Issue Category: Housing

Navigating Climate-Related Threats to the Public’s Health

The Urgency of Emergency Preparedness in Light of Extreme Weather Events

(August 29, 2023) In the first eight months of 2023, the United States confronted numerous climate challenges, indicating a pivotal moment for the nation and the planet. Hawaii faced the country’s deadliest wildfires in over a century, claiming more than 100 lives and leaving a staggering cost in their wake. In California, storms tested the state’s resilience through floods and mudslides, while in Phoenix, weeks of intense heat threatened its most vulnerable residents. In Vermont, rivers surged past their banks, while haze from Canadian wildfires degraded air quality in more than a dozen states. And all this as the year’s hurricane season is just getting underway.

These events demonstrate the escalating public health threats driven by climate change and the need for public health officials to play a role in addressing them. As global temperatures rise, we are seeing an uptick in heat-related illnesses and even fatalities, especially among individuals who are most at risk. Rising sea levels and intensified storms lead to flooding, which can contaminate drinking water and spread waterborne diseases. Meanwhile, wildfires, exacerbated by droughts and higher temperatures, compromise air quality, leading to a spike in respiratory problems, from asthma to chronic bronchitis. Furthermore, shifting climate patterns are expanding the range of many infectious disease vectors, like mosquitoes, exposing new populations to illnesses like malaria or dengue. The ripple effects of climate change touch nearly every aspect of public health, demanding policymakers’ attention and action.

Below is a partial round-up of the climate-related challenges that the country has already faced in 2023.

Wildfires in Hawaii. The U.S. grappled with its deadliest wildfires in over a century when fires that began as isolated brush incidents on the islands of Hawaii and Maui were intensified by the effects of Hurricane Dora and quickly escalated. Many public officials and residents were caught off guard by the size and rapid spread of the flames, leading to the tragic loss of more than 100 lives. Residents and officials now confront daunting reconstruction needs. Despite Hawaii’s reputation for lush greenery, its defenses have been compromised by significant reductions in rainfall. Diminished La Niña patterns, which traditionally bring cooler and wetter conditions to the region, have shifted, leading to warmer and drier trends. Furthermore, the proliferation of flammable invasive grasses, supplanting native vegetation, increases the fire risks.

Smoky skies. Canada, grappling with one of its harshest wildfire seasons, has seen tens of millions of acres of its landscape consumed by flames. The repercussions have been felt beyond its borders, with smoke significantly degrading air quality in several U.S. regions, including New England, the Southeast, and the Midwest. These conditions have led the Environmental Protection Agency to issue air quality alerts affecting millions of Americans. This sharp rise in fires is largely linked to the effects of global warming, which brings about drought and intense heat, rendering forests more vulnerable to blazes.

California storms. In early 2023, intense rains hit California. While they replenished reservoirs and snowpacks, they also caused flooding, mudslides, sinkholes, and tree damage that impacted infrastructure. A severe winter storm in late February trapped residents and led to the deployment of the California National Guard. Shortly after, another storm in the Sierra Nevada caused two fatalities and power disruptions. March saw the arrival of two bomb cyclones that brought tornadoes, heavy rain, and snow. These extreme weather events, exacerbated by climate change, underscore California’s oscillation between droughts and powerful storms. Such climatic shifts create atmospheric rivers that deliver heavy precipitation.

Notably, Southern California effectively weathered Tropical Storm Hilary’s record-setting rainfall in August, in part due to proactive measures like school closures and swift emergency response to road flooding and fallen trees. Despite the storm’s potential severity, no deaths were reported in major areas like Los Angeles and San Diego, highlighting the importance of preparedness.

Groundwater shortages in Arizona. Arizona officials sounded the alarm in June on groundwater shortages, signaling a potential halt to the rapid housing development in the Phoenix area, which is among the fastest-growing regions in the U.S. Although existing building permits will remain unaffected, the announcement underscores the urgent need for alternative water sources and conservation measures in future projects. Governor Katie Hobbs reassured that Arizona is not immediately running out of water, but shortages could have significant implications for the region’s future. Prolonged drought, combined with increasing water demand, have depleted the Colorado River and intensified water scarcity, posing a challenge for the region’s long-term sustainability.

Vermont flooding. In July, Vermont experienced severe flash and river flooding, leading to extensive damage to communities, roads, bridges, and causing significant property losses. This event broke several records, with Montpelier’s airport receiving the highest single-day rainfall since 1948. The destruction was comparable to the damage from Tropical Storm Irene in 2011. In terms of impact, the destruction from the 2011 and 2023 events was only surpassed by the Great Flood of  November 1927, which took place before modern flood control measures were implemented in the state.

Hot water off the coast of Florida. A buoy off Florida’s coast this summer measured a sea surface temperature of 101.1 degrees Fahrenheit, potentially setting a new world record and far exceeding the typical range of 73F to 88F. This extreme heat, part of a concerning trend of warming waters in Florida, poses grave risks to marine life, ocean ecosystems, and human livelihoods. Increasing temperatures, intensified by phenomena like El Niño, could also boost the strength of tropical storms and hurricanes.

Extreme heat in Phoenix. Phoenix endured an unprecedented heatwave in July, with temperatures exceeding 110°F for 31 straight days, surpassing a 1974 record. This coincided with a global trend marking July the warmest month ever registered. Hospitals reported an uptick in heat-related cases, ranging from heat cramps to lethal heat strokes. The city’s medical examiner confirmed 25 heat-related deaths and is investigating many more. Critical infrastructure, such as air conditioners in shelters and medical buses, malfunctioned due to the extreme temperatures. With shelters at full capacity and public housing waitlists stretching for months, many unhoused residents were left without a haven from the oppressive temperatures.

President Biden announced initiatives in July to support communities suffering from extreme weather. To combat the rising heat, the primary weather-related cause of death in the U.S., he directed the Department of Labor (DOL) to issue its first-ever Hazard Alert concerning heat, with the intent to reinforce worker protections against heat-related dangers under federal law. This alert will educate employers on their responsibilities and help ensure that workers know their rights. The DOL has committed to intensifying its enforcement against heat-safety violations, focusing especially on high-risk sectors like construction and agriculture. Meanwhile, the National Oceanic and Atmospheric Administration is allocating up to $7 million to enhance weather forecasting in collaboration with educational institutions, aiming to boost preparedness for extreme weather events. Additionally, the Department of the Interior is in the process of investing $152 million to bolster water storage and climate resilience in California, Colorado, and Washington, addressing the challenges of prolonged drought and ensuring access to clean drinking water.

These efforts build on past actions by the Biden-Harris Administration, such as channeling billions of dollars via the Department of Housing and Urban Development for energy-efficient building upgrades and the establishment of cooling centers. Additionally, in collaboration with Congress, it earmarked over $50 billion from the Infrastructure Investment and Jobs Act to bolster climate resilience throughout the nation.

As Trust for America’s Health (TFAH) has previously highlighted, preparing for weather-related events is a critical element of public health emergency preparedness. Collaboration between public health officials and partners—such as federal, state, local, tribal, and territorial agencies, emergency response teams, community-based organizations, and hospitals—is fundamental. Working together, they can pave the way for better preparation and response strategies, utilizing data to predict and lessen potential health impacts. Proactive measures are crucial in safeguarding communities from these escalating threats. For example, the nation needs significant investment in climate-resilient infrastructure — from storm-resistant housing to updated water management systems. To protect people from extreme heat, communities must prioritize public education on heat risks, establish cooling centers, and adapt urban infrastructure to reduce heat retention. It’s crucial to acknowledge that socioeconomic and health inequities have historically worsened the impact of extreme heat on communities of color, making targeted interventions in these communities even more essential. Strengthening early warning systems and ensuring equitable access to hydration and emergency healthcare resources are vital steps. It’s also imperative to bolster our health systems’ readiness to respond to the increasing burden of climate-related illnesses. This includes enhancing disease surveillance and training healthcare professionals to recognize and treat emerging health threats, especially in communities that face disproportionate risks.

In line with a comprehensive public health approach, the Building Resilience Against Climate Effects (BRACE) framework from the Centers for Disease Control and Prevention (CDC) offers a vital tool. This strategic framework empowers officials to develop and implement health adaptation plans tailored to their specific climate change challenges. By guiding health departments through a five-step process — from forecasting climate impacts and assessing vulnerabilities to developing and implementing a comprehensive adaptation plan — the BRACE framework ensures a data-driven response that accounts for local nuances. Recognizing the disparate effects of climate change on various populations, this approach emphasizes not just broad community safeguards but also targeted interventions to protect those most at risk. To more adequately support these crucial initiatives, TFAH recommends funding the CDC’s Climate and Health Program at a level of $110 million for Fiscal Year 2024. This program collaborates with state, local, tribal,  and territorial health agencies to address climate change impacts, primarily utilizing the BRACE framework. Additionally, it offers resources, funding, and support through various initiatives to enhance community preparedness and communication regarding climate-related health risks. As communities continue to witness the tangible effects of a changing climate, leaning into systematic and strategic frameworks like BRACE becomes paramount. The synthesis of proactive planning, community-specific interventions, and overarching public health strategies helps bring about a resilient and equitable response.

Acting to protect health and well-being by improving our systems’ readiness and enhancing protective measures—commonly termed climate adaptation—is a critical public health priority. Climate mitigation refers to efforts to reduce or prevent greenhouse gas emissions or to remove them from the atmosphere, aiming to curb future global warming. Both the Intergovernmental Panel on Climate Change, a scientific body under the auspices of the United Nations that assesses climate change information, and the United States Global Change Research Program, which coordinates U.S. research on global environmental changes and evaluates climate change impacts, emphasize that mitigation and adaptation are complementary strategies crucial for reducing the human impacts of climate change.

 

The Role of Community Development in Improving Population Health and How Pediatricians Can Help

A research article authored by Build Healthy Places Network and published by Academic Pediatrics, discusses the relationship between the zip code in which a child lives and that communities’ health implications that permeate well into adulthood. This includes the physical environment measured by things like access to healthy food, places to engage in physical activity, sanitation, and the mental and emotional environments including healthy relationships, communication with adults, and connectedness at school.

The effects of the environment in which a child is raised can be exacerbated by adverse childhood experiences (ACEs) like exposure to violence or family instability and can have negative impacts on a child’s health and into adulthood. Thee article reviews the role of pediatricians can play in advocating for community development initiatives that foster healthy neighborhood conditions where children can grow and thrive.

What Is Community Development?

Community development is a multifaceted term that has its origins in the antipoverty and racial justice movements of the 1960s. It partly began as a corrective response to racial segregation and redlining practices in the housing and finance markets that created and perpetuated low-resource neighborhoods. Organizations involved in community development work often focused on building generational wealth and quality of neighborhoods are increased through investments in affordable housing, grocery stores, health clinics schools and childcare centers, and small businesses to provide local jobs. These are direct resources in the community that are also known to have a positive effect on reducing crime, substance misuse, and other risk factors.
The Conway Center in Washington, DC  is an example. The Conway Center provides affordable family housing and housing for individuals experiencing homelessness, green space and a playground, office space, a job raining center, and a community health clinic in a property that is accessible by public transportation. The center has yet to be formally evaluated but the article’s authors advise that when such programs are evaluated the evaluators should measure its impact in ways beyond the traditional measurements of controlled or clinical experiments. For example, measures that capture the real world impact on people’s lives should be employed.

Other examples are the neighborhoods of the Villages at East Lake in Atlanta, GA and Columbia Parc in New Orleans, LA. Both communities were originally public housing projects, that now focus on children’s education and family economic success by prioritizing mixed-income housing, cradle-to=college education, healthy food access, recreation, public safety, and neighborhood services like shopping and banking. Columbia Parc has not been quantitatively evaluated, but the Villages at East Lake, Atlanta, has seen a significant decrease in violent crime, a 5-fold increase in household income, standardized test scores among the top five for K-12 schools in the Atlanta metro area, and a 97% high school graduation rate that was previously under 30% in the 1990s.

How Can Pediatricians Support Community Development?

What a child experiences and its impact on their developing minds and bodies can put them at risk well into adolescence and even adulthood. Interventions are therefore most effective when they target the early stages of a child’s life.

The opportunity to be healthy during childhood is a bridge to other opportunities – for education, emotional well-being and employment, the article states. Promoting health should therefore be a priority consideration for community development, and health experts should be included in the community development process. As experts in child health, pediatricians are uniquely qualified to integrate health as a protective factor in community development efforts. According to the National Academy of Medicine, only 10-20 percent of health status is related to medical care; the rest is accounted for by social determinants of health – opportunities for healthy behaviors like access to healthy food choices and safe and accessible places for physical activity, socioeconomic factors like education and employment,  and physical environment like housing and pollution. It is not just beneficial, but necessary for a physician to consider this holistic and interactive context in which health operates, knowing that health can be modified by any one of these non-clinical factors.

According to the article, a pediatrician therefore has a professional interest in understanding their patients’ family and community characteristics that influence health. Pediatricians’ input can help design community development initiatives that support families and children’s healthy development. Jutte, Badruzzaman, and Thomas-Squance share some tangible ways pediatrician can use their professional voice to drive neighborhood investments through a community development framework.

Next, researchers in the field of pediatrics can investigate the effects of neighborhood investments on child and adolescent health, in one potential way by studying health variables in neighborhoods where investments have already been made but impact has yet to be measured, like the Conway Center.

Policy Action is Needed

The Build Healthy Places Network’s article underscores the need for policy action Community development should be a central value and initiative in improving the health of and preventive services in neighborhoods. Neighborhood infrastructure has lasting effects on children that persist into adulthood, for both risk and protective factors. Pediatric professionals can use their expertise in the field to practice, educate, and advocate for the principles of community development that consider holistic wellness. Trust for America’s Health’s (TFAH) Promoting Health and Cost Control in States (PHACCS) report includes several policy actions that pediatricians can support in order to advance pediatric health:

  • School-based health centers that meet comprehensive pediatric needs in primary care including healthcare, oral care, behavioral healthcare, and health education in fixed, mobile, or telehealth location settings.
  • Early education and universal pre-kindergarten programs that benefit childhood development and reduce the likelihood of risk factors throughout the life course.
  • Housing rehabilitation programs that make physical improvements in neglected properties like lead abatement, re-housing programs that offer support services for individuals experiencing homelessness to transition to permanent housing, and policies that protect the affordability of housing like tax credits and incentives.
  • Developmental infrastructure like “Complete Streets” policies that promote physical activity, safer streets, and mixed-use land spaces that create inclusive, integrative, and healthier neighborhoods for living and growing.
  • Affordable, sustainable quality housing that provides stability, economic and social opportunity for families, and long-term health benefits that are protective factors for life-long wellness.

For more details on these solutions and policies, see TFAH’s PHACCS initiative and accompanying reports.

Increases in Drug Overdose Death Rates Were Up Before COVID-19 and Are Continuing to Rise During the Pandemic

Trust for America’s Health and Well Being Trust Call for Renewed Focus on Preventing Deaths of Despair

DISTRICT OF COLUMBIA & OAKLAND, CA – Dec. 23, 2020 – According to data released this week by the National Center for Health Statistics, in 2019 age-adjusted drug overdose deaths increased slightly over the prior year.  Coupled with data released last week by the CDC showing increases in drug overdose deaths in early 2020, these reports demonstrate the continuing upward trajectory of drug deaths in the U.S, a trend that is being compounded by the COVID-19 pandemic.

The age-adjusted rate of drug overdose during 2019 was 21.6 per 100,000 deaths, up from the 2018 rate of 20.7 per 100,000. In 2019, 70,630 people died due to drug overdose in the United States.

Between 1999 and 2019 the rate of drug overdose deaths increased for all groups aged 15 and older, with people aged 35-44 experiencing the highest single year increase in 2019.  While rates of drug overdose deaths involving heroin, natural and semisynthetic opioids, and methadone decreased between 2018 and 2019 the rate of overdose deaths involving synthetic opioids other than methadone continued to increase.

2018 data showing only minor progress after decades of worsening trends, provisional drug overdose data showing an 18% increase over the last 12 months, and the recent CDC Health Alert Network notice on early 2020 increases in fatal drug overdoses driven by synthetic opioids all underscore the continued impact of the deaths of despair crisis and how the COVID-19 pandemic has further diminished the mental health and well-being of many Americans.

“These 2019 overdose rates and the outlook for 2020 are extremely alarming and the result of insufficient prioritization and investment in the well-being and health of Americans for decades,” said John Auerbach, President and CEO of the Trust for America’s Health. “As we work to recover from the COVID-19 pandemic, we must take a comprehensive approach that includes policies and programs that help Americans currently struggling and target upstream root causes, like childhood trauma, poverty and discrimination in order to help change the trajectory of alcohol, drug, and suicide deaths in the upcoming decades.”

Over the last five years, Trust for America’s Health (TFAH) and Well Being Trust (WBT) have released a series of reports on “deaths of despair” called Pain in the Nation: The Drug, Alcohol and Suicides Epidemics and the Need for a National Resilience Strategy, which include data analysis and recommendations for evidence-based policies and programs that federal, state, and local officials.

“If leaders don’t act now to stymie America’s mental health and addiction crises, next year’s data will easily surpass the astounding numbers we’re seeing today,” said Dr. Benjamin F. Miller, PsyD, Chief Strategy Officer at Well Being Trust. “Overdose deaths can be prevented if individuals who are struggling are able to access the appropriate services and supports – and with greater demonstrated success if the care individuals receive is rooted in their immediate communities.”

 

Drug Overdose Deaths, 1999-2019 (Rates age-adjusted)

Year Deaths Deaths per 100,000
1999 16,849 6.1
2000 17,415 6.2
2001 19,394 6.8
2002 23,518 8.2
2003 25,785 8.9
2004 27,424 9.4
2005 29,813 10.1
2006 34,425 11.5
2007 36,010 11.9
2008 36,450 11.9
2009 37,004 11.9
2010 38,329 12.3
2011 41,340 13.2
2012 41,502 13.1
2013 43,982 13.8
2014 47,055 14.7
2015 52,404 16.3
2016 63,632 19.8
2017 70,237 21.7
2018 67,367 20.7
2019 70,630 21.6

 Sources:
CDC – NCHS – National Center for Health Statistics
https://emergency.cdc.gov/han/2020/han00438.asp
https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm

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About Trust for America’s Health
Trust for America’s Health is a nonprofit, nonpartisan organization that promotes optimal health for every person and community and makes the prevention of illness and injury a national priority. Twitter: @HealthyAmerica1

 

About Well Being Trust
Well Being Trust is a national foundation dedicated to advancing the mental, social, and spiritual health of the nation. Created to include participation from organizations across sectors and perspectives, Well Being Trust is committed to innovating and addressing the most critical mental health challenges facing America, and to transforming individual and community well-being. www.wellbeingtrust.org Twitter: @WellBeingTrust

 

Policymakers and Health Systems Must Earn Trust within Communities of Color and Tribal Nations to Ensure COVID-19 Vaccine Receptivity, Say Health and Public Health Leaders

Policy brief calls for building vaccine acceptance in communities of color and tribal communities through data transparency, tailored communications via trusted messengers, ensuring ease of vaccine access and no out-of-pocket costs

(Washington, DC – Dec. 21, 2020) – A woeful history of maltreatment of communities of color and tribal nations by government and the health sector, coupled with present day marginalization of these communities by the healthcare system, are the root of vaccine distrust among those groups, according to a policy brief, Building Trust in and Access to a COVID-19 Vaccine Among People of Color and Tribal Nations released today by Trust for America’s Health (TFAH) and co-authors the National Medical Association (NMA) and UnidosUS.

This historic maltreatment, coupled with current day structural racism, has played out in COVID-19’s disproportionate impact on communities of color and tribal communities. These factors also make ensuring vaccine receptivity and access within those communities challenging and of critical importance to protecting lives and ending the pandemic.

In October 2020, TFAH, NMA and UnidosUS hosted a policy convening with 40 leading health equity, healthcare, civil rights, and public health organizations. The purpose of the convening was to advise policymakers on the barriers to vaccine receptivity within communities of color and tribal communities and how to overcome those barriers.

“Earning trust within communities of color and tribal communities will be critical to the successful administration of the COVID-19 vaccine. Doing so will require prioritizing equity, ensuring that leaders from those communities have authentic opportunities to impact vaccine distribution and administration planning, and, the resources to fully participate in supporting vaccine outreach, education and delivery in their communities,” said Dr. J. Nadine Gracia, Executive Vice President and COO of Trust for America’s Health.

The convening created recommendations for policy actions that should be taken immediately within six key areas:

Ensure the scientific fidelity of the vaccine development process.

  • HHS and vaccine developers should release all available vaccine data at frequent and regular intervals to improve transparency and increase confidence in the vaccine evaluation process. Leadership at FDA and HHS must commit to advancing any vaccine only after it has been validated based on established federal and scientific protocols. Programs to monitor for adverse events must also be in place and transparent. Any perception of bypassing safety measures or withholding information could derail a successful vaccination effort.
  • FDA should engage health and public health professional societies, particularly those representing healthcare providers of color, local public health officials, as well as other stakeholders with a role in vaccination, and allow these groups to validate all available data, review the vaccine development and approval process, and issue regular updates on data to their patients, members, and the public.

 Equip trusted community organizations and networks within communities of color and tribal nations to participate in vaccination planning, education, delivery and administration.  Ensure their meaningful engagement and participation by providing funding.

  • Congress should fund CDC and its state, local, tribal, and territorial partners to provide training, support, and financial resources for community-based organizations to join in vaccination planning and implementation, including community outreach, training of providers, and participation in vaccination clinics. State, local, tribal, and territorial authorities should authentically engage and immediately begin vaccination planning with community-based organizations, community health workers/promotores de salud, faith leaders, educators, civic and tribal leaders, and other trusted organizations outside the clinical healthcare setting as key, funded partners.

Provide communities the information they need to understand the vaccine, make informed decisions, and deliver messages through trusted messengers and pathways.

  • Congress should provide at least $500 million to CDC for outreach, communication, and educational efforts to reach priority populations in order to increase vaccine confidence and combat misinformation. All communications must be culturally and linguistically appropriate and tailored as much as possible to reach diverse populations as well as generations within groups.
  • FDA and CDC should initiate early engagement with diverse national organizations and provide funding and guidance for state, local, tribal, and territorial planners to help shape messaging and engage locally with healthcare providers in communities of color and tribal communities, such as nurses, pharmacists, promotores de salud, community health workers, and others to ensure they have the information they need to feel comfortable recommending the vaccine to their patients. Congress and HHS should provide funding for training and engagement of trusted non-healthcare communicators to help shape messaging and to train informal networks, civic and lay leaders, and other trusted community leaders and community-based organizations to answer questions and encourage vaccination.
  • All messaging about the vaccine must be appropriate for all levels of health literacy. Communication should be realistic and clear about timelines and priority groups (and the rationale for these decisions), vaccine effectiveness, types of vaccines, the number of doses, costs, and the need for ongoing public health protections. Planners must provide information that meets people where they are (e.g., barber shops, bodegas, grocery stores, places of worship, etc.) and ensure that trusted messengers in those places have the information they need to be credible and authentic spokespeople.

 

Ensure that it is as easy as possible for people to be vaccinated. Vaccines must be delivered in community settings that are trusted, safe and accessible.

  • We urge the administration and Congress to appropriate the resources necessary to expand and strengthen federal, state, local, territorial, and tribal capacity for a timely, comprehensive, and equitable COVID-19 vaccination planning, communications, distribution, and administration campaign, including funding to support vaccine distribution at the local level and by community-based organizations.
  • Congress and HHS should allocate funding to increase access to vaccination services to ensure that people seeking to be vaccinated do not experience undue increased exposure to the virus as they travel to, move through, and return home from vaccination sites. Flexibility in funding is needed to enable transport of people to vaccination sites, increase accessibility to people without cars, and promote safety and minimize exposure at vaccination locations. Funding should also be provided to health and community-based agencies to assist those for whom transportation or childcare costs are an obstacle to receipt of the vaccine.
  • Planners should ensure that vaccination sites are located in areas that have borne a disproportionate burden of COVID-19, especially leveraging community-based organizations such as Federally Qualified Health Centers, community health centers, rural health centers, schools and places of worship. Mobile services will be particularly important in rural areas. Planners should prioritize congregate living facilities, such as long-term care, prisons, and homeless shelters. In addition, some families, displaced by the COVID economic fallout, may be living with relatives. Planners should ensure vaccination sites have services that meet the Americans with Disabilities Act (ADA) and HHS Office for Civil Rights (OCR) standards for disability and language access.
  • Federal state, local, tribal, and territorial officials must guarantee and communicate with the public that immigration status is not a factor in people’s ability to receive the vaccine and that immigration status is not collected or reported by vaccination sites/providers. Similarly, the presence of law enforcement officers or military personnel could be a deterrent for vaccination at locations, so planners should consider other means of securing sites.
  • In the initial phase, as communities vaccinate healthcare workers, planners must be sure to prioritize home health, long-term care, and other non-hospital-based healthcare workers, who are more likely to be people of color. Other essential workers that comprise large numbers of workers who are people of color and should be treated as within the vaccination priority groups are the food service industry, farmworkers and public transportation employees.

Ensure complete coverage of the costs associated with the vaccine incurred by individuals, providers of the vaccine, and state/local/tribal/territorial governments responsible for administering the vaccine and communicating with their communities about it.

  • Congress, the Centers for Medicare and Medicaid Services, and private payers must guarantee that people receiving the vaccine have zero out-of-pocket costs for the vaccine, related health care visits, or any adverse events related to the vaccine, regardless of their health insurance status.
  • HHS, with emergency funding from Congress, should provide funding so that state, local, tribal, and territorial governments do not bear any cost of vaccine communication efforts, working with their communities, organizing sites, training their staff, and providing personal protective equipment (PPE).

 Congress must provide additional funding and require disaggregated data collection and reporting by age, race, ethnicity, gender identity, primary language, disability status, and other demographic factors on vaccine trust and acceptance, access, vaccination rates, adverse experiences, and ongoing health outcomes.

  • CDC, and state, local, tribal, and territorial authorities should include leaders from communities of color and tribal communities and to plan on-going data collection on vaccination efforts, interpret data, add cultural context, share data with communities, and determine implications and next steps.
  • CDC, and state, local, tribal, and territorial authorities should use these data to inform ongoing prioritization of vaccine distribution and rapidly address gaps in vaccination that may arise among subpopulations by race, ethnicity, neighborhood, or housing setting.

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Trust for America’s Health is a nonprofit, nonpartisan organization that promotes optimal health for every person and community and makes the prevention of illness and injury a national priority. Twitter: @healthyamerica1

 

20 Public Health Organizations Condemn Herd Immunity Scheme for Controlling Spread of SARS-CoV-2

Great Barrington Declaration is not grounded in science and is dangerous

(Washington, DC – October 14, 2020) – SARS-CoV-2, the virus that causes COVID-19 has infected at least 7.8 million people in the United States and 38 million worldwide. It has led to over 215,000 deaths domestically, and more than 1 million globally – with deaths continuing to climb.

If followed, the recommendations in the Great Barrington Declaration would haphazardly and unnecessarily sacrifice lives. The declaration is not a strategy, it is a political statement. It ignores sound public health expertise. It preys on a frustrated populace. Instead of selling false hope that will predictably backfire, we must focus on how to manage this pandemic in a safe, responsible, and equitable way.

The suggestions put forth by the Great Barrington Declaration are NOT based in science.

  • There is no evidence that we are even remotely close to herd immunity. To the contrary, experts believe that 85 to 90 percent of the U.S. population is still at risk of contracting SARS-CoV-2. Herd immunity is achieved when the virus stops circulating because a large segment of the population has already been infected. Letting Americans get sick, rather than focusing on proven methods to prevent infections, could lead to hundreds of thousands of preventable illnesses and deaths.[i] It would also add greater risk in communities of color which have already experienced disproportionate impacts of the pandemic.
  • The declaration ignores what are our best tools to fight the virus, i.e. wearing masks, physical distancing, hand-washing, avoiding large crowds, strategic testing, rapid isolation of infected people and supportive quarantine for people who need to isolate.
  • We have seen the failure of the herd immunity experiment in nations such as Sweden, which has the highest mortality rate among Nordic countries.[ii] COVID-19 carries a much higher risk of severe disease and death than other infections where herd immunity was attempted before a vaccine was available.[iii] It is illogical to ignore public health and scientific evidence when so many lives are at stake.

Combatting the pandemic with lockdowns or full reopening is not a binary, either/or choice. We need to embrace common sense public health practices that allow for a safe reopening of the economy and a return to in-person work and learning while also using proven strategies to reduce the spread of the virus.

The declaration suggests a so-called focused protection approach. It suggests allowing the virus to spread unchecked among young people to create herd immunity in the entire population. This notion is dangerous because it puts the entire population, particularly the most vulnerable, at risk. Young people are not all healthy and they don’t live in vacuums.[iv] They interact with family members, co-workers and neighbors. Inviting increased rates of COVID-19 in young people will lead to increased infections rates among all Americans.

Public health guidance and requirements related to masking and physical distancing are not an impediment to normalcy – they are the path to a new normal. The goal is both public health safety and economic security; the two are not in conflict with one another, they are dependent on each other. We need to focus our efforts on the development and implementation of a national, science-based and ethical pandemic disease-control strategy.

The pandemic has created serious hardships on families’ economic security and on American’s mental health and well-being. What we need is a coordinated and robust national response including mask use, hand hygiene and physical distancing, while also ensuring social supports for those most vulnerable, including physical and mental health, and social factors.  What we do not need is wrong-headed proposals masquerading as science.


This statement was authored by:

American Public Health Association

Big Cities Health Coalition

Trust for America’s Health

American Academy of Social Work and Social Welfare

Association for Professionals in Infection Control and Epidemiology

Association of Public Health Laboratories

Association of Schools and Programs of Public Health

de Beaumont Foundation

Johns Hopkins Center for Health Security at the Bloomberg School of Public Health

Los Angeles County Department of Public Health

National Association of County Behavioral Health and Developmental Disabilities Directors

National Association of County and City Health Officials

National Association for Rural Mental Health

National Network of Public Health Institutes

New York City Department of Health and Mental Hygiene

Nurses Who Vaccinate

Prevention Institute

Public Health Institute

Resolve to Save Lives, an initiative of Vital Strategies

Well Being Trust

 

[i] https://www.medpagetoday.com/infectiousdisease/covid19/88401

[ii] https://www.medpagetoday.com/infectiousdisease/covid19/88401

[iii] https://coronavirus.jhu.edu/from-our-experts/early-herd-immunity-against-covid-19-a-dangerous-misconception

[iv] https://www.cdc.gov/mmwr/volumes/69/wr/mm6941e1.htm?s_cid=mm6941e1_w

COVID-19 School Closures Put 30 Million Children at Risk of Hunger

Many States with High COVID-19 Infection Rates Also Have Highest School-Meal Programs Participation Rates

(Washington, DC – July 16, 2020) – As COVID-19 infection rates continue to increase in states across the country, many of those jurisdictions are facing the complex dilemma of high infections rates complicating school re-openings and thereby limiting students’ access to school-based meal programs. Among the states with spiking infection rates and a high percentage of students participating in school-based meal programs are Arizona, Florida, Louisiana, Mississippi and South Carolina.

In March schools across the country began closing to stop the spread of the COVID-19 virus. In response, and recognizing the important source of nutrition school-based meals were to millions of American children, the U.S. Department of Agriculture’s Food and Nutrition Service began approving nationwide waivers to provide school systems flexibility in how meals were provided to students.  For example, these waivers enable schools to serve meals in non-congregate settings and outside of standard mealtimes, serve afterschool snacks and meals outside of structured environments, and waive requirements that students be present when meals are picked up.

Over half of all students in elementary and secondary schools across the country depend on the National School Lunch Program, and 12.5 million of those students also participate in the School Breakfast Program. As the COVID-19 pandemic closed schools this spring, these students were placed at risk of not having enough to eat.

A new policy brief, Beyond School Walls: How Federal, State and Local Entities are Adapting Policies to Ensure Student Access to Healthy Meals During the COVID-19 Pandemic, released today by Trust for America’s Health, reviews steps the federal and state governments have taken to ensure students’ access to healthy meals when schools are closed and what needs to be done to ensure continued meal access as all school systems face uncertainties about how to safely reopen for the 2020-2021 school year.

“School meal programs are the most important source of nutritious food for millions of American children. To the degree possible, school systems, with financial and regulatory relief from the federal government,  should continue to be innovative about how to deliver meals to students and should strive to meet or exceed federal nutrition standards for these meals despite product shortages created by the pandemic,” said Adam Lustig, Project Manager at Trust for America’s Health and the brief’s author.

Due to the economic impact the pandemic has had on millions of American families and the numerous uncertainties about how to safely re-open schools, the currently in place program waivers should be extended through the summer and may need to be kept in place during the 2020–2021 school year, the brief says.

Many of the states hardest hit by COVID also have highest school meal programs participation rates

States with some of the highest rates of COVID-19 infections also have high percentages of students who depend on school meals for much of their nutrition. States in which both COVID-19 infection rates are above national medians and school meals program enrollment is high include Arizona, Florida, Georgia, Louisiana, Mississippi, and South Carolina.

States in which more than half of students are enrolled in school-meals programs are:

Percentage of students enrolled in school meal programs

D.C.                                        76.4%

Mississippi                           75.0%

New Mexico                         71.4%

South Carolina                    67.0%

Arkansas                              63.6%

Louisiana                             63.0%

Oklahoma                            62.5%

Georgia                                62.0%

Nevada                                60.8%

Kentucky                             58.7%

California                            58.1%

Florida                                 58.1%

Arizona                                57.0%

Missouri                              52.7%

New York                            52.6%

Illinois                                 50.2%

Alabama                              51.6%

Oregon                                 50.5%

Hunger, poor nutrition and food insecurity can increase a child’s risk of developing a range of physical, mental, behavioral, emotional, and learning problems. Hungry children also get sick more often and are more likely to be hospitalized. Maintaining children’s access to nutritious meals despite school closures not only ensure they do not go hungry, but also promotes children’s health.

“State and federal guidelines waivers have allowed school systems to provide meals to students during the pandemic response, keeping them in place this summer and into the 2020-2021 school year will be the difference between kids who have enough to eat and kids who go hungry,” Lustig said.

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 Trust for America’s Health is a nonprofit, nonpartisan organization that promotes optimal health for every person and community and makes the prevention of illness and injury a national priority. Twitter:@HealthyAmerica1