Feeds:
Posts
Comments

Posts Tagged ‘public health’

Violence is a critical public health issue and one that contributes to an astounding number of years of life lost, with homicide and suicide among the top 5 causes of death for those aged 1-44.

Yet our response to violence as a society is not to treat and prevent but rather to criminalize and punish, which doesn’t seem to have helped prevent crime, much less have addressed the root causes of crime, as I have noted before.

The issue of criminal justice in the U.S. and the desperate need for a shift in the justice paradigm, from a system focused primarily on punishment to one emphasizing restorative practices, is one that has once again been on the forefront of my mind in the face of extensive coverage of the trial of Dharun Ravi last month.

Ravi and Clementi

Quick background: Dharun Ravi was charged on all 15 charges he faced for using a webcam to spy on his roommate, Tyler Clementi – Clementi killed himself soon after the spying incidents, though as this board member of the American Foundation for Suicide Prevention eloquently captures, blaming Ravi for Clementi’s suicide is utterly inaccurate and unfair. Suicide is an incredibly complex phenomenon, which always has multiple risk factors at play, including diagnosable mental health conditions which are present in over 90% of cases of completed suicide. You cannot draw a causal link between any one specific incident and suicide and you certainly cannot blame another individual for one’s suicide. Although Ravi was not charged for Clementi’s death, I find it highly unlikely he would be facing 10 years in prison as he currently is if it were not for the fact that Clementi killed himself.

Though Ravi’s actions – and any homophobic motivations behind them – were wrong, I am sure they have been, are, and will be repeated across dorm rooms everywhere – college kids can be foolish and immature, and I fail to see how putting Ravi behind bars for 10 years does anything to address the root issues here. We as a society need to be more tolerant of differences, more respectful of each other, and more communicative with those around us. We need to stop discriminating against others based on race, sexual orientation, religion, and any other such category. But instead of revisiting what we as a society are doing wrong that leads to incidents such as this one, we are instead throwing the blame at the feet of one college student, punishing him in a way that will neither help him, nor prevent cases like this in the future. It seems we perpetually take the easy way out – revisiting what we do as a society and as university, school, and other communities, would be much too difficult; blaming one individual and punishing them – far easier.

Moving beyond this one incident to the array of crimes that land people in prison, the true solution lies in prevention. At the individual level, depending on the nature of the issue, this means things like drug treatment, interventions with at-risk families, and school completion programs (among other things), all of which research has demonstrated to be “more cost-effective than expanded incarceration as crime control measures” according to this Sentencing Project report. At the population level, this means instilling values of respect and equality, tolerance and diversity, beginning at very young ages, at home, in our schools, and in our communities – through education, prevention programs, policies, laws, and more.

Yet, this does not seem to be the direction in which we are moving. I recently attended a symposium during which a prominent political figure, speaking on internet crimes (particularly child sex trafficking and sexual abuse), said “I really think the most meaningful solution is to put these people behind bars for as long as possible – as far as I’m concerned, that’s what prisons are for.”

I felt sick to my stomach – not a word about prevention or restorative practices in his talk, do people really not see how we are not only failing to treat and prevent and improve society, but also resigning ourselves to perpetually be throwing people in jail?

But there is hope, and there are ways out of this mess. A more recent publication of The Sentencing Project compiles the essays of 25 leading scholars and practitioners on their strategic vision for the next 25 years of criminal justice reform.

A truly incredible compilation of perspectives that is worth a read, but for now I will highlight some points from the essay capturing the public health perspective, written by leading violence prevention public health scholar and practitioner, Deborah Prothrow-Stith.

She writes, “We can’t address the many challenges in the criminal justice system without reducing the number of people entering the criminal justice system in the first place. This means prevention must be on par with law enforcement and punishment. As a nation, we already promise to respond to violence with expensive and sometimes harsh solutions. We need a companion promise, the promise of prevention.”

And, as she points out, this is an area in which we do have firm science as to what works and what doesn’t. Public health-based programs such as CeaseFire Chicago and the Urban Networks to Increase Thriving Youth (UNITY), school-based violence prevention efforts that have proven effective, programs like Boys and Girls Clubs and the Big Brothers Big Sisters of America initiatives, and the Nurse Family Partnership home visiting program have all proven to reduce crime and violence in meaningful ways.

Instead of focusing on punishment within a flawed and discriminatory system, instead of cutting prevention funds (as of last week, the Prevention and Public Health fund is yet again on the chopping block, much to my – and many other’s – dismay), let’s focus our attention on programs like the ones mentioned above – programs that prevent violence, promote health, and foster a more vibrant and productive society.

This post is cross-posted at http://occupyhealthcare.net

Read Full Post »

National Public Health Week kicks off today!

Let’s start with the basics: what is public health?

Ultimately, public health is about prevention at the population level.

As the Johns Hopkins Bloomberg School of Public Health’s motto so fittingly states, public health is “protecting health, saving lives – millions at a time.” We design neighborhoods more conducive to exercise; we strive for improvements in hospital systems so as to reduce mistakes; we pursue policy changes to ban false marketing by cigarette companies – all these things affect not one or two people, but hundreds, thousands, and millions.

Public health is also largely about prevention – keeping bad things from happening in the first place, as opposed to solving or managing already-present problems (although public health does a fair bit of that too). We clean environments to prevent asthma, we don’t provide inhalers; we teach you to cough into your elbow to prevent the spread of flu, we don’t prescribe antiviral medicine; and we redesign cars and roads to prevent injury, we don’t perform surgery.

Focusing on just this kind of population-level prevention, National Public Health Week offers us the following daily themes:

In addition to the above topics, National Public Health Week provides us a time and space to delve into the idea of integrating primary care and public health, an idea that was the focus of a recent IOM reportas explained on the occupy healthcare site just a couple days ago.

In addition to the case studies mentioned in that post, the operation of community health centers back when they originated provides a phenomenal example of true integration of primary care and public health.

The community health center movement started about 45 years ago, with roots in the civil rights and social justice movements of the 1960s, and with some incredible leaders at the helm. At the dawn of this movement, community health center leaders saw health as but an entry point to solving a broader range of problems, without raising the same level of opposition as more blatantly political “social change” programs. The goal was to not just to provide primary care and related outreach and patient education, but to address social determinants of health through job development, nutrition, sanitation, and social services. All while maintaining a core principle of respect for and involvement of community residents (aided by the legal requirement that governing boards of community health centers must be composed of at least 51% consumers).

While community health centers in the U.S. continue to do phenomenal work providing much-needed high-quality primary care services to largely underserved populations, most have become primarily – some entirely – deliverers of medical care. I would love to see these centers take a turn back to the roots of the community health center movement, propelled by grassroots advocacy by community members, national organizations such as the National Association of Community Health Centers, and advocates for integration of primary care and public health such as those of us here.

For more tips and action steps, visit www.nphw.org!

This post is cross-posted at http://occupyhealthcare.net 

Read Full Post »

In our attempts to encourage people to lead healthier lives, we often make the mistake of bombarding them with facts and stats, do’s and don’ts, assuming the problem is a lack of knowledge. But let’s be honest – most people know that French fries are not the healthiest food in the world, fruits and vegetables are good for you, and that you really ought to exercise regularly.

So, what’s the problem? One aspect of the problem is of course the systems level issues of food access, cost, time and space to be active, etc. that we have mentioned before.

Another aspect though is one of attitude and culture.

Feel Rich, which launched in December, is attempting to address just this (sidenote: the organization’s CEO and others involved were on a SXSW Panel just this past weekend).

Feel Rich’s goal is the creation of a health and fitness culture born from the urban and hip-hop community’s love and respect for music, movement, and entertainment. Their message: health is the new wealth.

As opposed to your typical public health campaign centered on facts, stats, and do’s and don’ts, Feel Rich is attempting to first foster a desire for health (in other words, crafting an attitude and creating a culture that sees health as critical and desirable as wealth), engaging urban youth in a meaningful way that speaks to their interests. In Feel Rich’s own words – “It’s health on your terms, fitness in your style, and food choices that make sense on the streets where you live.” It’s also about making health and wellness cool.

I think it’s an exciting and inspiring approach, and the way the Feel Rich movement taps into attitudes (not just information), reminds me of the baby carrots campaign I’ve written about before. After all, whether we’re talking about the junk food industry, big tobacco, or pretty much any other product we see commercials for, appealing to emotion and attitudes is the way advertising is done. It’s long past due that prevention and health promotion advocates started utilizing this powerful strategy.

Feel Rich ties this powerful appeal to attitude and culture with empowering information on food, fitness, and health, and an array of videos and stories to engage and inspire their audience.  And with over 3 million YouTube views, it looks like they are doing just that.

I’ll close with some food for thought on this topic from David Katz’s most recent Huffington Post article:

“What if health were more like wealth?

  • If health were like wealth, we would value it while gaining it — not just after we’d lost it.
  • If health were like wealth, we would make getting to it a priority.
  • If health were like wealth, we would invest in it to secure a better future.
  • If health were like wealth, we would work hard to make sure we could pass it on to our children.
  • If health were like wealth, we would accept that it may take extra time and effort today, but that’s worth it because of the return on that investment tomorrow.
  • If health were like wealth, society would respect those who are experts at it.
  • If health were like wealth, young people would aspire to it.

This post is cross-posted at http://occupyhealthcare.net 

Read Full Post »

Carmen shared with us a couple great Martin Luther King, Jr. quotes in her Occupy Healthcare post on Monday, and it inspired me to take a look at some of Dr. King’s other quotations. So many of them captured concepts relevant to public health that I wanted to share some of my favorites here. Here’s hoping we can take some of Dr. King’s wisdom and apply it to our work!

“True compassion is more than flinging a coin to a beggar; it is not haphazard and superficial. It comes to see that an edifice that produces beggars needs restructuring.”

I think this quote truly captures the essence of public health – public health isn’t about treating individuals with band-aids or quick fixes; it is about protecting health and saving lives– hundreds, thousands, sometimes millions at a time – by restructuring the systems that produce sickness, violence, and other problems that ail our society.

“Rarely do we find men who willingly engage in hard, solid thinking. There is an almost universal quest for easy answers and half-baked solutions. Nothing pains some people more than having to think.”

Indeed, we often see programs and initiatives implemented without nearly enough strategic planning and thought to sustainability, input from communities, constructive criticism, and/or evaluation (formative or post-program evaluation). Public health work (any work, really) is difficult and nuanced. We have to think hard and critically about what works and what doesn’t, and whether we are helping, hurting, or making no difference at all. At the risk of repeating myself one too many times – good intentions are not enough.

All labor that uplifts humanity has dignity and importance and should be undertaken with painstaking excellence.”  

Speaking of good intentions not being enough – I think we all owe it to ourselves and society to not rest upon the fact that we are at least trying to help, but to undertake our work with “painstaking excellence”.  If we’re going to try to do this, let’s try to do it right.

“It may be true that the law cannot make a man love me, but it can stop him from lynching me, and I think that’s pretty important.”

I have to admit, this quote made me laugh. And it’s a good point – laws and policies have their limitations, but they are also an incredibly powerful tool for change, particularly at the level of populations and systems.  I recently came across the Network for Public Health Law, and particularly love their overview of different public health topics.

And lastly, a quote from Dr. King that speaks for itself:

“Our lives begin to end the day we become silent about things that matter.”

Read Full Post »

The CDC calls tobacco use “the single most preventable  cause of disease, disability, and death in the United States” with an estimated 443,000 smoking related premature deaths and 8.6 million living with serious illnesses caused by smoking. In addition, according to the CDC, tobacco use is responsible for more than $96 billion a year in medical costs and another $97 billion a year from lost productivity. So there’s no question that tobacco plays a major role when it comes to our country’s (and the world’s) health, health care, and medical costs.

One of the most infuriating aspects of the tobacco saga is the role of the tobacco industry and its unlawful and deceptive practices, for which companies have been repeatedly called out and in the U.S. government’s landmark lawsuit,successfully sued. As U.S. District Judge Gladys Kessler stated in the final opinion of this lawsuit: “Despite [the] knowledge [of the harmful effects of tobacco], [the Defendants] have consistently, repeatedly, and with enormous skill and sophistication, denied these facts to the public, to the Government, and to the public health community… In short, Defendants have marketed and sold their lethal products with zeal, with deception, with a single-minded focus on their financial success, and without regard for the human tragedy or social costs that success exacted.”

The stories of deception continue to this day, with a new analysis from UCSF, published just a couple weeks ago in PLoS Medicine, showing that tobacco scientists altered their study protocols to obscure the increased toxicity of additives in cigarettes.

Despite the seemingly never ceasing stories of deception and defrauding the public, U.S. tobacco companies had the audacity to sue the federal government this past summer over proposed graphic cigarette warning labels, saying the warnings violate their free speech rights and will cost millions of dollars to print (the latter point elicits a very bitter laugh, given we’re talking about an industry that rakes in billions and billions in profit).

The case was decided in favor of the tobacco companies in district court, but is currently being appealed (and I was happy to see that 24 attorney generals filed a friend of the court brief a couple weeks ago, saying the First Amendment doesn’t prevent the government from requiring “lethal and addictive products carry warning labels that effectively inform consumers of the risks those products entail”).

But what I’d like to turn to is public reaction to the graphic labels fight. Certainly, there are those that support the use of graphic labels on cigarette packages as a way to discourage tobacco use (there is in fact quite a bit of scientific evidence supporting this). But there are also those clamoring about the “nanny state”.

Public health professionals are pretty used to such “nanny” claims, and I think Yale University’s Dr. David Katz captured it perfectly in his Huffington Post article, “Public Health and the Illusion of Your Autonomy”, a few days ago:

“You may think you are defending your autonomy by opposing a ban on toys in Happy Meals. But while you are resisting the tyranny of public health, you are playing right into the hands of a large and rich corporatio­n that is far more concerned with its profits than the health of your child.”

EXACTLY. Why are some people so much more willing to be dictated by for profit corporatio­ns (whether in the fast food industry, tobacco industry, or otherwise)  than the recommenda­tions of public health and medical professionals?

They are infuriated by the idea of government placing graphic warning labels on cigarette packets, but seemingly unfazed by the continued deceptive practices of tobacco companies  (including supposed public service announcements about the harmful effects of cigarettes, which have been shown to be ineffective and sometimes even cause youth to start smoking or have more favorable beliefs about tobacco companies – which is exactly what they have worked to achieve).

They are infuriated by the idea of curtailing the freedom of McDonald’s to put toys to Happy Meals, never mind that it was most likely a decision made after “highly-paid marketing executives told them how to manipulate you by manipulating your children,” as David Katz puts it.

What can we do on this front? My advice today is not so much specific action steps, but more about thinking critically. First, let’s look into the “illusion of our autonomy” in a variety of different arenas – who really controls our behaviors and choices, and what are their motives? Then let’s ask, what can we do – on the ground in our communities and in the policy sphere – to limit the sometimes manipulating and deceptive influence of those with their bottom line in mind instead of what’s best for our health and well being? If you have any thoughts about these questions or related topics, please sound off in the comments!

(This post is cross-posted at http://occupyhealthcare.net)

Read Full Post »

(Note: this post is cross-posted at Occupy Healthcare.)

An op-ed in the New York Times last week described the United States’ disproportionate spending on healthcare in comparison to other social services that have an impact on health – a characteristic that puts us in the minority, as one of only three industrialized countries. The chart below shows the ratios of healthcare:social service spending in the U.S. vs. peer countries (for details on these numbers and information on which countries are included, check out the published study).

In addition, when considering the combined spending on health and social services, the U.S. no longer leads the pack (as it does when examining only healthcare spending) – in fact, we come in 10th of 30 OECD countries examined. Furthermore, the authors of the study found that infant mortality, life expectancy, and potential years of life lost outcomes were significantly worse in countries where health-care spending was high and social-service spending low.

As the authors note, “The implication of our findings is that, if improved population health is our goal, then the United States should be looking beyond the health-care system to achieve that goal. Current reforms—targeting medical care and health services only—are unlikely to deliver that result.”

Amen. So, let’s look beyond the healthcare system. Each Monday starting today, I’m going to kick off our week here at #occupyhealthcare examining something outside the healthcare system that has enormous implications for our health (i.e. social determinants of health). I’ll try to end each post with a practical step or two you can take to address the topic at hand.

This week, let’s talk urban planning.

The idea that where you live, learn, work, and play is a major – perhaps the major – factor influencing your health is a core principle of public health.  Place matters.

While this idea encompasses far more than just physical living space, physical living space is certainly a key component. Development decisions can affect our physical health (through walkability, green spaces, proximity to healthy foods, pollution caused by vehicular traffic), our emotional and mental health (length of commutes, spaces for social interaction) and societal well being (spaces for civic engagement, degree of segregation by race and income).

Many in the fields of urban planning and public health have come to this realization, epitomized by the smart growth movement, which holds among its principles:

*Mixed land uses

*Mixed income housing – providing a range of housing opportunities and  choices

*Taking advantage of compact building design

*Creating walkable neighborhoods

*Preserving open space, farmland, natural beauty, and critical environmental areas

*Fostering distinctive, attractive communities with a strong sense of place

*Providing a variety of transportation choices

*Encouraging community and stakeholder collaboration in development decisions

Imagine the potential benefits:

*Less segregation could lead to more equitable policies across communities, and ultimately more equitable health and wellness outcomes

*More walkability and green spaces could increase physical activity

*Providing a variety of transportation choices could minimize our reliance on motor vehicles, and the resulting pollution and sedentary lifestyle

*Attractive communities with a strong sense of place could make us happier and more connected, reducing rates of depression

The list goes on. Moreover, many of these benefits have already been demonstrated through research. It is clearly time for us – and the U.S. – to invest in smart growth for healthier, happier communities.

So, what can we do? Today’s practical step: encourage use of health impact assessments in your local community when any kind of development project is being discussed, and advocate for state and federal laws that mandate or incentivize HIAs. HIAs provide a way to assess the health impact of any policy (development or otherwise) and would likely reveal the positive impact of smart growth, and the detrimental impact of development projects that don’t take into account smart growth principles. Certainly, there are complexities and challenges involved in conducting HIAs, and it is important to make sure they are being conducted in useful, cost-effective ways – but that is a topic for another post! Despite the complexities, I think HIAs when done well provide a concrete way to start thinking about the specific ways in which any policy that impacts the places we live also impacts our health and well being – and hopefully provide the impetus to start not just thinking about, but acting upon the results.

Read Full Post »

The United States spends $60 billion each year on incarceration and has the highest incarceration rate in the world (due more to the length of sentences than the number of individuals incarcerated each year), as this New York Times article details. The only other major industrialized nation that even comes close to the U.S.’s rate is Russia, with others having much lower rates (1/5 the U.S.’s rate or lower). The U.S. has less than 5% of the world’s population but almost 25% of its prisoners, with 2.3 million criminals behind bars, more than any other nation. China is a distant second with 1.6 million people in prison.

And as this NAACP report points out, there’s a lot more to worry about:

–  The majority of the 2.3 million people incarcerated in U.S. prisons and jails are people of color, people with mental health issues and drug addiction, people with low levels of educational attainment, and people with a history of unemployment or underemployment. (According to a 2008 study, 1 in 100 U.S. adults of any age and 1 in 9 black men ages 20-34 are in prison).

–  The nation’s reliance on incarceration to respond to social and behavioral health issues is evidenced by the large numbers of people who are incarcerated for drug offences – nearly a quarter of all those incarcerated.  (And as mentioned here, in 1980, we had 41,000 drug offenders in prison; today we have more than 500,000, an increase of 1200%.)

– During the last two decades, state spending on prisons grew at six times the rate of state spending on higher education.  (And according to a Pew report, total state spending on corrections, the bulk of which is spent on prisons, quadrupled during the past 20 years, making it the second fastest growing area of state budgets, trailing only Medicaid.)

Even worse – much of what we do in terms of incarceration does not seem to be preventing crime, much less helping people escape the various vicious cycles that can lead to things like poverty, crime, substance abuse, poor education, poor health, etc. This can be seen not only in the recidivism rates mentioned above (with about 1 out of 4 American offenders ending up right back in prison within three years of release), but also limited drug offender effects,  negative impacts on family and community, and other issues detailed in this Sentencing Project report. Moreover, as the report goes on to say, “a variety of research demonstrates that investments in drug treatment, interventions with at-risk families, and school completion programs are more cost-effective than expanded incarceration as crime control measures.”

The call is echoed in editorials such as this one, written to describe a consensus reached in a Pennsylvania conference among prosecutors and defenders, victim advocates, prison reformers, and parole officers and judges. The consensus: the need for a change in the justice paradigm, from a system focused primarily on punishment to one emphasizing restorative practices. The editorial goes on to highlight a number of public health strategies as promising alternatives including therapies that address addictive behaviors and mental and emotional disorders.

And there have also been repeated calls to take some of the billions of dollars we spend on incarceration and put it toward education, one of the more recent calls coming from Gaye Tuchman, a University of Connecticut sociology professor, in one of this week’s New York Times Room for Debate articles about Rick Perry’s “plan” for a $10,000 B.A. degree – “New money for education has to come from somewhere,” Tuchman writes. “Why not a new kind of retrenchment: Cut back on imprisonment for some victimless crimes — like marijuana possession — and use the money for higher education. As The New York Times reported in February, arrests for marijuana use have been skyrocketing in New York City alone. Better to educate people than lock them up.”

And indeed better to educate and support high risk youth than lock them up. Let’s target youth in high risk communities (a la “hot spotters”) for intensive tutoring and mentoring support, provision of safe spaces, and more, providing them with role models and people and places to turn to when in distress or in need of help accessing various resources.

John F. Kennedy once said “children are the world’s most valuable resource and its best hope for the future” – let’s invest in this resource and nurture this hope, preventing our children from entering the criminal justice system in the first place.

Read Full Post »

Older Posts »

%d bloggers like this: