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US Surgeon General Declares Gun Violence ‘a Public Health Crisis’

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Rachana Pradhan and Fred Clasen-
Tue, 25 Jun 2024 09:00:00 +0000

U.S. Surgeon General Vivek Murthy declared firearm violence a public health crisis, as gun deaths and injuries punctuate life in America.

On nearly every day of 2024 so far, a burst of gunfire has hit at least four people somewhere in the country. Some days, communities have endured four or five such shootings.

The nation's top doctor called on policymakers to consider gun safety measures such as bans on assault weapons and high-capacity ammunition magazines and universal background checks for all firearm purchases. His advisory also urges a “significant increase” in for research on gun injuries and deaths, as well as greater access to mental health care and trauma-informed resources for people who have experienced firearm violence.

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In 2022, more than 48,000 people were killed by guns in the U.S., or about 132 people a day, and suicides accounted for more than half of those deaths, according to data from the Centers for Disease Control and Prevention. An additional 200-plus Americans seek emergency care for firearm injuries each day, according to estimates from Johns Hopkins research. No federal database records nonfatal gun injuries.

The Office of the Surgeon General does not set or carry out gun policy, but historically its reports and warnings have nudged policymakers and lawmakers to act.

Murthy, a physician, told KFF Health he hoped to convey the broader toll of gun violence on the nation and the need for an urgent public health response. He cited soaring gun deaths among and and noted that “the mental health toll of firearm violence is far more profound and pervasive than many of us recognize.”

“Every day that passes we lose more kids to gun violence,” Murthy said, “the more children who are witnessing episodes of gun violence, the more children who are shot and survive that are dealing with a lifetime of physical and mental health impacts.”

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Firearm-related homicides over the past decade and suicides over the past two decades have driven the sharp rise in gun deaths, the advisory says.

Guns are the leading cause of death for children and teens, with higher death rates among Black and Hispanic youths. Researchers from Boston University found that during the height of the covid pandemic, Black children were 100 times as likely as white children to experience gun injuries. Hispanic and Asian children also saw major increases in firearm assault injuries during that time, that study showed.

Joseph Sakran, executive vice chair of surgery at John Hopkins Hospital in Baltimore and chief medical officer for Brady United Against Gun Violence, said the surgeon general's declaration is a “historic moment that sounds the alarm for all Americans.”

But Sakran added: “It cannot stop here. We have to use this as another step in the right direction. No one wants to see more children gunned down.”

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Murthy has long said gun violence should be framed as a health issue. He argued that the approach has been successful in combating significant societal problems, citing tobacco control efforts that took hold following the then-surgeon general's landmark 1964 report concluding that smoking cigarettes causes lung cancer and other diseases.

“We saved so many lives, and that's what we can do here, too,” Murthy said.

Murthy's move is one of several recent Biden administration actions designed to combat gun violence, as most gun-related measures remain political nonstarters in . Federal officials have allowed states to use Medicaid dollars to pay for gun violence prevention, and the White House has called on hospital executives and doctors to gather more data about gunshot injuries and to routinely counsel about the safe use of firearms.

While available data points to tragic outcomes across American communities, government officials and public health researchers have long been stymied by sparse federal funding devoted to gun violence research and the scope of its health effects.

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“I've been studying gun violence for about 33 years now and there's still some really basic and fundamental questions I can't answer,” said Daniel Webster, a gun violence researcher at Johns Hopkins University.

“To really understand gun violence, you need to do more than just look at publicly available surveillance data,” he said. “You need to actually do in-depth studies involving the populations at highest risk for shooting or being shot.”

A Brady analysis found that of the 15 leading causes of death in the U.S., firearm injuries received the third-lowest amount of federal research funding through the National Institutes of Health for each person who died. The only causes of death that garnered less research funding through NIH were poisonings and falls, according to the analysis.

Sonali Rajan, an adjunct associate professor of epidemiology at Columbia University who researches the effects of gun violence on children, said political leaders and others need to reframe the debate on gun violence from crime to public health.

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“We are raising a whole generation of children for whom exposure to gun violence is normal,” Rajan said.

In Michigan, “we had a kid survive the Oxford High School shooting only to go to Michigan State University and see another mass shooting,” she said. “It is unbelievably shameful.”

Serving as President Joe Biden's surgeon general since 2021, Murthy has, at times, caused political controversy with his views on gun violence.

Over a decade ago, former President Barack Obama nominated Murthy to be the nation's top doctor. But Murthy's support for a federal ban on the sale of assault weapons and ammunition and additional restrictions on gun purchases drew the ire of the National Rifle Association, as well as Republicans and some Democrats in Congress. The U.S. Senate narrowly confirmed Murthy to the job in December 2014, more than a year after his nomination.

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Murthy has previously issued advisories on social isolation and loneliness, youth mental health, and the well-being of health workers. He said gun violence comes up in many of his conversations with young people about the mental health challenges they're facing.

“Fears around gun violence have really pervaded so much of the psyche of America in ways that are very harmful to our mental health and well-being,” Murthy said.

Many other causes of death are treated differently as to understanding the problems and developing , Webster said. But “that's generally not what we've done with gun violence. We've oversimplified it and overpoliticized it.”

As Sakran put it: “As we look at firearm injuries, there's arguably no public issue that's as urgent.”

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——————————
By: Rachana Pradhan and Fred Clasen-Kelly
Title: US Surgeon General Declares Gun Violence ‘a Public Health Crisis'
Sourced From: kffhealthnews.org/news/article/gun-violence-us-surgeon-general-vivek-murthy-public-health-crisis/
Published Date: Tue, 25 Jun 2024 09:00:00 +0000

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Despite Past Storms’ Lessons, Long-Term Care Residents Again Left Powerless

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Sandy
Mon, 15 Jul 2024 19:11:05 +0000

HOUSTON — As Tina Kitzmiller sat inside her sweltering apartment, windows and doors open in the hope of catching even the slightest breeze, she was frustrated and worried for her dog and her neighbors.

It had been days since Hurricane Beryl blew ashore from the Gulf of Mexico on July 8, causing widespread destruction and knocking out power to more than 2 million people, including the Houston senior independent living facility where Kitzmiller lives. Outdoor temperatures had reached at least 90 degrees most days, and the heat inside the building was stifling.

Kitzmiller moved there not long ago with Kai, her 12-year-old dog, shortly after riding out 90-plus-mph winds from a May derecho under a comforter on the floor of the 33-foot RV she called home. She didn't need medical care, as a nursing home would offer, and thought she and Kai could be safer at an independent senior facility than in the RV. She assumed her new home would have an emergency power system in place at least equivalent to that of the post offices she'd worked in for 35 years.

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“I checked out the food. I checked out the activities,” said Kitzmiller, 61, now retired. “I didn't know I needed to inquire about a generator.”

Even after multiple incidents of extreme weather — including a 2021 Texas winter storm that caused widespread blackouts and prompted a U.S. Senate investigation — not much has changed for those living in long-term care facilities when natural disasters strike in or elsewhere.

“There has been some movement, but I think it's been way too slow,” said David Grabowski, a professor of health care policy at Harvard Medical School. “We keep getting tested and we keep failing the test. But I do think we are going to have to face this issue.”

A power outage can be difficult for anyone, but older adults are especially vulnerable to temperature extremes, with medications or medical conditions affecting their bodies' ability to regulate heat and cold. Additionally, some medications need refrigeration while others cannot get too cold.

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Federal guidelines require nursing homes to maintain safe indoor temperatures but do not regulate how. For example, facilities face no requirement that generators or other alternative energy sources support heating and conditioning . States are largely responsible for compliance, Grabowski said, and if states are failing in that regard, change doesn't happen.

Furthermore, while nursing homes face such federal oversight, lower-care-level facilities that provide some medical care — known as assisted living — are regulated at the state level, so the rules for emergency preparedness vary widely.

Some states have toughened those guidelines. Maryland adopted rules for generators in assisted living facilities following Hurricane Isabel, which left more than 1.2 million residents in the state without power in 2003. Florida did so for nursing homes and assisted living facilities in 2018, after Hurricane Irma led to deaths at one facility.

But Texas has not. And no requirements for generators exist in Texas for the roughly 2,000 assisted living facilities or the even less regulated independent living sites, like Kitzmiller's.

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Generally, apartment complexes marketed to senior citizens, known in the industry as independent living facilities, don't have any special regulations in Texas and many other states.

Nationally, assisted living facilities and independent living facilities have been the fastest-growing sectors in senior living. Residents at such facilities often have medical needs, Grabowski said, but for a variety of reasons have chosen to in an environment that allows more independence than a nursing home, which would provide medical care. That doesn't mean the residents in these lower-care-level facilities are any less susceptible to extreme temperatures when the power goes out.

“If you're overwhelmed by the heat in your apartment, that's unsafe,” he said.

Republican state Rep. Ed Thompson tried several times since 2020 to pass legislation requiring assisted living facilities in Texas to have backup generators. But the bills failed. He is not seeking reelection this year.

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“It's horrible what the state of Texas is doing,” said Thompson, blaming corporate greed and politicians more interested in stirring up their base and raising their national profile than improving the lives of Texans. “How we treat our elderly says something about us — and they're not being treated right.”

Nim Kidd, chief of the Texas Division of Emergency Management, said at a July 11 press conference that senior facility operators are accountable if they do not keep residents safe. “That location is responsible for the health, safety, and welfare of the and residents that are there,” he told reporters. “It is that facility's responsibility.”

Under Texas law, power restoration is supposed to be prioritized for nursing, assisted living, and hospice facilities.

The resistance to adding oversight or more governmental protections has not surprised Gregory Shelley, a senior manager at the Harris County Long-Term Care Ombudsman Program at UTHealth Houston's Cizik School of Nursing. He said that while he believes the safety and health of residents are paramount, he recognizes that installing generators is expensive. He also said some people within the industry continue to believe extreme are rare.

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“But all of us in Houston this year already learned that they're happening more frequently,” Shelley said. “This is already the third time since May that big portions of Houston have been without power for long periods of time.”

After the 2021 blackouts, Texas' Health and Human Services Commission conducted a voluntary survey that found 47% of the assisted living and 99% of the nursing care facilities that responded reported generators.

The U.S. Senate investigation following the 2021 Texas storm recommended a national requirement that assisted living facilities have emergency power supplies to both maintain safe temperatures and keep medical equipment running.

A 2023 annual report from Texas' long-term care ombudsman, Patty Ducayet, also recommended requiring generators at assisted living centers. The report suggested that all long-term care facilities maintain safe temperatures in a location that can be accessed by every resident. The report recommended requiring assisted living facilities to annually submit emergency response plans to state regulators to be reviewed by state officials. The recommendations have not been adopted.

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On July 15 — more than a after Beryl hit — Kitzmiller said she just wanted the power back on. She praised the staff at her facility but said she worried for residents who were isolated on her building's second and third floors, which were hotter amid the outage. Some were unable to keep required medicine refrigerated, she said. And without functioning elevators, many couldn't get to the first floor, where it was cooler.

Mostly, Kitzmiller said, she was frustrated with companies and politicians who hadn't yet fixed the problem.

“It's their mothers, their grandmothers, and their family in these homes, these facilities,” she said. “All I can think is ‘Shame on you.'”

——————————
By: Sandy West
Title: Despite Past Storms' Lessons, Long-Term Care Residents Again Left Powerless
Sourced From: kffhealthnews.org//article/texas-blackouts-nursing-homes-long-term-care-disaster-preparedness-power-outage-generators/
Published Date: Mon, 15 Jul 2024 19:11:05 +0000

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5 Cases of Bird Flu Reported in Colorado Poultry Workers, Doubling This Year’s US Tally

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Amy Maxmen
Mon, 15 Jul 2024 17:26:21 +0000

Five people who work at a poultry farm in northeastern Colorado have tested positive for the bird flu, the Colorado public health department reported July 14. This brings the known number of U.S. cases to nine.

The five people were likely infected by chickens, which they had been tasked with killing in response to a bird flu outbreak at the farm.

More than 99 million chickens and turkeys have been infected with a highly pathogenic strain of the bird flu that emerged at U.S. poultry farms in early 2022. Since then, the federal has compensated poultry farmers more than $1 billion for destroying infected flocks and eggs to keep outbreaks from spreading.

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The H5N1 bird flu virus has spread among poultry farms around the world for nearly 30 years. An estimated 900 people have been infected by birds, and roughly half have died from the disease.

The virus made an unprecedented shift this year to dairy cattle in the U.S. This poses a higher threat because it means the virus has adapted to replicate within cows' cells, which are more like human cells. The four other people diagnosed with bird flu this year in the U.S. worked on dairy farms with outbreaks.

Scientists have warned that the virus could mutate to spread from person to person, like the seasonal flu, and spark a pandemic. There's no sign of that, yet.

So far, all nine cases reported this year have been mild, consisting of eye irritation, a runny nose, and other respiratory symptoms. However, numbers remain too low to say anything certain about the disease because, in general, flu symptoms can vary among people with only a minority needing hospitalization.

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The number of people who have gotten the virus from poultry or cattle may be higher than nine. The Centers for Disease Control and Prevention has tested only about 60 people over the past four months, and powerful diagnostic laboratories that typically detect diseases remain barred from testing. Testing of farmworkers and animals is needed to detect the H5N1 bird flu virus, study it, and stop it before it becomes a fixture on farms.

Researchers have urged a more aggressive response from the CDC and other federal agencies to prevent future infections. Many people exposed regularly to livestock and poultry on farms still lack protective gear and education about the disease. And they don't yet have permission to get a bird flu vaccine.

Nearly a dozen virology and outbreak experts recently interviewed by KFF Health News disagree with the CDC's against vaccination, which may prevent bird flu infection and hospitalization.

“We should be doing everything we can to eliminate the chances of dairy and poultry workers contracting this virus,” said Angela Rasmussen, a virologist at the of Saskatchewan in Canada. “If this virus is given enough opportunities to jump from cows or poultry into people, it will eventually get better at infecting them.”

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To understand whether cases are going undetected, researchers in Michigan have sent the CDC blood samples from workers on dairy farms. If they detect bird flu antibodies, it's likely that people are more easily infected by cattle than previously believed.

“It's possible that folks may have had symptoms that they didn't feel comfortable , or that their symptoms were so mild that they didn't think they were worth mentioning,” said Natasha Bagdasarian, chief medical executive for the of Michigan.

In hopes of thwarting a potential pandemic, the United States, United Kingdom, Netherlands, and about a dozen other countries are stockpiling millions of doses of a bird flu vaccine made by the vaccine company CSL Seqirus.

Seqirus' most recent formulation was greenlighted last year by the European equivalent of the FDA, and an earlier version has the FDA's approval. In June, Finland decided to offer vaccines to people who work on fur farms as a precaution because its mink and fox farms were hit by bird flu last year.

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The CDC has controversially decided not to offer at-risk groups bird flu vaccines. Demetre Daskalakis, director of the CDC's National Center for Immunization and Respiratory Diseases, told KFF that the agency is not recommending a vaccine campaign at this point for several reasons, even though millions of doses are available. One is that cases still appear to be limited, and the virus isn't spreading rapidly between people as they sneeze and breathe.

The agency continues to rate the public's risk as low. In a statement posted in response to the new Colorado cases, the CDC said its bird flu recommendations remain the same: “An assessment of these cases will help inform whether this situation warrants a change to the human health risk assessment.”

——————————
By: Amy Maxmen
Title: 5 Cases of Bird Flu Reported in Colorado Poultry Workers, Doubling This Year's US Tally
Sourced From: kffhealthnews.org/news/article/five-bird-flu-cases-colorado-poultry-workers-virus-spread/
Published Date: Mon, 15 Jul 2024 17:26:21 +0000

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California Health Care Pioneer Goes National, Girds for Partisan Skirmishes

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Samantha Young
Mon, 15 Jul 2024 09:00:00 +0000

SACRAMENTO — When then-Gov. Arnold Schwarzenegger called for nearly all Californians to buy health insurance or face a penalty, Anthony Wright slammed the 2007 proposal as “unwarranted, unworkable, and unwise” — one that would punish those who could least afford coverage. The head of Health Access California, one of the 's most influential consumer groups, changed course only after he and his allies extracted a deal to increase subsidies for people in need.

The plan was ultimately blocked by Democrats who wanted the state to adopt a single-payer health care system instead. Yet the moment encapsulates classic Anthony Wright: independent-minded and willing to compromise if it could Californians live healthier lives without going broke.

This summer, Wright will assume the helm of the health consumer group Families USA, taking his campaign for more affordable and accessible health care to the national level and a deeply divided Congress. In his 23 years in Sacramento, Wright has successfully lobbied to outlaw surprise medical billing, require companies to report drug price increases, and cap hospital bills for uninsured patients — policies that have spread nationwide.

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“He pushed the envelope and gave people aspirational leadership,” said Jennifer Kent, who served as Schwarzenegger's head of the Department of Health Care Services, which administers the state Medicaid program. The two were often on opposing sides on health policy issues. “There was always, like, one more thing, one more goal, one more thing to achieve.”

Recently, Wright co-led a coalition of labor and immigrant rights activists to comprehensive Medicaid to all eligible California regardless of immigration status. The state funds this coverage because the federal government doesn't allow it.

His wins have come mostly under Democratic governors and legislatures and when Republican hasn't been needed. That will not be the case in Washington, D.C., where Republicans currently control the House and the Senate Democratic Caucus has a razor-thin majority, which has made it extremely difficult to pass substantive legislation. November's elections are not expected to ease the partisan impasse.

Though both Health Access and Families USA are technically nonpartisan, they tend to align with Democrats and lobby for Democratic policies, including rights. But “Anthony doesn't just to his own people,” said David Panush, a veteran Sacramento health policy consultant. “He has an ability to connect with people who don't agree with you on everything.”

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Wright, who interned for Vice President Al Gore and worked as a consumer advocate at the Federal Communications Commission in his 20s, acknowledges his job will be tougher in the nation's capital, and said he is “wide-eyed about the dysfunction” there. He said he also plans to work directly with state lawmakers, including encouraging those in the 10, mostly Republican states that have not yet expanded Medicaid under the Affordable Care Act to do so.

In an interview with California Healthline senior correspondent Samantha Young, Wright, 53, discussed his accomplishments in Sacramento and the challenges he will face leading a national consumer advocacy group. His remarks have been edited for length and clarity.

Q: Is there something California has done that you'd like to see other states or the federal government adopt?

Just saying “We did this in California” is not going to get me very far in 49 other states. But stuff that has already gone national, like the additional assistance to buy health care coverage with state subsidies, that became something that was a model for what the federal government did in the American Rescue Plan [Act] and the Inflation Reduction Act. Those additional tax credits have had a huge impact. About 5 million Americans have coverage because of them. Yet, those additional tax credits expire in 2025. If those tax credits expire, the average premium will spike $400 a month.

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Q: You said you will find yourself playing defense if former President Donald Trump is elected in November. What do you mean?

Our health is on the ballot. I worry about the Affordable Care Act and the protections for preexisting conditions, the help for people to afford coverage, and all the other consumer patient protections. I think reproductive health is obviously front and center, but that's not the only thing that could be taken away. It could also be something like Medicare's authority to negotiate prices on prescription drugs.

Q: But Trump has said he doesn't want to repeal the ACA this time, rather “make it better.”

We just need to look at the record of what was proposed during his first term, which would have left millions more people uninsured, which would have spiked premiums, which would have gotten rid of key patient protections.

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Q: What's on your agenda if President Joe Biden wins reelection?

It partially depends on the makeup of Congress and other elected officials. Do you extend this guarantee that nobody has to spend more than 8.5% of their income on coverage? Are there benefits that we can actually improve in Medicare and Medicaid with regard to vision and dental? What are the cost drivers in our health system?

There is a lot we can do at both the state and the federal level to get people both access to health care and also financial security, so that their health emergency doesn't become a financial emergency as well.

Q: Will it be harder to get things done in a polarized Washington?

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The dysfunction of D.C. is a real thing. I don't have delusions that I have any special powers, but we will try to do our best to make progress. There are still very stark differences, whether it's about the Affordable Care Act or, more broadly, about the social safety net. But there's always opportunities for advancing an agenda.

There could be a lot of common ground on like health care costs and having greater oversight and accountability for quality in cost and quality in value, for fixing market failures in our health system.

Q: What would happen in California if the ACA were repealed?

When there was the big threat to the ACA, a lot of people thought, “Can't California just do its own thing?” Without the tens of billions of dollars that the Affordable Care Act provides, it would have been very hard to sustain. If you get rid of those subsidies, and 5 million Californians lose their coverage, it becomes a smaller and sicker risk pool. Then premiums spike up for everybody, and, basically, the market becomes a death spiral that will nobody, healthy or sick.

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Q: California expanded Medicaid to qualified immigrants living in the state without authorization. Do you think that could happen at the federal level?

Not at the moment. I would probably be more focused on the states that are not providing Medicaid to American citizens [who] just happen to be low-income. They are turning away precious dollars that are available for them.

Q: What do you take away from your time at Health Access that will help you in Washington?

It's very rare that anything of consequence is done in a year. In many cases, we've had to run a bill or pursue a policy for multiple years or sessions. So, the power of persistence is that if you never give up, you're never defeated, only delayed. Prescription drug price transparency took three years, surprise medical bills took three years, the hospital fair-pricing act took five years.

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Having a coalition of consumer voices is important. Patients and the public are not just another stakeholder. Patients and the public are the point of the health care system.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

——————————
By: Samantha Young
Title: California Health Care Pioneer Goes National, Girds for Partisan Skirmishes
Sourced From: kffhealthnews.org/news/article/anthony-wright-qa-families-usa-health-policy/
Published Date: Mon, 15 Jul 2024 09:00:00 +0000

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