Happy Holidays from "Health on the Horizon"!

I will be taking the next 2 weeks off for the holidays, but will return Friday January 6, 2012 where I will continue on my journey around the state of Pennsylvania to see how the Patient Protection and Affordable Care Act applies to groups, individuals and institutions. 2012 should be an interesting year. You will meet a nurse from Lancaster General, explore the health/wealth gap in Philadelphia, meet recent college graduates and see a series on medicare. Above all however, we'll be paying close attention as the Supreme Court begins reviewing the PPACA.

In the meantime, join "Health on the Horizon" on Facebook and Twitter

Peace of the season and best wishes for a happy and healthy New Year! Holly

Happy Holidays from "Health on the Horizon"! 

I will be taking the next 2 weeks off for the holidays, but will return Friday January 6, 2012 where I will continue on my journey around the state of Pennsylvania to see how the Patient Protection and Affordable Care Act applies to groups, individuals and institutions.  2012 should be an interesting year.  You will meet a nurse from Lancaster General, explore the health/wealth gap in Philadelphia, meet recent college graduates and see a series on medicare.  Above all however, we'll be paying close attention as the Supreme Court begins reviewing the PPACA. 

In the meantime, join "Health on the Horizon" on Facebook and Twitter

Peace of the season and best wishes for a happy and healthy New Year!  Holly

Lebanon Family Health Services: Contraceptive Services

This is the fourth of a 5 part series on "Women's Health". Thank you to Lebanon Family Health Services for their assistance with this series.

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Lebanon Family Health Services
Ann Biser, Donna Williams, Kim Kreider Umble, Vicki DeLoatch

According to the National Campaign for the Prevention of Teen Pregnancy, the United States has the highest teen pregnancy rate in the industrialized world.  The United States teenage pregnancy rate is nearly 2X higher than the United Kingdom (the highest in Europe) and 10X higher than Switzerland (the lowest in Europe)[1].  Sadly, this is not shocking news to those that have worked in the field of adolescent reproductive health for the majority of the past half century.  It has been this way for quite some time.  It is a reality that advocates have been screaming about, but has either fallen on deaf ears or become a pandering tool for political debate.

The debate has been wide and has a tendency to tug at the social nerve that lies beneath the American Psyche.  While the issue is complexly intertwined with the dynamics of poverty, the debate concerning its solutions have ranged from attitudes towards sexuality education, access to contraception and cultural attitudes concerning sexuality in general.  The one thing all sides of the debate can agree upon is this:  unplanned teen pregnancy is a problem. 

Teen mothers are 60% more likely to drop out of school which further perpetuates the cycle of poverty and resulting in higher rates of babies being born into poverty[2].  These babies are also more likely to have poor school attendance, drop out of school, have lower cognitive scores, end up in prison and ultimately become teen parents themselves.  A cycle that weighs heavy on our society.  It is estimated that teen pregnancy costs tax payers $10.9 billion annually ($463 million in PA for 2008), but when rates are decreased huge savings can be found.  For example, between 1991 and 2004 we saw a 1/3 decrease in teen pregnancy that resulted in a $6.7 billion savings.[3]

This leads us back to the question posed above.  What are the other industrialized countries doing better than the US that leaves them with much more positive teen pregnancy statistics?  The answer is simple.  They have more open access to healthcare, including reproductive healthcare.

Since 1973 Lebanon Family Health Services has been meeting this reproductive health need for underserved women in Lebanon County.  According to Donna Williams, Chief Operating Officer at LFHS, “We often hear that women receiving medical assistance are treated differently at other offices.  It is important that in order to reach this population with the ultimate goal of improving health outcomes, that these clients are treated fairly and with respect.  In the end, these women will become active partners in their healthcare and society benefits.”

Now with the passage of the Patient Protection and Affordable Care Act, access to contraception will be considered an essential benefit under the preventive health component of the law.  In other words, insurance companies now have to cover birth control.

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[1] United States: Martin, J.A., Hamilton, B.E., Sutton, P.D., Ventura, S.J., Matthews, T.J.,  Kirmeyer, S. & Osterman, M.J.K.. (2010).Births: Final data for 2007. National Vital Statistics Reports,58 (24). Other Countries: United Nations Statistical Division. Demographic Yearbook  2007. New York: United Nations

[2] The National Campaign for the Prevention of Teen Pregnancy.  Counting it Up:  The Public Costs of Teen Childbearing, 2008.

[3] Ibid.

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Breastfeeding provisions in the PPACA



This is the third of a 5 part series on "Women's Health". Thank you to Lebanon Family Health Services for their assistance with this series.

Family Health Services
Ann Biser, Donna Williams, Kim Kreider Umble, Vicki DeLoatch

In 2010, Lebanon County reported that 56.9% of all infants were breast fed at birth; this rate lags far behind the national average of 75% according to the Centers for Disease Control’s 2010 Breastfeeding Report Card.  Furthermore, the CDC’s 2010 Breast Feeding targets were also to see 50% of babies still breast feeding at 6 months, the national average is 43% with Lebanon County’s breastfeeding average duration at 14.6 weeks.    

While much research has shown the immediate as well as long term benefits to breastfeeding such as the development of a healthy immune system and a reduced risk many chronic diseases, there still remains many cultural barriers to women’s ability to breastfeed.  Many of the cited barriers involve cultural acceptance of the practice.

Over the years, Lebanon Family Health Services has been working diligently with its clients to encourage, initiate and support their clients in breastfeeding as part of their WIC program, a challenge that is felt both locally and nationally.  “One of our biggest challenges the staff faces is overcoming the myths surrounding breastfeeding,“ states Sara Wingert, a WIC staff member at LFHS.  “They often express concerns that range from physical discomfort to issues of practicality, such as returning to work.  We spend individual time with clients educating about the benefits and advantages of breastfeeding,” she concluded. 

One of the essential benefits provisions under the Patient Protection and Affordable Care Acts (PPACA) is now to support breastfeeding as part of the preventive care component of women’s health.  All insurance plans must now cover breast feeding supports such as counseling, consultation with a trained provider and equipment rental for breast pumps.  The bill also requires employers to provide reasonable breaktime for mothers who are nursing.

Like many of the provisions included in the preventive health component of the PPACA, the breastfeeding provision falls in line with current research in the area of public health.  By increasing the number of infants that receive breast milk there is a risk reduction in acquiring many acute and chronic diseases such as GI infections, lower respiratory infections, asthma, obesity and diabetes[1].  Therefore, in the long-term, reducing the healthcare costs associated with treating such conditions.  It is estimated that 75% of national healthcare expenditures are spent on treating chronic diseases[2], many of which could be prevented or reduced by utilizing prevention practices such as breastfeeding. 

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[1] S ip et al., “A Summary of the Agency for Healthcare Research and Quality’s Evidence Report on Breastfeeding in Developed Countries,” Breastfeeding Medicine 4, no. s1 (2009):  s17-s30.

[2] “Chronic Disease and Health Promotion,” Centers for Disease Control and Prevention, 2009.

Lebanon Family Health Services: Tobacco Cessation in the PPACA

This is the second of a 5 part series on "Women's Health". Thank you to Lebanon Family Health Services for their assistance with this series.

Lebanon Family Health Services
Ann Biser, Donna Williams, Kim Kreider Umble, Vicki DeLoatch

In 2010 The Lebanon Family Health Services provided 1587 clients with tobacco cessation education and counseling sessions.  Through the years, funding for such programs has been a challenge.  However, buried deep within the 2010 Patient Protection and Affordable Care Act we can find that this will become a mainstream program provided for women’s health.

Under the essentialbenefits component of the PPACA, services that insurance companies are now required to cover, there are provisions for preventive health.    The preventive health element is further broken down into four categories: (1) Evidence-Based Screenings and Counseling, (2) Routine Immunizations, (3) Preventive Services for Children and Youth and (4) Preventive Services for women.    These services are based on the recommendations for the Institute of Medicine and will have no cost sharing on the part of the patient.

According to the Centers for Disease Control, women who smoke during pregnancy are 2x more likely to experience premature rupture of membranes, placental abruption and placenta previa.  Additionally, it leads to their babies having a 30% chance of being born prematurely and with a low birth weight.  These babies are also up to 3x more likely to die of SIDS (Sudden Infant Death Syndrome).  All together, this not only impacts quality of life for infants and children, but racks up costly medical bills.

While a recent study found that only 24% of insurance plans among insured people cover smoking cessation and counseling,[1] research has shown that smoking cessation programs for pregnant women can save as much as $6 for every $1 spent[2].  Given the fact that high risk populations, such as the one served by the Lebanon Family Health Services, are more likely to smoke during pregnancy, this provision would be an asset to their institution.

According to Vickie DeLoatch, “When a prenatal patient comes into our program and shares the challenge that she faces with tobacco addiction, we always view it as an opportunity to effect a positive change. The true appreciation that is expressed when they receive assistance is gratifying.  Help and support is sought to become tobacco free and we can provide this support through the tobacco cessation programs offered at Lebanon Family Health Services”.   

The recently passed Patient Protection and Affordable care act will comply with recommended strategies and policies put forth by the Centers for Disease Control by offering pregnant smokers counseling and cessation interventions from the first prenatal visit and throughout pregnancy.

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[1] Partnership for Prevention, Insurance Coverage of Clinical Preventive Services in Employer-sponsored Health Plans:  Preliminary Results of a Partnership for Prevention/William M. Mercer National Survey, 2001.  Washington, DC.  Partnership for Prevention.

[2] Marks JS, Koplan JP, Hogue CJR, Dalmat ME. A cost-benefit/cost-effectiveness analysis of smoking cessation for pregnant women. American Journal of Preventive Medicine 1990;6(5): 282-9.