A new report highlights what Tennessee could focus on to improve the health of its residents.

The latest America's Health Rankings report ranks Tennessee 44th among states for overall health outcomes. The report found nationwide, diabetes prevalence has increased to 11.5%, affecting nearly 32 million adults.

Dr. Millard Collins, professor and chair of the Department of Family and Community Medicine at Meharry Medical College, an HBCU in Nashville, said in order to ensure people are reaching their full health potential, facilities like his are charged with measuring care gaps in treating and managing such chronic conditions as diabetes.

"What we are fortunate to do at Meharry, we have these other individuals that are not just the providers to call these patients," Collins explained. "To follow up with these patients, to engage them and teach them how to use home blood pressure monitoring and blood sugar devices, so that we can capture these and intervene in real time."

Collins added diabetes is one of the leading causes of amputations among people of color, so services like podiatry and eye exams are especially important. Other challenges listed in the report for Tennesseans include high levels of what's described as "frequent mental distress," multiple chronic conditions and high numbers of smokers.

The report documented disparities in nearly all measured demographic groups in their prevalence of chronic conditions. Collins explained some reasons why people of color may have worse outcomes.

"Access. They just don't have a trusting relationship. And they either have limited access because of their insurance, or distrust of the system also affects the access, serves as a barrier," Collins outlined. "Two, resources, because it's one thing to diagnose someone with a condition, but another to tell them to go and spend $60 or $70 on one medication, when they need seven to control all their heart diseases."

Dr. Rhonda Randall, chief medical officer of employer and individual for UnitedHealthcare, said the new health ranking data reveals more than 29 million adults in the U.S. are living with three or more chronic conditions. She pointed out income and education are both strongly linked to these health challenges.

"Those who make less than $25,000 a year have the greatest number of chronic conditions," Randall reported. "Those who haven't received a high school diploma, have a tendency to have the greatest number of chronic conditions."

Randall also encouraged policymakers to find ways to incentivize people going into health care professions, with so many communities experiencing a shortage of health care professionals.

The number of avian flu cases in dairy cows is holding steady in New Mexico but experts say more testing is needed to prevent its spread and protect humans.

Technically known as H5N1, "bird flu" has been detected in eight Curry County herds, although no deaths were reported. In Texas, a man is known to have become ill with bird flu last month after contact with infected dairy cattle.

Andrew Pekosz, professor of molecular microbiology and immunology at Johns Hopkins University, said the transmission to humans is cause for concern.

"Given that dairy farms have a large number of people who come in contact with infected cows, there is an increased chance of the H5N1 virus also directly infecting humans and beginning that process of adapting to replication and spread within humans themselves," Pekosz explained.

He acknowledged the risk to the public is still very low, but argued the U.S. should improve its response to new and emerging infections in order to minimize the chance of another pandemic. The U.S. Department of Agriculture announced this week it will pay dairy farms with confirmed avian flu infections to help contain the virus' spread to people and more cows.

In Texas, the Centers for Disease Control and Prevention confirmed the virus killed a dozen cats who drank raw cow milk.

Meghan Davis, associate professor of environmental health and engineering at Johns Hopkins University, said due to extensive federal food checks prior to human consumption, she believes it is safe to eat poultry and drink milk, with one exception.

"Raw milk and raw milk products may not undergo the same processes to inactivate the virus," Davis pointed out. "I have very large concerns about the safety of raw milk."

In addition to New Mexico, last month's outbreak affected more than 33 dairy cow herds in seven other states. To date, federal officials only mandate testing for dairy cows moving between states.


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Newborns benefit the most from their mother's milk but may not always receive it.

An Indiana nonprofit group works to get breastmilk donations for premature babies. Similar to a blood bank, The Milk Bank accepts breastmilk donations from nursing mothers. Breastmilk is vital to a child's growth and development but what should be a natural occurrence between mother and child has sometimes historically been used as a tool of subordination.

Andrea Freeman, professor at Southwestern Law School, has conducted research on breastfeeding and found it has been a concern among Black families for more than 200 years.

"Black women breastfeed at lower rates than any other women, and always have done," Freeman explained. "This is a story that started during enslavement, and has continued ever since. And there are a lot of health consequences to Black families not having the same choice whether to breastfeed [or] use formula as other families."

Freeman asserted the baby formula industry is powerful in America, and the U.S. Department of Agriculture is its biggest purchaser. She stated the industry's perks and lobbying persuade medical professionals to promote using formula instead of encouraging new moms to breastfeed.

One study found infants who are not breastfed have higher chances of pneumonia, childhood obesity, diabetes, Sudden Infant Death Syndrome and more. But medications or a parent's financial need to return to work could mean opting for baby formula instead.

Jenna Streit, advancement director for The Milk Bank, said it sends 80% of breastmilk donations to the most medically fragile infants in neonatal intensive care units. She pointed out potential donors undergo thorough screening.

"They complete a prescreen online on our website and after that, they complete a more detailed health history," Streit outlined. "They get a blood test done at The Milk Bank's expense. And then, we also reach out to their health care provider to get their consent for donation as well."

She said the organization does experience shortages at certain times of the year. Streit acknowledged more donor milk was available during the pandemic because more moms were at home. According to the nonprofit Women4Change, one in four women returns to work within 14 days after childbirth.

Connecticut is slated to join a national nursing compact.

House Bill 5058 got the General Assembly's approval and awaits Gov. Ned Lamont's signature. The legislation allows Connecticut nurses to get a license permitting them to work in other compact participating states.

Cassandra Esposito, president of the Connecticut Nurses Association, said while it can attract nurses to work in the state, it does not alleviate workforce issues nurses face.

"It has to do with working conditions," Esposito explained. "We look at staffing, we look at workplace violence, we look at ways that nurses do their job, and the things that are making them a little bit harder to do their jobs."

Legislation established better nurse-to-patient staffing ratios and implemented better hospital security. The Connecticut Nurses Association pushed to resolve some issues, ensuring the compact was right for the state.

Lawmakers worked to address impacts to programs like HAVEN with an amendment that also develops a working group supporting compact implementation and addressing any unintended consequences. After three years, the working group will evaluate the efficacy of the compact on Connecticut.

Nationwide workforce shortages are not the only thing straining nurses. Burnout and mental health issues only aggravated by the pandemic are causing people to leave the field. Esposito argued barriers to nurses seeking help must be removed so the workforce thrives.

"Provide them with options," Esposito emphasized. "If your health care workers aren't well, the health care workers themselves suffer. The workforce itself suffers, patients, health care delivery as a whole suffers, so we really need to do more to take care of the mental health of our nurses."

Among respondents to an American Nurses Foundation survey, 64% said they feel stressed because of their job. Stress and other factors led to the national turnover average of nurses being as high as 37%, depending on location and specialty.


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