Tag Archives: prevention

The Minimum Wage and the Social Determinants of Mental Health

A new study in Health Economics shows a temporal association between Britain’s minimum wage law and substantially improved mental health of the low wage workers benefitting from the policy.

Source: The Minimum Wage and the Social Determinants of Mental Health

Fall in life expectancy for white Americans

Newly released 2014 data from the National Center for Health Statistics on life expectancy showed a worrisome decline in life expectancy for whites in the US, to 78.8 years in 2014 from 78.9 in 2013.

The good news is that, in contrast, life expectancy increased by 0.2 years for the Hispanic population (from 81.6 to 81.8 years) and by 0.1 years for the non-Hispanic black population (from 75.1 to 75.2). This continues a trend of a decreasing gap in life expectancy between black and white populations, with improving black life expectancies attributed to decreases in death rates due to heart disease, cancer, HIV disease, unintentional injuries, and perinatal conditions.db218_fig1

Life expectancy rates had steadily for decades, then flattened in 2010-2013. joi150117f1The decline in life expectancy is driven by increased death rates among young and middle-aged whites (mid 20’s to mid 50’s), especially among those with no more than a high school education.  A recent study attributed the rise in mortality in this group  to rising rates of suicide, liver disease and drug overdoses.

571a4a54160000e90031c7a2

Life expectancy has dipped before–most recently in 2005, the year of a severe influenza epidemic.

 

April no-fooling!

This week’s NY Times science section debunks several common misconceptions.  All are interesting reads:misconception-teeth-master1050

Talking with children about political bullies

Columns on “talking to your children about XXX” appear after mass shootings, natural disasters and other disturbing news events. This election cycle’s extreme levels of bullying have inspired columns on talking with your children about Trump. These include

Veteran political journalist Cokie Roberts even confronted Donald Trump about how his rhetoric is impacting children–specifically, focusing on reports that white children have been taunting children of color by invoking the Trump’s name and promises of deportation. He deflected the question, instead talking about his plans for a border wall:

“But what about the children, Mr. Trump? What about what the children are hearing from you and how they are responding to it?” Roberts asked.

“Well, I think people are responding very positively,” Trump replied.

“Children, I asked,” Roberts pressed.

“I think the messages are very positive you know. Make America great again is a very positive message, not a negative message,” Trump said, again ignoring Roberts’ question about the effects of his rhetoric on young people.

Citation

Avoid peanut allergy by early introduction of peanuts

A study released today in the New England Journal of Medicine showed that giving infants small amounts of peanut butter in their first year of life substantially reduced the prevalence of peanut allergy when compared to infants who avoided peanuts for their first year. The investigators found that the safeguard lasted for a year after the children stopped consuming peanut protein.

Overall, after the introduction of peanuts in the first year of life, peanut consumption for the following 4 years, and a year of abstinence from peanuts, the peanut-consumption group had a prevalence of peanut allergy that was 74% lower than the prevalence in the peanut-avoidance group, a finding that shows unresponsiveness to peanut after a long period (12 months) of peanut avoidance.

Screen Shot 2016-03-04 at 2.41.36 PMIn a second study also released today in the same journal, the investigators tried to repeat those findings with other foods that commonly lead to allergies in children, including milk, eggs, fish, wheat and sesame. They again showed that the approach might work, but because so few families stuck to the difficult feeding regimen, the outcome was not conclusive

.Screen Shot 2016-03-04 at 2.34.37 PM

Readmissions revisited

I am reposting  a post by Garret Johnson and Zoe Lyon, both research assistants for Dr. Ashish Jha at the Harvard T.H. Chan School of Public Health (who also has a great post on risk-adjustment for readmissions.  The post eloquently explores an issue I’ve visited in a recent post: the importance of understanding the diverse factors that drive the health outcomes that have become performance metrics.  Performance metrics–in this case, hospital readmissions–are intended to reward or penalize providers (hospitals) for the quality of care they deliver.  However, these measures are often strongly driven by factors beyond the hospital’s care–patient factors often called “social determinants of health”.  The authors state “there is now substantial evidence that high readmission rates — especially for medical conditions, as opposed to surgical ones — are driven more by patient factors outside of hospitals’ control (e.g. poverty, lack of social supports) than by hospitals’ quality of care and discharge planning.”

Source: Readmissions revisited

Guns, Drugs and Cars

This week’s JAMA released a comparison of major causes of injury death and how they contribute to the gap in life expectancy between the US and other high-income countries. Here are their findings:

Men in the comparison countries had a life expectancy advantage of 2.2 years over US men (78.6 years vs 76.4 years), as did women (83.4 years vs 81.2 years). The injury causes of death accounted for 48% (1.02 years) of the life expectancy gap among men. Firearm-related injuries accounted for 21% of the gap, drug poisonings 14%, and MVT [motor vehicle traffic] crashes 13%. Among women, these causes accounted for 19% (0.42 years) of the gap, with 4% from firearm-related injuries, 9% from drug poisonings, and 6% from MVT crashes. The 3 injury causes accounted for 6% of deaths among US men and 3% among US women.

These findings are also shown in tabular format here, in the paper’s Table 1:Screen Shot 2016-02-10 at 10.12.45 AM

What is simultaneously so hopeful and so frustrating about these findings is that all three causes of the mortality gap between the US and other high-income nations is that there are clear, proven public health answers to all three causes of injury (with thanks to Injury Epidemiologist Dr. Dawn Comstock for her scholarship and public health advocacy messages for all three).

  1. GUNS: I have written previously about prevention of gun violence deaths, including preventive technologies such as smart guns and required training for gun ownership (just as is required for vehicle licensure.
  2. OPIOIDS: I have also written about some local approaches to the opioid epidemic, including efforts to educate prescribers to prescribe carefully and efforts to improve prescription drug records as well as better packaging to prevent pill bottles and marijuana edibles from falling into the wrong hands and mouths.
  3. MOTOR VEHICLES: Finally, for motor vehicle related deaths, public health solutions include enforcing our existing laws (e.g., drunk driving laws, penalties for driving with suspended licenses) and improving technology (e.g., easier-installation car seats).

Findings of the JAMA study have also been covered in the media.