2004 Programs

From the Public Health Radio Archives: a re-broadcast of " . . " {A special Public Health Radio documentary} Show #35 is the first in a two part series on the health care safety net in the United States. Unlike all the other developed nations, the United States has allowed a large portions of its population-about 44 million individuals, according to the US Census-to go without health insurance. The high prices of medical care make it difficult for these individuals to seek care at most doctors offices and hospitals. A number of institutions-all with varying degrees of public funding-are specifically designed to address the health care needs of the poor and uninsured. Taken together, these institutions are referred to as the health care safety net. One key safety net institution is the 800 free clinics that have sprouted up across the United States. Because Vermont has only one community health center and no public hospitals, its nine free clinics serve a uniquely important role. In show #35 we interview free clinic volunteers, staff, and patients to provide a special documentary edition of Public Health Radio. Their experiences provide insights into the achievements and limitations of the services that free clinics are able to offer their patients. Relevant websites include the National Association of Free Clinics http://www.nafclinics.org/ and the Vermont Coalition of Clinics for the Uninsured http://www.vccu.net/. Other relevant websites are listed under Show #36.

The built environment—especially metro areas’ transportation and urban designs--have enormous impacts on public health--whether the issue is air pollution, traffic safety, or obesity. But when developers are designing new neighborhoods, and when public officials are crafting zoning regulations, they rarely consider what consequences their plans might have on the health of the community. Similarly, when metropolitan areas are planning transportation systems, the public health effects of their transportation plans are not a major consideration. The September, 2003 issue of the American Journal of Public Health was exclusively devoted to the issue of how the urban and suburban community design affects public health. The guests on this show--Howard Frumkin and Elliott Sclar--were two of the editors of that issue, and they join us to discuss the effect of built environment on public health. . During the discussion, we also look at some of the fiscal and political obstacles preventing the creation of an environment that fosters public health Howard Frumkin chairs the Department of Environmental and Occupational Health at Emory University, School of Public Health in Atlanta. Dr. Frumkin was named to EPA’s Children’s Health Protection Advisory Committee in 2001, where he chaired the Smart Growth work group. He serves as a Board member of the state of Georgia’s Clean Air Campaign. He currently serves on the Institute of Medicine Roundtable on Environmental Health Science. He is author of a recently released book titled Urban Sprawl and Public Health , available through Island Press. Elliott Sclar is Professor of Urban Planning and Public Affairs at Columbia University. He is a leading figure in the scholarly movement to reconnect the work of population health experts and urban planners in creating healthier cities. Professor Sclar has studied and written extensively on the economic, political and social forces that drive actual metropolitan land use decisions. While much of his attention has been focused on the United States, he recently was honored by his selection as Co-Coordinator of the United Nations Millenium development project taskforce addressing the health, environmental and economic impacts of rapid urbanization in the poor countries of the Global South. The website of the Centers for Disease Control and Prevention provides useful information on the road to urban and transportation plans that foster public health. The website is: http://www.cdc.gov/node.do/id/0900f3ec8000e044 — click onto the environmental health section of the website, which lays out health impacts of built environment. Smart Growth America is a coalition of groups which advocate for health-promoting growth that supports the local economy yet protects the environment. The web address is http://www.smartgrowthamerica.com . Finally, the Surface Transportation Policy Project helps translate the issues addressed on today’s show into the arena of legislation and policy. On the web, the project is found at http://www.stpp.org .

We continue our look at reproductive health services in the poor countries of the global south with guests, Kathy Hall-Martinez and Wendy Turnbull, two experts in reproductive health. We discuss the importance of the 1994 Cairo conference, and then turn to two important policy changes implemented by the Bush administration. The first is the withdrawal of support for the United Nations Population Fund, the lead international agency working in the area of women’s reproductive health. We then look at the impact of the Bush administration’s re-institution of the Mexico City policy, also known as the Global Gag Rule. This policy prohibits recipients of US development aid from discussing abortion, both with their patients, and in most other professional contexts. Wendy Turnbull is the Legislative Policy Analyst for Population Action International, one of the most prominent organizations advocating effective population policies that can both address concerns of population growth and also respect women’s reproductive rights. Kathy Hall-Martinez is the Director of the International Legal Program at the Center for Reproductive Rights, an organization that promotes women’s reproductive rights both in the US and abroad. Both have worked in numerous countries across the globe, exploring what policies are effective in promoting development and empowering women, and advocating for women’s rights at the United Nations, the World Health Organization, and in several other venues. To learn more about the work, as well as the issues discussed on today’s show, Population Action International’s web address is http://www.populationaction.org . The Center for Reproductive Right’s website addresses the Global Gag Rule in detail, and is accessed at http://www.reproductiverights.org . To learn more about the United Nations Population Fund, the website address is: http://www.unfpa.org. A campaign exists to raise private contributions for the same amount of money that the US formerly contributed to the UN Population Fund, $34 Million. That campaign has been dubbed the “34 Million Friends of UNFPA. The web address is http://www.34millionfriends.org . SOME FINAL THOUGHTS ON UNITED STATES’ DEVELOPMENT POLICIES IN THE AREA OF WOMEN’S REPRODUCTIVE HEALTH Marvin Malek provides a commentary on the United States’ current policies in the area of women’s access to health services in the developing world. Dr. Malek is the Host and Co-Producer of Public Health Radio.

At least one third of pregnancies in the poor countries of the Global South occur to women who would have used effective contraception had it been available to them. And many pregnancies in these countries end in needless infant death and disability, as well as grave maternal complications. Margaret Neuse discusses these problems, and describes the work occurring at the clinics and other facilities the US Agency for International Development (US AID) supports in the area of women’s health. Margaret Neuse is the Director of US AID’s Office of Population and Reproductive Health. Further information on US AID’s work in women’s health is available at: http://www.usaid.gov/our_work/global_health/pop/ . Johns Hopkins School of Hygiene and Public Health runs a web clearinghouse with information on women’s health program in the developing world. The website is: http://www.infoforhealth.org .

HYPERTENSION—UNDERSTANDING THE SILENT KILLER. Despite the fact that is is easily identified and treated, high blood pressure is the leading risk factor for stroke, kidney failure and vascular disease, and the main identifiable risk factor in most cases of heart failure. Robert Phillips joins us for an in-depth discussion of high blood pressure—what factors lead to high blood pressure, what are the benefits and risks of treatment, and what can individuals and government entities do to reduce the toll of suffering caused by high blood pressure. Dr. Robert Phillips is the Chairman of the Department of Medicine at Lenox Hill Hospital in New York City, and Professor of Medicine at New York University School of Medicine. Hypertension is his leading research interest, and he has published numerous articles on the topic. Currently, Dr. Phillips serves as Eastern Region President of the American Society of Hypertension, and is the Associate Editor of the Archives of Internal Medicine, and serves on the editorial boards of several other medical journals. The website of the National Heart, Lung, and Blood Institute has high quality, practical information on hypertension. The web link is http://www.nhlbi.nih.gov (Complete link is http://www.nhlbi.nih.gov /health/dci/Diseases/Hbp/HBP_WhatIs.html ) THE GLOBAL CAMPAIGN TO ERADICATE POLIO: SETBACK IN WEST AFRICA The existence of an effective vaccine against polio and lack of any animal reservoir of the disease allows for the possibility of completely eradicating polio. A global coalition led by UNICEF has set the goal of eradicating polio by the end of 2004. Unfortunately, an eight month long suspension of vaccination in the Kano state in northern Nigeria has produced a major setback to the eradication effort. Claire Hajaj joins us to discuss the status of the polio eradication campaign. Claire Hajaj is the chief spokesperson for UNICEF’s polio eradication program. Further information about the polio eradication program can be obtained at the UNICEF website, http://www.unicef.org.

A massive refugee crisis has developed in the Darfur region of western Sudan since autumn, 2003. Paramilitary gangs there have driven out much of the native population and destroyed one village after the next. Current estimates place the number of refugees at over 1M. The central government of Sudan done little to defend the native population, and is in fact widely viewed as supporting the paramilitary squads. Refugee crises invariably have major impacts on the health of refugee populations. Lack of sanitation and the crowded conditions in the refugee camps have led to infectious diseases, and malnutrition, and war-related injuries together have meant that the refugee crisis is also a public health crisis. Roberto DeBernardi and Paula Claycombe, two members of the staff of Sudan's UNICEF office, visit Public Health Radio to discuss the public health crisis in Darfur. Roberto DeBernardi is a medical doctor raised in Genoa, Italy, who has spent virtually his entire career doing humanitarian work. He joined the staff of UNICEF in 1988, and has served as a health and nutrition officer at several different sites throughout Africa since then. Currently, he is UNICEF's Senior Project Officer and Chief of Health and Nutrition at UNICEF's Office in Khartoum, the capital city of Sudan. Paula Claycombe is UNICEF's Communications Officer at UNICEF's Khartoum office. She has worked for UNICEF for 15 years, and prior to that worked for Amnesty International. She has devoted her career to the promotion of the protection and development of vulnerable children in some of the world's poorest countries. The UNICEF website is, http://www.unicef.org.. Doctors without Borders is also heavily involved in medical aid in the Darfur region. Website is http://www.dwb.org. To learn more about the political and human rights aspects conflict in the western Sudan, listeners can access the website of Human Rights Watch, at http://www.hrw.org and the International Committee of the Red Cross at http://www.icrc.org .

Most mercury than enters the environment does through due to human activity: It is found in many consumer products, and it emanates from the smokestacks of power plants. Once introduced into the environment, it concentrates in the biosphere, achieving very high concentrations in many fish, especially large predatory fish. Michael Bender describes the environmental distribution of mercury, as well as its toxicity to humans. Bender also discusses recent actions of the Bush administration to delay a previously approved plan that would have rapidly eliminated mercury release into the environment. • Michael Bender is the co-founder of the Mercury Policy Project, and has directed the Project since 1998. Bender helped form the Ban Mercury Work Group, an international coalition of interested organizations that helps coordinate work in various nations to mitigate the hazard caused by mercury. The Mercury Policy Project’s website: http://www.mercurypolicy.org . The Ban Mercury Work Group’s website: http://www.ban.org/Ban-Hg-Wg , and the International Conference on Mercury as a Global Pollutant website is: http://www.facome.uqam.ca/facome/home/recursos/eventos/eventos.html . Recently, the FDA and EPA jointly published a guideline of dietary advice for minimizing dietary mercury consumption. That website is: http://www.cfsan.fda.gov/~dms/admehg3.html STATUS OF THE GLOBAL AGREEMENT ON THE ELIMINATION OF PERSISTENT ORGANIC POLLUTANTS The Persistent Organic Pollutants are a group of organic compounds that serve as insecticides, solvents, and petroleum combustion products. These compounds cause cancer and damage to a variety of organic systems, especially the endocrine system. They are stable for decades, and bioaccumulate up the food chain. An international treaty negotiation, the Stockholm Convention on Persistent Organic Pollutants was convened to minimize exposure to these compounds. While President Bush signed the agreement, great controversy has arisen concerning how the Bush administration has proposed to implement the agreement. Karen Perry joins us to discuss the issue. Ms. Perry is the Deputy Director of the Environment & Health Program at Physicians for Social Responsibility (PSR). PSR’s website is http://www.psr.org . The Stockholm Convention on Persistent Organic Pollutants maintains a website http://www.pops.int/documents/convtext/convtext_en.pdf .

Public Health Radio presents the second in a two part series on the "Medicare Prescription Drug Improvement and Modernization Act of 2003" enacted in December, 2003. We start the show with a report from Al Laprade, a Medicare enrollee and patient of Dr. Malek, who catalogues the prescription drug costs he faces each month, and describes the actions he's taken to reduce those costs. Then Leslie Norwalk, the Deputy Administrator of the Center for Medicare and Medicaid Services, describes the mechanism the Medicare Reform Act relies on to negotiate prescription drug prices with the pharmaceutical companies. Because of their critical role in the Medicare Reform Act's prescription drug benefit, Public Health Radio next takes an in depth look at the pharmacy benefit management industry sector. Robert Garis joins us to discuss this industry sector, and reviews their track record in negotiating with the drug companies on behalf of private and governmental entities. Finally, Marvin Malek, host of Public Health Radio, provides a summary of the Medicare Reform Act, the likely impact on administrative costs and effort, and its potential to destabilize the Medicare insurance market. For more information on the Medicare program, including the reform act, the government's website in the Medicare program is http://medicare.gov. Critical analysis of the reform act is available at the Urban Institute's website www.urban.org, and at the Center for American Progress Medicare spotlight: http://www.americanprogress.org/site/pp.asp?c=biJRJ8OVF&b=24891 To learn more about the pharmacy benefit management industry, two articles co-authored by Dr. Garis are especially useful: 1 Garis R, Clark B, Siracuse M, & Makoid, M. Examining the Value of Pharmacy Benefit Management Companies. Am J Health-Syst Pharm. 2004; 61:81-85. 2 Garis R, Clark B. The Spread: Pilot Study of an Undocumented Source of Pharmacy Benefit Manager Revenue. J Am Pharm Assoc.2004;44:15-21. Leslie Norwalk JD is a lawyer, and the current Acting Deputy Administrator of the Center for Medicare and Medicaid Services, the agency that administers the Medicare program. Prior to serving in the current Bush Administration, she practiced law in the Washington, D.C. office of Epstein Becker & Green, P.C. where she advised clients on a variety of health policy matters. She also served in the first Bush administration in the White House Office of Presidential Personnel. Robert Garis, PhD is an Assistant Professor of Pharmaceutical Sciences at Creighton University in Omaha, NE. His primary research focus has been the pharmacy benefit management companies, and how that industry has impacted pharmacy costs. Marvin Malek, MD MPH is the host and co-producer of Public Health Radio.

DIABETES MELLITUS, THE MODERN EPIDEMIC. UNDERSTANDING DIABETES AND PREVENTING IT Robert Rizza discusses diabetes mellitus, a disease that is mushrooming in the United States and worldwide. We discuss the difference between the two types of diabetes, how diabetes is treated, and why it is becoming more and more common. We also look at personal and societal strategies to prevent diabetes. Robert Rizza, MD is a Professor in the Department of Medicine at the Mayo Clinic College of Medicine. Dr. Rizza is a specialist in the field of Endocrinology, with a research focus on the causes and treatment of diabetes mellitus. He currently serves as Vice-President of the Board of Directors of the American Diabetes Association (ADA). Many useful links on the topic are available at the ADA website http://www.diabetes.org REFORMING THE MEDICARE PROGRAM, PART 1: THE PRIVATIZATION OF MEDICARE Public Health Radio presents the first in a two part series on the "Medicare Prescription Drug Improvement and Modernization Act of 2003" enacted in December, 2003. This show looks at the incentives placed into the bill for private insurance plans and HMOs to participate in the Medicare program, as well as the incentives for patients to enroll in these plans. We discuss the implications on enrollees, on the future stability of Medicare, and on the overall cost of the Medicare program. Featured guests include Leslie Norwalk, Judy Feder and Robert Berenson. For more information on the Medicare program, including the reform act, the government's website in the Medicare program is http://medicare.gov. Critical analysis of the reform act is available at the Urban Institute's website www.urban.org, and at the Center for American Progress Medicare spotlight: http://www.americanprogress.org/site/pp.asp?c=biJRJ8OVF&b=24891 Leslie Norwalk JD is a lawyer, and the current Acting Deputy Administrator of the Center for Medicare and Medicaid Services, the agency that administers the Medicare program. Prior to serving in the current Bush Administration, she practiced law in the Washington, D.C. office of Epstein Becker & Green, P.C. where she advised clients on a variety of health policy matters. She also served in the first Bush administration in the White House Office of Presidential Personnel. Judy Feder, PhD is Professor and Dean of Georgetown University's Public Policy Institute. She also serves as Co-Director (with Sheila Burke) of the Georgetown University Long-term Care Financing Project, is a senior advisor to the Kaiser Family Foundation's Commission on Medicaid and the Uninsured, and is a member of the Commonwealth Task Force on the Uninsured. Her leading research and policy interest is in understanding and improving the nation's health insurance system. Robert Berenson, MD is a Senior Fellow at the Urban Institute. From April, 1998 until October, 2000 he was Director of the Center for Health Plans and Providers in the Health Care Financing Administration, now called the Centers for Medicare and Medicaid Services. CHPP was the focal point in HCFA for payment policy and operational issues related to managed care (Medicare +Choice) plans and health care providers. Dr. Berenson's research interests include Medicare, physician payment policy, managed care, and medical ethics. He has authored numerous articles on these topics, and coauthored The Managed Care Blues & How to Cure Them, a review and critique of health maintenance organizations in 1998.

Despite its convenient location as our northern neighbor, the news media in the United States rarely take an in-depth look at the Canadian health care system. Many observers feel that Canada would be a useful model for the United States to achieve universal health care, since Canada provides health care to all its citizens with only modest out-of-pocket expenses. Canada leads the United States in every major category of public health outcome, including infant mortality, maternal mortality, and life expectancy at every age at which it is measured for both men and women. And, as is the case with all the other developed nations, Canada spends far less than the United States-devoting about 10% of its GDP to health care, while the US spends over 15% of its GDP on health costs. Two health two health policy analysts and two Canadian doctors join us on this edition of Public Health Radio to provide an in depth look at health care in Canada. Catherine Oliver MD received her training at McGill University, and has served as a family physician in a poor neighborhood in Toronto for 15 years. She has previously worked in Tanzania, as well as in the far north of the province of Ontario. Joel Lexchin MD has worked in emergency medicine for over 15 years, and serves on the faculty of the University of Toronto. He has written extensively on rational drug prescribing and on the pharmaceutical industry, and in that area has worked for both the Canadian government and the World Health Organization. Hugh Armstrong is a Professor in the School of Social Work and in the Institute of Political Economy at Carleton University. With his wife, Pat Armstrong, he has co-authored several books on health care in Canada. Pat Armstrong is also an expert on health policy. She has served as Chair of the Department of Sociology at York University and Director of the School of Canadian Studies at Carleton University. Recent books by Pat and Hugh Armstrong: Wasting Away: The Undermining of Canadian Health Care Oxford University Press, Don Mills, Ontario. Universal Health Care: What the United States Can Learn from the Canadian Experience The New Press, New York.

1) . Paul Zeitz provides an update on the current state of the worldwide struggle to control the spread of HIV and provide care to individuals who are HIV infected. Dr. Zeitz discusses breakthroughs in treatment efficacy, the dissemination of effective treatment models to poor rural communities, the state of the donor community, and the effort to provide a reliable supply of anti-retroviral drugs at prices affordable to the many poor countries impacted by the epidemic. Dr. Paul Zeitz is the Executive Director of the Global AIDS Alliance, an alliance of organizations working to control the HIV epidemic across the globe. To learn more about the worldwide crisis-and the efforts of the public health community to address it, contact the Global AIDS Alliance at http://www.globalaidsalliance.org/ CERVICAL CANCER: CAN WE ELIMINATE CERVICAL CANCER IN THE UNITED STATES? Marie Savard joins us to discuss the new guidelines developed by the American Cancer Society to screen for cervical cancer. We highlight the proper use of a new test available to determine the presence of the human papilloma virus (HPV) -the causative agent of most cases of cervical cancer. Susan Crosby then discusses a new effort by female legislators across the country to draw attention to the prevention of cervical cancer Marie Savard is a physician specializing in women's health, and serves as director of the Center for Women's Health at the Medical College of Pennsylvania, where she is a faculty member. She is currently the Chair of the Pennsylvania Commission on Women. Susan Crosby served in the legislature of the state of Indiana, and is currently the Deputy Executive Director of Women in Government, a national organization of women who serve in state and federal government. More information about cervical cancer screening is available at the website of the American Cancer Society, http://www.cancer.org/ and at the website of the Centers for Disease Control and Prevention, http://www.cdc.gov/ . The website of the organization "Putting Women's Health First" is another useful website to explore the issue of how to prevent cervical cancer. The website is: http://www.puttingwomenshealthfirst.org/ The website of "Women in Government", the national organization of female state and federal legislators is http://www.womeningovernment.org/ .

The second part of the two part Public Health Radio series on the health care safety net looks at four other important programs that provide care to the poor and uninsured. These are the community and migrant health centers, the National Health Service Corps, and the public hospitals. We briefly explore their history, funding, and the breadth and limitations of the services each of these safety net institutions offer. Fitzhugh Mullan, MD served as Director of the National Health Service Corps, and later as Assistant Surgeon General. Currently, in addition to serving as a contributing editor to Health Affairs and a faculty member of George Washington University's School of Public Health, he practices pediatrics at the Upper Cardozo Community Health Center in Washington, D.C. Gordon Schiff, MD is on the faculty of the University of Illinois College of Medicine, and an attending physician at Cook County Hospital. He has served as an attending physician at Cook County Hospital for nearly 25 years. He served for ten years as Director of the General Medicine Clinic, the large internal medicine clinic associated with Cook County Hospital. He has published extensively on the health care safety net. Relevant websites include a major report on the state of the health care safety net in the US published by the Institute of Medicine (IOM)in the year 2000. http://www.iom.edu/report.asp?id=5502 . The IOM has also published a landmark series of reports on the lack of health insurance in the US, and its impacts on individuals, families, communities, and health providers. http://www.iom.edu/project.asp?id=4660 . The website of the National Association of Community Health Centers is http://www.nachc.org/ , and the website of the Bureau of Primary Health Care, which administers the migrant and community health centers is http://bphc.hrsa.gov/ . The National Association of Public Hospitals is http://www.naph.org .