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public health Archives - ChangingMedia

Apr 04
0

Smokescreen

By | Health, The Global Is Local | One Comment

America still smokes.

Just under 20 percent of us are regular cigarette smokers, although there is a lot of variation by gender and race (higher among men, lower among Asian Americans, for instance).

This is not a post about the evils of tobacco, the high health care costs associated with it, or even the socioeconomic patterns common to most addictive drugs that are so frustrating for public health workers.

Instead, one might look at this post as a reflection on the entrepreneurial spirit and technologically cutting edge strategies of tobacco companies, and the policies that are growing to address new growth in the industry.

This is a second golden era for tobacco users. It’s almost as though the 1950’s have taken a ride with Marty McFly and arrived in a world where pipes, chewing tobacco, and cigarettes might be frowned upon, but e-cigarettes, “smokeless” tobacco, and hookah lounges are embraced by hipsters, Fed Hill club goers, and baseball audiences alike. Despite the smoking bans enacted around the country (and locally in 2007), the broad range of new tobacco products on the market are also a dream come true for today’s youth. While my peers were limited to a traditional variety of options – basically cigarettes, maybe cloves for the cautious, maybe cigars for the adventuresome – middle and high school-age kids these days have a veritable smorgasbord of options including lots of fruity flavors. Paradise! According to the CDC, there’s been a big uptick in use of those little cigars – often with delicious flavoring – by the tween and teen set, since they can be bought individually with lower taxes and more flavors than cigarettes, and with fewer regulations and less oversight.

For the grownups as well as the kids, the e-cigarette is a non-smoking-friendly smokers option, as is the smokeless tobacco pouch, which doesn’t require all the spitting and blackened teeth of the bygone age of chewing tobacco.

Finally, perhaps the least bizarre on my earlier list is the hookah lounge, a long-standing, and, in many places around the world, culturally-important method of tobacco consumption. While I was in Public Health school, some colleagues and professors were conducting research into the potential harms associated with hookah use, as the popularity of these lounges is still relatively new. Their conclusions as well as well as those of the CDC are that there is significant risk for hookah users, particularly in the context of the hookah lounge, due to the length of use during a single session among other factors.

Interestingly, Baltimore County is considering a bill to sharply curb the hours of operation of local lounges, not because of tobacco-related health concerns, but because of several violent incidents that have taken place in or outside some establishments.

Regardless of the decision about this regulation, or any other local policy choices about tobacco use, the underlying fact is that tobacco remains a legal substance, used by a substantial minority of Americans. On the other hand, it is also an addictive and dangerous substance that causes a multitude of health effects, as well as correlating with negative socioeconomic indicators. Maryland, and Baltimore in particular, suffer from astonishingly high disparities in health between racial and economic groups. Tobacco related health problems, such as chronic lung conditions, are high on that list of disease disparities, and should be considered very seriously when policymakers choose how to regulate tobacco products, as well as how to allocate funding for cessation and harm reduction strategies.

Mar 21
0

Our Beliefs, Our Health

By | Health, The Global Is Local | One Comment

Monday’s issue of JAMA Internal Medicine included results of a survey about American’s perceptions about health interventions and medical practices. Half of all Americans, according to JAMA, believe in one or more medical conspiracy theories, such as the autism/vaccination connection and deliberate, CIA sponsored, HIV infection of African Americans.

These beliefs are powerful and real examples of the challenges faced by public health workers around the globe as well as here in Baltimore. Beliefs are incredibly hard to shake free once they have taken hold, and no preponderance of evidence will be sufficient to do so, unless a number of other factors come into play as well. This is one of the primary reasons that public health experts emphasize the importance of community involvement in interventions, in building trust and relationships among the families and networks that are targeted for the intervention, and supporting the growth and learning that leads to change.

The Health Belief Model, Wkimedia Commons

A study published in the late 90’s illustrates an example right here in Baltimore, in that case of the perceptions of the benefits of preventative oral health care. Beliefs are often tied to communities, including communities of geography, race, ethnicity, economic status, and gender. Those who are most likely to refuse vaccination, for instance, are likely to be well educated and well-to-do.

The implications for Baltimore are substantial, and tied to our burden of disease. Public health efforts to address the HIV rate among young black gay men, or the rate of narcotic use, or even more socioeconomic health factors such as poverty and nutrition can only succeed if the perceptions of healthy behavior are also addressed.

As all of us who have ever tried to argue with deeply held beliefs will attest, however, people who believe things believe they are true. This is true for all of us. Imagine someone well-meaning and intelligent coming up to you and saying: “Listen, I know you BELIEVE that this gravity thing is a force that pulls you downward, but this is merely a perception that is reinforced by your community. If you listen to this well reasoned argument, then you will be free from this inaccurate belief and thus free to enjoy the benefits of weightlessness, ease of motion, decreased back pain, and splinters in your socks.”

ChangeEngine is a group of public health advocates, whether through advocating for thoughtful design and public planning, creative solutions to aging, the importance of art, the awareness of racial, gender, and socioeconomic divisions. We encourage thoughtful and creative solutions to Baltimore’s challenges, and we challenge our readers to do the same. We must also encourage our ChangeEngine community members to consider and advocate for creative and thoughtful approaches that acknowledge and respect the burdens that belief can impose on community. We must respect that often the greatest barrier to changing ourselves IS ourselves. We need reflect no further than the New Year’s resolutions scattered upon the gym floor to appreciate that this is true.

My suspicion is that Baltimore – or whichever community you live in –  reflects the beliefs reported in the JAMA survey. If you have evidence that either supports or contradicts this suspicion, I encourage you to share in our comments sections and on social media. What are our beliefs about how we got to this time and place? What community legends prevent your neighbors from seeking care? What is the consensus among your colleagues about food, health, or wealth? We must first identify the biases of our community before we can leverage that knowledge to effect transformational change.

Jun 27
0

Silos II – The Power of the “Triple-S”

By | Health, Silo-Breakers, The Global Is Local | No Comments

Hopefully by now we have all begun to identify some of the ways in which our silos both benefit and limit our ability to innovate and achieve our goals of lasting, transformative social change. This reflection, for me at least, has led to the following conclusions:

1. The forces that hold us back also thrust us forward. While we may not have impact on a broad spectrum, specialization — focusing on issues within our sphere of influence — concentrates our laser beam of efficacy.

2. Becoming aware of someone else’s silo can make me judgemental, and I think I need to be cautious to avoid that.

3.  Even though last week I was promoting leaving your silo entirely in order to inform the silos of others and vice versa, I have been considering the idea of silo-“smushing” over strict silo-crashing. Smushing similar silos — Triple-S, if you will — would bring the resources and energy of seemingly disparate silos together, not to address a single issue but on the host of interrelated concerns that each silo is generally concerned with.

As usual, my perspective comes through the lens of public health. However, as my friend Michelle Geiss and I recently agreed, public health is a useful perspective to see almost all of our work through. There are some exceptions — the petrochemical industry, maybe, or reality TV — but otherwise almost everything has a public health connection.

I hereby submit public health as our mega-silo. Alternative suggestions are welcome, of course. But consider the impact that a unified public health effort could have in Haiti, where a million different NGOs are doing all their different things. If all of them had to work together, imagine the results. Not only would the output be magnified, each organization would help to keep its partners honest — a perpetual concern particularly in international aid efforts, especially after the publicity of Greg Mortenson of Three Cups of Tea infamy.

Speaking of which, the global polio eradication campaign has run into some serious hurdles in Pakistan and a more holistic strategy — including education, infrastructure improvements, and cultural outreach with vaccination efforts — could potentially help.

Part of the reason I think this would work and should be a priority is that no one can do everything, yet within the mega-silo model, that could not only be a goal but an expectation.

We all bump into barriers that limit our impact, and there is a pattern to that process- awareness, hope for solutions, frustration with lack of progress, development of workarounds, acceptance of limitations, and finally, sometimes, resistance to efforts to change those barriers lest they disturb our projects.

Now deploy the Triple-S, and call in your partners. Smash! Barriers? What barriers? We don’t need no stinking barriers!

So now that you’ve identified your silo, think about who else is in ít (organizations, individuals, funders), and what other silos may be nearby to integrate into a Triple-S mega-silo?

Mar 22
0

When Government Lets Us Down

By | Health, The Global Is Local | No Comments

If you have read a few of my posts over the past couple of months, you have probably realized I’m in favor of government; I think it has a place and serves valuable functions. A few of my favorite examples (when done right) are the regulation of pollution, the oversight of food, chemical, and product safety, and police forces committed to protecting our rights.

It is distressing, therefore, when this entity that provides us the space and safety to be here — the government — doesn’t do its job, namely to protect the citizens. Because I spent many hours looking at hopeful and uplifting HIV/AIDS news earlier this month, it was particularly sad to see that the ongoing budget battles will cut funding that provides therapeutic interventions for the most vulnerable AIDS patients in this country — the poor. As we learned last time, HIV/AIDS has a disproportionate impact in Baltimore. Global AIDS funding is being cut as well, despite earlier presidential promises to the contrary. This is unfortunate, since international AIDS funding gets far more bang for the buck, so to speak, and addresses regions where the need is incomprehensible to us here in the U.S.

Just to balance things out, however, there is an initiative taking place in the Oliver neighborhood that is essentially a blitz of Baltimore City services –– filling potholes, installing smoke detectors, offering access to drug rehab services, arresting drug dealers who frequent the area, and removing trash and debris. Whether or not this is what the neighborhood needs to pull out of its perpetual slump is uncertain, and probably a matter of opinion. Clearly, though, the reason for engaging in this effort is at least an attempt to make life better for the residents, which is the role that government ought to provide.

A  couple of updates in the “You Heard It Here First” category:

SARS Redux? recalled the Severe Acute Respiratory Syndrome (SARS) epidemic of 2003 and drew an uncanny parallel to an emerging coronavirus that has been causing an alarming respiratory condition in several patients in the Middle East. Several recent news items have called attention to this condition, confirmed that it has the potential to spread from person to person, and traced the spread from the Arabian Peninsula to the United Kingdom.

Outbreak discussed the nationwide fungal meningitis outbreak linked to contaminated pharmaceutical products made by the New England Compounding Center.  The outbreak is expected to continue to cause illness and death across the 20 states affected. The supply chain that provides us with the medicines we rely upon should remain under close public scrutiny or be expected to fail again.

Next time: Biking in Baltimore: awesome, terrifying, or obvious choice?

Unrelated sidebar: If you are interested in trying your hand at pottery, and possibly discussing health, politics, food, and the environment with yours truly, check out the Mesh Baltimore site this week.

IMAGE CREDIT. Library of Congress Flickr Photostream.
Nov 06
0
by WarmSleepy

Leaks, Sludge and Untreated Flushes, Oh My

By | Health, Oh Shit! | 5 Comments

Reports of America’s antiquated infrastructure are not new, but since much of the aging drinking water, wastewater, and stormwater infrastructure is underground the problem remains mostly unnoticed and forgotten. As officials scramble to clean up the raw sewage and industrial waste that flooded the waterways surrounding New York City in the wake of Hurricane Sandy, we are harshly reminded of the public and environmental health threat posed by the eroding pipes and outdated systems. Read More