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.

Soda Causes Cancer, Could it be?

A study done in Singapore has found that drinking 2 or more sodas per week is associated with nearly twice the risk of pancreatic cancer than staying soda free. The study was published this month in the journal Cancer Epidemiology, Biomarkers, & Prevention and reported on WebMD.

It's no surprise that the beverage industry is doing all it can to discredit the study; however, the methods used seem surprisingly sound. In fact, while the American Beverage Association claims that other studies have shown no association between soda and pancreatic cancer, a 2005 study out of Harvard School of Public Health found that soda (i.e. sugar sweetened beverage) consumption was associated with increased risk of pancreatic cancer in women, particularly those who were overweight.

Teenage Pregnancy: A Cool Website

This semester I started working with a group of Harvard School of Public Health (HSPH) students on a student-run social media campaign. After some collaboration with the Center for Health Communication at HSPH we decided to pursue an online campaign that targets pregnant teenagers in the Boston area.

Why? Because teens who become pregnant are less likely to have a healthy pregnancy and less likely to see a doctor for prenatal care. Everything from diet, activity, stress, and support are critical to having a healthy pregnancy. A healthy pregnancy leads to a healthy birth, a health birth leads to a healthy infant, and a healthy infant leads to a healthy child. You get the idea...

Harvard Vaccination Guru Speaks Swine

Still confused about whether the swine flu vaccine is safe?

Don't know whether you should be vaccinated?

Here's an interview published in today's Boston Globe with Dr. Marie McCormick, professor of maternal and child health at the Harvard School of Public Health and the lead advisor on an expert committee that reviewed data related to the safety of the swine flu vaccine.

In response to whether she will get vaccinated, McCormick said, "When it becomes available, I will certainly have it. I do see patients in the fall, and all my patients are younger than 3, so it’s really both for their protection and mine."

Series on Sex Trafficking in Central America

Many of you know that most of my latest research has been in the area of victimization and sexual health of victims of sex trafficking across the globe. I have the privilege of working with brilliant team of researchers at the Harvard School of Public Health that have started this work in Indian (Mumbai) and have expanded to include projects in Southeast Asia and now, Latin America.

On Sunday I leave for a 3.5 week trip to Central America to meet with several non-governmental and government organizations that are providing counseling services, medical care, or housing to victims of sex trafficking or trying to prevent this awful practice through social marketing campaigns or policymaking.

The majority of my time will be spent in Managua, Nicaragua. Arguably the poorest country in Central America and a source country for many trafficking victims. Then I will travel to San Jose, Costa Rica. I expect there to be quite a contrast in terms of resources, services, and trafficking awareness in the two countries.

I will be returning June 30th.

Stay tuned for my posts from the field. I will try and update you as to my whereabouts and observations as I travel. (Subscribe to the RSS feed or become a 'follower' to get my latest posts).

Is "Three Glasses of Milk a Day" Too Much?

Is your physician (or your spouse) pushing you to have three servings of dairy a day? Is that wisdom (based primarily on nutrition guidelines in the US stating that we need upwards of 1000 mg of calcium daily), though well-intentioned, misguided?

A recent lecture Dr. Walter Willett of the Harvard School of Public Health addressed this debate head-on. He cited much scientific evidence (some strong and some weak) and concluded that 3 servings of dairy, particularly milk does not only not seem to benefit adults, but may actually be harmful in excess. Similarly, while milk likely leads to bone growth it does not prevent against fractures the way that it once was anticipated to.

The take-away message: consume dairy in moderation (1.5 servings a day is fine) and make sure I am getting enough Vitamin D in my diet and through outdoor activity.

For more information see my post at Society and Health.

Humanitarian Action Summit: Part II

It has been fascinating to see how this tight-knit group of humanitarian aid workers (about 200 in all) interact and to see what are the primary topics of interest. The humanitarian professionals participating in the Summit are field workers and managers, leaders of huge United Nations operations and field workers from small NGOs. 

Some of the main themes and issues that I took away from the meeting yesterday were:

1. The challenge of neutrality

For example, in many countries where conflict is taking place and humanitarian aid (HA) workers are needed there is a balance and a neutrality that must be maintained in order to allow the HA organization to stay there. This can sometimes mean collecting minimal data on the population, their experiences, etc. 

2. The politics of data use

By remaining neutral, publishing and releasing information to the global media that might taint the image of either governmental leaders or their allies might be reason to expel hard-working HA NGOs from the country. This can mean a choice between using data for advocacy purposes (e.g., to provide the world with information about rape and gender-based violence being used by national police and security forces) versus remaining silent and using that information solely to improve programmatic efforts on the ground.

3. Human resources gap

As in most health professions there is a large unmet need for HA health professionals ranging from surgeons to community health workers. As a result there was a large discussion of how to move tasks from higher to lower skilled health workers and what those implications would be for changing compensation patterns. For example, if nurses are given diagnostic or prescriptive privileges how might that increase their workload and require increased pay?

Overall, this Summit brings together a community with common goals and a diversity of perspectives. Their aim is to improve and protect the health and lives of populations that are victims of humanitarian emergencies and post-conflict situations. 

Reviewing changes since last year's Summit showed that progress in HA has clearly been made. However, as humanitarian emergencies increase in light of climate change and changing ecosocial conditions globally the HA responses will also need to evolve. For example, as land and water runs dry and populations are forced to leave their agriculturally-based labors for economic alternatives what impact might this have on conflict escalation? There is evidence that we are already seeing these impacts develop.

What questions or interests do you have in humanitarian assistance and aid? 

Humanitarian Action Summit: Part I

Yesterday, the Harvard Humanitarian Initiative kicked off the 3rd Humanitarian Action Summit in Cambridge, MA. The Summit brings together International NGOs and United Nations Organizations as well as others involved with humanitarian assistance, specifically related to humanitarian health.

Today the 7 working groups are conducting panel discussion. The three I attend will be

• Civilian Protection in Conflict
• Human Resources for Humanitarian Health
• Humanitarian Health Information Management

I am assisting the Information Management Working Group as a co-Rappatour. Working groups will be publishing their proceedings in the journal Prehospital and Disaster Medicine.

This is a great opportunity to get a big picture view of humanitarian assistance (HA) activities. What has struck me is that HA is more than just emergency relief in acute crises. These situations are incredibly complex and require a great deal of coordination and multiple skills.

Check back soon for more updates from the Summit!

Sex Trafficking: An Introduction

Human trafficking is an absolute evil. It destroys families, inflicts unimaginable pain and suffering on its victims, and is a practice that needs to be prevented. Sex trafficking is particularly malicious as it primarily coerces young girls -- as young as 4 -- into a world that they could never imagine. In this world, these children's bodies are no longer under their own control -- it is abused, misused, mutilated. The physical and emotional toll of sex work can weaken even the greatest of spirits. 

Several articles by Nicholas Kristof and Josh Ruxin have really opened my eyes to the challenges, controversies, and monstrous tactics used to subdue and control girls who have been trafficked for sex work. Ruxin, a public health professional and aid worker who has been living in Rwanda for the past few years, writes in Kristof's blog pretty regularly -- his latest piece, "Asia is Not Alone: Sex Tourism in Mombasa" is an honest account of Ruxin's return to Mombasa, Kenya, and his shock at the extent of sex work and child prostitution in the city. 

Kristof, an Op-Ed contributor to the New York Times, recently reported on his trip to brothels in Cambodia and the horrors he saw inflicted in a young, rebellious, child sex worker named Long Pross. The article titled, "If This Isn't Slavery, What Is?" is a brilliant, heart-wrenching piece. Thankfully, there are places like the Somaly Mam Foundation in Cambodia that help to fight sexual slavery, and others like it in centers of trafficking around the world. In addition to providing treatment, recovery, and alternative work opportunities for girls trafficked into sex work -- a great challenge in itself -- there is an enormous need to prevent this practice in the first place. 

International Justice Mission is an organization committed to bringing justice in circumstances of slavery and human trafficking in countries with incredibly dysfunctional judicial and policing systems. The New Yorker published an article on the work of IJM's founder, Gary Haugen,  onJanuary 19, 2009, titled "The Enforcer: A Christian Lawyer's Global Crusade". I see the work of IJM as providing rescue to those currently enslaved world-wide as well as creating a message of caution for those who would seek to control and destroy the lives of others. Perhaps this will help prevent future abuse in these communities.

But there is more that can and must be done: 

• to identify the roots of trafficking -- the social and historical conditions, cultural and familial values, and a lack of awareness of trafficking tactics
• to breakdown the pathways through which trafficking comes to be -- the lack of political will, the absence of strong justice systems
• To recognize of the problem of demand -- that sex trafficking is driven by issues of male sexuality, gender supremacy, power, and control. 

The US has committed millions of dollars over the past 10 years to combat human trafficking.  In December, 2008 the US reauthorized the "Trafficking Victims Protection Reauthorization Act, HR7311. Additionally, advocacy efforts to implore President Obama to make anti-trafficking efforts in the US a priority are under way (you can sign and electronically send a letter to President Obama here at the IJM website). The number of sex workers in the US is unknown, government sources estimated it to be around 15,000 in 2004 according to a 2007 WashingtonPost.com article on the issue.

There are so many other resources on sex trafficking available online through any Google search. However, more research is needed, especially as the practice grows and expands to new regions. I am privileged to be a part of some trafficking work that is going on at Harvard School of Public Health. We hope to better understand the conditions from which these girls are trafficked, how they enter sex work, their living and work conditions, and how these impact their health and well-being. This work aims to inform service providers and other organizations who are working to prevent sexual slavery worldwide. Here is an example of some of the work our research team is doing.

Much more on this topic to come!

Mobile Phones for Health Surveillance

An article in the Yale Journal of Public Health recently reported on the use of mobile technology to improve public health surveillance activities. Advances in technology are not always quick to be adopted in public health, though the computer and Internet have exponentially increased the efficiency and productivity of information management and risk communication. How else could one so quickly be informed about a SARS outbreak or the current state of Avian flu?

My husband, after returning from a 2-week trip to Kenya, told me stories about the widespread use of mobile phones, even in the most rural and poor regions of the country. He noted that he never saw them actually talking on the phone, it was a device used for text messaging. "Minutes" are just too expensive.

Given the penetration of mobile technology - how might cell phones be used solve pressing public health issues? This article describes two CDC activities; one aimed at using PDAs to collect surveillance information for its "Household Morbidity Surveillance Survey" in Kibera, the other is to use text messaging to improve inter-governmental communication about disease outbreaks. 

There is certainly an irony on the use of PDAs to collect information from some of the poorest people in the world. However, if it is able to collect better data, more quickly, and to improve the delivery of health services and prevention information I am in full support! 

How else might mobile phones be used to collect or communicate health information?

If interested, check out the following websites

• Texting4Health - A conference held at Stanford University, February 2008
• MobileActive.org - Blogs, information, and a directory for activists using mobile technology worldwide

AIDS Sutra: Untold Stories from India

When you see the word AIDS what comes to mind?

Africa? Disease? Death?

Sex? Drugs? Prostitution?

Mothers? Orphans?

Treatment?

We know so much more today about the etiology of HIV/AIDS than when the epidemic began in the early 1980s. In some parts of the world, the stigma of having AIDS or being HIV positive has begun to weaken. We now have effective (albeit expensive and complex) treatment for the disease, more people are more aware of how the disease is spread, and today we know that if certain conditions are met women who are HIV+ can even give birth to babies unaffected by HIV/AIDS. In this day, in this place, one need not equate AIDS with death.

In India 2.5-3 million people are infected with HIV/AIDS. India has the 3rd largest number of HIV+ people in the world, behind sub-Saharan Africa, and the spread of HIV among women is increasing. (click here for more facts -- published 2006)

In many other countries, however, there is still great denial about just how widespread are the effects of AIDS. The Bill & Melinda Gates Foundation's Avahan India AIDS Initiative just released a book entitled "AIDS Sutra: Untold Stories from India". It is a collection of essays that brilliantly portrays the lives of people dealing with AIDS and facing its stigma in India. The stories uncover the brutallity and fear that come with social margnizalization, violation of privacy, and discrimination. 

Two authors, Nikita Lalwani and Sonia Faleiro, and an editor from Avahan visited the Harvard School of Public Health today to discuss the book. It was a fantastic event, with about 30 people in attendance. The stories told by the authors were heart wrenching.

Many Harvard affiliates, such as Jay Silverman and Felton Earls, are committed to preventing the spread of HIV/AIDS as well as serving populations who already have the disease. Though, I want to note that the work of my colleagues really seeks to inform the broader picture of how poverty, gender relations, family violence, and sex trafficking perpetuate the spread of HIV/AIDS beyond what service provision in "high risk" communities can provide. It is fascinating work and its implications are great, as the stories "AIDS Sutra" tell. Not only will understanding AIDS in India help those who are currently suffering, but it will provide a basis for future prevention efforts and cultural change that can halt the epidemic, save lives, and restore hope.

Happiness & Health

What makes you happy? 

What betters your quality of life?

What leads to a long life?

These three questions can be answered by one simple word. Not a gene nor a new-and-improved medical intervention can guarantee happiness or a long life. It is not how much money you earn (or save) or even where you live. Increasingly, evidence is showing that relationships make a difference in how happy and healthy people are.

Two people who I have the utmost respect for recently asked these questions and both came to the same conclusion; that our social relationships (i.e., how we connect with others) matters for our emotional, psychological, and physical well-being. Our social ties -- friends, family members, coworkers -- have an incredible influence on our happiness and health. A few weeks ago in class, Ichiro Kawachi provided numerous examples of emotional and material support provided by friends and family during times of difficulty and how this can improve health outcomes and positive health behaviors. 

Then this past weekend I was listening to a podcast by John Ortberg who was talking about what makes human life flourish (i.e., people be joyful). He said we experience genuine caring it is like "the roots of your soul are getting fed, and that's coming up into your being and making you strong. Every life has to have that connectedness." He gave many examples of how our relationships, specifically, taking risks and being vulnerable in relationship is critical to fostering joy in our life. And if life is full of joy, despair and anxiety are less likely to take their toll on health. 

If you are more interested in the idea of social relationships, happiness, and health check out these resources:

• Social Capital and Health by Ichiro Kawachi, SV Subramanian, and Daniel Kim
• EveryLife Needs a Cheering Section sermon by John Orberg, MPPC
• Bowling Alone: The collapse and revival of American community by Robert Putnam