Friday, July 31, 2009

Health Benefits of "Organic" Questioned Again

The debate over whether organically farmed produce is nutritionally superior to conventionally farmed produce has been around for a long time (I posted on the topic in my food blog: TastyKate last year!). This week an article in the American Journal of Clinical Nutrition reviewed the published literature on the topic and concluded that there is not scientific evidence that organic produce has greater nutritional benefits than conventional produce. This contradicts a 2008 US study by The Organic Center which concluded that organic produce has greater nutrients than conventionally grown produce.

My good friend, Wes (thanks!!), informed me of the study through a post on Science Daily that discusses the article and its findings. In reading the post I would like to make a few Veritas Health-minded comments:

"The review focused on nutritional content and did not include a review of the content of contaminants or chemical residues in foods from different agricultural production regimens."

The fact that the review did not consider the health effects of contaminants and liberal pesticide use suggests that while the findings indicate little or no nutritional benefit to eating organically grown fruits and vegetables, it makes no claims to conventional produce being just as 'healthy' as organic (in the sense that pesticides, chemicals, etc. may have long term health effects, especially if consumed frequently and over the span of one's entire life).

"For 10 out of the 13 nutrient categories analysed, there were no significant differences between production methods in nutrient content. Differences that were detected were most likely to be due to differences in fertilizer use (nitrogen, phosphorus), and ripeness at harvest (acidity), and it is unlikely that consuming these nutrients at the levels reported in organic foods would provide any health benefit."

It is great to see the study really trying to get at the root cause of any potential differences in the nutrition content of organic vs. conventional produce. Is it due to the chemicals used? Fertilizer? Or harvesting techniques? First, harvesting techniques do appear to matter. Take tomatoes that are picked before ripe and then ripened in climate-controlled environments (unripe tomatoes are MUCH easier to transport, right?!). Also, many farmers agree that industrial farming degrades the soil, reducing the nutrition content of the food grown in it. Some fruits and vegetables may be more sensitive to these differences than others. Civil Eats has a great blog post that questions this aspect of the study's findings.

Just as a quick aside. These differences in farming and harvesting while they may not make a huge difference in nutritional content, they certainly impact taste. If you want your kids to eat more vegetables, grow your own or buy some at the local market. They are going to be sweeter, fresher, and much easier to cook with (just a little extra virgin olive oil or butter, some salt and pepper and you are good to go!). Anyone who has had a fresh garden tomato will tell you that a supermarket tomato will never stack up.

Second, while the authors speculate that these small nutritional differences do not have health benefits, this fails to take a 'lifecourse' perspective on the issue. While the nutritional benefits of eating organic produce might not be important in the short term (1 or 5 years), doing so for 10, 15, or even 30 years might! There might even be points in life where our bodies are more receptive of these small nutritional advantages (such as during pregnancy or in utero).

Overall, I think this study was well conducted. I agree with Paula Crossfield of Civil Eats that the question being asked was perhaps not the most critical one at this point in time. We (public health advocates) can not and should not demonize conventional produce, especially when most Americans are not eating enough fruits and vegetables to begin with. However, we have to acknowledge that there may be a better way of producing, distributing, and buying our produce. Where have all the family farms gone? What is needed to inspire and market buying local (also usually organic -- without the USDA label).

In addition to not addressing the controversy of pesticide and chemical use in the growing of conventional produce, the article also does not discuss the nutritional differences in organically (or grass-fed) raised cattle and other livestock. While I may buy conventional produce on a regular basis, I am usually more cautious in buying industrially produced meat and dairy products. For evidence on the health (and nutrition!) benefits for eating sustainably and organically raised meat and dairy check out these links: Eat Wild and Sustainable Agriculture Research and Education .

Your thoughts? Have you tried to eat organic? What made it difficult or easy?

Thursday, July 30, 2009

National Initiative to Stop Teen Dating Violence

The Robert Wood Johnson Foundation (RWJF) just announced that Blue Shield of California Foundation and the Family Violence Prevention Fund will join with RWJF to help communities combat and control teen dating violence. The initiative called Start Strong targets kids aged 11 to 14 and the budget is big -- $18 million. However, this budget will be divided between 11 communities in the country.
If this sounds somewhat familiar it may be because you read my Society & Health post a few months back on the Teen Dating Violence Forum that was held by the Boston Public Health Commission (remember the Rihanna/Chris Brown event that put dating and intimate partner violence in the fore front of everyone's minds?).
Boston will be one of the communities funded for this initiative. And boy do we need it! I think every shooting and stabbing I hear about in this city (and I hear about it way too much...) is either gang-related or a case of intimate partner violence. I know...I should be scientific about this, but you can check out the stats at the BPHC website if you are interested.
The leadership of Start Strong in Boston seem up to the challenge before them. I am excited to see what kind of impact it has on the city and among young people. Maybe it will affect the same kids who hit me with an egg while I was riding home from work this week. (I had to throw that in there...true story.)

Tuesday, July 28, 2009

Input Wanted: Favorite Public Health Resources

I would like to create a "Resources" page to direct readers to websites and organizations that they may find interesting or useful. I started by thinking about the different public health topics that often appear in Veritas Health -- food/nutrition; violence prevention; health care reform. Then I have listed a few organizations/websites that I have discovered over the years that help me find valuable information on those topics.

I need your help! I won't be able to fill out this Resources page on my own and would like your input.

  1. What websites or organizations have you found useful in discovering public health information?
  2. What topics am I currently missing that you would like to see highlighted (and have me write more about)?

To see what I've already gathered click on my 'Favorite Web Resources' link to the right or click here.

Monday, July 27, 2009

Harry Potter Stirs Alcohol Controversy

I've been debating going to see the new Harry Potter movie ever since it came out in theaters. While I wouldn't call myself a huge "fan" I have enjoyed the previous films and think there is no substitute for a big-screen view of Quidditch. So after mixed reviews from friends, I was surprised to read about the intersection of Harry Potter and public health in today's New York Times Health Section.

Columnist Tara Parker-Pope discusses the proliferation of drinking in the recent film by painting a picture of the frequency of drinking scenes (often) and the connotations attached them (drinking as a way of coping with shyness or anxiety).

She poses the following question in her web-based forum on the column:

Will [the drinking scenes] have a negative influence on children or is the fantasy world of Harry Potter not worth the worry?

She thoughtfully presents and responds to skeptics that may suggest she is overreacting to the consumption of alcohol to even pose this question. For example, there is evidence that children's exposure to alcohol consumption in movies may lead to starting drinking at a younger age (from an Institute of Medicine Committee Report on the topic and a German Study). Also, critics may point out that in England the legal drinking age is lower -- age 18. Sixteen year-old Harry, Hermione, and Ron may have been in the clear during their pub crawls except that the film does not show them drinking with food (a legal requisite for drinking under age 18).

Beyond legal definitions of drinking -- it is more about understanding what kind of cultural norms the movie promotes. May this reinforce or set norms around teenage drinking? Might it inspire kids to use alcohol as a way to cope with uncomfortable social situations or as a way to escape problems or life's challenges? Could the film have been produced a little differently, to the same effect, without sacrificing the integrity or intent of the director or writer while not promoting youth's early use of alcohol? YES!

I don't think that the "magical" environment of Harry Potter or Hogwarts excludes the film from the scrutiny that should take place for any media. Alcohol and tobacco in media should both be cautiously employed in children's media. To join the discussion comment below or check out the original post.

Thursday, July 23, 2009

My Public Health Passion: Round 1

What is my public health passion?

When I arrived at HSPH in August, I was asked this question by Dr. Howard Koh, who is now sitting down in DC working on health care reform and preparedness for the Obama administration as Assistant Secretary for Health at HHS (Health and Human Services).

Dr. Koh has had a clearly articulated public health passion related to cancer prevention and tobacco control. He became involved in disaster preparedness as the Commissioner of Public Health for Massachussets. His energy and excitement permeated every part of his being, you could see it in his eyes and hear it in his voice. He no doubt inspired many others to enter public health careers because of his work and mentoring.

In my original -- and first Veritas Health! -- post on the topic I wrote that

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.

My broad definition reveals my own struggles with pinning down my public health passion. These past few months have made me confront this issue head on. After some pre-summer job searching, I traveled for 24 days contemplating my desire to commit to a doctoral program with a focus on gender-based violence/human trafficking. While my part-time research position came to fruition, the seeds of doubt and confliction did not die away. Was I ready for a doctoral program? Had I figured out my public health passion?

My month-long trip to Central America to explore the feasibility of conducting research on sex trafficking and health resulted in great success in the short-term, but I returned to the US more certain that becoming an 'expert' in a field that required substantial travel and time abroad was not for me. I also started wondering if I was getting more interested in the 'social' aspect of the 'social determinants of health' than the 'health' itself. And does that even matter?

After the past few months of soul searching and reflection I have yet to clearly articulate my public health passion. Could something as broad as "research" "prevention" or "communication" be it? Does it need to be articulated as a problem statement or research hypothesis? Must it be a particular aspect of health or disease - obesity, diabetes, HIV/AIDS? Finally, can I be a public health 'generalist' yet still have a public health passion?

Many questions. Few answers. This is where I stand right now, today. It is almost embarrassing to admit that I still wonder where I 'fit in' in the public health landscape. I know I am not (and do not want to be) a clinician. I still love research, but am unclear what type of research I want to be doing (epidemiology? policy? evaluation?). I sometimes think I could well enjoy monitoring and evaluation (that's research, right?) or even advocacy work.

What have I learned? I need time to work in a different area of research and practice to help confirm or disqualify these different public health career options. Maybe I will discover the health issue that I care most about or the type of research that ignites my public health passion.

Most importantly, I have learned that my family and my community (friends, church, and environment) are more important to me than my career. I may have always known this, but was too achievement-oriented to admit it. Maybe it took two cross country moves to realize that one would have been good enough.

No matter what, I know my public health journey will not end when I graduate in May. It is most likely only the beginning...again...

Tuesday, July 21, 2009

Buying "Organic" Or Are You?

A few weeks ago the Washington Post ran an article titled "Purity of Federal 'Organic' Label is Questioned." It discusses the major battle that is being waged by organic food advocates over the federal loopholes that allow companies to achieve a 'USDA Organic' seal of approval without assurances that 100% of the ingredients are non-synthetic or cultivated organically (in actuality the real proportion is only 95% organic ingredients - click here for an explanation of the tiers of 'organic' labels). A few examples:
  • Pre-grated organic cheeses -- wood starch
  • Organic beer - non-organic hops (how is it organic then? the water?)
  • Baby formula - synthetic fatty acids
So why did the federal government introduce these loopholes? Industry lobbying. The organic market is growing -- everyone wants to be 'in on it' even if they do not technically produce or sell organic products. So because Kraft and Dole (among others...) want to be able to put organic products in stores without the requisite time, energy, and skill they appeal to the Organic Standards Board to expand the list of allowable non-organic substances (...that 5%...). In 2002 that list had 77 items, now it has 245!

This is the reason why consumer education is so challenging and important. Industry is constantly trying to manipulate consumers by calling their products "100% whole grain," "fresh," and "natural". They play on consumer desire to eat healthier, but what results is little actual change and movement toward healthy because consumers are often being duped.

This is a major reason why small farms that sell to your local grocer -- not the big chains -- may not market their products as "organic" even though they are! Why go through the hassle of getting the organic label when the food giants are corrupting the name?

In my opinion, the addition of synthetic ingredients should disqualify products to be labelled as 'organic.' This is clearly not how the USDA defines it. And as for the quote by Barbara Robinson, the deputy USDA administrator for the organics program,
"We don't attempt to say how synthetic products can be produced... Manufacturers say the fatty acids [added to infant formula] are safe and provide health benefits to infants."
I would like to know how rigorous and effective are the health and safety checks conducted by manufacturers (??!!) -- I would say that is not a part of their training or expertise. These politicians can not rely on them for information! They need to look to an independent, expertly conducted evidence base of research. They must fund this and prioritize it for progress to be made and for this nonsense to end. 

We need people in Washington to stand up for small farmers and to not cave in to industry lobbyists. There needs to be a 'food constitution' and a revival of food culture in the United States that expects transparency and clarity with regards to what we are putting in our bodies each day and how that will affect our health, energy, and vitality down the road. 

Will Obama's increased funding for the Department of Agriculture's National Organic Program put an end to these charades? Or will it just expand the consumer abuse? 

I mean, really! If I'm paying more to buy 'organic' it better be exactly what I think it is...

Friday, July 17, 2009

Health Reform Quick Comparison

For a quick comparison of the two pending health care reform bills in the House and Senate from a prevention and social determinants of health perspective check out my post at Society and Health.

If you are interested in more detailed information about the plans, APHA seems to be updating their comparison table pretty regularly (last updated yesterday) so check out that site, as well.

Have a great weekend!

UPDATE 07/21: medpage Today ran an article July 16 that explains some of the key differences between the House and Senate Bills. A great (easy to read) article if you want to learn more! 

Wednesday, July 15, 2009

RP: Health Reform Jumps First Senate Hurdle

The Affordable Health Choices Act, legislation supported by the American Public Health Association, passed through the Senate Health, Education, Labor and Pensions (HELP) Committee this afternoon. Some of the most exciting aspects of the bill ( terms of social determinants of health) are:
  • Establish a program at the Centers for Disease Control and Prevention to "facilitate the use of health impact assessments to gauge the public health implications of major decisions regarding the built environment, including housing, transportation systems, waste disposal sites and other land-use planning decisions.
  • Establish a grant program for state and local governmental and community-based organizations to implement evidence-based community preventive health activities to reduce chronic disease rates, address health disparities (including social determinants of health), and develop a stronger evidence base of effective prevention programs and interventions.
  • Collect data and conduct research on the health and healthcare of populations that have traditionally experienced health efforts to improve the quality and effectiveness of health services." (quotes are taken from an APHA e-mail blast)
I am excited that these components of the plan take a social determinants approach to some of the health system issues that are currently lacking. Additionally, it was wise to articulate the needed move toward an evidence-based health care system, not only in terms of medical treatment, but also prevention activities!

I had wished, however, that the creation of programs for a "public health workforce loan repayment program" would have been a grant or scholarship program for students entering graduate degrees at accredited public health schools ( I bitter of the lack of funding for my master's degree? or the idea that I might have to fight for a stipend in a doctoral program?...)

While many health reform advocates are hopeful at this point, the slim (partisan) margin by which this bill was passed is worrisome (13-10). Next, the Senate Finance Committee holds a markup of its version of the legislation and later their version is merged with the recently passed HELP Committee bill.

Up next -- how do the House and Senate health reform legislation compare? Great question!

Tuesday, July 14, 2009

OFA-MA Health Reform Event This Saturday

Organizing for America - Massachusetts (OFA-MA) is holding a community forum called 'Healthcare Reform 101' to provide an informed perspective on the ins and outs of health care reform -- the process, the proposals, and potential outcomes.

Healthcare Reform 101 Forum
Saturday, July 18
10am - 1pm
SEIU 1199, 150 Mt Vernon St., Dorchester 02125
(Near the Bayside Expo, near the JFK/UMASS Red Line T stop)

If you are confused by the current health care debate (I am!) or want to show your support for health reform efforts (me too!) don't miss this event! For more information check out the OFA event webpage.

Monday, July 13, 2009

RP: What does climate change have to do with it?

If RT stands for 'retweet' on Twitter then RP stands for 'repost' on Veritas Health.

Check out my latest post on Society & Health. I discuss some of the health and social consequences of climate change, including insights from the Humanitarian Action Summit, held at Harvard University in March. Here's the first paragraph if you need a preview...

"An article on the intersection of climate change and social determinants of health (SDH) in Global Health Promotion recently caught my eye. Climate change interventions ought to consider the social context in which they (will) occur in order to prevent a widening of health inequalities. ..."
How might climate change affect your health?

Monday, July 6, 2009

Health Care Reform: Canadian Comedy

My goodness. The US is not and never will be like Canada. Period. Certainly not in terms of health care. It is for better or worse depending on who you talk to.

I am sick and tired of all the news hype and political rants about health care reform turning the fractured US system into ONE giant government-run health care plan. That is just not going to happen. Canada has a single-payer, government-run health care system. There is no private health care in Canada. This is an exception and not a rule for strengthening and expanding health insurance coverage and service access.

For example, last month I was in Costa Rica. Costa Rica has a government sponsored health insurance plan that covers all citizens. Citizens are required to pay into the plan whether they use those services or not. Those who seek faster or more specialized health care services can pay more for private insurance and seek private health services, as well. While the system may not work perfectly, it leaves no one behind. In fact, I was asking my Costa Rican friend where she would go if she had a major medical problem (say a diagnosis of breast cancer). She said she would absolutely, hands-down have her surgery at the public, government hospitals because the physicians are better skilled and trained for those intense surgeries.

Now, in many ways Costa Rica can be quite exceptional. However, it goes to show that government services do not have to lag behind those of the private sector. All too often we assume that government services will be below the standard of private insurance. My experience working at the Veterans Affairs in Palo Alto taught be otherwise. Sure, it wasn't perfect -- but it was light-years ahead of some other private providers.

If planned appropriately and with the right incentives, there should be no reason why US health care reform cannot maintain high quality health care (...and there is improvement needed in this area as well...) while lowering costs and covering all Americans. We should expect exemplary government-run health care (including Medicare, Medicaid, and VA health care) that creates a gold standard for private practices.

But we must not forget that good health is NOT simply a matter of medical care. Prevention is key to improving our health and lowering costs. We must promote health in our homes and in our communities. Without changes in our lifestyle and the societal pressures that surround us we will never be able to sustainably lower costs and increase our health outcomes. We can prevent heart disease, cancer, suicides, and HIV/AIDS without expensive medical technologies and overpaid specialists.

And when I say 'We' I mean 'We' and not 'Me' or 'You'. Because I believe health is a product not just of individual choices, but of social and community influences and environments. Steps to improve our nation's health and our health care system must proceed accordingly.