Monday, August 31, 2009
More recently I have noticed a flurry of internet public health activity. Departments of Public Health have Twitter accounts and even CEOs of large hospitals have their own blog. This public health and new media thing is really beginning to catch on.
Nonetheless, it would be inaccurate ignore that Veritas Health was also a way for me to chronicle my own public health journey. One that is far from complete. This week I begin my second year at Harvard School of Public Health. I am excited to be taking classes in communication (*hopefully*) and financial management at the Kennedy School of Government and Harvard School of Education, as well. I look forward to broadening my graduate school horizon and learning from professors and students not immersed in public health themselves.
I hope my readers will be patient with me as school ramps up, it is likely that posts will become a bit more infrequent (though I promise to still regularly post...whatever that may mean). I have lots of ideas and a Veritas Health New Year's resolution list to achieve!
Happy Anniversary Veritas Health.
Monday, August 24, 2009
I have decided to commit to increasing my consumption of locally grown/raised foods during my last year at HSPH (Harvard School of Public Health). It was difficult to decide whether to initiate this using Veritas Health or my food blog, TastyKate, but finally decided that TastyKate was a better venue. Check out my first post here.
There are many barriers to healthy eating that we, in public health, are always throwing around. Healthy food is too expensive. It's not available. It takes to much time to make. I'm going to try to put some of those theories to the test.
I hope that you will follow along. This will certainly be an adventure.
Saturday, August 22, 2009
It would be impossible to eliminate all chemicals and microbes from drinking water, right? Rather than elimination, the EPA often sets standards of "allowable" levels of chemicals and microbes in the water supply. For example, a chemical used to kill weeds, atrazine, has been considered safe when the yearly average does not exceed 3 parts per billion and the daily dose remains under 297 parts per billion.
New evidence suggests that atrazine may be particularly harmful for the babies' development. While still in the womb, dosages exceeding just 1 part per billion were associated with low birth weight and birth defects (if you find this article please pass it along!). In animal studies, atrazine exposure has been associated with development of cancer. Epidemiological studies suggest that there may be increased rates of some cancers, including prostrate cancer among people with close contact with atrazine, as well.
The most recent EPA document on the health concerns of atrazine (dated October 31, 2003) states that
"the Agency does not find any results among the available [epidemiological] studies that would lead us to conclude that a potential cancer risk is likely from exposure to atrazine."This statement is echoed in their July 2009 Status Update.
It seems like common sense to assume that any chemical that kills weeds would be safe to consume, and that the fetus of a pregnant woman may be particularly vulnerable to such exposures. To determine a cause-effect relationship here is extremely difficult, however. This is because the most convincing way to "determine" causality is to conduct a randomized-controlled trial, which would require subjecting some women (pregnant women?) to be randomly assigned to receive potentially dangerous dosages of atrazine.
The UK has banned atrazine because of how easily it contaminates groundwater. What is keeping the US from doing the same? Is there a safer alternative? Or has our dependence on industrialized farming found yet another cause for public health concern?
Wednesday, August 19, 2009
Someone please tell me WHY is it so difficult to put our heads together and come up with the best freakin' spinach and beets commercial that would knock even KFC's socks off? How can we get our kids, teens, and adults craving colorful kale and blueberries, rather than Coco Puffs and Poptarts? Does Popeye need to make a comeback?
Also, while I don't like to characterize myself as particularly "political," I was taught early on in my public health studies that there is no public health without politics. Given this reality, I have often been extremely fired up by the lies and deception of headline-headed politicos who would rather communicate falsehoods and create fear-mongering than present the facts to their constituents in a thoughtful way (think: health reform). I think politics often produces fear. Fear paralyzes progress. This is why it takes so much time to achieve so little systemic change. We must move beyond a dialogue of fear, in order to debate the true issues at hand. In health care reform this means covering the uninsured and reducing health care costs. This could be done in SO MANY different ways (though I would argue that a cooperative is not going to be one of them), using evidence-based solutions.
So what is next? It's time for the job search to begin! I have decided that I definitely want a job doing some sort of communication. This could be to policymakers, public audiences, or public health professionals. It will likely involve the communication of rigorous research or its implementation (I didn't take all those methods/epidemiology courses for nothing!). The forum could lend itself to me expressing my opinion on a specific topic (sort of like I do on this blog -- but a bit more focused) or I could serve as the go-between for the researchers and the programmers/policymakers. My ideal organization will deal head-on with social and environmental aspects of public health (neighborhoods, built environment, marketing/advertising, schools) and will probably work in the area of nutrition/obesity, food policy, or healthy lifestyles (diet and exercise).
While my aims are still quite broad, I like broad. I've always been more of a "well-rounded" individual than an expert in any one thing. Eventually that is likely to change, but for now I need to embrace it. There will be a place for me, out there...somewhere. If I am lucky it will be in Menlo Park or Palo Alto.
Tuesday, August 18, 2009
The latest racial health disparity to reach the front page of the Boston Globe is the increased prevalence of swine (H1N1) flu cases among African Americans and Hispanics in Boston. Stephen Smith of the BG reported that H1N1 cases are clustered in neighborhoods with a high proportion of residents of these racial and ethnic backgrounds.
Dorchester, Roxbury, and East Boston were particularly hit hard this Spring and Fall by the swine flu. Why might this be the case? The two theories presented in the BG report include:
- Crowded living conditions -- densely populated areas may precipitate the conditions needed for person-to-person transmission of the virus.
- The composition of the local public schools -- the over-affected neighborhoods have a large Hispanic and immigrant school-aged population may have facilitated the spread of the virus in these communities.
If the increased prevalence of H1N1 among African Americans and Hispanics is due to the people, then changes to living conditions would have no effect on the residents' health. If the increased prevalence is due to living conditions, then why try to change individuals' knowledge or behaviors? Activities targeting people would have no impact.
Likely the reason for increased risk of swine flu among these racial/ethnic groups is a combination of the two. Hispanics may be more likely to have recently traveled to or been in contact with someone who was in a high-prevalence area (such as Mexico City) or those most affected may have less knowledge of flu prevention activities. On the other hand, housing conditions and other neighborhood characteristics (lack of health care/vaccine access, less penetration of media messaging on how to prevent flu, etc) may have resulted in the heightened risk.
These hypotheses are even more complicated since residents in the over-affected Boston neighborhoods are also at higher risk for a variety of health issues that could compromise their immune systems, increasing their susceptibility to more severe cases of the H1N1 virus. Are those other health issues due to the people? Or the place?
The answer to that question has important implications for the type of prevention programs and actions that will be taken in the coming months to prepare for flu season. Would you try to change individuals' behaviors and raise awareness? Or would you tackle the social and built environment?
Resource constraints make it difficult, if not impossible, to attack every issue from all sides - which would you prioritize and why?
Sunday, August 16, 2009
After a few months living in California I was struck by the number of food allergies and intolerances of my friends, colleagues, and their families. Gluten-free, lactose-free, peanut-free, pit-free...the list goes on and on. I don't believe that these diseases are just more 'common' in people living in the Bay Area, rather I think it is more likely that doctors (and patients) are probably more aware of food allergy signs and symptoms and thus more apt to screen for and diagnose these problems. In a highly educated, wealthy area like the Penninsula (i.e. Silicon Valley) this makes sense.
The peanut allergy epidemic (I'm not sure that it would officially be characterized as such....) that led to pretzels in airplanes and banning of peanut products in some schools surely raised America's awareness about some food allergy issues. Lactose intolerance has been around for a long time and is fairly well-known. Although many Americans suffer through stomachache after stomachache unwilling to believe that glass of milk or bowl of ice cream could be the culprit. Celiac disease, an extreme form of gluten intolerance is another story.
This week the New York Times ran an article on Celiac disease entitled 'The Expense of Eating with Celiac Disease'. Celiac disease (CD) is an immune disorder triggered by eating products containing gluten (a protein found in most of America's staple grains: wheat, rye, and barley). Even products that you might not have these grains as a primary ingredient may contain traces of it that can trigger extreme pain and health problems for someone with CD.
While the number of Americans with CD is fairly small, a recent epidemiological study in Gastroenterology shows that the disease is more common now than in the 1950s. Lack of diagnosis and treatment of CD also seems to increase the risk of premature death (nearly 4 times!). Though few people are diagnosed with full out CD, many more likely suffer from gluten sensitivities (or intolerance) that might not reach clinical or immunological proportions. Avoiding gluten for the gluten-sensitive can result in greater energy and stamina, fewer digestive problems, and an overall feeling of wellness.
Nonetheless, dealing with health conditions related to food allergies and intolerances, including CD is not covered by health insurance in the US. This is because, as the NY Times article points out, there is no pill or prescription to treat it. The regimen: a strict, allergy-free diet. For those that can't have gluten this means avoiding many cheap, inexpensive, American staples. It means eating more 'whole foods' (fruits, vegetables, meats, legumes, etc). If you think I'm kidding, go to the grocery store and compare the price of a bag of brown rice flour to a bag of wheat flour.
Apparently in Britain, those with CD are afforded insurance coverage (albeit through their government plan) to help offset the added cost of a gluten-free diet.
I think these lifestyle changes are often overlooked by health insurance companies because they don't fit the pharmaceutical quick fix framework. However, I hope that there is good debate over how these types of real-world issues related to a diagnosable, medical condition can be subsidized and included in an insurance plan (even if its through that pre-taxed flexible spending account that you can use to buy over-the-counter drugs and copays).
Friday, August 14, 2009
After months of hard work compiling data for the United Nations Development Programme our final report on the intersection of HIV/AIDs and sex trafficking was presented in Bali (see my previous post on this international conference). Reuters picked up the story and published it in its AlertNet section on Wednesday.
Trafficking is a public health concern and HIV/AIDs illustrates one of the major ways that trafficking may contribute to infectious disease spread rapidly throughout a population. Our study entitled, "Sex trafficking and STI/HIV in Southeast Asia: Connections between sexual exploitation, violence and sexual risk," looks at the relationship between sex trafficking and sexually transmitted infections (STI) and HIV in Malaysia, Indonesia, and Thailand.
The Silverman lab at Harvard School of Public Health is currently working on more publications on the topic, with the hopes of disseminating our findings in influential (i.e. widely read) public health journals. We need to raise awareness about the horrific practices and trauma experienced by these women and girls, and we need to better understand how to prevent and protect women from trafficking of any kind.
For more on this topic check out the website of Not for Sale a great non-profit organizations committed to fighting human trafficking world wide.
Wednesday, August 12, 2009
The commercial begins with two cute kids in the frame. One is trying to figure out the other's height with measuring tape; they are playing in a large kitchen. Then the fact, which is something to the effect of
So what does the ad suggest? Feed your kids more vegetables (dark green leafy vegetables are a good source of calcium and salmon or tuna are excellent sources of vitamin D)? Encourage your kids to play outside during the day (sunlight is the best way to help your body produce its own vitamin D reserves)? No...
It's General Mills (GM) to the rescue! The sugar laden cereals they manufacture have added calcium and vitamin D. Didn't you know? And your kids may be fussy over collard greens or baked salmon and they love video games so much that you would be interrupting their valuable screen time to take them outside...so just feed them their favorite cereals. I'm not dissing all cereals, though I do wonder how they became such a staple in the American diet. It's just that I could think of a million things to market to increase kids intake of calcium and vitamin D, and Trix (it's for kids!) is NOT one of them.
Not to mention the fact that the universal companion to cereal (i.e. milk) has 30% of the daily recommended amount of calcium and 25% of the daily amount of vitamin D.
We've heard about the benefits of calcium a million times. But why is vitamin D so important? Vitamin D has been shown to promote bone strength and muscle growth (oh...you thought that was the calcium?). It may even protect against some common cancers.
The Harvard School of Public Health Nutrition Source suggests that most adults take a vitamin D supplement (especially those in colder, northern climates). I actually just bought some vitamin D3 (1,000 IU) at the health food store today. I plan on having it on those days when I just don't get to exercise outside (winter...brr...). I'm not sure that I would give that much (400 IU/day is recommended for children).
Back to the commercial...
It aired on the Food Network around 6:30pm today, at least that is when I saw it. Will the marketing tactic work? Without communicating alternative, natural sources of calcium and vitamin D it just might.
Tuesday, August 11, 2009
Save Dick Cheney or protect 180,000 kids against measles? ...interesting question...
The debate about rationing health care and reducing choice is somewhat misleading, if you ask me. We already ration health care based on our health insurance (the more expensive, the better the coverage) and our employers decide what doctors we can see and what benefits we have by deciding which insurance companies employees can use.
"Rationing healthcare is what health systems do. No scheme, no government, no insurer, no individual (save perhaps the über-rich) has unlimited money to buy all the healthcare everyone wants."
He contrasted the health care services received by former Vice President Dick Cheney (after years of smoking he suffered four heart attacks since age 35!) with those that would have been received by an uninsured domestic worker (those low-wage earning house keepers and landscapers the wealthy so often "employ"). Morever, he asks,
"Would you deny the Vice President, a former heavy smoker, his quadruple bypass surgery (estimated cost: $45,000.00) to pay for inoculating 180,000 children against measles (estimated cost: 25 cents per child)?"
Well, would you?
There is no use denying the fact that increasing health care services for the poor and underserved will likely draw resources away from the services provided to the top tier of society. Do I think this would have a major impact on the health of the rich? No. Such a change would only serve to improve the health outcomes of our nation as a whole. The gains to be made by making health care affordable and available to all Americans will be better for population health than small, nearly unattainable medical care services to the most well-off.
Medical care services, in general, have only led to modest gains in population health. Water, sanitation, immunizations, and environmental modifications have led to many of the greatest population health improvements in our global history. We must spend more effort and money on disease prevention (innoculating those kids with measles is a good start; preventing youth from smoking is another). Treatment will always provide great tradeoffs for societal well-being because of the enormous economic cost.
Monday, August 10, 2009
Today I listened to a Webinar hosted by the Robert Wood Johnson Foundation (RWJF) which discussed the nutrition recommendations of their own Commission to Build a Healthier America. The conversation, moderated on Harvard School of Public Health's own Dr. David Williams, focused on two of their three overarching recommendations:
- Fund and design WIC and SNAP (Food Stamps) programs to meet the needs of hungry families for nutritious food.
- Create public-private partnerships to open and sustain full-service grocery stores in communities without access to healthful foods.
The Webinar discussed how to address America's love affair with unhealthy, processed, nutrition-empty foods. How can we change the eating habits of nation? The Commission advocates personal responsibility, as well as committing as a society to remove the obstacles that prevent Americans from choosing healthy, nutritious food.
Obstacles? What Obstacles?
I was surprised that a few folks on the panel (made up of a broad spectrum of leaders from both sides of the political aisle, as well as those who serve in government and private industry) seemed shocked at the realization that their are huge disparities in access to fresh produce in neighborhoods based on socioeconomic status (e.g. income). Many low-income communities still do not have a local grocery store. This was something panelists recently learned. It outraged them. And they seem committed to doing something about it! That there are communities with easier access to McDonald's and liquor stores than to fresh fruits and vegetables needs remedy.
The Commission has put together a list of model programs for each of its recommendations, one of which I highlighted in an earlier Society & Health post on food desserts based out of Philadelphia. This widely acclaimed local program may be turned into a national "Fresh Food Financing Initiative". Other models include a standardized evaluation of elementary school food environments sponsored by the USDA and the Farmer's Market Nutrition Programs.
I recently noticed that 14 Boston Area Farmer's Markets (a select group, perhaps) provide a 2-1 matching for patrons who purchase produce using food stamps (here's an article from the Globe). This may provide an economic incentive for low-income women to choose healthy, farm fresh produce over grocery or convenience store alternatives.
This conversation is critical right now. We need to focus on health, not just health care. Health reform, not just health care reform. All of us can work toward eating healthier, and all it probably takes is some common-sense (my mom has thankfully always had this!). Doing so will mean living longer, healthier lives.
You can check out more from the Commission and Q&A's from the Webinar on their blog.
Sunday, August 9, 2009
There are a lot of rumors out there about health care reform that are completely baseless. They are politically (not empirically) motivated and lack respect. Remember why health care became such a huge topic during the debate: the number of uninsured are on the rise and costs are skyrocketing. Small business owners are struggling to afford health insurance benefits for their employees (and themselves!). An excerpt from David Gewirtz's upcoming book, How to Save Jobs, provides a statistically coherent and humorous reminder worthy to read (good marketing for the October release...).
Here are some quotes related to the highly contested health reform bills being proposed in the House and Senate. Let's exercise some common-sense people.
"[We] cannot continue to cling to health industry practices that are bankrupting families, and undermining American businesses, large and small. They know we cannot let special interests and partisan politics stand in the way of reform." -- President Barak Obama, Weekly Address July 18, 2009
Something I want to clarify: there is no "Obama health care bill" (as Fox news suggests). Both the House and Senate have developed two different bills that will be voted on before being reviewed, revised, and developed into a joint bill to be voted on and sent to the President for approval (see my previous post in Society & Health for a comparison and links). Obama has outlined what he would like to see in the bills; however, that does not mean that he has dictated every aspect of each bill.
"Health providers would be required to explain to seniors the end-of-life services available, including 'palliative care and hospice.'" Fox News, August 8, 2009
This provision in the House bill has been used by health reform opponents to scare Americans into believing that these mandated health education sessions would be used to convince seniors to prematurely end their life! There was even an Opinion piece in today's Boston Globe suggesting the provision was equivalent to sending a cyanide pill to all elderly! This will likely be removed from the Bill (especially given the outrage and attention to it) -- should it be a reason to oppose health care reform -- no?! Did the idea of providing education about end-of-life care to all seniors seem sensible to the drafters of the legislation, probably! Is it evidence-based? YES!! Will it survive the political onslaught? Probably not.
"Health care by definition involves life and death decisions. Human rights and human dignity must be at the center of any health care discussion." - Sarah Palin, Facebook Page, August 7, 2009
I admit this quote came after her rant about how "nationalized health care" is "evil" and that under the proposed health care reform "bureaucrats can decide" who gets health care services; leaving out the elderly, disabled, including her own child with Down's Syndrome. AGHHHH!! Palin shows a glimmer of wisdom amidst of a sea of stupidity (yes...I said it). Have we already forgotten that the health care "system" is dominated by profit-driven, money-hungry insurance company execs who decide whether you get care or not? How is that better than a coalition of health professionals (and albeit some politicians) accountable to the American public making those decisions? Common-sense -- doctors and patients will be the final decision makers.
I have done enough research in public health to understand that uninsurance is the cyanide pill of the poor and marginalized. That we have a moral and ethical responsibility to provide basic health care coverage to everyone. Do insurance companies share this responsibility? Thus far, they have not. Does our government? That looks like it may be the lone alternative. We need a solid debate on how to finance and fund health care reform. These scare tactics and ridiculous claims kill the debate on health care reform that is desperately needed.
Expanded government insurance may not be the answer. It might be tighter regulation or standardization of claims, so that health insurance companies have incentives to lower premium costs and provide (through mandate?) insurance to all Americans. Let's talk about the possibility of funding primary health clinics next to emergency rooms so that the un- and under-insured do not have to use expensive urgent care resources for basic medical issues. Let's discuss funding prevention and wellness -- incentives for gym memberships (especially in places with long winters), subsidies for local farms to provide nutrition-rich fruits and vegetables, increasing access to fresh produce in all communities, expanding bike path, and maintaining sidewalks and trails. Why haven't we heard of these aspects of the health reform proposals in the media?
We need debate, not distraction.
Update (08/11): Check out an excellent article in the New York Times that lays out the process of health care reform legislation (passing through each body of Congress and reaching the President's desk), as well as some of they primary arguments for and against health care reform as it is presented in the proposals and media.
Thursday, August 6, 2009
Today International Justice Mission (IJM) held phone conferences to prepare constituents nation wide to meet with their legislators during August recess to discuss the Child Protection Compact Act (HR 2737) that has been introduced in the House.
The Act aims to increase funding ($50 million over 3 years) to the State Department's Global Trafficking in Persons Office to help provide resources and support to countries that have the political will to rescue and assist child victims of trafficking, but do not have the capacity. The bill has been submitted by the bipartisan partnership of Rep. Chris Smith (R-NJ) and Carolyn Maloney (D-NY).
I will be meeting with an aide from Rep. Capuano's office early in September with a group of IJM supporters and others who want this initiative to pass. Let me know if you are interested in joining me or email your representative directly!
Wednesday, August 5, 2009
Tomorrow several international organizations kick-off the first "South East Asia Court of Women on HIV and Human Trafficking" in Bali, Indonesia. The United Nations Development Programme (UNDP), the Asian Women's Human Rights Council, Yakeba (a local NGO) among others are involved in the conference proceedings. This regional conference connects the human rights and public health implications of trafficking.
Needless to say there is much progress to be made. Human trafficking in South East Asia is widespread; the region is estimated to comprise 1/3 of cases worldwide. Empirical evidence, as well as narratives will be used to provide insight into the victims of such horrific indignities.
I hope to see concrete recommendations come out of the conference and be put into practice, either through policy-making, financing, or program development. Because of the transnational nature of trafficking, countries must work together for progress to be made.
For More on Trafficking in Southeast Asia:
Tuesday, August 4, 2009
The Boston Globe ran several front-page public health stories today, totally catching my attention. In case you missed it on NPR (I heard a few of them during my 6 hour drive from PA) or don't get the paper -- here are the links and a brief description of the stories.
- Safer Sex Campaign Launched by BPHC -- Boston Public Health Commission has launched their safer sex campaign targeting teens aged 15-19 because of the rising rates of Chlamydia (a serious STI) in this age group. The campaign uses new media, including YouTube (video above!) and Facebook, and more traditional forms of media -- MTV, for instance -- to communicate protecting yourself during sex (by using condoms) and getting tested for STI/HIV if sexually active. It uses a peer-to-peer model.
- MA Issues BPA Warning -- Children and pregnant women should avoid any and all contact with food and drink that has been stored or heated in containers with BPA. The article describes what to look for to avoid BPA plastics (7 PC or 7 on the bottom of the container where the recycle sign is) and who is most at risk: children and babies still in the womb. This warning does not mean that BPA will be banned from children's products, but it is a move in that direction.
- 119 New Bedford Residents Sickened by 'Mystery Fumes' -- Black outs, nausea, and itchy throats were just a few of the symptoms of over a hundred people who visited the ABC Disposal Services Inc transfer station in New Bedford yesterday. Several people were admitted to the local hospital. The odor was overwhelming, described as 'propane gas with ammonia mixed into it' by one person affected. Illegal dumping may be to blame. Seems like a case for Erin Brocovich.
- Road Tests for the Elderly in NH -- Should MA adopt our neighbor's policy of regularly testing adults over age 65 for driving competency before reissuing licenses? This article makes the claim that doing so may reduce crash fatalities involving seniors.
- Koh Brothers Making a Difference in Washington -- Harvard's beloved Howard Koh joins his brother, Harold, in Washington as the Assistant Secretary for Health and Human Services. I've mentioned him before. The Public Health leadership course at HSPH will not be the same without him.
Woohoo -- public health getting the attention it deserves!
Monday, August 3, 2009
A brief article today in the Boston Globe entitled 'Health officials are not too sweet on diet soft drinks either' revisit the controversy over artificially sweetened beverages and their place (or lack of it) in changing America's liquid consumption. Surprisingly (at least to me) Dr. Walter Willett, chair of the HSPH nutrition department, was quoted in support of diet soda, at least relative to its high-fructose corn syrup laden counterpart.
However, some research on the topic suggests that both sugary and diet sodas can increase a person's risk for poor health outcomes (the article cites an increased risk of metabolic syndrome, linked to heart disease or stroke). Also, as I have heard before, artificial sweeteners can trick the body into expecting a rush of calories from sugar and when it never arrives can lead to problems with one's metabolism and result in overeating later in the day.
While diet sodas may be a stepping stone on the path toward more healthful beverages, they should not be viewed as a healthy. More importantly, they should not be consumed by children (at least not regularly) given their link to metabolic disorders. We have enough metabolism problems as we age already -- let's not start that process in childhood!
What do you think? Do public health advocates need to embrace diet beverages in hopes of reaching those people who are now consuming the high-calorie sugar sweetened sodas? Or is it better to advocate for natural beverages (not artificial, not sugar-sweetened) and leave the diet soda marketing up to the beverage industry. Their budget is big enough, no?