THE COMMUNITY BASED PRIMARY HEALTHCARE WORKING GROUP INVITES YOU TO ATTEND
COMMUNITY-ENGAGED APPROACHES TO ADDRESSING MENTAL HEALTH AND OTHER NONCOMMUNICABLE DISEASES
NOVEMBER 9, 2023 10am-1pm ET
Keynote Speaker: Dr. Rima Afifi, Professor of Community and Behavioral Health, University of Iowa College of Public Health
Keynote Title: “Power Sharing in Community-Engaged Research: Guiding Fit to Context in Refugee Communities”
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According to Galvani et al. (2022), here in the U.S. “…the COVID-19 pandemic has underscored the public health, economic, and moral repercussions of widespread dependence on employer-sponsored insurance.” The majority of U.S. adults under age 65 access health insurance through their employer. From December 2019 to April 2020, there was a 14.5 million decrease in employer-sponsored health insurance enrollments, largely driven by the millions of Americans who became unemployed during this time. On the flip side, Medicaid enrollments increased by almost 10 million between March and December 2020, in no small part due to the Families First Coronavirus Response Act (FFCRA) which allowed state Medicaid programs to keep individuals continuously enrolled throughout the pandemic. Soon we may be seeing another drop in insurance coverage, though, as this provision ended on March 31st, 2023. It is expected that millions of people will lose coverage or experience a lapse in coverage, but the full impacts are yet to be seen.
The uniquely American dependence on employer-sponsored health insurance no doubt contributed to the COVID-19 outcomes we experienced as a country. Workers may fear losing their job and therefore health insurance, so they decide to go into work even if they are sick and contribute to transmission. If a person did lose their job and insurance, fear of high costs and delayal of care results in increased case fatality rates. It was found that essential workers in Pennsylvania were 55% more likely to contract COVID in the early stages of the pandemic compared to Pennsylvanians who were able to work from home. Family members and roommates of these workers were 17% and 38% more likely to test positive, respectively. In this study, “essential workers” were more likely to live in communities of predominantly Black or Latino residents and individuals below the poverty line. Thinking back to early 2020, one of the memories that stands out most is society’s collective glorification of essential workers. While this rhetoric of heroism was being propagated, the material conditions that these individuals were working under, and the policies that allowed these conditions, displayed blatant disregard for the health and safety of Americans who literally kept our communities running. Our drained workforce, and more importantly the families who have an empty seat at the dinner table, signify the lasting effects of the U.S.’s COVID-19 response.
COVID-19 may have jeopardized the great strides made towards UHC in the 21st century, hopefully this collective trauma illuminated the need for change and sparked renewed energy across the world. COVID-19 showed both leaders and ordinary people the importance of health, and the impacts of its absence. It puts on full display how a threat to health can impact all corners of society: physical health, mental health, the economy, school systems, availability of goods and services, and the list goes on. We are still feeling these impacts years later. As for myself [Martha Smee], I value my health now more than ever. As a future public health professional and healthcare provider, I will continue to advocate until those in power value my health and the health of all peoples as much as they should.
Martha Smee MPH (c) MMS (c)
Martha Smee is a current student in Arcadia University’s Dual Master of Public Health/Master of Medical Science in Physician Assistant Program. As an MPH student, her capstone research explored the relationship between state Medicaid policy and mental health outcomes. She completed an internship at the Free Library of Philadelphia’s Culinary Literacy Center where she assisted with curriculum development and program facilitation to promote literacy through food, cooking, and community-building. Her public health interests include health policy, access to mental health services, and environmental health. After graduating, she plans to continue practicing evidence-based public health as a primary care provider in the Philadelphia area.
Dr. Heather F. McClintock PhD MSPH MSW
Dr. McClintock is an IH Section Member and Associate Professor in the Department of Public Health, College of Health Sciences at Arcadia University. She earned her Master of Science in Public Health from the Department of Global Health and Population at the Harvard School of Public Health. Dr. McClintock received her PhD in Epidemiology from the University of Pennsylvania with a focus on health behavior and promotion. Her research broadly focuses on the prevention, treatment, and management of chronic disease and disability globally. Recent research aims to understand and reduce the burden of intimate partner violence in Sub-Saharan Africa. Prior to completing her doctorate she served as a Program Officer at the United States Committee for Refugees and Immigrants and a Senior Project Manager in the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania. At the University of Pennsylvania she led several research initiatives that involved improving patient compliance and access to quality healthcare services including the Spectrum of Depression in Later Life Study and Integrating Management for Depression and Type 2 Diabetes Mellitus Study.
July 20, 2023: Bernie Sanders (I-Vt.) will finally get a study of his proposal to do away with drug patents and other intellectual property protections in favor of rewarding inventions with prize money. Sanders has been pushing the prize approach since he was a House representative, many years ago. The measure directing the National Academies of Sciences, Engineering and Medicine to study the idea was added to the Pandemic All-Hazards and Preparedness Act a day before Sanders’ health committee passed the bill. Three Republicans voted against the overall bill, which renews several federal biodefense and pandemic-preparedness programs. Though Democrats last year passed historic legislation to let Medicare negotiate drug prices and cap seniors’ annual out-of-pocket drug costs, Sanders is demanding more drug price controls. He is delaying President Biden’s pick for running the National Institutes of Health until the president releases a plan to control drug prices.
June 22, 2023: The Food and Drug Administration is ramping up its efforts to force vape shops and other retailers to stop selling unauthorized disposable vape brands that are increasingly popular with young people. The FDA recently issued 189 formal warning letters to shops selling two brands of vape products, Elf Bar and Esco Bars, the agency announced in a press release Thursday. The FDA has not authorized either brand, both of which are ubiquitous in gas stations and smoke shops around the country. They are therefore illegal to sell. “This latest blitz should be a wake-up call for retailers of Elf Bar and Esco Bars products nationwide,” said Brian King, the head of the FDA’s tobacco center in a statement announcing the blitz.
July 17, 2023: On June 28, 2023, the Office of Disease Prevention and Health Promotion (ODPHP) hosted the sixth installment of the Healthy People 2030 Webinar Series: Strengthening Resilience in Children and Adolescents. During this one-hour event, ODPHP and the Centers for Disease Control and Prevention’s National Center for Health Statistics presented on the webinar’s three featured objectives, and Healthy People 2030 Champion Adaptive Sports Ohio presented on their efforts to increase participation in sports teams for children and adolescents with physical disabilities. You can view a recording of this webinar below. Be sure to visit ODPHP’s YouTube Channel for more Healthy People content, including recordings of past webinars.
July 18, 2023: The 2025 Dietary Guidelines Advisory Committee’s work continues, and the Committee will hold its third meeting September 12-13, 2023. The U.S. Departments of Health and Human Services (HHS) and Agriculture (USDA) invite the public to participate in this important event via livestream. Registration is required and will open on Thursday, August 10, 2023, at DietaryGuidelines.gov. The September meeting will include presentations by each subcommittee and deliberation by the full Committee on progress made since the last meeting, including draft protocol development, evidence review and synthesis, and plans for future Committee work. A meeting agenda will be published in advance of the meeting at DietaryGuidelines.gov.
March 2, 2023: Australia’s My Health Record is a national, integrated electronic record, intended to overcome the problem of having personal health information “siloed” in different systems. People can access their own My Health Record via MyGov or an app. Any of their treating health professionals can access it, too. My Health Record can hold various past information, including a shared health summary, records of health conditions, allergies and medications, summaries of cancer treatment, test and scan results, hospital discharge notes, vaccination records, organ donation choices, and notes entered by patients themselves. But is the system actually being used? Why is it, when people access their My Health Record, they often find little helpful information? Earlier this year, Health Minister Mark Butler promised an overhaul as part of the Strengthening Medicare Taskforce. But what needs to happen for it to be finally fit for purpose?
February 6, 2023: Cancer figures provide stark evidence of the gap between the health of Aboriginal and Torres Strait Islander people and non-Indigenous people in Australia. The difference is confronting – and it’s increasing over time. Cancer is the leading broad cause of death for Aboriginal and Torres Strait Islander people, accounting for 3,612 deaths (23% of deaths). Indigenous Australians are 14% more likely to be diagnosed with cancer. They are 20% less likely to survive at least five years beyond diagnosis. While the likelihood of dying from cancer in the general population declined by 10% from 2010 to 2019, it increased by 12% for Aboriginal and Torres Strait Islander people. These figures highlight major challenges for the federal government’s stated aim to close the life expectancy gap in a generation. But data will also be critical to meeting this goal.
July 24, 2023: A National Institute of Health-supported study found that statins, a class of cholesterol-lowering medications, may offset the high risk of cardiovascular disease in people living with HIV by more than a third, potentially preventing one in five major cardiovascular events or premature deaths in this population. People living with HIV can have a 50-100% increased risk for cardiovascular disease. The findings are published in the New England Journal of Medicine“This research suggests that statins may provide an accessible, cost-effective measure to improve the cardiovascular health and quality of life for people living with HIV,” said Gary H. Gibbons, M.D., director of the National Heart, Lung, and Blood Institute (NHLBI), a study funder. “Additional research can further expand on this effect, while providing a roadmap to rapidly translate research findings into clinical practice.” For the double-blinded phase 3 trial, known as Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) study, researchers randomized participants into either a treatment group, where they received a daily statin – in this case pitavastatin calcium – or a control group, where they received a placebo pill that contained no medication. The researchers followed participants for about five years, but ended the trial early when they discovered the treatment benefits outweighed potential risks.
July 22, 2023: At the 12th International IAS Conference on HIV Science, WHO calls for countries to expand use of HIV self-testing (HIVST), to offer HIVST for initiation, continuation and re-starting pre-exposure prophylaxis (PrEP) and to promote testing through sexual and social networks to increase testing coverage and strengthen uptake of HIV prevention and treatment services for the general population in high-burden settings and in populations and regions with the greatest gaps in testing coverage. These recommendations are issued at a moment of unique opportunity, when self-care and self-testing are increasingly being recognized as ways to increase access, efficiency, effectiveness and acceptability of health care across many different disease areas, including HIV. Although HIV testing is offered routinely in some clinical settings such as antenatal services, there are many missed opportunities for testing among people who present themselves at health facilities, including men who are often not offered testing even in high-burden settings. As of 2022, an estimated 5.5 million people with HIV still did not know their HIV status.
July 25, 2023: BANGKOK (AP) — Countries in the Asia-Pacific region need to drastically increase their investments in disaster warning systems and other tools to counter rising risks from climate change, a United Nations report said Tuesday. The report by the Economic and Social Commission for Asia and the Pacific, or ESCAP, says nearly $145 billion is needed to set up systems to minimize deaths and damage from floods, earthquakes, drought and other disasters. Artificial intelligence, satellites, remote sensing and other technologies would help with forecasting, notifying the public during emergencies and providing other services, but telecommunications systems must be fortified to ensure that vulnerable communities get the information, the report states. Most countries have failed to spend even 10% of what is needed, according to the commission’s review, which was released to mark the U.N.’s Disaster Resilience Week. The U.N. has set a goal of having every person on Earth covered by early warning systems by 2027, yet half of all countries lack such systems and even fewer have ones that are linked to emergency planning, Doreen Bogdan-Martin, head of the International Telecommunications Union, said in a video message on Twitter.
July 25, 2023: ALGIERS, Algeria (AP) — Fires raging through forests, mountain villages and towns in northern Algeria have left at least 34 people dead — with 23 of them in the coastal region of Bejaia, according to authorities and a local radio station keeping track of the grim toll in Bejaia. Among those killed were 10 soldiers encircled by flames during an evacuation, the Defense Ministry reported Monday night. Bejaia, part of the Berber-speaking Kabyle region east of Algiers, was the hardest-hit area, with 23 deaths since Sunday, the local Soummam Radio reported on Tuesday. Counting the deaths from the wind-driven blazes that swept through villages to the seaside, the radio report said that 197 other people were injured in the flames. The official APS news agency reported Monday night that 34 people had died across several regions, or “wilayas.” Some 8,000 firefighters and 530 trucks, backed by military fire-fighting aircraft, fought the blazes in scorching heat, according to the latest update. The Algerian Defense Ministry said on Monday night that 10 soldiers died in the hardest-hit region of Bejaia. It added that 25 people were injured and evacuated to the closest hospitals.
July 26, 2023: In April, the U.S. Environmental Protection Agency proposed limiting EtO emissions from sterilization facilities by 80% to minimize the risk of people developing cancer from exposure to the gas. AdvaMed has warned the limit could halve capacity at commercial sterilizing plants, and the FDA has cautioned that there is a lack of viable alternatives to EtO for many devices. The FDA is acting to support the transition to alternatives where possible. Earlier this year, officials began a pilot program to help companies change their sterilization sites or methods. Now, the FDA has moved to provide manufacturers with another sterilization option. Suzanne Schwartz, director of the Office of Strategic Partnerships and Technology Innovation at the FDA’s Center for Devices and Radiological Health, called low-temperature vaporized hydrogen peroxide “an important alternative sterilization method” in a Monday statement. The method uses hydrogen peroxide vapor under vacuum and, according to a trade body, shows “low toxicity.”
July 24, 2023: Philips said Monday its second-quarter sales rose 9% to €4.5 billion ($5 billion) from a year ago as it continued to make progress addressing the recall of millions of sleep apnea devices. The Dutch medical device maker said the previously disclosed litigation and U.S. Justice Department investigation into the recall are ongoing, as are discussions on a proposed consent decree. “Completing the Philips Respironics field action remains our highest priority. The vast majority of the sleep therapy devices are now with patients and home care providers, and we are fully focused on the remediation of the affected ventilators,” CEO Roy Jakobs said in a statement.
July 17, 2023: CHICAGO — Donna Carpenter, co-president of the community-led coalition POWER PAC-IL, has lived in Chicago’s Englewood neighborhood for more than 10 years. She spends much of her time attending rallies and advocating on behalf of low-income families in her community, where she raised six children and three grandchildren. Since 2017, Carpenter said her natural gas service has been shut off twice by her utility provider, Peoples Gas, because she’s been unable to pay bills. Like her, many residents of Englewood, a predominantly Black and low-income neighborhood, are struggling to keep up with the city’s natural gas bills rising prices. In fact, nearly 49% of residents are behind on bills in the neighborhood, according to data filed by Peoples Gas with the Illinois Commerce Commission. Yet as rates continue to rise, Carpenter said utilities aren’t looking out for marginalized communities. https://www.ehn.org/rising-energy-costs-2661985726.html
July 25, 2023: PITTSBURGH — A few years ago, Dr. Michael Boninger was thinking of leaving healthcare to pursue a job that would help address what he saw as the most pressing health issue of our time: the climate crisis. “I want the planet to be a safe place for my kids and my grandkids and the next generation,” Boninger, who specializes in physical medicine and rehabilitation, told Environmental Health News(EHN). He researched what jobs he might qualify for, but the answer was right in front of him: The healthcare industry takes a significant toll on the climate and human health. The sector accounts for an estimated 4.4% of total global greenhouse gas emissions and up to 9.8% of U.S. greenhouse gas emissions. Health damages from the U.S. healthcare sector’s pollution – including greenhouse gasses, carcinogenic emissions and other toxic air pollutants – from 2003-2013 are estimated to have cost Americans more than 400,000 years of full health, defined as years lived free of disease or disability.
July 18, 2023: While there are numerous studies on male and female cases of melanoma, there is limited research on racial differences of this skin cancer, especially among males. To learn more, a team of researchers reviewed the National Cancer Database. They examined cases of primary cutaneous invasive melanoma among non-Hispanic white, non-Hispanic Black, non-Hispanic Asian, non-Hispanic American Indian/Alaska Native, and Hispanic males. Their findings demonstrated disparities in melanoma among racial and ethnic groups. For American Indian/Alaskan Native, and white individuals, the trunk was the most common area for melanoma. However, Black, Asian, and Hispanic males were diagnosed with melanoma in the lower extremity. Stage 3 or 4 melanoma was also most common among Black people (48.6%). The 5-year overall melanoma survival rates were highest for white males (75.1%) and lowest for Black males (51.7%). Researchers discovered that Black people diagnosed with melanoma were 26% more likely to die than white people with the same diagnosis. “We hope that this study lays the foundation for future research to explore the reasons for why there are different presentations and survival among men of diverse racial groups in melanoma,” Dr. Bianka Bubic, study author and a dermatology research fellow at The Ohio State University Wexner Medical Center, told Medical News Today.
May 1, 2023: Younger women who have had a heart attack have more adverse outcomes and are more likely to return to the hospital in the year following their heart attack than men of a similar age. That’s according to a study published today in the Journal of the American College of Cardiology. The researchers used data from the VIRGO study, which provides observational information on the treatment and outcomes of heart attacks in people 18 to 55. In this study, the researchers looked at the health information of 2,985 people – 2,009 women and 976 men. The average age was 47. They reported that for all-cause hospitalizations within one year of discharge, nearly 35% of women were hospitalized again, compared to 23% for men. The researchers used any hospital or observation stay longer than 24 hours. The most common cause of re-hospitalization was heart attack and chest pain. In addition, women who had heart attacks had more adverse outcomes than men.
July 24, 2023: Among nearly 10 million US infants born between 2016 and 2018, breastfed babies were 33% less likely to die during the post-perinatal period (day 7-364) than infants who were not breastfed, reports a new study. The findings build on previous US research with smaller datasets, which documented the association between the initiation of breastfeeding and the reduction of post-perinatal infant mortality by a range of 19% to 26%. Among nearly 10 million US infants born between 2016 and 2018, breastfed babies were 33% less likely to die during the post-perinatal period (day 7-364) than infants who were not breastfed, reports a new study in the American Journal of Preventive Medicine, published by Elsevier. The findings build on previous US research with smaller datasets, which documented the association between the initiation of breastfeeding and the reduction of post-perinatal infant mortality by a range of 19% to 26%.
July 22, 2023: New mothers can expect sleep deprivation in the first few years of baby’s life. But too little sleep can take a toll on the health of both mother and child. A new study looks at maternal and infant sleep patterns, identifying predictors and providing recommendations for instilling healthy habits. New mothers can expect sleep deprivation in the first few years of baby’s life. But too little sleep can take a toll on the health of both mother and child. A new study from the University of Illinois Urbana-Champaign looks at maternal and infant sleep patterns, identifying predictors and providing recommendations for instilling healthy habits.
July 5, 2023: Social enterprises are organisations that promote social or environmental issues as their core business. They are useful to societies in lots of ways. They can help solve social and economic problems such as poverty and joblessness, among others. They can also help support the work of local, provincial and national government. Over the last decade a growing number of these enterprises have been started in many countries. South Africa has also seen an increase in social enterprises. But running a social enterprise isn’t easy. They need to pursue a social motive while also trying to remain sustainable with little funding. This often means that they need structures, processes and leadership acumen for both their operational success and sustainability.
April 7, 2023: Washington, DC: Yesterday, the Executive Board of the International Monetary Fund (IMF) reviewed the resource adequacy of the Poverty Reduction and Growth Trust (PRGT), Resilience and Sustainability Trust (RST), and Debt Relief Trusts including the Catastrophe Containment and Relief Trust (CCRT). The PRGT is the Fund’s main vehicle for providing concessional loans (currently at zero interest rates) to low-income countries (LICs). The RST delivers affordable long-term financing to low-income and vulnerable middle-income countries, as well as small states, to support reforms to reduce risks to prospective balance of payments stability from climate change and pandemics. The CCRT provides grants for debt relief for the poorest and most vulnerable LICs hit by catastrophic natural disasters or public health disasters, disbursing SDR 690 million across 31 countries during the pandemic, which left its cash balance almost depleted.
July 25, 2023: Hundreds of millions of people around the world are affected by humanitarian crises, including natural disasters, armed conflict, forced displacement, and major disease outbreaks. The frequency, intensity, and cost of these crises has steadily increased over the past several decades, trends that are expected to continue with ongoing threats from climate change and emerging pandemics. These crises have direct and indirect impacts on health, disproportionately affect vulnerable populations, especially in low- and middle-income countries. However, conducting health research in these settings is very difficult and there is a limited amount of scientific evidence that can inform how governments, nongovernmental organizations and other humanitarian organizations respond to them. The Fogarty Center for Global Health Studies (CGHS) leads a project exploring the role of global health research in the context of humanitarian crises. The goals of the project are to: (1) catalyze timely, high-quality, ethical and actionable research in crisis settings; and (2) strengthen the capacity of scientists, especially from LMICs, to conduct health research in crisis settings. Key partners in this activity include NIH Institutes and Centers, other U.S. government agencies, academic researchers from the U.S. and abroad, nongovernmental organizations and international organizations involved in humanitarian response. This field of research can also benefit the U.S. as lessons learned from global humanitarian crises can improve the government’s ability to respond to disasters in the U.S.
May 31, 2023: When I pull into the lot at the Harold Parker State Forest in North Andover at 8am, the early morning fog still burning off, people in camouflage and combat boots unload boxes alongside my car. Straight ahead is a roadblock erected out of boards, its scrawled, red-painted letters ordering passerby to stop and have their papers ready. I’ve arrived at the Harvard Humanitarian Initiative (HHI)’s three-day field simulation, which provides humanitarian students and professionals the rare opportunity to fully immerse themselves in the experience of working in a humanitarian emergency. The simulation acts as a capstone for Harvard graduate students in the Interdisciplinary Concentration in Humanitarian Studies. It is also the final project for those enrolled in HHI’s two-week Humanitarian Response Intensive Course, offered annually to humanitarian professionals from around the world. SIM attendees spend two nights in the forest, learning to think on their feet as they engage in a complex conflict and disaster scenario. The simulation has taken place yearly since its first iteration in 2004, but due to the pandemic, this is the first in-person one since 2019. It is a massive undertaking in terms of operations, coordination, and planning, explains Irini Albanti, HHI’s executive director. In addition to basic supplies such as large tents and food for hundreds of participants and volunteers, staff need to organize costuming, dozens of tents, and technological and medical supplies akin to what one would find at a real disaster site. However, HHI is greatly supported by local and international organizations, which donate supplies and space for its activities every year, and donors who support both the simulation and Harvard’s Interdisciplinary Concentration in Humanitarian Studies.
By Martha Smee MPH (c) MMS (c) and Dr. Heather F. McClintock PhD MSPH MSW
In the 21st century, the occurrence of pandemics has been increasing in frequency. A variety of factors explain this phenomenon, including increased travel and urbanization, a depleted health workforce, and climate change causing increased human-animal contact. Zoonotic diseases, which result from the passage of germs from animals to humans, account for 75% of emerging infectious diseases. The 2009 Swine Flu is just one earlier example of the impact of zoonotic disease. Other pandemics from the past two decades include the SARS-CoV-1 pandemic of the early 2000s and the SARS-CoV-2 pandemic which began in late 2019. SARS-CoV-2, which may be better known as COVID-19, is the most widespread and deadly pandemic in recent history. Most people are probably sick of hearing, “We’re living in unprecedented times!” But it’s true. No other event has so clearly exposed the vulnerabilities of our modern world. No other event has touched billions of lives, rattled economies worldwide, and changed the way that we think and feel. In the lens of public health, it is worthwhile to take a look at how COVID-19 impacted the healthcare systems landscape, and what role universal health coverage (UHC) could play in our preparation for future pandemics and our “new normal” in the context of COVID-19. COVID-19 may have been “unprecedented,” but when (not if) the next pandemic occurs we must not let history repeat itself.
Health systems across the world felt the impact of COVID-19. The World Health Organization (WHO) reports that 92% of countries reported disruptions in essential services. Included are 25 million children who were deprived of routine immunization. Diversion of supplies and manpower to COVID-related illness left few resources to administer essential services, treat routine illnesses, and respond to emergencies. Not all countries were equally affected. High-income countries reported less service disruptions compared to low-income countries. In addition, countries with greater UHC were less impacted. When controlling for covariates, one study found that countries with high UHC experienced significantly less decline in childhood immunization coverage compared to countries with low UHC. These results show the potential of UHC to act as a protective factor against external shocks to a health system, such as a pandemic. Further, economic inequality plays a role in the resiliency against COVID-19. One study showed that poor and more vulnerable populations had a harder time bouncing back, finding that the richest and poorest quintiles globally lost about the same amount of income in 2020, but only the richest quintile recovered the majority of their losses in 2021. Inequalities exacerbate the impacts of COVID-19 worldwide.
As great as it would be, UHC is not a cure-all. A better future can be built through coordination of various policies and efforts to promote population health and equity. UHC is one key component, but on top of it we need policies which invest in social services, promote climate resiliency, and increase global health security. All of these pieces work together. Investing in social services such as paid sick leave, supplemental nutrition programs, and affordable housing contributes to tackling the social determinants of health and root causes of inequity. Climate policy can address the threat that climate change is posing to our existing systems. Global health security programs and initiatives can promote the proactive response to acute threats to public health. All of these components complement one another and work in harmony to create the foundation to best promote health and well-being.
Martha Smee MPH (c) MMS (c)
Martha Smee is a current student in Arcadia University’s Dual Master of Public Health/Master of Medical Science in Physician Assistant Program. As an MPH student, her capstone research explored the relationship between state Medicaid policy and mental health outcomes. She completed an internship at the Free Library of Philadelphia’s Culinary Literacy Center where she assisted with curriculum development and program facilitation to promote literacy through food, cooking, and community-building. Her public health interests include health policy, access to mental health services, and environmental health. After graduating, she plans to continue practicing evidence-based public health as a primary care provider in the Philadelphia area.
Dr. Heather F. McClintock PhD MSPH MSW
Dr. McClintock is an IH Section Member and Associate Professor in the Department of Public Health, College of Health Sciences at Arcadia University. She earned her Master of Science in Public Health from the Department of Global Health and Population at the Harvard School of Public Health. Dr. McClintock received her PhD in Epidemiology from the University of Pennsylvania with a focus on health behavior and promotion. Her research broadly focuses on the prevention, treatment, and management of chronic disease and disability globally. Recent research aims to understand and reduce the burden of intimate partner violence in Sub-Saharan Africa. Prior to completing her doctorate she served as a Program Officer at the United States Committee for Refugees and Immigrants and a Senior Project Manager in the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania. At the University of Pennsylvania she led several research initiatives that involved improving patient compliance and access to quality healthcare services including the Spectrum of Depression in Later Life Study and Integrating Management for Depression and Type 2 Diabetes Mellitus Study.
By Martha Smee MPH (c) MMS (c) and Dr. Heather F. McClintock PhD MSPH MSW
The U.S. healthcare system is one of the biggest and most complicated healthcare systems in the world. Insurance and healthcare provision are provided through a mix of public and private, for-profit and nonprofit initiatives and organizations. Compared to other high-income countries, we spend the most amount of money on health care yet have the worst outcomes. At face value, that doesn’t add up. In a 2021 report, The Commonwealth Fund (CWF) took a closer look and found four factors that differentiate the U.S. health system from those of comparable countries. First, and perhaps most obviously, the U.S. lacks UHC. As a result, many Americans, most of which are low-income people of color, go uninsured. A host of poor outcomes are the result. Uninsured people are more likely to delay or go without care, be hospitalized for an avoidable reason, have higher rates of death when hospitalized, and financially suffer due to medical bills. Poor and marginalized individuals are more likely to suffer from chronic disease and less likely to be able to afford health insurance or treatment. Lack of UHC contributes to existing health disparities, and the cycle of poverty goes on. Second, CWF identified that the U.S. lags behind other industrialized nations in primary care. Although American primary care providers (PCP) are more likely to address social needs of patients, continuity of care is lacking. Americans are less likely to have a regular place to go for care or have a lasting relationship with a PCP. As a student [Martha Smee (MS)] entering the healthcare field as a future Physician Assistant, I see this deficiency in action, as many of my peers are more interested in entering specialties compared to primary care. Specialties are simply where the money is at. Third, the U.S. has a greater amount of administrative red tape compared to other countries. The American healthcare system is uniquely wasteful in terms of administrative expense, which mostly has to do with our free-market approach to healthcare and efforts to manage utilization (e.g., impeditive prior authorization). Fourth, the U.S. does not invest enough in social services. This is a problem, considering that social determinants of health, like housing, education, income, and insurance status, account for up to 40% of health outcomes. Even if not explicitly tied to health, social services play a role in disease prevention. For example, residents of states which had more supportive social policies (e.g., Medicaid, unemployment support, eviction moratoriums, etc.) had less adverse mental health outcomes during the COVID-19 pandemic.
My [Martha Smee] interest in population social services led me to complete my MPH capstone research on the association between state Medicaid policies’ support of mental health and mental health outcomes. I conducted a policy analysis using Medicaid state plans and hospitalization rate data from the Healthcare Cost and Utilization Project. After combing through eight states’ Medicaid plans, I ranked them by their promotion of mental health services and evaluated them in relation to each state’s depression hospitalization rates. The main finding was that states with better mental health outcomes tended to have Medicaid policies that more strongly promoted accessibility of outpatient mental health services compared to states with worse mental health outcomes. Investment in social services increases the efficiency of our health system and the health of the American people.
One simple sentence that I [Martha Smee] heard during my MPH studies has stuck with me since: “Health is not an individual decision.” If health were an individual decision, I would imagine most of us would be eating fresh fruits and vegetables every meal, getting enough exercise and sleep, and visiting a doctor regularly. In reality, health results from a collection of circumstances, some of which are within an individual’s control, but most of which are not. UHC has the potential to impact many of the underlying circumstances which contribute to individual and population health. UHC is the key to a more sustainable world which values health equity, and above all, human life.
IH CONNECT 