Public Health National, Statewide Conferences Reflect Greater Attention to Field

With concerns about the Zika virus reaching the United States as reflected in the recent report of four cases in Florida and state public health monitoring now reaching Connecticut, public awareness of the role of public health officials, here and across the country, is likely to increase in the coming weeks and months. That coincides with the National Conference of the National Association of Local Boards of Health next week in St. Louis, and the Annual Meeting of the Connecticut Public Health Association slated for November in New Haven.  The statewide organization is marking its hundredth anniversary this year, and the theme of the conference will be "Back to the Future- 100 years of Public Health in CT and Beyond."

For the past century, the Connecticut Public Health Association has been “committed to improving the quality of the public health profession and advocating for policies and programs that promote health and prevent disease.” The association’s members, representing a wide variety of disciplines, “are united in the goal of protecting and promoting the public's health.”

The CPHA has invested its advocacy and education resources in key areas of public health such as public health infrastructure, racial and ethnic health disparities, health literacy, universal health care, environmental health, and disease prevention. The organization’s president is Brittany Allen, staff attorney with the state Department of Public Health.

Among those from Connecticut expected to attend the National Association of Local Boards of Health session in Missouri will be the Secretary on the national organization’s Board of Directors, Judith Sartucci of Rocky Hill and the Central Connecticut Health District which serves the towns of Berlin, Newington, Rocky Hill and Wethersfield.   The National Conference is scheduled to focus on ways to improve community heath, the Flint (MI) financial and water crisis “through a board of health lens,” and collaborative governance in an era of population health management.  The public health threats identified by the national Centers for Disease Control and Prevention will also be highlighted, as will Zika, according to Association Director Jamie Michael.

The mission of the Connecticut Public Health Association is to “represent and unite the diverse expertise of Connecticut's public health professionals, to ameliorate the most pressing public health issues in the state, and to promote health and safe living for the people of Connecticut.” CPHA works to promote and protect the public's health through advocacy; education; program, professional and workforce development; and networking among the public health community.

The CPHA website points out that “today, more than ever, the value of public health in saving lives and reducing health care costs is at the forefront of public policy. Being a part of this movement is exciting for practitioners and organizations alike.”

Among the learning objectives anticipated at the state conference in November, where 300 public health officials from across the state are expected, “attendees will be able to:

• Describe how policies, systems, and environmental changes can be applied to improve the public’s health.
• Identify evidence-based strategies that engage communities to improve health outcomes and explain how they work and are applied effectively.
• Explain how collaboration with nontraditional partners supports the improvement of population health and wellness.
• Promote the formation of collegial professional networks and the exchange of ideas among members of the public health community.

The keynote address will be provided by Camara P. Jones, MD, MPH, PhD, research director on social determinants of health and equity in the Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion and President of the American Public Health Association (APHA).

Dr. Jones is a family physician and epidemiologist whose work focuses on the impact of racism on the health and well-being of the nation. She seeks to broaden the national health debate to include not only universal access to high quality health care but also attention to the social determinants of health (including poverty) and the social determinants of equity (including racism).

Her biography points out that:

• As a methodologist, she has developed new ways for comparing full distributions of data (rather than means or proportions) in order to investigate population-level risk factors and propose population-level interventions.
• As a social epidemiologist, her work on race-associated differences in health outcomes goes beyond documenting those differences to vigorously investigating the structural causes of the differences.
• As a teacher, her allegories on race and racism illuminate topics that are otherwise difficult for many Americans to understand or discuss.

Dr. Jones was an assistant professor at the Harvard School of Public Health from 1994 to 2000, is a member of the World Health Organization’s Scientific Resource Group on Equity and Health.

LED Street Lights Being Installed in CT Towns Even As Health Concerns Are Raised

The American Medical Association’s new policy stand “against light pollution and public awareness of the adverse health and environmental effects of pervasive nighttime lighting,” comes as municipalities across Connecticut and the nation are replacing longstanding lighting systems with LED lights in an effort to save money and improve safety.  The AMA however, is warning that the rapid pace of change could bring long-term detrimental health and safety effects. The AMA has noted that “it is estimated that white LED lamps have five times greater impact on circadian sleep rhythms than conventional street lamps. Recent large surveys found that brighter residential nighttime lighting is associated with reduced sleep times, dissatisfaction with sleep quality, excessive sleepiness, impaired daytime functioning and obesity.”

The organization noted earlier this month that “approximately 10 percent of existing U.S. street lighting has been converted to solid state LED technology, with efforts underway to accelerate this conversion.” The AMA’s Report of the Council on Science and Public Health on “Human and Environmental Effects of Light Emitting Diode (LED) Community Lighting” cautioned that “white LED street lighting patterns also could contribute to the risk of chronic disease in the populations of cities in which they have been installed. Measurements at street level from white LED street lamps are needed to more accurately assess the potential circadian impact of evening/nighttime exposure to these lights.

The AMA recommendations were developed to “assist in advising communities on selecting among LED lighting options in order to minimize potentially harmful human health and environmental effects”:

• an intensity threshold for optimal LED lighting that minimizes blue-rich light
• all LED lighting should be properly shielded to minimize glare and detrimental human health and environmental effects,
• consideration should be given to utilize the ability of LED lighting to be dimmed for off-peak time periods.

The concerns are not new, but they are receiving greater attention in the wake of the AMA’s formal community guidance and policy position, adopted at the organization’s annual conference in Chicago in mid-June.

Communities in Connecticut that have taken steps to switch to LED lighting include New London, Berlin, Plainville, East Hartford, Rocky Hill, Stamford, Southington, and Cheshire, according to published reports.  An article authored by UConn professor of Community Medicine and Health Care Richard G. Stevens, highlights red flags being raised by the AMA regarding the safety of LED lighting being installed in cities around the country.  The article first appeared on an international website, theconversation.com, and has since appeared on sites including CNN.  Stevens, an expert on the health impact of electric lighting, has raised concerns for more than a decade.

The Illuminating Engineering Society, founded in 1906 and based in New York, noted in a position statement that “exposure to optical radiation affects human physiology and behavior, both directly (acute effects including melatonin suppression, elevated cortisol production, increased core temperature) and indirectly (resetting the internal circadian body clock). There is no confirmation that typical exposures to exterior lighting after sunset lead to cancer or other life‐threatening conditions.” The Illuminating Engineering Society of North America (IES) is described as “the recognized technical authority on illumination.” The IES website indicates that the organization was “not represented in the deliberations leading to [the AMA document]. We intend to contact the AMA and work with them to ensure that any lighting related recommendations include some discussion with the IES.”

ANSES, the French Agency for Food, Environmental and Occupational Health & Safety, has published a report entitled (in English): " Lighting systems using light-emitting diodes: health issues to be considered," which focuses squarely on potential problems caused by LED lighting.  The LEDs Magazine website indicates that the full report is available in French only, but the report summary (in English) says that risks have been identified concerning the use of certain LED lamps, raising potential health concerns for the general population and professionals.

"The issues of most concern identified by the Agency concern the eye due to the toxic effect of blue light and the risk of glare," says the report, adding that the blue light necessary to obtain white LEDs causes "toxic stress" to the retina.

Back in 2011, a comprehensive report by Carnegie Mellon University’s Remaking Cities Institute (RCI) on the city of Pittsburgh’s transition to LED street lighting indicated that “Glare is an issue with LED street lighting. The RCI research team’s literature review and interviews with manufacturers and municipal agencies in cities with LED replacement projects indicate that the emphasis is being placed almost entirely on energy savings, to the exclusion of visual quality issues. The substantial glare caused by LEDs is not typically included as a measurable criteria in evaluation processes, and when it is, the tools of measurement are inadequate. As a result, glare persists as an issue.”

That report also noted that “the public is informed that LEDs save energy told that they are better in quality (often false) and that more accurate in color (often false).” In addition, the 113-page report indicated that “While the use of bright lights is believed to reduce accidents, it actually creates dangerous conditions for drivers, especially when night vision is affected by sharp differences in illumination. Bright lights are particularly hazardous for older persons because the human eye’s accommodation reflex slows with age.”

Regarding health concerns that have been raised, the report indicates that “Bright white light suppresses melatonin, the hormone that regulates tumors. Blue light wavelengths are to blame, because they ‘reset’ the circadian clocks of humans, animals, and plants even at very low levels of blue light. This might account for the significantly higher rates (30-60%) of breast and colorectal cancer in night shift workers.”

Some have compared the growing controversy regarding LED lighting to the ongoing debate in towns around the country regarding the use of crumb rubber from recycled tires as fill for sports turf fields.  Federal, state, and municipal governments have weighed in on the discussion, but even as health concerns continue to be raised, fields using the materials continue to be installed and used by youth in Connecticut and across the country.  The U.S. Environmental Protection Agency recently launched a research project aimed at providing better answers on that safety question.

Former UConn QB Cochran Says Football Puts Players in Harm’s Way, Urges End to "Cycle of Silence"

Former UConn quarterback Casey Cochran, who retired from the sport at age 20 after suffering his 13^th concussion, said this week that “There are problems with the game that need to be addressed. As it is played right now, tackle football — with its pads and helmets — puts players in harm’s way, all of the time, regardless of age and ability.” Cochran, writing a first-person story about his experiences with football and concussions in The Players’ Tribune, an online site founded by Derek Jeter, issued an alert to others who’ve journeyed through the sport, or continue to compete:

“I want to say to all former, current and future athletes who have or will suffer a concussion: Do not hide it. Tell your coaches, medical staff, parents, friends and teammates. Get treatment. The cycle of silence hurts more and more people each year.”

Cochran, from Monroe, explained that in the 18 months since his decision, after suffering a concussion on the last play of the first game of UConn’s 2014 season, against Brigham Young University, “I still feel the lingering effects from my many concussions. Life is a balancing act now. Some days it’s hard to wake up before noon. Sometimes I don’t want to leave my bed at all. In high school, I had a 3.9 GPA. Now I have trouble focusing and performing well in my graduate-school classes.”

He warned that “Those who play football, particularly those who begin in their youth, are given a glamorized version of the sport – one where camaraderie, discipline, toughness and leadership are highlighted and the wretchedness is ignored and swept under the rug. As a result, we fall in love with and value the good and push aside the bad.”

Cochran recalled that “I probably should have stopped playing football in eighth grade after my third concussion, but I was afraid to speak up. Afraid of disappointing people who had invested in my career. Afraid of who was I was without football. I wish I hadn’t hid the three concussions I had in one week during my junior year of high school, but I was afraid that college recruiters would find out.”

Even with increasing awareness of the risks of concussions, Cochran said the near and long-term effects haven’t led to enough changes.  “The only word I know to describe the first few moments after a concussion is limbo — there are a few moments between the world that you were just a part of and your new brain-injured reality,” Cochran explained.  “My head was seized with tremendous pressure, and that same awful, familiar depression from previous head injuries came over me — like a dark, heavy blanket, swallowing me up.”

With it all, he retains optimism: “There is life outside of the white lines. A lot of life. Stepping away from football was one of the scariest things I’ve ever had to do. I felt lost for a long time. For a little over a year, I felt like I was somewhere, deep in the ocean, being pulled by the currents. But what pulled me back from the depths was hope. Hope that things would get better.”

He now finds purpose in being an advocate for player safety, speaking to audiences, doing interviews and writing a book about his experiences.  To those going through what he did, during his 14 years of playing football, he says “If you feel alone, you aren’t. Chances are, there are a lot of people out there who have some idea of what you’re going through. Just keep looking. Reach out.”

Added Cochran: “Sometimes it’s nice to admit that things aren’t O.K.: ‘Hello, my name is Casey, and I have anxiety and depression.’ It may be permanent. It may be just the beginning. I don’t know what the future has in store for me and it will be some time before the medical field can paint a clearer picture for me. I may have CTE right now. I might have dementia at 50. My entire future is uncertain.”

AMA Policy, UConn Professor Raise Concerns About Municipal Conversions to LED Lighting

An article authored by UConn professor of Community Medicine and Health Care Richard G. Stevens, which highlights red flags being raised by the American Medical Association regarding the safety of LED lighting being installed in cities around the country, is gaining notice.  The article first appeared on an international website, theconversation.com, which features articles researched and written by college faculty from the U.S. and around the world.  The site’s tagline, “Academic rigor, journalistic flair,” reflects its approach.  The article has since been re-published on the CNN website, and it gaining traction on dozens of other internet sites. The article revolves around a policy statement issued by the AMA this month that suggests “conversions to improper LED technology can have adverse consequences.” Stevens, who has written about the health risks of electric lighting for more than two decades,  indicates that the policy statement comes "in response to the rise of new LED street lighting sweeping the country.” 

The new "white" LED street lighting which is rapidly being retrofitted in cities throughout the country has two problems, according to the AMA, Stevens highlights. “The first is discomfort and glare. Because LED light is so concentrated and has high blue content, it can cause severe glare, resulting in pupillary constriction in the eyes. Blue light scatters more in the human eye than the longer wavelengths of yellow and red, and sufficient levels can damage the retina. This can cause problems seeing clearly for safe driving or walking at night.” The AMA goes on to point out that blue-rich LED lighting can decrease visual acuity and safety, resulting in concerns and creating a road hazard.

In addition to its impact on drivers, the AMA notes that blue-rich LED streetlights operate at a wavelength that most adversely suppresses melatonin during night. It is estimated that white LED lamps have five times greater impact on circadian sleep rhythms than conventional street lamps, the AMA indicated. Recent large surveys, according to the AMA, found that brighter residential nighttime lighting is associated with reduced sleep times, dissatisfaction with sleep quality, excessive sleepiness, impaired daytime functioning and obesity.

The AMA points out that “converting conventional street light to energy efficient LED lighting leads to cost and energy savings, and a lower reliance on fossil-based fuels. Approximately 10 percent of existing U.S. street lighting has been converted to solid state LED technology, with efforts underway to accelerate this conversion.”

Although no comprehensive list is available, among the communities in Connecticut making the switch to LED lighting are Stamford, Plainville, East Hartford, Southington, and Berlin, according to published reports. Cheshire launched a streetlight replacement program earlier this year, indicating that “the new LED fixtures will provide the appropriate amount of lighting for locations across the town and will focus light directly downward on the sidewalks and roadway.  The fixtures have a ten-year product warranty, but are anticipated to have a much longer life. The project is expected to be completed in July 2016.”

"Despite the energy efficiency benefits, some LED lights are harmful when used as street lighting," AMA Board Member Maya A. Babu, M.D., M.B.A. "The new AMA guidance encourages proper attention to optimal design and engineering features when converting to LED lighting that minimize detrimental health and environmental effects."

The AMA encourages communities to minimize and control blue-rich environmental lighting by using the lowest emission of blue light possible to reduce glare. Stevens, however, says that “the AMA's recommendation for CCT below 3000K is not quite enough to be sure that blue light is minimized. The actual spectral irradiance of the LED -- the relative amounts of each of the colors produced -- should be considered, as well.”

Stevens concludes that “there is almost never a completely satisfactory solution to a complex problem. We must have lighting at night, not only in our homes and businesses, but also outdoors on our streets. The need for energy efficiency is serious, but so too is minimizing human risk from bad lighting, both due to glare and to circadian disruption. LED technology can optimize both when properly designed.”

The Hartford Courant reported last year that ESCO Energy Services is working with the Connecticut Conference of Municipalities to implement its municipal Street Light LED Conversion Program to buy the current streetlights from utilities and replace them with more efficient LED fixtures.

Stevens proposed in 1987 what was then seen as a radical new theory that use of electric lighting, resulting in lighted nights, might produce "circadian disruption" causing changes in the hormones relevant to breast cancer risk, according to the UConn Health website. Accumulating evidence has generally supported the idea, the site indicates, and it has received wide scientific and public attention. For example, his work has been featured on the covers of the popular weekly Science News (October 17, 1998) and the scientific journal Cancer Research (July 15, 1996). His most recent paper, “Shift work as a harbinger of the toll taken by electric lighting,” was published in Chronobiology International, The Journal of Biological and Medical Rhythm Research, in January 2016.

The Conversation website is a collaboration between editors and academics to provide "informed news analysis and commentary that’s free to read and republish." It launched as a pilot project in the U.S. in October 2014 after starting in Australia in March 2011 and​ the UK in May 2013. Boston University’s College of Communication is are hosting the operation in the U.S.

PHOTO:  Traditional street lighting (left) vs. LED lighting (right).

Bridgeport-Based Wholesome Wave Receives $500,000 USDA Grant to Increase Food Access in Hartford and Vermont

The announcement of the second round of funding for the U.S. Department of Agriculture’s Food Insecurity Nutrition Incentive (FINI) Program, included the selection of national nonprofit Wholesome Wave to receive nearly $500,000 designated to increase affordable access to healthy food in Hartford, Connecticut, and the Northeast Kingdom of Vermont (the northeast corner of the state, comprising Essex, Orleans and Caledonia counties). The funds will flow through an innovative Farm-to-Grocery Nutrition Incentive model, which funds coupons for fresh fruits and vegetables that match the value of SNAP spent at participating grocery stores and increases locally-grown food those stores procure from nearby farmers.

Combined with an additional $500,000 from other funding sources, this project will amount to a $1 million investment in Connecticut and Vermont’s local food economies, according to Wholesome Wave.

Wholesome Wave plans to work with two community nonprofits, Hartford Food System and Green Mountain Farm to School, and eight local grocery stores, to help an estimated 5,000 people purchase more fresh produce. Participating stores will purchase approximately $122,000 worth of regional produce from nearby farmers in Connecticut and Vermont.

The USDA award to Wholesome Wave was one of only 15 community-based initiatives across the country to be selected to receive multi-year grants.  The project is expected to trigger $920,000 in SNAP and incentive purchases in its first three years, officials project.  Overall, the initiative is aimed at  increasing food access for low-income residents, supporting grocery stores as healthy food providers, strengthening local economies, and driving revenue to nearby farms.

“Wholesome Wave is thrilled by the innovations that USDA is supporting through the new FINI grants, which are taking the work of increasing affordable access to healthy food to even greater levels of impact,” said Michel Nischan, CEO & Founder of Wholesome Wave. “So many SNAP shoppers are working parents with limited time to source healthier food choices. Through the new Farm-to-Grocery model, our partners in Connecticut and Vermont will be able to expand affordable access to SNAP consumers in a way that allows them to find and purchase more healthy food from a variety of retailers.”

The areas selected both face high levels of poverty and are home to farmers seeking new markets for their healthful crops, according to Wholesome Wave.  They point out that 40 percent of Hartford’s children live in poverty and 42 percent of the city’s residents use SNAP, formerly known as food stamps.

In the first iterations of healthy food incentives – which also match the value of SNAP spent – Wholesome Wave worked with local partners to offer them at farmers markets. By expanding healthy food incentives to grocery stores where many families already shop, this project is designed to offer a promising solution to each community’s food access challenges.

Wholesome Wave’s expertise in facilitating and scaling successful food access projects, combined with the local nonprofits’ experience within the communities, represents an ideal partnership to move this work forward, according to the organization.

This project builds on Wholesome Wave’s existing work across 40 states, including expansion through the large-scale FINI grant received last year, a $3.77 million grant from the USDA through the new Food Insecurity Nutrition Incentive (FINI) grant program.   Wholesome Wave began in Bridgeport in 2008; a 501(c)(3) nonprofit that strives to create a vibrant, just and sustainable food system. By making fresh, locally grown fruits and vegetables affordable and available, it enables underserved consumers to make healthier food choices.

In particular, this year’s FINI grant expands on the successes of Wholesome Wave’s and partners’ efforts to pilot nutrition incentives in grocery stores in Connecticut and Vermont.

In the first few months of 2016, Wholesome Wave invested in the Hartford food system by providing SNAP consumers with $23,000 in nutrition incentives to spend on fresh fruits and vegetables at two locally-owned grocery stores. During the program period, attributable at least in part to this project, SNAP sales at the local C-Town supermarket increased 7 percent and produce sales increased by 19 percent over the same period in 2015.

Executive Director of Hartford Food System, Martha Page, said: “As demonstrated in the pilot program, the SNAP Up! nutrition incentives are an excellent way to get more fresh fruits and vegetables on Hartford dinner tables. The enthusiastic response to the incentives by Hartford SNAP participants clearly shows that there is a demand for affordable, high quality produce.  For our local farmers, this will represent a new customer base that they have not been able to easily access. We are so excited at the opportunity to bring Hartford area farmers and Hartford consumers together; we believe that we will prove that good food is good business!”

National leaders emphasize how this new model will benefit their state’s economies, while increasing access to produce for low-income residents and improving the bottom line for regional farmers.

“Increasing access to fresh, healthy food for the low-income residents of food deserts will help move our communities one step closer to ending food insecurity. The federal funding awarded to Bridgeport’s Wholesome Wave to help provide fresh produce to Hartford’s local grocers is an investment in an incredible partnership that will help ensure the well-being and health of Hartford’s residents,” said U.S. Sen. Richard Blumenthal.

“Just a few days ago, I was at Hartford Regional Market talking to local farmers and Hartford community leaders about better connecting local food to city grocery stores,” recalled U.S. Sen. Chris Murphy. “This grant for Wholesome Wave is a great opportunity to make that happen. It just makes sense—we should help families afford locally-grown, fresh food at the grocery stores they already shop at. We worked so hard to get North Hartford its Promise Zone designation so that the city can hop to the front of the line when it comes to getting federal grants. This shows why that’s so important.”

“Food deserts correlate very highly with areas of poverty across our country, and a lack of healthy and affordable food options can have a very detrimental effect, especially on children,” said U.S. Rep. Jim Himes, who represents the Congressional District that includes Bridgeport. “With this grant, we will be able to help more families eat nutritiously in Hartford and also support the excellent work that Wholesome Wave is doing right here in Bridgeport, creating innovative ways to bring healthy, local produce into more stores and kitchens.”

In the initiative, neighborhood grocery stores will become access points for fresh local produce, and experience increased revenues. Beyond direct impact to the community, Wholesome Wave expects to use this project in the two states to develop a replicable Farm-to-Grocery Nutrition Incentive model that the organization hopes can spread nationally through their national network of over 110 organizations in 40 states – including 12 in Connecticut - with the promise of impact on a national scale.

The second-round USDA funding award to Wholesome Wave, announced this month, is for $499,720.  The programs in Hartford and Vermont’s Northeast Kingdom are expected to launch in August.

https://youtu.be/BU0sOg9GhWA

Four CT Community Health Centers Earn $1 Million Federal Grants to Expand Care

The federal Department of Health and Human Services (DHHS) has awarded Charter Oak Health Center, Inc. (COHC), located in the south end of Hartford, with a federal grant of $1 million to increase its capacity for patient care, one of four community health centers in the state to receive the federal grants. Grants of $1 million were awarded to three additional Connecticut community health centers:

• Fair Haven Community Health Clinic in New Haven
• Cornell Scott-Hill Health Corporation in New Haven
• First Choice Health Center in East Hartford

The grants to the four facilities in Connecticut are anticipated to extend program services to an additional 18,776 patients, according to DHHS.  Nationally, over $260 million in funding is to be provided to 290 health centers in 45 states, the District of Columbia, and Puerto Rico for facility renovation, expansion, or construction.

Health centers will use this funding to increase their patient capacity and to provide additional comprehensive primary and preventive health services to medically underserved populations.

"We are truly excited about the award," said Nichelle A. Mullins, President and CEO of COHC. “It is an honor and a great responsibility to serve our patients and community.  It is a significant accomplishment to be recognized on a national level for our quality of care. Our mission since 1978 is to offer health care services to our community and with the funding from this grant we will be able to improve and expand our specialty services.”

COHC currently offers a wide range of services from primary medical care, to specialty services including women’s health and gynecology, pediatric care, podiatry, dental and eye care as well as nutrition and wellness therapy. The center offers urgent care services where the patients can be seen quickly rather than in hospital emergency departments. There is also an on-site pharmacy and bilingual services in all areas of care.

According to Health and Human Services Secretary Sylvia M. Burwell, “With these awards, health centers will be able to do things like increase their hours of operation, hire more behavioral health providers, add dental facilities, better treat patients with opioid use disorders, and help people get coverage through the Health Insurance Marketplace and make the journey from coverage to primary care.”

In 2015, Charter Oak Health Center was one of 12 community health centers in the state to receive Expanded Service Awards from the Health Resources and Service Administration (HRSA) Health Center Program within the Department of Health and Human Services.

“Health centers are cornerstones of the communities they serve,” said Secretary Burwell.  “These awards will empower health centers to build more capacity and provide needed health care to hundreds of thousands of additional individuals and their families.”

The national grant was initiated in 2009, allowing health centers to add 6 million more patients. Health centers provide high quality preventive and primary health care to patients regardless of their ability to pay. Approximately 1 in 14 people in the U.S. relies on a HRSA-funded health center for medical care.

Nearly 1,400 health centers operate 9,800 service delivery sites in every U.S. state, D.C., Puerto Rico, the Virgin Islands and the Pacific Basin; these health centers employ more than 170,000 staff who provide care for nearly 23 million patients across the nation.

Charter Oak Health Center, Inc.  (COHC) was founded in 1978 and is an urban, 501(c) (3) federally qualified, Joint Commission-accredited, nonprofit community health center that serves the Greater Hartford, Connecticut Metropolitan Area and surrounding communities - Hartford itself being the poorest of the nation's cities with a population of greater than 100,000.

COHC is located in a medically underserved area (MUA) with an underserved population (MUP) and a health professional shortage area (HPSA). COHC is the only community health center located in southern Hartford and provides Medical, Dental, and Behavioral Health services to over 18,000 patients annually.

Cornell Scott-Hill Health Center is a federally qualified community health center established in 1968 in a collaboration between the community and Yale School of Medicine. The first community health center in Connecticut, the Cornell Scott-Hill Health Center has a long history of serving New Haven neighborhoods, which are among the most disadvantaged in the State. Cornell Scott-Hill Health Center also provides health care services to those from West Haven, Ansonia, Derby, Seymour, Shelton, Naugatuck and Oxford.

East Hartford Community HealthCare changed its name to First Choice Health Centers in recognition of growth as a regional provider of primary care services.  First Choice provides health care to 17,453 patients who made 67,663 visits in 2014. First Choice provides comprehensive primary care from newborn through adult and elderly services. The Center offers family practice, internal medicine, pediatrics, dentistry, nutrition, sonography, and in 2011 added podiatry followed by optometry in 2012 and behavioral health services in 2014.

With locations in New Haven and East Haven, Fair Haven Community Health Clinic provide comprehensive primary health care, delivered through innovative and alternative systems of health delivery.  Healthcare teams provide access to ongoing care throughout our patients' lifetime, including preventative health services, chronic disease management, and acute illness treatment. Fair Haven began in August 1971, under the leadership of a community advocacy agency called the Alliance for Latin American Progress, opening in a local elementary school two evenings a week.  The Clinic, also renamed, grew steadily in the decades since, expanding services and patients served.

link to FOX 61 news story.

https://youtu.be/j80B4ckjOT8

Connecticut Is 2016’s 2nd Best State for Working Dads; Two Norwalk Businesses Earn Spot Among Nation’s Top 50 for New Dads

Working fathers in Connecticut are in a great place, according to a newly released analysis.  Connecticut is ranked only behind only Minnesota as the 2^nd Best State for Working Dads, a glimpse of good news as Father’s Day approaches. Nearly 93 percent of dads with kids younger than 18 in the labor force, according to the personal-finance website WalletHub, which conducted an in-depth analysis of the Best & Worst States for Working Dads.

The top 10 states were Minnesota, Connecticut, Vermont, Massachusetts, New Jersey, Wisconsin, Iowa, Kansas, Virginia and North Dakota.  At the bottom of the list were Mississippi, West Virginia, Alaska and Nevada.

WalletHub analyzed the work-life balance, health conditions, financial well-being and child-rearing environments for working dads in the 50 U.S. states and the District of Columbia, using 20 key metrics, which range from day care quality to male life expectancy.

To identify the best and worst states for working dads, WalletHub analyzed the various factors in the work-life balance that affect paternal roles in the 50 states and the District of Columbia, focused on four key dimensions of fatherhood: 1) Economic & Social Well-Being, 2) Work-Life Balance, 3) Child Care and 4) Health.  Among the 20 factors included were parental leave policy, commute time, day care quality, pediatric services, median income, unemployment rate, and mental health.

Leading to its overall ranking of second in the analysis, Connecticut was 13^th in “economic and social well-being,” third in “work-life balance,” eighth in “child care,” and third in “health.”  Among the sub-categories, Connecticut was:

• 2nd – Male Life Expectancy at Birth
• 2nd – % of Kids Younger than 18 with Dad Present Living in Poverty
• 2nd – “Parental Leave Policy” Score
• 6th – Access to Pediatric Services
• 6th – % of Men Who Report Adequate or Any Physical Activity
• 7th – Male Uninsured Rate
• 14th – Average Freshman Graduation Rate for Men
• 16th – Mortality Rate due to Heart Disease per 100,000 Men
• 17th – Mean Hours Worked per Day Among Males
• 19^th - Median Income for Families (Dad Present) with Kids Younger than 18 Years, Adjusted for Cost of Living

Among the nation’s top businesses for new dad, an analysis by the website Fatherly, determined that two Connecticut-based companies – alcoholic beverages producer Diageo and financial data and analysis provider FactSet, earned slots in the top 50.  Fatherly is a digital lifestyle guide for men entering parenthood.

Just a handful of states had companies on the list:  California (18), New York (9), Oregon (4), Massachusetts (3) and Georgia, North Carolina, Washington DC, and Connecticut, with two each.

Norwalk’s Diageo ranked 34^th, and was praised for policies that include “employees receive up to 8 hours of school activity leave (up to 40 hours per year) so you won’t have to miss your kid’s big game or school play.”  FactSet, headquartered in Norwalk, ranked 46^th.  The company was praised because it “recently upped it’s paternity leave from one week to 4.”  FactSet has 8,000 employees in 21 countries.  Diageo is a global leader in beverage alcohol with iconic brands in spirits, beer and wine, producing well-known brands from more than 200 sites in over 30 countries.

The top companies were Netflix, Spotify, Facebook, Patagonia, Bank of America, Pinterest, Google, Microsoft, Twitter, Airbnb, Johnson & Johnson, Accenture, MasterCard, Intuit and Intel.

In addition, nine small businesses described as “leading the way,” were change.org (San Francisco), Laughing Planet Café (Portland), Upworthy (New York), Blue Corona (Maryland),  Badger Balm (New Hampshire), Square Root (Austin), Able Lending (Austin), Happy Family (New York) and ustwo (New York).

When Fatherly’s 50 Best Places To Work For New Dads was a year ago, nearly half the companies featured offered between one and 2 weeks of paid leave to fathers. Twelve months later, 7.5 weeks is the average, 35 percent of companies offer between 6 and 8 weeks, and another 12 companies offer between 10 weeks and a full year, the website pointed out, attributing much of the increase to tech companies, which make up nearly a third of companies on the top 50 list.

Data used to create the WalletHub report were obtained from the U.S. Census Bureau, the U.S. Bureau of Labor Statistics, the Council for Community and Economic Research, the Centers for Disease Control and Prevention, the National Center for Education Statistics, the National Partnership for Women & Families, the American Urological Association, the Social Science Research Council, Child Care Aware of America and WalletHub research.

Nine in Ten CT Residents Have a Usual Source of Care, But 3 in 10 Haven’t Seen Doctor in Past Year

A new federal report finds that all but 10.1 percent of Connecticut residents had a usual source of medical care during 2014 – tied for the sixth lowest percentage among the states.  The same report found great variation among states but, on average, 17.3 percent of Americans lacked a usual source of care. Vermont led the country with only 2.8 percent of residents reporting they do not have a regular care site, according to data compiled by the Centers for Disease Control and Prevention’s National Center for Health Statistics, followed by Delaware at 6.8 percent.

Even in Connecticut there remains room for improvement as nearly 3 in 10 – 29.6 percent - of Connecticut residents had not seen or talked to a general doctor during the last year, slightly better than the national average. Vermont also led the country in that statistic, with 84 percent having seen or spoken with a physician during the previous year.

The percentage of adults without a usual place of medical care ranged from 2.8 percent in Vermont to 26.7 percent in Nevada.  The percentage of adults who did not have a general doctor visit in the past 12 months ranged from 15.9 percent in Vermont to nearly have the state’s population - 48.1 percent - in Montana.

The federal data indicated that nine states (Nevada, Idaho, Texas, Oregon, Wyoming, Kentucky, Arizona, Alaska, and Florida) had a higher percentage of adults without a usual place of medical care compared with the national average (17.3%).

Conversely, Vermont, Delaware (6.8%), Massachusetts (7.5%), Wisconsin (9.5%), Hawaii (10%), Connecticut (10.1%), Rhode Island (10.1%), New Hampshire (11.6%), North Dakota (11.9%), South Dakota, New York, Alabama, Iowa, Maine, and Pennsylvania had a lower percentage of adults without a usual place of medical care compared with the national average.

Eleven states (Montana, South Dakota, Alaska, Nevada, New Mexico, South Carolina, Idaho, Nebraska, Texas, Florida, and California) had a higher percentage of adults who had not seen or talked to a general doctor in the past 12 months compared with the national average (34.0%).  Vermont, Delaware, Virginia, Pennsylvania, Michigan, Wisconsin, New Hampshire, Oklahoma, and Ohio had a lower percentage of adults who had not seen or talked to a general doctor in the past 12 months compared with the national average.

Connecticut, at 29.6 percent, ranked just outside the top 10 states in the second quartile, but just below the national average.

Also of note, the study found little impact on these metrics of states’ decisions to expand Medicaid or create a state-based health insurance exchange. The federal analysis concluded that “continued state-specific monitoring will be helpful in identifying and tracking state and regional disparities in health care utilization over time.”

The National Health Interview Survey is a multipurpose health survey conducted continuously throughout the year by the National Center for Health Statistics (NCHS). Interviews are conducted in person in respondents’ homes, but follow-ups to complete interviews may be conducted over the telephone. The federal report was authored by Lindsey I. Black and Jeannine S. Schiller, with the National Center for Health Statistics, Division of Health Interview Statistics.

CT An Also-Ran Among States in Entrepreneurial Growth, Despite Some Gains

Connecticut ranks 13^th among the nation’s 25 smaller states – and 36^th overall - in the growth of entrepreneurship, according to a new study and state-by-state analysis by Kauffman Foundation.  A year ago, the state ranked 17^th among the smaller states, slightly improving its ranking in the latest data.  The rate of start-up growth in Connecticut increased to 45.5 percent in the 2016 report, compared with 23.6 percent the previous year. The “share of scale-ups” also increased, from 1.29 percent in last year’s analyses to 1.33 percent this year.  Scale-ups measures the number of firms that started small but grew to employ fifty people or more by their tenth year of operation as a percentage of all employer firms ten years or younger.

One metric that dropped slightly measured high-growth company density – the number of private businesses with a least $2 million in annual revenue reaching three years of 20 percent annual revenue growth normalized by total business population.  Connecticut moved from 55.1 a year ago to 48.8 in the 2016 report.  Both researchers and entrepreneurs have suggested density as a key indicator of vibrancy in entrepreneurial ecosystems, and there is high variation on this indicator across U.S. states, according to the report.

The Kauffman Index of Growth Entrepreneurship, released this week,  is an indicator of business growth in the United States, “integrating several high-quality sources of timely information into one composite indicator of entrepreneurial business growth.”

In rankings by industry, Connecticut ranked in the top five among the 25 smaller states in two five categories – 3^rd in Business Products & Services and 3^rd in Software.  The state was ranked outside the top five in high-growth companies in the IT Services, Advertising & Marketing and Health industries.

Overall, the Growth Entrepreneurship Index rose in 2016 in thirty-nine states in the last year, indicating a continued return of broad-based business growth, the report concluded.

• Among the twenty-five largest states, the five states with the highest Growth Entrepreneurship Index were Virginia, Maryland, Arizona, Massachusetts, and Texas.
• Among the twenty-five smallest states, the five states with the highest Growth Entrepreneurship Index were Utah, New Hampshire, Delaware, North Dakota, and Oklahoma. (Connecticut ranked 13^th)

While most states experienced an increase in growth entrepreneurship activity, changes in state rankings— which measure relative yearly performance across states, as opposed to performance relative to a state’s own growth entrepreneurship rates in the previous year—were different. Twenty-three states ranked higher than they did last year, seven experienced no changes in rankings, and twenty ranked lower, the report pointed out.

"Growth entrepreneurship directly contributes to the economy through creating jobs, innovation and wealth," said Arnobio Morelix, senior research analyst at the Kauffman Foundation, which conducts the annual study.

Virginia took first place in growth entrepreneurship activity among the 25 largest states, followed by Maryland, Arizona, Massachusetts and Texas. Kauffman researchers said it is no coincidence that two of the top states include the highly entrepreneurial Washington, D.C., metro area. Among larger states, 12 ranked higher than they did last year, four experienced no change in rankings and nine ranked lower.

Among the 25 largest states, the five that experienced the biggest increase in rank from 2015 to 2016 were North Carolina (15 to 8), Alabama (13 to 9), Ohio (16 to 12), Tennessee (18 to 14) and Arizona (6 to 3).

The five large states that saw the greatest decrease in rank in 2016 were, with a tie for fifth place, New Jersey (8 to 20), Pennsylvania (10 to 16), Illinois (14 to 17), Wisconsin (20 to 23), Louisiana (4 to 6) and South Carolina (11 to 13).

Among the 25 smallest states, Utah led growth entrepreneurship activity, followed by New Hampshire, Delaware, North Dakota and Oklahoma. Eleven states ranked higher than they did last year, three experienced no change in rankings and 11 ranked lower.

The five small states that saw the biggest increase in rank were Mississippi (22 to 10), Wyoming (23 to 15), North Dakota (11 to 4), Nevada (15 to 8) and Connecticut (17 to 13).

Most CT Residents Concerned About Loss of Jobs, Access, Care in Aetna-Humana Merger, Poll Shows; Missouri Decision Points to Adverse Impact

The State of Missouri raised a red flag today, waving it directly into the headwind that is the pending merger between health care giants Aetna and Humana.  Missouri’s action came just as a public poll was released in Connecticut by consumer advocates opposing the merger which indicated a general lack of public awareness about the merger plan and substantial concern about potential job losses and adverse health care affordability and choices here if the merger goes forward. The Missouri Insurance Department issued an order banning Aetna and Humana from selling certain types of insurance in the state if the companies’ planned $37 billion merger comes to fruition. The order states that Aetna and Humana should “cease and desist from doing business” throughout Missouri with respect to individual and small group insurance and the group Medicare Advantage market if Aetna’s acquisition of Humana is completed.

In Connecticut, the Connecticut Campaign for Consumer Choice coalition released results of a recent poll which found that most Connecticut voters “didn’t know that the five major national health insurance companies – UnitedHealth, Anthem, Cigna, Aetna, and Humana - are attempting to merge down to three companies from five. The new research found that only 27 percent of respondents were aware of the plans.

After they were given more information about the consequences of the mergers among the five national health insurance providers (Aetna-Humana and CIGNA-Anthem), 71 percent of Connecticut voters were opposed to State Insurance Commissioner Katherine Wade approving the mergers in Connecticut.

Nine in ten state voters (91 percent) think that it’s either very or somewhat important that Commissioner Wade “considers the impact of these mergers on the affordability of insurance premiums and out-of-pocket costs, and their potential to limit health care choices, in her decision making process.” And those surveyed were overwhelmingly concerned that the proposed mergers will lead to job losses in Connecticut.

The Connecticut survey, conducted earlier this month by Public Policy Polling, found that 89 percent of Connecticut voters are either very or somewhat concerned that the proposed mergers will lead to job losses in Connecticut. Additionally, 89 percent of those polled believe it’s either very or somewhat important that the impact of these mergers on job losses in Connecticut be considered by state regulators.

Missouri is the first state regulator to release findings against the proposed deal, announced last year, published reports indicated. The deal is being reviewed by the U.S. Department of Justice, as well as state regulators and antitrust authorities, who are also reviewing competitor Anthem’s plan to buy Cigna Corp. Aetna has filed for regulatory approval in the 20 states where Humana is domiciled and of those, 15 have approved the deal thus far, including Connecticut.  Because of Humana's limited footprint in Connecticut, the review was more form than substance.  The Cigna-Anthem merger, however, is to receive a much fuller review, according to state insurance officials, as Cigna is a state-domiciled company.

Regarding Aetna-Humana, the Missouri Insurance Department “found that in its current, unmodified, form – as to a few specified lines of insurance – that the proposed acquisition would violate the competitive standard set forth in Missouri law, meaning that as to those lines the acquisition would substantially lessen competition in this state.”

The Missouri Insurance Department stressed that the decision “is not a final order. The statute provides that Aetna and Humana may submit a plan to remedy the anticompetitive effect of the merger as to those specified lines.”  If that step is taken, the department “would evaluate the plan and may modify or vacate” the order issued today banning the merged company from certain lines of insurance in the state.

"The Missouri order does not impede the Department of Justice approval process," Aetna said in a statement. "We're disappointed, but expect to have a constructive dialogue with the state to address their concerns."

In addition to the public poll, Connecticut Campaign for Consumer Choice – a coalition that includes the Universal Health Care Foundation, Connecticut Citizen Action Group and Connecticut State Medical Society -  released a letter to Commissioner Wade signed by 17 state legislators calling for multiple public hearings on the merger, intervenor status for interested consumer advocates, and a study that would “analyze the potential impact on cost, access, and the Connecticut economy, including jobs” and warning that if the merger is approved, “the resulting mega-insurer will cover 64 percent of covered lives in Connecticut, with an even greater concentration in some regions of our state.”

The Missouri decision comes following a public hearing held on May 16.  In testimony provided as part of the public record, Consumers Council of Missouri expressed “profound concern,” warning that the merger would result in a “significant reduction in competition (that) will most certainly result in increased cost to consumers,” adding that “the results will be catastrophic and we will have no power to undo it.”

The Missouri Hospital Association, in offering a detailed 21-page analysis, indicated that “Consolidation will affect the ability of hospitals and other health care providers to bargain competitively for contracts containing appropriate fees for medical services. In turn, such providers are less able to invest in the resources to maintain and improve the quality of care. An anticompetitive suppression of healthcare payments will suppress innovation, to the detriment of consumers.”