November 30, 2018 Edition
The California Legislative Analyst’s Office (LAO) this week released a report, “Taxation of Sugary Drinks,” which examines the purpose of sugar-sweetened beverage (SSB) taxes and key design decisions for the Legislature to consider. Recall, AB 1838 was a budget trailer bill that was passed and signed into law in June 2018 that bans the ability of local jurisdictions to impose taxes on sodas and SSBs until 2031.
The LAO’s report determines SSB taxes have a fiscal purpose (tax revenue) and a policy purpose (health outcomes) and outlines the following considerations:
- Defining the Tax Base – Determining what SSBs to tax and whether to exclude certain drinks (e.g. “diet” drinks, dairy-based drinks, juices)
- Choosing the Type of Tax – Setting taxes based on volume of drink, amount of sugar in drink, or a tiered tax that incorporates both volume and sugar amount
- Establishing an Initial Tax Rate – Setting a statewide SSB tax that would reduce sugary drink consumption
- Adjusting the Tax Rate Over Time – Indexing the tax rate to account for inflation to ensure fiscal and policy effectiveness of the tax over time
- Allocating Tax Revenues – Determining how and where to dedicate tax revenues
Included in the report is an examination of local jurisdiction, state, and federal nonalcoholic drink taxes in the U.S. and abroad. The LAO found that, based on nationwide SSB taxes implemented in places such as Mexico and Chile, a statewide tax of two cents per ounce would likely increase SSB prices by 15 to 25 percent and would likely reduce consumption of those beverages by 15 to 35 percent. The full LAO report is available here.
This week, researchers at UCLA and UC Berkeley released a new study that projects hundreds of thousands more Californians could become uninsured due to federal changes to the Affordable Care Act’s (ACA) individual mandate penalty. Recall, the ACA’s individual insurance coverage mandate tax penalty will be repealed beginning in 2019 as part of the sweeping tax reform measure passed by Congress and signed into law by President Donald Trump last December.
The UCLA-UC Berkeley study utilizes the California Simulation of Insurance Markets (CalSIM) model to determine how may Californians would become uninsured in 2020 and 2023. Researchers determine that without further policy action, the uninsured rate in California could grow between 150,000 to 400,000 people for a total uninsured rate of approximately 11.7 percent in 2020 (approx. 4.0 million people total). By 2023, the uninsured rate could grow between 490,000 and 790,000 people for a total uninsured rate of approximately 12.9 percent (approx. 4.4 million people total). The most substantial enrollment changes are expected to occur in the individual market where enrollment is projected to decline by 10.1 percent in 2020 and 14.4 percent in 2023. These estimates include undocumented Californians who only have restricted-scope Medi-Cal.
Researchers suggest state-based policies that could help California protect the progress made under the ACA in expanding health coverage and reduce remaining coverage gaps. These suggestions include:
- Expand Medi-Cal coverage to all low-income residents regardless of immigration status
- Provide state subsidies to make individual market premiums and out-of-pocket costs more affordable
- Implement a state individual coverage mandate
- Continue to support and strengthen outreach and enrollment efforts
The full UCLA-UC Berkeley policy brief is available here.
The U.S. Centers for Disease Control and Prevention (CDC) National Center for Health Statistics (NCHS) this week released three mortality reports, finding that life expectancy declined for the third consecutive year in 2017. Contributing to the declining life expectancy was an additional 70,000 deaths from overdoses and a 3.7 percent increase in the suicide rate. The three reports and selected key findings are detailed below:
Mortality in the United States, 2017
This report details the final 2017 U.S. mortality data on deaths and death rates by demographic and medical characteristics. In 2017, life expectancy for the U.S. population declined to 78.6 years. Other key findings include:
- Age-specific death rates increased from 2016 to 2017 for age groups 25-34, 35-44, and 85 and over, and decreased for the age group 45-54
- The 10 leading causes of death in 2017 remained the same as in 2016
- The infant mortality rate of 579.3 infant deaths per 100,000 live births in 2017 was not significantly different from the 2016 rate
Drug Overdose Deaths in the United States, 1999-2017
This report finds deaths from drug overdose continue to be a public health burden in the United States. Using the most recent final mortality data from the National Vital Statistics System (NVSS), the report details updated trends in overdose deaths, demographic and geographic patterns, and shifts in types of drugs involved. Other key findings include:
- The age-adjusted rate of drug overdose deaths in 2017 (21.7 per 100,000) was 9.6 percent higher than the rate in 2016 (19.8)
- Adults aged 25-34, 35-44, and 45-54 had higher rates of drug overdose deaths in 2017 than those aged 15-24, 55-64, and 65 and over
- The age adjusted rate of drug overdose deaths involving synthetic opioids other than methadone (drugs such as fentanyl, fentanyl analogs, and tramadol) increased by 45 percent between 2016 and 2017, from 6.2 to 9.0 per 100,000
Suicide Mortality in the United States, 1999-2017
This report details updated trends in suicide mortality from 1999 to 2017 and describes differences by sex, age group, and urbanization level of the decedent’s county of residence. Suicide has ranked as the 10th leading cause of death for all ages in the United States, and suicide became the second leading cause of death for ages 10-34 and fourth leading cause for ages 35-54. Suicide rates have steadily increased in recent years in the U.S. Other key findings include:
- From 1999 to 2017, the age-adjusted suicide rate increased 33 percent from 10.5 to 14.0 per 100,000
- Suicide rates in 2017 were significantly higher for both males and females of all age groups compared with 1999
- In 2017, the age-adjusted suicide rate for the most rural counties was nearly two times the rate for more urban counties
Last week, the U.S. Global Change Research Program (USGCRP) and its 13 federal member agencies released the Congressionally-mandated National Climate Assessment (NCA) which assesses the science of climate change and its impacts across the United States. The comprehensive and extensive report examines 12 different national topic areas on which climate change will have significant impacts, including communities, health, agriculture, water, and the economy.
Specific to public health, the report determines that “impacts from climate change on extreme weather and climate-related events, air quality, and the transmission of disease through insects and pests, food, and water increasingly threaten the health and well-being of the American people, particularly populations that are already vulnerable.” The report includes a comprehensive human health chapter that further examines heat-related illnesses, food-, water-, and vector-borne diseases, and mental health consequences and stress.
The report also examines regional impacts of climate change. California is included in the Southwest chapter, and likely impacts include higher temperatures, rising sea levels, droughts, and wildfire risk. Actions to respond to the historical impacts of climate change and to reduce future environmental risks that are being undertaken by local governments and organizations are featured in the report, as well.
The latest edition of the National Climate Assessment report is available here.
The National Association of County and City Health Officials (NACCHO) is accepting applications for the 2018-2019 Model Practices Program through Wednesday, December 12. The program honors and recognizes outstanding local health initiatives from across the country and shares and promotes these practices among LHDs through the Model Practice Database.
A Model Practices webinar recording which details the application process is available here. More information on the Model Practices Program is available here. Online submissions can be completed here.
The National Association of County and City Health Officials (NACCHO), with support from the U.S. Centers for Disease Control and Prevention (CDC), is accepting proposals for two awards with a maximum of $15,000 each to supplement ongoing climate change and health adaptation initiatives in local health departments. Applicants should have experience working in local initiatives and have current projects in climate and health that would benefit from supplemental funding. Priority will be given to applicants who have experience working with NACCHO on climate-related projects.
Applications are due by Friday, December 14, and applicants will be notified of decisions in early January. Additional information, as well as a link to apply, is available here.
The California Department of Public Health (CDPH) Office of Oral Health (OOH) Evaluation Team will be hosting a webinar on logic models on Wednesday, December 19 from 1:30 pm to 2:30 pm. The webinar will feature the basics and different types of logic models, the benefits and uses of logic models, and how logic models can inform program evaluation, among other topics. Additional information and webinar registration are available here.
The California Alliance for Prevention Funding (CAPF) recently issued a redesigned concept paper. The concept paper’s content has not changed, but the new look more clearly communicates the group’s mission and goals. The redesigned paper is available here.