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The flu has been devastating this year. By the end of the season in May, an estimated 34 million Americans will have been infected. Each week there are up to 4,000 flu-related deaths. So far, 97 of the dead have been children. Public health authorities are urging people to get vaccinated. The goal is to get 80 percent of all Americans and 90 percent of at-risk populations (the elderly and children, in particular) vaccinated every year. That would ensure “herd immunity,” meaning it would provide enough protection to stop the spread of the virus. Yet less than 60 percent of children and only 43 percent of adults were vaccinated last flu season. The result is lots of unnecessary illness. (Ezekiel J. Emanuel and Justin Bernstein, 3/1)

Homelessness affects the lives of all Angelenos, not just those forced to live on the streets. And it does so almost daily, in ways large and small. Consider the pairs of thick gloves that George Abou-Daoud has stashed inside the nine restaurants he owns on the east side of Hollywood. When a homeless person accosts his customers, Abou-Daoud says, he can no longer count on the police for help; unless there’s an imminent threat to safety, he contends, they don’t respond quickly and can’t just haul the person away. So he’s had to take matters into his own hands, literally, by physically ejecting problematic homeless people himself. That’s why he has the gloves — to keep his hands clean. (3/1)

I have enjoyed using Jefferson County's parks and green spaces all my life. I regularly take long hikes along the Beargrass Creek drainage, through the Cherokee, Highlands, Phoenix Hill and Ohio River neighborhoods. Now a regular feature of these jaunts is coming across the garbage-strewn encampments of homeless men. I am astonished that the community would even waste much debate about whether to create a program to improve this situation. In Los Angeles, ongoing struggles with a booming homeless population has included taking note of the social cost of leaving destitute people to struggle in hillside and railway corridor encampments. Some of the recent West Coast fires that cost millions in property damage originated in homeless camps. Bacterial and other disease outbreaks arise rapidly in homeless camps that lack basic sanitary facilities. ... It just makes good sense for everyone to protect community health and reduce emergency room costs while helping the desperately poor have a better quality of life. (Bud Hixson, 3/1)

The One Planet Coalition established at the recent climate summit is working to ensure that the 174 nations that have ratified the Paris Agreement follow through on their commitments to battle global warming. The agreement is widely seen as an effort to counteract the ecological and economic impact of rising global temperatures: melting glaciers and ice sheets, rising water levels, and increasing frequency of extreme weather, from severe storms to extended drought, that have had crushing economic consequences.But global warming is doing far more than changing topography and weather. It is also having a series of devastating, detrimental effects on human health. (Philip Landrigan and Robert Wright, 3/1)

Since last month’s high school massacre in Parkland, Fla., attention has focused on lapses by the FBI, which failed to act on tips that the alleged shooter, Nikolas Cruz, posed an imminent danger. It’s also the case that neighbors, teachers, classmates, acquaintances and local authorities were aware that Mr. Cruz was armed and potentially dangerous, a fact that President Trump noted the day after the killing spree. “Must always report such instances to authorities, again and again!” he tweeted. (3/1)

The issue of opioids will be center stage in Washington D.C., where a series of events will take place at the White House, on Capitol Hill, and at a variety of venues across town. The timing for these meetings is critical and U.S. government collaboration with the right partners is key to combat the growing threat of opioids. ...As state and local resources have been depleted, and President Trump declared the opioid crisis a public health emergency last year, freeing up federal resources for the response. But tackling this problem is not simply a matter of unlocking U.S. resources, it’s about continuing to support and partner with the United Nations, specifically agencies like the UN Office on Drugs and Crime (UNODC) and the World Health Organization. (Jordie Hannum, 3/1)

Kentucky is dying. Black lung, COPD, emphysema. This month’s Journal of the American Medical Association reports “the largest cluster ever reported of advanced black lung, also known as progressive massive fibrosis, was confirmed in an area that includes southeastern Kentucky.”  ...Then there is our opioid crisis where 1,471 Kentuckians died in 2016 trying to tamp down their pain, with even higher numbers expected for 2017.  ...Though Kentucky rates well for quality of life at No. 27 out of the 50 states, according to U.S. News and World Report, we rank No. 49 for quality of health care, No. 38 in higher education, No. 45 in economic opportunity and No. 46 in fiscal stability. Which begs the question: How does our senior senator — the man who has represented Kentucky for more than three decades — explain numbers like these? (Teri Carter, 2/28)

Raegan McDonald-Mosley, MD, MPH, served as chief medical officer of the Planned Parenthood Federation of America (PPFA) during a particularly tumultuous time in its history. “We were battling this crazy smear campaign, and then the [presidential] election happened,” said McDonald-Mosley, who became PPFA’s chief medical officer in July 2015, only days after an antiabortion group released a heavily edited video that suggested Planned Parenthood violated federal law by selling fetal tissue. The ensuing state and US House committee investigations found no evidence of wrongdoing by PPFA. However, in January 2017, another House panel called for de-funding the organization. Meanwhile, in September 2017, just months after the call to defund PPFA, the organization was awarded the prestigious Lasker-Bloomberg Public Service Award “for providing essential health services and reproductive care to millions of women for more than a century.” (Rita Rubin, 2/28)

Since hormonal contraception became available in 1960—in the form of a combined estrogen-progestin pill—researchers have evaluated its risks and benefits. Though widely recognized as a breakthrough in medicine and the first effective long-term, reversible method of birth control, hormonal contraception, which is used by an estimated 140 million women worldwide, has never been free of adverse effects. Studies have long found an association between hormonal contraception (now available in other forms, including intrauterine devices [IUDs], the transdermal patch, the vaginal ring, and injectables) and adverse outcomes, such as an increased risk of breast cancer, depression, thrombosis, and other cardiovascular events. Therefore, clinicians have needed to weigh these risks carefully when counseling patients about birth control options—taking into consideration a woman’s family medical history, individual risk factors, and the benefits of hormonal contraception. (Rachel Rabkin Peachman, 3/1)

In the past, I have argued that Medicare needed to move away from its reliance on the Resource-Based Relative Value Scale (RBRVS) and the Sustainable Growth Rate formula (SGR) for physician reimbursement if it was serious about supporting value-based health care delivery. Indeed, the RBRVS–SGR combination represented the opposite of a value-based system: reimbursement reflecting the average effort and expenses of a physician providing a given service, in a system that assumed the “collective guilt” of physicians, in that all physicians’ Medicare fee-for-service reimbursements were adjusted according to whether aggregate Medicare fee-for-service spending for physicians grew faster or slower than the overall economy. With a level of bipartisan support that has become rare, Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA) in 2015, eliminating the SGR. The purpose of the legislation was to move Medicare toward reimbursement based more on outcomes and value. The Medicare Payment Advisory Commission (MedPAC) has now questioned whether the current version of MACRA accomplishes these goals or even moves the system in a better direction. (Gail R. Wilensky, 3/1)