As a writer within HHS, it is my job to interview and profile amazing people doing great work to improve the health and well-being of all Americans. In honor of Black History Month, I was excited to find that my latest subject was also a familiar face: Alexa Canady, a college friend and college-newspaper colleague of mine. As she later told me, when we re-connected, it never occurred to her that she would be making history.
After our undergrad days (many days ago), Alexa became the first African-American woman neurosurgeon in the United States. When I asked her how it felt being a part of African-American history, she said, “I just wanted to do what I wanted to do. I had no idea that I would be making history.”
Alexa did eventually realize “there weren’t that many women neurosurgeons in front of me.”
But, she said, “For me it didn’t mean as much at the time as it did for other people, for young girls. Even if they’re not going to be surgeons, or even be in medicine, they can see there’s a world open to them.”
“It was also important that white male residents now wanted to enter my world,” she said. “I didn’t realize the significance at the time, that it was important to other people to see that.”
Alexa grew up in an upper middle class Michigan family. Her father was a dentist. She went to the University of Michigan (where we worked together on the campus newspaper, the Michigan Daily), and became interested in the medical field during a summer program for minority students.
Alexa later decided she had a good fit with pediatric neurosurgery. “I liked the honesty of it. I liked fixing things,” she said. She also liked watching her patients and their families grow over the years. Alexa told the National Women’s Law Center: “The children taught me so much — about living in the moment with tremendous courage and grace despite serious and often terminal illnesses. I took care of some children for 15 to 20 years. I watched them grow up. I got up in the middle of the night to care for them. I cared for every single one of them as if they were my own.”
Her choice of neurosurgery drew only a tepid response from her parents, which surprised her because they had always been strongly supportive of her decisions. She thinks they worried about her getting hurt by people who didn’t have faith in a black woman making it in such a demanding field.
And there were obstacles. When she was attending to patients at the University of Minnesota, one of the senior administrators said, “Oh, you must be our new equal-opportunity package.”
She also had to work hard to convince her neurosurgery department chairman that she was not a risk to drop out or be fired. That would have been “a disaster in a program where there are only one or two residents per year. I was the first African-American woman” in the department, she told NIH’s National Library of Medicine in its "Changing the Face of Medicine" report.
But such obstacles didn’t stop her.
Alexa got her medical degree, cum laude, from the University of Michigan in 1975. After graduating from medical school, she became a surgical intern at Yale-New Haven and then trained at the University of Minnesota, where she was the first African-American woman neurosurgery resident in the U.S. She became a pediatric neurosurgery fellow at the Children’s Hospital of Philadelphia and, in 1984, became the first African-American woman certified by the American Board of Neurological Surgery. At the age of 36, she became chief of neurosurgery at Children’s Hospital of Michigan, where she specialized in congenital spinal abnormalities, hydrocephalus, trauma and brain tumors.
Alexa retired in 2001—sort of. When she moved to Florida, she was persuaded to practice part-time at Pensacola’s Sacred Heart Hospital because there was no pediatric neurosurgeon locally. She’s fully retired now.
Making her way in medicine wasn’t always easy. Despite the outward self confidence that others saw in her, Alexa said she feared that as a black woman, her opportunities to practice would be limited. But she found that by focusing on her patients and their families, “the practice growth was exponential.”
And though it didn’t occur to her at the time, or perhaps simply did not seem very important to her then, Alexa secured her place in black history.
Being pregnant is a very special time in a mother’s life. A lot of time is spent planning for a baby’s arrival, from making sure to eat healthy foods and staying active to purchasing the safest car seat. Pregnancy is also a time when parents worry about their future child’s health and well-being.
One big worry parents may have is whether their child will have to start out life with a serious birth defect. According to the Centers for Disease Control and Prevention, 1 in 33 babies is born with a birth defect. While not all birth defects are preventable, a woman increases her chances of having a healthy baby by lowering her risk of infection before and during pregnancy.
January is National Birth Defects Prevention Month, and this year’s theme, “Prevent to Protect,” focuses on the importance of maintaining a healthy pregnancy to lower the probability of having a baby with a birth defect.
The first line of defense is the mother and her healthcare provider. A woman who is planning to conceive or is pregnant should consult her physician about any prescription or over-the-counter medications she is currently taking and nutrition, as well as any alcohol, drug and tobacco use. During her visit, she can be screened for any pre-existing conditions, including heart disease and diabetes and review her and her partner’s family health history to identify any potential risks.
A key priority is eating a healthy diet that includes the B vitamin folic acid. Getting 400 micrograms of folic acid every day at least a month before becoming pregnant can help prevent serious birth defects of the brain and spine.
Staying current on vaccinations is another important precaution to decrease the chances of transferring diseases from mother to fetus. Pregnant women should be vaccinated against whooping cough Tdap (tetanus-diphtheria-pertussis) and the flu during pregnancy to protect themselves and their baby. Women should receive vaccines such as the measles, mumps and rubella (MMR), a month or more before pregnancy. A healthcare provider should be consulted before receiving vaccinations.
Mosquitoes, mites and other disease vectors can be not only nuisances, but can also transmit illnesses through the blood stream that are harmful to the fetus. Some mosquito-borne diseases include malaria, Zika, dengue and chikungunya, all of which can exhibit mild to severe symptoms. To an unborn child, exposure to these diseases can lead to congenital infection, fetal brain defects, premature birth and, in some cases, death. In warm climates, mosquitoes can pose a hazard to pregnant women and their partners. Expectant mothers are warned to reduce their exposure to mosquito-borne infections by avoiding bodies of standing water, wearing cover up clothing at peak mosquito feeding times, using EPA-approved repellent, and staying in cool and well-screened areas.
Although not all birth defects can be prevented, the best weapons are education and prevention. By knowing the potential risks, taking the right precautions, and preventing exposure to certain infections, mothers can help prevent many birth defects and give their children the healthiest start in life possible.
As the Region III administrator for SAMHSA, the Substance Abuse and Mental Health Services Administration, I have the privilege of working with and serving the people of Pennsylvania, Delaware, Maryland, Washington, D.C., Virginia and West Virginia.
One of my main jobs is making sure that when there is a conversation about health, behavioral health is at the table. There was a time when that was not the case. But today we know that working collaboratively is a key success factor in reducing the impact of mental health and substance use disorders. Complex, public health problems can best be solved when the behavioral health needs of those we serve are considered.
My role in many ways is that of a “connector,” bringing state governments, academic institutions, foundations and other stakeholders together to find the best solutions. You do what the stakeholders in your states need you to do.
For example, we recently held a series of 13 meetings all over the state of West Virginia with a diverse array of public and private stakeholders to address the opioid epidemic. At the end, we brought everyone together to see what we learned, what’s working and how can we expand evidence-based treatment for individuals with substance use disorders.
What’s exciting is building upon those relationships, listening, connecting those who need help with experts and advocates who know what works, and being nimble enough to deliver resources and technical assistance.
But for me, making sure we work efficiently with our customers is in some ways just as important as the science underlying the recommendations.
After working across the six states in Region III since 2011 has shown me that solutions customized to meet community and state needs can help states improve their own systems. And adoption of solutions is more rapid when developed collaboratively with the stakeholder taking the lead. There are no cookie-cutter solutions.
Before joining SAMHSA, I served as senior adviser to the assistant secretary for administration at HHS. Beginning with Hurricane Katrina, I worked in Region VI for the assistant secretary for preparedness and response, and had the opportunity to lead public health and medical planning and response for Louisiana, Texas, Oklahoma, New Mexico and Arkansas. Prior to joining HHS, I served in the VA in San Francisco for five years.
I'm also a proud veteran, having served 20 years in the Navy Nurse Corps, retiring as a captain. I am honored to have served other veterans and their families in a variety of clinical and administrative roles, which were each enriching and rewarding.
When I left the Navy, I wanted to stay in government so I could continue to be of service and find new opportunities to connect people in need with resources and solutions. Every position in my career has had its unique challenges and that is certainly true today. But the reason I'm excited and positive is that almost every day I hear about individuals getting the help they need.
One patient now in recovery was asked what was it about his treatment program that enabled him to succeed. His answer: “My counselor knew what to say and what to do to keep me in the program.”
That's what keeps me motivated—being in an organization like SAMHSA that I know is making a difference.
The bigger the challenge, the better I like it. Why? To have the opportunity to have a bigger impact. That’s the essence of public service.
My name is Jean Bennett. I'm a veteran, a nurse and a regional administrator — and I am HHS.
Jean is one of more than 79,000 people who make HHS run every day. You can share her story and see others on Twitter and Facebook using #IAmHHS.
“Everybody can be great, because everybody can serve.”
-- Martin Luther King Jr.
The observance of the Dr. Martin Luther King Jr. holiday on January 15 is a time for us to reflect on the life and achievements of an extraordinary leader in American history.
Dr. King devoted his life to advancing equality, social justice and economic opportunity through service to others. He also linked the quest for equality to healthcare and talked about the importance of being first in moral excellence and generosity. He taught us that everyone has a role to play.
On what would have been Dr. King’s 89th birthday, we can also hold ourselves accountable to acknowledging the work that remains to fulfill his dream. Many will mark the King holiday by volunteering in their neighborhoods – service is a powerful tool for strengthening our communities. Beyond volunteer service, there is much that can be done, for example, to improve the conditions in which all Americans are born, grow, work, live and age.
Overall, we have made considerable progress improving health and healthcare for racial and ethnic minorities and disadvantaged populations since the founding of the HHS Office of Minority Health (OMH) more than 30 years ago. The life expectancy gap between blacks and whites is at its narrowest point over the last three decades; cancer disparities are improving for all minority groups, including Asian-Americans and Pacific Islanders; and teen birth rates have dropped for all races and Hispanic groups.
However, persistent and pervasive health disparities remain and addressing them will require not just a federal response, but also state and local organizations dedicated to achieving health equity.
At HHS, we’re also working on three of the most pressing issues facing the nation: the opioid epidemic, childhood obesity and serious mental illness. Every day, 115 Americans die from drug overdoses due to opioids. One in 5 children in the United States is overweight or obese, and the rates are higher among African-American and Latino children. And about 10 million American adults experience serious mental illness affects each year.
At OMH, our new Empowered Communities for a Healthier Nation Initiative is designed to generate community partnerships to help meet these challenges. OMH has awarded grants to 15 organizations across the country that serve communities disproportionately affected by opioids, obesity or serious mental illness, with the goal of expanding the use of actions with the greatest potential impact.
Whether to address these issues or others, throughout the country many of us at HHS and in other federal departments and their communities will participate in the MLK Day of Service on January 15. The holiday remains the only federal holiday observed as a national day of service – a “day on, not a day off.”
Wherever you live, I hope you will join the hundreds of thousands of Americans who will spend the MLK Day of Service volunteering for a good cause or community activity.
You can find more information about Martin Luther King Jr. and MLK Day of Service activities here.
Can you imagine having a chronic condition like diabetes and not being able to receive the treatment that you need? Or not knowing where or how to get treatment or having a long wait for services when you have a medical crisis?
Well that is exactly what happens to millions of people with serious mental illness.
My job is to try and change that, by helping people with serious mental illnesses get the help, treatment services and recovery supports they need, when they need it, so they can lead healthy lives of purpose in the community.
My name is Cindy Kemp and I work for SAMHSA, the Substance Abuse and Mental Health Services Administration, where I’m the chief of the Community Support Programs Branch in the Center for Mental Health Services.
Before I came to SAMHSA I worked in behavioral health at the local level in Arlington County, Virginia, for more than 30 years — building programs for people with serious mental illness and substance use disorders.
That experience informs everything I do.
My job at SAMHSA is to listen to people with serious mental illness, their families and providers in local communities to inform our programs. I administer almost 200 grants and contracts worth more than $55 million annually that help those communities deliver quality, evidence based mental health services.
That can mean anything from making sure people with serious mental illness can see a primary care doctor as well as a psychiatrist, training the police on how to interact with people with serious mental illness to divert them from jail when that’s appropriate, helping people find and keep employment to simply ensuring people have access to quality mental health treatment and recovery support services.
For example, one program that I helped get off the ground at SAMHSA has truly been one of the highlights of my career.
It's a National Demonstration program that’s implementing 67 new Certified Community Behavioral Health Clinics in eight states to focuses on improving access to quality services. The states in the program are developing programs that improve and expand their crisis services, improve accessibility, provide high quality, evidence-based practice, and integrated and coordinated care for people across the life span, as well as measuring their outcomes.
It's a game changer.
People are getting the critical behavioral healthcare services they need, when and where they need them. And since this is a Medicaid demonstration, the funding to pay the expected cost of services is provided by the federal government.
While it's a bit premature to draw any conclusions the early signs are very encouraging. The paradigm shift is ensuring that individuals with behavioral health disorders and their families receive the treatment and services they need. For too long, people have faced discrimination, received limited or no treatment, or have just been ignored by society. Too often someone with mental health issues also has a substance use disorder, but they’re treated only for one or the other condition.
I know because it’s personally impacted my family. About a decade ago we lost my younger brother to mental illness and substance abuse. It was devastating, and his loss and the challenges he faced as a person motivate me every day. I truly believe that he would be alive today if he had had accessible, quality integrated care.
And that's really the bottom line, it's why I took a chance almost four years ago and left local government to come to SAMHSA, to have new and different challenges and to make an impact on a national level.
It's important to know that people with serious mental illness can and do recover -- there is opportunity and there is hope. SAMHSA is helping to make this a reality, and I get to be a part of it all.
My name is Cindy Kemp, and I am HHS.
Cindy is one of more than 79,000 people who make HHS run every day. You can share her story and see others on Twitter and Facebook using #IAmHHS.
During the Christmas and holiday season, we enjoy the opportunity to spend time with our family and loved ones. So it’s an appropriate time to remember how important it is to secure the blessing of a loving family for every American, and it’s appropriate that November marks National Adoption Month.
The Department of Health and Human Services plays an important role in helping American families adopt children now in foster care. HHS’s Children’s Bureau, part of the Administration for Children and Families, funds and partners with federal, state, tribal and local agencies to improve the overall health and well-being of our nation’s children and families.
America now has more than 430,000 children in foster care, from infants to 21-year-olds, and new data released by HHS this week found that there are now more children in foster care than ever. We are happy to note that in 2016, there were more adoptions out of foster care than ever.
However, we need to improve our adoption rate, the need is especially urgent for teenagers. Like the rest of us, teenagers need strong, loving, permanent families to help them get their bearings in the world, live healthy and productive lives, and contribute to their communities and their country. Sadly, youths between 15 and 18 are often overlooked in foster care adoptions.
Statistics show that about 20,000 of the youths currently in foster care will likely not find permanent homes before they leave the system (which occurs at between 18 and 21, depending on the state where they live). These teens, many of whom were abused, neglected or abandoned, will then be completely on their own. A range of evidence suggests that making this transition to adulthood without the guidance and support of parents can bring a host of challenges later in life.
That’s why the HHS Children’s Bureau has a new initiative to promote awareness of the need for teen adoption. In partnership with the Ad Council, AdoptUSKids, and the advertising agency KBS, the Children’s Bureau has a new series of ads called “What to Expect When You’re Expecting … A Teenager.”
The series highlights the importance of adopting teenage girls and boys from foster care and emphasizing that adoptive parents do not have to be perfect to be a perfect parent to a youth from foster care. We all know no parent is perfect; good families are created out of commitment and love.
The Children’s Bureau also partners with AdoptUSKids and Child Welfare Information Gateway to promote awareness of this issue during National Adoption Month each year. This year’s theme is “Teens Need Families, No Matter What,” which highlights the need to find permanent, safe families for this vulnerable group, as well as to emphasize the importance of making youth adoptions successful.
Helping children and youth find the loving, permanent families they need and deserve is a key part of our goals at HHS of building better health and stronger communities.
We each have a role to play in helping these children and teenagers—whether it’s choosing to be a foster or adoptive parent or supporting those who are. Go to AdoptUSKids.org or call 1-888-200-4005 (English) or 1-877-236-7831 (Spanish) to receive information about the foster care system and the adoption process.
Each day, according to the Centers for Disease Control and Prevention, more than 140 Americans die from drug overdoses, 91 specifically due to opioids.
These numbers are staggering and disturbing, but having a clearer picture of the devastating effects of the opioid epidemic across the nation can help us target interventions and develop new solutions to end it. To do this, we need data. Lots of data. We have to understand the epidemic in order to stop it.
We at the Office of the Chief Technology Officer (CTO) put out a call and more than 300 data scientists, programmers, coders and public health experts raised their hands to help us develop data-driven solutions to the opioid epidemic with the common goal of saving lives.
Over the last four months, our team has been working with our colleagues at HHS and data stewards from private industry and at the state and local level to compile data sets for the Code-a-Thon. On December 6 and 7, more than 50 coding teams will have 24 hours to work with these data and develop solutions to address one of three challenge questions:
How can we help federal, state, and local stakeholders improve access to effective treatment and recovery services?
How can we help federal, state, and local stakeholders identify at-risk populations and their underlying risk characteristics of opioid misuse or abuse?
How can we help federal, state, and local stakeholders predict and analyze the supply and movement of legal and illicit opioids?
In addition to data from HHS, we have data from other federal agencies, including the US. Department of Education, the U.S. Department of Commerce, the U.S. Department of Labor, the U.S. Department of Justice, and the U.S. Department of Transportation and data from state and local agencies including those in Virginia, Louisiana, Indiana, Washington, and North Carolina.
We have coding teams from across the country coming to Washington, D.C. for this event including teams from Nashville, TN; Austin, TX; Los Angeles, CA; Chapel Hill, NC and East Lansing, MI, to name a few.
The Symposium on December 6 will bring together leaders on the front lines of the opioid epidemic and influential leaders in health, data and technology to discuss how data and technology can be used to address the opioid epidemic. Many of the speakers at the symposium work with data and technology to address the opioid epidemic, which has proven successful in their communities.
Complex health crises like the opioid epidemic require a diverse group of stakeholders at the table and that is why we are bringing together state and local leaders, law enforcement, data stewards and policy leaders for two days with the common goal of developing innovative solutions to address the opioid epidemic and save lives.
An important value of the Office of the CTO is the notion that we alone do not have all the answers. We look for input from a variety of stakeholders to develop solutions to solve problems.
This epidemic has affected countless lives, families, communities and professions. This event is just one piece of the puzzle and will build on the important work taking place in communities across the country. The event also builds upon efforts already underway at HHS. In April 2017, the Department launched its comprehensive, evidence-based Opioid Strategy that provides the overarching framework to leverage the expertise and resources of HHS agencies in a strategic and coordinated manner. The HHS Opioid Strategy aims to:
Improve access to prevention, treatment, and recovery support services
Target the availability and distribution of overdose-reversing drugs
Strengthen public health data reporting and collection
Support cutting-edge research
Advance the practice of pain management
The Office of the Assistant Secretary for Planning Evaluation created a Data Brief for Code-a-thon participants to create an overview of the data sources that could be leveraged to study the opioid crisis within each of the five HHS strategic areas, highlight some of the key research questions within these areas, and summarize data linking strategies that can be used to support research on opioids.
If you are joining us on December 6 and 7 in Washington, DC, I want to personally say “Thank you.” Thank you for your work, thank you for your ideas and thank you for coming together with one common goal, saving lives.
During the holidays, many of us are tempted to go overboard—overeating, overspending, and overextending ourselves. But when it comes to our health, less may be better than more, especially during the busy holiday rush.
For instance, to avoid the weight gain that seems inevitable this time of year, try eating foods with less fat and added sugar. Less screen time for both children and adults may also help keep extra pounds at bay, especially if that time gets replaced with physical activity.
Although NIH research has shown the average holiday weight gain often isn’t as much as most people think—it’s less than a pound between Thanksgiving and New Year’s Day—even a pound a year can begin to add up over time, making it harder each year to lose the extra weight. And overweight and obesity—with which more than 70 percent of the U.S. adult population struggles—increase the chances of developing health problems such as diabetes, high blood pressure, and kidney disease.
No Holiday from Your Health
So how can you stay healthy this time of year? Don’t put your healthy habits on hold. Here are some tips to help you stay on track and lead you into a healthy new year.
Plan. Don’t go to a party hungry. Have a healthy snack before you leave—an apple, banana, or fat-free or nonfat yogurt—so you are less likely to overeat or make unhealthy food choices later on. If you’re concerned about not having healthy food options available, offer to bring a healthy dish to share.
Choose wisely. Go for the salads, cut-up vegetables and fruit, and lean protein, such as fish, chicken, or turkey breast without the skin. Try to avoid salad dressings, gravies, sour cream, and other toppings that can add extra sugar, salt, and fat. Select water, seltzer, or unsweetened tea when available. If you really want an alcoholic beverage, limit yourself to one. And if you want to enjoy the holiday treats, sample just one cookie or a small sliver of pie.
Focus on the festivities. Instead of lingering around the food table or bar, move around and meet someone new, catch up with friends or family, or participate in dancing or party games.
Sit less, move more. More than 2 hours of TV-watching a day has been linked to overweight and obesity. Turn off the TV, computer, and phone, and take a walk, play hide-and-seek, or toss a football around. If you’re shopping or running errands and time permits and it’s safe to do, park farther from where you’re going and walk the rest of the way.
Manage stress. Less stress is best, but when the holiday pressure is on, it can build and may lead to overeating. Physical activity can help relieve stress. Even if you’re pressed for time, squeezing three
10-minute walks into your busy day may make a difference.
Get enough sleep. Don’t sacrifice sleep to try to get more done. Some studies show that a lack of sleep may increase the risk of weight gain. Adults need 7 to 8 hours of sleep each night to maintain health.
Of course there will be temptations and setbacks, but don’t give up and don’t look back. If you overeat one day, get back on track the next—or as soon as you can. Recruit support from family and friends—they may share your goal of having a healthy holiday. With determination and support, you can achieve better health today, tomorrow, and for life.
The NIDDK website has tools and information to help you improve your health. You also can find healthy tips on our Facebook page and my weekly Healthy Moments radio broadcast. Learn more and listen to recorded episodes by searching “Healthy Moments” on the NIDDK home page.
Through innovative systems and unique partnerships, rural communities across the United States have made critical advancements toward improving their health outcomes. The Health Resources and Services Administration’s (HRSA) Office of Rural Health Policy and the National Organization of State Offices of Rural Health recognize National Rural Health Day on Thursday, November 16, by spotlighting the pioneering work of our rural communities.
This year’s National Rural Health Day focuses on the Power of Rural, how collaborations in rural communities and throughout HRSA support the delivery of quality healthcare in rural America.
National Rural Health Day is a time to recognize the countless strides rural communities have made. More than 800,000 rural Americans receive health services thanks to rural community-based grants. HRSA’s rural grantees have successfully leveraged funds to provide access to services across the healthcare spectrum. They have increased access to primary care, established early intervention services for patients with behavioral health needs, and expanded access to healthcare via telehealth. HRSA’s rural grantees have played a critical role in enhancing the quality and availability of healthcare services.
Dr. Sigounas visited Fairfax Medical Facilities in Newkirk, OK. From left: Claudia Dilbeck, Quality Coordinator, Fairfax Medical Facilities, of Newkirk, Okla.; Ryan Smykil (HHS/Indian Health Service); Dr. Sigounas; and Karen McConnell, CEO.
Along with acknowledging the accomplishments made by rural communities, it is also important to acknowledge the disproportionate obstacles that rural Americans must overcome. In the context of HHS priorities, rural Americans have poorer outcomes when it comes to substance abuse (particularly the opioid abuse epidemic), childhood obesity, and mental health.
While we have seen a rise in opioid abuse deaths on a national level, rural residents face an even greater disparity as rural states are more likely to have higher rates of overdose deaths, specifically from prescription opioid overdoses. Rural children face their own disparity when considering childhood obesity. Rural children aged 10 – 17 years have higher rates of obesity than their urban counterparts.
Additionally, while the prevalence of mental illness is comparable among urban and rural communities, the barriers lie within the availability and accessibility of mental health services.
But these challenges also present opportunities. This past September, HRSA awarded $200 million to health centers to address mental health and the opioid crisis. HRSA also awarded $3 million in grants to address the unique obstacles rural communities face in addressing the opioid crisis. This included three grants focusing on the use of telehealth to provide comprehensive substance abuse services.
Access to quality and comprehensive healthcare services is an essential focal point when thinking about the well-being of rural Americans. HRSA is working to foster access to quality healthcare through collaborative work and programs that include supporting rural health facilities, investing in Community Health Centers, and building a strong health workforce. HRSA supports nearly 1,400 health centers operating more than 10,400 service sites across the United States, with more than 40 percent of those health centers serving rural communities. HRSA is also working to increase access to healthcare providers through our health professional training programs. Through the Area Health Education Centers (AHEC) Program, a program to enhance education and training networks in order to improve healthcare delivery to rural or underserved areas, 41 percent of students and residents came from a rural setting. Additionally, 144 Rural Health Clinics partnered with AHECs to provide training experiences to students and residents. Also, in fiscal year 2017, roughly a third of National Health Service Corps and Nurse Corps members worked in rural communities, providing services in primary care, oral health, and mental health.
As part of National Rural Health Day, let us celebrate the successes of our rural communities and also take this time to reflect on how our partnerships, whether at the community, state, or federal level, can continue to transform and improve rural health outcomes. While rural communities face unique challenges, they also have unique ideas and solutions that bring the community together and engaged in ways to improve the lives of rural Americans.
Earlier this week, HRSA moderated a series of Twitter chats November 13-15. The topics were workforce development, the social determinants of health, and behavioral health, respectively. You can review the chats by following @HRSAgov or using hashtag, #OurRural.
During #NRHD, we recognize the considerable contributions that rural communities have made to improve health outcomes. https://go.usa.gov/xnZXp
Antibiotic resistance is a significant threat to our nation’s public health, and one that is spreading and evolving rapidly. It was only a couple of years ago that scientists discovered the emergence in China of mcr-1, a gene that makes bacterial infections resistant to colistin, an antibiotic that is increasingly used as a “last resort” treatment when others don’t work. Americans are already dying of untreatable infections.
This discovery and the robust multi-agency and international response illustrates the constantly evolving threat of bacteria that are resistant to antibiotics and the importance of widespread surveillance to detect new resistance types, quick response to prevent spread and development of new treatments.
As soon as the mcr-1 gene was discovered in China, the U.S. government began conducting surveillance for it here. Less than six months later, the gene was found in a patient in Pennsylvania. Given the mcr-1 gene’s ability to move to other bacteria and make them resistant, the federal government implemented an urgent public health response to contain and slow any potential spread, coordinating across multiple agencies and surveillance systems, and relying on collaboration and innovation. The CDC, FDA, USDA, DOD and state agencies all got involved to swiftly respond and prevent further spread of resistance.
The mcr-1 gene is just one example of the broad challenge of antibiotic resistance. Every year, more than 2 million people in the U.S. get infections that are resistant to one or more antibiotics, and at least 23,000 people die as a result. Another 15,000 or more deaths each year in the U.S. are caused by Clostridium difficile, a bacterium often associated with unnecessary antibiotic use and advanced age and can cause serious complications.
The increasing resistance to antibiotics puts at risk our ability to effectively treat sepsis or to provide effective care to cancer patients, organ transplant recipients, and burn victims, who are at higher risk of complications and infections. Drug-resistant infections can complicate the U.S. medical response to chemical, biological, radiological or nuclear emergencies. We’re also seeing more common infections, like urinary tract infections, becoming increasingly difficult to treat because of antibiotic resistance.
This is why the federal government developed the National Action Plan on Combating Antibiotic-Resistant Bacteria (CARB), to coordinate and enhance the public health response to the threat of antibiotic resistance in humans and animals, domestically and internationally. The Plan provides a five-year roadmap to guide the nation in reducing the prevalence of antibiotic-resistant bacteria by:
Slowing the emergence of resistant bacteria and preventing the spread of resistant infections.
Strengthening national surveillance efforts to combat resistance.
Advancing development and use of rapid and innovative diagnostic tests for identification of resistant bacteria.
Accelerating research and development for new antibiotics, other therapeutics, and preventive strategies, including vaccines.
Improving international collaboration and capacities for antibiotic-resistance prevention, surveillance, control and antibiotic research and development.
The federal government has been working diligently to implement the Plan since its release in 2015. As part of U.S. Antibiotic Awareness Week, November 13-19, 2017, HHS, on behalf of the Interagency CARB Task Force, has released a Progress Report to detail the significant progress made during the first two years of implementation of the National Action Plan. Highlights include:
The percentage of U.S. hospitals reporting antibiotic stewardship programs using CDC’s Core Elements for Stewardship rose to 64 percent in 2016, up from 46 percent in 2015. The goal is to reach 100 percent by 2020.
Methicillin-resistant Staphylococcus aureus (MRSA) in acute care hospitals declined by 13 percent between 2011 and 2014, and by a further 5 percent by 2016. C. difficile infections declined in acute care hospitals by 8 percent between 2011 and 2014, and by a further 7 percent by 2016.
CDC established the Antibiotic Resistance Laboratory Network, enhancing lab capacity to better detect, respond and contain resistance and resistant infections. CDC has invested in all 50 states, five large cities and Puerto Rico to detect and respond to CRE, “the nightmare bacteria.” CDC has also established seven regional labs to detect and support response to resistant organisms recovered from human samples.
Since the National Action Plan was released in March 2015, NIH has provided support to investigators through multiple funding opportunities and access to a wide array of preclinical resources designed to facilitate new drug development. These efforts are greatly expanding the pipeline of new drug candidates, at various stages of development, to treat antibiotic-resistant infections. In particular, the NIH-supported Antibacterial Resistance Leadership Group is pioneering an innovative clinical research agenda on antibacterial resistance.
As of April 2017, USDA’s Animal and Plant Health Inspection Service for the first time has begun conducting antibiotic use monitoring, resistance surveillance, and antimicrobial use surveys of beef feedlots and swine farms. These data are critical to understanding the relationships between antibiotic use and resistance in animals and humans.
In the past two years, FDA approved, cleared or granted marketing authorization for marketing several new diagnostic devices that may significantly enhance detection or prevention of antibiotic resistance.
Last year, NIH and the Biomedical Advanced Research and Development Authority (BARDA) launched the Antimicrobial Resistance Diagnostic Challenge, which seeks tests that identify antibiotic-resistant bacteria or that distinguish between viral and bacterial infections to reduce unnecessary use of antibiotics.
In July of 2016, BARDA launched CARB-X, a five-year, $450 million public-private partnership between BARDA, NIH, and the Wellcome Trust aimed at bolstering innovation in antibacterial product development. As of November 2017, CARB-X had granted awards to 23 biotech companies and research teams for drug discovery and development projects to tackle antibiotic resistance.
The U.S. Government has also worked with international partners, including the World Health Organization, the Food and Agriculture Organization, and the World Organization for Animal Health, to combat antimicrobial resistance. Through the Global Health Security Agenda, U.S. agencies have enhanced efforts to combat antibiotic resistance in over 30 countries.