Steve Sartino – Page 2 – Lister Hill Center for Health Policy

Policy Review: Climate Change Initiatives in the Deep South

March 14, 2022 | Anushree Gade, LHC Intern

Chimneys smoking

White smoke is pouring out of the chimneys of the power plant.

BACKGROUND

Last year in late October and early November, we saw many news articles pertaining to the Glasgow Climate Change Conference. Counties across the world are collaborating with one another to address the international crisis of Climate Change. At the Glasgow Climate Change Summit, 151 countries submitted climate plans for emission reduction in order to maintain their goal of preventing temperatures from rising more than 1.5 degrees Celsius. Furthermore, there was also an agreement to significantly reduce coal consumption as it serves as a major source of CO2 emissions. It is important to note that developing countries lack funds to adopt sustainable practices. Developed countries have agreed to financially aid developing countries.

INITIATIVES/POLICIES

It’s imperative to address climate change on an international level as it is a global crisis. However, what are we doing as a nation to be mindful of our contribution to this crisis? Recently, President Biden announced plans to reduce the United States’ greenhouse gas emissions by 50-52% by 2030. The United States is a major source of greenhouse gas emissions. In 2019, the United States emitted 6,558 million metric tons of greenhouse gases. Greenhouse gases contribute to global warming as they trap heat in the atmosphere and cause atmospheric temperatures to increase. Increasing greenhouse gas emissions has been a major cause of the observed global warming. Therefore, Biden’s plan to decrease greenhouse gas emissions comes with importance. Furthermore, the US has vehicle and aircraft emission standards set in order to ensure that greenhouse gas emissions are regulated. To learn more about these emission standards, click here. To learn more about greenhouse gases, click here.

Did you know?

Health effects of Climate Change include, but are not limited to:

Heat-related illness

Respiratory illness (i.e. asthma)

Water-borne diseases

Noncommunicable diseases

Malnutition

To learn more, visit this link.

You have probably heard about the Environmental Protection Agency’s (EPA) Clean Air Act. The Clean Air Act was first introduced in 1955, however, the act introduced in 1970 is the one that is most often referred to as the Clean Air Act and was one of the first policies that pertained to climate change. This act is one that “regulates air emissions from stationary and mobile sources.” The Act also sets deadlines for state and local governments to achieve the goals set forth by the Act. There are more components to the act that you can explore here.

We have discussed initiatives and policies targeted at climate change on the national level, but what are some ways climate change is being addressed at the local level? One way in which this is being done is that local and state governments are adopting standards in alliance with national standards to address local power plants and vehicle emissions. Additionally, there are various organizations that are aiming to address climate change from the local level. A primary example of such an organization is the Greater-Birmingham Alliance to Stop Pollution (GASP). They are an organization based in our city. GASP came about in the late 1960s when there was resistance to the ideals set forth by the Clean Air Act. This organization advocates for clean air policies right here, in Birmingham. GASP played a significant role in exercising the Act in Birmingham.

TAKING ACTION

The Lister Hill Center for Health Policy recently hosted a seminar with GASP discussing the Birmingham Green New Deal and how to get involved in local advocacy with climate change called Local Action: How the Urgency of Climate Change is Impacting Birmingham. GASP is a non-profit climate advocacy center dedicated to creating cleaner air for the city of Bimringham. A full recording of the event is available below.

Policy Review: Alabama’s Push Toward Electric Vehicles

March 1, 2022, | Anushree Gade, LHC Intern

As a state, Alabama has been making a more pronounced effort to adopt sustainability initiatives. This may result from people becoming more knowledgeable about climate change and how sustainability directly plays into it.

Electric vehicles have been receiving a lot of attention in the previous years. There are many more fully electric vehicles and hybrid cars on the road in the past year compared to five years ago. For example, we probably see numerous Teslas while driving around in Birmingham these days compared to how many we saw just two years ago. Why is this significant? It is important to note that transportation accounts for 70% of petroleum consumption in the United States. Hybrid vehicles consume less fuel than vehicles that are dependent entirely on gasoline. Electric vehicles rely solely on electricity as the source of energy. Electric and hybrid vehicles are better alternatives to conventional cars as it helps us decrease our fuel consumption and decrease our ecological footprint.

In this case, California serves as a model state for other states across the United States. California provides incentives to its residents to encourage them to purchase hybrid or electric vehicles. The state has a Clean Vehicle Rebate Program (CVRP) in which California residents who are buying hybrid or electric cars are given a rebate. This incentive encourages the residents to consider purchasing such vehicles to decrease the state’s contribution to air pollution and climate change. The state also provides grants to purchase electric buses to further their effort to increase the amount of zero-emission vehicles in the state. For more information on these incentives and other incentives for electric vehicles in California, visit this link.

The Alabama Department of Economic and Community Affairs has been attempting to encourage the public to learn about electric vehicles and their benefits through a marketing program called “Drive Electric Alabama.” This program aims to include TV, radio, and digital advertising to increase Alabama residents’ exposure to information about electric vehicles. They have also created a website where the public can learn more. Click this link to access the website! Furthermore, Alabama has an Electric Vehicle Supply Equipment (EVSE) Grant Program. This grant program provides funds to expand electric vehicle infrastructure. Alabama also offers grants to replace diesel vehicles with newer diesel vehicles or alternative fuel vehicles. Vehicles eligible for this include medium- and heavy-duty trucks, school buses, shuttle, transit buses, freight switchers, airport, and ground cargo handling equipment. The state has also been making an effort to increase the number of electric vehicle charging stations across the state. Lack of access to charging stations can serve as a con for those considering switching to electric cars. Increasing charging stations can further encourage residents to make the switch.

Despite the push towards electric vehicles being a success in California, such vehicles are relatively new and in the works for most states. Alabama has been making this transition, though it may take more time and effort to do this more effectively.

Furthermore, several different solar initiatives are in place for the residents of Alabama to encourage them to consider installing photovoltaic systems (solar panels) for the production of renewable energy. These initiatives include, but are not limited to:

Tax Credit: If you install solar panels, your tax credit is 26% of the cost of the entire solar panel system.
Property Tax Abatement: the Alabama Tax Code provides property tax abatement for qualifying facilities that use renewable energy.
Net Energy Metering helps people save some money on their electricity bills when they send electricity produced from their solar panels back to the grid.

A Conversation with Dr. Eri Saikawa

February 24, 2022

The Lister Hill Center for Health Policy recently hosted Dr. Eri Saikawa for a seminar on climate-smart agriculture and the impact of urban gardening on public health. Dr. Saikawa’s research includes evaluating the impact of fertilizer on air quality and how heavy metal toxicity in the soil of formerly red-lined neighborhoods has public health implications on the communities of Atlanta.

Q&A

When we’re talking about heavy metal toxicity and urban gardening from a policy perspective do you think it’s more important to focus on mitigation or prevention?

I definitely think prevention. There is so much we can be doing to prevent exposure, and that’s why I think we need to be pushing for more urban testing so that we don’t put kids into unnecessary exposure. After the fact, it’s usually too late. So these lead exposures, as I understand, once you are exposed you are exposed. We really need to do a much better job to prevent that situation

Slag dumping in neighborhoods causes high levels of lead. Are there any local or federal bills to prevent the dumping of slag in residential areas? Are there any in progress and how can we support them if so?

This is a very good question. So, the problem with the slag dumping is that it happened a long time ago before there was legislation to prevent it. We believe that this might have happened in the 60s or so, and at that time they were considered to be non-toxic materials. That’s why they use that as the fundamentals of buildings. What we are seeing is that the EPA is working to clean up [and reduce the metals in the soil]. They told me that sometimes they’ll dig eight feet down and they were still seeing slag, and so they decided that they cannot go any deeper.

In so many places, they dumped so, so much. Now they’re only digging up to a foot or two, and I think this is a very big problem as well. I think it is pretty prevalent in many different places, too, so how can we figure out the history. I just wonder if that’s because of the low-income neighborhood, we don’t have enough history like historical documentation on why was that area chosen [as a dumping site]. Because of that, we cannot tell from the existing documents that we could find.

How can you test lead levels in your backyard before planting a garden? If you find high lead levels, what do you do next, and how can you decrease those?

In Georgia, what we started doing is called the Community Science Soil Shop. We have collection boxes in different parts of the greater Atlanta area [to drop off soil samples] and then we allow people to send in the soil samples to our lab. We have a video that shows how to collect soil samples, dry them, and then they can either ship them or drop them off. Then we would analyze them for free and then give them the results. These are just screening so it’s not the full testing because we’re not saving them but I think that’s a good way to know if that might be contaminated to look into it more.

But the second question is more important. What can you do once you know that it is contaminated? So I think this is also a problem on why people are not really willing to test. In the state of Georgia, if you find that there is lead in your soil then you have to disclose that if and when you want to sell your house. There have been several people that tell me that they found slag in their backyard, and when I asked them if we could go and take soil samples to figure out the lead levels they would say no because they want to make sure that their home value is not going to be impacted. So that’s a problem.

Another thing though is that cleaning up can be very expensive. So if you dig, that’s the best way, but it would cost a lot of money. We have community partners asking if we can use hyperaccumulator plants as a way to take up [some of the heavy metals] so we did some testing with sunflowers, peas, and Chinese cabbage. We saw quite good results from Chinese cabbage and peas but [the heavy metals] went to the edible parts. We did these experiments in the greenhouse, but we are worried about actually doing the experiment in the field in the case that people come and then start eating them and get exposed.

There is no good way in a cost-effective manner [to treat soil] and that is a problem. But you can do easy things [to prevent exposure] like washing hands, for example, and making sure if you have pets they wouldn’t be going into the garden and then coming back with their dirty feet everywhere in the home.

When it comes to climate change policy there is a lot of finger-pointing between industry and individual action. In your experience working with agriculture, which is more important, and what individual actions can we take that are going to make the biggest amount of difference?

I get asked that question a lot, and I do think that we need to be pointing at the industry. Ninety percent of the emissions are potentially coming from a very small number of industries, and if they are not going to do anything then nothing is going to happen. I don’t want to say that individual actions are not important, but I do think that the companies that are really burning a lot of fossil fuel need to stop. Otherwise, even if we do everything we can, that’s not going to stop climate change.

That being said, the individual efforts to really voice concerns to push the government and also the industry to take action is important. We see that a lot from the youth movement, and I think they are the hope. They have shown how that’s possible and how that could work, so I think we need to do that more.

Does a yard contaminated with lead have impacts for children other than eating food grown there?

The biggest impact that you would see is actually the kids eating the soil, either consciously or unconsciously. There are kids with certain behaviors or disorders that would really want to eat the soil, and that is the biggest worry. I think it can also be airborne, too. If you’re running around in those highly-contaminated areas, then you can breathe in the lead particles. It’s not just about eating the food that’s grown in those contaminated soils.

Learn More

Want to learn more about Dr. Saikawa’s work? Check out these recent publications.

Invited Perspective: Assessing the Contaminant Exposure Risks of Urban Gardening: Call for Updated Health Guidelines

The terrestrial biosphere as a net source of greenhouse gases to the atmosphere

Global soil nitrous oxide emissions since the preindustrial era estimated by an ensemble of terrestrial biosphere models: Magnitude, attribution, and uncertainty

The impact of cold weather on respiratory morbidity at Emory Healthcare in Atlanta

Keeping in Touch

Follow Dr. Saikawa on Twitter!

More information on the Atlanta-based soil contamination investigation can be found at https://atlsoilsafety.com/

Be sure to check out her podcast, AmpliFIRE, which aims to equip listeners to accelerate climate action by providing accessible information; amplifying diverse voices; and highlighting the intersections of environmental issues.

Policy Watch: The Impact of Eliminating Grocery Sales Tax

February 14, 2021 | Kimberly Randall, LHC Program Coordinator

Photo Courtesy of Getty Images

Background

For almost two decades, Alabama policymakers have debated whether or not to remove the sales tax on groceries. Currently, sales tax on groceries accounts for nearly $500 million in state revenue from a 4% sales tax, earmarked for education spending. Additionally, in many cases, local taxes are added to the state tax, making the total grocery tax as high as 11% in some areas of the state. According to Alabama Arise, Alabama is one of three states in the nation with no tax breaks on groceries, and the 4% markup accounts for as much as two weeks’ worth of food for a family.

While Mississippi currently holds the highest grocery state sales tax rate in the nation, other surrounding states such as Georgia and Florida have eliminated sales tax on most groceries. Overall, 37 states have eliminated sales tax on groceries, while ten have a reduced sales tax. In addition to the sales tax rates, food costs are increasing overall. According to a report by KPMG, average consumers are seeing increases of up to 20% on prices at the grocery store, compared to 2019.

Proposed Legislation

Currently, two bills are being discussed to eliminate the state sales tax on groceries. House Bill 174, proposed by Representatives Holmes, Hanes, Meadows, Wadsworth, Fincher, Mooney, Wingo, Kitchens, Howard, Warren, Drummond, Paschal, Whorton, Sorrell, Wheeler, Brown (K) and Shaver, reads:

“Under existing law, the state imposes sales or use taxes upon certain persons, firms, or corporations. Sales of certain items are taxed at a reduced rate. Sales of other items are exempt from the taxes. This bill would exempt sales of food from the sales and use taxes beginning September 1, 2022.”

Meanwhile, House Bill 173, proposed by Representatives Holmes, Fincher, Wingo, Meadows, Paschal, and Mooney, also eliminates the sales tax on groceries but offers an alternative funding method by way of state income tax to make up the budget deficit earmarked for education.

“This bill would exempt sales of food from state sales and use taxes beginning January 1, 2023. Under existing law, individual income taxpayers are allowed to deduct the amount of federal income taxes paid or accrued within the year. This bill would amend Amendment 225 to the Constitution of Alabama of 1901… [to] limit the amount of federal income taxes paid or accrued an individual income taxpayer can deduct to a maximum of $4,000 for individuals filing as single, head of household, and married filing separately and $8,000 for individuals filing as married filing jointly.”

Impact

Reducing the amount of taxes for necessary purchases, such as groceries, has been shown to significantly impact the health of households falling below the poverty line. According to Zheng et al. (2021), states which impose income tax on groceries tend to see higher levels of food insecurity, which disproportionately affects lower-income households. In states with a sales tax rate of 4%, the probability of a household experiencing food insecurity rises 3% compared to states without a tax rate.

Additionally, sales taxes on groceries correlate to higher rates of obesity. A recent study published in the Health Economics Review found that “Counties with grocery taxes have increased prevalence of obesity and diabetes [and] estimate the economic burden of increased obesity and diabetes rates resulting from grocery taxes to be $5.9 billion.”

The main difference between the two bills comes from funding. HB174 allows the state sales tax to expire without a plan to replace the lost revenue for the education system. However, lawmakers have stated that the Education Trust Fund has seen an increase in recent years, and the ability to cut taxes overall could be beneficial for the state as a whole. HB173 creates a limit on the amount of federal income tax that individuals can write off on their state income tax filing, ultimately only increasing taxes on individuals falling in the top 5%.

According to an analysis from Alabama Arise, the income tax proposal would offer a tax cut to the majority of Alabamians.

Next Steps

The Alabama Legislative Session is currently underway and will continue for several months. Both bills are currently being discussed in committee and have not yet gone to a vote. If you want to make your voice heard on this or future legislation, click here to identify your elected officials.

Don’t know what to say? Check out this guide from the American Civil Liberties Union on drafting a letter to your government officials.

Stay Informed

Want to know more? Alabama Arise, a statewide, member-led organization advancing public policies to improve the lives of Alabamians who are marginalized by poverty, has officially endorsed HB173 due to the impact of removing the sales tax without jeopardizing the state’s education budget.

Policy Watch: Top Public Health Issues in the 2022 Alabama Legislative Session

February 7, 2022 | Kimberly Randall, LHC Program Coordinator

Montgomery Capital Sign

Montgomery CapitalPhoto Courtesy of Getty Images

Legislatures have spoken about various agendas, and points of interest as the Alabama House of Representatives and Senate reconvene for the official 2022 session. The Alabama House Republican Caucus has dubbed its plan “Standing Tall for Alabama” and includes legislation banning Critical Race Theory, allowing concealed weapons to be carried without a permit, and increasing technology access to rural areas of the state. Meanwhile, state democratic lawmakers have declared that social issues such as reducing or eliminating grocery sales tax, expanding Medicaid, and prison reform to be their top priorities. Here is a look at the leading public health issues expected to come up for debate over the next few months and the corresponding bills filed in the Alabama legislative directory.

Infrastructure

Infrastructure packages have been proposed at nearly every level of government over the last year. H.R.3684 – the Infrastructure Investment and Jobs Act passed through the US Congress in November, authorizing $65 billion to improve passenger railways, rebuild or repair roads and bridges, upgrade airports and improve public transportation in various metro areas across the country. Alabama seems to be following in the trend, as HB1 advocates the use of $225,000,000 to “improve access to clean water to the citizens of Alabama through investments in water and sewer infrastructure projects.”

The bill allocates:

Up to $120,000,000 in water and sewer systems grants for emergency or high need projects previously identified for participation in the Clean Water State Revolving Fund or the Drinking Water State Revolving Fund.
Up to $100,000,000 in matching grants to public water and sewer systems for water or sewer infrastructure projects.
Up to $5,000,000 provided as grants to install clustered decentralized wastewater system demonstrations utilizations utilizing a collection system known as Septic Tank Effluent Pump (STEP) or other demonstration systems in the Alabama Black Belt areas of low population density, rural poverty, and/or soils with poor perc characteristics, where there is a finding of discharge of raw sewage onto the ground due to the utilization of straight pipes, failing septic systems, or similar circumstances.

In addition to the improvements to water and sewer systems, the bill also allocates $85 million for statewide improvements to broadband internet access, particularly in rural communities. The Federal Communications Commission found that while broadband service is accessible to roughly 75% of the state’s population, some rural areas, such as Greene County, had fewer than 2% of residents subscribed to the service. According to SpeedMatters.org, high-speed internet access in rural communities is vital to economic growth and development in these areas. Additionally, as more services such as telehealth and online pharmacies become more prevalent, broadband internet can impact the healthcare of rural citizens.

Gender-Affirming Medical Treatment

In 2021, the Alabama Senate passed SB10, also called the Vulnerable Child Compassion and Protection Act, which made the administration of gender-affirming medical treatment a felony in Alabama. At the time, the Southern Poverty Law Center released a statement in opposition to the bill:

“We are disappointed that, despite reservations expressed by committee members, House Bill 1 is moving forward, particularly after the heart-wrenching testimony during last week’s public hearing by Sgt. David Fuller. This legislation disregards the medical needs of transgender children and the hard choices that their families make in their best interest. It would criminalize the very doctors that so many families turn to in their times of need. The last place for governmental overreach is at the bridge of personal medical decisions and the advice of trained professionals.”

While SB10-2021 ultimately never went to a vote in the house, failing, similar legislation has been proposed this year as HB150 was filed by Representative Wes Allen and SB5 was filed by Senator Shelnutt.

Did you know: The Lister Hill Center published a testimonial from a UAB student on SB10. Read it here.

The bill works to “prohibit the performance of a medical procedure or the prescription or issuance of medication, upon or to a minor child, that is intended to alter the appearance of the minor child’s gender or delay puberty … [and] establish criminal penalties for violations.”

Prison Reform

Following a special session in October 2021, critical pieces of legislation were passed to address prison reform. Overcrowding, a significant contributor to the spread of COVID-19 in prison systems, inspired a bill that funded the construction of new prison facilities. Additionally, legislation was passed that retroactively applied a mandated probationary period to individuals sentenced before 2015. However, in the 2022 general session, SB87 has been filed in the general session, which looks to roll back some of the granted probation initiatives.

The legislation reads: “Under existing law, certain prisoners in the physical custody of the Department of Corrections are eligible for correctional incentive time. This bill would provide that any person who enters into a plea agreement would not be eligible for correctional incentive time.”

The United States legal system has come underfire in recent years for a trend referred to as “coercive plea bargaining,” where prosecutors can use a wide variety of techniques to convince defendants to accept a guilty plea rather than going to trial. According to a report by the Pew Research Center, over 90% of convictions at the state level come from a plea rather than a jury, even though trial by jury is a constitutionally protected right. While it has not been passed, SB87 could remove the protections granted in the special session last year related to the mandated probationary period to those who plead guilty, a large percentage of current inmates in the Alabama Department of Corrections.

HB28 looks to approach prison reform from a different angle. Pre-filed by Representatives Hollis and Hall, the bill offers protections for women who are pregnant or up to six weeks postpartum who are incarcerated. The legislation reads:

“This bill would provide for prohibited practices relating to a pregnant female inmate or a female inmate who is in the immediate postpartum period. This bill would also specifically prohibit certain actions relating to strip searches, restraints, examinations, labor and delivery, solitary confinement, and transfer.”

Specifically, the bill details specific instances in which pregnant or postpartum women would or would not be restrained through the use of wrist cuffs or placed in solitary confinement. The ACLU has declared that ending the shackling of pregnant inmates is a priority in the coming year. The United States is the only remaining industrialized nation to partake in this practice due to the abundance of evidence pointing to the mental and physical health implications to both the mother and child.

Health Insurance Reform

Healthcare and insurance reform have been a growing state and national politics trend. The Department of Health and Human Services enacted new federal guidelines on “surprise” hospital bills effective January 1, 2022. The new rules work to shield Americans from unexpected bills from an out-of-network provider, out-of-network facility, or out-of-network air ambulance provider. However, legislation has been proposed at the state level to help patients receive the proper medical treatment approvals from their insurance providers. SB27, proposed by Senator Butler, enacts a timeline for insurance providers to approve or deny a request for prescription drug coverage. The legislation reads:

“This bill would require a health insurer to communicate to a physician or other health care professional with authority to prescribe drugs, within three business days of receiving a request for insurance coverage of a prescription drug benefit, that the request is approved, denied, or requires supplemental documentation. This bill would also require a health insurer to communicate to a physician or other health care professional with authority to prescribe drugs, regarding the approval or denial of the request, within three business days of receiving sufficient supplemental documentation.”

This legislation will work to streamline the authorization process in Alabama, hopefully increasing the speed at which patients receive their medications. According to a report by HPI, 66% of first-time prescriptions are rejected at pharmacies due to required authorizations, causing a bureaucratic battle for patients who may be waiting for weeks. Only 29% of patients end up with their initially prescribed medication when authorizations are required.

The Widespread Impact of Eco-Anxiety

January 31, 2022 | Anushree Gade, Lister Hill Center Intern

Head in clouds

Climate change has been gathering large amounts of attention in recent years. Since the late twentieth century, temperatures have been rising, and 2020 was the second warmest year in recorded history. Greenhouse gas emissions have tremendously contributed to the observed increase in atmospheric temperature. As a result, ice sheets have been melting worldwide, making some cities more prone to flooding because of the rising sea levels. One example is the city of Jakarta, Indonesia, which has been experiencing frequent flooding and is expected to be entirely submerged by the year 2050.

With the climate changing so rapidly, many people are becoming anxious about their future and future generations, a phenomenon often called eco-anxiety. Eco-anxiety is experienced more extensively by today’s youth. In a large study done with 10,000 young adults, more than half of those that participated were worried for their future. Additionally, about half of the respondents indicated that their anxiety regarding climate change impacted their daily lives. Many people experiencing eco-anxiety believe that their country’s governments have not been doing enough to address the growing issue of climate change and global warming. In a poll conducted by the Post-Kaiser Family Foundation, 57% of the teenagers said that climate change scared them, and 52% said it made them sad. Only 29% of the teenagers reported that they were optimistic.

The youth today think significantly about climate change and its associated consequences in the future. As a result, eco-anxiety is a common experience for today’s youth, more so than older adults. This anxiety also stems from the fear of uncertainty that humans generally possess. The youth also report low levels of optimism for the future due to the climate crisis. The impacts of climate change on mental health are immense and must be recognized. Anxiety and stress can have adverse long-term effects on health. Experiencing prolonged anxiety can develop other health complications such as respiratory problems, gastrointestinal issues, weakened immune system, heart disease, hypertension, and more. With the likelihood of anxiety leading to additional health consequences, we must address this anxiety stemming from the changing climate.

If you are experiencing eco-anxiety or are passionate about addressing this issue of climate change, here are some things you can do:

Make lifestyle changes to be more environmentally conscious and sustainable.
- Example: Re-evaluating how you commute to work. You can consider carpooling, using public transportation, walking, or cycling to places near where you live.
Identifying small things in your life that can help make a change
Participate in the political processes to promote environmental policies where you live.
Talk to your family and friends to express your concern.
Connect with others who are also going through the same as you.

Policy Works: US Launches At-Home Covid Testing Initiative

January 18, 2022 | Kimberly Randall, Lister Hill Center Program Coordinator

Photo Courtesy of Getty Images

Health policy can take many forms and impacts multiple parts of the public health sector. From housing reform to addressing nutrition in impoverished communities to climate change, legislation can have widespread impacts on the health of citizens.

Following rising cases of the Omicron variant of the novel coronavirus, President Biden announced a series of executive actions on December 21st to assist hospitals and public health agencies. In addition to mobilizing 1,000 troops with medical experience to be dispersed to hospitals overrun with COVID-19 cases and launching distribution systems for PPE to hospitals, clinics, and the general public, the White House also announced an initiative to provide free at-home antigen testing kits to be delivered through the United States Postal Service.

This initiative follows similar actions in the United Kingdom and Canada, where at-home test kits have been available to citizens free of charge for several months, either through mail delivery or at designated pharmacies. Tuesday, January 18th saw the launch of https://www.covidtests.gov/, the official website where US Citizens can request a set of four at-home test kits to be delivered via USPS. While the test kits are estimated to be delivered in late January, registration is open now. The federal government has purchased 1 billion test kits for this initiative, after doubling its original pledge of 500 million.

In addition to the at-home delivery service, President Biden announced that private insurance companies will be required to reimburse expenses for at-home test kits purchased at local pharmacies. According to the Centers for Medicare and Medicaid Services, private insurance companies are required to reimburse over-the-counter COVID-19 tests purchased on or after January 15, 2022 at a cost of up to $12 per test. Health insurance providers must reimburse the cost of up to 8 at-home test kits per month, per person enrolled. According to Blue Cross Blue Shield Alabama, the largest health insurance provider in the state, “members who purchase a test kit should file a claim to be reimbursed. Claims can be filed electronically by logging in to your account or by submitting a Medical Expense Claim Form along with the test kit receipt.” A full list of reimbursable kits can be found on the FDA’s website.

The Centers for Disease Control lists at-home testing as one of the key measures to reduce the spread of COVID-19. While at-home tests have a higher chance at a false-negative than a PCR test, it is suggested to utilize them prior to indoor social gatherings and other close-contact situations where the virus might be transmitted. According to the CDC, “a negative self-test result means that the test did not detect the virus and you may not have an infection, but it does not rule out infection. Repeating the test within a few days, with at least 24 hours between tests, will increase the confidence that you are not infected.”

Want to register for your at-home test kits? It’s a simple, two-step process.

Visit https://www.covidtests.gov

Select “Order Free At-Home Tests” which will direct you to the official page on the USPS website.

Fill in the information as needed. Tests are estimated to ship starting in late January.

Reviewing Alabama’s Policy Efforts to Improve Mental Health

December 13, 2021 | Anushree Gade, LHC Intern

Mental Hospital

Closed mental health institution in Alabama | Photo courtesy of Getty Images

Mental health has been a growing concern in our state of Alabama over the past decade. However, despite its growing prevalence, mental health has been pushed aside due to funding issues that came with the Great Recession. This had caused three mental health institutions to be closed. Since 1990, at least 10 total mental health institutions have been closed and with the Great Recession, more were closed.

With mental health at the forefront of our concerns, Alabama’s legislature has been attempting to improve access to mental health care and services in order to support mental health in the state of Alabama. In February 2021, HB 284 was passed, which allows for law enforcement to take individuals into custody if that individual is capable of inflicting harm to themselves or others. Law enforcement will escort them to the care facilities and will have them in custody for 72 hours. There were concerns about the bill regarding the 72 hour hold as well as detaining children. As the bill progressed, changes were made to address these concerns and the bill would not apply to children under 14.

Additionally, another bill was passed where a mental health service coordinator was required for each school district. As of October 2020, 102 Alabama school districts had a mental health service coordinator. These coordinators ensure that students are receiving counseling and other mental health services they are in need of. There is an increasing number of students who are suffering from mental health problems and are in need of proper care. This bill aids, somewhat, with improving mental health for school children.

Another one of Alabama’s growing mental health concerns comes with the increased rates of incarcerated individuals developing mental health issues such as depression and anxiety. Incarcerated individuals are almost 6 times more likely to develop such conditions and jails spend a large sum of money to address this. Rep. Anthony Daniels has been encouraging Alabama counties to adopt the Stepping Up Initiative, which aims to reduce the prevalence of mental health in jails. Currently, 26 counties are involved in the Stepping Up Initiative, including Jefferson County, Mobile County, and Madison County.

As mentioned previously, several mental health institutions were shut down due to a lack of funding. Senator Garlan Gudger proposed a resolution for implementing crisis diversion centers in the state in order to provide facilities where people can go to seek mental health care. This was enacted in May 2020 as Act 2020-86. Medicaid expansion was also suggested as an option to address mental health in the state; however, Alabama is not anticipated to expand Medicaid under the Affordable Care Act. For more information on the impact of Medicaid Expansion on Mental Health, be sure to read this article.

Local Initiatives to Reduce Food Insecurity in Birmingham Communities

November 22, 2021 | Kimberly Randall, LHC Program Coordinator

Food bank — Photo Courtesy of Getty Images | 2020

2021 marked the 80th anniversary of President Franklin D. Roosevelt’s Four Freedoms: Religion, speech, want, and fear. While religion and speech are constitutionally protected, many families in the Birmingham metropolitan area regularly suffer from food insecurity and are unable to provide for themselves and their families. The pandemic has worsened food insecurity nationwide, with food banks reporting 55% more people going to food banks, according to Feeding America. The US Department of Agriculture officially defines food insecurity as “a lack of consistent access to enough food for an active, healthy life” and affects an average of 1 in 8 Americans.

With Thanksgiving approaching, many families will turn to non-profit and charity organizations to access a holiday meal and offers an opportunity to evaluate the causes, effects, and resources related to food insecurity.

What causes food insecurity?

Food insecurity is differentiated by low and very-low access to nutritious food on a stable basis. 2008 saw a substantial jump in the number of families experiencing food insecurity with approximately 22% of children claiming food insecurity of some kind. While there are several nuances in terms of how families can become food insecure, the root of all food insecurity comes from financial instability. Geographical regions, such as the rural south, see higher numbers of impoverished families and, correspondingly, a higher number of families and individuals applying for food assistance.

However, wages alone aren’t the only deciding factor. One major issue with food insecure individuals comes with the lack of nutrition available in affordable food options. According to the USDA, fresh foods have seen an exponentially higher increase in cost compared to less nutritious alternatives. Between 1985 and 2000 a study found that “the retail price of carbonated soft drinks rose by 20%, the prices of fats and oils by 35%, and those of sugars and sweets by 46%, as compared with a 118% increase in the retail price of fresh fruits and vegetables.” Consequently, households often choose to purchase higher calorie, less nutritionally dense foods that are highly processed.

Additionally, a policy research report commissioned by The Future of Children determined that non-income factors can influence food insecurity, such as a caretaker’s poor mental and physical health. The report states that “children living with a disabled adult are three times as likely to experience very-low food insecurity” compared to children with similar income levels who are not living with a disabled adult.

What are the long-term impacts of food insecurity?

According to Feeding America, hunger and health are very closely related. A 20140 study found that food insecurity can increase the likelihood of chronic conditions such as diabetes, hypertension, and obesity (Seligman and Schillinger, 2010), ultimately leading to a cycle of higher healthcare expenditures and reducing income even further. It is estimated that food-insecure households account for nearly $60 billion in healthcare costs annually. Additionally, many families have to choose between many other necessities such as utilities in order to provide food.

In addition to the health disadvantages of food insecurity, food-insecure children and teens see a direct impact on their education. Research shows that food insecurity prevents youth from fully participating in social and school settings and have difficulty engaging in daily activities, assignments, and social interactions during school while also having greater difficulty in creating peer relationships. According to No Kid Hungry, by the time most food-insecure children reach high school, they are twice as likely to have been diagnosed with a mental health problem such as depression, anxiety, and behavioral problems by a psychologist and are significantly more likely to have been suspended from school. With all other factors accounted for, food insecurity also decreases a child’s chances of graduating from high school, ultimately affecting their income-earning ability later in life and continuing the poverty cycle.

What can be done about food insecurity?

Solving or mediating food insecurity has been a priority for many organizations and policymakers for years. The child tax credit, a part of the American Rescue Plan, was partially intended to reduce food insecurity by providing extra income to families. According to the Household Pulse Survey, an experimental tool utilized by the US Census Bureau to evaluate the economic and social impacts of the pandemic, there was a 3-point drop in the number of households with children reporting food insecurity from 11% to 8.4%.

Future policy changes are possible as well. Lawmakers have declared their intention to make the child tax credit a permanent fixture in the Internal Revenue Code, as well as expanding SNAP (Supplemental Nutrition Assistance Program) benefits by 15%. However, community organizations are often the first point of contact for individuals experiencing food insecurity.

Currently, there are eight food banks in the state of Alabama with one, the Community Food Bank of West Alabama, serving the Birmingham Metro. Operating primarily as a food distribution center, the Food Bank purchases food through industry connections and distributes it to a series of community agencies, over 250 of them, to be administered to local individuals and families in need. Information regarding food distribution events can be found on the Community Food Bank of West Alabama’s website. Information regarding volunteer opportunities, events, and a donation page can be found here.

Recently re-opened Blazer Kitchen, operated on UAB’s campus, provides resources for students experiencing food insecurity. In order to abide by COVID-19 regulations, the center is offering online appointment timesfor students and employees to collect pre-packaged parcels of food. Blazer Kitchen operates out of the Hill Student Center and the 1613 Building. A donation portal, volunteer opportunities, and more information can be found on the official Blazer Kitchen website.

Food banks and local pantries are integral toward mitigating food insecurity in communities and are considered the first line of defense in the fight against hunger. According to the University of Vermont, 85% of food pantry users reported a good or very good experience with them. While some individuals surveyed complained of the long lines and limited selection, the overwhelming majority stated that they were positively impacted by food banks. Food banks are vital to improving food security in communities.

Policy Review: Medicaid Expansion’s Impact on Mental Health

November 15, 2021 – Anushree Gade, LHC Student Assistant

Background

Medicaid and Medicare are often used together, but the qualifications and operations for each are vastly different. Medicare is regulated by the federal government and is age-dependent (for people that are 65 years of age or older). Medicare is not income-based and functions as an insurance plan, providing coverage to seniors who no longer have access to private insurance through an employer. Medicaid, on the other hand, is managed at the state level, which independently creates its own qualification criteria. In Alabama, you must meet income qualifications and fall into one of these categories:

Pregnant
Blind
Have a disability or a family member in the household has a disability
Be responsible for someone 18 or younger
Be 65 years of age

The low-income designation is assigned depending on the annual household income and the number of people in the household. Medicaid Expansion under the Affordable Care Act (ACA) allowed for more people to be considered eligible for Medicaid. The expansion would ease some of the guidelines that would make Medicaid more inclusive and increase the number of people who qualify for Medicaid. However, Alabama remains one of twelve states who have yet to expand Medicaid even as most states in the northeast and west and adopted and implemented the expansion already.

In March of 2021, President Biden signed the American Rescue Plan into law which contained financial incentives for the remaining states to adopt Medicaid expansion. According to the Georgetown University Health Policy Institute, “the American Rescue Plan encourages states to finally take up the Medicaid expansion by offering even more favorable financial incentives than those already in place and allows states to provide longer postpartum health coverage for new mothers. Among its private insurance provisions, the American Rescue Plan provides full premium subsidies for COBRA coverage, substantially increases subsidies for the purchase of health plans offered through the Affordable Care Act’s marketplaces, and targets additional marketplace subsidies to those receiving unemployment benefits.”

Impact on Mental Health

In a study conducted by researchers at Indiana University, it was identified that Medicaid expansion was responsible for increasing the use of preventative care visits, mental health services, and primary care. Furthermore, this study also observed that Medicaid expansion increased how people perceived their own health. There were lower rates of poor mental health days/psychological distress; moreover, there was increased reporting of better perceived physical health. Researchers suggested that the increase in better mental health perception could be an effect of increased access to medical services. The inability to access health care services could potentially place stress and impact the mental health of individuals. Medicaid expansion would allow more people to access health services; thereby, positively impacting mental health.

Medicaid expansion would allow for more people who are diagnosed with mental health illness to qualify for Medicaid. The expansion would allow for people, despite disability status, to qualify depending on their income level. This would increase the number of people that can access health care services and mental health care. Medicaid would allow for people with mental illness to access services such as psychotherapy, inpatient psychiatric treatment, and prescription medications.

If a patient makes an appointment with a primary care physician for a checkup, the physician would be able to refer the patient to mental health services covered under Medicaid. However, there are challenges that come with Medicaid referrals including delays associated with processing the referral request and the lack of cooperation between services. These challenges significantly impact one’s ability to get access to health services in a timely manner. Furthermore, there are also challenges associated with continuous access to mental health services. In order to provide continuous care, the social workers are required to justify why the recipient is still in need of mental health services and requires a diagnosis and formalized treatment plan.

Opposition

Medicaid expansion was initially suggested in 2015 by Governor Robert Bentley’s task force. These plans were put forth with intentions to transition to a managed care model. This type of insurance model would allow for contracts with medical professionals and facilities by which they would provide care at reduced costs for those who are covered by that health insurance (if implemented, it would be Alabama Medicaid). However, this would entail increased costs associated with financing it. Eventually, Gov. Bentley dropped the idea as it would promote strong opposition from the state legislature.