Costs of Air Pollution in California's San Joaquin Valley: A Societal Perspective of the Burden of Asthma on Emergency Departments and Inpatient Care.

Introduction: The San Joaquin Valley (SJV) is often recognized as one of the most polluted regions in the US. Periods of pollution exposure are associated with increased health burden related to respiratory inflammation and undermined lung function, which aggravates respiratory diseases such as asthma and leads to symptoms such as coughing, wheezing, or difficulty breathing. Asthma costs US$ 82 billion annually in healthcare costs, missed work and school in the US. Methods: Employing a societal perspective, a cost of illness design was combined with environmental epidemiological methods to analyze the economic impact of O3, NO2, and PM2.5-related adverse respiratory health outcomes amongst SJV residents who attended the emergency department (ED) or were hospitalized in 2016. Results: Asthma exacerbations monetized value ranged from US$ 3353 to US$ 5003 per ED visit and for hospital admissions US$ 2584 per inpatient day for adults 65 years and older to US$ 3023 per child. The estimated value to society in healthcare costs, productivity losses, school absences, and opportunity costs from air pollution adverse health outcomes totaled US$ 498,014,124 in ED visits and US$ 223,552,720 in hospital admissions for the SJV population in 2016. The marginal reduction in the background concentrations of pollutants would avert 21,786 ED adverse events and 19,328 hospitalizations from the health burden on the SJV population or US$ 8,024,505 cost savings due to O3, US$ 82,482,683 from NO2 reductions, and US$ 46,214,702 from decreased concentration of PM2.5. Conclusion: This study provides evidence that air pollution is a negative externality that imposes substantial social, environmental, and healthcare costs on the SJV. Furthermore, the region would avert significant adverse health outcomes realizing economic savings by reducing air pollution and exposures.

Will tobacco price increases lead more people who smoke to vape? The results from a discrete choice experiment amongst U.S. adults.

OBJECTIVE: To understand the extent to which people who smoke, people who vape and nonsmokers would switch between smoking cigarettes and vaping in response to policies (price increases, restrictions on nicotine, places, and information on addictiveness and/or health risks) aimed at decreasing tobacco use by people who smoke and vaping by nonsmokers. DESIGN: A total of 525 adults aged 18 to 88 years completed a discrete choice survey of 16 choices between two smoking/vaping alternatives. Analysis was conducted using conditional logistic regression for the entire sample and stratified by nonsmokers, people who smoke, and people who vape. RESULTS: The results suggest that most people who vape also smoke. Nonsmokers were more favorable to vaping and were concerned about long-term health risks and cost associated with vaping. Marginal analysis suggests that price increases will have only modest success in moving people who smoke to start vaping or encouraging people who vape to vape rather than use cigarettes. Nonsmokers are not very sensitive to price changes but are sensitive to information about health impacts. CONCLUSIONS: Findings indicate that increasing the price of cigarettes would lead to a limited increase in the probability of people who smoke switch to vaping. The study advances our understanding of the views of current nonsmokers toward cigarettes and vaping, suggesting that price increases and increased knowledge of addiction would likely deter nonsmokers from vaping. Changing the amount of nicotine associated with smoking would increase the probability of vaping slightly and have little impact on nonsmokers or vaping preferences, but the most significant change would come from increasing the perceptions of the risk of smoking.

Development and implementation of a community health survey for public health accreditation: Case study from a rural county in California.

OBJECTIVE: To describe the planning, development, pilot testing, fielding, and outcomes of a community health survey in a rural California county pursuing public health accreditation. DESIGN: Community partners helped the local health department develop the community health survey. Extensive English- and Spanish-language pilot testing was conducted over a period of four months. Final survey fielding was conducted online and at 20 community sites. RESULTS: 2189 completed surveys were collected. Total costs for developing and fielding the survey were approximately $25,000. Survey results indicated that alcoholism/drug abuse, breathing problems, and obesity were the primary health concerns of county residents. Benefits of conducting the community survey included strengthening inter-organizational partnerships between community partners, engaging a large and diverse respondent sample, and gathering information on a nuanced set of health indicators. Challenges included an unexpectedly high number of respondents and managing the needs of respondents with disabilities or poor literacy. CONCLUSION: The information gathered from the community health survey was used in the implementation of a county-wide multi-agency strategic plan to address health priorities identified in the CHA. Engaging a broad set of community partners throughout the survey process was critical for ensuring the project's relevance and long-term regional impact.

Factores sociales como mediadores de la salud pública / Social factors as mediators of public health

The World Health Organization (OMS) defines health as a state of complete physical, mental and social wellbeing, not just the absence of disease and illness. Wermuth inferred that 56 percent of health status variations could be explained by social and ecological factors, 21 percent by health behaviors, 19 percent by the quality of health services and public health systems, and only 4 percent by genes and biological agents. Few governments have designed policies to eradicate health disparities with direct correlation to social factors. Legislators in under developed countries face a plethora of national and local issues with limited resources to solve them within challenging political juncture to prioritize. The goals designed to improve the public’s health must compete to raise political awareness and obtain resources within those political circumstances.

La Organización Mundial de la Salud (OMS) define la salud como un estado de completo bienestar físico, mental y social, no solamente la ausencia de afecciones o enfermedades. Wermuth dedujo que 56 por ciento de las variaciones en estado de salud son explicadas por factores sociales y ecológicos, comportamientos de salud en un 21 por ciento, la calidad de los cuidados médicos y los sistemas de salud pública en 19 por ciento y sólo 4 por ciento por genes y agentes biológicos. Muy pocos gobiernos han legislado políticas explícitas con el objetivo de eliminar las inequidades de salud determinadas por factores sociales. Legisladores en los países en vías desarrollo enfrentan una plétora de problemáticas con limitados recursos para resolverlas, así mismo en un contexto de conflictos en las imperativas políticas. Las metas diseñadas para mejorar la salud pública deben competir para atraer la atención política y los recursos, bajo estas difíciles circunstancias políticas.