|ACPM Headlines 12/4/15|
December 4, 2015
Policy and Practice
Research and Reports
1. PUBLIC HEALTH FUNDING DECLINING, DESPITE AFFORDABLE CARE ACT PROVISIONS
Per capita spending in public health has dropped 9.3% since 2008, including a $40.2 billion decrease in disease-prevention and related programs through 2014, according to a study published in the American Journal of Public Health. This drop occurred despite provisions in the Affordable Care Act (ACA) to boost spending toward prevention. The ACA mandated insurance coverage of clinical preventive services recommended by the U.S. Preventive Services Task Force with A or B grades and also created a mandatory $15 billion investment fund for community public health services called the Prevention and Public Health Fund.
Analyzing historical and projected National Health Expenditure Accounts data, the authors found that inflation-adjusted per capita spending in public health grew steadily from $39 in 1960, peaked in 2008 at $281, and then fell to $255 in 2014. Public health’s share of total health expenditure increased from 1.36% in 1960 to high of 3.18% in 2002, to 2.65% in 2012. This accounts for a decline of 17%.
A 2012 law cut the Prevention and Public Health Fund funding by $6.25 billion. Sequestration reduced the total amount even further, and the 2015 appropriations allowed for less than half of $2 billion originally budgeted for public health. State and local departments, which are primary sources of public health services, have also faced financial constraints.
ACPM President Daniel Blumenthal, MD, MPH, FACPM was interviewed for and quoted extensively in an article celebrating twenty years of public health achievements. Dr. Blumenthal weighed in on issues such as cardiovascular disease and stroke, obesity, tobacco use prevention, the role of public health in violence, substance use and addiction, infectious and vaccine-preventable diseases, global health, and electronic health records.
He said that outreach efforts by the public health and preventive medicine community to help people who don’t know their blood pressure has contributed to the decline in the rates of hospitalization for cardiovascular diseases and stroke. Between 1999 and 2011, hospitalization rates have dropped 38% for heart attack, 30.5% for heart failure, and 33.6% for stroke.
Regarding the leveling off of obesity, Dr. Blumenthal said, "We have become aware of obesity as a public health problem. It will affect gains in cardiovascular disease prevention and cancer prevention.” He added that the current level of awareness, along with public health policy initiatives such as taxing sugar-sweetened beverages and the Affordable Care Act’s requiring chain restaurants to post calorie counts, will help address the obesity crisis.
On tobacco, Dr. Blumenthal noted that only small improvements have been made in tobacco cessation since the early years and that "e-cigarettes could put us in stalemate.”
As 2015 draws to a close, now is the time to make your 100% tax-deductible gift in support of the 2015 Annual Fund. Your support helps ACPM be a strong and vibrant leader in the field of preventive medicine. Your gift is a partnership in supporting our mission and helps empower ACPM to continue to pursue its most important initiatives and programs that contribute to our shared goal of preventing disease and promoting health and wellbeing among individuals and populations.Every single gift we receive, both large and small, helps. Please make your gift today by visiting the 2015 Annual Fund.
If you have any questions about the Annual Fund or any other aspects of ACPM’s fundraising program, please contact Maureen Simmons, MA, CFRE, Chief Development Officer, at firstname.lastname@example.org 202-466-2044, ext. 120.
4. PM RESIDENCY DIRECTOR DISCUSSES FUNDING SHORTFALL AT CONGRESSIONAL BRIEFING
ACPM Member Clarence Lam, MD, MPH, preventive medicine residency program director at the Johns Hopkins Bloomberg School of Public Health, participated in a congressional briefing on Capitol Hill where he spoke to a standing-room-only crowd about the challenges of training preventive medicine residents in an era of eroding federal budget support for health professions training. Dr. Lam noted how reduced federal spending under sequestration led to cuts in funding for his program from the Health Resources and Services Administration (HRSA), forcing what had been the largest preventive medicine training program in the country to drastically cut back on the number of residents it was training.
ACPM, an active member of the Coalition for Health Funding, helped the coalition organize the congressional briefing to highlight lost investments in public health programs. Dr. Lam stressed the importance of expanding support for the preventive medicine training pipeline to help improve our health system’s focus on population health. ACPM thanks Dr. Lam for taking the time to represent the College as a speaker at the briefing.
5. DON’T MISS YOUR CHANCE TO REGISTER FOR THE BUILDING HEALTHY COMMUNITIES SYMPOSIUM
Registration is now open for the ACPM symposium, "Building Community Health and Wellbeing through Business, Culture and Policy,” which will take place February 23, 2016, in Crystal City, VA, one day prior to Preventive Medicine 2016.
"Building Healthy Communities is a fantastic opportunity for representatives from every part of the health care ecosystem to come together to explore how to create successful, vibrant and healthy communities," said ACPM’s President Daniel S. Blumenthal, MD, MPH, FACPM."We're excited to offer a wide variety of perspectives from experts across the spectrum of public health, prevention, and lifestyle medicine and I think everyone will benefit from a more robust understanding of what community health looks like and how we can best contribute to it."
The one-day symposium will explore the impact of a variety of societal influences on community health. Faculty and attendees will examine key questions related to community health and healthy living, including topics like engineering better health, the role of communities in healthcare, and strategies for pharmaceutical, insurance, health systems, and other healthcare companies to serve as agents for positive change.
information or to register, visit
ACPM Associate Executive Director Dani Pere and ACPM Medical Student Section President Rani Bhatia are participating this week in the Institute of Lifestyle Medicine "Active Lives” conference, hosted by Harvard Medical School. ACPM will be hosting a booth at the conference and encourages members attending the conference to stop by.
The conference focuses on building clinician competencies in helping patients initiate and sustain more active and healthier lifestyles to prevent or treat chronic disease. ACPM has several lifestyle medicine initiatives in which members can become active. Learn more and sign up to receive program updates and our new lifestyle medicine newsletter on our website.
ACPM joined its partner organizations in medicine and public health on a sign-on letter to Congress urging enhanced FY 2015 funding for the Health Resources and Services Administration (HRSA), which provides support to preventive medicine residency training programs. The letter notes that the original House and Senate FY 2015 Labor, Health and Human Services, and Education Appropriations bills "cut the Public Health and Preventive Medicine program by over 50 percent.”
ACPM has been working to restore the proposed 50% cut following passage of the two-year budget agreement that resulted in a larger funding allocation for the Labor, Health and Human Services, and Education Appropriations bill. The letter concludes by stating, "With the additional resources provided by the budget deal, you have a real opportunity to reinvest in the health of the American people and restore the proposed funding cuts to HRSA programs.”
In a unique collaboration with the Centers for Disease Control and Prevention (CDC), ACPM will research, develop, and disseminate new lifestyle medicine curriculum modules and educational materials designed specifically for the needs of CDC WISEWOMAN providers, building off the comprehensive curriculum developed by ACPM and the American College of Lifestyle Medicine (ACLM). The WISEWOMAN program, administered through CDC’s Division of Heart Disease and Stroke Prevention, provides low-income, uninsured/under-insured women (age 40-64) with chronic disease risk factor screening, lifestyle programs, and community linkage/referral in efforts to prevent cardiovascular disease.
ACPM has named four distinguished members, Ayanna Buckner, MD, MPH, FACPM; Deepa Sannidhi, MD; Jaqueline Coleman, MD, MSPH; and Kelley Hagerich, MD; as expert faculty and advisory council representatives for the projects. These four members, along with Denise White-Perkins, MD, PhD and Alina Robert, MD, MPH will provide strategic direction, guidance and module development.
Under the one-year project, ACPM also will disseminate the new educational modules to WISEWOMAN grantees, providers and ACPM members through various channels and venues including three regional trainings in WISEWOMAN grantee states, the Preventive Medicine 2016 conference, webinars, conference calls, newsletter, website, on-line educational library, and social media. ACPM also will evaluate the reach and impact of educational activities and materials to identify gaps in the knowledge base and improve ACPM’s dissemination strategy.
9. USPSTF RELEASES DRAFT RECOMMENDATION ON SCREENING FOR SKIN CANCER
The U.S. Preventive Services Task Force (USPSTF) has released a draft recommendation statement and draft evidence review on screening for skin cancer. The Task Force found insufficient evidence to recommend for or against visual skin cancer screening by doctors in adults. The draft recommendation statement and draft evidence review are available for review and public comment from December 1, 2015 through December 28, 2015.
Children insured through Medicaid or Children’s Health Insurance Program (CHIP) were more likely to get preventive medical and dental care (88%) than privately insured children (83%), according to an article published in JAMA Pediatrics. The study also found that children with CHIP coverage or private insurance had more difficulty accessing specialty care.
The findings in the study suggest that Medicaid might be better at covering children in low-to moderate income families than other types of health insurance. The study analyzed data from the National Survey of Children’s Health and looked at four types of insurance: Medicaid, CHIP, private insurance and uninsured.
While this article did not address why there were problems accessing care, an accompanying editorial notes that the possible reasons include high out-of-pocket expenses, lack of available services, or not enough residents choosing a pediatrics subspecialty.
ACPM is supporting a petition started by Doctors for America to build support against a provision in the FY 2015 House Labor, Health and Human Services, and Education Appropriations bill that would ban the Centers for Disease Control and Prevention (CDC) from engaging in any firearm research. While the president proposed $10 million to support a CDC firearm research agenda in his proposed FY 2015 budget, Congress has signaled its opposition to such funding and to any firearm data collection or research efforts. You can view and sign the petition here.
The rate of prostate screenings and the incidence of prostate cancer diagnoses have both declined sharply since the U.S. Preventive Service Task Force issued its recommendations in 2012 that average-risk men should no longer have the prostate-specific antigen (PSA) blood test, according to a study released in the November 17 issue of JAMA. The researchers from the American Cancer Society noted that longer follow-up is needed to see whether these decreases are associated with trends in mortality.
The studyfound that 30.8% of men ages 50 or older reported getting the PSA test in 2013, down from 37.8% in 2010 and 40.6% in 2008. It also found that the rate of prostate cancer diagnoses in that age group fell from 534.9 per 100,000 in 2005 to 416.2 in 2012. About 33,519 fewer men received a diagnosis of prostate cancer in 2012 than in 2011, the researchers estimated.
A second study in the same journal found a similar drop in the proportion of men who had the PSA screening.
13. CDC: ADULT OBESITY STILL GROWING; YOUTH RATES HOLD STEADY
Adult obesity rates continue to rise for U.S. adults, but they have stabilized for children and teens, according to a data brief released by the Centers for Disease Control and Prevention (CDC). From the national data collected between 2011 and 2014, more than 36% of adults and 17% of youth are obese. The researchers used data from the National Health and Nutrition Examination Survey.
The study also analyzed weight trends over ten years between 2003-2004 and 2013-2014. Among kids aged 2-19 years old, 17.2% were obese in 2014 compared to 17.1% in 2013. On the other hand, 38% of adults were obese in 2013-2014, compared to 32% in 2003-2004.
The data brief also showed that more women were obese than men; more whites, blacks and Hispanics were obese than Asians, and obesity was higher among older and middle aged adults than young adults.
A 48-week study of individuals at high risk for HIV infection found that the rate of new infection among those who received and remained on preexposure prohylaxis (PrEP) was drastically low for the entire length of the study, while the relatively high rate of sexually transmitted infections (STI) and high-risk sexual behaviors remained stable, according to an article in JAMA Internal Medicine. The study looked at 557 men who have sex with men (MSM) and Transgender women in three cities (San Francisco, Miami and Washington DC) who were given PrEP free-of-charge for 48 weeks through a community health provider. The participants also received HIV testing, counseling and clinical monitoring.
While the results of the study are promising, 21.5% of the participants did not remain in the study for all of 48 weeks. This month’s issue of Vital Signs, produced by CDC, addresses PrEP and the need to increase its awareness among certain high risk groups.
For the first time since 2006, the number of cases of three sexually transmitted infections (STI)—syphilis, gonorrhea and chlamydia—have increased, according to a report released by the CDC. There was a total of 2.8 million chlamydia cases reported in 2014, which is a 1.4% increase compared to the number of cases in 2013. This is the largest number of cases for any STI reported to CDC in one year.
There were also substantial increases in gonorrhea and syphilis, increasing by 5% and 15%, respectively, in 2014 compared to the previous year. Syphilis rates were highest among gay and bisexual men. While the STIs are preventable and treatable, the report notes that reduced access to clinics has contributed to the increased epidemic in recent years.
16. MEMBERS IN THE NEWS: KHANNA
ACPM Fellow Prerna Mona Khanna, MD, MPH, FACPM, a triple board-certified physician and Emmy award-winning medical reporter, received the 2015 American Medical Association (AMA) Foundation Health Education Award.
Dr. Khanna, known to public as "Dr. Mona,” is the only physician journalist inducted into the Delta Omega Public Health Honor Society. For her leadership in empowering people across the globe, she has been recognized with more than 50 awards in the past 10 years. The AMA Foundation Award for Health Education encourages and recognizes professional health education activities by practicing physicians, especially those working in the areas of alcohol, tobacco and other drugs. Congratulations Dr. Mona!
The National Institutes of Health (NIH) & Centers for Disease Control & Prevention (CDC) are sponsoring a free workshop on work-related safety research titled, "Pathways to Prevention: Total Worker Health®—What's Work Got to Do With It?" on December 9–10. The workshop will evaluate the current state of knowledge on integrated approaches to worker safety, health, and well-being, and will plot the direction for future research. This free event will take place in the Masur Auditorium on the NIH campus in Bethesda, Maryland. A videocast will also be available.Registrationis encouraged for both in-person and videocast attendees.
You can now watch
archived content from TEDMED
2015 on an exclusive channel available only to American Medical
Association partners, including ACPM. This opportunity is available to you
until Dec. 20, 2015,
and can only be accessed through the AMA website.
ACPM’s Resident Physician Section (RPS), Young Physician Section (YPS), and Medical Student Section (MSS) are co-sponsoring a free webinar on how to negotiate your first (or next!) job offer on Friday, December 11, from 2:00–3:30 PM, EST. In this interactive workshop, Paul F. Levy and Farzana Mohamed will share lessons and insights from years of real-world experience in job negotiations, sitting on both sides of the table. Register here to join!