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PBS NewsHour

Getting ‘to zero’ in the fight against Ebola


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JUDY WOODRUFF: Now an update on the Ebola outbreak in West Africa.

As of yesterday, the World Health Organization reported nearly 18,500 confirmed cases in Liberia, Sierra Leone, and Guinea, with more than 6,800 deaths. And while a newly published study finds that the number of unreported, and therefore undercounted, cases may not be as high as once feared, health officials say that, to halt the outbreak, every infection must be traced to its source.

Here to talk about that and more is the president of the World Bank Group, Dr. Jim Yong Kim. He is a medical doctor, and he has just returned from West Africa.

Dr. Kim, thank you for being here.

DR. JIM YONG KIM, President, World Bank Group: Thank you, Judy. Thanks for having me.

JUDY WOODRUFF: So you wrote while you were there that this is the worst epidemic you have ever seen. Of course, I guess, to many, that wouldn’t be surprising, considering the numbers, but what did you see in West Africa?

DR. JIM YONG KIM: Well, when I say it’s the worst, I spent a lot of my life fighting AIDS in Africa. And that was pretty bad, and drug-resistant tuberculosis.

The reason this is so bad is because it is so deadly, and we have to get to zero. There’s no getting almost to zero. Each one of the epidemics in the three countries started with a single case. And what we now know is — especially in this epidemic, is that if you leave a single case untreated and then if you let that transmission continue, it could explode again.

I’m very, very worried about this, because we still don’t have in place plans to get to zero in each of the three countries.

JUDY WOODRUFF: So what is it going to take? You wrote — in the column that you wrote the other day, you said it’s not just money, it’s more local control over what’s happening there.


JUDY WOODRUFF: What do you see that needs to get done that isn’t getting done?

DR. JIM YONG KIM: Well, let me tell you about two countries, Senegal and Nigeria. And I had a chance to talk with the presidents of both of those countries.

In Senegal, they had one cross-border case. It was a Ghanaian student. And it took just about everything they had, at a cost of $1.3 million, and they had to do contact tracing; 78 people had contact with him. They had to provide food for them. They had to take their temperatures twice a day. And it was $1.3 million for the one case.

In Nigeria, same thing, more than 200 physicians, more than 600 other health workers, 19,000 home visits for 19 cases. Now, just get that in your head, $13 million. We’re going to have to do that in each of the three countries for all the cases in order to get to zero.

That’s a level of rigor and discipline that is very hard to get even in the United States. To do it in those three countries is going to be a challenge, but we have no choice. We have got to do it.

JUDY WOODRUFF: It sounds impossible.

DR. JIM YONG KIM: It’s not.

And it’s because the Senegal and Nigeria examples really gave us a sense that it is possible. But the health systems in those two countries are much more developed. So we now have to bring in experts who can on a day-to-day basis make the judgments. These are really virus hunters. These are the people who shut down the SARS epidemic.

We now have them on board. And they’re in these countries working. And they have to work with local people. We’re hoping that one of the things we can do is to hire local people to be the contact tracers.

And so while, on the one hand, we’re doing all the work that you need to do from a public health perspective, we hope that it will also be an employment program and put some badly needed cash into the economy.

JUDY WOODRUFF: What about the organization, just the idea of pulling it all together and making sure it happens, the follow-through? Is that in place in these countries?

DR. JIM YONG KIM: Not yet, but especially the U.S. and the U.K. have done a lot of fantastic work in putting some of the infrastructure in place.

So, up until now, the idea has been, is there anything we can do to just take some of the heat out of the epidemic? Can we knock down in any way the rapid increase in the number of cases?

We did that in Liberia. In Guinea, it’s — the numbers aren’t going up as quickly. In Sierra Leone, we’re still in very rapid growth. So we have to on the one hand do all the things we need to do, safe burials, and just identifying people to slow down the rapid rise in the number of cases, but then, after you do that, you take on this next stage, which is every single case has to be traced.

JUDY WOODRUFF: Talk about the World Bank’s role in all of this. People think of the World Bank as a place that looks — it’s economy-focused and you focus on developing parts of the world.

And you have noted that, in these countries, there had been some economic advances made, but that this Ebola outbreak has set them way back.

DR. JIM YONG KIM: Well, just as an example, Sierra Leone in 2013, its GDP grew by 20 percent, among the highest rates in the world.

And, in 2015, we think it’s going to contract by 2 percent. So there were the discovery of minerals, for example, in Liberia. Despite the fact that the rubber industry had not come back from before a — the civil war, it was beginning to come back. There were mineral discoveries. Guinea, of course, has bauxite and iron ore.

So, there were a lot of very positive signs. This has really set them back. But the bigger issue, Judy, is that we have to sit back and ask a deeper question: What if this weren’t Ebola? What if it were an even worse virus? What if it were a faster-moving virus? What if it was pandemic flu?

These are fundamental downside risks to not only the local economies, but to the global economy. And we didn’t have a mechanism in place that would immediately disperse literally billions of dollars to tackle the epidemics in the way that we need to.

So, now what we’re putting on the table, the World Bank is one of the institutions that has to protect the global economy from these downside risks that are very real, but for which we don’t have buffers. So, not only are we responding in these three countries, but we’re now looking to the future and saying, what can we do to make sure that this spiraling of an epidemic out of control never happens again?

JUDY WOODRUFF: So, can you make that assurance now?

DR. JIM YONG KIM: Not right now.

But one of the things we’re doing now — we just had a meeting at the Institute of Medicine, where we brought the people who led the smallpox response and other responses, H5N1, and we sat down and said, what would it take to build a system that would truly protect the world from an even more devastating pandemic?

For example, if we had a flu outbreak that was as deadly as the one in the early 1900s, percentages of global population died in that particular outbreak. We need to be ready right now to respond much more quickly and much more effectively the next time Ebola or any other virus breaks out.

JUDY WOODRUFF: But it sounds like you’re saying you think it can be done?

DR. JIM YONG KIM: Well, we know it can be done. It is going to be extremely difficult. It’s going to take everything we know about public health. It’s going to take groups like the World Bank Group using our balance sheet.

And the good news is that we’re a bank. And so we can actually put our balance sheet to use in putting together innovative instruments, like insurance policies almost, that, when something happens, boom, it will fall into place.

But, you know, we have been humbled by this, every single one of us.

JUDY WOODRUFF: As the head of the World Bank, you’re someone I have to ask about the segment we just — Jeffrey Brown just did that interview about what has happened in Russia, the collapse of their currency, the ruble, the effect of the falling price of oil.

How worried are you and other folks who look at these issues about what’s going on in Russia right now?

DR. JIM YONG KIM: We’re worried. But contrary to what was said before, I think that we sort of could have seen this coming.

The supply of oil had been going up for quite some time, and these prices do go up and down. We have seen this in the past. And in this particular case, there are winners and losers. And so, for example, even the countries that are dependent on remittances from Russia who are oil importers are going to see — are going to have problems with their economies.

So it’s a very complex picture. The currencies of Brazil, of Norway have also gone down. So it’s not just Russia. But the Russia case is a little bit more dramatic than some of the others.

Our role is to really think about what are the macro-fiscal measures that can be taken? We’re especially concerned about the poorest countries. But if you look at other countries, for example, Indonesia, Indonesia is an importer. And, in this case, their price of oil is going to go down. They may be able to actually take off some of the fuel subsidies that they have been wanting to take off for quite some time.

So the hope is that some good will come out of this in countries, for example, taking action now because it’s easier to do, removing fuel subsidies, which will have a positive impact, we hope, on climate change.

Now, the other part of it is that, if the demand for renewable energy goes down, then it makes it even more complex.

JUDY WOODRUFF: Tough for some, but you’re saying a possible opening for others.


DR. JIM YONG KIM: Well, we really have to watch this carefully. I mean, the situation is very worrisome right now in Russia.

JUDY WOODRUFF: Dr. Jim Yong Kim with the World Bank, we thank you.

DR. JIM YONG KIM: Thank you.

The post Getting ‘to zero’ in the fight against Ebola appeared first on PBS NewsHour.

Can government policies correct race and ethnicity disparities in child health?

Photo by Jahi Chikwendiu/The Washington Post via Getty Images

Photo by Jahi Chikwendiu/The Washington Post via Getty Images

When Dolores Acevedo-Garcia and Pamela K. Joshi set out to study the racial and ethnic equity of federal policies impacting child health, they didn’t expect it to be terribly difficult. After all, they figured, there are federal mandates that require agencies to collect data on race and ethnicity.

But finding the data that the researchers from Brandeis University wanted to analyze was difficult. It was buried in reports or tied up in semantics.

Health Affairs“We thought this would be a relatively easy project,” Pam Joshi, a senior research scientist at Brandeis’s Heller School for Social Policy and one of the author of the study, said. “And three years later, here we are.”

To study the data, they created the Policy Equity Assessment, which questions how the policy works in relation to race and ethnicity. Their results showed multiple gaping holes — in the data on policy impact and racial/ethnic inequalities in access to benefits.

“It’s hard to put together the picture across ethnic groups and across geographies,” said Dolores Acevedo-Garcia. “Everyone should be on top of this — it shouldn’t be on an individual project to do.”

Joshi explains their primary goals as getting data into the hands of policymakers, using research evidence to help policymakers adopt “reasonable, policy-based decision to reduce gaps,” and to find room for states to work on these issues on their own.

To make the data more accessible, and, hopefully as a result, to lead to more effective policy, they created the website, which they will continue to maintain after the paper is published.

The NewsHour recently spoke with Joshi and Acevedo-Garcia about their study, which was published in Health Affairs’ December issue. The conversation has been edited for length and clarity.

NEWSHOUR: What surprised you about the process or results of the study?

PAMELA K. JOSHI: First, the lack of data was very surprising. The lack of data in terms of gaps and reporting on disparities, considering that it’s a part of the mandate in Healthy People 2020. Ideally, you’d think they would also be reporting on disparities.

For Hispanic kids, we saw lower participation in all programs. So that was really surprising to see the differential access for Hispanic parents and kids in these three landmark policies that address child health.

“Some of the potential solutions are well within existing policy tools. It’s moving toward knowledge from a lack of information…. It’s getting a smarter way of reaching these populations.”
DOLORES ACEVEDO-GARCIA: There are underlying issues that should be explored further. There is this unequal or differential access. We found that across all the groups, there is limited access to coverage. That’s the first thing we want to emphasize. Secondly, the group that has the least access is Hispanic.

Hispanics are 25 percent of the child population today and the only group which the majority of households today is raising kids in. If we want to invest in children’s health, obviously an important investment is what we do for Hispanic families.

NEWSHOUR: Because of recent events, race is a big national conversation right now. How does your study figure into that?

DOLORES ACEVEDO-GARCIA: Given the climate of a littler more openness to talk about these things, the mission of our project is to put the mission of equality in the [spotlight] of the country and to make sure we are raising kids with equal access to good outcomes. It’s a really stark example of how there are inequalities by race. They start much earlier in life, even if you only see it when they are teenagers or young adults. The mission of our project is when we have the chances to invest: When do we meet these opportunities across life and geography?

Of course, this very important event [in Ferguson] is what we’re talking about, but about 50 percent of the African-American kids in the St. Louis metropolitan area live in neighborhoods that are high-poverty and don’t have quality early childhood education centers. In white neighborhoods, that number is only 8 percent. A lot of investments could be made in early and middle childhood. Some of the issues are injustice in the criminal justice system, but there are preventative measures that could be taken with early childhood education and adult time off. A lot of these inequalities could be corrected if we address some of these underlying issues. We need to be paying a lot of attention to how all kids are going to develop.

NEWSHOUR: Why did you chose to apply the Policy Equity Assessment to Head Start, the Family and Medical Leave Act and Section 8?

PAMELA K. JOSHI: We take a social determinative health perspective on how politics affect child health. We have an ecological approach where we look at different places where children live, where they go to school, what their family is like, where their parents work and the health care system — the environments that kids interact with. From there, we think about politics. For this particular paper, we looked at non-health policies that have health components. That’s how we got Head Start, the Family and Medical Leave Act and Section 8.

NEWSHOUR: Are there parallels between your paper’s recommendations and affirmative action?

PAMELA K. JOSHI: This policy, this website, is really looking at differential access to existing policies. It’s just access to the policy. We don’t consider this at all affirmative action. We do know when programs target vulnerable populations, and the racial and ethnic makeup of those population. There is, for example, a targeting of migrant and seasonal worker parents. We know that these are mainly hispanic kids. It has to do with how we serve migrant kids.

DOLORES ACEVEDO-GARCIA: Some of the potential solutions are well within existing policy tools. It’s moving toward knowledge from a lack of information. It’s not getting preferential treatment. It’s getting a smarter way of reaching these populations.

NEWSHOUR: How people are using the data already?

DOLORES ACEVEDO-GARCIA: One New York advocacy group, the Child Neighborhood Opportunity Index, has been using it. Someone in New York took the data from the website, created their own maps, and are using it to show the disparities children are facing at the neighborhood level. We heard about that just as we heard about the no indictment decision in the New York case

PAMELA K. JOSHI: Another example is state paid leave for families. We met a group called Family Values at Work at the White House [during] a Working Families Summit this summer. We asked them, is this data helpful to what you’re doing? That group has been using our data to push change because a lot of the family leave, if it’s unpaid, prices the families out of the market. If you’re trying to help the most disadvantaged workers, this data helps make this case at the state policy level. Our data is meant to be useful to the people who go and do the advocacy work for improving access to coverage.

The post Can government policies correct race and ethnicity disparities in child health? appeared first on PBS NewsHour.

More teens use e-cigarettes than tobacco ones, survey reveals

Photo by Flickr user  Monica Grigsby.

Photo by Flickr user Monica Grigsby.

WASHINGTON — Electronic cigarettes have surpassed traditional smoking in popularity among teens, the government’s annual drug use survey finds.

Even as tobacco smoking by teen dropped to new lows, use of e-cigarettes reached levels that surprised researchers. The findings marked the survey’s first attempt to measure the use of e-cigarettes by people that young.

Nearly 9 percent of eighth-graders said they’d used an e-cigarette in the previous month, while just 4 percent reported smoking a traditional cigarette, said the report being released Tuesday by the National Institutes of Health.

Use increased with age: Some 16 percent of 10th-graders had tried an e-cigarette in the past month, and 17 percent of high school seniors. Regular smoking continued inching down, to 7 percent of 10th-graders and 14 percent of 12th-graders.

“I worry that the tremendous progress that we’ve made over the last almost two decades in smoking could be reversed on us by the introduction of e-cigarettes,” said University of Michigan professor Lloyd Johnston, who leads the annual Monitoring the Future survey of more than 41,000 students.

E-cigarettes often are described as a less dangerous alternative for regular smokers who can’t or don’t want to kick the habit. The battery-powered devices produce vapor infused with potentially addictive nicotine but without the same chemicals and tar of tobacco cigarettes.

Nearly nine percent of eighth-graders said they’d used an e-cigarette in the previous month, while just 4 percent reported smoking a traditional cigarette, said the NIH report. The survey didn’t ask about repeat use, or whether teens were just experimenting with something new. But between 4 percent and 7 percent of students who tried e-cigarettes said they’d never smoked a tobacco cigarette, noted University of Michigan professor Richard Miech, a study senior investigator.

“They must think that e-cigarettes are fundamentally different,” he said.

E-cigarettes began to appear in the U.S. in 2006 but this was the first year that the Monitoring the Future survey asked teens about them. The Centers for Disease Control and Prevention has estimated that during 2013, 4.5 percent of high school students had tried e-cigarettes during the prior month, a tripling since 2011.

The CDC reported last week that 10 states permit the sale of e-cigarettes to minors. The Food and Drug Administration has proposed regulating e-cigarettes, including banning sales to minors; there is no timetable for final rules.

Other findings from the survey, funded by NIH’s National Institute on Drug Abuse:

  • Marijuana use appeared to level off after recent increases, with 6.5 percent of eighth-graders reporting past-month use, 17 percent of 10th-graders and 21 percent of 12th-graders. Nearly 6 percent of 12th-graders reported daily use.
  • Fewer teens are trying synthetic marijuana, highly dangerous drugs known by such names as K2 and Spice. About 6 percent of seniors said they had used fake pot this year, down from 8 percent last year and 11 percent in 2012.
  • Abuse of prescription painkillers is dropping. Six percent of high school seniors reported using the narcotics without medical supervision in the past year, down from 9.5 percent in 2004.
  • Nearly 1 in 5 12th-graders reported binge drinking, defined as five or more drinks in a row in the previous two weeks. That’s down from 1 in 4 high school seniors in 2009.

The post More teens use e-cigarettes than tobacco ones, survey reveals appeared first on PBS NewsHour.

Insurers relax Obamacare deadline

Illustration by Getty Images

Illustration by Getty Images

WASHINGTON — Trying to head off a new round of consumer headaches with President Barack Obama’s health care law, the insurance industry said Tuesday it will give customers more time to pay their premiums for January.

America’s Health Insurance Plans, the main industry trade group, says the voluntary steps include a commitment to promptly refund any overpayments by consumers who switched plans and may have gotten double-billed by mistake.

Though the website is working far better this year, the industry announcement highlights behind-the-scenes technical issues between the government and insurers that have proven difficult to resolve. Last year’s enrollment files were riddled with errors, and fixing those has been a painstaking process. As a result, renewing millions of current customers is not as easy as it might seem.

The industry “wants to do everything we can to make sure consumers have greater peace of mind about their health care coverage and support them throughout the open enrollment process,” Karen Ignagni, head of the trade group, said in a statement.

The health care law offers subsidized private insurance to people who don’t have a health plan on the job. Renewing coverage each year is standard operating procedure for the industry, but 2015 is the first renewal year for the health law. The process involves a massive electronic data transfer from the government to insurers, happening right around the holidays. Insurers then have to use that data to generate new cards for their customers.

Normally, premiums for January would be due by Dec. 31. The industry’s grace period for 2015 could vary among different carriers, so consumers should check with their plan. Insurers say they also plan to help customers who have problems filling prescriptions or getting medical care at the start of the year.

Midnight Monday, Pacific time, was the deadline for new customers in most states to pick a health plan to take effect Jan. 1. It was also the deadline for current enrollees to make changes that could reduce premium increases before the new year. The administration announced a last-minute extension for some people unable to get through to the jammed federal call center.

Making matters more confusing, open enrollment actually runs for another two months, until Feb. 15. People enrolling by that date will get coverage starting March 1. Current customers can still make plan changes through Feb. 15.

Based on early numbers, it’s looking like the majority of the roughly 6.7 million current customers have opted to stay with the plans they have now and be automatically renewed Jan. 1.

Assuring that happens as smoothly as it’s been advertised is the administration’s next major challenge. The insurance industry announcement provides a safety valve for the administration. It mirrors similar steps the industry took last year to soften the consequences of the botched rollout of health insurance markets around the country.

The favorite political scapegoat of the White House during the battle to pass the health care law, insurers keen on signing up millions of new taxpayer-subsidized customers have turned into indispensable allies.

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