Photograph of memorial to victims of the El Paso, TX mass shooting

Pervasive Health Effects of Anti-Immigrant Rhetoric at the U.S.-Mexican Border

By Lilo Blank

The current xenophobic, racist, and anti-immigrant climate in the United States and its detrimental impact on immigrant communities and their health cannot be ignored. This month, gunmen have executed a series of mass shootings, including one specifically in El Paso, Texas, in which the gunman killed 22 people. The FBI is currently investigating the shooting as a suspected hate crime against immigrants. Terroristic acts of violence such as this are enough to incite fear in anyone, but especially in Hispanic communities on the border, who are facing additional forms of structural violence.

“Stigma is fundamentally about alienation and exclusion,” said stigma expert Dr. Daniel Goldberg, Associate Professor at the University of Colorado Anschutz Medical Campus’s Center for Bioethics and Humanities, in a recent interview. “Even when you control for access, people who are stigmatized get sicker and die quicker. And of course, we are social creatures. If stigma exists persistently and longitudinally, the more likely you are to be socially isolated, and social isolation is one of the most powerful predictors of mortality.”

Read More

Photo of pencil case filled with colored pencils and an e-cigarette

Tracking Youth Electronic Cigarette Laws with Policy Surveillance

By Justine Fuga

Just last year, one in five high school students and one in 20 middle school students across the country used electronic cigarettes (e-cigarettes). According to the 2018 National Youth Tobacco Survey, more than 3.6 million middle and high school students used electronic cigarettes, more than double the number of youth using e-cigarettes in 2017. This increase is concerning given what is known about the adverse health effects of e-cigarettes. Recent research shows that nicotine has a negative effect on the developing brain. Other chemicals found in e-cigarettes are toxic to cells and have been linked to cardiovascular and lung diseases, including cancer.

Diverse strategies have emerged to curb the youth e-cigarette epidemic, including million-dollar campaigns from CVS Health and school policies implementing random nicotine testing. Most notable is the recent ordinance passed by San Francisco, the first city to institute a large-scale sales restriction. The city-wide ban prevents residents from purchasing any e-cigarettes in stores or online until products have undergone a premarket review by the U.S. Food and Drug Administration (FDA). The ban is motivated in part to decrease youth access to e-cigarettes. From 2016 to 2017, current e-cigarette use among California high school students increased from 8.6% to 10.9%, according to the California Student Tobacco Survey.The San Francisco ban is not the first law implemented to impact youth access to e-cigarettes. California state law sets various online purchasing requirements for e-cigarettes: online purchasers must provide proof of age, distributors must deliver to verified mailing addresses, and online purchaser age must be verified by a third-party service. These laws were in place in 2016 and 2017, but it is unclear whether these state laws had any impact on the 2.3% increase in youth vaping because, problematically, there is no current research exploring the link between the laws and youth e-cigarette use.

Read More

The NHS in England Launches a New Patient Safety Strategy

On July 2, 2019 a new National Health Service (NHS) patient safety strategy was launched in England. The strategy promises many things and lays out the future trajectory of NHS patient safety policy making.

Aidan Fowler, the NHS National Director of Patient Safety highlights the scale of the NHS patient safety problem in the foreword to the strategy:

 Too often in healthcare we have sought to blame individuals, and individuals have not felt safe to admit errors and learn from them or act to prevent recurrence…The opportunity is huge. Hogan et al’s research from 2015 suggests we may fail to save around 11,000 lives a year due to safety concerns, with older patients the most affected. The extra treatment needed following incidents may cost at least £1 billion (p3).

 

Read More

NHS logo on the side of a building

Testing the Temperature of Patient Safety in the NHS

In terms of transparency and accountability the National Health Service ( NHS) in England is excellent at producing insightful, well-produced reports on health quality and patient safety. It does this on a regular basis and one of the great difficulties faced by NHS nurses and doctors today is the sheer volume of reports published. It’s an impossible task for nurses and doctors to keep up to date with all the reports published and to maintain heavy workloads in resource constrained environments. It’s also hard for health care staff to know which reports to prioritize and which are authoritative.

There is an urgent need for the NHS to create a one stop, patient safety information hub which collects reports from all NHS sites and other important global sites, putting everything into one accessible place. Some recent reports on written patient complaints have been published which are helpful in assessing, testing patient safety and health quality in the NHS. Read More

Polar chart depicting state conscience protection laws for abortion (46 states), sterilization (17 states), contraception (16 states), or emergency contraception (5 states).

New Dataset: Conscience Protections for Providers and Patients

Scholarship and public debate about law’s role in protecting health care providers’ conscience rights often focus on who should be protected, what actions should be protected, and when and whether there should be any limitations on conscience rights.

But the how of these legal protections is rarely addressed – that is, when health care providers decline to participate in medical services that violate their deeply-held beliefs, exactly what consequences do state laws protect them from? The new dataset I’ve just released on LawAtlas answers this question in the context of reproductive health conscience laws, and reveals some surprising trends.

Read More

Patient Safety: The Urgent Need for Global Information Sharing and Learning

Patient harm is the 14th leading contributor to the global disease burden, according to a new report by WHO, OECD, and the World Bank.

In resource-constrained health care environments, it is important not to reinvent the wheel and waste money when existing, proven patient safety solutions already exist in other countries. Global patient safety knowledge sharing, and learning helps all countries, regardless of income level and this needs to be encouraged. Read More

Pro-choice and pro-life protesters face off in front of the Supreme Court

“Fetal Heartbeat” Bans are Gaining Momentum, but Abortion Restrictions Come in Many Forms

By Alexandra Hess

Alabama, Georgia, and Ohio have passed laws in recent weeks that ban many, if not all, abortions in their state. These bans are the latest additions to the litany of laws and policies that severely limit or totally prevent access to abortion for women in the United States.

“Fetal heartbeat” bans, like those enacted in both Ohio and Georgia, are some of the most restrictive types of gestational limitations on abortion in the U.S. They prohibit abortion at the point a fetal heartbeat is detectable by ultrasound—as early as six weeks’ gestation. This is often a point before many discover they are pregnant. Ohio and Georgia are not the first states to have enacted fetal heartbeat bans, however, and current legislative trends suggest they will not be the last. In 2019 alone, lawmakers have proposed heartbeat bans in at least 14 other state legislatures. Read More

Zeroing In on “Zero Tolerance” School Discipline Laws

By Alexandra Hess

Exclusionary school discipline (ESD) policies, also known as Zero Tolerance policies, enforce disciplinary measures like suspension, expulsion, or law enforcement referral to address particular student behaviors.

Though it began as part of the Gun-Free Schools Act of 1994, which mandated one-year expulsion for possessing a firearm at school, ESD became more widely adopted over time. Now, the policies apply nationwide to a broad range of behaviors — from damaging property and fighting, to possessing a cell phone or tobacco, as well as behaviors described by subjective terms often undefined in the law, like willful defiance, obscenity, or profanity. Read More

Suicide Prevention and Patient Safety

Suicide prevention needs to be taken more seriously globally by governments, health systems as an urgent public health concern.

WHO (World Health Organisation) states that close to 800,000 people die due to suicide every year, which translates to one person dying every 40 seconds. For each adult who died by suicide there may have been more than 20 others attempting suicide. Suicide is the second leading cause of death among 15 to 29-year-olds globally, and occurs throughout the lifespan. Read More

hand reaching for blue pills

Author Q&A: Reducing High-Dose Opioid Prescribing

Sara Heins, PhD
Sara Heins, PhD, Associate Policy Researcher, RAND Corporation

From 1999 to 2017, almost 218,000 people died in the United States from overdoses related to prescription opioids. Overdose deaths involving prescription opioids were five times higher in 2017 than in 1999, according to the CDC.

Previous research has indicated that patients who receive higher doses of prescription opioids have an increased risk of overdose and mortality. In response, several states have established Morphine Equivalent Daily Dose (MEDD) thresholds that convert opioid prescriptions to their equivalent dose in morphine and divides the total prescription by the number of days the prescription is intended to last, allowing for comparison among different opioid formulations and strengths. MEDD policies set thresholds for prescribers, which may only be exceeded in limited circumstances, such as when being prescribed to certain patient groups or as short-courses.

Sara Heins, PhD, an associate policy researcher at RAND Corporation, used policy surveillance to track MEDD policies through June 1, 2017 (data are available on LawAtlas.org). She published an article in Pain Medicine on March 13 that describes U.S. MEDD policies.

We asked Dr. Heins a few questions about her work and this recent publication. Read More