The department of health policy and management at UNC Gillings School of Global Public Health is pleased to announce the following recent research study results, a faculty perspective on M-health and student award winners.
One in 5 North Carolinians lacks health insurance
One in five people in North Carolina under age 65 lacked health insurance in 2010 -- an increase from previous estimates completed five years earlier -- according to a new study from the North Carolina Institute of Medicine (NCIOM).
The analysis, which compared 2004-2005 data with 2009-2010 data, showed that 291,000 non-elderly North Carolina residents were added to the ranks of the uninsured, an increase of 2.4 percent of the population. Overall, the state had 1.6 million uninsured residents.
"These new data will provide valuable insights as we strive to improve the health of North Carolinians," said Pam Silberman, NCIOM president and clinical professor of health policy and management at UNC's Gillings School of Global Public Health.
"Policymakers, health-care professionals, insurers and community groups can use this information to better address the needs of the uninsured and the factors contributing to North Carolinians living without health insurance," Silberman added.
While the majority of the uninsured live in families with at least one full-time worker, the study found a notable increase in the number who lived in families with no workers, part-time workers or only one full-time worker.
Mark Holmes, PhD, assistant professor of health policy and management at the public health school, said this may be a reflection of tough economic times.
"The recession has led to an increased proportion of adults being unemployed and losing their employer-based coverage," said Holmes, who led the study. "This 'recently uninsured' population might benefit from strategies quite different from the long-term uninsured."
Holmes also is director of the N.C. Rural Health Research and Policy Analysis Center at UNC's Cecil G. Sheps Center for Health Services Research and former vice president of NCIOM.
In addition to the statewide analysis, NCIOM released county-level data, including rankings, for North Carolina's 100 counties. Greene County had the highest percentage of uninsured residents, at 25 percent, while Catawba County had the lowest, at 16.5 percent.
"The county-level data can be especially useful to community collaborations of safety net providers designed to meet the health care needs of local uninsured populations," Holmes said. "By better understanding the population in their community, they can more efficiently design their services and capacity. Furthermore, these data can be very helpful in demonstrating need to public and private funders assisting with the cost of services for the uninsured."
The Patient Protection and Affordable Care Act could extend coverage to many of the uninsured. If upheld by the courts, uninsured North Carolinians with incomes below 138 percent of the federal poverty level may be eligible for Medicaid coverage. In addition, many uninsured North Carolinians with incomes below 400 percent of the federal poverty level will be eligible for subsidies to purchase health insurance coverage through a newly created Health Benefits Exchange.
County-level estimates were developed using data from the U.S. Census Bureau and the North Carolina Employment Security Commission.
NCIOM is an independent agency, chartered by the North Carolina General Assembly to provide balanced, nonpartisan information on issues of relevance to the health of North Carolina's population.
Visit www.nciom.org for more information about the study.
M-health improves health outcomes, especially in developing countries, Thirumurthy says
An article in the May issue of the Bulletin of the World Health Organization suggests that use of text messaging and other mobile phone applications may be an increasingly effective and cost-efficient means of improving health outcomes, especially in developing countries.
Harsha Thirumurthy, PhD, assistant professor of health policy and management at UNC Gillings School of Global Public Health, co-authored "M-health for health behavior change in resource-limited settings: applications to HIV care and beyond," a perspective article that summarizes findings from recent studies of m-health interventions in low-income settings, including one Thirumurthy conducted in Kenya to improve adherence to HIV treatment.
"M-health" is shorthand for mobile, or electronic, health, a means of improving people's health through messages sent via mobile phones or the Internet.
Thirumurthy notes that in 2011, 79 percent of people in developing countries had cellular phone subscriptions, compared to 26 percent with Internet access. This makes the mobile phone a particularly available potential tool for improving health.
He reported on two m-health interventions in Kenya that showed text messages can improve adherence to antiretroviral therapy (ART), thereby prolonging suppression of HIV. One study featured a weekly message that asked about patients' health and recommended they seek advice from their health-care providers. These patients adhered better to their treatment than those in a control group who did not receive any messages.
In a second study, patients with HIV received one-way communications, either weekly or daily, that reminded them to take their medication. Those who received the weekly message adhered better to the ART than those who were reminded daily. The findings suggested that compliance was influenced more by supportive text in the messages than by simple daily reminders.
"These studies, which show that text messages can improve treatment adherence, suggest that such messages can be applied to evoke any behaviour that is amenable to the influence of encouragement and periodic reminders," Thirumurthy wrote.
He says that the messages could be used to increase adherence to treatment regimens for malaria, tuberculosis and noncommunicable diseases, for the uptake of preventive interventions such as childhood vaccinations, and to prevent mother-to-child transmission of HIV.
"M-health interventions could be applied to a very broad range of health-related behaviours," he said. "However, what works in one context does not necessarily work in another. Rigorous evaluations of small- and large-scale interventions could reveal the extent to which m-health can provide cost-effective solutions to public health challenges."
Thirumurthy is planning future work in this area, starting with an evaluation of a phone-based intervention to improve maternal and child health outcomes in Uganda.
Richard Lester, MD, clinical assistant professor in the University of British Columbia's Department of Medicine, co-authored the Bulletin article.
Jessica Broadus selected as Barbara Jordan Health Policy Scholar
Jessica Broadus, rising senior in health policy and management at UNC Gillings School of Global Public Health, was selected this spring as a 2012 Barbara Jordan Health Scholar.
The Barbara Jordan Scholars Program provides opportunities for recent graduates and college seniors to work in congressional offices in Washington, D.C., where they learn about health policy issues, particularly ones that affect racial and ethnic minorities and underserved communities. Through an 11-week program, scholars learn about legislative procedures and develop critical thinking and leadership skills.
Broadus will serve through August in the office of U.S. Sen. Olympia Snowe of Maine, where she works with on health-related hearings and policy projects with Sen. Snowe's health legislative assistant, Amy Pelligrino.
"Currently, we are helping with Medicare payment reform discussions," Broadus said. "As a member of the Senate Finance Committee, Senator Snowe has the opportunity to be involved in several sustainable growth rate roundtables. I have been helping with her briefing materials. I also attend congressional briefings or hearings on topics related to health care and assist the health legislative assistant with her projects."
Broadus already has learned a lot about the legislative process. "I have witnessed the steps involved in drafting a bill or an amendment, securing support, getting to a vote and following through with implementation," she said.
Broadus said her undergraduate work prepared her well for the program. "I am excited and grateful for the opportunity to see, firsthand, the legislative process at work -- especially during such a pivotal time in health policy," she said. "Being part of the BSPH program has equipped me with a solid understanding of the challenges in the health care system and has allowed me to fully engage my time on the Hill."
The Barbara Jordan Health Scholars Program was established through The Henry J. Kaiser Family Foundation, in partnership with Howard University, to honor the legacy of former foundation trustee and congressional representative Barbara Jordan. Jordan's career was distinguished by her tireless advocacy on behalf of vulnerable populations.
HPM student receives Royster Society fellowship
Kimberley Geissler, doctoral student in health policy and management at UNC Gillings School of Global Public Health, has been selected for a Royster Society of Fellows' 2012-2013 dissertation completion fellowship.
Geissler's dissertation examines the effect of violence on health care access and utilization in Mexico towns and cities near the U.S. border. More specifically, she is analyzing the impact of homicides in Mexican border municipalities on access to health care providers, preventable hospitalizations and emergency department use in the U.S.
The Royster Society of Fellows, founded in 1996, is an interdisciplinary, university-wide fellowship program that allows Carolina to recruit the most promising doctoral students from across the nation and support them in reaching their highest potential.
Geissler's award will provide tuition, fees and health insurance for the academic year, as well as a $20,000 stipend and $1,000 toward travel to professional meetings or conferences.
In addition to the financial award, the Society supports and nurtures fellows through mentoring by senior faculty, interdisciplinary learning and leadership development opportunities.
"I am excited for the opportunity to continue working full-time on my dissertation research next year," Geissler said. "I am planning to graduate in May 2013, and the fellowship will be very helpful in reaching that goal."
Read more about the Royster Society of Fellows.