Prevention and Public Health Policy Archives - Page 15 of 20

New Orleans’ Efforts to Prevent and Respond to Childhood Lead Exposure

Background

In New Orleans, Louisiana, more than 90 percent of housing structures were built prior to 1978 – the year lead was decreased in residential paint – making city residents vulnerable to lead-based paint hazards. In addition to deteriorating paint and the lead contaminated dust it generates, the lead dust from the use of leaded gasoline contributed significantly to elevated soil lead levels.

While leaded gasoline was phased out in the 1970s through the 1990s, the lead dust remains in soil, particularly within transit-heavy areas of the city. Researchers estimate that vehicles deposited more than 10,000 metric tons of lead dust in New Orleans soil between 1950 and 1985. In 2004, more than 40 percent of New Orleans soils exceeded the EPA’s cleanup standard for play areas.

Lead in soil can disproportionally impact children because they are more like to inhale and ingest dust and dirt.

Hurricanes Katrina and Rita

In August, 2005, storm surges from the Hurricanes flooded 80 percent of the homes of New Orleans and deposited massive quantities of low lead sediments into the city. The sediments created a natural barrier on top of the pre-existing high-lead soil establishing a cleaner, less hazardous landscape. This, combined with citywide cleanup and remediation efforts, reduced lead dust in homes and surrounding soil. Lead assessments conducted in Katrina’s immediate aftermath found a 46 percent reduction in median soil lead levels. And the declines continued. Before the storm, 15 of the city’s 46 census tract neighborhoods exceeded the EPA’s regulatory soil lead standards; by 2010, only 6 neighborhoods exceeded standards.

At the same time, there was a decrease in children’s BLL. Prior to the Hurricanes, 50 percent of New Orleans’s children had BLL’s equal or greater that the federal reference value of 5 µg/dL. Ten years after the Hurricanes, about 5 percent of the children’s BLL exceed that exposure value.

Lead-Safe Soil Emplacement Interventions

Inspired by the city’s unique natural experiment, researchers used a similar approach to clean up soil at 10 childcare centers in New Orleans, covering lead-contaminated surface soils with a water-permeable barrier and 6-inch layer of low-lead soil. Since 2005, nine of the 10 federal public housing projects were rebuilt using this process—landscaped with low lead soil to raise the elevation of the housing. This intervention was expanded to all New Orleans’s childcare center play areas and public playgrounds that tested high for lead.

Challenges Remain

These efforts, combined with the potential reduction of lead from fresh topsoil deposited by the storm surge during Hurricane Katrina, led to a decrease in the percentage of children with elevated BLLs in high-lead communities (mainly inner city) from 64 percent in 2005 to 19 percent by 2015. In short, household restoration and cleaning reduced lead-based paint hazards and washed-in sediments reduced soil lead. The remaining challenge is to reduce exposure in high lead communities by conducting more “soil emplacement interventions and continuing lead paint hazard reduction strategies.”

___________________

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.

California’s Efforts to Prevent and Respond to Childhood Lead Exposure

Background

In the mid-1980s, the California state legislature declared childhood lead exposure the most significant environmental health problem in the state and subsequently established the Childhood Lead Poisoning Prevention Branch within the state’s Department of Public Health (CDPH).

The program compiles information, identifies target areas, and analyzes data to design and implement ways to reduce childhood lead exposure. The statutes also determine a “standard of care” to evaluate children for lead-exposure risk; mandate reporting by laboratories of all state blood lead test results; and require public health and environmental services for children identified with elevated blood lead levels, including ordering property owners to remove hazardous lead conditions. The state requires the establishment of procedures and the adoption of regulations regarding residential lead paint, and lead-contaminated dust and soil. It also authorizes and administers a lead-based paint prevention training, certification, and accreditation program.

Funding

To help pay for the program, in 1993, California adopted an annual Childhood Lead Poisoning Prevention Fee, administered jointly by CDPH and the California Board of Equalization (BOE), on manufacturers and other entities involved with the production or sale of lead and lead-based products collected from businesses in the petroleum and architectural coatings industries and from facilities reporting releases of lead into the air. The department deploys a “historical market share attributions” concept to estimate each payer’s long-term contribution to environmental lead contamination and allocate fees. It then deploys collected funds (the fee generated $20.6 million in fiscal 2015) to support healthcare referrals, assessments of homes for hazards, and educational activities.

Banning Lead in Certain Products

California has led U.S. efforts to ban lead from a range of products beginning with a 1986 law, Proposition 65, which requires manufacturers, retailers, and other businesses to notify consumers when they are being exposed to toxic chemicals, including lead. The law has made consumers more aware of toxic chemicals in their environment, and advocates have successfully pressed for more regulations to ban or curtail the use of lead and other toxins in products. In conjunction with these efforts, California passed a number of strict laws to safeguard products and protect its citizens from lead exposure. For example:

In 2005, California implemented a lead-in-candy law. The state considers candies with lead levels in excess of 0.1 parts per million (ppm) to be contaminated. The Food and Drug Branch of the California Department of Public Health is required to test samples, notify the manufacturer of the adulteration, and issue a health advisory. The federal Food and Drug Administration subsequently issued national guidance in 2006 recommending that all candy likely to be consumed by children contain no more than 0.1 ppm of lead.
In 2006, California enacted the Metal-Containing Jewelry Law. This requires jewelry and components, such as dyes and crystal, that are sold, shipped, or manufactured for sale in California to meet limits set by the state under a 2004 consent judgment that applied to a number of manufacturers, retailers, and distributors in response to a lawsuit filed by the Attorney General of California and two environmental groups. The law forbids the manufacture, shipping, sale, or offer for retail sale or promotional purposes jewelry in California unless it is made wholly from one or more specified materials. It also mandates lead restrictions for certain specified materials allowed in manufacturing jewelry and establishes provisions for children’s jewelry and that used for body-piercing.
California passed additional legislation in 2006, effective in 2010, to reduce the lead content in water distribution products. The law prohibits more than 0.25 percent lead in commercial pipes, fittings, and fixtures. In 2010, the U.S. Congress amended the Safe Drinking Water Act, including provisions similar to the California standard, and, in 2014, the 0.25 percent standard for lead in pipes, fittings, and fixtures became national.
In 2009, California passed the California Lead in Wheel Weights Ban to prevent lead from wheel weights, used to balance tires in vehicles, from entering the environment. Before the ban, lead wheel weights, which can become dislodged from the wheels and end up on roads where they are abraded into lead dust and debris, were responsible for releasing 500,000 pounds of lead annually onto California roads. Since 2009, six other states, including Washington, Maine, Illinois, New York, Vermont, and Minnesota, have followed California’s lead. Also in 2009, the U.S. Environmental Protection Agency (EPA) started the process to consider banning lead wheel weights in the United States, but it has not taken formal action. The European Union has already banned lead wheel weights, while manufacturers in Japan and Korea stopped installing them in 2005.

In 2010, both California and Washington passed legislation restricting the use of heavy metals including lead in motor vehicle brake pads. In 2014, in California, and 2015 in Washington, brake pads sold in those states could not contain more than 0.1 percent by weight. The legislation also limits the levels of asbestiform fibers, cadmium, chromium, copper, and mercury in the brake friction materials. In January 2015, brake manufacturers signed a memorandum of agreement with the Environmental Protection Agency and the Environmental Council of the States declaring that all brake pads sold in the United States will meet the California/Washington standards. The brake- pad standards were adopted immediately, while standards for copper are being phased in.

In 2003, California passed the Toxics in Packaging Prevention Act, which limited harmful substances in packaging and reduced the levels of toxins contaminating soil and ground water near landfills. While the original law exempted lead paint or applied ceramic decoration on glass bottles, a 2008 amendment banned such uses if the lead content exceeds 600 ppm.

California passed a law in 2013 that made it the first state to require the use of only lead-free ammunition be used for hunting with a firearm in California. The regulations, which began to phase in in 2015, will be fully implemented in 2019. Lead ammunition for hunting waterfowl was banned nationally in 1991, but the California law extends the ban to hunting for all wildlife. The main purpose of the law is to protect endangered wildlife, including the California condor, from lead exposure. However the legislation should have the added benefit of reducing lead exposure for the families of hunters.

Results

The number of children from 0 to under 21 years who have been identified with blood lead levels at and above 4.5 mcg/dL has been decreasing significantly. In 2013, 1.7 percent of tested children had blood lead levels in this range. In 2007, 6.5 percent tested above 4.5 mcg/dL.

_______________________________________________

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

Graham-Cassidy is Legislative Malpractice – It Would Greatly Harm the Nation’s Health

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

Washington, D.C., September 25, 2017 – Below is a statement from American Public Health Association, Prevention Institute, Public Health Institute, and Trust for America’s Health on Graham-Cassidy, which would cause millions to lose healthcare coverage, decrease access to clinical preventive services, and eliminate the Prevention and Public Health Fund.

“Graham-Cassidy would do untold damage to the nation’s health, unraveling the progress we’ve made to expand access to quality, affordable healthcare, reorient our healthcare system to value prevention and equity, and invest in a healthier future for all Americans.

Graham-Cassidy upends efforts to improve the nation’s health in the future by threatening to strip people of access to preventive care and zeroing out the Prevention and Public Health Fund. Over the next five years alone, states and communities stand to lose more than $3 billion in funding to prevent chronic disease, stop the spread of infectious diseases, and invest in resources that support health and equity. The Prevention and Public Health Fund also provides 12 percent of the Centers for Disease Control and Prevention’s annual budget. Losing this much funding—about $900 million a year—would irreparably damage our public health infrastructure, including our ability to respond to disasters and emerging epidemics. These short-term cuts will lead to more chronic conditions and exact a heavy burden of preventable illness and death – as well as higher healthcare expenditures for worse health outcomes – down the line.

Investing in public health makes the difference between health and illness, safety and injury, and life and death. The deep cuts this bill proposes – to Medicaid, to public health and prevention – would touch every community, especially those communities that are struggling most with longstanding inequities in health and safety.

Passing Graham-Cassidy is tantamount to legislative malpractice. The undersigned groups find this approach unacceptable and strongly urge Congress to work in a bipartisan manner to improve the nation’s public health and healthcare systems.”

TFAH Statement on the ACA and the Prevention and Public Health Fund

Washington, D.C., July 28, 2017 – The below is a statement from John Auerbach, president and CEO, Trust for America’s Health (TFAH).

“TFAH is thankful that healthcare coverage will continue to be available for millions of Americans. We applaud the decision by the majority of senators to avoid the damaging repeal of the Affordable Care Act (ACA). As a result, millions can breathe a sigh of relief that their coverage will not be cut, their benefits reduced and/or their premiums become unaffordable.

That said, there is a need for continued support to increase and sustain access to affordable, high-quality healthcare, covering the range of needs from life- and cost-saving preventive care to comprehensive treatment.

And, importantly, efforts must ensure the Prevention and Public Health Fund remains intact. The Prevention Fund is one of the most important and biggest sources of funding for prevention-focused efforts, comprising 12 percent of the budget for the Centers for Disease Control and Prevention (CDC).

The Fund supports essential work at CDC and provides more than $600 million a year directly to states and communities to address their leading health concerns using the best public health approaches available. Without these funds, we are putting Americans across the country at unnecessary risk for health problems that could be prevented.”

###

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.

Public Health Groups Decry Potential Elimination of the Prevention and Public Health Fund in Senate Bills

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

July 27, 2017

WASHINGTON, D.C. – The Senate is expected to soon vote on a ‘skinny’ repeal bill that would target key components of the Affordable Care Act – including potentially eliminating the Prevention and Public Health Fund.

This short-sighted move would cause long-term damage to our nation’s health. If the Prevention and Public Health Fund is eliminated, the pain of these cuts will be felt across the country, reverberating in every state and community. Over the next five years alone, states stand to lose over $3 billion in funding they rely on to prevent chronic disease, halt the spread of infections and epidemics, and invest in the community resources that support health and equity. It would cut the budget of the Centers for Disease Control and Prevention by 12 percent.

In the lives of individuals and communities, strong public health infrastructure makes the difference between health and illness, safety and injury, life and death. Slashing public health and prevention funding would increase preventable suffering and death, make the poorest and sickest communities fall even further behind, and leave our country far less prepared for and capable of responding to public health emergencies. The undersigned groups find this vision of the future unacceptable, and stand for prevention and public health.

###

The Senate’s Latest Obamacare Replacement Effort will not improve the Nation’s Health, Affordable Care Act

Washington, D.C., July 25, 2017 – The below is a statement from John Auerbach, president and CEO, of Trust for America’s Health (TFAH) on the Senate’s motion to proceed.

“Each new iteration of Obamacare repeal legislation has failed to do what a health bill should: improve the nation’s health.

We know—according to the Congressional Budget Office’s scores on any number of the attempted bills—that tens of millions of people will quickly lose access to health insurance and the preventive services and programs which keep them from developing debilitating and costly chronic diseases.

That is, simply, the opposite of what a bill—intended to improve the nation’s health—should do.

Continued attempts to eliminate the Prevention and Public Health Fund would irreparably harm the nation’s health. States and communities rely on the hundreds of millions of dollars they receive annually to work on the critical health issues—including the opioid epidemic, lead poisoning, obesity, tobacco use and vaccine-preventable illnesses—facing their citizens.

To date, any funding included in repeal legislation for the opioid crisis has been nowhere near enough to solve the problem and will not make up for the substantially larger cuts to Medicaid and the Prevention Fund.

Estimates have found that the total coverage cost for people receiving treatment for substance misuse disorders could reach $220 billion over the next decade. And, people with substance misuse disorders often suffer from additional health problems – for example, mental illness and chronic conditions such as heart disease or diabetes – and need the routine access to care and services provided by Medicaid. As such, substance misuse treatment must remain part of the Medicaid integrated care system.

TFAH encourages the Administration and Congress to start over and create a true healthcare bill that will improve upon Obamacare, keep people covered and safeguard the nation’s health.”

###

The Senate’s Better Care Reconciliation Act is Irredeemable, would eliminate 12 Percent of CDC’s Budget for Fiscal Year 2018

Washington, D.C., June 22, 2017 – The below is a statement from John Auerbach, president and CEO, of Trust for America’s Health (TFAH) on the Senate’s Better Care Reconciliation Act.

“The Senate version is no better than what the House proposed and in no way improves upon the Affordable Care Act (ACA). In reality, this Act is irredeemable.

If the Better Care Reconciliation Act becomes law, tens of millions will lose insurance. A critical part of what they’ll lose is access to the care they need to prevent or manage chronic conditions in a life- and cost-saving way. More than 80 percent of the $3 trillion dollars we spend every year on healthcare goes to individuals with one or more chronic conditions—with better preventive care and well managed chronic disease clinical services we can reduce costs and improve health outcomes.

A better way for Congress to cut healthcare costs and keep Americans healthy would be to create legislation that increases investments in preventive services and programs and ensures people have access to clinical care before they develop costly conditions.

This bill does the absolute opposite.

In addition to millions losing insurance, the Senate bill would eliminate the Prevention and Public Health Fund beginning next fiscal year, which supplies 12 percent of the budget (or close to $900 million) for the Centers for Disease Control and Prevention (CDC). And, $625 million of that goes directly to states and communities to address their most pressing health needs, including drug misuse, infectious diseases, lead poisoning, obesity, diabetes, hypertension, cancer and tobacco use.

In addition, with the phasing out of Medicaid expansion and possible loss of guaranteed essential health benefits, effective preventive services—including vaccines and screenings for cancer—will no longer be required of insurers.

If the Better Care Reconciliation Act becomes law, the American people will be sicker and poorer. We will likely see more overdoses and untreated STDs, rises in infant mortality and increases in innumerable other preventable health issues, all of which add up to ever-increasing healthcare costs.

We strongly urge the United States Congress to start over and create a true healthcare bill that will actually improve the ACA and the nation’s health.”

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.

The President’s FY 2018 Budget Proposal Would be Perilous for the Nation’s Health

Washington, D.C., May 23, 2017 – The below is a statement from John Auerbach, president and CEO, of Trust for America’s Health (TFAH) on the President’s Fiscal Year (FY) 2018 proposed budget announcement.

“The proposed $1.2 billion cut to the Centers for Disease Control and Prevention (CDC) would be perilous for the health of the American people.

From Ebola to Zika to opioid misuse to diabetes to heart disease, the CDC is on the frontlines keeping Americans healthy. Cutting nearly 20 percent of the CDC’s Chronic Disease Prevention and Health Promotion center’s budget would be disastrous.

Enormous cuts are also proposed throughout the rest of the agency including to programs that protect the American people from infectious diseases, environmental contaminants, exposure to tobacco and much more. If these budget cuts were to occur, they would cripple CDC’s operations and result in increased illnesses, injuries and preventable deaths.

CDC has already lost more than $580 million in funding since 2010 – and the proposed American Healthcare Act would, in FY 2019, repeal the Prevention and Public Health Fund, which supplies 12 percent of CDC’s budget—of which more than $620 million goes yearly to states.

Even now, with a relatively stable FY 2017 budget, CDC is operating with nearly 700 vacancies and will function with diminished resources once the Zika emergency supplemental funding runs out.

As such, this unprecedented and dramatic cut would have unparalleled and drastic consequences for our nation’s health and would likely lead to staggering increases in our healthcare service costs. It would also create massive holes in state public health funding, as states and local communities rely on the hundreds of millions they receive from CDC every year.

In essence, the proposed budget would force CDC to fight epidemics and health threats with both hands tied behind their back while wearing a blindfold.

We urge the Administration and Congress to work together to ensure CDC is able to protect the American people and help Americans be healthy and thrive.”

###

House ACA Replacement will Cripple the Nation’s Health, Trust for America’s Health Statement

Washington, D.C., May 4, 2017 – The below is a statement from John Auerbach, president and CEO, of Trust for America’s Health (TFAH).

“As historic as the passage of the Affordable Care Act was, any passage of the American Health Care Act will be just as infamous.

Tens of millions of American citizens will lose coverage. And millions of people on private insurance and Medicaid may lose access to life- and cost-saving clinical preventive services.

In particular, the Meadows-MacArthur Amendment would permit states to eliminate the requirement around essential health benefits (EHBs) and allow for the discrimination of people with pre-existing conditions.

Research tells us time and again two truths: Americans with coverage of preventive services are more likely to access these services and investing in preventive services improves health and reduces costs, yielding massive returns on investment.

Additionally, the agencies responsible for keeping us safe daily from ever-increasing public health threats will have their budgets slashed.

If the bill eventually becomes law, the Centers for Disease Control and Prevention (CDC) will lose 12 percent of its budget, of which a significant portion—$625 million a year—goes directly to state and local health departments.

This is a double whammy to the nation’s health.

Every day, the CDC and local public health departments are on the front lines in preventing disease outbreaks like Zika and Ebola, in protecting our children from lead poisoning, in lowering rates of heart disease, in stopping epidemics like prescription drug misuse and in helping people quit tobacco.

If the bill eventually passes, the results won’t be celebrated—they’ll be infamous.

We will likely see more overdoses and untreated STDs, rises in infant mortality and increases in innumerable other preventable health issues—not to mention mounting healthcare costs. All the while, our most vulnerable—the elderly, children, sick and less advantaged—will be at most risk.

That should not be the result of a health law.

We hope the United States Senate sees the many problems in the legislation.”

###