On the Road to Green Energy, Germany Detours on Dirty Coal

Yale Environment 360 - May 29, 2014
While Germany continues to expand solar and wind power, the government’s decision to phase out nuclear energy means it must now rely heavily on the dirtiest form of coal, lignite, to generate electricity. The result is that after two decades of progress, the country’s CO2 emissions are rising. BY FRED PEARCE
Categories: Environment, Health

Video Report: Americans on the Front Lines of Climate Change

Yale Environment 360 - May 28, 2014

A fire chief in Colorado whose department is battling increasingly intense blazes in the American West. A Texas rancher struggling to operate in the face of years of drought. Oyster farmers in Washington state scrambling to adapt to increasingly acidic waters that are damaging their harvests. These Americans are the subjects of videos created by The Story Group, a non-profit journalism initiative. The videos are meant to put a human face on the science behind the recently released National Climate Assessment, which stressed that global warming is already having a major impact on the United States.
Watch the videos.
Categories: Environment, Health

Not an “accident”: Juan Carlos Reyes suffers fatal work-related injury in Harlingen, Texas

Pump Handle - May 28, 2014

Juan Carlos Reyes, 35, suffered fatal traumatic injuries on Saturday, April 24 while working at a construction site located in Harlingen, Texas. News reports indicate:

  • A Marriott Hotel is being built at the site.
  • Reyes was on a [boom] lift moving supplies into a fourth floor window. Reyes fell to his death.
  • The general contractor of the hotel is Houston-based Matrix Builders.

The firm’s profile lists more than a dozen completed hotel construction projects in southeast Texas, including Comfort Inns, La Quinta Inns, Comfort Inn and Suites, and Candlewood Suites. The profile also notes that Matrix Builders’ president, Ritesh Patel, says he is “OSHA Certified.” The trouble is, there is no such thing as being “OSHA certified.” Individuals can become authorized OSHA trainers after completing two 26-hour OSHA courses. They receive a wallet card that reads “Authorized Construction Trainer,” not a designation they are “OSHA certified.”

Federal OSHA will conduct a post-fatality inspection of the construction site. If the agency’s inspectors identify violations of health or safety regulations, the company will be cited. OSHA records suggest the most recent inspection of Matrix Builders’ construction project was in May 2006 at a site in Webster, TX. The inspection was opened and closed on the same day. No citations were issued.

Each year, more than 500 workers in Texas are fatally injured on-the-job. The Bureau of Labor Statistics reports 536 work-related fatalities in Texas during 2012 (most recent available data.) Nationwide, at least 4,628 workers suffered fatal traumatic injuries in 2012.

The AFL-CIO’s annual Death on the Job report notes:

  • Texas has 98 OSHA inspectors to cover more than 525,000 workplaces.
  • The average penalty in Texas for a serious violation is $2,187.

OSHA has until mid-November to issue any citations and penalties related to the incident that stole Juan Carlos Reyes’ life. It’s likely they’ll determine that his employer’s safety program was inadequate and Ramos’ death was preventable. It was no “accident.”


Categories: Health

Bringing perspective to ACA-related insurance cancellations

Pump Handle - May 27, 2014

Late last year as many Americans purchased affordable health insurance for the first time, others opened their mailboxes to find notification that their coverage had been cancelled. The story erupted across media channels, as President Obama had promised that people could keep their plans, but the overall issue was presented with little perspective. Thankfully, a new study offers something that’s become seemingly rare these days: context.

Published in May in the journal Health Affairs, the study examined the stability of the nonemployer-based insurance market in the years before the Affordable Care Act to gauge whether the recent wave of cancellations was out of the ordinary or a typical feature of the individual health insurance market. (Quick background: People who received ACA-related cancellation notices had nongrandfathered plans that did not meet the law’s new minimum coverage rules.) To find out, author Benjamin Sommers, an assistant professor of health policy and economics at the Harvard School of Public Health, studied U.S. Census data from 2008 to 2011 on people ages 0 to 64 who reported buying health insurance that was noted obtained through an employer or union.

The big take-away? The individual insurance marketplace was already home to a high turnover rate, with only 42 percent of people keeping their plan after 12 months. Also, more than 80 percent of those experiencing coverage changes obtained insurance within a year, usually through an employer. In all, Sommers’ results suggested that 6.2 million people leave nongroup coverage every year.

“In this context, reports that recent cancellations of coverage may affect as many as 4.7 million adults (though precise estimates are lacking) are likely capturing a great deal of the normal turnover in the market,” Sommers wrote in the study. “The findings presented here also suggest that overall coverage rates in the United States are unlikely to fall as a result of these cancellations: Most people who left nongroup coverage in this study acquired other insurance within twelve months, even before the ACA offered increased coverage via the Medicaid expansion and tax credits for marketplace insurance.”

The study found that participation in the nongroup coverage markets was mostly “short-lived.” More than one-third of the study sample no longer had the coverage after four months. Within two years, only 27 percent still had the coverage. Younger people had the highest turnover rates, with only one-third of younger adults maintaining stable nongroup coverage for at least one year, compared to nearly 50 percent of older adults. Older adults, whites, self-employed people and people living in the West or Midwest experienced more stable nongroup coverage, while children, younger adults, blacks, Hispanics and people living in the Northeast experienced higher insurance turnover. Sommers wrote that people leave the nongroup marketplace for a number of reasons, such starting a new job that offers health benefits, qualifying for Medicaid or not being able to afford insurance anymore.

Still, some people did lose a plan that they had hoped to keep. To that, Sommers wrote that the ACA does offer new coverage options via Medicaid (in some states, anyway) as well as in the new insurance marketplaces. He also noted that 65 percent of his study sample had incomes below 400 percent of poverty, which means that many people who received cancellations would be eligible for subsidized, less expensive insurance plans in the new marketplace.

“These results can serve as a useful pre-ACA baseline with which to evaluate the law’s long-term impact on the stability of nongroup coverage,” the study stated.

To read the study in full, visit Health Affairs.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.

Categories: Health

To Sway the Public, ‘Global Warming’ Beats out ‘Climate Change’

Yale Environment 360 - May 27, 2014
If politicians and scientists want to convey the urgency and importance of a warming world, they are far better off using the term "global warming" than “climate change,” according to a new report. Produced by researchers at the Yale Project on Climate Change Communication and George Mason University, the report says that Americans are much more familiar with the term “global warming” and that it engenders more negative associations and concern. Based on recent surveys, the report said moderates, women, Hispanics, political independents, and younger Americans associate “global warming” with alarming developments such as melting glaciers and extreme weather. Among many groups, “global warming” also creates a greater sense of threat to one’s family and future generations. “Scientists often prefer the term climate change for technical reasons, but should be aware that the two terms generate different interpretations among the general public and specific subgroups,” the report said. The survey found that among Republicans the two terms are generally synonymous.
Categories: Environment, Health

To Sway the Public, `Global Warming’ Beats out `Climate Change’

Yale Environment 360 - May 27, 2014
If politicians and scientists want to convey the urgency and importance of a warming world, they are far better off using the term "global warming" than “climate change,” according to a new report. Produced by researchers at the Yale Project on Climate Change Communication and George Mason University, the report says that Americans are much more familiar with the term “global warming” and that it engenders more negative associations and concern. Based on recent surveys, the report said that moderates, women, Hispanics, political independents, and younger Americans associate the term “global warming” with alarming developments such as melting glaciers and extreme weather. Among many groups, “global warming” also creates a greater sense of threat to one’s family and future generations. “Scientists often prefer the term climate change for technical reasons, but should be aware that the two terms generate different interpretations among the general public and specific subgroups,” the report said. The survey found that among Republicans the two terms are generally synonymous.
Categories: Environment, Health

As Dairy Farms Grow Bigger, New Concerns About Pollution

Yale Environment 360 - May 27, 2014
Dairy operations in the U.S. are consolidating, with ever-larger numbers of cows concentrated on single farms. In states like Wisconsin, opposition to some large operations is growing after manure spills and improper handling of waste have contaminated waterways and aquifers. BY ELIZABETH GROSSMAN
Categories: Environment, Health

Study: Public input can offer valuable insights during pandemic flu planning

Pump Handle - May 23, 2014

Despite our best preparedness efforts, a real-life flu pandemic would require some difficult and uncomfortable decisions. And perhaps the most uncomfortable will be deciding who among us gets priority access to our limited health care resources. How do we decide whose life is worth saving?

There are so many different ways to view such a scenario; so many different values and ethical dilemmas to consider. In the chaos of a pandemic, life-saving allocation decisions would not only impact the patient in question — the repercussions would likely ripple throughout families and entire communities. And yet, few disease preparedness efforts have systematically engaged in gathering public input about what kind of values we should use to guide these decisions. In response, a group of researchers set out to test their hypothesis that residents could, indeed, provide policymakers with meaningful input on these somewhat unpleasant questions. Their findings were recently published in the Annals of the American Thoracic Society.

“One of the big challenges in this arena is that there are a number of ethically appropriate ways to make these really tough decisions, but they’re not always consistent with the values of any given community,” Lee Daugherty Biddison, an assistant professor in the Division of Pulmonary and Critical Care at Johns Hopkins School of Medicine, told me. “People spend years of their lives studying bioethics…but can the average community member also provide us with meaningful feedback on these complex ethical issues? We thought that they could and we found that they did.”

Biddison was part of the team of researchers who examined whether the “democratic deliberative methodology” was effective in engaging residents on ethically challenging health care questions and whether those methods could elicit input that state officials could ultimately use to shape policy. Using the methodology, which requires citizen participation in open and informed conversations, researchers held five-hour community meetings in two Maryland communities with a total of nearly 70 residents. At the community meetings — one in affluent Howard County, Md., and the other in inner Baltimore City, where more than a quarter of families live below the poverty line — attendees were presented with a scenario in which a severe flu pandemic had overwhelmed Maryland’s critical care capacity. They were asked two main questions: What should we do in situations where there are more patients needing ventilators than there are ventilators to use? And should health care providers ever be allowed to remove a ventilator from one patient who needs it to survive and give it to another patient who also needs it to survive?

Interestingly, study co-author Alan Regenberg, director of Outreach and Research Support at Johns Hopkins Berman Institute of Bioethics, told me that the first reaction among many meeting participants was try to find a way out of having to ration medical care in the first place, such as asking if people can share ventilators or if more ventilators can be built. That’s what made ventilators such a good subject for conversation, Regenberg said — they’re expensive to manufacture, they don’t store very well in the long term and it’s plausible that we’ll run out in a pandemic.

“As the day proceeded and people understood the decisions that had to be made they were happy to contribute,” Regenberg said. “Many may have thought coming in that the experts could handle this…but they really came to realize that this is a tough issue and they’ve got just as valid an opinion on it as anybody else. It sort of empowered them.”

Biddison she was surprised at how quickly people grabbed hold of the concept and how willing they were to wrestle with these issues — “these are not comfortable questions,” she added. For example, some thought children and young people should be a priority, while others thought that elders and the wisdom they offer were an equally important part of the community.

“It’s really so important to get down and dirty in those conversations,” Biddison said. “At least then policymakers can respond to those values and communicate decision-making respectfully in the context of people’s values.”

In discussing the differences between the two communities, Biddison noted that individual experience drove the conversation. She and her study co-authors Regenberg, Howard Gwon, Monica Schoch-Spana, Robert Cavalier, Douglas White, Timothy Dawson, Peter Terry, Alex John London, Ruth Faden and Eric Toner wrote:

Comparing the two meetings, certain distinct concerns emerged that may be explained, in part, by the contrasting circumstances that the communities represent. People engage with medical ethics on the basis of their life experiences, social roles, political concerns and cultural beliefs. People’s moral perspective on medical practice emerges from what they have experienced and learned about the world, including relations of inequality, and not simply from abstract high-order values.

In particular, people at the Baltimore meeting — residents from a community with a high crime rate — talked a lot about whether certain people, such as convicted felons, shouldn’t have access to ventilators. They also “adamantly” felt that access shouldn’t be determined by a person’s ability to pay. Baltimore participants were also concerned about the transparency of the decision-making process and whether their input would be considered. The study noted that “such concerns would be well-founded among groups with historic reasons to question whether public policies represented the interest of disadvantaged people who are often politically marginalized.”

Among Howard County participants, logistical concerns were more common, the study found. Noting that Howard County residents had more exposure to disaster planning, researchers reported that they struggled with how much time decisions would take — in other words, “would someone die without a ventilator while decision-makers were still making up their minds?” Howard County participants were also concerned about fairness, recommending that officials use “science” or “statistical analysis” to make allocation decisions. Both community groups felt no single principle, such as prioritizing those most likely to survive, would be adequate to address the pandemic scenario.

Overall, the study found that the “deliberative democratic method provided a format for facilitating civil conversation that might otherwise be fraught with both misinformation and contentious debate.”

“I think there’s a lot of anxiety about what goes on in the ivory tower…and given the fact that we’re talking about a true disaster scenario in which everything has changed, it’s really critical to have established transparency and through that, public trust,” Biddison told me.

The study is part of a larger project to engage the public on the values that should guide officials in making health care allocation decisions in a disaster. Having found that the deliberative democratic method was an effective engagement tactic, Biddison said the next step is to synthesize public feedback into a report that, hopefully, will help shape state policy.

“Trust is going to be absolutely essential if, God forbid, we have to enact this kind of plan, and transparency will play a big role,” Regenberg said. “It’s essential that people trust in the fairness of the process.”

To read more about the study and the public engagement project, click here.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.

Categories: Health

Oil Drilling Permits Issued for Key Area of Yasuni Park

Yale Environment 360 - May 23, 2014
The Ecuadorean government has issued permits to begin oil drilling in a key area of the Yasuni Biosphere Reserve and National Park, one of the most biodiverse places on the planet. Environment Minister Lorena

Watch e360 Video

Yasuni Biosphere Reserve Tapia said the government had signed permits to begin preparations for drilling in the so-called ITT section of the park, which contains two uncontacted indigenous tribes; drilling itself could begin as early as 2016, the government said. Ecuador’s President, Rafeal Correa, had offered to ban drilling in large sections of the park if the international community raised $3.6 billion to compensate the country for leaving the oil in the ground. But after only $13 million was raised, Correa gave the green light to drilling, saying “the world has failed us.” Oil drilling has already taken place in some areas of the 6,500-square-mile park. As this Yale Environment 360 video shows, Yasuni is home to a remarkable array of species, including roughly 400 species of fish, 600 species of birds, and thousands of species of vascular plants and trees.
Categories: Environment, Health

Vaccination and other matters of trust

Pump Handle - May 22, 2014

by Anthony Robbins, MD, MPA

As an editor of the Journal of Public Health Policy, I have been following developments where public health intersects with the activities and policies of espionage agencies. New happenings appear regularly.

First there was the Central Intelligence Agency’s (CIA) creation of a special immunization campaign in Pakistan, where the only purpose of the program was to collect material containing DNA that stuck on the needles used to deliver hepatitis vaccine. The Agency hoped to find Osama Bin Laden. We published an editorial that predicted the terrible damage that would follow: set backs in polio vaccination, just as it was nearing effective eradication of the disease.

The CIA appeared to be oblivious to the damage they might do to immunization efforts, but this is unlikely. In the 1990s, when I ran the US National Vaccine Program, immunization programs were becoming a keystone in improving health around the world. The CIA recognized the value of controlling disease as part of US national security, and posted this observation on the Agency website. So in 2010, it is more likely that the CIA knowingly traded the lives of dozens of vaccinators in Pakistan and put thousands of unvaccinated children around the world in harm’s way to kill one terrorist. People all over the world were allowed to confirm their worst suspicions, that vaccination programs were part of a CIA plot. Trust, absolutely needed in public health, was surely a victim of CIA subterfuge. We must hope that the US government officials responsible for the vaccination ruse will end up in the docket in The Hague at the International Criminal Court.

Then came the National Security Agency revelations. Again trust became the central issue as James R. Clapper, Jr. explained that testimony he gave to the US Senate about collecting private data on millions of American citizens, was the “least untruthful” way to answer the Senate’s questions. We editorialized, “Least Untruthful, a new standard?

Have things come full circle? Just this week, almost two years after our first editorial, the CIA announced that it had decided several months ago to abandon the use of vaccination programs for espionage. The White House made its announcement last week via a letter sent to the deans of 12 schools of public health. More than 16 months earlier, after my post here on The Pump Handle, the deans wrote to President Obama about the sham vaccination and its dire consequences to goals of disease eradication.

Here in France, I got a call from Jason Beaubien at National Public Radio. (By the way, this is exactly the kind of international call that the National Intelligence Agency may record: Americans talking to other Americans abroad.) As I told Beaubien, the CIA’s not exclusively responsible for the problems we have in getting children vaccinated, but it certainly didn’t make anything easier. Without trust, a vaccination program fails.

As I thought about this string of developments, I found it hard to imagine that if the Agency were doing so intentionally, the CIA could not have invented a more damaging assault on the trust on which public health relies.

With the US Director of National Intelligence apologizing for lying to the Senate, calling his testimony “least untruthful”, is there any reason that either Americans or the rest of the world should trust anything that the CIA says? And as we have asserted before, public trust is the central element of all public health programs.

Anthony Robbins, MD, MPA is co-Editor of the Journal of Public Health Policy.


Categories: Health

Donors Commit $220 Million To Protect and Expand Huge Amazon Reserve

Yale Environment 360 - May 22, 2014
A coalition of private donors and government funders has pledged $220 million over the next 25 years to better protect the Amazon Region Protected Areas (ARPA), the world’s largest protected area network. WWF, the World Bank, the Gordon and Betty Moore Foundation, the Inter-American Development Bank, and more than a dozen other donors are contributing funds to the initiative, which also will add another 8.9 million hectares of Amazon rainforest to the ARPA program, driving the total to more than 60 million hectares. That’s 232,000 square miles, an area larger than France. Most of the funds will be used to better police and enforce environmental laws on ARPA territory, which includes 90 parks and comprises 15 percent of the Brazilian Amazon. "The explosion in demand for natural resources has made our parks and world heritage sites vulnerable," said WWF president Carter Roberts. The initiative is also upgrading long-neglected parks and creating sustainable-use reserves for local communities and indigenous people.
Categories: Environment, Health

Putting San Francisco On the Road to Zero Waste

Yale Environment 360 - May 22, 2014
For two decades, Jack Macy has spearheaded San Francisco’s efforts to become a global leader in recycling. In an interview with Yale Environment 360, he talks about how San Francisco has engaged the public in a recycling crusade that has resulted in the city reusing or composting 80 percent of its garbage. BY CHERYL KATZ
Categories: Environment, Health

Women and the ACA: Coverage, contraception, and disparities

Pump Handle - May 21, 2014

Last week was National Women’s Health Week, and the Kaiser Family Foundation used the occasion to release the report Women and Health Care in the Early Years of the ACA: Key Findings from the 2013 Kaiser Women’s Health Survey, by Alina Salganicoff, Usha Ranji, Adara Beamesderfer, and Nisha Kurani. The telephone survey of 3,015 women ages 15 – 64 was conducted before the launch of the health-insurance exchanges and several states’ Medicaid expansions, but after several other key provisions of the Affordable Care Act took effect. Starting with plan years beginning after September 22, 2010, insurers with non-grandfathered plans now have to cover preventive services without cost-sharing and allow adult children up to age 26 to remain on their parents’ insurance policies (see the Kaiser Family Foundation implementation timeline for details). The Kaiser Women’s Health Survey results demonstrate that these provisions are especially important for women’s health, but it also offers a reminder that coverage doesn’t always translate into receiving healthcare services or having good health outcomes.

“Preventive services” covered by this ACA provision include those getting top ratings (A or B) from the US Preventive Services Task Force, immunizations recommended by the Advisory Committee on Immunization Practices, and services specified in guidelines from the Health Resources and Services Administration (HRSA). For these services, insurers may not require enrollees to pay co-payments or other cost-sharing. In 2012, the Department of Health and Human Services calculated that 47 million women would be eligible to receive a range of co-pay-free services, including “well-woman visits, screening for gestational diabetes, HPV DNA testing, domestic violence screening and counseling, HIV screening and counseling for sexually transmitted infections, breastfeeding supplies, contraceptive methods and family planning counseling.”

Guidelines developed by the Institute of Medicine and supported by HRSA specify that the “contraceptive services” category includes “all Food and Drug Administration approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity.”  The Center for Consumer Information & Insurance Oversight provides more detail in an FAQ:

The HRSA Guidelines ensure women’s access to the full range of FDA-approved contraceptive methods including, but not limited to, barrier methods, hormonal methods, and implanted devices, as well as patient education and counseling, as prescribed by a health care provider. Consistent with PHS Act section 2713 and its implementing regulations, plans and issuers may use reasonable medical management techniques to control costs and promote efficient delivery of care. For example, plans may cover a generic drug without cost-sharing and impose cost-sharing for equivalent branded drugs. However, in these instances, a plan or issuer must accommodate any individual for whom the generic drug (or a brand name drug) would be medically inappropriate, as determined by the individual’s health care provider, by having a mechanism for waiving the otherwise applicable cost-sharing for the branded or non-preferred brand version. This generic substitution approach is permissible for other pharmacy products, as long as the accommodation described above exists.

Certain religious employers have received an exemption for contraceptive coverage requirement (see this National Health Law Program timeline for more details), and the Supreme Court will soon decide whether private employers can also refuse to cover healthcare services to which they object.

For younger women, the possibility of remaining on a parent’s insurance plan until age 26 can be important not only for accessing healthcare, but for exploring new job opportunities. During a panel discussion at the Kaiser event, Amy Allina of the National Women’s Health Network and Raising Women’s Voices noted that first jobs these days often lack employer-sponsored insurance, and that young women’s earnings may be higher if they’re not experiencing job lock – that is, if having a parent’s insurance coverage enables them to change jobs rather than staying in less-than-ideal positions in order to keep health benefits.

Incomplete awareness of contraceptive coverage and confidentiality
Key findings from the 2013 Kaiser Women’s Health Survey include the following:

  • 57% of women had employer-sponsored insurance in 2013, while 18% were uninsured (the remaining figures: 9% Medicaid, 7% individual policies, 6% other government program).
  • Uninsurance rates were higher among Hispanic and Black women – 36% and 22%, respectively – than among White women (13%).
  • 26% of women delayed or went without healthcare due to cost over the past 12 months, and 28% report problems paying medical bills.

As far as preventive services, many women were either unaware of ACA provisions on cost-sharing or did not receive contraceptive services free of charge – and perhaps partly as a result, nearly one in five women are at risk of an unintended pregnancy:

  • 57% of women knew the ACA requires most private plans to cover the full cost of many preventive services.
  • Among women with private insurance, only 35% reported their insurers covered the full cost of contraceptives.
  • Among sexually active women not trying to become pregnant, 19% were not using any form of contraception.

Many young women seem to be taking advantage of the ability to stay on parent’s private health plans; however, a significant portion of them are unaware that these plans can send Explanation of Benefit (EOB) statements that may alert their parents to the services the young women receive:

  • 45% of women ages 18 -25 have employer-sponsored insurance through a parent, while only 8% are insured by their own employers.
  • Among women ages 18 – 25, 71% rate confidentiality as important, but only 37% know private plans can send EOBs to policyholders.

Panelist Francisco Garcia, Director and Chief Medical Officer of the Pima County Health Department in Arizona, warned that insufficient privacy protections can have a chilling impact on women’s use of reproductive-health services – but, he noted, safety-net providers like community health centers and family-planning clinics offer a high level of confidentiality. (See Kim Krisberg’s recent post about Title X-funded clinics in Massachusetts for more on this issue.)

Barriers and disparities persist
The Affordable Care Act aimed to slash uninsurance rates nationwide, but the Supreme Court’s decision that states could choose whether or not to accept the ACA’s Medicaid expansion has left many of the poorest residents of Florida, Texas, and several other states without health insurance. At the Kaiser event, panelist Cara James, Director of the Office of Minority Health at the Centers for Medicare and Medicaid Services, noted that state decisions not to expand Medicaid have had a disproportionate impact on Black and Latina women. There’s hope that more states will accept the expansion in the coming years, or develop HHS-approved plans (waivers) to devote federal dollars to other mechanisms for covering residents with incomes near or below the federal poverty level. (For instance, Arkansas is using federal funds that would have gone to a Medicaid expansion to instead buy private insurance coverage for adult residents with income up to 138% FPL).

As I’ve written before, insurance coverage is not synonymous with access to healthcare or with improved health outcomes. As the 2013 Kaiser Women’s Health Survey found, many women didn’t get all the healthcare recommended, and not everyone knows that private insurers are supposed to pay the full cost of preventive services like well-woman visits and contraceptive services. Some insurers may drag their heels on adding coverage for certain forms of contraception, for instance. Panelist Vanessa Cullins of Planned Parenthood Federation of America noted that it will take “enforcement and diligence” to ensure that women are able to get what they’re entitled to under the Affordable Care Act.

Even when women have insurance coverage and know that they can get preventive services without cost-sharing, other barriers can persist. The Kaiser survey found the following about reasons women gave for delaying or going without care:

  • 23% of women couldn’t find time to go to the doctor.
  • 19% of all women, and 26% of those with incomes under 200% FPL, couldn’t take time off work.
  • 15% had problems getting childcare (19% for those under 200% FPL).
  • 9% of all women, and 18% of those with incomes under 200% FPL, had transportation problems.

All the panelists emphasized that difficulties with time, transportation, and childcare – as well as money for cost-sharing – can be significant barriers to care, especially, but not solely, for lower-income women. Cullins stressed that these are among the determinants of health “that the ACA cannot address, but need to be addressed through our political process – such things as income inequity, such things as paid leave, personal days that are paid, sick time that is paid.” (The good news here is that several cities and states have already passed laws for paid medical and/or family leave and paid sick days, and several more jurisdictions are considering paid-leave bills and ballot measures. A bill for a national social-insurance system for paid medical and family leave has also been introduced in the US Congress.)

Garcia pointed out that safety-net providers – including community health centers, family-planning clinics, and public-health departments that provide healthcare services – will continue to be a key source of care for many people, especially black women and women of color. These providers are accustomed to meeting the needs of low-income clients, and are already a trusted source of care for millions of people with and without insurance. However, Garcia warned that some public officials assume that such safety-net providers will be less needed as the ACA is implemented, when in fact they are still essential and should keep receiving funding. Practitioners and advocates will need to communicate about the crucial role of safety-net providers to those who make resource-allocation decisions.

In her remarks at the beginning of the panel discussion, the Kaiser Family Foundation’s Alina Salganicoff (one of the authors of the new report) noted that the 2013 survey was conducted shortly before much of the ACA’s coverage expansion took effect – so, it will serve as a baseline to which to compare future findings. Usha Ranji, also of the Kaiser Family Foundation and an author of the report, expressed the hope that the insurance marketplaces won’t just allow more women to get coverage, but will also help them understand what different plans cover and compare their options. Panelists agreed that improving health literacy and insurance literacy will be important to help people make the best use of their benefits and achieve better health outcomes, and several efforts are underway, including one being pilot-tested by the Office of Minority Health. The next survey, scheduled for 2017, should give some indication of women’s awareness of and ability to use the benefits they’re entitled to under the ACA.

Categories: Health

Trash-scooping Water Wheel Cleans up Garbage From Baltimore Harbor

Yale Environment 360 - May 20, 2014
A new contraption in a Baltimore river is helping to clear trash and debris — up to 50,000 pounds of it each day — from the city's Inner Harbor. The 50-foot-long

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Baltimore's trash-scooping water wheel "water wheel" gathers garbage floating in the Jones Falls River, which runs through the city to the Baltimore Inner Harbor, and deposits it in a large dumpster so the trash can be hauled away. Two large booms funnel debris toward a conveyor belt powered by the wheel, which itself is powered primarily by the flowing river. When the flow isn't strong enough to turn the wheel, water pumps, run by solar panels lining a canopy over the wheel, turn on and push water up to spin the wheel. The water wheel was designed to handle the heavy debris and larger pieces of trash that the river often carries, said its designer, Baltimore-based Clearwater Mills. It began operating earlier this month and cost $750,000, with $500,000 of that contributed by the Maryland Port Administration, Co.Exist reports.
Categories: Environment, Health

Occupational Health News Roundup

Pump Handle - May 20, 2014

The Pump Handle’s own Celeste Monforton was quoted in an investigative piece on the tank cleaning industry and the dangerously toxic environments that its workers face. In an investigative article in the Houston Chronicle, reporter Ingrid Lobet found that even though industry workers are coming into contact with extremely toxic and often combustible chemicals, the methods that the Occupational Safety and Health Administration uses to track tank and barge cleaning operations is woefully deficient.

Lobet begins her story with the life and death of David Godines, a Houston tank cleaner found dead inside a railcar, in which “hydrogen sulfide gas was so concentrated that the cells in his lungs stopped exchanging air. Yet experts said his brain would have been alive for a little while, and he would have asphyxiated, sentient.” The story chronicled the deaths and injuries of other workers as well, such as tank truck cleaner Chris Shirley of Freeport, Texas, who “was exposed to a mixture of ‘9 or more chemicals,’ including ‘oxirane, amine, oxide, formaldehyde and phthalate’ according to OSHA records. He was overcome by the vapors and slid into the belly of the tanker. He was not quite dead when retrieved, but he died at the hospital.” Despite the danger, Lobet reported that not even OSHA knows how many tank cleaning operations it’s inspected, as there’s no standard industry code for tracking and inspecting such businesses. Lobet writes:

“We have no way to find companies that do tank washing,” said Robert McDonough, a compliance officer for the Occupational Safety and Health Administration, in response to a Chronicle request. Officials can’t count how many tank and barge cleaners have lost their lives on the job, or how many suffer from nerve damage or cancer related to workplace chemical exposure.

“It’s alarming it is so under the radar,” said Celeste Monforton, who lectures at the Milken Institute School of Public Health at George Washington University and worked at OSHA. “You are talking about extremely toxic environments. Many of those chemicals have health effects that workers may not experience until 10 to 20 years down the line.”

The Chronicle identified 373 tank and barge cleaning sites using trade publications, news reports, OSHA records and interviews. There could be many more. Owners of the sites range from individual family-owned facilities like Rainbow Transport Tank Cleaners in Carson, Calif., to Quala, the Florida-headquartered chain of 51 mostly truck wash facilities in 22 states. They stretch across the country, concentrated in Texas and Louisiana, heart of the nation’s petrochemical industry. The epicenter: Harris County.

Only a third of the 373 sites have been inspected by OSHA in the past 10 years, the Chronicle determined by searching OSHA inspection reports through the end of 2013.

In other news:

Mother Jones: Republican state legislators in North Carolina have introduced a bill that would make it a criminal offense to disclose confidential information about fracking chemicals outside the parameters of an emergency. In fact, the bill would allow companies to force first responders to sign confidentiality agreements. Reporter Molly Redden reports that “environmentalists point out that the bill would also prevent local governments from passing any rules on fracking and limit water testing that precedes a new drilling operation.”

Huffington Post: A Wal-Mart warehouse contractor agrees to pay $21 million to workers in a wage theft case. According to writer Dave Jamieson, the settlement is “a victory for workers who argued that the world’s largest retailer sets the working conditions in the warehouses, even if it’s Walmart’s contractors who actually employ the workers.”

The Denver Post: The growing movement for better wages within the fast food industry wasn’t cited in this national story. However, the recent move by shareholders to rein in executive pay at Chipotle certainly can’t hurt the argument that these companies can continue to make a very healthy profit and still pay their workers a living wage. This Denver Post story notes that the “top five executives at Chipotle make nearly as much as their counterparts at General Electric, a global conglomerate with 45 times the sales,” while a typical Chipotle worker makes $21,000 a year. In somewhat related news, Daily Kos reports that McDonald’s, a central target in the movement for better fast food wages, is barring reporters from its shareholder meeting.

Al Jazerra: In the wake of Turkey’s worst coal mining disaster, which killed nearly 300 workers at last count, writer Cengiz Aktar asks if worker safety is becoming little more than a luxury in the quickly developing nation. NBC covered the protests that have erupted in response to the mining disaster.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.

Categories: Health

Widespread Greenland Melting Was Due to Forest Fires and Warming, Study Says

Yale Environment 360 - May 20, 2014
Rising temperatures and ash from Northern Hemisphere forest fires combined to cause large-scale surface melting of the Greenland ice sheet in 2012, an

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Extent of Greenland ice melt, July 8-12, 2012 echo of a similar event that occurred in 1889, a new study finds. The massive Greenland ice sheet — the second largest ice body in the world after the Antarctic ice sheet — experiences annual melting at low elevations near the coastline, but surface melt is rare in the dry snow region in its center. In July 2012, however, satellites observed for the first time surface melt across more than 97 percent of the ice sheet, generating reports that the event was almost exclusively the result of climate change. In the new report, published in the journal Proceedings of the National Academy of Sciences, researchers found that in both 2012 and 1889 exceptionally warm temperatures combined with black carbon sediments from Northern Hemisphere forest fires to darken the surface of the ice sheet to a critical albedo threshold, causing the large-scale melting events. Since Arctic temperatures and the frequency of forest fires are both expected to rise with climate change, large-scale melt events on the Greenland ice sheet may begin to occur almost annually by 2100, the researchers say.
Categories: Environment, Health

White House is the reason children are still working in US tobacco fields

Pump Handle - May 19, 2014


“I got a headache before. It was horrible. It felt like there was something in my head trying to eat it.” 

Those are the words of a 12 year-old boy who works in the tobacco fields of eastern North Carolina. His words are just one of many from other young seasonal workers who work on U.S. tobacco farms in KY, NC, TN, and VA. Their experiences are catalogued in Human Rights Watch’s (HRW) “Tobacco’s Hidden Children: Hazardous Child Labor in US Tobacco Farming.” The report was released last week.

Credit: Human Rights Watch

The 139-page report was also the subject of editorials appearing on Sunday in the New York Times and Washington Post.  The Times noted the “gaping flaws in how America regulates child labor on farms,” and the Post reminded us that these young workers are day laborers or the children of migrants who are “being exploited” in work that is “hardly a vocation beneficial to society.”

During 2012 and 2013, HRW interviewed 141 children ages 7 to 17 who said they had worked in tobacco picking or curing. Nearly three-quarters of them reported experiencing symptoms, such as nausea, vomiting, headaches, dizziness, skin rashes, and difficulty breathing. Their reports of adverse health effects are consistent with the literature on green tobacco illness (e.g., here, here, here.)

The young workers’ sicknesses could have been prevented had the Obama Administration not caved to political pressure at the youngsters’ expense. The Labor Department had proposed a regulation in September 2011 to protect agricultural workers under age 16 from a handful of very dangerous tasks, including working in tobacco production and curing. Opposition to the rule from the farm lobby was fierce. But that was no surprise. Opposition to worker health and safety regulations is par for the course. Members of Congress jumped on the bandwagon. And it wasn’t just Republican lawmakers leading the charge, as the New York Times’ editorial asserts. A quick Google search provides a sampling of Democratic Senators who called for the rule’s withdrawal: Max Baucus (D-MT), Dan Boren (D-OK), Al Franken (D), Claire McCaskill (D-MO), Ben Nelson (D-NE), Jeanne Shaheen (D-NH), Debbie Stabenow (D-MI), and  Jon Tester (D-MT).

Feeling the heat in an election year, the White House instructed Labor Department withdrew the proposal in April 2012. To emphasize the point, their announcement read:

“To be clear,” a 2012 Labor Department statement read, “this regulation will not be pursued for the duration of the Obama administration.”

The Administration washed its hands of protecting the health and safety of young workers. It even erased all evidence of the proposed rule from the Labor Department’s website.

HRW’s investigation, conducted in the time period following the Administration’s cop out, is a powerful example of the health consequences of failing to regulate workplace hazards. The Administration’s failure is especially pathetic because it involves our country’s most vulnerable workers. But the Obama White House can right this wrong, or at least right some of it.

The Labor Department’s proposed regulation addressed ten tasks that pose particularly high risk of serious injury or death to young workers. I think all of them are pretty dangerous, but I suspect that child safety experts, if pressed, could probably identify those that rise to the top of the list. Working as a pesticide handler, or in a grain silo, or with tobacco, all sound like good candidates to me. I can’t help but believe that those who opposed the proposal in its entirety, could agree that at least some of these hazardous tasks should be off-limits for workers younger than 16 years.

One characteristic of an effective leader is admitting mistake. The Administration should do so on this issue. Even an abbreviated version of the Labor Department’s 2011 proposal that simply addressed children working on tobacco farms and with pesticides would be an important step forward.

It’s the Administration’s fault that young workers are still toiling in U.S. tobacco fields. The HRW’s report resurrects the issue. The Washington Post’s editorial board has it right:

“Now that Mr. Obama has been re-elected and no longer needs to court Southern swing states, his administration should reverse its pathetic retreat.”

Categories: Health

India's New Prime Minister Plans To Make A Major Push on Solar Energy Major Push on Solar Energy

Yale Environment 360 - May 19, 2014
India's new government plans to bring electricity to the homes of its entire population of 1.2 billion within the next five years, largely through solar panel installations, Narendra Modi Bloomberg News reports. Although nearly 400 million Indians do not have access to electricity, newly elected prime minister Narendra Modi, who won an overwhelming victory in last week's national vote, has pledged to enable every household to run at least one light bulb by 2019. If all goes well, household solar projects would allow every home to run two light bulbs, a solar cooker, and a television, one of Modi's energy advisers said. The plan follows an unfulfilled pledge from the previous administration to bring electricity to all homes by 2012. Modi, who pioneered India's first incentive program for large-scale solar projects when he was chief minister of Gujarat state, has made expanding solar a top priority because it has the potential to create jobs and supply power to millions of households, many of which are scattered throughout rural areas and not connected to the grid. "We look upon solar as having the potential to completely transform the way we look at the energy space," said the energy adviser.
Categories: Environment, Health
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