Epi Monday 06/23/2008

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Salmonella Cases Continue To Climb With No Point Source Yet Identified

The number of identified cases of salmonella thought to be linked to the consumption of tomatoes increased to more than 500 in CDC’s latest report. Cases have now been identified in over 30 states, though the latest increase was not attributed to new cases but rather to improved surveillance and completion of some pending laboratory work. CDC’s latest report suggests that the widespread consumption of raw red plum, red Roma, or round red tomatoes or any combination of these and of products containing these raw tomatoes is responsible for the extensive outbreak. (Only three cases of this salmonella serotype were reported last year). There is no unusual distribution of cases by age or sex. Almost a fifth of the studied cases have been hospitalized but without any deaths. The FDA reported last week that it has been able to traceback some tomatoes from points of purchase or consumption to farms in Mexico and Florida. Further investigations are underway there as well in Texas where a cluster of cases has been identificd which might make tracing easier to accomplish.

Editor's Quote of the Week (06/23/2008) “The evidence is in: Health inequities are the embodiment of social inequality.” Nancy Krieger, Harvard social epidemiologist, in her advice to the next president included in the Harvard Public Health Review in which seven faculty give their advice to the next US president.

 

Role of Financial Incentives In Assuring Patient Compliance Being Investigated at Penn

An Aetna Foundation study being carried out at the University of Pennsylvania will compare patients who comply with taking their medications and thereby earn the chance to participate in a lottery with a good chance of winning ten and hundred dollar prizes with controls who do not have a chance at the lottery to see if the financial incentives make a difference in compliance. The article describing the study and giving an overview of the role of financial incentives in health appeared in the June 22 Hartford Courant. According to Troyen Brennan, the Aetna chief medical officer, “From a public health point of view, this is a very sensible thing to do. It recognizes that simply exhorting people to do what’s best for themselves isn’t going to work and that we need to come up with more innovative ways to improve people’s health care and recognize that people don’t comply with their medication regimen.” And “I do think that we have to recognize in this society, as well as most societies, that financial incentives do affect people’s behavior, and we need to take advantage of those in the most ways possible to improve public health.”

 

Epidemiologists Among Those Giving Advice To The Next President On How To Achieve Health Equity

An article in the Harvard Public Health Review entitled “Advice to the Next President” includes recommendations from seven Harvard faculty members, including two epidemiologists Ichiro Kawachi and Nancy Krieger, on how to “level the playing for all Americans” in terms of health. According to the article, taking a lead from the work of epidemiologist Michael Marmot,  Premature death is more than three times more likely to occur in those at the bottom income levels of American society. Even middle-income Americans are more than twice as likely to die earlier than top earners.

The advice in a nutshell is to tackle the broad social determinants of health. Only tobacco control is mentioned as a specific and direct health intervention.

Krieger’s advice is notable for its trenchant nature and her worldview seems more likely to fit with the election of Barack Obama than John McCain. Here’s a sample, “ Jettison the neo-liberal and neo-conservative policies of the past quarter century. Reprioritize reducing poverty. Promote insightful diplomacy, not reckless, horrific, wasteful wars (e.g., in Iraq). Spend 20 percent not 1 percent, of US health dollars on public health and prevention to address societal determinants of health…”

And “the shorter, sicker lives of people burdened by economic deprivation, discrimination, noxious jobs, and environmental pollution result from injurious political priorities, not individual failure.”

 

 

 

 

 

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