Catching the Political Bug: Moving the Needle on Public Health Issues

Alec Stone, MA, MPAHealth Policy DirectorONS Congress 2015

Orlando Florida

Public Awareness Campaigns Successes in the 20th Century

CDC Identifies 10 Public Health Achievements of First Decade of 21st Century

Vaccine-Preventable Diseases: A number of new vaccines were introduced during the first decade of the 21st century. Two of the most significant were the pneumococcal conjugate vaccine, which has prevented an estimated 211,000 serious pneumococcal infections and 13,000 deaths and the rotavirus vaccine, which now prevents an estimated 40,000-60,000 rotavirus hospitalizations each year. Other achievements included record low reported cases of hepatitis A, hepatitis B, and chicken pox. A recent economic analysis indicates that vaccinating each child born in the United States in a given year with the current childhood immunization schedule could prevent approximately 42,000 deaths and 20 million cases of disease.

Prevention and Control of Infectious Diseases: The first decade of the 21st century saw a 30 percent reduction in reported tuberculosis cases in the United States and a 58 percent decline in central line-associated bloodstream infections. A central line is a tube that a doctor usually places in a large vein of a patient's neck or chest to give important medical treatment. When not put in correctly or kept clean, central lines can become a freeway for germs to enter the body and cause serious bloodstream infections. These infections can be deadly. Other achievements included improvements in lab techniques and technology that made it easier to identify contaminated foods more rapidly and accurately to help control the spread of foodborne illness outbreaks. Broader HIV screening recommendations led to an increase in the number of people getting earlier HIV diagnosis, which provided them earlier access to live-saving treatment and care. The development of a blood donor test to screen for West Nile Virus has identified an estimated 3,000 potentially infected U.S. blood donations, removing them from the blood supply.

Tobacco Control: The number of states with comprehensive smoke-free laws grew from zero in 2000 to 25 states and D.C. in 2010. In 2009, a new federal cigarette tax took effect, bringing the combined federal and average state excise tax for cigarettes to $2.21 per pack, an increase of 76 cents per pack since 2000. By 2010, FDA had banned flavored cigarettes, established restrictions on youth access to tobacco products, and proposed larger, more effective graphic warning labels. Smoking still results in an economic burden, including medical costs and lost productivity, of approximately $193 billion per year.

Maternal and Infant Health: The past decade has seen significant reductions in babies born with birth defects such as spina bifida. This is due largely to folic acid fortification of cereal grain products in the United States as well as public health campaigns encouraging women of childbearing age to make sure they get the recommended amounts of folic acid. These efforts have led to a 36 percent reduction in babies born with neural tube defects.

Motor Vehicle Safety: From 2000 to 2009, the death rate related to motor vehicle travel went from 14.9 per 100,000 people to 11 per 100,000. The injury rate fell from 1,130 per 100,000 people to 722. The decade also saw a decline of 49 percent in pedestrian deaths among children, and a 58 percent decline in the number of bicyclist deaths. These achievements are likely the result of improved safety of vehicles and roadways, and safer behavior on the part of both motorists and pedestrians as a result of strong seat belt, child safety seat and other regulations.

Cardiovascular Disease Prevention: Heart disease and stroke are still among the nation's leading killers. However, deaths from both diseases have declined over the past decade, continuing a trend that began in the early 1900s for stroke and the 1960s for heart disease. These declines in deaths are mainly due to lower smoking rates as well as improvements in treatment, medications and quality of care, which has led to reductions in major risk factors for heart disease and stroke, such as uncontrolled high blood pressure and high cholesterol.

Occupational Safety: The United States has seen significant improvements in working conditions and the risk of workplace-associated injuries during the past decade. Examples of these improvements include patient lifting guidance for U.S. health care workers that has reduced, by 35 percent, back injuries among these workers, a comprehensive childhood agricultural injury prevention initiative, which has resulted in a 56 percent decline in farm injury rates among young people, and reductions in deaths among crab fisherman from overturned fishing vessels as the result of a U.S. Coast Guard initiative to correct stability hazards.

Cancer Prevention: Improvements in screening techniques along with strong cancer screening recommendations have led to improved screening rates and a reduction in deaths of 2–3 percent per year from colorectal, breast and cervical cancer. In addition, the creation of the National Breast and Cervical Cancer Early Detection Program has reduced disparities by providing breast and cervical cancer screenings to uninsured women.

Childhood Lead Poisoning Prevention: By 2010, 23 states had comprehensive lead poisoning prevention laws compared to just five states in 1990. Enforcement of these statutes, along with federal laws that reduce hazards in the highest risk housing, has significantly reduced the prevalence of lead poisoning. The percentage of children aged 1 to 5 years with elevated blood lead levels has declined significantly going from 88.2 percent in 1980 to under 1 percent in 2008.

Improved Public Health Preparedness and Response: There has been much progress made since September 11, 2001 expanding the capacity of the public health system to respond to public health emergencies and disease outbreaks. The first decade of the 21st century also saw improvements in laboratory response for identifying and reporting disease outbreaks. In addition, influenza vaccination, along with other public health measures taken during the 2009 outbreak of H1N1, prevented an estimated 5–10 million cases, 30,000 hospitalizations, and 1,500 deaths. The decade also saw the percentage of state public health agencies that were prepared to use Strategic National Stockpile (SNS) material increasing from 70 percent to 98 percent. SNS has large quantities of medicine and medical supplies to protect the American public if there is a public health emergency (such as terrorist attack, flu outbreak or earthquake) severe enough to cause local supplies to run out.

CDC’s 5 Health Achievements in 2014Tips From Former Smokers campaign, A CDC study published this year in The Lancet shows that an estimated 1.6 million smokers attempted to quit smoking and more than 200,000 did immediately following the three-month “Tips From Former Smokers” (Tips) national ad campaign in 2012.

Listeria & Advanced Molecular Detection, Listeria ranks third as a cause of death from major foodborne germs in the US and sickens about 1,600 people each year. Because it can be so deadly, CDC has increasingly focused on better ways to track and trace Listeria outbreaks.

Million Hearts® CDC released a Vital Signs in 2013 showing that at least 200,000 deaths each year from heart disease in the US could be prevented through changes by individuals, such as stopping smoking, more physical activity, and less salt in the diet; community changes to create safe places to exercise and smoke-free areas; improvements in managing high blood pressure, high cholesterol, and diabetes; and improvement in acute care, secondary prevention, and rehabilitation.

Healthcare-Associated Infections (HAI) On any given day, about 1 in every 20 hospitalized patients has an infection caused by receiving medical care. These infections cost the U.S. healthcare system billions of dollars and can present patients with devastating emotional, financial, and medical consequences.

Celebrating 10 Years of PEPFAR CDC and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) commemorate a decade of success in fighting global HIV/AIDS. Today, there is extraordinary progress in reducing new HIV infections and providing life-saving care and treatment to those living with HIV/AIDS.

CDC’s 5 Health Threats in 2015

• Antibiotic Resistance & Advanced Molecular Detection: Coping with untreatable infections in The End of the Antibiotic Era • Prescription Drug Abuse and Overdose: Reducing the number of

misuse, abuse or overdose amidst a growing epidemic • Global Health Security: Securing our global health borders knowing

that disease can spread nearly anywhere within 24 hours• HPV: Preventing cancer in the U.S. by vaccinating preteens and teens • Polio: Coming together to end polio once and for all

Cancer

• Cancer is the name given to a collection of related diseases. In all types of cancer, some of the body’s cells begin to divide without stopping and spread into surrounding tissues. Cancer can start almost anywhere in the human body, which is made up of trillions of cells. Normally, human cells grow and divide to form new cells as the body needs them. When cells grow old or become damaged, they die, and new cells take their place.• When cancer develops, however, this orderly process breaks down. As cells

become more and more abnormal, old or damaged cells survive when they should die, and new cells form when they are not needed. These extra cells can divide without stopping and may form growths called tumors. Many cancers form solid tumors, which are masses of tissue. Cancers of the blood, such as leukemias, generally do not form solid tumors.

NINR: Leading By ExampleWHAT IS NURSING RESEARCH?

Nursing research develops knowledge to:• Build the scientific foundation for clinical practice • Prevent disease and disability • Manage and eliminate symptoms caused by illness • Enhance end-of-life and palliative care

Public Awareness Campaign

The National Institute of Nursing Research (NINR), a part of the National Institutes of Health, developed the

Palliative Care: Conversations Matter™ campaign to raise awareness of pediatric palliative care and to help health care professionals and patients discuss palliative

care earlier. It can be hard for health care professionals to talk about palliative care with their patients—particularly

with children. Many patients and their families have never heard of palliative care, and they are not aware that it can give them extra support in dealing with a

serious illness. This is especially true when talking about palliative care for children.

Outreach and ApproachThe Palliative Care: Conversations Matter™ Customizable Tear-off Pad

This tear-off pad provides readily available tips, resources, and answers to common questions about palliative care to help encourage interactive

discussions with patients and their families or caregivers. Learn more about the tear-off pad and download the PDF.

The Palliative Care: Conversations Matter™ Campaign VideosThese informational video vignettes highlight the importance of palliative

care for pediatric patients and provide ideas about how to start and manage a palliative care conversation with pediatric patients, their parents

or caregivers, and their families. Watch the three short videos to get tips from NINR Director Dr. Patricia Grady and hear the personal story of a mother’s experience with pediatric palliative care.

NIH Grants for EOL

NIH designated NINR as the lead institute for end-of-life research. NINR’s palliative and end-of-life interdisciplinary research efforts apply behavioral, biological, and social science strategies to address challenges for life-threatening illness and the caregivers. NINR supports research that explores interventions to optimize patient and caregiver quality of life across care settings and cultural contexts. NINR recognizes that high-quality, evidence-based palliative care is a critical component of maintaining quality of life at any stage of illness, not just at the end of life. Specific research topics and activities include: relief of pain, suffering, and distressing symptoms through effective palliative care; understanding and facilitating decision making by patients, caregivers, and providers; and developing new investigators in this area of science.•Improve understanding of issues and choices underlying palliative and end-of-life care•Develop bio-behavioral interventions in palliative care for the chronically ill across lifespan•Develop strategies to minimize the physical and psychological burdens, and better maintain the health of caregivers, particularly as the patient nears the end of life•Determine impact of providers trained in palliative and EOL care on healthcare outcomes •Create new communication strategies among clinicians, patients, families, and communities to promote decision making regarding complex treatment and care options in the face of life-threatening illness.

ONS Health Policy Agenda

ONS respectfully calls on the U.S. Congress and the Administration to: • Promote and improve cancer symptom management and palliative care; • Advance and ensure access to quality cancer prevention and care; and • Bolster the nation’s nursing workforce to safeguard public health

Why Oncology Nurses?

Grassroots AdvocacyGrass Tops Influence

ExpertisePersonal Stories

Constant ContactUsing Tools In Your Arsenal

Trusted AdvisorCalling Not A Career

One Person Can Make A Difference

References

• http://www.cdc.gov/about/history/tengpha.htm

• http://www.cdc.gov/media/releases/2011/p0519_publichealthachievements.html

• http://beta.congress.gov/bill/113th-congress/house-bill/1339?q=%7B%22search%22%3A%5B%22HR+1339%22%5D%7D

• http://www.ninr.nih.gov/newsandinformation/conversationsmatter

• http://www.ninr.nih.gov/newsandinformation/conversationsmatter-providers

• http://www.hpna.org/DisplayPage.aspx?Title=Legislative%20Alert

• http://www2.ons.org/LAC/media/ons/docs/LAC/pdf/HealthPolicyAgendaJan2014.pdf

• http://www.ninr.nih.gov/researchandfunding/spotlight-on-end-of-life-research

• www.house.gov

• www.senate.gov

Contact Information

Alec Stone, MA, MPAHealth Policy Director125 Enterprise Drive

Pittsburgh, PA 15275-1214(412) 859-6401 office(301) 661-1428 cell

astone@ons.org@ONSAlec

www.ons.org/LAC