World Hepatitis Day Proclamation

WORLD HEPATITIS DAY, 2011

BY THE PRESIDENT OF THE UNITED STATES OF AMERICA

A PROCLAMATION

Across our Nation, millions of Americans are living with viral hepatitis. As many as three-fourths of Americans living with the disease are unaware of their status and are not receiving care and treatment for their condition. Raising awareness about hepatitis is crucial to effectively fight stigmas, stem the tide of new infections, and ensure treatment reaches those who need it.

On World Hepatitis Day, we join with people across our country and around the globe in promoting strategies that will help save lives and prevent the spread of viral hepatitis.

Viral hepatitis is inflammation of the liver, and can cause a lifetime of health issues for people who contract it. Hepatitis B and C viruses are the cause of a growing number of new liver cancer cases and liver transplants. In the United States, hepatitis is a leading infectious cause of death, claiming the lives of thousands of Americans each year. While we have come far, work still needs to be done to prevent and treat this disease.

Viral hepatitis touches Americans of all backgrounds, but certain groups are at greater risk than others. Past recipients of donated blood, infants born to mothers infected with viral hepatitis, and persons with sexually transmitted diseases or behaviors such as injection-drug use have risks for viral hepatitis. Baby boomers and African Americans have higher rates than others of contracting hepatitis C. Half of all Americans living with hepatitis B today are of Asian American and Pacific Islander descent, and one-third of people living with HIV also have either hepatitis B or hepatitis C. Worldwide, one in twelve people is living with viral hepatitis.

We must make sure that this "silent epidemic" does not go unnoticed by health professionals or by communities across our country. Under the Affordable Care Act, services including hepatitis immunizations for adults and hepatitis screenings for pregnant women are fully covered by all new insurance plans. My Administration has also released a comprehensive Action Plan for the Prevention, Care and Treatment of Viral Hepatitis. The plan brings together expertise and tools across government to coordinate our fight against this deadly disease. Our goal is to reduce the number of new infections, increase status awareness among people with hepatitis, and eliminate the transmission of hepatitis B from mothers to their children.

The first step toward achieving these goals is raising public awareness of this life-threatening disease. We must work to reduce the stigma surrounding hepatitis, and to ensure that testing, information, counseling, and treatment are available to all who need it. The hard work and dedication of health-care professionals, researchers, and advocates will help bring us closer to this goal. On this day, we renew our support for those living with hepatitis, and for their families, friends, and communities who are working to create a brighter, healthier future.

NOW, THEREFORE, I, BARACK OBAMA, President of the United States of America, by virtue of the authority vested in me by the Constitution and the laws of the United States, do hereby proclaim July 28, 2011, as World Hepatitis Day. I encourage citizens, Government agencies, nonprofit organizations, and communities across the Nation to join in activities that will increase awareness about hepatitis and what we can do to prevent it.

IN WITNESS WHEREOF, I have hereunto set my hand this twenty-seventh day of July, in the year of our Lord two thousand eleven, and of the Independence of the United States of America the two hundred and thirty-sixth.

BARACK OBAMA

- Doug Hirano, MPH, APCA Executive Director

A warm reception from our President

With approximately 200 Asian American and Pacific Islander colleagues, I had the pleasure of visiting the White House today in acknowledgment of Asian American and Pacific Islander Heritage. Here’s what my “thank you” note to the President will read:

"Thank you, Mr. President, for the opportunity to visit your stately home. Your hospitality in the form of your kind words and the hors d’oeuvres and beverages was most generous – particularly since you already had a lot on your plate, including an imminent national TV appearance about the war in Afghanistan.

While I didn’t get a chance to speak to you directly, I did have the chance to speak to one of your key health officials, Dr. Howard Koh – your Assistant Secretary for Health and Human Services (pictured). He was kind enough to say that he would look into my suggestion that the federal government support a hepatitis B testing day for Asian Americans. Considering that there is already an HIV/AIDS awareness day for Asian Americans, it would seem reasonable that attention be paid to the preponderance of chronic hepatitis B infection among this group as well.

I will be following up with Dr. Koh about this matter. I believe hepatitis B among Asian Americans needs to stay on the radar screen until something more is done. There are far more Asian Americans unknowingly infected with chronic hepatitis B than all Americans unknowingly infected with HIV/AIDS. We on the front lines in various communities throughout the nation fight the good fight to increase hepatitis B awareness among the general public, among Asian Americans and Pacific Islanders, and the medical community, but sometimes one is not a prophet in his or her own land. Hearing more from our federal officials about this preventable epidemic of liver disease due to hepatitis B is critical and essential. Action can prevent more death and disability due to hepatitis B.

Again, thank you for your cordiality, and I hope that you and your family stay well. Please feel free to come visit us in Arizona, and we would be happy to share some of our Asian American and Pacific Islander hospitality in return."

- Doug Hirano, MPH, APCA Executive Director

AHCCCS

According to a recent New York Times article, the Arizona Medicaid program, known as AHCCCS, is considering charging a $50 fee to smokers and obese individuals. This would apply only to childless adults. The idea is that since both smoking and obesity lead to preventable disease and illness and increased health care costs then why not have such individuals pay more for their coverage?

On the surface, this seems reasonable. An extra $50 fee might be just the incentive individuals need to make lifestyle changes relating to tobacco use, healthy eating and active living. If they make the needed changes to quit smoking and/or lose weight, then everyone wins – they’re healthier in the long run, and AHCCCS incurs less medical costs. If they don’t manage to make the behavior changes, then at least the State of Arizona can apply the extra revenue from the fees to partially offset the additional health care costs these individuals incur.

However, the third alternative is perhaps the most worrisome. If they don’t have the extra $50 to spare and can’t make the changes needed, then they will be deterred from receiving health insurance coverage. These individuals are indeed at increased risk for illness and therefore have a disproportionately high need for routine medical care – the very care that can help them quit smoking or work to drop some pounds. Perhaps AHCCCS should consider offering smoking cessation assistance and weight management counseling to all those who would be impacted by this new policy prior to its implementation?

Also, one could argue that obesity is not purely an individual behavioral choice. Genetics do come into play, and studies indicate that the economic, social and physical environment in which people live can influence obesity-related behaviors such as diet and physical activity. To a lesser extent, tobacco use is a product of both individual choice and environmental circumstance. In my mind, though, obesity is perhaps too far outside an individual’s choice to make it a logical candidate for penalization through a fee.

Lastly, I found it interesting that this fee would only be applied to childless adults. Don’t obese and smoking parents also incur greater health care costs related to their obesity and tobacco use? In fact, wouldn’t decreasing tobacco use among parents decrease the likelihood of secondhand smoke exposure among children?

In any case, one has to give credit to AHCCCS for thinking creatively about both revenue stream and health-related behaviors. It will be curious to track the impact of this proposal if it gets implemented.

- Doug Hirano, MPH, APCA Executive Director

Winnable Battles

Public health practitioners are justifiably proud of the improvements in health status over the past 100 years. In fact, the Centers for Disease Control and Prevention has generated a list of the ten greatest public health achievements from 1900 to 1999. Major achievement areas include immunizations, tobacco, motor-vehicle safety, and control of infectious diseases, among others.

Now, ten years into the 21st century, those of us practicing public health must ask ourselves about our progress in this century. My sense is that we’ve made relatively slim headway in the past decade. Indeed, the end of the 20th century saw an unprecedented and largely unabated rise in childhood and adult obesity, and the beginning of the 21st century has seen deadly global outbreaks of SARS and novel H1N1 flu. Rates of tobacco use are still hovering around 20% here in the United States, and far higher in many other countries.

So, where do we go from here? Well, the CDC has offered a relatively new way of thinking about our 21st century health challenges. They have coined the term “winnable battles” to describe “public health priorities with large-scale impact on health and with known, effective strategies to intervene.” Winnable battle areas include HIV, motor vehicle injuries, obesity/nutrition/physical activity/food safety, healthcare associated infections, teen pregnancy and tobacco.

Interestingly, several winnable battle areas (i.e., tobacco and motor vehicle injuries) also show up on the list of the 20th century ten greatest public health achievements. Be that as it may, I think it is wise to generate a “winnable battle” list. It provides a clear health agenda for health departments, community-based organizations, and others interested in wide-scale health improvement.

For Asian Americans and Pacific Islanders though, I would add two additional winnable battles:

1. Screening and referring to medical care those individuals with chronic hepatitis B infection; and,

2. Increasing rates of screening for breast, cervical and colon cancer;

One in ten Asian Americans and Pacific Islanders carries the hepatitis B virus (HBV), a major cause of liver cancer. Most are unaware of their infection. A simple blood test can detect the presence of the virus, and there is now treatment that can decrease the likelihood of serious liver disease due to HBV infection.

Studies indicate that Asian Americans and Pacific Islanders do not receive preventive screenings for breast, cervical and colon cancer as often as non-Hispanic whites. The scientific literature now includes proven interventions to increase screening rates for these cancers among AAPIs.

A focus on winnable battles is efficient and sensible. We must act on this knowledge. Let’s hope that our collective legacy includes success in these areas.

Doug Hirano, MPH, APCA Executive Director

Can We Really Eliminate Health Disparities?

For the past nine months, I’ve been meeting with some folks from other health-related organizations here in the valley. We share an interest in addressing the fact that selected groups of people systematically suffer worse health outcomes (i.e., health disparities) when compared to the general population. We are in the early stages of forming a cross-cultural institute to address the problem of health disparities here in Maricopa County. Here’s an excerpt from the draft document that we’ve been developing:

“Despite steady improvement in the overall health of the U.S. population, racial and ethnic minorities, with few exceptions, experience higher rates of illness and death than non-minorities. African Americans, for example, experience the highest rates of death from heart disease, cancer, stroke, and HIV/AIDS when compared to any other U.S. racial or ethnic group. American Indians disproportionately die from diabetes, liver disease, and unintentional injuries. Hispanic Americans are almost twice as likely as non-Hispanic whites to die from diabetes. In addition, some Asian-American subpopulations experience rates of stomach, liver and cervical cancers that are well above the national averages.”

This paragraph succinctly describes our collective problem related to health disparities. These disparities continue to exist 25 years after the 1985 landmark report from the U.S. Department of Health and Human Services that originally called for action on health disparities.

I personally believe that with our current science, technology and health promotion evidence base, health disparities can be eliminated. However, this is not a quick fix. Health disparities are directly associated with multiple overlapping issues, including poverty, educational attainment, the physical environment, access to health services, and personal health behaviors. Race and culture matter as well. For even when all other factors are adjusted for, people of color in this country suffer disproportionately in terms of preventable disease and death.

APCA is glad to be involved with a group of agency representatives that is willing to expend the time and resources to tackle health disparities in Maricopa County, and we thank St. Luke’s Health Initiatives for supporting our group through its TAP Program. We have a large task at hand. We believe that our cross cultural institute must advocate for social and health policies that level the playing field so that everyone – regardless of race, ethnicity, disability status or sexual identity – has an opportunity for good health. We also believe that more work is needed in the health care and public health sectors to provide culturally proficient health services.

I will continue to update this blog about our efforts. Anyone interested in this initiative should feel free to contact me for further information.

- Doug Hirano, MPH, APCA Executive Director