The votes are in! These are the top 10 public health stories in Utah for 2016:
#1 Uninsured Rate at Lowest Point in a Decade
New
data
from the Utah Department of Health show 8.8% of Utahns (265,100
residents) did not have health insurance during 2015. The figure
represents the lowest uninsured rate Utah has experienced in more than a
decade.
“There are likely several factors that have
lead Utah to this point,” said UDOH Executive Director Dr. Joseph Miner.
“The state’s healthy economy and low unemployment rate certainly play a
role. Changes in health insurance that allowed more young adults to
remain on their parents’ health plan and that offered health insurance
subsidies to some lower-income families appear to be having a positive
effect on the uninsured rate as well.”
The 2015 data
show a continued decrease in the number of uninsured Utahns between the
ages of 19-26. In 2011, 23.6 percent of these residents did not have
insurance, but last year that number had decreased to just 12 percent.
The number of uninsured Utahns who fit into the population targeted for
Medicaid expansion, those between the ages of 19-64 who earn between
0-138 percent of the federal poverty level, has also decreased over the
past several years.
#2 Zika Virus Arrives in Utah
As of November 28th, 678
people had been tested for Zika virus in Utah; with a total of 21
Zika-positive test results. Nine of these positive test results were in
women who were pregnant; five of which have delivered infants with
normal outcomes so far, two resulted in pregnancy loss, one was lost to
follow-up, and one has not delivered yet. However, it was two unique
cases that brought international attention to state.
The
Salt Lake County Health Department announced the death of a county
resident infected with Zika virus on July 8th, the first confirmed
Zika-related death in the continental U.S. The deceased individual had
traveled to an area with Zika. Ten days later, Utah health officials
confirmed a new case of Zika virus
infection in a family contact who helped care for the individual who
died. The person had not recently traveled to an area with Zika and had
not had sex with someone who was infected with Zika or who had traveled
to an area with Zika. A CDC team was dispatched to Utah to help with the
investigation. Extensive mosquito trapping as well as a community
survey shows there is no evidence at this time that mosquitoes that
commonly spread Zika (aedes species) virus are in Utah.
The Bureaus of
Epidemiology, Maternal and Child Health, and
Children with Special Health Care Needs are
keeping a close eye on the situation and developed a Zika virus plan
that includes guidelines on monitoring, testing, and educational
outreach to the public. The
Utah Public Health Laboratory
recently became certified to perform Zika virus blood testing and will
be ready to perform a more specific type of Zika testing.
The
CDC recommends that women who are pregnant not travel to areas with
Zika. They should also use condoms or not have sex with partners who
have traveled to or live in an area with Zika for the duration of their
pregnancy. Tips on Zika prevention are available at
https://www.cdc.gov/zika.
#3 Syringe Exchange Programs Have Go-Ahead to Start in Utah
Syringe exchange programs (SEPs),
also called syringe services programs (SSPs), needle exchange programs
(NEPs), or needle-syringe programs (NSPs), are community-based programs
that provide access to sterile needles and syringes free of charge. The
programs also facilitate safe disposal of used needles and syringes.
SEPs are an effective component of a comprehensive, integrated approach
to HIV and hepatitis C prevention among people who inject drugs. Most
SEPs offer other prevention materials (e.g., alcohol swabs, vials of
sterile water, and condoms) and services, such as education on safer
injection practices and wound care; overdose prevention, including
Naloxone distribution; referral to substance abuse treatment programs;
and counseling and testing for HIV and hepatitis C. Many SEPs also
provide links to critical services and programs, such as HIV care,
treatment, pre-exposure prophylaxis (PrEP), and post-exposure
prophylaxis (PEP) services; hepatitis C treatment; hepatitis A and B
vaccinations; screening for other sexually transmitted diseases and
tuberculosis; partner services; prevention of mother-to-child HIV
transmission; and other medical, social, and mental health services.
Syringe exchange programs became legal in Utah on March 25, 2016, when Governor Herbert signed
House Bill 308
into law. The bill went into effect May 10, 2016, and states that
agencies in Utah “may operate a syringe exchange program in the state to
prevent the transmission of disease and reduce morbidity and mortality
among individuals who inject drugs and those individuals’ contacts.”
Rule 386-900 Special Measures for the Operation of Syringe Exchange Programs,
sets forth operating requirements for entities conducting syringe
exchange. As of November 10, 2016, agencies throughout Utah may enroll
their Syringe Exchange Programs with the UDOH. The rule requires
agencies conducting SEP to register with the UDOH and provide quarterly
reports of activities to be analyzed and then reported annually to the
Utah State Legislature, showing effectiveness and sustainability of the
program. The UDOH will provide support, technical assistance, training
and guidance to all Utah SEPs and will apply for, and distribute,
funding as available.
#4 Utah Pharmacists Can Now Dispense Naloxone without a Prescription
On December 8, 2016, Dr. Joseph Minder, executive director of the Utah Department of Health (UDOH), signed a statewide
standing order
allowing pharmacists to dispense naloxone, without a prior
prescription, to anyone at increased risk of experiencing an opioid
overdose. Naloxone is a safe and legal drug that can reverse heroin and
prescription opioid overdoses by blocking the effects of opiates on the
brain and restoring breathing in minutes. There is no potential for
abuse and side effects are rare.
Six Utahns die every
week from opioid overdoses. In 2015, 268 Utahns died from a prescription
opioid overdose (such as oxycodone, hydrocodone, methadone, morphine,
and fentanyl), 127 died from illicit opioids such as heroin, and 10
deaths involved both prescription and illicit opioids; an average of 33
each month (13.5 per 100,000 population). An estimated 80% of heroin
users start with prescription drugs. Utah ranks 4th highest in the
nation for drug overdose deaths.
#5 Updated Utah Air Quality Recess Guidance for Schools
The
average adult breathes 20,000 liters of air a day. During inversion
months, poor air quality can trigger asthma attacks. The primary
pollutant of concern during the winter months is particulate matter (PM)
2.5. The elderly, immunocompromised, and children have been identified
as sensitive groups to air pollution and special precautions should be
taken during poor air quality days to reduce their exposure.
On
June 13, 2016 the Utah Department of Health Asthma Program hosted the
"Air Quality and Health Summit." The purpose of the summit was to ensure
the
Utah Air Quality Recess Guidance
was based on current evidence and supported by schools, health
professionals, and community members. The event included a variety of
expert led presentations, moderator led discussion, and was attended by
53 stakeholders representing 27 different organizations in the
community. The result of the Summit was an updated Utah Air Quality
Recess Guidance that better aligns with Air Quality Index (AQI)
recommendations and colors. The Guidance now recommends the following:
- When PM2.5 levels are below 35.4 (green and yellow zone), all students can go outdoors for recess.
- When PM2.5 levels are between 35.5-55.4 (orange zone), sensitive
high-risk students and students with respiratory symptoms should remain
indoors for recess.
- When PM2.5 levels are above 55.5 (red and purple zone), all students should be kept indoors for recess.
#6 Teen Birth Rate Reaches Historic Low
The
Utah teen birth rate continued to fall in 2015, reaching a historic low of 17.6
births per 1,000 girls ages 15-19. Considered by the Centers for Disease
Control and Prevention to be a “Winnable Battle”, a goal of reducing teen
pregnancy by 20% between 2010 and 2015 was set. The rate of teen birth in Utah
declined 37% in this period. While no one factor can explain why teen
pregnancy rates are declining, evidence supports that teen pregnancy prevention
education efforts and increased access to contraceptives has led to teens using
more reliable forms of contraception. Another contributing factor may be
teens mirroring the trends of delayed childbearing in women ages 20 and over.
To
address teen pregnancy in Utah, two education programs, abstinence only and
personal responsibility, are conducted with adolescents. To find out more about
these programs and where they are located, visit www.health.utah.gov/mihp.
#7 Electronic Cigarette Substance Rule Set in Place
Since 2011, Utah has seen a
sharp increase
in the use of electronic cigarettes and other vape products. Current
use of electronic cigarettes and other vape products among Utah youth
has grown five-fold, from 1.9% in 2011 to 10.5% in 2015. Among Utah
adults, electronic cigarette and other vape products has remained
unchanged, from 1.9% in 2012 to 4.8% in 2014.
Effective
December 31, 2016, R 384-415, Electronic-Cigarette Substance Standards,
seeks to regulate electronic-cigarette substances at the point of sale
between the retailer and the consumer. The regulation takes the form of
standards for: (1) labeling; (2) nicotine content; (3) packaging; and
(4) product quality. As stated in Utah Code 26-57-103, the sale of
electronic-cigarette substances that fail to meet these standards will
be prohibited. The purpose of enacting regulatory standards for these
products is to attempt to limit the increased number of nicotine related
poisonings in the state. Labeling standards seek to better communicate
nicotine toxicity to the consumers. Standards for nicotine content set a
limit for the concentration of nicotine in an electronic-cigarette
substance. Packaging standards are intended to make child entry to the
product more difficult. Product quality standards prescribe requirements
for eventual product approval by the FDA and a restriction on the sale
of certain products.
#8 Harmful Algal Blooms Plague Utah Waterways
In July
2016, a large harmful algal bloom was discovered along the eastern shore
of Utah Lake. Although algae are a natural part of many freshwater
ecosystems, under the right conditions they can proliferate to create
large algal blooms. High levels of nutrients in the water, combined with
warm temperatures, abundant sunlight, and calm water, can promote rapid
algal growth, resulting in the extensive, bright-green blooms. These
blooms can contain harmful cyanobacteria, a type of bacteria (often
referred to as blue-green algae) that produces toxins that can pose
risks to humans, wildlife, domestic animals, and fish.
The
Utah Department of Health and Utah County Health Department (UCHD)
closed Utah Lake to the public on July 15, 2016 due to the harmful algal
bloom. State and local health departments have the legal authority to
close public places, such as a lake, to protect the health of the
public. While the UCHD has previously issued advisories regarding algal
blooms on Utah Lake due to public health concerns, this is the first
time the entire lake has been closed. Additional warnings and closures
of bodies of water – the Jordan River canal system, Scofield Reservoir,
Mantua Reservoir, Big East Lake, Box Lake, and McClellan Lake – were
closed in the weeks and months following. Coordination with the
Utah Department of Environmental Quality and state and local agencies was essential for testing water samples and informing the public about the algal bloom.
#9 Statewide Health Assessment
UDOH collaborated with Intermountain Healthcare and the Local Health Departments to conduct a
Statewide Health Assessment.
Data on more than 100 health indicators, broken out, where possible, by
geography, age, sex, race, ethnicity, income, and education as well as
trends over time were reviewed. Twenty-seven community input meetings
were held around the state to gather views on the health issues of
greatest need and disparity for a particular area. Other needs
assessments conducted by community or health agencies were reviewed. A
prioritization methodology was decided upon and applied to the data and
information gathered. The top priorities were then taken to a broader
Utah Health Improvement Plan Coalition that consists of state and local
health agencies, Tribes, partner agencies, and health systems for
further review and prioritization. The Coalition also assisted in the
public health system strengths, weaknesses, opportunities, and threats
analysis. Three priority areas have been prioritized as a result of this
process and the collaborating partners are developing a Utah Health
Improvement Plan to work towards improvement in these areas.
- Reducing obesity and obesity-related chronic conditions
- Reducing prescription drug misuse, abuse and overdose
- Improving mental health and reducing suicide
This is a new level of collaboration and it is hoped that collective efforts may contribute to greater levels of improvement.
#10 Medicaid Expansion Update
The Affordable Care Act (ACA) gives individual states the option to expand Medicaid to new adults earning up to 138% of Federal Poverty Level (FPL). Without expansion, there is a gap in coverage for adults who do not currently qualify for Medicaid and are ineligible to receive benefits and subsidies through the federally facilitated marketplace. After years of deliberation and research, state leaders have developed a plan for a Utah-specific approach to reduce the number of the uninsured adults in the state.
During the 2016 Legislative Session,
House Bill 437 passed and directed the Utah Department of Health’s Medicaid agency to implement a health coverage improvement plan (known as the 115 waiver). Based on funding and approval from the Centers for Medicare and Medicaid Services (CMS) the program is designed to provide Medicaid coverage for the following adults:
- Parents with dependent children earning up to 60% of the FPL
- Adults without dependent children earning up to 5% of the FPL who are: chronically homeless;involved in the justice system through probation, parole, or court ordered treatment needing substance abuse or mental health treatment; or Needing substance abuse treatment or mental health treatment.
Public hearings on the health coverage improvement plan took place in April and May 2016. The final plan was submitted to CMS on July 1, 2016 and if approved, will begin enrolling new members on January 1, 2017.
Other public health stories that received honorable mentions:
