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Listen to Ellen Bayer and Marianne Amoss discuss some of the latest headlines in health care, including child immunization rates, suicide care for veterans, and public health concerns surrounding gas stoves.
Health Affairs This Week places listeners at the center of health policy’s proverbial water cooler. Join editors from Health Affairs, the leading journal of health policy research, and special guests as they discuss this week’s most pressing health policy news. All in 15 minutes or less.
00;00;39;05 - 00;00;48;21
Ellen Bayer
Hello and welcome to another episode of “Health Affairs This Week”, the podcast where Health Affairs editors go beyond the headlines to explore the health policy news of the week. I'm Ellen Bayer.
00;00;49;02 - 00;01;10;27
Marianne Amoss
And I'm Marianne Amoss. So Ellen, 2023 has gotten off to a busy start in the health policy world. There's a lot going on this week. So today we want to talk about several important public health stories that caught our attention. Coverage of emergency suicide care for veterans, the latest on child immunization rates, and growing concern about the health risks of gas stoves.
00;01;11;09 - 00;01;35;12
Ellen Bayer
Before we get started, I just want to mention that yesterday our Editor-In-Chief, Alan Weil, released his picks for the top ten Health Affairs Journal articles of 2022, and that comes after we released the most read Health Affairs Journal articles of last year, as well as the top ten Forefront articles and the top 12 podcast episodes of 2022.
00;01;35;21 - 00;01;59;12
Ellen Bayer
And we'll put a link to all of those in the show notes for today. So first off, there's important news out from the Veterans Administration. Starting this week, veterans can access emergency care for a suicide crisis at no charge. And this includes inpatient care or crisis residential care for up to 30 days and outpatient care for up to 90 days.
00;01;59;25 - 00;02;29;27
Ellen Bayer
And veterans don't have to be enrolled in the VA system to use the benefit. In this policy is a final rule to implement part of the Veterans’ COMPACT Act, and that's short for the Veterans Comprehensive Prevention Access to Care and Treatment Act that became law in late 2020. And among other things, the VA will pay for veterans emergency suicide care, related transportation costs, and follow up care at a VA or non-VA facility.
00;02;30;19 - 00;02;44;06
Ellen Bayer
Other provisions of the COMPACT Act include requirements to improve the transition from the military to VA services, conduct outreach to at-risk veterans and improve care and services for female veterans.
00;02;44;19 - 00;03;12;02
Marianne Amoss
It's worth noting that the VA has named suicide as its top clinical priority for FY (Fiscal Year) 2018 to FY 2024, and in the past year, the VA has conducted a number of outreach efforts, including promoting the national Toll-Free 988 number for the Suicide and Crisis Lifeline and conducting a public outreach campaign on firearm suicide prevention, as well as a national veteran suicide prevention awareness campaign,
00;03;12;03 - 00;03;13;09
Marianne Amoss
“Don't wait. Reach out.”
00;03;14;06 - 00;03;24;09
Ellen Bayer
In other public health news this week, I noticed that there are new data out from the CDC showing that routine child immunizations went down again last year. Can you say a bit about that?
00;03;24;22 - 00;03;58;04
Marianne Amoss
Yeah, that's right, Ellen. So last Friday, the CDC released new data on vaccination coverage among kindergartners for the 2021-2022 school year. They found that approximately 93% of kindergarten children nationwide had received vaccines for measles, mumps and rubella, known as MMR; diphtheria, tetanus and pertussis, known as DTaP; and polio and varicella. So that 93% is lower than the 94% reported during the 2020-2021 school year that we discussed in an episode of This Week last spring.
00;03;58;21 - 00;04;04;06
Marianne Amoss
And it's even lower than the 95% reported during the 2019-2020 school year.
00;04;04;26 - 00;04;29;28
Ellen Bayer
So a two percentage point drop over two years might not seem like that much, but of course that translates into hundreds of thousands of children, and clusters of unvaccinated and under-vaccinated children can lead to outbreaks of preventable diseases. In fact, there's an ongoing outbreak of measles in Ohio right now, mostly among unvaccinated children. So, Marianne, what are some of the reasons for this trend?
00;04;30;17 - 00;04;57;29
Marianne Amoss
Several of them are related to COVID. For one, we're seeing low levels of trust in the FDA, the CDC and other key public health agencies, as well as less willingness to follow public health policies. Also, pandemic lockdowns and supply chain disruptions contributed to children missing routine vaccinations. And since many children weren't physically going to school in 2020 and 2021, they didn't have to meet school vaccination requirements.
00;04;58;20 - 00;05;28;19
Marianne Amoss
Plus, some children have been given exemptions from vaccination. Most states allow religious and medical exemptions and a growing number grant personal or philosophical exemptions as well. And there seems to be growing public support for exemptions in the last few years, according to recent national surveys. The Kaiser Family Foundation’s COVID vaccine monitor survey that came out in December asked adults whether parents should be able to opt out of vaccinating their school age children, even if doing so creates health risks for others.
00;05;29;04 - 00;05;40;15
Marianne Amoss
28% of adults said yes, parents should be able to opt out. And this is a big jump up from the 16% of adults that felt this way in 2019. So this is definitely an issue to keep an eye on.
00;05;41;03 - 00;05;52;03
Ellen Bayer
And finally, on the theme of public health, a topic that's gotten a lot of attention in the last few weeks, even though it's not actually a new issue, is concern about health risks from gas stoves.
00;05;52;10 - 00;06;17;18
Marianne Amoss
Yep. And even though it's been top of mind in the last few weeks, data on health risks from gas stoves has been out there for quite some time now. The bottom line is that gas stoves have been found to be a significant source of indoor air pollution, including nitrogen dioxide, which is a chemical that creates health risks, most notably for asthma among children, as well as increased risk of asthma related hospital admissions for older adults.
00;06;18;09 - 00;06;32;19
Marianne Amoss
A key issue here is ventilation. So if ventilation to the outside is correctly installed, it generally can reduce the health risks. But gas stoves in most households today typically don't vent to the outside, since there are no requirements that they do.
00;06;33;18 - 00;06;55;28
Ellen Bayer
And there are some equity issues here. Low income households and communities of color are disproportionately affected because of the longstanding history of housing discrimination. In these communities, there are more people living in rental homes with less ventilation, no option to choose another kind of stove and also more exposure to outdoor air pollution. So really compounding the risks.
00;06;56;20 - 00;07;24;02
Marianne Amoss
And ventilation doesn't completely take care of the issue of pollution from gas stoves because even when they're not being used, gas stoves can still emit the greenhouse gas methane, which is harmful to the environment. And right now there are no national indoor air pollution standards in this country. Some jurisdictions have established building codes that require installation of electric appliances and new construction, but otherwise indoor air pollution is not regulated at state or local levels.
00;07;24;24 - 00;07;48;02
Ellen Bayer
So the issue really started getting big headlines last week when one of the commissioners of the U.S. Consumer Product Safety Commission made a statement in an interview that many people interpreted to suggest that the commission was thinking about banning gas stoves. And then the uproar that resulted led the head of the agency to walk it back with a clarification stating that the agency is not planning to ban gas stoves.
00;07;48;14 - 00;08;08;17
Ellen Bayer
Instead, he said the Consumer Product Safety Commission is doing research on emissions from gas stoves and looking at new ways to address health risks, as well as working on strengthening voluntary safety standards. In the spring of this year, they will be looking for public comments on gas stove emissions and potential solutions to reduce the risks.
00;08;08;17 - 00;08;48;05
Marianne Amoss
And given the growing evidence of the risks, the American Public Health Association approved a policy statement in November 2022 that's now publicly available. It includes multiple recommendations, such as calling on the U.S. Environmental Protection Agency to set indoor air quality guidelines for all indoor residential settings, asking the Consumer Product Safety Commission to set mandatory or voluntary performance standards for gas stoves and range hoods and to launch a public awareness campaign, and calling on Housing and Urban Development to adopt policies with preferences for installing electric appliance in new and retrofitted buildings that are federally funded.
00;08;48;23 - 00;08;52;10
Marianne Amoss
These are just a few of the recommendations, and we'll put a link in the show notes.
00;08;52;27 - 00;09;02;27
Ellen Bayer
Also, it's worth noting that the Inflation Reduction Act that became law last year provides funding to states for consumer rebates on electric and induction stovetops.
00;09;03;08 - 00;09;06;18
Marianne Amoss
And I wish I had known about that before I bought my new gas stove last year.
00;09;06;29 - 00;09;13;06
Ellen Bayer
So I'm sure there'll be more to come on that story, so, we'll have to keep a close watch on it in the coming months. I think we'll have to leave it there for today.
00;09;13;17 - 00;09;23;27
Marianne Amoss
Thanks so much to our listeners for joining us. Please leave us a review, and if you liked the show, please tell a friend and subscribe to “Health Affairs This Week” wherever you get your podcasts. Thanks, Ellen.
00;09;24;12 - 00;09;33;05
Ellen Bayer
Thanks, Marianne.