What We Worry About Least in the Health Policy Debate

You shouldn’t have to worry about anything during vacation season.

So this column is my vacation gift to you. It is about all the health policy matters we seem to worry about the least. 

I have written close to 150 columns.  If you look down the right side of the page, you will find links to the ten most-read ones.  The subjects won’t surprise you – fairness in mental health treatment, Obamacare and private insurance, and cursed football players lead the way.

But do you ever wonder about the columns with the fewest readers?

Based solely and unscientifically on my numbers, here are a half dozen or so health policy matters we seem to care about the least.

Long Term Care. 

Are you worried about continuing high unemployment rates, taxes on small businesses, or another stock market crash ruining your family’s financial security?   If so, you should redirect that worry.  Because US Trust CEO Keith Banks called long term care costs “the biggest risk to family wealth” during a June 27, 2013 CNBC interview.

That’s because neither regular health insurance nor Medicare covers them.

So you can either pay $80,000 or more per year for long term care, or hope states continue to spend billions of dollars to expand Medicaid, or wait for Congress to create a national private long term care insurance program– something a new national Commission on Long Term Care has just been given three months to do.  That should get anyone’s anxiety level up.  But chances are – if you are still reading this column – your mind is wandering already, and you are ready to move on.

Medicare.

Whenever I write about Medicare, I lose 30 percent of my readers that week.  For example, I wrote two columns earlier this spring about something I found really intriguing and have never read anywhere else – that Medicare regularly pays more for men with depression than it does for women.  To me, this is blockbuster news about disparities in care.  But not to my readers. Maybe we need to be eligible for Medicare before we really start thinking about it?

Research.

Without research, there would be no modern healthcare system.  There would be no effective cancer treatments and no once-deadly communicable diseases – like polio – that ruined more than just children’s summers as recently as sixty years ago.  But the one time I wrote about why research matters – just two weeks after I wrote my most popular column ever – it was one of my least-read ones ever.

Child health.

Everybody loves children, but my columns on child health – even ones with sensational headlines – don’t seem to attract much attention.  It may be that we feel that we have solved most of our child health problems over the last few decades.  But as a brand-new Annie E. Casey Kids Count report points out, while we’re trending in the right direction, we still have a way to go.

Personal Responsibility and Wellness. 

This is another subject I have shied away from, after dipping a toe in the water two years ago.  I wrote about the way in which Connecticut, a liberal state, added a component of personal responsibility, a historically conservative concept, to its state employee health plan.  The state believes that it has saved money by doing this, and the approach has proved popular with employees.  But the column wasn’t popular with readers.  Why not?  We all want to be healthier. But maybe we don’t want health insurance to be tied to health!

Environmental health. 

While environmental health is a huge part of public health, environmentalists and public health officials often go their separate ways in policy advocacy.  I wish it were different.  But even when I wrote about the environmental devastation in the immediate aftermath of the Japanese nuclear disaster in March 2011 and put it in a broader public health context, not too many people paid attention.  The column drew fewer readers than almost every other column I wrote that spring.

Eric Cantor.

Don’t ask me why, but the least-read of my 150 columns was the only one that used the words “Eric Cantor” in the title.  If you have forgotten who Eric Cantor is, I am not going to remind you.  But once upon a time, he was actually relevant to the health policy debate in this country.

Lately he seems to be taking a vacation.  A long one.  As we all should be!

Paul Gionfriddo via email: gionfriddopaul@gmail.com.  Twitter: @pgionfriddo.  Facebook: www.facebook.com/paul.gionfriddo.  LinkedIn:  www.linkedin.com/in/paulgionfriddo/

President Obama and Governor Christie: A Model of Cooperation for Protecting Public Health

It took Super Storm Sandy to remind us how much we need our government. And how rarely we see government leaders truly cooperate.

Cooperation has been a dirty word in politics for close to two decades.  But in responding to the crisis caused by Sandy, President Obama and Governor Christie showed us that political adversaries are at their best when they work together to meet our needs.

It took an environmental holocaust for this to happen.  But as the pictures of destruction in state after state circulated throughout the media, no one talked about privatizing FEMA.  No one complained that the government was spending too many taxpayer dollars rescuing people from death. 

It was a fine way for the President to end his first term in office – one that may ultimately have won him his re-election.  And also won him a new opportunity to collaborate with the states.

In the storm’s aftermath, we understand that one of the prices of having the freedom to live where we desire – Queens or Greenwich, Staten Island or the New Jersey Shore, Hoboken or New Orleans, the West Virginia mountains or the central plains – is that we must protect our living environment.

We understand that no place is safe from sudden destruction.  So we need all levels of government – and they need our support – to build better flood berms, hire more first responders, and put in place pumps and sewers to get polluted water more rapidly out of streets, subways, and homes.

And to prevent such catastrophes in the future.

God only knows if Sandy itself was caused by preventable climate change.  And it’s not really worth arguing anymore with people who deny what they see with their own eyes – that our weather has changed dramatically over the past few years.

What no one can deny is that we have been lax in our preparation for catastrophe.  We have been lax in investing in the infrastructures needed to clean up and repair the devastation.  And we have been lax in investing in the infrastructures that can prevent such catastrophic damage in the future.

This time, the crisis was in the northeast.  In recent years, the central plains and gulf coast have experienced similarly horrifying environmental catastrophes. 

No one knows who will be next. But we all know someone will be next.

So we need to prepare.  And this means strengthening our public health infrastructure.  That infrastructure:

• Prepares for and organizes our response to natural disasters.
• Makes certain we have access to emergency services.
• Handles pollution control and abatement, decreasing our negative effect on our environment.
• Enforces our building codes.
• Prevents environmental and health disasters every day.

We have let this infrastructure go during the last few years, with deadly consequences.

• Local and state health departments have lost over 55 thousand workers to budget cuts.
• In New York and New Jersey alone, over half of local health departments lost jobs due to budget cuts in 2011.
• Almost one-quarter (23%) of local health departments nationwide have reduced or eliminated emergency preparedness functions. 

Robert Pestronk, Executive Director of the National Association of County and City Health Officers (NACCHO), predicted what would happen  almost a year ago, when he said “at this critical juncture of dwindling funding and difficult choices, health departments are now doing less with less.  Budget cuts and a declining public health workforce challenge their ability to protect the health and well-being of all people in their communities.”

How well the people of Staten Island and scores of other communities understand this now!

Despite the closeness of the election, Barack Obama has a mandate as he enters the next four years.  It is to continue the bi-partisanship that served us so well at the close of the campaign season.

And governors like Chris Christie have a new mandate, too – they need to rebuild public health infrastructures in partnership with the federal government, no matter what their Congressional representatives may say or do. 

As we continue to pray for our most recent victims, let us hope – for the good of all – that in the coming years our leaders heed these needs, and tackle together all the real crises that command our attention as a nation.

And let us hope that rebuilding the infrastructure that has been devastated as much by budget cuts as it was by Sandy will be at or near the top of the list.

If you would like to arrange for Paul Gionfriddo to speak to your group or organization, or have questions about this column, please send an email to gionfriddopaul@gmail.com.

The Biggest Environmental Disaster of the Decade

Here is a cautionary tale about the risk of downplaying the importance of environmental health.

A year ago, Fukushima City was a bustling city with a population of 290,000.  Its people were going about their business the day the earthquake and tsunami hit northern Japan, triggering the biggest environmental disaster most will ever experience.

At first, the trains stopped running because of damage to the railways, and most of the city’s water stopped running because of ruptures in water mains.

Over the next several days, a silent toxin began to spread along with word of the natural disaster.  The Fukushima nuclear power plants, 39 miles southeast of the city, began melting down, releasing radioactive particles into the air and water. 

Although Fukushima remained outside the quarantined evacuation zone stretching twelve miles out from the nuclear facility, waves of radioactive cesium dust escaped the zone, flying on the winds toward the city.  As it rained and snowed, the cesium dust fell to the ground, infiltrating homes and businesses, hospitals and markets, roadways and parks. 

A year later, the Fukushima government is still trying to save people’s homes by cleaning up a deadly environmental mess.

If you have ever experienced a home construction or renovation project, you have an idea of what environmental health officials are facing.  When you tear down a wall, sheetrock dust collects everywhere and sticks to everything – furniture and floors, wall hangings, clothes, and even inside cupboards and cabinets.  To clean it, you have to wipe down everything individually.  And what you don’t catch goes back into the air, eventually needing to be cleaned up again.

Now imagine that this dust were completely invisible and radioactive, and both indoors and outdoors.  That’s what the people of Fukushima have to clean.  Building by building and property by property, they go about their task.  They can’t just wash the cesium down the drain.  They have to dig out the top two inches of their landscapes, and cart away the vegetation and dirt as radioactive waste, or create mini nuclear waste dumps by burying everything contaminated in deep holes in their own backyards.    

If just one property owner refuses, then as it rains again, the entire neighborhood can be re-contaminated.

We should all know by now that Fukushima’s story today could be Hartford’s, Miami’s, or West Palm Beach’s tomorrow.  Hartford is just 40 miles from the Millstone nuclear plants, Miami is 25 miles from the Turkey Point nuclear plants, and West Palm Beach is 40 miles from the Jensen Beach nuclear plants.

If a Fukushima-level event hit near me or my family, I’d want a strong Health Department with a clear environmental health mandate ready to respond. 

But that’s not what people in Florida are getting.

Last week, Florida’s State Legislature passed a law eliminating the Division of Environmental Health from the State Health Department.  It also eliminated the Community Environmental Health and Healthy Communities, Healthy People programs.  The Florida Public Health Association and others fought valiantly against these changes.

Not only did the legislature eliminate the Division of Environmental Health, it removed from the Health Department’s duties in section 381.0011 of the Florida statutes the power to quarantine “premises as the circumstances indicate for… providing protection from unsafe conditions that pose a threat to public health.”

Faced with a Fukushima-level event, radioactive or otherwise, the Florida Health Department will no longer have the independent power to create an evacuation zone to protect the public health.

The legislature did give some quarantine responsibility back to the Department as an amendment to section 381.00315 of the Florida Statutes.  But in that section, the Department’s authority is severely restricted.  It must consult with any agency that might be affected, its quarantine order is limited to sixty days, and violations of the order are punishable by as little as a $500 fine.

In other words, if the Fukushima meltdown had happened in South Florida, any general quarantine orders related to Miami would have expired ten months ago, and the only penalty for repeated re-contamination of a neighbor’s property might be a $500 fine.

Political leaders often embrace nuclear energy and many other industrial contaminants, in spite of the risks and costs.  These risks may not bother them, but at the very least they could give the rest of us a modicum of protection.

Otherwise, the biggest environment disaster of the decade may not be the one we witnessed in Japan.  It could be the one that just played out in the Florida legislature.

If you have questions about this column or wish to receive an email notifying you when new Our Health Policy Matters columns are published, please email gionfriddopaul@gmail.com.

The Nuclear Nightmare in Japan

The catastrophic nightmare in Japan could happen anywhere.  It is a reminder of the fragile relationship between our environment and our health.

As the tsunami waves swept over the land, they swept away any pretense that we are more powerful than our environment.  The mere shifting by several feet of two constantly moving plates of the earth resulted in the death of thousands, the destruction of a region, and catastrophic worldwide effects.

Experts have noted that as many as 24% of premature deaths can be attributed to environmental factors.  These result from our inadequate understanding of our environment, and/or our inability to manage its forces.

While the underdeveloped world is more susceptible, the Japanese tsunami reminds us that the overdeveloped world is not immune.   

The images are more powerful than their descriptions.  In the wake of such destruction, we can see -- as we do in the aftermath of hurricanes -- the breeding grounds for disease.  We know that many of the survivors of the initial devastation will still become its victims. 

There are clear psychological effects as well.  In a matter of minutes, the lives of the shocked and stunned people of northeast Japan were changed forever.  Up to 15% of children who survived the tsunami, twice the norm for adults, will likely be diagnosed with PTSD.

Still greater effects are hidden in what we can’t see.

The partial meltdowns of multiple nuclear reactors are resulting in the release of deadly radiation into the atmosphere that will compromise human health for decades. 

Our leaders have forgotten how dangerous nuclear power can be.  Even some who consider themselves environmentalists naively believe that we “harnessed” the atom and made nuclear energy “green.”

Nothing could be farther from the truth.

In the 1950s and 1960s, nuclear energy was promoted as “safe, clean, and cheap” by the brand-new nuclear industry.  It was said that it was safer than walking across the street and would be too cheap to meter.  School children toured nuclear power plants to learn about the “peaceful atom.” 

Our government knew better.  In 1957, it passed the Price-Anderson Act, limiting the liability of nuclear plant owners in the event of a nuclear accident.  This is still the law of the land.  Without it, not a single nuclear power plant would have been commercially viable in this country. 

Each reactor owner must carry only $375 million of insurance to pay for damages from an accident; up to $12.6 billion more is in a secondary insurance pool.  If you lost your home to nuclear contamination, your homeowners insurance would pay nothing.

To put this in perspective, the total cost resulting from the Japanese quake and tsunami is already estimated to be up to $60 billion, and Hurricane Katrina did even more damage than this.  The Chernobyl accident cost Ukraine alone an estimated $201 billion.  The total compensation for a nuclear accident in this country could be as little as five cents on the dollar.

Once their liability was limited, nuclear companies were free to put their plants anywhere – near population centers and even along earthquake fault lines.

After many “minor” incidents in the United States and around the world during the 1960s and 1970s, the Three Mile Island accident in 1979 proved once and for all that the safety systems in nuclear power plants did not work as advertised.    

Then came Chernobyl in 1986.  This was the defining civilian nuclear disaster of the 20^th century.  Twenty-five years later, experts are still tallying its effects.  The World Health Organization conservatively estimates the number of deaths at nearly 10,000, plus thousands more excess cancers, and other health and mental health effects. 

A YouTube video shows how radiation would spread into the atmosphere if a Chernobyl-like accident were to happen in the United States.  It is a frightening reminder of the risks we are taking.

There is a lot we don’t yet know as the fuel rods melt down and the crisis unfolds in Japan.  One thing is certain.  It will be years before we understand the full global effect on human life from this event. 

We can all put those years to good use if we finally take to heart the lessons from this unspeakable tragedy.  We cannot overcome the limitations of our planet.  We do not control the forces of nature.  We can choose, however, not to stand in harm’s way. 

There are 104 operating nuclear reactors in the United States today.  Just as in Japan, some are built near earthquake fault lines and most are close to cities. 

Any one of them could be a time bomb.  It’s time we lived a little greener, and not supply so much fuel for the next environmental health disaster.

We can pretend that what’s happening in Japan is just someone else’s nightmare, or we can wake up and start doing something about it.