Safety Net Services Research Articles

Tennessee BH safety net expansion allows more consumers free service access

More Tennesseans will receive free mental health services courtesy of a proposal by Gov. Bill Lee and the legislative approval of $5 million in new state funding to provide safety net services to them. Officials estimate that about 7,000 more Tennesseans will receive such services, they announced July 1.

Evaluation of the Reduction of Escherichia coli O157:H7 Surrogates in Beef Ribeye Rolls at 54.4°C

ObjectivesE. coli infections are a primary source of gastroenteritis requiring strict cooking and handling procedures for meat producing companies as directed by the USDA. This study evaluated the reduction of Escherichia coli O157:H7 surrogates in a low temperature cook process at a local medium-large meat processor. This is one of three microbial validation projects; the other projects will investigate Clostidium perfrigens and Salmonella spp. The objective of maintaining meat quality (rare color) throughout cooking processes urges the study of low temperature cook processes to determine their efficacy in microbial control.Materials and MethodsThis study was completed in three replications each consisting of a sample size of n = 25. Four strains of Escherichia coli (American Type Culture Collection, ATCC® BAA-1427, 1428, 1429, and 1431), each approved as a surrogate for E. coli O157:H7, were used in this study. Each surrogate was grown separately. Inoculations of surrogates were prepared utilizing 800 mL of distilled water mixed with 24 g of TSB and inoculated with surrogates. The inoculations were incubated at 37°C for 24 h prior to application. The surrogates were mixed together to make a cocktail just prior to inoculation of meat. Seventy-five (25 per replication) ribeye rolls (IMPS 112-A) were removed from vacuum bags and trimmed. Initial samples were taken to determine initial microbial load prior to inoculation. The pH and temperature were taken in raw meat, after spraying with antimicrobial, and after brining. The pH and temperature of the brine was also recorded. Meat was inoculated with 90 mL of inoculum and was distributed evenly on the surface with a sponge on a stick. The inoculum was allowed to dry for 30 min prior to sampling for inoculation load. Ribeye rolls were then sampled 15 min after going through an antimicrobial spray. Samples for raw meat, initial inoculated meat, and after antimicrobial spray were taken from the surface of the ribeye roll (approximately 100 g). Following sampling, the ribeye rolls were pumped with a brine solution (sugar, salt, and proprietary ingredients) to 15%. The meat was vacuum-packaged in cook-in bags and allowed to sit in a cooler to mimic the longest period of time from packaging until it would be placed in the smokehouse. Ribeye rolls were cooked according to Appendix A at 54.4°C for 112 min, and chilled until the internal temperature was below 4.4°C. Final cooked and chilled samples were taken by cutting a 4 cm steak from the center of the roast. All samples were packaged and sent to Food Safety Net Services (FSNS) for culturing on coliform film. At FSNS 25 g of meat and 225 mL of BPW were stomached, serial dilutions were done and plated on coliform petrifilm and allowed to incubate for 24–48 h. Results were analyzed using the proc GLM procedure of SAS, determining the LSMean and StdError as well as Microsoft Excel.ResultsInitial inoculation loads after inoculation were 6.5 logs and all cooked and chilled samples had less than 1 log. Therefore, the mean log reduction was 5.1 with a standard error of 0.04 from inoculation to post-cook over the three replications.ConclusionThe results suggest that this cook method is sufficient to reduce E. coli O157:H7 in whole-muscle beef ribeye rolls. This information would be beneficial to companies looking to preserve meat quality while utilizing a low temperature cook process.

Rehabilitation and reintegration of Fistula Clients through Micro credit linked services

Objectives: To describe the process and performance of reintegration and rehabilitation of women with Fistula through microcredit linked services in north-western region in Bangladesh.
 Introduction: Ad-din Social Financing for Community Health Development is a non profit microcredit system established in 1996. The program provides small capital and technical assistance for entrepreneurship development for its members, particularly women from underprivileged communities.
 Methods: 56 paramedics linked with Ad-din microcredit system were provided training on fistula case identification, referral, reintegration and rehabilitation. The paramedics identified fistula clients and conducted customized need assessments for their reintegration and rehabilitation services. This included liveihood skills training, financial assistance for fistula clients or their family members and mobilization of local institutions.
 Results: Out of 86 fistula clients identified by paramedics, 76 were in need of rehabilitation services and 12 were in need of reintegration support. Only three (4%) were covered by government safety net services. The program provided customized skill training to 43 fistula clients or family members. Three fistula clients were selected for food box drop at their place of residence. 
 Conclusions: Customized need assessment of reintegration and rehabilitation of fistula clients is effective for sustainable result. The field resources of a micro credit system, which is present in many settings with a fistula burden, can efficiently provide rehabilitation services to fistula clients.

Public benefits, recognition, and the same old materialist conclusion: a lyric essay

ABSTRACT In this lyric essay, the author uses auto-ethnographic inquiry to re-contextualize a qualitative study of Latina parents’ experiences of safety net services, benefits, and programs. That study concluded that at the heart of service use was ambivalence about dependency; at the heart of ambivalence about dependency was the desire for recognition. The purpose of this article is to express and explore that finding intersectionally, i.e. in the context of gender, race, and class. The author deliberately avoids narrative coherence, yet relies on Axel Honneth’s theory of recognition as an orienting framework.

Neighborhood Health Care Access and Sexually Transmitted Infections Among Women in the Southern United States: A Cross-Sectional Multilevel Analysis.

The United States has experienced an increase in reportable sexually transmitted infections (STIs) while simultaneously experiencing a decline in safety net services for STI testing and treatment. This multilevel study assessed relationships between neighborhood-level access to health care and STIs among a predominantly Human Immunodeficiency Virus (HIV)-seropositive cohort of women living in the south. This cross-sectional multilevel analysis included baseline data from HIV-seropositive and HIV-seronegative women enrolled in the Women's Interagency HIV Study sites in Alabama, Florida, Georgia, Mississippi, and North Carolina between 2013 and 2015 (N = 666). Administrative data (eg, United States Census) described health care access (eg, percentage of residents with a primary care provider, percentage of residents with health insurance) in the census tracts where women lived. Sexually transmitted infections (chlamydia, gonorrhea, trichomoniasis, or early syphilis) were diagnosed using laboratory testing. Generalized estimating equations were used to determine relationships between tract-level characteristics and STIs. Analyses were conducted using SAS 9.4. Seventy percent of participants were HIV-seropositive. Eleven percent of participants had an STI. A 4-unit increase in the percentage of residents with a primary care provider was associated with 39% lower STI risk (risk ratio, 0.61, 95% confidence interval, 0.38-0.99). The percentage of tract residents with health insurance was not associated with STIs (risk ratio, 0.98, 95% confidence interval, 0.91-1.05). Relationships did not vary by HIV status. Greater neighborhood health care access was associated with fewer STIs. Research should establish the causality of this relationship and pathways through which neighborhood health care access influences STIs. Structural interventions and programs increasing linkage to care may reduce STIs.

Abstract C07: Transitions to Medicare for Cancer Care Services: A Study of Safety Net Clinics in Georgia

Abstract Background: Advanced age and low socioeconomic status are major risk factors for cancer among women in the United States. Beginning at age 50, the probability of developing invasive cancer increases for women for almost every major type of cancer, including breast, colon, lung, and uterine cancer. Furthermore, uninsured patients and those from many ethnic minority groups are substantially more likely to be diagnosed with cancer at a later stage. Safety net health care providers offer primary care as well as cancer screening services for medically underserved patients. Publicly funded programs, such as the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), offer breast and cervical cancer screening services in many of these safety net settings. Little is known, however, about whether and to what extent safety net providers prepare older women for transitions to cancer care once they become eligible for Medicare and age out of publicly funded cancer screening programs like the NBCCEDP. To better inform future research, policy, and intervention programs designed to promote a coordinated transition to cancer screening and treatment among older women using safety net services, this study explored safety net provider practices about transitions to cancer care in Georgia. Study Purpose: The purpose of this study was to: 1) assess the extent to which safety net clinics in Georgia provide cancer screening services to medically underserved women ages 50 and older; and (2) explore safety net provider policies and practices for assisting older women to transition to Medicare for their cancer care services. Methods: This study applied an explanatory sequential mixed methods design. The quantitative phase included an online-survey with safety net providers who offer breast and cervical cancer screening services to older, uninsured and medically vulnerable women in Georgia. The survey addressed clinic and client characteristics, provision of cancer care services, health education and patient navigation services, and policies and practices specific to care transitions. In-depth interviews with a purposive sample of participating providers were conducted as the following explanatory qualitative phase to explore the survey results in greater detail. Results and Implications: Quantitative survey results from 193 safety net clinic providers in Georgia indicate about 20% of their clientele are uninsured women ages 50-64. A large majority of clinics offer breast and cervical cancer screening services (95%), as well as referrals for diagnostic follow-up (80%) and referrals for cancer treatment via the Georgia Women's Health Medicaid Program (82%). Most safety net clinics (57%) do not provide cancer screening services to women older than age 65 and do not have a formal policy in place to help these older women transition to Medicare for their cancer care (51%). However, about one-third of safety net clinics offer some information or informal counseling to older women about how to enroll in Medicare and find a Medicare-participating provider. Qualitative findings suggest that providers support the development of a care coordination model, such as patient navigation, to assist older women in their transition from safety net clinics to private, Medicare providers for cancer care services. Enhanced provider education and training regarding Medicare benefits and policies was also recommended. Considered together, these strategies offer an opportunity to enhance safety net provision of cancer screening services for older women and to create new models of transition cancer care for the medically underserved in Georgia Citation Format: Sarah Blake, Jonathan Hawley, Susanne Erni, Arpita Mehrotra. Transitions to Medicare for Cancer Care Services: A Study of Safety Net Clinics in Georgia. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C07.

Evaluation of the Reduction of Salmonella Surrogate in Beef Strip Loins at Temperatures Lower Than 54.4°C

ObjectivesAccording to the CDC, Salmonella is a leading cause of gastroenteritis in humans and continues to be significant in relation to public health concerns for the food industry. This may be attributed to inadequate heating/cooking. According to Appendix A to achieve a 6.5-log10 reduction in Salmonella the lowest time/temperature that can be utlized is 54.4°C for 112 min. To date there is limited research in utilizing lower temperatures for strip loins to increase juiciness and perceived tenderness. This study evaluated the reduction of Salmonella surrogate on strip loins cooked to internal temperatures of 54.4°C or lower to determine if temperatures less than 54.4°C would achieve a 6.5-log10 reduction in accordance with Appendix A.Materials and MethodsA local company provided their proprietary brine and rub ingredients and raw meat materials for the experiment. A cocktail of 5 stains of Escherichia coli (ATCC BAA-1427, 1428, 1429, 1430, 1431) were utilized. These strains are approved by the USDA as surrogates for Salmonella for in plant verification studies. Inoculations were prepared by inoculating TSB with each E. coli strain and allowed to grow at 37°C for approximately 24 h. Strip loins were dip inoculated with E. coli to achieve a 7.5-log10 CFU/g inoculation level on the meat. Strip loins were pumped 15% with a brine solution and then rubbed with the rub. They were then placed into cook-in bags and vacuum-sealed. Packages were placed on a smokehouse trolley in the smokehouse. The combination of temperatures and times held were 54.4°C for 2 and 3 h, 51.7°C for 3 and 5 h, and 48.9°C for 10 and 12 h. Times were determined utilizing a model from the North American Meat Institute. Internal temperatures were continuously monitored utilizing Type-K Thermocouples. Once removed from the smokehouse 1-kg samples were taken from each strip loin and were vacuum-packaged for Salmonella surrogate enumeration. Samples were taken to Food Safety Net Services for enumeration. MacConkey Sorbital Agar was utilized to determine Salmonella surrogate survival. The experiment consisted of 3 replications with 2 samples per treatment per replication. Data were analyzed using excel to determine variance and the GLM procedure of SAS (SAS Inst. Inc., Cary, NC) to obtain lsmeans with statistical differences set at p < 0.05.ResultsNo treatment was more effective at inactivating the Salmonella surrogate than another (p > 0.05). However, there was a trend (p = 0.08) that the temperature 54.4°C was more effective at inactivating the Salmonella surrogate than 48.9°C. Strip loins had a 6.2-log10 reduction (var = 0.3) at 54.4°C when held for 2 h and a 6.4-log10 reduction (var = 0.07) when held for 3 h. When held at an internal temperature of 51.7°C a 5.1-log10 reduction (var = 0.59) was achieved when held for 3 h and a 5.5-log10 reduction (var = 0.59) when held for 5 h. Strip loins that were cooked to 48.9°C and held for 10 h resulted in a 4.8-log10 reduction (var = 3.23) and when held for 12 h achieved a 4.9-log10 reduction (var = 1.28). Reduction from brine and rub will be presented on the poster.ConclusionResults suggest that lower temperatures may possibly achieve a 6.5 to 7.0-log10 reduction in accordance with Appendix A if the product was held at the temperature for the correct time. This information is useful for companies that wish to use other temperature/time relationships than those stated in Appendix A.

Evaluation of the Reduction of E. Coli in Beef Ribeye Rolls at Temperatures Lower Than 54.4°C

ObjectivesAccording to the CDC, Salmonella is a leading cause of gastroenteritis in humans and continues to be significant in relation to public health concerns for the food industry. This may be attributed to inadequate heating/cooking. The lowest temperature and holding time the USDA recommends in Appendix A to achieve a 6.5-log10 reduction in Salmonella is 54.4°C for 112 min. To date there is limited research in utilizing lower temperatures for ribeye rolls to increase juiciness and perceived tenderness. This study evaluated the reduction of Escherichia coli in strip loins, top rounds and ribeye rolls cooked to internal temperatures of 54.4°C or lower to determine if temperatures less than 54.4°C would achieve a 6.5-log10 reducation in accordance with Appendix A.Materials and MethodsA local company provided their proprietary brine and rub ingredients and raw meat materials for the experiment. A cocktail of five stains of Escherichia coli (ATCC BAA-1427, 1428, 1429, 1430, 1431) were utilized. These strains are approved by the USDA as surrogates for Salmonella for inplant verification studies. Ribeye rolls were dip inoculated with E. coli to achieve a 7.5-log10 CFU per gram inoculation level on the meat. Ribeye rolls were pumped 15% with a brine solution and then rubbed with the rub. They were then placed into cook-in bags and vacuum-sealed. Packages were placed on a smokehouse trolley in the smokehouse. The combination of temperatures and times held were 54.4°C for 2 and 3 h, 51.7°C for 3 and 5 h, and 48.9°C for 10 and 12 h. Times were determined utilizing a model from the North American Meat Institute. Internal temperatures were continuously monitored utilizing Type-K Thermocouples. Inoculations were prepared by inoculating TSB with each E. coli strain and allowed to grow at 37°C for approximately 24 h. Once removed from the smokehouse 1-kg samples were taken from each ribeye roll and were vacuum-packaged for E. coli enumeration. Samples were taken to Food Safety Net Services for enumeration. MacConkey Sorbital Agar was utilized to determine E. coli survival. The experiment consisted of three replications with 2 samples per replication. Data were analyzed using excel and the GLM procedure of SAS (SAS Inst. Inc., Cary, NC) to determine average reduction of E. coli in top rounds.ResultsRibeye rolls had a 6.3-log10 reduction (var = 0.1) at 54.4°C when held for 2 h and a 6.5-log10 reduction (var = 0.01) when held for 3 h. When held at an internal temperature of 51.7°C a 6.08-log10 reduction (var = 0.74) was achieved when held for 3 h and a 5.43-log10 reduction (var = 0.22) when held for 5 h. The lower reduction when held at for a longer period of time may have occurred due to a sample having a higher inoculation level or contamination during sampling. Ribeye rolls that were cooked to 48.9°C and held for 10 h resulted in a 5.3-log10 reduction (var = 1.07) and when held for 12 h achieved a 6.1-log10 reduction (var = 0.36).ConclusionResults suggest that lower temperatures may possibly achieve a 6.5–7.0-log10 reduction in accordance with Appendix A if the product was held at the temperature for the correct time. This information is useful for companies that wish to use other temperature/time relationships than those stated in Appendix A.

Nothing Left to Lose? Changes Experienced by Detroit Low- and Moderate-Income Households During the Great Recession

The Financial Crisis and ensuing Great Recession caused enormous hardship for households. Using original datasets, we examine the effects of the recession on a population many might think had nothing left to lose: low- and moderate-income households in the Detroit metropolitan area. We find that the Great Recession in fact imposed significant costs on these households, reducing employment and assets and increasing hardships in a wide variety of ways. Our findings suggest the need for more robust safety net policies and financial services that can help cushion the blows from sharp reductions in incomes and assets.

Suburban safety net service providers and the Latino community

Within the last forty years, the Latino population in the United States has increased incrementally. Moreover, in the most recent decade, Latinos have been found to migrate with relative speed and number to suburban spaces. Poverty is also on the rise in suburban communities. Thus, the demographic landscape of suburbia is shifting and consequently, requires shifts in the provision of resources, particularly by the safety net provider community. This study examines the scope of safety net providers in suburban Chicago to reveal the extent to which they are prepared to provide services to the suburban, low income, Latino population. Data reveals that differences exist across the suburban safety net provider community in how they choose to serve the Latino population. Recommendations to improving service delivery to this clientele are provided.

Barriers to health care for undocumented immigrants: a literature review.

With the unprecedented international migration seen in recent years, policies that limit health care access have become prevalent. Barriers to health care for undocumented immigrants go beyond policy and range from financial limitations, to discrimination and fear of deportation. This paper is aimed at reviewing the literature on barriers to health care for undocumented immigrants and identifying strategies that have or could be used to address these barriers. To address study questions, we conducted a literature review of published articles from the last 10 years in PubMed using three main concepts: immigrants, undocumented, and access to health care. The search yielded 341 articles of which 66 met study criteria. With regard to barriers, we identified barriers in the policy arena focused on issues related to law and policy including limitations to access and type of health care. These varied widely across countries but ultimately impacted the type and amount of health care any undocumented immigrant could receive. Within the health system, barriers included bureaucratic obstacles including paperwork and registration systems. The alternative care available (safety net) was generally limited and overwhelmed. Finally, there was evidence of widespread discriminatory practices within the health care system itself. The individual level focused on the immigrant’s fear of deportation, stigma, and lack of capital (both social and financial) to obtain services. Recommendations identified in the papers reviewed included advocating for policy change to increase access to health care for undocumented immigrants, providing novel insurance options, expanding safety net services, training providers to better care for immigrant populations, and educating undocumented immigrants on navigating the system. There are numerous barriers to health care for undocumented immigrants. These vary by country and frequently change. Despite concerns that access to health care attracts immigrants, data demonstrates that people generally do not migrate to obtain health care. Solutions are needed that provide for noncitizens’ health care.

What is the role of sexually transmitted disease clinics?

What is the role of sexually transmitted disease clinics?

Impact of Community Investment in Safety Net Services on Rates of Unsheltered Homelessness Among Veterans

Impact of Community Investment in Safety Net Services on Rates of Unsheltered Homelessness Among Veterans

Can hepatitis C be eradicated in the United States?

The advent of highly effective antiviral regimens will make the eradication of hepatitis C in high-income countries such as the United States technically feasible. But eradicating hepatitis C will require escalating our response to the epidemic in key domains, including surveillance and epidemiology, prevention, screening, care and treatment, policy, research, and advocacy. Surveillance must be nimble enough to quickly assess the magnitude of new transmission patterns as they emerge. Basic prevention strategies – community-based outreach and education, testing and counseling, and access to sterile injection equipment and opioid substitution therapies – must be scaled up and adapted to target groups in which new epidemics are emerging. All adults should be screened for hepatitis C, but special efforts must focus on groups with increased prevalence through community outreach and rapid testing. Government, industry, and payers must work together to assure full access to health services and antiviral drugs for everyone who is infected. Access to the new regimens must not be compromised by excessively high prices or arbitrary payer restrictions. Partnerships must be forged between hepatitis providers and programs that serve people who inject illicit drugs. Healthcare providers and systems, especially primary care practitioners, need education and training in treating hepatitis C and caring for substance-using populations. Services must be provided to the disadvantaged and stigmatized members of society who bear a disproportionate burden of the epidemic. Environments must be created where people who use drugs can receive prevention and treatment services without shame or stigma. Action is needed to end the policy of mass incarceration of people who use drugs, reduce the stigma associated with substance use, support the human rights of people who use drugs, expand social safety net services for the poor and the homeless, remove the legal barriers to hepatitis C prevention, and build public health infrastructure to reach, engage, and serve marginalized populations. Governments must take action to bring about these changes. Public health agencies must work with penal institutions to provide prevention and treatment services, including antiviral therapy, to those in need in jails and prisons or on probation or parole. Research is needed to guide efforts in each of these domains. Strong and sustained political advocacy will be needed to build and sustain support for these measures. Leadership must be provided by physicians, scientists, and the public health community in partnership with community advocates and people living with or at risk for hepatitis C. Eliminating hepatitis C from the United States is possible, but will require a sustained national commitment to reach, test, treat, cure, and prevent every case. With strong political leadership, societal commitment, and community support, hepatitis C can be eradicated in the United States. If this is to happen in our lifetimes, the time for action is now. This article forms part of a symposium in Antiviral Research on “Hepatitis C: next steps toward global eradication.”

A Profile of Mexican-Born Women Who Adhere to National Cervical Cancer Screening Recommendations

The purpose of this study was to examine Mexican-born women’s utilization and adherence to cervical cancer screening guidelines. Ninety-seven women in the southeastern United States participated. Data were collected in Spanish. The majority of women met adherence guidelines for the pap exam. Marital status, educational attainment, marianismo, blood pressure knowledge, fatalism, cultural cancer beliefs, trust in provider, and perceived provider communication abilities were not associated with utilization or adherence to screening guidelines. This study had higher than expected adherence to screening guidelines. Nearly all women received screenings through safety net services indicating the need to advocate for continued public health funding.

Sexually transmitted disease clinics in the era of the affordable care act: is it time to tear down the walls?

Sexually transmitted disease clinics in the era of the affordable care act: is it time to tear down the walls?

OP0007 What if all cancer patients in Malaysia had access to the best available care: How many deaths are avoidable?

Background Malaysia spends 4% of its gross domestic product (GDP) on health care despite its wealth (GDP per head in 2011 was PPP-US$15,589). There are no data for Malaysia’s spending on cancer care, only on anti-cancer medicines, which amounted to US$ 1900 per cancer patient (IMS 2012). By contrast, Australia spent US$ 4800 per patient. This could be one factor affecting cancer mortality; GLOBOCAN12 reported a mortality-to-incidence ratio of 60% for Malaysia (49% for breast cancer [BC]), whereas the corresponding ratio for Australia was 30% (16% for BC). This underinvestment in cancer care in Malaysia could be due to various reasons. There is room to improve our understanding and appreciation of the economic and health benefits of cancer care. Evidence of the potential effect of adequate cancer services on the health of the nation will help in the revision of priorities. To make the health benefits of cancer care more tangible, we aimed to estimate the number of deaths due to BC that would be avoidable if all Malaysian patients had access to the care provided by leading centres in Malaysia. Methods The number of avoidable deaths is the difference between the number of deaths estimated by GLOBOCAN12 and the expected number of deaths if all BC patients had experienced the age-ethnic-stage specific survival outcomes observed in leading cancer treatment centres in Malaysia. Data for age-ethnic-stage composition of the general BC population were from local cancer registries and public hospitals providing safety net services. Findings Of the 2572 deaths due to BC reported by GLOBOCAN12, 1299 (50%) were avoidable. Of these avoidable deaths, 647 (50%) were attributable to late-stage presentation and 652 (50%) were due to lack of access to optimum treatment. Interpretation Avoidable premature deaths were high in Malaysia, consistent with its high cancer mortality rate. Avoidable deaths were equally attributable to lack of early detection and access to treatment.

Are Latino Immigrants a Burden to Safety Net Services in Nontraditional Immigrant States? Lessons From Oregon

The significant growth of the Latino population in the midst of an economic recession has invigorated anti-Latino, anti-immigrant sentiments in many US states. One common misconception is that Latino immigrants are a burden to safety net services. This may be particularly true in nontraditional immigrant states that have not historically served Latino immigrants. Oregon data suggest that despite a higher prevalence of poverty, use of safety net services among Latino immigrants in Oregon is lower than that among non-Latino Whites. Immigration status, costs, lack of insurance coverage, and discrimination are among the reasons for this group's limited use of services. Nevertheless, policies designed to strengthen community and institutional support for Latino immigrant families should be considered in the context of current health care and immigration reform efforts.

A national audit of Australian dental practice distribution: do all Australians get a fair deal?

Australia is the sixth biggest (by area) country in the world, having a total area of about 7.5 million km(2) (3 million square miles). This study located every dental practice in the country (private and public) and mapped these practices against population. The total population of Australia (21.5 million) is distributed across 8,529 suburbs. On average about one-third of the population from each State lives in suburbs without practices and 46% live in suburbs with one to five dentists. Of those living within the study frameset, 86.6% live within 5 km of a private practice and 84.4% live within 10 km of a government practice. Australia's dental practices are distributed in a very uneven fashion across its vast area. Three-quarters of suburbs have no dental practice and over one-third of the population live in these suburbs. This research clearly identified that in a vast and uneven socio-geographically distributed country, service planning, if left to market forces, will end with a practice distribution that is fixed by economic drivers of scale and not that of disease burden. A more population health-driven approach to future design and construction of government safety net services is needed to address these disparities.

Advancing Obesity Prevention: Emerging Models and Best Practices

Advancing Obesity Prevention:Emerging Models and Best Practices Sarah Linde, MD (bio), Natasha Coulouris, MPH (bio), and Eliza Heppner, MPA (bio) The Health Resources and Services Administration (HRSA), an agency of the U.S. Department of Health and Human Services (HHS), is the primary Federal agency for improving access to health care services for people who are uninsured, isolated, or medically vulnerable.* In communities in every state and U.S. territory, HRSA provides financial support, technical assistance, and collaborative leadership to improve systems of care. Grantees of HRSA provide broad safety-net services for underserved populations, as well as health care to uninsured people, people living with HIV/AIDS, and pregnant women, mothers, and children. Grantees also recruit, train, and support health professionals in numerous disciplines. As its programs are vast, HRSA leverages them to meet the needs of communities, including racial and ethnic minority populations, rural populations, and the uninsured, who are at greater risk for health problems such as heart disease, cancer, stroke, and obesity.1 The agency also advances national public health priorities such as the National Prevention Strategy, the National Quality Strategy, and Healthy People 2020. This commentary will discuss significant shift s in national policy, particularly the Affordable Care Act, that open new opportunities for obesity prevention and treatment, describe some of HRSA's initiatives that promote healthy weight, and highlight a specific HRSA project in which quality improvement (QI) is applied to obesity prevention. The Affordable Care Act, the health care law of 2010, substantially expands investments in primary and preventive care programs and strongly emphasizes preventing illness, controlling costs, improving quality, and keeping people healthy. The National Prevention Strategy, created under the law, recognizes that good health, including a healthy weight, comes not only from receiving quality health care, but also from clean air and water, safe outdoor spaces for physical activity, safe worksites, healthy foods, violence-free environments, and healthy homes. Social and environmental determinants of health are now widely recognized as critical factors to address in the pursuit of optimum personal and population health. In addition, the Affordable Care Act establishes [End Page viii] the Prevention and Public Health Fund (PPHF) that supports public health and prevention efforts in states and communities. The fund is an unprecedented investment in promoting wellness, preventing disease, and recognizing the connectedness between personal and population health. Many PPHF-funded initiatives, such as Community Transformation Grants, target the prevention of obesity through healthy eating and physical activity. Further supporting the focus on prevention, the First Lady Michelle Obama's Let's Move! initiative mobilizes communities in a nationwide effort to solve the epidemic of childhood obesity within a generation by providing healthier food in schools, helping children become more physically active, and making healthy, affordable food more easily available in every part of the country. There is a great deal of momentum across federal, state, and local levels to address obesity prevention. Committed to helping individuals and communities stay or become healthier, HRSA is working to identify collaborative strategies for addressing and reducing obesity. As community-based organizations, HRSA-supported community health centers are well-positioned to address disease prevention, health promotion, and management of chronic illnesses, such as obesity. In 2011, 1,128 federally funded health centers served 20.2 million patients across the country. Among these patients, 93% were low-income (below 200% of the federal poverty level) and 62.2% were racial/ethnic minorities.* The 2009 Health Center Patient Survey showed that 76% of adult patients in these centers were overweight or obese (BMI= 25.0), which is 8 percentage points higher than the general U.S. population.2 In 2011, HRSA introduced two weight-related performance measures on which health centers had to report: (1) percent of children and adolescents with a documented body mass index (BMI) percentile and who received nutrition and physical activity counseling, and (2) percent of adults with documented BMI and who received a follow-up plan if BMI was outside healthy parameters. Tracking these measures helps health centers plan and implement obesity counseling, treatment, and other services as well as supporting quality improvement. In order to continue the work of community health centers, the Affordable Care Act...