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Tuesday, March 27th

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Women make up more than half the population yet hold only 17% of the U.S. Congressional seats, less than a quarter of state legislative seats and only six governorships. Of those, women of color constitute only 4.5% of the total members of Congress and 3.5% of state legislators. This under-representation has a profound impact on policymaking.

The 2012 Project, a national, non-partisan campaign to increase the number of women in Congress and state legislatures by leveraging the once-in-a-decade opportunities of 2012, aims to change this. In collaboration with The Association for Women in Communications, and the co-sponsors listed above, The 2012 Project will explain why it is essential for women to throw their hats in the ring in 2012. This webinar will highlight the experiences and insights of two 2012 Project faculty members who will share what it takes to be a candidate, the difference women make in government, and why it is important for more women (like you!) to run. Filing deadlines have not yet passed in many states, so it’s not too late!

By Diana Mason. Two weeks ago, I got my hearing checked by a doctoral student in audiology at a faculty practice clinic at a university. The student was quite thorough. She advised me that she was not a physician and could not diagnose and treat hearing problems. Later on during the visit, her faculty supervisor repeated this mantra.  I said each time, “Yeah, yeah…I know the spiel.”

I know it because for decades nurses were not allowed to say a patient was dead or bleeding or in congestive heart failure despite the obvious signs. Physicians were the only ones who could do these things. About 100 years ago, nurses didn’t even take blood pressures–or temperatures! As new technology was introduced into medicine and health care, the physicians claimed it as their purview–until they were bored with it. Then, they decided that nurses could be taught to do these things. Of course, in many states, including New York until last year, nurse practitioners still can’t pronounce a dead patient to be thus.

When she was the Associate Dean at the Yale Law School, Barbara Safriet (now at Lewis and Clark School of Law) wrote a classic article on the laws regulating medicine and other health care professions. She pointed out that state medical practice acts that govern the practice of medicine were written so broadly that they precluded other health professionals from doing most anything without the authorization and supervision of physicians. As such, podiatrists have fought endless battles to move from working independent of physicians on foot problems; optometrists, to do more advanced assessments of eye problems; chiropractors, to practice at all; audiologists, to use an otoscope to look in patients’ ears; and advanced practice registered nurses (APRNs), to be able to diagnose and treat common health problems.

The battle between APRNs–nurse practitioners, certified nurse midwives, nurse anesthetists, and clinical nurse specialists–and organized medicine is heating up because of the Institute of Medicine’s recommendation that all health professionals be able to practice to the full extent of their education and training and that the barriers to them doing so be removed. A very large body of evidence supports that APRNs provide high quality, safe care and produce the same or better outcomes as physicians. While some states already permit nurse practitioners and nurse midwives to practice without physician supervision or mandated collaboration, the majority of states continue to have restrictive laws and regulations that get in the way of APRNs being able to improve people’s access to affordable, quality, efficient care. (more…)

By Randi Kahn. As GOP Presidential candidates and some in Congress discuss ways to roll back decades old environmental policies that protect our air and water under the pretense of saving money and protecting American jobs, the Environmental Protection Agency (EPA) is focusing on the opportunity for women to become green champions for themselves, their families, and their communities.  On Tuesday, in honor of Women’s History Month, EPA invited a group of female health leaders, including myself, to join Administrator Lisa Jackson for a round table discussion on the connection between the environment and health and the enormous stakes of today’s policy discussions.

The Administrator’s message was clear and simple, “You do not have to choose between a healthy environment and a healthy economy,” she said. “We have a moral obligation to address climate change and the majority of things to tackle it actually add jobs.”

Others around the table discussed the impact of poor health on the job market and the economy as a whole – with those who are chronically ill or have a child who is chronically ill frequently missing work and often distracted when they are able to attend. Some are even unable to hold a steady job at all because of preventable ailments.

“Poor health is a greater cost of jobs and productivity than making an investment in the environment,” said Lisa Allen from the American Heart Association.

Janice Nolan from the American Lung Association added, “In terms of health care, we can save $10 for every $1 invested in clean air programs.” (more…)

The following is a guest post by Karen Kahn who is the director of Communications for PHI, a national, not-for profit organization that works to improve the lives of people who need home and residential care—and the lives of the workers who provide that care.

By Karen Kahn. When it comes to ensuring elders are safe, healthy and independent, it takes a village. We want our loved ones to be able to live at home in their communities, but often, we can’t be there to make sure Mom doesn’t fall getting out of the shower, or Dad doesn’t get confused by the bills.

When adult daughters—the primary caregivers for parents and other loved ones—can’t be there as often as needed, we often rely on paid home care aides. An often invisible workforce, home care aides make it possible for millions of elders and people with disabilities to remain in their homes—and for their children to have a little peace of mind.

Across the nation, our families employ about 2.5 million home care workers, and these jobs are expected to grow by about 1.3 million between 2010 and 2020. In fact, according to the latest occupational projections from the Department of Labor, home care jobs are the fastest-growing jobs in the nation.

Home care workers provide an array of critical services such as bathing, dressing, food shopping, meal preparation, medication management, and transportation to medical appointments. Yet, largely because they are women doing the work expected of women, these hardworking home care aides are undervalued. Half of them earn wages at or below 200 percent of the federal poverty level and rely on public assistance like food stamps and Medicaid to take care of their own families. (more…)

By Mary Grealy. We’re all concerned about how our healthcare workforces will keep up with an increasing patient population.  Not only is Medicare growing at the rate of 7,500 new beneficiaries per day, but the Affordable Care Act will lead to millions more Americans having health coverage when fully implemented.

We’re seeing one answer in the form of technology that is helping to reduce hospital readmissions and enable health facilities to evaluate patient conditions and needs without requiring them to come to the doctor’s office.

This week, the Geisinger Health Plan and AMC Health announced the results of a two-year evaluation of a telemonitoring program developed by AMC.  Geisinger found that home telemonitoring of patients with congestive heart failure reduced 30-day hospital readmission rates by more than 40 percent.

Here’s how the system works.  Patients receive scheduled calls from an interactive voice response system.  The patients report their symptoms, with those responses immediately stored in their electronic health record and evaluated.  A determination is made whether the patient needs a follow-up with a nurse or a case manager.  96 percent of the Geisinger case managers said the system was allowing them to monitor heart failure patients more effectively.

This also bolsters our argument that there are better ways to address healthcare’s cost issues than simply axing dollars out of the system and consequently reducing patient access and care quality.  There are technological solutions, as shown in this innovative work by AMC Health and Geisinger, that can make the system more cost-effective while providing even better care to patients.

By Elita Wong. At the United Nations Plaza in New York City, nurse midwives and public health leaders representing diverse geographic regions such as Australia, Ghana, Taiwan, Zimbabwe, and the Appalachians, united in a discussion about the current health status of rural communities and health workforce for women. I had the pleasure of attending this event as the latest addition to the NYU College of Nursing (NYUCN) Global team, a division of the college dedicated to public health research internationally.

Tuesday’s event featured presentations by World Health Organization (WHO) Executive Director Dr. Jacob Kumaresan and International Confederation of Midwives President Frances Day-Stirk, with NYUCN Global Executive Director Dr. Ann Kurth serving as moderator. Kumaresan’s and Day-Stirk’s presentations were followed by productive discourse between audience members and panelists to lay out future solutions.

Source: The Lancet, September 2011

In his presentation, Dr. Kumarensan introduced the framework for the forum by emphasizing several of the eight Millennium Development Goals (MDG). These goals, which were conceptualized back in 2000 by 193 UN member states, have a looming target completion date – set for 2015. As of now, MDG 5, related to maternal mortality, and MDG 8, related to the availability of essential medicines, are behind schedule. Below is an image that he presented predicting MDG 5 attainment, which requires a three-quarter reduction in the maternal mortality ratio and universal access to reproductive health. As you can see, most countries are not going to meet the goal by 2040, let alone the predetermined deadline three years from now.

Dr. Kumarensan also underlined health disparities in a country-to-country comparison. As he explained, “In Japan 99.8% of women have access to skilled care during childbirth…take another country in Asia, Bangladesh, only 18% of women deliver with skilled professionals. Is that acceptable?”

The presentation also emphasized the enduring challenges facing rural communities and the health workers who serve them. Dr. Kumaresan’s recommended recruiting elected members of rural communities, thereby producing health workers who are more likely to stay, instead of relying heavily on trained professionals from urban areas who may offer only a temporary, less satisfactory solution. He cited two examples of such an approach — a successful national health program for family health and primary care called Lady Health Workers in Pakistan and a program in Ethiopia that selected women in the community to provide primary care, education, family planning, antenatal, delivery, and postnatal care. (more…)

By Carrie Winans. With spring in the air and new beginnings all around, it is nice to see some new changes in health care as well.  Here’s what happened this week while you were dreaming of warm weather:

At Home

In Oregon, a new approach to Obama’s health care has been put in place.  The Associated Press reports that if all 50 states adopted this approach the federal budget could save $1.5 trillion in the next decade.

If you’re wondering how your leaders are debating your reproductive health, ABC news gives you the spark notes version.

Were you excited to see Digital Health Records cut costs?  The New York Times cautions against breaking out confetti just yet, they may not help that much after all.

A Texas showdown sounds like something out of an old movie.  Instead, NPR uses the term to highlight some antiquated health practices.

Desperate Housewives’ Felicity Huffman guest writes for CNN about her views on women’s health care in America, an issue that needs some desperate improvement. 

Abroad

The euro isn’t the only thing to watch during the Greek Debt Crisis.  Reuters reports that several health care companies based in France, Germany, and the UK are trying to resolve their monetary issues with the struggling country.

While we’re busy worrying about our reproductive health, the World Health Organization is focusing on the health of women in rural areas.  The Voice of America highlights some of the struggles of the world’s poorest and least developed regions.

By Meryl Bloomrosen. Perhaps my quest should have started as soon as my prior primary care physician (PCP) decided to focus his practice on his medical subspecialty.    That was 5 years ago or so.   Of course, back then I was pre-occupied with my parents’ various chronic illnesses and end of life issues.  So I never bothered to “change doctors”.    In the meantime, I continued to see various providers for an assortment of health and wellness issues as well as some basic and thankfully non-life threatening medical/health needs such as eye exams and mammograms, plus a few minor repairs here and there.   However, at the end of each encounter there were those nagging questions:   Who is your primary care physician? Who should we send the test results to?     

Not a problem…until I set out on the search.  I began checking with colleagues and friends and inquiring about their PCP and sought  suggestions and recommendations.   I reviewed several public listings and guides to “the area’s top doctors” or the areas’ top physicians. They used various rating methodologies to rank or “evaluate” providers.   I didn’t want to travel too far and I preferred a practice with multiple providers.  After all this is the Washington DC metropolitan area, right?    Feeling relatively confident with a list of names and telephone numbers I started “dialing for doctors”.    “I’m sorry Dr. X is not accepting/taking/seeing any new patients.”  Or “Call back after the new year”.    Not even a question about my health insurance coverage or my age or my problem(s).   No question about who referred me.     So then it dawned on me that I should have “gone on line” to seek and find my answer and here is what I found:

Notice:

• Not all physicians may be accepting new patients at this time. To see whether the physician is accepting patients, please click on the link to his/her name. (more…)

By Robin Strongin. For political fanatics, health policy wonks and constitutional law scholars, March Madness will take place this year on 1 First Street, NE in Washington, DC, where the Supreme Court will hear oral arguments concerning the controversial Affordable Care Act, beginning a process that may affect the fate of health reform in this country and affect the year’s political campaigns.

There should be no doubt as to the significance of this pending Court action.  The Court has now set aside six hours on March 26-28 to hear this case.  That is a highly unusual amount of time for oral arguments, equaled previously in the Court’s deliberations on the Voting Rights Act and the landmark Miranda v. Arizona case that established the rights of criminal defendants. 

At stake is more than just a controversial piece of legislation.  The primary issue being decided by the Court is the constitutionality of the health reform law’s mandate upon individuals to possess health insurance.  The debate will focus on the Commerce Clause of the Constitution which empowers the federal government to “regulate commerce…among the several states.”

For proponents of the mandate, the Court must uphold the provision in order for Congress to have the ability to address the nation’s health care challenges.  As Jonathan Cohn, a frequent writer on health policy issues, put it in Kaiser Health News, “Health care …is very clearly a national problem beyond states’ ability to control.  Hospitals routinely charge for services that insurers in other states must pay.  Employers negotiate premiums for workers in multiple states.”  And, as proponents have made clear, without a mechanism to bring healthy Americans into the insurance pool, the insurance marketplace will be extraordinarily expensive and unstable. (more…)

The following is a guest post by Saralyn Mark, MD. Dr. Mark is the President of SolaMed Solutions, LLC, a world renowned leader in women’s health, an endocrinologist, geriatrician and women’s health specialist, was the first Senior Medical Advisor to the Office on Women’s Health within the Department of Health and Human Services and the National Aeronautics and Space Administration (NASA).  She designed the first women’s health fellowship in the Nation, helped create the National Centers of Leadership in Academic Medicine, the National Centers of Excellence in Women’s Health in academic and community health centers across the country and landmark educational campaigns on critical health issues.

By Saralyn Mark. Have you ever been asked a question that makes you smile? Sometimes, the best questions come from the mouth of a child. Sheer innocence and curiosity propelling the boundaries of inquisitiveness. Now imagine being asked that question in a classroom in the upper northeast part of England in a small town blanketed by verdant hills and rolling rivers.

A few weeks ago, I was invited to talk to 90 students near Durham, England about the importance of science and space. Soon after I entered the classroom with walls covered by drawings of planets and stars, 7 year old students obediently marched into the room and stood in rows until their teachers told them to sit down. Some had chairs, others had the floor. With military precision they quickly took their places. I immediately bonded to my new audience. Their wide smiles and eyes filled with wonder warmed my heart.

I was in England to give a lecture on medicine and exploration for a space technology conference sponsored by NETPark -an incubator for technology and innovation in Durham. It was also the launch of my new book, Stellar Medicine: A Journey Through the Universe of Women’s Health (Brick Tower Press). The day before, I gave a book reading nearby for a lovely group of women who were on the other end of the age spectrum from this classroom. Following my reading, I entertained questions and found them be provocative and personal.

My new book is a part memoir/part guidebook on controversial health issues. I explore the political and social environment which shapes these decisions while weaving in many of my experiences on all the continents and with the space program to illustrate my points. I know that many of the topics would generate heated discussions. I believe that we may have different views on issues, but there is generally some common ground if we take the time to find it. (more…)

By Ufuoma Lamikanra. In Nigeria, many politicians turn out to be poor leaders. This is mainly because most political office holders never prepare for governance. They were either pressurized to run for office or had pecuniary gain as a goal. Consequently, the political manifestos of such politicians are usually drawn to deceive or to cajole the electorate into voting them into office. Once elected, they pursue their personal agenda while making little or no effort to deliver on their electoral promises.

One of the exceptions to the scenario described above is the case of Dr. Olusegun Mimiko, Governor of Ondo State, Nigeria. He has clearly fulfilled a very important pre-election campaign promise that has positively impacted the lives of women in Ondo state. When he assumed office in 2009, he introduced the Abiye Safe Motherhood pilot scheme in a local government area in the State. The scheme was intended “to bring qualitative and accessible health care to women and children to reduce maternal and infant mortality.” The success recorded, referred to by the World Bank as one of the success stories coming out of Africa, led to the recent implementation of the programme in the other 17 local government areas. An interesting feature of the Scheme is the establishment of Health Rangers, specially trained community health extension workers, who effectively monitor the pregnant women and provide them with mobile phones linked to a toll free closed user group.

Another state leader in Nigeria also made strides in women’s health and gender equality in 2009. When Dr. Kayode Fayemi of Ekiti State, Nigeria assumed office, he had an eight point agenda with which he asked that his performance be assessed which included participatory governance, infrastructural development, modernizing agriculture, education and capital development, industrial development, tourism, gender equality and empowerment and health care services. The last item, health care services is of great importance, since Nigeria has the second highest maternal mortality rate in the world. Fayemi introduced a free health programme which takes care of physically challenged, pregnant women, children under the age of five years and adults over the age of 65 years.

Political will and redirection of resources, as evidenced by the success stories above, have led to marked improvement in the health status of vulnerable members of both states, including women. We believe that very soon, the life expectancy of women in Ekiti and Ondo States will rise above the national average of 54 years. Similar programmes implemented by the other 33 state governors (Lagos also has good health programmes for its citizens), will swing Nigeria back on track to achieving the Millennium Development women’s health goals.

The following post ran on The Kaiser Family Foundation’s Notes on Health Insurance and Reform on February 21st.  It was authored by Alina Salganicoff and Usha Ranji.

The last several weeks have been a roller coaster ride for those interested in insurance coverage of contraceptives. In this post, we answer some of the key questions about the new contraceptive coverage policy generally, and more specifically, how it will be applied to religious organizations.

Why is contraceptive coverage part of health reform?

When the Affordable Care Act was passed, it included considerable attention to preventive care, for the first time stipulating that new private plans cover a wide range of recommended clinical preventive services to plan holders without cost-sharing. Specifically, this section of the law (2713) requires that private plans cover services that receive a strong recommendation from the U.S. Preventive Services Task Force (USPSTF); vaccines recommended by the Advisory Committee on Immunization Practices (ACIP); preventive services for children recommended by Bright Futures guidelines for pediatric preventive care; and “with respect to women,” new services that will be identified by the Health Resources and Services Administration (HRSA). In 2010, the Department of Health and Human Services (HHS) requested that the Institute of Medicine (IOM) convene a committee of experts in women’s health and prevention to identify gaps for women in the current preventive recommendations.

The IOM committee identified eight new preventive services for women, including screening for intimate partner violence, well woman visits, breastfeeding supports as well as the inclusion of contraceptive services and supplies, including all methods approved by the Food and Drug Administration. These recommendations were adopted by HHS in August 2011. Contraception is also recommended as a part of health care for women by the nation’s leading health care professional associations, including the American Medical Association, the American Congress of Obstetricians and Gynecologists, the American Academy of Pediatrics, and the American Public Health Association.

This new provision has significant implications for access to contraception and affordability for millions of women. It is estimated that half of pregnancies in the U.S. are unintended, among the highest rate among developed nations. The vast majority of women in the U.S. have used a contraceptive at some point in their lives to prevent unintended pregnancy, plan future pregnancies, or space childbearing. Cost-sharing requirements, such as co-payments and co-insurance, have been shown to curtail utilization of preventive services. (more…)