Public health advocates are praising the $1 billion for disease prevention and wellness programs included in President Obama's economic stimulus package but say that it is only a fraction of the billions needed to keep the country healthy.
The United States spent about $35 billion a year on disease prevention in 2008, or about $17 per person, according to Jeffrey Levi, executive director of Trust for America's Health, a Washington-based advocacy group. That compares with $2.4 trillion spent on treatment.
According to the ounce-of-prevention argument, spending on the former would help whittle down the latter.
Public health spending covers a wide variety of programs, including inspecting restaurants, tracking tuberculosis cases, providing vaccines, preparing for disasters and promoting exercise and nutrition. Such services are intended to counter, among other things, food poisoning outbreaks, the spread of infectious diseases and the surge in chronic conditions such as obesity and diabetes.
But faced with a financial crisis, local and state governments are cutting public health spending. More than 11,000 public health jobs were eliminated in 2008, Robert M. Pestronk, executive director of the National Assn. of County and City Health Officials, said during a teleconference this morning. That, he said, is the equivalent of two states completely shutting down their public health departments.
The teleconference was called to publicize the release of a report called "Shortchanging America's Health: A State-By-State Look at How Federal Public Health Dollars Are Spent," produced by Trust for America's Health and the Robert Wood Johnson Foundation.
"It's essential that as the country considers ways to reform its health system, we not only think about providing quality healthcare to everyone but that a strong public health program has to be the cornerstone," Pestronk said.
California's Department of Health issued an advisory today about the salmonella outbreak that's been linked to peanut products from a Georgia factory.
Peanut butter cookies and cookie dough that have been distributed by fundraisers at 162 public and private schools in California have been added to the list of recalled products, the department said.
The products were produced by Dough-to-Go Inc. of Santa Clara and distributed in 30 California counties. No illnesses associated with Dough-To-Go peanut butter cookie dough have been reported.
Dr. Mark Horton, director of the Department of Public Health, told consumers not to eat or handle the recalled items.
Dough-to-Go produced frozen peanut butter cookies and frozen peanut butter cookie dough under the Dough-to-Go and Jane Dough labels. The affected products were sold by groups to raise funds from last August to Jan. 16. The food is not part of the school lunch program, state officials said.
A list of schools and fundraising groups affected can be found here. Consumers can also check for the following lot codes printed on the side of the box:
A salmonella outbreak in 43 states linked to peanut butter and peanut paste used in many products, including cookies, might make even an ardent Girl Scout cookie fan hesitate. But the Girl Scouts of the U.S.A., like other organizations, announced that its cookies are safe.
The Girl Scouts bakers did not buy ingredients from the company the federal government says is the source of the salmonella. For more on the cookies, check out the Daily Dish.
Worried less about Joe the Plumber than Josephine the Working Mother, the Economists' Policy Group for Women's Issues put out a report card, grading the presidential candidates' positions on issues that affect women. Made up of a network of 40 economists across the country, the group used information on the candidates' positions drawn from their websites, campaign speeches, past voting records and research on the costs and benefits of specific proposals.
Sen. Barack Obama's grade point average was B, while McCain's GPA was a D.
They were closest on healthcare, where Obama earned a B minus while McCain got a C minus, his highest grade.
Dr. Lois Shaw is a senior consulting economist for the Institute for Women's Policy Research, and formerly was with the U.S. Government Accountability Office and Ohio State University's Center for Human Resource Research. She explained the difference in the healthcare grades at a news conference today.
"Senator McCain’s plan offers a tax credit to offset the cost of buying private insurance or contributing to an employer’s plan. But, insurance companies often deny coverage to those with known health problems, and Senator McCain does not adequately address this problem. We rate Senator McCain’s plan as worth only a C- as the credits offered are not large enough to cover costs for many women. Senator Obama offers a national plan that would make coverage available for all who chose to apply. He would also offer more help than Senator McCain does for those with low and middle incomes. While Senator Obama’s plan stops short of universal coverage for adults, it does mandate universal coverage for children. The Tax Policy Institute estimates that Senator Obama’s plan is likely to achieve more coverage than Senator McCain’s. Still Senator Obama’s plan rates only a B- because, without a universal mandate, younger and healthier adults may decide not to purchase insurance, driving up costs for others."
In a recession, they argue in the report, women and children will have an especially hard time.
"The financial crisis and the threat of severe recession make it particularly important that the next president be cognizant of the problems that women face, and be determined to address those problems. Women of all ages and children will be among those hardest hit by the recession because they already comprise a majority of Americans living in poverty. And women perform a majority of low-wage and unpaid carework in precarious economic circumstances.It is important that the policies taken to deal with economic distress account for the situation and interests of American women and their families."
-- Susan Brink
Graphic: Economists' Policy Group for Women's Issues
Did you know there was a journal called Political Psychology? Well, there is and it's all about exploring the interrelationship between psychology and political processes.
In its October issue, a study in the journal finds that voters from heavily contested battleground states, like Indiana, Ohio and West Virginia, are more confused than voters in states that are strongly red or blue.
The study was based on survey responses from what seems like ancient history, the 2000 contest between George W. Bush and Al Gore. In addition to examining the survey results for that election, from the American National Election Studies, researchers from the University of Michigan conducted 1,800 face-to-face interviews with people who voted in 2000.
What they found was that the more voters were exposed to dueling ads, as candidates concentrated their efforts in the up-for-grabs states, the more ambivalent the voters became.
"In battleground states especially, both candidates will invest a lot of money in television commercials. So people in these states are getting a lot of competing messages from both candidates and that translates into voters in these states wrestling with conflicting ideas," said Luke Keele, in a news release. He is a co-author of the study and assistant professor of political science at Ohio State University. "But if you live in a state that is not competitive, you're probably seeing one-sided messages from a single candidate or few messages at all, so you're less likely to be ambivalent. So the state in which you live can influence your decisions."
With or without a deluge of political ads, ambivalence levels dropped among people who lived in neighborhoods where one candidate dominated. So if you're undecided and there are a lot of McCain signs on your street, or if your block is saturated with Obama signs, you're less likely to waiver, more likely to jump on the locally popular bandwagon, researchers found.
But being swayed, or confused, by an onslaught of political ads is less likely among people who have party ties, or who have already made up their minds.
The ad-producing ambivalence effect is most pronounced on those pesky undecided voters -- folks who at this late stage of the 2008 race are the main targets of political ads.
-- Susan Brink
Upper photo: Ad image provided by McCain campaign. Credit: AP Photo.
Lower photo: Ad image provided by Obama campaign. Credit: AP Photo
Still parsing the health reform plans of Sens. Barack Obama and John McCain? Here's one more useful synopsis, courtesy of NPR's Oct. 20 Day to Day. It features an interview with Trudy Lieberman, head of the graduate journalism program in health and medicine reporting at City University in New York.
(And, of course, you can find lots of links to the candidates' proposals on health insurance in our online guide, here.)
Timing is everything, and as of tonight's debate, the time for abstract messages is over, according to a study from the Journal of Consumer Research. Researchers found that voters facing a choice in the distant future are fond of vague concepts like hope, change, experience and low taxes. And the more uninformed the voter, the happier they are with abstract promises.
But only to a point. In a series of studies with marketing undergraduates, researchers from Canada and the U.S. gave participants a series of statements from fictional candidates, along with a time frame for the fictional election. What they found is that, compared with highly informed potential voters, those who were less informed viewed abstract, high-falutin ideas more favorably when the election was long in the future. But if they thought voting day was getting near, they wanted more specifics, and those least informed were the most antsy for specifics.
Here's how the researchers explained the phenomenon:
"Imagine taking a vacation to Cancun some time in the future. If the vacation is six months away, the traveler is probably thinking about beaches, sunsets, and other abstract information. On the other hand, if the vacation begins the following week, the traveler is thinking about taxi cabs, boarding passes, and specific concrete concerns."
So when it comes to healthcare policy, the New America Foundation has some pretty specific ideas they'd like to see addressed in tonight's debate.
Our struggling healthcare system is hurting U.S. businesses and the American workforce.
We must reduce healthcare costs for every American family.
We must improve the quality of care that patients receive.
Controlling healthcare costs is part of the solution to our entitlement crisis.
Improving our healthcare system is part of a comprehensive economic recovery plan.
"John McCain's plan would be the best. It isn't perfect but at least the insurance would not be handled by the government. We have medicare ins. It is very difficult to get a doctor to accept our insurance even with a supplement because the government is so slow at paying bills and then will pay such a small amount. Doctors can't wait until some gov. office decides to pay the bill. And what sick person can afford to wait for some politician to decide whether the illness should be covered or not and to what extent. No Thanks. Government needs to stay out of people's business. It needs to enable people to make choices, not make them for them."
From "Laura Remson Mitchell:"
"The McCain approach would be a disaster for anybody who has--or ever gets--a major health problem. If you want health care to remain essentially a private rather than a public good, we need *more* regulation, not less. The tax credit promised by McCain would be meaningless without *significant* regulation of private insurance underwriting practices, among other things. What good is the McCain health-care credit if you can't buy the coverage you need at *any* price, much less an affordable one?"
From "Strauss:"
"Obamas Healthcare Plan? McCain's Healtcare Plan ? None of the above will win. Just another campaign promise that will never happen. It never ceases to amaze me that people continue to believe candidates who make promises to get elected and then never keep them. You have a better chance of winning the lottery than getting a national health care plan. Here's a better idea. Start exercising and loose weight and quit taking blood pressure medication. Quit eating junk food and stop tsking cholesterol pills. The US is currently 45 in the world in life expectancy."
There's plenty more of that, and you are welcome to add your comments over there (or here).
The problems within America's healthcare system have been around longer than $4-a-gallon gas, longer than sub-prime mortgages, longer than the war in Iraq, says Dr. Arthur Garson Jr., vice president and provost at the University of Virginia. And they're not going away. That's why he hosted a debate Oct. 1, which you can see on podcast in full, at the university between representatives of the two presidential candidates.
Representing Sen. John McCain's health system reform plan was Dr. William Winkenwerder, former assistant secretary of health for the Department of Defense, while Dr. Irwin Redlener, professor of pediatrics at Columbia University, spoke for Sen. Barack Obama.
Redlener began by saying, "Sen. Obama believes every American should have access to healthcare. We want to get everybody into the system. We want to control costs. And we want to improve quality."
Winkenwerder began by saying, "Cost is the core issue that (Sen. McCain) is concerned about. His vision is a system in which everyone can afford the care and treatment they need."
If that sounds like they're on the same page, they're not.
It'll take you about an hour to listen to the whole debate, with questions and answers from the audience, but if you stick with it, you'll have a good understanding of how each candidate envisions changes to the healthcare system, and what it will mean for you.
When Tommy Thompson scans the horizon, here's what he sees. "The next catastrophe." Thompson is former secretary of Health and Human Services under President George W. Bush, former governor of Wisconsin, and former Republican presidential candidate. He held a conference call with Kenneth Thorpe, former deputy assistant secretary of policy at HHS under President Bill Clinton and now executive director of the Partnership to Fight Chronic Disease. "Healthcare has the potential of being the next calamity," Thompson said.
They're looking for bipartisan solutions to the healthcare mess, the main solution being to prevent chronic diseases such as diabetes, heart disease and obesity in a U.S. population that is seeing epidemics in all three.
Those conditions stay with a person for a long time -- or until death -- once they hit, and chronic diseases eat up 75% of all healthcare costs. That's three-quarters of the total $2.2 trillion spent on healthcare in the United States. That comes to $1.65 trillion, if my online calculator serves me correctly.
That's more than two Wall Street bailouts.
America can't wait for another segment of the economy to collapse before doing something about it, they said. "There's some concern that given the current state of the economy, taking on healthcare might be too much, too big," said Thorpe. "I would argue the opposite. Failure to act on the issue of making healthcare more affordable is a recipe for disaster. This issue is too important to ignore. As wages slow down and the deficits rise, we've got to find places in the public budgets and in the private sector to make healthcare affordable for families and businesses."
They suggest some major redesigns of the system, including the efficiency of electronic medical records (which Thompson says should be government funded to speed up their implementation) and a team approach, using nurses, nurse practitioners and physician assistants, to prevent and control chronic illnesses.
It's too big an issue, they said, to be anything but bipartisan.
Tami Dennis, who takes the word "skeptic" to previously uncharted territory, is the Times' Health and Science editor. She's adamant that pitches promoting awareness days, weeks or months are, by their nature, non-stories. And, because she's an adult, she refuses to use words like "veggies," "tummy" and "yummy."
Rosie Mestel, deputy Health and Science editor, studied genetics before abandoning flies, fungi and DNA for health/medical writing. Her hero is the biologist Ernst Haeckel, whose jellyfish paintings inspired snazzy chandeliers. Her favorite toast-spread is Marmite, a British delicacy made of yeast extract. Her least-favorite word is "millenniums."
Melissa Healy is a staff writer for the Health section reporting from Washington D.C. Healy's a veteran of The Times' National staff, having covered the Pentagon, Congress, poverty and social welfare, the environment, and the White House before shifting to Health in 2003. She writes frequently about mental health and human behavior, about federal health policy, prescription medication and ethics in medicine. More wonk than wellness freak, Healy chooses to believe in the health benefits of coffee and wine, and considers water a better work-out medium than beverage.
Karen Kaplan covers genetics, stem cells and cloning. She and colleague Thomas H. Maugh II comprise about 25% of the unofficial MIT-Alumni-in-Journalism Club, and she is proud to have taken more math (5) than English (0) courses in college. Her contributions to Booster Shots will, she hopes, appear more frequently than postings to her mommy blog.
Thomas H. Maugh II has been a science and medical writer at the Times for 23 years. Before that, he was on the staff of the journal Science for 13 years.
He has bachelor's degrees in English and chemistry from MIT and a doctorate in chemistry from UC Santa Barbara.
After a brief stint as a sports writer, Shari Roan turned to health journalism and has covered the topic for The Times for 18 years. She is the author of three books and the mother of two daughters, both teenagers who refer to her as a "health freak." She likes to jog, watch baseball and is very happy that dark chocolate contains some health benefit.
Jeannine Stein writes about fitness, sports medicine and obesity for the Health section. She’s a gym rat from way back and never met an elliptical trainer she didn’t like. Well, maybe one or two. She tempers exercise with a steady diet of reality television because she believes it’s all about balance.
research on the costs and benefits of specific proposals.
In its October issue, a study in the journal finds that voters from heavily contested battleground states, like Indiana, Ohio and West Virginia, are more confused than voters in states that are strongly red or blue. 
their efforts in the up-for-grabs states, the more ambivalent the voters became.
Those who don't navigate over to our 