Friday Five: Veterans, birth, ACA, Politifact, #HealthPolicyValentines

It's back by popular demand! (Okay, maybe only Carmen asked if I was ever going to write another Friday Five, but she's so awesome that she counts as at least ten people.) Each Friday, I use five sentences to summarize and comment on five important, interesting, or just plain amusing health stories from the week. Obama signs vet suicide prevention act Yesterday, President Obama signed the Clay Hunt Suicide Prevention for American Veterans Act, legislation aimed at improving the VA’s mental health care and removing barriers that prevent veterans from seeking treatment for mental health conditions. Death by suicide is particularly high among veterans over age 50. While their wish to end their lives may not be directly related to their service, the VA has a responsibility to care for veterans who qualify for VA care and are in need of it. The VA is notoriously problematic, and I hope that the newly-required external audits built into this Act will keep it accountable. After asking them to do what nearly every other American refuses to do, we continually fail our veterans--this Act is just a fraction of what they deserve.

Birth: Home versus hospital A short literature review by Dr. Rikki Lewis reveals interesting findings about the complexities and controversies surrounding home birth.

  • In the US, home births increased by 29% between 2004 and 2009.
  • Among studies investigating the risks and outcomes of home birth, there is little consistency in patient selection and the necessity of reporting infant deaths after transport to the hospital means that those deaths are reported as hospital deaths rather than deaths at home.
  • Policies for deciding to take a woman laboring at home are much clearer in the United Kingdom than in the US.
  • Home births are far less expensive than hospital births, which average about $20,000.

As the hospital versus home birth debate continues, it will be important to use correctly interpreted research as the basis for argument.

ACA open enrollment ends on Sunday The last day to sign up for insurance through the Marketplace is Sunday, February 15. According to the awesome website ACAsignups.net 10.5 million people have already signed up. Originally, the Department of Health and Human Services estimated that 13 million people would receive coverage during the open enrollment period, but later readjusted the estimate to between nine and ten million. If you need insurance and haven’t signed up, do it now...don’t procrastinate! (Also, can we take a moment to wonder why the “marketplace.gov” doesn’t redirect to healthcare.gov? Missed opportunity!)

 

Politifact takes on measles and vaccines One of the best, most useful sites ever, Politifact, evaluated the truthfulness of public statements about measles and vaccines. While their website could use a redesign to make articles like this one easier to read, the information they’ve provided is really valuable. They’re successful in debunking the “vaccines have mercury” claim and Rush Limbaugh’s accusation that Obama’s immigration policy allowed measles to enter the United States through Mexico. Politifact also highlights some of the true statements made by Megyn Kelly and other cable news pundits. While you’re reading their website, take a look at their ratings of statements about health care in general.

Health policy nerds love bad jokes Valentine’s Day isn’t only about romantic love. It can also be a time for you to express your deep, abiding passion for one of the nerdiest arms of public health: policy. Back in 2011, Emma Sandoe started the hashtag #HealthPolicyValentines so we could enjoy gems such as:

and

Groan worthy? Maybe, but totally great anyway.

Have an awesome Friday. I'll be back here tomorrow with a Valentine's Day-themed post!

Measles 101

As of January 30, 2015, 91 cases of measles have been reported in California, and 59 of those are linked to the Disneyland measles outbreak. So much for being the place where dreams come true. Hipster Ariel says I wanna be where the people are, better get my MMR

While this current outbreak is upsetting, and another reason for anti-vaxxers to shut up already, measles is a much bigger problem globally than it is in the United States. As with most infectious diseases that aren’t common here, there’s a lot of misunderstanding about what measles is and how dangerous it can be. Here’s a little Measles 101, sourced from WHO, CDC, and reputable scientific journals.

How serious is measles? In 2013, WHO reported 145,700 measles deaths worldwide--that’s about 16 deaths per hour, every day. Prior to 1980, when vaccination became widespread, WHO estimates there were 2.6 million measles deaths per year.

But I thought it wasn’t much worse than chicken pox! Well, there’s a rash and fever. But the complications are what make measles so frightening. Blindness, encephalitis, and pneumonia are a few of the serious complications. Severe measles is more likely among populations who are under age five or over age 20, undernourished (particularly with a vitamin A deficiency), or who have weakened immune systems.

How is measles transmitted? The measles virus can stay alive, airborne or on a surface, for two hours. People who have been infected are contagious for four days prior to the emergence of a rash, and for four days after the rash appears. Historically, each person infected with measles will infect between 11 and 18 other people, though there is some evidence that measles is becoming slightly less contagious in recent years. (This is a really awesome explanation of R0, R, and eliminating infectious diseases. Public health nerds, unite!)

But I thought measles was eliminated from the United States. Technically, as of 2000, it is. All elimination means is that a virus no longer regularly circulates through the population--its theoretical incidence in a geographic area is 0. But that doesn’t mean that measles no longer exists on Earth, so it’s easy for measles to guest star in an outbreak here and there. In 1989-1991, there was a particularly nasty outbreak in the United States in which about 55,000 people were infected, resulting in 11,000 hospitalizations and 123 deaths.

How can I avoid getting measles? Get the MMR vaccine. It doesn’t cause autism, and a 95% of people who get a single dose are immune to measles, mumps, and rubella. A second dose closes the gap, and close to 100% of people who get two doses of the MMR vaccine are protected against all three viruses. Yeah science!

To learn more about measles, check out the Measles and Rubella Initiative. For a more humorous take, The Onion wrote up a great outline of the 2015 outbreak.