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.

Fav Five Public Health Headlines

From Haiti to Brooklyn, this week's Fav Five highlights promising strategies to improve kids' health, the  fate of national health care reform, and the public health and medical response to the Haiti disaster.

Altering Our Salt Obsession: A New York City Initiative

Salt is a hot topic in health right now. For more than a decade Americans have been consuming nearly twice the recommended amount of salt in their foods, mostly due to eating out more and the increased consumption of heavily processed, heavily salted foods.

Nutritionists and doctors have been concerned about individuals' excess consumption of salt (or sodium), particularly among those with high blood pressure. The US Department of Health and Human Services recommends a maximum of 2,300 mg of sodium/day (only about 1 tsp of salt), and even less for those with high-blood pressure. But many Americans consume closer to 3 tsp of salt each day.

Eating too much salt has been shown to raise blood pressure and increase a person's risk of suffering from heart disease or stroke. That's why if you or someone you know has been diagnosed with high blood pressure, your doctor has likely advised you to cut back on your salt intake and switch to low- or no-sodium products so that you can add your own salt to taste.

This week public health professionals and politicians stirred interest in salt -- particularly the abundant use of salt and salt-laden products by restaurants, especially fast food restaurants. The New York Times reported on January 11 of Mayor Bloomberg's plan to support the reduction of salt in packaged and restaurant foods by 25% over the next 5 years.

Have American Waistlines Stopped Growing?

Pam Belluck of the New York Times reported today that obesity rates have been seen to stabilize (for some groups like blacks and whites, but not Mexican-Americans) over the past 5 years. I've heard this data in several classes, and it does appear to be true. But this shouldn't be taken to mean that obesity rates are declining -- they certainly are not.

What puzzles me and other obesity researchers is: Why?

Smart Choices Labeling System Divided, Fails?

The "Smart Choices" label, which was meant to be a guide for consumers to make healthier food choices when shopping the supermarket, may be lying on its deathbed, according to a recent article in the New York Times. A few of the major food industry supporters, including PepsiCo and Kellogg's have cut its ties with the program and will phase out production of products (like Froot Loops cereal) with the Smart Choices logo prominent on the box front. Although, Kraft indicates it has no intentions to remove the logo from its foods.

Battleground School Food

It may be a fluke or it may be fortune that the New York Times has taken up the "cause" of school food and nutrition in the last week or so. First there was the article profiling the cafeteria at a popular New York City public school in Queens. Then, Saturday, they ran an article on the ban of sugary foods from public schools in New York City even for celebrations (think kids' birthdays) and bake sales or fundraising activities. Actually, the 'bake sale ban' is not something new, it was issued in June but is just beginning to be implemented.

After my Public Health in the Media class last year (take it if you get the chance...I'll be the TA!) I am sure that it is not a mere coincidence that school nutrition has landed in the newspaper several times in the past month. I think the reason that the New York Times is talking about school nutrition policy is because people are starting to care about it! People want someone to do something about childhood obesity and schools are a natural starting place.

But it is important to ask: Does the ban on sugary snacks and treats in schools go too far?

School Nutrition Policies, MA on my mind

As I mentioned on Twitter this morning, french fries appear to be the lunch food of choice for students in a popular school in Queens, New York, according to the New York Times. That probably doesn't surprise anyone who works in a school or has visited one during lunch. Unfortunately, I have not.

Nonetheless, my memories of school lunch are not much different. I remember tater tots and pepperoni hot pockets being standard fare. By the time I graduated, there was a salad bar in place; it was not very popular. Occasionally, I opted for the food served as part of the National School Lunch Program (spaghetti comes to mind) and on days of cross-country meets I habitually ate a peanut butter and jelly sandwich, which was a pretty good choice thinking back on it.

News Flash

The intersection between the environment and public's health has made recent headlines in the New York Times. I wonder if it is any surprise that conditions related to CAFOs (concentrated animal feeding operations) are implicated in at least one of the public health disasters. Here two of the most interesting (and disturbing) stories I read recently:

• Health Ills Abound as Runoff Fouls Wells - The New York Times reported today that excess cattle manure is contaminating local water systems. The pollution is resulting in a wide-range of health problems including diarrhea, ear infections, and skin rashes. The problem appears to be in the enforcement of laws already on the books. Local communities need more safety mechanisms in place to identify and prevent possible sources of water contamination and to act quickly once a problem is identified.



• Clean Water Laws Are Neglected, at a Cost in Suffering - A Sunday special in the New York Times investigates the problem of contaminated drinking water, beginning with a community in coal country West Virginia. Though legislation is in place (the Clean Water Act and the Safe Drinking Water Act) both are systematically violated resulting in dental caries, skin rashes, and likely far greater medical conditions. Again, regulators are overwhelmed, but urgent action and redress is needed.
  
  
  

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?

Missing the Health in Health Care Reform

Michael Pollan was preaching to the choir today in his New York Times op-ed piece on "Big Food Vs. Big Insurance." His words were music to my ears:

"...the fact that the United States spends twice as much per person as most European countries on health care can be substantially explained...by our being fatter. ...

That's why our success in bringing health care costs under control ultimately depends on whether Washington can summon the political will to take on and reform a second, even more powerful industry: the food industry."

As excited as I was to hear Obama's rallying cry on health care reform last night, I was disappointed to hear prevention offered as a critical element of reform only one, maybe two, times.  Prevention isn't a sexy or politically inspiring topic, I know. Yet, public health is all about prevention. Public health is about "creating the conditions in which people can be healthy."

The food industry has significantly changed the way Americans (and populations globally) eat. Few countries have been spared. Those that refuse to let huge US-based multinational food manufacturers in, or that limit their reach, have often met much resistance and criticism. Yet, as Barbara Kingsolver would say, these resistant countries are protecting their food culture. They are also consequently protecting their health.

In an effort to get the cheapest, most convenient food we have sacrified quality, nutrition, and health. We have kids in America who are both obese AND malnourished. How have we let that happen?

While I am all in support of health care reform moving forward, it will in no way be a panacea for America's poor health. There are enough players out there who want to profit from sickness, not just the insurance companies. Pollan has brought this to our attention, once again.

Banning Peformance-Enhancing Drugs from the Military?

While today's New York Times article is titled "A Focus on the Effects of Dietary Supplements Among Troops in War Zones," the article actually discusses the use performance-enhancing (PE) supplements meant to build  and maintain muscle mass quickly by our U.S. troops.  At first glance I thought the article might talk about Vitamin D or Calcium intake; a poor editorial title choice if you ask me.

These PE supplements have been clearly linked to heart problems and several deaths, and military health experts are concerned that the conditions of deployment (e.g. hot climate, increased stress, high activity) might create a heightened risk for these serious health outcomes.

While performance-enhancing drugs carry with them health risks (many of which have only recently been acknowledged), they also do increase strength, endurance, and help users fight muscle fatigue. It seems to me that these are desirable outcomes for men and women who will be fighting insurgents and charged with strenuous tasks that require peak performance.

This will be a difficult decision for those in the Secretary of Defense. Surveillance of PE supplement use and associated health outcomes should be integrated into the military health system if they are serious about understanding the scope of the problem. 

What do you think should be done?

"Smart Choices" Is Fool's Gold

The New York Times today ran a story today on the "Smart Choices" food labeling campaign that is being heavily endorsed by the biggest food industry players. The program claims to respond to consumers' need to be able to make quick, convenient choices on "healthier" food products. I mean, who has time to read through ingredient lists and nutrition labels? Well...I do. But, I know most people do not. Nonetheless, despite its good intentions, this food labeling system is inherently flawed.

Actually, this is a public health abomination! Walter Willett (whose name often appears on Veritas Health), is actually quoted in the article as saying "These are horrible choices." Enough said.

It is really no surprise to me that the article was titled "For Your Health, Froot Loops." As I've written before, sugary breakfast cereals seem to be constantly popping up in marketing to parents and kids as a nutritious breakfast food. It's as if food manufacturers fear people will find out that highly refined, processed cereals are not that great for them and switch to something that resembles what one might find at a farm somewhere (fruit, eggs, dairy, etc.).

So why am I so upset by this? It's just a few labels, right? Well, not exactly. This is an example of industry exploiting a true (Veritas) public health need. Consumers, parents especially, need to have a more simple, credible system on which to base their food choices. This, as Willett dually notes, is not a credible system.

It is not as though parents are choosing between donuts and Fruit Loops as Eileen Kennedy of the Friedman School of Nutrition Science and Policy is quoted as saying. Indeed, it will be more likely a consumers' choice between Froot Loops and some other "un-labeled" potentially healthier cereal product. One that possibly is unable, or unwilling to pay the annual $100,000 dues for the label.

As Kennedy notes, those products without the "Smart Choices" label will be perceived as nutritionally inferior, and, even worse, that those with the label are good for you. I believe there is a big difference between what is good for you and what is "better" for you...relative to something that is really "bad" for you. Come on, "Cocoa Puffs" do not provide any of the health benefits of cacao and there is no fruit in Froot Loops.

Other questions I have: What must companies do to get the "Smart Choices" label? And why are there such generous guidelines for what products qualify? Since when and who exactly decided that Coco Puffs and Froot Loops (in addition to many other similar products, I presume) are actually smart choices? This statement in the article is telling...

Ten companies have signed up for the Smart Choices program so far, including Kellogg’s, Kraft Foods, ConAgra Foods, Unilever, General Mills, PepsiCo and Tyson Foods. Companies that participate pay up to $100,000 a year to the program, with the fee based on total sales of its products that bear the seal.

Recently, I read that if it requires a label it probably isn't that good for you. Here's to simple criteria. In general, stick to foods that don't require a label to tell you that it is a smart choice.

Health Reform Update: Congress Resumes

What has happened to health reform? 

If you are like me, you are wondering if this "deep sigh" of health reform silence will turn into a coma or a comeback. Will health reform get its much needed second-wind? The New York Times today reported that President Obama hopes to create momentum in Congress for health care reform as senators and representatives return from their roller-coaster of an August recess. Obama will be focusing his speech on bipartisan points of agreement (though it may be up for debate whether any really exist). Here are a few that the article notes:

• Regulation of health insurance companies to eliminate denials in coverage based on medical history or current condition.
• Creation of federal subsidies to make insurance affordable to financially vulnerable, low-income populations.

...Did anyone else notice that this is a fairly short list?

It's no surprise that the Times reporters began comparing this speech to the one given by Bill Clinton 16 years ago. 

On a much brighter note I get to follow this story as it develops over the next few months -- mandated Times reading courtesy of my reporting on politics and policies class. Boy, am I excited!!

Respect for Others: A Universal Principle

The gender-neutrality of the need for respect is articulated beautifully in an article by Perri Klass in the Health Section of yesterday's New York Times. Respect is not just an issue for men -- the oft acknowledged perpetrators of violence -- but also for women. Respect is not just meant to be towards the elderly, it is to be targeted toward peers and parents.

Learning how to genuinely respect others is a lesson that can be applied in so many spheres of life, from riding the bus to marriage. Is respect a rare commodity these days? How far have we strayed from the "Yes, Sir" and "Yes, Mam" days -- and what does it take to instill those values in our children? How do we progress toward a more empowering understanding of both men and women -- so as to not always paint men as the aggressors and women as victims?

What you can do:

Read the NYTimes article. Talk to a young person about respect. Practice respect towards those around you -- whether in your home or on your way home.

Candidates Health Plans: Revisted

The NY Times just ran a series of letters to the editor that critiqued the candidates' so-called "solutions" to our health care woes. Below is one that sums up many of the readers' positions quite well. 

Most letters are written by physicians and lawyers -- I hope that public health professionals continue to be an active voice in the debate. We bring the perspective that access to health care is only a part of the solution -- prevention of poor health and improving peoples' built and social environment is essential to improving our nation's health.

NY Times: Letter to the Editor published November 1, 2008

“The Candidates’ Health Plans” (editorial, Oct. 28) reveals the critical flaw in both candidates’ proposals. Both merely redistribute the cost of health care; neither actually lowers the cost. Their common flaw: continued dependence on insurance companies.

Here’s a better plan: a single national nongovernment not-for-profit health insurance company financed by a payroll tax. By eliminating the profit margin and cost of marketing, we can reduce the cost of health insurance, and thus health care, dramatically.

Glenn Alan Cheney
Hanover, Conn., Oct. 28, 2008