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Putting Humpty Dumpty Together Again: Consolidating Regulatory Authority Over Food Safety


February 23rd, 2015

The fragmented nature of regulatory authority over food in the United States is well known. More than a dozen federal agencies are responsible for the safety of the nation’s food supply. The Food and Drug Administration (FDA) and the Department of Agriculture (USDA) have the lion’s share of responsibility, together overseeing over 80 percent of the nation’s food safety.

Generally, the USDA regulates meat, and the FDA regulates everything else, but overlaps, exceptions, gaps, and therefore examples of resulting absurdities abound: the FDA regulates frozen pizza, unless it has pepperoni. The FDA regulates seafood, unless it’s catfish. The USDA has jurisdiction over packaged open-face meat sandwiches, but if the sandwiches are closed, authority shifts to the FDA.

This division in regulatory authority is neither planned nor rational. It is instead a historical accident, originating in the early twentieth century. When the Pure Food and Drug Act and Meat Inspection Act were passed on the same day in 1906, both targeting the adulteration of the food supply, their oversight was assigned to different departments within the USDA. The fissure widened when the FDA was moved out of the USDA in 1940. This divided regulatory framework is not the only reason for the fragmentation of regulatory authority over food in the US, but it is a main driver.

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Request For Abstracts: Health Affairs Food And Health Theme Issue


February 4th, 2015

Health Affairs is planning a theme issue on food and health in November 2015. The issue will present work that explores the relationship between the food we consume and our wellbeing on the individual, societal, and global levels. Articles will address causes and consequences of dietary excess and insufficiency, analyze policies and programs aimed at influencing these, and explore the roles of public policy, industry, and stakeholder groups in the context of dietary behavior.

We invite all interested authors to submit abstracts for consideration for this issue.

The issue will consider the implications of global food production and distribution for the health of consumers and food workers, environmental quality, and food prices, among other things. It will also examine actions taken from the community level upward to address increasingly universal concerns about food-related illness. Several papers will provide broad overviews of key issues, but we are particularly interested in empirical analyses of specific policies, programs, and practices aimed at influencing dietary behavior and clarifying our thinking about food’s role in health.

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Does Public Health Have A Future?


December 10th, 2014

Ebola’s arrival in the U.S. hit Americans with a jolt. Regardless of how you feel about the response to date, it should remind everyone of the importance of public health.

Fortunately, public health in the U.S. has built an extraordinary track record of success. Smallpox, one of the most dreaded diseases in history, was eradicated worldwide. New vaccines have sharply cut the toll of deaths and disabilities from H flu meningitis, tetanus, pneumococcal sepsis and other deadly diseases.

Adding folate to foods dramatically reduced neural tube defects in newborns. Safer cars and better roadway designs cut fatal crashes per million vehicle miles traveled by 90 percent. Because smoking is far less popular than it once was, 8 million Americans have been spared early and agonizing deaths from cancer, heart disease, emphysema, and other smoking-related diseases.

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Health Policy Brief: The Relative Contribution Of Multiple Determinants To Health Outcomes


August 22nd, 2014

A new Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation (RWJF) examines factors that can contribute to health status. In the United States, less than 9 percent of health expenditures go to disease prevention, and there is little support for social services, such as programs for older adults, housing, and employment programs.

This brief focuses on “multiple determinant” studies that seek to quantify the relative influence of some of these factors on health. It is part of a larger project, supported by the Robert Wood Johnson Foundation, which aims to create a structure for conducting analyses that demonstrate the value of investments in nonclinical primary prevention and their impact on health care costs.

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Recent Health Policy Brief: E-Cigarettes And Federal Regulation


July 11th, 2014

The latest Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation (RWJF) describes federal policy makers’ recent efforts to propose rules for e-cigarette regulation. E-cigarettes, virtually non-existent ten years ago, have skyrocketed in popularity, including among people who claim to use e-cigarettes as a tool to help them quit smoking altogether.

The 2009 Family Smoking Prevention and Tobacco Control Act gave the Food and Drug Administration (FDA) authority to oversee the manufacture, marketing, distribution, and sale of regulated tobacco products such as cigarettes, tobacco in cigarettes, roll-your-own, and smokeless tobacco. But it left unregulated other tobacco products such as cigars, pipe and hookah tobacco, nicotine gels, and e-cigarettes.

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Washington Wakes Up To Socioeconomic Status


July 11th, 2014

John Mathewson, executive vice president of Health Care Services for Children with Special Needs (HSC) – a Medicaid managed care plan in D.C. for children on Supplemental Security Income (SSI) – recently spoke at the Association for Community Affiliated Plans (ACAP) CEO Summit before the July 4 Recess.

Mathewson described what he has dubbed The Kitten Paradox: When HSC examined environmental factors for children with asthma, it found that the presence of pets in the house was a common thread, not too far behind having a smoker around. Yet, it turns out the value a cat brings by protecting from mice or spawning a litter for sale outweighs any financial costs to the family associated with an ER visit, which are often free or carry a low copayment. Thus the paradox.

An awardee at the conference, Hennepin Health, catalogued the evidence showing that reliable housing can improve health outcomes, including improving mental health and lowering emergency room and inpatient hospital utilization.

The focus of these sessions was the social determinants of health, and a lot of these safety net health plan leaders’ heads were nodding throughout. The plans, which disproportionately serve Medicaid enrollees and thus ‘dual eligible’ seniors in Medicare, know something about the importance of social determinants that the health policy community – at least in Washington – is only now slowly waking up to.

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Broadening the ACA Story: A Totally Accountable Care Organization


January 23rd, 2014

Note: This post is coauthored by Stephen Somers and Tricia McGinnis of the Center for Health Care Strategies.

Amid the bumpiness of Obamacare’s widely publicized technical launch, some in the media started taking the opportunity to laud the Affordable Care Act’s (ACA) largely untold story in reforming our “overpriced, underperforming health care system.”  The New York Times’ Bill Keller and Harvard health economist David Cutler, writing in the Washington Post, reported that progress was being made on multiple fronts in re-orienting the system to pay “for the value, not the volume, of medical care.” They pointed to penalties for hospital readmissions; the use of bundled payments; the development of Medicare and commercial accountable care organizations (ACOs); and a slowdown in health care cost growth at least partially attributable to these changes.

Within state-run Medicaid programs, a parallel phenomenon has been taking shape—the creation of ACOs tailored to the care needs of Medicaid’s beneficiaries, many of whom have multiple chronic health and social challenges. While ACOs for the broad range of Medicaid beneficiaries will be similar to the ACOs that already exist in the Medicare and commercial insurance sector, a new breed of Totally Accountable Care OrganizationsTACOs – offer the potential to push accountability for Medicaid populations, including those with complex needs, to a new level. “Totally” refers to the expectation that these organizations will be responsible for services beyond just medical care (for example, mental health, substance abuse treatment and other social supports), as well as the aspiration that these organizations will assume accountability for all associated costs of care, ultimately, through global payment mechanisms.

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Health Affairs Web First: First-Ever Quantitative Data About The Toll Of BPA Exposure


January 22nd, 2014

The risks of exposure to Bisphenol A (BPA) have been well known for some time. While exposure to BPA in the United States affects an estimated 92.6 percent of Americans over the age of five, there are gaps in the knowledge of the health consequences of BPA exposure.

A new study, released today as a Web First by Health Affairs, presents the first estimate of the potential disease burden and costs associated with ongoing exposure to BPA. Author Leo Trasande found that $2.98 billion in annual costs are attributable to BPA-associated childhood obesity and adult coronary heart disease. Of the $2.98 billion, the study identified $1.49 billion in childhood obesity costs, the first environmentally attributable costs of child obesity to be documented. Trasande holds faculty appointments at New York University’s School of Medicine, Wagner School of Public Service, and Steinhardt School of Culture, Education and Human Development.

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RWJF’s 2011 ‘Top 20′ Includes 6 From HA; Voting Open For ‘Final 5′


December 9th, 2011

David Colby, vice president of Research and Evaluation at the Robert Wood Johnson Foundation (RWJF), has announced the lineup for RWJF’s Most Influential Research Articles of 2011. As it has done in past years, the foundation has listed 20 RWJF-funded articles across the broad spectrum of its program areas. The articles were selected based on […]

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New Health Affairs: Community Development Sector Helping Build Healthier Neighborhoods


November 8th, 2011

The community development sector –a network of real estate developers, banks, city planners, and non-profit groups — has traditionally focused on promoting jobs, affordable housing and improved quality of life in low-income communities.  Now it is increasingly taking on the role of improving public health, and building healthier, more prosperous communities with nutritious food, clean […]

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Release Event For New HA Issue: Reminder & Live Webcast Info


November 7th, 2011

Tomorrow, Tuesday, November 8, Health Affairs will release its November 2011 issue, “Linking Community Development & Health.”  The issue explores the connection between improving the health of populations and undertaking efforts to raise incomes, employment and overall economic activity in low-income communities.  In addition to the community health material, the issue features a number of […]

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Uwe Reinhardt Confirmed For Health Affairs November Issue Release


November 4th, 2011

Uwe Reinhardt will speak at the release event for the November issue of Health Affairs. Reinhardt, the James Madison Professor of Political Economy at Princeton University and the author of an article in the issue, will offer a presentation titled “An All-Payer System: Solution For The Alleged Cost-Shift.” The event will take place on Tuesday, […]

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Health Affairs Briefing: Linking Community Development & Health


October 31st, 2011

On Tuesday, November 8, Health Affairs will release its November 2011 issue, “Linking Community Development & Health.”  The issue explores the connection between improving the health of populations and undertaking efforts to raise incomes, employment and overall economic activity in low-income communities. The issue builds on the work of the Robert Wood Johnson Foundation and […]

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New Health Affairs Issue Explores Health And Health Care Disparities


October 7th, 2011

In terms of both health and health care, America is an unequal nation. There are well-documented differences in health between whites and racial and ethnic minorities—for example, in life expectancy.  There are also demonstrable differences in health care provided to people of different races and ethnicities—for example, in screening rates for cancers. Despite these gaps, […]

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Health Affairs Disparities Briefing: Reminder And Twitter Information


October 4th, 2011

On Thursday, October 6, Health Affairs will hold a briefing to release its October 2011 issue, “Agenda For Fighting Disparities.”  The issue explores the relationship of social and economic determinants to health disparities; the role of specific environmental factors; disparities in the quality of health care delivered at hospitals; and other relevant topics. Health Affairs […]

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Women and Smoking: New Funding for Tobacco Control in the Developing World


September 22nd, 2011

The author, who is president of the Pfizer Foundation, spoke at a UN meeting this week on noncommunicable diseases. The United Nations (UN) has been hosting its High-Level Meeting on Non-Communicable Diseases September 16–21 in New York City. This is an important opportunity to highlight the alarming incidence of chronic diseases in developing countries and […]

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Post On Health Reform And Medicare Tops May’s HA Blog Most-Read List


June 3rd, 2011

Thomas Saving’s and John Goodman’s post on the implications of the Affordable Care Act for Medicare leads the list of most-read Health Affairs Blog posts for May. On the list as well are posts on the hazards of ignoring the lessons of the Clinton years; the opportunities offered by clinical registries; and the implications of […]

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Protecting Children from Environmental Chemical Exposures: An Economic Priority


May 24th, 2011

In the May Health Affairs issue, Sarah Vogel and Judy Roberts map out the disastrous history of the 1976 Toxic Substances Control Act (TSCA), the major legislation that regulates chemicals.  TSCA makes it difficult for the Environmental Protection Agency (EPA) to restrict use of any of the 62,000 chemicals already in commerce.  It does not […]

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Community Development And Health Is Topic Of November HA Cluster


May 13th, 2011

Health Affairs plans a thematic cluster for its November 2011 issue on the topic of community development and health. Manuscript submissions are due no later than July 5, 2011. Papers will be selected for the issue based on competitive review. The publication of this cluster is supported by the Robert Wood Johnson Foundation, which in […]

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Strengthen Restrictions On Health-Threatening Chemicals, Says Study


May 10th, 2011

With growing evidence of the link between exposure to toxic chemicals and chronic diseases, especially in children, the United States needs to step up its efforts to protect the public from hazardous chemicals, say researchers writing in the May issue of Health Affairs. The Environmental Protection Agency (EPA), stymied by the outdated Toxic Substances Control […]

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