Improving Population Health

In the Literature: Alcohol Policy and Mass Media Campaigns

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:

The Raising of Minimum Alcohol Prices in Saskatchewan, Canada: Impacts on Consumption and Implications for Public Health. Tim Stockwell et al. American Journal of Public Health. 102 (12), e103-e110.

This article describes the impact of raising minimum alcohol prices by 10% in Saskatchewan, Canada. Saskatchewan provides a unique case study in that the provincial government has established a monopoly to control alcohol distribution. The intervention led to an 8.43% reduction in alcohol consumption, with the greatest declines from beer, spirits, and wine respectively. Notably, a significant portion of this effect was observed via retail sales, as opposed to bars and restaurant consumption. Equally interesting, the study found a differential affect by alcoholic beverage potency. High alcohol content beer and wine were associated with the largest decreases in consumption, with high alcohol beer dropping 22% compared to only 8% for low alcohol beer. The surprisingly targeted effects of the alcohol pricing legislation investigated here merits further research, including probing for broader policy application.

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.

Race, Education, and Life Expectancy

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 recent paper caught our eye:

Differences In Life Expectancy Due to Race And Educational Differences Are Widening, And Many May Not Catch Up. S. Jay Olshansky et al. Health Affairs (2012), 31 (8), 1803-1813.

The two overarching goals of population health improvement are improving overall health and reducing disparities. Successive generations of Americans enjoyed upward trends in life expectancy and improved general health during the twentieth century. However, in spite of the technological advancements in modern medicine and escalating health care expenditures, disparities in longevity based on race/ethnicity and educational attainment remain persistent and damaging to our society. This article by a distinguished group of investigators from the MacArthur Research Network on an Aging Society quantifies these life expectancy disparities in terms of race and education level, using data from NCHS as well as the American Community Survey (the largest household survey in the U.S.). Investigators found the largest disparity in life expectancy at birth to be between highest educated whites and lowest educated blacks: 14.2 years for males and 10.3 years for females (2008 data). The authors found that while race plays a role in longevity, education level is even more important across all groups, except Hispanic females. Educational attainment at age 25 correlated more strongly with expected life years, both within and among racial groupings. For example, highly educated blacks had a life expectancy 7.5 years higher than their less educated white counterparts, which defies the overall racial disparity.

Monitoring State Health Policy and Policy Cost Effectiveness

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). Two recent papers caught our eye:

Improving State Health Policy Assessment: An Agenda for Measurement and Analysis James Macinko, PhD, and Diana Silver, PhD, MPH American Journal of Public Health, Ahead of Print; e1-e9. Doi:10.2105

We have argued in this blog about the potential importance of local population health “policy packages” tailored to the specific health outcomes, factors, and policy resources and climate of individual jurisdictions. Macinko and Silver go beyond speculation with a compelling and important analysis of how states have varied over time with regard to public health policy. They approach this through the lens of two policy constructs: intradomain, which is the extent to which a state adopts the entire set of evidence based policies for a given policy set such as motor vehicle crashes, and interdomain referring to the extent a state adopts evidence based policies across multiple domains such as smoking, alcohol, and nutrition policies. Twenty-seven proven policies were examined, such as seatbelt laws, indoor smoking bans, and firearm restrictions, to uncover patterns within state policy environments between 1980 and 2000. One of the figures in their paper demonstrates some interesting patterns, including clustering of certain states into a few highly similar trajectory groupings which basically negates the typical red/blue state patterns in terms of health policy. The authors contend “these illustrations of state policy behavior, albeit crude, nevertheless suggest there may be patterns of state policymaking that bear further investigation.” This conceptualization and tracking of state policy patterns is a fresh and important perspective that should help us move forward with advancing a balanced investment portfolio of health in all policies.

Disparity Improvement, Disparity Persistence

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). Two articles in June caught our eye:

Trends in the Black-White Life Expectancy Gap, 2003-2008 (Harper S, Rushani D, Kaufman J. JAMA. 2012;307(21):2257-2259). 

The gap in life expectancy between non-Hispanic white and non-Hispanic blacks has continued to be one of the greatest lingering disparities of public health in the modern era. However, this brief report in JAMA asserts that this gap may be beginning to close. The authors have found that between 2003 and 2008 the life expectancy gap has been reduced from 6.5 to 5.4 years for men and 4.6 to 3.7 years for women. This reduction is significant, as a reduction of this magnitude has not been observed since the early 1990s, with the authors concluding “these racial inequalities among men and women in 2008 are the lowest ever recorded in the United States.” Authors attribute the narrowing gap among both men and women to declines in heart disease and HIV mortality rates, as well as a recent increase in poisoning mortality that has affected middle-aged white men more than any other group. This example illustrates that disparity rates are ratios that can be improved by worsening health among advantaged groups as well as improved health among disadvantaged groups. Overall, these results are remarkably hopeful and need to be followed in future years for clues about how such trends can be sustained.