“The biggest drivers of inpatient spending for high-cost patients were catastrophic events such as sepsis and cancer, as well as expensive orthopedic procedures such as spine surgery and hip replacement,” wrote Karen Joynt, lead author, instructor in the Department of Health Policy and Management at HSPH, and colleagues. “These findings suggest that strategies focused on enhanced outpatient management of chronic disease, while critically important, may not be focused on the biggest and most expensive problems plaguing Medicare’s high-cost patients.”

Other authors included Atul Gawande, professor in the Department of Health Policy and Management; E. John Orav, associate professor of medicine (biostatistics), Harvard Medical School, and associate professor in the Department of Biostatistics, HSPH; and Ashish Jha, senior author, professor of health policy and management at HSPH.

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Read the JAMA press release

The study appeared online June 24, 2013 in JAMA Internal Medicine.

Led by Marta McCrum, research fellow in the HSPH Department of Health Policy and Management, and senior author Ashish Jha, professor of health policy and management, researchers found that hospitals performing in the top quartile on the three publicly reported measures had five times better odds of also being in the top set on a more global measure of quality—overall risk-adjusted mortality.

The ability of these three metrics to reflect broader hospital performance is “extremely important,” wrote the authors of an accompanying commentary about the study. “We do not have to measure every aspect of quality to get a sense of overall quality.”

Other HSPH authors included Atul Gawande, professor, and Karen Joynt, instructor, both from the Department of Health Policy and Management; and E. John Orav, associate professor of biostatistics.

Read the JAMA Internal Medicine abstract

Read the accompanying commentary in JAMA Internal Medicine

In an analysis of data from 92 randomized trials and studies involving a total of nearly two million women in 48 countries, researchers found that a daily iron supplement lowered a woman’s risk of anemia by 12% and of having a baby with low birth weight by 3%.

The study was published online June 21, 2013 in the British Medical Journal.

Serious iron deficiency tends to affect women in poorer countries, but wealthier countries can also learn from this research, said lead author Batool Haider, a researcher in epidemiology and nutrition at Harvard School of Public Health. An estimated 16% of pregnant European women have anemia, she said in a BBC interview published June 20, 2013.

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“Science suggests if we want to have a breakthrough impact on children, we have to transform the lives of adults who take care of them,” Shonkoff said. “Children and their health are shaped by the people around them. Adults have to be prepared to buffer children from stress in their lives – to help children learn to be resilient and overcome adversity.” Many adults may need help developing their skills so they can hold jobs, and have less stressful homes for their children, he said.

The Commission called the public meeting to hear testimony from leading experts on how best to support health in communities and during early childhood as a follow-up to its 2009 recommendations. Commissioners include Katherine Baicker, professor of health economics at HSPH, and Sheila Burke of Harvard Kennedy School.

David R. Williams, staff director of the Commission, Florence Sprague Norman and Laura Smart Norman Professor of Public Health at HSPH, and professor of African and African American Studies and of Sociology at Harvard University, moderated the program. Since the Commission met in 2009, he noted more children have access to fresh produce, healthier foods, and physical activity; the SNAP and WIC programs have been improved, and the U.S. child obesity rate has declined slightly. However, he said, much remains to be done to bring the overall health of children in poor communities up to that of youngsters in wealthier areas.

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Read about the RWJF Commission and the meeting

Overcoming Obstacles to Health in 2013 and Beyond (RWJF Commission to Build a Healthier America report by the National Research Council and Institute of Medicine)

HSPH Forum: The Toxic Stress of Early Childhood Adversity (February 7, 2012)

Stress plays key role in racial disparities in health (HSPH press release)

Center on the Developing Child at Harvard University

Since the study did not find any significant health improvements among those on Medicaid, some have reacted by criticizing Medicaid expansion and “Obamacare.” Others think it’s important to consider health insurance’s association with lowered depression—likely the result of less worry about finances—because depression has been linked with increased risk of stroke, heart disease, and diabetes.

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Expanding Medicaid lowers rates of depression, reduces financial strain, but no improvement shown in physical health (HSPH release)

Two takes on the Oregon Medicaid study (HSPH news)

Medicaid increases use of health care, decreases financial strain, and improves health for recipients (HSPH release)

In the article, Lu described visiting hives being studied in Worcester County, Mass. in spring 2011 and finding that those exposed to the pesticide imadacloprid—a commonly used neonicotinoid—were all dead. “This is the replication of Silent Spring,” he told the Globe. While pesticides are “a tool that we cannot afford to lose,” Lu added, he thinks there is a responsible way to use them. “I think it can be done,” he said.

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Use of common pesticide linked to bee colony collapse (HSPH release)

Last February, Berwick expressed his interest in the governorship during a Decision-Making: Voices from the Field talk at HSPH. “In D.C., I was so amazed by what government can do,” Berwick said at the time. “Government is the place where we come together to do things that we can’t do otherwise, and it’s the place where people get protected.”

Read Boston Globe article about Berwick’s decision to run for governor

Watch video clip of Berwick mentioning interest in governorship

Watch entire video of Berwick’s February 2013 Decision-Making: Voices from the Field talk

The study appeared online June 17, 2013 in JAMA Internal Medicine.

Researchers also found that those who decreased their red meat consumption lowered their type 2 diabetes risk by 14% during a 10-year follow-up period. And, as with previous studies linking red meat to negative health impacts, they found that processed meats such as hot dogs and bacon were more strongly associated with increased diabetes risk.

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Red meat linked to increased risk of type 2 diabetes (HSPH release)

Red meat consumption linked to increased risk of total, cardiovascular, and cancer mortality (HSPH release)

Simple steps to preventing diabetes (HSPH Nutrition Source)

While researchers have yet to provide a definitive answer about whether more costly and harder-to-find organic food, such as produce, milk, and meat, is healthier than conventional foods, “It only makes sense that food free of pesticides and chemicals is safer and better for us than food containing those substances, even at trace levels,” Lu wrote.

What’s more, he wrote, “Some convincing scientific does exist to suggest that an organic diet has its benefits.” In 2006 Lu led a study published in Environmental Health Perspectives that showed that within five days of substituting mostly organic produce for conventional produce in children’s diets, pesticides disappeared from the children’s urine.

Both Lu and a University of Florida physician, who countered Lu’s view on buying organic, advised those on limited budgets to consider buying organic versions of foods on the Environmental Working Group’s “Dirty Dozen” list, or focus on organic versions of foods eaten most frequently. Eating more fruits, vegetables, and whole grains and less processed foods remains the goal, they wrote.

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Vegetables and Fruits (HSPH’s The Nutrition Source)

Organic food no healthier than non-organic: study (HSPH in the News)

Avoiding pesticide residue on fruits and veggies (HSPH in the News)

Exposure to Pesticide in Produce with Dr. Alex Lu, Harvard (Environmental Working Group video)

The study was published online June 12, 2013 in Neurology.

“We found that the increased risk was not associated with the usual known risk factors, such as older age, being overweight, lack of sleep, smoking, being physically inactive, and having an unhealthy diet,” Gao said in a June 13, 2013 CBS News article. “Through research, we need to pinpoint why and how RLS leads to this possible higher risk of dying early.”

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