Research and Policymaking Merge in Public Health

How does a State know whether fluoridating its water supply will prove cost-effective in reducing tooth decay and its related health costs of their residents? Are mass media campaigns effective in discouraging smoking among young people?

These questions and others are posed in a Fall 2008 report by the Council of State Governments entitled "State Policy Guide: Using Research in Public Health Policymaking". 

The report indicates strong support for State governments to begin making public health decisions based on empirical evidence rather than the influence of lobbyists or in the interest of political expediency. The challenge of making evidence based decisions is directly addressed in the report, as is the need to distinguish public health policies directed at the population (i.e. community) level from medical care policies, which focus on treating or preventing disease in individual patients. 

Rating scales to evaluate the evidence for particular interventions are provided, as well as a step-by-step guide to drafting and reviewing proposed legislation on public health policy. 

I wonder how much attention to evidence-based policy making is currently happening at the local and State level. Have other sectors of government (apart from health) been making evidence-based policies or is this something new altogether?

It is imperative that we elect and promote individuals with a strong ability to identify and critique the public health literature so that informed public health policies can be implemented. At the least, we must expect our policymakers to surround themselves with people who are public health experts and can inform the content that goes in to the legislation. This guide is a good first step -- a call to action of sorts. 

Next Steps:

• Are evidence-based public health policies being made in your State? 
• What are the risks/rewards of being the first State to adopt a new public health policy? Can these decisions still be evidence-based?
• Who will keep local and State governments accountable for their public health policies?

Big Food: Bad News?

Here are two articles I came across in Consumer Affairs this morning:

FDA Warns General Mills About Cheerios Claims

According the the Food and Drug Administration (FDA) Cheerios has stepped out of bounds in its recent campaign to market that "Cheerios may reduce your cholesterol!". GM also promotes other scientific claims such as the ability of Cheerios to lower LDL cholesterol (the bad kind) and to lower cholesterol 4% over 6 weeks. FDA officials feel that these statements market Cheerios as a drug, not food because of these claims.

I applaud the FDA efforts in this area. GM and other large food companies are itching to show just how "healthy" their foods really are -- when really, their foods are not all that healthy. In fact, they would love to play up the RELATIVE advantage of sugary cereal over no cereal or the benefits of diet soda over regular soda. 

Come on! Leave out the sugar, cut back the sodium and use less refined products. Then you might not have to try so hard to prove that your food is good for the public.

Nothing beats a home cooked meal. We all should try it some time.

Senate Studies Soda Tax

The Center for Science in the Public Interest, a public health advocacy group, has finally gottenthe attention of Congress in efforts to pass a national tax on soft drinks and sugar-ladenbeverages.

According to the article a study conducted by the Harvard School of Public Health in 2006 found that added sweeteners contributed to 1/3 of all carbohydrate calories that Americans consume, and that the sugar from sugar-sweetened drinks is a full 1/2 of that caloric amount.

We have been down this road before without much success. Even in Massachusetts we have a law that explicitly exempts CANDY and SODA from State sales tax. How can this be?! Our Stateneeds money and this sort of sales tax on absolutely, undeniably, unhealthy food seems likelow hanging fruit, right?

How many of our politicians are in bed with the food and beverage industry to block this votefrom passing? We will know in due time.

Community Make-Over: Food Edition

There was a link to this Reuter's article on a friend's Facebook page (thanks Sara!) and I couldn't help but pass it along.

Jamie Oliver and Ryan Seacrest Productions team up to create healthy food environments in America's most unhealthy places. It is like the Hell's Kitchen spin-off for a whole town! I am so excited about this project. They have money, they have looks, and they have tenacity. 

I hope that they also have success and that this grows into a movement!

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Swine Flu Controversies

For more on current controversies over swine flu (including xenophobic reactions from leading talk radio hosts and the slaughtering of pigs in Egypt) see my recent post in Society & Health.

Swine (...I mean H1N1) Flu Hits Harvard

View H1N1 Swine Flu in a larger map

I have been (whether it's obvious or not) avoiding blogging about swine flu, now referred to as H1N1. However, since classes at the Harvard Dental School, Medical School, and School of Public Health were cancelled today, I I decided to take this extra 2 hours in my Friday to write a brief post from a public health students' perspective.

The widely communicated message of "be concerned, but not alarmed" jives well with what I know about the cases that have emerged in the US and suggests that ongoing monitoring will respond to any changes in cases or further mutations of the virus. 

So why is there cause for concern?

• This is a new strain of the flu virus, which means that those who received flu shots last Fall will not be protected against it.
• We still do not know why young, healthy people are dying in Mexico, but not in the US. The US only has 1 confirmed death at this point of a Mexican toddler in Texas. 
• Flu is and always has been a deadly disease. The CDC estimates that nearly 36,000 people die from the flu each year.
  

But not alarm?

• Cases tend to be spreading slowly in the US, mostly to people in close contact with individuals that traveled to Mexico (parents, siblings, children, etc.).
• Tamiflu and Relenza, two stockpiled antiviral medications, are available to treat people who get infected with H1N1.
• Local, State, and Federal governments are collaborating to make sure that resources reach those who need them and have a flu emergency plan.

I must say I was a little surprised that HSPH cancelled classes today (as well as a couple on-campus conferences). Few students have classes on Fridays, so perhaps it was the least disruptive day to do so. Additionally, if more students have been infected the weekend may give time for symptoms to emerge so that others do not get sick, as well.

Nonetheless, I am feeling great (for anyone out there that cares). I am washing my hands frequently (especially after riding public transit) and making sure I eat well and get enough sleep. I always try to avoid sick people -- so that's not a change I need to make. Friends, I encourage you to do the same. Leave your lovely blue masks at home.

To learn more about emerging cases in the US check out the CDC site for global cases of H1N1 see the WHO website. 

I wonder what Google came up with for the Swine flu outbreak. Did they see anything on Google Flu Trends? Check it out here.

Next Steps:

More to come on how an infectious disease, like swine flu, intersects with social determinants of health including discrimination and poverty.