News Article | April 26, 2017
More than 8 million U.S. children depend on the Children’s Health Insurance Program for access to timely medical care. The program is authorized through 2019, but its federal funding expires in September and it’s unclear what Congress will do. That uncertainty stresses all the systems and families that depend on CHIP, but it may be especially risky for the 2 million chronically ill children who get care through the program, which was originally designed for families falling in the gap between market affordability and Medicaid eligibility. In a study published this month in Health Affairs, researchers found that low-income children with chronic conditions would face higher out-of-pocket costs if forced to move from CHIP to the individual marketplace. With the future of CHIP funding unclear, researchers simulated two scenarios: one in which CHIP funding is extended, and another in which CHIP children are enrolled in the Affordable Care Act insurance markets. After analyzing health plan data from CHIP and the marketplace, they found that CHIP enrollees may face thousands of dollars in additional costs on the individual market, with families of children with diabetes, epilepsy or mood disorders facing the highest additional costs. Study co-author Alon Peltz, a physician who cares for children with special health care needs, noted that about one in every four kids in CHIP has a chronic health condition. “We’re coming up on the 20th year of CHIP and there are concerns about how to maintain coverage for these children,” Peltz, also a postdoctoral fellow in the Robert Wood Johnson Foundation’s Clinical Scholars Program at Yale School of Medicine, told me. “We wanted to think more critically about different avenues policymakers could take as they think about the future of health insurance coverage.” In conducting the study, which included more than 7,000 children with one or more chronic conditions, Peltz and colleagues assumed that ACA subsidies would still be available to help former CHIP families buy coverage on the marketplace. (Unfortunately, the future of those subsidies is also unclear.) They found that at every income level, children with chronic health problems would pay more for coverage in the marketplace than they would have in CHIP. For example, a family living at 100-150 percent of the federal poverty level (that’s about $30,000 for a family of three) would spend about $233 more in the marketplace annually, while a family at 251-400 percent of poverty (or between $51,000-$81,000 a year) would pay $1,078 more in the marketplace. Researchers also found that marketplace costs were higher for all six of the chronic conditions studied: asthma, ADHD, developmental disorders, diabetes, epilepsy and mood disorders. Children with epilepsy experienced the biggest spending increase in shifting to the marketplace, with the difference ranging from about $400 to nearly $2,500 depending on household income. The study attributed a majority of the out-of-pocket differences to spending on prescription drugs and inpatient hospitalizations. For instance, among children with asthma or ADHD, higher prescription expenses accounted for much of difference in CHIP and marketplace spending. For kids with diabetes, epilepsy and mood disorders, higher spending was typically associated with hospitalization costs. The study’s findings also assume that children shifted to the marketplace would continue to get all the services they need. However, researchers cautioned that “in reality, families could encounter networks that are inadequate to meet their children’s specialty care needs and (that could) lead to even higher out-of-pocket expenses.” In addition, about 2 million children now covered by CHIP don’t currently qualify for ACA subsidies due to a loophole known as the “family glitch,” which would certainly impact their ability to afford coverage outside of CHIP. (Right now, families can get ACA subsidies as long as they don’t have access to affordable employer-sponsored coverage. However, that affordability determination is based on coverage for the individual employee, not the employee and her or his family. Hence, the “family glitch.”) The study offered three strategies for leveling affordability between CHIP and marketplace plans: enhancing cost-sharing reductions in the ACA marketplace; re-examining cost-sharing for the two big drivers — drugs and hospitalization — of CHIP-marketplace spending differences; and monitoring whether marketplace deductibles negatively impact a child’s ability to access timely care. (CHIP plans rarely include deductibles.) However, all those strategies are based on an assumption that the ACA isn’t repealed and any changes to the law are relatively small. With that in mind, the researchers concluded that keeping CHIP funded is the best option for kids who need reliable access to care. “Given concerns about the viability of the marketplace, the legal battles regarding the cost-sharing reduction payments and the efforts to repeal the ACA, reauthorizing funding for CHIP is most likely the least disruptive strategy moving forward,” researchers wrote. Peltz said that if federal CHIP funding did disappear, many states would likely continue the program in some form. But with only state funds — and no matching federal funds — CHIP families may see reductions in services or higher cost-sharing requirements. He also noted that the ACA increased federal CHIP reimbursement to states. If Congress eliminated that enhanced reimbursement that could negatively affect state CHIP plans as well. Still, Peltz said he’s hopeful that policymakers can find a solution that ensures care for the 8 million children who depend on CHIP. “With some uncertainty right now in the political landscape, the CHIP program seems to be the best option for making sure that children, particularly those with chronic conditions, can continue accessing affordable care,” he told me. “We have a strong history of providing services to this vulnerable group of children…and as both a researcher and clinician, I hope we’ll continue the tradition of caring for these children.” For a copy of the CHIP study, visit Health Affairs. Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years. Follow me on Twitter — @kkrisberg.
News Article | April 28, 2017
In an analysis of Medicare billing data submitted by more than 2,300 United States physicians, researchers have calculated the average number of surgical slices, or cuts, made during Mohs micrographic surgery (MMS), a procedure that progressively removes thin layers of cancerous skin tissue in a way that minimizes damage to healthy skin and the risks of leaving cancerous tissue behind. The study, the researchers say, serves as a first step towards identifying best practices for MMS, as well as identifying and informing physicians who may need re-training because their practice patterns deviate far from their peers. A report of the study, published in the journal JAMA Dermatology April 28, suggests that identifying and informing high outlier physicians of their extreme practice patterns can enable targeted re-training, potentially sparing patients from substandard care. The analysis is part of a medical quality improvement project called "Improving Wisely," funded by the Robert Wood Johnson Foundation and based at The Johns Hopkins University. The initiative focuses on developing and using individual physician-level measures to collect data and improve performance. The U.S. Centers for Medicare and Medicaid Services provided broad access to their records for the study. "The project aims to work by consensus, encouraging outliers to seek educational and re-training tools offered by their professional society," says Martin Makary, M.D., M.P.H., professor of surgery at the Johns Hopkins University School of Medicine and the paper's co-senior author. "That's the spirit of medicine's heritage of learning from the experience of other physicians." He estimates that the initiative could result in Medicare savings of millions of dollars. Ideally, says Makary, those who perform MMS make as few cuts or slices as possible to preserve as much normal tissue as possible while ensuring complete removal of cancers. As each layer of skin is removed, it is examined under a microscope for the presence of cancer cells. However, there can be wide variation in the average number of cuts made by a physician. Measuring a surgeon's average number of cuts was recently endorsed by the American College of Mohs Surgery (ACMS) as a clinical quality metric used to assess its members. "Outlier practice patterns in health care, and specifically Mohs surgery, can represent a burden on patients and the medical system," says John Albertini, M.D., immediate past president of the American College of Mohs Surgery and the paper's other senior author. "By studying the issue of variation in practice patterns, the Mohs College hopes to improve the quality and value of care we provide our patients." Taking their cue from that support, Makary and his research team analyzed Medicare Part B claims data from January 2012 to December 2014 for all physicians who received Medicare payments for MMS procedures on the head, neck, genitalia, hands and feet. These regions of the body account for more than 85 percent of all MMS procedures reimbursed by Medicare during those years. A total of 2,305 physicians who performed MMS were included in the analysis. The researchers also gathered the following data for each physician: sex, years in practice, whether the physician worked in a solo or group practice, whether the physician was a member of ACMS, whether the physician practiced at an Accreditation Council for Graduate Medical Education site for MMS, volume of MMS operations, and whether the physician practiced in an urban or rural setting. Physicians had to perform at least 10 MMS procedures each year to be included in the analysis. The researchers found that the average number of cuts among all physicians was 1.74. The median was 1.69 and the range was 1.09 to 4.11 average cuts per case. Of the 2,305 physicians who performed MMS during each of the three years studied, 137 were considered extremely high outliers during at least one of those years. An extremely high outlier was defined as having a personal average of greater than two standard deviations, or 2.41 cuts per case, above all physicians in the study. Forty-nine physicians were persistently high outliers during all three years. Physicians in solo practice were 2.35 times more likely to be a persistent high outlier than those in a group practice; 4.5 percent of solo practitioners were persistent high outliers compared to 2.1 percent of high outlier physicians who performed MMS in a group practice. Volume of cases per year, practice experience and geographic location were not associated with being a high outlier. Low extreme outliers, defined as having an average per case in the bottom 2.5 percent of the group distribution, also were identified. Of all physicians in the study, 92 were low outliers in at least one year and 20 were persistently low during all three years. Potential explanations for high outliers include financial incentive, because the current payment model for MMS pays physicians who do more cuts more money, Makary says. These charges are ultimately passed on to Medicare Part B patients, who are expected to pay 20 percent of their health care bill. Low outliers may be explained by incorrect coding, overly aggressive initial cuts, or choice of tumors for which MMS is not necessary, he says. Although the study was limited by lack of information about each patient's medical history, or the diameter or depth of each cut, Makary says it's a meaningful step toward identifying and mitigating physician outliers. "Developing standards based on physicians' actual experience and practices is the home-grown approach needed now to improve health care and lower costs of care," says Makary. Other authors on this paper include Aravind Krishnan, Tim Xu, Susan Hutfless and Angela Park of the Johns Hopkins University School of Medicine; Thomas Stasko of the University of Oklahoma; Allison T. Vidimos of the Cleveland Clinic; Barry Leshin of The Skin Surgery Center; Brett M. Coldiron of the University of Cincinnati Hospital; Richard G. Bennett of Bennett Surgery Center in Santa Monica, California; and Victor J. Marks and Rebecca Brandt of the American College of Mohs Surgery. Funding for this study was provided by a grant from the Robert Wood Johnson Foundation (grant No. 73417) and the American College of Mohs Surgery.
News Article | April 20, 2017
ABOUT THIS YEAR’S SUMMIT The Summit is IHI’s signature offering for quality improvers who are in the trenches of creating team-based and new, more collaborative models for patients in primary care extending into the community. The event is also the place where some of the freshest approaches to improving health and health equity emerging from communities themselves – often using the tools and methodologies of Quality Improvement (QI) – can be learned about and brought back home. To that end, the Summit will also feature lessons learned from two years of IHI’s SCALE initiative (Spreading Community Accelerators through Learning and Evaluation; funded by the Robert Wood Johnson Foundation), dedicated to testing and spreading community-level health interventions. About the Institute for Healthcare Improvement IHI is a leader in health and health care improvement worldwide. For more than 25 years, we have partnered with visionaries, leaders, and front-line practitioners around the globe to spark bold, inventive ways to improve the health of individuals and populations. Recognized as an innovator, convener, trustworthy partner, and driver of results, we are the first place to turn for expertise, help, and encouragement for anyone, anywhere who wants to change health and health care profoundly for the better. Learn more at ihi.org.
News Article | May 3, 2017
In his role at the alternative investments management firm Altamar, Fernandez is focused on the design, fundraising and management of Altamar's Credit Business and is a member of the Investment Committee of Alta Life Sciences, a life sciences venture fund with a Spanish and European focus launched in 2016. Fernandez has also worked as Managing Director at Credit Agricole Corporate and Investment Bank, and as a consultant for the World Bank as a securities and debt capital markets expert. Fernandez has also served on the Board of Directors of the European Investment Bank and as a Board Member of CESCE (Spain's export credit agency). Between 2010 and 2013, he worked for Professor Andrew W. Lo at MIT's Laboratory for Financial Engineering on the biomedical megafund project. He has authored various papers on this field, focusing on the use of securitization techniques to spur investments in early stage drug development for critical diseases. Fernandez holds an MBA from MIT Sloan (Sloan Fellows Program in Innovation and Global Leadership), a Masters in Finance from the London Business School, a Masters in Portfolio Management degree from I.E.B. and Bachelor's Degree in Economics and Business from CUNEF (Madrid). "I have a passion for using financial engineering to solve problems and create a better, more sustainable world, and I believe that my goals and dreams align well with the mission of the Human Vaccines Project," said Fernandez. "I am eager to start my work in support of the Human Vaccines Project as the organization advances research in an area that is critical to the future of human health – decoding the human immune system to understand why and how it works to help the body combat diseases." About the Human Vaccines Project The Human Vaccines Project is a nonprofit public-private partnership with a mission to decode the human immune system to accelerate the development of vaccines and immunotherapies against major infectious diseases and cancers. The Project brings together leading academic research centers, industrial partners, nonprofits and governments to address the primary scientific barriers to developing new vaccines and immunotherapies. Support and funding for the Project includes the Robert Wood Johnson Foundation, John D. and Catherine T. MacArthur Foundation, GSK, MedImmune, Sanofi Pasteur, Crucell/Janssen, Regeneron, Pfizer, Moderna, Boehringer Ingelheim, Aeras, Vanderbilt University Medical Center, UC San Diego, The Scripps Research Institute, J. Craig Venter Institute and La Jolla Institute for Allergy and Immunology. To learn more, visit www.humanvaccinesproject.org. To view the original version on PR Newswire, visit:http://www.prnewswire.com/news-releases/jose-maria-fernandez-joins-the-human-vaccines-project-board-of-directors-300450282.html
News Article | April 17, 2017
Receive press releases from The Gateway Family YMCA: By Email Elizabeth, NJ, April 15, 2017 --( “At The Gateway Family YMCA, strengthening community is our cause and our three pillars are youth development, healthy living and social responsibility. The work that we are doing achieves all of those goals and we know that we can only be successful serving our community by partnering with other key stakeholders. We are proud to have moved the needle toward greater health specifically in Elizabeth and overall in Union County,” stated Melynda A Mileski, EVP/COO, The Gateway Family YMCA, in the opening address. Speakers at the event included Bob Atkins, Director, New Jersey Health Initiatives, a program of Robert Wood Johnson Foundation, Colette Lamothe-Galette, Director of the Office of Population Health, NJ Department of Health, Krishna Garlic, Director of Health & Human Services, City of Elizabeth, Alane McCahey, Project Manager, Shaping Elizabeth and Senior Director of Community Initiatives, The Gateway Family YMCA, Joseph McTernan, Senior Director of Community & Clinical Services, Trinitas Regional Medical Center, Priscilla Mendoza, MSW, Parent Advocate, Bayway Family Success Center, Jonathan Phillips, Executive Director, Groundwork Elizabeth and Toni Lewis, Community Coach, County Health Rankings & Roadmaps. “The Gateway Family YMCA is a cause-driven, nonprofit charitable organization serving Eastern Union County and Northern Middlesex County since 1900. Our YMCA is honored to be chosen as the host site for this event, and to be asked to showcase our local collaborations and the health rankings in New Jersey, specifically in Union County,” stated Krystal R. Canady, CEO, The Gateway Family YMCA. “In line with the Robert Wood Johnson Foundation we are committed to supporting Elizabeth in order to ensure all people reach their full potential by improving where they live, work and play through policy and environmental changes which will create safe, affordable, accessible options for healthy eating and physical activity to reduce obesity and chronic disease,” stated Alane McCahey, explaining the work of Shaping Elizabeth, a coalition to decrease obesity and chronic disease through collective impact in order to support Health Equity in Elizabeth. “Due to all of these factors, and the supporting data as well as the commitment and diligence of our Executive Committee and work group teams we have created a 'roadmap' for the next 3-5 years which has focused our work on 6 priorities: An overarching strategy for community engagement and communication, Clinical care support, Increasing physical activity, Affordable, available and accessible healthy food, Aids Education and Diabetes Prevention. We have broadened our vision to reflect the social determents of health that create barriers for making the healthy choice the easy choice for our residents.” “Today we are here to celebrate the work we have done thus far,” stated Krishna Garlic, Director of Health & Human Services, City of Elizabeth. Union County ranked 8 of the 21 New Jersey counties on the 2017 County Health Rankings for health outcomes. For detailed information on the county health rankings, visit countyhealthrankings.org. The Gateway Family YMCA is a 501(c)(3) non-profit, health and community service organization of caring staff and volunteers dedicated to strengthening the foundations of community and stands For Youth Development, For Healthy Living and For Social Responsibility. The Gateway Family YMCA impacts the community by providing quality services to people of all ages, races, faith or incomes. The Y doesn’t just strengthen bodies – it strengthens people, families and communities. The Y.™ For a better us. To learn more about The Gateway Family YMCA, visit tgfymca.org or contact the Elizabeth Branch at 908-355-9622, Five Points Branch 908-688-9622, Rahway Branch 732-388-0057, Wellness Center Branch 908-349-9622 or the WISE Center YMCA Branch 908-687-2995. Elizabeth, NJ, April 15, 2017 --( PR.com )-- On March 29, 2017, the 2017 County Health Rankings & Roadmaps were released at an event at The Gateway Family YMCA – Elizabeth Branch, 135 Madison Avenue, Elizabeth, NJ. Local community organizations shared their collaborative efforts to create a Culture of Health within New Jersey.“At The Gateway Family YMCA, strengthening community is our cause and our three pillars are youth development, healthy living and social responsibility. The work that we are doing achieves all of those goals and we know that we can only be successful serving our community by partnering with other key stakeholders. We are proud to have moved the needle toward greater health specifically in Elizabeth and overall in Union County,” stated Melynda A Mileski, EVP/COO, The Gateway Family YMCA, in the opening address.Speakers at the event included Bob Atkins, Director, New Jersey Health Initiatives, a program of Robert Wood Johnson Foundation, Colette Lamothe-Galette, Director of the Office of Population Health, NJ Department of Health, Krishna Garlic, Director of Health & Human Services, City of Elizabeth, Alane McCahey, Project Manager, Shaping Elizabeth and Senior Director of Community Initiatives, The Gateway Family YMCA, Joseph McTernan, Senior Director of Community & Clinical Services, Trinitas Regional Medical Center, Priscilla Mendoza, MSW, Parent Advocate, Bayway Family Success Center, Jonathan Phillips, Executive Director, Groundwork Elizabeth and Toni Lewis, Community Coach, County Health Rankings & Roadmaps.“The Gateway Family YMCA is a cause-driven, nonprofit charitable organization serving Eastern Union County and Northern Middlesex County since 1900. Our YMCA is honored to be chosen as the host site for this event, and to be asked to showcase our local collaborations and the health rankings in New Jersey, specifically in Union County,” stated Krystal R. Canady, CEO, The Gateway Family YMCA.“In line with the Robert Wood Johnson Foundation we are committed to supporting Elizabeth in order to ensure all people reach their full potential by improving where they live, work and play through policy and environmental changes which will create safe, affordable, accessible options for healthy eating and physical activity to reduce obesity and chronic disease,” stated Alane McCahey, explaining the work of Shaping Elizabeth, a coalition to decrease obesity and chronic disease through collective impact in order to support Health Equity in Elizabeth.“Due to all of these factors, and the supporting data as well as the commitment and diligence of our Executive Committee and work group teams we have created a 'roadmap' for the next 3-5 years which has focused our work on 6 priorities: An overarching strategy for community engagement and communication, Clinical care support, Increasing physical activity, Affordable, available and accessible healthy food, Aids Education and Diabetes Prevention. We have broadened our vision to reflect the social determents of health that create barriers for making the healthy choice the easy choice for our residents.”“Today we are here to celebrate the work we have done thus far,” stated Krishna Garlic, Director of Health & Human Services, City of Elizabeth. Union County ranked 8 of the 21 New Jersey counties on the 2017 County Health Rankings for health outcomes. For detailed information on the county health rankings, visit countyhealthrankings.org.The Gateway Family YMCA is a 501(c)(3) non-profit, health and community service organization of caring staff and volunteers dedicated to strengthening the foundations of community and stands For Youth Development, For Healthy Living and For Social Responsibility. The Gateway Family YMCA impacts the community by providing quality services to people of all ages, races, faith or incomes. The Y doesn’t just strengthen bodies – it strengthens people, families and communities. The Y.™ For a better us.To learn more about The Gateway Family YMCA, visit tgfymca.org or contact the Elizabeth Branch at 908-355-9622, Five Points Branch 908-688-9622, Rahway Branch 732-388-0057, Wellness Center Branch 908-349-9622 or the WISE Center YMCA Branch 908-687-2995. Click here to view the list of recent Press Releases from The Gateway Family YMCA
News Article | April 25, 2017
A new technique developed at the University of Virginia School of Medicine will let a single cancer research lab do the work of dozens, dramatically accelerating the search for new treatments and cures. And the technique will benefit not just cancer research but research into every disease driven by gene mutations, from cystic fibrosis to Alzheimer's disease - ultimately enabling customized treatments for patients in a way never before possible. The new technique lets scientists analyze the effects of gene mutations at an unprecedented scale and speed, and at a fraction of the cost of traditional methods. For patients, this means that rather than thinking about the right drug for a certain disease, doctors will think about the right drug to treat the patient's specific gene mutation. "Every patient shouldn't receive the same treatment. No way. Not even if they have the same syndrome, the same disease," said UVA researcher J. Julius Zhu, PhD, who led the team that created the new technique. "It's very individual in the patient, and they have to be treated in different ways." Understanding the effect of gene mutations has, traditionally, been much like trying to figure out what an unseen elephant looks like just by touching it. Touch enough places and you might get a rough idea, but the process will be long and slow and frustrating. "The way we have had to do this is so slow," said Zhu, of UVA's Department of Pharmacology and the UVA Cancer Center. "You can do one gene and one mutation at a time. Now, hopefully, we can do like 40 or 100 of them simultaneously." Zhu's approach uses an HIV-like virus to replace genes with mutant genes, so that scientists can understand the effects caused by the mutation. He developed the approach, requiring years of effort, out of a desire to both speed up research and also make it possible for more labs to participate. "Even with the CRISPR [gene editing] technology we have now, it still costs a huge amount of money and time and most labs cannot do it, so we wanted to develop something simple every lab can do," he said. "No other approach is so efficient and fast right now. You'd need to spend 10 years to do what we are doing in three months, so it's an entirely different scale." To demonstrate the effectiveness of his new technique, Zhu already has analyzed approximately 50 mutations of the BRaf gene, mutations that have been linked to tumors and to a neurodevelopmental disorder known as cardio-facio-cutaneous syndrome. The work sheds important light on the role of the mutations in disease. Zhu's new technique may even let researchers revisit failed experimental treatments, determine why they failed and identify patients in which they will be effective. It may be that a treatment didn't work because the patient didn't have the right mutation, or because the treatment didn't affect the gene in the right way. It's not as simple as turning a gene on or off, Zhu noted; instead, a treatment must prompt the right amount of gene activity, and that may require prodding a gene to do more or pulling on the reins so that it does less. "The problem in the cancer field is that they have many high-profile papers of clinical trials [that] all failed in some way," he said. "We wondered why in these patients sometimes it doesn't work, that with the same drug some patients are getting better and some are getting worse. The reason is that you don't know which drugs are going to help with their particular mutation. So that would be true precision medicine: You have the same condition, the same syndrome, but a different mutation, so you have to use different drugs." Zhu and his team have described the technique in an article published in the scientific journal Genes & Development, making it available to scientists around the world. The paper was written by Chae-Seok Lim, Xi Kang, Vincent Mirabella, Huaye Zhang, Qian Bu, Yoichi Araki, Elizabeth T. Hoang, Shiqiang Wang, Ying Shen, Sukwoo Choi, Bong-Kiun Kaang, Qiang Chang, Zhiping P. Pang, Richard L. Huganir and Zhu. The work was supported by the National Natural Science Foundation of China, the Robert Wood Johnson Foundation, the National Honor Scientist Program of Korea, the Howard Hughes Medical Institute and the National Institutes of Health, grants MH108321, NS065183, NS089578, HD064743, AA023797, MH64856, NS036715, NS053570, NS091452 and NS092548.
News Article | April 13, 2017
To get a clearer sense of just how bad our drug overdose problem has gotten, look no further than this year’s County Health Rankings. The annual report found that after years of declining premature deaths, that rate is on the rise and due primarily to overdose deaths. It means we could be seeing the first generation of American kids with shorter life expectancies than their parents. “We often think of the opioid crisis either as happening in very rural communities or as an urban issue,” Kate Konkle, Action Center Team director for County Health Rankings & Roadmaps, told me. “But this is an issue everywhere and particularly in suburban and small metro counties. The good thing is we’re hearing lots of communities talk about this problem — they’re aren’t hiding it or ignoring it.” Released March 29, the 2017 County Health Rankings measure health in every U.S. county and examine a variety of factors that influence people’s health, such as high school graduation rates, smoking rates, income and access to health care. This year, the “dramatic increase” in premature deaths topped announcements about the report’s release. Specifically, between 2014 and 2015, 85 percent of the increase in premature deaths was attributable to growing early death rates among people ages 15 to 44. Drug overdoses were the top factor driving that rate upward, though homicide, suicide and traffic crashes were even bigger factors for those ages 15 to 24. In just one decade, large suburban counties went from having the lowest premature death rate due to drug overdoses to having the highest. That’s “alarming,” said Konkle, also an associate researcher at the University of Wisconsin Population Health Institute. Getting into the numbers, the rankings report found that in 2015, more than 1.2 million people died prematurely, an increase of more than 39,000 people over the previous year. Such rates are highest — and have consistently been highest — among blacks, American Indians and Alaska Natives. Rural counties are home to the highest premature death rates, followed by small metro areas. (How exactly does the report define premature death? Like this: “Rather than examine overall death rates, we look at deaths that occur among people under age 75. These deaths are considered premature because loss of life prior to age 75 is often preventable.”) Intentional and unintentional injuries — which include homicide, suicide, drug overdose and traffic fatalities — were the top drivers of the premature death increase among youth and younger adults. That’s in contrast to premature deaths due to HIV, cancer and heart disease, which have gone down. In 2015, among those ages 15 to 24, suicide and homicide rates — high percentages of which involved firearms — were highest among Asians and Pacific Islanders and blacks, respectively. Konkle noted that while drug overdoses are a critical issue for young people in many communities, violence is the main injury threat in others. For example, in some communities, black teens are more likely to lose their lives to firearm-related deaths, many of which are suicides, than drug overdoses. The differences, she said, underscore the need for local engagement and locally tailored responses. Brand new to this year’s rankings report is a measure on “disconnected youth,” defined as people ages 16 to 24 who are not in school or working. Researchers write of the new measure: Konkle said adding the new measure reflected a renewed recognition that “we need to pay attention to and take care of our young people…and help communities think about avenues for reconnecting kids and making sure they don’t get off the path in the first place.” Here’s what researchers found: About 4.9 million youth and young adults — or one in eight — aren’t working or in school. Rates were highest among American Indians, Alaska Natives, blacks and Hispanics as well as in rural counties in the American West and South. Areas with high rates of youth disconnection were also home to high rates of child poverty, unemployment, teen births and low educational attainment. “This represents so much creativity and skills that aren’t being tapped into,” Konkle told me. “Each community may have slightly different challenges based on when kids are leaving and where they’re falling out of the system. This data are just a starting point for each community — then they need to dig deeper to see where they’re falling short on creating opportunities for young people.” However, the rankings report can offer help on that end as well, as it highlights successful local programs that are making a difference. For example, on the issue of youth disconnection, researchers highlighted an effort within the Menominee Nation in Wisconsin, where schools created classroom safe zones where students can develop positive coping techniques. Such efforts have helped dramatically turned around the community’s high school dropout rate: In 2008, less than 60 percent of students at Menominee Indian High School graduated, whereas during the 2015-2016 school year, the graduation rate was at 92 percent. “We think of this report as a call to action,” Konkle said. “The data is a starting point — it’s not a full picture of everything happening in a community. We give you the numbers, but there are people living behind those numbers. What’s the rest of the story?” She went on to say: “This helps us remember that health is local, and people have the power to make change happen in their communities.” To access the new 2017 County Health Rankings, which are a joint endeavor of the Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute, as well as a host of interactive tools, visit www.countyhealthrankings.org. Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years. Follow me on Twitter — @kkrisberg.