Public data set highlights: Obamacare and (Medicare) drugs

Thursday, December 22, 2016

Both this week's and last week's editions of Data is Plural featured health-related data sets. This week spotlighted state-specific metrics on the Affordable Care Act:
The Affordable Care Act, quantified. Last week, the U.S. Department of Health and Human Services released a dataset of state-level Obamacare metrics. The dataset is divided into five main categories: coverage gains, employer coverage, individual market coverage, Medicaid, and Medicare. Between 2010 and 2015, the proportion of Nevadans without health insurance dropped from 22.6% to 12.3% — the largest percentage-point decrease of any state. (In 2015, an estimated 17.1% of Texans still didn’t have health insurance, the highest rate of any state that year.) The metrics come from various sources, including the Census, academic studies, and the department’s own estimates.
Last week, which I did not post at the time because I was sick after returning from vacation to Brazil (worth it), Medicare drug costs were featured:
Medicare drug costs. The federal government has released data on Medicare’s prescription drug spending from 2011 to 2015. Previously, Medicare had only published data on the most expensive drugs; the new release includes data on all drugs used by at least 11 Medicare patients in a given year. Caveat: Medicare “is prohibited from publicly disclosing drug-specific information on manufacturer rebates,” so the “spending metrics do not reflect any manufacturers’ rebates or other price concessions.”

@foreignpolicy features Russia's #HIV rates

Wednesday, November 23, 2016

Yesterday, FP published an article on Russia's rising HIV rates, primarily driven by injection drug use:
Today, there are an estimated 1.5 million people who have been diagnosed with HIV or AIDS in Russia, which has a population of 140 million. Although the spread of HIV has been stemmed in sub-Saharan Africa, in Russia the rate of HIV infection is rising 10 to 15 percent each year — a pace comparable to the infection rate in the United States in the 1980s, when the basic biology of HIV was poorly understood and the antiretroviral drugs used to treat the disease were years away from discovery. And the uncontrolled rise of the disease is unlikely to abate in the foreseeable future, as the Russian government firmly rejects scientifically tested policies out of apathy and political expedience.
Needle exchange programs in Russia...currently receive almost no funding. Until 2009, needle exchange programs had been widely available, mostly with financing from the Global Fund, a public-private consortium that is the world’s largest financier of HIV projects. But when that agency’s money was withdrawn in 2010 — largely because Russia had achieved the status of a high-income country — Moscow did not replace funding, and the number of needle exchanges in the country dropped from 80 to 10.
Russia’s zero tolerance drug policy reflects, in part, a strain of social conservatism running through the country that views drug use as a personal moral failing. “Methadone is considered in the same category as tolerance to gays — rotten Western practices,” said Sergey Lukashevsky, the director of the Sakharov Center, a Moscow-based facility for discussion on Russian culture and history.

This perspective — which paints the problem as a foreign-imported plot — is inflamed to build support for the government.
To HIV prevention specialists, this is not exactly news; in fact, I featured a piece on the same topic by the BBC a year and a half ago. But I was pleased to see it featured in a high-profile publication.

I was very interested to see that the pace of increase of new infections is strikingly similar to that of South Korea's new HIV infections, and the government response shares a lot of features with Russia's, including a lack of interest in evidence-based prevention strategies and socially conservative views that promote the idea that infection is the result of moral degeneracy.

The good, the bad, and the ugly for my birthday

Tuesday, November 22, 2016

As a kid, I was always salty that my birthday fell so close to (and occasionally on) Thanksgiving that most of my friends and classmates would forget about it. Of course, it's amusing now to reflect on the fact that my nine-year-old self's biggest worry was whether her nine-year-old friends would remember her birthday, rather than whether my beloved country will regress into authoritarianism. But I digress.

First, the good: I was delighted to start my day with gingerbread pancakes (with bananas!) and a edition in my inbox that featured an article on two female computer engineering pioneers who were awarded the Presidential Medal of Freedom:
Rear Admiral Grace Hopper...was a major figure in the development of fundamental computing systems. She worked on some of the earliest computers ever made, like the Mark I, programming and performing research alongside the likes of Howard Aiken and John von Neumann. She aided in the construction of UNIVAC and created the first working compiler.

If she had retired then, in 1952, she would already be considered a critical part of the development of the modern computer. But she continued her work, under public and private auspices, leading to the creation of many of what could be considered the first modern programming languages (you see the COBOL book in her hand above) and helping the Navy standardize and modernize its computing infrastructure. She’s even credited with popularizing, if not inventing, the modern definition of “debugging” after a moth was found in Harvard’s Mark II computer.
Margaret Hamilton...was tapped to work with the Apollo program, creating the mission’s onboard flight systems.

Apollo 11 ran her software, and at a critical moment during the lunar landing demonstrated its reliability — and also the importance of good documentation — when it activated alarms related to receiving more input than it could handle. The astronauts and mission control recognized that these errors in particular were something a computer could handle, though — the program prioritized critical systems, as it was designed to do, instead of shutting down or delaying calculations, and the landing was accomplished successfully.

“Because software was a mystery, a black box, upper management gave us total freedom and trust. We had to find a way and we did,” she told NASA for a retrospective. “Looking back, we were the luckiest people in the world; there was no choice but to be pioneers; no time to be beginners.”

Hamilton has continued working on software engineering — she coined the term, by the way — in the private sector ever since.
Alas, the bad: While I have been relatively impressed with Vox's data reporting over the last few months, I was disappointed to see this piece today, which suggested a causative element in the correlation between opioid use and Trump-voting with the unfortunate subheading declaring, "Another potential explanation for Trump’s surprising win." Methinks Vox needs to start reading XKCD.

As for the ugly, one of my colleagues from APHA's Human Rights Forum highlighted an article on this registry of left-wing academics:
A new website is asking students and others to “expose and document” professors who “discriminate against conservative students, promote anti-American values and advance leftist propaganda in the classroom.”

The site, called Professor Watchlist, is not without precedent -- predecessors include the now-defunct, which logged accounts of alleged bias in the classroom. There's also David Horowitz's 2006 book, The Professors: The 101 Most Dangerous Academics in America. But such efforts arguably have new meaning in an era of talk about registering certain social groups and concerns about free speech.
In a write-up of the project, Kirk said, “It’s no secret that some of America’s college professors are totally out of line” and that he often hears stories about “professors who attack and target conservatives, promote liberal propaganda and use their position of power to advance liberal agendas in their classroom. Turning Point USA is saying enough is enough. It’s time we expose these professors.”
"Expose" them for what, exactly - expressing their views? On a more mischievous note, perhaps it will enable me to find additional inspiration to start seriously looking for Ph.D. programs, so I can eventually make it into that registry. Happy birthday, indeed.

Public data set highlights: hate crimes and fake news

Thursday, November 17, 2016

This week's Data is Plural highlighted two things that I have been following particularly closely since the election. The first is hate crimes:
Hate crimes in the United States. Since the 1990s, the FBI has collected data on hate crimes from local law enforcement agencies. On Monday, the bureau released data for 2015, reporting “5,850 criminal incidents and 6,885 related offenses, as being motivated by bias toward race, ethnicity, ancestry, religion, sexual orientation, disability, gender, and gender identity.” Those numbers are based on reports from 14,997 participating agencies. On the FBI’s website, you can view and download summary tables of the most recent data. You can also download incident-specific data for 1992 through 2014 from the National Archive of Criminal Justice Data. Unfortunately, as ProPublica noted yesterday, the FBI dataset is “deeply flawed”; more than 3,000 law enforcement agencies don’t participate in the program.
It is too early to say definitively that hate crimes are in fact on the rise, but there is reason to be concerned. The analysis of the aforementioned data showed that hate crimes against Muslims rose by about 6% last year, and two other groups that collect data on hate crimes, the Southern Poverty Law Center and the Council on American Islamic Relations, have noted a spike in reported hate crimes during election week and in the days since. Reports of a 46% increase hate crimes in post-Brexit UK certainly don't make anybody feel better, either.

It is worth pointing out that police department non-participation also causes problems for tracking information on police shootings and excessive use of force. Vox does a pretty good job of laying out these data problems. (Side note: I've been quite enamored with some of their data reporting lately.) DiP has featured open data on police activity in several editions:
The second, which has been the focus of very intense discussion for some time now, is on media coverage:
Fake news on Facebook. Last month, colleagues at BuzzFeed News and I analyzed and fact-checked 1,000+ posts from hyperpartisan Facebook pages, and found a disturbingly high rate of fake news. Here’s the data. Facebook CEO Mark Zuckerberg has dismissed the possibility that fake news influenced the election, calling it a “pretty crazy idea”. Meanwhile, renegade Facebook employees have now formed an unofficial task force to battle fake news on the platform.
There was more than a little hubbub about Facebook's role (or lack thereof) in driving the election by reinforcing people's self-constructed information bubbles. I personally think the more important ethical question is whether Facebook has a responsibility to do something about it by correcting its users' bad habits driven by the very natural (despite also being very unfortunate) human tendency toward confirmation bias. But I think it is also worth noting that the tendency toward that bias may have been exacerbated by the media's own self-constructed bubble.

I don't have a whole lot of optimism that the polarization of this country, or the tendency of its citizens to only accept information that confirms what they already believe. But on the bright side, at least analysts and the media are paying closer attention now.

Public dataset highlights: Medicare

Tuesday, November 8, 2016

This is a bit late, as last week's Data is Plural came out while I was attending the APHA Annual Meeting in Denver, but I still wanted to highlight the Medicare Health Outcomes Survey data that was featured:
Medicare beneficiaries. The U.S. government’s Medicare Health Outcomes Survey tracks the “physical and mental health and well-being” of Americans covered by Medicare. Each survey, currently available for 1998–2000 to 2012–2014, follows a sample of Medicare beneficiaries for two years, and asks them questions along the lines of, “In the past 12 months, have you had a problem with balance or walking?” The 2012–2014 data includes (at least partial) responses from 296,320 people.

Another @APHAAnnualMtg: Successes and challenges in #HIV and #humanrights advocacy at #APHA2016

Monday, November 7, 2016

This now marks the second year in a row I haven't done anything fun for Halloween. This is not because I don't like Halloween or have some kind of personal or ethical objection to it, but rather because I have attended the Annual Meeting of the American Public Health Association, which has fallen on Halloween for the last two years. I always know it will be busy, and yet I consistently underestimate how much energy the conference will take out of me as an introvert going into extreme networking and advocacy mode for four straight days.

When I called my mother on the last day of the conference (because it was her birthday), she asked me how I know whether or not these types of conferences are a worthwhile investment (since I don't go as a function of my day job and thus pay for them out of pocket), and I gave her a sort of canned response that networking and meeting people and getting noticed can turn into potential employment or collaboration opportunities in the future. Which is not untrue per se, but I think that the real benefit for me personally was to be able to see progress in my advocacy work on HIV-related travel restrictions in general, and those in place in South Korea in particular.

After getting a late-breaker policy passed last year that specifically addressed the mandatory HIV testing policy for English teachers in South Korea and the UN CERD decision in response to its challenge, I was able to get a permanent policy proposal adopted by APHA's Governing Council with the enthusiastic support of multiple components, including the HIV/AIDS Section, the Epidemiology Section, and the LGBT Caucus of Public Health Professionals. (My component, the International Health Section, sponsored the policy.) While APHA has not yet taken official action on the basis of the policy, having the position statement in writing and publicly available is certainly progress, and I remain optimistic that the policy can be leveraged to inspire future action from both the organization and its members within. I also hope to be able to work with the World Federation of Public Health Associations to pass a similar policy that can then be used to inspire action from the Korean Public Health Association (which is a member of WFPHA).

After two years of beating this particular drum, I have learned that advocacy can be slow and frustrating work. There is a lot of self-funded travel for opportunities to publicize your cause, and having metaphorical doors repeatedly shut in your face gets old after a while. After a draining four days in Denver I had begun to wonder if my work was making a dent in anyone's attention outside of my immediate circle of APHA colleagues. Imagine my pleasant surprise when I was contacted by This Morning with Alex Jensen, an English-language radio program in Seoul, requesting an interview on the topic of rising HIV rates in Korea because of the article I wrote for Humanosphere last December. It was broadcast on Monday morning in Seoul; a podcast of the interview is available for listening or download here.

Obviously there is still a lot to do, but it is encouraging to see that this issue is finally getting some traction.

Public data set highlights: DHHS local-level health data

Wednesday, October 19, 2016

In this week's Data is Plural, Dr. Jeremy Singer-Vine highlights county- and local-level health data:
County-level health care. Each year, the Department of Health and Human Services updates its Area Health Resources Files, a vast suite of local health care data collated from more than 50 sources. Among the topics covered: the number health care professionals by specialty, various rates of hospital usage, air quality, and demographic profiles. You can download the data, or explore and map it online.

Finally, a #humanrights win for #HIV in Korea

Tuesday, October 18, 2016

Seven years after it dismissed initial complaints against the South Korean Ministry of Justice's (MOJ) policy of mandatory HIV and drug tests for foreign English teachers, the National Human Rights Commission of Korea (NHRCK) has (finally!) recommended that the MOJ remove the testing requirement. NHRCK's recommendation follows the decision of the UN's Committee on the Elimination of Racial Discrimination (CERD) in May 2015, which stated that the MOJ's policy requiring a health check which includes HIV and drug tests for native-speaking English teachers (those on the E-2 visa) constitutes racial discrimination.

The complaint which led to the ruling, filed by a teacher from New Zealand against the Ulsan Metropolitan Office of Education, was initially submitted to the NHRCK in 2009 when the testing policy was first implemented. Unfortunately, the commission dismissed it, along with 50 others protesting the policy, and cancelled its initial plans for a public hearing on the grounds that they were not willing to hear cases on individual complaints. (You can read more about the NHRCK's decision and the events leading up to it in a paper (PDF) by Ben Wagner, the human rights attorney who filed the case on the New Zealand teacher's behalf.) In dismissing the complaints, however, the commission allowed the case to be taken to the CERD, where it was accepted in 2012.

Now the commission has formally backed the CERD's ruling, which - despite the fact that it took seven years to get there - is a big win on the topic. HIV is a forgotten disease (PDF) in South Korea and is incredibly stigmatized, which makes it easy for government agencies like the MOJ to codify this kind of direct discrimination without any public outrage or pushback from within the country. In this sense, the challenge to this ongoing affront to human rights from an authoritative domestic institution is crucial. In particular, the commission's decision calls out the MOJ's policy as blatant racial discrimination, specifically citing the fact (also noted in the CERD's decision) that the tests have no basis in the protection of public health because both Korean nationals and non-citizen ethnic Koreans are exempt from the testing requirement:
[T]he Ministry of Justice takes a stand that an independent state is bestowed with wide discretion in its immigration control and, in particular, such tests are indispensable as the instructors are supposed to protect young students and facilitate a safe environment and public health.

However, as noted by the CERD, even the vast discretion embedded in immigration control hardly renders it reasonable that while Korean teachers and ethnically Korean foreign language instructors are exempted from the testing, only foreign E-2 visa holders are under an obligation to test for HIV. Likewise, the concerns about a safe public health environment offer little ground for different treatment between ethnically Korean teachers and foreign instructors with E-2 visas.
Second, it points out that the policy has the potential to stigmatize foreigners as being high-risk for HIV and thus lead the general public to believe that they are not at risk for infection. This is important, as the country's HIV infection rate continues to climb.

The MOJ never responded to, or changed its testing policies in response to, the UN CERD's ruling. Hopefully the Korean government will be more responsive to a ruling from a domestic institution, but there is no way to know for sure. However, foreign English teachers now have a resource to challenge the testing if they wish. The NHRCK decision explicitly states that the UN CERD decision carries the same authority as domestic Korean law:
Article 6 (1) of the [Korean] Constitution states, “Treaties duly concluded and promulgated under the Constitution and the generally recognized rules of international law shall have the same effect as the domestic laws of the Republic of Korea,” indicating that the country has a legally binding obligation to facilitate the rights prescribed by the treaty to which it agrees by means of accession, ratification or succession. Article 26 of the Vienna Convention on the Law of Treaties stipulates, “Every treaty in force is binding upon the parties to it and must be performed by them in good faith,” while Article 27 states, “A party may not invoke the provisions of its internal law as justification for its failure to perform a treaty.”
English teachers may be able to use the CERD decision to persuade their employers not to require the HIV test; alternatively, they have the option to file a complaint with the NHRCK (either named or anonymous) and/or the UN CERD Secretariat. The full decision has been made available by Matt von Volkenburg on Gusts of Popular Feeling.

Shameless plug: I will be presenting on this topic, including successes and ongoing advocacy initiatives, at this year's APHA Annual Meeting in Denver.

(Breaking Radio Silence with) Public Data Set Highlights: Healthcare Spending and BRFSS

Wednesday, September 14, 2016

It has been a long while since I was active here, primarily due to a sustained larger-than-average workload in my (now former) day job. I have since transitioned to a new position in a different agency with the state of Texas, which will hopefully afford me a bit more time and breathing room to be able to comment here more regularly on the many things that fascinate me about health, human rights, their intersection, and the myriad data sets analyses that relate to them.

And so I would like to break my radio silence by pointing out (as I have done previously) two health-related datasets that Dr. Jeremy Singer-Vine has highlighted in his Data is Plural series this month, which I continue to find delightful. The first is AHRQ's Medical Expenditure Panel Survey:
Healthcare spending. Since 1996, the Medical Expenditure Panel Survey has collected data on “the specific health services that Americans use,” and the “health insurance held by and available to U.S. workers.” In a typical year, the survey collects data from more than 30,000 people from more than 10,000 families. In addition to the raw data files, the Agency for Healthcare Research and Quality, which runs the survey, also provides summary data tables. They show that, for example, in 2013 an estimated 61% of Americans faced expenses for prescription drugs, which cost the median patient about $278 before insurance.
The second is the Behavioral Risk Factor Surveillance System, which was really cool to see since several analysts in my unit (while I was with the HIV prevention program) work with that data quite a bit:
Health habits. The CDC calls its Behavioral Risk Factor Surveillance System “the largest continuously conducted health survey system in the world.” Every year, the survey asks more than 400,000 American adults about a range of health-related topics, from tobacco to seatbelt use, from alcohol consumption to arthritis, from HIV testing to immunizations. Annual datasets from 1984–2015 are currently available.

APHA (@PublicHealth) late-breaker policy on HIV testing for immigrants posted

Sunday, January 31, 2016

Note: This was cross-posted to the IH Blog.

As I mentioned in my recap of the 2015 APHA Annual Meeting, I authored a late-breaker policy, "Opposition to Policies Requiring a Negative HIV Test as a Condition of Employment for Foreign Nationals," that was put forth by the International Health Section and passed by the Governing Council with overwhelming support. That policy has now been finalized and posted to APHA's Policy Statement Database. You can read the full text of the policy here.

According to APHA Joint Policy Committee (JPC) guidelines,
Approved late-breaker policy statements will be considered valid, but interim for one year. Late-breaker policy statement authors will need to revise, update, and resubmit their policy statements to the standard proposed policy statement review process...Late-breaker policy statements will be subject to full review and reaffirmation in the next annual policy development cycle. If the late-breaker is not resubmitted, it will expire after one year.
I am working with the Section's Policy/Advocacy Committee to develop a standard policy proposal as a follow-up to the late-breaker, which will be submitted for consideration at this year's Annual Meeting in Denver.