New Federal Initiatives Help States Expand Support for Children and Families Affected by Substance Use by Hannah Eichner, National Academy for State Health Policy (NASHP) 
December 4, 2018

In the recent election, Republican and Democratic gubernatorial candidates offered strategies to address the opioid epidemic and meet the needs of children and families affected by substance use disorder (SUD). Incoming and incumbent executives will have new federal resources – including the new Maternal Opioid Misuse (MOM) and Integrated Care for Kids (InCK) models and the SUPPORT for Patients and Communities Act – to bolster their state efforts.

The recent SUPPORT for Patients and Communities Act includes a number of provisions that also support children and families affected by SUD, including several provisions that could provide new funding to states and new ways for states to use existing federal funds.

Several of the act’s provisions address the impact of childhood trauma. There are multiple connections between SUD and trauma — childhood trauma is a risk factor for SUD and growing up with a parent who has an SUD is itself considered a traumatic experience. Recognizing the significant and long-lasting impacts of childhood trauma, the SUPPORT Act:

  • Creates an interagency task force to develop best practices for identifying and supporting children and families who have experienced or are at risk of experiencing trauma. The task force is also responsible for crafting a coordinated federal response to families impacted by SUD and other forms of trauma. These best practices and coordinated federal approach will help states as they promote evidence-based approaches to care. (Section 7132)
  • Permits the US Centers for Disease Control and Prevention to collect data about adverse childhood experiencesthrough existing public health surveys, in cooperation with states, with $2 million in annual funding. States can use the findings to track trends, allocate resources, and refine programs that address adverse childhood experiences. (Section 7131)
  • Authorizes $50 million per year for grants to state, local, and tribal educational agencies to increase student access to trauma support services by linking educational agencies with mental health systems. The US Secretary of Education would administer the grants in coordination with the Assistant Secretary for Mental Health and Substance Use. (Section 7134)

What's Killing America's White Men? BBC News 
October 18, 2018

Every year, nearly 45,000 people in America kill themselves. That is more than twice the number that die in homicides, and the numbers are increasing. There is one group in particular causing this spike - white, middle aged men. India Rakusen goes to Montana, where suicide rates are double the national average, to find out what drives so many of these men to despair and taking their own lives.

Master Gardener Training for Inmates 
Posted on October 1, 2018

Powell County is situated in Southwestern Montana, home of MSU Extension Agent, Jodi Pauley and home to the Montana State Prison and Montana Correctional Enterprises (MCE). While working with MCE in the summer of 2017 Pauley realized that there was a need for a Master Gardener class for inmates. Several of the inmates had asked Pauley for horticulture information, MontGuides and any literature related to gardening and horticulture. Currently, MCE has a small greenhouse in which they grow tomatoes and a few raised beds for onions and lettuce. MCE also recently acquired a high tunnel which opens the doors for more horticulture opportunities. Pauley approached the MCE Ag director about holding a class for some of the inmates and he was very open to the idea and in January of 2018 the first Master Gardener class was held at MCE.

Six inmates were allowed to take the class, all with an interest in gardening and the horticulture industry. Pauley taught most of the classes along with fellow agents Ben Hauptman and Brent Sarchet as well as MSU Horticulture Specialist Toby Day.  The inmates interacted very well with the instructors and thoroughly enjoyed the course. More at

Leveraging Laws and Policies to Help Achieve Healthy People 2020 Objectives 
Posted on September 13, 2018 by ODPHP

Law and policy are among the most effective tools to improve health and well-being, yet many people may not be aware of the precise impact these interventions and approaches can have on population health. To address this, the Healthy People 2020 Law and Health Policy project is developing resources that will provide practical information to a broad audience about the impact that laws and policies can have on health outcomes. 


Extension Opioid Crisis Response Workgroup (EOCRW) 

In February, 2017, the Extension Committee on Organization and Policy (ECOP) established the Extension Opioid Crisis Response Workgroup (EOCRW) and charged it to develop a "nationwide opioid crisis response strategic framework for Extension." The EOCRW consists of 25 members, of which 10 expert are partners. On July 16, 2018, the EOCRW established a new Opioid Response website that provides content on eight existing opioid-related programs. The following summary information is available for each of the programs:

1) brief description;

2) format, duration, and approach;

3) target audience;

4) degree to which the program is research-based/evidence-based; and,

5) costs of adoption and use.

Contact information, links to key resources and webinar recordings offer more detailed descriptions of the programs. ECOP and Workgroup members believe these resources are useful to those seeking opportunities to address the opioid crisis in their states. Over time, new content will be added. Directors and Administrators may access details on this initiative and others in the "Learning and Initiatives" section of this blog - see menu, right found on the full view of this blog

 All of Us Program - May 6, 2018

 All of Us is a new research program from the National Institutes of Health (NIH). The goal is to advance precision medicine. Precision medicine is health care that is based on you as an individual. It takes into account factors like where you live, what you do, and your family health history. Precision medicine’s goal is to be able to tell people the best ways to stay healthy. If someone does get sick, precision medicine may help health care teams find the treatment that will work best.

To get there, we need one million or more people. Those who join will share information about their health over time. Researchers will study this data. What they learn could improve health for generations to come. Participants are our partners. We’ll share information back with them over time.

At the moment, health care is often one-size-fits-all. But imagine a future where your health care is tailored to you. We want to make that future possible. How? By creating a resource that allows researchers to conduct thousands of studies on health and disease.

The All of Us Research Program brings together a unique group of participants on a scale never before achieved. These participants will help speed up health research and medical breakthroughs.

We expect the program to last at least ten years, and we hope you’ll stick with us throughout the study.

What the Arlee Warriors Were Playing For - The New York TimesMagazine

Starting at noon on Feb. 23, the town of Arlee, Mont., evacuated. Most of its 600-odd residents drove 70 miles south through Missoula and then into the Bitterroot Valley, a river corridor full of subdivisions, trailers, exclusive private communities and ammunition stores. The crowd filtered into the gymnasium at Hamilton High School, wearing red shirts and pins bearing the faces of the Arlee Warriors basketball team, who that evening would be playing the Manhattan Christian Eagles.

Manhattan Christian is a faith-based private school near Bozeman. Arlee is a public school on the Flathead Indian Reservation; about half the town is Salish, descendants of the people forced out of the Bitterroot in the 19th century. Manhattan Christian’s boys were tall and muscled; most of Arlee’s players were well under six feet and on the thinner side. Manhattan Christian arrived in a sleek black bus with aerodynamic curvature and tinted windows; Arlee came in a yellow Blue Bird. The Feb. 23 game would be a rematch of the previous year’s Class C state championship, which the Warriors won. On one wall of the gym, Manhattan Christian had hung a banner reading “#unfinished.” Arlee had their own banner, but they did not need it. They had Phillip Malatare.


What it Takes - Creating Healthier Communities

Healthcare is one of our nation’s most dynamic and rapidly growing industries. It is also where the nation faces one of the greatest shortages of trained professionals, especially in rural areas like many parts of Montana. MSU is making sure today’s medical and nursing students and programs are prepared to address that need. WATCH THE VIDEO >>>

Healthiest Cities & Counties - Aetna Foundation, APHA, & NACo

The National Association of Counties (NACo) is partnering with the Aetna Foundation and the American Public Health Association (APHA) on a $1.5 million prize competition, the Healthiest Cities & Counties Challenge (the Challenge). The challenge aims to improve measurable health outcomes and promote health, wellness, equity and social interaction through practical, evidence-based strategies and cross-sector collaboration.

Counties and cities involved in the Challenge will work to improve their residents’ health by incorporating health considerations into policies and practices, developing replicable strategies that achieve measurable results and creating sustainability by leveraging prize money from the Challenge. For more information, visit

Special Issue on Rural Families - Family Science Review, Vol 22, Issue 1, 2018

This special issue of the Family Science Review is a compilation of five papers representing 20 years of an accumulated body of knowledge on the lives of rural, low-income families. The papers focus on various aspects of their everyday experiences including economic security, family well-being, food insecurity, and health issues, as well as on rural diversity with special emphasis on Latina families.

Building a Culture of Health Across the Nation  CES-RWJF Partnership March 2018

Together, the Robert Wood Johnson Foundation (RWJF) and National 4‑H Council are working to improve the health of 1,000 communities across the nation over the next 10 years. Leveraging the national Cooperative Extension System (CES) and 4‑H’s proven youth leadership model, youth will work alongside community members, public health organizations, businesses, government entities and non-profit agencies to address top public health priorities and implement community action plans that ensure all community members can be healthy at every stage of life.

USDA to Host Round Tables on Rural Opioid Misuse  USDA,OC March 7, 2018

Assistant to the Secretary for Rural Development Anne Hazlett today announced USDA is hosting a series of monthly roundtables on opioids through the summer.

“The opioid epidemic in rural communities is more than a public health issue,” Hazlett said. “This is a matter of rural prosperity. Opioid misuse is impacting the quality of life and economic well-being in small towns, which is why partnering with rural leaders to address this crisis is critical to the future of rural America.”

Beginning this month, Hazlett will convene regional roundtables to bring together partners in five states to raise awareness and better understand what support rural communities need to address opioid misuse. Key topics will include challenges associated with substance use disorder; strategies for prevention, treatment and recovery; and how these measures can be replicated to effectively address the epidemic in other rural communities.

Roundtables will be held:

Updated Atlas of Rural and Small-Town America  USDA,ERS March 1, 2018

The rural atlas, maintained and updated by the Economic Research Service at the U.S. Department of Agriculture, provides statistics on three broad categories of socioeconomic factors:  demographics, including migration and immigration, education, and characteristics of veteran population;  jobs, with employment trends, industrial composition and household income; and county classifications that include the rural-urban continuum, economic dependence, persistent poverty and other characteristics.

Opioid Misuse in Rural America  February 2018

The United States is experiencing an epidemic of drug overdose deaths.  In 2016, nearly 64,000 Americans died from a drug overdose. At 174 people each day, this is more than the number of lives lost in car accidents or gun-related homicides. An overwhelming majority of these overdose deaths involved an opioid.  While no corner of the country has gone untouched by this issue, the opioid epidemic has hit rural America particularly hard.

As rural leaders respond to this growing challenge, an effective solution to addressing this issue will take leadership and collaboration from a broad range of partners at the federal, state and local level.  Under the leadership of Secretary of Agriculture Sonny Perdue, USDA is keenly focused on facilitating prosperity in rural America.  With a concern for quality of life and economic opportunity, USDA is partnering to strengthen local responses to the opioid epidemic in rural communities. 

The purpose of this website is to assist rural leaders with resources, information and best practices to help rural communities respond to and manage the crisis.

Pain in the Nation: Deaths from Alcohol, Drugs and Suicide Reach the Highest Level Ever Recorded  February 2018

According to the most recent data, in 2016, 142,000 Americans, the highest number ever recorded, died from alcohol- and drug-induced fatalities and suicide – an average of one every four minutes. These 142,000 ‘despair deaths’ in 2016 add to the more than one million Americans who died from drugs, alcohol or suicide in the previous decade (2006 to 2015). For context, deaths from these three causes are nearly identical in number as those who died in 2016 from stroke, the fifth leading cause of death in United States, and are greater than the number of Americans who died in all U.S. wars since 1950 combined.

The National Institutes of Health (NIH) Produces Five Wellness Toolkits  February 12, 2018

The National Institutes of Health recently published five wellness toolkits. The topics of these toolkits include: Your Surroundings, Your Feelings, Your Body, Your Relationships and Your Disease Defense. Within each toolkit, view a checklist of actions one can take to improve their health within each topic area. The checklists can be quickly reviewed and accessed as a PDF for easy printing.

Communities Driving Health Equity - A Spotlight Video Series  January 2018

The National Academy of Medicine (NAM) is proud to present a documentary video series that spotlights local organizations across the U.S. advancing health equity for their communities by addressing the environmental, social, economic, and structural challenges that may impact residents’ health. The videos show that, while challenges are numerous, progress is possible when community members, organizations, funders, and policy makers work together to drive local-level solutions that improve health equity and well-being for all.

Our nation’s health depends largely on the health and well-being of its communities, but many of them don’t have adequate access to jobs, safe and affordable housing, health care, green space, healthy food options, and other things they need to thrive. While biology, genetics, and individual behaviors play a role in people’s health, the socially-driven conditions in which one lives—often referred to as “social determinants of health”—influence and limit individuals’ choices. By taking on these health-limiting factors and developing solutions with partners, communities can help empower residents to grasp their full health potential.

We are proud to present the stories of these three diverse communities that face complex, pervasive challenges but are all making progress in advancing health equity—meaning everyone has the same shot at living a healthy life. While each community needs to develop an approach suited to its own unique needs, our hope is that in sharing these stories, communities facing similar challenges might be inspired and informed to build solutions that are right for them.

HHS Announces New Conscience and Religious Freedom Division  January 18, 2018

The U.S. Department of Health and Human Services (HHS) is pleased to announce the formation of a new Conscience and Religious Freedom Division in the HHS Office for Civil Rights (OCR). The announcement will take place at an event at HHS headquarters from 10:30 a.m. to noon on January 18, 2018. Speakers will include Acting Secretary Eric D. Hargan, House Majority Leader Kevin McCarthy, Representative Vicky Hartzler, Senator James Lankford, OCR Director Roger Severino, and special guests.

The Conscience and Religious Freedom Division has been established to restore federal enforcement of our nation’s laws that protect the fundamental and unalienable rights of conscience and religious freedom. OCR is the law enforcement agency within HHS that enforces federal laws protecting civil rights and conscience in health and human services, and the security and privacy of people’s health information. The creation of the new division will provide HHS with the focus it needs to more vigorously and effectively enforce existing laws protecting the rights of conscience and religious freedom, the first freedom protected in the Bill of Rights.

OCR already has enforcement authority over federal conscience protection statutes, such as the Church, Coats-Snowe, and Weldon Amendments; Section 1553 of the Affordable Care Act (on assisted suicide); and certain federal nondiscrimination laws that prohibit discrimination on the basis of religion in a variety of HHS programs. 

OCR Director Severino said, “Laws protecting religious freedom and conscience rights are just empty words on paper if they aren’t enforced. No one should be forced to choose between helping sick people and living by one’s deepest moral or religious convictions, and the new division will help guarantee that victims of unlawful discrimination find justice. For too long, governments big and small have treated conscience claims with hostility instead of protection, but change is coming and it begins here and now.”

Acting HHS Secretary Hargan said, “President Trump promised the American people that his administration would vigorously uphold the rights of conscience and religious freedom.  That promise is being kept today. The Founding Fathers knew that a nation that respects conscience rights is more diverse and more free, and OCR’s new division will help make that vision a reality.”

To learn more about the new Conscience and Religious Freedom Division, visit us at

To file a complaint with OCR based on a violation of civil rights, conscience or religious freedom, or health information privacy, visit us at

OCR Announces New Conscience and Religious Freedom Division. It will restore federal enforcement of our nation’s laws that protect the fundamental rights of conscience and religious freedom.

Turmoil In Long-Term Insurance Industry Hits Customers Hard     January 18, 2018

Almost every insurer in the business badly underestimated how many claims would be filed and how long people would draw payments before dying. People are living and keeping their policies much longer than expected, which is making the business unsustainable for the companies. In other marketplace news, some of Humana's employees will be getting a wage increase thanks to the Republicans' tax plan, and Aetna has agreed to settle claims over a privacy breach.

The Wall Street Journal: Millions Bought Insurance To Cover Retirement Health Costs. Now They Face An Awful Choice Long-term-care insurance was supposed to help pay for nursing homes, assisted living and personal aides for tens of millions of Americans when they became unable to take care of themselves. Now, though, the industry is in financial turmoil, causing misery for many of the 7.3 million people who own a long-term-care policy, equal to about a fifth of the U.S. population at least 65 years old. Steep rate increases that many policyholders never saw coming are confronting them with an awful choice: Come up with the money to pay more—or walk away from their coverage. (Scism, 1/17)

Opioid Crisis Affects All Americans, Rural and Urban

Posted by Ahlishia Shipley, Division of Family and Consumer Sciences, National Institute of Food and Agriculture (NIFA), USDA      January 11, 2018      

Every day, more than 90 Americans die after overdosing on opioids. That’s three people every hour.

As if the death rate wasn’t bad enough, the Centers for Disease Control and Prevention (CDC) estimates that the “economic burden” of prescription opioid misuse in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, and addiction treatment.

Despite the grim subject matter depicted in TV and movies, opioid addiction is not confined to big cities. The effects of the opioid epidemic are more intense in rural communities where employment opportunities are often limited and isolation is pervasive. Between 1999 and 2015, opioid death rates in rural areas have quadrupled among those 18-to-25-year-olds and tripled for females.

FDA Identifies Four Priority Areas for Additional Policy Activity in 2018 - January 2018

1. Reduce the burden of addiction crises that are threatening American families
2. Leverage innovation and competition to improve healthcare, broaden access, and advance public health goals
3. Empower consumers to make better and more informed decisions about their diets and health; and expand the opportunities to use nutrition to reduce morbidity and mortality from disease
4. Strengthen FDA’s scientific workforce and its tools for efficient risk management

10 Ways Health Care in America Changed in 2017 by Shanoor Seervai & David Blumenthal, M.D.

While many issues and crises competed for the public’s attention in 2017, health care captured headlines throughout the year. Perhaps as a result, almost half of Americans say health care is their top concern going into 2018, according to a new Associated Press-NORC poll. Here, we look at 10 critical events in health care during the past year.

The Hague Protocol: Identifying kids at risk by interviewing parents in the ER by Rob Waters

In the summer of 2007, a woman was brought by ambulance to the emergency department of the Medical Center Haaglanden, a hospital that serves an inner city area of The Hague. The woman was drunk and had a severe head injury. Her 8-year-old son was with her.

Hester Diderich, an emergency nurse, and other hospital staff members looked after the boy while they attended to his mother. “We were very nice to him,” Diderich remembers.

After treating the woman’s injuries, they were ready to release her and her son. What happened next led Diderich and her colleagues to realize they needed a better way to protect children and evaluate the risks they face. They created a new process, known as The Hague Protocol, and started a study to evaluate it. The protocol is now in use throughout the Netherlands and is being adopted by other European countries as well.

The idea is that hospital emergency departments are places where, by asking adults a few of the right questions, families in which children may be experiencing violence or abuse can be identified with surprising accuracy and ease.

Full interview of ER nurse, Hester Diderich, by Rob Waters is at:

This is Your Brain on Walking, by Jenna Birch - August 14, 2017
The general wellness perks of getting fresh air and exercise might be reason enough for you to tie up your shoes and get some steps. But here’s more good news about walking: a new study shows walking can benefit the brain. In research findings presented at Experimental Biology 2017, scientists found that the foot-to-ground impacts created during a walk may send pressure waves surging through your arteries, and ultimately increase the amount of blood sent to the brain.

Healthy Children, Healthy Communities -- Missoula, MT
An intervention to prevent childhood obesity has blossomed into a communitywide effort led by a local hospital. Providence St. Patrick Hospital helped launch CATCH -- Coordinated Approach to Child Health -- in Missoula, Mont. Based on the CDC's Whole School, Whole Community, Whole Child model, CATCH is an evidence-based program to encourage physical activity and healthy food choices by elementary schoolchildren. After a successful two-year pilot, St. Patrick Hospital, the Missoula City-County Health Department and the school district expanded the initiative. The hospital funded a part-time registered dietitian and community health specialist to provide on-site training for all school staff and to help add salad bars and new fruit to the school lunch program. The community health specialist also works with local organizations and offers CATCH support to other hospitals. Missoula's Parks and Recreation department, Food Bank and YMCA also have embraced CATCH in their programs and activities. Pilot results showed that students? knowledge about how to eat a healthy diet increased by more than 30%, and the number of children reporting they ate fruit daily increased by nearly 40%. Providence St. Patrick Hospital now has guided 10 school districts in implementing CATCH. Identifying dedicated hospital champions to coordinate and spread the program has been critical to success as well as partnering with a broad range of community stakeholders for support.

Stakeholder Perspectives on a Culture of Health
Since 2013, the Robert Wood Johnson Foundation (RWJF) has embarked on a pioneering effort to advance a Culture of Health. The Culture of Health action framework is founded on a vision in which "everyone in our diverse society leads healthier lives now and for generations to come." To put the Culture of Health vision into action, RWJF asked RAND Health to support the development of an action framework and measurement strategy. This report summarizes the stakeholder engagement efforts that RAND used to inform this work. It draws on a series of interviews and focus groups that RAND researchers conducted with stakeholders both within and outside the United States. It should be of interest to RWJF, as well as to those individuals and organizations interested in advancing the Culture of Health action framework. Given that RWJF is focused on using the Culture of Health action framework and measures to catalyze national dialogue about content and investments to improve population health and well-being, the report should be beneficial to a range of national, state, and local leaders across a variety of sectors that contribute to health as described by the Culture of Health action framework.

Medicaid Suspension Policies for Incarcerated People: 50-State Map 
Medicaid eligibility for people getting out of prison is smart policy. People who are in prison are generally not eligible for Medicaid. But making sure they can get health care when they are released is smart policy. States can adopt a policy to suspend-rather than terminate-a person's Medicaid coverage while he or she is incarcerated. The map below shows which states suspend and which states terminate Medicaid for people entering jail or prison. Suspending Medicaid makes it easier for a person leaving the criminal justice system to regain health coverage. This ensures quicker access to mental health services, prescribed medicines, and other needed care. It also helps the economy, improves the health of local communities, and reduces the chance of people returning to prison.

Building a Culture of Health Equity at the Federal Level
The United States spends significantly more resources on health care than any other nation. Despite this fact and the remarkable improvements in the quality of health care over the past century, the nation's relative standing in health outcomes and life expectancy continues to erode. "Americans die sooner and experience more illness than residents in many other countries," a 2013 report from the National Research Council and Institute of Medicine bluntly noted (NRC and IOM, 2013). The report identifies six actionable opportunities for stakeholders focused on advancing a health equity agenda at the federal level: (1) Develop a "Health Equity Learning Community" of federal mid- and senior-level civil servants in partnership with philanthropy; (2) Develop a federal "Healthy Communities" designation, employing Promise Zone design principles; (3) Collaborate with the National Institute on Minority Health and Health Disparities (NIMHD) to expand research linked to place-based initiatives around how social and economic conditions are linked to health outcomes; (4) Facilitate increased coordination at the local level around Community Health Needs Assessments (CHNAs) through federal funder encouragement and information sharing; (5) Increase collaboration between the National Prevention Strategy (NPS), the Federal Interagency Health Equity Team (FIHET), and the Convergence Partnership; and, (6) Embed equity as a value in Executive Core Qualifications for Senior Executive Service.

Strengthening Our Future: Key Elements to Developing a Trauma-Informed Juvenile Justice Diversion Program for Youth with Behavioral Health Conditions
Developed by the National Center for Mental Health and Juvenile Justice (NCMHJJ) and the Technical Assistance Collaborative, Inc. (TAC) as part of the 2014-15 Policy Academy-Action Network Initiative, this report: (1) presents the current understanding of child trauma in the context of juvenile justice; (2) identifies 9 implementation domains essential to achieving a trauma-informed juvenile justice diversion approach; and, (3) highlights case examples from each state involved in the initiative (Georgia, Indiana, Massachusetts, and Tennessee). The 2014-15 Policy Academy Action Network Initiative was a joint effort supported by the John D. and Catherine T. MacArthur Foundation (as part of Models for Change: Systems Reform in Juvenile Justice) and the Substance Abuse and Mental Health Services Administration. The overall goal of the initiative was to facilitate implementation of innovative strategies for probation-intake diversion and improved outcomes for youth in contact with the justice system who have behavioral health and trauma-related conditions.

Walking: A simple route to improving your health
The path to good health through fitness can be a challenging but rewarding journey. But if you?re looking for a simple way to break into getting fit, look no further than your own two feet and the path outside your door. Walking is an easy and accessible way for people of all ages to get fit. Depending on where you live, walking can even be the healthier alternative to places you normally drive, such as your job or the grocery store.

Stepping Up: A National Initiative to Reduce the Number of People with Mental Illnesses in Jails
The National Association of Counties (NACo), the Council of State Governments (CSG) Justice Center, and the American Psychiatric Association Foundation (APAF) have come together to lead a national initiative to help advance counties' efforts to reduce the number of adults with mental and co-occurring substance use disorders in jails. With support from the U.S. Justice Department's Bureau of Justice Assistance, the initiative will build on the many innovative and proven practices being implemented across the country.​ In May 2015, NACo and partners at the CSG Justice Center and APAF launched Stepping Up: A National Initiative to Reduce the Number of People with Mental Illnesses in Jails and announced a Call to Action demonstrating strong county and state leadership and a shared commitment to a multi-step planning process that can achieve concrete results for jails in counties of all sizes. As part of this Call to Action, county elected officials are being asked to pass a resolution and work with other leaders (e.g., the sheriff, judges, district attorney, treatment providers, and state and local policymakers), people with mental illnesses and their advocates, and other stakeholders to reduce the number of people with mental illnesses in jails.

What is a Culture of Health?
The Robert Wood Johnson Foundation is committed to building a national Culture of Health that enables all in our diverse society to lead healthier lives now and for generations to come. A Culture of Health is broadly defined as one in which good health and well-being flourish across geographic, demographic, and social sectors; fostering healthy equitable communities guides public and private decision making; and everyone has the opportunity to make choices that lead to healthy lifestyles. The exact definition of a Culture of Health can look very different to different people. A national Culture of Health must embrace a wide variety of beliefs, customs and values. Ultimately it will be as diverse and multifaceted as the population it serves.

Step It Up! The Surgeon General's Call to Action to Promote Walking and Walkable Communities 
One out of every two U.S. adults is living with a chronic disease, such as heart disease, cancer, or diabetes. These diseases contribute to disability, premature death, and health care costs. Increasing people's physical activity levels will significantly reduce their risk of chronic diseases and related risk factors. Because physical activity has numerous other health benefits-such as supporting positive mental health and healthy aging-it is one of the most important actions people can take to improve their overall health. Step It Up! The Surgeon General's Call to Action to Promote Walking and Walkable Communities recognizes the importance of physical activity for people of all ages and abilities. It calls on Americans to be more physically active through walking and calls on the nation to better support walking and walkability. Improving walkability means that communities are created or enhanced to make it safe and easy to walk and that pedestrian activity is encouraged for all people. The purpose of the Call to Action is to increase walking across the United States by calling for improved access to safe and convenient places to walk and wheelchair roll and by creating a culture that supports these activities for people of all ages and abilities. The Call to Action includes five strategic goals to promote walking and walkable communities in the United States: make walking a national priority; design communities that make it safe and easy to walk for people of all ages and abilities; promote programs and policies to support walking where people live, learn, work, and play; provide information to encourage walking and improve walkability; and fill surveillance, research, and evaluation gaps related to walking and walkability. Action by multiple sectors of society, as well as by families and individuals, will be needed to achieve these goals.

Healthy Youth Website
CDC's Division of Adolescent and School Health is excited to announce that the Healthy Youth website has a new look! The new Healthy Youth website is in a responsive web design, which means that the content can be easily accessed via multiple devices, including smart phones, tablets, laptops, and desktop computers. In addition, the website has been reorganized to make it easier to find information.

What Really Makes Us Healthy? Health Beyond Healthcare
The top contributors to long-term health may be surprising to most. As it turns out, only a fraction of what affects our health is actually related to healthcare. To truly improve outcomes, we need to look beyond healthcare at a variety of factors that impact health.

Pets help knit community together
We know pets calm us down and cheer us up, but now researchers have found they can good for us in ways we could never have imagined. Not only do pets help develop friendships between people, but they can increase the amount of physical and emotional support that people give each other, says Associate Professor Lisa Wood from the University of Western Australia's School of Population Health. There is good evidence that pets can boost our mental health by providing companionship and improve our physical health by reducing our blood pressure and stress levels. But Wood and colleagues were interested in looking at the role that pets might play in creating connections between people and reducing social isolation.

The Facts behind Medicaid Estate Recovery
Under federal law, states are required to bill estates for the cost of an individual's long-term care costs while on Medicaid. But recovering the costs of health services is not required by federal law, and most states simply aren't interested in doing so because they fear the high administrative costs of collecting money from a broad Medicaid expansion population. As a case in point, only 10 states have indicated a willingness to pursue the recovery of health care costs from estates. What is very real is the immediate financial risk of not signing up for Medicaid and consequently remaining uninsured. Someone who passes up Medicaid coverage and remains uninsured because they are concerned that the state might recoup some health care from their estate sometime in the future runs the risk of incurring large medical debts today. If that happens, creditors won't wait until the person dies. Medical debt is the leading cause of personal bankruptcies in the U.S. And that's a serious risk that can cause long-term financial damage to families. Someone who is currently uninsured and eligible for Medicaid should sign up for the program.

Our New Rankings Are Out Today
Our new Rankings are now live, with new data, new measures, new resources, and a new look and feel to our website. So what's new for 2015? Visit your county's Snapshot and see for yourself. Income Inequality is a new measure we've added for 2015, and our measures have been updated with new data. We've also rolled out new measure maps that more accurately show where on the spectrum of health your area falls. See the data for your community on our website. Our Roadmaps to Health Action Center has not only been given a new look, we've added new tools and resources to help you improve health where you live. We've also added some new ways to interact with What Works for Health, our searchable database of strategies and evidence, and to see the inspiring things communities are doing across the country to improve health via the RWJF Culture of Health Prize.

Get ready to enroll in Marketplace coverage
Starting November 15th, you'll be able to apply and enroll in 2015 Marketplace coverage. If you're eligible, the Health Insurance Marketplace can help you find affordable health coverage. Most people who apply qualify for premium tax credits and other savings based on their income. If you already have 2014 Marketplace coverage, you'll be receiving important information about how to keep your coverage for 2015. Here are some things you can do now to get ready for November 15th: (1) Learn about important dates and deadlines for Marketplace coverage; (2) Download this Marketplace checklist to gather the documents you'll need to apply; (3) Find someone in your community to help you apply and answer your questions; and, (4) Be the first to know! Sign up for timely text message updates and connect with us on social media.

From Coverage to Care
The Centers for Medicare & Medicaid Services (CMS) have launched From Coverage to Care, an "initiative to help people with new health care coverage understand their benefits and connect to primary care and the preventive services that are right for them". This initiative includes written resources, images, videos, and various ways to connect with CMS.

CMS: Health spending to grow average 5.7% annually through 2023
National health spending is expected to grow an average 5.7% annually through 2023, due to coverage expansions under the Affordable Care Act, anticipated economic growth and an aging population, the Centers for Medicare & Medicaid Services reported today in Health Affairs. That?s up from an anticipated 3.6% growth rate in 2013, but down from an average 7.2% between 1990 and 2008, the agency said. Health care spending is expected grow an average of 1.1 percentage points faster than the economy between 2013 and 2023, raising the health care share of gross domestic product from 17.2% to 19.3%. CMS expects spending growth for hospital care to slow from 4.9% in 2012 to 4.1% in 2013, then increase to 4.5% in 2014 and 5.1% in 2015 as the ACA?s coverage expansions increase use of services. Medicare spending on hospital care is expected to slow from 4.5% in 2012 to 2.5% in 2013 due to the effects of sequestration and slower growth in utilization.

NIC's Health Reform Webinar Series . . . Health Literacy: Enhancing Access to Health Care for Justice-Involved Individuals 
With the advent of the Patient Protection and Affordable Care Act, it is now possible for millions of low-income justice-involved individuals to obtain insurance coverage for their physical and behavioral health care needs. This far- reaching systems change will impact every component of the criminal justice system from pretrial to reentry, from corrections health to behavioral health. Criminal Justice professional and Health professionals alike have a role in helping these individuals develop the capacity to obtain and understand basic health information to make appropriate health care decisions. In this one and half hour presentation you will hear from national correctional health care and health literacy experts. The content of this webinar on July 22, 2014,will meet the following objectives: Objectives: 1. Understand the health needs and incidence of chronic disease in the CJ population 2. Understand the importance of maintaining a continuum of care as inmates transition from jails to the community 3. Understand the barriers to access to care for this population, i.e., health literacy 4. Understand the role of criminal justice professionals, (corrections health, transition counselors, and probation/parole) in incorporating linkage to health care into case managements 5. Provide strategies for establishing linkages / maintaining continuum of care

Health Reform and Public Safety: New Opportunities, Better Outcomes 
Research shows that there are a disproportionate number of justice involved individuals suffering from chronic illness and/ or mental health and substance abuse disorders. We also know that a majority of the justice-involved individuals are young adults and unemployed or earn an income that is well below the federal poverty line leaving them without the ability to obtain health care. There is now an opportunity to enhance collaboration between the criminal justice/corrections and healthcare systems. Early estimates indicate a significant number of justice-involved individuals may be eligible for provisions under the Patient Protection and Affordable Care Act (ACA), specifically; enrollment in Medicaid or the ability to purchase health care coverage through state health insurance exchanges. Because of the many health care expansion possibilities for this population we are witnessing an unprecedented opportunity to help connect the justice population to healthcare coverage and the associated healthcare services. Federal, state and local criminal justice systems are poised to change the way they do business with the advent of the ACA. It is now possible for millions of low income, justice- involved individuals to obtain healthcare or insurance coverage for their physical and behavioral health needs. This far reaching system change will impact every decision point in the criminal justice system from arrest to individuals returning to the community upon release. Presented on June 18, 2014, this program informed and increased awareness around this historic healthcare expansion opportunity. The broadcast highlighted promising practices by providing resources and strategies to expand healthcare coverage to justice-involved individuals. During this national discussion and broadcast by the National Institute of Corrections, presenters: ? Established the relevance of the Affordable Care Act to the criminal justice system. ? Provided concrete examples for collaboration and system linkages between the criminal justice system and healthcare system. ? Provided healthcare enrollment strategies to increase informed decision-making between criminal justice and healthcare stakeholders. SOURCE: National Institute of Corrections (NIC) (Washington, DC).

Health Happens in Libraries
Health Happens in Libraries seeks to improve public library eHealth services and increase library staff capacity to respond to patron requests for information regarding the Affordable Care Act (ACA). This work acknowledges the growing intersection of digital technologies and individual health management (eHealth), and the opportunities for libraries to provide digital access to health information in their communities. We will engage several states to more thoroughly assess the context of ACA and other eHealth needs in public libraries. These partnerships will inform the development of customized resources and promising practices for state and public libraries nationwide to utilize in related patron services. Resources will be posted here as they are developed.

A Reader Asks: If I Am On COBRA, Do I Have To Buy A New Marketplace Plan? 
By Michelle Andrews Feb 14, 2014 Q. I am currently insured under COBRA. It expires in August 2014. I have a pre-existing condition and I'm unemployed. Can I apply for a plan under the ACA sometime in June for coverage that will start in September? Is there something I should do now before the end of March? A. When consumers lose or leave their jobs, they can opt to continue their work-based health insurance under a federal law known as COBRA. Those insurance policies qualify as health coverage under the health law, so you don?t have to do anything before the open enrollment period for coverage on the federal and state marketplaces ends March 31. But you may want to check out marketplace plans to see if you could find similar coverage for a better price, says Laurel Lucia, a policy analyst at the University of California-Berkeley Labor Center. Since you have a pre-existing condition, you may be concerned that marketplace plans could involve switching doctors or high deductibles. You may be surprised, though, says Lucia. "I think people have heard about the high deductibles on bronze plans, and they may not realize that the platinum and gold level plans available may have lower cost sharing," she says. In addition, you may be eligible for premium tax credits and cost-sharing subsidies on the exchange if your income is less than 400 percent of the federal poverty level (currently $45,960 for an individual). Under COBRA, in contrast, you're likely paying the entire premium plus a small administrative fee.

Libraries Serve As Health Insurance Info Hubs 
By Elana Gordon, WHYY Feb 14, 2014 What can't librarians do? Many are now becoming health insurance guides. The buzz at the American Library Association's winter meeting recently wasn't just about the annual awards (a.k.a. the book award "super bowl"); the Affordable Care Act was also on the agenda. Libraries across the country have been trying to meet a growing demand for health insurance information. At the Free Library of Philadelphia's central branch, library coordinator Nani Manion has started running twice-weekly enrollment clinics in the technology lab. Manion is one of 33 librarians in the Philly system who have undergone a five-hour training session to become certified application counselors.

Get Covered America
Your pets want you to take care of your health. And they've created a video to tell you.Watch and share! Then change your social media profile picture to your favorite pet to get the word out!