Washington State is facing a Whooping cough epidemic that state health officials say could surpass the number of cases in any year since before the vaccine went into wide use in the 1940s. The state has recorded 1,284 cases through early May — 10 times as many as last year’s total at this time. But as the New York Times reports, budget cuts are hampering state and local health departments’ responses to the increasing number of Whooping cough, also known as pertussis, cases.

For example, the local Public Health Department in Skagit County, which has been hardest hit by the epidemic, has half the staff it did four years ago, and most of its preventive care programs have disappeared:

The county’s top medical officer, Dr. Howard Leibrand, who is also a full-time emergency room physician, said that in the crushing triage of a combined health crisis and budget crisis, he had gone so far as to urge local physicians to stop testing patients to confirm a whooping cough diagnosis.

If the signs are there, he said — especially a persistent, deep cough and indication of contact with a confirmed victim — doctors should simply treat patients with antibiotics. The pertussis test can cost up to $400 and delay treatment by days. About 14.6 percent of Skagit County residents have no health insurance, according to a state study conducted last year, up from 11.6 percent in 2008.

“There has been half a million dollars spent on testing in this county,” Dr. Leibrand said late last week. “Do you know how much vaccination you can buy for half a million dollars?” And testing, he added, benefits only the epidemiologists, not the patients. “It’s an outrageous way to spend your health care dollar.”

State health officials suggest that there could be more pertussis cases than current estimates show. Due to incomplete testing, as few as one in five cases is being tracked because of incomplete testing. Becky Neff, a registered nurse with a school district in Skagit County, told the New York Times that she has stopped asking for confirmation of suspected Whooping cough cases because there are only two nurses processing the disease reports instead of the five nurses doing the job a few years ago.

Mary Selecky, the state’s secretary of health, said under-immunization in children could be a compounding factor in the rapid increase in pertussis cases. Until the Washington legislature changed the state law last year to make it more difficult to opt out of childhood vaccines, Washington state had the highest number of kindergartners who did not meet state or national goals for any required immunizations, according to a Centers for Disease Control and Prevention study.

And because the vaccine for pertussis fades over time, the CDC recommends that adults receive a booster shot every 10 years to increase their protection against pertussis. Officials say this is especially important for adults who are around infants too young to be vaccinated because of how easily pertussis can spread.

President Obama came out in support of marriage equality on Wednesday, saying that it was important to him to “go ahead and affirm that I think same sex couples should be able to get married.” His position is also good for public health. Studies have shown that legalizing same-sex marriage helps improve mental health. In one Massachusetts study, it led to fewer visits to health clinics, and all gay men saw benefits, according to the Los Angeles Times:

A study published in February by the American Journal of Public Health found that gay men in Massachusetts were in better physical and mental health after that state became the first to recognize same-sex marriage in 2003. Researchers examined the medical records of 1,211 gay and bisexual men who went to “a large, community-based health clinic” in a “large metropolitan city” and compared the patients’ use of medical services before and after the law went into effect. [...]

Overall, the number of visits to the clinic fell by 13% after gay marriage was legalized – and both partnered and single gay men benefited, the researchers found. “One mechanism that may explain these findings is a reduction in the amount and frequency of status-based stressors that sexual minority men experience when institutionalized forms of stigma are eliminated,” they wrote.

Researchers in California found that married gay men were more relaxed and less depressed than gay men in domestic partnerships. And legally married same-sex couples rely on welfare less than single people, according to another Massachusetts study. “Marriage appears to confer a number of benefits, psychological and otherwise,” Letitia Anne Peplau, a social psychologist at UCLA, told Science. “There isn’t anything in the scientific literature that suggests that gay or lesbian people would benefit less or differently than heterosexual people from access to the institution of marriage.”

Obesity is a growing health concern in the United States. A projection earlier this year estimated that 75 percent of Americans will be overweight or obese by 2020, higher than any other country surveyed. That, in turn, is expected to grow health care costs considerably.

Now, experts are warning that those kinds of preventable health conditions could make the current generation the first to live shorter lives than their parents. At a conference in Atlanta yesterday, health professionals talked about health problems like obesity, why they are becoming more prevalent, and what needs to be done to encourage Americans to live healthier lives:

Tyler Norris, a senior adviser on Total Health at Kaiser Permanente, cited the life expectancy warning as he spoke to an Atlanta audience about the burden of obesity and diabetes. [...] Of course, it’s partly what Americans eat. Many people consume too many ‘’cheap, empty calories,’’ [Kaiser Permanente health advisor Tyler] Norris told the Connections conference, sponsored by Healthcare Georgia Foundation. Lack of exercise and the increase in sedentary jobs are other major factors contributing to obesity.

Norris presented several ideas to reduce to the problem, including providing more biking and walking routes; promoting breastfeeding; and serving better food in school cafeterias.

In one case, another expert noted, two communities in New Orleans had dramatically different life expectancies, with one at 55 and another at 80. According to Brian Smedley, director of the Health Policy Institute of the Joint Center for Political and Economic Studies, much of the difference can be attributed to things like “food deserts,” or areas with many fast-food restaurants and few nutritious options, and a lack of parks or recreational facilities.

Unfortunately, Republicans in Congress have publicly rejected the idea that prevention programs, which have already started to help communities get healthier using those same actions, are worth funding, despite the fact that many of their constituents have a lot to gain from them.

-Zachary Bernstein

In an attempt to win back some ground on the student loan battle, Republicans have proposed legislation which would keep the interest rate on federally subsidized Stafford Loans at 3.4 percent. However, they would pay for it by repealing the Affordable Care Act’s Prevention and Public Health Fund. The Fund is designed to support states and communities in fighting chronic diseases like heart disease, stroke and diabetes – a plan Republicans used to support.

Yesterday, the House Energy and Commerce Committee released a list of projects paid for by the law’s prevention program, slamming it as a “slush fund” and touting their votes to repeal it. But an analysis of national health care data shows that states represented by Republican members of the committee suffer from disproportionately high obesity and smoking rates and stand to benefit from additional investment in prevention. For instance, 14 of the states represented by a Republican are home to residents who smoke at rates at or above the national average (which stands at 19.3 percent), while eight have an obesity rate above 30 percent (national average is 35.7 percent):

State	Obesity Rate (%)	Smoking Rate (%)
California	24.0	12.9
Colorado	21.0	17.1
Florida	26.6	17.1
Georgia	29.6	17.7
Illinois	28.2	18.6
Kansas	29.4	17.8
Kentucky	31.3	25.5
Louisiana	31.0	22.1
Michigan	30.9	19.6
Mississippi	34.0	23.3
Nebraska	26.9	16.7
New Hampshire	25.0	15.8
New Jersey	23.8	17.9
North Carolina	27.8	20.3
Ohio	29.2	20.3
Oklahoma	30.4	25.5
Oregon	26.8	17.9
Pennsylvania	28.6	20.2
Tennessee	30.8	22.0
Texas	31.0	17.9
Virginia	26.0	19.0
Washington	25.5	14.6
West Virginia	32.5	25.6

As the committee’s own press release noted, several grants have been made to encourage Americans to engage in more physical activity, like biking, walking or “urban gardening,” which is designed to increase access to affordable fresh food. Others have been used to push for higher cigarette tax rates or a moratorium on fast food construction. As the data shows, obesity and smoking are at epidemic levels in these states; the programs the committee scoffed at could actually do a lot of good by bringing those rates down and lowering health care costs.

The White House has promised to veto the bill should it pass both houses of Congress, which is considered unlikely.

-Zachary Bernstein

According to a new study, Americans’ life expectancy varies widely based on region and race, particularly in the Southeastern United States. White men born in the ten percent of counties considered the healthiest had a 77 percent chance of living to age 70, but only a 61 percent chance if they were born in the ten percent of counties considered the least healthy.

For black men, the disparity was more pronounced: Only 45 percent would be expected to survive to age 70 in the least healthy counties, while 68 percent would live that long in the most healthy counties. Similar disparities were also found among black and white women depending on where they lived. According to a Centers for Disease Control and Prevention map released last year, the southeast had the highest concentration of counties where at least 30 percent of the population is overweight. As seen in the maps below, the odds of surviving until age 70 are also lowest in the southeast.

The map to the left examines white men, while the map on the right examines black men. The darker the map, the lower the chance of living to age 70:

– Zachary Bernstein

Our guest bloggers are Rebecca Friendly and Araceli Ruano from the Center for American Progress’ California office.

At all levels of government there has been a serious push for increasing access to food among low income households and fostering more nutritious eating habits in communities and schools.
Last July, First Lady Michelle Obama and the Partnership for a Healthier America secured pledges from Wal-Mart, Walgreens, SuperValu and several other stores to open or expand stores in “food deserts”, bringing healthy affordable food to approximately 10 million people over the course of five years.

That same month the First Lady also announced the California FreshWorks Fund, a public-private partnership loan fund with $264 million available to support grocery stores and other healthy food retailers in low-income, underserved communities in California. The California Endowment and a team of partners that include banks, grocers, health care providers, and nonprofits lead this initiative. Modeled after a successful program in Pennsylvania, this loan fund provides grants to healthy food retailers willing to locate stores in “food deserts”, areas lacking access to fresh, healthy food.

On Feb. 1, the First Lady spoke at a community event in Los Angeles to celebrate the progress that the California FreshWorks Fund has made in bringing affordable and healthy food to neighborhoods around the city. As one of its initial projects, the California FreshWorks Fund committed more than $20 million in funding to Southern California grocer Northgate Gonzalez Markets for its first three projects: a San Diego location as well as stores in Inglewood and South Los Angeles. The President and CEO of the California Endowment, Robert K. Ross, MD, also spoke at this event and enthusiastically stated, “we all have a shared interest in ensuring our neighborhoods, grocery stores and school cafeterias contribute positively to the health of our communities. Today’s announcement marks the beginning of what we hope will be a robust effort to expand access to nutritious food for all Californians!”

These commitments are a step in the right direction in the effort to combat the country’s obesity and hunger epidemics. Approximately one in four children in the U.S. live in a household that experiences hunger. Additionally, 30 percent of children in the U.S. are overweight or obese and among African Americans and Latinos the number soars to an estimated 40 percent.

Although hunger and obesity are oftentimes viewed as two distinct problems, they are deeply interconnected. Hunger and food insecurity are key contributors to obesity as low-income Americans are forced to rely upon high calorie, low nutrition foods to quell hunger pangs. Notably, studies have consistently demonstrated the lack of supermarkets and other stores selling healthy, affordable food in low-income communities as compared to wealthier ones. Adults in California neighborhoods with low access to healthy food are 20 percent more likely to be obese than those in higher-access neighborhoods, increasing their risk of developing chronic diseases. The California Fresh Works Fund website features a very useful interactive map that displays “Grocery Gap” statistics for various counties throughout the US and can be broken down into detailed indicators. The California FreshWorks Fund was created to tackle these food access concerns, while also addressing additional challenges faced by communities in so-called “food deserts”. In addition to improving community health, drawing grocery stores into “food deserts” also creates opportunities for economic development. Grocery stores create jobs (an estimated 49 to 120 new jobs per store), attract other small businesses to the area, and increase the surrounding residential real estate values.

Additional benefits include increased property values in the surrounding communities and increased income and property tax. This increased economic activity and property value help relieve pressure on state and local budgets and increase community sustainability.

California’s Freshworks Fund serves as a model for an innovative public-private partnership loan fund with the potential to increase access to healthy and affordable food throughout the state. This new program is proving itself as a vital component in California’s fight against hunger and obesity, and as an important force in strengthening the economies of affected communities.

Katie Wilczak, CAP CA Intern, contributed to this piece.