March 16, 2018 Edition
The 2018 CHEAC Annual Meeting will be held on October 17 – October 19 in Sacramento and will provide local health department leadership and staff throughout the state with networking and learning opportunities. This year’s conference theme is “Celebrating 30 Years of Improving the Health of All Californians” and will include keynote sessions with guest speakers and additional workshop opportunities to stimulate best practice sharing and discussion around significant issues impacting public health.
We are pleased to announce an opportunity for key organizations to partner with us to strengthen the 2018 CHEAC Annual Meeting. CHEAC Annual Meeting sponsors are recognized for their valuable contribution and are welcome to network with local health department leadership and staff. Additional information on sponsorships is available here.
CHEAC Members are encouraged to circulate this information among their networks and/or pass along any recommended potential sponsors to CHEAC Staff. Further information about this year’s CHEAC Annual Meeting, including speakers, workshop, and registration details, will be provided in the coming months. Feel free to visit our 2018 CHEAC Annual Meeting webpage here.
With one week remaining before its one-week spring recess, the California Legislature continues with its busy spring, amending bills and scheduling and holding policy committee hearings. The CHEAC Legislative Committee met last Friday to review the second batch bills introduced in 2018 and identified nearly 60 new bills that have an impact on public health and local health departments. These new bills are indicated in the latest edition of the CHEAC Weekly Bill Chart.
Below, we highlight actions taken on bills in the Legislature this week:
SB 835 (Glazer) as amended March 5, 2018 – Support
SB 836 (Glazer) as amended March 5, 2018 – Support
Both of Senator Steven Glazer’s tobacco bills were heard in the Senate Natural Resources and Water Committee earlier this week. Recall that last year Senator Glazer’s SB 386 banned smoking and the disposal of cigarette/cigar waste at all state coastal beaches and state parks and was vetoed by Governor Brown who noted the fines in the bill were excessive and there must be limits to the “coercive” power of government. This year, Senator Glazer has split his smoking ban proposals into two bills – SB 835 bans smoking in all state parks and SB 836 bans all smoking on state coastal beaches – and he has reduced the fines for violations in response to the Governor’s veto.
In Committee, most members were generally favorable to the bills although Senator Stone did express some skepticism, particularly on the inclusion of vaping since one of the arguments the Senator and environmental proponents have made is due to cigarette filter litter. Both bills passed out of committee to the Senate Appropriations Committee as amended with clarifying amendments on the use of tobacco for good faith religious practice or for ceremonial purposes.
SB 905 (Wiener) as introduced January 17, 2018 – Watch
Senator Scott Wiener’s SB 905 was heard in the Senate Governmental Organization Committee this week. SB 905 would require the Department of Alcoholic Beverage Control (ABC) to conduct a five-year pilot program to issue additional hour license permits to allow specified bars and nightclubs to remain open until 4:00 am in the cities of Sacramento, Oakland, San Francisco, Los Angeles, West Hollywood, and Long Beach. For one of the six cities to acquire additional hour license permits, local governing boards of cities must convene a task force to study and develop a local plan related to public health and public safety matters.
Recall, Senator Wiener proposed a similar measure last year which would have authorized ABC to issue additional hours permits to any local jurisdiction. This year’s measure significantly limits the jurisdictions and increases reporting requirements.
During this week’s hearing, advocates of the measure highlighted the ability of increased economic development and enhanced nightlife opportunities if bars and nightclubs could remain open until 4:00 am, while opponents raised concerns over increased alcohol consumption and potential for increased drunken driving and injuries. The measure was passed as amended by the Senate Governmental Organization Committee to the Senate Appropriations Committee.
This week, the Assembly Budget Subcommittee No. 1 on Health and Human Services continued to hear budget issues related to public health. Highlights from the discussion are provided below:
Maternal, Child, and Adolescent Health (MCAH). Connie Mitchell, Deputy Director of the California Department of Public Health, the Center for Family Health (the Center) provided members with an overview of the program, including touching on both federal Title V and Title XIX funding. She noted that Title V must be used equally for case management for children with special needs, child adolescent services and maternal health services. Assembly Member Arambula demonstrated an interest in maximizing federal funding for the state and inquired about whether California could draw down more federal funding with an additional investment of state funds.
Women Infants & Children (WIC). Christine Nelson, Chief of the WIC Division provided members with an overview of program activities. She noted trends of participation declining both in California and nationally, though California’s participation rate remains the highest of all. According to CDPH, they have focused their efforts into three groups: 1) retaining active participants – those that are certified and utilize their benefits; 2) re-engaging certified families that are no longer coming back for checks; and 3) recruiting new eligible families.
CDPH also provided an update on the EBT system for WIC and was pleased to announce that they are on track to launch EBT system ahead of scheduled implementation in 2020. The Department will need to replace the 23-year old IT system used at state and local agencies and will be announcing the new vendor within the next few weeks. The selected vendor will use an existing system used in other states, modified for California. According to CDPH, in 2018 they will focus on building the infrastructure for the transition by training WIC and local agency staff. In summer 2019, CDPH will pilot the new system and start services in Solano County. The Department intends to do a tiered rollout throughout the state, which will be staggered for better flow and evaluation of lessons learned. They anticipate the transition to be completed by Spring 2020.
Infant and Early Childhood Home Visiting Program. CDPH provided the Subcommittee with an update of the Infant and Early Childhood Visiting Program, which currently operates in 23 counties in California. Members expressed concern for ensuring the CalWORKS Home Visiting program, which was included in the Governor’s January Budget Proposal would not duplicate efforts that currently exist under the home visiting program overseen by CDPH. CDPH indicated the CalWORKS Home Visiting Program would fall under the oversight of the California Department of Social Services (CDSS), and that there is regular discussion between the two state agencies.
Members were also interested in adverse childhood experiences (ACEs) and touted home visiting as a key tool to address ACEs. Assembly Member Arambula referenced the recent Oprah Interview on 60 Minutes and declared his passion around addressing ACEs.
Hepatitis A. Dr. Gil Chavez, Deputy Director for the CDPH Center for Infectious Disease, recapped activities undertaken to address the hepatitis A outbreak highlighted key lessons learned. He noted a lack of sanitation related to homelessness made the transmission of Hepatitis A more difficult to contain. He further noted that the homeless population is harder to reach and that the delivery of preventive services is difficult and costly. He highlighted local health department efforts that ensured the vaccination was taken into homeless encampments.
STDs. Dr. Karen Smith, Director of CDPH, provided the overview on the departments STD control efforts. She noted rapidly increasing cases of STDs and noted some contributing factors included: increase in substance use disorders, increased occurrences of sex in exchange for money or resources, and meet-ups arranged through online forums.
Dr. Smith noted that despite the one-time increased funding dedicated to STD control, that local jurisdictions do not have sufficient funding to maintain a workforce level that can address the growing trends in STD cases.
Valley Fever. Assembly Member Rudy Salas presented his proposal for $3 million one-time General Fund in 2018-19 to fund research for a vaccine and cure for valley fever through the University of California and $1 million for a statewide public outreach and awareness campaign about symptoms, diagnosis, and treatment of valley fever. He was accompanied by a Representative from Kern Medical Center, who stated valley fever was the most significant disease facing their county, even beyond the flu. A representative from Valley Children’s Hospital spoke to the increasing cases of children with valley fever presenting at their hospitals. He noted that in addition to receiving patients from the Kern, Kings, and Tulare counties, Valley Fever cases were also from the San Joaquin and coastal counties as well.
Assembly Member Vince Fong also came before the Subcommittee to present his proposal for $3 million for a research grant within the California Department of Public Health to fund Valley Fever treatment research and outreach at the Valley Fever Institute at Kern Medical Center. The Institute is the only academic institution that is specifically dedicated to Valley Fever. It provides several treatment options that are not available in other locations throughout the world and the funding would allow the Institute support a Valley Fever repository of samples for research and create education programs to support provider education.
All items were held open by the Subcommittee. For your reference, we are providing a link to the agenda and recording of the hearing.
On Wednesday, the Senate Health Committee and Senate Education Committee held a joint informational hearing on Health Insurance Coverage and Access to Care for College Students. Senator Ben Allen, Chair of the Senate Education Committee, provided opening comments for the hearing, which included aim of the hearing, desire to understand the scope of problem, learn more about the unique needs of the student population, and gain insights to help the committees with policy decisions.
Deborah Kelch, Executive Director for the Insure the Uninsured Project (ITUP), provided members with the landscape of coverage options for students. Her presentation led to discussions around potential gaps in coverage. In particular, Senator Richard Pan raised questions around students with chronic conditions, that may be subject to lifetime limits under their student health insurance and/or whether they are left without access to coverage should their conditions lead to them withdrawing from school.
Jennifer Kent, Director for the Department of Health Care Services (DHCS), and Sarah Brooks, Deputy Director for Health Care Delivery Systems within DHCS, shared information around how Medi-Cal rules impact students. For example, many students may qualify for Medi-Cal under the Medicaid expansion, however since managed care plans vary by county, students may be required to either change their plan or return home for care to avoid out-of-network issues. In addition, she walked through how eligibility is processed when a beneficiary moves to another county. Again, the issue of students with chronic conditions was raised, which led to a discussion around the California Children’s Services (CCS) Program. Director Kent noted options a student with a CCS-eligible condition would be provided and how decisions regarding whether to transfer their care to a different jurisdiction is more complex.
The hearing also included perspectives representing the policy and practices of colleges and universities and health plans. For further information, please reference the hearing agenda and recording.
The Assembly Select Committee on Health Care Delivery Systems and Universal Coverage this week released its final report after holding a series of hearings on the topic between October 2017 and February 2018. Recall last year, Assembly Speaker Anthony Rendon shelved SB 562 (Lara) which would have created a universal health care system in California and instead appointed a Select Committee to study the topic, identify the path forward for universal health coverage in California, and explore strategies for improving the state’s health care delivery system.
After convening a number of experts, scholars, and advocates in health care delivery systems, health policy, and financing, the Assembly Select Committee worked with the University of California, San Francisco (UCSF) to assist in identifying and analyzing components of a sustainable and affordable universal health care system and to develop a report summarizing the Select Committee’s hearings and findings. The report covers major components of California’s health system, including:
- Current sources of health care coverage, care, and payment
- Challenges associated with uninsured and coverage gaps, access and delivery issues, and cost of care
- Options to address coverage gaps, affordability barriers, and fragmentation of care
- Considerations around health care financing and a unified publicly-financed approach
Ultimately, the plan explores and outlines short-term steps for California to improve coverage, affordability, access, fragmentation, and transparency that could be implemented over the next several years. The plan also details a longer-term roadmap for a broader transformation of California’s health care system through unified public financing.
A package of bills related to health care coverage access and affordability has been introduced by the Legislature in 2018, largely as a result of the Assembly Select Committee’s work and this report. The topic is highly likely to continue to garner significant attention in Sacramento and throughout the state as the Legislature attempts to determine the best path forward. The full Assembly Select Committee report is available here.
On Wednesday, the Robert Wood Johnson Foundation (RWJF) and the University of Wisconsin Population Health Institute released the 2018 County Health Rankings which help counties understand what influences the health of residents and their life expectancy. The Rankings are unique in their ability to measure the current overall health of each county in all 50 states given that look at over 30 health-influencing factors that affect the future health of communities, including high school graduation rates, access to healthy foods, rates of smoking, obesity, and teen births.
This year’s Rankings highlights key connections between race and place, finding that segregated communities of color are less likely to be able to access investments that promote good schools, affordable housing, and other opportunities for health. The report also finds that black residents of more segregated counties fare worse in rates of child poverty, infant mortality, and high school graduation than those in less segregated counties.
Other trends noted in this year’s Rankings show increasing rates of children in poverty, increasing rates of babies born at low birthweight, and decreasing rates of teen births. To help address some of these troubling trends, the Rankings website includes a database of nearly 400 evidence-informed strategies that can be used in supporting local health-related agencies and entities in building healthy communities.
Overall, the Rankings serve as a resource for counties and local communities to garner support for local health improvement initiatives among local health departments, healthcare providers, community organizations, business leaders, policymakers, and the public. The 2018 County Health Rankings & Roadmaps are available here.
The Smart Approaches to Marijuana (SAM), a nonprofit organization based in Virginia, and dedicated to a health-first approach to marijuana policy, released a study this week entitled “Lessons Learned from Marijuana Legalization in Four U.S. States and D.C.” The study found that legalized states are leading the nation in past-year use of cannabis in every age group, and young adult use is highest in legalized states. Furthermore, the study found that drugged driving and motor vehicle fatalities have increased in states that have legalized cannabis. SAM recommends policy makers focus on developing the following research efforts and data collection categories:
- Emergency room and hospital admissions related to cannabis;
- Cannabis potency and price trends in the legal and illegal markets;
- School incidents related to cannabis, including representative data sets;
- Extent of cannabis advertising toward youth and its impact;
- Cannabis-related car crashes, including THC levels even when testing positive for alcohol;
- Mental health effects of cannabis;
- Admissions to treatment and counseling intervention programs;
- Cost of implementing legalization from law enforcement to regulators;
- Cost of mental health and addiction treatment related to increased cannabis use;
- Cost of needing but not receiving treatment;
- Effect on the market for alcohol and other drugs;
- Cost to workplace and employers, and impact on employee productivity.
The full report is available here.
On Thursday, FDA Commissioner Scott Gottlieb announced regulatory plans to sharply decrease the amount of nicotine in combustible cigarettes to minimally or non-addictive levels. The ultimate goal of the FDA is a pivotal public health step to reduce the use of cigarettes by millions of regular smokers and prevent millions more from becoming regular smokers in the first place. This move comes as a part of the FDA’s broader comprehensive plan on tobacco and nicotine regulation that was announced last summer.
Thursday’s issuance of an advance notice of proposed rulemaking (ANPRM) regarding nicotine levels is one of the first concrete steps of the FDA’s outlined strategy in reducing and preventing tobacco-related deaths throughout the country. The ANPRM cites a wide range of scientific evidence showing the role nicotine plays in creating and sustaining addiction to cigarettes and seeks comments on key areas related to the development of cigarette product standards and maximum allowable nicotine levels in such products. While the FDA is signaling its progress in regulating nicotine levels through this action, no firm decisions have yet been made and many regulatory factors must still be considered.
The FDA is soliciting public and scientific commentary and feedback on the ANPRM related to nicotine standards through June 14, 2018. The full FDA proposal is available on the U.S. Federal Register.
In a first-of-its-kind study, the U.S. Center for Disease Control and Prevention (CDC) reports that U.S. adults consumed more than 17 billion binge drinks in 2015. CDC researchers found that 1 in 6, or 37 million, U.S. adults drink about once a week, consuming an average of seven drinks per binge. Binge drinking is defined as consuming five or more drinks for men or four or more drinks for women within approximately two hours.
The CDC analyzed data on self-reported binge drinking from the past 30 days from CDC’s 2015 Behavioral Risk Factor Surveillance System (BRFSS). In conducting the study, the CDC also found that more than half of binge drinks consumed each year were by adults ages 35 and older, 4 in 5 total binge drinks were consumed by men, and binge drinkers with lower household incomes and lower educational levels consumed substantially more binge drinks per year than those with higher incomes and educational levels.
In its report, the CDC highlights dangers of binge drinking, including increased risks of cancer, heart disease and liver failure, dangerous driving, violent behavior, and risky sexual behavior. Binge drinking is responsible for more than half of the 88,000 alcohol-attributable deaths and three-quarters of the $249 billion in economic costs associated with excessive drinking. The full CDC report is available here in the latest edition of the American Journal of Preventive Medicine.