Connecticut is the fourth richest state in the country and the third healthiest. Nevertheless, it still has three very poor cities where health disparities among minorities are reflected in health statistics across the board, said Dr. Raul Pino, commissioner of the Connecticut Department of Public Health (DPH).
Pino held a forum at the Yale School of Public Health on Wednesday (Nov. 29) to engage researchers and students in a discussion of health priorities and to elicit ideas. Much of the data presented in his overview, said Pino, was generated from the Yale School of Public Health, including statistics on the HPV vaccine, opioid epidemic and HIV/AIDS.
Residents of Connecticut’s wealthier towns are generally healthier than the nation as a whole. However, while the largely minority populations in New Haven, Hartford and Bridgeport fare much more poorly. Contributing factors include poverty, environmental exposures from old housing stock, high cost of health care and insurance plans with high deductibles. Their effects are reflected in higher rates for cardiovascular disease, infant mortality, diabetes, asthma, smoking and HIV. More interventional research is needed to address these disparities, said Pino. In addition, he is calling for measures to address health care costs, including full disclosure of prices, rewarding healthy behaviors and reducing duplication of services.
“These discussions are important to the Yale School of Public Health,” said Dean Sten Vermund, “especially as we revamp our curriculum to meet workforce and research needs in the field.”
Among the state’s public health victories are its childhood vaccination rates and, starting next April, universal HPV vaccination for all children. The HPV (human papillomavirus) vaccine prevents a range of oral and cervical cancers. By providing the vaccine free to all children by age 14, there are significant health savings because only two doses are now necessary (instead of three) and efficacy rates are higher. YSPH’s Linda Niccolai, a professor in the School’s Department of Epidemiology of Microbial Diseases, led much of the research behind the policy and funding changes.
The state also has succeeded in preventing new HIV infections and treating people with the disease. While the number of diagnoses continues to fall and people are living longer, African- American men who have sex with men (MSM) are at highest risk for new infection. Needle exchange and outreach to intravenous drug users (IDUs), an intervention strategy developed at YSPH in the late 1980s, has reduced what was once the state’s main source of new infections. In 2015, there were 12 new HIV cases among IDUs and 134 among MSM.
Despite these successes, Connecticut remains in the midst of a deadly opioid epidemic. With nearly 1,000 deaths so far this year alone, this epidemic is concentrated among non-Hispanic whites and deaths from overdose are highest among those who are 30 to 60 years old. Prescription opioids and heroin are being mixed with other drugs, such as fentanyl and benzodiazepines, creating deadly cocktails. Recent regulations to reduce access to prescription opioids, make Naloxone more readily available to first responders and patients and new requirements for insurers to cover detoxification have yet to stem the death toll. The epidemic is different than anything the state has seen before, said Pino. DPH, meanwhile, is engaging other state agencies, such as the Departments of Correction and Health and Human Services, to implement more structural prevention and improve insurance coverage for addiction services.
The Yale School of Public Health has collaborated with the state on public health issues since C.-E. A. Winslow, its founding dean in 1915 spearheaded the establishment of the DPH in 1917.