WASHINGTON, DC and NEW YORK—A new report by the Geiger Gibson/RCHN Community Health Foundation Research Collaborative at the George Washington University School of Public Health and Health Services (SPHHS) examines the impact of federal and state policy decisions on community health centers (CHCs) and their ability to continue providing primary care to the nation’s poorest residents. The report, “How Medicaid Expansions and Future Community Health Center Funding Will Shape Capacity to Meet the Nation’s Primary Care Needs,” estimates that under a worst-case scenario, the nation’s health centers would be forced to contract, leaving an estimated 1 million low-income people without access to health care services by the year 2020.

“Without continued support, community health centers will not be able to meet the rising demand for primary care in underserved parts of the United States,” said the lead author of the report, Leighton Ku, PhD, MPH, a professor of health policy and director of the Center for Health Policy Research at SPHHS. “Unless policymakers act now to support these centers, many low-income Americans will be left without the high-quality care that can prevent many expensive health conditions from developing in the first place.”

The authors analyzed two key policy issues—the level of federal grant funding and the expansion of Medicaid eligibility under the Affordable Care Act (ACA)—and examined the impact of various levels of support on health center capacity. The researchers found that with sufficient federal funding and Medicaid expansion in all states, health centers could nearly double their capacity by 2020. In contrast, health centers would have to curtail services and turn away patients if grant funding is limited, and Medicaid expansion is not broadened.

Today there are 1,128 community health centers that provide care at 8,000 sites in rural or underserved areas of the United States. The ACA bolstered federal funding for health centers, with mandatory support reaching $3.6 billion in 2015. However, mandatory funding expires starting in 2016 and given the push to trim the federal budget there is no guarantee that lawmakers will continue to support enhanced federal funding in the coming years.

The researchers modeled several scenarios to predict what might happen to CHCs in the near future. In the worst case scenario, CHCs would see their core federal funding cut as lawmakers try to reduce the deficit. This funding helps pay for infrastructure and staff and helps health centers stay open despite high levels of free care provided to low-income patients. If low grant funding occurs in combination with limited Medicaid expansion, health center capacity nationwide would fall from 21.1 million patients currently served to about 20.1 million patients in 2020. That drop in capacity raises concerns because it would undermine the ACA’s goal of providing affordable health care, and particularly primary care, to many more Americans. CHCs provide the comprehensive high-quality primary care that can prevent or control chronic conditions and potentially avert costly future medical crises. To date, 25 states and the District of Columbia have opted to expand Medicaid.

The study paints a very different picture when more favorable assumptions are made: If federal funding continues to rise, health center capacity would increase substantially to serve 35.6 million patients, or about two-thirds more than currently served, even if additional states do not expand Medicaid.

Finally, the authors  analyzed the impact of high federal funding levels in concert with expansion of the Medicaid program across all states. Medicaid expansion helps boost the bottom line for community health centers because many previously uninsured patients would gain health coverage, and this would provide additional revenue to the health centers. In  this best-case future, the health centers would be able to care for  a total of 37 million people by 2020, or nearly twice the number of patients currently served. The researchers found that federal funding decisions about whether to keep CHC grants at the current or enhanced levels will have significant effects on future growth. Stagnant or diminished funding, especially if it is coupled with no additional Medicaid expansion, might mean that clinics must turn away patients and would not have the funds needed to expand or send primary care doctors into areas of the country that do not have access to basic health care.

Today, about one-third of the nation lives in a medically underserved area, places where doctors or clinics are in short supply and patients often have to travel for miles or hours in order to find a primary care provider.

“Community health centers have the unique ability to help fulfill the promise of health reform by providing much-needed primary care to our nation’s most vulnerable populations, “ said Feygele Jacobs, president and CEO of the RCHN Community Health Foundation. “But health centers will be able to fill the primary and preventive care gaps only if they receive continued support.”

The report, “How Medicaid Expansions and Future Community Health Center Funding Will Shape Capacity to Meet the Nation’s Primary Care Needs,” can be accessed by clicking here.

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About the Geiger Gibson / RCHN Community Health Foundation Research Collaborative:

The Geiger Gibson Program in Community Health Policy, established in 2003 and named after human rights and health center pioneers Drs. H. Jack Geiger and Count Gibson, is part of the School of Public Health and Health Services at The George Washington University.  It focuses on the history and contributions of health centers and the major policy issues that affect health centers, their communities, and the patients that they serve. Additional information about the Research Collaborative can be found online at https://sphhs.gwu.edu/projects/geiger-gibson-program or at rchnfoundation.org.

About the RCHN Community Health Foundation:

The RCHN Community Health Foundation is a not-for-profit operating foundation established to support community health centers through strategic investment, outreach, education, and cutting-edge health policy research. The only foundation in the U.S. dedicated solely to community health centers, RCHN CHF builds on a long-standing commitment to providing accessible, high-quality, community-based healthcare services for underserved and medically vulnerable populations. The Foundation’s gift to the Geiger Gibson program supports health center research and scholarship. For more information, visit www.rchnfoundation.org.

About the George Washington University School of Public Health and Health Services:

Established in July 1997, the School of Public Health and Health Services brought together three longstanding university programs in the schools of medicine, business, and education and is now the only school of public health in the nation’s capital. Today, more than 1,100 students from nearly every U.S. state and more than 40 nations pursue undergraduate, graduate, and doctoral-level degrees in public health.  The school now offers an online Master of Public Health, MPH@GW, which allows students to pursue their degree from anywhere in the world.  

CARVER, Mass. – Cranberries are more than a holiday favorite, given their remarkable nutritional and health benefits. A new research review published in the international journal Advances in Nutrition provides reasons why these tiny berries can be front and center and not just a side dish. The review authors conclude that cranberries provide unique bioactive compounds that may help reduce the incidence of certain infections, improve heart health and temper inflammation.

Ten worldwide experts in cranberry and health research contributed to the article, including scientists and medical experts from Tufts University, Pennsylvania State University, Boston University, Rutgers University, French National Institute for Agricultural Research, University of East Anglia in the United Kingdom and Heinrich-Heine-University in Germany. The authors included more than 150 published research studies to create the most thorough and up-to-date review of the cranberry nutrition and human health research.

"Hundreds of studies show that the bioactive compounds found in cranberries improve health," said lead author Jeffrey Blumberg, PhD, FASN, FACN, CNS, Director of the Antioxidants Research Laboratory and Professor in the Friedman School of Nutrition Science and Policy at Tufts University. "For example, the polyphenols found in cranberries have been shown to promote a healthy urinary tract and exert protective benefits for cardiovascular disease and other chronic conditions."

Based on the totality of the published cranberry research, the authors concluded that the cranberry fruit is truly special because of the A-type proanthocyanidins (a polyphenol from the flavanol family), in contrast to the B-type proanthocyanidins present in most other types of berries and fruit. The A-type proanthocyanidins appear to provide the anti-adhesion benefits that help protect against urinary tract infections (UTI), which affect more than 15 million U.S. women each year. They present evidence suggesting that cranberries may also reduce the recurrence of UTIs – an important approach for relying less on antibiotic treatment for the condition.

Cranberry Health Benefits Extend Beyond Urinary Tract Health

The authors also cite data that shows the cranberry may improve cardiovascular health by improving blood cholesterol levels and lowering blood pressure, inflammation and oxidative stress. Cranberries have been shown to help support endothelial function and reduce arterial stiffness. Together, these benefits may promote overall health and functioning of blood vessels to help slow the progression of atherogenesis and plaque formation, which can lead to heart attacks and stroke.

Need Fruit? Eat More Cranberries

While all fruit contributes necessary vitamins and minerals to the diet, berry fruits offer a particularly rich source of health-promoting polyphenols. Because of their tart taste and very low natural sugar content, sugar is often added to cranberry products for palatability. Even with added sugar, cranberry products typically have a comparable amount of sugar to other unsweetened fruit juices and dried fruit products. Additionally, the 2010 Dietary Guidelines for Americans asserts that the best use of calories from added sweeteners is for improving the palatability of nutrient-rich foods, as is the case when adding sugar to cranberries. As an additional option, non-nutritive sweeteners are used to produce low calorie versions of cranberry products. Americans can help increase their fruit intake by incorporating cranberries and cranberry products into their diet and there is no need to wait for the holidays – cranberries can be enjoyed year round – fresh, frozen, dried, or in a juice or sauce.

"While we look forward to more research to better understand how cranberries affect our well-being and longevity, we know that including cranberries and cranberry products in a healthy diet is a great way to increase fruit intake," said Dr. Blumberg.

The Cranberry Institute provided support for the research article. For more information about the Cranberry Institute, the health benefits of cranberries and current scientific research visit https://www.CranberryInstitute.org.

About the Cranberry Institute

The Cranberry Institute is a not-for-profit organization founded in 1951 to further the success of cranberry growers and the industry in the Americas through health, agricultural and environmental stewardship research as well as cranberry promotion and education. The Cranberry Institute is funded voluntarily by Supporting Members that handle, process, and sell cranberries. Supporting Members are represented in national and international regulatory matters and research efforts are done on their behalf.  

Prior research has shown not getting enough sleep can impact your weight, but new Brigham Young University (BYU) research finds the consistency of your bed time and wake time can also influence body fat. 

Exercise science professor Bruce Bailey studied more than 300 women from two major Western U.S. universities over the course of several weeks and found that those with the best sleeping habits had healthier weights.

The main findings from the study, published online in the American Journal of Health Promotion:

• A consistent bed time and, especially, a consistent wake time are related to lower body fat.

• Getting less than 6.5 or more than 8.5 hours of sleep per night is associated with higher body fat.

• Quality of sleep is important for body composition.

Women in the study were first assessed for body composition, and then were given an activity tracker to record their movements during the day and their sleep patterns at night. Researchers tracked sleep patterns of the participants (ages 17-26) for one week.

The most surprising finding from the study, according to the researchers, was the link between bed time and wake time consistency and body weight. Study participants who went to bed and woke up at, or around the same time each day had lower body fat. Those with more than 90 minutes of variation in sleep and wake time during the week had higher body fat than those with less than 60 minutes of variation.

Wake time was particularly linked to body fat: Those who woke up at the same time each morning had lower body fat.  Staying up late and even sleeping in may be doing more harm than good, Bailey said.

“We have these internal clocks and throwing them off and not allowing them to get into a pattern does have an impact on our physiology,” Bailey said.

Bailey related consistent sleep patterns to having good sleep hygiene. When sleep hygiene is altered, it can influence physical activity patterns, and affect some of the hormones related to food consumption contributing to excess body fat.

Bailey and his team also found there was a sweet spot for amount of sleep: Those who slept between 8 and 8.5 hours per night had the lowest body fat.

Sleep quality also proved to have a strong relationship to body fat. Sleep quality is a measure of how effective sleep is, or how much time spent in bed is spent sleeping. Those who had better sleep quality had lower body fat. 

To improve sleep quality Bailey recommended exercising, keeping the temperature in the room cool, having a quiet room, having a dark room, and using beds only for sleeping.

“Sleep is often a casualty of trying to do more and be better and it is often sacrificed, especially by college students, who kind of wear it as a badge of honor,” Bailey said.

BYU exercise science professors James LeCheminant and Larry Tucker are coauthors on the paper, as is statistics professor William Christensen.

Income, education level, sex, race, ethnicity, employment status, and sexual orientation are all related to health and health outcomes for a number of Americans, according to a new Morbidity and Mortality Weekly Report Supplement released last week by the Centers for Disease Control and Prevention (CDC).

The "CDC Health Disparities and Inequalities Report — United States, 2013," is the second CDC report that highlights differences in mortality and disease risk for multiple conditions related to behaviors, access to health care, and social determinants of health – the conditions in which people are born, grow, live, age, and work.

The latest report looks at disparities in deaths and illness, use of health care, behavioral risk factors for disease, environmental hazards, and social determinants of health. This year’s report contains 10 new topics including access to healthier foods, activity limitations due to chronic diseases, asthma attacks, fatal and nonfatal work-related injuries and illnesses, health-related quality of life, periodontitis in adults, residential proximity to major highways, tuberculosis, and unemployment.

“Better health for all Americans depends on focusing our efforts where they’re needed most,” said CDC Director Tom. Frieden, M.D., M.P.H." This kind of information helps us target health programs and promotes accountability for improving health equity at the federal, state and local level."

Some of the report’s key findings include:

• The overall birth rate for teens 15-19 years old fell dramatically -- by 18% -- from 2007 to 2010.  Birth rate disparities also decreased because the rates fell by more among racial and ethnic minority populations that had higher rates.  However, across states, there was wide variation, from no significant change to a 30% reduction in the rate from 2007 to 2010. 

• Working in a high risk occupation -- an occupation in which workers are more likely than average to be injured or become ill -- is more likely among those who are Hispanic, are low wage earners, were born outside of the United States, have no education beyond high school, or are male. 

• Binge drinking is more common among persons aged 18-34 years, men, non-Hispanic whites, and persons with higher household incomes.

• While the number of new tuberculosis cases in the United States decreased 58% from 1992 to 2010, tuberculosis continues to disproportionately affect racial and ethnic minorities, including foreign-born individuals. 

The report also underscores the need for more consistent data on population characteristics that have often been lacking in health surveys, such as disability status and sexual orientation. To help ensure that such data are more available in the future, the Affordable Care Act required the U.S. Department of Health and Human Services to develop a set of uniform data collection standards for national population health surveys. These standards were published in 2011.

“It is clear that more needs to be done to address the gaps and to better assist Americans disproportionately impacted by the burden of poor health,” said Chesley Richards, M.D., M.P.H., director of CDC’s Office of Public Health Scientific Services, which produced the report. “We hope that this report will lead to interventions that will allow all Americans, particularly those most harmed by health inequalities, to live healthier and more productive lives.”

The full "CDC Health Disparities and Inequalities Report — United States, 2013" and related information on the individual chapters is available at https://www.cdc.gov/DisparitiesAnalytics.

The Affordable Care Act can help to reduce health disparities in the United States. Through the Affordable Care Act, more Americans will qualify to get health care coverage that fits their needs and budget, including important preventive services that are covered with no additional costs. Reducing disparities in health insurance coverage and access to care will contribute to health equity and is a key strategy of the U.S. Department of Health and Human Services Action Plan to Reduce Racial and Ethnic Health Disparities. Visit Healthcare.gov or call 1-800-318-2596 (TTY/TDD 1-855-889-4325) to learn more about open enrollment in the Marketplace that began October 1 and ends March 31, 2014. For those enrolled by December 15, 2013, coverage starts as early as January 1, 2014.

Recife,Brazil--The world will be short of 12.9 million health-care workers by 2035; today, that figure stands at 7.2 million. A World Health Organization (WHO) report released this month warns that the findings – if not addressed now – will have serious implications for the health of billions of people across all regions of the world.

The report, "A universal truth: No health without a workforce", identifies several key causes. They include an ageing health workforce with staff retiring or leaving for better paid jobs without being replaced, while inversely, not enough young people are entering the profession or being adequately trained. Increasing demands are also being put on the sector from a growing world population with risks of noncommunicable diseases (e.g. cancer, heart disease, stroke etc.) increasing. Internal and international migration of health workers is also exacerbating regional imbalances.

The findings were released at the Third Global Forum on Human Resources for Health together with recommendations on actions to address workforce shortages in the era of universal health coverage. The main recommended actions include:

• Increased political and technical leadership in countries to support long-term human resource development efforts.

• Collection of reliable data and strengthening human resource for health databases.

• Maximizing the role of mid-level and community health workers to make frontline health services more accessible and acceptable.

• Retention of health workers in countries where the deficits are most acute and greater balancing of the distribution of health workers geographically.

• Providing mechanisms for the voice, rights and responsibilities of health workers in the development and implementation of policies and strategies towards universal health coverage.

“The foundations for a strong and effective health workforce for the future are being corroded in front of our very eyes by failing to match today’s supply of professionals with the demands of tomorrow’s populations,” says Dr. Marie-Paule Kieny, WHO Assistant Director-General for Health Systems and Innovation. “To prevent this happening, we must rethink and improve how we teach, train, deploy and pay health workers so that their impact can widen.”

While the report highlights some encouraging developments, for example, more countries have increased their health workforce, progressing towards the basic threshold of 23 skilled health professionals per 10 000 people, there are still 83 countries below this basic threshold. But it is the future projections that raise the loudest alarms. In a stark assessment, the report says the current rate of training of new health professionals is falling well below current and projected demand. The result will be that in the future, the sick will find it even harder to get the essential services they need and preventive services will suffer.

Whilst the largest shortages in numerical terms are expected to be in parts of Asia, it is in sub-Saharan Africa where the shortages will be especially acute. On education and training, for example, in the 47 countries of sub-Saharan Africa, just 168 medical schools exist. Of those countries, 11 have no medical schools, and 24 countries have only one medical school.

“One of the challenges for achieving universal health coverage is ensuring that everyone – especially people in vulnerable communities and remote areas – has access to well-trained, culturally-sensitive and competent health staff,” says Dr. Carissa Etienne, WHO Regional Director for the Americas. “The best strategy for achieving this is by strengthening multidisciplinary teams at the primary health care level.”

Universal health coverage aims to ensure that all people obtain the health services they need without suffering financial hardship when paying for them. In the Americas, 70% of countries have enough health care workers to carry out basic health interventions, but those countries still face significant challenges linked to the distribution of professionals, their migration and appropriate training and skills mix.

“Training of health professionals must be aligned with the health needs of the country,” adds Dr. Etienne.

All countries are urged to heed the signals of shortages. For example, in developed countries, 40% of nurses will leave health employment in the next decade. With demanding work and relatively low pay, the reality is that many young health workers receive too few incentives to stay in the profession.

The publication also identifies maternal and child health as an urgent health workers’ action area. Around 90% of all maternal deaths and 80% of all still births occur in 58 countries, largely because those countries lack trained midwives. Also, of the 6.6 million under-five year olds who died in 2012, most deaths were from treatable and preventable diseases. Again, more health workers would prevent most of those unnecessary young deaths.

The Third Global Forum for Human Resources for Health is the largest event ever held on human resources for health, with more than 1300 participants from 85 countries, including 40 ministers of health. 

Please watch the Webcast from the CDC entitled "Combatting Resistance: Getiing Smart About Antibiotics" at 1 PM EST, Tuesday. 

This session of Grand Rounds will explore how improved prescribing practices and policies can not only help reduce rates of antibiotic resistance, but also improve individual patient outcomes. The session will also provide insight into interventions, such as patient and provider education and clinical decision support, which are key in reaching the goal of reducing unnecessary antibiotic use.

Learn more. 

CHICAGO —The American Dental Association (ADA) is pleased by the provisions related to dental amalgam included in the global mercury treaty signed by a representative of the United States on Nov. 6. U.S. ratification of the treaty is subject to Senate approval. Many other countries signed the treaty in Minamata, Japan, in October; however, the U.S. was unable to do so due to the government shut down.

The treaty upholds the use of dental amalgam, a durable, safe, effective cavity-filling material. Caries, the disease that causes tooth decay, afflicts 90 percent of the world's population making this a global public health issue. Unlike other products addressed in it, the treaty places no restrictions on the use of amalgam. Instead, the treaty calls for signatory countries to set national objectives and implement programs aimed at dental caries prevention and health promotion. The ADA also supports the treaty’s call for more research into new dental treatment options. 

The ADA is pleased that the treaty carries forth the ADA’s long commitment to capture and recycle amalgam waste. Dental office best management practices established by the ADA can prevent up to 99 percent of waste amalgam from entering the environment through capture and recycling.

By phasing up global preventive strategies, we can improve oral and general health outcomes world-wide.  In addition, raising global awareness of the importance of oral health to overall health, including how to prevent dental diseases, decreases the need for all cavity-filling restorative materials, including dental amalgam.

The global treaty aims to limit mercury emissions to the environment and sets forth measures pertaining to the burning of coal, which is the largest single manmade source of mercury in the environment. The treaty also considered a number of other sources such as small-scale gold mining and the Chlor-alkali sector. Five products were also considered, including dental amalgam.

Dental amalgam is made by combining metals such as silver, copper, tin and zinc with elemental mercury. As such, dental amalgam has entirely different physical and chemical properties than mercury alone. Amalgam has been used safely and effectively for generations to restore teeth damaged by tooth decay. Dental amalgam use in the U.S. has declined considerably over the past few decades primarily because people prefer more natural-looking, tooth colored materials. However, tooth-colored materials can be less durable, more costly and in some clinical situations not as effective as dental amalgam.

The ADA encourages people to talk with their dentists about their dental treatment options. More information on dental amalgam and other restorative materials may be found on www.mouthhealthy.org.

By Dr. Griffin P. Rodgers, Director, National Institute of Diabetes and Digestive and Kidney Diseases for World Diabetes Day

Diabetes does not strike a person alone. It strikes families and communities. It strikes our nation and the world. During World Diabetes Day and National Diabetes Month this November, we at the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health, renew our efforts to prevent, manage and one day cure diabetes. As well, we encourage families to take steps to improve their health and work together to fight diabetes and its serious and sometimes fatal consequences.

Diabetes affects nearly 26 million Americans, and an estimated 79 million people are at risk for developing the disease. Worldwide, diabetes is on the rise, especially in Asia and the Middle East. For people living with diabetes or at risk for type 2 diabetes, family support is critical to staying healthy. NIDDK has taken important steps to curtail this epidemic, from funding research on diabetes and its complications to providing help through education.

Diabetes is a complex group of diseases with a variety of causes. In type 1 diabetes, the body does not make insulin. People with type 1 need to take daily insulin to live. Thanks to NIH-funded research, we now know that good early management of the disease through insulin, diet and exercise can prevent serious complications even decades later.

Type 2 diabetes is more pervasive and often preventable, yet more and more people are at risk for type 2 diabetes due to the obesity epidemic and the aging of the U.S. population. Although still rare, young people are increasingly developing type 2 diabetes, and we have learned that the disease is even more difficult to treat in youth than adults. A third type, gestational diabetes, occurs in some women during pregnancy. It usually goes away after birth, but these women and their children have a greater chance of getting type 2 diabetes later in life.

The National Diabetes Education Program, a joint effort of the NIH and the Centers for Disease Control and Prevention, and the NIDDK’s National Diabetes Information Clearinghouse provide research-based health information, resources and support for people and their families and communities to make positive changes together to improve diabetes outcomes.

But we are also each other’s best resource. Preventing type 2 diabetes and managing diabetes involves the entire family. Cook a balanced meal. Share a brisk walk. Talk with your family about your health and your family’s diabetes risk. Schools, work sites and places of worship can also be part of the diabetes prevention and management solution. What we can do alone to fight diabetes and its consequences, we can do so much more effectively together.

At NIDDK, we are committed to improving diabetes treatment and advancing public health through diabetes research and education. We aim for a diabetes-free future: for ourselves, our family, our community, our nation and our world.

The NIDDK, a component of the NIH, conducts and supports research on diabetes and other endocrine and metabolic diseases; digestive diseases, nutrition and obesity; and kidney, urologic and hematologic diseases. Spanning the full spectrum of medicine and afflicting people of all ages and ethnic groups, these diseases encompass some of the most common, severe and disabling conditions affecting Americans. For more information about the NIDDK and its programs, see https://www.niddk.nih.gov

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.