Cigarette Chaos in China

This article was just published in the New York Times this morning, and it illustrates the grim realities that follow a smoking ban as it is attempted in China. Starting on Sunday, all bars, restaurants, hospitals and other public places are mandated to be smoke free inside and out.

Smoking related conditions account for four of the five leading causes of death in China. And, of all of the cigarettes smoked in the world, 1/3 are consumed in China, with both of these statistics according to the World Health Organization.

However, an owner of a cafe in Beijing had only this to say "Our whole restaurant is the smoking section," he said. "Maybe we'll try to ask people to go outside, but in the end, the customer is God."

So, why even make a legislation in the first place? And why had the legislation made great progress in areas like the United States as compared to the speculation around China attempting to install the same practice?

Along with China having the sheer greatest number in its population, there is also as expected the greatest number of smokers. The smoking population in China has reached 300 million at this point. This entire movement was sparked by a treaty that the State Council of China signed with the World Health Organization in 2006, in which they were expected to enact legislation to control the rampant tobacco use within 5 years. However, up until now all campaigns to try and achieve this goal have been overridden by various ill circumstances and excuses. China is already 5 months past this deadline.

The way that this legislation works is that if establishments do not comply with the regulations that take effect tomorrow, then they will be charged 30,000 yuan or $4600. However, the problem with the standing legislation is that restrictions are unclear, and so violations are also unclear. With all of these gray areas, enforcement looks bleak.

Something to consider though is how much smoking is a part of the Chinese culture. In America, the trend had already been dying out a bit before it was mandated in public places. However, in China, this is still a mainstay of business men in their transactions as well as normal people trading cigarettes as gifts because it has been a symbol of class and social settings for a long time. And, education stands to be an issue seeing as according to a survey, only approximately 23% of the adults in China would understand that smoking can lead to cancer and other various illnesses.

It is yet to be determined how individual municipalities will interpret the law, and then how this will be reinforced.

Genital Cutting and its impacts

So in class today we talked about female genital cutting in the context of women's health. This article in the New York Times talks about its impact on young women who have undergone this procedure.

What shocked me about this procedure is the extent to which families would go to have their children receive this "treatment." The article cites numerous cases in which children are flown out of the country; this has been such a problem that laws have been created to prevent this from continuing. I think its also shocking that in many West African villages, the mother's consent is not needed to carry out the procedure. For such a potentially psychologically-harming event to be treated in a cavalier manner, I feel, presents the need to influence cultural perception. This is one of those cases in which public health understands the science, that the treatment is actually not beneficial, but needs to overcome a cultural barrier. That this treatment is already controversial in nations that allow the procedure indicates that cultural norms in around the world are at the very least being challenged.

Another aspect that struck me is the level of psychological trauma many young girls feel regarding this event. Many of them describe it as the worst day of their lives. This trauma could have a severe impact on the future mental health stability of these young women. In addition, these girls could face social stigmatism, especially in the United States, where the cultural norms of other countries may not be understood nor appreciated.

Link Between Women's Poverty and Height Found

There was recently a study published by Harvard that explored the heights of women in developing countries. This was important to their study of the conditions that these women were living in, as height as an adult is often linked to levels of childhood nutrition, poverty, and disease.

As such, it can be used to track the conditions of women in these countries. It found that in 14 African countries, the heights of women have decreased over the past two decades. Additionally, heights have remained the same in 21 countries in both Africa and South America. What this suggested to researchers is that women in these countries were actually worse off and being raised in poorer conditions than their mothers and grandmothers had been.

One Harvard professor involved in the study went as far as saying that the results showed that conditions for women in lower socioeconomic classes are getting worse. This underlies again what we talked about in class regarding the ties between poverty and health. According to the study, these women lacked the economic ability to have proper nutrition at a young age, and as a result of this suffered from lowered height then previous generations. While a little height in and of itself could be seen as benign, the bigger problem is what this says about the health of these women in other areas.

The study covered 54 countries considered "poor to middle class" and looked at the heights of over 365,000 women. Only those between the ages of 25 and 49 were looked at, so that women still growing or women who had started shrinking wouldn't interfere with the data.

One thing that I wish the study had done is examine data from women in countries considered developed as well, so that there would be a basis for saying that women in poor countries deviated strongly from those in other areas. Without this comparison, I don't think that you can cite it as purely an indication of poverty in these countries.

This article was found on the New York Times website

The Importance of Vaccination in Children

The measles, a virus that affects one’s pulmonary system, has long since been eradicated from the Americas. However, recent outbreaks have posed an alarming threat. This article talks about the importance of vaccination in preventing the disease’s comeback.

                The disease was first declared eliminated in the United States in 2000 by the CDC. However, a recent report suggests that measles are on a rise. The primary cause: different strains of the disease are brought into the US from different countries. These cases of “imported measles” tend to target unvaccinated children, in particular. According to the report, the children who had the measles had recently traveled abroad, and none had received their recommended measles, mumps, or rubella vaccinations.

                So what is the cause for these outbreaks? One of the main reasons is a difference in rules and regulations for vaccination between different countries. While one country may require travelling children to be vaccinated starting at age 1, another may not require vaccination and immunization until an age of 4 years. Now, the CDC is recommending that any child over the age of 6 months receive a dose of the MMR (mumps, measles, rubella) vaccine.

                I thought this article was interesting in that it brought up issues mentioned in class, such as the concept of the double burden of disease. As mentioned in the past, with rapid globalization comes some drastic health consequences. One of these consequences includes the spread of disease that was previously thought to be eradicated. This article is a perfect portrayal of the consequences of globalization and the spread of disease, and in this case, it is important for everyone to be vaccinated before traveling to a foreign country so as to prevent the spread of disease.

link: http://thechart.blogs.cnn.com/2011/04/07/kids-traveling-abroad-need-measles-vaccine/

Miracles and Health

When culture and health cross-cut each other, there's often rather treacherous terrain ahead for public health officials. Too often, health officials come in and approach health solely from one end--that being the purely physical side of things. As health treatment methods increasingly learn to adapt to the idea of wellness (complete mental, physical, and spiritual) health, I think the new question is how much credence do we give to each area. This article addresses the role of spiritual prayer in the cure of an infectious disease.

A young boy sustained a minor injury in a basketball game, only to become subject to a bacterial infection caused by "a flesh-eating bacterium called strep A" according to the article. The infection then consumed his flesh at a rapid pace, disfiguring his face. According to medical professionals, the infection was so dire as to be life-threatening and the doctors informed the young boy's family that he might not survive. Shortly thereafter, the family (who was Catholic) brought in a priest to give the boy his last rites and began praying to a Kateri Tekakwitha who according to the article, "was a Mohawk who converted to Catholicism. Her face was scarred by smallpox. Legend has it, when she died, her scars vanished. She was beatified in 1980...". The family and religious officials felt she would be an appropriate person to intercede for the boy due to their shared Native American heritage and similar sufferings.

After news of the boy's illness and prayer intercessions spread through his school and family, others elsewhere took up his cause and began to pray for him. Later, a representative from the Society of Blessed Kateri came to the hospital and gave his family a pendant with Kateri's image on it. Shortly thereafter, the boy began an abrupt and miraculous recovery. After two months, the boy was released and returned home. And now, thanks to the unexplainable alteration in the disease's course, religious officials are investigating the case as a potential miracle.

Reading this, I definitely had my doubts. The article also went on to detail how the Church investigated each individual potential "miracle" and fastidiously rejected nearly 95% of submitted cases and sorted through the rest.

I think the point I took away from this article is how important it is to approach health from all sides--especially when one or another fails. Too often we are uncreative with our approaches or unwilling to try a new method. Prayer, meditation, etc. have all been shown to have effects on issues such as stress, heart rate, etc. Non-traditional medicine such as herbal remedies and acupuncture have also provided new and often reliable treatment avenues. This is not to say though that traditional medicine should be entirely eschewed, but rather perhaps when couple to non-traditional routes we can find better, even more effective cures. If anything, perhaps they will be better-suited to a particular populations' needs and beliefs. Often times too they can be more cost-effective than traditional medicine.

In public health and medicine, perhaps we become a little too jaded after a while as well. Truly, every success against a disease, every prevented death and DALY is a miracle in and of itself. Sometimes we just need to take a step back to see it.

Guidelines Allow Earlier Definition of Alzheimer's

This article discusses the new definition of Alzheimer's recently released which includes an earlier stage of the disease in addition to the other two already in existence. This new stage is necessary because by the time most people today are diagnosed with Alzheimer's, they have been experiencing symptoms for many years and it is too late to treat the disease. The new stage is diagnosed before symptoms start becoming readily visible but changes can be observed withing the brain. Alzheimer's is a disease which very little is still known about and there is not much treatment for it at this time. Another reason for this change in the definition is because of the need for more research on Alzheimer's so effective drugs can be developed. When people today are diagnosed, it is usually too late to do much research about the disease and try to find effective drugs or treatment. The scientists and doctors are hopeful this new definition will allow for better research and subsequent treatments to be discovered.

Alzheimer's disease covers many aspects of global health and is very different than many other mental illnesses. Unlike depression or other mental illnesses, I do not believe that Alzheimer's carries any negative stigma with it whatsoever. Instead, it generates and sympathy because of its long and debilitating nature. This makes it easier in some regards to diagnose patients early. People are going to want to know if they have Alzheimer's as soon as possible so that they can take steps to slow the onset of symptoms. Someone suffering from depression is much less likely to ask the doctor if there is anything that can be done for example. The article talked about the diagnosis of Alzheimer's using biomarkers as a way to predict the onset of Alzheimer's much like is used for heart disease already. The more people researchers can see in the early stages of the disease, the more able they will be to find a treatment.

The search for a cure or effective treatment is very important because the prevalence of Alzheimer's is expected to triple in the next 15 years. With no cure, Alzheimer's could become an even bigger problem than it already is today. It is a helpful step as well that a program has been set up to help fund treatment and research of people diagnosed with Alzheimer's in early stages. This will allow the effort to treat people earlier more effective because many people will likely not want to pay for treatment of a disease that is not affecting them and won't affect them for many years.

It is necessary that the public be educated by doctors about the early signs of Alzheimer's and to not be afraid to ask for tests. The earlier it is detected, the more effective treatment can be. Researchers are expecting to make rapid progress in finding an effective treatment with the cooperation of more patients in the early stages. The funding for this treatment was a great idea and will be very helpful. As more information is discovered about Alzheimer's, this definition will undoubtedly change again. The article talked about how the nature of Alzheimer's is not well understood by the general public but did not answer the question of how doctors and researchers plan to fix this problem so the research can be most effective.

Panic in the Meat Industry?

As I was scrolling through a few of the major online news sources a few days ago, I came across an article on each page about a huge crisis in the meat industry. Here is one example from FoxNews, with the headline exclaiming "Nearly Half of U.S. Meat Tainted With Drug-Resistant Bacteria." The New York Times and CNN.com each published articles with similarly shocking headlines. The information came from a release by the Associated Press after the Translational Genomics Research Institute published a study concerning the contamination.

The researchers announced that 47% of tested meat was found to be contaminated and 52% of the contaminated samples were drug resistant. Clearly, this news is extremely worrisome. My initial reaction to this article was anger. I saw this as another example of a public health category where the US was outspending almost every country on the globe, but not seeing the results. How could we claim to be such a developed country and lag so far behind on the safety of out our meat products? However, upon closer examination, I found several glaring problems with the articles themselves that frightened me even more.

The first problem with the headline published by Fox News is that half of the contaminated samples are drug resistant, not half of all of the samples. How can a "reliable" news source publish a title of a headlined article with such a mathematical error. The difference between "nearly half" and 24% is enormous. How did this error slip past the editors?

Despite this math error, there is another even larger problem that I discovered in the article. The study conducted by these researchers examined only 136 samples of meat. To declare that half of the meat in the US in infected based on this extremely limited sample size seems fairly far fetched to me. There are more than 136 portions of meat consumed in one restaurant in one night, much less the entire country.

I wonder how carefully these news sources inspect releases by the AP before publishing them. It also concerns me how the headline so poorly reflects the actual study being done. Especially on the topics concerning public health, the spread of misinformation can be very costly. The meat industry provides nutrition for much of the country, in addition to creating income and jobs for many people. A simple "math mistake" in this headline could yield very costly health results for these people. In addition, when studies like this create a startling effect, but then are later retracted, the effect of a real scare can be lost on the population when something does need to be done.

How can this misinformation in the media be dealt with? As we have discussed in class, the communication of information in public health is more important than anything else in the field. Misinformation like this can do unimaginable harm for many years to come. What can those in the public health field do now to prevent this nightmare situation from happening in the future? What can we do to limit the damage that has already been done?

Ties Between Suicide Rates and Economy

According to an article found in the New York Times, there is a huge relationship between the number of suicides and the economic trends of a society. The relationship has been tracked since the Great Depression, and shows that in the United States, suicide rates go up the worse the economy is and down the better it is.

Though this trend seems almost common sense to some researchers, what has been mixed are the proposed reasons for it. Some argue that the bad economy causes people to develop depression or mental illness, while others say that the root cause is that the economy pushes already mentally vulnerable people further towards suicide.

Even though this distinction requires a far more elaborate analysis of people's previous and current mental conditions, job description, etc. than is currently available, The American Journal of Public Health published an extensive study to try to track rates among different age groups. It showed that only young to middle-aged adults were affected by the economy in terms of suicide rates, with both children and the elderly being unaffected. 

Also cited in the study were the potential effects that cultural influences could have placed in terms of the transition. For example, the study mentioned that during the sixties, the suicide rates could have been higher because of the increased social tension and unrest, not just the economy.

The article went on the suggest that this sort of research could help doctors treat patients better by taking the economic and cultural conditions into account when screening for mental illness problems. Public health has a role to play here in terms of educating the public, including health workers, about the negative effects that the economy can have on mental health so that there can be increased awareness. Personally, I think that it also has a responsibility to try to influence people to incorporate healthy things such as meditation into their lives, especially in stressful economic ties in light of the relationship that this has to mental health. This can also include eliminating the stigmas surrounding mental health currently in our culture (things like thinking that it's just weakness) so that people feel like it's acceptable to seek our help.

One Well of a Problem

Article

From 2005 to 2009, it has been estimated that oil companies, in well over 13 states in America, have injected millions of gallons of hazardous or carcinogenic chemicals into the wells in the area. These chemicals "used by companies during a drilling process known as hydraulic fracturing, or hydrofracking, which involves the high-pressure injection of a mixture of water, sand and chemical additives into rock formations deep underground," are becoming a public health hazard to the population.

This process of hydrofracking is under investigation by epidemiologist, environmentalists, and policy makers alike. It has been made a concern that the use of these chemicals could potentially find their way out of a well bore, due to events such as above-ground spills, underground failures of well casing, or migration through layers of rock, and into nearby sources of drinking water. Ingredients found in these dumpings were extremely toxic, including benzene and lead. Other harmful fluids that contained at least one toxic or carcinogenic chemical were also found in Colorado, Oklahoma, and Texas in larges volumes.

With the oil shortage occurring in our world today, should oil companies cease to carry out this process? Without it, tapping into large reserves of natural gas in our country will not be possible, thus our economy based upon oil might experience a decline. However, if water is contaminated as a consequence to this action, the endangerment that millions of people will be subjected to can result in serious damages to health. Much of the identified contaminated water has been cycled through waste plants that are not designed to filter out waste containing these such chemicals. The debate still continues in Congress whether or not the hydrofracking has the potential to poison the water supply, and if so, the legislation that needs to be discussed to place regulations on oil companies and the process of hydrofracking.

Sleep Loss (aka College) and Its Effects on Health

There's an interesting article this week in the New York Times that talks about a recent study done to determine how many hours of sleep people actually need to function throughout the week. Since I'm sure some of us are probably not getting 8 hours of sleep each night, I figured this article would apply perfectly to us.

In a study done by David Dinges from the University of Pennslyvania, dozens of people were assigned various hours of sleep for each night (4 hours, 6 hours, and 8 hours) and then tested using the "psychomotor viligance task", which is a fancy term for a test used to measure people's response times. The study showed that those in the 4 hour and 6 hour brackets not only showed lowered scores than those with 8 hours of sleep, they became progressively lower as the week went on. This means that even if you are getting just 6 hours of sleep, your body isn't capable of successfully adapting to this change. Essentially you can't just "get used to it", like so many people would like to think they can do.

The article then compares this study to one done where people were only allowed to sleep for 7 hours. Even after this much sleep, people's reactiveness decreased and decreased even more so over time. The article has a great quote that says, "Americans average 6.9 hours on weeknights, according to the National Sleep Foundation. Which means that, whether we like it or not, we are not thinking as clearly as we could be."

This is why sleep is so important to public health. Not getting the correct amount of sleep affects everything from stress levels and cardiac health to proper decision making and clear thinking. Seeing that so much of public health is about making healthy decisions, there should be a real push to make sure people are getting enough sleep to want to make these decisions. It's pretty easy to visualize. I know that when I'm tired the last thing I want to do is go to the rec center, and the first thing I want to do is eat some Fusz pizza and then take a nap.

If America can begin to shape its culture in a way that encourages a full night's rest every night, the health benefits could be enormous. Yet doing this is clearly not easy task. Can you think of any ways that might get people to just go to bed?

Community Health Workers In the News

Here is an interesting infographic from www.good.is discussing the roles and effects of having well-trained community health workers as part of a health system, particularly in rural or low-income areas. I found two things about this infographic very interesting and neither of them was explicitly stated. First of all, the fact that information about community health workers is being posted on a news outlets is an indication that having community health workers may be gaining the respect and awareness of many people. Secondly, the information for the infographic came from writings released by the Bill and Melinda Gates foundation. After learning in class about how helpful community health workers can be, particularly with maternal and child health, it is encouraging to me to see foundations such as the Bill and Melinda Gates foundation taking a role in helping place community health workers where they are needed. The infographic also listed some simple, but effective tools and medications that community health workers often use to help improve maternal and child health, which is definitely something worth taking a look at.

Success in Zambia

I recently read an article that was an encouragement among many of the depressing stories we read about in the news. This article was a success story having to do with Zambia. According to recent data, Zambia has been able to decrease the incidence of malaria by 66%. This decrease accomplished many of the goals previously set for the country to achieve by 2010. According to this article, the success was largely due to the resource allocation to malaria control programs and the Government’s commitment to fighting the disease.

I think that this article is a great example of what can be accomplished when resources are placed in effective areas and the government is on board for the fight against the disease. I know it is a rare occasion for things to come together this well and have this much success, or at least we do not hear about it too often. I thought it was nice to be able to see what can be accomplished when the pieces fall together properly.

The major interventions used were the distribution of Insecticide Treated Nets and the indoor Residual Spraying. Fortunately, cultural barriers did not inhibit the use of these items as it may in many other countries. Also, there were enough financial resources to make sure these treatments extended to almost all of the population. Again, these blessings assisted the success of the malaria treatment and prevention. However, we must not undermine the contribution of the well-organized team that headed these interventions.

Zambia still has some kinks to work out, such as the potential threat of resistance development because of the continued use of insecticides. However, this story is an inspiration to all interventions worldwide. Change and success are possible, and many lives can be saved.

Immunization vs Vaccination

I wondered whether the words "immunzation" and "vaccination" are interchangeable. In fact, they are not. Immunization refers to any process by which the an individual may develop resistance to a disease (see diagram). Vaccination is one form of immunization. Vaccination refers to the process of exposing individuals to a biological preparation of a weakened or heat-killed disease-causing pathogen in order to induce an adaptive immune response in their bodies, rendering them immune to the disease. There are forms of immunization that do not involve vaccination. If an individual effectively fights off and survives an infection from a pathogen, that person has been"immunized." In the 1700s, milkmaids who caught cowpox developed immunity to small pox without being vaccinated. Vaccinations often take the form of injections but they are also frequently administered orally or through inhalation. ----------------------------------------------------------- sources: www.WHO.int/en and http://wordnet.princeton.edu/ Here is a faccinating article describing vaccine-produced immunity, or vaccination.

Poor Eye Health: A Silent Enemy

A report issued last November indicates that the world is facing an often overlooked opponent: poor eye health. An area that is often neglected by many health policy makers throughout the globe, eye health plays a crucial role in public health.

                Throughout the world, an estimated 285 million people are visually impaired; demographically, about 90% of these people live in developing countries. According to the report, only 3 in 10 people in Africa have access to eye health services, and in many other rural countries, the numbers are even worse. Another demographic study displayed that less than 15% of those suffering from eye conditions received treatment in Nigeria.

What’s more disturbing is the fact that over 80% of this blindness can be easily treated and cured. Over half of the world’s preventable blindness exists in the form of cataracts, a condition that only costs about 60 US dollars to cure. So why isn’t the job getting done? According to the WHO, effective eye health requires a workforce, effective service delivery, adequate funding, and government support and leadership. However, as previously mentioned, government support is often absent. In the continent of Africa where diseases such as HIV, malaria, and tuberculosis are running rampant, it is easy for health policy officials to overlook eye health as an important issue to address. Because of this limited government action and funding, there is a large deficit of skillful health workers, eye health drugs, and medical equipment needed to address these alarming eye health issues.

The report also shows that eye health issues have a huge impact on the global economy. Claire Gilbert, a professor of eye health in London, estimates that the global economy lost about 42 billion dollars in revenue due to preventable blindness and eye health issues; these numbers are only predicted to rise, as the annual global productivity loss is estimated to be 110 billion dollars by 2020 if no intervention programs are employed.

There is also a strong relationship between eye health and poverty. Studies in Kenya, Philippines, and Bangladesh show that people who are visually impaired are much more likely to live in poverty. In these countries, many rely on daily wages to put food on the table for their families. If one of the primary family providers becomes visually impaired, the family’s source of income immediately becomes cut in half, thus forcing the family into poverty. Similarly, studies in rural villages in Tanzania found that women with eye health issues were limited in daily activities such as cooking or caring for their children, thus also reducing the quality of life of the family. It is also because of eye health issues that many children in developing countries are forced to drop out of school, thus drastically reducing the countries’ work force.

In conclusion, eye health, although often overlooked and underestimated, is a crucial aspect to the health of the globe, and should not be ignored.

Something Smells Fishy

Some people like the taste of fish, and some don't. However, as found in this article, and as discussed this past week at the 2011 Experimental Biology meeting, a popular and highly nutritional stearidonic acid that was typically found only in fish is going to be available in a different form in hopes of increased consumption among our population. Stearidonic acid is a vital omega-3 acid that provides many benefits for the heart, along with a decrease in major depression symptoms as well as proper enzyme functioning. In fact, it is even recommended that American's find a way to eat two meals of seafood a week- and this reasoning stems mainly from various health organizations' desire for humans to intake an increased amount of two of the long-chain omega-3's :eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Another way to think about the amount of seafood that we are due to be eating is the normal person should consume 8 ounces per week of either fish or shellfish, and pregnant women are advised to eat up to 12 ounces.

As probably obvious, we are not even close to meeting these guidelines, with most Americans falling a stunning 75% short of the goal. Also, there are other things to be considered with this change in diet demands. Toxic levels of methyl mercury can be present in these nutritional sources as well, so this source of vital omega-3's is important, but not necessarily the panacea that we are seeking to fix the deficiency of these nutrients.

It has been recommended in the past that these essential fish oils be used in cooking, especially at restaurants, much like the addition of iodine to our salt sources. However, along with this idea there is also the consideration of the possibly fishy taste that this might add to the dishes, making many unwilling to consider this idea.

However, the good news as discussed at the Experimental Biology conference discussed earlier is that commercially derived searidonic acid (SDA) will soon be available to fill these gaps in usefulness and delivery of the nutrients. This new altervative calls for the genetical manipulation of soy, as presented by the commericial agriculture company of Monsanto. This company also petitioned the Food and Drug Administration (FDA) at this time to have their SDA-enriched soy oil granted the status of "generally recognized as safe". This company wants to bring this oil into baking mixes, meat products, milk products and various others. Now, this newly engineered oil is not a replacement of all the vital nutrients that are present in fish oils, but it is simply an answer to try and fill the hole of this major nutritional deficiency within our population. The company recently received the desired status from the FDA and products with this fortification are expected to be seen around 2012.

Department of Health and Human Services to Eliminate Inequity

The U.S. Department of Health and Human Services (HHS) launched an "Action Plan to Reduce Racial and Ethnic Health Disparities." This plan has five major goals: (1) expand access to care and insurance for racial and ethnic minorities, (2) strengthen the health workforce serving racial and ethnic minorities, (3) implement the CDC’s new Community Transformation Grants, focusing efforts on heart disease, childhood obesity, tabacco-related disease, maternal and child health, asthma, and flu, (4) advance disparity-related health research, and (5) "Increase the efficiency, transparency, and efficacy of HHS programs." The HHS plans to assess progress biannually to ensure efficacy.

Specific strategies for achieving these goals include the recruitment and training of undergraduates in undeserved communities for careers in community health, public health, and biomedical research.pursue careers in medicine and as community health workers. The National Health Service Corps and the NIH already offer incentives for newly-trained health workers to begin there careers in regions lacking access to primary care practitioners (see NHSC loan repayment program), but there are relatively few scholarships or loan repayment programs available to students pursuing careers in Public Health. The act also purports to implement cultural competence education into health worker training. The act has already taken effect.

All five goals rely on funding, especially the recruitment of health workers from undeserved communities. Depending on the outcome of arguments in Washington, budget cuts may negatively impact this initiative.

If the plan succeeds in having even half of its intended effect, the health status of this country would improve significantly. Outside of financial concerns, what limitations do you foresee in carrying out this action plan?

Government Shutdown and Public Health

In light of the impending government shutdown over the failure to reach a solution regarding budget cuts, the CNN posted this article on its potential impact on the health services of the country. The actual divide between Republicans and Democrats in Congress centers mainly on the issue of cutting particular health services for women, especially revolving around the use of federal funds for abortion. Both Democrats and Republicans agree that the budget needs to be cut by about $35-39billion, but refuse to budge on issues regarding womens health.

One consequence to the healthcare sector as a result of this government shutdown is the ceasing of research. The CDC and NIH will not be able to start any studies nor take on additional patients, nor will grants be handed out to research universities and institutions. Reducing services in the health sector may have a debilitating effect in our government's response to potential health threats that may occur over the course of the shutdown. While the government assures us that services such as food and drug treatment will not be affected, I struggle to see how the normal services can operate efficiently under such uncertainty. Additional sectors like the military, mail carrier, air traffic, environmental protection, law enforcement, emergency and disaster personnel, and TSA and coast guard could be affected as well, either by shutting down services or with-holding paychecks.

The last time government was shut down was 15 years ago, for 5 days, with a partial shutdown of 21 days afterwards. Here is more information on the shutdown.

Pennsylvania Calls for More Water Tests

In an article addressing both the role of policy makers in public health and the vital importance of water safety, the New York Times addressed a new push from environmental regulators in Pennsylvania to examine the state's rivers. These regulators fear that the increase of natural gas drilling in the area has caused an increase in radioactive materials in rivers there.

According to Michael Krancer, who is the secretary of the Pennsylvania Department of Environmental Protection, that state has been trying to both monitor the safety of the water supply and not interfere with the success of the natural gas industry.

In conjunction with this department, the state of Pennsylvania sent a letter to water treatment centers through the state (25 known) urging them to increase their levels of treatment. This happened after an earlier article in the times that revealed the large amount of radioactive waste being discharged from sewage treatment facilities in Pennsylvania. These facilities were not designed to remove radioactive materials, thus leading to a very dangerous contamination of the environment and water supply.

Another issue here is that many of the water treatment plants were taking the heavier biosolids (which can include radioactive elements) that settled out of the treated solutions and were selling them as commercial fertilizers. An official from the Pennsylvania Department of Environmental Protection said that they were looking into having the plants revise this policy, though they described it as a "guideline" rather than a mandate.

To me, this seems like a waste of the power that comes with the department. In some instances, it is important to utilize "nudges" in promoting health, but in an instance of such potential danger to the public (which they also have no control over, or probably knowledge of), it's a time when policy makers should step in with laws and regulations. This article also made me think about the risk associated with living in developed counties where we take things like safe water for granted. There still need to be policies and regulations implemented to ensure that the water supply remains safe, despite increased natural gas drilling, etc. 

Bad Mouthing Vaccines

In Somalia, a Measles outbreak that began five weeks ago has escalated. Unlike most every other disease, this outbreak has showed an aversion to the poorest members of Somalia's population. (See Related Article)

Actually, this highly contagious virus does not discriminate against poor children, but the poorest children in Somalia are more likely to be vaccinated against measles. Why? The measles vaccine is provided in all mother-child health facilities in Somalia every day free of charge. However, parents who can afford medical care shun free vaccinations because they are rumored to cause HIV/AIDS and interfere with a child's ability to reproduce. This is an instance where cultural beliefs eclipse resources that would protect individuals from disease.
Lul Mahamud Mohamed, the head of Pediatrics in Mogadishu said it is up to religious leaders to debunk rumors about the vaccines.
What obstacles do you think health authorities will face in trying to get religious leaders on their side? How would you approach negating wide spread rumors about the vaccines?

Born Into Brothels

I recently watched the documentary "Born Into Brothels" and thought it did a nice job of exploring the lives of some of the children who live in India's red light district. The documentary follows a young woman who is a photographer as she lives among the brothels and conducts photography classes with the children. It also delved into the children's lives on an individual level.

While much has been written about the booming prostitution industry in India, I had never taken notice of how little other media was available. The documentary made the point that many people in the district did not like having their picture taken or hid for a variety of reasons. While the photographer had initially gone to investigate the lives of the women who worked in the brothels, she fell in love with the children there. They were so curious in the movie, and as far as I could tell they all seemed to be very intelligent for their ages--perhaps a symptom of having to raise themselves or growing up in that environment.

The female photographer, Zana Briski, who began the project gave the children cameras and taught them the science and art of photography: composition, lighting, etc. She had such great success that the children's pictures drew heavy interest from news sources and eventually were sold through Southeby's. She then used the funds in the children's interest to provide them with an education. Unfortunately in the epilogue of the film, many of the children failed to complete their education. Some withdrew themselves, others had limitations placed on them by their own families. It was heartbreaking that these children should have this opportunity only to lose it.

I think what I took away from the film was the sheer number of relatively unsupervised children running about the streets and the lives they led. They were prostitutes, slaves, child laborers and were treated harshly as such. The film depicted a young boy being beaten, a young girl being forced to carry on the line of prostitution in her family, a mother being burned to death by her pimp, and very cruel daily verbal abuse. The sheer hopelessness that the children admit at times really affected me--that children, those who are most innocent and the biggest dreamers in the world, could admit such desperation and depression. As countries rise, as India has, there still seems to be a wide dearth of adequate management of social ills--the lower class falls through the cracks. This begs the question of who is really rising. The rich, the middle class, ethnic majority, etc.?

I was surprised to see the children could speak so eloquently and so intelligently as well. They were young kids. Yet, they exhibited an independence and a mastery of language that made me think they were much older. Clearly, life experience was a contributing cause. The question is then how do countries manage children's ability for growth and curiosity while allowing them their childhood. Children are a great resource for a country. They are the next workforce, but NOT the current one.

If anyone is at all interested in the growth of developing nations, prostitution, children's health, India, etc. I would definitely recommend this film.

For more information about the project you can visit this website: http://www.kids-with-cameras.org/home/

Public Health Impact of Decreasing Recess Time

David Bornstein's opinion piece in the New York Times highlights the time children spend time playing each day has decreased rapidly over the past decades. He cites a publication from the Center for Disease Control (CDC) that demonstrates "strong evidence" that physical education has a positive impact on academic achievement for young children. The CDC document presents evidence that disproves the idea that physical activity during the school day contributes to problems in the classroom, a lack of concentration, etc. The CDC uses 50 different studies to reach these conclusions. Bornstein continues his analysis of these alarming trends in our school systems by discussing the effectiveness of punishing children by taking away the "privilege of recess." He talks about how children who engage in negative behavior such as fighting at recess lose the opportunity participate in this time for physical activity.

The author questions whether or not it is fair to punish children for not knowing how to play. He states that this concept is something that parents, teachers, and society are responsible for passing on to the youngest children. I agree with his criticism of this trend. We all know how great the impact of violent video games and television shows have on children. Aren't they simply engaging in the games that they are being taught? Bornstein highlights the gains made in the area of teaching children how to play by a group called Playworks. They bring in coaches and staff to moderate disputes at recess, help the children learn games, etc. with the goal of having children teach each other these lessons to each other. I find his article very accurate in its criticisms.

This alarming trend of decreasing recess tim corresponds to the obesity epidemic being experienced in this country. Clearly this relationship has huge connections for Public Health. However, there are several other ways that these two topics tie together that I feel that may be even more important. Foremost, why is a document very carefully put together by the CDC being completely ignored? If there is overwhelming evidence that our children would benefit from physical activity, why is there still a decreasing trend in the amount of recess? Why are schools choosing a schedule that has been proven to have a negative affect on the academic success of its students? Even more alarming for me, why is the CDC not worried about this blatant rejection of its research? How can this group accept the obvious failure that is occurring in this area. One idea I have is that the schools are being pressured to achieve the standards set by such goals as the No Child Left Behind Act. If they are already falling behind, how can they afford to increase recess time? Of course, this position is short sighted. Bu cutting recess time, the schools are actually making it much harder for their children to score high academically and meet these goals. Is there anything the CDC and the public health field can do to answer some of these questions?

Image from: http://nymag.com/daily/intel/2007/01/fancy_new_seaport_playground_n_1.html

Disparities: Illness more Prevalent Among Older Gay Adults

There was a very interesting article in the New York Times a few days ago that dealt with an examination of the physical and mental health among heterosexual adults versus those identifying as lesbian, gay, or bisexual. The article was based on information gathered by the University of California, Los Angeles, as a part of their Center for Health Policy Research. Though they only conducted the study in California, it showed that there was a significant different in the two groups in terms of both mental and physical health.
In gay and bisexual men between the ages of 50 and 70, high blood pressure was more common than in their heterosexual counterparts. Also higher were rates of psychological stress, which were 45 percent higher among the gay and bisexual group.
A similar trend was seen among lesbian and bisexual women, who were 26 percent more likely than heterosexual women to report that they had either "fair" or "poor" health. Their rates of hypertension and diabetes were higher as well.
The differences between health in differing sexual orientations in a population is something that we haven't discussed too much in class so far besides in the context of HIV/AIDS. I think that it's interesting to identify that the two groups have different levels of health relating to things like diabetes of mental health as well, as the first step in any public health issue is identifying the problem or discrepancy between groups and then identifying a potential cure.
In investigating the "why" for this problem, the researchers found that approximately half of gay or bisexual men lived by themselves between the ages of 50 and 70, as opposed to only 13.4% of heterosexual men in this age category. This suggests that an underlying component of health is having a stable support network to provide care.
What the article didn't address, and what I'm curious about, is what role public health providers could have in adjusting this difference in health between sexual orientation groups. One potential solution is giving additional mental health and general physiological health screenings to groups that seem to be at greater risk for health problems to ensure that they receive adequate monitoring and attention even without people actually living with them to provide this role.

The Change in American Medicine

There is a great article on New York Time's website this week about the change occurring in the coming generations of doctors and what it means for healthcare in America. It follows the story of Dr. Kate Dewar, a 31 year-old emergency room doctor and 3rd generation doctor in her family.

The article discusses how Kate, after watching the hectic lifestyles her father and grandfather led while trying to run private practices, came to the conclusion that she wanted to have more control over her life and schedule, and because of this picked to work in an ER rather than her own practice. It discusses the fast shift that is occurring between private practices, known for their hard and time-consuming work, to more hospital-run care. The article uses an interesting quote saying that, "Metaphorically, medicine has gone from being an individual to a team sport." It is interesting to see that new doctors, who dedicated their lives to help their patients, are finding new ways of doing so that doesn't involve sacrifices themselves for their job.

I think this is an important change that is necessary for the future of medicine. If doctors are to provide the best care possible, they must be willing to not hold so much control over their own patients and work together with other health-care professionals. Yet I think that there is a balancing act that is yet to be perfected in America's health care system. Most would agree that due to the difficulties faced with owning a private practice, doctors have switched to specialties or hospital-administered care. But currently it seems that the health care "corporations" are demanding too much of doctors in order to maximize patient-output and revenue. It seems that somehow a balance must be struck where doctors can still maintain the personal and necessary bonds needed in trusting someone with healthcare while also not overworking healthcare professionals.

One of the most interesting parts of the article is that the father and grandfather are interviewed to ask for their opinions on the change occurring in medicine. The father interestingly states that after hearing his daughter was going into Emergency medicine, " “On the one hand, it bothers me that the generation of doctors that my daughter is in doesn’t work as many hours and isn’t willing to do the stuff that I did,” he said. “On the other hand, I’m almost a little jealous.”

So what do you guys think? Is medicine heading in the right direction in terms of the demands placed on doctors? Is it even possible to strike a balance between personal patient care and not being overworked?