A comment on the education -> income -> health pathway.

By PHS 795 Student Elvera Wollor:

In the article entitled “Education isn’t the Key to a Good Income”, the author makes the argument that there are factors, outside of education and more important than education, that may increase a person’s future earned income. Factors like race and neighborhood while growing up are predicting factors for future income. Also, segregation, family structure, income inequality, local school, and social capital play a big part in future earned income. I don’t necessarily agree with all of the authors conclusion. I believe that education is a leading factor for future economic gains. Just looking at the job postings you see how important education level is to employers. In the Grossman model, there is a specific section that shows how education enables one to avoid risky behavior and make better decisions when it comes to finances and health. However, agree that education is not the only factor that can affect a person’s income. During our life course lecture, we learned about how neighborhoods, family structure, and socioeconomic factors come together to determine health. It’s important to address all these factors when creating programs that promote disadvantage groups to excel, because all these factors come together to determine health and wellbeing.


Opioid prescription policy: the need for evidence-based policy-making

By PHS 795 student Austin Gerdes:

This article opens up by citing recent CDC guidelines that recommend that for cases of acute pain, healthcare practitioners prescribe opioids for no more than 7 days.  The authors then go on to argue that there are still discrepancies among the evidence for best opioid prescribing practices and that well-intentioned policy that’s not well grounded in solid evidence can actually be harmful.  For example, one study that’s commonly used as evidence to reduce prescription duration actually concludes that risk for addiction rise after the third day of opioid prescription (and increase furthermore after that), however offhandedly mentions that “caution … be exercised when prescribing > 1 week of opioids” in its discussion.  If the CDC takes this and formally advises doctors not to prescribe opioids for more than 7 days, it could be interpreted that a 6-7 day prescription is non-addictive, which is not supported by the rest of that study.  This could lead to a false sense of comfort in acute-pain related opioid prescribing.

This article relates to many topics we have covered in PHS 795, such as the course theme of understanding the sheer complexity associated with optimizing a public health intervention.  If assigning a 7-day limit on opioid prescription isn’t backed up by evidence, how else might we reduce opioid addictions in an upstream manner?  Should we still have a prescription duration limit, and if so how should that be defined?  Different dosages?  Different drugs?    Will this impact different populations of opioid users differently?  Will this have any impact on heroin or fentanyl caused overdoses?  These are all questions that should be considered and answered with evidence when making public health policy decisions.

Vaccination, autonomy and public policy.

PHS 795 student Rissa Lane invites to think about the role of government in population health. She writes:

In Professor Oliver’s lecture on December 5th, the class had a rather passionate discussion about the interface between individual choice in health behaviors and the role of government to writing and policing policies to ensure health of individuals and the population at large. This discussion reminded me of a news segment I heard one morning in October: Detroit mom jailed for refusing court order to vaccinate child. While the Today Show is perhaps not the most credible source for news, I found two things about this story striking immediately, and wanted to introduce the conversation to the blog for input from the class. First, I was surprised to hear on the segment that the mom was jailed and her son was vaccinated during her 7-day holding. Further digging into the story revealed that the mother had already agreed in a consent order to vaccinate her child, and then later failed to follow-through. This story has been used by vaccine skeptics and opponents to draw national attention to their views. What is the role of government in ensuring the unraveling of a system that relies on a critical mass of vaccination among individuals in the population? Second, the article explains that parents and guardians that want to claim a non-medical waiver to vaccination has to go through health education about the benefits of vaccination and risks of disease. How might persons from backgrounds that do not value vaccinations pose a threat to herd immunity? Does government have greater responsibility to intervene and enforce consequences to not vaccinating?

Policy Effects on Pharmacotherapy for Mental Illness

One of the overarching themes of PHS 795 is how social and economic forces shape health care utilization and population health. A PHS 795 student found an excellent illustration of these principles in a 2005 paper by Richard Frank, Rena Conti and Howard Goldman:

This study shows how expanded insurance coverage for prescription drugs has in turn affected the growth in spending and use of psychotropic drugs. The amount of money spent on psychotropic drugs raised from an estimated $2.8 billion in 1987 to nearly $18 billion in 2001. Since the late 1970s, insurance coverage for prescription drugs in the United States has grown extensively. Despite the long history of differential insurance coverage of mental health services, prescription drugs for the treatment of mental disorders are generally covered at “parity” with other medical treatments. Today, all states offer prescription drug coverage to Medicaid recipients, including those dually eligible for both Medicare and Medicaid. Medicaid spent five times more for antipsychotics in 2001 than it did in 1993. This study is relevant to our class because they analyze the economic and policy forces that have created the high levels spent on psychotropic drugs and considered policy issues related to these drugs’ influence on the access to and cost of mental health care, as well as the quality of that care.

Alcohol Use and Older Adults

A PHS 795 student writes about how population health concepts apply to the problem of alcohol abuse among older adults:


As I was reading through this article, I found couple of population health concepts in this article: Aging and Cognitive health, Opioid epidemic, Substance abuse, Determinants of health –Age. In this article, the author talks about how “age” can be a determining factor for substance abuse. Older adults specifically have easy access to substances such as alcohol, and/or opioid drugs that are prescribed to them. According to the Association of Health Care Journalists, alcohol addiction is among the worrisome trends in substance abuse among older adults. This addiction can be easily confused by the doctors to cognitive decline in older adults. The addiction can cause severe health problems in older adults including balance problems, risk of fall and other health risks due to intake of alcohol, as older adults are less tolerant as compared to younger adults. What can be the remedies to such an epidemic? How can age as a health determinant can impact the health of an individual?

Global Health vs. International Health: A distinction without a differece?

By PHS 795 Student Ryan Rohde

John Hopkins Bloomberg School of Public Health Global Health NOW published this article discussing the growing popularity of the term “global health” and its presumed distinction from “international health”. The author, David Peters mentions that there is little distinction between the bodies that use either term. Peters further explains that health equity and multidisciplinary approaches have always been attributes to international health and have recently been claimed as new and unique to global health. He goes on to give detailed explanations of how health equity and multidisciplinary approaches are fundamental to international health by illustrating accomplishments achieved by WHO and UNICEF by working as nongovernmental entities.

I was recently having this discussion with colleagues of mine about the distinction between using the term “international health” and “global health” and if there truly is any difference. My understanding of each is that international health was multi-national, recognizing nation-states, borders, and governmental powers within that border and are not always universal; whereas, global health is universal by definition. Global health in my mind emphasizes the importance of global citizenship which transcends borders. Moreover, highlighting the vulnerability of those who do not have national citizenship (e.g. displaced people). Though we can debate over possible distinctions, I believe the use of either term has become interchangeable and the line distinguishing each is a thin one.


The effect of marijuana legalization on opioid-induced fatalities

A PHS 795 student has some observations about a recent study associating medical marijuana legalization with lower opioid-induced fatalities at the state level between 1999 and 2010. While this misses the recent wave of mixed heroin/synthetic deaths, it is interesting food for thought! They write:

Due to the recent focus on opioid use in America, this study explores the legalization of marijuana and how it has led to a decrease in fatal opioid overdoses. The researchers found that opioid-related deaths decreased by approximately 33% in 13 states in the following 6 years after medical marijuana was legalized.

 This study presents a new possible solution for the United States’ epidemic on opioid use. The use of cannabis is extremely controversial in medical practice but some studies indicate that it is also strongly effective for chronic pain. The study concluded that there needed to be further investigations on how medical marijuana laws interact with laws preventing opioid overdoses.

 Overall, this article brought up an excellent option for opioid fatalities in American and how the legalization of marijuana might change the statistics. As of July 2014, 23 states had enacted laws creating cannabis programs that were directed towards chronic pain. These states will be excellent case studies relating to opioid use and overdoses over the next ten years.


A pet problem…

Pop Health 795 student Kelsey Baubie draws our attention to another possible factor in the nation’s ongoing opioid crisis: veterinary prescriptions. In response to a recent article in the Washington Post, she writes:

The Washington Post worked with Pew Charitable Trusts to publish this report recently


about certain states’ attempts to require veterinarians to look into the pet’s medical record and the owner’s medical record to see if a pattern of opioid prescriptions appears. Colorado and Maine (one of the hardest hit states in terms of percentage change in overdose deaths) are two states which have enacted new legislation like this recently. The thing that stuck out so much to me that I wanted to write about this is the reaction of Dr. Kevin Lazarcheff, the California Veterinary Medical Association president, who pushed back on these new laws, saying he should not have access to human’s medical records.

What do you think about this reaction? My initial response to this was indignant: “How could you not want to do something fairly small to help stop the opioid epidemic?”. Yet I’m sure for vets, this issue is more complicated than my initial simplistic reaction allows. Do you think Dr. Lazarcheff is acting as a mouthpiece for the CVMA, whose members do not want extra responsibilities or ways they can be implicated for wrongdoing? We talked a little about malpractice and suing providers in class…are vets just trying to protect themselves from that? What more could be done to close loopholes like “vet shopping” for opioid access? What systematic changes can be made to decrease the chance of someone becoming addicted in the first place?

Population health in a boom economy…

A PHS 795 student draws our attention to a thought-provoking article in the New York Times describing a perhaps counterintuitive finding that mortality seems to increase during economic booms. They write:

This article encompasses the idea that has been brought up in every lecture – studying population health is messy. There are so many different factors that lead to the populations health outcomes that make it hard to study.

The article presents some surprising connections to economic growth and health of the population. The author referenced several studies that found an increase in mortality during economic booms. One factor that may lead to this is the increase in pollution and waste that enters the environment during these times. I think this links how everything effects everything in the system and you can’t study two factors without confounders being present. I also think it links to the post earlier on the blog about environmental health and environmental justice.

While a richer economy means people have the funds to afford health care, maybe it also means they have less time to eat healthy or exercise due to increase workloads or maybe people spend their money on more frivolous goods that contribute to a ‘stuff culture’ that harms the environment from excess production. The article states that alcohol and tobacco consumption increase during economic booms as well as occupational hazards and stress – all things that lead to greater mortality. Even though the initial thought of having a richer economy increasing mortality may be surprising, if you think about it, it makes a little more sense.

I liked how the author brought up the life time effects on an individual’s health depending on life events such as birth and college graduation. Being born in a healthy economy means you more likely have access to resources to develop skills and learn how to live a healthy life. Another example he talked about was graduating during a recession can reduce the amount of money you are able to earn over your life time.

This article brought up so much so many factors and how they are all connected to our health. Always a good thing to keep in mind when preforming or reading studies.

A closer look at soda taxes…

In response to a recent CNN story on recent declines in sugar-sweetened drink sales (featuring comments by UW LaFollette School Professor Jason Fletcher), a PHS 795 student offers comments about challenges in identifying the effect of soda taxes:

In certain areas of the country, sugary beverage tax policies have not always proved as effective of a strategy on reducing obesity rates as policymakers hoped. Well, what happens when independent citizens take it upon themselves to implement low-dose public health interventions within the community?

One could argue, speaking strictly about the 2017 Cornelsen article that studied Jamie Oliver’s restaurant intervention, that it’s even difficult to determine with certainty whether private businesses who’ve imposed additional taxes on unhealthy beverages have indeed seen the victories they’re heralding as significant wins in the fight against obesity. For example, how can one be certain (thanks, in part, to study design flaws and insufficient study controls) whether the reduction in sugary drink purchases, in one quasi-experiment involving a number of Oliver’s restaurants, is attributable to patrons having in fact made healthier choices? Is that the only alternative explanation/option that’s left, or couldn’t there be some other confounding factor(s) that might explain the sales declines and change in patron behaviors, like perhaps customers buying sodas at nearby stores instead? And, while Oliver’s business did accompany this price hike with a televised public health campaign, how do we know this increase alone is sufficient enough to inspire customers – from all backgrounds – to actually adopt measurable health reforms for themselves?

In short, what are some potentially unhelpful assumptions underlying incomprehensive studies such as this, and what might happen when we try to generalize these sort of limited results into real-world policy constructs?