Health Relay

Holiday health and hygiene go hand-in-hand

Roberta Smith, RN, MPH, is a nurse and preventionist at Children's Hospital Colorado. Daniel Hyman, MD, MMM, is the chief quality officer at Children's Hospital Colorado.

The holiday season brings many opportunities to eat, drink and be merry with family, friends and co-workers. But as we line up behind the buffet table and exchange handshakes or hugs with colleagues and friends, we're more susceptible to viruses that could leave us bedridden for the rest of the year.

That's why good hand hygiene and infection prevention is a sound public health practice for everyone. Those of us in health care have become familiar with efforts to improve hand hygiene practices. After all, cleaning our hands is the most important preventive measure we take in protecting our patients from hospital-acquired infections. But the need for good hand hygiene goes well beyond the walls of our health care organizations.

In the winter months, people from all walks of life spend a majority of their time inside small spaces where viruses can reside for days – sometimes weeks – at a time. For example, influenza virus can spread for two days on some surfaces. Hepatitis B virus can last up to seven days. Norovirus (also known as the cruise ship gastrointestinal virus) has survived in carpets for up to 12 days.

Everyday, we touch railings, tables and doorknobs – then proceed to touch our eyes, nose and mouth. Monitor yourself: How many times do you touch your face in the course of an hour? How about touching others? This is why hand hygiene is so important.

Here are two effective strategies for keeping your hands clean:

• Alcohol-based hand sanitizer sprays and gels for when your hands are not visibly soiled – Remember this motto: "Liberally apply, rub your hands until dry, it's as simple as pie!"

• Soap and water whenever one's hands are dirty (and of course, after using the toilet) – While frequent hand cleaning can dry out the skin in Colorado's dry climate, hand lotions can reduce this problem and help to eliminate cracks in the skin that can harbor germs.

Have you ever heard someone say "we wash our hands too much these days" or "I want to build up my immune system" as an excuse for not practicing good hand hygiene? Humbug! Spraying your hands with a bit of alcohol rub is much more pleasant than running to the bathroom every 15 minutes with a stomach virus or being stuck at home with a fever, cough and flu.

By practicing some basic public health principles (such as hand cleaning, getting annual flu immunizations, staying home when you are sick and covering your cough with the inner crook of your elbow), we can all do our part to protect ourselves and others from getting sick during the holiday season ... and throughout the year.

Fiscal challenges will persist despite good economic news

Jeffrey A. Roberts is a research analyst at the University of Denver's Center for Colorado's Economic Future.

It is heartening to know that Colorado's economy is finally showing some signs of recovery. As you may have read in a recent article in The Denver Post, more than 30,000 jobs have been added since the start of 2011, and employment growth in the state from September to October was at its highest level since March 2007.

For state government, a healthier employment picture should boost the collection of sales and income taxes – the revenue that finances major General Fund programs including K-12 education, Medicaid and higher education. But this bit of good news hardly spells the end of Colorado's fiscal troubles – which will persist in both the short- and long-term.

In the short-term, General Fund revenues for fiscal year 2012-13 are projected to be 5 percent lower than the pre-recession peak of fiscal year 2007-08. That doesn't sound too bad until you consider that the demand for state services has grown substantially since the recession began. For example, Medicaid enrollment will have increased 72 percent through next fiscal year, the Children's Health Plan Plus (CHP+) caseload grew by 19 percent and higher education enrollment swelled by 20.5 percent.

As the name implies, the Center for Colorado's Economic Future looks at the long-term – and that is where you will find state government's most confounding fiscal problem. It is a structural problem that requires a structural solution.

According to "Financing Colorado's Future: An Analysis of Fiscal Sustainability of State Government," the combined growth rate of the General Fund's three largest programs (education, Medicaid and prisons) will far outpace the growth rate of revenues through fiscal year 2024-25.

Authored by the Center, the report also shows that even a strong economic recovery will not help the state avert the inevitable. Furthermore, absent sweeping policy changes, total state expenditures in fiscal year 2024-25 will exceed tax collections by 20 percent – or $3.5 billion. Expect that gap to widen even more beyond our forecast horizon as the aging baby boom generation causes Medicaid long-term care costs to skyrocket.

An additional and potentially expensive factor that our study did not account for is the impact of the Dec. 9 court decision in Lobato vs. State of Colorado. In that case, a Denver District Court judge ruled that Colorado's school finance system is not as "thorough and uniform," as the state's constitution requires. The decision could increase the state's education funding obligation by billions of dollars a year, depending on the outcome of a likely appeal to the Colorado Supreme Court.

How can we address the $3.5 billion structural imbalance that the Center projects? Cuts alone would drastically change the very nature of state government. We modeled a long-term scenario that protects health care programs (so as not to risk leveraged federal dollars) as well as the prison system and functions required by the state constitution including the governor's office and court system. Balancing the budget this way (and putting the Lobato ruling aside), public school funding by the state would be cut by nearly 20 percent in most years. By fiscal year 2024-25, funding for 10 departments – including higher education, public safety and public health – would be reduced by more than 90 percent.

The magnitude of the projected revenue/expenditures gap suggests that a combination of cuts and tax increases is necessary. But to illustrate how it could be bridged with new revenues alone, we developed a package of taxes designed to grow in step with future spending, limit volatility and better reflect the economy, among other criteria. It includes a sales tax on personal services, a graduated individual income tax and a phased-in uniform mill levy aimed at reducing the state's share of total K-12 education costs.

Our latest effort involves demonstrating how such a package, if fully implemented, would affect median households in each school district. Understanding that most people don't match the median, we are redesigning interactive features on the Center's website so that any Coloradan may calculate how the package might affect his or her own household.

Meanwhile, we continue to brief policymakers and the public on our findings. So far, we have made – or are scheduled to make – more than 80 presentations. A narrated version of our PowerPoint presentation is online.

How can the state solve its long-term and short term budget quandary? Post your thoughts in the comment box below.