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Why Process Is US Health Care’s Biggest Problem

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A lot of money has been spent on information technology in health care with little to show for it. To understand why we must pay a visit to the hospital.

It only takes 10 minutes of direct observation of a nurse in a hospital to understand care-delivery processes are not standardized and are dependent on individuals, not systems. This lack of reproducibility leads to errors. Since every caregiver does it his or her own way, it’s difficult to improve anything. Stable systems that are reproducible are required to deliver consistently high quality. Industrial companies figured this out 50 years ago. The writings of manufacturing gurus Imai and Shingo provide insight into how quality is built into processes. A process must first be stabilized then standardized before being improved. Because few standardized processes exist in care delivery there are many possibilities for error. That’s why simply making a poor process electronic by implementing an electronic health record (EHR) doesn’t lead to better quality or cost.

When it comes to change, the technology is the easiest part. Most health systems in America have or are implementing the EHR. And the vendor processes for implementation have become very good. The hard part is to get the doctors, nurses, and administrators to agree on what is the best way to deliver the care. Since the doctors control most care decisions, the rest of the provider team follows the doctors’ lead. If the doctor wants to do things a certain way, that’s what is done. The problem is the next doctor wants it his way and so on. Eventually, we end up with a hopeless mess in which no one knows how anything should be done on any given day. And good luck to a new nurse or technician coming into the system who must learn a multitude of work processes and remember the doctor-dependent differences.

Health care technology is very effective when it is used to support a well-designed care process. The design of new standard care processes need to be owned and driven by the people doing the work, not by some outside consulting firm that brings a 100-page playbook as the answer. As the frontline workers create new designs, they need certain systems that can help them deliver the improved care. Examples of these systems include electronic alerts for medication interactions and reminders to ensure all steps in the care process for the pneumonia patient are followed.

Insight Center

There are two types of improvement systems needed to create a well-designed care process. One is a improvement approach that brings members of an existing clinical team members together to improve an existing care process. They use proven improvement methods such as the principles, systems, and tools of the Toyota Production System (TPS). The second is an innovation process aimed at radically redesigning care. It’s associated with TPS and employs design thinking.

In both cases, the initial effort where rapid experimentation occurs might be an ambulatory clinic or an ER. It becomes a place for others in the organization to learn. It is an inch-wide, mile-deep change in practice that incorporates new processes not only for care delivery but also management. It should result in the systems necessary for sustaining improvement over time. As the model line achieves 50% to 80% improvement over baseline performance, the learning should be spread to other parts of the organization. This new way becomes the new best-known way to deliver care.

One example of a radical innovation is the attempt of HealthEast (now part of Fairview Health Services), which serves the Minneapolis-Saint Paul area, to create the clinic of the future. The leaders brought the vendors in their extended supply chain to the table to help in the design process. This included Epic, an EHR company; Herman Miller, an office furniture company; Boldt, a construction company; and HGA, an architectural firm. Together, the team began redesigning the care-delivery model. Each vendor had the opportunity to deeply understand the needs of the HealthEast providers. By the end of the design phase a new process supported by electronic records, architecture, furniture, and building was integrated to create a unique patient experience.

Before HealthEast formed the model clinic, a group of 11 clinicians had over 11 preferred ways for “their” clinic assistant to do just about everything. One key process, screening the patient for health risks such as cancer and hypertension, resulted in over seven places in the EMR for the provider to look for relevant information. Not only is that time-consuming (contributing to physician burnout), but it also greatly increases the chances of missing important information.

The multi-disciplinary team created a single screening process. Now, clinicians have just two places to look in the EMR for information on whether patients have had screens like mammograms and colonoscopies for cancer, staff can remind patients about what screening tests they need, and leaders are able to support the development of standardized clinical processes. The leader’s standard work is to audit the process and monitor the data. If the process stops being followed or the data shows deteriorating results, leaders will know that immediately.

In the first three months after its introduction, the redesigned process reduced provider search time per patient by 23 minutes. The overall screening rate went from 60% compliance to 72% compliance, meaning over 500 more individuals were appropriately screened over baseline. Perhaps more telling are the changes in patient comments. They went from comments such as “I do not feel my medication list was reviewed,” to “My doctor and medical assistant are always timely, thorough, and reassuring.” These results would not have happened unless all parties were working to build a better process.

Technology now exists to support disruptive innovation in health care. It is an important enabler, but the process must precede the technology. For example, Hospital at Home is an innovation that may well cut the cost of care significantly by reducing the need for inpatient beds. It couldn’t happen without the technology, which allows 24-hour monitoring of patients, real-time electronic communication between providers, and complex equipment to be rapidly set up in the patient home. But it still requires a nurse and a doctor.

What that nurse and doctor do and how they do it are still what will determine successful outcomes of care. Building the care process through careful understanding of what each process step delivers is critical. The medical team can then leverage the technology for data and communication and other needs that support the steps in the process.

Again, this requires standardized work. Every nurse and doctor does not get to do it his or her own way. Standards are established about how the work is performed, and those standards are followed by all until a better way is determined collectively by the team. New innovative care models such as Hospital at Home are based on clear and reproducible standards and will obsolete the old ways of the non-standardized care delivered in most hospitals.


It takes more design time to create a care model that builds in quality and efficiency, but without that work upfront, the technology doesn’t matter and, in fact, only increases costs. This thinking is not new. Many industries from aviation to automotive to nuclear power have been applying this concept of “process before technology” for a long time. The safety and quality results in those industries is second to none. It’s about time health care catches up. Our lives may depend on it.

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The Best Medicine for America’s Mental Health Crisis

The popular—and controversial—Netflix series, 13 Reasons Why, focused on teen suicide, and in one episode, showed the life-ending act in horrible, graphic detail.

Some have blamed the show for triggering copycat suicides, but Amy Powell, president of Paramount Television and Digital Entertainment, says those decisions were deliberate and well-considered. The goal, she says, was to spark a conversation.

“Kids and their parents weren’t connecting about this provocative topic, and they felt isolated from each other on both sides,” said Powell speaking at Fortune’s Brainstorm Health conference in Laguna Niguel, Calif. on Monday. “We struck right into the heart of the controversy to say to parents and kids, ‘Talk to each other. Talk to someone.’”

Bernard Tyson, the chairman and CEO of Kaiser Permanente, the California-based health system that serves more than 12 million Americans, agreed that a large part of America’s mental health problem is that we don’t talk about the issue. “Most of us have [a mental health issue], or we’re one degree from it. It’s all around us, but nobody wants to talk about it.”

He points out that in roughly half of suicides—the leading cause of death for young women, ages 15-19, and the second greatest killer for people ages 15-29—individuals never shows any sign they’re thinking about the act.

Tyson has implemented a multi-pronged approach for improving the mental health of Kaiser patients. One of those efforts, which he calls “Find Your Words,” is aimed at combating the persistent stigma around mental health issues and involves “showing people that there is a way to ask for help and to say you have a problem.”

He’s also addressing the long-held disconnect between the way health providers deal with issues of the body and the mind. Mental health problems are often relegated to separate providers where issues are tracked in separate records. “We treat it differently,” he said.

At Kaiser, teams are now taking an integrated approach, working psychiatry and behavioral health services into the primary care practice. Patients get referred to behavioral health specialists for issues like stress and sleep issues just like they might be referred to an orthopedic specialist for knee pain. “You start to treat the brain like an organ. It’s our hope that sooner or later we’ll start talking about mental health as easily as we talk about diabetes cancer,” Tyson said.

Tyson suggested beyond just speaking about it, we may need to do a better job in selecting and defining the language we use when talking about mental health. (He is troubled by the way in which mental illness is thoughtlessly invoked in every tragedy or “shoot out.”) He suggests we may need to adopt new terms like “brain health” or “mental wellness.”

As for Powell, who is preparing for the third season of 13 Reasons Why, she remains focused on being “responsible in our content creation.” Paramount is working with Netflix to make it possible for viewers to engage immediately with a crisis center if they’re having suicidal thoughts and to get the help they need.

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Racial gap in heart health down due to declining health of white Americans: Study

A new study out of UCLA has shown that health disparities between black and white Americans have decreased because overall heart health for white Americans has declined.

Researchers looked at health records 40,876 adults — white Americans, African-Americans, and Mexican-Americans — and sorted them as having either “optimal,” “suboptimal” or “poor” cardiovascular health, using a standardized classification system. The study was published in Annals of Internal Medicine.

The researchers noted that between 1988 and 1994, the number of black Americans ages 25 to 44 in “optimal” health was 22 percent lower than in white Americans. For black Americans ages 65 and older, it was 8 percent lower than white Americans in the same period. Those numbers have changed — but those in good heart health went down for both racial groups, according to the study.

PHOTO: Men and women are running on treadmills in this undated stock photo. Erik Isakson/Getty Images
Men and women are running on treadmills in this undated stock photo.

Between 2011 and 2014, only 10.6 percent of white Americans and 3.8 percent of black Americans had their heart health rated “optimal.” (The findings from this study, by the way, were not connected to the patient’s overall long-term health.)

The conclusion: Cardiovascular health has declined in general in the U.S., and the “gap” between the heart health of different racial groups is smaller, but likely due to poorer scores for white Americans.

The study used a system called LS7 (“Life’s Simple 7”) to generate health categories. LS7 uses information from body mass index, blood pressure, total cholesterol, blood sugar, physical activity, diet healthfulness and smoking status, to generate an overall index of heart health.

PHOTO: A nurse takes a patients pulse in an undated stock photo.STOCK/Getty Images
A nurse takes a patient’s pulse in an undated stock photo.

The researchers also studied each racial group over time. They noted that over almost 30 years, no more than 15 percent of black Americans or 40 percent of white Americans were ever in “optimal” cardiovascular health.

The group also analyzed Mexican-Americans, both those born in the United States and those born elsewhere. Regardless of where they were born, no more than 25 percent were considered to be in “optimal” cardiovascular health at any time. However, a smaller analysis of their data showed that foreign-born Mexican-Americans were at lower risk for obesity, high blood pressure, cholesterol and diabetes.

Differences between white Americans and other groups were most pronounced in high body mass index, poor levels of HbA1c (a measure that tracks blood sugar) and physical activity. There were few differences across race/ethnicity for scores on blood pressure, cholesterol, diet and smoking.

“The good news is that the LS7 health factors and behaviors are simple to understand and provide the opportunity for everyone — patients, providers, payers, policymakers, and public health practitioners — to take action,” wrote George A. Mensah, MD, of the Center for Translation Research and Implementation Science at the National Heart, Lung, and Blood Institute in Bethesda, Maryland, in an editorial on the study.

Heart disease is America’s No. 1 killer, according to the Centers for Disease Control and Prevention, and this study may allow doctors to further guide their patients into better heart health and overall outcomes.

Dr. John Byun is a radiation oncology resident based at the Rutgers Cancer Institute of New Jersey and a resident in the ABC News Medical Unit.

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Are There Risks From Secondhand Marijuana Smoke? Early Science Says Yes

Scientists are finding that, just as with secondhand smoke from tobacco, inhaling secondhand smoke from marijuana can make it harder for arteries to expand to allow a healthy flow of blood.

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Maren Caruso/Getty Images

Scientists are finding that, just as with secondhand smoke from tobacco, inhaling secondhand smoke from marijuana can make it harder for arteries to expand to allow a healthy flow of blood.

Maren Caruso/Getty Images

The inspiration arrived in a haze at a Paul McCartney concert a few years ago in San Francisco.

“People in front of me started lighting up and then other people started lighting up,” says Matthew Springer, a biologist and professor in the division of cardiology at the University of California, San Francisco. “And for a few naive split seconds I was thinking to myself, ‘Hey, they can’t smoke in ATT Park! I’m sure that’s not allowed.’ And then I realized that it was all marijuana.”

Recreational pot was not legal yet in the state, but that stopped no one. “Paul McCartney actually stopped between numbers and sniffed the air and said, ‘There’s something in the air — must be San Francisco!’ ” Springer recalls.

As the visible cloud of pot smoke took shape, so did Springer’s idea to study the effects of secondhand marijuana smoke.

Cancer Patients Get Little Guidance From Doctors On Using Medical Marijuana

He started thinking: San Franciscans would never tolerate those levels of cigarette smoke in a public place anymore. So why were they OK with smoke from burning pot? Did people just assume that cannabis smoke isn’t harmful the way tobacco smoke is?

Springer was already researching the health effects of secondhand tobacco smoke on rats at his lab at UCSF. He decided to run the same tests using joints.

“By the time I left the concert, I was resolved to at least try to make this happen,” he says.

He knew it would be difficult. Marijuana is still an illegal drug under federal law, and Springer’s research uses federal funds; so he has to purchase specially approved government cannabis for study. He also can’t test it on humans; hence, the rats.

In the lab, Springer puts a cigarette or a joint in a plexiglass box. Then he lights it, and lets the chamber fill with smoke, where an anesthetized rat is exposed to the smoke.

So far, Springer and his colleagues have published research demonstrating that secondhand smoke makes it harder for the rats’ arteries to expand and allow a healthy flow of blood.

With tobacco products, this effect lasts about 30 minutes, and then the arteries recover their normal function. But if it happens over and over — as when a person is smoking cigarette after cigarette, for example — the arterial walls can become permanently damaged, and that damage can cause blood clots, heart attack or stroke.

Springer demonstrated that, at least in rats, the same physiological effect occurs after inhaling secondhand smoke from marijuana. And, the arteries take 90 minutes to recover compared to the 30 minutes with cigarette smoke.

Doctors Say Parents Shouldn't Smoke Pot Around Kids

Springer’s discovery about the effect on blood vessels describes just one harmful impact for nonsmokers who are exposed to marijuana. Statewide sampling surveys of cannabis products sold in marijuana dispensaries have shown that cannabis products may contain dangerous bacteria or mold, or residues from pesticides and solvents.

California law requires testing for these contaminants, and those regulations are being initiated in three phases over the course of 2018. Because much of the marijuana being sold now was harvested in 2017, consumers will have to wait until early 2019 before they can purchase products that have been fully tested according to state standards.

“People think cannabis is fine because it’s ‘natural,’ ” Springer says. “I hear this a lot. I don’t know what it means.” He concedes that tightly regulated marijuana, which has been fully tested, doesn’t have as many chemical additives as cigarettes.

But even if the cannabis tests clean, Springer says, smoke itself is bad for the lungs, heart and blood vessels. Other researchers are exploring the possible relationship between marijuana smoke and long-term cancer risk.

Certainly, living with a smoker is worse for your health than just going to a smoky concert hall. But, Springer says, the less you inhale any kind of smoke, the better.

“People should think of this not as an anti-THC conclusion,” he says, referencing the active ingredient in marijuana, “but an anti-smoke conclusion.”

In The Age Of Legalization, Talking To Kids About Marijuana Gets Tougher

So is the solution simply to avoid smoke from combustion? In other words, is it safer to eat cannabis-infused products, or use “smokeless” e-cigarettes or vaping devices?

Springer still urges caution on that score because vaping, for example, can have its own health effects. Vaping devices don’t produce smoke from combustion but they do release a cloud of aerosolized chemicals. Springer is studying the health effects of those chemicals, too.

All this research takes time. Meanwhile, Springer worries that people might come to the wrong conclusion — that the absence of research means the secondhand smoke is OK.

“We in the public health community have been telling them for decades to avoid inhaling secondhand smoke from tobacco,” Springer says. “We have not been telling them to avoid inhaling secondhand smoke from marijuana, and that’s not because it’s not bad for you — it’s because we just haven’t known. The experiments haven’t been done.”

Antismoking campaigners say we can’t afford to wait until the research is complete. Recreational pot is already a reality.

Cynthia Hallett is the president of Americans for Nonsmokers’ Rights, based in Berkeley, Calif. The organization was established in 1976, before there was a lot known about the health effects of secondhand smoke from tobacco.

Now that cannabis is becoming more common across the country — more than 20 cities or states have legalized it in some form — her organization is taking on the issue of secondhand marijuana smoke, too.

Hallett says some of the arguments being made in support of cannabis remind her of the arguments made on behalf of tobacco decades ago.

“I’m seeing a parallel between this argument that, ‘Gee, we just don’t have a lot of science and so, therefore, let’s wait and see,’ ” Hallett says. “The tobacco companies used to say the same thing about tobacco cigarettes.”

In California, smoking cannabis is prohibited anywhere tobacco smoking is prohibited — including schools, airplanes and most workplaces. Hallett is worried that the legalization of pot could be used to erode those rules.

It starts with the premise of decriminalization, she says, and then, over time, there’s “a chipping away at strong policies.”

Some cannabis advocates want to see pot regulated like alcohol — cities would issue permits for specialized smoking lounges, similar to wine bars.

But Hallett points out that smoke drifts, and affects workers in a way that alcohol doesn’t.

“The difference is, if I were to spill my beer on you in a bar, it wouldn’t affect your long-term health,” she says. “If I choose to smoke, it can affect the health of the person near me.”

Pot is more like tobacco in that respect — and Hallett believes it should be regulated that way.

She says this era of California culture brings to mind a similar perioid in the 1970s and ’80s, when Americans started demanding more regulations for secondhand smoke, and a new etiquette around smoking took form.

When it comes to marijuana, Hallett says, “it is still polite for you to say: ‘Would you mind not smoking around me?’ “

At Magnolia, a cannabis dispensary in Oakland, Calif., pot smokers talk about what responsibilities — if any — they should have when it comes to nearby nonsmokers.

“This is the first time that I have heard secondhand smoke in reference to cannabis,” admits Lee Crow, a patient-services clerk at Magnolia. “I’ve tried to be courteous — just common courtesy, like with anything.”

The dispensary’s director of clinical services, Barbara Blaser, admits she thinks a lot about secondhand smoke from cigarettes, but not pot.

“Both of my parents died of lung cancer!” she says. “I will stop a stranger and say, ‘You shouldn’t be smoking. My dad died of that!’ “

California’s Proposition 64, approved by state voters in 2016, requires that some of the state tax revenue from the sale of marijuana to be distributed to cannabis researchers. In addition, the state’s Occupational Safety and Health Standards Board is examining workplace hazards that are specific to the cannabis industry.

This story is part of NPR’s reporting partnership, local member stations and Kaiser Health News.

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Lawmakers Weigh Pros And Cons Of Mandatory Screening For Postpartum Depression

Wendy Root Askew with her husband Dominick Askew and their son. When the little boy (now 6) was born, Root Askew struggled with postpartum depression. She likes California’s bill, she says, because it goes beyond mandatory screening; it would also require insurers to establish programs to help women get treatment.

Courtesy of Wendy Root Askew

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Courtesy of Wendy Root Askew

Wendy Root Askew with her husband Dominick Askew and their son. When the little boy (now 6) was born, Root Askew struggled with postpartum depression. She likes California’s bill, she says, because it goes beyond mandatory screening; it would also require insurers to establish programs to help women get treatment.

Courtesy of Wendy Root Askew

Lawmakers in California will begin debate next month on a bill that would require doctors to screen new moms for mental health problems — once while they’re pregnant and again, after they give birth.

But a lot of doctors don’t like the idea. Many obstetricians and pediatricians say they are are afraid to screen new moms for depression and anxiety.

“What are you going to do with those people who screen positive?” says Dr. Laura Sirott, an OBGYN who practices in Pasadena. “Some providers have nowhere to send them.”

Nationally, postpartum depression affects up to 1 in 7 women during or after pregnancy, according to the American Psychological Association.

And of women who screen positive for the condition, 78 percent don’t get mental health treatment, according to a 2015 research review published in the journal Obstetrics Gynecology.

Sirott says her patients give a range of reasons why they don’t take her up on a referral to a psychologist: ” ‘Oh, they don’t take my insurance.’ Or ‘my insurance pays for three visits.’ ‘I can’t take time off work to go to those visits.’ ‘It’s a three-month wait to get in to that person.’ “

She says it’s also hard to find a psychiatrist who is trained in the complexities of prescribing medications to pregnant or breastfeeding women, and who is willing to treat them, especially in rural areas.

“So it’s very frustrating,” Sirott says, “to ask patients about a problem and then not have any way to solve that problem.”

Moms are frustrated, too. After the baby comes, no one asks about the baby’s mother anymore.

Wendy Root Askew struggled for years to get pregnant, and when she finally did, her anxiety got worse. She couldn’t stop worrying that something would go wrong.

“And then, after I had my son, I would have these dreams where someone would come to the door and they would say ‘Well, you know, we’re just going to wait two weeks to see if you get to keep your baby or not,’ ” Root Askew says. “And it really impacted my ability to bond with him.”

She likes California’s bill, AB 2193, because it goes beyond mandated screening. It would require health insurance companies to set up case management programs to help moms find a therapist, and connect obstetricians or pediatricians to a psychiatric specialist.

Health Insurers Are Still Skimping On Mental Health Coverage

“Just like we have case management programs for patients who have diabetes or sleep issues or back pain, a case management program requires the insurance company to take some ownership of making sure their patients are getting the treatment they need to be healthy,” says Root Askew, who is now advocating for the bill on behalf of the group 2020 Mom.

Health insurance companies haven’t taken a position on the legislation. It’s unclear how much it would cost them to comply, because some already have infrastructure in place for case management programs, and some do not. But there is consensus among insurers and health advocates that such programs save money in the long run.

“The sooner that you can get good treatment for a mom, the less expensive that condition will be to manage over the course of the woman’s life and over the course of that child’s life,” Root Askew says.

Some doctors still have their objections. Under the bill, they could be disciplined for not screening. Some have said they worry about how much time it would take. What if a doctor asks a mom how she’s sleeping, and she’s in tears for the next 30 minutes?

The health care system, and the incentives, aren’t set up for this sort of screening, Sirott says.

“Currently, I get $6 for screening a patient,” she says. “By the time I put it on a piece of paper and print it, it’s not worth it.”

It’s not clear the direct and indirect costs of screening would be worth it to the patients either. Four other states — Illinois, Massachusetts, New Jersey, and West Virginia — have tried mandated screening, and it did not result in more women getting treatment, according to a study published in Psychiatric Services in 2015.

Even with California’s extra requirement that insurance companies facilitate care, women could still face high copays or limits on the number of therapy sessions. Or, the new mothers might be so overwhelmed with their care for a newborn, that it would be difficult to add anything to the busy schedule.

What does seem to work, according to the study of mandated screening in other states, is when nurses or mental health providers visit new moms at home.

Mommy Mentors Help Fight The Stigma Of Postpartum Mood Disorder

“Despite abundant good will, there is no evidence that state policies are addressing this great need,” the study’s authors report.

Supporters of California’s proposed bill, however, say doctors need to start somewhere. Screening is the first step in recognizing the full scope of the problem, says Dr. Nirmaljit Dhami, a Mountain View, Calif., psychiatrist. Women should be screened on an ongoing basis throughout pregnancy and for a year after birth, Dhami says, not just once or twice as the bill requires.

“I often tell doctors that if you don’t know that somebody is suicidal it doesn’t mean that their suicidality will go away,” she says. “If you don’t ask, the risk is the same.”

This story is part of NPR’s reporting partnership with KQED and Kaiser Health News.

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Annual County Health Rankings Highlight Racial Disparities

Wealth and health are definitely connected. But race is also a significant factor, with black residents facing health outcomes that lag behind those of white New Jerseyans — often significantly — over the span a lifetime.

Those are among the conclusions of data released last week as part of the annual County Health Rankings, a national report produced by the New Jersey-based Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. The findings compare counties across the nation on measures like low birth-weight babies, poor health days, and early death — as well as factors that impact these outcomes, including smoking, education levels, and obesity.

Racial disparities in health have become a growing focus in recent years, and Dr. Shereef Elnahal, the acting commissioner of the state Department of Health, has made it a priority to reduce these gaps, which he called “embarrassingly high” at a recent hearing. “Needless to say, we have much work ahead to improve New Jersey’s public health,” he told the Senate Judiciary committee earlier this month.

Among other things, the 2017 County Health report found that, in New Jersey, Morris, Hunterdon, and Somerset were the three best counties in terms of health outcomes; those three also happen to be the counties with the highest median income levels, with Hunterdon topping the state at nearly $113,700, according to 2016 data from the U.S. Census Bureau.

Income and health outcomes

Cumberland County had the poorest health outcomes, followed by Salem and then Camden counties; Cumberland also had the lowest median income, at just over $49,100, followed by Salem. (Camden ranked 13th in terms of low median income.)

Past rankings show similar, if not identical, results: Hunterdon has held the top healthcare outcome spot for several years, with Morris and Somerset trading second and third positions. Cumberland and Camden typically rank near the bottom, with Atlantic and Essex and Salem counties vying for the third-worst outcomes.

The latest report shows that, statewide, 15 percent of all Garden State youth live in poverty, compared to a national average of 20 percent. But black kids were twice as likely to come from low-income backgrounds in New Jersey, with one in five growing up in poverty, compared to 11 percent of white children. Nearly one-third of Hispanic children live in poverty here.

African-American babies in this state were nearly twice as likely to be born below weight, at 13 percent, versus 7 percent for white and Hispanic infants, according to the report. Black babies were also more than 40 percent more likely to die prematurely than their white counterparts, and nearly 60 percent more likely to die early than Hispanics.

“Communities of color are exposed to many public health risks at rates that far exceed the general population: lead exposure, infant mortality, and maternal mortality are just a few of these risks,” Dr. Elnahal said. “Decreasing these disparities is a top priority for me and the entire department.”

Census findings released last fall showed a significant income disparity between black and white residents in the Garden State, a gap that is larger than the nationwide difference and one that has increased over the past decade. Data from 2016 shows that the median income for blacks (almost $47,700) was, on average, a little more than half that of white residents (nearly $86,400).

Wealth, race, and health

Experts have begun to focus more attention on the connections between wealth, race, and health as part of a growing awareness of how social determents impact wellbeing – factors like poverty, the impact of racism and other stresses, and environmental factors. This is also reflected in New Jersey’s increasing emphasis on tracking and improving public health and in efforts by traditional healthcare systems to add programs that address nutrition, affordable housing, exercise, and more.

“We can’t be a healthy, thriving nation if we continue to leave entire communities and populations behind,” said Dr. Richard Besser, the foundation’s president and CEO. (RWJF is a funder of NJ Spotlight.) “Every community should use their County Health Rankings data, work together, and find solutions so that all babies, kids, and adults — regardless of their race or ethnicity — have the same opportunities to be healthy,” he said.

When compared to nationwide outcomes, New Jersey residents have about the same chance of being born underweight (8 percent), are slightly less likely to report poor or fair health or unhealthy days, and 18 percent less likely to die early.

This may reflect stronger health factors: lower rates of smoking, obesity, and unhealthy drinking, and better access to healthy food and insurance coverage. New Jersey also graduates more high school and college students than is the average nationwide, and has lower levels of violence — all factors that contribute to good health.

However, there are fewer doctors per person here than the national average, and nearly 20 percent fewer dentists per capita; the state does track close to the national norms on diabetes screenings, mammograms, and preventable hospital stays. But other challenges include higher levels of air pollution and housing problems, and longer commutes by car.

In addition, in the Garden State there is significant variation within these averages. Insurance coverage ranges from 5 percent to 15 percent, and there are huge gaps in access to primary-care physicians and other providers. Child poverty ranges from a low of 4 percent to a whopping 27 percent. Low birth weights vary from 6 percent to 10 percent, and adults reporting poor or fair health range from 11 percent to 23 percent.

The County Rankings report also touched on how communities can use this data and other findings to improve public health. The authors urged officials to invest in early-childhood education, which can boost an individual’s economic prospects over a lifetime, expand access to affordable health insurance, and invest in other social-welfare programs.

“Sharing data and trends through reports like the County Health Rankings empowers communities to improve health outcomes and develop solutions to address disparities,” Dr. Elnahal said.

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Yemen: Diphtheria outbreak ‘symptoms of collapsed health system’

The World Health Organization (WHO) is racing to vaccinate people in Yemen against a rapidly spreading outbreak of diphtheria.

Around 1,300 people have been infected and more than 70 have died since the disease was first detected six months ago.

Al Jazeera’s Hannah Hoexter reports.

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CHI Health clinic groundbreaking planned Monday

A groundbreaking is planned Monday for the new CHI Health clinic in Council Bluffs.

The new clinic will be located on the corner of Valley View Drive and Mall Drive. A groundbreaking is planned for 2 p.m. on Monday, according to CHI Health officials.

The new clinic is the 46th for CHI Health and will offer primary care, along with a rotating cast of specialists. The facility will replace the current CHI Health clinic on Madison Avenue, with those employees moving to the Valley View location. According to the Council Bluffs Building Division, the new facility will be 38,844 square feet, compared to 8,960 at Madison Avenue.

The address for the under-construction facility is 1288 Valley View Drive.

Specialties at the clinic will include behavioral health, radiology, ultrasound, pharmacy and physical therapy, according to Angie Baber, division manager of development for CHI Health.

The clinic will have 54 exam rooms and is expected to open in May 2019.

In addition to the larger space, CHI officials said the new clinic will have an economic impact on the metro area:

• Building the clinic will support 83 jobs in the construction industry which will support an additional 35 jobs in the community.

• 45 clinic jobs will help support an additional 28 workers in the community (for example, real estate, retail, restaurants, etc.).

• When fully operational, the economic activity generated by the project will add about $10.4 million to the local economy every year (this includes “spillover” activity).

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• The local economy will see a payroll income boost of about $3.6 million for the clinic, additional household spending and additional business-to-business spending.

CHI Health partnered with NexCore Group, a national health care real estate developer, to create a facility that is convenient, efficient and productive, according to a release.

“The partnership with CHI Health has been a very positive one from the beginning. We have really enjoyed working with the team and look forward to providing an outstanding facility for the Council Bluffs community,” Todd Varney, NexCore’s managing principal, said in the release.

“Access to quality health care is vital to successful economic development,” said Paula Hazlewood, executive director of the Advance Southwest Iowa Corporation. “We are honored to assist CHI Health with the development of their newest clinic.”

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Crain’s 2018 Health Care Heroes never quit

What makes a Crain’s Health Care Hero?

For one, they never quit. When they see a problem, an unmet need, a crisis, they don’t form a commission or draft a memo. They don’t pass the buck. They take action.

Now in its 17th year, Health Care Heroes recognizes outstanding and beyond-the-ordinary achievements in health care in Michigan. Each Hero has either directly saved lives or significantly contributed to alleviating human pain and suffering. All have improved the quality of lives of the people or patients they touch.

Competition for our Heroes is stiff, and many worthy candidates who have changed lives in their own right have been left out. Out of the 80 nominees we received this year, we could have easily selected 25 for recognition in the eight categories: physician, allied practitioner, corporate achievement, board member, administrator, heart, cancer and other researcher.

Our judges vigorously debated the nominees. Our judges included former Heroes Rob Casalou, CEO of St. Joseph Mercy Health System; Lisa Newman, M.D., an oncologist with Henry Ford Health System; pharmacist Ghada Abdallah; and Crain’s senior reporter Jay Greene.

In the end, we decided that two categories required co-winners. One of those was a new category the judges decided we needed to create on the spot — lifetime achievement.

One of the never-quit co-winners in lifetime achievement is George Mogill, M.D., a 100-year-old family medicine doctor from Detroit who took care of soldiers and others during the Normandy invasion in World War II and helped break the color barrier in Detroit in the mid-1940s.

At 95 years old, Jean Kantrowitz continues to promote and support cardiac medical device research with two Michigan-based companies. For years, she collaborated and assisted her late husband, Adrian Kantrowitz, M.D., whose team attempted the world’s first pediatric heart transplant at Maimonides Medical Center in Brooklyn in 1967.

The other category with co-winners was administrator. Sharing the honor are Chris Allen, CEO of Authority Health, who for years has worked to expand access to health care in Detroit; and James Fahner, M.D., division chief of the hematoloy/oncology department at Helen DeVos Children’s Hospital in Grand Rapids, who also is involved with the Make-A-Wish Foundation.

The physician Hero award went to Tolulope Sonuyi, M.D., an emergency physician at DMC Sinai-Grace, who founded DLIVE, the first hospital-based violence intervention program in Michigan. More than 65 people have participated in the program with a 100 percent success rate.

Corporate achievement went to Molly MacDonald, founder of The Pink Fund, which provides short-term financial support to women who are in active cancer treatment. A breast cancer survivor herself, MacDonald’s own story is worthy of a television special.

Allied practitioner went to Najah Bazzy, R.N., CEO of Zaman International, an Inkster-based nonprofit that helps women and children pull themselves out of poverty with job training, food, furniture and emotional support.

The heart and vascular care research Hero is William O’Neill, M.D., medical director of the Henry Ford Center for Structural Heart Disease, who has pioneered multiple balloon angioplasty and valve replacement innovations over the years.

Our oncology care and research Hero is Jeffery Taub, M.D., a Children’s Hospital of Michigan pediatrician who also has been involved in multiple research projects, including a study on children with Down Syndrome, acute lymphoblastic leukemia and acute myeloid leukemia and using zebrafish to identify genetic and environmental factors that may lead to childhood leukemia.

In the other health services research category, Gregory Auner, a medical engineering researcher at Wayne State University, won for conducting some of the most cutting-edge research in the nation on cancer detection, pathogen and infection detection and traumatic brain injuries.

The board member Hero selected was Jody Burton Slowins, co-founder of Partners in Personal Assistance, an Ann Arbor-based nonprofit that provides patient-directed care to clients and also competitive wages and benefits to caregivers.

Crain’s Health Care Heroes will be honored at Crain’s Health Care NEXT event, to be held in June. Stay tuned for further information.

Read about all the winners here.

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Health Care Costs Could Drop

Medical costs are doing something unusual: They’re growing more slowly than costs for other things that consumers buy, including restaurant meals, housing, and gasoline. Over the 12 months through February, medical inflation was just 1.8%, the Department of Labor wrote in a report last week. That’s barely half the rate of the prior 12 months, and below the 2.2% inflation rate for all items.


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