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California Health Policy

Report received:

Health Insurance: Can Californians Afford It? Jon Gabel, Jeremy Pickreign, and Heidi Whitmore of NORC at the University of Chicago, June 2007, 32 pp., including appendices, http://www.chcf.org/documents/insurance/Affordability07.pdf. Funded by the California HealthCare Foundation (CHCF). Among the report’s findings is that for health maintenance organization (HMO) coverage, “monthly premiums for single coverage among California’s small employers increased 75 percent from 2003 to 2006.” Watson Wyatt Worldwide did the actuarial analysis.

Related resource:

Trends in the Golden State: Small-Group Premiums Rise Sharply While Actuarial Values for Individual Coverage Plummet,” Jon Gabel, Jeremy Pickreign, Roland McDevitt, Heidi Whitmore, Laura Gandolfo, Ryan Lore, and Katy Wilson, Health Affairs Web Exclusive, 14 June 2007, http://content.healthaffairs.org/cgi/content/abstract/hlthaff.26.4.w488. Funded by the CHCF. This article, which is a companion to the CHCF report mentioned above, notes that “California consumers in the small-group and individual markets face financial barriers to health coverage, in large part because of rising health care costs.” The authors say that there has been a “persistent and precipitous increase in underlying health care costs” and suggest that state reform initiatives, such as that proposed by California Gov. Arnold Schwarzenegger (R), “incorporate strategies to confront” this cost growth.

Global Health

Recent funding:

The University of Washington (UW), Seattle, WA. This university has launched its new Institute for Health Metrics and Evaluation, “a new research center that will conduct independent, rigorous evaluations of health programs worldwide,” according to a June 2007 press release. The “goal is to help guide international policymaking by providing high-quality data and analysis on health needs and outcomes, and [by] assessing the performance of health programs.” Chris Murray, a health economist who previously directed Harvard University’s Initiative for Global Health, will direct this UW institute. When it is “fully operational,” the institute will have more than 100 faculty and staff members. Also, it will set up “an international network of collaborating research centers.” Julio Frenk, who is now at the Bill and Melinda Gates Foundation and was the former minister of health of Mexico, will chair “an international board of health experts” that will oversee the institute. Frenk said in the release that the institute will work with the Health Metrics Network (HMN), which is hosted by the World Health Organization. Read more about the HMN in the GrantWatch section of the upcoming Jul/Aug 07 issue of Health Affairs, to be released 16 July 2007, http://www.content/healthaffairs.org/cgi/content/full/26/4/1186.

$105 million. Funded by the Bill and Melinda Gates Foundation.

$20 million. Funded by the University of Washington.

Report received:

Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care, Karen Davis, Cathy Schoen, Stephen C. Schoenbaum, Michelle M. Doty, Alyssa L. Holmgren, Jennifer L. Kriss, and Katherine K. Shea, 16 May 2007 (corrected version), 39 pp., http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=482678. Funded by the Commonwealth Fund. All authors are or were affiliated with the fund. This report focuses on six countries: Australia, Canada, Germany, New Zealand, the United Kingdom, and the United States. Having looked at three Commonwealth surveys conducted in 2004 (Germany was not included in that one), 2005, and 2006, the authors conclude is that “the U.S. health care system ranks last or next-to-last on five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives.” According to the report, however, the United States “does especially well in providing preventive care for its population.” (Prevention measures fall under the “quality” dimension.) The authors say that the 2006 survey of physicians “shows the U.S. lagging in adoption of information technology and use of nurses to improve care coordination for the chronically ill.” The report updates previously released 2004 and 2006 editions of Mirror, Mirror.

Publication to be released 16 July 2007:

Health Affairs Jul/Aug 07 issue, a thematic issue on global health care. Watch for it: On that day, go to http://www.healthaffairs.org/content/vol26/issue4. This issue was funded by the Gates Foundation.

Health Philanthropy

Report received:

Knowledge to Action: Critical Health Issues and the Work of Health Philanthropy over Twenty-five Years, Grantmakers In Health (GIH), February 2007, 176 pp., http://www.gih.org/info-url2678/info-url_show.htm?doc_id=465303. Prepared in celebration of GIH’s twenty-fifth anniversary, this book looks at ten health issues—among them, access to care, HIV/AIDS, mental health, public health, and racial and ethnic disparities in care—and considers “changes in the health sector and in health policy” over this quarter-century “and the work of health foundations in addressing these challenges,” according to the GIH Web site. Each topic’s chapter includes an essay, “fast facts,” and suggestions for further reading. One chapter discusses how health philanthropy itself “has evolved.” The report concedes that “grantmakers continue to grapple with how best to measure a foundation’s overall effectiveness and gauge its impact.” This volume is good for those new to the field of health philanthropy or to grant seeking and is a good summary for those of us who have been following health philanthropy for many years. The report also provides a helpful “Health Milestones 1982–2006” timeline, which lists a number of major events.

Public Health

Recent funding awarded:

Florida Public Health Institute (FPHI), Lantana, FL. This institute, envisioned as “a center for excellence in public health,” according to a 29 May 2007 Palm Beach County Health Department press release, “is well on its way to becoming a reality.” It will be a collaborative effort of the county health department, the State of Florida, the town of Lantana, and community groups. Jean M. Malecki, director of the county health department, was a key player in getting the institute—“a collaborative, community-based, integrated approach to public health that will have long term benefit for the state”—started. Claude Earl Fox, a research professor at the University of Miami’s medical school and a former administrator of the Health Resources and Services Administration (HRSA), was recently named executive director of the institute. He will maintain his affiliation with the university.

The FPHI will be located on some 145 acres of land owned by the State of Florida. The institute’s campus will include “a respiratory hospital, public health clinics, public health laboratories, and educational/administrative space to support the Institute and affiliated academic partners,” according to the FPHI master plan. Also, “excellence is achieved and maintained first through excellent public health patient care,” it explains. “Excellent patient care also creates important public health data that can be used by researchers to seek better ways of disease prevention and control.” Then, in completing a cycle, the results of these data can “be used in improving the education of public health providers.”

Malecki’s staff, working with Fox, applied for and received the grants listed below. The Fostering Emerging Institutes Matching Grant Program is run by the New Orleans–based National Network of Public Health Institutes (NNPHI) and funded by the Robert Wood Johnson Foundation (RWJF). The NNPHI defines a public health institute as “a multi-sector entity able to function as a convener to improve health status and foster innovations in health systems.” This NNPHI program aims “to enhance states’ public health capacity” and help emerging institutes to “operate with heightened efficiency and direction,” according to its Web site. The Fostering Emerging Institutes matching grant, along with the dollars from the Brumback Fund, support core organizational development for the Florida institute. The NNPHI will also provide the FPHI with “technical assistance, which includes mentoring, tools, and resources that will focus on building a sustainable organization,” Erin Bertschy of the NNPHI said.

Most recently, the FPHI received “seed funding” from the Quantum Foundation, according to an 18 June 2007 press release. That grant will support the institute’s core staffing. Quantum’s “leadership sees the FPHI as part of its overall strategy to invest in health-related initiatives that develop coordinated systems of care in the areas of care access, disease prevention, and health promotion.” A Quantum spokesperson explained to Health Affairs, “Our money will serve Palm Beach County,” but the state of Florida “will indeed benefit as we collaborate” with others statewide, and “other regions can duplicate our efforts.”

She said that the FPHI is “already affiliated” with several universities around the state. (These are Florida A&M University, Florida Atlantic University, Florida International University, Nova Southeastern University, University of Miami, University of North Florida, and University of South Florida.) Also, the FPHI is affiliated with the Florida Department of Health and hopes to work with the Pan American Health Organization (PAHO) in the future.

$1,050,000 over three years. Funded by the Quantum Foundation.

$100,000 over two years. Funded by the Brumback Fund. This fund is named for a physician who directed the Palm Beach County Health Department for many years “and is held by the University of Miami for distribution in that county,” the Quantum spokesperson said.

$100,000 over two years. Funded by the RWJF-funded Fostering Emerging Institutes Matching Grant Program.

Substance Abuse Prevention:

Recent report:

Wasting the Best and the Brightest: Substance Abuse at America’s Colleges and Universities, National Center on Addiction and Substance Abuse (CASA) at Columbia University, March 2007, 231 pp., including appendices, notes, and bibliography, http://www.casacolumbia.org/supportcasa/item.asp?cID=12&PID=155. A print copy for $25 may also be ordered at this Web site. The report is funded by the American Legacy Foundation, Sally Engelhard Pingree and the Charles Engelhard Foundation, Hillswood Foundation, Norval Stephens and the Stephens Charitable Trust, National Institute on Drug Abuse (NIDA), two individuals, two universities, and numerous college fraternities and sororities. Members of the commission that produced this report include Nancy Kassebaum Baker, Harvey V. Fineberg, Cheryl G. Healton, Herbert Pardes, Charles A. Sanders, and Louis W. Sullivan. In the introduction to the report, Joe Califano, CASA chairman and president, calls substance abuse “an alarming public health crisis on college campuses” across the United States. He comments, “It is time to take the ‘high’ out of higher education.” This report looks at use of alcohol, controlled prescription drugs, illegal drugs, tobacco, and steroids, as well as “poly-substance use” (using more than one addictive substance at a time); the “increasing consequences of college student substance use and abuse”; possible causes of student substance abuse; and “what colleges should do and are doing to prevent or reduce student substance use.” Part of one section of the report is devoted to prevention of legal liability in instances of substance abuse. The report has recommendations for a variety of stakeholders, including the National Collegiate Athletic Association (NCAA) and federal and state governments. Several of these recommendations have to do with advertising and marketing practices. Among CASA’s recommendations for state governments are to ban smoking on state school campuses, “enforce state substance abuse laws,” and raise taxes on tobacco and alcohol.

Alcohol remains “the main drug of abuse” on campuses, the report says; however, “since the early 1990s, the proportion of students abusing controlled prescription drugs [such as OxyContin and Ritalin] has exploded.” CASA says that colleges should care about substance abuse on campus because it “compromises academic performance”; colleges “have a public health obligation”; and abuse has important “legal implications.” The report also says that “white students are likelier to use and abuse all forms of drugs [including tobacco and alcohol here] than are minority students.” Other interesting findings are that “fraternity or sorority members are likelier than non-members to be . . . binge drinkers” (63.8 percent versus 37.4 percent). (Here, such drinkers are defined as those who have consumed five or more alcoholic beverages at one sitting during the past two weeks.) Also, “the greater a student’s level of religiosity” was, “the less likely the student is to drink, smoke or use other drugs.” CASA’s board members include Columba Bush, Jamie Lee Curtis, David A. Kessler, and Louis Sullivan.

Related resources:

“California Proposition 36: The Substance Abuse and Crime Prevention Act of 2000,” Web site maintained by the Drug Policy Alliance, http://www.prop36.org/.

Evaluation of the Substance Abuse and Crime Prevention Act: Final Report, Darren Urada and Angela Hawken of Integrated Substance Abuse Programs, University of California, Los Angeles (UCLA), released 13 April 2007, 203 pp., including appendices, http://www.adp.ca.gov/PDF/SACPAEvaluationReport.pdf. This evaluation of the fourth year under California’s Proposition 36 was funded by California’s Department of Alcohol and Drug Programs. Prop 36 was approved by voters in the state in November 2000. UCLA’s Web site notes that this “study is timely and of policy significance, as the California governor’s May budget revision [was then] weeks away and the state Legislature is debating the future” funding of the law. Coauthor Darren Urada told Health Affairs 25 June 2007 that the future funding status for Prop 36 is still unknown. He explained that “the California legislature has not yet passed a final statewide budget”; funding for Substance Abuse and Crime Prevention Act activities is a part of that overall budget. A conference committee of the legislature is determining how much funding Prop 36 will get. Urada said that it is his understanding that the total expected to be approved by that panel “should be higher” than what Governor Schwarzenegger proposed. In response to an inquiry from Health Affairs, a staff member with the California Legislative Analyst’s Office confirmed this information on 28 June 2007, but events are evolving, he indicated.

“Is There a College Substance Abuse Crisis?” Maia Szalavitz, Statistical Assessment Service (STATS), 21 March 2007, http://www.stats.org/stories/2007/is_there_college_crisis_mar21_07.htm. See what Szalavitz’s criticisms of the CASA report mentioned above are. STATS is a nonprofit, nonpartisan “resource on the use and abuse of science and statistics in the media.” Located in Washington, D.C., it is an affiliate of George Mason University and is also affiliated with the nonprofit and nonpartisan Center for Media and Public Affairs.

“Meeting Reviews Progress on Prescription Opioid Misuse,” NIDA Notes 21, no. 3, http://www.nida.nih.gov/NIDA_notes/NNvol21N3/BBoard.html. Read in this NlDA publication about a March 2007 meeting on “a growing public health challenge: balancing appropriate pain treatment with efforts to minimize prescription opioid misuse.” NIDA and the American Medical Association cosponsored the meeting in conjunction with the National Institutes of Health Pain Consortium.

“The Promise of Prop. 36,” R. Konrad Moore, San Francisco Chronicle, 23 May 2007, http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2007/05/23/EDGF2PVK7O1.DTL. This opinion piece was written by a supervising deputy public defender for Kern County, California.