Delivery of Care

The power of community connectedness

Health equity zones to expand, fentanyl test strips hit the streets, a bill to protect women’s health care rights gets its first hearing in 2019, and the economic consequences of climate change are on the agenda

Photo by Richard Asinof

The economic truths and political consequences will be the focus of a one-day workshop on Feb. 1 at the Watson Institute at Brown University. Above, a large public mural, from the photograph by James Balog, which was attached last April to the brick facade of the School of Engineering at Brown University, portraying Birthday Canyon and the melting of the Greenland ice sheet.

By Richard Asinof
Posted 1/28/19
The Health Equity Zone initiative in Rhode Island is expanding; 3,000 fentanyl test strips are now being distributed in Rhode Island as a harm reduction tool; the first hearing will be held this week by the House Judiciary Committee on the Reproductive Health Care Act to codify Roe v. Wade in Rhode Island law; and a conference at Brown will explore the economic truths and political consequences of the threat from climate change.
Will those Rhode Islanders suffering from Lyme disease, including many golfers, become a potent advocacy group to address what the state can do to address the threats from climate change in Rhode Island? When will The Providence Journal cover the development of health equity zones in Rhode Island? How has the political conversation changed in Rhode Island around protecting women’s right to control decisions about their health? How will the introduction of fentanyl test strips change the metrics around drug overdoses and recovery in Rhode Island?
The excellent story by G. Wayne Miller on the failed suicide attempt by a Rhode Islander who jumped off of the Pell Bridge showed the power of journalism to tell a compelling story and raise the awareness around suicide prevention. What it did not do, sadly, was make the connection to the diseases of despair – suicide, alcohol and drugs – and economic and family disruption. It did not document the way that these diseases of despair are ravaging Rhode Islanders between the ages of 25-34, with some 60 percent of all deaths in that age group tied to alcohol, suicide and drugs.
If Miller is interested, I would be happy to share the research data available over a cup of coffee at Olga’s.

PROVIDENCE – Where to begin? Talk about distractions. It can become wearying to read political columns written by national pundits such as Frank Bruni from The New York Times, who drop in for a day visit to Rhode Island and then talk about how the lonely moderate Gov. Gina Raimondo is getting “whacked” by all sides in the political fray. [For many Rhode Islanders, the idea of getting “whacked” conjures up a different kind of imagery, more apt to be found in the dialogue in “Crimetown.”]

What do you think would be the best tune to cue up? Randy Newman’s “Lonely at the Top?” Or, Linda Ronstadt’s “Poor, Poor, Pitiful Me?”

The next time Bruni decides to visit Rhode Island to talk about local politics, here is an open invitation for a cup of coffee at Olga’s Cup + Saucer, to give him some food for thought about what is really happening on the ground in Rhode Island. Maybe invite newly elected state Sen. Sam Bell and state Rep. Rebecca Kislak to stop by. And Joanna Detz and Frank Carini from ecoRI News. And Peter and Toby Simon. And Angela Ankoma from United Way of Rhode Island. Maybe Ana Novais from the R.I. Department of Health and Deb Dettor from the Anchor Recovery Community Center. Also, Neil Steinberg from The Rhode Island Foundation and Annie De Groot from EpiVax. Why not include Dr. Michael Fine to talk about Health Care Revolt? Who knows who else may sit down and join the discussion, by serendipity? And Steve Ahlquist can tape the conversation.

Now, that would be a lively political conversation to write about. [Not that Bruni reads ConvergenceRI, but then again, I rarely read Bruni.]

Back to the news
In Rhode Island, next week promises to be a big week in health care:

Letters of intent are due next week on Friday, Feb. 1, for qualified municipalities and nonprofit community-based organizations that would like to apply to become new members of the Health Equity Zone initiative.

The R.I. Department of Health has braided together $1.4 million in funding to support the expansion of its current HEZ initiative, which is now operating in nine Rhode Island communities, the efforts having begun in 2014.

Full proposals from all applicants are due to the State by March 15, 2019. Awards will be made on a competitive basis.

The initial contract period will begin in approximately July 2019 and continue for one year. Contracts may be renewed for up to four additional 12-month periods, similar to the previous four years, based on vendor performance and the availability of funds.

The HEZ initiative is grounded in research that showed some 80 percent of all health outcomes are determined by factors that occur outside clinical settings in a doctor’s or nurse’s office. In response the HEZ model encourages and equips community members and partners to collaborate to address the social disparities of health and to build health equity by creating healthy places for people to live, learn, work, and play.

“A key feature of our Health Equity Zone initiative is that it puts the community’s voice front and center, since residents understand the challenges facing their communities the best, said Dr. Nicole Alexander-Scott, director of the R.I. Department of Health.

Public health leaders across the country are highlighting Health Equity Zones as a national model, she continued. “We are thrilled to expand this opportunity to additional communities here in Rhode Island.”

While there was no money for the HEZ initiative in Gov. Gina Raimondo’s proposed FY 2020 budget, Ana Novais, the executive director at the R.I. Department of Health, said that she was OK with that decision, calling it “a tough budget year.” The Governor told us in a conversation, Novais continued, that she is committed to Health Equity Zones and to working with us.

Novais said that she could not predict where the interest would come from for communities wanting to establish a new HEZ. She also praised the decision by The Rhode Island Foundation to direct $3.6 million in new investments in partnership with community-based HEZs.

Fentanyl test strips being distributed
Some 3,000 newly purchased fentanyl test strips are being distributed to community recovery groups, similar to the manner used for Overdose Prevention Day on Aug. 31, 2018, according to Tom Coderre, senior advisor to Gov. Raimondo and co-chair of the Governor’s Task Force on Overdose Prevention and Intervention.

The fentanyl test strips, which cost about $1 each, can detect the presence of fentanyl in illicit drugs with approximately 98 percent accuracy; they are seen as an important harm reduction tool in the toolbox to save lives and prevent ODs.

Colleen Daley Ndoye, the executive director of Project Weber/RENEW, has been one of the recovery community groups engaging with folks around fentanyl test strips. In an previous interview, she described the importance of the new harm reduction tool in her agency’s work:

“Fentanyl test strips are such a unique and useful resource,” Daley Ndoye explained. “They can be the moment that someone decides to take charge of their own life. They can decide, at that moment, to say: I want to live; I want to see what is in these drugs; I want to educate myself.”

Maybe they are not ready to stop using drugs, Daley Ndoye continued. “But maybe that moment of education, that moment of awareness, is a sign that they are willing to start making small changes. Once you’re willing to start to make small changes, that can snowball, so you can start making bigger changes in your life.”

The importance of access to fentanyl test strips, Daley Ndoye concluded, was the way in which the harm reduction tool could change the equation. “Somebody who decides to test their drugs for fentanyl might not be will to stop using, but they might use less, they might use slower, they are at lower risk for an overdose, and then they might consider, in six months time, getting into recovery, and that’s a big victory for us.”

There are efforts underway to create metrics to track the use of fentanyl test strips and the outcomes, as a way to correlate how they may be reducing the number of ODs in Rhode Island.

First hearing on Reproductive Health Care Act
The first hearing on the Reproductive Health Care Act [H5217] is scheduled for Tuesday, Jan. 29, in Room 101 before the House Judiciary Committee, at the “rise of the session,” sometime after 4 p.m.

The Reproductive Health Care Act would codify Roe v. Wade in Rhode Island; it has garnered 39 sponsors in the House, more than a majority of representatives. A competing bill has been filed by Rep. Anastasia Williams.

Expect a long and perhaps boisterous hearing, as numerous groups are mobilizing people to turn out for the hearing.

The House hearing will, in many ways, mark the first test of the strength of the reform coalition to be able to champion progressive legislation to a vote on the House floor.

America’s climate change future
On Friday, Feb. 1, from 9 a.m. to 5 p.m., the Watson Institute for International and Public Affairs at Brown University, in partnership with he Rhodes Center for International Economics, the Institute at Brown for Environment and Society, and the Office of the President, will host a one-day conference on the economic and political consequences of climate change.

The conference focuses on three key areas: housing markets, stranded assets and entrenched interests. In particular, the discussion will zoom in on the economics of rising sea levels for coastal real estate markets, which comprise a large portion of the U.S. housing market growth – and personal wealth.

Panelists will also discuss the economics of what is known as “stranded carbon assets” – the raw materials and financial investments tied up in carbon release.

A third focus will be on the organized politics of climate denial: who are the agents and institutions behind scientific disinformation, and how can such politics best be countered.

Sen. Sheldon Whitehouse is scheduled to give the lunchtime keynote address.

One topic not included on the agenda that perhaps should be are the rapidly increasing public health disease threats as a result of climate change disruption and changing vectors of disease-carrying insects, such as mosquitoes.

Beyond the increased spread of Zika, Dengue and malaria, which have enormous public health cost consequences, there is Lyme disease and its growing prevalence in Rhode Island. According to data from the R.I. Department of Health:

• In 2017, Rhode Island had 1,132 cases of Lyme disease, with an incidence rate of 107 cases per 100,000 people, an approximately 20 percent increase in cases observed from previous years.

• In 2016, Rhode Island was the state with the fourth highest rate of Lyme disease in the country.

• Washington County consistently has the highest rate of Lyme disease in Rhode Island with a rate of 214 cases per 100,000 people in 2017.

Anecdotally, several folks have reported to ConvergenceRI that they have contracted Lyme disease as well as other viral diseases carried by ticks; some have reported that they have then been re-infected.

In addition, every one of the people who have contracted Lyme disease have told ConvergenceRI that they have been using medical marijuana, both in Massachusetts and Rhode Island, to help alleviate the chronic, severe and debilitating pain.

While stranded assets and plummeting real estate values may make for forceful economic arguments, the high public health costs of diseases such Lyme, Zika and malaria may provide a more personal way to document the threats from climate change.

Ask yourself the question: how many people do you know that have contracted Lyme disease?


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