Legislature(2015 - 2016)CAPITOL 106
11/03/2015 10:00 AM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
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| Start | |
| Presentation: Proposals for Increasing Wellness and Prevention to Reduce the Number of People Accessing Medicaid or Other Health Care Services, Initiatives for State Government, Social Programs and General Practice. | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
November 3, 2015
10:04 a.m.
MEMBERS PRESENT
Representative Paul Seaton, Chair
Representative Liz Vazquez, Vice Chair
Representative Neal Foster
Representative David Talerico
Representative Geran Tarr
Representative Adam Wool
MEMBERS ABSENT
Representative Louise Stutes
COMMITTEE CALENDAR
PRESENTATION: PROPOSALS FOR INCREASING WELLNESS AND PREVENT TO
REDUCE THE NUMBER OF PEOPLE ACCESSING MEDICAID OR OTHER HEALTH
CARE SERVICES, INITIATIVES FOR STATE GOVERNMENT, SOCIAL PROGRAMS
AND GENERAL PRACTICE.
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
JEFF GOODELL, Building Manager
Maintenance
Legislative Administrative Services
Legislative Affairs Agency
Juneau, Alaska
POSITION STATEMENT: Discussed the current seismic retro-fit
construction project, maintenance department, and safety issues
within the Capitol building.
NELLY AYALA, RN, MSN
Division of Public Health, Program Manager
Department of Health & Social Services
Anchorage, Alaska
POSITION STATEMENT: Presented Chronic Disease Prevention Health
Promotion, Diabetes Prevention and Control.
PATRICK SIDMORE, Planner
Alaska Mental Health Board
Advisory Board on Alcoholism and Drug Abuse
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Discussed links to health and economic
outcomes.
JAY BUTLER, Chief Medical Officer/Director
Division of Public Health
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Clarified the source of the three research
papers.
MARK ERICKSON, M.D.
Alaska Psychiatric Institute (API)
Anchorage, Alaska
POSITION STATEMENT: Testified regarding vitamin D and
depression.
ACTION NARRATIVE
10:04:04 AM
CHAIR PAUL SEATON called the House Health and Social Services
Standing Committee meeting to order at 10:04 a.m.
Representatives Foster, Vazquez, Talerico, Tarr, and Seaton were
present at the call to order. Representative Wool arrived as
the meeting was in progress.
^PRESENTATION: PROPOSALS FOR INCREASING WELLNESS AND PREVENTION
TO REDUCE THE NUMBER OF PEOPLE ACCESSING MEDICAID OR OTHER
HEALTH CARE SERVICES, INITIATIVES FOR STATE GOVERNMENT, SOCIAL
PROGRAMS AND GENERAL PRACTICE.
PRESENTATION: PROPOSALS FOR INCREASING WELLNESS AND PREVENTION
TO REDUCE THE NUMBER OF PEOPLE ACCESSING MEDICAID OR OTHER
HEALTH CARE SERVICES, INITIATIVES FOR STATE GOVERNMENT, SOCIAL
PROGRAMS AND GENERAL PRACTICE.
10:05:18 AM
CHAIR SEATON reminded the committee that today it would review
different proposals and opportunities to help people stay well
and; therefore, avoid placing a burden on the health care
system.
10:05:52 AM
REPRESENTATIVE TALERICO described himself as a "rubber meets the
road" type of fellow and that health safety and safe
environments have always been a concern. He explained it is
likely that 3 out of 100 workers will file a worker's
compensation claim in the United States, and there may be 11-13
fatalities today in the United States' workplace. He advised
the United States has lived with those statistics for quite some
time and the goal of safety professionals throughout the
country, and hopefully all private business and government
organizations, is to bring the number to zero. He offered that
a person witnessing a fatality at the workplace can sometimes
take years to recover and its traumatic effects can take a
person to a numb stage. He offered that safety officers are
concerned with an avalanche of "those things" happening because
the focus suddenly goes away from the actual job and the safety
portions of it.
10:08:46 AM
JEFF GOODELL, Building Manager, Maintenance, Legislative
Administrative Services, Legislative Affairs Agency, advised
that the maintenance department purchased updated safer
equipment, such as a saw-safe table saw that will shut off
should a human part, wet wood, or a piece of metal contact the
blade. He explained that additional safety measures have been
taken, such as: air filter boxes installed in the shop; and
safety gear is required and should an individual work on a piece
of equipment without safety equipment, the individual is banned
from that piece of equipment for a period of time just to get
the message across as eyes, ears, and lungs are very important.
As far as the building in general for all of its tenants, within
the seismic retro-fit all of the Asbestos Containing Material
(ACM) is being removed that "we are in contact with within the
project delineation." He pointed out that the Capitol Building
was built during the late 1920s - early 1930s, and pipe was
insulated with asbestos wrap. He advised he has received
authority in areas outside of the project but that are exposed
to eye sight, and people's access, to have ACM removed for
everything within his reach. Although it is expensive, the
United States is targeting buildings for ACM removal, and even
though he does not have that luxury, everything he can get to
has been removed by the abatement contractor, he explained. Mr.
Goodell noted that "we" are doing our best to improve the air
quality in the building, and within that goal a number of heat
recovery and ventilation (HRVs) units will be implemented next
year. He noted there is a three-year process for Phase 2 of the
retro-fit, and commented that he will doing everything he can
physically and economically to improve the quality of the
building.
10:13:44 AM
CHAIR SEATON asked for more detail regarding safety exercises or
meetings.
MR. GOODELL responded that daily and weekly they discuss any
issue personnel is interested in. Previously bulletins were
used, but many of the purchased bulletins predominantly did not
pertain to this particular environment and they are in search of
a "more practical, more maintenance based" weekly bulletin, he
advised. He related that he is "constantly" reminding his
maintenance and custodial staff about safety, and should an
individual notice something to bring it forward.
10:15:25 AM
REPRESENTATIVE FOSTER recalled previous safety meetings he had
been involved with and described them as important in that they
can save a life, limb, [or injury]. He asked whether there is
anything the committee or state can do to "get back to the
basics," and suggested a possible safety education campaign for
public awareness.
10:16:31 AM
REPRESENTATIVE TALERICO offered that it is encouraging that Mr.
Goodell presented today as one of his main focuses are safety
activities, and that safety is considered on a routine basis
under his leadership. He pointed out that Mr. Goodell's
subordinates are well aware of his commitment to safety in that
it provides a better environment for the worker. Representative
Talerico commented that everyone in a management or leadership
role, whether government or private, should take a safety role
and lead as there are tremendous educational opportunities and
suggested googling safety. He said, "safety first."
10:18:42 AM
CHAIR SEATON offered appreciation that the subject of
maintenance safety is discussed and noted that the state
workforce includes secretaries and office personnel. He opined
that feedback has not been obtained from the commissioners of
other departments as to how they address ongoing or possible
safety problems of every shift as there have been lots of
workman's compensation claims within the office personnel. He
suggested a letter to each commissioner from the committee
inquiring as to what they are doing with each class of their
personnel to promote safety and, thereby, not requiring health
care. He asked Representative Talerico for more information
regarding his previous safety meetings and employment.
10:21:08 AM
REPRESENTATIVE TALERICO answered that many private industries
[hold safety meetings], spurred by reducing the costs of health
care and insurance, and noted that workers often support an
entire family. He explained that many workplaces have adopted a
"safety share;" a daily event for work crews or individuals to
ascertain that an awareness is brought forth to be alert and
safe in a work environment. He related that safety share
requires participation and everyone involved is encouraged to
routinely share a safety moment, such as sharing something of a
very serious nature that may not be obvious to some people. He
remarked that he advises his staff that one of the largest
workplace injuries is referred to as "slips, trips, and falls,"
and sometimes the daily reminder can not only avoid the injury
but the costs associated with the injury. He offered that
recently it was actually safer to work in the mining industry
than working in a big box store, which may have a lot to do with
focus. The Occupational Safety and Health Administration (OSHA)
has very distinct, rigid safety rules to abide by and over the
years many people covered by the Mine Safety and Health
Administration (MSHA) have determined the best way to do this is
to get very aggressive with their safety programs.
Consequently, he explained, workers are safer and they save
money, yet beyond that there is a quality of life issue for the
injured worker. He agreed that the committee should learn from
all of the departments where they are on safety for their
employees.
10:25:03 AM
CHAIR SEATON commented that the House Health and Social Services
Standing Committee is looking at initiatives, projects,
proposals, and procedures to ascertain that the state has not
only a healthy workforce, but healthy citizens. He related that
a number of legislators went to the North Slope and stayed at
the ConocoPhillips Alaska facilities for lunch and noted that at
every stairwell is a "3 points of contact" sign requiring that
all workers use the handrail. Many times staff and legislators
do not use the handrail and may trip and, he said, hopefully
there will be other ideas to share with the legislators of their
responsibilities with their staff.
10:26:34M
REPRESENTATIVE FOSTER admitted to being the latest victim in the
area of texting and falling down the stairs.
REPRESENTATIVE TALERICO related that the "3 points of contact"
is a standard in most industrial sites, and under MSHA rulings
during an inspection of a company if MSHA witnesses someone not
utilizing "3 points of contact" when using a staircase or
getting on or off pieces of equipment it is an automatic
citation and fine because it keeps people safe.
CHAIR SEATON expressed appreciation on focusing on safety,
together with nutrition and staying off drugs.
10:27:36 AM
REPRESENTATIVE VAZQUEZ mentioned areas in office work that need
adjusting in the focus for safety, such as the correct way to
pick up items, avoiding eye strain, stretch to avoid muscle
strain, and carpel tunnel syndrome.
REPRESENTATIVE TALERICO expressed appreciation to Mr. Goodell
for staying "on top of this" and expressed confidence in his
leadership.
10:28:57 AM
REPRESENTATIVE WOOL asked whether anyone has lost any appendages
on the table saw here.
MR. GOODELL responded no, not on his watch or the few years
prior to his employment.
CHAIR SEATON stated that the committee will solicit from the
different departments how they are attempting to control
[injuries] and their procedures for health in their workplace.
10:29:44 AM
CHAIR SEATON announced the next order of business would be the
presentation of Diabetes Prevention and Control.
10:30:27 AM
NELLY AYALA, RN, MSN, Division of Public Health, Program
Manager, Department of Health & Social Services, offered a power
point presentation to explain what the Diabetes Prevention and
Control Program is doing to help people stay well and increase
diabetes awareness in Alaska. She turned to slide 2: "Chronic
Disease Prevention & Health Promotion," and said the slide shows
a whole person with many chronic diseases, and that each of the
chronic diseases risk factors are addressed by projects and
programs within the Chronic Disease Prevention and Health
Promotion.
MS. AYALA turned to slide 3: "What is Diabetes." She said that
diabetes is a problem in the body that causes blood glucose
(sugar) to raise higher than normal. She advised that within
this presentation, the discussion is Type 2 diabetes as it is
the most common form of diabetes in the country and Alaska.
With regard to Type 1, the estimates are that approximately 5-10
percent of children are affected, she advised. Type 2 risk
factors include: weight; inactivity; fat distribution especially
around the mid-center, belly or abdomen; family history - a
sibling or parent with Type 2 diabetes; age - as a person ages
Type 2 is more commonly seen and quality of life is important in
aging; race - Alaska Native, African Americans, Hispanics, Asian
Pacific Islanders; pre-diabetes diagnosis - estimated that
within five-years diabetes will occur unless lifestyle behavior
is changed; Gestational diabetes - diabetes while pregnant or
having a baby nine pounds or heavier puts the woman at greater
risk of type 2 diabetes; and Polycystic Ovarian Syndrome
increases risk for diabetes.
10:33:38 AM
MS. AYALA turned to slide 4: "Diabetes and Prediabetes
Prevalence in Alaska (BRFSS 2013)," and explained the chart as
data from the Behavioral Risk Factor Surveillance System 2013
(BRFSS), which is the nation's premier system of health related
telephone surveys collecting [indisc.] data about United States'
residents regarding their health risk behaviors, chronic health
conditions, and use of all preventive services. She advised the
chart represents the percentage of Alaskans age 18 and older
diagnosed with pre-diabetes and diabetes. She explained that
pre-diabetes is a condition in which individuals have a blood
glucose level higher than normal but not high enough to classify
as diabetes. She said the people listed in the numerator
answered the question yes, as to whether they were ever told by
a health care professional they had diabetes or were pre-
diabetic, border-line diabetic or diabetic during pregnancy.
The denominator represents all adults age 18 and older that
responded to the diabetes and prediabetes question, excluding
all unsure answers. She pointed out that the chart indicates
6.5 percent out of 100 Alaskan women are estimated to be
diabetic, while 10.5 out of 100 Alaskan women are estimated to
be pre-diabetic. Individuals age 65 and older are at greatest
risk for pre-diabetes and diabetes; 45-64 age group are second
largest; and the 34-44 age group is slowly rising, she advised.
10:36:47 AM
MS. AYALA turned to slide 5: "Age-Adjusted Diabetes Prevalence
in Adults, Alaska (BRFSS)" and said the graph indicates that
from 1991-2013 there is a slow increase with time depending upon
issues. Slide 6: "Cost of Diabetes." She explained that in
2010, the annual cost of care for the U.S. Medicaid diabetes
group is approximately $14,229; and for those without diabetes
in the same age group on Medicaid was approximately $4,568. She
pointed to 2012, and said for the Medicaid diabetes group in the
United States, the estimated cost was $13,741; and those without
diabetes was $5,853. Table 2: "Incurred cost of Medicaid
beneficiaries 20 years and older in AK" represents numbers from
the 2014 Evergreen Report. She pointed out that the 2012
diabetes Medicaid beneficiaries included 5,938 people, incurred
cost per diabetic beneficiary was $26,468, and the total cost of
diabetic beneficiary was $157,167,553. [The chart also
indicates the costs for 2013 and 2014.]
10:38:55 AM
MS. AYALA turned to slide 7: "The Key is Prevention." Risk
factors for Type 2 diabetes include: inactivity, obesity and now
smoking has been shown as a causal relationship, she explained.
Educating people on the major complications of diabetes is
important because this year the CDC estimates that one out three
people do not know they have pre-diabetes, and one out four
people do not know they have diabetes, she said.
MS. AYALA turned to slide 8: "Among Alaska Adults with
Diabetes." She offered that it is known that 19 percent smoke,
30 percent are inactive, and 59 percent are obese. She opined
she is unclear as to how many of the individuals knew they were
diabetic. Ms. Ayala turned to slide 9: "What is the Diabetes
Prevention and Control Program?" She said it is a program
housed by the Chronic Disease Prevention & Health Promotion
Division, and works hand-in-hand with Obesity, Tobacco, Cancer,
and Cardiovascular Disease Prevention and Stroke Programs to
prevent these diseases. She explained that the program focuses
mainly on Type 2 diabetes for adults in Alaska, and access to
resources for those affected by Type 2 diabetes.
10:41:03 AM
MS. AYALA turned to slide 10: "Barriers." She explained that
Alaskan barriers include: access to health care and continuity
of care, such as the military and seasonal workers; referrals to
community resources as education, information, and communication
must be increased; and community level case management because
there is a lack, community resources often don't know about
other resources available within that city or town and it is
difficult in "spreading the word" about diabetes self-management
classes and residents often do not know resources are available
within their community. She pointed out that barriers also
include financial, such as: insurance coverage in that some
resources are not covered; staffing in programs as staff burnout
with complaints of too many tasks for one person, low morale;
costs of implementation, evaluation, and follow-through in
programs to ascertain that people are receiving the highest
quality care in sustainable programs; and cost of effective
health communication plans and reaching Rural Alaska and not
focusing solely on the urban areas. She pointed to a barrier of
knowledge on impact of chronic disease on the overall health
that includes: a person suffering more than one chronic disease
and a person over 65 years of age is considered a complex
patient; and that the direct relationship in Alaska between
tuberculosis and diabetes, obesity and diabetes, and smoking and
diabetes is being reviewed. A final barrier could be: education
on the chronic disease and self-managing a disease as people
need to feel empowered, need to know they can actually control
their diabetes or chronic disease, knowing about prevention, and
that changing life style behaviors can delay the progression of
disease up to 11 years.
10:44:37 AM
MS. AYALA turned to slide 11: "Community-Based Approaches."
She said the current focus is on community-based approaches in
more people being screened via partnerships with local
organizations for diabetes especially, she reiterated, when one
out of three people do not know they have pre-diabetes and one
out of four do not know they have Type 2 diabetes. She advised
that screening partnerships include: Alaska Health Fairs, Inc.,
to provide free HbA1c tests; Diabetes Lipid Clinic provide free
HbA1c tests; Providence Outreach Center to inform the public
about Alaska Health Fairs; YMCA to inform the public about
Alaska Health Fairs and provide paper screening tests for those
who do not want to do a blood test; Alaska Commercial to provide
the public with paper screening tests in their store; Anchorage
Neighborhood Health Centers to include information about
screening in their website and Facebook page; and American
Diabetes Association to get more paper screening tests
throughout Alaska and generate more health fairs at new
locations.
MS. AYALA turned to slide 12: "Community-Based Approaches,"
includes working with local organizations to spread the word
about diabetes because if it is not discussed people tend to
forget about it because they think "it could not happen to
them." She offered that community-based organizations approach
spreading the word, increase awareness about diabetes, and those
organizations include: the American Diabetes Association; Alaska
Commercial Stores; Alaska Public Media; ANTHC Special Diabetes
Program for Indians; YMCA; Faith-based organizations; Alaska
Primary Care Associates; Providence Hospital involves tele-
medicine, tele-health, and creating programs to reach other
areas such as, Sitka Hospital, SEARHC, and Kodiak.
10:47:30 AM
MS. AYALA turned to slide 13: "Programmatic Approaches." She
said that a focus is the self-management program to empower
patients, such as those with a chronic disease, or a care taker
of a person with a chronic disease, or requesting information
regarding diabetes or a chronic condition. She explained it is
a six-week program, meets once a week in a group setting (10
people or more,) is evidence-based and is recommended by the
2015 ADA clinical guidelines. The goal, she offered, is to
teach individuals the goals necessary to adopt healthy habits
and promote the idea of life style changes and behaviors. She
explained that the self-management programs are offered in two
way: Chronic Disease Self-Management Program (CDSMP); and,
Diabetes Self-Management Program (DSME).
10:48:43 AM
MS. AYALA turned to slide 14: "Programmatic Approaches." She
offered that they are also working with patients affected by
pre-diabetes, or at-risk of diabetes through the National
Diabetes Prevention Program. This program, she explained,
begins with 16-weeks of weekly meetings, then small group
meetings monthly up to one year, with access to a CDC nationally
recognized online program to support the monthly support group
meetings. She said the online program is free of charge due to
a partnership with Nutrition Quest, and the on-site locations
include: Anchorage, Juneau, Fairbanks, and in the near future
Seward.
MS. AYALA turned to slide 15: "Benefits of DSME." The
evidence-based benefits of the diabetes self-management
education (DSME) are important as it reduces health
complications including: heart disease, stroke, kidney disease,
nerve damage, pregnancy complications and eye diseases; it can
sustain successful long-term self-management with ongoing follow
up and support; and lower hospitalization rates by 34 percent.
She pointed out that DSME is included in the American Diabetes
Association Standards of Medical Care in Diabetes and Clinical
Practice Recommendations, and is noted as a best practice
program.
10:51:05 AM
MS. AYALA turned to slide 16: "Economic Savings of DSME." She
proposed that one way to decrease the economic burden on the
health care system is by taking the time to implement a
successful DSME program. She pointed out that the Evergreen
Report estimates that for each Alaska Diabetic Medicaid
beneficiary the cost is $26,300, yet if every Medicaid enrolled
diabetic in Alaska took at least one DSME class, there would be
an estimated Medicaid cost savings of $6.9 - $36 million per
year. She offered that this amount equals a net of $4 return
investment for every $1 spent.
10:52:00 AM
MS. AYALA turned to slide 17: "Pre-Diabetes." She explained
that the online system is because of pre-diabetes "hot pockets"
that are mainly in urban areas, such as Anchorage, Kenai, and
the Matanuska-Susitna area, and it is important there is free
and accessible [information] available. People are being
advised, through various health fairs with their partnership
with Alaska Health First, that [DSME programs] are available,
evidence-based, and high quality, she offered. When signing up,
a one-year free subscription is included and, she noted, there
are long-term effects by changing life styles and habits.
MS. AYALA turned to slide 18: "Summary Slide." Self-management
programs help empower people and provide them with the tools
necessary to take care of their health and, she pointed out,
that the total annual cost of Alaskan diabetic Medicaid
beneficiaries is $165.7 million. She stressed that diabetes
prevention is needed and the CDC estimates that by 2050, one out
of three people in the United States will have diabetes. She
related that these people enjoy the services and the opportunity
to learn from the programs.
10:54:23 AM
MS. AYALA turned to slide 19: "Resources." She explained that
the slide includes some of the diabetes resources available,
such as "[email protected]; [email protected];
Http://list.state.ak.us.
10:55:09 AM
REPRESENTATIVE TARR referred to Ms. Ayala's statement that the
greatest increases of [pre-diabetes] are found in urban centers,
and asked her to discuss the issue from a statewide perspective.
MS. AYALA responded that the rate focuses on 6.5 percent per 100
people, and the more densely populated area would have the most
people.
10:57:42 AM
REPRESENTATIVE TARR pointed to the community outreach slides and
noted that quite a number of organizations may be located in the
urban center. She inquired as to whether they were working with
the tribal health organizations, or working within some of the
harder to reach areas of the state in community based
prevention.
MS. AYALA replied that they are working on a long-term
partnership with the Alaska Native Health Consortium and are
working. She said discussions have included how funding would
be effective for this special diabetes program for Alaska
Natives, and how the state can assist, she said. She then
explained that on December 1, 2015, the Alaska Native Diabetes
Conference takes place in Anchorage and all tribal health
representatives will attend, and they will listen to understand
the stakeholders' needs in developing sustainable programs
before implementing or recommending a program. She said that
Diabetes Prevention and Control has discussed creating a
partnership with Alaska Health Fairs and its wellness base in
order to implement a wellness program and use less resources
that could be directed elsewhere. She explained that
discussions have also taken place as to receiving recognition
for the gold standard Diabetes Prevention Program (DPP), which
was the first program by the Indian Health Board to be created
for diabetes prevention and control. She remarked, in order to
move in that direction, the staff must offer input as to what
type of support would be needed as it would require creating
more reports to become CDC recognized. She offered that they
have been brainstorming issues in preparation for the December
meeting, and that there must be a dialogue from tribal villages
and their community leaders.
11:00:57 AM
CHAIR SEATON pointed to slide 3, noting that the factors are not
addressable as to age, family history, race, or pre-diabetes,
which leaves weight, inactivity, obesity, and smoking, although
mechanisms or prevention programs could address gestational
diabetes. He asked whether they had reviewed what is different
in Alaska and why the rate is higher than the rest of the United
States.
MS. AYALA responded that Alaska does not necessarily have a
higher rate of weight and inactivity as Alaska fits with the
rest of the United States. She related that obesity is a global
epidemic.
CHAIR SEATON questioned whether Alaska has a higher rate of
diabetes.
MS. AYALA replied no, in 2013, the rate of diabetes in Alaska
was 7.1 percent, and approximately 7 percent for the national
average.
11:03:07 AM
REPRESENTATIVE TARR asked members to bring the committee
materials to the next meeting.
11:04:10 AM
CHAIR SEATON recessed to a call of the chair.
4:03:28 PM
CHAIR SEATON reconvened the House Health and Social Services
Standing Committee at 4:03 p.m. Representatives Talerico, Wool,
Tarr, and Seaton were present at the call back to order.
Representatives Vasquez and Foster arrived as the meeting was in
progress.
4:04:16 PM
REPRESENTATIVE TARR referred to the earlier presentation and
asked the committee to keep the same risk factors in mind, such
as tobacco use, alcohol use, diet, and obesity. She turned to
the PowerPoint presentation entitled "Adverse Childhood
Experiences [ACEs]," slide 1: "What is ACEs?" She said there
was a 1998 landmark study that reviewed middle class adults to
quantify health outcomes in relationship to traumas they may
have experienced as a child. She explained that the study was
performed in partnership with the Center for Disease Control
(CDC) and the Kaiser Permanente Health Appraisal Clinic in San
Diego, with over 17,000 participants. The study developed an
ACEs 0-10 score for individuals in order to predict health
outcomes which in turn assists in understanding how to achieve
prevention savings, she remarked.
REPRESENTATIVE TARR turned to slide 2: "What is your ACEs
Score?" She read the 10 questions to the committee for their
response. [The ACEs quiz can be found at
www.npr.org/sections/health-shots/2015/03/02/387007941/take-the-
ace-quiz-and-learn-what-it-does-and-doesn't-mean.] Following
the questions, she noted that each member may want to use their
ACEs score in context to the implications of high ACEs scores.
4:11:34 PM
REPRESENTATIVE TARR turned to slide 3: "ACEs studies in
Alaska." She said that two findings include: childhood trauma
is more common than previously realized; and that the impacts of
this trauma affects individuals over a lifetime and societies
over generations. She described a current exciting genetics
study called "Epi genetics" that reviews how experiences or
environmental influences change the way a gene is expressed and
that intergenerational trauma changes can occur at the cellular
level and impact the next generation.
REPRESENTATIVE TARR referred to [page 3, figure 3] of the
handout entitled "Adverse Childhood Experiences Overcoming ACEs
in Alaska," and advised the pyramid and circle [on page 5,
figure 4, "Adverse Childhood Experience Cycle] are used to
assist people in understanding the whole life experience. She
referred to the pyramid example and said that adverse childhood
experiences lead to social, emotional, and cognitive impairment,
which leads to the adoption of health risk behaviors, which
leads to disease, disability and social problems, which leads to
early death. She referred to the circle and explained that it
walks through how someone with early childhood traumas might be
changed throughout their entire lifetime.
4:13:47 PM
REPRESENTATIVE TARR turned to slide 4: "ACEs Scores in Alaska."
She advised it offers the most recent percentage research, and
that there is concern regarding individuals with a score of 4+
and how those scores can be reduced to improve health outcomes.
She referred to the pinwheel in the handout entitled "Adverse
Childhood Experiences Overcoming ACEs in Alaska," page 6, figure
5, of potential negative outcomes. She questioned that among
the variety of undesirable health outcomes, what percentage of
these can be linked back to ACEs. She explained that in an
attempt to reduce costs, the pinwheel depicts that if the state
could reduce the frequency of these particular adverse childhood
experiences then the frequency of poor health outcomes would be
reduced, thereby reducing costs.
REPRESENTATIVE TARR referred to slide 5: "Select Negative
Health Outcomes," and said, for example the Medicaid piece shows
that 40.6 percentage of individuals currently receiving Medicaid
services can be attributed back to high ACEs scores, current
smokers 32 percent, heavy drinking 20.5 percent, and overall
poor physical health 33.2 percent. She described this as a
significant number of individuals who could potentially benefit
by performing prevention efforts.
4:16:46 PM
REPRESENTATIVE TARR turned to slide 6: "Costs Associated with
ACEs," and referred to the pinwheel and said that 32 percent of
the current smokers can be attributed back to ACEs, and
approximately $576 million a year is spent on smoking related
illnesses which could translate up to $186 million in savings.
She offered that in reducing substance abuse by 20 percent there
would be [Patrick Sidmore's figure] $250 million in savings and
that reducing Medicaid cost by 40.6 percent would be a savings
of $350 million. She explained that when translating this into
the cost, the total in annual savings by preventing ACEs is
approximately [$786] million. She related there is a double
benefit in saving money and also improving health outcomes.
REPRESENTATIVE TARR turned to slide 7: "Opportunities for
Prevention." She offered that those include: trauma informed
health care, and that trauma informed curriculum speaks to
providing educators with tools to understand the life challenges
some of their students are facing and improve their educational
outcomes. She offered that a prevention opportunity could be
the movie "Paper Tigers" that is being shown by Alaska
Children's' Trust and community partners. Her concern is that
with regard to ACEs, the state may currently be doing the wrong
intervention and in doing so further isolate these students and
cause a bigger challenge for them to succeed in school. She
said that Trauma Informed Curriculum speaks to the idea that if
educators can be provided with tools to understand some of these
life challenges their students are facing, it would inform them
as to how to administer curriculum in the classroom and improve
student's educational outcomes.
4:19:32 PM
REPRESENTATIVE TARR said that other states offer pilot programs,
and that Vermont passed legislation to look into ACEs and
determine additional opportunities to educate community members,
and provide resources for individuals working especially with
children. She remarked that Montana passed legislation in 2013,
and that other initiatives are happening in other states. She
referred to the handout entitled "Adverse Childhood Experiences
Overcoming ACEs in Alaska," [page 7, table 2] and pointed to the
areas marked in red where Alaska ranks at the top of those
categories. In discussing recidivism and anti-recidivism
efforts, she said, think of the life of a child growing up and
that the repetitive instances of the trauma must be more
damaging. Substance abuse in the home, domestic violence, and
sexual assault impacts other behaviors, she related. When
looking at how to prevent diabetes and its risk factors, such as
tobacco use, alcohol use, and obesity, are things associated
with having bad outcomes. There is much to gain if these
adverse childhood experiences can be prevented in that it could
prevent a whole series of costly health problems, she opined.
4:22:56 PM
PATRICK SIDMORE, Planner, Alaska Mental Health Board, Advisory
Board on Alcoholism and Drug Abuse, Department of Health and
Social Services, advised there are links to health and economic
health outcomes regarding cancer, heart disease, asthma, smoking
and drinking. He said, for example injecting drugs, 78 percent
of the people were linked back to ACEs. In other words, he
explained, if all ACEs was eliminated, 78 percent of people
injecting drugs would be eliminated. He said that powerful data
has been replicated over and over in other countries and there
are scores and scores of studies now. He advised they now have
survey information on 8,000 Alaskans taken in 2013 and 2014,
which will give them information about their ACEs scores and
communities. He provided a recently completed document entitled
"The Economic Costs of Adverse Childhood Experiences in Alaska"
to the committee, and advised that six items were reviewed:
Medicaid, smoking, binge drinking, arthritis, and obesity. He
explained that they picked two states (Arkansas and Vermont)
that performed well in ACEs, and overlaid their ACEs score onto
Alaska's results and found that in Medicaid the state could save
$32 million a year and smoking would be approximately $30
million less. The six items added up to a savings of over $90
million and it does not include the savings of the other
approximately 20-30 measures linked to ACES, he offered. He
said [ACEs] is catching on in communities throughout the state
as a way to impact the health of their communities and hopefully
have lower cost interventions early for young families to
prevent this trouble down the road. He added that the CDC says
that every child found with the substantiated report of harm
costs the state $50,000 in childhood alone. The savings start
right away, but the long term is "really where the money is," he
said.
4:26:22 PM
REPRESENTATIVE TARR pointed to the handout "Adverse Childhood
Experiences Overcoming ACE's in Alaska," page 3, figure 1, "ACE
Score and Suicide Attempt Prevalence," and stressed that ACEs
may be an area to explore when discussing suicide prevention and
missing pieces. She advised that men ages 18-24 are the highest
rates of suicide, and if they had adverse childhood experiences
it would have been a building problem in their life before they
choose to finally take their life. The adverse childhood
experiences program offers the potential for better health
outcomes, she explained. She said she is hopeful opportunities
will be taken to address ACEs as a legislative body, whether
that means providing funding for a pilot program or legislators
doing things in their communities as the opportunities are
endless at this time.
4:28:10 PM
REPRESENTATIVE FOSTER referred to grant programs and noted that
previously money was appropriated for a program called the
Qungasvik, which is out of the Alakanuk and Emmonak area. He
reminded the committee that the whole area of Hooper Bay and the
whole Lower Yukon has seen a rash of suicides, a high per capita
number, and the unique reason the Qungasvik program worked was
because it was culturally relevant and there were activities
based in the local culture. He said that the results of the
program showed that numbers were improving.
4:30:00 PM
REPRESENTATIVE WOOL expressed that these kinds of studies are
illuminating in that they can assess a person's upbringing and
environment to determine a number and then correlate that number
with certain unhealthy activities. Obviously, he noted, the
goal is to eliminate unhealthy instances in a child's upbringing
so their score is lower, and also to intervene later on and
educate them. He asked whether there are programs to educate
people about their high ACEs number, as well as trying to
eliminate the behavior early on.
REPRESENTATIVE TARR answered yes, such as the trauma informed
curriculum and also building resiliencies. She noted there has
been a bit of controversy over that concept, but the idea is
that if the instances cannot be prevented from happening, how to
help an individual be stronger in light of that and be resilient
throughout their lifetime and avoid some of the unhealthy
outcomes. She noted that an individual with an ACEs score of 1
has a 20 percent increased risk of heart disease; the score of 2
is twice as likely to experience humanoid disease, and 70
percent more likely to have heart disease; a score of 4 has a 3-
4 times higher risk of depression, is 5 times more likely to
become an alcoholic, is 8 times more likely to experience sexual
assault, and up to 10 times more likely to attempt suicide. She
noted that it is likely that multiple things are going on in the
home, such as alcohol or drug abuse and a parent goes to jail
which could cause neglect. She asked Mr. Sidmore to comment on
the recent study and neglect issues.
4:32:54 PM
MR. SIDMORE advised that during the first year of the study
using the behavioral risk factor surveillance system discussed
earlier regarding diabetes. He explained that they did not
include neglect, but did include neglect in the second year of
the study. Neglect, he explained, is the most common reason
children are taken out of their homes at OCS, and in reviewing
the data today noted that neglect is highly correlated with the
other adverse childhood experiences. He said they continue to
learn from this and will put it out to professionals, and
related that therapists around the state are using this more and
more and explaining ACEs score with clients. Therapist are
changing from "what is going on with you" to "what happened to
you" and it is powerful and helpful to individuals to heal, he
stated.
4:34:15 PM
REPRESENTATIVE VAZQUEZ referred to the handout "Adverse
Childhood Experiences Overcoming ACEs in Alaska," and noted that
the Advisory Board on Alcoholism and Drug Abuse, and the Alaska
Mental Health Board were involved. She pointed out that page 6,
reads that 60.1 percent of individuals experiencing frequent
mental distress have ACE scores, and asked the score.
MR. SIDMORE explained that those numbers are a calculation
commonly used in epidemiology called the "Population
Attributable Fraction." He further explained that it is based
upon a score of one-eight ACEs. He described it as a
calculation that within the population with zero ACEs there is a
certain percentage of people that will have "whatever"
condition. The 60.1 percent would go away if all ACEs would go
away, he said.
REPRESENTATIVE VAZQUEZ surmised it is the range from zero to
whatever. She suggested that the Alaska Mental Health Authority
could be source of funding as they are supposed to be taking
care of the mental health area, or at least assist in that
process.
REPRESENTATIVE TARR advised that she learned from Jeff Jessee,
Alaska Mental Health Authority, that they like pilot programs.
She opined that through the wisdom of the members of the
legislature that possibly ideas could be addressed and approach
them to determine whether they would be a good partner in
obtaining additional research.
4:36:29 PM
CHAIR SEATON surmised that a portion of the legislature's
problem in looking forward is "really long-term solutions," when
discussing eliminating things in childhood to prevent problems
in adolescence and adulthood. He opined that in moving forward
his hope is reviewing interventions and changing the mechanisms
of interventions because this is such a long-term process that
if there are no changing interventions accomplishing things in
the nearer term it is going to be hard to wait around for 18,
19, 40 years to say "what was the effect." He said that
removing stressors from life, and ACEs identifies a multitude of
them, is helpful in the health of individuals. He said he hopes
next year the committee will discuss some of the directed
changes in interventions and changes in the way things are
currently dealt with. He agreed with Mr. Sidmore's statement
that instead of telling an individual there is something wrong
them, rather to say this is what happened to you so the
individual can take control and make intentional changes in
their life.
4:38:38 PM
REPRESENTATIVE WOOL noted that some things can have a dual
function, such as recidivism and alternate sentencing practices,
in that by reducing prison populations it would save the state
money immediately, and also have the effect of preserving a home
situation.
REPRESENTATIVE TARR surmised it is difficult to quantify how to
undertake long-term change and also live within a world of
budget pressure. She offered that she recently learned about
the Heckman Equation and will obtain more information. She
said, it essentially shows opportunities for how to actually
quantify the evolution over a long period of time, and how to
see some of those changes. An area most promising, she advised,
is the trauma informed curriculum and what happens in schools,
and that there could be an immediate improvement in graduation
results, academic performance, as well as a reduced number of
suspensions and behavioral outbursts that are costly for a
school district to address. She noted the CDC website has more
information on outcomes.
CHAIR SEATON passed the gavel to Vice Chair Vazquez.
4:41:04 PM
REPRESENTATIVE VAZQUEZ asked Chair Seaton to proceed with his
presentation.
4:41:12 PM
CHAIR SEATON referred to the booklet that mainly targets surgery
entitled "Reducing Negative Health Outcomes Through Prevention,"
and a handout on Vitamin D, published by the Emery University
Hospital validating the use of Vitamin D. He reminded the
committee that Dr. L. Ray Matthews, Director of the Surgical
Intensive Care Unit at Grady Memorial Hospital testified last
year and presented information to the committee. There were
questions regarding the components of vitamin D, Omega 3, fatty
acids, and whether vitamin D was doing its job. He noted that
the vitamin D initiative at Emery University Hospital verifies
that vitamin D, at least as one of the components, is making a
difference on those health care outcomes that the protocol works
on. The goal is how to better understand the immunological
basis of causes of depression and other mental health concerns
and how that could provide a primary health care prevention
window into reducing Alaska's behavioral health needs. He
explained that there is a growing body literature indicating
that inflammation and inflammatory markers, such as the pro-
inflammatory cytokines, have a strong association with
depression. In cases of major depression, the inflammatory
response system is often activated and higher levels of
inflammation appear to increase the risk for the development of
new depression cases and pointed to "cytokines and depression"
and how the immune system causes depression. Articles include
"Immunology of major depression," "Meta-analysis of cytokines
and major depression," "Association of high sensitivity C-
reactive protein with de novo major depression."
4:44:19 PM
CHAIR SEATON related that it is interesting when discussing
cytokines, as those are chemicals the body produces that
influences how the genes work and vitamin D is one of the major
controllers of cytokines in the body. He listed known
environmental factors that can elevate the risk of depression
including: stress, poor diet, and vitamin D deficiency. Chair
Seaton pointed to an article that depression is an inflammatory
disease, and other studies found that the association between
vitamin D supplementation and reduced inflammatory markers are
associated with depression, as well as the association between
vitamin D deficiency and suicide. A couple of the articles
state that depression is an inflammatory disease but where does
the inflammation come from, and they get into the details of how
exactly that works. He said that previous double-blind
randomized controlled trials out of India show that bodily
inflammation such as gingivitis was drastically reduced by
vitamin D supplementation.
4:46:02 PM
CHAIR SEATON referred to an article entitled "Suicidal Patients
are Deficient in Vitamin D," that is associated with pro-
inflammatory status in the blood. He offered that [it is
important] to look at the immunological basis of depression
because it is known that these things are a basic cause of
depression, then treating that immunological basis. Vitamin D
supplementation is also associated with an increased sense of
well-being as the article "Randomized comparison of the effects
of vitamin D3 adequate intake versus 100 mcg. (4000 IU) per day
on biochemical responses and the wellbeing of patients,"
indicates they found that vitamin D levels at 4000 IU per day
resulted in a definite wellbeing increase as well as limited
respiratory tract infections, he explained.
4:47:23 PM
CHAIR SEATON noted that last year an expert panel for the
Department of Defense found sufficient scientific evidence to
support an increase in the daily recommended intake of Omega 3
for military members. In fact, he noted, the panel said that
given the strong evidence for the reduction of depressive
symptoms and suicide prevention found "it would be unethical to
not attempt elevating Omega 3 status among military personnel."
He pointed out that diverse federal agencies are conducting
expert panels regarding nutritional status and how Omega 3 and
vitamin D can influence behavioral health. Chair Seaton opined
that the committee needs to review ways to [help] people change
the way they operate their lives, and that it is a very
difficult position as found with obesity and smoking. He said
that if there are things that can be done to change the
immunological status of people and get to some of these bases of
mental health, it offers a new outlook instead of just
psychiatry. The problem regarding Alaska mental health is that
there are a reduced number of providers, and those providers are
in very short supply across the entire United States which makes
trying to recruit to Alaska difficult. Looking at the
immunological basis could be very important for Alaska, he
noted.
4:49:58 PM
CHAIR SEATON said physicians and primary care providers report
spending a lot of time on behavioral health and they are really
not trained to do that; however, there are some initiatives to
get training for primary providers. Unfortunately, he remarked,
that is a difficult job and if it is more related to treating
the immunological basis the committee cannot ignore that. He
reiterated that he is presenting findings to the committee on
cytokines, and the immunological basis of depression and mental
health, as it appears the issue has been somewhat ignored. He
related that the Journal of Circumpolar Health had an excellent
article on how the Native hospital and providers in Anchorage
have been doing to [help] the primary health care providers
identify mental health issues and depression issues so that
treatment is followed up within 12 weeks. He acknowledged that
it doesn't always happen, the percentages are in the reports,
but it is something that needs to be done; however, one of the
statements is that 40-60 percent of people receiving anti-
depressants go off of them because they don't like the side-
effects. When reviewing the "Vitamin D and Depression: A
Systematic Review and Meta-Analysis Comparing Studies with and
without Biological Flaws" article by Simon Spedding, it reviewed
vitamin D usage without biological flaws and found that vitamin
D supplementation had basically the same size effect as anti-
depressant drugs. A consideration should be looking at an
alternative that has the same size effect but do not have the
same kind of depressive side effects. He pointed out that
nutrition is one of the biggest things the state can
effectively, cheaply, and quickly change within the status of
Alaskans and noted the changes in technology in that drying fish
and meat used to be all sun dried. He explained that vitamin D
is made with animal oil, exposing it to ultra-violet B rays,
thereby changing it to vitamin D and strengthening the amount of
vitamin D in the tissues. The process has gone to freezers and
smoke houses with plywood roofs and tarps with the FDA saying
everything has to be covered and screened. He opined that he
does not know how it has changed the nutritional status of
people across Alaska. There is a project underway now that he
opined might be very enlightening for us all, he noted.
4:54:41 PM
REPRESENTATIVE FOSTER opined that vitamin D appears to have many
significant benefits and further opined that the medical
profession probably agrees. He questioned how to get people to
take their vitamin D, and suggested that when doctors ask their
patients whether they had their flu shot to also ask whether
they are taking their vitamin D supplements. He noted that the
evidence is clear, and further questioned how to get everyone to
take their vitamin D.
CHAIR SEATON responded that education and people graphically
being shown the results of the ongoing studies and offering
people experience. He noted that various legislators have
reported taking vitamin D supplements and that they've noticed a
change in their daily lives and attitude, and also ask how to
educate and offer experience to their constituents. Chair
Seaton used an example of how he offered experience to people
during his involvement in a health fair in Homer. At that time,
they took a survey and offered that if the person would fill out
a survey three-months from that date and return it, they would
be given a three-month supply of 5,000 IU vitamin D. After
reviewing 101 returned surveys, (10 percent of all people
attending the health fair) he noted that the following results
were surprising: people got more exercise; 40 percent of the
people surveyed took over-the-counter pain relievers less often;
22 percent of the people consuming alcohol reported they
consumed less alcohol, which lends support to the issue that
people are self-medicating when feeling bad; 52 percent of the
people reported a difference in their emotional state as they
felt much better than during previous winters; and 98 percent of
the people said they intend to continue taking their vitamin D
supplements. He offered that there would be a health fair next
week in Homer with starter kits for people. He said he tries to
inform people that since they often do not get sunshine in
Alaska for seven months out the year, they should get vitamin D
another other way - whether it is eating sun dried fish, or
taking supplements. He said, "I think when you look at the
booklet that we had on surgery, which are an immediate thing,
and which ... when the journal patient's safety in surgery comes
out and says ... you know, we've reached the point of its
ethical challenge to not test for and treat people before
surgery with ... elevate their vitamin D levels. I think the
medical community is realizing that the risk to their patients
is high if they don't have them with an optimal immune system."
5:00:19 PM
REPRESENTATIVE VAZQUEZ advised that Dr. Jay Butler provided
three research papers included within the committee packet.
5:00:35 PM
JAY BUTLER, Chief Medical Officer/Director, Division of Public
Health, Department of Health and Social Services, stated he was
unsure of the three research papers Representative Vasquez
referred and asked whether someone else might be involved.
REPRESENTATIVE VAZQUEZ specified that the first paper is
entitled, "Vitamin D Supplementation to reduce depression in
Adults: Meta-Analysis of randomized control trials," published
by the Nutrition Journal. The second paper is entitled "Vitamin
D Supplementation for Depressive Symptoms: A Systematic Review
and Meta-analysis of Randomized Control Trials," published by
National Institutes of Health Public Access. The third paper is
entitled "Vitamin D and Depression: A Systematic Review and
Meta-Analysis Comparing Studies with and without Biological
Flaws," by Simon Spedding.
DR. BUTLER opined that the papers came from Dr. Mark Erickson.
5:02:22 PM
MARK ERICKSON, M.D., Alaska Psychiatric Institute (API),
informed the committee that he submitted the three research
papers, and that Chair Seaton is right on target with his
emphasis on depression. He offered that a recent study showed
that in 2010 depression became the second leading cause of
global disability that is an enormous problem. He explained
that from 2008-2013 he was the medical director of Behavioral
Services, Southcentral Foundation, and in 2009 became aware of
the research regarding the relationship between low vitamin D
and depression. At the time, the relationship was somewhat
equivocal but it looked promising. In 2013 the first meta-
analysis basically confirmed that low vitamin D is associated
with depression, but at the time he was medical director the
research on whether raising vitamin D level by taking
supplements improved mood was even more equivocal. He pointed
out that this issue was discussed during staff meetings and that
many staff, including himself, would routinely obtain vitamin D
levels on patients and if the vitamin D level was low would
supplement.
DR. ERICKSON offered that over the weekend he went to the
National Library of Medicine and looked for meta-analysis of the
relationship between supplementing vitamin D and recovery from
depression, he advised, and to his surprise there have been four
published articles within the last year. He noted that two
studies did [find an association] but were in subsets and he
emphasized that all four analysis pointed out how relatively
poor the quality of the research had been, and that the evidence
suggesting a favorable relationship were performed better. The
studies carefully measured the vitamin D level and it was found
to be lower than normal. He said that the study population was
verified to have clinical depression and they offered a vitamin
D supplement that was substantial enough to raise the vitamin D
level to a normal range. In these cases they showed exactly
what would be expected of a decent study, but unfortunately the
data is not as impressive as he would like. That said, he
commented, there has been a tenfold increase in the number of
publications on vitamin D over the last decade and he has little
doubt that there are studies going on now that will likely
verify in a randomized controlled way that increasing vitamin D
levels in depressed people with low vitamin D will be helpful.
Unfortunately, the data is still a little bit equivocal, but
certainly strongly suggests that if studies are performed
properly there will be good data, and offer an idea as to how
much vitamin D to supplement, he related.
5:07:03 PM
DR. ERICKSON noted there is a concern about primary prevention
and opined that the literature for the primary prevention of
adverse childhood experiences is stronger than is generally
appreciated and said there has been an enormous amount of
research about the basic biology of parental care over the last
15-20 years. He mentioned a study by Dr. Lane Strathearn,
published in 2009 in pediatrics ["Adult attachment predicts
maternal brain and oxytocin response to infant cues"], in that
Dr. Strathearn was aware that when a mother breast feeds, not
only is the baby fed but within the mother's brain there is a
release of oxytocin (a bonding hormone), prolactin (also related
to maternal care), and dopamine. He described it as an "elixir
of bonding" so every time a mother nurses these chemicals are
released in her brain increasing the likelihood that she will
bond with her baby. Dr. Strathearn made the prediction that the
longer the ratio of breast feeding would be associated with the
reduced rate of child abuse and neglect. He pointed to a study
cohort of Dr. Strathearn's in Australia, of over 6,000 mothers
who had been followed for 15 years along with their children.
Dr. Erickson said that they had verified maltreatment in these
cases and found that mothers who breast fed longer than four
months were almost five times less likely to maltreat their
children. Dr. Strathearn controlled for 18 different potential
confounding variables, including whether the mother wanted the
baby, and whether she was using drugs, and he still found over a
2.5 (indisc.) reduction in rates of child maltreatment. He
offered that this raises the question about what is known about
increasing the duration of breast feeding.
5:09:09 PM
DR. ERICKSON said that the gold standard, a United Nations
Initiative, called the "Baby Friendly Hospital Initiative" is
robust and has been around for 15-20 years. In 2011, the United
Kingdom decided that 100 percent of all their hospitals would be
baby friendly. Yet, he pointed out, the United States has only
two percent of its hospitals baby friendly, but there is an
initiative having to do with the quality birth experience of the
mother which often double, triples, or quadruples the rate and
duration of breast feeding. He noted this is just one example
of how a fairly simple process can dramatically reduce and
prevent child abuse and neglect, and that other possibilities
include the learning of hormonal changes occurring in men as
they become fathers as there are ways in which to leverage this.
He stressed that there are probably a number of ways to prevent
child abuse from ever happening if close attention is paid to
the emerging biology of parental care.
5:10:40 PM
CHAIR SEATON requested Dr. Erickson to forward his information
in an email as the committee has been trying to determine
effective health interventions. He asked whether the two
percent figure for hospitals means that there is zero percent in
Alaska or 100 percent of Alaska, and further asked what can this
committee can do to help with those issues. He said the
committee needs the background data, studies, and proposals
coming forward from the department where the committee can add
its weight and assistance in the efforts.
5:12:15 PM
DR. ERICKSON related his understanding that Providence Alaska
Medical Center is the only baby friendly hospital in Alaska, and
that he will forward the requested pertinent publications.
CHAIR SEATON said they would see about getting 100 percent of
the hospitals [to be baby friendly]. He said that the meta-
analysis studies take a systematic review, and turned especially
to the meta-analysis "Vitamin D and Depression: A Systematic
Review and Meta-Analysis Comparing Studies with and without
Biological Flaw" by Simon Spedding that do not have biological
flaws. In other words, he related, they are given enough
vitamin D to raise the low [vitamin D level] and determined that
"the effect size was comparable to that of anti-depressant
medication."
5:14:50 PM
DR. ERICKSON interjected that he entirely agrees with Chair
Seaton's comments as it seems the Simon Spedding study is most
reasonable. He said that, basically, in order to get to the
point where vitamin D is part of a standard algorithm in medical
care, a number of higher quality studies to verify Simon
Spedding's study, must be performed. He reiterated there are
several other ways to go about preventing child abuse and
neglect by paying close attention to the biology of parental
care.
REPRESENTATIVE VAZQUEZ returned the gavel to Chair Seaton.
5:15:59 PM
CHAIR SEATON pointed out that smoking is an issue that came
across on many of the topics heard today, whether diabetes,
ACEs, or adverse effects at surgery. He expressed hope that the
committee can get the message across to students by taking the
initiative and possibly advertising in their district's middle
school and high school publications twice a year that it may
limit their potentials for dating to only other smokers, and it
might make a difference in their attitudes. He suggested the
advertisement could read "Kissing a smoker tastes like licking
an ash tray," and speculated that this would have more effect
than the committee trying to start a big initiative to convince
people not to smoke.
5:18:56 PM
REPRESENTATIVE WOOL pointed out that vaping is becoming more
prevalent with the upcoming middle school and high school
students.
CHAIR SEATON replied there are things that are not good, but the
committee knows what is really bad.
5:19:44 PM
REPRESENTATIVE TARR offered that she likes the idea of outreach
to youth and asked what Chair Seaton envisions the committee's
next step to be.
CHAIR SEATON answered that the previous presentations identified
smoking as a crucial issue for health, and that each committee
member could form a message that works in their communities. He
suggested that the members speak with students in their areas,
formulate an initiative, and report back to the committee on the
initiative and what feedback was received. He said smoking and
clean conversation with students by committee members in the
middle school and high school may be effective.
5:22:28 PM
REPRESENTATIVE VAZQUEZ referred to Representative Tarr's study
of "Adverse Childhood Experiences, Overcoming ACEs in Alaska,"
and asked whether this information had been received by the
various school district's nurses and counselors.
REPRESENTATIVE TARR responded that the information is new, and
noted that the school nurses recently held their annual
conference and a panel was on Erin's Law and discussing adverse
childhood experiences. She described [the outreach] as
beginning and opined that it will take more time as they work
through with the different professionals. She reminded the
committee that there is a lot of pressure on them right now with
testing and different things. She opined that they are taking
little steps to incorporate this information, but are making the
information known known together with opportunities for
additional training. She acknowledged that she could not say it
has been implemented in every school or that every educators is
currently aware of it.
5:23:42 PM
REPRESENTATIVE VAZQUEZ asked about school counselors.
REPRESENTATIVE TARR replied that the same is true for school
counselors with some awareness. A challenge with health care
providers is that certain information was part of the curriculum
when they went through their schooling, which is why these
profession require Continuing Education Credit because research
is ongoing with new things are coming out, she said. Sometimes,
she pointed out with state's practitioners, there is a gap in
what was considered the relevant body of information at the time
they were in school and what a student might learn today. There
is the issue of trying to catch some people up to what the
newest information is, which is where they are at with this
particular information penetrating all of the professionals that
might find it useful in their daily work, she explained.
CHAIR SEATON noted that Homer adopted this most pervasively and
that there is Mobilizing for Action through Planning and
Partnerships (MAPP) that is a whole community-wide focus on
improving health. He said it focused specifically on ACEs as
one of the mechanisms in addressing things such as low socio-
economic status, and that it will be hard to change some of the
things considered in ACEs, such as smoking.
5:25:50 PM
CHAIR SEATON asked whether the committee was in agreement to
developing an initiative in their areas, and coming back to the
committee with the progress made, after the interim. Chair
Seaton noted that there was general agreement, and offered that
should a member prefer not to participate they do not have to.
He stated that should a member prefer not to put their name on
the initiative, to send a copy to the committee [aide] and they
will use the House Health & Social Services Standing Committee
as the sponsor of the ad. Also, he pointed out, having this
agreement makes it a legislative priority and should people need
$20-$30 to put an advertisement in the student body paper they
can use their office account.
5:27:32 PM
REPRESENTATIVE TARR offered support for Chair Seaton's ideas of
doing something and mentioned talking with health teachers,
middle school principals in her area and stated that if the
members work collaboratively they could cover Anchorage. She
asked whether there could be a working group meeting prior to
session to share ideas.
CHAIR SEATON clarified that he does not believe a working group
is necessary, and advised staying away from sex. He said he
would like a copy of what the members are doing, and that
committee approval is not required. He reiterated that the
committee agreed the members will work on initiatives within
their communities to share among the members.
REPRESENTATIVE TARR commented that if other members come up with
a great idea then possibly she could take the idea and go with
it.
CHAIR SEATON said he would like to see the committee moving
forward with an action that is shown to be a large problem in
Alaska's health care.
5:30:01 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 5:30 p.m.