Dubuque Telegraph-Herald. June 8, 2024.

Editorial: Reducing Iowa’s cancer rates a battle to be fought on many fronts

Today, the Telegraph Herald kicks off a three-part series examining the causes and impacts of Iowa’s high cancer rates, as well as efforts to combat the disease locally.

Nearly everyone has been touched by cancer in some way. Whether it’s a personal story of the diagnosis or the impact of having a friend or family member walk that path, most people have felt the blow of cancer.

In Iowa, that prevalence is well documented. According to the 2024 Cancer in Iowa report, produced by Iowa Cancer Registry, Iowa has the fastest-growing rate of new cancers in the country and the second-highest rate of new cancers overall for the second year in a row.

So if it seems like there sure is a lot of cancer stories going around, it’s true. The data backs it up.

The report estimated there will be 650 new cancer cases in Dubuque County in 2024, with an age-adjusted rate of 475.3 per 100,000 people from 2016 to 2020. Delaware County’s rate is 527.2 per 100,000, Clayton County’s is 449.3 and Jackson County’s is 512.6. The report estimates that there will be 140 new cancer cases this year in Clayton County, 125 in Delaware County and 170 in Jackson County.

Public health officials are balancing a push for continued research with advocacy and policy changes to not only sort out why Iowa’s cancer rates are so high, but also to help bring them down.

Breast cancer, prostate cancer, lung cancer and melanoma are the top four kinds of cancer driving the rates in Iowa, but officials say there isn’t one answer to what is causing those rates.

While finding cures to specific cancer is a daunting prospect, much more could be done by Iowa officials. Unfortunately, any discussion of the causes of cancer in Iowa leads back to questions about whether state agriculture practices, and specifically the use of pesticides, herbicides and fertilizers, could be contributors. And politicians aren’t excited about the prospect of poking too hard at concerns about one of Iowa’s biggest industries.

Cancer knows no political party. Efforts to address cancer should be bipartisan and unanimous. Addressing high cancer rates in Iowa would require a multifaceted approach involving various sectors, including health care, public health, environmental regulation, education and community outreach.

What might that look like?

How about ensuring that all Iowans have access to affordable health care, including cancer screenings and treatment?

___

Des Moines Register. June 9, 2024.

Editorial: Iowans should benefit from Brenna Bird’s victim assistance audit, despite some missteps

The attorney general has given no compelling explanation for not continuing contraception reimbursement while the audit was conducted.

Iowa Attorney General Brenna Bird has followed through on a campaign promise, producing after 17 months in office a report on her staff’s “top-down, bottom-up” audit of services that the state provides for crime victims.

It’s a mostly solution-focused document. It acknowledges deceptively dense logistical challenges in victim assistance, but pairs that with commendable commitment to overcoming those obstacles for the sake of Iowans who already have suffered plenty. For Iowans turned off by Bird’s constant public focus on suing President Joe Biden, the plans in the audit are a welcome change of pace.

Bird also made missteps. Before its release, the audit was known mostly because it was taking a long time and because Bird stopped reimbursing sexual abuse victims for emergency contraception and abortions until the audit work was done. That was wrong. She has given no compelling explanation for not continuing reimbursement while the audit was conducted. Pausing payment caused needless scrambling by pharmacies and other health care providers determined to ensure that already traumatized victims would receive the care they needed — even if that meant the providers paid the bill themselves.

Thankfully, Bird now says victims will once again be reimbursed for contraception. However, they will not be reimbursed for abortions, even though rape is one of the narrow exceptions in the abortion ban Bird is defending in court, and even though women whose pregnancies result from rape often face extraordinary physical and financial vulnerability.

The good: Real behind-the-scenes improvements for vital services

Victim assistance is one of many underappreciated functions carried out mostly by government and nonprofits. Our eyes tend to move toward the work of punishing offenders, but for those who were harmed, help with health care, including therapy; with housing; with safety — and all the bills accompanying those needs — is at least as important. In most cases, victims can’t count on offenders to quickly and fully pay court-ordered restitution.

Millions of dollars annually that pay for a wide array of compensation and services come from criminal penalties and fees and from federal and state appropriations. Bird’s report identifies several bureaucratic problems with what the state has been doing — and those bureaucratic problems have had substantive, even dangerous, consequences for Iowans. “Our audit has revealed a cracked system,” she said at a May 31 news conference. The report was based on dozens of conversations with stakeholders in the months after Bird was sworn in.

The most serious findings deal with systems that are supposed to help victims know what’s happening with people who’ve attacked them. As the Register reported earlier, notifications about the status of no-contact orders (including their imminent expiration) are required by law but were shut down in 2019 under Attorney General Tom Miller because of technical problems and the challenge of collecting timely and accurate information from hundreds of police agencies, county attorneys and the judicial branch.

That’s a major disservice that can lead to, for instance, a survivor of domestic violence unexpectedly bumping into the perpetrator at the grocery store, Bird said. Work to build a replacement is underway.

Miller said in an interview that he and other administrators determined that the problems couldn’t be fixed without a significant budget increase. They worried that keeping an inconsistent system in place would give protected persons “a false sense of security” and noted the program’s end in an annual report to lawmakers. Fair enough, but a replacement should have been developed. Victims deserve this service. Bird is right to believe that Iowa can figure out how to pull this off.

The difficulty of achieving and maintaining equity in heavily decentralized systems is a consistent theme in the audit report. Bird said that training opportunities and communications from the state to the network of service providers through the state are being overhauled, and that she has revamped staffing, job descriptions and procedures in her office.

The attorney general’s office has also revised its tracking of sexual assault kits and will amend rules to increase pay for sexual assault nurse examiners to $400 per procedure, up from $200.

The report goes out of its way several times to blame shortcomings on how Miller, who was attorney general from 1975 to 1990 and from 1995 to 2022, ran the victim assistance programs. He said that characterizations of neglect were wrong and unfair.

“They say that the main office was disconnected or didn’t coordinate with crime victims; that’s just totally false,” Miller said. He disputed several claims in the report, saying that he was “mystified” by an assertion that important documentation went missing between administrations, and he noted that the victim assistance division’s work earned national praise and received clean audits.

Asked whether he had concerns about any of Bird’s purely structural plans, he said, “I think that generally they’re headed in the right direction. And generally they have a right to organize it like they want it.”

The bad: Unnecessary delays in payment, the wrong move on abortions

At her news conference, Bird evaded a reporter’s question about why she found it necessary to stop paying for emergency contraception and, rarely, abortions during the audit, instead emphasizing that “not one victim was delayed in receiving services” and that backlogged claims are being paid out. True enough, and some local governments have been covering the cost of Plan B drugs, usually less than $50, during the past year-plus. But it is easy to imagine circumstances where the reimbursement controversy could have caused rape victims additional anxiety about hurdles to treatment and potential financial hardship.

As for abortions, it’s certainly nothing new for Republicans to put a foot down about public money going toward that specific form of health care. But drawing the line here seems artificial. An Iowa abortion law passed in 2023, blocked by a judge from taking effect, allows abortions past six weeks of gestation if a woman reports a rape within 45 days. The state ought to assist girls and women who need legal health care after an assault. And victim compensation money comes from penalties and fees, not from taxpayers.

Oddly, the audit report references the Iowa Legislature not advancing Democraticproposals to change Iowa law to require reimbursement for emergency contraception and abortion, interpreting this as “Iowans have made their position on public funding of abortions clear.” Is Bird really setting a standard that, on policy questions, she’ll defer to the whims of a committee chair?

Finally, Bird insisted that 17 months was the right amount of time for the audit because it was important to get the results right and because staff working on it also had other responsibilities. It would be cavalier to dismiss Bird’s judgment on that out of hand — she would know best. But it’s also fair to question whether any of the new employees or $1.2 million in increased funding she received for the fiscal year that ends this month (more than twice as large as the cumulative budget increases Miller received during all of his last four-year term) could have been applied to speed up the process, perhaps at the cost of one or two lawsuits against the federal government.

This work offers the potential of tangible help for Iowa crime victims

Despite these notable warts, Bird and her staff appear to have done good work here that will deliver real benefits for Iowans in need, provided they follow through on these commitments to improve victim assistance. And we all look forward to seeing the fruit from the same dedication to other underappreciated duties of the attorney general’s office, such as consumer protection.

END