A study published in the Archives of Pediatrics and Adolescent Medicine
this week found that 1 in 5 American 4-year-olds is obese. The study,
conducted by National Center for Education Statistics, indicates that
Native American 4 year olds are twice as likely to be obese as
non-Hispanic White or Asian children in the United States. Although
obesity was higher among Black and Hispanic children, Native American
preschoolers were more overweight than youngsters in other ethnic
groups.
According to an Associated Press report, health
officials blame genetic differences, a high rate of gestational
diabetes among Native American mothers and the federal commodity food
program (high in cheap carbohydrates) for this outcome. Other factors
including poverty and less educated parents were also cited.
In an interview with AP,
Jessica Burger, a nurse with the Little River Ottawa tribe of Michigan
noted that exercise may not be a priority among families who are
struggling to make ends meet.
The Washington Post reports this morning that "Chronic stress from growing up poor appears to have a direct impact on the brain, leaving children with impairment in at least one key area -- working memory." It's been clear for some time that children raised in poverty have health troubles and problems staying in school. But what was the cause? The article by Rob Stein points out that previous research has focused on intelligence, genetics, exposure to environmental toxins and on the effects of being raised in less intellectual environments.
Cornell University professor Gary Evans knew poor children grew up with much stress. "When you are poor, when it rains it pours," Evans said. "You may have housing problems. You may have more conflict in the family. There's a lot more pressure in paying the bills. You'll probably end up moving more often. There's a lot more demands on low-income families. We know that produces stress in families, including on the children." He measured the presence of hormones produced by stress in a group of children, their blood pressure and their weight, and he tested their short-term memory.
The researcher found that the longer a child lived in poverty, the higher the presence of the stress hormones and the lower these children tended to score on measures of memory. "It's not just 'Read to our kids and take them to the library,' " Evans told the Post. "We need to take into account that chronic stress takes a toll not only on their health, but it may take a toll on their cognitive functioning."
From the "Department of Keeping Your Eye On The Ball," the Center for Rural Affairs has released at Top Ten list of what will be important in the coming debate about health care. There are at least ten points about health care that are particularly important to rural America, says the advocacy group from Lyons, Nebraska.
Number One on the list is that health care coverage "must be available to everyone, without gaps in coverage." Coverage should also have options for small businesses and, especially in rural areas, the self-employed. Many rural communities have aging populations. "Reform must provide the services and facilities to enable aging rural people to stay in their homes and communities," CFRA says. With more than 80 percent of rural counties "medically underserved," a third of rural Americans "live with a shortage of health professionals, and only 3% of current medical students plan to practice in rural areas," CFRA states. "Reform must offer new approaches and incentives for rural health professionals."
The list goes on, including provisions for mental health (over half the counties in the U.S. have no mental health professionals) and emergency services. Here is the Center's full report. It's a good guide to keep handy as the debate continues.
Dr. Yvette Roubideaux, Rosebud Sioux, has been appointed director of
the Indian Health Service, within the Department of Health and Human
Services.
Well known for her extensive work on diabetes and health policy in
Indian country, Roubideaux is currently an assistant professor in the
Department of Family and Community Medicine at the University of
Arizona College of Medicine.
Roubideaux, 46, decided to become a doctor in order to help improve the
quality of healthcare for American Indians. She recalls waiting between
four to six hours to see Indian Health Services physicians as a child.
In a profile by the National Institute on Health, she describes the IHS
system as severely underfunded and understaffed.
Roubideaux provided testimony before the Senate Committee on Indian
Affairs in 2000 for the reauthorization of the Indian Health Care
Improvement Act. Republican lawmakers repeatedly voted against the Act
during the G.W. Bush administration. Leaders in Indian country are
hopeful that Roubideaux’s appointment will lead to the eventual passing
of this legislation.
Roubideaux received her MD from the Harvard
Medical School and a Masters in Public Health from the Harvard School
of Public Health. She also served on President Obama’s transition team.
A recipient of several awards for her work on diabetes and
health policy for American Indians, she was co-editor of the American
Public Health Association’s book, “Promises to Keep: Public Health
Policy for American Indians and Alaska Native in the 21st Century."
One in four Americans live more than an hour away from a hospital with an emergency room equipped to handle a life-threatening situation. A University of Pennsylvania School of Medicine study shows that 71 percent of Americans have access to an emergency department of some kind within 30 minutes, and 98 percent can reach one within an hour. But on a state-by-state basis, the findings suggest that many of those nearby facilities may not be able to provide care for the most emergent conditions.
Most of those living far from the best emergency care reside in rural areas. In South Dakota, for instance, just 13 percent of the population has access within 60 minutes to an emergency department that sees three or more patients per hour; in Montana, only 8 percent do. In Vermont and Main, only half the residents can reach high-volume emergency rooms.
Among possibilities for boosting care quality in rural or other underserved areas, the authors suggest subsidizing rural hospitals or offering incentives for physicians to practice at those facilities, improving interhospital referral networks and identifying hospitals that can specialize in treatment of certain emergent illnesses.
Senators from Iowa and North Carolina say Medicare Advantage is vital for rural communities. But not many rural residents use these plans — and the plans they get are costly and unproven.
The Iowa Independent’s Lynda Waddington began with a story about yet
another rural hospital that will no longer deliver babies. (Pregnant
women in Mitchell County (far northern Iowa) will have to travel
elsewhere for prenatal care and deliveries.)
Iowa’s nursing shortage, low rates of Medicaid reimbursement, and “even
limited rural broadband access” all make it difficult for small
communities to attract and retain doctors, despite some federal
financial incentives.
“The [student] loan forgiveness program, which has been the traditional
way of trying to keep [physicians] in rural areas, has been, for the
most part, a failure,” said Christian Fong of the Generation Iowa
Commission.
Waddington reports that some communities, like Salina, Kansas, are taking a more aggressive “grow your own” approach to medical education.
“You get people who are oriented toward primary care who are from rural
areas,” says Kelley Donham, who teaches rural health at University of
Iowa. “They have to have rural mentors and have a rural experience.”
President Barack Obama has chosen Mary Wakefield (above) to direct the Health Resources and Services Administration, an agency that handles $6.85 billion dollars. Wakefield directs the Center for Rural Health at the University of North Dakota. The Grand Forks Herald published a good biography of the nurse who will be the top advocate for rural health care in the Obama administration.
The agency is charged with helping provide health care to all Americans, particularly the poor, children and pregnant women. The HRSA also helps provide access to health care for rural residents, according to InForum.
InForum reports: "Her first priority, she said, is to disperse the additional $2 billion HRSA will get as part of the economic stimulus package. The second priority, she said, is to help the administration with health care reform. 'I’ll be at Warp 7,' she said. 'I’m not sure my feet will touch the ground.'"
When tobacco was found to be both addictive and unhealthful, it was regulated and the companies agreed not to market to children. Well, how about Mountain Dew?
Dr. Robert Bowman, M.D. describes the broken design of American health care:
physicians are concentrated in locations and careers that fail to serve
the majority and the most urgent medical needs.