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Public Affairs Update

  • Lack of health insurance for millions of Americans causes problems throughout communities . . . . Almost 41 million people in the United States lack health insurance, representing more people than live in the states of Texas, Florida, and Massachusetts combined. The uninsured are more likely to have poorer health and die prematurely than those with insurance. And communities with high rates of people without insurance are more likely to reduce hospital services, divert public resources away from disease prevention and surveillance programs, and reallocate tax dollars to pay for uncompensated medical care, according to A Shared Destiny: Community Effects of Uninsurance, a new report from the Institute of Medicine (IOM). The presence of large numbers of uninsured people can result in reduced access to emergency care, specialty services, and hospital care across the community—even for those having health coverage. The report is the fourth in a series of six examining the consequences of being uninsured for individuals, families, communities, and society as a whole. According to Arthur L. Kellermann, Emory University School of Medicine, co-chair of the Committee on the Consequences of Uninsurance, “…it is both mistaken and dangerous to assume that the prevalence of uninsurance in the United States harms only those who are uninsured. [T]he financial strain of treating large numbers of people without health insurance can hurt the viability of local governments and local health care providers,” reducing access to (or availability of) emergency services and trauma care, specialists, and hospital-based services. The situation ultimately damages a community’s economy. The report assessed existing studies and proposed a research agenda to determine community-level effects. Kellermann claims that the report is “the most complete, evidence-based picture to date of the many adverse effects of uninsurance.…” The report’s four primary conclusions are that (1) Most people are not uninsured by choice but rather because insurance is not offered by their employer or is unaffordable; (2) Insurance contributes to improved health status and outcomes for children and adults and a lack of health insurance results in worse outcomes and greater risk of death; (3) When even one member of a family lacks coverage, it can affect the health and financial well-being of the entire family, including insured members; (4) Uninsurance can adversely affect the financial viability of a community’s health care institutions and providers, particularly emergency medical and trauma care. Public policies to control health care costs have eroded the financial support that allowed subsidization of uncompensated care. Many state, county, and municipal facilities serve as uncompensated providers by default, and public safety-net funding accounts for up to 85 percent of the estimated $34–38 billion in uncompensated care costs incurred by uninsured patients in 2001. To view the report for free, visit www.nap.edu/catalog/10602.html?do_ph31.

  • Presentations from NIH racial/ethnic bias aaans health conference are available . . . . In April 2002, the Office of Behavioral and Social Sciences Research of the National Institutes of Health (NIH) convened a meeting, titled “Racial/Ethnic Bias and Health: Scientific Evidence, Methods, and Research Implications,” of approximately 100 leading scientists to present scientific evidence of the effects of racial/ethnic bias on health and to identify areas for future research to further explicate the relationship. The conference co-chairs (James Jackson, David Williams, Nancy Krieger, and Virginia Cain) and NIH planning committee designed the conference to consider the historical and contextual factors relating to racial/ethnic bias in the United States today, and the evidence relating various forms of bias and the well-documented disparities in health that are found among the various racial/ethnic groups in U.S. society. Papers from the conference are published in the February 2003 American Journal of Public Health (see www.ajph.org/content/vol93/issue2/index.shtml).

  • AAAS President Bloom asserts the value of social and behavioral sciences . . . . Neuroscientist-physician Floyd Bloom, President of the 140,000-member American Association for the Advancement of Science (AAAS), praised the behavioral and social sciences for research that improves health in the United States during his President’s Lecture at the AAAS 2003 annual meeting. He called for a national commission to restore the American health system and said “exemplary social science research—such as the European Whitehall Study and a recent, 25-year follow-up report—should serve as a model for researchers seeking to advance human welfare world-wide through improved medical care. Socially focused research such as the United Kingdom-based Whitehall Study, which investigated correlations between education, status level in the British Civil Service and health outcomes, promise far more immediate advances than the widely anticipated transition to genomics-based health care.” Bloom said that as the world’s largest general scientific society, AAAS will help define the requirements for a U.S. national commission, and ask the President and Congress to create it. The American health care system faces an array of crises, said Bloom, former editor of AAAS’ journal, Science. “The puzzles of better health promotion and disease prevention may be approached more rapidly and effectively through intensified social science research, rather than by awaiting the expected evolution of gene-based explanations and interventions based on future genetic discoveries.” Bloom believes that social science approaches may be especially useful for addressing diseases arising from complex genetic environmental interactions and that effective social science strategies have included public outreach to specific populations at risk for specific disorders and studies of the correlation between various illnesses and socio-economic status, education, occupation, and other factors. To see the complete speech, visit www.aaas.org/news/releases/2003/0213bloom.shtml.