Making Impactful Public Health Policy Change:
 - PowerPoint Presentation

Slide1

Making Impactful Public Health Policy Change:
The Legislative Process from the Inside of the Maryland General AssemblyFriday, May 6, 2016

Manasa ReddyMPH Candidate in Health Systems and PolicySlide2

OutlinePreceptor OrganizationObjectives and RationaleMethods and ApproachBillsSmoking

in cars with childrenCorrectional educationSyringe exchange programsChallenges

ConclusionsQuestionsSlide3

IntroductionPreceptor Organization: The Office of Delegate Clarence Lam, MD, MPH in the Maryland General AssemblyDuties:

Researching existing policies in Maryland and other states

Writing policy briefs

D

rafting testimony, and

R

esponding

to constituent lettersPhoto credit: msa.maryland.gov/mdmanual/07leg/html/gaf.htmlSlide4

Rationale and ObjectivesBroadly: Sometimes only limited or insufficient protections in place for Marylanders against public health and social problems

Personally: Wanted to gain exposure to all aspects of the policy making process.Slide5

MethodsReviewed existing policies in Maryland and other statesReviewed interventions for their effectiveness and cost in the public health and grey literature using PubMed, Google, and the General Assembly website, mga.leg.maryland.gov

.Slide6

Childhood Second-hand Smoke Exposure in CarsSmoke disproportionately harms young children and associated with increased risk of mental health and behavior disorders such as depression, anxiety, and attention deficit hyperactivity disorder (ADHD) in children (3

).Exposure to smoke in a confined space, such as a car, amplifies these effects.(1,2)Secondhand exposure in cars disproportionately affects disadvantaged children (3, 4)

Annually, childhood smoke-exposure costs us:

$40 million in direct medical costs for asthma (1)

$644 million for medical care for ADHD (2)

$2.9 – 9.23 billion to the education system (2

)

Semple

S,

Apsley

A,

Galea

KS,

MacCalman

L,

Friel

B,

Snelgrove

V. Secondhand smoke in cars: assessing children's potential exposure during typical journey conditions. Tobacco control. 2012;21(6):578-83

.

Northcross

AL, Trinh, M., Kim, J., Jones, I.A., Meyers, M.J., Dempsey, D.D.,

Benowitz

, N.L., Hammond, S.K. Particulate mass and polycyclic aromatic hydrocarbons exposure from secondhand smoke in the back seat of a vehicle. Tobacco control. 2012;23:14-20.

Bandiera

FC, Richardson AK, Lee DJ, He JP,

Merikangas

KR. Secondhand Smoke Exposure and Mental Health Among Children and Adolescents. Archives of pediatrics & adolescent medicine. 2011;165(4):332-8

.Slide7

HB 1431: No Smoking in Cars with ChildrenSought to penalize smoking in cars with childrenOutcome: WithdrawnSlide8

Educational Opportunities for the Incarcerated22,087 Marylanders behind bars

most from disadvantaged backgrounds and during their most productive years

Fewer than half of inmates have a high school degree (1)

95% of those incarcerated each year will eventually be released

(2).

Education

and Workforce Training Coordinating Council for Correctional Institutions: Activity Report 2015. State of Maryland, Department of Labor, Licensing and Regulation; Maryland Department of Public Safety and Correctional Services, 2015.

U.S

. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, “Reentry Trends in the United States,” March 1, 2016. http://

www.bjs.gov

/content/reentry/

reentry.cfm

; hereinafter “Reentry Trends.” Slide9

HB 1195: Correctional EducationEducation can empower inmates to return to the community as productive members of societyImproved earnings: GED programs in prisons on increase post-release earnings by 15% on average 

(1)Potential reduction in recidivism: The Bard Prison Initiative in NY has reduced recidivism by 4%.

HB1195 proposed a task force to explore such optionsOutcome:

Did not pass House

Appropriations Committee

1. Tyler

JH, Kling, J.R. Prison-Based Education and Re-entry Into the Mainstream Labor Market. National Bureau of Economic Research. 2006.Slide10

Opioid Addiction464 heroin-related deaths in Maryland in 2014 (1)27.4% of HIV cases and 38-54% of HCV cases attributable to injection drug use (2,3)

High cost of treating each case of HIV (estimated at $380,000 over the course of a lifetime) and HCV ($84,000 for a full course of treatment)

(4)

1. ARTIGIANI

, E. E., WISH, E.D. 2014. Patterns and Trends of Drug Abuse in the Baltimore/Maryland/Washington, DC, Metropolitan Area—Epidemiology and Trends: 2002–2013 Proceedings of the Community Epidemiology Work Group

.

2. DANIELS

, D., GRYTDAL, S., WASLEY, A. 2009. Surveillance for Acute Viral Hepatitis - United States, 2007.

Morbidity and Mortality Weekly Report,

58

.

3. 2015b

. HIV Among Injection Drug Users in Maryland, 2013. Maryland Department of Health and Mental Hygiene

.

4. BIRNBAUM

, H. G., ET AL. 2011. Societal costs of prescription opioid abuse, dependence, and misuse in the United States.

Pain medicine,

12

,

657-667

.Slide11

HB 468: Syringe ServicesHB 468 proposed to expand syringe exchange services in MD, and increase preventive education and linkage to addiction treatment programsGiven high cost of treatment, many programs would be cost-effective even if they only prevented one case

Outcome: Passed by House and Senate!Slide12

Challenges and ObservationsSlow-moving processCost a common barrier to implementationNeed to manage different stakeholders’

needsValue of hearing personal experiences in testimonySlide13

ReferencesSemple S, Apsley A, Galea KS, MacCalman L,

Friel B, Snelgrove V. Secondhand smoke in cars: assessing children's potential exposure during typical journey conditions. Tobacco control. 2012;21(6):578-83.Northcross

AL, Trinh, M., Kim, J., Jones, I.A., Meyers, M.J., Dempsey, D.D., Benowitz, N.L., Hammond, S.K. Particulate mass and polycyclic aromatic hydrocarbons exposure from secondhand smoke in the back seat of a vehicle. Tobacco control. 2012;23:14-20.

Bandiera

FC, Richardson AK, Lee DJ, He JP,

Merikangas

KR. Secondhand Smoke Exposure and Mental Health Among Children and Adolescents. Archives of pediatrics & adolescent medicine. 2011;165(4):332-8

.U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, “Reentry Trends in the United States,” March 1, 2016. http://www.bjs.gov/content/reentry/

reentry.cfm

; hereinafter “Reentry Trends.”

Education and Workforce Training Coordinating Council for Correctional Institutions: Activity Report 2015. State of Maryland, Department of Labor, Licensing and Regulation; Maryland Department of Public Safety and Correctional Services, 2015.

Tyler JH, Kling, J.R. Prison-Based Education and Re-entry Into the Mainstream Labor Market. National Bureau of Economic Research.

2006.

ARTIGIANI

, E. E., WISH, E.D. 2014. Patterns and Trends of Drug Abuse in the Baltimore/Maryland/Washington, DC, Metropolitan Area—Epidemiology and Trends: 2002–2013 Proceedings of the Community Epidemiology Work

Group.

DANIELS

, D., GRYTDAL, S., WASLEY, A. 2009. Surveillance for Acute Viral Hepatitis - United States, 2007.

Morbidity and Mortality Weekly Report,

58.

2015b

. HIV Among Injection Drug Users in Maryland, 2013. Maryland Department of Health and Mental

Hygiene.

BIRNBAUM

, H. G., ET AL. 2011. Societal costs of prescription opioid abuse, dependence, and misuse in the United States.

Pain medicine,

12

,

657-667.Slide14

Questions?