Gardasil for boys and men?

There is currently debate over Gardasil, the vaccine that protects against certain strains of HPV proven to cause cervical cancer, being endorsed for use in boys and young men.  The vaccine has been available to girls and women ages nine and over since its FDA approval in 2006 and, in December 2008, Merck applied for FDA approval for use in boys and men ages nine to 26.  In men, Gardasil would aim to protect against genital warts and less common cancers, such as penile, anal, throat and mouth, that HPV can cause.

As the Washington Post reports, the discussion “illustrates the complex interplay of political, economic, scientific, regulatory and social factors that increasingly influence decisions about new types of medical care.”  The decision is primarily being based on a cost-benefit analysis of endorsing the vaccine, priced at $500 for a series of three shots, for both males and females.  The CDC committee overseeing the issue will meet again in June to review the findings.  The centrality of cost effectiveness, as opposed to public health benefits, in the decisionmaking is a point of controversy in itself.

Gregory Zimet, a professor of pediatrics and psychology at Indiana University, said that although the cost-effectiveness studies are “really important,” he does not believe they should be the “sole driver of public health policy.” He said Gardasil “principally benefits women’s health,” adding, “I wonder if it was the reverse, and there was a vaccine for women that helped prevent prostate cancer in men, this would be as much of an issue.”

For more in-depth analysis of the issue, see The Daily Women’s Health Policy Report.

The Human Right to Health

Ipas, an international sexual health and reproducive rights organization, believes that health care advocates and reform activists can find support for their work in the principles underlying health as a human right.

Accordingly, Ipas, in collaboration with the National Economic and Social Rights Initiative, the National Health Law Program, the National Latina Institute for Reproductive Health and the National Asian Pacific American Women’s Forum, published a new fact sheet on The Human Right to Health and Women’s Reproductive Health Policy.

Health has been recognized as a human right by the UN Commission on Human Rights since 1994.  While not all of the standards outlined by the UN are legally binding in the United States, they provide a conceptual framework for advocates in the field.  The right to health requires that health services, goods, facilities and the underlying determinants of health be available, accessible, acceptable and of good quality, equally to everyone.  The factsheet applies the UN framework for the international right to health to  women’s reproductive health policy:

• Reproductive health facilities, goods and services, including trained medical professionals, medicines, and underlying determinants of health, must be adequately available to all women within a country. Policies that result in fewer abortion providers, such as onerous facilities requirements, curtail the right to health for women. Also, where providers are allowed to refuse to provide contraception or abortion, effectively making these services unavailable to certain women, a woman’s right to health is violated. According to the CEDAW Committee, in such places, policies must be in place to ensure that women are referred to alternative providers willing and able to provide contraceptive and abortion services.

• The same facilities, information, goods and services must be accessible to everyone without discrimination. Accessibility must be a reality in law and in fact, particularly for the most marginalized groups. For example, comprehensive reproductive health services must be accessible to everyone, regardless of socioeconomic status, race, national origin, language ability, immigration status or sexual orientation and gender identity. Services must also be physically accessible for everyone, with a focus on vulnerable groups such as older women, women in prison or detention, women with disabilities and women who live in rural areas. Economic accessibility is an essential component of the right to health. Reproductive health services such as contraception, prenatal care and abortion must be affordable to all. Policies such as the Hyde Amendment, which bans abortion funding, disproportionately affect particular groups of people, such as poor women of color, who are unable to afford certain reproductive health services. Therefore, their right to health is violated. The government also does not fulfill the right to health in situations where poor women lack health insurance, and health care is, in effect, inaccessible. Information on reproductive health issues must also be accessible to all. Policies that restrict information on condoms for adolescents, for example, violate the right to health. 

• Reproductive health services must be acceptable to all women, particularly those who are outside the dominant culture. Policies must ensure that reproductive health services are culturally competent and acceptable according to the needs and perspectives of particular communities. To fulfill the right to health of immigrant communities in the United States, policies must ensure that the health-care workforce is culturally competent and able to work in a language that women they serve can understand. Policies must also ensure that reproductive health services are confidential.

• Health facilities, goods and services must be of good quality and based on evidence where it is available. To generate appropriate evidence to improve quality, research on health care must better include women, children and people of color. One example of poor quality is is the funding of pregnancy prevention programs that are limited to abstinence-untilmarriage messages despite evidence that such programs fail to achieve their objectives.

Public Plan Disagreements Persist

In testimony given before the Senate Health, Education, Labor and Pensions Committee on March 24th, insurance industry representatives argued against including a public plan, but said they could phase out the practice of varying premiums based on health status.

Ronald A. Williams, chairman and chief executive officer of Aetna Inc said that with a public plan option, government could act as both “player and referee” and price private practices out of the market.

Karen Ignagni, president and chief executive officer of America’s Health Insurance Plans, also opposes a public plan option, arguing instead for guaranteed issue of coverage and an individual mandate to improve the system, both of which would be impeded by a public plan option that would destabilize the employer-based system.

Along with Scott P. Serota, president and chief executive officer of Blue Cross Blue Shield Association, Ignagni said that even if premiums were not based on an individual’s health risk, rating flexibility based on age, geography, family size and benefit design would still be needed to maintain affordability.

Len Nichols, director of the health policy program at the New America Foundation, says that the solution is not to place everyone in a Medicare plan, but to create rules to ensure that the people running the public plan are not the same a the people regulating the market. 

Insurance Lacking for Workers

American workers, whose taxes pay for massive government health programs, have, as of late, seen their premiums rising much faster than their wages.

Though workers pay taxes which assist the elderly, children, and the poor, the government provides little direct assistance to help workers cover themselves. Almost all retirees are covered, as well as nearly 90% of children, leaving workers most vulnerable.

Currently 1 in 5 workers is uninsured, up from 1 in 7 in the mid 1990s, due in large part to premiums for employer plans rising six to eight times faster than wages. In the 1990s,  eight states had 20% or more of their working population uninsured. Now that number is up to fourteen.

For more, click here

For the full report, released by The Rober Wood Johnson Foundation click here

Maternity Coverage

According to an article in the San Francisco Chronicle, the number of individual health insurance policies in California that do not include maternity coverage has increased from around 192,000 in 2004 to about 805,000 now. With a steady increase in the number of people losing their jobs, more and more are starting to pay for private plans, which oftentimes costs less than staying on a former employer’s plan.

Assemblyman Hector De La Torre (D-Los Angeles County) is introducing a bill that requires health insurance products regulated by the State Department of Insurance to include maternity benefits. Governor  Schwarzenegger, a Republican, has vetoed a similar bill brought forth in 2004 by then-Senator Jackie Speier, a Democrat, and one brought forth by De La Torre last year.

Those opposed to including maternity coverage say that they should not be forced to pay for a service they have no intention of using, especially because it would cause their premiums to increase. But those in support claim that for a monthly average of $7.17, society would save money if fewer women were on government supported programs.

De La Torre said, “Why do women pay for prostate cancer? Why do men pay for breast cancer? Because that’s the whole point of insurance,” arguing that excluding maternity benefits opposes the whole philosophy of shared risk.

Massachusetts, New Jersey, and New York already have laws in place for maternity coverage, and Ben Singer, a spokesman for Anthem Blue Cross, claims that their costs are higher for individual insurance coverage than California’s. Pregnancy is a choice, Singer maintains, clearly overlooking the accidental pregnancies that occur yearly, unlike heart-disease or adult-onset diabetes, which is linked to poor eating and exercising habits, which can also be labeled as “choices”.

Patricia Bellasalma, president of California’s National Organization of Women, argues that not all pregnancies are by choice, and excluding maternity coverage in health insurance is discriminatory against women, the only ones in that pool. This discrimination is part of the reason Californian women pay as much as 39% more for health insurance than Californian men.

For the full article click here

Health Reform Legislation Needed Now

On March 19, Senate Finance Committee ranking minority member Chuck Grassley (R-IA) said that Congress must pass health reform legislation this year, or it will not be done during Obama’s first term. Grassley also said that he does not see a compromise in sight between Democrats and Republicans regarding a public plan option. Democrats say that a public plan would spur competition and cut costs, while Republicans and those in the health insurance industry say it would be difficult for private companies to compete and would lead to more government sponsored healthcare.

But Grassley says that Congress could set minimum benefit standards that private health plans must meet and/or allow health insurance companies to sell policies across state lines. Sources have said that America’s Health Insurance Plans, which represents private insurers, might be willing to embrace a Community Rating, which spreads risk evenly and charges the same  regardless of age, health status, and claim history.

Health reform legislation should be fully paid for, Grassley said, with necessary “upfront” spending. Savings would be possible via Medicare stressing quality, not quantity of care. The reform legislation will not help the economy in the short-term, he emphasized, but will relieve some federal budget concerns in the long-term. The reforms will not cancel the need for Medicaid and Medicare reforms.

Grassley has said that reform should be considered via so-called regular order, using committee hearings and markups, rather than budget reconciliation. The former takes 60 votes to be approved by the Senate, the latter 51. Finance Committee Chairman Max Baucus (D-MT) wants to mark up health reform legislation in June, and House Democrats plan to clear a bill by the August Congressional recess. Grassley maintains that if a reform bill is not completed by late fall, Congress will have to pass legislation preventing a 20% cut in physicians’ Medicare reimbursement from being enacted in 2010.

Loss of Dashle Blow to Health Reform? He Doesn’t Think So…

“When I withdrew from consideration to be secretary of health and human services, some pundits said health reform had received a devastating blow. While it would be flattering for me to believe that, it would also be completely wrong…the biggest error those pundits made was in thinking that the debate over health-care reform would be decided by who occupies certain positions in Washington. It won’t. It will be decided by the American people. And at the Forum on Health Reform, those voices were finally heard,” says former HHS Nominee Thomas Daschle.

The former South Dakota Senator reports that while it may be flattering to hear that his withdrawal is a serious blow  to health care reform in this country, he believes that there are many advocates and reformers in Washington that are able to achieve change.  Furthermore, Daschle notes that with a President who believes “Health-care reform cannot wait, it must not wait, and it will not wait another year” , a committed HHS nominee  Gov. Kathleen Sebelius , White House Office of Health Reform head Nancy-Ann Min DeParle, Republicans who support health reform and allies from the pharmaceutical lobbyists, not to mention the thousands of Americans who have already voiced their concerns, health reform has many staunch supporters.

Unions United

On Wednesday, after a year-long dispute, The Service Employees International Union and The California Nurses Association, two of the fastest-growing unions, have agreed to work together to unionize hospital workers and push for universal health coverage.

With a national effort for health reform and a law to make it easier to unionize workers, both groups feel they can accomplish more by working together.

The Service Employees International Union has 1.8 million members, 80,000 of them nurses, while The California Nurses Association represents 85,000 nurses, a number which is about to jump to 150,000 as they merge with United American Nurses and the Massachusetts Nurses Union, making it the largest nurses union in American history.

As part of their joint agreement, the unions will seek to unionize hospitals around the country, focusing on the largest hospital systems, and call for allowing states to adopt single-payer systems.

For the full New York Times article click here

Our Bodies Ourselves Women’s Health Heroes Awards!

Nominate Your Women’s Health Hero!

From the Our Bodies Ourselves website: “Whoever your heroes are, we want to know about them! We’ve created the Our Bodies Ourselves Women’s Health Heroes awards to honor those who make significant contributions to the health and well-being of women. It’s a great way to publicly recognize people who make a difference in your life or the lives of others.”

For more information or to nominate someone, visit http://www.ourbodiesourselves.org/heroes.asp

National Public Health Week! Check it Out!

The American Public Health Association (APHA) is sponsoring National Public Health Week on April 6-12, 2009 to educate the public, policymakers and practitioners about issues related to the theme, “Building the Foundation for a Healthy America.” 

The goal of the week is to raise awareness nationally and locally of public health’s critical role in ensuring a healthy America.  APHA has also created the 2009 Partner Toolkit including fact sheets, media outreach materials, suggested community events, legislative information and resources to use throughout the week. 

Access the National Public Health Week Web site for more information at http://www.nphw.org/nphw09/default.htm. 

To download a copy of the Toolkit, go to http://www.nphw.org/nphw09/pg_tools_toolkit.htm.