3 Updates on Zika: Transmission, Surveillance & Funding

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Image courtesy of Time

Image courtesy of Time

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Posted in Global Health, WHO; Tagged: , , , , , , , , .


Ladies, know your hearts

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I wanted to share a creative and fun public health message that I ran across recently. Rosie O’Donnell, the stand up comedian and former daytime television host, suffered a massive heart attack in the summer of 2012. She didn’t realize that she was having a heart attack because the symptoms that she suffered were not the symptoms that we typically see portrayed in media or in public health messaging. She eventually went to see her doctor when her symptoms didn’t subside and found out that she had a 99% artery blockage, a scenario which almost always results in death. Thankfully Ms. O’Donnell survived and the experience inspired her to create a new comedy routine to both share her experience and to publicize the message about women, heart disease, and the types of symptoms women should look for and the actions they should take if they think that they might be experiencing a heart attack.

According to the CDC, heart disease is the leading cause of death for women in the United States, causing 1 out of every 4 female deaths in 2009. Despite heart disease playing such an enormous role in female mortality across ethnic and socio-economic lines, only about half of women know that heart disease is such a significant issue. One of the major issues that Ms. O’Donnell identified in her comedy routine was that as a society, we are very familiar with the symptoms of a heart attack that are experienced by men, such as sharp chest pain, however we are not at all familiar with the unique symptoms which women experience. Women are much more likely to experience pain in the neck, throat, jaw or in the upper back, to feel exhausted and to be nauseous. Beyond not recognizing the symptoms, the American Heart Association says that the #1 reason why heart attacks kill more women than men is because women are significantly less likely than men to call 9-1-1. These delays in seeking help ultimately limit the treatment options available and result in higher mortality rates.

It is important that we share the symptoms of female heart attack widely and that they become as ingrained as our knowledge about heart attacks in men. It is also important that we encourage women to know their risk factors some of which can be changed (like smoking, exercise and diet) and some that cannot be changed (such as age, family history and race) and to proactively discuss heart health with their healthcare providers. Finally it is essential that we encourage the women in our lives to seek help immediately as soon as they notice anything off and not to wait-and-see or assume that their symptoms do not warrant a call to emerge services.

You can find Ms. O’Donnell’s full story and comedy routine online, but this is clip specifically relates to how she is getting the message out about women’s heart attack symptoms in a creative, engaging, and I think, effective way. Enjoy and please learn the risks and prevention methods both for yourself and for the ladies in your lives!


Posted in Non-communicable diseases; Tagged: .


Ending tax subsidies for junk food advertising to children

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The United States is in the midst of an obesity epidemic. This public health crisis demands urgent attention and action, including removing the little-known tax subsidy for junk food advertising to children.

Boy infront of TVChildhood overweight and obesity

In the past three decades, obesity has more than doubled among children and quadrupled among adolescents. Today, nearly 13 million American children aged 2 – 19 years are obese. Childhood obesity is a serious health condition with immediate health effects including increased risk of pre-diabetes, bone and joint problems, and psychological problems. Longer-term health effects include increased risk for heart disease, some cancers, and type 2 diabetes.

Junk food advertising to children

Junk food advertising contributes to childhood overweight and obesity. In 2009, 48 food and beverage companies reported spending $1.79 billion on marketing to children and adolescents. This included $695 million on traditional media, including television, radio, and print and $122.5 million on new media advertising, including online, mobile, and viral. Many of these advertisements promote nutritionally poor, calorie dense foods and beverages that are high in fats, salt, and added sugars. The extensive, pervasive, and integrated marketing of junk foods influences children’s food preferences, purchase requests, and consumption patterns. Children are particularly vulnerable to advertising because they cannot identify persuasive intent.

Tax subsidy for junk food advertising to children

Under the Federal Income Tax Code, advertising costs may be deducted as ordinary business expenses. Assuming a corporate tax rate of 12.6%, the US Government provided food and beverage companies a subsidy of over $103 million in respect of the $817.5 million worth of traditional and new media advertising to children and adolescents purchased in 2009. In theory, the elimination of the subsidy would reduce the incentive for food and beverage companies to advertise junk food to children, resulting in less exposure to such advertisements among children. In turn, this would result in children eating less junk food, leading to health benefits and reduced healthcare costs.

Law-makers have tried to eliminate the tax subsidy before. Various bills have been proposed, including by Senators Blumenthal and Harkin and Representative DeLauro. Although none of these bills have passed, there is mounting evidence of the positive impact that eliminating the subsidy would have on children’s health outcomes and healthcare costs, including a 2015 study by Sonnerville et al., which modelled “the effect of a national intervention that eliminates the tax subsidy of advertising nutritionally poor foods and beverages on TV to children aged 2-19 years.” The study found that the intervention would result in a small reduction in obesity prevalence resulting in increases in quality-adjusted life years (QALYs) and substantial reductions in healthcare expenditures. The authors also concluded that “the intervention was “cost saving,” as it would result in an increase in QALYs and reduction in total costs compared with current practice.”

A comprehensive approach to reducing marketing of junk food to children

Eliminating tax subsidies is one of many possible approaches to reducing rates of child and adolescent overweight and obesity. Indeed, the World Health Organization, the American Academy of Pediatrics, and many other important authorities recommend banning junk food advertising to children. Although the US Government has not moved to adopt a ban, many scholars argue for this approach, adding that the correct interpretation of the First Amendment allows for regulations to protect children from junk food advertising.

In the meantime, eliminating tax subsidies for such advertising is a step in the right direction. Eliminating the subsidy may also play a role in increasing public awareness of children’s unique vulnerability to advertising and generate public support for a comprehensive ban.

Posted in Non-communicable diseases;


Regulating the Modern Day Marlboro Man and His Electronic Cigarette

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No_Vaping_Sign_(18562436519)This post was written by Janelle Langan, an LL.M. in Global Health Law candidate at Georgetown University Law Center. Any questions or comments about the post should be directed to jl2009@georgetown.edu.

The rebellious, rugged images of the Marlboro Man linked the idea of smoking filtered Marlboro cigarettes with masculinity to promote tobacco sales at the cost of public health. The idea of glamorizing tobacco use is nothing new. However, over the past decade, the regulation of tobacco products as well as increased awareness has helped to educate consumers on the dangers of smoking in order to protect public health. Until recently, the popularity of electronic cigarettes (e-cigarettes) was largely driven by the lack of regulation upon its use and marketing. E-cigarettes have been a controversial topic since they entered the marketplace nearly a decade ago.

E-cigarettes are composed of a battery, a nicotine cartridge, and an atomizer. Through “vaping,” nicotine is delivered in an aerosol form that is exhaled by the user in vapor form, which e-cigarette manufacturers market as a healthier alternative to traditional cigarettes. Confusion surrounding the categorization of e-cigarettes created a wild west-like environment that contributed to its popularity. Unlike smokers who are stigmatized and banished to remote, unpleasant, outdoor locations, vaping was often permitted inside public areas. Additionally, manufacturers were able to target younger audiences through marketing practices that included advertising at sporting events and providing free samples.

Under the Food, Drug, and Cosmetic Act, as amended by the Family Smoking Prevention and Tobacco Control Act, the Food and Drug Administration (“FDA”) was granted the power to regulate the sale and distribution of “tobacco products,” which specifically includes cigarettes, cigarette tobacco, roll-your-own tobacco, and smokeless tobacco. In order for the FDA to regulate other forms of tobacco products, it must “deem” the product within its regulatory authority.

The degree to which e-cigarettes should be regulated has been the source of a vigorous debate. Some advocate for minimal regulations because e-cigarettes may help smokers reduce or cease nicotine consumption. However, the level of nicotine varies greatly depending upon the product’s characteristics, user’s puffing behavior, and nicotine solution concentration. Thus, others advocate for harsher regulations, arguing that e-cigarettes contain addictive and harmful ingredients that pose significant public health risks.[1]

This past week, the FDA expanded the definition of “tobacco products” to deem electronic nicotine delivery systems (“ENDS”) within its regulatory authority. ENDS specifically includes: e-cigarettes, e-cigars, e-hookah, vape pens, personal vaporizers, and electronic pipes. In addition to expanding the definition of tobacco products, the FDA issued the following consumer-based restrictions:

  • E-cigarettes will not be allowed to be sold to anyone under the age of 18;
  • Those under the age of 27, must provide identification when purchasing e-cigarettes;
  • E-cigarettes may not be sold in vending machines, unless the machine is located in an adult-only facility; and
  • E-cigarettes will not be distributed to consumers through free samples.

These restrictions, which take effect in 90 days, are aimed at reducing e-cigarette use amongst young consumers as nicotine exposure during adolescence may adversely affect brain development. Beyond these regulations, manufacturers are subject to additional regulations, which include: registering manufacturing establishments and providing product listings; reporting ingredients, and harmful and potentially harmful constituents; undergoing premarket review and authorization of new tobacco products; placing health warnings on product packages and advertisements; and not selling modified risk tobacco products including those described as “light,” “low,” or “mild” unless authorized by the FDA.

The new regulations are aimed at striking a delicate balance between deterring young tobacco use without preventing the use of a product that may aid traditional smokers in reducing or ceasing nicotine use. This recent action by the FDA: (1) makes a preliminary step forward by creating much needed regulation upon the use of electronic nicotine delivery systems and (2) focuses upon requiring more data on the nature of health risks posed by the use of electronic nicotine delivery systems.

[1] See, e.g. Martin McKee, Electronic Cigarettes: Proceed with Great Caution, 59 Int’l J. Pub. Health 683, 684 (2014).

Posted in Tobacco; Tagged: , , , , , , , .


May is National Hepatitis Awareness Month: Hepatitis C testing is critically important as CDC reports infection rates and deaths in U.S. at all-time high

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Hepatitis Awareness Month

May 19. HEPATITIS TESTING DAY. Click here to learn more. http://www.cdc.gov/hepatitis/TestingDay/

May is National Hepatitis Awareness Month. The CDC has designated May 19th, 2016 as National Hepatitis Testing Day in the U.S. This campaign is particularly timely this year given the report released this Wednesday by the CDC  which states that new infections and deaths caused by Hepatitis C (HCV) are at the highest rates ever reported. The number of acute cases of Hepatitis C rose from 850 in 2010 to 2,194 in 2014. There were 19,659 deaths caused by HCV in 2014, a sharp rise from 15,106 deaths reported in 2007.

Hepatitis C has few noticeable initial symptoms, so most who are infected are unaware of their status until the illness causes severe symptoms such as liver inflammation and scarring. This means that it is likely that there are many more undiagnosed and underreported infections attributable to HCV than noted in this report. Dr. John Ward, Director of the CDC’s Division of Viral Hepatitis, states that the estimate of actual new infections in the U.S. is closer to 30,000 per year. Chronic and untreated Hepatitis C infections can cause cirrhosis, liver cancer and liver failure.

Americans who fall into the “Baby Boomer” demographic – people born between 1945 and 1965 – are at high risk for having chronic and undiagnosed Hepatitis C infections. This is due to many in this group receiving blood transfusions and organ transplants prior to 1992, when HCV screening of donated blood and organs became standard. However, the recent rise in new infections is largely attributed to infections spread by persons who inject illegal drugs (PWID). This cohort is comprised mainly of younger people, and also lends to an increased risk of HCV transmission from mother to child, as many of the women in this high-risk group are of child-bearing age.

Screening for Hepatitis C requires a simple blood test. However, this screening is still not widely conducted on many in the population. The CDC is trying to address this issue by raising awareness both amongst the public and the health care system of the risk factors for HCV infection and the long-term benefits of early detection and treatment. The existence of highly effective curative drug treatments for HCV infections allow acute infections to be easily treated and will greatly reduce the long-term and potentially deadly health complications that arise from chronic Hepatitis C infections.

If you haven’t been recently screened for HCV, ask  your health care provider for a test.

You can learn more about all types of Hepatitis infections at the CDC’s website at http://www.cdc.gov/hepatitis/index.htm.

Posted in Health reform, National Healthcare; Tagged: , .


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The views reflected in this blog are those of the individual authors and do not necessarily represent those of the O’Neill Institute for National and Global Health Law or Georgetown University. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.

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