This public health series uses influenza as a common illness to explore the intersection between public health, policy and politics, and today, we're going to talk a bit about children's health insurance (SCHIP) and smoking. For your weekly seasonal flu update go here or here. Connecticut is peaking and beginning to drop, but the occasional flu case can be deadly. From CDC:
Six influenza-associated pediatric deaths were reported to CDC during week 6 (Arkansas, Colorado, Florida, North Carolina , and Pennsylvania). One death occurred during week 8 of the 2006-07 season (week ending February 24, 2007), bringing the total number of reported pediatric deaths occurring during that season to 78. The remaining five deaths reported this week occurred between January 25 and February 14, 2009. Since September 28, 2008, CDC has received nine reports of influenza-associated pediatric deaths that occurred during the current season.Staph infections and bacterial co-infections in general are always a threat with flu... reports from 1918 suggest bacterial co-infection was a major source of mortality. However, in a pandemic, even if this is the major culprit (and it's not been in the current H5N1 outbreak from 2003 onward), the lack of resources (antibiotics and hospital beds, or as we call it, the lack of "staff, space and stuff") would be a huge problem.
Bacterial coinfections were confirmed in six (66.7%) of the nine children; Staphylococcus aureus was identified in four (66.7%) of the six children
In most modern healthcare systems, which increasingly emphasize just-in-time supply chains, shortages of antimicrobial drugs may occur rapidly unless more are stockpiled. These shortages would limit the treatment of secondary bacterial infections in the middle and the later stages of a pandemic.These kind of logistical nightmares are part of the health infrastructure discussion we've been having in this series (including surveillance and lab capacity in part II), and for this week's offering (I'm planning a future post on staph aureus and it's antibiotic resistant cousin, MRSA), we had a chance to catch up to Erika Sward, Director, National Advocacy at the American Lung Association, and ask a few questions about that organization's views on the intersection of policy and politics. By the way, the ALA provides a zip code search of flu vaccine sites and is a strong supporter of flu prevention. Just click here.
Funding for the program comes from a 62-cent increase in the federal cigarette tax. By increasing the cigarette tax to $1.01 per pack, the expanded CHIP adds the benefit of reducing youth smoking to the already substantial impact it will have on improving children’s health nationwide.Erika Sward pointed out in response to a question about reduced usage and reduced funds that in states like NY with high tobacco taxes (and reminded me that all tobacco products are problematic), a "tipping point" where revenues dry up because of high taxes has not happened, so it's more a theoretical than an actual problem, hence the "win-win" designation. This was partly behind the thinking that led Congress to fund the bill with a cig tax mechanism. And as the ALA site notes, the tobacco industry is not passive about children and smoking:
Higher cigarette taxes are proven to prevent kids from starting to smoke. The 62-cent increase is a significant increase over the previous 39 cents and will mean tobacco use among children and adults alike can be reduced, saving lives and preventing the incidence of many chronic diseases, including Chronic Obstructive Pulmonary Disease.
For decades the tobacco industry has developed cigarette brands and marketing campaigns aimed at young women and girls. The effect on women’s health has been devastating.Another issue we touched on is the idea that tobacco control is no longer, as Sward put it "the third rail" of American politics, and that it can now be openly discussed. In fact, for two decades, the ALA has recognized that only the Federal Government can regulate tobacco, and that if it is treated as a drug, that properly belongs under the auspices of the FDA. John McCain sponsored legislation in the Senate to do that, and in 2004 it passed the House, but never became law. This year, Henry Waxman promises to include such a provision as part of comprehensive health reform:
He [Waxman] also said he would advance legislation requiring the FDA to regulate tobacco products "in a matter of weeks" and a bill on embryonic stem cell research to move "very fast."The ALA is among the many science and health advocacy groups supporting science and health dollars in the stimulus bill including the pandemic doillars that were removed in the final bill (as we learned last week, likely to reappear ion an omnibus spending bill later this year). "Spending dollars on wellness and prevention is spending dollars and state and local health departments, and that means jobs," Sward said. And on the health reform side, Sward would like to see prevention and wellness emphasized, as well as evidenced based outcomes research on TB, asthma and influenza to help guide policy. This means research dollars (and jobs), and therefore appropriate for stimulus discussions.
Like a fire department that's only open three times a week, health departments won't be there when you need them if they get cut when times are tough. And whether it's food and restaurant surveillance, asthma surveillance or influenza surveillance, sometimes you only realize that when they're gone.
In the meantime, look for continued rather than diminished pressure on tobacco as health reform gets into gear. Tobacco companies are far more sophisticated than most when it comes to PR, and there'll be plenty of push-back. SCHIP is one battle, but the conflict will go on, and FDA regulation of tobacco as a drug looks to be the next big battle on the horizon.