Prevention | HealthyCal
 

Posts Tagged prevention

  

Voters support prevention over prisons, poll says

Published: March 10, 2011 | No Comments

By Daniel Weintraub

California voters think major reforms of the state’s criminal justice system are needed, and they support changes that would focus on prevention and rehabilitation programs targeted at young people, according to a new poll released Thursday.

The survey by Tulchin Research Co. of 601 registered voters found that voters favor prevention more than building more prisons and adopting tougher sentencing laws.

“They don’t have this mentality to lock everybody up and throw away the key,” said Ben Tulchin, who supervised the poll. “They see a need for reform, that the status quo is not working.”

The poll, commissioned by the non-profit California Endowment, was released first at a meeting of political consultants in Washington, D.C. – an indication that its sponsors hope the results will influence the current political and policy mood in the country as well as in California. (The California Endowment was also the initial funder of this web site, HealthyCal.org)

With politicians often fearful of being labeled “soft on crime,” attempts to cut prison budgets or shift money from incarceration to prevention have difficulty gaining traction. Even this year, with the state facing a $26 billion shortfall, Gov. Jerry Brown is proposing a $200 million increase in the prison budget.

“The voters have very different priorities than the politicians do right now,” Tulchin said.

The clearest point to emerge from the survey was the emphasis on youth.

While 80 percent of voters said either major or minor reform of the criminal justice system is needed, 49 percent said they were most concerned about youth crime, compared to 31 percent who said adult crime was the biggest problem.

And when offered a series of alternative policy approaches, the voters in the survey repeatedly sided with prevention over prisons.

For example, voters were asked which of the following should be a higher priority:

“Build more prisons and youth facilities and pass strict laws to ensure violent offenders are kept of the streets;” or

“invest in ways to prevent kids from taking wrong turns and ending up in gangs or prison and help them stay in school.”

Seventy-six percent said they second statement better reflected their view. Only 14 percent chose the first statement.

Similarly, 55 percent said they “strongly agreed” and 32 percent “somewhat agreed” with the following statement:

“By investing in proven youth violence prevention such as after school programs and job training, we can prevent crime before it happens and save money down the road.”

Tulchin said the survey showed a strong voter preference for prevention programs. This might be somewhat surprising given that 36 percent of those surveyed identified themselves as conservative, while 26 percent said they were liberal and 33 percent were moderates. But the electorate, more than their elected leaders, seems to sense that prevention programs would save money, and make communities safer, in the long run.

The overwhelming preference for prevention over prisons was true among men and women, all ethnic groups, all regions of the state and pretty much across party lines. Even among Republicans, 58 percent said they preferred more prevention programs to building more prisons.

“Voters want to intervene as soon ass possible and give every kid a chance to succeed,” Tulchin said.

 

Senator sees opportunity for change amid crisis

Published: January 18, 2011 | 1 Comment

By Daniel Weintraub

If every crisis also presents an opportunity, state Sen. Mark DeSaulnier thinks the state’s current predicament makes this an ideal time to restructure the way government operates.

DeSaulnier, a former Concord city councilman and Contra Costa County supervisor, has seen California government from just about every level, and he has seen its dysfunction.

Now he is chairman of the Senate budget subcommittee that deals with health and human servivces programs, and he is hoping to use the crisis to drive innovation and collaboration into the system. I caught up with DeSaulnier last week at the Working Families Summit in Sacramento, and discussed his take on the problem and potential solutions.

DeSaulnier was a county supervisor during the early 1990s recession, when Contra Costa helped introduce the idea of integrated service delivery. That’s a fancy name for having workers from different programs stationed in one place so a resident can get help from different agencies without having to go from building to building or even town to town.

“Most of our demands on services are in impoverished communities,” he said. “Those are the places where school districts struggle, those are the places where rates of obesity are high, drug abuse, all those things. They are interconnected. The opportunity is to change the way you deliver services to the people who need the services, so it’s less driven by the bureaucracy and more driven by the clients’ needs.”

“It’s not rocket science, but the project has shown that the outcomes are much better and the costs over a long period of time come down.

The problem, though, is that this sort of change inevitably involves start-up costs, and no one wants to put money into new endeavors during a budget crisis, even if it’s clear that the move will save money in the long run.

“It’s like obesity,” he said. “We know that if young people get in a habit of eating healthy food, the likelihood of them being healthier later in life and saving all of us money and having a richer, more rewarding life is much higher.”

But obesity prevention costs money, and no one wants to put money into a new program when old ones are being cut.

“It’s just very frustrating,” he said. “People don’t like change. That’s the problem. It’s trying to get people to change.”

DeSaulnier said the first step might be to give local governments incentives to collaborate and adopt prevention policies as part of a state move to transfer programs, and money, to cities and counties from the state government. Even that, however, might be a challenge, he said.

“Big system changes never happen when things are going well,” he said. “They happen when you are really in tough shape. But it’s still very hard. “

 

Preventable hospitalizations decline, but big differences among counties persist

Published: December 28, 2010 | No Comments

By Daniel Weintraub

Preventable hospitalizations for ten health conditions have declined in California over the past decade, but wide disparities remain among the state’s 58 counties, according to new data from an agency that tracks statewide health trends.

The most dramatic progress has come in the reduction of hospitalizations for for chest pain, which declined by more than 60 percent, and for pediatric gastroenteritis and chronic obstructive pulmonary disease, which dropped by 40 percent over the past ten years.

Hospitalizations for three preventable conditions — urinary tract infections and hypertension and long-term complications from diabetes — have increased during the past ten years.

Overall, the hospitalization rate declined nearly 7 percent, from about 11,300 per 100,000 people in 1999 to about 10,530 in 2008, according to the data collected by the Office of Statewide Health Planning and Development.

Hospitalizations for preventable conditions are considered a sign of a community’s access — and use of — primary care services. Long-term complications from diabetes, for example, are believed to come from poor control of the disease over a long period of time, something that generally does not happen when a person has access to a regular doctor and goes to the doctor regularly for check-ups and care. Urinary tract infections can usually be treated with antibiotics prescribed by a doctor, heading off the need for hospitalization. And hypertension can be controlled with medication and lifestyle changes.

One interesting thing that shows up in the charts is how different counties lead the state in preventable hospitalizations for different conditions. The numbers for the counties have been adjusted for the age and sex of each county’s population to reflect the different risk factors among different groups, making it easier to compare how each county is doing.

Yuba County, for example, had more than 90 hospitalizations per 100,000 people for short-term complications of diabetes, nearly twice the statewide average. Santa Barbara County had fewer than 40 such cases per 100,000 residents.

Los Angeles County is the worst when it comes to high blood pressure. LA County had about 37 cases per 100,000 population, compared to the statewide average of about 28 cases. Sonoma and Fresno counties had only about 11 hospitalizations for hypertension per 100,000 residents.

Alameda County, meanwhile, was off the charts when it comes to pediatric asthma. Despite improvements over the past ten years, the county still averaged more than 250 hospitalizations per 100,000 children aged 2 to 17, which was 2.5 times the statewide average. Tulare and Merced counties had fewer than 50 such hospitalizations.

Dr. David Carlisle, director of the Office of Statewide Health Planning and Development, said the new numbers should help Californians better understand the health of their communities and spotlight places that need improvement.

“Through these prevention quality indicators communities can better focus on planning and shaping systems that better meet community needs,” Carlisle said in a statement released with the report.

To read the full report or see the county by county charts and maps, click here.

 

Local grants will aim to transform communities, improve health

Published: August 19, 2010 | No Comments
Megan Baier

Megan Baier

By Megan Baier
HealthyCal.org correspondent

A little known part of the federal health reform enacted earlier this year aims to improve health by improving the conditions under which people live. Part of a planned $15 billion investment in prevention programs, community transformation grants will provide money to clean up neighborhoods, rejuvenate neglected parks, and expand access to healthy foods.

The idea behind the grants is to go straight to the source of what ails people, acting on research that shows a connection between where people live and how long, and how well, they live. Many of the medical services to be financed through the health reform wouldn’t be needed if people could prevent illness by living in better conditions and in conditions that encourage them to change unhealthy behavior.

A preview of how that change might look in California is rolling out in Los Angeles, where the county earlier this year was awarded $32 million from the economic stimulus package to undertake projects similar to those that will be financed by the community transformation grants.

Under the supervision of the Los Angeles County Department of Public Health, locally based groups and non-profits, as well as the city and county have began implementing prevention projects.

Alliance for a Better Community (ABC), is working to coordinate joint use agreements between schools and private groups to increase access to safe recreational facilities for community members.

“Our ultimate goal is to increase access to school facilities for physical activities,” said Vanessa Rodriguez, a community health coordinator for ABC.

In Boyle Heights, the local YMCA and Sunrise Elementary have partnered, allowing the YMCA to organize after school exercise programs on school grounds.

The East Theater Company and Esteban Torres High School have established a joint use agreement that allows the theater company to use the school’s outdoor stage for rehearsals and plays.

Joint-use agreements often take many years to establish and ABC is working to simplify and expedite the process.

Instead of creating new parks and facilities, Rodriguez said, working to transform existing parks into safe and active places for the community is more cost effective. It’s a “creative use of spaces,” she said.

Another project is attempting to clean up the alleyways of South Central LA and make them useable for residents. Many of the alleyways in the area are full of trash and residents feel unsafe in them.

Jenny Scanlin, a project coordinator for the Community Redevelopment Agency of the City of Los Angeles (CRA), said CRA is looking to “reuse this dead space” and create a space that fosters health.”

Many of the alleys connect schools, groceries, and parks, so they could provide an opportunity to connect people and places.

CRA is working to create a safe and free space to exercise in the alleys for the residents that live in the surrounding apartments. By installing lighting, permeable roads, benches and even circuit training equipment, residents will be able to exercise in their community.

In addition, CRA is looking to develop gardens and vegetation in the alleys.

Throughout southeast LA, “food deserts” inhibit residents from eating nutritious foods. Convenience stores and liquor stores are in abundance, but grocery stores are often miles away.

The Corner Store Conversion project is working with convenience stores in strategic locations, close to schools, transit, and homes, to bring in refrigeration units and begin carrying fresh and healthy foods.

Another goal of the conversion project is to improve the exterior as well as interior and the lighting of stores to make them more appealing and hopefully increase the number of customers.

Other projects include anti-tobacco campaigns, increasing bike access throughout the county, installing fit zones or places for adults to work out for free in parks, and changing school meals to make them more nutritious.

 

Cuts to breast-cancer screenings affect more women than expected

Published: May 21, 2010 | No Comments

Budget cuts to a state program that provides mammograms to screen low-income women for breast cancer have affected far more women than expected, according to state figures. While the cuts had been expected to reduce the number of recipients by 17 percent to about 21,000 per month, only about 10,000 women per month received the service in the first three months of the year, according to this AP story. Some of the centers that perform the mammograms report that they are struggling to keep their doors open because the steep drop in the number of patients has left them short of funds to pay their overhead costs. State officials say they expect the number of screenings reported to rise as more centers file their paperwork later this year.

 

A different kind of Youth Uprising

Published: May 11, 2010 | No Comments

By Daniel Weintraub

The numbers are all too familiar in East Oakland. Nearly one quarter of the community’s residents live in poverty. Unemployment is 27 percent. The teen birth rate is three times the Alameda County average. And all of this in the context of greater Oakland, where the high school drop out rate is 44 percent and homicide is the leading cause of death for young people age 15 to 24.

Amid this crisis, the Youth Uprising center on MacArthur Boulevard, spotlighted by US Attorney General Eric Holder Tuesday, stands like an oasis of hope.

Created five years ago with funding from the Alameda County Health Services Department in a building that was once a health center, Youth Uprising now serves about 5,000 registered members and 250 to 350 daily visitors.

A mural at the Youth Uprising Center in East Oakland depicts a community torn by youth violence.

The center has a dizzying array of services. Counseling. Health care. Job training and readiness, including a closet full of clothes for member to borrow for job interviews. A computer lab with 20 Internet-linked machines. A music production center, dance hall and, soon, a skateboard park and basketball court. The youth at Youth Uprising even run two businesses — a cafe and a data processing service for technology firms.

All of this is centered around a theme of violence prevention. This is done overtly through counseling, mediation and restorative justice programs, but it is also woven into everything the center does. The violence prevention team, for example, sits at cubicles in the middle of the music production center.

“We’re a center that believes in community and community transformation and the power of young people to do that,” said Omana Imani, Youth Uprising’s deputy director.

The center trains youth to think and talk about what is happening in the world and in their neighborhood, and leads them to think about how they can make change. It gives them opportunities to personally transform their own lives, and it gives them job skills that can carry them into a productive future.

Clarence Thomas, music production coordinator at Youth Uprising, works with two youths on a new number.

“They can see that they can make decisions that change their lives, and that gives them hope and a vision for the future,” Imani said. “Getting people to invest in a vision for themselves can be tricky when they come in with so little hope.”

Antoinette Wilson was in that position. Now 21, Wilson first came to Youth Uprising when she was 16 to compete in the center’s “Dance Battles.” The child of an alcoholic mother and a father who has been in jail for most of her life, Wilson left her adoptive mother and was living on the streets. She had been repeatedly suspended from school for fighting. Her life was going nowhere, in other words.

“I used to be very angry,” she said. “I was rebellious. After I came here everything started to come way easier.”

After getting hooked on the center through the dance program, Wilson got counseling, she says, “without really knowing it.” Later, she attended a women’s retreat.

Antoinette Wilson, dance choreographer at the Youth Uprising Center

“I learned how to talk about what was bothering me,” she said.

“In talking to people who had been through far worse situations than me I could see there was a hope,” she said. “They showed me, your problems are because of you, not nobody else.”

Wilson got a job as a janitor at the center, and has since become a dance choreographer.

“A lot of kids in Oakland are hurting,” Wilson said. “They don’t know how to show it. You can do that here. Here I feel protected. I’ve never felt so protected in my life. When we come to the center we feel like a family. This is a really safe place.”

Marcus Churchwell, who works for the center’s cafe, had a similar experience. He first came to Youth Uprising because the football coach at neighboring Castlemont High wanted his players occupied in the hour between the end of classes and the start of practice.

He later returned on his own and went through leadership training.

“This place helps people stay out of trouble,” Churchwell said. “People who see each other on the streets and might give each other trouble, they come here and don’t even pay attention to each other. It’s like a big family here.”

Marcus Churchwell, cafe worker at the Youth Uprising Center in East Oakland.

Nicole Lee, director of Urban Peace Movement, a local nonprofit that works with high-risk youth on violence prevention, said Youth Uprising is part of a broader effort to transform the “culture of violence” in Oakland.

The idea, she said, is to work from the ground up to rebuild community ties so that people see there is an alternative to violence. And that starts with youth.

“We’re training young people to be ambassadors, to spread a culture of peace,” she said. “We’re trying to get people out of their houses and talking to each other. We need to provide young people with opportunities and prevention instead of only dealing with the crises on the back end.”

Later this year, the center will host a special program through which 400 Oakland police officers will meet in groups of 12 weekly with 18 area youths. Called “Code 33″ — the police code for “Emergency, Clear the Air” — the program aims to bridge what can be a huge divide between the police and the community, especially young people.

“They will begin to talk about how they perceive each other, what they think of each other,” said Jacky Johnson, who came to the center as a youth and is now its manager of outreach and events. “We’re hoping the police will be able to take that back to their work and approach young people with the new knowledge that they have.”

Police Chief Anthony Batts said he hopes the program helps “build relationships” with young people so “we are not just dealing with suppression.”

Holder, the nation’s top law enforcement officer, agrees. He came to Youth Uprising Tuesday for a closed-door round table discussion with local officials, community leaders and youth. Afterward, he said he is a big supporter of programs that seek to help create conditions that can reduce violence or stop it before it starts.

“The Justice Department is not only about enforcement,” he said. “Prevention has to be a part of effective justice programs.”

 

Prevention: insurer to pay Y to keep its customers fit

Published: April 14, 2010 | No Comments

United HealthGroup is trying to act on research that shows keeping patients healthy can cut costs for everyone, including the insurance company. The firm is going to start paying the Y.M.C.A. to offer weight loss and nutrition counseling to consumers who are at risk for developing diabetes. Research has shown that losing just a few pounds can dramatically reduce the risk of an overweight person developing the disease. That weight loss is no doubt a marker for other lifestyle changes that come with a commitment to eating better and exercising. This kind of policy is likely to be more common once insurance companies shift from trying to keep risky customers out of their business to finding ways to reduce the risk that comes with accepting all comers regardless of their health condition. This story from the New York Times details the company’s initiative.

 

Federal health reform bill includes a new focus on prevention

Published: March 30, 2010 | No Comments

By Daniel Weintraub

The federal health reform bill that President Barack Obama signed into law last week will expand access to health insurance for millions of Americans. But the bill will also pour billions of dollars into programs intended to keep those people from ever needing the kind of care for which they will now be eligible.

Prevention programs, while hardly debated on the floor of Congress or mentioned in the heated national discussion about health reform, are a key part of the legislation.

The bill provides $15 billion over 10 years for a wide range of programs drawn from the wish lists of those who are part of a growing consensus in the country arguing for doing more to prevent illness rather than only treating sickness once it happens.

The legislation will require health insurers and government health programs to provide more check-ups, screenings and health counseling with little or no co-pays by the patient. It will require chain restaurants to provide nutrition information on their menus and menu boards. And it will give grants to small businesses to provide wellness programs for their employees. And it creates a new cabinet-level council to ensure that health and disease prevention are part of the discussion of every major domestic policy change.

But the most intriguing provision in the package might be its grants designed to transform low-income communities so that people will find it easier to develop the habits that can prevent diabetes, heart disease and other chronic ailments that account for a growing share of the nation’s health costs.

“In a normal legislative year4, one or two of these provisions would be considered a huge victory,” said Jeff Levi, executive director of the Trust for America’s Health, a nonprofit group that promotes policies focused on prevention. “This is an unprecedented level of sustained investment in public health and an unprecedented focus on building healthier communities.

“It provides individuals the kind of support they need to make healthy choices, and it provides state and local health departments the resources to make community prevention work.”

Levi described the bill’s “community transformation grants” as the centerpiece of the program. The money will come from the bill’s total prevention package, at the discretion of the Obama Administration and will go to local governments and private, community-based organizations. The grants are intended to change conditions at the community and neighborhood level that prevent healthy living.

The program envisions a decentralized process in which local communities decide for themselves what kind of problems they face and what can be done to solve them. The projects could involve getting healthier food onto the local’s school’s menu, creating multi-use agreements with the schools to keep playgrounds open after hours, or programs to encourage people to reduce their consumption of tobacco and alcohol.

“Because so much of health care costs are driven by chronic disease, there is a recognition that the things proven to be most effective in preventing and even mitigating disease are things that happen outside the clinic,” Levi said. “It’s how active we are, what we eat. Looking at the impediments to making those healthy choices really has become a new focus. It’s changed the nature of the discussion.”

Lucy Johns, a San Francisco-based health consultant who has studied and designed prevention programs for more than a decade, pointed to research that shows a correlation between where you live, how healthy you are and your life expectancy.

“Access to health services is only one piece of a very big puzzle that affects health status,” Johns said. “Income and education are essential for maintaining good health and improving health. Even where access to health care is equal, we know that life expectancy differs by income.”

Johns said she expects the local grants to be used to improve safe routes to school so children can walk rather than being driven, and to provide more and bigger parks so people in low-income communities have a place to exercise. Other projects might be aimed at bringing more fresh food to neighborhoods that now lack grocery stores that sell it. Beyond that, the grant money could be used to reduce pollution, such as that from the diesel trucks that idle for hours outside the ports of Long Beach, Los Angeles and Oakland.

“This bill recognizes that we need to start investing in the health of communities to do something in the long run about poor health status in the United States,” she said. “This bill recognizes that for the first time.”

Note: The California Endowment, which is the initial funder of this web site, sponsors the Building Healthy Communities program, which focuses on transforming 14 California communities in much the same way envisioned by the new community transformation grants in this bill.

Here is a summary of many of the prevention provisions in the federal health reform bill.

Prevention Goals and Priorities:

National Prevention, Health Promotion & Public Health Council – Creates cabinet-level council to coordinate prevention, wellness and health promotion policies and to develop a “National Prevention Strategy.”

National Prevention and Health Promotion Strategy – Requires the council to create a strategy that sets goals for improving health through prevention and public health programs, and establishing measurable actions and timelines.

Community Prevention:

Prevention and Public Health Fund. Establishes a fund to provide for an expanded national investment in prevention and public health programs. The fund will support programs authorized by the Public Health Service Act for prevention, wellness and public health activities, including prevention research and health screenings and initiatives. The fund will receive $500 million this year, $750 million next year and increase by $250 million a year until it reaches $2 billion.

Community Health Centers and the National Health Service Corps Fund. – Creates a Community Health Center Fund that provides enhanced funding for the Community Health Center program, the National Health Service Corps, and construction and renovation of community health centers.

Targeted Community Prevention Programs:

Community Transformation Grants – Authorizes the Centers for Disease Control to award competitive grants to State and local governmental agencies and community-based organizations for prevention activities that reduce chronic disease rates, prevent the development of secondary conditions, and address health disparities.

National Diabetes Prevention Program – Creates a CDC National Diabetes Prevention Program targeted at adults at high risk for diabetes.

Education & Outreach Campaign Regarding Preventive Benefits – Directs the Secretary of Health and Human Services to provide for the planning and implementation of a national public-private partnership for a prevention and health promotion outreach and education campaign to raise public awareness of health improvement across the lifespan.


Health insurance mandates

Essential Health Benefits Requirements – Requires a health benefits package that covers essential health benefits defined by the Secretary of Health and Human Services and limits cost-sharing. Preventive and wellness services and chronic disease management are to be included in the basic benefits package.

Coverage of Preventive Health Services – Requires group health plans and health insurance companies to provide coverage, without any cost-sharing, for :
(1) evidence based items or services that have in effect a rating of ‘A’ or ‘B’ in the current recommendations of the US Preventive Services Task Force;
(2) immunizations that have in effect a recommendation from ACIP;
(3) Evidence-informed preventive care and screenings for infants, children, and adolescents.


Medicare prevention strategies

Removal of Barriers to Preventive Services – Waives coinsurance requirements for most preventive services, requiring Medicare to cover 100 percent of the costs. Services for which no coinsurance or deductible would be required are the personalized prevention plan services, an initial preventive physical examination and any covered preventive service if it is recommended with a grade of A or B by the US Preventive Services Task Force.

Coverage of Annual Wellness Visit – Provides Medicare Part B coverage, with no co-payment or deductible, for personalized prevention plan services. Personalized prevention plan services means the creation of a plan for an individual that includes a health risk assessment and may include other elements, such as updating family history, listing providers that regularly provide medical care to the individuals, BMI measurement, and other screenings and risk factors.

Evidence-Based Coverage of Preventive Services in Medicare – Provides the Secretary with the authority to modify coverage of existing preventive services, consistent with the prevention task force’s recommendations.

Medicaid (Medi-Cal)

Improving Access to Preventive Services – Expands states’ option to provide prevention services and immunizations with matching funds from the federal government.

Tobacco Cessation Services for Pregnant Women – States would be required to provide Medicaid coverage for counseling and drugs for tobacco cessation by pregnant women without cost-sharing.

Incentives for Prevention of Chronic Diseases – Directs the Secretary of Health and Human Services to award grants to states to provide incentives to Medicaid beneficiaries who successfully participate in a healthy lifestyles program and demonstrate changes in health risk and outcomes.


Other measures

Nutrition Labeling of Standard Menu Items at Chain Restaurants – Requires chain restaurants with 20 or more locations to provide nutrition information on their menus and menu boards.

Employer-Based Wellness Programs – Directs CDC to help employers evaluate wellness programs and employer-based wellness practices.

Grants for Small Businesses to Provide Comprehensive Workplace Wellness Programs – Award grants to small businesses to provide employees with access to comprehensive workplace wellness programs.

Source: Trust for America’s Health.

 
 
 

Home | Cal Health Report | Community Report | Legislation | Ideas | Forums | About Us

©2013 HealthyCal.org