New Year Resolutions: 2009

For many Americans the New Year ushers in a day (or maybe two...) of thinking about what they want to do differently or achieve in the next 365 days. While I don't plan on making any half-hearted declarations that I will start exercising every day or eating more veggies (we should all do that anyway), I do think that this would be a good time to outline a few goals for Veritas Health.

Veritas Health Resolutions for 2009:

1. Create at least 5 posts a month.

2. Start posting video blogs - 4 for the year.

3. Have an average of 25 hits/post.

4. Organize a community public health blog -- TBA.

5. Build a better audience-friendly Veritas Health.

I hope that you have enjoyed my posts, thus far. Please send me messages with any thoughts on how I might improve this blog. 

Happy New Year!

Merry Christmas!

Merry Christmas, readers! Hope you have a fantastic holiday, full of joy and laughter. If you need any tips for staying healthy through the holiday check out the post by Modern Forager here.

See you in the New Year!

Biking for Health

It really was not until we moved to California that I was introduced to a bike culture. Many people we met were committed to traveling by bike; they rode everywhere  - to school, to work, even to sporting events. The roads were wide, the bike lanes were well marked and well maintained (no debris, no dangerous obstacles to maneuver around) and young and old partook in this type of activity. Was it exercise? Yes! Did it necessarily feel like it? No! For many, riding was a lifestyle, not an exercise routine. 

A recent study (reported in the press here) examined modes of transportation across several countries and rates of obesity. Countries where more people walked, cycled, or took mass transit to get around found lower rates of obesity. Obviously this study gives us no insight into why this is the case. While I don't expect that we can just start building bike lanes everywhere and expect communities to up and start riding bikes overnight, I see great promise in each place that I have lived to put in bike lanes to make it easier to get around without needing a car. Especially in the suburbs, where owning a car is assumed to be necessary. 

How do public health professionals, especially in suburban communities, change these transportation norms? What might be the impact for community health? 

R. Shephard provides an excellent article discussing the "active commuting" debate. Another study by scholars in Scotland examined adolescents' walking and biking commuting behaviors (to school, obviously) with regards to distance as a potential barrier. The authors found that adolescents were more likely to walk or bike to school if they lived within 2.5 miles, living farther than that was considered a sufficient barrier to active commuting. I wonder what that threshold would be in active cities in the US. This is a ripe area for future research and public health activity.

Mobile Phones for Health Surveillance

An article in the Yale Journal of Public Health recently reported on the use of mobile technology to improve public health surveillance activities. Advances in technology are not always quick to be adopted in public health, though the computer and Internet have exponentially increased the efficiency and productivity of information management and risk communication. How else could one so quickly be informed about a SARS outbreak or the current state of Avian flu?

My husband, after returning from a 2-week trip to Kenya, told me stories about the widespread use of mobile phones, even in the most rural and poor regions of the country. He noted that he never saw them actually talking on the phone, it was a device used for text messaging. "Minutes" are just too expensive.

Given the penetration of mobile technology - how might cell phones be used solve pressing public health issues? This article describes two CDC activities; one aimed at using PDAs to collect surveillance information for its "Household Morbidity Surveillance Survey" in Kibera, the other is to use text messaging to improve inter-governmental communication about disease outbreaks. 

There is certainly an irony on the use of PDAs to collect information from some of the poorest people in the world. However, if it is able to collect better data, more quickly, and to improve the delivery of health services and prevention information I am in full support! 

How else might mobile phones be used to collect or communicate health information?

If interested, check out the following websites

• Texting4Health - A conference held at Stanford University, February 2008
• MobileActive.org - Blogs, information, and a directory for activists using mobile technology worldwide

AIDS Sutra: Untold Stories from India

When you see the word AIDS what comes to mind?

Africa? Disease? Death?

Sex? Drugs? Prostitution?

Mothers? Orphans?

Treatment?

We know so much more today about the etiology of HIV/AIDS than when the epidemic began in the early 1980s. In some parts of the world, the stigma of having AIDS or being HIV positive has begun to weaken. We now have effective (albeit expensive and complex) treatment for the disease, more people are more aware of how the disease is spread, and today we know that if certain conditions are met women who are HIV+ can even give birth to babies unaffected by HIV/AIDS. In this day, in this place, one need not equate AIDS with death.

In India 2.5-3 million people are infected with HIV/AIDS. India has the 3rd largest number of HIV+ people in the world, behind sub-Saharan Africa, and the spread of HIV among women is increasing. (click here for more facts -- published 2006)

In many other countries, however, there is still great denial about just how widespread are the effects of AIDS. The Bill & Melinda Gates Foundation's Avahan India AIDS Initiative just released a book entitled "AIDS Sutra: Untold Stories from India". It is a collection of essays that brilliantly portrays the lives of people dealing with AIDS and facing its stigma in India. The stories uncover the brutallity and fear that come with social margnizalization, violation of privacy, and discrimination. 

Two authors, Nikita Lalwani and Sonia Faleiro, and an editor from Avahan visited the Harvard School of Public Health today to discuss the book. It was a fantastic event, with about 30 people in attendance. The stories told by the authors were heart wrenching.

Many Harvard affiliates, such as Jay Silverman and Felton Earls, are committed to preventing the spread of HIV/AIDS as well as serving populations who already have the disease. Though, I want to note that the work of my colleagues really seeks to inform the broader picture of how poverty, gender relations, family violence, and sex trafficking perpetuate the spread of HIV/AIDS beyond what service provision in "high risk" communities can provide. It is fascinating work and its implications are great, as the stories "AIDS Sutra" tell. Not only will understanding AIDS in India help those who are currently suffering, but it will provide a basis for future prevention efforts and cultural change that can halt the epidemic, save lives, and restore hope.

McDonald's Moms Marketing Madness

What alliteration! My new not-so-cuss word for how livid I am about this new marketing maneuver by McDonald's (...there I go again). I can't believe I did not see it coming. I'm sure other advocates did. 

So here is how it went down...

I was quitely watching CNN the other night, tucked under my blanket, homework in hand, when all of a sudden "moms declare McDonald's FRENCH FRIES healthy..." I think I stopped breathing. Of all things, the french fries are healthy?! And of all people, moms are now voluntary public media advocates for McDonald's?! 

This is clever, very clever. 

Honestly there is not much I can say about this. Later clips on CNN suggest that many moms won't be fooled. While I am all for a big mac (well maybe a chicken sandwich...) every once in a while, I cannot imagine anyone saying that McDonald's main offerings are healthy. Though, I will give the salads some credit. Perhaps, McDonald's is healthy if you are comparing french fries and double bacon cheeseburgers to...umm...cheez whiz and ding dongs? 

Many don't believe that big macs, chicken nuggets, and french fries harm health. I beg to differ (call me crazy or rent Super Size Me). Do you know that years ago (perhaps still today) people & their kids ate McDonald's food thinking that it was perfectly "healthy." There can be no debate that fast food corporations have done everything within their power to prevent nutrition information from effectively reaching consumers. Furthermore, even if fast food does harm health, no one can prove that disease had anything to do with diet. Maybe lack of exercise, but diet...no. For more on Big Food "wellness" tactics check out Michele Simon's Book: Appetite for Profit.

I digress. There are fervent believers on both sides of the issue. I know this post leans to the left. Feel free to comment either way. I need to know what you think -- my future public health career may depend on it!

Google Gets Public Health

Flu season is almost upon us. Google "flu" or "flu symptoms" and you are likely to have been picked up by the new Google surveillance system that aims to become an early warning system for regional flu outbreaks and trends across the United States. The New York Times recently reported (and blogged) about the Google.org web tool, called Google Flu Trends, which may be able to save lives.

There are no doubt questions about how well this tool will can reliably predict flu outbreak before people visit the doctor. But it is exciting to hear yet another way that Google is attempting to provide some public health improvements and innovation.

We all know that our Internet use is not exactly private knowledge. But does this surveillance cross the line? I would argue, no. I see little to no harm in Google relaying aggregate data of flu symptom searches from its site to public health organizations. But, would people feel differently if it was monitoring searches for "HIV symptoms" or "HPV symptoms"?

Mobile technology, the internet, and Web 2.0  is increasing in use by people of all ages and incomes. This provides public health practitioners with new opportunities to target outreach and education activities more effectively and to harness the power and creativity of people to change social norms and improve social support. I look forward to seeing where the intersection of internet technology and public health meet next. 

Comparing Apples to Apples: The Organic Debate

Check out my review of a recent Boston Globe article discussing the potential harms and benefits of eating conventional vs. organic produce.

I think it might be of interest to the VeritasHealth readership.

Defining "Risk": Statins and Heart Disease

The front page of CNN.com today read "Study: Cholesterol drugs can help low-risk patients." This is a perfect example of the medicalization of health. Rather than advocating high-risk prevention strategies for those at higher risk of developing disease, we now have "medical creep"  -- where even moderate risk of heart disease makes someone a good candidate for medical intervention. 

Dr. W. Douglas Weaver, president of the American College of Cardiology was quoted as saying, "This takes prevention to a whole new level, because it applies to patients who we now wouldn't have any evidence to treat." 

This is great news for Big Pharma -- not mainstream America. Note: cholesterol lowering drugs like AstraZeneca's Crestor (used in the study cited and funder of the research) or Lipitor by Pfizer are laden with awful side effects: headache, diarrhea, muscle pain and even depression, insomnia, and ulcers. Who needs that?

What is the alternative to pharmaceutical intervention? Hmmm...let me think...a healthier diet, regular exercise, and quitting smoking. And the side effects of such a drastic lifestyle change?  Side effects may include lowered risk of diabetes, stroke, cancer, and depression. 

While the choice of pill or persistence may seem obvious to me, the barriers to sustainable lifestyle change are great. Choosing persistence may seem more expensive or too restrictive (who is to say I can't eat another slice of mom's apple pie?). But the truth is we all have the power to make change in our life that will improve our health. The result may be 10 more years of healthy life or 10 more days. How do you measure the worth of your days and years?

My choice: a healthier lifestyle.  I will leave the statins for those who truly need them.

The Girl Effect

Adam directed me to a YouTube video called "The Girl Effect". It is a well-made "awareness" spot on the potential world-changing implications of improving  the opportunities, and hence lives, of young girls.

There is certainly a good deal of evidence that suggests maternal education is a strong predictor of children's health. I think this video is particularly insightful in that it does not stop with educating of girls, but insists on conditions in which women can prosper from that education: start a business, make money, have a political voice, influence social norms. Thus, reaching out to girls can have long-lasting effects on not only her family, but also the society in which she lives. 

What do the men think of all this?

Candidates Health Plans: Revisted

The NY Times just ran a series of letters to the editor that critiqued the candidates' so-called "solutions" to our health care woes. Below is one that sums up many of the readers' positions quite well. 

Most letters are written by physicians and lawyers -- I hope that public health professionals continue to be an active voice in the debate. We bring the perspective that access to health care is only a part of the solution -- prevention of poor health and improving peoples' built and social environment is essential to improving our nation's health.

NY Times: Letter to the Editor published November 1, 2008

“The Candidates’ Health Plans” (editorial, Oct. 28) reveals the critical flaw in both candidates’ proposals. Both merely redistribute the cost of health care; neither actually lowers the cost. Their common flaw: continued dependence on insurance companies.

Here’s a better plan: a single national nongovernment not-for-profit health insurance company financed by a payroll tax. By eliminating the profit margin and cost of marketing, we can reduce the cost of health insurance, and thus health care, dramatically.

Glenn Alan Cheney
Hanover, Conn., Oct. 28, 2008

The Looming Health Care Crisis

An Op-Ed submission by three Harvard School of Public Health students: Alana Wooley, Katelyn Mack and Jamie Zwiebel. For your reading pleasure. Comments welcome!

As our government leaders grapple with the current economic crisis, another crisis is gaining momentum. We can no longer ignore its symptoms: rising rates of preventable, chronic illnesses; Americans facing trade-offs between doctor visits, prescription drugs, mortgage payments, gas or food; financial concerns determining patient treatment for catastrophic illnesses; and an inability to obtain insurance with a pre-existing illness, among others.  In 2007, 45 million Americans were uninsured.  These numbers will no doubt continue to climb as families and employers alike increasingly feel the direct impact of rising unemployment and inflation.  If we do not address the looming health care crisis, we will undeniably face yet another bailout, this time for health insurance companies and the health care community.

In the most recent presidential debate, Senator Barack Obama (D) told the nation he believed health care is a right and Senator John McCain (R) believed health care is a responsibility.  Whether it is a right or a responsibility, both candidates believe that access to and affordability of health care are important.  While we may disagree about solutions to and responsibility for the health care crisis, 51% of Republicans and 79% of Democrats believe that our nation’s broken health care system is in need of repair (Blendon et al. 2008). While the Presidential candidates agree that something needs to be done, their health care proposals are in vast opposition to one another. 

Senator McCain offers a short-term solution to this imminent crisis.  His health care plan proposes a $2500 and $5000 tax-credit for individuals and families, respectively, to help absorb the rising costs of health insurance.  However, not only is this credit, which is payable only to the insurance companies, considered taxable income, it does not address rising premium costs and treatment expenses.  While this tax credit may be beneficial for young, healthy adults, it would exacerbate the financial burden of health insurance for families and adults living with chronic or catastrophic illnesses. Simply offering a tax-credit to help deflect expenses for an already expensive health care system is not a sustainable solution and one that will be ineffective in reducing the rising numbers of uninsured Americans. 

Senator Obama offers a more comprehensive, long-term solution to the health care crisis. He proposes allowing individuals and families to keep their current employer-offered health care, or opt into a public insurance or obtain private insurance coverage through an insurance clearinghouse. The public insurance would offer coverage similar to that which Senator Obama and Senator McCain have as government officials. Contrary to rumors of socialized health care and fines for not obtaining insurance, this proposal only mandates health insurance coverage for children.  Senator Obama offers a more comprehensive plan that would extend insurance access to those whom the current system does not capture.  While this plan would reduce the number of uninsured Americans and improve coverage for children and families, Senator Obama’s plan would not cover everyone.

The health of our nation is central to the health of our workforce, the strength of our families and communities, and our national security. This election is an opportunity to ensure that the housing and credit woes we now face do not similarly beset the fragile US health care system.  As voters, we must elect someone with sound judgment and visionary thinking.  We can no longer afford short-term solutions.  Our next President must offer long-term, sustainable solutions to the long-standing dysfunction and discord of the US health care system. Let us enter the polls with the economy, health care, and education on our minds, all of which are inextricably linked together. Now is the time.  It is our responsibility to avoid another bailout blunder by electing the candidate with the best solution to improving the health and well being of all Americans.

Health Care: Head to Head

The Wall Street Journal recently assessed Obama and McCain's health care plans (October 23, 2008; Personal Journal Section, D1). Depending on your income, health status and what kind of insurance you currently have the plans may have different effects on your insurance situation. The WSJ concluded that Obama's plan would tackle the large (and growing) uninsured population, but both plans could reduce out-of-pocket spending for Americans in the short-term.

How much will each candidates' health insurance programs cost? The Tax Policy Center has suggested both plans will cost between 1.3 (McCain) and 1.6 (Obama) trillion dollars over 10 years; however, the Lewin Group determined McCain's plan would cost almost twice as much as Obama's plan ($2.1 vs. 1.2 trillion). 

Both candidates plan to use money from taxes (by rolling back the Bush tax cuts) or other incentives (taxing employer health benefits) to offset the costs of their health care proposals. I encourage you to read the full article if you have a chance.

Happiness & Health

What makes you happy? 

What betters your quality of life?

What leads to a long life?

These three questions can be answered by one simple word. Not a gene nor a new-and-improved medical intervention can guarantee happiness or a long life. It is not how much money you earn (or save) or even where you live. Increasingly, evidence is showing that relationships make a difference in how happy and healthy people are.

Two people who I have the utmost respect for recently asked these questions and both came to the same conclusion; that our social relationships (i.e., how we connect with others) matters for our emotional, psychological, and physical well-being. Our social ties -- friends, family members, coworkers -- have an incredible influence on our happiness and health. A few weeks ago in class, Ichiro Kawachi provided numerous examples of emotional and material support provided by friends and family during times of difficulty and how this can improve health outcomes and positive health behaviors. 

Then this past weekend I was listening to a podcast by John Ortberg who was talking about what makes human life flourish (i.e., people be joyful). He said we experience genuine caring it is like "the roots of your soul are getting fed, and that's coming up into your being and making you strong. Every life has to have that connectedness." He gave many examples of how our relationships, specifically, taking risks and being vulnerable in relationship is critical to fostering joy in our life. And if life is full of joy, despair and anxiety are less likely to take their toll on health. 

If you are more interested in the idea of social relationships, happiness, and health check out these resources:

• Social Capital and Health by Ichiro Kawachi, SV Subramanian, and Daniel Kim
• EveryLife Needs a Cheering Section sermon by John Orberg, MPPC
• Bowling Alone: The collapse and revival of American community by Robert Putnam

Health Care: A Right?

In the second Presidential debate of the season, the two Presidential candidates were asked whether they believe that health care is a privilege, a right, or a responsibility. 

Senator McCain responded:

"I think it's a responsibility, in this respect, in that we should have available and affordable health care to every American citizen, to every family member. And with the plan that...I have, that will do that. But government mandates I -- I'm always a little nervous about. But it is certainly my responsibility. It is certainly small-business people and others, and they understand that responsibility. American citizens understand that. Employers understand that."

I had trouble figuring out what McCain meant by saying health care is a responsibility since he followed that up with "we should have available and affordable health care to every American citizen." After going through his health care proposal I have come to understand his response as: it would be his responsibility as President to encourage the market (employers and insurance companies) to provide health care for American workers. He does not believe that increases in health care accessibility and affordability should result from increases in government spending on health care. But what about the people who cannot afford to work enough hours to be eligible for employer-based insurance (due to economic turmoil, layoffs, or family responsibilities)? What about the elderly? The disabled? What about the hard-working Americans who are working double-duty shifts and yet still earn less than half the median income-- not enough to pay $5-8,000 out-of-pocket for quality health care coverage for their family? Whose responsibility is it then? If it is the government's responsibility to provide access in these cases, the government is not doing enough.

On the other hand, here is Senator Obama's response:

"Well, I think it should be a right for every American. In a country as wealthy as ours, for us to have people who are going bankrupt because they can't pay their medical bills -- for my mother to die of cancer at the age of 53 and have to spend the last months of her life in the hospital room arguing with insurance companies because they're saying that this may be a pre-existing condition and they don't have to pay her treatment, there's something fundamentally wrong about that."

That health care is a human right is widespread belief. The preamble to the World Health Organization Constitution declares "the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition." Recently, the Office of the United Nations High Commissioner for Human Rights and the World Health Organization released "The Right to Health," a fact sheet that seeks to outline the basic understanding of what "the right to health" is and "its implications for specific individuals and groups." 

While no country has a perfect health care system, some certainly have achieved more equity and better health outcomes than what we observe in the US. Ours is a system driven by capitalist principles for all but the most impoverished families (who are eligible for Medicaid and SCHIP). While I have heard it argued that no one can be turned away from medical services for immediate life-threatening illness or injury, we all know that chronic health conditions are increasingly placing a burden on our system in terms of human and financial resources. Plenty of studies (including an upcoming publication in Journal of Women's Health -- woohoo!) support the notion that men and women without health insurance are less likely to access and receive preventive health services. This results in later disease complications and even (preventable) death. I will readily acknowledge, however, that providing health insurance to everyone is not a magic bullet solution to the current state of (ill-) health  in our country.

What are your thoughts on health care as a right or a responsibility? Do you think health care rights include social conditions such as safe drinking water, adequate nutrition, proper housing, and gender equality? What about access to essential medications, preventive health services (screening, education, vaccinations), reproductive health services? Why?

Finally, will the country's looming health care crisis factor into your vote on November 4th? 

Comment! I know you want to.

Update: America's Health Insurance Plans investigated the average cost of health insurance. While premiums for families varied widely depending on the State in which you live, the average cost was $5799. In Massachusetts, the average cost was over $13,000. Obviously, there are huge differences as well in what you get for $6000 family insurance in terms of deductibles, preventive care, and copayments. 

Bailout: the $810 billion bombshell

There was a great op-ed written by Joel Berg in last week's Washington Post. He wrote from a social services advocate's perspective on the looming government bailout of failing financial institutions. While I acknowledge that some remedy is needed for the mess that lenders have gotten themselves into by thinking the housing bubble would never burst. I am nonetheless baffled by the shear magnitude of the cost. Now, we are learning that the $700billion initially proposed has grown to $810billion (...because of pork?!) -- I am forced to reflect on what this money actually means. Our politicians can talk about the need for social protections, serving "the people", providing for families, communities, and the country. But talk is cheap. True values are revealed by where we spend our money (and our time). Thus, this bailout may (I hope) mean more than rescuing troubled Wall Street investors; rather, it represents a greater value of protection of our livelihoods and lifestyles -- being able to own and keep one's home, start a new business, invest in our children's future education. The details and implementation of this bailout bill will further reveal the underlying values and priorities of those whom we entrust the future of our nation. 

Back to reflection upon this $810billion. What would I do with $810 billion? Would I provide food for the hungry? Legal counsel for the oppressed? Food for the malnourished? Mobile technology for the isolated? Job training for low-wage workers? Bed nets in malaria territory? Funds for non-profit organizations? 

What would you do with $810 billion dollars?

Debate Politics: Taxes

Friday, September 26 9pmEST

MCCAIN:

"Now, that's a fundamental difference between myself and Senator Obama. I want to cut spending. I want to keep taxes low. The worst thing we could do in this economic climate is to raise people's taxes."

response

OBAMA:

"What I do is I close corporate loopholes, stop providing tax cuts to corporations that are shipping jobs overseas so that we're giving tax breaks to companies that are investing here in the United States. I make sure that we have a health care system that allows for everyone to have basic coverage. I think those are pretty important priorities. And I pay for every dime of it."

--------------------------------------------------------------

John Paulson, a Hedge Fund manager, earned 3.7 BILLION dollars in 2007. He paid only about 15% in taxes due to loopholes in the current system. I find this appalling. Our tax system is flawed. He and 5 other hedge fund managers who made over $1,000,000,000 (...look at all those zeros!) were able to keep millions of dollars in capital gains. McCain and most Republicans would have us think that somehow this translates into a stronger economy and more jobs - but how this is so really is beyond my comprehension. Please comment if you know how reducing taxes for those most wealthy (we are talking about millionaires and billionaires) is going to turn around our economy. On the other hand, there is firm evidence that this growing income inequality harms society (poorer overall health, broken community networks, decreased social support, etc), and has the most deleterious effects for the disadvantaged in our country.

Last night during the debate there were 17 "mentions" of the health care system in the United States. However, I was less interested in their discussion of McCain's $5,000 health tax credits (via increased employer based health taxes...) and Obama's spending to cover the uninsured -- all of that will be another post, coming soon-- and I was more interested in listening to them debate their tax reform plans. Most Americans are unhappy with the tax system in our country. I am currently among them.

Many Americans may feel overtaxed, but the truth is that those who are escaping like bandits are the ones who you think would be taxed 30 or 40% and are actually paying proportionally less in taxes than you probably are. I would be intrigued to hear a family with a household income of $500,000 argue that taxes (even slight increases) would prevent them from living very comfortably (for my California friends, I would consider views on variable taxes based on cost of living by State/region -- they do it for government employees already!). Consider that our government expects a family of 4 to be able to survive (how about: thrive?) on $21,200/year. 

Taxes are not a fun topic to discuss -- most Americans are unhappy to be paying taxes at all, despite the extent to which they personally benefit from them with government funded social services (e.g., public education, Medicare, Medicaid, social security, veterans benefits, etc). However, something must be done to tackle the growing income inequality in our country. The pressure that is put on the government to lower taxes reduces public spending for the poor and lower classes that desperately need help. We are still a society that has difficulty taking care of our own and making it possible for all Americans to live out their dreams without having to overcome inordinate and, in some cases, insurmountable obstacles. We need to accept that all is not equal in our great country. Yet, we can move in a direction that reduces such inequity.

The Good Sheet

I hadn't heard of GOOD magazine until walking into Starbucks yesterday. To my surprise, I noticed a small brochure of sorts on newspaper media entitled "Good: Health Care". It is the second in a series of "Good Sheets" aimed at exploring major issues facing Americans during this election season including health care, clean energy, and education. The Good Sheet on Health Care provides an overview of the US health care system and gives some facts on how much the US spends on health care compared to other developed countries, where the money comes from, history of the health care system, and strategies that could help mend the health care mess. If you're stopping by Starbucks in the next couple days, pick one up! Otherwise, you can just follow either of the links above and get the information online. It's easy to read and pretty informative. You can even see where Obama and McCain agree (and of course, disagree) on how to bring about systemic change in the different topic areas.

U.S. Addictions: High-fructose corn syrup & other artificial sweeteners

Americans have a major sweet tooth. The US has a sugar addiction that is quite unlike most other countries in the world. Rather than using natural sources of sugar minimally, we have increased our consumption of sugar over 250% in the past two decades. An article published in US News & World Report stated "In 2003, each person consumed about 142 pounds of sugar per year. ...[compared to] a dismal 8.3 pounds of broccoli and just over 25 pounds of dark lettuces." Now, this is not in the form of honey, agave nectar, or raw sugar cane. No, most of this is often in the form of highly processed (refined), or artificial sweeteners. One of the most inexpensive and widespread commercially used sugars is high fructose corn syrup (HFCS). 

HFCS is particularly toxic because of its pervasiveness in commercially available foods (ketchup, soup, cookies, crackers, cereal, yogurt, etc.), many of which would be considered "healthy" choices. Please, check your ingredient labels!! Whenever possible, chose an alternative that is made without sugar, or uses natural or minimally processed sugar.

Well, what is so bad about HFCS? ...good question, one I was recently asked...

High-fructose corn syrup has been shown to deplete the amount of chromium in the body. This is dangerous because chromium aids the glucose (sugar) molecules in passing from the bloodstream into the cells. A drop in chromium (like that caused by eating foods containing HFCS) can raise bad (LDL) cholesterol and triglycerides, as well as interfere with immune system functioning. Therefore, not only does it heighten peoples' risk of chronic disease (i.e., heart disease and stroke), but also acute illness (i.e., cold or flu). There are also studies that suggest excess sugar consumption (with HFCS and just generally) may be linked with certain types of cancer.

My general thoughts: the less you consume HFCS in your diet, the better. 

For more information see Mark's blog on the subject.

UPDATE: A good friend reminded me that strong evidence of the impact of HFCS on human health (particularly its effects on overweight/obesity) is relatively scarce. The extent to which HFCS is harmful to one's health is highly controversial and well debated. Yet, I felt a need to address some of the recent advertising from the Corn Refiners Association.  In my opinion, any information equating (or even implying) consuming HFCS with eating actual corn is as silly as equating consuming vegetable oil with eating -actual- vegetables. The statement that there is NO evidence of the effects of consuming substantial quantities of HFCS on health and disease is misguided. Healthful living depends on limiting your intake of refined carbohydrates -- which really means sugar in any of its multiple forms, HFCS being just one of them. If I have a choice between a popsicle made of simple sugar versus HFCS I think I will continue to choose the one made with sugar, better yet, I may choose no popsicle at all!

BlogHer reviews several online sources that examine the role of HFCS on health and wellbeing. I urge those who are more interested in getting information from both sides of the HFCS debate to check it out and make your own -informed- decision!

Inequality in America: Does it Matter?

This is a question that I will be asking myself a lot during the next two years. There is an incredible documentary that was shown on PBS last year called 'Unnatural Causes: Is inequality making us sick?' Unlike the biased, easily dismissed mainstream films like Sicko, which lack rigorous empirical evidence, 'Unnatural Causes' brings together the best research on social issues and health. It considers how our biological makeup (our DNA), our environment (exposure to toxins and violence), and our wealth and education influence our health status. Note that what we experience biologically, behaviorally, and socially in childhood influences our health outcomes throughout our life. 

Watch this video clip for a taste of the series. If you would like to see more visit the website.

Presidential Health Care Politics: Part I

I write this as I await the acceptance speech of John McCain for Republican nominee for President of the United States. In the past few weeks I have noticed how issues that were once so important in the primaries (e.g., health care) are now hardly mentioned at all in the candidates discourse. I wonder if now that the candidates are facing off against each other the issues will shift to no longer include a reorganization of the US healthcare "system" and will be replaced with promises about strengthening the economy, improving education, and winning the war in Iraq (all important issues, as well -- and ones that are inextricably linked to the health of our country).

My passion for improving peoples' health and well-being has led me to try and understand which candidate will put into effect policies that will improve the nation's health. The United States (which spends outrageously more on health care than any other country in the world) ranks about 30th in life expectancy! Most estimates compare the United States to other countries in the OECD, where the US life expectancy falls well below the average. While years of healthy life expectancy in other countries has continued to increase, health improvements in the US has stagnated. And that's not all - There is nearly a 20 year gap in life expectancy within the United States! The average life expectancy in the District of Columbia is 72 years, 18 years less than the life expectancy in Hawaii. A recent publication draws attention to the "8 Americas" and I encourage any interested in health inequalities in the United States to take the time to read it.

The variability in health outcomes across our own nation is disturbing. It is an issue that needs to be addressed -- and now is the time. I listen with anticipation to here what the Presidential candidates will say about this critical issue that affects the lives of us all -- whether we realize it or not.

Changing the Paradigm for Healthy Eating: The NEW food pyramid

1 in 5 Americans is currently overweight or obese. This constitutes a serious health problem. Many Americans know that obesity is an issue that must be confronted, but despite public health efforts little has been achieved in curbing this epidemic. Have we, as a nation, lost our understanding of what it is to live well? How can those working in public health make a difference? What policies can we support? What marketing campaigns can we promote? What programs can we implement that will effectively halt this rapid epidemic?

One great educational tool for how to choose a "well-balanced diet" has been the government's Food Guide Pyramid. However, the original version proved to be misleading and inaccurate (the influence government lobbyists, perhaps?). Harvard researchers have revised this outdated tool with a Healthy Eating Pyramid using the best current science. It emphasizes eating vegetables, whole grains, and lean proteins (fish, beans, etc) and exercising regularly. Check it out -- and let it replace any lingering influence that the old food pyramid has on your eating habits.

Quality or Quantity of Life?

While visiting family this weekend I ended up getting into a very interesting discussion about peoples' different views of what "quality of life" means. For one person, having high quality of life (or QoL) could mean being able to enjoy life's pleasures -- food, drink, sex, etc. To the hedonist, diet and exercise may be perceived as lowering QoL rather than as means to improve it. For another person, QoL may reflect the need for purpose or strong relationships and friendships. It could mean being happy and living a care-free life. I think QoL is a complex concept that can mean different things for different people. However, from a public health perspective there must be underlying concepts that can be measured and intervened upon in order to improve peoples' QoL. The Centers for Disease Control and Prevention (CDC) uses a series of questions called the "Healthy Days Measures" to evaluate the health-related QoL of populations. This measure is widely used in surveys, and is a tool to evaluate the nation's progress toward the Healthy People 2010 goals of

1) Increasing quality and years of healthy life, and 

2) eliminating health disparities.

In public health we must find a way to balance our desire to promote longevity with improving the life people live as long as they are here with us. What are your thoughts on prioritizing resources that improve quantity versus quality of life?

Decriminalizing Marijuana: Public Health Considerations

Boston Metro News ran a brief article this morning about a major funder of advocacy efforts for decriminalization of marijuana in Massachusetts. The decriminalization of marijuana (lessening or eliminating the penalty for marijuana use and/or possession) has been hotly debated in the US and around the globe for decades. It led me to ask, what are the public health implications for the decriminalization (for even small amounts) of marijuana?

A technical report by Alain Joffe and W. Samuel Yancy in a 2004 Pediatrics publication thoroughly reviewed literature on the legalization of marijuana and adolescent health. Joffe and Yancy report that:

1. Marijuana may reinforce dependence on other addictive drugs.

2. Impaired memory, judgement, coordination, and concentration are just a few of the adverse consequences associated with short- and long-term marijuana use.

3. Young adolescents would likely be most affected by changes in marijuana laws.

4. A 1% increase in marijuana use among adolescents would result in approximately 190,000 new users. 

A common argument by proponents of the decriminalization of marijuana is that marijuana, as compared to tobacco and alcohol, is a relatively harmless and "benign" drug. Yet as Joffe and Yancy point out, "That alcohol and tobacco cause far more harm in our society than marijuana is undeniable, but it does not follow logically that yet a third addictive psychoactive drug (marijuana) should be legalized." Looking at "lessons learned" from the tobacco industry, public health professionals would unanimously agree that millions of lives would have been saved by greater regulation and restricted distribution of tobacco products. 

In researching this topic I couldn't help but notice that marijuana use is associated with adolescents' risk factors for poor health including dating violence, lack of education/employment, greater depressive symptoms, and lower life satisfaction. While tobacco use and alcohol were also associated with the problems identified, this weakens the argument of the "benign" nature of marijuana use. Are the risks of marijuana decriminalization/legalization really worth it when considering the impact on future generations?

What is "public health?"

As a current student in the field of public health I was recently asked to define what public health means. It was a great question, and so I pose it as a point of reflection.  Surely, after 6 years of public health education and professional experience I am able to define my career field -- or can I?

My peers had some extremely profound and humorous responses to this question. My favorite was "It is when Uncle Sam passes up McDonalds and cigarettes for a salad and banana... and actually understands why." See Drea's post on simple.com for more about the BK pic above. Other perspectives on public health included promoting attainment of the highest level of health for all people, helping people enjoy a healthy and long life, and maximizing population well-being. 

My personal definition was quite broad. It sums up what public health means to me while taking into account how others have defined public health in the past: Public health is the science and art of increasing peoples' well-being and quality of life through promoting healthy lifestyles and increasing access to health services. Okay, so it took me a little more than the 60 seconds originally allotted to come up with that. Still, I think that is a pretty decent working definition.

I invite you to comment and share your own definitions of "public health" particularly as you explore your own health experience and that of those around you. 

About Veritas Health

The Veritas Health blog began as an experiment in new media and public health communication in the summer of 2008. Its goal is to inform, inspire, and communicate news and controversies in public health related to public policy, global health, nutrition and physical activity. 

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About the Author

Katelyn Mack is the founding and primary contributor Veritas Health. She recently completed her Master's degree at the Harvard School of Public Health in the Department of Society, Human Development, and Health. Her passion for improving population health by investigating social and economic influences on health and behavior is constantly increasing. She believes that translating the latest research for use in policy-making and public health practice is critical to improving the health of our nation and peoples around the world.

Aside from Veritas Health, Katelyn founded a community blog with several other HSPH students called Society and Health, which merged with the Harvard School of Public Health Connection, another HSPH student blog. She also has a food blog, TastyKate that chronicles her passion for delicious, healthy and affordable food.