Health Care

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Jobs, environmental disparities and food safety are new battlefronts in efforts to improve the health of Americans.
Under the ?Healthy People 2020? initiative unveiled in December, the U.S. Department of Health and Human Services outlined goals and priorities for health promotion and disease prevention in the next 10 years, and the actions it plans to take to meet those goals.

Launched in 1979 and managed by the department?s Office of Disease Prevention and Health Promotion, Healthy People establishes 10-year national health objectives, monitors strides toward those objectives and measures the impact of prevention activity. For the 2020 campaign, Health and Human Services identified 13 new focus areas: adolescent health; blood disorders and blood safety; dementias, including Alzheimer?s disease; early and middle childhood genomics; global health; health-related quality of life and well-being; health care-associated infections; lesbian, gay, bisexual and transgender health; older adults; preparedness; sleep health; and social determinants of health.

Acknowledging the importance of the Healthy People initiative for their community and the new focus areas of the 2020 blueprint, the African-American community and health professional groups are drawing their own battle lines.

Jobs
?Without jobs, families are more likely to lack health insurance and access to affordable health care?? This year, the National Urban League will redouble our efforts with a renewed focus on jobs and job creation,? the National Urban League proclaimed in its Dec. 30 donations appeal headlined ?Quality and Affordable Health Care Solutions for Every American.?

Evidence shows that good nutrition can help to improve one?s health and prevent diseases. Without jobs, however, families are less likely to be able to afford a healthy diet, often resorting to inexpensive, high-fat foods and meals that may immediately satisfy hunger but provide few essential nutrients. This link between poor nutrition and the disproportionately high incidence of hypertension, heart disease and other obesity-related diseases in poor Black communities, particularly among adolescents, is hardly new news. ?We see evidence of this every day in our [African-American] patients who have a higher incidence of obesity-related diseases, such as diabetes and hypertension, than the rest of the population,? Charles Francis, Ph.D., president of the Charles R. Drew University of Medicine and Science, was quoted as saying in the Summer 2001 issue of? MinorityNurse.com. Based in Los Angeles, the university provides health care to underserved populations.

According to the Centers for Disease Control and Prevention, 35 percent of adults earning less than $15,000 per year are obese, compared to 24 percent of adults earning $50,000 or more per year. Hispanic boys and African-American girls have the highest rates of obesity, with 22.1 percent of Hispanic boys and 27.7 percent of African American girls classified as obese, the CDC says.

Environmental disparities
In the past two decades, the Healthy People initiative has honed in on health disparities among Americans, with ?Healthy People 2000? focused on reducing such disparities and Healthy People 2010 on eliminating them. ?Healthy People 2020? goes further, seeking to achieve health equity, eliminate disparities and improve the health of all groups.

At his inauguration last August as president of the National Medical Association, the country?s leading advocacy and support organization for Black physicians, Leonard Weather Jr., M.D., raised the issue of environmental disparities, linking it to health problems among African-Americans and other communities of color.

?We know the stories and as physicians we can connect the dots, even when our patients may not. Stories of women with endometriosis, which has been linked to byproducts of chemical factories and environmental toxins,? Dr. Weather said. ?The examples are widespread and include connections to cancer, lupus, rashes, respiratory illnesses, chromosome damage, and other genetic and reproductive disorders,? he added, citing a 2007 study commissioned by the United Church of Christ Justice and Witness Ministries that shows people of color making up most of the more than nine million people estimated to live in neighborhoods within two miles of the nation?s commercial hazardous waste facilities.

The report ?2007 Toxic Wastes and Race at Twenty? was a follow-up to the church?s 1987 landmark ?Toxic Wastes and Race? disparities study that gave birth to the phrase ?environmental racism.??

Weather?s battle plan calls for aggressive education of physicians who treat minority patients and residents of minority neighborhoods about the environmental toxins that lurk in those neighborhoods, and further studies showing the relationship between toxic environmental exposure, cancer and other disorders in African-Americans.

Food Safety
Closely linked to ?Healthy People,? environmental health disparities and income/nutrition-related diseases is the safety of the food we consume.

Food safety refers to the conditions and practices that preserve the quality of food to prevent contamination and food-borne illnesses. According to the Centers for Disease Control and Prevention, one in six people in the United States, or 48 million people, suffers from food-borne illness, more than a hundred thousand are hospitalized and thousands die.? Food can be contaminated in many different ways. Some food products may already contain bacteria or parasites. The germs can be spread during the packaging process if the food products are not handled properly.?

In a focus group to assess the quality and effectiveness of the University of Minnesota Extension?s Nutrition Education Programs, African-American participants told researchers that maintaining a healthy lifestyle through nutrition was ?hard work,? citing ?lack of resources, money and poor quality food in local grocery stores.?

The Food Safety Modernization Act, signed on Jan. 4 by President Barack Obama, for the first time will give the Food and Drug Administration a legislative mandate to require prevention-based controls across the food supply, from farm to table. The first overhaul of the federal food safety regulatory system in more than seven decades, the legislation will transform the FDA?s approach to food safety from one that primarily responds to outbreaks to
one than prevents them. FDA Commissioner Margaret A. Hamburg, M.D., says the bill lays the foundation for a prevention-based, 21st-century food safety system that makes everyone in the global food chain responsible for safety. ?This law helps us take the critical steps toward strengthening the food safety system that is vital to the health and security of the American people,? Hamburg says.

The better the system handles producing, processing, transporting and preparing foods, the safer our food supply will be, FDA officials contend. Companies will be required to develop and implement written food safety plans, FDA will have the authority to better respond and require recalls when food safety problems occur, and FDA will be able to better ensure that imported foods are safe for consumers.

?If someone does become sick ? and approximately three hundred and twenty-five thousand people are hospitalized with a diagnosis of food poisoning every year ? the Act will allow HHS to more easily and quickly track and trace the source of the contamination,? says Janice D. Lai, a partner in the Hartford office of the law firm LeClairRyan. ??In formulating the regulations, the HHS Secretary will work with the food industry, the Secretary of Agriculture and representatives of state departments of agriculture in pilot programs to develop product-tracing programs to more effectively identify recipients of the food to prevent or mitigate food-borne illness outbreaks.???

????? Key Provisions of the Food Safety Modernization Act?

Prevention Controls
Food facilities to evaluate the hazards in their operations, implement and monitor effective measures to prevent contamination, and have a plan in place to take any corrective actions that are necessary;
The FDA to establish science-based standards for the safe production and harvesting of fruits and vegetables to minimize the risk of serious illnesses or death.

Inspection and Compliance
The FDA to apply its inspection resources in a risk-based manner;
The FDA to take innovative steps with existing resources to make its inspection approaches the most efficient and effective.

Imported Food?

With an estimated 15 percent of the U.S. food supply imported, including 60 percent of fresh fruits and vegetables and 80 percent?of seafood, the legislation:
Requires importers to perform supplier verification activities to ensure imported food is safe;
Authorizes the FDA to refuse admission to imported food if the foreign facility or country refuses to allow an FDA inspection;
Authorizes the FDA to require certification, based on risk criteria, that the imported food is in compliance with food safety requirements;
Provides an incentive for importers to take additional food safety measures by directing the FDA to establish a voluntary program through which imports may receive expedited review of their shipments if the importer has taken certain measures to assure the safety of the food.

Response
For the first time, the FDA will have mandatory recall authority for all food products.

Enhanced Partnerships
The legislation strengthens existing collaboration among all food safety agencies ? Federal, state, local, territorial, tribal and foreign;
Provides for building the capacity of state, local, territorial and tribal food safety programs;
Directs the Secretary of Health and Human Services to improve training of state, local, territorial and tribal food safety officials;
Authorizes grants for training, conducting inspections, building capacity of labs and food safety programs and other food safety activities.

Opportunities
The push for a healthy America creates opportunities for professionals and entrepreneurs in areas ranging from health services and administration to information technology, construction, quality assurance and product tracking.?

?Healthy People? wants developers to come up with easy-to-use applications for professionals who are working with the new national health objectives and state and community health data. ?[Healthy People 2020] creates an opportunity to leverage information technology to make Healthy People come alive for all Americans in their communities and workplaces,? says Health and Human Services Chief Technology Officer Todd Park. ?The ?myHealthyPeople? apps challenge will help spur innovative approaches to helping communities track their progress using Healthy People objectives and targets as well as develop an agenda for health improvement.?

Under the Food Safety Modernization Act, grants are available for training, conducting inspections, building capacity of labs and food safety programs and other food safety activities.?And under health-care reform, the Health and Human Services Department is making $31 million in ?Communities Putting Prevention to Work? grants available to designated communities and states (Grants.gov) to support innovative programs designed to fight child-
hood obesity. ????

????? Reading the Nutrition Facts Label?

Shirley Blakely, a nutrition expert with the U.S. Food and Drug Administration and a registered dietitian, offers these guidelines on how to use the Nutrition Facts label when making food choices:

Serving size
One container isn?t necessarily one serving; make sure you?re eating only one serving by pre-measuring your food and eating it from a plate or bowl instead of out of the container.

Percent daily value
Tells what percentage of the recommended daily amount of each nutrient is in one serving of a food. Based on the amount of each nutrient recommendation for one day, 5 percent or less is low; 20 percent or more is high.

Nutrients
Try to get 20 percent or more of protein, fiber, and some essential vitamins and minerals (such as vitamin C and calcium) in a single serving; but limit your intake of saturated fats and sodium to 5 percent or less per serving of food. Strive for 0 trans fat, or trans fatty acids ? this harmful fat raises your bad cholesterol (LDL) and lowers your good cholesterol (HDL).