May 16, 2010

Utah public health officials are investigating two separate clusters of illness linked to the consumption of raw milk. To date, the first cluster includes nine reported cases of Campylobacter infection among residents in Weber, Davis and Cache Counties. The second cluster includes six reported cases of Salmonella infection in residents in Utah, Salt Lake and Wasatch Counties. All of the patients involved have reported drinking raw milk (unpasteurized milk) purchased at local vendors licensed in the State of Utah to sell raw milk.

Health officials are working closely with the Utah Department of Agriculture and Food (UDAF) and the dairies where the raw milk was produced. Raw milk from the two dairies has been tested for several bacteria.

The dairy in central Utah that produced the raw milk linked to the Salmonella illness cluster provided samples of raw milk produced from April 5 to April 22. These samples came back positive for Salmonella. However, raw milk samples taken from milk produced by the dairy collected April 22 to April 30 have come back negative for Salmonella.

Coliform testing done on milk at the dairy in northern Utah linked to the Campylobacter illness cluster came back high for coliform counts. High coliform counts may be linked to the presence of disease-causing pathogens in the milk.

There are inherent risks associated with the consumption of raw milk because of disease-causing bacteria that are commonly found in milk, such as Campylobacter, Salmonella, Listeria, and E. coli. Even with strict state regulations in place regarding the sale of raw milk, there is no guarantee that raw milk is free of disease-causing bacteria.

Raw milk contaminated with disease-causing bacteria does not smell or look any different from non-contaminated raw milk, and there is no obvious way for the consumer to know if the raw milk is contaminated.

Common symptoms of infection with Campylobacter and Salmonella include: diarrhea, abdominal pain, fever, headache, nausea and vomiting. Illness can last for up to a week or more and can be serious, especially for young children, pregnant women, the elderly and those who have weakened or compromised immune systems. In some severe cases, illness can lead to more serious complications, including Guillain-Barré Syndrome.

If you have consumed raw milk in recent days and are experiencing any of these symptoms, contact your health care provider.

If you choose to purchase and/or consume raw milk (or raw milk products) take these steps to help prevent the raw milk or raw milk product from causing illness:

• Purchase raw milk only from those stores or dairies permitted by law to sell it. However, a goverment permit still does not guarantee that the raw milk (or raw milk product) will be bacteria-free.
• Keep raw milk and raw milk products refrigerated at or below 40°F. Do not let raw milk sit out at room temperature.
• Infants, young children, pregnant women, the elderly, and those with weakened or compromised immune systems are at higher risk for serious illness from Campylobacter, Salmonella, Listeria, and E. coli and should avoid consuming raw milk or raw milk products.

Mold can trigger asthma problems in sensitive individuals with asthma. According to the Asthma in Utah, Burden Report 2009, 8.0% of Utahns say they have asthma and 10.8% of adults with asthma reported seeing mold in their homes.

“It’s not known for certain that exposure to mold can cause asthma, but we do know that it can trigger asthma symptoms,” said Rebecca Jorgensen with the Asthma Program at the Utah Department of Health (UDOH). “Mold can trigger symptoms like wheezing, coughing, fatigue and difficulty breathing in people who have asthma and are sensitive to mold,” she added.

Exposure to mold can lead to increased doctor visits or emergency room trips and an overall lower quality of life for people with asthma. Mold can also trigger reactions in people without asthma, irritating the eyes, skin, and lungs.

Mold growth is usually related to excess moisture inside the home. “In Utah, most mold problems are the result of poor drainage, improper maintenance and homes being well insulated and sealed, which doesn’t allow as much air circulation,” said Mark Jones, UDOH Environmental Epidemiology. “Fortunately, mold problems can usually be fixed by cleaning up the source of moisture. So homeowners should repair leaks, reduce condensation by increasing the circulation of humid indoor air, and direct outside water away from the home.”

The UDOH recommends the following for mold cleanup and prevention:

• If you have asthma or any respiratory disease, avoid contact with mold.
• Mold can grow in areas that are hard to see. Watch for common signs of mold growth including water stains and a musty or earthy smell.
• Check your home often for signs of mold or moisture.
• Wipe up any excess water and dry the area quickly to prevent mold growth.
• If you have or see mold in your home use your resources (time and money) to just clean it up.
• If the area of mold you need to clean is less than about 10 square feet, you can usually clean it yourself.

Refer to this Environmental Protection Agency (EPA) resource for help with mold cleanup: Mold, Moisture, and Your Home at www.epa.gov/mold/moldguide.html
Tips to reduce moisture and condensation in your home:

• Use exhaust fans when showering and cooking
• Vent the clothes dryer to the outside and don’t air dry clothes in the home
• Fix leaks in roofs, pipes or foundations
• Open a window
• Use the air conditioner

More information about asthma and mold in Utah is available by calling the Health Resource Line at 1-888-222-2542 or by visiting www.health.utah.gov/asthma

Most people have no problems after arriving in Utah. However, some people experience unpleasant reactions to Utah’s high altitudes. Symptoms of high altitude illness can include headache (generally at the back of the head-particularly in the morning), dizziness, fatigue, dry cough, loss of appetite, nausea/vomiting, disturbed sleep, and a general feeling of being ill. Symptoms of altitude illness may mimic those produced by hypothermia, dehydration, carbon monoxide poisoning or low blood sugar.

Most of these symptoms are caused by a lack of oxygen. At 6,500 feet (1,981 meters), the air we breathe contains about 20% less oxygen than at sea level. Lack of oxygen affects most bodily functions. Our muscles cannot do as much work, our nervous system cannot take as much stress, and our digestive system cannot handle fat as well.

If possible, arrive a few days in advance of your planned physical activities to allow time for your body to acclimate. Also for those first few days, stay away from fatty foods and drink plenty of water.

People who are overweight, have high blood pressure, sickle-cell anemia, heart or lung disease should consult with a doctor before coming to Utah’s high elevation.

Loss of muscular control, blurred vision, hallucinations, and mental confusion are signs to get down to a lower altitude immediately and seek medical attention.

Altitudes in Utah

• Alta Ski Resort Base - 8,527 feet (2,599 meters)
• Arches National Park - 6,000 feet (1,829 meters)
• Bryce Canyon National Park - 7,586 feet (2,312 meters)
• Canyonlands National Park - 6,000 feet (1,829 meters)
• Capitol Reef National Park - 6,843 feet (2,086 meters)
• Cedar Breaks National Monument - 10,662 feet (3,250 meters)
• Kings Peak in the Unita Mountains 13,528 feet (4,123 meters)
• Lake Powell - 3,700 feet (1,128 meters)
• Park City - 6,900 feet (2,103 meters)
• Salt Lake City Airport - 4,330 feet (1,320 meters)
• Snowbasin Ski Resort Base - 7,497 feet (2,285 meters)
• Snowbird Ski Resort Base - 7,756 feet (2,364 meters)
• Zion National Park - 3,913 feet (1,193 meters)

Most ski resort summits are above 10,000 feet (3,048 meters)

State improves three spots from last year’s rankings

New data released today in the United Health Foundation’s (UHF) 20th annual America’s Health Rankings™ report show Utah is the 2nd healthiest state in the nation. The report credited Utah with the lowest rates in the nation for smoking, cancer deaths, infant mortality and binge drinking.

The annual report provides a measurement of the overall health of the nation on a state-by-state basis, with the purpose of educating individuals, elected officials, healthcare professionals, employers and communities to take action to improve health. In 2008, Utah ranked as the 5th healthiest state in the nation.

“The UHF report is the most respected of its kind in the public health world, so to be recognized as the 2nd healthiest state is truly something to be proud of,” said Utah Department of Health (UDOH) Executive Director Dr. David Sundwall. “However, it doesn’t mean we can rest on our laurels. My goal is to be the healthiest state in the nation, and we still have some challenges to address before we can achieve that goal.”

The UHF cited Utah’s limited availability of primary care physicians, high geographic disparity within the state, and low public health funding as significant challenges.

“To become the healthiest state in the nation Utah must focus on closing the gap in health disparities, particularly among the state’s rapidly growing minority populations,” said UDOH Deputy Director Teresa Garrett. “Utah should be a place where all people can enjoy the best health possible.”

And despite being ranked 5th in the nation for prevalence of obesity, Utah’s rate continues to climb, with 23 percent of Utahns falling into that category.

“I take no comfort in being ranked 5th in the nation for obesity, as it simply means Utahns are not yet getting fat as fast as the rest of the nation is. However, we are on a quick track of getting there,” Sundwall said. “Obesity is a significant public health threat to our entire community; my goal is to see a time where our obesity rate actually falls from one year to the next.”

The UHF report praises Utah for its efforts in preventing infant mortality; the state’s rate dropped by 45 percent over the 20 years the health rankings report has been published. The state also received credit for decreasing its rate of uninsured residents.

Utah ranks in the top 10 in 12 of the 22 determinants, including;

Prevalence of smoking	1st (no change from 2008)
Infant mortality	1st (up from 4th)
Cancer deaths	1st (no change)
Prevalence of binge drinking	1st (up from 3rd)
Children in poverty	2nd (up from 9th)
Preventable hospitalizations	2nd (no change)
Cardiovascular deaths	3rd (no change)
Prevalence of obesity	5th (up from 7th)
Poor physical health days	5th (down from 4th)
Violent crime	6th (up from 7th)
Infectious diseases	6th (down from 5th)
Premature death	7th (up from 6th)

There are many factors at work in Utah’s consistent top 10 ranking over the 20 years of the UHF report. “The rankings document much of the valuable work done in public health,” said Sundwall. “But we fully acknowledge the benefit of other significant factors that contribute to good health. These include a culture that promotes healthy behaviors, and our nationally-recognized, high quality private health care systems.”

The report ranked Vermont as the healthiest state in the nation. Massachusetts, Hawaii and New Hampshire round out the top five.

For a full copy of the United Health Foundation—America’s Health Rankings™ Report, visit www.americashealthrankings.org or www.unitedhealthfoundation.org

From the Utah Health Policy Project Newsletter

Rochelle is insured.  This year after getting very sick with pancreatitis and resulting severe complications, she was in the hospital for a couple months.  By April, she had hit her annual insurance benefit cap of $250,000.  Since then, she has been paying her monthly premium of $850 but is essentially uninsured.  Rochelle now has $35,000 in medical debt and is postponing surgery she needs until next year when her annual cap resets.  But in the meantime, she worries about getting sick and ending up in the hospital again.  How would she pay that bill?

We can all agree that health reform is needed.  A recent poll by the Salt Lake Tribune found that a majority of Utah voters – 55% — said health reform is a “necessity.”  Utahns recognize the need for health reform and are critical of the existing system.  We see everyday examples of our fellow Utahns, like Rochelle, who are falling through the cracks.  We also see how the cost of health care escalates every year.

At the same time, health care is responsible for 17% of our gross domestic product (GDP) and 13.7 million jobs nationally. One in 10 Americans work in the health care sector. The health care industry impacts every one of us personally, our businesses and employers.  The enormity of this issue explains why our country has gone decades without meaningful health reform.  And why the current debate has devolved into a bitterly partisan political battle.

The Tribune poll also found that Utah voters’ disapproval of the national health reform is tied to dissatisfaction with the President. Fifty seven percent of registered and active Utah voters oppose President Obama’s proposal to reform health care. HOWEVER, when the President’s name is removed from the equation, most of the opposition dissipates. A solid majority, 57%, say it’s necessary for the federal government to reform health care.  This reflects the results of our small business survey from this summer, which found that 68% of Utah small business owners agree that the state and federal governments must be partners in reforming health care.

This federal-state partnership is how health care is regulated and delivered today, and both partners will need to act in order to remove the barriers Utahns face in getting or keeping quality, affordable coverage and care.  The national reforms focus on access and affordability of coverage, while containing costs through new efficiencies in Medicare.  Using uniquely American solutions, national reforms will strengthen the private insurance market by creating new exchanges where small businesses and individuals can shop and compare plans, while pooling their risk together.  Low and moderate income Americans will have access to subsidies to help them afford coverage. Small businesses will be largely exempt from coverage obligations but given new tax credits to help them purchase coverage.  In addition, insurers will no longer be able to deny coverage or charge more for pre-existing conditions or gender.

While national reforms will provide a much needed framework and parameters for reform, Utah still has a very important role to play.  Our state has already demonstrated a commitment to health reform, and we will need Utah to build on these efforts if we are ever going to sustain the commitment to quality, affordable coverage and care for every Utahn.  While the national reforms focus on reining in costs for public programs, our state can take an active role in bending the cost curve in the private market.  We already have pilot programs underway to study changing the payment structure so that providers are rewarded for keeping us healthy rather than being paid for every test and procedure.  We need to increase our investment in these pilot projects and work on implementing them on a broader scale. Our state’s innovative approach to value-based purchasing and care delivery could easily propel us to the front of the pack on issues that matter most.

While national and state health reforms are far from perfect, we have to recognize two things.

1. The status quo is unsustainable: it’s time to get started on health reform. Like us, you may be surprised—and much relieved—to learn that even countries with lower costs and universal coverage go through a process of fine tuning their reforms every 10 years or so (read all about it in Healing of America by T.R. Reid).
2. This is a process.  The bill that is passed won’t be implemented until 2013 and 2014.  There will be plenty of time to improve upon these reforms—at both the state and national level.

In the Tribune poll, when respondents were asked which of 6 reasons is most responsible for rising health care costs (health care providers charging too much and performing unnecessary procedures; insurance companies charging high premiums and refusing to cover bills; lawyers who file too many malpractice suits; people living unhealthy lifestyles; people who don’t buy insurance and then use emergency rooms for care; or, government over-regulating), the most common answer, without any prompting from poll-takers, was “all of the above.”  This finding confirms an abiding belief of the coalition Utahns for Sustainable Health Reform (U-SHARE) that all stakeholders—insurers, providers, hospitals, employers, and individual Utahns—must share in the responsibility for reforming health care.  Each group stands to gain something and lose something from reforms. But the question is: are we courageous enough to take the leap, to imagine a more sustainable approach to financing and delivering health care?

This January, 10-year-old Benjamin Mitchell of Sandy was skiing with his grandmother when he lost control and crashed headfirst onto the slope. He wasn’t wearing a helmet and suffered a devastating frontal lobe brain injury.

“I still remember that terrible phone call from my mother-in-law,” said Benjamin’s mother, Kari. “I also remember the guilt I felt for not making him wear his ski helmet like he always did while riding his bike.”

Nearly 10 months later, Mitchell still deals with memory problems caused by the traumatic brain injury. He is just one of thousands of Utahns who suffer a TBI every year. As a young male, he is in the highest risk category.

“Most males under age 30 sustain a TBI in car crashes and sports activities,” said Trisha Keller, manager of the UDOH Violence and Injury Prevention Program “And the real tragedy is that most of the injuries are easily preventable.”

When asked if he would wear a helmet when skiing again and what he would tell his friends, Mitchell said, “Definitely I would wear my helmet. It may not be cool but it’s your life.”

The Brain Injury Association of Utah is the only non-profit organization dedicated solely to education and support for the issues of prevention and recovery of brain injury in Utah. Each year an estimated 44,000 Utahns receive services through BIAU.

Like Mitchell, 19-year-old Andrew Allred of Salt Lake City deals daily with the life-changing effects of several sports-related TBIs. Allred sustained multiple concussions in football, lacrosse, longboarding, and snowboarding. His first was during his first football game as a freshman at Olympus High. Allred was cleared to go back in and play, but after struggling to catch the football and remember the plays, he knew his injury was more serious than previously thought. Allred has suffered from depression, memory loss, dizziness, and even had to re-learn how to read as a result of his brain injuries.

“Going back in the game after the first concussion only increased the severity of it,” said Allred. “Coaches and athletes need to understand how serious a concussion is. I’m going to be dealing with these issues for a long time,” he added. “Sitting out and letting your body heal is a small sacrifice when you’re talking about the rest of your life.”

Utah Department of Health data show just how serious the problem of TBI is:

• In 2007, 2,329 Utahns suffered traumatic brain injuries (TBIs) severe enough to require hospitalization
• 205 (9 percent) of the injuries in 2007 occurred during sports-related activities like biking, skiing/snowboarding, skateboarding, water sports, and baseball.
• 500 (23%) died of their injuries.

For more information visit the BIAU website at www.biau.org To learn more about TBI-related data in Utah, visit www.health.utah.gov/vipp/

Source: Utah Health Policy Project

Three years ago, 62-year-old Merce Butler, left her job of 11 years to care for her dying mother overseas. She sold her car and drained her savings to make the move. Sadly, her mother passed away after a few months. Upon returning to Utah, Merce tried to re-enter the workforce, but with the economic downturn, nobody was hiring, particularly women in their sixties. She now makes due with her social security income, coping day by day.

In June disaster struck. Merce became extremely ill and ended up in the emergency room.  She was diagnosed with a serious case of the swine flu and had to remain in the hospital for three days. Since Merce lost her health insurance when she left her job, the $16,000 hospital bill fell in her lap. She pleaded with the hospital to take her situation into account and reduce the bill, but she still owes over$11,000. “I have no idea how I’ll pay this off – I don’t even have $100 dollars right now, and I’m living month to month. I don’t know how this happened – I’m such a healthy person.  The swine flu?  I still can’t believe it. What was I supposed to do in the emergency room?  Go home because I had no insurance, and infect everyone around me?”

Merce will not qualify for Medicare for another three years. In the meantime she feels trapped. Although, she has recovered from the swine flu, she has not recovered from the medical debt. She also knows that at any moment, disaster could strike again.

Pass National Health Reforms This Year

Utahns like Merce are playing Russian-roulette with their health and their finances when they go uninsured. People like Merce are less likely to get vaccinated, raising the risk of contracting swine flu and infecting all of us!  The status-quo is not sustainable. Without federal and state action this year, our health care costs will double over the next decade, millions more of Americans will become uninsured, and bankrupt our state and federal governments. Congress and Utah must enact health reforms this year to bring peace of mind and security to Utah families.  Reforms should ensure Utahns can get the care they need, when they need it, and from the doctor they choose.

Some look like candy and mints, others like toothpicks. Then there are the dissolvable strips you’d swear are breath fresheners. But inside, they’re still just cancer-causing tobacco, wolves in sheep’s clothing that will entice and hook new, young smokers and keep current smokers addicted.

At a news conference today, the Utah Department of Health (UDOH) helped the public understand just how insidious the new products are. Faced with a growing number of quitters, big tobacco is now offering nicotine that doesn’t need to be smoked or chewed: some of the new products melt quickly in your mouth and deliver nicotine straight to the bloodstream. Others are shaped like breath mints and come in eye-catching tins that hide easily in a pocket.

“As comprehensive tobacco control efforts help to lower use, the industry quickly responded by developing new ‘tobacco candy’ products to maintain their profits at the expense of public health,” said Amy Sands, program manager for the UDOH Tobacco Prevention and Control Program (TPCP). “These products are designed to make tobacco addiction more accessible as well as to promote the dual use of cigarettes and smokeless products, creating an even stronger addiction.”

“Because these products were brought to market very quickly, there’s limited research about their long-term effects,” said University of Utah Health Care pediatrician Ellie Brownstein, M.D. “What we do know is that they have a high nicotine content and could be very deadly to a child who thinks he’s picking up a piece of candy.”

Kathy Baebler, Salt Lake Valley Health Department health educator, pleaded with parents today to be aware of the products and their harmful effects. “The slick packaging makes the products appealing to children,” said Baebler. “Teachers, too, need to be aware that they are very likely to be making their way to the classroom. So it’s critical to remind students that there is no safe tobacco product.”

Tobacco prevention and control efforts in Utah are working, but much more needs to be done. Tobacco use in Utah costs taxpayers $369 million in smoking-related medical expenses and $294 million in lost productivity each year. Cost-effective anti-tobacco programs and quit services pay for themselves through the resulting health and economic benefits for the state. In addition to saving lives, each percentage point reduction in the smoking rate equals savings of $315 million in future health care costs.

For free information or to get help quitting, call the Utah Tobacco Quit Line at 1-888-567-TRUTH or visit www.utahquitnet.com

A new report shows Utah is not meeting national goals for consumption of fruits and vegetables. The Centers for Disease Control and Prevention (CDC) reports just 32% of Utah adults meet the goal of eating at least 2 fruits daily and just 25% eat at least 3 vegetables a day. Adolescents in grades 9-12 fare even more poorly, with 30% meeting the 2 fruits goal and 11% eating 3 vegetables daily.

“Most of us already know how important it is to eat fruits and vegetables to preserve our health and prevent disease,” said Utah Department of Health (UDOH) dietitian Patrice Isabella. “But just getting fresh produce can be difficult for many families for a variety of reasons,” she added.

The report card points out that schools may not provide enough produce in foods offered outside of regular school meals, such as a la carte and vending. And some communities don’t have full-service grocery stores within walking distance for residents who don’t have transportation.

Other key report highlights include:

• Utah does not have a state-level policy for improving the availability of stores that offer healthy foods.
• Only 25% of middle and high schools in Utah offer fruits and non-fried vegetables in school stores or vending machines.
• Utah is one of 29 states that do not have a state policy for ‘Farm to School’ programs. These programs link schools with local farms and can help increase fruit and vegetable access, as well as students’ knowledge of nutrition and agriculture.

The good news is Utah is one of just 20 states with an active Food Policy Council. The group’s mission is to educate and inform the public and policy makers about relevant food system issues, and advocate for policies that support and strengthen a sustainable community food system.

The report card lists in detail produce consumption rates across the state and will help UDOH target the communities and schools that need the most help. The information will also help advocates shape policies that will help promote healthy eating in all neighborhoods.

“We’re very glad to have this new information,” said Isabella. “Now we’ll pull together government, health professionals, businesses, schools, farmers and community members to talk about how to make healthier food more available and affordable,” she added. “As has been shown in other states, this can be a key difference in helping people eat better and stay healthier.”

The State Indicator Report on Fruits and Vegetables, 2009 is available from the CDC’s Division of Nutrition, Physical Activity and Obesity at www.fruitsandveggiesmatter.gov/indicatorreport