When You Can’t Afford the Flu

The flu is here. It is not only all over the news; it is all over the country.  Oklahoma was hit hard last week, with the rate of flu related hospitalizations up, and the number of flu related deaths climbing.  Experts are advising those who have not already received a flu shot to get one now.  Simply put, the shot not only protects people who are vaccinated but everyone around them.  Avoiding the flu is serious business, too, because in addition to the miserable experience, many Americans simply can’t afford to take the time off to be sick.

In addition to the flu shot, health experts advocate other effective ways to avoid spreading the flu, including: frequently washing your hands; covering your mouth when you cough; and most importantly, staying home when you have the flu.  It is the last one that poses a significant problem for low income families. According to a 2010 report from the U.S. Bureau of Labor Statistics, only 33% of private sector workers within the lowest 25% of wage earners had the benefit of paid sick leave. Compare this to 81% of private sector workers with access to paid sick leave among the highest 25% of wage earners, and the disparity is quite drastic. The segment of the workforce who can least afford to miss a day’s wages is also the one least likely to have access to paid sick days.

Read Full Post »

The Challenge to Raise Awareness about SNAP

For anyone following Newark Mayor Cory Booker on Twitter, or keeping up with him in the news, Tuesday, December 4^th was the big day. Booker will try to live a week on the monetary equivalent of the average SNAP benefit, which comes out to $1.40 a meal. Newark’s mayor will demonstrate how tough it is for low-income families to cover the cost of a healthy diet, especially if the main resource for their grocery budget is SNAP, formerly known as Food Stamps.

Booker is not the first politician to take the challenge. However, his prominence has turned the endeavor into national news, and it is worth a brief discussion about how the numbers play out in Oklahoma, where 880,939 people received SNAP benefits in 2011.

First some background. The Supplemental Nutrition Assistance Program, or SNAP, is designed to do just what the name suggests: act as a supplement to other income. Recent numbers from the American Community Survey (ACS) show the program is largely living up to its name in Oklahoma, where an estimated 77% of participants are working families.

The supplemental income provided by SNAP in Oklahoma amounts to $1541.16 annually. The value is loaded onto a card, similar to a debit card, and funds can only be used on qualified food items; so no diapers, no alcohol, no dog food, and no vitamins.

To qualify for SNAP in Oklahoma, monthly household income for a family of four must fall below $2,422, or $29,064 annually. Combining the average SNAP benefit with the maximum allowable income in this scenario puts total household income at $30,605.16. According to Federal Poverty Guidelines, this combined total puts a family of four at about 137% of

Read Full Post »

Uninsured Children: National Improvement, but Local Disparity

Georgetown’s Health Policy Institute has been busy analyzing health insurance trends across the country using data taken largely from the American Community Survey (ACS), a product of the U. S. Census Bureau discussed in a previous post. Their findings laud the drop in the number of uninsured children nationally, while pointing out the disparities among states, as thirty states failed to show any improvement in this area. By and large, it was the increase in the number of insured children in states like Texas, Florida and California that drove up the national average, not improvements across the entire country. Georgetown researchers attribute the large gains in those states to new policies under the Affordable Care Act (ACA) and the fact there were so many uninsured children in those three states to begin with.

In 2011, the number of uninsured children fell to around 5.5 million, down from nearly 6.4 million in 2009. Since there has been no significant decrease in the number of children living in poverty, the drop shows how changes in policy and programs are making a positive impact. This report gives us a starting point to begin comparing successful practices and determine what changes still need to be made across the country. But in essence, to tackle this problem states need to increase access to existing programs and take the opportunity to expand coverage using funds from the upcoming Medicaid expansion.

Read Full Post »

What to do about the flu?

Since I’m stuck at home with H1N1 this week, I thought I’d do a little public service and offer you all some flu-related resources:

1. Flu.gov. First stop is FLU.gov. This is the federal government’s central clearinghouse for flu information. You can find out where to get flu shots, how to prevent and treat the flu, and what your workplace or organization can do about it.
2. Flu Shot Locations. The seasonal flu vaccine is normally available at your county health department, many health clinics and pharmacies, and through schools and workplaces. However, the Tulsa Health Department is currently out of seasonal vaccine.The H1N1 vaccine is available for healthcare workers and for at-risk populations only, including school-aged children in schools with high levels of flu-related absenteeism, children under age 18 with chronic medical conditions, and pregnant women. As supplies become available, the vaccine will be offered to the general population. Check this page from the Oklahoma State Department of Health for the latest information.
3. Flu Self-Evaluation. If you think you might possibly have the flu, seasonal or H1N1, this simple questionnaire will help you determine whether to visit the doctor. It’s the first thing I did when I woke up Tuesday morning feeling feverish, achey, and stuffy.
4. If you have the flu: Stay home!! You should stay home until you have been fever-free (without fever reducers such as acetaminophen) for at least 24 hours. Even when you do return to work or school, be extra vigilant in practicing good hygiene by washing your hands frequently, coughing into a kleenex and then throwing it away, and avoiding close contact with your colleagues whenever possible.

Finally, a couple things I learned from my doctor:

• If you get the flu now, it’s almost certainly H1N1. Seasonal flu isn’t currently affecting the Tulsa area. H1N1 symptoms may be more severe than seasonal flu, and is more likely to include nausea and diarrhea. However, my symptoms have been relatively mild – so there’s hope for you!
• Your doctor can prescribe you the anti-viral Tamiflu, which is shown to reduce the duration of flu (including H1N1) by 1 to 2 days as well as the severity of its symptoms. It’s especially effective as a preventive measure or if begun very soon after contracting the flu. However, the CDC anticipates a Tamiflu shortage this year, so only take it if it’s necessary for your personal situation.

Disclaimer: Obviously I am not a doctor, so go talk to a real one or visit the above links if you have any questions of medical importance.

Read Full Post »

Tulsa Health Department Releases County Health Improvement Plan

The Tulsa Health Department has released its first draft of the Community Health Improvement Plan for public review and comment. The document, which culminates the Department’s Pathways to Health community planning initiative, identifies six strategic objectives to improve the health of Tulsa County citizens:

• Decrease the prevalence of childhood and adolescent obesity
• Improve affordability and availability of nutritional foods
• Provide safe, affordable, and healthy housing for Tulsa residents
• Improve mental health in the community
• Reduce tobacco use in the community
• Increase the density and accessibility of health care facilities

Each objective identifies specific measurable outcomes and a number of suggested intervention strategies. Read the full document here.

The Department is asking for comments, feedback, and additions to the document before submitting it for approval by the Pathways to Health Partnership. You can comment on the public blog for your region or email your feed back to Alicia Plati, Program Development Coordinator, at aplati@tulsa-health.org. Comments are due Monday, August 3 – so do it this weekend!

Read Full Post »

The Positive Deviant Solution to Our Health Care System

Just over a year ago, CAP hosted seminars in a new method of social change called “positive deviance.” The basic idea of positive deviance is that, within any given community possessing any given problem, some members through their own actions will fare better than others given equal resources. Observing what makes these “deviants” positive can unlock the secret to solving the challenges facing the community.

Recently the New Yorker ran a widely-praised article by Atul Gawande about the problem of health care costs in the U.S., focusing on the unlikely town of McAllen, Texas. As a follow up, the New Yorker posted a transcript of his commencement address to Northwestern University the Pritzker School of Medicine at the University of Chicago, in which Gawande explains the concept of positive deviance and  suggests applying a positive deviance approach to the national health care crisis:

Jerry Sternin was for awhile the director of a Save the Children program to reduce malnutrition in poor Vietnamese villages. The usual methods involved bringing in outside experts to analyze the situation followed by food and agriculture techniques from elsewhere.

The program, however, had itself become starved—of money. It couldn’t afford the usual approach. The Sternins had to find different solutions with the resources at hand.

So this is what they decided to do. They went to villages in trouble and got the villagers to help them identify who among them had the best-nourished children—who among them had demonstrated what Jerry Sternin termed a “positive deviance” from the norm. The villagers then visited those mothers at home to see exactly what they were doing.

Just that was revolutionary. The villagers discovered that there were well-nourished children among them, despite the poverty, and that those children’s mothers were breaking with the locally accepted wisdom in all sorts of ways—feeding their children even when they had diarrhea; giving them several small feedings each day rather than one or two big ones; adding sweet-potato greens to the children’s rice despite its being considered a low-class food. The ideas spread and took hold. The program measured the results and posted them in the villages for all to see. In two years, malnutrition dropped sixty-five to eighty-five per cent in every village the Sternins had been to. Their program proved in fact more effective than outside experts were.

If you attended our positive deviance seminars, led by a friend of the Sternins, you know this story by heart. Positive deviance has gone on to a distinguished history of discovering innovative, community-based solutions, particularly in healthcare. It’s shown success in reducing hospital infection rates by, gasp, encouraging medical staff to wash their hands thoroughly.

Gawande looks through this lens of positive deviance and sees solutions to today’s runaway health care costs that go unaccompanied with improved health:

Like the malnourished villagers, we are in trouble. But the public doesn’t know what do about it. The government doesn’t know. The insurance companies don’t know. …

Well, let us think about this problem the way Jerry Sternin thought about that starving village in Vietnam. Let us look for the positive deviants.

Read Full Post »

Health Department Identifies Tulsa Neighborhood Needs

The Tulsa Health Department’s Pathways to Health program is a community planning process for improving the health and quality of life in neighborhoods across Tulsa. Part of the process was an extensive survey, which they have used to identify priorities and strengths in every Tulsa zip c0de. You can view the priorities for your area by entering your zipcode here. My zip code, 74120, is located in the “Central West” region (as is the Kendall-Whittier neighborhood), where our strategic issues are:

• Chronic diseases on the rise
• Mental health and substance abuse must be treated as health issues
• Obesity
• Improper ER utilization

The second and fourth bullets, in particular, make sense to me. My zip code is home to St. John’s and Hillcrest, where the emergency rooms are absolutely slammed, and Parkside Psychiatric Hospital. (On the other hand, I haven’t noticed the prevalence of obesity in this area – we’re a relatively young set and are in a walkable area.)

Go type in your zip code to find out what your neighbors are identifying as important to their quality of life. You’ll notice that this feature is part of the website’s blog function, and you can actually post your own blog posts on your zip code’s page. I don’t see that anyone is taking advantage of this, but if you’ve got something to say you should head over there and start the conversation!

Read Full Post »

The Power of Germ-x

Researching the consequences of elementary school absenteeism (or, if you’re an optimist, the benefits of attendance). Came across a study that found that the availability of an  “alcohol gel hand sanitizer” (i.e. Germ-x) in elementary classrooms reduced child absences school wide by 20% and teacher absences by 10%. Specifically, teachers and students used the product every time they entered and left the classroom.

Maybe we should re-think that theory of change.

 

Read Full Post »

Insurance Out of Reach for Newly Unemployed

Families USA has a report (PDF) out detailing the inadequacy of COBRA. As you may know, COBRA allows displaced workers who lose their health insurance to purchase their previous employers’  policy for a certain period of time. In Oklahoma, the average worker who loses her job will pay 31.1% of her unemployment insurance on COBRA coverage. Even worse, if that worker must purchase insurance for her family, that premium will eat up nearly 83% of unemployment compensation. That family will have just $207 left for other necessities for an entire month. The result? Just 18 to 26% of eligible individuals elect to purchase COBRA benefits.

Read Full Post »

Dept. of Unhealthy Correlations

Children of smokers are more likely to be hungry.

Not good.

Read Full Post »