Saturday, September 27, 2008

Debate Politics: Taxes

Friday, September 26 9pmEST


"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."


"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.

Sunday, September 21, 2008

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.

Friday, September 12, 2008

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!

Saturday, September 6, 2008

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.

Thursday, September 4, 2008

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.

Wednesday, September 3, 2008

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.

Monday, September 1, 2008

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?