Tagged Public Health

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No More Tater Tots? California Schools Put Healthier Lunches To The Test

When Miguel Villarreal addresses a crowded education conference, a group of school district administrators or a room full of curious parents, he often holds aloft a foil-wrapped package of Pop-Tarts — the heavily processed, high-sugar snack routinely sold on school campuses.

Villarreal, who oversees nutrition for the San Ramon Valley Unified School District in Northern California, then speaks clearly and loudly as he unloads the news: “School food services are completely broken.”

Can they be fixed? Villarreal and other school nutrition crusaders are trying to do that for this generation of students not only by providing more nutritious lunches but also by taking advantage of some surprising cost savings that come with fresher food.

From a multipronged attempt to reshape student lunches in Oakland to the addition of vegan options in the sprawling Los Angeles Unified School District, K-12 schools across California are rethinking and reformulating student meals.

They are not alone. Minneapolis schools long ago began phasing out processed foods, replacing them with locally sourced, fresh choices that have proved popular. Miami-Dade County Public Schools, the nation’s fourth-largest school district, expanded its plant-based menu options and began offering free daily breakfast to every student — a clear recognition of the significant role schools play in the nutrition of many students.

“It is a movement,” said Villarreal, an industry pioneer who ran the food program in Marin County’s Novato Unified School District for 17 years. “Slowly but surely, others are coming on board. But there are always challenges.”

A new challenge is a federal directive from the Trump administration to roll back Obama-era standards that called for less sodium, more whole-grain foods and fewer sweetened milk drinks in school lunches. The U.S. Department of Agriculture said it was easing those standards in recognition of “the persistent menu-planning challenges experienced by some schools,” both budgetary and cultural.

California and five other states are suing to block the action.

Inauspiciously, the USDA’s analysis suggests that some 500,000 schoolchildren may lose their free or reduced-cost lunches altogether because of the agency’s recently announced plan to tighten eligibility requirements for food stamps. Many students qualify for school nutrition programs as a result of their families’ food stamp eligibility.

The push for fresh ingredients, whole foods and fewer meat-based meals must pass a crucial litmus test: the students’ palates.

“I don’t want fillers; I want winners,” said Manish Singh, food services director for the Los Angeles Unified School District, with an enrollment of more than 730,000. “If the students don’t like it and don’t eat it, we have not succeeded. And we can’t afford not to succeed.”

Success is important because about 1 in 5 children ages 2 to 19, or roughly 14 million kids, were obese in 2015-16, according to the Centers for Disease Control and Prevention. In California, close to one-third of children ages 10 to 17 are considered overweight or obese. Unhealthy diets are a big reason.

The benefit of nutritious food for students has been well documented. Numerous studies draw a direct link between higher-quality meals and better brain function, including improved academic performance.

For those who survived the era in which fish sticks and tater tots passed as a good day in school cafeterias, a visit to a contemporary K-12 lunchroom in Oakland is illuminating. Tables abound with fresh fruit choices, heavily used salad bars and freshly made entrees such as chicken tikka masala with rice, lime-cilantro slaw and cucumber and tomato salsa.

But Villarreal and others working to improve school food say progress remains halting and erratic. And the factors that hindered it in the past are still in play: cost, governmental regulation and the heavy involvement of the food industry.

Villarreal has been addressing the challenge of providing healthy meals to students in California since he arrived in Novato in 2002 and discovered that the district, though surrounded by more than 60 farms, was serving the same processed, heat-and-eat food that kids got at his previous district in Texas.

In collaboration with local growers, parents and administrators, Villarreal crafted a new approach, incorporating more whole grains, eliminating processed sugar and saturated fats, using fresh ingredients and even offering cooking classes.

It worked, Villarreal said, but it took time, determination and cooperation.

“It isn’t enough to talk about healthy food,” Villarreal said. “The food has to be healthy and affordable.”

To make their finances work, many districts rely on the National School Lunch Program, which is funded by the USDA. That gives the agency considerable sway over the food those districts offer.

In L.A., where about 80% of students qualify for free or reduced-cost lunch, “we get asked about having organic foods,” Singh said. “Well, the USDA doesn’t reimburse us for that. When that policy changes, we will be happy to go to organic foods.”

Districts have to balance the books, so offering foods that cost less to buy and have higher profit margins — say, Pop-Tarts or quickly reheated chicken nuggets — will always be tempting.

These highly processed, low-nutrition items, Villarreal said, are often produced by food industry giants that can leverage their tremendous market clout and government subsidies to lower costs.

So how do schools effect real change in menus on a no-frills budget?

The answers, somewhat surprisingly, may lie close to home.

In cash-strapped Oakland, administrators formed a farm-to-school cooperative, bringing in fresh produce from local growers. It was part of a complete overhaul intended to put more plant-based items on their lunchroom menus.

They cut back on mass meat purchases, instead buying smaller quantities of higher-quality meat and pairing it with more legumes. They installed a central kitchen in the district to expedite cooking from scratch, enabling them to deliver freshly prepared entrees to their campuses.

Friends of the Earth, a Berkeley-based environmental advocacy group, analyzed the Oakland district’s procurement over a two-year period and found that the district saved nearly $42,000, or about 1% of its annual food budget, according to Kari Hamerschlag, the group’s deputy director for food and agriculture.

And student satisfaction with the menu grew.

Such efforts could get a boost from state lawmakers in Sacramento: The Assembly this year passed a bill to help pay for more plant-based meals and types of milk in schools. It now requires action in the Senate.

But taste still rules. In Singh’s Los Angeles district, all prospective dishes must run a three-step qualifying gantlet, which ends with a taste test by students. Anything lower than 80% approval means the dish is scrapped.

“That’s a B average,” Singh said. “Why would we serve anything below that?”

This KHN story first published on California Healthline, a service of the California Health Care Foundation.

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Health Care Stayed Front And Center At Democratic Debate

This time, it wasn’t just about “Medicare for All.”

Voters got a better look at Democrats’ health care priorities on Tuesday, as 12 of the leading candidates vowed to codify abortion access, threatened to jail opioid company executives and added a few more details to their health plans during the fourth Democratic debate.

While the debate began on the topic of impeaching President Donald Trump, Sen. Bernie Sanders of Vermont soon steered the discussion back to kitchen-table issues.

“I think what would be a disaster, if the American people believe that all we were doing is taking on Trump,” he said. “We’re forgetting that 87 million Americans are uninsured or underinsured.”

That was only the beginning of a series of health care conversations that lasted through much of the three-hour debate.

With Sen. Elizabeth Warren of Massachusetts polling in second place before the night began, she was pressed to offer more details about what Medicare for All would look like under her leadership — in particular, whether she would raise taxes to pay for it.

“I have made clear what my principles are here,” she said. “That is, costs will go up for the wealthy and for big corporations, and for hard-working, middle-class families, costs will go down.”

But Mayor Pete Buttigieg of South Bend, Ind., pushed back, pointing out that, unlike Sanders — who has said taxes would increase to pay for his universal health care plan — she had not actually said whether she would raise taxes.

“Your signature is to have a plan for everything, except this,” Buttigieg said. “No plan has been laid out to explain how a multi-trillion dollar hole in this plan that Sen. Warren is putting forward is supposed to get filled in.”

Sen. Amy Klobuchar of Minnesota challenged the practicality of focusing on such a sweeping overhaul as “Medicare for All.” She pushed her support for a public option and noted the importance of issues that get less attention, like long-term care.

“The difference between a plan and a pipe dream is something that you can actually get done,” Klobuchar said.

But Warren stood her ground. When she was studying bankruptcy as a professor at Harvard Law School, she said, she noticed that two out of three families that went bankrupt after a medical problem had health insurance. The problem is cost, she said: “That is why hard-working people go broke.”

The candidates also staked their claim on two issues that are critically important to Democratic voters: strengthening gun control measures and guaranteeing access to reproductive health care.

Former Vice President Joe Biden trumpeted his role in securing the now-lapsed assault weapons ban in 1994. Among others, Sen. Kamala Harris of California called for a “comprehensive” background check requirement and a ban on the importation of assault weapons.

And one-by-one, the candidates vowed to codify abortion access, especially in light of recent conservative attacks in a number of states on the premise of the Supreme Court’s Roe v. Wade decision.

“It’s not an exaggeration to say women will die because these Republican legislatures in these various states who are out of touch with America are telling women what to do with their bodies,” Harris said, a reference to crackdowns on abortion access in many Republican-controlled states.

After pointing out earlier in the evening that two Planned Parenthood clinics in Ohio recently closed due to a Trump administration policy change, Sen. Cory Booker of New Jersey said he would create an office of reproductive freedom and reproductive rights in his White House.

“It’s an assault on the most fundamental ideal that human beings should control their own body,” Booker said.

And addressing the opioid crisis blamed for lowering life expectancy in the United States, many of the candidates called outright for jailing the executives of opioid manufacturers, whom Harris called “nothing more than some high-level dope dealers.”

“The people who should pay for the treatment are the very people that got people hooked and killed them in the first place,” she said.

The evening was also Sanders’ first appearance on the debate stage since he had a heart attack and underwent heart surgery just weeks ago. Asked about his health, he seemed impatient: “I’m healthy. I’m feeling great,” Sanders said as he brought the conversation back to policy.

The debate took place in Westerville, Ohio, a more traditionally conservative suburb of Columbus that had turned blue in recent years — a nod to Democrats’ hopes of winning with the support of suburban voters in 2020.

And with those 12 Democrats standing elbow-to-elbow, the debate hosted by CNN and The New York Times had an unusual distinction: the most candidates to ever appear onstage at a presidential debate.

The fifth Democratic debate is scheduled for Nov. 20. The Democratic National Committee plans to hold 12 primary debates in total.

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California Governor’s Bill-Signing Marathon Offers Glimpse Of 2020 Issues

Gov. Gavin Newsom wrapped up his bill-signing marathon Sunday, capping the end of a legislative session that will have a big impact on Californians’ health care and coverage.

Some of the most high-profile — and contentious — measures of the year were health care-related: Who hasn’t heard of the bill that spawned raucous protests at the Capitol by anti-vaccine activists? After some hesitation, Newsom signed SB-276 and an accompanying measure, which will give state public health officials authority to review and, in some cases, revoke questionable medical exemptions for childhood vaccinations.

In a blow to Big Pharma, the Democratic governor also signed what health advocacy groups deem this year’s biggest effort to lower prescription drug costs. AB-824 will give the state attorney general more power to go after pharmaceutical companies that engage in “pay for delay,” a practice in which makers of brand-name drugs pay off generic manufacturers to keep the lower-cost generic versions of their medications off the market.

And legislation adopted as part of the state budget this year will require Californians to have health insurance next year or face a penalty. The budget also funded new state-based tax credits for Californians who purchase health insurance through Covered California, including some who earn too much to qualify for federal financial aid.

Also starting next year, young adults in the country illegally will be eligible for Medi-Cal if their incomes qualify.

“This was a landmark year in health care,” said Anthony Wright, executive director of the consumer advocacy group Health Access California. “Over a million Californians will be getting help to access or afford coverage.”

But many lesser-known health care measures could also have a dramatic impact on Californians’ lives, including college students, dialysis patients, older adults and new moms. Some of the laws put California in the forefront nationally, such as a measure to expand access to HIV prevention drugs.

Most of these measures take effect Jan. 1:

HIV Prevention

California will be the first state to allow people to access HIV prevention drugs from pharmacies without a doctor’s prescription. Pre-exposure prophylaxis (PrEP) is a once-a-day pill for HIV-negative people that may keep them from becoming infected, and post-exposure prophylaxis (PEP) is medication that can help prevent the virus from taking hold if they have been exposed to it. SB-159 by state Sen. Scott Wiener (D-San Francisco) will allow pharmacists to dispense a 60-day supply of PrEP, or a 28-day course of PEP. Patients will need to see a physician to obtain more medication. The bill prohibits insurance companies from requiring patients to obtain prior authorization before obtaining the medication.

Abortion Pill

Students at California’s 34 California State University and University of California campuses will have access to medication-induced abortion — commonly known as the abortion pill — at on-campus student health centers by Jan. 1, 2023. Under SB-24 by state Sen. Connie Leyva (D-Chino), students who are up to 10 weeks pregnant will be eligible. Initial costs, such as the purchase of medical equipment, will be paid for with private, not state, dollars.

Maternal Health

Black women are three to four times more likely to die during childbirth and from other pregnancy-related causes than white women, according to the Centers for Disease Control and Prevention. SB-464 by state Sen. Holly Mitchell (D-Los Angeles) will require perinatal health care providers to undergo bias training with the goal of reducing preventable maternal deaths among black women. “The disproportionate effect of the maternal mortality rate on this community is a public health crisis and a major health equity issue,” Newsom said upon signing the bill.

Some new moms returning to their jobs who want to pump milk at work will face fewer barriers. SB-142 by Wiener will require employers to provide new mothers with a private space that includes a table, chair, electric outlet and nearby access to running water and refrigeration. Businesses with fewer than 50 employees may be eligible for an exemption. “Too many new mothers are unable to express milk at work or are forced to do so in a restroom or other unsuitable space,” Wiener said.

Financial Abuse Of Older Adults

Investment advisers and broker-dealers will be required to report suspected financial abuse of elder or dependent adults. SB-496 by state Sen. John Moorlach (R-Costa Mesa) allows these financial experts to temporarily delay requested transactions, such as stock trades and disbursement of funds, when they suspect potential abuse. “With growing Alzheimer’s and dementia concerns, it is critical that we provide safeguards to prevent financial abuse for those in the beginning stages of a difficult life journey,” Moorlach said in a statement.

Smoking In State Parks

Californians will be prohibited from smoking or vaping at state beaches and parks, except for paved roads and parking areas. Violations of SB-8 by state Sen. Steve Glazer (D-Orinda) will carry a fine of up to $25. Similar efforts were vetoed by former Gov. Jerry Brown.

Nurse Staffing 

State health officials who make unannounced inspections of hospitals will start reviewing nurse staffing levels. Some California hospitals disregard the state’s current nurse-to-patient ratio requirements, Leyva, the bill’s author, argued. SB-227 establishes penalties for violations: $15,000 for the first offense and $30,000 for each subsequent violation.

Medical Marijuana On School Grounds

Even though medicinal cannabis has been legal for years in California, it has not been allowed on school grounds. SB-223 by state Sen. Jerry Hill (D-San Mateo), will allow school boards to adopt policies that authorize parents or guardians of students with severe medical and developmental disabilities to administer medicinal cannabis on campus, as long as it is not via smoking or vaping. This allows students to “take their dose at school and then get on with their studies,” Hill said.

Dialysis Industry Profits

One new law could disrupt the dialysis industry’s business model. Dialysis companies often get higher reimbursements from private insurers than they do from public coverage. One way low-income patients remain on private insurance is by getting financial assistance from the American Kidney Fund, a nonprofit that receives most of its donations from the two largest dialysis companies, Fresenius Medical Care and DaVita Inc. AB-290, by Assemblyman Jim Wood (D-Santa Rosa), will limit the private-insurance reimbursement rate that dialysis companies receive for patients who get assistance from groups such as the American Kidney Fund.

Health Care In Jails And Prisons

County jails and state prisons will be prohibited from charging inmates copays — usually $3 to $5 — for medical and dental services with the passage of AB-45, by state Assemblyman Mark Stone (D-Scotts Valley). Some states already prohibit copays in prison, but California is the first to eliminate copays in county jails.

Cancer Patients

Some Californians undergoing cancer treatment such as radiation or chemotherapy will have insurance coverage for fertility preservation treatments. Under SB-600 by state Sen. Anthony Portantino (D-La Cañada Flintridge), private health plans regulated by the state must cover procedures such as the freezing of eggs, sperm or embryos for patients who want to try to have children in the future.

This KHN story first published on California Healthline, a service of the California Health Care Foundation.

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Must-Reads Of The Week From Brianna Labuskes

Happy Friday! Yours truly is back from beautiful Vietnam and it seems I missed one or two … ahem … minor news events while traipsing around.

I come bearing no souvenirs but rather two health reminders (one via Sen. Bernie Sanders). Firstly, don’t forget your flu shot — Australia has had an unusually early and severe season, which rarely bodes well for our own. The second comes in the form of a hard-earned lesson from a 2020 candidate: Don’t ignore those heart attack warning signs! (This is especially directed at women, who are dying unnecessarily from cardiac events.)

Now enough mother-henning. (You missed me, didn’t you?) On to the news of the week!

The Supremes are back in action, and a look at the high court’s docket reveals a potentially doozy of a politically charged term (with rulings expected to land as the general election heats up in 2020).

In the health care sphere, a big case to watch is the Louisiana abortion suit. An essentially identical Texas law — which requires doctors performing abortions to have admitting privileges at nearby hospitals — was ruled unconstitutional by the court in 2016, but that means little with two new justices appointed by President Donald Trump weighing in.

The New York Times: As the Supreme Court Gets Back to Work, Five Big Cases to Watch

Oral arguments in two other health-related cases were held this week. The justices grappled with the moral and legal complexities of the insanity defense. The case prompted questions such as this one from Justice Stephen Breyer: One defendant kills a victim he thinks is a dog. “The second defendant knows it’s a person but thinks the dog told him to do it,” Breyer said. “They are both crazy. And why does Kansas say one is guilty, the other is not guilty?”

The New York Times: Supreme Court Opens New Term With Argument on Insanity Defense

Tuesday was all about LGBTQ rights. Although most of the justices were divided along ideological lines on whether federal civil rights legislation applies to sexual orientation and gender identification, Justice Neil Gorsuch hinted his vote might be in play. As an avowed believer in textualism, he suggested that the words of Title VII are “really close, really close” to barring employment discrimination for those workers. But don’t go placing bets on the outcome yet. He also noted that he was worried about “the massive social upheaval” that would follow such a Supreme Court ruling.

The New York Times: Supreme Court Considers Whether Civil Rights Act Protects L.G.B.T. Workers

On that note, the 2020 Democratic candidates participated in an LGBTQ forum on the eve of National Coming Out Day. There were a handful of notable moments through the night (including a zinger from Sen. Elizabeth Warren that was met with loud applause), but much of the spotlight was on protesters who demanded the candidates pay attention to violence against black transgender women. “We are hunted,” said one member of the audience.

CNN: Protesters Interrupt CNN LGBTQ Town Hall to Highlight Plight of Black Transgender Women

Elsewhere on the campaign trail this week, controversy over a pregnancy discrimination talking point from Warren’s stump speech prompted women — including Warren rival Sen. Amy Klobuchar — to speak out on social media about their own and their mothers’ experiences.

NBC News: Women Rally in Support of Elizabeth Warren by Sharing Their Own Pregnancy Discrimination Stories

Sanders’ campaign confirmed that the health scare from last week was indeed a heart attack. The 2020 candidate — who promised to return “full blast” to the race — said he hopes people learn from his “dumb” mistake of ignoring the warning signs. In true politician-running-for-office style, he also was able to use the scare as a way to emphasize the importance of his signature policy proposal, “Medicare for All.”

Reuters: Democratic Presidential Hopeful Sanders Says He Was ‘Dumb’ to Ignore Health Warnings

In a sign of what’s to come for Big Pharma, South Bend Mayor Pete Buttigieg, one of the field’s more moderate candidates, released a drug pricing plan that is decidedly not moderate. The move falls in line with a broader sense that there’s an ever-growing appetite among even middle-ground Dems for action to rein in drugmakers.

Stat: Buttigieg Unveils an Aggressive Plan for Lowering Drug Prices

And for you political wonks out there, this was an interesting read on the shifting political dynamics of doctors, who once used to be a sure thing for the GOP.

The Wall Street Journal: Doctors, Once GOP Stalwarts, Now More Likely to Be Democrats

A key ruling on the health law is expected in the next few weeks, but officials (on condition of anonymity,  mind you) said that if the ruling is against the ACA, the Trump administration will ask the court to put any changes on hold — possibly until after the election. The reports further support the idea that the law, which has been, uh, politically fraught (to say the very least) over its entire life span, is at the moment viewed as an Achilles’ heel for Republicans.

The Washington Post: Trump Administration Plans to Delay Any Changes If the ACA Loses in Court

Two other major news items out of the administration this week to pay attention to:

The Associated Press: Trump Signs Proclamation Restricting Visas for Uninsured

The Associated Press: Overhaul Is Proposed for Decades-Old Medicare Fraud Rules

The first teenager’s death in the outbreak of vaping-related lung illnesses drove home this week public health officials’ message that young people are “playing with their lives” when they partake. The number of cases jumped to 1,299 as of Oct. 8, with the number of deaths rising to 26.

The Wall Street Journal: New York City’s First Vaping-Related Death Is a Bronx Teen

Reuters: U.S. Vaping-Related Deaths Rise to 26, Illnesses to 1,299

Although Juul is facing a barrage of lawsuits, one filed this week was notable. It was believed to be the first from school districts, which claim that fighting the vaping epidemic has been a drag on their resources. While some legal experts are dubious about whether the school districts can establish their standing, others aren’t ruling it out.

The New York Times: Juul Is Sued by School Districts That Say Vaping Is a Dangerous Drain on Their Resources

And the ripple effect of the crisis is spreading to life insurance prices.

Bloomberg: Prudential Plans to Boost Life Insurance Prices for Vapers

Time for you to flex your ethical muscles for the week: Should there be boundaries to highly personalized medicine? A pricey drug designed — and named for! — just one patient sparked questions this week about how far researchers should go in the name of curing a single person. Especially when there are thousands of patients out there with rare diseases. Would only the wealthiest subset be given cures? Who would decide which patients deserve limited research hours over others?

The New York Times: Scientists Designed a Drug for Just One Patient. Her Name Is Mila.

And ProPublica shines a light on the practice of drug companies using flashy Facebook ads, cash incentives and other marketing techniques to woo Mexican residents over the border to donate plasma. It’s not as innocuous as it might seem — donating too much plasma can compromise the immune system. (Selling plasma has been banned in Mexico since 1987.)

ProPublica: Pharmaceutical Companies Are Luring Mexicans Across the U.S. Border to Donate Blood Plasma

In the miscellaneous file for the week:

  • An Ohio doctor is being charged in 25 fentanyl-related deaths. How on earth was such a lapse allowed to occur? The New York Times peels back the curtain on years of lapses and missed warnings in one Columbus intensive care unit.

The New York Times: One Doctor. 25 Deaths. How Could It Have Happened?

  • During the week of World Mental Health Day, research finds that Americans are starting to internalize all the political rhetoric (and myths) about the connection between mental health and violence. “People want simple solutions: They want to be able to neatly explain things,” said one expert.

Los Angeles Times: Americans Increasingly Fear Violence From People Who Are Mentally Ill

  • There’s more than one way to keep a community healthy, and that goes beyond doctor’s offices, clinics and hospitals. A growing number of medical professionals are embracing the notion that steady paychecks, stable housing and good food are crucial to supporting their patients before they get sick.

The New York Times: When a Steady Paycheck Is Good Medicine for Communities

  • In a sad sign of the times, a muppet on “Sesame Street” is going to have a mother struggling with addiction. The storyline is meant to help an ever-increasing number of children affected by the opioid crisis.

Stat: ‘Sesame Street’ Launches Initiative to Help Explain Parental Addiction to Kids

  • High levels of uranium were found in the blood of Navajo women and babies in a study that underscored the real costs of America’s atomic development. Lawmakers are pushing for legislation that would compensate those who have been exposed.

The Associated Press: US Official: Research Finds Uranium in Navajo Women, Babies

  • And the Nobel Prizes are given out this week: In medicine, scientists who worked with oxygen and cells were honored. Their work has the potential to be the building blocks for things like cancer treatments.

The Washington Post: Nobel Prize in Medicine Awarded for Discovery of How Cells Sense Oxygen

That’s it from me! It’s good to be back with you guys, and I hope you have a great weekend!

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