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In 1965, in an impoverished rural county in the Mississippi Delta, the pioneering physician Jack Geiger co-founded the nation’s first community health center. Many of the children Geiger treated were seriously malnourished, so he began writing “prescriptions” for food — stipulating quantities of milk, vegetables, meat, and fruit that could be “filled” at grocery stores, which were instructed to send the bills to the health center, where they were paid out of the pharmacy budget. When word of this reached the Office of Economic Opportunity in Washington, which financed the center, an official was dispatched to Mississippi to reprimand Geiger and make sure he understood that the center’s money could be used only for medical purposes. Geiger replied: “The last time I looked in my textbooks, the specific therapy for malnutrition was food.” The official had nothing to say and returned to Washington.

In some ways, the United States has come a long way since Lyndon Johnson declared the “war on poverty.” But in others, we’re still at square one. We now have a variety of federally-supported nutrition programs, but the health care system remains senselessly disconnected from the “social determinants of health.” In this regard, the United States has fallen behind the rest of the world. If a politician in India announced a public health plan that neglected malnutrition, he would be ridiculed. Here, leaders make this kind of omission all the time. Almost all of the debate about the 2010 Affordable Care Act was consumed with questions about health care access and quality. But if we really want to improve the health of millions of people, we have to address the conditions that make them sick.

One of the most impressive organizations in the country that is developing an approach to do this is Health Leads, which mobilizes and trains about 1000 volunteers each year who staff resource desks located in the waiting rooms of 23 hospital clinics or health centers in Baltimore, Boston, Chicago, New York, Providence, R.I., and Washington. At these sites, doctors now regularly “prescribe” a wide range of basic resources — like food assistance, housing improvements, or heating fuel subsidies — which Health Leads’ volunteers “fill” — applying their problem solving skills (and tenacity) to identify resources anywhere they may be available.

Health Leads was co-founded by Rebecca Onie in 1996, while she was an undergraduate student at Harvard University. Onie had first witnessed the intimate relationship between poverty and health while volunteering at Greater Boston Legal Services, where she assisted low-income clients who had housing problems. Many lived in dilapidated apartments with leaky pipes, broken windows, rooms full of mold, and walls infested with cockroaches and rats. Often families couldn’t afford to pay for heat. Towards the end of the month, some ran out of food. Onie found herself interviewing mothers whose children came to the office wheezing and coughing from asthma and lung infections — health problems caused or triggered by bad housing. Often, the children had been in and out of hospitals for years; many had fallen far behind in school.

One day, she read a magazine story about Barry Zuckerman, chairman of pediatrics at Boston Medical Center (B.M.C.), who had established the Medical-Legal Partnership for Children, a program that connected doctors with lawyers to assist patients (it has since spread to more than 235 health institutions nationally). Close to 70 percent of the patients at B.M.C. are poor and Zuckerman, like Geiger, had grown tired of treating children, only to see them readmitted to the hospital because nothing was done to address the causes of their illnesses. In some cases — as when a child has chronic asthma attacks because the landlord refuses to clean up mold — a lawyer could be more effective than a doctor.

“I thought bringing lawyers into the hospital was brilliant,” recalled Onie. She called Zuckerman to see how she could help and he invited her to spend six months talking to people in the unit. There Onie found doctors who were “smart, passionate and totally committed to their patients” and yet “stymied in terms of their ability to bring about the health outcomes they wanted.” Some physicians told her they knew they should be asking more about food, housing or social issues, but they were afraid of opening a “pandora’s box.” “I have no idea where to begin to address the problems,” one physician told Onie. “I have 13 minutes with each patient.” (Studies reveal that doctors are reluctant to inquire about issues — domestic violence, for example — when they feel powerless to intervene.)

Onie thought that students could help. With Zuckerman, she founded Health Leads (formerly Project Health) to recruit and train students to provide patients with connections to resources deemed necessary by doctors and other health care providers. “What are college students built to do?” asks Onie. “Track down information!” She adds: “Say your client is a Latina mother working two jobs. She needs food supplements. She has no transportation. Your job is to locate a food pantry within walking distance of her home that’s open after 8:00 p.m. and has a Spanish speaker on staff. That’s a perfect problem for a college student. It’s like a really fancy Google search.”

From the outset, Onie made the decision to work only with students who demonstrated high levels of motivation and commitment. In some of Health Lead’s sites today, as few as 10 percent of students who apply get selected. This has had the effect of attracting serious volunteers. In 2010, the organization reported that in 57 percent of cases its volunteers secured a needed resource within 90 days. This year, Health Leads will serve 9,300 patients and families — not a huge number given the scope of the problem it seeks to address — but the approach is gaining momentum.

One indication is that, where Health Leads works, doctors are changing their behavior. In the Children’s National Medical Center, in Washington, for example, over the past year, there has been a 300 percent increase in doctors “prescribing” Health Leads through the hospital’s Electronic Medical Record. The resources they request for patients include things like exercise or summer meal programs for children or subsidized child care for mothers, so they can find work and afford better food and housing.

Health Leads is also demonstrating that it can improve the efficiency of social workers. In some of the large urban hospitals where the program operates, the ratio of patient visits to social workers is close to 25,000 to 1. Because students can handle basic — but time consuming — cases, social workers can concentrate on what they’re trained for. At The Dimock Center, in Roxbury, Mass., initial data suggests that the program has doubled the time social workers can devote to therapeutic work.

Health Leads is also preparing a pipeline of new health care leaders. Two thirds of its students are either in pre-med tracks or pursuing careers in health, and the exposures they are getting are likely to shape the way they think about health care. As one volunteer said: “When I’m a doctor, I will never prescribe antibiotics that say ‘take with food’ without making sure that the family actually has food in the house.”

Many health care professionals know that social conditions impact health more than medical care. In a survey conducted by Health Leads at Bellevue Hospital in New York, almost every pediatric primary care provider said the failure to address social and psychological needs “impairs” their ability to treat patients effectively. The vast majority said that the hospital needed a standardized system to screen for these needs on routine well-child visits. But 80 percent said it lacked the capacity to do it.

There is very little money available for this work. Medicaid doesn’t generally reimburse social workers for non-therapeutic tasks. Most of the time, this kind of assistance falls through the cracks. Society then spends oodles of money treating the crises that follow. “There is a tension between what we all know, and agree, needs to be done, and what we are doing,” says Onie. “As a society, we haven’t yet decided that we actually want less emergency room visits.”

Just a year ago, Onie thought that Health Leads’ biggest obstacle would be getting doctors to pay attention to patients’ social needs — given all the demands on their time. Today, the organization is getting so many referrals from doctors, for the first time in its history it has long waiting lists. Five decades after the war on poverty, a work force that can systematically address the social causes of illness is still to be built. Health Leads offers a model of how it might work. A broader system could incorporate students, community health workers, and lay workers. It need not be a perfect solution, nor an expensive one. But something has to be done. And the big challenge is getting health care decision makers to prioritize and pay for it. As Onie says: “How would we ever think that we’re going to secure a return on our health care dollar until we start dealing with these social factors?”

Source: http://opinionator.blogs.nytimes.com/2011/07/28/treating-the-cause-not-the-illness/?hp

Stepping outside to smoke a cigarette may not be enough to protect the lungs and life of a pregnant woman’s unborn child, according to a new study in the American Journal of Physiology.

The study, by researchers at the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center (LA BioMed), found prenatal exposure to toxic components of a newly recognized category of tobacco smoke — known as “thirdhand smoke” — can have as serious or an even more negative impact on an infants’ lung development as postnatal or childhood exposure to smoke. Thirdhand smoke is the newly formed toxins from tobacco smoke that remain on furniture, in cars, on clothing and on other surfaces — long after smokers have finished their cigarettes.

“Thirdhand smoke is a stealth toxin because it lingers on the surfaces in the homes, hotel rooms, casinos and cars used by smokers where children, the elderly and other vulnerable people may be exposed to the toxicants without realizing the dangers,” said Virender Rehan, MD, a principal investigator at LA BioMed and corresponding author of the study. “Pregnant women should avoid homes and other places where thirdhand smoke is likely to be found to protect their unborn children against the potential damage these toxins can cause to the developing infants’ lungs.

Dr. Rehan, a National Institutes of Health-funded investigator who has been researching the effects of smoking on lung development for more than a decade, said this is the first study to show the exposure to the constituents of thirdhand smoke is as damaging and, in some cases, more damaging than secondhand smoke or firsthand smoke.

“We looked at the mechanisms that drive normal lung development and found those mechanisms were clearly disrupted by thirdhand smoke,” he said. “Based on this, we can conclude that prenatal disruption of lung development can lead to asthma and other respiratory ailments that can last a lifetime.”

Thirdhand smoke is aged secondhand smoke, and it attaches to the surfaces in homes and other surroundings. It is composed of smaller, ultrafine particles with a greater molecular weight that pose a greater asthma hazard than firsthand or secondhand smoke. Although concerns about the dangers from thirdhand smoke have been raised recently, this new study is the first to provide biological data to support these concerns.

Dr. Rehan said touching surfaces contaminated with thirdhand smoke, as well as ingesting dust containing the superfine particles of thirdhand smoke, are the most likely major pathways for exposure to these toxins.

“Children and pregnant mothers in busy households are especially susceptible to thirdhand smoke exposure because they could touch or breathe in the toxic substances from contaminated surfaces,” he said. “Among infants, it has been found that the rate of ingesting dust is more than twice that of adults, making babies especially vulnerable to the effects of thirdhand smoke.”

He also noted that nicotine levels are six times lower among infants living in homes with strict no-smoking policies.

“The dangers of thirdhand smoke span the globe because smoking is more prevalent in many other countries than it is in the United States,” he said. “While further study is needed, the alarming data clearly highlight the potential risks and long-term consequences of thirdhand smoke exposure.”

While previous studies had documented the danger of nicotine in thirdhand smoke, this new study measured the effect of two other toxins in thirdhand smoke — 1-(N-methyl-N-nitrosamino)-1-(3-pyridinyl)-4-butanal (NNA) and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK). The researchers found prenatal exposure to thirdhand tobacco smoke components plays a much greater role in altered lung function in offspring than postnatal or childhood exposures.

The study was published online and is scheduled for publication in an upcoming special edition of the American Journal of Physiology on the effects of smoking. The study was funded by the National Institutes of Health (Grant Nos. HL75405, HD51857, HD058948 and HL55268) and the Tobacco-Related Disease Research Program (Grant Nos. 14RT-0073, 15IT-0250 and 17RT-0170.)

Updated: Thu Dec. 30 2010 11:46:40

ctvedmonton.ca

Before she died at the age of 41 from lung cancer, Barb Tarbox was an anti-tobacco activist. Now, under the federal government’s new plan to display larger and more graphic warning labels on cigarette packages in an effort to get more Canadians to stop the habit, images of Tarbox in the final stages of lung cancer will be included.

The new images will cover 75 per cent of cigarette packaging, which is an increase from the current 50 per cent standard.

The plan includes featuring a variety of captions and pictures of Canadians who have been harmed by smoking, including  Tarbox, who died of cancer in 2003.

During a Thursday morning news conference, Health Minister Leona Aglukkaq said the warnings will appear on cigarette packaging as soon as possible. The government also says the warnings will be changed frequently to drive the message home to smokers.

“Using a testimonial from her [Tarbox] tragic story will make people stop and think about the dangers of tobacco use. Canadian and international research has shown that to be effective health warning on tobacco packages must be noticeable and memorable,” said Aglukkaq.

The health minister stressed the government is committed to helping Canadians kick the habit, which kills an estimated 37,000 people in Canada each year.

The government also plans to introduce a phone hotline and website that smokers can access to get information on how to quit.

With files from Sonia Sunger and CTV.ca News Staff

There is an old saying that an ounce of prevention is worth a pound of cure. This of course refers to our health and well being since by making healthier lifestyle choices, we can improve our quality of life and greatly reduce our chances of becoming sick.

In our busy lifestyles, we find ourselves increasingly sedentary and spending more and more time in front of computers or on our smart phones/media devices etc.

However, all this lack of interacting with the real world has been linked to diabetes, heart disease, depression and a host of other illnesses of both body and mind. The best way of preventing this has been shown to involve simply getting out and visiting green spaces such as parks, gardens, and other natural environments.

By interacting more with our world we are essentially improving the health of our selves both physically and mentally, which in turn helps fight off illness and depression. It is well known that people who are constantly stressed out are more likely to catch ailments whether it is physical or even mental since our minds and bodies are both intimately involved in our health and too much stress can weaken the immune system.

As a result, doing things such as visiting the park, socializing with others, spending time with family and friends, and exercise will all have beneficial effects on our health. As an added bonus, many of these activities are free and so will have minimal effect on ones finances, making it much more accessible.

With health care such an important issue, prevention is starting to look all the more tantalizing since, after all, people would rather avoid becoming sick or depressed instead of having to find treatment once it happens. Spending some time with the natural world has been making its way back into people’s minds because of its ability to improve people’s outlook on life, and improve the emotional state of the ill, which in turn can help the healing process.

Research carried out by researcher Dr. Roger Ulrich had found that surgery patients who’s beds had a view of nature, such as trees, rivers, mountains etc had a faster rate of healing compared to those who could only see buildings and walls. In fact, more and more doctors are beginning to prescribe simply getting out and around nature, as a growing number of research studies are discovering the positive effects of spending time with the natural world and taking in some natural light.

All of these discoveries are also influencing the design of hospitals all over the world. A field referred to as evidence based design in health care architecture, involves taking these new findings and implementing them in the build and layout of hospitals and clinics; such as more natural light, reducing noise, and increased view of nature and gardens, all for the purpose helping the healing process. In addition, providing comfortable and positive spaces for family and friends of patients will also help heal as it fosters interaction and support for one another by alleviating stress for patients, family/friends, and hospital staff as well.

Further Reading:

http://www.nytimes.com/2010/11/30/health/30brody.html?_r=1&ref=health

http://www.webmd.com/depression/guide/exercise-depression

http://www.asianhhm.com/healthcare_management/hospitals_heal.htm

Mayor Michael R. Bloomberg of New York telephoned the Uruguayan President Jose Mujica on Monday morning to pledge his financial assistance to that nation’s fight against the world’s leading cigarette company.

Mr. Bloomberg, a billionaire with a long record of anti-smoking activism, said his pledge was prompted by a front-page article in The New York Times on Sunday. The article detailed some of the lobbying, marketing and court activities by multinational tobacco companies.

On Monday afternoon, Mr. Bloomberg announced at a news conference that he would direct to Uruguay’s legal defense some of the $375 million he has set aside in a philanthropy to fight smoking. In a news release, he did not name a precise figure.

Uruguay, viewed as a world leader in anti-smoking laws, is being sued by Philip Morris International in a Washington-based affiliate of the World Bank. The cigarette giant objects to two new Uruguayan laws. One covers 80 percent of the front and back of cigarette packages with a graphic health warning. The other bans more than one type of any brand of cigarette, such as Marlboro red, gold and silver.

The suit has rallied anti-smoking forces globally. They interpreted it as an attempt to intimidate Uruguay and send a message to other developing nations on the eve of a conference of tobacco control officials from 171 nations. The conference in Punta del Este, Uruguay, is planning to recommend guidelines to enforce a broad anti-smoking treaty sponsored by the World Health Organization.

In the press release, Mr. Bloomberg said his money “will assist Uruguayan government officials by providing legal research and expertise, launching public education mass media campaigns, and galvanizing world support and public opinion.”

Peter Nixon, a spokesman for Philip Morris International, said in recent interviews that the lawsuit was necessary to protect the company’s trademark and intellectual property rights. He said its filing in February was unrelated to the conference of tobacco control officials. The suit seeks unspecified damages.

Of the size of the health warning, Mr. Nixon said, “The previous ones were 50 percent and we thought that was reasonable. Once you take it up to 80 percent, there’s no space for trademarks to be shown. So we thought that was going too far.” The limit on brands, he added, forced Philip Morris to remove a number of brands from the market.

A group of health nonprofit organizations bought a full-page advertisement in Uruguay’s leading newspaper Monday to thank the country’s president for standing up to tobacco companies. Philip Morris International’s $66 billion in annual revenues is twice the size of Uruguay’s gross domestic product.

Article By DUFF WILSON

Source: http://prescriptions.blogs.nytimes.com/2010/11/15/bloomberg-backs-uruguays-anti-smoking-laws/?partner=rss&emc=rss