March 25, 2020

SOME REFLECTIONS ON A PANDEMIC

March 25, 2020

The early part of the 1600s was characterized by the plague in Europe. Vaccinations were unknown, so health authorities had to rely on other forms of conventional wisdom. Health officer Cristofano di Giulio of Prato in Italy wrote a manuscript back then with the title Libro della Sanità, in which he provided a summary of what he believed a public health officer ought to know in time of plague.

He asserted that it has been proven by experience that to respond to an epidemic, first of all it is necessary to resort to the majesty of God and in the intercession of the Holy Virgin and of the Saints. Then it is necessary to observe with every possible diligence the following rules: (1) disinfect with sulphur and perfumes all homes or rooms wherein there has been death or sickness; (2) separate at once the sick from the healthy as soon as the case of illness is discovered; (3) burn and take away at once those objects such as have been used by the deceased or by the sick; and (4) shut up straight away all houses wherein there have been infected patients and keep them closed for at least 22 days so that those who are segregated inside the houses will not carry the infection to other individuals.

Physicians suggested that patients should be treated at a distance with the barber-surgeon of the lazaretto (i.e., a pest house for isolating persons believed to have the disease or to be incubating it), shouting from the window the quality, sex, condition of the patient, and the stage of illness. A cautious physician then would shout back the cure from a safe distance. Another belief was that even though a patient had recovered, convalescents remained infectious for some time.

Unfortunately, related public health measures failed to produce salutary outcomes. Orders for the mass slaughter of dogs and cats, in the belief that the coats of these animals harbored the plague bearing miasma, made life easier for rats, the creatures eventually discovered to be more closely associated with disease outbreaks. Oddly enough, resorting to the majesty of God often led to crowded religious processions and packed houses of worship, which aided in the rapid transmission of infection.

1960 Nobel Prize winner Sir Macfarlane Burnet stated in 1962 that “One can think of the middle of the 20th century as the end of one of the most important social revolutions in history, the virtual elimination of the era of infectious diseases as a significant factor in social life.” Since then, the appearance of Zika, Ebola, SARS, MERS, and other devastating communicable diseases has shown that his prediction was issued prematurely. Enormous progress over the past four centuries has been made in medical laboratory procedures, hospital care, health devices, communication capabilities, and the highly sophisticated education and training of health professionals. These developments will have a decisive bearing on how successful efforts will be in eliminating the COVID-19 threat.

For the present, however, it is reasonably safe to assume that household pets are in no immediate danger of being slaughtered and physicians will not find it necessary to stand across the street from homes and holler instructions through bullhorns to their beleaguered patients.

Return to March 2020 TRENDS

QUANTIFYING HEALTH SYSTEMS’ INVESTMENTS IN SOCIAL DETERMINANTS OF HEALTH

John Colbert

February 25, 2020

Trends Archives

Social determinants (e.g., conditions in which individuals are born, grow, work, live, and age) are seen as accounting for substantially more of the variation in health outcomes than medical care does while interest in addressing these determinants has increased markedly in recent years. According to a study reported in the February 2020 issue of the journal Health Affairs, the past decade has involved a growing recognition of the importance of social determinants of health for health outcomes. Meanwhile, the degree to which health systems in the U.S. are investing directly in community programs to address social determinants of health as opposed to screening and referral is uncertain.

Researchers conducting this investigation searched for all public announcements of new programs involving direct financial investments in social determinants of health by U.S. health systems from January 1, 2017, to November 30, 2019. They identified 78 unique programs involving 57 health systems that collectively included 917 hospitals. The programs involved at least $2.5 billion of health system funds, of which $1.6 billion in 52 programs was committed specifically to housing-focused interventions. Additional focus areas were employment (28 programs, $1.1 billion), education (14 programs, $476.4 million), food security (25 programs, $294.2 million), social and community context (13 programs, $253.1 million), and transportation (six programs, $32 million). These figures demonstrate that health systems are making sizable investments in social determinants of health. To cite one example, housing-related programs included strategies, such as direct building of affordable housing, often with a fraction set aside for homeless patients or those with high use of health care; funding for health system employees to purchase local homes to revitalize neighborhoods; and eviction prevention and housing stabilization programs.

return to february 2020 trends

THE ROAD TO IMMORTALITY IS PAVED WITH EPONYMS

John Colbert

February 25, 2020

Trends Archives

The health sphere represents fertile ground for the production of eponyms. Prominent examples are Salk vaccine, Alzheimer’s disease, Parkinson’s disease, and Obamacare. Perpetual glory appears to be associated with having one’s name used in such ways and the website Whonamedit.com provides thousands of examples of medical eponyms. Is the practice of employing them a constructive use of nomenclature or has it become more timeworn than beneficial? This kind of question is addressed in a manuscript that appeared in the February 11, 2020 issue of the journal Neurology in which a study is described that assesses historical trends of medical eponym use in neurology literature, and knowledge and attitudes among current trainees related to eponyms. The yearly prevalence of eponyms among neurologist-authored publications ranged from 15% and 25%, with a mean of 21%. The total number of unique eponyms appearing in titles and abstracts increased from 693 in 1988 to 1,076 in 2013, representing 1.8% average annual growth.

Worth noting is that medical eponyms represent a polarizing issue among clinicians, including neurologists. Impassioned calls for the abandonment of eponyms in the published literature and in clinical use have appeared regularly in the literature for decades. Supporters explain that eponyms are concise and memorable, providing an effective shorthand to communicate precisely in clinical settings. Eponyms also may represent an essential thread of medical history, an oral tradition transmitted to successive generations of students through teaching rounds. An opposing perspective is that eponyms can be viewed as lacking accuracy and being characterized by inconsistent usage, frequent misattribution of credit, and occasional recognition of individuals with unethical research practices, such as Nazi-affiliated physicians. Study findings indicate that residents with at least one year of neurology training reported familiarity with significantly more eponyms than those before neurology training (p < 0.001). For familiar eponyms, most residents either were unaware of an alternative descriptor or preferred using the eponym. Despite recognizing both the benefits and drawbacks of eponyms, the vast majority of trainees stated that historical precedent, pervasiveness, and ease of use would drive the continued use of eponyms in neurology. For the nonce, it seems reasonable to predict that this path to immortality will remain open.

return to february 2020 trends

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

John Colbert

February 25, 2020

Trends Archives

Clinical Prevention and Population Health Curriculum Framework

The Association for Prevention Teaching and Research (APTR) announced the release of the newly revised Clinical Prevention and Population Health Curriculum Framework, which undergoes revision and public comment every five years, and is the result of almost two years of review and deliberation by the Healthy People Curriculum Task Force (HPCTF). This group’s mission is to achieve Healthy People objectives of increasing health promotion, disease prevention, population health, and interprofessional learning experiences for students in health professions education programs. Kenneth Johnson, Associate Dean of the Dumke College of Health Professions at Weber State University, represented the Association of Schools Advancing Health Professions (ASAHP) in this important endeavor. The Clinical Prevention and Population Health Curriculum Framework provides a common core of knowledge for clinical health professions about individual and population‐oriented prevention and health promotion efforts. The Framework can support interprofessional prevention education and practice. The 4th revision of the Framework features: a new domain addressing mental and behavioral health; greater emphasis on Social Determinants of Health (SDOH) and health equity; improved, updated illustrative examples; and 14 new or revised topic areas. The Framework can be obtained here.

Precarious Work Schedules And Population Health

According to a new brief from the journal Health Affairs, work has become more precarious in America over the past half century as employers have transferred more of the risks and uncertainties of doing business onto workers and households. As part of this shift, many workers have experienced an erosion of job quality—reductions in the real value of their wages; a loss or cutback of fringe benefits such as retirement plans and health insurance; and an increase in job insecurity. Policymaking responses to the rise in precarious employment have commonly focused on the economic dimensions, exemplified by appeals for a living wage. Yet, alongside changes in the economic dimension, the temporal dimension of work also has undergone seismic shifts. Unstable and unpredictable work schedules have become the new normal for many workers as the U.S. economy has shifted from manufacturing to service-sector jobs—and from steady Monday through Friday, 9–5 work hours—to a 24/7 economy. The brief synthesizes research findings that allow dots to be connected between precarious work schedules and health, and gaps are identified that remain to be filled. The brief can be obtained here.

Quantification Of U.S. Neighborhood-Level Social Determinants Of Health

The consequences of social determinants of health (SDOH) increasingly dominate public health discussions in the U.S. as population health outcomes have not kept pace with those of other developed nations despite higher per-person spending for medical services. A report in the journal JAMA Network Open on January 29, 2019 looks at geographic variation in social determinants of health in the continental U.S. Fifteen variables, measured as a five-year mean, were selected to characterize SDOH as small-area variations for demographic characteristics of vulnerable groups, economic status, social and neighborhood characteristics, and housing and transportation availability at the census-tract level. This data matrix was reduced to four indices reflecting advantage, isolation, opportunity, and mixed immigrant cohesion and accessibility, which then were clustered into seven distinct multidimensional neighborhood typologies. The report can be obtained here

return to february 2020 trends

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

John Colbert

February 25, 2020

Trends Archives

2020 Patient Data Breach Barometer

In 2019, the healthcare industry continued to be plagued by data breaches involving sensitive patient information, with public reports of hacking jumping a staggering 48.6% from 2018. This number of reported hacking incidents is a reminder of how vulnerable patient data remain. An analysis by Protenus is based on 572 health data breaches reported to the U.S. Department of Health and Human Services (HHS), the media, or some other source during 2019. For the 481 incidents where data exist, breaches had an impact on 41,404,022 patients, which is likely to be a huge underestimate. Two incidents for which there were no data affected 500 dental practices and clinics and could affect significant volumes of patient records. The number of breaches went from 503 in 2018 to 572 in 2019, along with a substantial increase in the number of affected records. In 2019, the total number of affected records almost tripled when compared to 2018 data (i.e., 15,085,302 affected records).

Self-reported Marijuana Use In Electronic Cigarettes Among U.S. Youth

The National Youth Tobacco Survey (NYTS) is a cross-sectional, school-based study conducted annually using a stratified, three-stage cluster sampling design to produce a nationally representative sample of middle school (grades 6-8) and high school (grades 9-12) students in the U.S. They were asked about whether they ever have used marijuana in an e-cigarette. As reported in the February 4, 2020 issue of the Journal of the American Medical Association, the study identified a significant increase in self-reported ever marijuana use in e-cigarettes from 2017 to 2018 among U.S. students. Prevalence estimates reported for all students (14.7%) and current e-cigarette users (53.5%) in 2018 also were much higher than those reported in 2016 (8.9% and 39.5%, respectively). The increase in marijuana use in e-cigarettes could be attributable to the increase of sales of pod-mod–style e-cigarette products, access to marijuana through informal sources (e.g., friends, family members, illicit dealers), and reduced perception among adolescents of the harms of marijuana use.

HEALTH TECHNOLOGY CORNER

Light-Adapted Electroretinogram Differences In Autism Spectrum Disorder

A new eye scan could help identify autism in children years earlier than currently possible. This non-invasive device uses a hand-held instrument to locate a pattern of subtle electrical signals in the retina that are different in children on the autism spectrum. According to a manuscript published on February 7, 2020 in the Journal of Autism and Developmental Disorders, the retina is an accessible model of neural connectivity in the brain where specific retinal signaling pathways can be probed and measured with an electroretinogram (ERG). Light-adapted (LA) electroretinograms (ERGs) of individuals with autism spectrum disorder (ASD) were compared to control subjects in a multicenter study of children. The results show that the LA-ERG is a potential marker for neurodevelopmental conditions, such as ASD in children. These potential biomarkers for ASD also could allow for early detection of other disorders, such as attention deficit hyperactivity disorder (ADHD).

Evolving Magnetically Levitated Plasma Proteins Detect Opioid Use Disorder As A Model Disease

As reported on January 29, 2020 in the journal Advanced Healthcare Materials, new research from the University of British Columbia, Harvard Medical School, and Michigan State University suggests that levitating human plasma may lead to faster, more reliable, portable, and simpler disease detection. The researchers used a stream of electricity that acted like a magnet and separated protein from blood plasma, which is the clear, liquid portion that remains after red blood cells, white blood cells, platelets, and other cellular components are removed. The basic notion is that as plasma proteins are different densities, when separated the proteins levitate at different heights, and therefore become identifiable. An evaluation of these types of proteins and how they group together can produce a picture that identifies whether a patient has the possibility of contracting a disease or becoming addicted to drugs, such as opioids.

return to february 2020 trends

DEVELOPMENTS IN HIGHER EDUCATION

John Colbert

February 25, 2020

Trends Archives

It is a tossup on any given day in the nation’s capital whether health care or education can result in the most congressional perturbations. Education definitely can holds its own when it comes to demonstrating a proclivity for generating partisan-oriented activity. February 2020 was marked by groups representing the nation's colleges and universities in the act of rebuking a Trump administration proposal aimed at punishing institutions for violating students' free speech rights. Proposed regulations would allow the U.S. Department of Education to cut off some federal grants to public colleges that don't comply with the First Amendment or private universities that don't follow their own campus speech policies. Under the proposal, department officials would rely on the “final judgement” of a court in determining whether a school violated the First Amendment and should lose access to funding.

The American Council on Education (ACE), along with several other national education organizations, responded by indicating that the proposed rule would encourage excessive and frivolous litigation in ways that undermine the Department’s and academia’s shared goal to maintain broad protections for campus speech. Another concern is that courts will reach different conclusions as to whether an institution violated the First Amendment or its stated policies, even when looking at the same or similar set of facts. Also, unique considerations in the freedom of speech context call for greater clarity in defining when the Department may terminate federal grant funding.

If the Department proceeds with its proposed rule, the education groups offer the following recommendations to minimize some of the more problematic aspects: (1) Modify the trigger for when an institution is deemed to be out of compliance with the First Amendment or its stated policies, (2) Provide clearer criteria under which the Department will attempt to terminate or suspend a federal grant, (3) Strike from the text of the regulation references to “academic freedom” as well as the clause that attempts to enumerate specific rights under the First Amendment, (4) Extend the window for submitting notice of a final judgment to the Department, and (5) Remove language from the preamble that would require private institutions to certify to the Secretary compliance with institutional policies on free inquiry as a material condition of an award.

A Bipartisan Proposal For Reauthorization Of The Higher Education Act (HEA)

A task force convened by the Bipartisan Policy Center over an 18-month period examined a variety of issues and conducted modeling, where relevant data were available, to inform decision-making. Recommendations in a report issued in January 2020 are aimed at advancing multiple objectives: promoting college affordability and reducing equity gaps; strengthening institutional accountability while also ensuring that low-capacity institutions have the resources needed to succeed; simplifying the federal student loan program and reducing unsustainable borrowing; and providing better information and data to policymakers, researchers, and, most importantly, students and families. Specific challenges that must be addressed to ensure the U.S. higher education system meets the needs of students and the economy are: Access and Affordability; Outcomes and Accountability; and Data and Information.

Access and Affordability: Twenty-three recommendations were identified to address the need for improvement and reform in areas, such as (1) Renewing the federal-state partnership in higher education, (2) Strengthening the federal Pell Grant program, and (3) Reforming the federal student loan program.

Outcomes and Accountability: Ten recommendations were identified to promote quality assurance, increase schools’ capacity to support students and deliver better student outcomes, and give postsecondary institutions stronger incentives for improvement.

Data and Information: Twelve recommendations were identified to address a lack of high-quality data on student outcomes and institutional behavior; prepare students to understand and make informed decisions regarding federal financial aid; and aid in comparing financial implications of one institution over another.

return to february 2020 trends

HEALTH REFORM DEVELOPMENTS

John Colbert

February 25, 2020

Trends Archives

Debates by candidates seeking to be the Democratic party’s nominee to run against President Donald Trump in the upcoming election indicate that health care is a major policy issue that cries out for significant improvement. Proposals range from eliminating private forms of insurance coverage available through employers to protection offered solely by the federal government to a single-payer government operated program that also includes options for other forms of coverage. The latter choice recognizes that some beneficiaries may prefer having insurance provided by an employer rather than being compelled to participate in a governmental program.

Recent findings from the National Health Interview Survey help to highlight why some form of remediation is considered desirable. An estimated 14.2% of U.S. residents said they or a family member had problems paying medical bills in 2018, down from 19.7% in 2011, according to a report issued in February 2020 from the Centers for Disease Control and Prevention. The percentage of individuals in families having problems paying medical bills was higher among females (14.7%), children (16.2%), and non-Hispanic black persons (20.6%) compared with males, adults, and other racial and ethnic groups, respectively. Among persons under age 65, those who were uninsured were more likely than those with Medicaid or private coverage to have problems paying medical bills.

The Challenge Of Financing The Costs Of Health Care

National spending on healthcare is projected to grow 5.5% between 2018 and 2027, according to the Centers for Medicare & Medicaid Services (CMS) Office of the Actuary's annual report that was issued in February last year. This growth would outpace average projected GDP growth by 0.8%. The forecast means the healthcare segment of the U.S. economy would climb to 19.4% by 2027, up from 17.9% in just two years. Medicare for All is one proposal being touted as a way of addressing the challenge of financing the cost of health care. Differences exist among advocates of this approach regarding whether it will be necessary to impose additional taxes. Individuals in favor of higher taxation believe that the amount beneficiaries must pay will be offset by eliminating other expenses associated with deductibles, co-payments and co-insurance.

A concern is that even if Medicare for All ever becomes the law of the land, there is no guarantee that it will be implemented and sustained as originally planned. The Affordable Care Act furnishes compelling evidence of the kinds of unintended alterations that can occur once a significantly large national endeavor leaves the launching pad. An original element of the ACA pertained to Community Living Services and Supports (CLASS) as a means of meeting the costs of long-term care. Seventeen months after the law was enacted, however, the HHS Secretary announced that CLASS would be abandoned because it was unsound financially. Reforming the federal tax code in 2017 resulted in repeal of the individual mandate to purchase health insurance or pay a penalty for failing to do so. In December 2019, legislation was enacted to eliminate three mechanisms designed to pay for the ACA: the so-called “Cadillac Tax”, the “Health Insurer Tax”, and the “Medical Device Tax.”

Curbing Waste In The Provision Of Health Care Services

A review of 54 unique peer-reviewed publications, government-based reports, and reports from the gray literature described in the October 15, 2019 issue of the Journal of the American Medical Association yielded the following estimated ranges of total annual cost of waste: (1) failure of care delivery, $102.4 billion to $165.7 billion, (2) pricing failure, $230.7 billion to $240.5 billion, (3) fraud and abuse, $58.5 billion to $83.9 billion, and (4) administrative complexity, $265.6 billion. The estimated annual savings from measures to eliminate waste were as follows: (1) failure of care delivery, $44.4 billion to $97.3 billion, (2) pricing failure, $81.4 billion to $91.2 billion, and (3) fraud and abuse, $22.8 billion to $30.8 billion. No studies were identified that focused on interventions targeting administrative complexity. The estimated total annual costs of waste, including items not listed here, were $760 billion to $935 billion and savings from interventions that address waste were $191 billion to $286 billion.

return to february 2020 trends

PULLING BACK THE CURTAIN

John Colbert

February 25, 2020

Trends Archives

Two events that are prominent in the nation’s annual political pageant enable voters to obtain a glimpse of the kinds of policies that may be concealed behind the curtain. One is the President’s State of the Union Address, which makes it possible to boast of past achievements and describe in broad terms anticipated future legislative initiatives. While members of the President’s party cheer vigorously at each utterance, Congressional members of the opposition party typically are more reticent. The second noteworthy event is the release by the Administration of its federal budget for the next fiscal year. Stock full of details on how money should be allocated, it’s relatively easy to determine which budgetary elements are destined to undergo some exceptionally rough legislative sledding based on who cheered wildly at the State of the Union address and who remained silent.

Lobbyists and leaders of special interest groups pay close attention to the proposed federal budget. Each year, the plot lines in the drama are reasonably clear. Many liberals tend to fret that important discretionary social programs involving health care and education will be seriously underfunded, while proclaiming that some military programs are too bloated and either should be eliminated outright or undergo significant reductions in spending. Many conservatives view matters differently and it is rare for them to fail to acknowledge what they perceive as redundant and wasteful amounts of money allocated for ineffective social programs.

The budget sent to Congress on February 10, 2020 contained some of the following items:

The administration proposes funding $38.7 billion for the National Institutes of Health (NIH) in FY 2021, which amounts to $3 billion less money or more than a 7% cut below the FY 2020 enacted program level.
The Agency for Healthcare Research and Quality (AHRQ) would be funded as a new institute within the NIH in the amount of $257 million, representing an $82 million (24%) reduction below AHRQ’s current funding level.
On the plus side, the budget proposes a nearly $900 million increase in career and technical education funding.
The Food and Drug Administration (FDA) would obtain a small budget increase in FY 2021 ($25 million, for a total of $3.29 billion).

Apart from legislation that involves spending, bipartisan cooperation has aided in producing efforts aimed at protecting patients from surprise medical billing. House Ways and Means Committee Chairman Richard Neal (D-MA) and Ranking Member Kevin Brady (R-TX) on February 7, 2020 announced the Consumer Protections Against Surprise Medical Bills Act of 2020 while Education and Labor Committee Chairman Robert “Bobby” Scott (D-VA) and Ranking Member Virginia Foxx (R-NC) revealed their surprise billing legislation, the Ban Surprise Billing Act.

return to february 2020 trends

PRESIDENT’S CORNER

John Colbert

February 25, 2020

Trends Archives

BY ASAHP PRESIDENT PHYLLIS KING

A Blueprint for the Future (2020 – 2024) of the Association of Schools Advancing Health Professions

I am pleased to announce a new Strategic Plan is in place that articulates ASAHP’s priorities and will focus our energy and resources to best serve the organization in accomplishing its mission of advancing health through interprofessional collaboration. This plan includes a shared vision of ASAHP being THE source for interprofessional collaboration to improve health.

Values driving our actions include quality education, interprofessional collaboration, connecting education and health, innovation, leadership and diversity. Five strategic areas of activity have been identified, each led by a board member with a committee structure, to achieve ASAHP’s mission and vision:

Communications, public relations and marketing – Andrew Butler
Leadership development – Deborah Larsen
Education – Ces Thompson
Partnerships, alliances and advocacy – Teresa Conner-Kerr
Research, member services and programs – Brian Shulman

Over the coming months you will receive more detailed information on the activities and metrics each committee is employing and how you can be involved. Member benefits of networking, professional development, research and development, the institutional profile survey, the leadership development program, representation on the Federal level and in other health organizations, and publications are retained with an eye toward adding even more value for members. Rest assured you have a dedicated leadership team excited to shape the future of ASAHP and adapt to ever changing environments with you.

TEAM ABOUT TO BREAK THE HUDDLE TO REVISE STRATEGIC PLAN

return to february 2020 trends

GEOGRAPHIC INFLUENCE ON HEALTH DISPARITIES

John Colbert

February 25, 2020

Trends Archives

Individuals possess distinguishing characteristics, such as age, education, level of income, extent of health insurance coverage, and degree of health literacy that contribute to the likelihood they will experience health disparities. Where they live and work also will play an important role due to a rural-urban divide that exists. For example, an article in the January 2020 issue of the American Journal of Preventive Medicine discusses how in the U.S., rural residents have poorer health than urban residents and this disadvantage is growing. Compared with metropolitan county residents, inhabitants of the most rural counties were seven percentage points more likely to have a usual source of care (81% vs 74%), but their providers were 13 percentage points less likely to be physicians (22% vs 35%). Despite having to travel longer to reach their usual source of care providers, residents of the most rural counties were 12 percentage points less likely than metropolitan residents to have usual source of care providers with office hours on nights and weekends (27% vs 39%).

Rural counties make up approximately 80% of the land area of this nation, but they contain less than 20% of the U.S. population. The relative sparseness of the population in rural areas is one of many factors that influence the health and well- being of the inhabitants of these places. An important difference pertaining to the health workforce is that some rural counties may lack the presence of a single member of a particular health profession, such as dentistry or psychiatry. Older patients with chronic ailments often require rehabilitation care, which typically requires a team consisting at a minimum of physicians, nurses, dietitians, occupational therapists, physical therapists, and speech therapists.

Hospitals often serve as the main type of venue where such teams are located, but as Seema Verma, Administrator of the Centers for Medicare & Medicaid Services, pointed out in a presentation she made on February 12, 2020 at the National Rural Health Association’s policy institute, more than 120 rural hospitals have closed since 2010, which does not appear to be a step in the right direction of ensuring the presence of a sufficient network of health providers. Unlike students who live in big cities that have access to several academic institutions with health professions programs reachable by subway and bus, rural students lack this luxury and may live hundreds of miles from educational resources. Fortunately, telehealth services can benefit patients and online degree programs may be available to enable the pursuit of academic degrees necessary to become health professionals, but it is not the same as having face-to-face kinds of opportunities that exist in urban areas.

Health policy is in a state of flux. Some presidential candidates propose new approaches, such as Medicare for All, but it is not entirely clear what impacts possibly could materialize that affect the delivery of health care services. Changes in reimbursement patterns, for example, either could slow the pace of hospital closings in rural areas or accelerate their disappearance if financing levels prove to be less than what is necessary to enable these facilities to remain afloat financially.

return to february 2020 trends

GEOGRAPHY DETERMINES WHEN A DEATH CAN BE DECLARED

John Colbert

January 24, 2020

Trends Archives

Apart from decision fatigue, there is the issue of decision confusion. An example is that it is possible for an individual to be pronounced dead in one state, but not dead in a neighboring jurisdiction. As described in an article appearing on December 24, 2019 in the Annals of Internal Medicine, this situation exists because only 36 states have incorporated the complete language of the Uniform Determination of Death Act (UDDA) into their respective definitions of death. An original goal was for all states to adopt the UDDA as the legal standard for death by neurologic criteria (DNC). Instead, there is ongoing confusion about DNC since medical standards of determination vary, public acceptance is inconsistent, and responses to family objections have ranged from continuation of organ support indefinitely to unilateral discontinuation. Unresolved problems pertain to: (1) lack of uniformity in the medical standards used to determine DNC, (2) uncertainty about whether “all functions of the entire brain, including the brainstem” entail hormonal functions, (3) the UDDA does not address whether consent is needed before a determination of DNC, and (4) the UDDA does not address religious objections to discontinuation of organ support after DNC.

In a related vein, a debate is underway in the field of Alzheimer’s disease (AD) research over the definition of the disease itself. As described in the December 11, 2019 issue of the journal Science Translational Medicine, a problem is that the terms dementia and AD have become interchangeable. Arguments in favor of using a biological versus a clinical diagnosis for AD are that: the latter is not specific for any etiology; a biological definition of AD will lead to a better understanding of the sequence of events that leads to cognitive impairment and dementia; biological markers will improve efficiency of clinical trials; and a biological definition of AD enables study of the disease from the preclinical stage through all symptomatic stages and of all disease phenotypes, not only the memory loss phenotype.

return to dec 2019 - jan 2020 trends

A CONCEPTUAL ANALYSIS OF DECISION FATIGUE

John Colbert

January 24, 2020

Trends Archives

The Lovesong of J. Alfred Prufrock by T.S. Eliot contains the following verse:

Time for you and time for me,
And time yet for a hundred indecisions,
And for a hundred visions and revisions,
Before the taking of a toast and tea.

The memory of the TRENDS newsletter’s editor of this portion of the poem was triggered while perusing an article on the topic of decision fatigue that appeared in the January 2020 issue of the Journal of Health Psychology, in which it is estimated that an American adult makes 35,000 decisions each day. While some of them seemingly are benign, an emerging body of science indicates that making decisions may possess negative ramifications for controlling one’s behavior and the quality of subsequent decisions. The phenomenon is known as “decision fatigue,” an impaired ability to make decisions and control behavior as a consequence of repeated acts of decision-making that often lead to choices that seem impulsive or irrational. Decision-making is a central component of modern health care, with each decision possessing some level of influence on patient outcomes. With a substantial proportion of all adults possessing at least one chronic condition, decision-making may be considered a central facet of day-to-day chronic disease self-management.

Decision fatigue as a concept has been applied scantily to health care disciplines, despite its potential relevance to inform the decision-making behaviors of patients and clinicians. If health professionals are working to the point where they are in severe states of ego depletion (manifesting as decision fatigue) and are not in an ideal cognitive state to make logical and safe decisions for patients, an exploration of decision fatigue may serve as a highly relevant and necessary endeavor. Hence, decision fatigue analysis may possess significance to inform regulatory policies related to health care employee workload.

return to dec 2019 - jan 2020 trends

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

John Colbert

January 24, 2020

Trends Archives

U.S. Investments In Medical And Health Research And Development 2013 - 2018

A new report from the advocacy group Research!America finds that the total spending on health and medical research was more than $194 billion in 2018. Since 2013, medical and health R&D spending has increased by $51 billion. Industry and academia funding have increased by nearly 40% over this time. Industry was responsible for two-thirds of the 2018 R&D funding, while federal agencies invested about 22%. Academic institutions and foundations made up the rest. Spending on health care far outweighs spending on health research. In 2018, $3.6 trillion was spent on care, which means research funding accounts for only five cents of every health sector dollar. The report can be obtained here.

More Americans Delaying Medical Treatment Due To Cost

Approximately one out of four Americans say the cost of treatment caused them to delay care for a serious medical condition, according to Gallup’s annual Health and Healthcare poll in 2019. An additional 8% of respondents indicated that costs played a factor in deciding to delay seeking care for less serious conditions. In 2018, 19% of Americans claimed that treatment costs led to a delay in treatment for a serious condition. The poll tracked a few trends within this data, including the following: On the basis of household income, 36% percent of adults with household income of less than $40,000 reported delaying treatment for a serious condition, a jump in 13 percentage points since last year. Rates stayed relatively flat for middle-and high-income households. Americans who reported having a pre-existing condition, or living with someone who has, were more likely to delay medical care for a serious condition this year compared to 2018. According to Gallup, these trends could have broad implications for both the health care system and the economy. The report can be obtained here.

Do Advanced Driver Assistance And Semi-Automated Vehicle Systems Lead To Improper Driving Behavior?

According to a report from the AAA Foundation for Traffic Safety, the ultimate goal of advanced driver assistance systems (ADAS) is to increase traffic safety and driving comfort. Despite their potential safety benefits, there are concerns about unintended consequences associated with intermediate levels of automation. In these scenarios, speed control and/or steering are automated, but the driver still is required to monitor traffic and be ready to resume control. A key concern is that drivers may become inattentive due to engagement in non-driving-related tasks or become drowsy while driving using these systems. As drivers gain experience using advanced driver assistance systems (ADAS), such as adaptive cruise control and lane-keeping assist, they also are more likely to drive distracted while using the systems, according to research from AAA Foundation for Traffic Safety. Conducted in collaboration with the Virginia Tech Transportation Institute, the study found that drivers with experience using ADAS were nearly twice as likely to engage in distracted driving while using the systems compared to when they were driving without the systems. Researchers noted the opposite effect in drivers with less familiarity using the technology. Those drivers were less likely to drive distracted with the systems engaged compared to when the systems were not in use. The report can be obtained here.

return to dec 2019 - jan 2020 trends

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

John Colbert

January 24, 2020

Trends Archives

Adult Physical Inactivity Prevalence Maps By Race/Ethnicity

According to new state maps of adult physical inactivity made available by the Centers for Disease Control and Prevention (CDC) in January 2020, all states and territories had more than 15% of adults who were physically inactive and the estimate ranged from 17.3 to 47.7%. Inactivity levels vary among adults by race/ethnicity and location. The data come from the Behavioral Risk Factor Surveillance System (BRFSS), an ongoing state-based, telephone interview survey conducted by CDC and state health departments. Maps use combined data from 2015 through 2018 and show noticeable differences in the prevalence of physical inactivity by race/ethnicity. Hispanics (31.7%) had the highest prevalence of physical inactivity, followed by non-Hispanic blacks (30.3%) and non-Hispanic whites (23.4%). Non-Hispanic blacks and Hispanics had a significantly higher prevalence of inactivity than non-Hispanic whites in the majority of states.

Driving Under The Influence Of Marijuana And Illicit Drugs Among Persons Aged ≥16 Years—U.S.

Data from the Substance Abuse and Mental Health Services Administration’s National Survey on Drug Use and Health (NSDUH) indicate that in the United States during 2014, 12.4% of all persons aged 16–25 years reported driving under the influence of alcohol, and 3.2% reported driving under the influence of marijuana. This report provides the most recent national estimates of self-reported driving under the influence of marijuana and illicit drugs among persons aged ≥16 years, using 2018 public-use data from NSDUH. Prevalences of driving under the influence of marijuana and illicit drugs other than marijuana were assessed for persons aged ≥16 years by age group, sex, and race/ethnicity. During 2018, 12 million (4.7%) U.S. residents reported driving under the influence of marijuana in the past 12 months; and 2.3 million (0.9%) reported driving under the influence of illicit drugs other than marijuana. Driving under the influence was more prevalent among males and among individuals aged 16–34 years.

HEALTH TECHNOLOGY CORNER

Benefit To Patients Using Wearable Devices Such As Fitbit Or Health Apps On Mobiles

According to a study reported in the December 2019 issue of the American Journal of Medicine, wearable devices have become a standard health care intervention with emerging health care technologies. These devices are designed to promote healthy behaviors and decrease risk for chronic ailments, such as cardiovascular disease and diabetes. A systematic search of 550 articles revealed little indication that wearable devices provide a benefit for health outcomes. Only one study showed a significant reduction for weight loss among participants. No significant reduction was discovered in cholesterol or blood pressure. A conclusion reached is that current literature evaluating wearable devices indicates little benefit of these items on chronic disease health outcomes. Although wearable devices play a role as a facilitator in motivating and accelerating physical activity, current data do not suggest other consistent health benefits.

Light-Degradable Hydrogels As Dynamic Triggers For Gastrointestinal Applications

Different kinds of medical devices can be inserted into the gastrointestinal tract to treat, diagnose, or monitor GI disorders. Many of these items need to be removed by endoscopic surgery after their function has been performed. According to an article published on January 17, 2020 in the journal Science Advances, engineers at the Massachusetts Institute of Technology have developed a way to trigger such devices to break down inside the body when they are exposed to light from an ingestible light-emitting diode (LED). A potential advantage is that light can act at a distance and doesn't need to come into direct contact with the material being broken down. Also, light normally does not penetrate the GI tract, so there is no chance of accidental triggering. Light-triggerable hydrogels have the potential to be applied broadly throughout the GI tract and other anatomic areas. By demonstrating the first use of light-degradable hydrogels in vivo, biomedical engineers and clinicians are provided with a previously unavailable, safe, dynamically deliverable, and precise tool to design dynamically actuated implantable devices.

return to dec 2019 - jan 2020 trends

DEVELOPMENTS IN HIGHER EDUCATION

John Colbert

January 24, 2020

Trends Archives

Supplementing the information provided on page three of this issue of the newsletter, it is worth noting that the appropriations portion of the bill for higher education programs provides $2.5 billion, an increase of $163 million above the 2019 enacted level and $941 million above the President’s budget request. For federal student aid programs, the bill provides $24.5 billion, which is $75 million above the 2019 enacted level and $1.5 billion above the President’s budget request. Within this amount, the bill furnishes $865 million for the Supplemental Educational Opportunity Grant (SEOG) program, $1.2 billion for Federal Work Study, and an increase to the maximum Pell grant to $6,345.

A report issued on December 10, 2019 by the Pew Charitable Trusts on how the U.S. has changed in key ways in the past decade indicates that nonwhites now account for the majority of the nation’s newborns, as well as the majority of K-12 students in public schools. More than half of newborn babies in the U.S. are racial or ethnic minorities, a threshold first crossed in 2013. Nonwhite students also account for the majority of the nation’s K-12 public school students. As of fall 2018, children from racial and ethnic minority groups were projected to make up 52.9% of public K-12 students. With the passage of time, these facts will have an enormous impact on higher education in general and on the health professions in particular. Future issues of the ASAHP newsletter TRENDS will serve as a vehicle for discussing how the education sector will be affected by these kinds of societal changes.

Costs Associated With Attending College

Year-over-year increases in college expenses have grown steadily in the U.S. since 1981. Although the Pell Grant Program also has expanded at regular intervals, the maximum does not align well with much higher tuition costs. Consequently, students and their families increasingly find it necessary to take out various kinds of loans. Beyond the day when degrees are awarded, the amount of debt borne by recent college graduates may delay the attainment of milestones associated with adulthood later in life, such as buying a house, getting married, and having children. The situation is even more gloomy for students who have incurred substantial debt, but never ended up graduating from college.

A report made available on December 31, 2019 from the National Center for Education Statistics (NCES) describes four measures of the price of undergraduate education in the 2015–16 academic year: total price of attendance (tuition and living expenses), net price of attendance after all grants, out-of-pocket net price after all financial aid, and out-of-pocket net price after all aid excluding student loans. Estimates are based on the 2015–16 National Postsecondary Student Aid Study, a nationally representative survey of students enrolled in postsecondary institutions in the 50 states, the District of Columbia, and Puerto Rico. The total price of attendance consists of tuition and nontuition expenses (fees, books, supplies, transportation, and living expenses )., For example, full-time students at public two-year institutions had the lowest average total price of attendance at $16,100 in 2015-16. The average total price of attendance was higher at public four-year institutions ($26,900), higher still at for-profit institutions ($32,600), and highest at private non-profit four-year institutions ($48,000). The percentage of students with loans was greatest at private for- profit schools (74%) and lowest at public 2-year institutions (20%).

Opposition To Student Loan Forgiveness Rule

Congressional Democrats aim to prevent implementation of a Department of Education policy that would make it more difficult for federal student loan borrowers to cancel their debt based on misconduct by any college. Set to take effect on July 1 of this year, the Trump administration policy that was finalized last year establishes more stringent rules for when the government will wipe out the debt of students claiming they were misled or deceived by a higher education institution. Democrats are using the Congressional Review Act, a tool that allows Congress to stop recently enacted regulations with a simple majority in both chambers and the president's signature.

return to dec 2019 - jan 2020 trends

HEALTH REFORM DEVELOPMENTS

John Colbert

January 24, 2020

Trends Archives

Approximately 18% of the U.S. economy, the largest in the world, is represented by the health sector, which suggests that there always will be something occurring within that domain that will prove to be newsworthy. Typical stories in the media and relevant topics in policy discussions revolve around the central issues of cost, quality, and access. The last item is guaranteed to continue to attract significant attention as long as there are any individuals in this country who lack health insurance coverage.

The Patient Protection and Affordable Care Act was signed into law by President Barack Obama on March 23, 2010. Usually referred to as either the ACA or Obamacare, this key piece of legislation has been in the news since its various provisions began to unfold. Its enactment was supported wholly in Congress by Democrats in both legislative chambers, without a single Republican vote. That outcome alone essentially assured that the years ahead would be marked by strenuous efforts to repeal and replace its most important features either in whole or in part. Republicans came close to repealing the ACA in 2017 when they were the majority in both the House and the Senate and President Donald Trump occupied the White House, but the attempt did not meet with success, albeit by a close margin. Failure in Congress did not mean that opposition fervor would be diminished, however, as repeal efforts then shifted to the judicial arena.

Repeal Of the Individual Mandate Penalty Set The Stage For Repeal Of The ACA

As part of a successful attempt to overhaul U.S. tax law aimed at energizing the economy, Republicans were able to zero out the individual mandate penalty in 2017. Once that happened, they insisted that a mandate stripped of its penalty for not purchasing health insurance meant the provision no longer was enforceable and could not be considered as being constitutional. Because the mandate is viewed as being such an essential component of the Affordable Care Act, eliminating it led to a claim that the entire law now should be struck down. A federal district court in Texas subsequently declared the ACA invalid in December 2018.

Twenty-one Democratic attorneys general and the House of Representatives then appealed this ruling to to the Fifth Circuit. That court partially affirmed the district court in 2019 in a 2–1 decision, agreeing that the mandate absent a penalty is unconstitutional. Significantly, this narrow majority ruling did not include what should be done with the ACA as a whole. Instead, the case was remanded back to the Texas district court for a more complete severability analysis. A main issue awaiting resolution is whether the mandate can be severed from the ACA, leaving the rest of the law to continue to be constitutional. Meanwhile, the Democratic attorneys general have appealed the ruling by the Fifth Circuit to the U.S. Supreme Court. Whether it will accept the case and deal with it in 2020 is unknown at this juncture.

PCORI Remains In Effect While Some ACA Taxes Are Repealed

The Patient-Centered Outcomes Research Institute (PCORI) was established by the ACA to promote comparative effectiveness research to assist patients, clinicians, purchasers, and policymakers in making informed health decisions. Although it enjoyed widespread support from the time of inception, detractors viewed it as a politically-driven program with attendant dangers associated with central planning. During 2019, there was some opposition to reauthorizing PCORI. Instead, the Institute enjoyed bipartisan support and its funding was reauthorized for 10 years as part of appropriations legislation described on page three of this issue of the newsletter.

That same appropriations package affected the ACA in other important ways. Members of Congress fully repealed the health insurance tax beginning in 2021, along with the so-called Cadillac tax on beneficiaries who have expensive insurance policies, and the medical device tax beginning in 2020. Repeal of the medical device tax always enjoyed bipartisan support because many states have companies affected by it. A potential downside is that these taxes were intended to cover the costs of expanding health insurance coverage under the law. It is estimated that repealing them will result in the loss of approximately $400 billion in revenue over the next ten years.

return to dec 2019 - jan 2020 trends

LABOR-HHS FUNDS ALLOCATED FOR FY 2020

John Colbert

January 24, 2020

Trends Archives

It is characteristic in any given year for Congress to be unable to complete work in the area of appropriations in time for necessary funds to be made available for the start of a new fiscal year each October 1. Instead, a series of short-term continuing resolutions (CRs) are implemented so that government functions can continue to operate. The year 2019 was no exception to this sequence of events. Even until late December when a CR was about to expire, there was no firm assurance that another one one would not be necessary.

Nevertheless, the holiday season proved to be a happier one as agreement was reached on how much funding to provide for a wide range of entities that come under the umbrella of the Departments of Labor, Health and Human Services, Education, and Related Agencies, which commonly are referred to as Labor-HHS. That piece of legislation was one of eight large bills that made up one minibus package (four national security bills made up another minibus package). The Labor-HHS bill included $184.9 billion in discretionary funding, an increase of $4.9 billion over the 2019 enacted level and $43 billion over the President’s 2020 budget request.

The Department of Health & Human Services (HHS) was allocated $94.9 billion, an increase of $4.4 billion above the 2019 enacted level and $16.8 billion above the President’s budget request. The largest increase, $2.6 billion, went to the National Institutes of Health. HRSA (the Health Resources & Services Administration) obtained $7.04 billion, a $193 million increase over the FY 2019 level. Within HRSA, Title VII health professions programs received $424.5 million, a $32.3 million increase over the FY 2019 level, and the Health Careers Opportunity Program was funded at $15 million. The Department of Education was awarded a total of $72.8 billion in discretionary appropriations, which was $1.3 billion above the 2019 enacted level and $8.7 billion above the President’s budget request, with the maximum Pell grant increasing to $6,345.

Moving forward, it is unclear to what extent any meaningful legislation involving social determinants of health, surprise billing, drug pricing, and lowering health care costs will be approved by Congress in 2020. One possible impediment to meaningful action is the necessity of having a trial in the Senate now that House officials have transmitted two articles of impeachment. Once the trial begins, its length could depend on whether both impeachment supporters and opponents agree to allow witnesses to testify. Also, a national election next November will contribute to a compression of the legislative calendar. Apart from determining the outcome to elect a U.S. President, all House members and one-third of the Senate who wish to remain in office must face the voters. As the time of the election approaches, campaign activities necessarily must take precedence over legislative business.

A related consideration is that even in the best of times, the nature of certain pieces of legislation will preclude any rapid action. The Higher Education Act (HEA), to cite one key illustration, last was reauthorized in 2008. That authorization expired in 2013. Now that almost seven years have elapsed and several hearings have been conducted, apart from separate bills currently being championed by members of the House and Senate, the prospect of reaching agreement any time soon does not appear to be on the near horizon.

return to dec 2019 - jan 2020 trends

PRESIDENT’S CORNER

John Colbert

January 24, 2020

Trends Archives

BY ASAHP PRESIDENT PHYLLIS KING

Interprofessional Education and ASAHP – Fostering a Culture of Collaboration

The Association of Schools Advancing Health Professions (ASAHP) has a strong commitment to improving collaboration and outcomes in health care by supporting Interprofessional Education (IPE). Through the leadership of Immediate Past President Susan Hanrahan, ASAHP’s commitment to IPE in both the academic and clinical learning environments has grown significantly and gained clarity over the past two years.

ASAHP’s interprofessional identity comes from both its structure and its actions. We built off these strengths identifying that interprofessional collaboration threads throughout all aspects of ASAHP. The dedicated section on IPE in the Journal of Allied Health has grown in popularity and impact. ASAHP continued its engagement as members of the Interprofessional Education Collaborative (IPEC) Council, the National Academies of the Sciences, Engineering and Medicine Global Forum on Innovation in Health Professional Education, and the Health Professions Accreditors Collaborative (HPAC). ASAHP’s Annual Meeting has been recognized by the American Interprofessional Health Collaborative (AIHC) as an Affiliate Conference in 2018 and 2019.

ASAHP also engages academic institutions, governmental and industry partners to translate interprofessional education to improve society by addressing workforce readiness, health outcomes and social determinants of health. We sponsored the inaugural ASAHP Summit in 2018 to bring together a diverse group of key stakeholders in dialogue to address issues regarding IPE, collaborative practice and work-force readiness. The 2019 Summit teamed up with ASAHP’s Clinical Education Task Force to conduct an on-campus event at Saint Louis University where representatives from academia and industry engaged in conversation regarding the CETF’s recommendations and co-creating action steps moving forward.

In 2018, ASAHP also started to recognize best practice in IPE through a new “ASAHP Excellence and Innovation in Interprofessional Education and Collaborative Health Care” award. This provided a mechanism for sharing model initiatives from our members by highlighting institutions for excellence in interprofessional collaboration. Texas Tech University Health Sciences Center and Indiana University Purdue University at Indianapolis were honored with the award in 2018 and 2019 respectively. Additionally, three ASAHP member institutions were recognized as “Programs of Merit” each year.

The upcoming ASAHP board strategic planning meeting will no doubt address how we advance IPE initiatives to leverage our identity and our commitment to quality improvement in health care through interprofessional collaboration. ASAHP has a unique combination of attributes that other organizations strive to achieve with our institutional and industry membership, leadership development/networking, international outreach, student engagement, well-regarded journal, and vibrant annual meeting. We look to accelerate our current momentum with a continued commitment to innovation, excellence and impact.

ASAHP is well-positioned to emerge as a leader nationally in IPE and collaborative practice.

Anthony Breitbach PhD, ATC, FASAHP
Professor/Director, Athletic Training
Saint Louis University

Phyllis King PhD, OT, FAOTA, FASAHP
President, ASAHP

return to dec 2019 - jan 2020 trends

RESOLVING NETTLESOME HEALTH POLICY DISPUTES

John Colbert

January 24, 2020

Trends Archives

Controversies often are involved when initiatives are undertaken to arrive at the best approach to gaining wide acceptance of proposals involving contentious public policy issues, such as gene editing, euthanasia/assisted dying, and recreational use of marijuana products. A basic question pertains to deciding whom to involve in making decisions that enable these policies to move forward. Three possible groups are: elected public officials; health scientists and other experts in fields, such as ethics; and voters, along with other concerned members of the general public.

To note just one example, President William Clinton, along with British Prime Minister Tony Blair, announced at the White House on June 26, 2000 that the international Human Genome Project and Celera Genomics Corporation both had completed an initial sequencing of the human genome, the genetic blueprint for human beings. This landmark achievement was hailed as promising to bring exciting new approaches to prevent, diagnose, treat, and cure disease. Since that widely heralded occasion, germline gene editing provides a vivid illustration of a current topic that has emerged as a serious concern because of its potentially grave threat to the health of future generations.

Netflix offered a four-episode documentary series in October 2019 entitled “unnatural selection” as a means of furnishing an overview of genetic engineering, with an emphasis on the DNA-editing technology of CRISPR (clustered regularly interspaced short palindromic repeats) from the perspective of scientists, corporations, the public, and biohackers tinkering in garages. Apart from the goal of editing genes to eradicate certain diseases or even to produce so-called designer babies who will possess enhanced abilities (e.g, intellectual, artistic, and athletic), it should be obvious that there are great amounts of money to be made by entrepreneurs able to reach the finish line first with the most effective products.

The problem currently is that: some envisioned new gene therapies may not improve human lives, various species may be at risk of changing in unforeseen ways or perhaps even being eliminated, and assurance still is lacking on whether desired sought after improvements ever will materialize. The Netflix episodes feature discussions with (1) residents of Nantucket Island in Massachusetts who are apprised of a proposal to modify a species of mice affected by ticks that cause disease among humans, (2) inhabitants of New Zealand where rats are killing off many breeds of birds, and (3) villagers in Burkina Faso, Africa where mosquitos continue to cause children to die from malaria.

In all three settings, the notion of Gene Drive to change an entire species to achieve a purported social good encounters resistance. A major concern is that apart from positive outcomes that are touted by proponents of genetic interventions, it remains worrisome that no firm guarantees can be offered regarding possible unanticipated, dangerous outcomes that might occur. While members of the general public may lack the sophisticated knowledge of scientific experts, their basic instincts make them wary of approving proposals that are equivalent to attempting to play God.

return to dec 2019 - jan 2020 trends

HOUSING DISCRIMINATION AND RACIAL CANCER DISPARITIES

John Colbert

November 25, 2019

Trends Archives

In areas with greater mortgage discrimination, the gap between black and white cancer mortality rates was larger (correlation coefficient [r] = 0.32; P = .001). This relationship persisted in sex‐specific analyses (males, r = 0.37; P < .001; females, r = 0.23; P = .02) and in models controlling for confounders. As described in the November 1, 2019 issue of the journal Cancer, mortgage discrimination is associated with larger black‐to‐white cancer mortality disparities. Some areas are exceptions to this trend. Examination of these exceptions and of policies related to housing discrimination may offer novel strategies for explaining and eliminating cancer disparities. Racial cancer disparities represent a substantial proportion of the overall mortality disparity between blacks and whites and are a major consideration in the provision of clinical care and public health practice and policy. In 2010, cancer accounted for 17% of the life‐expectancy gap between black and white populations, second only to heart disease for women, and, for men, third, also after homicide. A higher chance of mortgage application denial for black applicants tends to reduce black home ownership and increase the likelihood of renting. As opposed to being able to purchase, renting results in a reduced ability to accumulate home equity—a primary source of wealth—which may limit resources available to offset the financial burden of cancer.

return to november 2019 trends

More Articles from March 2020 TRENDS