While large hospitals and pharmaceutical manufacturers battle over drug costs, Missouri community health centers see themselves as collateral damage.

Section 340B of the 1992 Public Health Service Act, allows small community health centers and hospitals to buy pharmaceuticals at highly discounted prices.

Colleen Meiman, national policy adviser for the State Association of Community Health Centers, said the centers use the savings to support other community support services like dental, behavioral health or opioid treatment programs, all without taxpayer dollars.

"We don't have any negotiating power. We're stuck having to pay full price because we've got this tiny little nonprofit community entity up against a giant drug company," Meiman pointed out. "The law was meant to equalize that a little bit and then enable us to get the drugs at a discount."

Drug manufacturers are concerned about the misuse and fast expansion of the 340B program. Hospital and pharmacy drug provider sites increased from 8,100 to 50,000 between 2000 and 2020. An August 2022 report by the Health Resources and Services Administration found discount drug purchases through 340B increased 16% between 2021 and 2022 to $44 billion.

Meiman noted 340B can be helpful in Missouri where she lives, but added current restrictions limit the number of contract pharmacies in a given area of the state, which can create hardships for patients.

"In Missouri it can be hard to get around in the wintertime," Meiman explained. "If suddenly you have to drive a really long distance to get your medications, either because that's the only way you can get them discounted enough to afford them, because you're low income uninsured, or because you were trying to support your health center."

Meiman added health centers across the country have been forced to reduce staff or curtail services because they have lost access to 340B savings.


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By Liz Carey for The Daily Yonder.
Broadcast version by Mark Richardson for Michigan News Connection for the Daily Yonder-Public News Service Collaboration

In September, the Centers for Disease Control and Prevention (CDC) unveiled its Rural Public Health Strategic Plan, which outlines the priorities, objectives and outcomes the agency hopes to see over the next five years as it collaborates with other federal agencies and various stakeholders on how to improve the health of rural residents.

The plan was developed with the help of more than 50 experts within the CDC who reviewed more than 200 rural initiatives, programs and efforts to identify opportunities. Then the agency enlisted the feedback from more than 230 federal and external partners through listening sessions, lunch meetings and town hall events, Dr. Diane Hall, the director of the CDC’s Office of Rural Health (ORH), said in an interview with the Daily Yonder.

The strategic plan is a guide for ORH and the CDC at large, as it moves forward with programs and research into rural health needs. Developed with stakeholders such as the National Rural Health Association (NRHA) and state offices of rural health, the plan seeks to combat issues that are seen at higher levels in rural communities, like obesity, chronic illnesses and substance abuse.

Opened last year, the ORH came as a result of the Covid-19 pandemic. Disparities between urban and rural access to care shined a spotlight on the need for more attention on rural public health, she said. The strategic plan is the office’s first major publication.

“We really wanted the strategic plan to actually be strategic, but also be actionable,” Dr. Diane Hall, the director of the CDC’s Office of Rural Health, said in an interview with the Daily Yonder. “But more than that, we wanted it to be relevant to the lives of people that live in rural communities.”

Stakeholders, like Alan Morgan, CEO of the NRHA, said the plan is an indication of what is coming in rural health. 

“Realistically, this is a blueprint for the future,” Morgan said in an interview with the Daily Yonder. “They have highlighted long-standing issues and now they have a direction and a plan to get to where they need to be.”

The plan focuses on four main priorities – engaging with community health partners, strengthening rural public health infrastructure, advancing rural public health science and improving rural public health preparedness and response.

“CDC is committed to advancing rural public health across America by identifying and addressing gaps in the evidence base, data analytic capabilities, and the workforce in rural communities,” the plan said.

Hall said her office will work alongside stakeholders and other subject matter experts to develop a more specific action plan and to determine how best to serve rural areas.

“A lot of times, rural communities haven’t really been served well by government policies or decisions,” she said. “All of that needs to be addressed when we’re talking about health decisions.”

The plan isn’t regionally or state-specific, but it is a step toward an action plan, Hall said.

“Rural health is an issue that garners bipartisan support in Congress,” Hall said. “And Congress has been very clear that they wanted the CDC to create this office. These are the first steps in a very long process to address the rural urban disparities in healthcare.”

Hall said that before the end of the year, the National Center for Health Statistics (NCHS), part of the CDC, will release an updated method for urban-rural classification.

That will make researching rural health issues easier, Katy Backes Kozhimannil, the co-director of the University of Minnesota Rural Health Research Center, said in an interview with the Daily Yonder. One of the issues facing researchers is determining the rurality of subjects.

Although the strategic plan doesn’t provide direct actionable items, it is a step in the right direction, Kozhimannil said.

“This is a long process,” she said. “Working with local hospitals and rural public health agencies, as well as research centers like ours, is the beginning of the process. I think we’re all looking forward to the next steps and seeing what action items come out of this strategic plan.”


Liz Carey wrote this article for The Daily Yonder.


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Exposure to air pollution is a growing concern for public health and a breakthrough study from Wayne State University is shedding new light on its link to head and neck cancers.

In collaboration with Johns Hopkins University and Mass General Brigham, Wayne State researchers found fine particulate matter pollution known as PM2.5 may greatly increase the risk of cancers in the upper respiratory system. It is the tiny form of pollutants found in smoke, car exhaust and industrial emissions.

Dr. John Cramer, associate professor of otolaryngology at Wayne State University and the study's co-author, explained where the condition appears.

"Head and neck is actually very similar to lung cancer," Cramer explained. "These are cancers that typically occur in the lining of the mouth, the throat or the voice box."

According to the report, research on air pollution's effects on the lungs and heart is extensive but studies linking it to head and neck cancers are limited.

Dr. Cramer pointed out the tissue in the head and neck is especially vulnerable to air pollution because it comes into direct contact with the harmful particles. He emphasized there is a strong link between tobacco smoke and the most common type of head and neck cancer, squamous cell carcinoma.

How aggressive is it? Cramer stressed it is in the family of medium to highly aggressive cancers.

"Not the most aggressive cancer out there but it's also not one that is a total turtle of the cancer world," Cramer outlined. "I think it's a bit more of kind of a rabbit that can be a little bit sneaky and kind of get away."

He added the treatments for head and neck cancers, like radiation and surgery, are often intense and do not always succeed. He emphasized he would rather see fewer cases than treat them.

Medicaid renewals and steps the state is taking to improve maternal health are all topics experts will cover at the upcoming Kentucky Voices for Health annual meeting in Lexington on December 10.

Sessions count toward continuing-education requirements for the Commonwealth's Certified Community Health Workers and social workers.

Emily Beauregard, executive director of Kentucky Voices for Health, said The University o Kentucky's pharmacy team will be onsite - with a pop-up vaccine clinic for attendees and the general public.

"Everyone is welcome to come," said Beauregard. "It's going to be really convenient to have it right there. People can swing by for their seasonal boosters."

Attendees will also get the latest on initiatives to improve access to health care for students, incarcerated residents and individuals living with serious mental illness or substance-use disorder. More information is on the Kentucky Voices for Health website.

The state has made major strides in addressing maternal-health disparities among Black and brown Kentuckians.

Experts will break down the latest efforts to continue improving the health of moms and babies - including a special-coverage enrollment period for pregnancy, lactation supplies and consultation, a new helpline to support providers who are caring for new parents struggling with perinatal mood and anxiety disorders, and a newly commissioned study to look at the impact of doula care.

Beauregard said the upcoming legislative session offers opportunities to improve the health and lives of families.

"Policies that we expect to see, in terms of legislation in the coming session," said Beauregard, "will be paid parental leave for parents of new babies, and improving access to non-emergency medical transportation for Medicaid beneficiaries."

A 2023 state report found pregnancy-related-deaths in the Commonwealth went down in 2018 and 2019, but in 2020 increased to 21.2 deaths per 100,000 live births.

It's estimated more than 80% of pregnancy-related deaths are preventable.