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Adam Conway

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.

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.

Natty Boh Vinaigrette, perhaps?

By | Health, The Global Is Local | 3 Comments

What’s your favorite food?

OK, what’s your favorite nutritious and healthy food?

Given that the top ten favorite foods in the United States include burgers, hot dogs, fries, oreos, ice cream, and pizza, it’s unlikely that those two items you listed are the same (USA Today claims that the second and third most popular foods in 2013 are “fruit” and “vegetables” respectively, but I have my doubts about that).

Baltimorean specialties are also unlikely to fall into the healthy and nutritious category, no matter how delicious the fried chicken or tender the pit beef. However, as hipster culture has filtered out to the larger community and policymakers have shifted toward making a concerted effort to promote healthy food options, Baltimore may be undergoing a healthy food renaissance. Since it is National Nutrition Month, it seems appropriate to acknowledge progress in a positive direction (despite ongoing concerns of limited food access and food deserts).

However, as Amber and Robyn have pointed out in some truly stellar pieces recently about the racial and cultural divisions in the city, a new addition to the Woodberry Kitchen franchise in Belvedere Square or Charles Village does not provide the high quality healthy options that people need in areas bereft of supermarkets. A more comprehensive, holistic solution is clearly necessary to bring the benefits of the organic/natural/healthy/hipster/minimalist/traditional food movement to those who need it most, i.e. those with limited access, time, or financial means to eat healthy food.

The Today Show has chosen Baltimore for it’s “Shine A Light” campaign to improve health and wellness in 2014, based on votes on social media. Whether or not Baltimore is a logical choice for the Today Show is being debated on their Facebook page. Personally, I wonder whether this type of campaign will make much difference, but there is certainly a great need for solutions. Baltimore has higher than average rates of disease burden, poverty, substance abuse, and homelessness than the state and national average.

One strategy that has been percolating for some time is to re-orient the corner stores toward supplying healthier foods. Many neighborhoods that lack easy access to supermarkets are served exclusively by these stores, which typically offer lots of deliciously salty packaged snacks, cigarettes, and other comforts. An initiative formally launched a couple of weeks ago by city officials funds a collaboration between the city and a number of the neighborhood institutions to bring fresh vegetables and other healthy, nutritious foods to under-served communities in west Baltimore. This effort is (at least on it’s face) an excellent example of an intervention in population health that targets a need by leveraging the relationships and resources already available to the community. 

The incentives for store owners are strong – support from government on a new, potentially risky venture, free advertising exposure, and a chance to deepen and broaden their influence in the community. Residents win as well, with added attention from city officials there is a potential ripple effect on other city services, the addition of easily accessible fresh foods for meals, and the undeniable benefits of positive energy and attitude that come with positive change.

A question that we have debated in this space and others is whether positive change is truly what is occurring. Is a change initiated from the lofty towers of Johns Hopkins or City Hall really the kind that neighborhoods in Baltimore need, or are the projected needs of the affluent (or merely well-intentioned) mistaken in their assumptions?

Regardless of the answer, there are clear needs in our city, and the symptoms include health disparities tied to healthy food. If the Today Show, the mayor, and the universities want to try to help, then we should all encourage that help, while advocating that the voices of those who are impacted are heard.

Finally, in case you’ve gotten all the way to this point and are wondering about the title, I want to encourage all of us who are engaged in some way or another in the gastric renaissance of Charm City to maintain awareness of what makes Baltimore so idiosyncratically delightful. Keep the crabs, the chicken box, and the pit beef when you design your new hipster restaurant, but feel free to put a spin on them, and I’ll take my salad of urban farm greens with the Natty Boh Blue Cheese vinaigrette.

No One Cares Which Fork You Use This Week

By | Health, The Global Is Local | 8 Comments

Culinary connoisseurs take cover, the untutored masses are flocking to your places of worship. Stay in, order out, but for the love of all that you hold tastily sacred, do not go to your favorite fancy restaurant, because I will be there and will be using my salad fork to eat my soup.

This is the end of Restaurant Week here in Baltimore, an event that has become a tradition for many foodie cities around the country and even the world (I just found one for Bangalore). The culture of food in our city is a microcosm for the psychological and sociological issues that we wrestle with, as is all food, in all settings. It also brings us together, or at least it can. Imagine if all the countries that excel at making hummus fought about who makes it best instead of all the things they have fought about for hundreds or thousands of years.

The first Restaurant Week took place in New York City as a gimmick during the Democratic National Convention, but it has steadily grown and spread. The premise, for you fellow heathen fork users out there, is that while we may occasionally glance through the massive panes of glass at the sophisticates inside the hottest and most happening eatery, we will not enter and savor a fine meal because of cost and fear of embarrassment. Restaurants participate in RW in an effort to bring us in, to tease us with scintillating samples, and like any good dealer, hook us on the finer things. Not everyone loves it of course, including those who would typically frequent the nicer restaurants since they are crowded and full of people like me. I personally am of two minds about it, and while I partake, I suspect that I am participating in a bourgeois charade and/or missing out on the genuine experience these places have to offer.

It is entirely possible that RW plays into stereotypes about rich and poor by allowing us to act the part of the rich and encourages us to value certain types of cultural experiences as more valid or valuable than others. My sense however, is that this is an event for young, white hipsters, and is not an especially democratizing event. This is not to say that I think Baltimore is not capable of food events that have these qualities, however. One of my favorite things about the farmers market downtown is that the customers there look like the city as a whole. A broad spectrum of ages, races, and religions (I love seeing folks in their Sunday clothes after church at the market) all coming together to buy kale and apples. The Gathering – the monthly food truck events held throughout the summer – also bring together a diverse mix of Baltimorean eaters, at a price point that is affordable by most, and providing street food that is often very good.

Restaurant Week purportedly excels at bringing us in to taste what we are missing, except that they are not necessarily serving the food that we would eat if we came in for a normal meal at $29-$45 for an entree. There is a reason that the prix fixe menus are affordable, and that the servings are small. This is a sample, good enough to bring us back, but not so good as to cause a major hit to their bottom line. For that reason, and despite the fact that I take advantage of the event at least once each year, I wonder if it is really effective at opening up fine dining to all.

Then again, it’s important to note that Restaurant Week’s economic impact is highly skewed toward the local marketplace. Most RW participants in Baltimore and around the country are locally owned and operated, single sites or small restaurant groups, and the money that is spent there by local people is much more likely to stay in community, where it will do the most good. Eating is in many ways a political act, the most demonstrative version of voting with your dollars, as you are also putting your money where your mouth is (and chewing and swallowing). Committing more of those dollars than an average week to local businesses, their employees, and the vendors that serve them is a tasty political action.

Now stand back, I’m going to use my soup spoon as a knife.

Lot’s Wife Is My Doppelganger

By | Health, The Global Is Local | 5 Comments

My wife often makes fun of me for being fat. She is being ironic, as I struggle to maintain a weight above that of a large watermelon, but she enjoys gently poking fun at me, and prefers to do it in a way that is very hard to take too seriously (I am very sensitive).

This personal anecdote is all a segue to the fact that I weigh a little shy of 140 pounds on average. 137 up to 144 depending on my meals. It’s genetic, my father is also a wiry but very skinny man. Anyway, this isn’t actually a post about obesity or healthy weight. I have lately become obsessed with the signs of Baltimore’s commitment to eliminate snow and ice from the road, and Smithsonian tells me that in the United States, 137 pounds of salt are spread on the road PER PERSON! That’s a me’s worth of salt for every person in the country.

It’s different this year in Maryland, of course, since we’ve been on the receiving end of our pal the Polar Vortex and a higher than average number of winter storms. The State Highway Administration has used around 280,000 tons (576,000,000 pounds) of road salt so far this year (which is about what is budgeted for the entire year, by the way, so drive carefully from now on), or about 100 pounds per person. And February is just beginning.

So a pillar of road salt that weighs as much as I do is an interesting concept, but doesn’t really address the confusion/disgust/horror/amazement that hits me every time I walk past a giant pile of salt that seems to have been dropped off the back of the salting truck in case of a very local, very intense blizzard (like maybe fifteen feet of snow, but in a two foot radius). I wasn’t really sure what I was so disturbed about — the run-off of salt water into the bay, the damage to the ecosystem from excessive salinity, the waste of resources evident in the inconsistent salt-spreading operation, the drain on city coffers for treating waste water, salty tap water. All of these vague and uninformed concerns together make observing these urban salt spills a disconcerting experience for me, and so I needed to learn more.

The short answer is that my reactions may be overblown. No one is going to die from salt exposure anytime soon. On the other hand, salt pollution is actually pretty serious in the broader public health context, if you consider environment, biological diversity, and watershed stability.

Researchers at the University of Minnesota determined that a majority of the salt applied to roads stay in the watershed where it is spread, and removal is difficult at best, in addition to being expensive. Fortunately in Baltimore a great deal of salty runoff goes toward the bay, where the salinity will do less harm than in a fresh water environment. Fish populations and plant life in local streams that experience significant road salt runoff are at risk, however, as some freshwater fish cannot tolerate salinity above 1000 mg/liter, 1/20th that of highway runoff.

Clearly, the Jones Falls and other streams in Baltimore City are no longer supporting thriving fish populations, but the overall goals of city planners claim to take stream and tributary health into consideration in the greening and cleaning goals centered on the inner harbor.

Salt will continue to be used, though, especially in winters like this one, for two compelling reasons:

  1. It’s cheap, around $35 a ton. That’s a lot of Adam salty doppelgangers for about the price of three six packs of Resurrection Ale.
  2. It works really well. At least down to a certain temperature. Salt lowers the freezing point of water, but it doesn’t prevent it from freezing altogether, as many of us have seen firsthand with the recent spell of temperatures in the single digits

Despite these advantages, road salt has some significant hazards to health and safety that should cause highway officials to consider moderation rather than excess. In addition to the dangers to fish and plants mentioned above, excess salt buildup (essentially giant salt-licks) on the side of roads can attract deer, heightening the possibility of vehicle/deer accidents causing injury or death to deer and driver alike.

So if roads must continue to be treated in order for driving to be (relatively) safe in B’more, then perhaps alternatives should be investigated. Polk County Wisconsin uses a mixture of traditional road salt and cheese brine. Other localities have had success with other mixtures of salt and locally available ingredients such as beet juice and sugar cane molasses. Baltimore could take advantage of one of many industry cast-offs that could be re-purposed in the interest of public safety. If no other appropriate source could be found, there is always the water from the bay itself. At least runoff of Chesapeake water sprayed on the roads would not cause a net addition of salt to the harbor.

The “I Have A Bike” Speech

By | Health, The Global Is Local | No Comments

Often, events of the past week will influence the content of my ChangeEngine contributions, and this week offers a number of temptations. The annual ritualistic dilution of the legacy of Dr. King into a few snatches of his “I Have A Dream” speech? The 41st anniversary of Roe v. Wade that spurs otherwise pleasant people to say things that make other otherwise pleasant people want to shake them and yell? The hint of peace talks in Syria? Terrorism threats in Sochi? Polar Vortex 2.0?

All tempting, of course, and all intimately connected to the broader subject of lower case P, lower case H public health.

However, something much closer to home also caught my attention, and I wanted to bring it to yours. It may not relate closely to the Olympics or global weather patterns, but biking in Baltimore can and should be considered a major public health issue, especially in the context of urban planning overall, access to city services, affordable housing, decent jobs, and promotion of healthy foods and practices.

Biking does have a substantial connection to equity and social justice, as an affordable means of getting to work, accessing services and being part of the life of a broader and more interwoven community. In that way, the words and deeds of Martin Luther King Jr. are not such a giant leap away from steps being taken to provide greater safe bicycling access to the center of the city to residents living to the East and West.

Downtown Bike Network

Whether or not you are an avid urban cyclist, it should be no surprise to anyone that biking in Baltimore City is a logistical challenge.

This, say some of you, is putting it mildly. In fact, you carry on, this so-called “logistical challenge” is a biking nightmare and furthermore, you state emphatically, it is the entire reason I won’t bike in the city.

Well, you make good points, I have to hand it to you there. On the other hand, I have argued that it ain’t really so bad, and that you should just get out and do it. Regardless, if we go back to my original contention of “logistical challenge,” for a moment, I would like to clarify that the problem is primarily directional. Within the city core, it is not that hard to get from North to South, and vice versa, on an admittedly limited number of fairly safe routes. However, if you have any interest in going East-West, with the exception of the harbor trail (not a great option for cars or bikes with traveling rather than sightseeing in mind) or perhaps Baltimore street (at certain hours a parking lot, at others a great biking route), you’re going to have a bad time – a geographic divergence in access that mirrors Baltimore’s socio-economic divides. Drivers are well aware also, but at least have a few good options that move pretty well through the snarl of North-South biased stop lights. Bikers do of course have more freedom, we can squeeze up to the front, maybe cut across traffic if we see an opportunity, and I won’t say I never do it. But it’s not safe, and it’s not nice, and it pisses all the drivers off, even the ones in Subaru Outbacks with a bike rack on the roof.

This is why the above graphic is so exciting. It promises East-West commuting plus a more westerly addition to the existing North South routes available on the Eastern half of the city’s core.

This is not revolutionary, it’s not providing relief from the food deserts, urban blight, or crime rates in deeply impoverished sections of the city. It does make a start, however, reaching from the west side in Sandtown/Winchester through to Oliver and into Broadway East. This represents a major access change for individuals either trying to cross the central part of the city or reach their homes from their place of work. Biking is fast – often faster than driving and definitely faster than public transit over relatively short distances. It is healthy, reduces the number of cars on the road, represents a major income boost to those who can make bike commuting a viable option, and builds community.

The planned changes are scheduled to start this coming summer, and are hopefully just the beginning. For a great number of reasons, both rich and poor people live close to the city center and also far outside it, and increasing bicycle access for all parties is a great equalizer.

Dr. King’s ultimate goal was equity. Equity for black and white, equity for rich and poor. I think that he would agree that in forging a path to the beloved community he dreamed of we could do a lot worse than travel by bike.

Resolve Yourself to Good. And Kale.

By | Health, The Global Is Local | One Comment

Hasdai Westbrook, ChangeMonger-in-Chief over here at the ChangeEngine central tower, sent over this link from Psychology Today on resolving to help others vs. helping yourself, noting that I had expressed interest in tying in the tradition of setting New Year’s resolutions in this week’s post.

“Oh, great. Thanks, Hasdai. As if failing at keeping my own resolutions isn’t enough for me, now I have to feel guilty about failing at the goals these folks have for me as well,” I thought to myself. However, as he often does, Hasdai demonstrated his benevolent and thoughtful ChangeMongering with intuition and foresight.

To summarize the main point of the author, setting resolutions aimed at helping others can contribute in multiple and reinforcing ways to the well-being of our communities. These beneficial activities leave their mark both on other people and the environment, and on the people who commit to them, driving positive physiological and psychological feedback loops.

None of this will come as a surprise, especially to readers of ChangeEngine blogs, but how can we ensure these social change resolutions will be successful as we plan our goals for the year. Think how many gym memberships purchased in January go unused; the same goes for our benevolent souls. Here’s a few behavioral change concepts and goal-setting techniques to make sure our do-gooding intentions don’t turn to flab:

1. Make yourself accountable to someone else. This is a strategy employed by the running and socio-economoic empowerment organization Back On My Feet, which has several chapters in Baltimore. The principle is simple: we are far more likely to do something, even (or especially) if it’s hard, if someone is counting on you.

2. Set SMART (specific, measurable, attainable, relevant and time-bound) goals, as Jasmine suggested on Friday. Cities around the country are setting measurable and attainable goals to spur action on ending homelessness. As demonstrated by the recent social media campaign to ensure those suffering homelessness were safe from dangerous cold during the ravages of the polar vortex this week, simple and specific actions by individuals like you and me can create real impact. All the campaign asked was for people to dial a hotline if they saw a homeless person so that that the authorities could offer them shelter. SMART goals can lead to real positive outcomes.

Baltimore Homeless Hotline

3. Use a commitment device. The principle is sound enough – your present self has a goal and doesn’t trust your future self to maintain your current level of enthusiasm and commitment to that goal, so Current Self sets up consequence that will kick in if Future Self doesn’t toe the line. The commitment device  is a little controversial, in that experts such as Freakonomics author Steven Levitt are dubious as to it’s efficacy. As we saw with the federal sequester last year, the prospect of something idiotic happening to you doesn’t necessarily mean it won’t it happen if Future Self is stubborn enough. One of my favorite commitment device stories was of someone who wanted to quit smoking so badly they wrote a $5,000 check to the KKK, and made someone else promise to send it if she smoked. The hatred of giving the KKK money was more compelling than the urge to smoke. As you can see, strategy #1 is essentially a form of commitment device and happens to be very effective.

Now I’m not suggesting you whip out your checkbook and start making a postdated check to your local klavern. Thankfully, organizations and movements such as Back on My Feet utilize the commitment device of accountability to others. They establish healthy practices that are beneficial to all of the participants, and have a multiplicative effect in the community. Maybe I could argue the same for my resolution to eat kale three times per week, but it would be a stretch. A better strategy for my kale aspirations might be to seek out one of the volunteer or cooperative urban farms nearby and commit to a task that would make my presence necessary, and guarantee me — almost incidentally — kale for each week. Thus, my kale supply is assured through my combined guilt complex at abandoning my duties and my satisfaction in contributing to the farm’s success. Oh, and incidentally, I have some free, locally grown and freshly harvested kale, so I had better go reward myself for keeping my commitments!

If Not You, Who?

By | #SaveBmore, Health, The Global Is Local | No Comments

This week has been an uplifting one for social and political activists and media hounds. The death of Nelson Mandela has brought together world leaders, pundits, politicians, and us common folk to celebrate the passage of a transformational leader.

I imagine that no one ever expected to see a Castro and a Bush standing together, yet the respect that people hold around the world for the life and works of Nelson Mandela brought them into the same room (or in this case, arena).

The power that is demonstrated in the aftermath of Mandela’s life — the celebration, the near universal belief in his goodness — is testament to the effect that a leader can have in engaging and motivating his or her people to do their own great things.

This week has also been a rewarding one for those in the ChangeEngine community. There has been great response to the weeklong campaign to discover what will “save” Baltimore, whether it needs to be saved, what that saving will look like to us, our neighbors, and the world, and how we as Baltimoreans might go about doing some saving ourselves.

My column here deals with issues related to public health on a macro scale with a micro focus, and so I meander from vaccination to food, from food to transport, to poverty, to pollution, to economics, and now to leadership.

One of my most psychologically taxing classes in public health school was centered around leadership. The professor brought in health care leaders and drilled us on the proper layout of a corporate leadership structure, including the role of board members and executives. I can speak from the authority of at least the upper left hand quadrant of the room that ‘bored’ members were what he had in front of him, and that the lesson was not sinking in. However, he was there to teach it, and so I was convinced that there was a reason.

Each of us has experienced a piece, a whiff of transformational leadership, perhaps on the job, in the classroom, on the playing field: A leader who transcends the role they are inhabiting and creates in each member of the team a desire to excel, as if some grand musical score is accompanying your every movement. This may happen for only a moment, or it may infuse your entire work experience (lucky you!), but the feelings and actions brought to the surface by this type of leadership allow us to be better than we are alone.

Photo credit: Wikimedia Commons

 

 

It is better to lead from behind and to put others in front, especially when you celebrate victory when nice things occur. You take the front line when there is danger. Then people will appreciate your leadership.

 

 

 

 

 

How does this tie into public health, and more importantly this week, into saving Baltimore?

My sense is that Baltimore is a city that is reaching for success. The city government, neighborhood associations, the ChangeEngine bloggers, the urban gardeners, the foundations, the artists — everyone has a vision for a better Baltimore, and they each view it through their lens. Chris Merriam of Bikemore commented on the ChangeEngine Facebook page yesterday that what will save Baltimore is “Bike lanes. Lots and lots of bikelanes.” OK, so I agree with him, of course. See here, here, here, and here, oh, and here for evidence. But he (and I) are speaking from a cyclocentric point of view (although we would likely both agree that this has broad implications for health, wealth and society far beyond bikers). The Weinbergs, Stephanie Rollings Blake, Hasdai Westbrook (of ChangeEngine fame), and you all have different visions of a successful Baltimore.

Now despite the wealth inequalities, segregation, and disease burden here that I often write about, Baltimore is not South Africa. However, leadership that is empowering, vision-driven, and inclusive has the power to be transformative anywhere in the world, in any setting. I am not advocating for the ouster of the mayor; I think she’s probably doing fine. But is she a transformative leader? She has taken on a number of challenging projects that have great promise — more families in the city, a clean harbor, lower vacancy rates — but these efforts have not inspired a groundswell of concerted support and action. Perhaps that is not the role in this city for a transformational leader. “Bureaucrat” may sound like a dirty word, but bureaucracy is effective, reliable, and honest (when done correctly at least, Ms. Sheila Dixon, we’re looking at you…).

Perhaps instead the role needs to be taken up by others in that list I mentioned above, as Chris Merriam is doing in the biking community. His sheer force of will and passion drive others to work toward his cause, and to feel good about it.

Nominate a transformational leader, Baltimore (or wherever you are):

Who do you see bringing people together, challenging them to do their best and more by example? Who is using vision-driven empowerment to allow their colleagues to do more, do better, or with more grace? Who among your social or professional circles takes on that role? How can you emulate those techniques to generate even MORE positive growth in your particular arena?

Are you a champion of transformational change by leadership and example? If not you, who?

Typhoons Are Not Someone Else’s Problem

By | Health, The Global Is Local | 3 Comments

On the other side of the world, there is another Inner Harbor — a narrowing area of water leading to the city, part of a larger bay that faces the ocean. Today the people by that harbor in the Philippines are suffering from lack of food and water, their homes and businesses have been badly damaged or destroyed, and their future is uncertain.

Our harbor is quiet and serene, if a bit murky, and has remained so throughout this year’s hurricane season. However, planners here in the city have been working steadily to prepare for a Baltimore that may be a great deal more chaotic and dangerous. The greater Chesapeake may not historically have suffered significantly from tropical storms, but the consensus among weather-watchers is that history is no longer the great predictor it once was.

On this side of the world, just to our north, another similar coastline traces Far Rockaway Beach, in Queens, where recovery efforts are still underway from damage sustained during Hurricane Sandy. The impact of Sandy is far-reaching in New York and New Jersey in particular, and has caused residents and politicians alike to plan for a very different future, one that requires them to be prepared for a far wider variety of effects from the ocean and the atmosphere. Cold winters with plenty of snow are still likely in New York, but Sandy has awoken us to the possibility of far less benevolent summers and falls.

A common theme among natural disasters is that the greatest suffering falls on the poor, sick, and fragile because they already find themselves in less safe housing, with little or no insurance, and falling through a tattered safety net. When these elements are combined with a vulnerable geographic position, there is a great deal of danger for the population. When municipal supports fall away and housing is damaged, this danger often comes in the form of public health threats, both from disease and exposure to the elements.

This is an important moment for us to reflect, especially with Thanksgiving around the corner, that we were spared a hit by Sandy, and to send our best wishes to those currently in dire straits in the Philippines. When events over a certain magnitude occur, there is a need for far greater resources than individuals can provide, and thus aid groups and governments are essential. If you are moved to donate, my understanding is that money is the most effective donation.

We can take some comfort here that the geography of Baltimore has important built-in safety features, namely the relatively rapid increase in elevation that would protect most areas north of Fayette Street; and the meandering vastness of the Chesapeake, which would absorb some of the storm surge if a hurricane were to make landfall in D.C./Baltimore. But the broader picture is bleak. This week, the United Nations Climate Conference kicked off it’s ten day set of talks, negotiations, and events in Warsaw. National Geographic referred to a tone of “realism” on the part of the negotiators — in other words, don’t hold your breath for a solution to climate change from an international group of nations.

This caused a bit of a crisis for me, and I wallowed for a brief time over the futility of it all. However, I felt better after recalling some of the many stories about the revitalization of cities — how Generations X through iPhone (or whatever we’re calling the kids these days) have a greater interest in urban living, access to public transportation, art and music — and are driving the redesign and resurgence of American cities.

We now see citizens demanding bike lanes and green spaces, prioritizing community, and opening and supporting small businesses. This wave of social change has the power to influence even the insulated green towers of the United Nations Climate Conference, at least in theory, but it will take time. The drastic change in driving habits has forced industry to change, and the same is becoming true for architecture and urban planning as well.

The responses to Sandy, Katrina, and Haiyan are political reactions. These reactions are guided by the policies of elected officials. In order to effect change, civic engagement is essential beyond the voting booth. If the prospect of another superstorm truly concerns us, then the health of the harbor could be a target for this engagement. Speaking with your friends and neighbors at a community meeting, taking a more global view can help put things into perspective: instead of cursing the ‘Rain Tax,’ your colleagues could be encouraged to understand that the fees are directed to the Harbor, and thus economic, ecological, and physical safety.

Finally, despite Hipster Trickle Down Complacency, remember that your dollars are your votes. The policies we support or reject in the voting booth often make little difference, but the values we support or reject with our dollars mean a great deal. Observe the use of the word “fresh” or the phrase “gluten free,” both largely unimpressive marketing strategies a decade or two ago, and now central or growing components of many major food, beverage, and hospitality brands. Your money IS your vote, and your beliefs.

What are you voting for, and what do you believe?

Vaccination Nation

By | ChangeEngine, Health, The Global Is Local | No Comments

My arm is killing me. I got my flu shot yesterday, fine, great. I am adding to the collective resistance to the flu for 2013 and 2014, go me! However at the moment, my arm hurts and I’m a little bit annoyed with my past self for allowing me to be stuck with a needle.

By contrast, one of my colleagues mentioned that her son doesn’t believe in vaccination and is going to India without getting any of the so-called “required” shots. Although I find it a little bit challenging to get behind that perspective, his perception is a useful one to consider.

The perception of interventions differs widely among different groups. For example, many younger people believe that insurance is unnecessary. Women and men have differing attitudes about what constitutes sufficient health care services. Different economic, social, and ethnic groups also demonstrate a diverse range of values and preferences — not just about health services, of course, but about trends, fashion, technology, social practices, religious beliefs, and so on.

These differences have substantial public health impact. Especially in a place like Baltimore, home of Henrietta Lacks, there is still a strong memory of the crimes of the Tuskegee syphilis study that only adds to a long history of discrimination, segregation, and well-earned mistrust of institutions. Currently, this plays out in disparities in rates of HPV vaccination among young women, influenza vaccination, and of course overall disease burden.

In my opinion, the duty to educate and promote healthy interventions falls on the institutions that have generated so much mistrust in the past — government, large hospitals, pharmaceutical companies, and the like. The successful experiences of the private sector — particularly in marketing and advertising — in spreading innovation among groups that are new to the United States might be one source of inspiration. Spreading immunization adoption among a population could follow the same model as spreading smartphone adoption — both benefit the maker of the technology (money in their pocket), the recipient (resistance to disease, greater productivity), and the group as a whole (herd immunity, better educational and economic prospects).

Regardless of the rationale behind a mother’s resistance to a vaccination program, the motivation remains consistent — protecting her child from harm. This is true here and around the world. The World Health Organization has found that vaccine adoption has less to do with medical understanding of the vaccine itself than with social norms and trust of the vaccine provider. This lesson must be taken to heart when attempting to address the 2.5 million vaccine-preventable deaths in Asia and Africa every year, and also when attempting to improve influenza and HPV vaccination numbers in Baltimore. A recent uptick in polio cases in Somalia is cause for concern, but so is the fact that the first few cases of influenza have been reported in Maryland. We can all do something about the second of these, at least, by taking steps to protect ourselves as well as encouraging our friends and families to do the same.