Population Health Blog

Population Health Blog

Why It Matters

Opioid Epidemic Requires Integrated Strategies that Meet Local Needs

By Juan Luis Marquez

The opioid epidemic in America has raised alarm among public health practitioners across the nation. The multiple factors driving this epidemic have been well documented in both the popular press and academic literature including: deceitful marketing by pharmaceutical companies, increased focus on pain as a 5th vital sign by hospital and physicians, and high rates of poorly managed chronic pain. Additionally, there is increasing realization of the role of social isolation and childhood trauma (ACEs) in driving opioid use. Although this week there was an announcement by the secretary of the U.S. Department of Health and Human Services, Alex Azar, that the death rate of opioid overdoses was finally slowing down, as noted by Secretary Azar, “We are so far from the end of the epidemic, but we are perhaps, at the end of the beginning,” meaning that there remains a significant public health burden resulting from this epidemic.

No state is immune to the opioid epidemic, but its effects are not distributed equally across the country. The Midwest, Northeast, and Appalachia are some of the hardest hit regions with opioid overdose rates up to 250% the national average (CDC). There are significant efforts at the federal, state, and county level to combat this epidemic. Some evidence based strategies that have been employed include harm reduction (Naloxone distribution, syringe distribution ), increasing access to Medication Assisted Treatment (MAT), provider education, and policy changes (Good Samaritan Laws). One example of a county that is working to implement these strategies is Washtenaw County, Michigan, a state in the heart of the opioid epidemic. The Washtenaw Health Initiative, a coalition of organizations including the county health department, regional health systems, the sheriff department, and local treatment and recovery centers among others, is working to implement many of these strategies. Some strategies implemented by WHI partners include: 1) distribution of Naloxone to county law enforcement and training on how to use it; 2) naloxone distribution and training for community members; 3) syringe distribution by local organizations; and 4) improved efforts to provide treatment rather than punishment to those arrested for opioid related crimes. Most recently, an opioid summit was held to inform and engage the Washtenaw provider and resident community. Given the variability in community demographics, local resources, and local opioid use, it is critical for counties to be actively engaged in prevention and treatment efforts as there is currently no standard, “one size fits all,” approach that will work for all communities.

Juan Luis Marquez, a preventive medicine resident and Masters of Public Health student at the University of Michigan, is a 2018-19 Albert Schweitzer Fellow, Detroit chapter. His focus is on assessing the network of services for people and families with opioid addiction in Washtenaw County.

How can economic indicators be relatively good, while our sense of well-being is so poor?

By Dennis Archambault

The economy is good, though we haven’t fully recovered from the 2007-10 recession and are anxious about the impact of job losses at Ford and General Motors; home values are up; the region continues to diversify with immigrant populations; millennials are finding the region desirable; and the health care industry continues to be a major source of employment. However, our sense of “well-being” is poor, worse than comparable cities.

The Detroit Free Press https://www.freep.com/story/money/business/john-gallagher/2018/12/04/detroit-regional-chamber-state-region-report/2193863002/ and The Detroit News https://www.detroitnews.com/story/business/columnists/daniel-howes/2018/12/04/headwinds-buck-regions-upward-trajectory/2196383002/ covered the story from a business perspective, citing a Gallup-Healthways Well-Being Index https://www.sharecare.com/static/well-being-index. That struck me as curious – business writers citing a well-being survey — not the Robert Wood Johnson Foundation county health rankings, which would offer mixed reviews for Wayne, Oakland, and Macomb county.

The Gallup poll, known formally as “State of American Well-Being,” defines the holistic concept as “more than just physical health or economic indicators.” Well-being includes five elements: “purpose, social, financial, community, and physical.” Of seven indicators listed in the Free Press article, all were related to economic development. The inclusion of well-being didn’t seem to be relevant. Or is it?

It seems as though business writers have, in this case, inadvertently linked health – albeit defined through a “well-being” framework – with economic vitality. Of course, mentally and physically healthy people are more productive and more engaged in the communities and social networks. We should all be concerned why the well-being index is low, and lower in Metropolitan Detroit than in other areas, in a robust economic period. What is population feeling and thinking? Unlike the RWJ County Health Rankings, this is driven by perceptions of respondents, not statistical data. Overall, we don’t feel well. And that isn’t a good indicator for population health.

Dennis Archambault is vice president of Public Affairs at Authority Health.