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!

Smoking Outside, A Public Health Threat?

The New York Times has been impressing me recently with its coverage of public health issues. Sure, health care reform makes that coverage pretty much a no-brainer, but today's front page article on the proposal to ban smoking outdoors in New York City definitely peaked my interest. It is part of the "Take Care New York Plan 2012" and includes other public health proposals in addition to banning smoking in public parks and beaches.

New York City has long been an early adopter of public health initiatives, such as eliminating trans-fat from prepared foods, improving menu labeling in fast food chains to include calorie counts, and banning smoking from nearly all indoor spaces.

The proposal, launched by the NYC health commissioner, Dr. Thomas A. Farley, to ban smoking from public, outdoor spaces is not without precendence, as the article points out:

"A number of municipalities — particularly in California — have banned smoking at outdoor parks, playgrounds and beaches. In 2007, Los Angeles extended its smoking ban, which already covered beaches and playgrounds, to include municipal parks. Later that year, Chicago banned smoking at its beaches and playgrounds, though smoking is still allowed in many parks."

Nonetheless, there is much controversy over the need for such a ban. What are its objectives?

Support Healthier School Lunches TODAY!

Slow Food USA is sponsoring a National Day of Action (today, September 7, 2009) which includes hundreds of "eat-ins" (a.k.a. pot lucks) all across the country. You can log in to their website to sign a petition to improve school lunches, spread the word, or attend an eat-in.

I heard about this too late to attend an eat-in; if I hear of more in the future I will try to get the word out sooner! Labor day was full of activity (including a health care reform rally in the Boston Commons) and you can't be all places at once.

Keep an eye out for the Child Nutrition Act, which has to do with the National School Lunch program and will be up for "reauthorization" at the end of the month. Civil Eats had a recent blog post on the topic which really drives home the urgency and timeliness of this issue!

Outrage Over Afghan Law

A law pending in Afghanistan appears to limit women's rights by actually legalizing marital rape and leaving the house without a male's permission was illegal. The wording is what struck me most, that it is the right of the man to have sex with his wife every fourth night (shown on CNN tonight). The idea of sexual and reproductive rights is one that warrants strong consideration. For example, the 1995 Beijing Conference (cited here) produced a Platform for Action stating

[t]the human rights of women include their right to have control over and decide freely and responsibly on matters related to their sexuality, including sexual and reproductive health, free of coercion, discrimination, and violence.

International human rights language makes clear that a woman has the right to decide when and how to use her body, not a man and not a relative. Furthermore,  it acknowledges "shared responsibility for sexual behaviors and its consequences." 

The Afghan law makes explicit that the desire of a husband to have sex trumps the rights of a wife to not want to have sex, this has enormous implications for legitimizing trauma and sexual violence (yes -- rape does happen within marriage -- no always means no), as well as has long term implications for family planning.

This case illustrates the enormous variability in conceptualization of sexual and reproductive rights and decision-making in different contexts. An essay on intimate partner violence (IPV) from the Peaceful Families Project highlights that in Muslim culture 'marital rape' is considered a contradiction in terms.  And while this Afghan law aims to politically legitimize the practice, it is important to note that many women and girls experience sexual violence and will continue to regardless of this legislation. It will take a social movement to eliminate these horrid practices. Much like the women's movement in the US served to overturn laws in US states that  exempted spousal rape as a crime until the 1970s.

More must be done to empower girls and to oppose those who impose barriers. Obama and other international actors have spoken out against this legislation that comes with the signature of our Afghan ally (he signed it at the end of last month). The result of this international pressure is yet to be decided.