Improving Population Health

A Population Health Hurricane Sandy?

By David A. Kindig, MD, PhD

I was in New York City a couple of weeks ago giving several lectures. How strange it was to fly in over the city lights, cab through a recently flooded tunnel, and find my hotel without incident. Only after talking to cab drivers and old professional friends did the impact on so many reveal itself, including major hospitals still closed, and particularly the many, many stories of how those spared immediate devastation reached out to those not so fortunate.

At the beginning of my talks I acknowledged this terrible devastation, but asked if there could be a silver lining in that finally the greater public and policy makers will have to confront the realities of climate change in increasingly frequent extreme weather events. Ideally, this increased attention will lead not only to short run defensive measures like seawalls but also the more difficult but critical upstream policies like taxing carbon that will be needed to save the planet for our grandchildren.

Can States Opt Out of Expanding Medicaid Coverage?

By David A. Kindig, MD, PhD

Of course they can, and several governors and legislatures have indicated they might. Would this improve population health?

Under the Affordable Care Act, states have the option in 2014 of expanding Medicaid coverage to all adults earning less than 133% of the federal poverty level, or about $31,000 for a family of four. The federal government will cover the full cost to the states until 2016, and gradually reduce their share to 90 percent in 2020, maintaining that rate in the following years.

The broad population health model that informs this blog’s perspective recognizes health care as one of many factors that drive health outcomes. In our model, health care plays a less prominent role than either health behaviors or social/economic factors. Yet health care is a critical determinant of health, particularly when provided under cost effective conditions. People without health insurance do access care in emergency rooms and free clinics, but this generally occurs under circumstances where it is difficult for providers and the system they work within to provide high quality, low cost care.

Can Our Environmental Stressors be Inherited by Our Children?

By David A. Kindig, MD, PhD

A while ago I presented a cautious population health perspective on the potential impact of modern genomics, ending with the observation that:

It is not anti-scientific to worry that our American belief in technology and venture capitalism could result in much waste, while less expensive investments we already know to be effective are ignored.  The problem is that it is hard to predict the future, and decades from now there will certainly be important benefits from genomic research, including both treatments and preventive interventions.  We can only insist that the most careful evidence on population health cost-effectiveness be used to guide investments, rather than the potential for profit from very expensive therapies that benefit few.

But what to make of this quote I came upon the other day from Duke University geneticist Randy Jirtle?

Health in All Policies & Payment Reform

By David A. Kindig, MD, PhD

We regularly scan eleven journals for new studies of particular population health relevance (the list of journals is at the end of this post). A couple of recent papers caught our eye:

Health in All Policies: The Role of the U.S. Department Of Housing And Urban Development and Present and Future Challenges

Bostic, R. et. al., Health Affairs, 31(9), 2130-2137.

This article reviews the approach that one federal department, the Department of Housing and Urban Development (HUD) has taken in response to recent calls for a health in all policies approach, both by Office of Management and Budget (OMB) and notably in the cross sectoral National Prevention Strategy. The impact of housing on health has been appreciated since the tenement reforms around the turn of the last century. More recently HUD has been active in lead abatement efforts; its1992 Moving to Opportunity for Fair Housing Demonstration used vouchers to move residents out of public housing into more affluent neighborhoods. This project showed positive health impacts, including reductions in psychological distress, depression, and obesity among adults.