Issue Category: Health Equity/Social Determinants of Health

New York City’s Efforts to Prevent and Respond to Childhood Lead Exposure

Background

According to the New York City Department of Health and Mental Hygiene, lead paint, and the related dust, is the primary source of lead exposure for New York City children. Between November 2013 and January 2016, New York City’s Department of Housing Preservation and Development (HPD), which enforces the city’s housing code, issued more than 10,000 violations for dangerous lead paint conditions in units with children under 6-years-old.lead

Lead poisoning disproportionately affects lower-income individuals in New York City who live in older, poorly maintained housing. Half of the total violations were found in just 10 percent of the city’s ZIP codes in primarily low-income neighborhoods in northern Manhattan, Brooklyn, and the Bronx. And, more than three-quarters of all violations for lead paint hazards in units with children under age six were found in areas where the poverty rate exceeds the city’s average.

Rebuttable Presumption and Billing Noncompliant Landlords for Lead Hazard Control

In 2004, New York City introduced Local Law 1 amending its Administrative Code and replacing Local Law 38 of 1999 (additional information here). Local Law 1 requires building owners to identify and repair any unsafe lead paint conditions in units where young children live. The law applies to all buildings with three or more units built before 1960 (New York City prohibited the use of lead in residential paint in 1960 while the federal government did so in 1978). Buildings built between 1960 and 1978 are also subject to Local Law 1 if the owner knows that lead paint is present. Under the law, landlords must determine annually which units are home to children under age six and inspect them at least once a year for peeling paint.

The building owners must address whatever lead hazards they find promptly and safely. When fixing hazards and conducting general repair work that may disturb lead paint, they must use lead-safe work practices and trained workers. They are also responsible for repairing lead paint hazards in any apartment before turning it over to a new tenant. The law mandates that owners maintain records of all notices, inspections, lead paint hazard repairs, and other matters related to the law.

Local Law 1 requires the HPD to inspect deteriorated lead paint whenever they receive a complaint in any apartment occupied by young children. HPD may issue positive lead-based paint violations (if it tests the paint during the inspection) or presumed lead-based paint violations (if it is unable to test the paint during the inspection because the proper equipment is not available).

Under the law, once HPD issues a lead paint violation, the building owner has 21 days to repair the hazard or, if the presumed violation was issued, to contest the violation. If the owner either fails to meet the deadline for the repairs or is not given an extension (called a postponement), the city must try to perform, or contract for, the repairs at the owner’s expense. Repairs include remediation of peeling paint, the use of an EPA certified firm, and appropriate clearance testing.

Local Law 1 also mandates the New York City Department of Health and Mental Hygiene to investigate the potential sources of lead exposure. This includes, but is not limited to, paint inspections in a dwelling in response to a report of a person under 18 years of age with an elevated blood lead level of 15 mcg/dL or greater. The Health Department may issue a lead-based paint violation (notifying HPD), and, under the law, the building owner has to do the specified repairs. If the owner fails to complete the work, the dwelling is referred to the city’s emergency repair program as described above.

Functionally, the city’s Department of Finance bills the property for the cost of the emergency repair, related fees, and/or the cost of any repair attempts. It is likely to be far more expensive for the city to arrange repairs than if the owner had taken care of them in the first place. The added cost acts as an incentive for the owner to conduct the work before a violation is issued or, when a violation is issued, to complete it in a timely manner. This is likely the only regulation in the country in which the local government conducts lead remediation and bills the landlord if the landlord fails to do what is required.

Finally, if the owner fails to pay, the city files an interest-bearing tax lien against the property.

Results

Data from the New York City Department of Health and Mental Hygiene shows the number of children with a blood lead level of 5 µg/dL or greater has dropped over 80 percent since Local Law 1 was adopted, although in 2014, 6,550 New York City children younger than 6 still had blood lead levels at or above 5 mcg/dL.

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In August, 2017, the Health Impact Project, a collaboration between the Robert Wood Johnson Foundation (RWJF) and Pew Charitable Trusts released: Ten Policies to Prevent and Respond to Childhood Lead Exposure. The Trust for America’s Health (TFAH), National Center for Healthy Housing (NCHH), Urban Institute, Altarum Institute, Child Trends and many researchers and partners contributed to the report. TFAH and NCHH worked with Pew, RWJF and local advocates and officials to put together the above case study about lead poisoning and prevention initiatives.

The case study does not attempt to capture everything a location is doing on lead, but aims to highlight some of the important work.

Access a story on New York State’s efforts here.

Access a story on Rochester’s efforts here. 

Public Health Leaders Make Urgent Joint Call to Protect Prevention and Healthcare

Joint Statement from American Public Health Association, Prevention Institute, Public Health Institute and Trust for America’s Health

June 20, 2017

The fight to protect public health is more important than ever.

The Senate is moving quickly—and secretively—on their version of legislation to repeal the Affordable Care Act (ACA). While we don’t know the content of the bill, we do know that the House-passed repeal bill—the American Health Care Act—would cause over 23 million people to lose their healthcare, restructure Medicaid, pare down essential benefits like maternity and newborn care, result in the loss of over a million American jobs, and zero out the Prevention and Public Health Fund. As leaders of organizations dedicated to protecting and advancing the public’s health, we call on Congress now to protect federal investments in public health funding, the Prevention and Public Health Fund, and affordable, high-quality healthcare.

Public health is at the very core of keeping our country safe, healthy, resilient, and secure. It works behind the scenes to ensure we have clean water to drink, safe food to eat, and healthy air to breathe. It works to safeguard us from infectious diseases like measles or Ebola by preventing the onset or spread of disease. It builds on time tested strategies to reduce the toll of chronic diseases and injuries. Public health works to redress long-standing inequities in health and safety, by investing in communities of greatest need. Through prevention, evidence-based treatment of substance use, prescription drug monitoring, and improved opioid prescribing, public health can solve the opioid epidemic, which kills ninety-one Americans a day. From opioid overdoses to rising infant and maternal mortality rates, Americans are seeing both the length and quality of their lives decline—and we need more, not fewer, investments in public health to turn the tide.

Repealing the ACA and its investments in public health and prevention dismantles the capacity of public health to do its work. The pain will be felt in every state, every congressional district, and every neighborhood, and those who are most vulnerable will suffer the most. If the Prevention Fund is eliminated, over the next five years states stand to lose over $3 billion they rely on to prevent chronic disease, halt the spread of infections, and invest in the community resources that support health and safety. Repealing the ACA and the Prevention Fund ensures there is no progress to reduce healthcare spending or improve the health of our workforce. Repealing the ACA will result in an America where preventable suffering and death are more widespread, and an America where the poorest and sickest communities fall even farther behind.

A strong public health infrastructure is at the very core of making our country safe, healthy, and secure. We need to act now to protect it.

How Embedding Health Access and Nurses in Schools Improves Health in Grand Rapids, Michigan

For more than 20 years, Grand Rapids Public Schools (GRPS) has partnered with Spectrum Health to improve educational and health outcomes for their students through Spectrum’s School Health Program. Started in 1995, the School Health Program will be expanded to its 14th additional school districts in 2017.

The GRPS Model

The GRPS program utilizes school health teams comprised of registered nurses (RNs), licensed practical nurses (LPNs), and health aides to provide direct services to students in 48 schools. GRPS’ branch of the School Health Program currently employs 34 RNs, 11 LPNs, and 34 health aides and operates four full-service school-based health centers.

In the GRPS model, school teams operate under the supervision of a school nurse whose primary responsibility is oversight of health care delivery to students during the school day. The district has established policies and procedures to describe how care is to be delivered by the team under the supervision of the Registered Nurse. The nurse may delegate care to other school staff.

School nurse responsibilities include: identification of students who have health conditions; developing a plan for care during the school day; training and oversight of staff for safe delivery of medications and treatments; providing services that cannot be delegated; establishing medical response teams to respond to emergencies; telephone triage and support; surveillance and reporting of communicable diseases; connecting students to medical, dental, and mental health care through referrals; promoting health; health education; health screenings and follow up; and assisting students in obtaining immunizations.

GRPS uses funds from a variety of sources to support their school nurses including:

  • the district budget;
  • their local intermediate school district;
  • the State Department of Education—including grants and 31A funds (for students deemed at high risk); and
  • Spectrum Health.

The full-time equivalent (FTE) for the nurses for each school is adjusted based on the health needs of the student population and the availability of funds. Even though some funding for school nurses is still provided through Title I, GRPS has largely moved to alternative funding streams due to cumbersome reporting requirements.

While RNs serve as the cornerstones in the model, GRPS also braids together funding streams from both public and private entities to allow for reimbursement and service provision under a variety of health delivery models beyond the traditional school nurse reimbursement model. Coordinating funds and services across the spectrum of health providers and sources enables GRPS to provide services outside of the traditional school nurse model—such as dental services.

GRPS has also partnered with Cherry Health Services a local Federally Qualified Health Center (FQHC) to deliver health services in their school-based health centers and through a traveling dental program. Because these services are provided through an FQHC, they are eligible for Medicaid reimbursement and receive the FQHC enhanced reimbursement rate.

While data systems and privacy concerns have hindered data sharing and integration in the past, GRPS is actively moving towards linking education and health data under one system. The new data system is built upon the district’s student record system and has the potential to more easily link school health metrics to attendance and academic data. These system improvements are crucial steps to helping Spectrum Health and GRPS track and accomplish both its short-term goals to improve attendance and reduce chronic absenteeism and its long-term goals to improve graduation rates, workplace readiness and college entry.

Consultative RN Hub Model

In more rural districts, Spectrum Health has developed a consultative RN hub model for service delivery. Nurses are able to serve students utilizing telemedicine through its MedNow program—reducing travel time for school nurses and costs for the district. The Regional program will serve 13 districts in 2017 with 14 RN and two LPN.

Results

The partnership between Spectrum Health and the school districts have produced significant improvements in important school health indicators. Key accomplishments from FY 2015 included:

  • 97 percent of students at participating schools met current immunization requirements to attend school;
  • 98 percent of problems identified were resolved on-site by the school health care team;
  • 195,092 visits occurred to the school health office; and
  • 28,864 students were served across 7 school districts.

 

For more information, please visit http://www.spectrumhealth.org/healthier-communities/our-programs/school-health-program

TFAH Statement: Strongly Opposed to the House Obamacare Replacement Bill

Washington, D.C., March 7, 2017 – The below is a statement from John Auerbach, president and CEO, of Trust for America’s Health (TFAH).

“We are strongly opposed to the House Obamacare Replacement bill, which would repeal significant portions of the Affordable Care Act (ACA), including the Prevention and Public Health Fund.

Under this plan, millions of people could lose health insurance—a devastating blow to the health of many of our nation’s most vulnerable individuals and families. Without affordable insurance coverage we will see increased levels of preventable illnesses, injuries and deaths.

In addition, eliminating the Prevention Fund would erase 12 percent of the Centers for Disease Control and Prevention’s (CDC) budget. Of that investment, $625 million directly supports state and local public health efforts to fight preventable diseases such as diabetes, heart disease and cancer.

Losing this funding would wreak havoc on our efforts to reduce chronic disease rates, immunize our children, stop the prescription drug and opioid epidemic and prepare the public health system to prevent infectious disease outbreaks.

We know how to prevent many chronic and infectious illnesses—which make up a significant portion of the $3 trillion the nation spends yearly on healthcare.  If we lose access to health care coverage and to the Prevention Fund, our children, families and communities will suffer and ultimately costs will rise.

The bottom line? This Bill would make untold numbers of the American people less healthy.”

 

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Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.

TFAH Statement on the Draft House Republican Obamacare Replacement Bill: Our Nation’s Health Will Suffer

Washington, D.C., February 24, 2017 – The below is a statement from John Auerbach, president and CEO, of Trust for America’s Health (TFAH).

“The draft House Republican Obamacare replacement bill—which would eliminate the Prevention and Public Health Fund—would threaten the health of American children, families and communities.

Thanks to the Prevention Fund, hundreds of thousands of Americans benefit from increased access to vaccines and other preventive health services. Quite simply, more people are getting and remaining healthy because of the Prevention Fund.

Yet, the proposed replacement bill would eliminate this important Fund and 12 percent of the U.S. Centers for Disease Control and Prevention’s (CDC) budget along with it.

And, without the Prevention Fund, states will lose substantial sums of money—totaling as much as $3 billion over the next 5 years—which fight growing epidemics and emerging diseases.

Every year, we spend $3 trillion on healthcare, yet millions suffer from chronic diseases and death rates among Blacks and other people of color remain too high. At the same time, death rates among white middle-aged Americans increased for the first time in decades, mainly due to preventable conditions.

Time and again research shows that the vast majority of these conditions—heart disease, diabetes and others—can be prevented by investing in addressing the root causes. Yet, the country has repeatedly failed to do so.

The nation cannot afford to trade away our single best investment in preventing disease, preparing for and responding to infectious disease outbreaks, reducing rates of chronic illness, and saving lives and money.

If this draft becomes law, our nation’s health will suffer—and it will be exponentially harder to fight growing epidemics, like the rise in prescription drug and heroin overdoses.”

 

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Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.

It Takes a Village: How Mancelona, Michigan Worked Together to Improve Health and Education

By Mike Swain, MPH, Community Health Coordinator, Health Department of Northwest Michigan

In the early 1990s, residents of Mancelona (a northern Michigan town) had limited access to healthcare, social services and higher education and there were sparse employment opportunities.

With the lowest per capita income in the immediate area, most families lived in poverty, and were underinsured, uninsured altogether or enrolled in Medicaid.

Some of the community’s youngest were hardest hit: the area had the state’s highest rates of youth physical and sexual abuse, teen pregnancies, drinking and drug use. And as could be expected, these health risks had a significant impact on academic performance – with behavior problems in the classroom, low grades, and high dropout rates. In the 1994-95 school year, 39 percent of Mancelona high schoolers dropped out and just 64 percent of the senior class graduated.

Terry McCleod, the Middle School Principal at the time, recognized the critical role of student health and wellness in academic success – and he led the charge for change in Mancelona.

First, he brought together a grassroots network of public and private service providers. Along with a three year grant from the W.K. Kellogg Foundation, they built Project S.H.A.R.E. (School Home Alliance for Restructured Education) to provide a comprehensive assessment and evaluation of the gaps and needs in Mancelona.

The results made it clear that any successful, lasting intervention would need to improve the environment and families by addressing the underlying, interconnected issues of poverty. The layout of the community’s schools—all three were essentially on the same campus—allowed for a unique solution: building a dedicated family resource center right next to school grounds. With thoughtful outreach, community advocates and the public health administration were engaged in the cause, and the land for this building was secured.

The group secured a grant from the Michigan Department of Health and Human Services (MDHHS) to fund the beginning of construction, with the Mancelona Family Resource Center (MFRC) officially opening in 1996.

MFRC housed health, social, daycare, educational, and economic services, offering a unique and comprehensive suite of services to support Mancelona’s students and their families. Staffing and programs were brought in with continued support from Project S.H.A.R.E., including the Michigan Works! Association – which resided in a dedicated wing of the MFRC.

Michigan Works! played a critical role in turning the tide of poverty by strengthening the employability of adults with workforce development services and mobilization of local businesses.

Still, quality healthcare was at the heart, with the local Health Department providing previously unattainable care, including a Dental Health Clinic, on site. Additionally, the MFRC team provided convenient and confidential, family planning, reproductive health services, and education. And working closely with the school, this innovative approach included the development of a dedicated class for pregnant mothers to help improve the health of future Mancelona generations.

Over time, partnerships and additional resources were added within the center, the school and the community. In 2001, Communities In Schools (CIS) began providing programs and services in Mancelona. Founded on the national CIS model, this non-profit organization provided new programs for before/after school activities, mentoring and tutoring.

The CIS team worked in collaboration with the MFRC, providing care coordination and referrals for students and their families. And, when the state of Michigan expanded school-linked health center qualification requirements to include areas with rural status, the MFRC leadership were among the first applicants in line. Mancelona was included with the first round of funded centers under this new qualification.

In 2006, with this additional funding, the Mancelona school-linked health center opened, called the Ironmen Health Center, was opened. The Center offered services to students aged 10-21 regardless of health insurance status. In addition, social work and behavioral health services were provided.

By blending and braiding different funding sources and bringing to bear all community resources to link families to important social services and interventions, the community is much improved.

In fact, rates of teen pregnancy, drug and tobacco use, and child abuse are all down. And, high school graduation is up—to 91 percent, a 42 percent increase from the inception of project.

The benefits of this innovative care model doesn’t stop there: 60 percent of the 2013 graduating class enrolled in college that fall. And nearly 100 percent of the 2015 seniors are making plans to pursue some form of higher education or technical skills training post-graduation. What was once and ending is now just the beginning of a story.

Here you can find a timeline and more information on the model, including details on the Women’s Resource Center, Communities in Schools and the Ironmen Health Center. 

 

Survey Finds 73 Percent Support Investments to Improve Health; Obesity, Future Health of Children Top Concerns

Washington, D.C., January 19, 2017 —A new national survey of registered voters has found that nearly three-quarters (73 percent) of Americans support increasing investments to improve the health of communities.  Support spans across party lines (57 percent of Republicans, 87 percent of Democrats and 70 percent of Independents) and regionally across the country (75 percent in the Northeast, 71 percent in the Central U.S., 72 percent in the South, and 75 percent in the West).  Women are the strongest proponents of supporting health improvement efforts (62 percent of Republican women, 87 percent of Democratic women and 80 percent of Independent women).

The survey, released today by the Robert Wood Johnson Foundation and the Trust for America’s Health, was conducted by Greenberg Quinlan Rosner Research, in consultation with Bellweather Research, on September 8-9, 2016 of a nationwide sample of 1302 registered voters across the country.

A majority (51 percent) believe that today’s children will be less healthy than previous generations when they reach adulthood.  The groups who hold this belief most strongly include: Republicans (55 percent); rural residents (60 percent); Southerners (57 percent); Independent women (62 percent); and Black women (68 percent).  Most registered voters with children under age 18, however, believe their own children are very healthy (92 percent give an 8-10 rating on a 10-point scale); this is the case for parents of all ideologies, incomes, education levels, and ethnicities.

Additionally, 64 percent believe that the number of health issues facing the country has grown in recent years. Obesity is the top health concern (41 percent), cancer ranked second (33 percent), followed by heart disease and stroke (14 percent) and diabetes and substance misuse (both at 11 percent).

Americans also rate their own health better than the health of the community where they live (66 percent rate their own health as 8-10 (very good) on a 10 point scale, but only 36 percent rank their community’s health as very good).  There are differences based on income, age, education and area of the country on how people rank their health.  For instance:

  • 73 percent of college-educated Whites rank their health as very good compared to 57 percent of Whites without college degrees; and
  • 72 percent of individuals with a household income above $50,000 per year rank their health as very good compared to 59 percent of those with incomes below $50,000.

A majority of American registered voters also strongly support (rating 8-10 out of a 10 point scale) a range of priorities and strategies for improving health, including:

  • 74 percent of people highly support providing enough time — during the school day and afterschool – for kids’ physical education, physical activity or community sports;
  • 74 percent also highly support creating partnerships among farmers, food suppliers and community health groups to bring fresh produce trucks or mobile markets to communities that lack access to grocery stores;
  • 65 percent highly support providing kids with more information on making healthy food choices and being physically active;
  • 63 percent highly support investing more in preventing obesity and chronic diseases like heart disease, diabetes and stroke;
  • 62 percent highly support increasing early childhood health programs, including home visit programs, mobile health screenings and treatment for diseases like asthma;
  • 61 percent highly support investing more in preventing the spread of infectious diseases like the Zika virus, bird flu and hepatitis;
  • 60 percent highly support treating substance use, including addiction to prescription painkillers and heroin, like a disease, not a crime;
  • 60 percent highly support planning for building more parks, walking and biking trails and other recreation areas for people to be physically active in all communities;
  • 60 percent highly support increasing access to safe and affordable housing and routinely testing for things that create health problems in homes, like lead in water and paint, carbon monoxide, and harmful chemicals in the air;
  • 59 percent highly support increasing incentives that encourage business owners to open grocery stores in communities that lack access to healthy food options; and
  • 58 percent highly support building local partnerships across businesses, health systems, schools and community organizations to address specific health problems in communities.

Methodology:  On behalf of the Robert Wood Johnson Foundation and the Trust for America’s Health, Greenberg Quinlan Rosner Research, in consultation with Bellwether Research, conducted a survey among 1,320 registered voters nationwide (1,019 weighted). The survey was conducted between September 8th and 19th, 2016. Voters were randomly selected from a list of registered voters and reached on a landline or cell phone depending on the number they designated on their voter registration. Interviews were conducted by live telephone interviewers; 50 percent were reached on a cell phone. Included in the sample were three oversamples: 100 Black voters, 100 Hispanic voters, and 100 White non-college voters. Upon completion of the survey, the results were weighted to bring the three oversamples into line with the racial and ethnic composition of registered voters nationwide. The data was weighted to reflect the total population of registered voters, taking into account regional and demographic characteristics according to known census estimates and voter file projections. The data are subject to a margin of error of +/- 3.1 percentage points.  Full survey and topline results are available upon request.

For more than 40 years the Robert Wood Johnson Foundation has worked to improve health and health care. We are striving to build a national Culture of Health that will enable all to live longer, healthier lives now and for generations to come. For more information, visit www.rwjf.org. Follow the Foundation on Twitter atwww.rwjf.org/twitter or on Facebook at www.rwjf.org/facebook. 

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Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.