A recent public opinion poll finds it's the best of times and the worst of times for Missourians. The "Speak up Missouri" poll from The Missouri Foundation for Health, reveals that residents treasure deep community connections, but they're also burdened by significant challenges, such as cost of living, access to adequate health care, and drug and alcohol use in the Show-Me State.

Sheldon Weisgrau, MFH vice president for health policy and advocacy, said the poll confirmed that the cost of health care is really fundamental.

"And that addressing that problem can make life better for people in Missouri in a whole lot of other areas. If we can bring down the cost of health care, people would have money to spend on other things," he said.

Many Missourians view their state positively, often recommending it as a good place to live and praising it as safe and welcoming, especially for raising children.

The poll showed significant demographic differences in concerns: More than 80% of Black Missourians cited crime and gun violence as major issues. White respondents mainly worried about the rising cost of living and health care costs. Weisgrau notes views on climate change also varied.

"Thirty nine percent of respondents said that climate change was not too serious a problem. But for Democrats, nearly two-thirds labeled it as an extremely serious, or very serious problem, compared with only 8% of Republicans," he continued.

He stressed the importance of elected officials paying close attention to their constituents' concerns, especially during this election year, to tackle the pressing issues affecting their daily lives.

Wildfires are becoming bigger and more frequent in Colorado and across the Mountain West, and health experts are offering tips to breathe easy even during bad air-quality days.

Dr. Anuj Mehta, pulmonary and critical-care physician at Denver Health said pregnant women, infants, children, older adults and people with heart or lung disease are most at risk.

"Wildfire smoke has a lot of particulate matter. So really, really small microscopic particles that can cause inflammation in the lungs. Just breathing in that particulate matter, that inflammation may not just stay in your lungs. It can really cause inflammation around your body," Mehta said.

Exposure to smoke from wildfires has been linked to an increased risk of heart attack, stroke, lung cancer and a decline in cognitive function. Using air purifiers with HEPA filters and high MERV rated air conditioning filters can improve indoor air quality. Limiting strenuous activities is also a good idea, because when your breathing rate goes up, you inhale more particulates.

Workers and others who need to be outdoors can get air-quality updates on particulate matter and ozone pollution levels online at colorado.gov/airquality. Mehta says N-95 masks and respirators can also help, if worn correctly.

"If you can be indoors, that's going to be really good. If you have to be outdoors, and you are somebody with underlying breathing problems, wearing the mask actually can reduce the amount of particulate matter that you are going to breathe in," Mehta continued.

Colorado has already seen six wildfires that have burned more than 1,000 acres since May, and as humans continue to burn fossil fuels, wildfire risks are widely expected to increase into the foreseeable future. Mehta said it's important to understand the risks, and to be prepared.

"So every summer we're going to be dealing with bad air quality days. And so people, especially people with underlying health concerns, should be discussing with their medical teams about a bad air-quality plan," Mehta continued.


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A new bipartisan federal bill could improve end-of-life care planning.

The Compassionate Care Act creates guidelines for advanced care and end-of-life planning to make the services more widely known. It comes as people are still reeling from seeing family member's experiences during the pandemic.

Sen. Richard Blumenthal, D-Conn., the bill's sponsor, said the pandemic demonstrated the importance of having a person's health care wishes spelled out.

"As much as people may be reluctant or averse to facing the need for an advanced directive or a living will, once that time arrives they are so much better for it because it's their wishes," Blumenthal explained.

A University of Michigan survey found 46% of older adults completed at least one advanced care plan. Feedback about the bill has been positive but Blumenthal noted misconceptions about it could obstruct its passage. He is concerned the bill could be misinterpreted as requiring patients to complete a living will. While the bill has been recently introduced in Congress, the busy election season might delay its passage.

The bill also calls for studying the efficacy of a national advanced care planning registry so patients can transfer advanced directives from state to state. Another provision of the bill is expanding telehealth services for hospice patients.

Kim Callinan, president and CEO of Compassion & Choices, said such services are essential since people at the end of their lives may not have the strength to visit an in-person doctor.

"To be able to access more care at the end of life via telehealth instead of having to do more in-person visits that rob people of precious quality of life can profoundly impact how one dies," Callinan pointed out.

Beyond federal bills, Callinan added state legislation like Physician Orders of Life-Sustaining Treatment bills bolster end-of-life care. They are portable medical orders letting health care facilities know a patient's wishes for end-of-life care and emergency medical services. Currently, 42 states and Washington, D.C. have enacted similar bills.

In preparation for the upcoming legislative session, workers at Arkansas Advocates for Children and Families are interviewing Arkansans about their health coverage and finances.

The nonprofit advocates for families before state and national lawmakers.

Camille Richoux, health policy director for the group, said many residents are still dealing with the aftereffects of Medicaid "unwinding," when recipients lost their health insurance despite being eligible for continued coverage.

"We've encountered people who are having to choose between medications at the pharmacy," Richoux reported. "People who are saying, 'What's the most important prescription of all the prescriptions that I have that's gonna keep me alive?' And that has impacts on their long-term health."

She pointed out more than 270,000 adults and around 150,000 children lost coverage last year. Many people did not know they were uninsured until they tried to schedule doctor's appointments.

Advocates have been collecting the stories of Medicaid recipients for about six months. Richoux noted they have spoken to postpartum moms who can no longer receive care and unhoused residents who have not received paperwork because they do not have a permanent mailing address. She emphasized they try to represent people who sometimes feel like they don't have a voice.

"We think it's very important that the people who are impacted by Medicaid policy have a seat at the table and to be sure that their voices are heard," Richoux explained. "Part of this work is going around the state collecting those stories, sharing those with our leaders and administrators around the state."

Richoux added they will be monitoring the upcoming legislative session to ensure any changes to coverage will not have a negative effect on Medicaid recipients.


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