I am confused by the term “health equity.” What exactly does that mean? Does it mean that everyone regardless of where they live in the U.S. has access to medical care? Does it mean that people choosing to live in rural areas are entitled to the same care as in urban areas? No one seems to define that term the same.
I appreciate your time and hope that you can clear this up for me.
Sincerely,

Lauri Jones RN, BSN
Community Health Director
Okanogan County Public Health

Posted by Lauri Jones on Wednesday, June 24, 2009 5:29:21 pm ET
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Wondering if this report has been published and where I can find it: "In the coming months, we will publish proceedings from this meeting and a White Paper on the Social Determinants of Health."

I believe we need a significant "PR" campaign to bring attention to the social determinants of health. There are a few (too few?) leaders who are vocal on this right now. The question remains: Is anyone listening? And if not, why?

Meanwhile, on a grass-roots level, multi-stakeholders are coming together in a growing number of communities to explore and take action on the social determinants of health in the places people live and work. We welcome participation by all: www.communitiesofhealth.org.

Thanks,
Rick Brush
Co-Founder, Communities of Health
www.communitiesofhealth.org

Posted by Rick Brush on Friday, May 01, 2009 at 12:54 pm ET
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I believe that "social stress" from broken relationship, or pressure on the workplace may lower immunity, and thus makes affected person susceptible for infection. In this state of low immunity, many people feel tired and seek medical advice, but lab tests often show only elevated antibodies to some viruses from previous infections. These findings upset many of them, so they go and spend a lot of money for additional testing, often with no success.

My question: Is there any reliable laboratory test that would serve as an evidence of "low immunity" in situations when a persons feels down? I mean for the period before eventual infection. It's a serious question. In "low immunity" some viruses, like EBV may (supposedly) reactivate, but there's often not clear why. There are several disorders with elevated EBV antibodies (http://healthwriter.eu/explanation-of-raised-ebv-antibodies-in-the-blood-serum/), but is there any test that would show that the cause of reactivation is low immunity? 

Jan Modric,
health writer

Posted by Jan Modric on Tuesday, February 24, 2009 at 12:54 pm ET
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I am writing to you regarding a new strategy being adopted by paramedic services in Ontario for the immediate containment and isolation of respiratory diseases on first contact.  Although a popular concern is the prevention of other respiratory borne illnesses, this also applies to TB, where the risk to healthcare providers has been shown to be significantly high.  A simple strategy, it involves the use of patient care devices (oxygen masks and medication delivery devices) that have been designed to filter exhaled particles.  Conventional patient care policies involve the use of surgical masks on patients suspected of carrying a contagious respiratory borne illness.  However, many patient activating the healthcare system will require and receive oxygen therapy and medication by masks, which cannot be used with a surgical mask.  Therefore, a concerned healthcare provider would have to choose between isolating the patient or treating the patient and risk exposing surrounding surfaces and people.  Conventional oxygen masks have been studied and shown to expel a substantial amount of particles through normal use.  These particles can then travel onto surfaces or be inhaled by others, leading to hospital acquired infections.  As you are aware, many patients carrying respiratory borne illnesses activate the healthcare system for issues other than an underlying respiratory illness.  This scenario was revealed after the 2003 SARS crisis in Canada, where 44% of the victims were healthcare providers or ancillary staff, and 19 people were infected throughout a hospital by a patient being treated for a cardiac complaint. They later went on to infect an additional 16 people.

The strategy of replacing conventional oxygen masks with similar devices that offer filtration of exhaled particles is a logical extension of providing a physical barrier between the infectious agent and the surrounding environment.  Hopefully, this strategy will be considered by other prehospital and hospital agencies as another cost effective approach  to a multifaceted problem.  Please note that I am not promoting any particular brand or type of device, however you should be aware that several types of filtering oxygen masks are available by a number of manufacturers across the globe.

All the best,

Ted Reesor, Registered respiratory Therapist

BLS Systems Ltd.
1124 South Service Road West
Oakville, Ontario
L6L 5T7

Posted by Ted Reesor on Friday, January 16, 2009 at 12:54 pm ET
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Thank you for your post. You bring up a very important question and I welcome the chance to address this important issue.

TB bacteria is spread through the air from one person to another when someone who is sick with TB disease of the lungs or throat coughs, speaks, laughs, sings, or sneezes. In most people who breathe in TB bacteria and become infected, the body is able to fight the bacteria to stop them from growing. The bacteria become inactive, but they remain alive in the body and can become active later. This is referred to as latent TB infection. A person can have latent TB infection for years. But if that person's immune system gets weak, the infection can quickly turn into active TB disease. Also, if a person who has a weak immune system spends time with someone with active TB disease, he or she may become infected with TB bacteria and quickly develop active TB disease.

Because HIV infection weakens the immune system, people with latent TB infection and HIV infection are at very high risk of developing active TB disease. All persons with HIV infection should be tested to find out if they have latent TB infection. If they have latent TB infection, they need treatment as soon as possible to prevent them from developing active TB disease. If they have active TB disease, they must take medicine to treat the disease. CDC has a booklet, Take Steps to Control TB When You Have HIV, about the importance of TB testing, treating TB infection, and treating TB disease when a person has HIV infection.

As far as risk factors for HIV and TB co-infection, I will have to give you a two - fold answer. First, there are specific risk factors for acquiring HIV. We have outlined these risks on the basic information section of our HIV Web site.

Next, to get infected with TB bacteria, an individual would have to come in contact with someone with active TB disease. People with TB disease are most likely to infect people they spend time with every day, such as family members or coworkers. Individuals who have come in contact with someone with active TB disease should contact their doctor or their local health department to get tested. CDC provides contact information for the TB Control Offices in each state on our TB Web site.

Hope this answers your question.
Kevin


Posted by Dr. Kevin Fenton on Monday, January 12, 2009 at 10:32 am ET
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