Last Wednesday, the White House hosted the White House Conference on Hunger, Nutrition, and Health in DC—the first since the Nixon administration’s conference in 1969.
Noting that food insecurity is an issue in one in four US households and the eroding nutritional value of the food supply chain, the Administration laid out its strategy in a 44-page document featuring 5 pillars of its attention:
1. Improving food access and affordability, including by advancing economic security; increasing access to free and nourishing school meals; providing Summer Electronic Benefits Transfer (EBT) benefits to more children; and expanding Supplemental Nutrition Assistance Program (SNAP) eligibility to more underserved populations;
2. Integrating nutrition and health, including by working with Congress to pilot coverage of medically tailored meals in Medicare; testing Medicaid coverage of nutrition education and other nutrition supports using Medicaid section 1115 demonstration projects; and expanding Medicaid and Medicare beneficiaries’ access to nutrition and obesity counseling;
3. Empowering all consumers to make and have access to healthy choices, including by proposing to develop a front-of-package labeling scheme for food packages; proposing to update the nutrition criteria for the “healthy” claim on food packages; expanding incentives for fruits and vegetables in SNAP; facilitating sodium reduction in the food supply by issuing longer-term, voluntary sodium targets for industry; and assessing additional steps to reduce added sugar consumption, including potential voluntary targets;
4. Supporting physical activity for all, including by expanding the U.S. Department of Health and Human Services’ Centers for Disease Control and Prevention’s (CDC) State Physical Activity and Nutrition Program to all states and territories; investing in efforts to connect people to parks and other outdoor spaces; and funding regular updates to and promotion of the Physical Activity Guidelines for Americans; and
5. Enhancing nutrition and food security research, including by bolstering funding to improve metrics, data collection, and research to inform nutrition and food security policy, particularly on issues of equity and access; and implementing a vision for advancing nutrition science.
In its FACT SHEET, the White House claimed that “At least $2.5 billion will be invested in start-up companies that are pioneering solutions to hunger and food insecurity. Over $4 billion will be dedicated toward philanthropy that improves access to nutritious food, promotes healthy choices, and increases physical activity.”
And it advanced this GOAL: Ending hunger as measured by a reduction in the number of households with insufficient food (defined as very low food security) to less than 1% of households and cut the number of households struggling to put enough nutritious food on the table (defined as food insecurity) in half.
My take:
The Strategy is comprehensive and timely: it addresses both public and private sector activity and is far reaching. Of particular note is the plan’s collaboration with physicians and direct caregivers to elevate nutrition as a priority in training and delivery: studies show both are neglected due to time/budget constraints.
But there are three glaring oversights in the strategy:
The Private Insurance Market: the National Strategy appropriately calls for nutritional benefits and coverage considerations in Medicare and Medicaid, but neglects the role of private insurance that covers more than 160 working age Americans. The majority of privately insured plans neglect ‘food as medicine’ coverage and offer members negligible assistance in healthy eating. While the national strategy appropriately leans into the lower-income, under-served and senior markets, it neglects others.
Fragmentation: A Nutrition Czar is needed to address not only menacing food insecurity issues but the food supply and regulatory context of its oversight. It is currently a loose patchwork involving more than 3100 state and local public health agencies, 60 federal agencies, 50 Medicaid programs, 300 trade and non-governmental organizations and thousands of manufacturers, distributors, wholesalers, retail and social media outlets. Until and unless authorized and budgeted by Congress to execute the national strategy working with but not under other federal departments, improvements will be incremental.
The Designation of Not-for-Profit Hospitals as Nutrition Hubs in Community Health: Not for profit hospitals enjoy tax exempt status on the premise they serve their communities. Social determinants of health including food insecurity contribute to poor community health and unnecessary, expensive use of hospital and specialty care. Regulation assigning accountability to NFP hospitals would empower innovation in consumer health and reduce demand for beds. Incorporating nutritional sufficiency as a priority in CMS’ hospital-based value programs would be a start.
The White House Strategy is a great start but the issues of food insecurity and nutritional deficiency require urgent, comprehensive and dedicated attention. The White House says it has secured pledges of $8 billion from the private sector to advance the strategy: that’s a good start, but only a fraction of what’s needed.
Paul
PS This conference found itself competing with Hurricane Ian and stock market volatility for media attention. It deserves more attention.
Resources
White House Conference on Hunger, Nutrition, and Health White House Conference on Hunger, Nutrition, and Health | health.gov
BIDEN-HARRIS ADMINISTRATION NATIONAL STRATEGY ON HUNGER, NUTRITION, AND HEALTH
Economy
S&P year to date at modern low: After the third quarter ended yesterday, the S&P 500, Nasdaq and small-cap Russell 2000 are now all on three-quarter losing streaks for the first time since 2009: YTD the Dow -20.9%, S&P -23.6% and Nasdaq -32.4% are each down at least 21% for 2022. By comparison, the S&P Health Care Index is down 17.36% YTD.
My take: The healthcare industry fares comparatively well when economic conditions are challenging. Nonetheless, the U.S. economy is in an unprecedented place: high inflation, high employment, and higher interest costs. How healthcare companies navigate this financial market is being closely watched by regulators, investors and lenders. And it’s certain to force some tough discussions (finally) about how to fund rural health, how to turbo-charge technology-enabled self-care, how to de-lever the industry from operating processes and work rules that add unnecessary labor costs and how to integrate health and public health services at the national and local levels to improve population health status and better manage pandemics and social determinants and how to achieve equitable access and affordability.
Standard and Poor’s September 30, 2022 www.spglobal.com
Stocks Close Lower Friday, S&P 500 Down for Third Straight Quarter Wall Street Journal September 30, 2022 www.wsj.com
Consumers
Study: Value in Higher education: Per Morning Consult, 2 in 3 U.S. adults said vocational education, community and two-year colleges offer good value in secondary education, while slightly more than half said the same when it came to getting a degree from an in-state, public university.
46% of adults said attending for-profit private colleges for undergrad would not be worth the cost, while about 2 in 5 said the same for out-of-state public universities and not-for-profit private institutions.
Among those with student loans, 56% said that taking on debt was worth it to get a college degree, while 38% said attending college wasn’t worth the financial burden.
Morning Consult September 29, 2022 Most Americans See Good Value in Community College and Vocational Programs. Opinions Are Much More Split on Various Undergraduate Offerings – Morning Consult
Public Health
CDC: suicide rate up: Both the number and rate of deaths by suicide rose 4% in 2021, reversing two years of decreases recorded by the CDC’s National Center for Health Statistics. The number rose from 45,979 in 2020 to 47,646 in 2021 and the rate of suicides per 100,000 went up from 13.5 in 2020 to 14.0 in 2021– still lower than the peak in 2018, when suicides climbed 35% from 1999 before dropping by 5% through 2020. Other findings:
· The increase in suicides was higher among males (4%) than females (2%); the suicide rate went up more for males (3%) than females (2%).
· The largest increase in the suicide rate was among males ages 15-24 (8%).
· The number of suicides was higher in nine months during 2021 compared to 2020, with the largest increase occurring in October (11%).
CDC www.cdc.gov
Study: substance abuse disorders up during pandemic: Per the Fair Health analysis of commercial claims:
· From 2016-2021, males accounted for 62% to 63% of the gender distribution of patients with a substance use disorder diagnosis, while females made up 37% to 38%.
· From 2016-2021, females accounted for 60% to 61% of the gender distribution of patients with an overdose diagnosis, while males made up 39% to 40%.
· From 2019 to 2021, 42 states saw an increase in the proportion of patients with opioid and opioid-like drug overdoses compared with the total number of patients using medical services by state. The increases ranged from 148.4% in Pennsylvania to 0.7% in Minnesota.
· During the pandemic, the percentage of patients with a substance use disorder diagnosis decreased by 4.4%, from 3.5% of all patients in 2019 (pre-pandemic) to 3.4% in 2021 (during the pandemic). But in one age group, those 65 and older, the percentage of patients with a substance use disorder diagnosis increased 5.3%, from 3.3% of all patients in that age group in 2019 to 3.5% in 2021.
· The percentage of patients with an overdose diagnosis increased 4.3%, from 0.56% of all patients in 2019 to 0.59% in 2021.
Fair Health A Comparison of Substance Use Disorders before and during the COVID-19 Pandemic: A Study of Private Healthcare Claims.September 27, 2022 www.fairhealth.org
McKinsey focus of NYT unflattering attention: “The consulting firm’s work with opioid makers is well known, but for decades McKinsey worked with Big Tobacco and has also advised Juul, the e-cigarette company.
Bogdanich and Forsythe, investigative reporters at The Times, are the authors of the forthcoming book “When McKinsey Comes to Town: The Hidden Influence of the World’s Most Powerful Consulting Firm,” from which this article is adapted.”
How McKinsey Got Into the Business of Addiction Sept. 29, 2022 www.nytimes.com/2022/09/29/business/mckinsey-tobacco-juul-opioids.htm
Coverage, Affordability
CBO: Prices, not utilization, drives costs for private payers: “Capping the level and growth rate of healthcare prices could result in “moderate to large” reductions in the prices health insurers pay to providers” the Congressional Budget Office said in a Sept. 29 report.
The CBO said the prices that commercial insurers pay for hospitals’ and physicians’ services are much higher on average and have been rising faster than those paid by public health insurance programs. It suggested three policies federal lawmakers could implement to cap the level or growth of prices:
· Setting maximum amounts that hospitals and physicians could receive from commercial payers.
· Capping the annual growth rate of those prices.
· Taxing services whose prices exceed certain maximum amounts.
The CBO said capping both the level and annual growth of prices in all markets would decrease prices by either a moderate percentage (3-5%) or a large percentage (more than 5%) in the first decade compared with the projected path of prices under the current law.
Congressional Budget Office Policy Approaches to Reduce What Commercial Insurers Pay for Hospitals’ and Physicians’ Services September 2022 www.cbo.gov/publication/58541
Commonwealth: 43% of working age population underinsured: Per Commonwealth’s survey of 6301 U.S. adults under age 65 conducted March-July 2022. Related findings:
· For those with employer coverage, 29% were underinsured, while 44% of those with individual market and marketplace coverage were underinsured.
· Those who were uninsured for a year or longer were disproportionately young, Latinx or Hispanic, poor, sicker and living in the South.
· High healthcare costs prevented or delayed care for 46% of respondents, and 42% said they had difficulties paying their medical bills or debt: half of those surveyed said they wouldn’t be able to pay an unexpected $1,000 medical bill within 30 days, including 68% of low-income adults, 69% of Black adults and 63% of Latinx/Hispanic adults.
The State of U.S. Health Insurance in 2022: Findings from the Commonwealth Fund Biennial Health Insurance Survey September 29, 2022 www.commonwealthfund.org/publications/issue-briefs/2022/sep/state-us-health-insurance-2022-biennial-survey
Life sciences
Study: industry research payments for bio up, down elsewhere in healthcare during pandemic: Researchers examined trends in industry research and marketing payments from 2018 to 2021 using the Centers for Medicare & Medicaid Services Open Payments database. Findings:
During the 4-year study period, 705, 490 physicians and 4631 hospitals received $25.2 billion in research payments and $6.0 billion in marketing payments. Compared with the pre-pandemic period, mean monthly research payments increased by 5.7% in the pandemic period ($485.8 million to $513.4 million), while marketing payments declined by 38.6% ($161.9 million to $99.5 million). Growth in research payments was driven by increased payments for biologics and “not specified” product types. Declines were observed among all marketing payment categories.
Uppal et al Changes in Industry Marketing and Research Payments to US Physicians and Teaching Hospitals During the COVID-19 Pandemic JAMA Health Forum September 30, 2022;3(9):e223342. doi:10.1001/jamahealthforum.2022.3342
International Comparisons
Study: “informal payments” to clinicians prevalent in EU: “Corruption is a major challenge in health care systems across the European Union (EU), where it manifests most visibly as informal payments from patients to providers… Given the lack of research on the topic, we explored trends in informal payments using representative data from twenty-eight EU member states during the period 2013–19 and in relation to changes in public health care expenditure. Overall, we found that informal payments increased in 2019 compared with 2013, whereas the perception of corruption decreased… Our results suggest that informal payments may be driven by other factors, although the directionality of this relationship requires further investigation. Moreover, additional public health care investments may be insufficient to confront corruption unless coupled with measures to limit wasteful spending and increase transparency. Policy makers should understand that factors external to health systems, including media coverage and cultural and political factors, should be explored to explain country-level differences in corruption.”
Dallera et al Corruption In Health Care Systems: Trends In Informal Payments Across Twenty-Eight EU Countries, 2013–19 Health Affairs September 2022 No Access https://doi.org/10.1377/hlthaff.2021.01931
Demographics
Pew: Middle class shrinking: The share of adults who live in middle-class households fell from 61% in 1971 to 50% in 2021, according to a new Pew Research Center analysis of government data. Changes 2021 vs 1971 for income groups:
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Median Household income: Upper +69%, Middle +50%, Lower +45%
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Change in Share of Total HH Income: Upper +21% to 50% of total, Middle -20% to 42% of Total, Lower -2% to 8% of Total
