What Does a Healthy Population Look Like?

How do you quantify something as complex and dynamic as a person's health?

First, you define it. What does health mean? Or asked another way, what does it look like to be healthy? The World Health Organization defines health as

"a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity."

For a long time, I found that answer sufficient. Then I became an evaluator. Now I reflect on this definition, and find that it does surprisingly little to help clarify or make measurable what health means. Replacing the word "health" with "well-being" does not provide much additional guidance and it's only somewhat useful to know that health is not equivalent to the absence, or lack of, a medical diagnosis.

Now, I don't mean to undercut the importance of WHO's game-changing definition in the history of our understanding of wellness and illness. I am saying that measuring what we mean by "health" (as well as many other constructs in the social sciences) takes significant effort. It is a complex task indeed!

A few months ago the Institute of Medicine (IOM) took a stab at defining what health means by releasing its Leading Health Indicators for Healthy People 2020 report. The report prioritizes 12 health indicators and 24 health objectives for the US government's Healthy People initiative, including indicators of access to care, mental health, tobacco use, responsible sexual behavior, and obesity. The indicators were picked from among 43 topics and nearly 600 objectives!

An editorial in the Lancet highlights that for the first time objectives for lesbian, gay, bisexual, and transgender health are addressed, particularly around increasing health insurance coverage and reducing obesity.

These indicators have long been an important way to prioritize and track changes in our nation's health. It provides leverage for advocates of particular issues and vulnerable populations. In addition, it helps allocate funding to address gaps and areas that are most lagging in progress over the course of the decade.

Yet, I can't help but find it ironic that the single best measure of health comes from a simple survey question often asked by the CDC. It has been validated and recognized as credible in multiple studies through the years. To assess health, all that's needed is to ask:

Would you say that in general your health is excellent, very good, good, fair or poor?

Now that's something to think about...

What Shapes Health? Find Out!

I've always had the perspective that my successes and wellbeing were influenced by factors far beyond my individual control. My family, friends, and influential members of my community provided me with opportunities and a perspective on life that helped me to 1) not be afraid to tackle challenges and 2) believe that I could be "whatever I wanted to be" if I worked hard enough.

So what does shape our health?

Is it genetics? 
Access to health care?
What you eat? 
Your environment?
The beliefs and culture you grew up in? 

I bet its a mix of all of these, with a special emphasis on those things in our social, political and economic context that are easy to ignore or may seem too difficult to measure or evaluate. I've talked about the importance of recognizing the social determinants of health in my April 2009 post 90210: Does ZIP Code Affect Health?

A Robert Wood Johnson Foundation webinar explores this question and many more this coming Thursday. Dr. David Williams, Professor at Harvard School of Public Health will moderate the discussion.

Register below and attend!

Thursday, March 24, 2:00-3:30 p.m. (EST)
What Shapes Health?
A panel discussion on how our environments and experiences, including those that shape development in childhood, also shape our opportunities to live healthy lives. Moderated by David Williams, Ph.D., former staff director of the Robert Wood Johnson Foundation’s Commission to Build a Healthier America.

• Register for What Shapes Health.

Evaluating Impact: Storytelling Versus Metrics, Which Matters?

Stories can capture the heart of a person like a number or statistic never can. Even mind-boggling statistics are just that – incapable of being fully processed and affecting us into action. Human experience on the other hand, touches us deeply and creates empathy that we are unable to ignore.

On Thursday, I listened to Jessica Jackley (co-founder of Kiva and founder of Profounder) and Jennifer Aaker (Stanford Business School Professor and author of The Dragonfly Effect) talk about the power of storytelling. It was at a Philanthropy and Civil Society event at Stanford University that was supposed to be on social media, but focused on something much more enlightening: the power of people's stories.

Many people are talking right now about the importance of metrics in measuring nonprofit impact. Metrics quantify activity and changes that are seen as a result of a program, service, or policy. While there is a place for metrics and quantifiable successes, I believe it can’t be the only way we assess change.

While some questions are amenable to a single numerical answer, many are nuanced and require skill in listening, capturing, synthesizing and communicating in creative qualitative ways. The latter begins through asking thoughtful questions and consequently by listening to peoples’ stories.

There are two reasons that we must consider the questions we ask about impact and how we gather information to answer those questions, whether through collecting numerical data or capturing stories.

Veritas Health: Evaluation Unplugged

Greeting from California!

Veritas Health has officially relocated to the West Coast. I'm excited to start putting my newly minted Harvard degree into action. I am now working for FSG, a nonprofit strategy consulting firm, in San Francisco as an evaluation consultant.

I've been learning every day how my public health training translates into skills and expertise as a strategy consultant, and I'm sure it will take a long time to figure out how (if at all) those two totally align. But what I love about my job right now is getting to integrate my data and analytical savvy with advice for decision-makers in real-time, which is a very cool opportunity.

In addition to my day-to-day activities (mostly related to data collection and analysis), I am learning about a whole new sector: funders! I am living and breathing philanthropy in a way that I never would have expected two years ago.

So what does this mean for Veritas Health? Even though I have put off writing in this blog for the past few months, I believe there is an important role that this blog could play in the field. I hope one day this project goes beyond just a place for my friends and family to find out what I've been thinking about, but really provides stories and tips that are useful to others promoting public health!

That means that I am recommitting to writing regularly in Veritas Health. You'll see a new approach to public health issues on the site: one that places considerably greater emphasis on evaluating social sector initiatives. I hope that this will provide a forum for individuals, nonprofits, and funders to be inspired, learn, and make a greater impact in their community.

Happy reading. More to come!

Documentary Film Discussion "The Day My God Died": Child Sex Trafficking in Nepal

In Nepal, a small country in South Asia, hundreds of children are trafficked into work as sexual slaves each year. While nonprofits like Maiti Nepal have emerged to fight, prevent, and assist victims of sex trafficking, political, social, and economic circumstances in and around Nepal have created conditions where child slavery and trafficking persist.

A film that documents the personal, social and human rights abuses of child trafficking, "The Day My God Died" was recently screened at Harvard University (I found the video via the Geo Blog). A panel discussed the film following the screening and was hosted by the Carr Center for Human Rights Policy at the Harvard Kennedy School of Government.



Anuradha Koirala, Founder and Executive Director of Maiti Nepal, was among the panelists.

In attendance were academics, journalists, and anti-trafficking/slavery activists. One of my favorite questions was: "What do you think needs to happen in the Nepal, India and the US to change the social mindset so that...you can not buy another human being, that it will not be tolerated." The question was asked by a woman working to curb the commercial sex trade through reducing demand for commercial sex among men.

Koirala responded without hesitation: "Education. Education. Education. Awareness."

Watch this short video - or find a way to view the film. I'll be looking for an opportunity to see it, as well!

Since 2001 the US government has supported anti-trafficking programs in Nepal. For more information on the U.S. anti-trafficking policy in Asia read this November 2009 USAID Trafficking in Persons report.

Guest Post: A ridiculous burger

As you are probably aware, this is a time of transition for Veritas Health. I just completed my Master's degree from Harvard School of Public Health and am moving back to the San Francisco Bay Area to begin a new phase in my public health career.

Interviewing and packing has been taking up a lot of my time these past few weeks - so I am extremely grateful to Jessica Yen, who serendipitously offered to write a guest post for VH. Jessica is a great friend and public health colleague and I hope that you enjoy her writing and insights as much as I do!
- Katelyn Mack

A Ridiculous Burger
by Jessica Yen

The other day my roommate saw a report that Lotteria, a fast food chain restaurant in Japan, has a new ten-layered hamburger called the “Cheeseburger Tower.”  Ten slices of cheese alternating between ten beef patties, the burger will subtract ten dollars from your wallet and add ten points to your cholesterol level. 

The ad claims that they created the Cheeseburger Tower in response to customer demand, but really now – I’d like to have seen those focus groups!  And although one would hope that such a menu item could not possibly catch on among Japanese consumers, it’s the broader health implications that worry this household of self-professed public health nerds.

Lead Poisoning - A true global health problem

Around the world children are dying from lead poisoning and many more suffering from the neurological and physical health problems associated with lead exposure. In one region of Nigeria, lead poisoning has caused an estimated 163 deaths, mostly among children.

CNN ran a lead story on the tragic developments this week, even though it seems that the problem was first recognized back in January. Lead is a toxin that can cause serious neurological problems and even death in young children, as well as adults. The most commonly cited consequences of lead poisoning in the US are learning disabilities and behavior problems.

I am mostly familiar with the problem of lead poisoning affecting children and families through inadequate housing that contains lead-based paint. However, in the Zamfara State of Nigeria, the region where these recent lead-related deaths are concentrated, the source of lead exposure appears to be the minerals brought home by workers from the mines.

Gates Pledges $1.5b for Maternal & Child Health

The Bill & Melinda Gates Foundation has pledged $1.5 billion over 5 years to improve systems that will reduce maternal and newborn deaths and illness in the developing world. The announcement came yesterday during the Women Deliver conference.

I heard the story first on NPR  - you can access their brief interview with Melinda Gates here. But this story peppers papers from the Wall Street Journal to USA Today and has now made headlines on Politico and the Kaiser Family Foundation websites. Melinda Gates wrote her own article, 'A New Vision for the Health of Women & Children' in the Huffington Post.

The Gates Foundation sees this clearly as an area that requires public-private partnerships. In other words, they recognize that in the case of maternal & child health private organizations and nonprofits cannot have meaningful, sustainable change without the support of local and national governments.

Improving consistent access to contraceptives to prevent unwanted pregnancy clearly appears to be a major focus of the Foundation's efforts.

This investment is great news for the field of maternal and child health -- and will hopefully raise these issues to greater prominence both here in the US and abroad. In addition to raising awareness, effective use of $1.5 billion ought to have considerable impact on the health of women and children - and I hope to see and read about these improvements.

Task Force Releases Report on Childhood Obesity

To rollback childhood obesity in one generation.

Ambitious goal - to get the prevalence of childhood obesity down to 5% by 2030. No society has ever succeeded in undertaking such an enormous task - one that is complicated by deeply ingrained norms around diet and exercise, a well-financed commercial industry (not only fast/junk food, but also when it comes to diet and weight loss), and a general distrust of government-led initiatives.

The White House Task Force on Childhood Obesity released its report (commissioned by President Obama on February 9, 2010) and it combines the best evidence for tackling weight gain among our nation's kids.

It quickly lays out the facts: our children are fatter than ever and it is impacting their health.

Updating Nutrition Labels

It was only 20 years ago that we began seeing uniform nutrition labels on processed food products telling us how many calories, how much fat and sugar, and what nutrients are in the food we eat.

But many health groups believe it's time to update nutrition labels. I agree that it's time to give consumers information in a way that is useful and helps people make healthy choices. In this week's Time, the Center for Science in the Public Interest suggested a few updates for the Nutrition Facts label.

One suggestion was to make "unhealthy" content like sugar and fat stand out using different colored text. I think that this could be misleading, given that not all fat is bad for you and it could lead to making less healthy choices. However, I love the idea of having the calorie count (per serving and per package) displayed clearly on the packaging. This is particularly important for beverages and "snack" foods -- like those $.99 chips or peanuts that are usually 2.5-3 servings and many more calories that people probably realize!

I would make it easier to read nutrition labels by changing words such as "sodium" to "salt". Hopefully innovators will see this as an opportunity to create a change in a space that will affect millions of peoples' food choices over the next few decades and will get involved.

How would you change the nutrition label?

Remember the Food Pyramid?

Every five years the US federal government reviews the Dietary Guidelines for Americans. Remember the days of the "Food Pyramid" and then the recent 2005 edition of the "My Pyramid"? Well, if you missed my past post on the topic you should see the Harvard School of Public Health rendition - the Healthy Eating Pyramid - which has a much simpler and scientific food guide for health!

Marion Nestle noted author and public health professor said in a blog post in the Daily Green today that the new recommendations acknowledge

"The need to change the food environment to help individuals meet the Dietary Guidelines."

This is a huge step in the right direction. No longer are our food addictions being looked at simply from the perspective on the individual, but as rooted firmly in the policies and norms of the communities we live in. Our environment impacts our choices, and our food choices affect our health.

There will be an opportunity for public comment on the new guidelines early this summer.

Allentown High School Student Wins Top Public Health Honors!

Two girls from *near* my hometown in Pennsylvania won top honors from the Robert Wood Johnson Foundation in the YES Competition for high school students.

According to the news release,

"Shoshanna Goldin, a 17-year-old student at Moravian Academy in Bethlehem, Pennsylvania, won for her research project entitled, Energy Epidemic: Teen Perception and Consumption of Energy Drinks."

Not only is she interested in public health, but also the epidemic of obesity. Overconsumption of energy (i.e. calories) is what leads to obesity, right?!

Way to go Shoshanna!

Caution: Camel Orbs are NOT Kid Friendly

Photo from the HSPH website

Candy or tobacco? Do you think your child could tell the difference?

Harvard School of Public Health professor, Gregory Connolly, recently published an article in Pediatrics on the dangers of this Camel Orbs, a dissolvable nicotine tablet, widely available in the US.

(Click here for the news release)

Note: I looked up the Colbert Report segment that references Camel Orbs and embedded it below. I think Stephen Colbert is hilarious. Thanks, Kelsey for your comments!

 

The Colbert Report	Mon - Thurs 11:30pm / 10:30c
Cheating Death - Tobacco Mints, Breast Milk & Hallucinogens
www.colbertnation.com
Colbert Report Full Episodes Political Humor Fox News

Breastfeeding Saves Money, Saves Lives

Most parents enter labor expecting to breastfeed. Many are confronted with numerous challenges (some from the start, others as they go back to work) to continue breastfeeding throughout infancy.

A CNN news report highlights the challenges and public health importance of promoting and supporting new mothers in breastfeeding their baby throughout the first 6 months of their child's life.

This challenge makes me wonder how much of the problem is one of

• Biology - Moms physically aren't able to breastfeed their kids.
• Education - Moms don't know to breastfeed - exclusively - until their child reaches 6 months.
• Awareness - Moms don't know about the benefits/risk of breastfeeding - or not - on their child's health.
• Social - Relationships (partners, family members) and social norms interfere with moms' decision or ability to breastfeed.
• Structural/Political - Policies and structural factors like break time at work inhibit moms from being able to breastfeed or pump throughout the day.

As a quick aside: the new health care reform law makes it mandatory for employers to provide breaks to female workers who are lactating (i.e. breastfeeding). I expect that will begin to address some of the structural barriers mentioned above!

World Health Day 2010

Today, April 7, 2010 marks World Health Day.

I've been thinking a lot about my own health habits. It's easy to get complacent when it comes to our health. We expect that our bodies will just keep on functioning like they always have. Usually reality hits us when it's too late.

It's Public Health Week!

This week is National Public Health Week 2010 - and there are many ways you can get involved to promote a Healthier America. You can view a video and get tips on how your individual actions and easy changes can have a HUGE impact on our nation's health! To find out more visit: http://generationpublichealth.org.

Here are some of my favorite tips:

• Go for a run! (or bike ride)
• Get proper sleep and find time to relax.
• Wear a seat belt every time you ride in a car!
• Buy locally grown produce (almost available here in New England...)
• Recycle
• Advocate for policies and programs (health, transportation, agricultural or other) that will improve the health of your community!

Veritas Health: Back from Hiatus?

Life has never been busier. With school work, classes, legislative events, teaching, and flying around the country Veritas Health has gotten short shrift. Sorry to all my readers! And this has come at a terrible time -- Health care reform has passed, been signed into law, been revised, and signed again! The School Nutrition Act in Massachusetts has been passed by the Senate and will likely make its way to the Governor's Office for a signature this year. And the Child Nutrition Reauthorization Act (...the one that sets prices for school breakfast and lunch reimbursement and sets school food standards) is back on the table in Congress with the introduction of the Healthy Hunger-Free Kids Act of 2010.

Top Picks in 2010 Health Care Reform: Bill Passed!

I can't believe we've passed national, comprehensive health care reform! A first for public health. With all that I learned from the esteemed Bob Blendon in Political Strategies, I knew it would be a long shot. Presidential diplomacy likely played a strong hand in back deal negotiations, as well as the organizing and activity of pro-reform groups in putting pressure on key (read: moderate) legislators!

Here's what pumps me up about national health care reform:

1. Millions of uninsured (an estimated 32 million, to be exact) will now be covered! This means greater continuity of care and hopefully less late, untreatable conditions get prevented and treated early!
2. National menu labeling for chain restaurants! Calorie counts will be visible at point-of-purchase for most chain restaurant menu items across the United States (and the National Restaurant Association sings its praises in the Wall Street Journal blog...miracles do happen!).

There are tons of hurdles yet to be overcome when it comes to implementation and the elephant in the room is cost controls on skyrocketing premiums. I've heard it said that legislators want to "Tackle coverage first, then deal with cost." Whether that approach helps or hurts the health of Americans will be closely monitored, I'm certain!

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From Cigarettes to Snus: Tobacco Advertising Returns!

I had read about the tobacco industries attempts to shift its marketing from cigarettes to a "spitless" tobacco (or what it is calling Snus), but it didn't really sink in until I was reading Entertainment Weekly.

Sitting on the T on my way up to Cambridge I saw this ad. My first thought while reading it was "That's interesting...Camel is promoting quitting smoking?" It's fascinating how quickly I recognized it as a smoking ad...