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Message from the HHS OMH Director: The Surgeon General is calling on us to lead
Every day, more than 75 people in our country die from a prescription drug or heroin overdose. In 2013, nearly 249 million prescriptions were written for opioids—enough for every adult in America to have a bottle of pills. A significant factor in the opioid epidemic is legally written prescriptions from doctors, dentists, nurse practitioners and physician assistants.
As a physician myself, I understand the important role that we—the doctors, nurse practitioners, dentists and physician assistants of America—can play in the effort to turn the tide on this epidemic. To help address the prescription opioid crisis, U.S. Surgeon General Dr. Vivek Murthy is taking historic action by sending a personal letter to more than 2.3 million health care practitioners and public health leaders. I want to make sure you see his letter, a copy of which I have included below. Please take a moment to read it and then visit www.TurnTheTideRx.org/join to join with clinicians from across the country in a simple but powerful movement to end this epidemic.
TurnTheTideRx.org provides clinicians with practical tools, information, and in-the-trenches stories from colleagues offering their insights into the epidemic. This new resource becomes another crucial tool in our work to reduce the behavioral health disparities that minorities experience, including lack of access to services and treatment. Some of these barriers to care include systemic issues of bias in the health care delivery system; discrimination; lack of insurance; and cultural, language, and communication barriers between patients and providers.
For the communities we serve at the HHS Office of Minority Health, we are for example concerned by the prescription opioid overdose deaths among American Indian/Alaska Native (AI/AN) populations–death rates that surpass those of non-Hispanic whites according to data from the CDC. And while AI/AN populations have the highest prescription opioid deaths rates of all Americans, the devastation of this epidemic is felt across all populations, including all racial and ethnic minority populations. Now is the time to shine a light on the hidden realities of mental and substance use disorders in communities of color—conditions that are often intensified by trauma. And, lack of health coverage and the ability to afford care are often reported as barriers to seeking treatment, further compounding the disparities generated by adverse social and economic conditions.
The HHS Office of Minority Health, along with Dr. Murthy, encourages you to spread the news about this new effort to combat the prescription opioid crisis to your networks and communities. We hope you will join the movement and be a part of the solution. Together we can turn the tide.
J. Nadine Gracia, MD, MSCE, is the Deputy Assistant Secretary for Minority Health and Director, Office of Minority Health, U.S. Department of Health and Human Services
About Turn the Tide Rx
Turn the Tide Rx is a national campaign created to enable “prescribers talking to prescribers.” Turn the Tide Rx aims to educate prescribers about the opioid epidemic, mobilize health care professionals to improve prescribing practices, provide the public with information to protect themselves and their families from opioid misuse and overdose, learn from communities around the country that are finding creative ways to tackle the opioid epidemic, and change the cultural perceptions around addiction so that it is not seen as a moral failing but a chronic illness that must be treated with skill, urgency and compassion.
UNITED STATES SURGEON GENERAL
Vivek H. Murthy, M.D., M.B.A.
I am asking for your help to solve an urgent health crisis facing America: the opioid epidemic. Everywhere I travel, I see communities devastated by opioid overdoses. I meet families too ashamed to seek treatment for addiction. And I will never forget my own patient whose opioid use disorder began with a course of morphine after a routine procedure.
It is important to recognize that we arrived at this place on a path paved with good intentions. Nearly two decades ago, we were encouraged to be more aggressive about treating pain, often without enough training and support to do so safely. This coincided with heavy marketing of opioids to doctors. Many of us were even taught – incorrectly – that opioids are not addictive when prescribed for legitimate pain.
The results have been devastating. Since 1999, opioid overdose deaths have quadrupled and opioid prescriptions have increased markedly – almost enough for every adult in America to have a bottle of pills. Yet the amount of pain reported by Americans has not changed. Now, nearly 2 million people in America have a prescription opioid use disorder, contributing to increased heroin use and the spread of HIV and hepatitis C.
I know solving this problem will not be easy. We often struggle to balance reducing our patients’ pain with increasing their risk of opioid addiction. But, as clinicians, we have the unique power to help end this epidemic. As cynical as times may seem, the public still looks to our profession for hope during difficult moments. This is one of those times.
That is why I am asking you to pledge your commitment to turn the tide on the opioid crisis. Please take the pledge. Together, we will build a national movement of clinicians to do three things:
First, we will educate ourselves to treat pain safely and effectively. A good place to start is this pocket guide with the CDC Opioid Prescribing Guideline. Second, we will screen our patients for opioid use disorder and provide or connect them with evidence-based treatment. Third, we can shape how the rest of the country sees addiction by talking about and treating it as a chronic illness, not a moral failing.
Years from now, I want us to look back and know that, in the face of a crisis that threatened our nation, it was our profession that stepped up and led the way. I know we can succeed because health care is more than an occupation to us. It is a calling rooted in empathy, science, and service to humanity. These values unite us. They remain our greatest strength.
Thank you for your leadership.
Earlier this year, when the word “Zika” was just becoming known in the U.S., promotores de salud, also known as community health workers (CHWs), in Miami, Florida were already taking action and learning about the prevention and control of mosquito-borne diseases. In February, the Miami Dade Florida Health Department convened a community meeting that resulted in a call for more multilingual community education and awareness of Zika. The Florida Community Health Worker Coalition partnered with the Health Council of South Florida , the Miami Clinical and Translational Science Institute, and the Miami-Dade Health Action Network to facilitate a series of Zika education workshops for CHWs .
This series of free, accredited, and multi-lingual capacity-building workshops specifically tailored for CHWs/promotores took place in March and April of this year. The workshops tackled the public health challenges that arise before and during the emergence or re-emergence of vector-borne diseases, as well as strategies for their control. The infographic below highlights the lessons learned about Zika virus, dengue fever and chikungunya.
This capacity building effort identified the need to educate and update communities frequently about how to prevent Zika, especially as our knowledge about the transmission and impact of the disease continues to change. CHWs are uniquely situated to spur community members to ask themselves, “What can I do to protect myself, my family, and my community from Zika?” and then serve as the resource to engender appropriate action in the community, with health care professionals and local government officials.
The Centers for Disease Control and Prevention (CDC) recommendation for the best way to prevent diseases spread by mosquitoes is to avoid mosquito bites by controlling mosquitoes outside and inside the home, using repellent registered by the Environmental Protection Agency with DEET, picaridin, IR535, or oil of lemon eucalyptus or para-menthane-diol.
Zika can also be transmitted through sex; infections that occur during pregnancy can cause microcephaly and other severe fetal brain defects. As a result, the CDC recommends all pregnant women with sexual partners (male or female) who live in or traveled to an area with Zika, use condoms or a barrier method during sex or abstain from sex for the remainder of their pregnancy. Many people infected with Zika virus won’t have symptoms or will only have mild symptoms. That is why is so important to avoid mosquito bites, control mosquitoes, and protect pregnant women from getting Zika. We all can do our part to #StopZika.
Ed. note: This was originally published on the HHS.gov blog.
Summary: The 100-Day Challenge will help catalyze community action to establish bold, creative, and innovative ways to help homeless youth find stable housing.
In communities across our country, too many young people face the harsh reality of not having a safe place to lay their heads and sleep for the night. In our recent Street Outreach Program report, we learned that most older youth become homeless for the first time because they are asked to leave home by a parent or caregiver. More than half have tried to stay at a shelter but it was full. More than 60% were raped, beaten up, robbed, or otherwise assaulted. Nearly 30% identified as gay, lesbian or bisexual, and nearly 7% identified as transgender. About half of the youth had been in foster care, and those who had been in foster care had been homeless for much longer compared to youth who hadn’t.
It doesn’t have to be this way. To do better, we are teaming up with A Way Home America and the Rapid Results Institute to launch a 100-Day Challenge to end youth homelessness.
The purpose of the 100-Day Challenge is to help catalyze community action to establish bold, creative, and innovative ways to help homeless youth find stable housing. The short timeline is intentional, inviting communities and their cross-sector partners to generate urgency and action.
The 100-Day Challenge will launch on September 7, 2016, in three communities -- Austin, Cleveland, and Los Angeles, who were chosen through a competitive process for their innovative approaches to addressing youth homelessness. We are grateful for the leaders who are willing to work in these communities to solve this daunting challenge. The 100-day challenge is only one part of a comprehensive solution. Together with our federal partners, the Department of Health and Human Services is committed to ending youth and family homelessness by 2020.
At the Administration on Children, Youth, and Families, we support the plan by working to support vulnerable youth experiencing homelessness through programs like Basic Center, Transitional Living, and Street Outreach and in partnership with the Children’s Bureau and the nation’s child welfare systems to prevent homelessness before it begins.
By working together to put into place proven practices along with continuous bold new thinking we intend to make the goal a reality. Our youth deserve nothing less.
To learn more and follow the challenges, visit www.awayhomeamerica.org.
For information about how the federal government is involved in ending youth homelessness, go to the Federal Framework to End Youth Homelessness.
Rafael López is the Commissioner for the Administration on Children, Youth and Families
Ed. note: This was originally published by the National Cancer Institute.
The largest study ever to investigate how genetic and biological factors contribute to breast cancer risk among black women launched today. This collaborative research project will identify genetic factors that may underlie breast cancer disparities. The effort is funded by the National Cancer Institute (NCI), part of the National Institutes of Health.
The Breast Cancer Genetic Study in African-Ancestry Populations initiative does not involve new patient enrollment but builds on years of research cooperation among investigators who are part of the African-American Breast Cancer Consortium, the African-American Breast Cancer Epidemiology and Risk (AMBER) Consortium, and the NCI Cohort Consortium. These investigators, who come from many different institutions, will share biospecimens, data, and resources from 18 previous studies, resulting in a study population of 20,000 black women with breast cancer.
“This effort is about making sure that all Americans – no matter their background – reap the same benefits from the promising advances of precision medicine. The exciting new approaches to cancer prevention, diagnosis, and treatment ring hollow unless we can effectively narrow the gap of cancer disparities, and this new research initiative will help us do that,” said Douglas R. Lowy, M.D., acting director of NCI. “I’m hopeful about where this new research can take us, not only in addressing the unique breast cancer profiles of African-American women, but also in learning more about the origin of cancer disparities.”
Survival rates for women with breast cancer have been steadily improving over the past several decades. However, these improvements have not been shared equally; black women are more likely to die of their disease. Perhaps of most concern is that black women are more likely than white women to be diagnosed with aggressive subtypes of breast cancer. The rate of triple-negative breast cancer, an aggressive subtype, is twice as high in black women as compared to white women.
The exact reasons for these persistent disparities are unclear, although studies suggest that they are the result of a complex interplay of genetic, environmental, and societal factors, including access to health care. Large studies are needed to comprehensively examine these factors, and NCI is supporting several such efforts.
As part of the study, the genomes of 20,000 black women with breast cancer will be compared with those of 20,000 black women who do not have breast cancer. The genomes will also be compared to those of white women who have breast cancer. The project will investigate inherited genetic variations that are associated with breast cancer risk in black women compared to white women. In addition, researchers will examine gene expression in breast cancer tumor samples to investigate the genetic pathways that are involved in tumor development.
“This $12 million grant—in combination with previous investments—should help advance our understanding of the social and biological causes that lead to disparities in cancer among underserved populations,” said Robert Croyle, Ph.D., director of NCI’s Division of Cancer Control and Population Sciences (DCCPS), which is administering the grant. “A better understanding of the genetic contributions to differences in breast cancer diagnoses and outcomes among African-Americans may lead to better treatments and better approaches to cancer prevention.”
“A number of studies have suggested that genetic factors may influence breast cancer disparities, so we’re hopeful that this project can help to shed further light on this matter.” said Damali Martin, Ph.D., program director for the DCCPS Genomic Epidemiology Branch. Dr. Martin’s office is working directly with the grant recipients as well as the consortia groups that have been researching black women and breast cancer.
The grant has been awarded to Wei Zheng, M.D., Ph.D., of Vanderbilt University, Nashville, Tennesee; Christopher Haiman, Sc.D., of the University of Southern California, Los Angeles; and Julie Palmer, Sc.D., of Boston University. Additionally, minority scientists from various institutions, including from one Historically Black College and University medical school, are playing an important role in this study, and they have been involved in previous research that this study builds upon. For example, the Southern Community Cohort Study, a contributing study for this grant, represents a 15-year partnership between Vanderbilt and historically black Meharry Medical College in Nashville, Tennessee. In addition, this grant will provide training opportunities for scientists from minority populations.
Support for ongoing research in this area represents NCI’s continued commitment to fund a comprehensive portfolio of research aimed at reducing cancer risk, incidence, and mortality, as well as improving quality of life for cancer survivors across all demographic groups.
The National Cancer Institute leads the National Cancer Program and the NIH’s efforts to dramatically reduce the prevalence of cancer and improve the lives of cancer patients and their families, through research into prevention and cancer biology, the development of new interventions, and the training and mentoring of new researchers. For more information about cancer, please visit the NCI website at www.cancer.gov or call NCI's Cancer Information Service at 1-800-4-CANCER.
About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.
Summary: The effects of incarceration are felt far beyond prison walls: children, families, and communities also experience the consequences of incarceration.
The effects of incarceration are felt far beyond prison walls: Children, families and communities also experience the consequences of incarceration. New research estimates that more than 5 million children, or 7 percent of all children in the United States, have had a parent in prison at some point during their childhood. Though every family’s story is different, many struggle with financial strain, stigma and discrimination, and the challenges of getting back to normal after a family member returns home from incarceration.
On June 29, HHS, DOJ, and the Federal Interagency Reentry Council Subgroup on Children of Incarcerated Parents hosted a listening session with 20 young people (ages 16-24), from across the country who have or have had an incarcerated parent. The listening session was an opportunity for federal staff from across government to learn more about the unique challenges of having a parent behind bars. The federal audience was able to hear stories like:
AnthonyAnthony, now 20 years old, was just 10 when his mother was first incarcerated for a nonviolent drug-related offense. With his mother absent, Anthony and his six siblings lost their housing assistance and bounced in and out of shelters. Anthony struggled with his feelings of resentment and found himself in trouble with the law as a teenager. Fortunately, with free legal assistance, he was able to get his record expunged, turn his life around, and will be the first in his family to attend college, starting this fall.
AubreyAubrey was in 7th grade when her mother was first incarcerated. She recalled the humiliation she felt when being called out of class after her mother was arrested and the shame of having teachers and classmates look at her differently. The following year, Aubrey’s mother was arrested again in the middle of the night. Aubrey remembers hearing her mother plead with police to let her say goodbye to her kids, and the police carrying her off without letting her say a word to them, leaving Aubrey and her young brother home alone with her mother’s boyfriend at the time. Aubrey is grateful for Northwest Family Services for providing her with two incredible mentors, Marilyn and Marianne, who helped support her, and to organizations like Angels in the Outfield, who provided rental assistance and school supplies when she needed them.
JessicaJessica was only 2 when her father was sentenced to 21 years in prison. Though expensive, Jessica and her family frequently take the five-hour journey to visit him. After years of only being able to talk through glass, Jessica’s father was granted contact visits this past February. She recalled how incredible it was to finally get to hug her dad after 14 years of not being able to touch. For Jessica, the worst part about the visits was the strict and confusing dress code imposed by correctional staff. Even after traveling such a long distance to see her father, Jessica was turned away at the door for wearing blue because it was associated as a gang color. She said she felt treated like a prisoner even though she had done nothing wrong.
These stories reflect the experiences of many youth who have an incarcerated parent. When parents are incarcerated, multiple agencies often provide support for these children through direct services such as foster care placement or mentoring. Many programs provide indirect assistance to caregivers, but efforts are rarely coordinated among the agencies that may have a stake in this issue, including human services, education, child welfare, police, parole and probation authorities, and corrections. At the listening session, the young people expressed the need for more and better programs and called for bold action by policy makers.
This week, the White House and the Department of Justice will convene the Federal Interagency Reentry Council, which was launched in 2011 by then-Attorney General Eric Holder and formally established by the President in April, to bring together the heads of 15 cabinet-level departments and agencies. The Council will explore how the federal government can continue to identify and eliminate unwarranted barriers to successful reentry and support families affected by the criminal justice system. For more information, please visit youth.gov/coip.
Charles Homer is the Deputy Assistant Secretary for the Office of Human Services Policy at the HHS Office of the Assistant Secretary for Planning and Evaluation