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3 posts from March 2020


Daniel Dawes Discusses His Just-Published, "The Political Determinants of Health" (March 25th)

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It is altogether appropriate to discuss the political determinants of health since this past Monday we marked the ten year anniversary of the Affordable Care Act (ACA).   The law was intended, in part, to reduce health inequities.  Research published earlier this month in Health Affairs concluded, “the ACA produced broad gains in insurance coverage,” and “that coverage increased most among groups whose members were mostly likely uninsured before the reforms,” i.e., racial and ethnic minority groups.   We would do well to remember the 19th century German physician Rudolph Virchow whom argued, we should think of medicine as a social science - meaning medical care requires collective action to address social inequality’s contribution to ill health.  (Concerning social inequities, I encourage listeners will to listen to my March 10th conversation with the Center for Budget and Policy Priorities' Mr. Joseph Llobrera regarding the administration's treatment of SNAP.)

During this 33 minute conversation, Daniel Dawes begins by providing historical context, i.e., early efforts in our nation's history to address population health and health inequities, e.g., creation of the (short lived) Freeman's Bureau in 1864.  He identifies and discusses three over-arching political determinants of health, possible reasons why the ACA (and again its health inequity provisions) have been so polarizing and current progress in political determinants addressing inequities, e.g., as related to the climate crisis.      

Mr. Daniel Dawes is the Director of the Morehouse School of Medicine’s Satcher Health Leadership Institute and Associate Lead for Government Relations.   Among previous Danieldawes-685x1024positions he founded and chaired the advocacy group, the National Working Group on Health Disparities and Health Reform and was the co-founder of the Health Equity Leadership and Exchange Network (HELEN).  He has worked to shape federal health equity policies including the Mental Health Parity Act, the Americans with Disabilities Act Amendments Act, the Genetic Information Nondiscrimination Act and the Affordable Care Act.  He is the author of the 2017 work, 150 Years of Obamacare.  He is an elected fellow of the New York Academy of Medicine and has served on several boards, commissions, and councils focused on improving health outcomes and elevating health equity in the United States.  He is an adviser to international, national, regional, state, and municipal policymakers, as well as think tanks, associations, foundations, corporations, and nonprofit organizations.  Mr. Dawes obtained his Juris Doctorate from the University of Nebraska. 

For more information on The Political Determinants of Health go to: https://jhupbooks.press.jhu.edu/title/political-determinants-health


Dr. Dan Blazer Discusses the National Academy of Sciences Just-Published, "Social Isolation and Loneliness in Adults: Opportunities for the Health Care System" (March 24th)

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Increasing social isolation and loneliness have been recognized for several decades.  The issues was the topic of Harvard’s Robert Putnam’s much publicized research three decades ago, i.e., his 2000 publication "Bowling Alone."   More recently, the Pope has observed “radical loneliness,” caused by a consumer culture is subverting social relationships.  In Japan, loneliness deaths among the elderly have become so common the Japanese have named the phenomenon, kodokushi (lonely death).  In the UK, former Prime Minister Theresa May in 2018 created the new cabinet position, Minister of Loneliness.   In the US, former US Surgeon General Vivek Murthy called loneliness a “growing health epidemic.”  

During this 32-minute conversation, Dr. Blazer begins by defining social isolation and loneliness or collectively social connections.  He then discusses the numerous associated adverse health effects including cardiovascular disease and dementia.  He discusses the current state of play regarding the extent to which the health care sector is addressing, social isolation in context of the ongoing COVID-19 pandemic, he notes several recommendations the report makes, discusses programming, and the scientific evidence for, that attempt to address these issues and potential problems associated with some of these interventions moreover use of technology.        

Dan G. Blazer II, M.D., M.P.H., Ph.D., is the J. P. Gibbons Professor of Psychiatry Emeritus and a professor of community and family medicine at Duke University as well as D014dac2e1-image_0770942adjunct professor in the Department of Epidemiology, School of Public Health, University of North Carolina.  He is the author or co-author of more than 180 books chapters, more than 220 published abstracts, and nearly 500 peer-reviewed articles.  He is also the editor or author of 40 books.  Many of the book chapters and scientific articles are on the topics of late life depression, epidemiology, consultation liaison psychiatry, the interface between religion and psychiatry, and the epidemiology of substance use disorders.  Most of his research projects have focused on the prevalence of physical and mental illness in the elderly.  He has served as the principal investigator (PI) of the Duke University Established Populations for Epidemiologic Studies of the Elderly, the Piedmont Health Survey of the Elderly, and the MacArthur Field Studies of Successful Aging.  He also was the original PI of the Duke Clinical Research Center for the Study of Depression in Late Life.  Dr. Blazer is an elected member of the National Academy of Medicine from which he received the Walsh McDermott Award for Distinguished Lifetime Service to the Academy.

The NAS report is at: https://www.nationalacademies.org/our-work/the-health-and-medical-dimensions-of-social-isolation-and-loneliness-in-older-adults.


CBPP's Dr. Joseph Llobrera Discusses the Administration's Proposed Cuts to the Supplemental Nutrition Assistance Program (SNAP) (March 10th)

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Despite the fact the US is a net food exporter, the country suffers a significant food security problem (defined as uncertain of having or unable to acquire enough food).  Per the USDA, over 11% of Americans, or over 37 million(including 12 million children), are food insecure or worse.   In addition, the US ranks first among OECD countries in obesity, a primary indicator of a poor or low nutritional diet.  (Many Americans also suffer from "hidden hunger" or micro-nutrient deficiency.)  What explains this includes the fact 42% of American workers are paid $15 an hour or less – causing the US to have one of the highest poverty rates among developed/wealthy countries.   The US, unlike 158 other countries, is not a signatory to the 1966 International Covenant on Economic, Social and Cultural Rights which recognizes “the fundamental right of everyone to be free from hunger.”  In addition, health care ironically contributes to hunger in America.  If health care cost what it does, for example in Switzerland or 30% less per capita, median income growth over the past 30 years would have grown to twice what it is.  Phrased another way, medical expenses push millions of Americans below the poverty line, including 7 million who earn 150% of the poverty level.  (Devoted listeners may vaguely recall I interviewed the CBPP's Dr. Paul Van de Water in January 2013 regarding Medicare and Social Security reform.) 

During this 32-minute conversation Dr. Llobrera begins by providing an overview of the SNAP program and its benefits.  He then explains the Trump administration's proposed FY 2021 SNAP budget that would, like the administration's previously proposed budgets, cut SNAP spending by $182 billion over ten years, or by over 25%, he discusses administration regulatory reforms currently being implemented that will cut SNAP by $50 billion and remove approximately 4 million from the program, how or what rationale the administration uses to explain these budget cuts/program changes, the Congress's response to these policies and what the health care industry/health care providers are doing programmatically to address the reality that food is medicine.     

Dr. Joseph Llobrera is the Director of Research for the Food Assistance team at the Center on Budget and Policy Priorities (CBPP).   Previously, Dr. Llobrera served as Research Associate at Joseph-llobrera-500x500the Center between 2002 and 2007.   Before returning to the Center, he served as an Associate Director of Learning and Improvement at Insight Policy Research, providing technical assistance and training to federal, state, and local human service agencies that administer the Supplemental Nutrition Assistance Program and the Temporary Assistance for Needy Families program.  He also also employed as a researcher at IMPAQ International and the Urban Institute, focusing on food assistance policy, workforce development, and health policy.  Dr. Llobrera received his Ph.D. in Nutrition from the Friedman School of Nutrition Science and Policy at Tufts University, his master’s degree from the University of Washington (Seattle), and a bachelor’s degree in Mathematics and Urban Studies from Brown University.

The CBPP's February 18 memo providing an overview of the president's proposed 2021 SNAP budget is at: https://www.cbpp.org/research/food-assistance/presidents-2021-budget-would-cut-food-assistance-for-millions-and-radically

CBPP's November 2019 SNAP Chartbook is at: https://www.cbpp.org/research/food-assistance/chart-book-snap-helps-struggling-families-put-food-on-the-table