Unfamiliar Road Ahead: Student Policy Briefs for the Next President

The surprising outcome of the 2016 election promises changes to the public health landscape, reminding the field once again of the urgent need to communicate the value of scientific evidence and to defend against threats to population health, particularly to the most vulnerable. In the lead up to the election, Transmission sat down with six Mailman School students to gather their ideas on ways the next administration can improve health. They agree: Now more than ever, public health needs to speak up.

Improve Oversight of Prescription Drugs

A 2015 report by the Office of the Inspector General in the Department of Health and Human Services (HHS) revealed that more than 400 pharmacies billed for extremely high numbers of prescriptions per beneficiary. In parts of the country, drugs with genetic equivalents are prescribed at multiple times the national average, raising questions about whether these drugs were medically necessary or even offered to beneficiaries at all. The report also found that 500 pharmacies billed for commonly abused opioids in an extremely high percentage of their prescriptions.

Since 2006 when Part D was first available, Medicare has relied on the companies who provide prescription drug coverage as well as a private contractor tasked with identifying fraud, abuse, and waste. As the HHS report makes clear, this approach is insufficient. To correct this issue, the government should empower the Office of the Inspector General to pursue efforts to prevent fraud, waste, and abuse. Doing so will help insure the long-term viability of Medicare. –Grant Conway, MPH ’18, Biostatistics

Shore Up Medicare

Medicare has reliably brought healthcare to Americans age 65 and older for half a century, but today the program faces a twin threat. As the Baby Boomer generation retires, their numbers threaten to overwhelm the system. At the same time, healthcare costs are sharply up. According to Medicare Trustees, outlays are projected to increase from $527 billion in 2015 to $866 billion in 2024, exhausting the program’s reserves by 2028.

To ensure Medicare’s survival, the government should cap the amount the program spends every year. To do this, we need to restructure Medicare from a defined benefit program in which beneficiaries get healthcare services no matter the cost to one in which they receive a payment from the government used for the purchase of health insurance. This cost-sharing approach asks beneficiaries to contribute some of their own money. Because Medicare accounts for more than a fifth of total healthcare spending, any fix to the program would have the added benefit of bringing down healthcare costs overall. –Divya Devli, MHA ‘17, Health Policy and Management

Reign In Drug Prices

The fury around the EpiPen shows how upset Americans are about the high cost of prescription drugs. According to an analysis by Reuters, prices for four of the nation’s top ten drugs increased more than 100 percent since 2011, leading some Americans to stretch their doses, or stop taking their medicines entirely. In India, where I am from, prescription drugs prices are much lower. One reason is that the government monitors drug prices set by companies and regulates the prices of essential and life-saving drugs so they are affordable and available to all.

I hope the next administration will take India’s lead and create a federal regulatory body to set prices for prescription drugs. One starting point would be allowing Medicare to negotiate drug prices for its beneficiaries. With the money Americans save on prescription drugs, they will have more left over for everything else, including preventive care. Perhaps this reform could help offset rising insurance premiums on plans offered through the Affordable Care Act. –Maitreyi Oka, MPH ’18, Epidemiology

Sensible Sex Ed

According to recent data from the CDC, the United States now has the highest rates of STIs in our history; half of these infections are among young people, ages 15-24. We also have the highest rate of teen pregnancy among industrialized nations. Approximately 70 percent of teen females who give birth drop out of school, which can dramatically curtail future opportunities. Both STIs and pregnancy can endanger a young person’s immediate and long-term health and well-being.

I urge the incoming administration to remove funding for abstinence-only education and further invest in comprehensive sexual education that equips young people with the knowledge and skills to engage in healthy relationships. There is widespread misconception that programs that talk about sexuality promote sexual activity in teenagers. The opposite is true: evidence shows comprehensive sex education delays onset of sexual activity and increases use of birth control and STI prevention measures. Now, more than ever, the U.S. needs a national strategy that will improve young people’s ability to create happy, healthy futures for themselves. –Sarah Timmons, MPH ’17, Population and Family Health

Home Is Health

Increasingly, researchers are recognizing that where we live is a critical determinant of health and wellbeing, both inside and outside the home. Indoor toxins like lead and mold are associated with high childhood asthma rates and impaired cognitive development. Neighborhoods with limited health-promoting resources may lack public transportation and parks for physical activity. More broadly, housing unaffordability and instability can lead to psychological stress and exacerbate existing health disparities. Of particular concern is the disproportionate housing-related health burden among communities of color—an urgent environmental justice issue.

Investing in affordable and healthy housing has enormous potential to promote public health among future generations of Americans, especially in marginalized communities. A broad set of policies might fund lead paint abatement, ban toxic chemicals, and restore parks. We also need to hold state and local governments accountable for ensuring thorough housing rehabilitation and protecting tenant rights. At a time when the country is building more three-car garages than one-bedroom apartments, we must incentivize more construction and maintenance of affordable housing. –Joanna Xing, MPH ‘17 Sociomedical Sciences

Track Disease Vectors

For Floridians this summer, mosquitos went from minor annoyance to major health concern. Zika, carried by the Aedes aegypti mosquito, affected at least 93 people in the state (far more people have been affected throughout Latin America and the Caribbean, including Puerto Rico). The threat of vector-borne diseases like Zika is complicated by climate change, which may be driving mosquitos and other vectors into new areas. But without a robust system to track this process, we may not be able to so easily stop the next outbreak of Zika or something worse.

We need a systematic, national surveillance system for vector-borne diseases to understand how vector habitats are shifting, both in the United States and globally. Over the summer, I was involved in a project to look at how climate change may be altering the ecology of ticks and their hosts that carry Lyme and other diseases. In parts of the country climate change is adding moisture and precipitation; and like many insects, ticks like wetter weather. Funding national surveillance will allow public health officials to be ready for whatever diseases come our way. –Sara Zufan, MPH ‘17, Environmental Health Sciences