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A March Madness Health Wonk Review

March 27th, 2014
by Chris Fleming

Welcome to the “March Madness” edition of the Health Wonk Review. The NCAA college basketball tournament seemed like a natural theme for a health care policy blog post: huge amounts of money floating around in ways that only sometimes correlate with performance, and head-to-head match-ups that can yield results no one expected (though in the tournament those unexpected results produce quicker and more certain changes than is often the case in health care).

We considered illustrating each blog post with pictures of a college basketball team from the author’s home state celebrating a championship, but we thought better of that after seeing this cautionary tale. So let’s get to the great collection of posts from our Wonkers.

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The New Nutrition Facts Panel: Public Health Improvement Or Distraction?

March 19th, 2014
by Brian Elbel

Last month, the United States Food and Drug Administration announced long awaited proposed changes to the Nutrition Facts Panel (NFP), the nutrition information found on the back of packaged foods and beverages. The NFP is required to be on all packaged foods, with significant regulations on what is presented and how the information can be presented. Initially mandated in the first Bush Administration, the NFP offers a clear and consistent manner of presenting nutrition information—at least for those with the time and nutrition knowledge to benefit from the information.

The key questions behind the proposed changes are: will they be successful in altering consumer behavior, how might they be improved, and what overall role might they play in obesity prevention?

The NFP is clearly a source from which those already motivated and knowledgeable can easily access information and a base on which to build future approaches to addressing obesity. Put differently, this information will only work if people actively, directly choose to turn the package over, engage in information, and push past the many impulses pulling them towards the less healthy foods. The compelling nature of unhealthy foods means that individuals have to be particularly motivated, or the nutrition information has to be particularly compelling.

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Neighborhood Grocery Stores Combat Obesity, Improve Food Perceptions

March 12th, 2014
by Yael Lehmann

The Cummins et al article “New Neighborhood Grocery Store Increased Awareness of Food Access but Did Not Alter Dietary Habits or Obesity,” published in the February issue of Health Affairs, generated considerable media attention, with headlines claiming that grocery stores do not contribute to healthy diets or reductions in obesity.  However, the study offered no conclusive proof showing that access to grocery stores is not a part of the solution to preventing obesity.  In fact, the study showed clear signs of promise that the intervention was working in key aspects during the short time the researchers collected data.  Within just a few months after the new supermarket opened, for example, researchers documented significant improvement in residents’ perceptions about the choice and quality of fresh fruits and vegetables, along with improvements in their perception of healthy food accessibility.

The subject of the study, the Fresh Grocer in North Philadelphia, is a beautiful store with a bountiful fresh produce section. The supermarket, which is now thriving in one of the poorest neighborhoods in the country, was built from the ground up after a 15-year hiatus in which the surrounding community had no grocery store. Its opening has revitalized a historic African-American owned shopping plaza and reinvigorated the local neighborhood’s retail economy.

Has the store reduced the rate of obesity among local residents? This is a crucial question, but one that cannot be adequately deduced from the present study. All we know from this study’s findings is that obesity rates did not change significantly during the first six to nine months after the store’s opening – not surprising, given the many decades of gradual changes in eating habits that have led to the obesity epidemic.

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New Health Affairs Issue: Successes And Missing Links In Connected Health

February 3rd, 2014
by Chris Fleming

Health Affairs’ February issue focuses on the current evidence and future potential of connected health — encompassing telemedicine, telehealth, and mHealth. The importance of connected health is sure to grow as more Americans gain access to health care and new, team-based models seek to provide better quality care in more efficient ways. The issue offers a variety of articles that explore what can entice hospitals, health systems, and individual providers to embrace telehealth, as well as the policy solutions that can better facilitate adoption across the health care system:

Want to increase telehealth adoption among U.S. hospitals? Look to state legislatures. Julia Adler-Milstein of the University of Michigan School of Information and co-authors emphasize that state policies are influential. According to their findings, states that wish to encourage the use of telehealth should promote private payer reimbursement and relax licensure requirements.

Overall, Adler-Milstein and coauthors found that 42 percent of US hospitals had adopted telehealth by late 2012, with significant variation across the country: Alaska was the highest with 75 percent, and Rhode Island had minimal adoption.

Market forces and individual hospital features also influence telehealth adoption rates. Factors that positively influence adoption rates include serving as a teaching hospital, being part of a larger system, having greater technological capacity, and higher rurality. Factors negatively affecting adoption include high population density, being for-profit, and operating in a less competitive market.

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

January 22nd, 2014
by Tracy Gnadinger

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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The Unintended Consequences Of The New Statin Guidelines

December 24th, 2013
by Amir Al-Kourainy

The American Heart Association (AHA), in collaboration with the American College of Cardiology (ACC), recently released new guidelines that urge a shift in how statins are prescribed. Until now, the drugs had primarily been used to treat high cholesterol; now, the guidelines say they should be used as preventive tools to lower an individual’s overall risk of heart attack and stroke. This change will pave the way for tens of millions of Americans who were previously not candidates for statin therapy to be placed on statins.

Advocates say this new approach will make a big difference in the fight against heart attack and stroke. But in practice such a major change may also have unintended consequences that threaten to move our society even further from prevention toward an increasing reliance on drugs.

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Provider Opportunities for Population Health Improvement

November 5th, 2013
by Anand Parekh

Significant changes in the health care sector have been set in motion or accelerated by the Affordable Care Act.  For health care providers, much of this activity has focused on improving patient care and lowering costs.  There are also numerous opportunities through the Affordable Care Act for health care providers to improve population health, either […]

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Inequality Is At The Core Of High Health Care Spending: A View From The OECD

October 9th, 2013

It is commonly said that the US spends more than twice as much on health care as other developed countries, yet its outcomes are worse. The inference is that too much care is provided, to no good end.

Such international comparisons are drawn from the Organization of Economic Cooperation and Development (OECD), a group of 34 developed countries. Analyzing these data is a multi-step process, like peeling an onion, and the truth resides deep within its core.

The process starts by adjusting health care spending for “purchasing power parity” (PPP) and expressing it in US dollars. By that measure, per capita spending in the US is 160 percent more than the OECD mean (Panel A, left bracket), and this is the basis for the notion that the US spends more than twice as much. But it is only the first layer.

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Food Marketing To Children: A Commentary On William Dietz’s Health Affairs Article

September 19th, 2013
by Sen. Tom Harkin

Editor’s note: This post comments on “New Strategies To Improve Food Marketing To Children,” by William Dietz, the former director of the Division of Nutrition and Physical Activity at the Centers for Disease Control and Prevention, in the September issue of Health Affairs.

For decades, I have fought to replace our nation’s “sick care” system with a genuine health care system, one focused on wellness, prevention, and public health. In the Affordable Care Act, I made sure that all proven preventive services would be available with no copays or deductibles, and I included provisions to enhance community prevention programs.

However, much more needs to be done, as evidenced by the shocking rise of America’s twin epidemics of childhood obesity and type 2 diabetes in young people. Some attribute this crisis largely to changing nutrition patterns – more calories, more junk food. Others say the cause is a dramatic decline in physical activity. Obviously, both are at fault.

Likewise, who needs a Harvard study to prove that the sophisticated, aggressive, all-pervasive marketing of unhealthy foods and beverages to children is also a contributor to the twin epidemics assaulting our children’s health? Food and beverage companies don’t spend nearly $2 billion a year to market their products to kids because they like to waste money; no, they do so because it is brilliantly effective in persuading children to demand – often to the point of throwing temper tantrums in the supermarket aisle – a regular diet of candy, cookies, sugary cereals, sodas, and all manner of junk food.

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Narrative Matters: Wrestling With Obesity, Individually And Globally

April 22nd, 2013
by Chris Fleming

In the Narrative Matters essay in the April Health Affairs issue, Laura Blinkhorn and Mascha Davis write about how working with an obese woman in a Gabon hospital led them to seek solutions to obesity and its related health problems in the developing world. “Public health campaigns, government regulation, and improved education are necessary to bring about real change,” write Blinkhorn, a fourth-year medical student at the Pritzker School of Medicine, University of Chicago, and Davis, a registered dietician and public health professional who lives in Addis Ababa, Ethiopia, and works for Catholic Relief Services.

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Rachael Fleurence on Patient Engagement

April 3rd, 2013
by Rachael Fleurence

In today’s Q and A on Patient Engagenment, we feature Rachael Fleurence, a Senior Scientist at PCORI where she leads the research prioritization initiative to help identify important patient and stakeholder generated questions and establish a rigorous research prioritization process to rank these questions. (Also, check out her recent blog post and follow the link to her February Health Affairs article here.)

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A New Feature for Narrative Matters: The Policy Checklist

January 28th, 2013
by Chris Fleming

Health Affairs readers may have noticed something a little different about the Narrative Matters essay in January’s issue. The essay, “To Fight Bad Suga’, Or Diabetes, My Neighborhood Needs More Health Educators,” by Joseph West of Sinai Urban Health Institute, is the first to include the Policy Checklist, a new feature that will accompany all of our Narrative Matters essays going forward.

The feature points readers to related readings, enacted or proposed legislation, current or planned governmental and private initiatives, and other resources that can help to round out perspectives on a given health policy issue. In the case of the checklist accompanying West’s essay, about the need for more community health workers to serve residents in one poor Chicago community devastated by diabetes, the checklist points to Affordable Care Act grants for outreach to medically underserved populations, community-based diabetes management projects like the CDC’s Project DIRECT, and Health Affairs papers on a national diabetes prevention strategy and on the measured benefits of community health workers.

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CMS Spending Articles Lead Health Affairs Top-Ten List For 2012

January 2nd, 2013
by Chris Fleming

An extraordinary slowing of growth in the use of health care goods and services contributed to a second year of slow health spending growth in 2010, analysts from the Office of the Actuary at the Centers for Medicare and Medicaid Services reported in the most-read Health Affairs article of 2012. To celebrate the New Year, […]

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It’s Too Late To Turn Back: A Transformation To Wellcare Is Underway

June 18th, 2012
by Mary Pittman

As pundits and politicians ruminate on the impact of the looming Supreme Court’s decision on the Affordable Care Act, there is one incontrovertible and uncontroversial message for the country. Our commitment to wellness and health, rather than simply treatments for illness is underway. The tide has turned in support of prevention and it is too […]

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Health Policy Brief: The Prevention And Public Health Fund

March 1st, 2012
by Chris Fleming

Editor’s Note: For more on the state of prevention efforts and the impact of the cuts to the Prevention and Public Health Fund, see Health Affairs Blog “Contributing Voices” posts by Georges Benjamin and Jeffrey Levi. The latest policy brief from Health Affairs and the Robert Wood Johnson Foundation focuses on the Prevention and Public […]

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Prevention For A Healthier America

March 1st, 2012
by Jeffrey Levi

Editor’s note: For more on the state of prevention efforts and the impact of the cuts to the Prevention and Public Health Fund, see this Health Affairs Blog “Contributing Voices” post by Georges Benjamin and an additional post about a Health Policy Brief on the Fund. The Prevention and Public Health Fund, created by the […]

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Prevention Funding: One Step Forward, Two Steps Back

March 1st, 2012
by Georges Benjamin

Editor’s note: For more on the state of prevention efforts and the impact of the cuts to the Prevention and Public Health Fund, see this Health Affairs Blog “Contributing Voices” post by Jeffrey Levi and an additional post about a Health Policy Brief on the Fund. Two years ago with enactment of the Affordable Care […]

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A Promising Calorie-Cutting Approach: Would You Like To Downsize That?

February 16th, 2012
by Chris Fleming

How do you get people to eat less? Turns out that, for a significant number of people, the answer may be as simple as asking them. That’s the conclusion of a study in the February issue of Health Affairs, by Janet Schwartz of Tulane’s Freeman School of Business and coauthors, that has been receiving a […]

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View Health Affairs Diabetes Briefing

January 26th, 2012
by Chris Fleming

Video of the release event for the January issue of Health Affairs, “Confronting The Growing Diabetes Crisis,” is now available on the Health Affairs Web site.

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The Diabetes Threat: Can It Be Contained?

January 11th, 2012
by Chris Fleming

Diabetes now affects nearly twenty-six million Americans, and over the next decade, an estimated forty million more US adults could develop the condition. Another 100 million more could suffer from an insidious prediabetic condition, one that often leads to the full-blown disease.  Growing scientific evidence suggests that lifestyle interventions, such as weight loss and fitness […]

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