit or stop any treatment that is not useful, is disproportionate or has no other object than to artificially prolong life” and to “use that offered pain relief even if they might, as a side effect, shorten life,” according to AP. French president Francois Hollande took this one step further and introduced a bill that would allow for physicians to keep terminal patients in a deep, continuous, sedation until the patient died naturally. France’s Lower house of Parliament passed this bill just recently with a vote of 436 – 34. The bill is now on the way to the Senate for approval. If this bill is passed, it will arguably be one step closer to legalizing euthanasia in the country.  Physicians will be able to sedate his or her terminal patients so they do not feel pain as they succumb to their inevitable death or finally starve to death. Physicians are divided about this because some feel that sedating the patient only drags out the death process and patients may be left sedated for weeks before they actually die. Some physicians, law makers, and citizens feel euthanasia is actually a more human method when compared to a long, drawn out death. Even if sedation is allegedly numbing the pain.

Measles Outbreak Causes Vaccine Debate

vaccinesBy Steve Sack at the Star Tribune

In 2000, the Center for Disease Control said measles was completely gone from the United states. Now, according to the New York Times, the United States already has more confirmed cases of the measles in the first month of 2015 than the number of cases typically diagnosed in a full year. The CDC confirmed 102 cases of the measles, although numbers are thought to be higher. At least 40 of the people diagnosed with measles visited or worked at Disneyland, in California, although the disease has spread to 13 other states including Arizona, Colorado, Illinois, Minnesota, Michigan, Nebraska, New York, Oregon, Pennsylvania, South Dakota, Texas, Utah, and Washington.

Measles is a very serious disease, killing 1 in every 1,000 people it infects, most of them infants and young children. It is the leading cause of childhood blindness in the world.The people most vulnerable for contracting the disease are those who are not vaccinated and those who cannot be vaccinated, such as infants and young children and those with weak immune systems, such as cancer patients. The reason we are seeing an outbreak of the measles in the U.S. now is because of the new “anti-vaccine movement.” This fad began with unsubstantiated rumors being spread that the MMR vaccine caused autism.

At first, there did seem to be a correlation between the vaccine and the manifestation of autism. However, medical and scientific communities confirm that the MMR vaccine DOES NOT cause autism. In fact, the correlation exists because the age that autism normally manifests is around the same age children are able to receive the MMR vaccine. Parents who do not trust these studies, or those who are ignorant to them, still refuse to vaccinate their children. Not only does this put that child at risk, this puts everyone at risk. Especially the young who cannot yet receive the vaccine, measles can cause deafness, blindness, brain damage, and even death. Measles is extra dangerous because once someone is infected, it is estimated that 90% of people who are in contact with that person and are not vaccinated will become infected. A person does not even need to be in the same room as the infected person because the measles virus can live in the water molecules in the air for up to two hours after the infected person has left the room.

With the outbreak of measles, the question of whether or not vaccinating children should be a choice has made its way Capitol Hill. House Speaker John Boehner thinks that everyone should vaccinate their children, but there should not be a law forcing parents to vaccinate. Many other important political figures, including Obama himself, feel the same way. Obama supports vaccines and encourages parents to vaccinate their children.

Although it is unlikely congress will pass a law requiring children to be vaccinated, non-vaccinated children may not be able to go to public school and non-vaccinated people may be asked to stay away from certain public places. There is a balance between individual rights and the rights of others. For example, there is a first amendment right to free speech, however one may not defame anyone else. There is a right to bare arms, but states, cities, and even businesses can regulate whether or not the weapon is allowed in that certain place. This will, and has happened with children who are not vaccinated. The 2nd Circuit Court in New York recently ruled that, yes, people may chose to not vaccinate children, but those children must be kept away from the public schools.  Although this case may be challenged in the Supreme Court, it is likely the Court will uphold their 1905 decision that compulsory vaccines are lawful for public safety purposes.

Save American Workers Act: What’s the Magic Number?

The House of Representatives started out the new year by passing the Save American Worker’s Act with votes 252-171. Although this Act was designed by the republicans, it also has some support from the democratic party. With the exception of President Obama who has threatened to veto the bill if it comes before him.

Currently, the Affordable Health Care Act requires companies with over 50 employees to provide health insurance to all full time employees or the company will face a tax penalty. A full time work week is currently defined as working 30 or more hours per week. What this Act would do is modify the Affordable Health Care Act and change the 30 hour per week as full time requirement back to the traditional 40 hour work week as full time employment.

At first glance, this seems like a terrible idea. Those opposing SAWA argue that by extending the definition of full time employment to a 40 hour work week would significantly reduce the amount of people who are able to get health insurance through his or her employer, would increase the number of people on government funded insurances such as medicaid, and increase the amount of uninsured people.

What opponents fail to take into consideration though is that companies will and are currently cutting down their employees hours to under 30 hour per week to avoid having to pay for insurance coverage. The people most effected by this are unskilled and underpaid employees who work about 30-35 hours per week. Take the restaurant industry for example. In Ohio, even at a high end restaurant, a dish washer makes about $9.00 per hour. Even at 30-35 hours a week, this person may still qualify for government assistance, especially if the person has children. Some of these people are already getting governmental help with insurance coverage, if they have it at all. What the restaurant will do in order to save money is cut the old employees hours to about 25 hours per week and hire someone else, for under 30 hours a week as well, to take the shifts no longer covered after cutting the old employees hours.

If this act passes, this means that the vulnerable people effected by this will be able to keep his or her hours, even though they will not qualify for health insurance through his or her company. If these people are able to work, they will be able to at least get on an income based health insurance plan, whereas if their hours are cut, they may end up on medicaid where the government pays everything.

Right now, the bill is on its way to the senate where it does have some democratic support, possibly even enough to get the 60 votes needed to overcome a democratic filibusterer. Even if it passes here, the president says he will veto it as soon as it hits his desk. The argument here is that more people actually work a 40 hour work week then a 30 hour work week. If t he definition of a work week is changed from 30 to 40 hours, employers who were uncomfortable cutting employee hours from 40 to 29 would not hesitate to cut hours from 40 to 39 so people did not have to pay. Another argument is that republicans are just being republicans and want to force people to work 10 more hours a week to qualify for coverage and that they just want to undermine the AHCA.

Although I can see both sides of these arguments, I can tell you personally about the negative affects of having only a 30 hour work week. People in the service industry were seriously effected by this as I noticed both mine, my boyfriends, and all of my friend hours being slowly cut to under 30 hours per week. The restaurant became over staffed and everyone was fighting for hours. Even the older ladies in the retail store had their hours cut substantially and at least two had to find a second job, one retired, and at least one quite to try to find employment elsewhere. Although I do like the idea that employers should have to provide health insurance to employees working at least 30 hours, I think most business owners are greedy and will cut hours. The cut in hours will seriously hurt the people most in need of every hour they can work. I think though that instead of expanding the work week to 40 hours, companies should be penalized for cutting employee hours to avoid providing insurance coverage. There should even possible be a mandate as to how many employees a company must have as “full time” vs. “part time.”

Ebola Prevention in the U.S.

To date, there have been four confirmed cases of Ebola in the United States. One patient died from the disease, two recovered, and one patient is still receiving treatment in a New York City hospital. It seems like we have this disease under control. Right? Wrong. The real outbreak is occurring in West Africa, where more than 10,000 cases of Ebola have been reported. True, West Africa is all the way across the Atlantic Ocean, and far away from the United States. But what about travelers? Can we stop people from vacationing in the infected areas? What about people that must travel to these places for work, business, or family matters? Does the United States just not allow these people to return? Of course not. The federal government has actually taken a very hands on approach to stopping the spread of Ebola by attacking it at its source. The government has placed troops in the affected areas to help contain the spread of the virus.

Here in the U.S., the Department of Homeland Security has designated five airports for people returning from affected countries to be received: New York’s JFK, Newark, Dulles, Atlanta and Chicago. These people must undergo advanced screening upon arrival. Those people exhibiting symptoms of Ebola will be subjected to a 21 day post arrival monitoring , meaning for 21 days the state and/or local health care facilities will monitor the person for 21 days after their arrival in the U.S. The federal government is working to identify around 20 hospitals that will serve as Ebola referral centers. These hospitals will likely be concentrated near the five cities that are willing to except travelers from infected areas. Domestic training teams, known as FAST teams have already been deployed in four out of five of these cities. They are also currently working to put together a team of 30 health care professionals including 20 nurses, five doctors and five specialists in Infectious Disease Protocol, to serve and assist medical personal throughout the U.S. in treating Ebola patients. Some states such as New York, New Jersey and Illinois are also taking additional steps to supplement the federal response and have announced mandatory quarantines for certain health care workers returning from West Africa.

Could a vaccine be on the way? The World Health Organization (WHO) plans to start human testing of an Ebola vaccine on 20,000 health care workers and other people in the infected areas. This testing is set to take place as early as January 2015.  Researchers at the National Institute of Allergy and Infectious Disease are also working on a vaccine, VSV-ZEBOV, and hope to conduct an early phase trial to evaluate the outcome and effect of the vaccine. Many privet companies, such as Johnson & Johnson and Facebook, are donating millions of dollars to vaccine research in hopes to control the outbreak of Ebola. The best way to stop the spread of a disease is to attack it at its source. If the vaccine works, this could save numerous lives, not only from death, but from being subjected to things such as quarantines, inconvenient travel, and invasive tests.

For more information on Ebola and travel guidelines, please see:  http://www.cdc.gov/vhf/ebola/index.html and http://www.cdc.gov/vhf/ebola/hcp/index.html.