More than 20 million Americans may have lab tests showing kidney disease, and rates are growing among adults. Kidney damage can cause waste to build up in the body, and is linked to heart disease and other health problems. In advance of March’s observance of National Kidney Month, The Nation’s Health spoke with Griffin Rodgers, MD, MACP, director of the National Institute of Diabetes and Digestive and Kidney Diseases, about kidney disease risks and steps for prevention.
Who is at greatest risk for kidney disease and why?
People at greatest risk for chronic kidney disease, or CKD, are people who have diabetes, high blood pressure, cardiovascular disease or a family history of kidney failure. Diabetes and hypertension, at least in this country, are the leading causes of kidney damage. Nearly 1 in 4 people with diabetes has CKD, while about 1 in 5 with hypertension has CKD.
Research also shows that there’s a correlation between heart disease and kidney disease. People who have cardiovascular disease are at higher risk for developing kidney disease. Conversely, people with kidney disease are at a high risk for developing cardiovascular disease.
Read the full Q&A with Rodgers in The Nation's Health.
As he prepares to leave office, Centers for Disease Control and Prevention Director Tom Frieden shared with us his hopes for the future of public health and the challenges that still lie ahead.
What’s the outlook for public health funding given a new administration and Congress? In particular, pledges to repeal the Affordable Care Act and eliminate the Public Health and Prevention Fund would deal a blow to CDC’s budget. How do you foresee the agency’s strategy changing while continuing the progress that’s been made thus far?
Protecting American’s health, safety and security will continue to be CDC’s mission, as it has been throughout the agency’s 70 years and a dozen presidential administrations.
Whatever Congress does regarding the Affordable Care Act, public health will be as relevant – or more relevant – today than ever before. The ACA established the Prevention and Public Health Fund to provide expanded and sustained national investments in prevention and public health, to improve health outcomes and to enhance health care quality. The fund supports more than 10 percent of CDC’s total program budget, with most of these funds supporting widely supported programs at the state and local level such as the public health and social services block grant, protecting children and adults through immunization, strengthening capacity to respond to domestic infectious disease threats and preventing childhood lead poisoning.
The threats to our nation’s health are real and come in different forms and in different ways. Public health is a quintessential government function; it is part of our infrastructure and needed to keep Americans safe. And public health is a best buy: investments in public health are repaid many times over. The work CDC and our partners do saves lives and money, protects the American people’s health and is good for the country.
Read the full Q&A with Frieden on the 'State of Public Health 2017' in Public Health Newswire.
Larry Cohen, founder and executive director of Prevention Institute, has been a public health and prevention advocate and pioneer for more than 40 years. In his latest book, “Prevention Diaries: The Practice and Pursuit of Health for All,” he explores the aspects of daily life that influence our health and argues that a prevention approach offers many common-sense solutions that save lives and money, and reduce human suffering.
APHA is a long-time partner of Prevention Institute. As APHA strives toward our strategic goal of creating the healthiest nation, how can a prevention approach lead to new ways of thinking about how to reach this goal?
We know that prevention works. We understand that health matters to everyone, but some communities have been systematically disadvantaged and affected more than others, and it’s time to build that into a system that advances prevention and equity. We understand that our bodies, our minds, and our environments need to be aligned for health. We can’t talk about asthma and ignore housing and traffic; it’s not just about getting individuals to adjust, but about ensuring safe housing and improved air quality. We can’t talk about high utilization and ignore mental health and trauma — and it’s not just about identifying individuals with adverse childhood experience but about transforming adverse community environments into healthier ones that promote resilience. It is time not only to recognize the importance of community well-being, but to fully engage and align with community. This means partnering far beyond health organizations and achieving new strategies. It means ensuring our policies and practices move our norms and environments. APHA plays a critical role in enabling new thinking and solutions to be shared, and their methodology understood. More importantly, APHA is a partner and a leader in promoting policy and practice changes across the country.
Read the full Q&A with Cohen in Public Health Newswire.
Victor Dzau, MD, has had an exciting term since assuming the presidency of the National Academy of Medicine in July 2014. For one thing, the organization was not called NAM when he came on board — its membership voted in 2015 to transform the then-Institute of Medicine into the National Academy of Medicine. Now, the independent NAM is branching even further into what it means to develop meaningful research to be used in health fields. Dzau spoke with The Nation’s Health about the future of the academy and its ongoing work.
What new NAM initiatives are you most excited about?
The one that we are very excited about…is called Vital Directions in Health and Health Care. A year ago, we were well aware that there’s going to be a change in U.S. administration. Our members, our council are saying, what would it look like under new administration? What are things that still haven’t quite been achieved? What are things that we need to think about going forward?
We convened a steering committee of 18 members, which commissioned over 100 experts to write papers, 19 in total, under the three themes: health and well-being, or health and wellness; health care delivery; and science and technology. Under those three themes are specific papers that look at life course management, social determinants of health, precision medicine, payment reform, science and technology for the future.
On Sept. 26, these reports were released by (the Journal of the American Medical Association) as what they call viewpoints. On the same day, we (had) public discussion we call a national conversation of the various Vital Directions. We can have authors and also non-authors to come and sit together and talk about what we believe are the issues that should inform the next U.S. administration and get input from the public. Following all this, we’ll have a synthesis paper that will bring together all these dialogues into one final paper, published in Perspectives and in JAMA. That’s going to happen around December.
We are thinking and hoping that this initiative will inform the next U.S. administration. Therefore, we are beginning to reach out to transition teams and to work with the next administration after the election, and begin to work with them in any fashion we can to help advise them.
Read the full Q&A with Dzau in The Nation's Health.
Jonca Bull, MD, FDA's assistant commissioner for minority health, talked with The Nation’s Health about some of the barriers to diversity in clinical trials and FDA’s efforts to spread awareness and show transparency about who is participating to inform outreach in the the future.
How diverse are U.S. clinical trials currently? Where are the biggest gaps?
I think it varies. The basic question is how much variability in terms of the disease burden, what patient characteristics are most critical that would raise the significance of diversity in a clinical trial.
Optimally, we are very interested in seeing populations, as stated in our policies, that reflect the population that use the products in the post-market environment.
There certainly are challenges. We live in a world where medical product development is a global enterprise. A real challenge for us is establishing that populations are adequately comparable so that the data that informs an approval decision is as accurate and close as possible to the population here in the U.S. will use the product.
Read the full Q&A with Bull in The Nation's Health.