Joanne Goldblum of New Haven is on a mission to get health care clinicians to recognize that poverty may be the underlying cause of their patients’ illnesses and that the best treatment might be as simple as a brown bag of food or a tube of toothpaste. Goldblum is CEO of the New Haven-based National Diaper Bank Network (NDBN), an organization dedicated to getting basic needs to people. She co-authored the Basic Needs-Informed Care Curriculum—with support from Yale School of Medicine faculty—designed to help clinicians, social workers and educators recognize the myriad ways a lack of resources can present itself. For example, a baby comes to a well child visit in dirty clothes. Clinicians might typically ask: Is the mother too depressed to care for the infant?
On a snowy Saturday morning in January, Selvin, 13, and his mother were in the basement of the First and Summerfield United Methodist Church in New Haven, to support a friend in sanctuary. As they sat there, the boy tried to push away thoughts of how it would be when ICE came to take away his own mother, who is also under a deportation order. “I’m going to be alone with my little brother and my dad,” Selvin said. “Sometimes I feel I don’t want to talk to anybody. I just go to my room, lock the door, and I feel depressed.”
Selvin – whose family asked that his last name be withheld – is among thousands of immigrant children in Connecticut and nationally feeling the effects of prolonged stress, which can become so toxic it can damage the developing brain.
While the prevalence of strokes in Connecticut has essentially remained the same in recent years, progress in slowing the number of deaths from stroke has declined in the state, a development the Centers for Disease Control and Prevention (CDC) calls “disturbing.”
The spike reverses a national decades-long trend that brought stroke death rates down. From 1999 to 2014, deaths from strokes were on the decline in the state and nationally. But a recent CDC report found that Connecticut was among 39 states in which the decline in stroke deaths has slowed or the number of stroke deaths has started to increase. From 2012 to 2015, the number of stroke deaths in Connecticut increased 9.5 percent, from 1,263 to 1,384. Stroke deaths were highest in the northeast and northwest regions of the state, CDC data show.
There are 27 facilities in Connecticut that use such large quantities of hazardous chemicals that they are required to submit disaster response plans to the U.S. Environmental Protection Agency. About 170,000 people—roughly 5 percent of the state’s population—live within a mile of these facilities, risking exposure to a leak, explosion or adverse health effects. Low-income people and children of color under the age of 12 are more likely than their white counterparts to live in these “fenceline” communities, according to a report by the Center for Effective Government. In its report “Living in the Shadow of Danger: Poverty, Race and Unequal Chemical Facility Hazards,” the center examined more than 12,500 facilities in 50 states, grading states based on the “disparities faced” by people living adjacent to or near these facilities. The center reported that children of color under age 12 living in the state were 2.2 times more likely than white children to live within a mile of one of these facilities. In many instances, residents are unaware of the dangers just blocks from their homes, the report said.
On the surface, Connecticut is a great place to raise children. Our schools, on average, perform well. Families have access to incredible learning opportunities in our history, science and creative arts. But what do you call a crisis in waiting? A report from the Annie E. Casey Foundation, ranked Connecticut sixth in the nation for things such as economics, education and health among our younger residents.
Roughly 68,000 seniors and disabled residents will lose access to a Medicare financial assistance program January 1, when income eligibility requirements change under the newly enacted state budget. Currently, through the Medicare Savings Program, the state Department of Social Services (DSS) pays Medicare Part B premiums for low-income elderly and disabled adults earning less than 246 percent of the federal poverty level, or about $29,667. Part B covers things like doctor visits, lab tests and outpatient care. Those earning less than 234 percent of the poverty level, or about $28,220, can receive additional help covering co-pays, deductibles and prescriptions. In the new year, only those earning less than 100 percent of the poverty level—or $12,060—will qualify to receive all benefits under the program, and those receiving subsidies for premiums alone must earn less than 135 percent of the poverty level to be considered for eligibility.
Consumers can begin shopping for 2018 health insurance through Access Health CT (AHCT) Wednesday, but will see sizeable price increases and have far less time to enroll than in previous years. Officials at the state’s health insurance exchange are boosting marketing and outreach efforts at a time when many consumers may be confused, said Andrea Ravitz, AHCT’s director of marketing and sales. Despite efforts by President Donald Trump and Republicans in Congress to repeal the Affordable Care Act (ACA), which created AHCT, the legislation and the marketplace still stand. “The constant mixed messages are confusing people,” Ravitz said. “There are certain things that are affecting the federal platform that are not affecting Connecticut at all.
A few years ago, patient navigators at Project Access-New Haven set out to see if they could change the course of health care treatment for some Medicaid patients who frequently used emergency rooms.
They contacted emergency departments at Yale New Haven Hospital and its Saint Raphael campus and enrolled 100 patients in their study in 2013. Those selected had visited emergency rooms four to 18 times in the past year for chest pain, abdominal pain or chronic migraines, among other ailments. The navigators at Project Access coordinated health care for the patients. They scheduled appointments with primary care physicians, provided reminders, accompanied patients to physician visits and followed up to ensure compliance with the prescribed treatment. The preliminary results were eye-opening: “We saw an average cost reduction of $153 per member per month,” said Dr. Roberta Capp, assistant professor, Department of Emergency Medicine at the University of Colorado Denver, and lead investigator of the study.
The number of people diagnosed with a sexually transmitted disease has increased in Connecticut as well as across the country, data from the Centers for Disease Control and Prevention (CDC) reports. Though experts note that some of the increase is due to better screening, they are concerned about an actual rise in cases and attribute that to more casual sex through hookup apps and an increase in unprotected sex. Nationwide, more than 2 million cases of chlamydia, gonorrhea and syphilis were reported in 2016, the highest number ever, with chlamydia making up the majority of cases. The annual Sexually Transmitted Disease Surveillance Report, released in late September, found that a total of 1,598,354 cases of chlamydia were reported in 2016, a 4.7 percent increase over 2015. Gonorrhea cases increased by 18.5 percent to 468,514, and syphilis increased 17.6 percent to 27,814 cases. In Connecticut, 14,028 cases of chlamydia were reported, 759 more than in 2015, a 5.7 percent rise.
Connecticut’s rural residents die at higher rates than their city and suburban counterparts and a large percentage of those deaths may be preventable if better public health programs or better access to health care services were available, according to the latest data from the National Center for Health Statistics (NCHS). Doctor shortages and long commutes make it harder for rural residents to get health care. And some officials worry that changes in hospital ownership and the Affordable Care Act could amplify existing problems.
“We have excellent medical care as a general rule in the state,” state Rep. Susan Johnson, D-Windham, said. But rural and other high poverty areas, where many residents are on Medicaid rather than private health insurance, remain vulnerable to hospital service reductions and changes in eligibility for health care coverage, she said. “My battle is to make sure the basic hospital services, like critical care units, are maintained in the small rural hospitals,” Johnson said.