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This Is a Critical Moment: Delaware Must Not Go Backward in Health Equity
The proposed Delaware House Bill 350 is well-intended but would have terrible consequences for Delaware’s most vulnerable populations. There is a better way. By LeRoi S. Hicks, M.D., MPH, FACP As a Black physician who has dedicated his 25-year career to understanding and addressing health equity, I am deeply concerned about Delaware’s proposed House Bill 350, which aims to address rising health care costs by establishing a body of political appointees that would oversee the budgets of Delaware’s nonprofit hospitals. While the goal of bending the cost curve in health care may be well-intentioned, this bill will have horrific consequences for Delaware’s most vulnerable populations, including Black people, Hispanic people and other groups that have been traditionally underserved in health care. We can and must work together to solve this problem and provide the right care, in the right place, at the right time. A tale of two cities To borrow a phrase from Charles Dickens, Delaware, like much of America, is a tale of two cities. The experience of life—including a healthy, safe environment and access to good-quality health care—is vastly different depending on where you live and your demographic background. In the city of Wilmington, for example, ZIP codes that are just a few miles apart represent more than 20 years difference in life expectancy. This is not OK—it’s a sign that we have serious structural problems in our communities that are causing harm to people and making their lives shorter. Importantly, chopping $360 million out of Delaware’s hospital budgets, as House Bill 350 would do in year one, is not going to help this problem—it’s going to make it worse. And in doing so, it would ultimately make health care in Delaware more expensive—not less expensive. The key to lowering health care costs is to improve quality, access and equity Data show that about 5% of patients in the United States account for more than 50% of all health care costs. These are primarily patients who have complex and poorly managed chronic conditions that cause them to end up in the most expensive care settings—hospitals, operating rooms, emergency departments. The key to driving down health care costs is to improve quality and equity so that everyone is supported in achieving their best health, and these high users of the most expensive kinds of care are better supported in managing their health conditions such as diabetes or heart failure in the appropriate way. In doing so, they prevent the need for costly emergency or “rescue” care. Let’s do more—not less—of what we already know works Health care is not a one-size-fits-all industry. The delivery of care for patients across a diverse population requires multiple interventions at the same time. These interventions are designed not only to improve the quality of care but also to close the gap in terms of health care disparities. That’s important, because when we improve care and outcomes for the most vulnerable populations, we tend to get things right for everyone. One type of intervention is about doing exactly the right things for a patient based on the evidence of what will help—and doing nothing extra that will cause harm or generate additional costs without providing additional benefit. An example of this might be ensuring that every patient who has a heart attack gets a certain drug called a beta blocker right after their heart attack, and they receive clear guidance and support on the actions they must take to reduce their risk of a second heart attack, such as regular exercise and good nutrition. The second type of intervention is for the highest-risk populations. These are patients who live in poor communities where there are no gyms and no grocery stores, and people commonly have challenges with transportation and lack of access to resources that makes it difficult—sometimes impossible—to follow their plan for follow-up care. They lack access to high-nutrient food that reduces their risk of a second heart attack. They also live in areas where there are fewer health care providers compared to more affluent areas. These interventions tend to be very intensive and do not generate income for health systems; in fact, they require significant non-reimbursed investment, but they are necessary to keep our most vulnerable patients healthy. The medical community has developed interventions for these populations that are proven to work. A local example is the Delaware Food Pharmacy program, which connects at-risk patients with healthy food and supports their ability to prepare it. The program helps patients improve their overall health and effectively manage their chronic conditions so they can prevent an adverse event that would put them back in the hospital or emergency department. When we work together, we succeed We’ve seen incredible examples of how this work can be successful right here in Delaware. Delaware was the first state in the country to eliminate a racial disparity in colorectal cancer, and we did this by expanding cancer services, including making it easy for vulnerable people to get preventive cancer care and screenings. This is an incredible success story that continues to this day, and it was the result of thoughtful, detail-oriented partnerships among the state and the health care community. The work continues as we collaborate to reduce the impact and mortality of breast cancer in our state. Unfortunately, these kinds of interventions are the first thing to go when health care budgets get slashed, because they don’t generate revenue and are not self-sustaining. These kinds of activities need to be funded—either through grants or an external funder, or by the hospitals and health care systems. By narrowly focusing on cost, we risk losing the progress we have made Delaware House Bill 350, as it’s proposed, would cause harm in two ways: First, it would compromise our ability to invest in these kinds of interventions that work. Second, it increases the risk that higher-cost health services and programs that are disproportionately needed by people in vulnerable communities could become no longer available in Delaware. In states where the government has intervened in the name of cutting costs, like Vermont and Massachusetts, we see the consequences–less quality and reduced equitable access to much-needed services. House Bill 350 will widen the gap between those who have means and those who are more vulnerable. These changes will lead to increased disease burden on these populations. They will end up in the emergency room more and hospitalized more, which is by far the most expensive kind of care. That’s not what anyone wants—and it’s the opposite of what this bill was intended to accomplish. At this moment, in Delaware, we have an opportunity to put our state on a sustainable path to better health for all Delawareans. House Bill 350 is not that path. However, the discussion that House Bill 350 has started is something that we can build on by bringing together the stakeholders we need to collaborate with to solve these complicated problems. That includes Delaware’s government and legislators, the hospitals and health centers, the insurance, pharmacy and medical device industries, and most importantly, patients and the doctors who care for them. LeRoi Hicks, M.D., is the campus executive director for ChristianaCare, Wilmington Campus.
Researcher develops microrobots to battle cancer with unique precision
Magnetic robots that can target cancer cells are nothing new. But the patented microrobots developed by the University of Delaware's Sambeeta Das can be guided with a magnetic field to deliver medication to cells – or to destroy infectious cells, such as cancer – inside the body. To mark the launch of National Inventors Month, Das, assistant professor of mechanical engineering, shared her journey toward invention. Q: Tell us about your patented invention on microrobots for cancer research. What problem were you trying to solve? Das: One of the biggest issues with cancer research is the ability to target cancer cells without harming healthy cells. Cancer cells are sneaky, and they have evolved ways of hiding from the body’s immune cells. A big part of our research focuses on targeting, specifically precision targeting. We want to be able to target a single cell in a mass of cells, whether that is a single cell in a mass of cancer cells or whether it is a single abnormal cell surrounded by healthy cells. To do this, we use magnetic microrobots that can be driven inside the body by magnetic fields to a particular cell location. Magnetic fields are biocompatible, meaning they are not harmful to biological tissues, and our microrobots are very small, around 20 microns, which is about the size of a single bacteria cell. We can load our microrobots with various drugs and modify their surface in such a way that when the robots come in contact with the cells we are targeting, they can kill the target cell or perform some other function. Q: How is this solution unique? Das: Other people have made magnetic microrobots, but our system is unique since it allows us to do automatic targeting with a lot of precision. For example, a person operating our microrobots can just point to a cell and our system will drive the microrobot there. Additionally, the instrument we have made and patented is an all-in-one portable device that can be used anywhere. We don’t need a separate microscope, camera or software, it is all built in and very user friendly. Anyone can use it. This makes it super portable, which means quick solutions for health practitioners. In addition, poor and resource challenged areas can also be accessed with this portable solution. Q: What drives you toward invention? Das: I like to solve problems, and I like seeing something come together from nothing. I am very interested in problems that affect human health and longevity, particularly those that affect the common person. Q: How do you approach solving a problem, and whose support has been critical along the way? Das: One thing I have realized is that it is imperative to ask the right question to solve a problem. You must really get to the core of the issue. The second thing is to always keep the end user in mind. So, it’s kind of a two-pronged approach—looking from both ends of the problem. For support, I would say my team members and my collaborators. Their support has been invaluable in helping me solve the problems that I want to solve. In fact, my graduate students keep a running list of crazy ideas that they have come up with. It helps us look at problems in a unique way and come up with innovative solutions. Q: Not every invention makes it. How do you deal with failure? Das: The way that I start working on a problem is to assume that whatever we do, we are going to fail. I always tell my students that their first couple of experiments or designs will always fail. But failure is essential because it will teach you what not to do. And knowing what not to do is sometimes the critical part of the invention process. The failures inform us about the ways of not doing something which means now there is another way of doing something. Q: What is the best advice you’ve ever received? Das: The best career advice I’ve ever received is that there is always another way. If you run into roadblocks there is always another answer, there is always another opportunity. So we just need to keep going and trying new and crazy ideas. Q: How are inventive minds created – is it innate or can it be developed? How do you encourage innovation among your students? Das: That’s an interesting question and honestly, I am not sure. I do believe in what Edison said, “Genius is 1% inspiration and 99% perspiration.” He is a known inventor, so I would go with his interpretation on this. As for my students, I give them lots of freedom. I think freedom is essential in encouraging innovation. The freedom to come up with crazy ideas without anyone saying that won't work and the freedom to fail—multiple times. Das is available for interviews to talk about her microrobots and other projects at UD. To reach her, visit her profile and click the "contact" button.
The ChristianaCare Hospital Care at Home program, a national leader in providing acute care in a place most familiar to patients – their own homes – has reached a new milestone with more than 1,000 admissions since opening in December 2021. ChristianaCare’s innovative program enables patients with common chronic conditions, such as congestive heart failure and diabetes complications, as well as infections like pneumonia, to receive hospital-level care at home through virtual and in-person care provided by a team of physicians, nurse practitioners, paramedics and others. Technology kits deployed to patient homes ensure round-the-clock access to a health care professional, along with twice daily visits from caregivers, medication deliveries and mobile laboratory services. ‘Absolutely amazing’ for patients Patients are evaluated for the hospital care at home program when they come to Wilmington or Christiana hospital emergency departments. Those who can be treated at home receive a technology kit that connects them to the command center, powered by the ChristianaCare Center for Virtual Health. With a touch of a button, they can access an expert team of ChristianaCare doctors and nurses. But hospital care at home isn’t just virtual care — the technology supports an entire care team that works inside the patient’s home and remotely to provide optimal support at all times — just like in a hospital. Carol Bieber, whose 98-year-old father Bill has been a hospital care at home patient, sees the difference it makes for him to wake up in his own bed, sit in his own living room and still get the care he needs to get better. “The whole hospital care at home experience is really calm and easy and familiar to him,” said Bieber, who lives in Newark, Delaware. “My dad is a people person, so to be able to connect with everybody who comes in to see him or talk to him on the screen is just amazing.” Innovative solutions for in-home care ChristianaCare’s Hospital Care at Home program was developed in 2021 after the Centers for Medicaid & Medicare Services (CMS) began the Acute Hospital Care at Home waiver program to allow Medicare beneficiaries to receive acute-level health care services in their home. U.S. Sen. Tom Carper, who represents Delaware, worked to pass the bipartisan “Hospital Inpatient Services Modernization Act” in 2023 that extended this program. Last month. Sen. Carper introduced the bipartisan “At-Home Observation and Medical Evaluation (HOME) Services Act” that would expand this lifesaving and cost-saving program. “Hospital at Home – which grew out of the COVID pandemic – was an opportunity for us to meet seniors where they are,” Carper said. “It has delivered positive outcomes, higher patient satisfaction, and saves money.” Sarah Schenck, M.D., FACP, executive director of the ChristianaCare Center for Virtual Health, said the hospital care at home program has yielded lower readmission rates than brick-and-mortar hospitals. Patient experience scores are about three times higher than a national average traditional hospital experience. “We’ve been conditioned to believe that care only happens within the four walls of a hospital. For our patients who have loved ones at home or their pets, a favorite chair or favorite food, they’re now able to have all of that as they heal,” Schenck said. “Once our patients have experienced this, what we hear from them is that they are truly grateful.” Promoting healing – at home Helping patients recover in their homes also has been transformational for caregivers who get to see a different side of their patients and better understand what they need to successfully recover. “I can’t express how much I enjoy the patients and their families,” said Heather Orkis, a paramedic with Hospital Care at Home. “To be able to enjoy the family and see these people get better in their own homes, with their families, their grandkids, their dogs, their cats – it’s just a completely different kind of medicine.” For Bill Bieber’s family, hospital care at home is more than health care. “It’s just the best thing ever,” Carol Bieber said.
Anthony Fauci to visit University of Delaware as part of Disaster Research Center's 60th anniversary
Dr. Anthony Fauci will take part in a fireside chat on Friday, May 3 in honor of the 60th anniversary of the University of Delaware's Disaster Research Center. Fauci, former director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health and former chief health advisor to President Joe Biden, will join Valerie Biden Owens, Chair of UD's Biden Institute, for a chat at 4 p.m. about decision-making during crises as well as lessons for the next generation of leaders. The visit caps off an international workshop held by the Disaster Research Center (DRC) from May 2-4. The workshop will include a pre-workshop for graduate students; a researcher-in-residence day at the DRC where the E.L. Quarantelli Resource Collection (full of rare, disaster-related objects) will be showcased and available for use; and a two-day workshop with a range of presentations, films and activities. Fauci's chat takes place at UD's Clayton Hall and will be livestreamed from 4-5 p.m. NOTE: For future coverage of hurricanes, floods, tornadoes, earthquakes, wildfires and other disasters, visit the profiles of the Disaster Research Center-affiliated experts connected to this post and click "contact."
Veterinary deal would increase UK agrifood exports to EU by more than a fifth, research shows
A veterinary deal would increase agri-food exports from the UK to the EU by at least 22.5%, say researchers Agri-food exports overall are worth £25 billion to the UK economy, but the two years since the new trading rules were put in place have seen a fall of 5% in exports to the EU from 2019 levels, during a period where the sector has otherwise grown. Team from Aston University and University of Bristol have analysed trade deals and export figures worldwide to estimate impact of a new veterinary deal on UK–EU exports A veterinary deal with the European Union could increase UK agricultural and food exports by over a fifth, according to new research. The team, from Aston University’s Centre for Business Prosperity and the University of Bristol, analysed the agricultural and veterinary aspects of trade deals around the world to estimate their impact on exports. They then modelled the potential impact of different types of agreement on UK exports to the EU. Veterinary Agreements specifically focus on regulations and standards related to animal health and welfare, as well as to the safety of animal-derived products such as meat, dairy, and seafood. They aim to align, harmonise, or recognise veterinary requirements and certifications, and reduce the number of inspections between countries to facilitate the safe and efficient trade of live animals and animal products. The EU–UK Trade and Cooperation Agreement (TCA), implemented in January 2021, eliminates tariffs and quotas but does not remove non-tariff barriers to trade. These can be particularly burdensome for agricultural and animal-derived food (agri-food) exports, involving complex rules and requirements, production of extensive documentation and veterinary checks. The UK agri-food sector is a cornerstone of the UK economy, with exports worth £25 billion and employing 4.2million people. Although the sector is growing overall, exports to the EU shrank in 2022 by 5% compared to 2019, in part due to the new trade arrangements. This has led to calls for an EU–UK veterinary agreement from business and agri-food organisations, including the Confederation of British Industry, British Chambers of Commerce, UK Food and Drink Federation, Chartered Institute of Environmental Health and British Veterinary Association. Analysing data from the World Bank on 279 trade agreements and export statistics from over 200 countries, the researchers found that shallow agreements, that went little further than provisions already covered by World Trade Organisation (WTO) rules, had significant negative impacts on agri-food exports. However, where trade agreements went beyond WTO provisions to include more commitments on sanitary and phytosanitary (SPS) measures (which aim to protect countries against risks relating to pests, diseases and food safety) and were legally enforceable, they had a robust, positive impact on exports, particularly exports of animal products and food. Applying this to the UK–EU relationship, the team estimate that a veterinary agreement that went beyond the existing TCA provisions would increase agri-food exports from the UK to the EU by at least 22.5%. Imports from the EU would also increase by 5.6%. In the 203 countries studied for the research, positive effects of deep trade deals that included provisions on agriculture took between 10 and 15 years to manifest. But the UK might not have to wait so long, according to report co-author Professor Jun Du, Director of Aston University’s Centre for Business Prosperity. “There is no blueprint out there that mirrors the UK–EU relationship. Most veterinary agreements are agreed as part of a trade deal between countries that haven’t previously had close alignment and it takes a while for the benefits to take effect. “Until recently, the UK had frictionless agri-food exports to the EU, so it’s possible that a supplementary veterinary agreement to reduce some of the frictions created by Brexit could allow trade that previously existed to pick up again quite quickly.” However clear the economic arguments, the legal and political barriers to a veterinary agreement still remain. The researchers address these in their report, suggesting that the best format for the additional measures would be as a supplementary agreement to the TCA. The key question for the UK government in negotiating such an agreement would be what the EU demanded in return. “The closest model is the EU-Swiss relationship, which sees Switzerland largely follow EU law,” said report co-author from the University of Bristol, Dr Greg Messenger. “That’s unlikely to be an option for the UK. As we wouldn’t expect to eliminate all paperwork, we could both agree that our rules meet each other’s standard for phytosanitary protection. As most of our rules are still essentially the same as the EU, that wouldn’t require any major change, though we’d have to agree a greater level of coordination in relation to the development of new rules.” The report was written jointly by Professor Du, Dr Messenger and Dr Oleksandr Shepotylo, senior lecturer in economics, finance and entrepreneurship at the Centre for Business Prosperity, Aston Business School.
Dr Raghunath Anant Mashelkar delivered the 2024 Aston University Annual Distinguished Lecture He has been president of the Indian National Science Academy and director general of the Indian Council of Scientific and Industrial Research and has received multiple honours and awards He was also presented with an honorary professorship in recognition of his outstanding contribution to academia and beyond. Dr Raghunath Anant Mashelkar delivered Aston University’s 2024 Annual Distinguished Lecture to more than 70 invited guests on 22 April. One of the world’s renowned figures in polymer science, research leadership and intellectual property rights, Dr Mashelkar, a chemical engineer, is a global leader and inspiration in his native India and the wider international research community. In recognition of his outstanding contribution to the research community, Dr Mashelkar was bestowed with an honorary professorship at the end of the lecture by Professor Aleks Subic, Vice-Chancellor and Chief Executive of Aston University. The title of Dr Mashelkar’s lecture was ‘Trapeze Artistry in Biomimetic Smart Gels’. ‘Smart gels’, made from synthetic polymers (types of plastics), can be developed with specific functional properties, such as reacting to changes in temperature and pH. Whilst Director at India’s National Chemical Laboratories, Dr Mashelkar led work which discovered smart gels which can mimic biological functions (biomimetic), including being self-healing, self-organising, and acting as enzymes in chemical and biological processes. Their properties can be reversibly switched on or off, or they can change volume or shape, through the use of pH or temperature, the ‘trapeze artistry’ of the title, giving them many uses. This included temperature-responsive comfortable insoles for diabetic feet, drilling fluids which can quickly, but reversibly, plug an oil well, and medical devices for the digestive system, which resist the acidic environment of the stomach to deliver drugs, but dissolve harmlessly in the alkaline environment when they leave the stomach. One of the defining factors of Dr Mashelkar’s work has been serendipity. He told the story of a smart gel that dried to become a completely different shape when dried in his laboratory’s old oven rather than the new oven. One of his research team discovered this was due to the presence of copper ions from corrosion in the oven, which changed the way the molecules arranged themselves and led to a whole new area of research on polymer self-assembly. As he said: “Eyes do not see what the mind does not know. Look at the 'failed' experiment very carefully, maybe the next big breakthrough is waiting there!” Dr Mashelkar also spoke on his life story, from a young boy in India, attending the local municipal school, to addressing thousands of the world’s best minds at places like the World Economic Forum and the World Bank. His great passion now is ‘Gandhian Engineering’ based on the principle of more performance, from fewer resources, for more people. He created the Anjani Mashelkar Award, named after his mother, for the best low-cost, high-technology innovations. Winners have included an Internet of Things-based maternal healthcare system for rural areas and a smartphone app to assess lung health. Dr Mashelkar is proud of his work on Gandhian Engineering. Speaking after the lecture he said: “Rising inequalities create social disharmony. Now, you can’t make the inequalities vanish because you can’t make poor people rich overnight. What is needed is access. Can we give access equality, despite the income inequality? And that’s the principle of Gandhian Engineering. In my lecture I showed a photograph of a poor lady in a hut with a mobile, and a rich lady from a city who also had a mobile. This is equal access. It was not possible previously when mobiles were so expensive. In India now we have good public infrastructure. Data is now Rs 4 per GB and wireless is free. Once you start giving access, there is a parity.” Professor Subic said: “It was a privilege and a pleasure to welcome such a celebrated scientist as Dr Mashelkar to give the Aston University Annual Distinguished Lecture this year. Once again, we have brought a renowned international leader to engage with our community and present some of the most exciting research going on in our world today, while also inspiring the next generation of researchers and international citizens. I am deeply honoured that Dr Mashelkar has accepted an honorary professorship from Aston University in recognition of his international standing and significant contributions to scientific research and innovation.” The distinguished lecture series was established by Professor Subic in 2023. It brings influential speakers to the University to address major scientific breakthroughs, as well as social, cultural and policy issues. The first distinguished lecture was given by Nobel Laureate Peter Agre in 2023. Speaking after the lecture, Dr Mashelkar said: “I am absolutely honoured to get this honorary professorship from Aston University. Aston University is excelling in a number of areas. In terms of its future, I consider that to be very bright for the simple reason that the University’s dynamic Vice-Chancellor is making big changes with speed and skill, with expansion, inclusion and excellence. To be honoured with an honorary professorship is one of the greatest satisfactions and fulfilments of my life.” The lecture was followed by a drinks reception to allow guests to meet Dr Mashelkar and further discuss his work. A video recording of the 2024 Annual Distinguished Lecture will be made available on the University website at a later date.
#ExpertSpotlight: 10th anniversary of Flint, MI, water crisis beginning
The 10th anniversary of the Flint, MI water crisis marks a pivotal moment in environmental justice and public health awareness. This event matters deeply to the public as it sheds light on systemic failures in infrastructure management, government accountability, and the disproportionate impacts of environmental hazards on marginalized communities. Here are several sub-topics that could be of interest to a broad audience: Health Impacts and Long-term Consequences: Explore the lingering health effects on residents exposed to lead-contaminated water, including neurological disorders, developmental delays, and mental health challenges. Government Response and Accountability: Investigate the role of local, state, and federal authorities in addressing the crisis, including accountability measures taken against officials responsible for the negligence and mismanagement. Community Resilience and Activism: Highlight the resilience of Flint residents and grassroots organizations in advocating for clean water access, demanding justice, and implementing community-led solutions. Infrastructure Challenges Nationwide: Examine the broader implications of Flint's water crisis on infrastructure investment, maintenance, and regulation across the United States, particularly in aging urban areas. Policy Reforms and Prevention Efforts: Discuss policy reforms enacted post-crisis to prevent similar incidents, such as improvements in water quality testing, infrastructure upgrades, and measures to ensure environmental justice. Legacy of Environmental Injustice: Analyze the broader socio-economic factors contributing to environmental injustices like the Flint water crisis, including racial disparities in access to clean water and the intersectionality of poverty and environmental hazards. This anniversary presents an opportunity for journalists to revisit the ongoing repercussions of the Flint water crisis, amplify the voices of affected communities, and advocate for sustainable solutions to prevent similar tragedies in the future. Connect with an Expert about the Flint, MI water crisis: To search our full list of experts visit www.expertfile.com Gerald Kauffman Project Director, Water Resources Center, Institute for Public Administration; Assistant Professor, Biden School of Public Policy and Administration · University of Delaware Viviane Yargeau Professor, Department of Chemical Engineering · McGill University Jared L. Cohon University Professor · Carnegie Mellon University Joe Brown Assistant Professor, Environmental Engineering · Georgia Tech - COE For journalists with questions or looking to cover the streaming wars, here is a select list of experts. Photo Credit: Bruno Guerrero
The research team asked one group of participants to follow healthy eating accounts and another to follow interior design accounts After just two weeks, participants following healthy eating accounts ate more fruit and vegetables and less junk food Even minor tweaks to social media accounts could result in substantial diet improvements in young adults. Researchers from Aston University have found that people following healthy eating accounts on social media for as little as two weeks ate more fruit and vegetables and less junk food. Previous research has shown that positive social norms about fruit and vegetables increases individuals’ consumption. The research team sought to investigate whether positive representation of healthier food on social media would have the same effect. The research was led by Dr Lily Hawkins, whose PhD study it was, supervised by Dr Jason Thomas and Professor Claire Farrow in the School of Psychology. The researchers recruited 52 volunteers, all social media users, with a mean age of 22, and split them into two groups. Volunteers in the first group, known as the intervention group, were asked to follow healthy eating Instagram accounts in addition to their usual accounts. Volunteers in the second group, known as the control group, were asked to follow interior design accounts. The experiment lasted two weeks, and the volunteers recorded what they ate and drank during the time period. Overall, participants following the healthy eating accounts ate an extra 1.4 portions of fruit and vegetables per day and 0.8 fewer energy dense items, such as high-calorie snacks and sugar-sweetened drinks, per day. This is a substantial improvement compared to previous educational and social media-based interventions attempting to improve diets. Dr Thomas and the team believe affiliation is a key component of the change in eating behaviour. For example, the effect was more pronounced amongst participants who felt affiliated with other Instagram users. The 2018 NHS Health Survey for England study showed that only 28% of the UK population consumed the recommended five portions of fruit and vegetables per day. Low consumption of such food is linked to heart disease, cancer and stroke, so identifying ways to encourage higher consumption is vital. Exposing people to positive social norms, using posters in canteens encouraging vegetable consumption, or in bars to discourage dangerous levels of drinking, have been shown to work. Social media is so prevalent now that the researchers believe it could be an ideal way to spread positive social norms around high fruit and vegetable consumption, particularly amongst younger people. Dr Thomas said: “This is only a pilot intervention study at the moment, but it’s quite an exciting suite of findings, as it suggests that even some minor tweaks to our social media accounts might lead to substantial improvements in diet, at zero cost! Our future work will examine whether such interventions actually do change our perceptions of what others are consuming, and also, whether these interventions produce effects that are sustained over time.” Dr Hawkins, who is now at the University of Exeter, said: “Our previous research has demonstrated that social norms on social media may nudge food consumption, but this pilot demonstrates that this translates to the real world. Of course, we would like to now understand whether this can be replicated in a larger, community sample.” Digital Health DOI: 10.1177/20552076241241262
Healthy Environment, Healthy People: The Intersection Between Climate and Health
How is climate change influencing our health? Why does climate change have a greater impact on vulnerable populations and low-income people? How does the U.S. health care system affect the climate? How can health care systems improve their impact on the climate and the environment? ChristianaCare’s inaugural Climate and Health Conference addressed these topics and raised possible solutions at the John H. Ammon Medical Education Center on the Newark, Delaware, campus on April 12. At the conference, the common denominator was this: An unhealthy environment can lead to illnesses and deaths from air pollution, high heat, contaminated water and extreme weather events. Health systems, government entities, community organizations and individuals all have a role to play in decreasing these effects. “Climate, the environment and health care systems are intertwined,” said Greg O’Neill, MSN, APRN, AGCNS-BC. “We need to pay close attention to this relationship so we can improve health for everyone.” O’Neill is director of Patient & Family Health Education and co-chair of the Environmental Sustainability Caregiver Committee at ChristianaCare. Climate change and intensifying health conditions Negative health effects are so closely tied to the environments where people live, work and play that The Lancet called climate change “the greatest global health threat facing the world in the 21st century [and] the greatest opportunity to redefine the social and environmental determinants of health.” At the conference, speakers addressed specific areas of concern. Asthma. Air pollutants, while largely invisible, are associated with asthma. What’s more, people who live in urban areas with little green space are more likely to have uncontrolled asthma, said speaker Robert Ries, M.D., an emergency medicine resident at ChristianaCare. And there’s the rub, he said: When people with asthma spend time in green spaces, it may improve their health. “In Canada,” he said, “some doctors prescribe nature – two hours a week for better overall health outcomes. Could we do that here?” Heat-related illness. Temperatures worldwide have been rising, increasing the likelihood of heat-related health incidents. Heat waves may be harmful to children and older adults, particularly those who don’t have access to air conditioning, swimming pools or transportation to the beach, said speaker Alan Greenglass, M.D., a retired primary care physician. Children visit the emergency room 20% more frequently during heat waves. Weather-related illness. Climate change is causing more floods, which may result in respiratory problems due to mold growth; and droughts, which may threaten water safety and contribute to global food insecurity, said speaker Anat Feingold, M.D., MPH, an infectious disease specialist at Cooper Health. Stress and anxiety. Climate change can affect mental health, even leading to “solastalgia,” which is distress about environmental change and its effect on one’s home, said speaker Zachary Radcliff, Ph.D., an adolescent psychologist at Nemours. He encouraged clinicians in the audience to keep this mental health concern in mind when seeing patients as it may become more prevalent. Cardiovascular disease risk. Frequent consumption of red meat increases the risk of cardiovascular disease, the top cause of death in the U.S. It’s also unhealthy for the environment, said speaker Shirley Kalwaney, M.D., an internal medicine specialist at Inova. Livestock uses 80% of available farmland to produce only 17% of calories consumed, creating a high level of greenhouse gas emissions. By comparison, plant-based whole foods decrease the risk of cardiovascular disease and diabetes. They use only 16% of available farmland, producing 82% of calories consumed. This makes reducing red meat in our diets one of the most powerful ways to lower the impact on our environment. Health equity and the environment People in low-income communities are more likely to live in urban areas that experience the greatest impacts of climate change, including exposure to air pollutants and little access to green space, said speaker Abby Nerlinger, M.D., a pediatrician for Nemours. A Harvard study in 2020 demonstrated that air pollution was linked with higher death rates from COVID-19 — likely one of the many reasons the pandemic has disproportionally harmed Black and Latino communities. Similarly, access to safe, affordable housing is essential to a healthy environment, said Sarah Stowens, Ed.D., manager of State Policy and Advocacy for ChristianaCare, who advocated for legislation including the Climate Solutions Act, another bill that increased oversight regarding testing and reporting of lead poisoning and a policy to reduce waste from topical medications. Opportunities for change in health care Reduce emissions from pharmaceuticals and chemicals. These emissions are responsible for 18% of a health system’s greenhouse gas emissions. One way to reduce this number is for clinicians to prescribe a dry-powder inhaler (DPI) instead of a metered-dose inhaler (MDI) when applicable and safe for the patient and to give patients any inhalers that were used in the hospital at discharge if they are going home on the same prescription. Hospitals have opportunities to reduce greenhouse gases while caring for patients, said Deanna Benner, MSN, APRN, WHNP, women’s health nurse practitioner and co-chair of ChristianaCare’s Environmental Sustainability Caregiver Committee. The health care sector is responsible for 8.5% of U.S. greenhouse gas emissions, the highest per person in the world. U.S. greenhouse gas emissions account for 27% of the global health care footprint. One way to significantly reduce the carbon footprint is to use fewer anesthetic gases associated with greater greenhouse gas emissions, Benner said. Limit single-use medical devices. Did you know that one surgical procedure may produce more waste than a family of four produces in a week? Elizabeth Cerceo, M.D., director of climate health at Cooper Health, posed this question during her talk. Sterilizing and reusing medical devices, instead of using single-use medical devices, she said, may meaningfully reduce hospital waste. ChristianaCare’s commitment to healthy environments and healthy people As one of the nation’s leading health systems, ChristianaCare is taking a bold, comprehensive approach to environmental stewardship. ChristianaCare reduced its carbon footprint by 37% in 2023 by purchasing emission-free electricity. ChristianaCare joined the White House Climate Pledge to use 100% renewable energy by 2025, reduce greenhouse gas emissions by 50% by 2030 and achieve zero net emissions by 2050. ChristianaCare has created an Environmental, Social and Governance structure to help advance a five-year strategic plan that delivers health equity and environmental stewardship. Nearly 150 staff members have become Eco-Champions, an opportunity to be environmental change-leaders in the workplace. In 2023, ChristianaCare’s successful environmental stewardship included: Reducing our carbon footprint by 37% by purchasing emission-free electricity. Recycling 96,663 pounds of paper, which preserved 11,485 trees. Reducing air pollution by releasing an estimated 33,000 fewer pounds of nitrogen oxides and sulfur oxides through the use of a cogeneration energy plant on the Newark campus. Donating 34,095 pounds of unused food to the Sunday Breakfast Mission in Wilmington, Delaware. Donating 1,575 pounds of unused medical equipment to Project C.U.R.E., ChristianaCare’s Virtual Education and Simulation Training Center and Delaware Technical Community College. “In quality improvement, they say you improve the things that you measure,” O’Neill said in expressing goals for continued success. In looking ahead, said Benner, “I really hope that this conference is the catalyst for positive change with more people understanding how climate is connected to health, so that we can protect health from environmental harms and promote a healthy environment for all people to thrive.”
Nurse Leaders Danielle Weber and Michelle Collins Named Fellows in Nursing Innovation
Two ChristianaCare nurse leaders have been named fellows in the 2024-25 cohort of the prestigious Johnson & Johnson Nurse Innovation Fellowship Program. The fellows are Danielle Weber, MSN, MSM, RN-BC, NEA-BC, chief nurse executive, and Michelle Collins, DNP, APRN, CNS, ACNS-BC, NPD-BC, NEA-BC, LSSBB, vice president of Nursing Professional Excellence. These nurse innovators will work collaboratively to address a real-world challenge in ways that can be implemented at ChristianaCare. Weber, who also is chief nursing officer of Wilmington Hospital, leads ChristianaCare’s nursing staff in setting strategic imperatives, advises leadership on best practices in nursing, establishes nursing policies and procedures, oversees nursing education and research and creates a collaborative environment to ensure evidence-based care practices in both the acute care and home health settings. Collins leads ChristianaCare’s systemwide efforts to support nursing practice innovation, governance infrastructure and problem-solving, including a successful initiative in virtual acute care nursing. She also led ChristianaCare to achieve its third Magnet designation, the preeminent designation for excellence from the American Nurses Credentialing Center. With a strong commitment to innovation in nursing, ChristianaCare is at the forefront of virtual acute care nursing. This entails experienced nurses practicing virtually in another location supporting hospital-based nurses by documenting health information, providing patient education, monitoring patient lab work, completing patient admission documentation and helping with discharge planning and care coordination. The fellowship, administered by Penn Nursing and the Wharton School at the University of Pennsylvania, is a one-year, team-based program for chief nursing officers, nurse executives and other senior nurse leaders that aims “to advance health care by powering up nurse-led innovation and leadership within health systems.”
