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Health

Oct 18
0

The Architecture of Our Psychological Health

By | Health, The Global Is Local | 4 Comments

“A beautiful old mansion would be easier to redevelop than a home where someone was murdered.”

This week’s post by Lindsey Davis spurred me to think again about how our environment influences the way we experience the world around us, and the impact it has on our lives. Lindsey points out the balance that is struck when planners and city leaders determine that a neighborhood or area of the city would be better demolished than repaired.

Perhaps, she argues, these parts of the city should start a new story, free from the architecture that haunts their past.

I think she is probably right. Their present is the part that I have been thinking about, though, and the impact that living with a history and an environment may have upon the residents in any neighborhood. Each of us experiences Baltimore in a different way, and so that architectural impact is different for all of us, depending on our habits and our pre-existing constitution. Many of us cut a fairly narrow slice of the Baltimore pie (or whichever city or pastry you live in), because of where we work, study, play, or live, and the locations and routes between these activities vary for all of us.

This past weekend, the Baltimore Marathon (which I watched, but did not run) wound it’s way through much of the city, hitting the Inner Harbor, Druid Hill, Waverly, and many miles in between. The Baltimore Bike Party often has a similarly winding route, and I appreciate that both attempt to expose both residents and guests to parts of the city that typically do not get seen by tourists, commuters, and — more often than not — white people like myself.

There is no way to understand the city from the Johns Hopkins Homewood campus, or from the Inner Harbor, or from the Under Armor headquarters. The particular portions of the city that Lindsey makes reference to are not pretty, and in fact may be derelict or downright abandoned, but are integral to understanding what makes this place. Neighborhoods stricken by urban blight have an enormous impact on the financial, social, and psychological health of the city.

From a public health standpoint (which, I have argued before, is perhaps the best lens through which to analyse a human population), there are a number of concerns that urban blight brings up, including correlation with poverty, high disease burden, low literacy rates, crime and violence incidence, access to food and services.. the list goes on, of course. However, an issue that is harder to quantify is the psychological impact of a blighted neighborhood.

A 2002 article in the British Journal of Psychiatry linked found statistically significant associations between the built environment and rates of depression. Another study published in 2002, this one in the Journal of Social Science & Medicine,  found that “neighborhood disadvantage was associated with higher rates of major depression and substance abuse disorder” among other negative psycho-social conditions.

This is not surprising. Think about your own home, and your favorite room or space in it. What are a few of the things that you like about it? Pick two or three of them and then meet me at the next paragraph…

Hi, welcome back. Although I can’t be sure, I strongly suspect that the things you like about your favorite room in your house have to do with beauty, comfort, positive memories or associations, or attractiveness. Now reverse that scenario, imagine your least favorite part of your home, and I would again be willing to bet a bowl of freshly roasted pumpkin seeds that the space you just identified has negative connotations, gives you feelings of dread, disappointment, or even disgust (if you’re struggling to get your walls out of the 1970s, I hear wood paneling looks great with a coat of white paint). Now scale these impressions to a street or a neighborhood, and the correlation with psycho-sociological outcomes starts to make a lot of sense.

It all comes back to the poverty/wealth disparity, in my opinion. Will money make you happy? Certainly not in isolation, but if it buys/rents you a decent place on an attractive street in a part of the city with strong civic engagement, then you’ve probably got a head-start on happiness compared to someone who lives sandwiched between abandoned buildings, has to rely on an unpredictable bus system to get to their job, and lives in one of only a half dozen occupied homes in a three block radius. Besides, once you’re in that nice neighborhood, there’s a good chance that grocery stores will be easier to get to, crime rates will drop, and transportation options will be better (well, maybe that last one is a stretch…).

The question that lingers for me is one that Lindsey also raised — is there a point where the “institutional memory” of a place is so malign that the only recourse is to remove the architecture of those memories? According to Lindsey, that may be the case. The individuals who collectively hold and live these institutional memories may be the most compelling reasons of all, however. Preserving a neighborhood of decay and bad memories is no way to effectively raise morale and standard of living. Instead, city planners may hope to cause social change through infrastructure improvements, a tired, but tried and true strategy that has had positive results in the past.

Oct 07
0

Baltimore’s Queen of Bioethical Conundrums

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

Hi, one baby please. We’d like a boy who will grow up to be 6’2″, play the piano, graduate from Harvard Law School, and dance a mean Polka. Actually, make it two, we might want to enroll them in tennis camp together.

The designer baby patent, as it is now known in the media, was recently granted to a company called 23andMe, which has made several splashes in the past few years as they released in-home genetic testing kits and other products. This has caused a lot of consternation among the public as well as the scientific community. I spend a lot of words in these posts declaring my lack of expertise on things, so let me carry on the tradition: I am not a geneticist, an expert in in-vitro fertilization, or a father, any of which might help me to help you understand this issue better, but I will carry on regardless.

One of the primary concerns for technology of this type is, of course, the potential for abusive use of screening technology. At one end of the spectrum are some generally acceptable uses of this kind of thing — screenings for congenital disease that would lead to an early death amid suffering, for instance. At the other end, I think we can agree, are the designer children I described in my intro. Press one if you would like a baseball team full of babies with extreme athletic ability, press six for the next Mozart.

This weekend was also the third annual Henrietta Lacks Memorial Lecture, hosted by the Johns Hopkins Institute for Clinical and Translational Research. For those of you who have not read Rebecca Skloot’s blockbuster non-fiction book about Henrietta, The Immortal Life of Henrietta Lacks, heard her interviews on NPR, or seen her on the Colbert Report AND live in Baltimore, please try to find one of those things right now and come back. The short version, however: Henrietta was born in Virginia, married, and eventually moved to Baltimore in order for her husband to work in the steel industry. In 1951 she was diagnosed with cervical cancer, a condition that led quickly to her death. During her treatment, a sample of her tumor was collected without her knowledge or consent, cultured, and propagated successfully — the first time human cells were successfully cultured. Since then, more than 60,000 scientific articles have been published on research involving HeLa cells; they were used to make the Polio vaccine, and they have traveled into space, among thousands of other applications.

The lecture was largely intended to memorialize Mrs. Lacks and acknowledge her contribution to science and humanity, through the distribution of scholarships for a high school student in the sciences and technology as well as for community college students. In addition, a long hoped for plaque was put up at the end of the day on the former home of Mrs. Lacks, commemorating the site.

The last hundred years have seen a remarkable span of growth in our awareness of bio-ethical issues, which has included the Nuremberg trials, the Tuskegee experiments, the Belmont Report, the Health Insurance Portability and Accountability Act, and others. The rate of informed legislation and rulings on bio-ethical issues is surpassed by the rate of innovation, as with all types of technological advancement, and so a greater burden must fall to us as citizens to act as monitors. There are promising strategies that emerge regularly, but these should not sacrifice the patients involved.

As I say, the past century has seen a dramatic and sometimes shocking number of ethical lapses in the medical and scientific community, particulary pertaining to the use of human subjects. This is one reason that stories like the recent patent granted to 23andMe give us cause for concern. We worry that we (or our brothers and sisters in the human race) will be treated poorly, abused, or taken advantage of.

In fact, this is the position that the Lacks family has been struggling with for over 50 years. At some points they have tried litigation to gain control over the use of the HeLa cell line, or at least share in the massive money-tree that their matriarch begat, or sue Johns Hopkins for their unethical (although at the time, legal) behavior. It is interesting how time and circumstance can change paradigms. The descendants of Mrs. Lacks are not so different from the majority of Baltimore residents. Like their mother/grandmother/great grandmother, many of them are still poor, still in a struggling neighborhood, still in the black majority that is treated like a minority. A process that began 20 years after Henrietta’s death — as researchers began trying to learn more about the cell line — has finally yielded results. David, Henrietta’s grandson, sits on a committee that helps to determine how the full genome of Henrietta Lacks will be used in research around the world. Rebecca Skloot’s book provided insight into the wishes of Henrietta’s daughter, Deborah. And Henrietta herself is remembered as a giving, charitable, loving person who shared and gave freely for the benefit of her community.

How can Henrietta help us to understand? A Baltimorean lady unknowingly at the forefront of a scientific revolution, she could not have guessed at what might come next.

The patent for testing for specific traits is only the beginning of a process that is almost certain to continue. Increased consumer access to previously Ivory-Tower-style scientific advancement is nothing new; in fact, it is something old. It is exactly how diffusion of innovative technologies always works, for better or worse [author’s note: except in the health care system, which is a discussion for a different day]. We are still struggling to determine how best to regulate the cell phone, which just had it’s 40th birthday, so even if we are concerned that drive-thru babies are about to ruin our world, something like that idea is eventually coming, in one form or another, and a better strategy than stopping it would be to make sure it happens with ethical oversight, by entities who have committed themselves to the public good. We shall see if 23andMe lives up to that challenge.

Sep 19
0

Obamacare? Isn’t That Socialized Medicine?

By | Health, The Global Is Local | No Comments

A recent trip up the East Coast to visit family and friends presented a brief but intense glimpse into the debate that still rages around the Patient Protection and Affordable Care Act, now often referred to as Obamacare, even by the President himself.

Some aunts were very enthusiastic, some suspicious, some entirely opposed, and everyone confused. Many people I talked to — friends, family, and brief acquaintances — had some facts that they were holding onto firmly, which often informed their overall opinion. Some facts were more factual than others, but given the scope of the legislation and the broader health care debate, this is hardly surprising. A representative of the Kaiser Family Foundation health news branch was on NPR this morning, and she pointed out that many of those that the law is likely to benefit most don’t even know that they will soon be eligible for coverage.

If you have concerns about your own eligibility and how to move forward, I recommend Leanne’s post, A Guide to Shopping for Health Exchange Insurance Plans, that ChangeEngine published earlier this week. She links to several other resources that could also help further your understanding. But a more cerebral question has now been kicking around in my head for the past 48 hours: if clever, well educated people with lots of resources have a hard time grasping the basic elements of this law, and the implications that will soon be forthcoming, how on earth will someone who has a limited social support network, perhaps limited internet access, and other limitations fare?

I believe that the roll-out of the ACA will have a net societal benefit, but on the individual level, many questions remain. Questions of access, for instance, as I just mentioned, or of equity for those caught in between economic categories: too ‘wealthy’ to qualify for Medicaid, too ‘poor’ to access high quality insurance products. There are answers out there to these questions, and I plan to devote myself to finding as many of them as I can between now and the beginning of October, when the open enrollment begins on state exchanges and Healthcare.gov, the federal portal.

If you have burning questions that you would like to have answered, please put them into the comments section at the bottom of this post. If there are a sufficient number of questions to warrant it, the next edition of this column will be devoted to answering them. If not, I will endeavor to answer the most pressing concerns that I have heard from friends and family over the past week, since I am confident they will apply to just about all of us.

In the meantime, please stay healthy!

Sep 16
0

A Guide to Shopping for Health Exchange Insurance Plans

By | Health | No Comments

In just two short weeks the online exchanges or health insurance marketplaces will open and millions of people will have the opportunity to begin shopping for various health insurance plans. Coverage won’t begin until January 1, 2014, but it is super important to know what you are getting into before choosing a plan.

The online exchanges are intended for small business owners and people who don’t receive health insurance through their job. If you are unsatisfied with your employer’s health insurance, you probably won’t be able to get a different plan through an exchange unless it costs you more than 9.5 percent of your income or if it doesn’t cover the required essential health benefits.

The first thing to consider when shopping for a plan is that all health insurance plans in the exchanges will be categorized into four tiers: bronze, silver, gold and platinum. Although all plans are required to cover essential health benefits, they differ in how you pay for them. The bronze plans have the lowest premiums but the highest out-of-pocket costs whereas the platinum plans are the opposite with the highest premiums and lowest out-of-pocket costs. In the bronze plans, the individual is expected to pay about 40% of health service costs with each tiered plan covering about 10% more ( so, silver: 30%; gold: 20%; platinum: 10%). The idea behind this is that if you are a generally healthy person who rarely needs more than preventative care, a bronze plan may work best for you. If you are someone who gets sick a lot and seems to need a lot of health services, a platinum plan may work best for you.

It may be easy to choose between a bronze and platinum plan, but maybe not between bronze and silver or silver and gold. One consideration is that the out-of-pocket costs for the bronze plans will be capped at $6,350. If you think the bronze plan monthly premiums are still too expensive for you, you may be able to apply for a Catastrophic Health Plan if you are under 30 or get a “hardship exemption.” In this type of plan, your monthly premium will be a lot lower but you’re only covered for 3 yearly primary care visits. If you’re have a medal plan however, you may be able to add benefits to your coverage.

Another huge consideration is the subsidies on your premiums for which you may qualify. The Advance Premium Tax Credit will be applied directly to your premiums, so you save immediately. Incomes up to 400 percent of the Federal Poverty Level will qualify for these tax credits with the lowest incomes receiving the largest credit. A general range for individual households receiving credits is an annual income between $11,490 – $45,960. If you want more specifics, you can try out the Kaiser Family Foundation’s Subsidy Calculator until October 1st.

So if you have an idea by now of what plan you’d like to go with, the last thing to do is pick an insurance company. Here is a list of estimated premiums for plans in the Baltimore area (many other states/areas can be found here). Each company will differ in the specifics on how much you pay for certain services. For example, one plan may cover completely your prescription drugs but charge you a little more for dental services. Besides price, you may want to consider how the health insurance company is run. I encourage people to check out the CO-OP insurance plans since they are non-profit and will probably put you, the patient, first.

Still confused? Don’t worry, once the exchanges open, many clinics and online/telephone support services will provide trained “Navigators” who will help you decide which plan is the best for you.

IMAGE CREDIT. [www.protocol.gov.hk].
Sep 06
0

Choo Choo ChangeEngine?

By | Health, The Global Is Local | 3 Comments

Our ability to get to our places of employment is one of the greatest contributing factors to health and wealth. I and other ChangeEngine bloggers have made this connection a number of times over the past year. Without access to sufficient capital (i.e. wages), your ability to access adequate and sufficient food, shelter, and services is extremely limited. It is no coincidence that high-income neighborhoods have transportation flexibility and even redundancy — train, bus, (perhaps multiple) reliable cars, bikes, and pedestrian options may all be available.

This week, Governor O’Malley and a group of local and state officials including Mayor Rawlings-Blake came together at the the West Baltimore MARC station to announce a number of major investments in transportation projects for the city. The headline item is of course the Red Line, a Light Rail line that will be intended to travel East-West from Woodlawn through to the Hopkins Bayview campus — two major employment hubs, while intersecting with existing rail and bus routes on the way.

Many Baltimoreans already have a sense of eye-rolling weariness about the Red line, and justifiably so. It has been a long time in the planning phase, and is not anticipated to start carrying riders until 2021, far too far into the future for us to think seriously about it on a regular basis, at least until construction begins. However, the frustration citizens currently feel with the protracted planning process is nothing to how they will feel after six or more years of major construction.

I must advocate for patience and acceptance, however. Rail networks are an essential component of modern cities, and without it, Baltimore will lag behind its neighbors. As I have said in previous columns, Baltimore’s anemic public transit system contributes to health and wealth inequalities, and perpetuates deeply entrenched racial divisions throughout the city. An expansion on the scale of the Red Line project has the potential to demolish some of those boundaries, although 2021 is a long time to wait. Construction and transit system jobs will increase, however, and many of those jobs will likely be filled by locals.

What concerns me, of course, is the broader transportation landscape around this massive infrastructure effort. Living in Pittsburgh for the past few years, we lived with an ongoing light rail project the entire time. The North Shore Connector cost half a billion dollars and connects two points that are about a mile apart — although it has to go under the river to get there, which IS pretty cool. The problem there, and potentially here, is that there was not a holistic approach to the project: no similarly herculean effort put toward making it easy to get to the station, no bike-share program implemented simultaneously, and no broad improvement of pedestrian walkways outside the immediate station entrance. Sidewalks a quarter mile away that were previously (virtually) inaccessible to wheelchairs or mobility-limited individuals got no attention, and the city busses or disability-access vans remained an essential tool for all those who used them in the past.

There is still lots of time for Maryland to steer this transportation initiative. The Governor announced $1.5 billion in funding for Baltimore area projects, but the overall Transportation Infrastructure Investment Act allocates $4.4 billion over the next six years. The most expensive parts of these projects involve major construction efforts, but many comparatively inexpensive additions could be made as well, such as pedestrian services, bike-shares, and downtown greening.

Although not the biggest part of the announcement, the first change we will see is weekend MARC train service finally being offered between Baltimore and Washington D.C., beginning in December. Personally, I am very excited about this, as I will be able to get down to the Capital on my day off without needing to know where to park or how to navigate the city.

Weekend MARC service has the (probably unintended) potential to provide access to higher wage jobs for those who work in the service and retail sector. Restaurants, stores, hotels, and hospitals do not maintain the five day work week, and opening up a relatively inexpensive route to D.C. on the weekends means that Baltimore residents have greater choice and earning potential in those sectors. It remains to be seen how popular this option is, of course, but tracking the results over time will be very interesting.

My hope is that the Governor’s announcement will address the needs of the community — improving our ability to get to work, make a decent living, and support our families and communities.

Sep 03
0

Where Obamacare Fails

By | Health | No Comments

I shy away from criticizing Obamacare too much because I think it provides some major improvements to our health care system. Personally, the law has positively impacted me — more free preventative care, more services covered and longer coverage. But lately I’ve become a bit fed up with my own health insurance and doctors’ visits, and it’s hard not to ignore all the negativity surrounding the law. Obamacare isn’t the problem here. It’s definitely not the solution either. Rather, Obamacare is kind of like a band-aid that distracts you from the real problem — a health care system that perpetuates inequality.

Ironically, this past year I met a lot of bright-eyed Johns Hopkins students who came to be a part of the “best” health care system in the world. And our medical education is arguably the best in the world (thanks to the 1910 Flexner Report that set Johns Hopkins Medical School as the gold standard for medical education and compared all other schools to it.) There’s no doubt our doctors can do amazing things. A news report stated that a Chicago suburban hospital has a 97% survival rate for gunshot wounds that enter the ER. Considering that a bullet can enter your upper torso and exit in your lower torso, damaging every organ in between, that is a spectacular rate. It’s the long-term care after the fact where we drop the ball.

Here’s an all-too-typical story: a patient is admitted to the hospital, can’t get out of bed for weeks on end and when it’s time to leave,  they no longer have the strength to walk. Patients lie in their hospital bed for weeks eating crappy hospital food and their only option for exercise is to be the creepy person walking up and down the hallway in their hospital gown dragging the IV stand. Healthcare in the United States is amazing at the quick-fix, but when it comes to helping a patient overcome root causes of illness, we don’t really try. There’s rarely any sufficient patient education or measures taken to prevent re-admittance to the hospital.

What’s even worse is what can come after the hospital — a nursing home. No one wants to be in one. Not even the workers like being there. If you can’t afford at-home help, off you go to spend most of your time eating more crappy food and watching more TV in bed.

Patients at all hospitals should be receiving holistic care. Take the New York program that allows doctors to prescribe vegetables, for instance. Instead, many patients are being subjected to a long-standing though theoretically taboo practice called “patient dumping” where patients at one health facility are forced to another, usually because of their insurance status. Though hospitals are required to treat whoever enters their doors under the Emergency Medical Treatment and Active Labor Act of 1986, patient dumping still occurs, even as horrible as busing people to another state.

Soon about 30 million more people will have health insurance, but it’s scary to think that “patient dumping” might still occur even if the majority of Americans are insured. Will you be referred to a crappier facility if you have the cheapest health insurance? That’s the thing with our health care system — if you have more money, you receive better and faster care. There will be minimum benefits thanks to Obamacare, but people with more money will still be able to afford better health insurance even with the “Cadillac” tax for the more exhaustive insurance plans. In Germany, health insurance will cover spa days and yoga if your doctor prescribes it. Why can’t everyone have benefits that would get a “Cadillac” tax? If only we could take a step back and realize the care we’ve been delivering is actually not the best in the world, then maybe we could start on the path to the equal holistic care we all need and deserve.

IMAGE CREDIT. [robcares.com].
Aug 22
0

We Just Keep Doing Dumb Stuff

By | Health, The Global Is Local | No Comments

Do you ever wonder if we are a species of idiots?

I generally don’t feel that way, actually, but sometimes it seems like the only viable hypothesis. It explains SO many things about our behaviors.

This afternoon I read that lots of young women in this country think that exposing themselves to harmful radiation on a regular basis for the purpose of slightly changing the color of their skin is a good idea.

Question: Is this dumb, or smart?

Answer: Dumb. The increase in risk level for skin cancer as a result of using a tanning bed is 100 percent for those younger than 25, and 75 percent for those under 35.

Don’t worry, lots of guys are dumb too, as are almost all groups of people, divided any way you like — age, gender, race, geographical origin, religion, cultural heritage, etc. All groups do things that are bad for us, more often than not with a pretty good grasp of the facts about what makes the practice dumb.

I won’t bother to list examples beyond tanning and smoking, though, because despite the fact that culturally ingrained practices are dumb, they are often passionately defended by their practitioners. And, let’s face it, there’s just not enough space here for equal opportunity mockery of all of our traditions, so if your family or friends love to eat fried food, binge drink, self-flagellate, do drugs, run marathons, drive fast, or listen to terrible, terrible music (Bieber, Public Health Enemy No. 468), I am not going to take you to task at the moment. Rest easy, your practice is safe from my attention, but be aware that you are probably doing something dumb on a regular basis.

Smoking is one of my favorite examples, but not for the general populace, although I think we can agree that most smokers know that their habit is harmful. What really amazes me are the health care workers who I see at the side entrance of hospitals or long term care facilities, taking their smoke break. There are few people out there who have a clearer idea of the harm they are inflicting on themselves.

Obviously I don’t have any suggestions about how to alter the fact that we all do things that are bad for us. If I did, clearly I would have applied for my grant from the Robert Wood Johnson Foundation, hired a staff of investigators, and maybe patented something.

The obvious solution — more education — has a fatal flaw, exemplified by the smoking nurses: it doesn’t work. People who know better just do it anyway. This isn’t true of all behaviors, or all groups — harm reduction strategies in Baltimore and elsewhere involving educating IV drug users about needle re-use have been quite effective over the past 30 years, leading to lower infection rates for HIV, Hepatitis C, and other diseases.

Maybe the true problem is that education efforts are ineffective. Some are unfortunately ineffective because they operate based on incorrect assumptions, such as those with a strong basis in religious or cultural opinion rather than fact, like abstinence-only pregnancy prevention programs or vaccine avoidance. However, there are lots of hours and dollars spent on methods that are scientifically validated, and yet many long term, population level problems persist. According to a 2012 publication from the World Health Organization, effective health education requires interventions at individual, local, regional, and state and/or national levels. This requires comprehensive policy guidance that presupposes informed, or at least engaged politicians and leaders, which is not always the case.

Money is a factor as well, of course, both in the form of raw capital needed to produce materials and pay salaries, but also in terms of competing interests. Often the things we do that we know we shouldn’t have a strong economic interest behind them, and so those who try to counteract the negative effects of the behaviors are working against vested interests as well as their clients/friends/family members.

In the meantime, remember that family and peers have the greatest level of influence on behavior, so be an advocate for the well-being of those around you.

Aug 21
0

To Be Young and Invincible

By | Health | No Comments

After a year of AmeriCorps, living in poverty while dealing with Hopkins staff and students and Baltimore city youth (all intimidating in their own way), I do feel quite powerful and invincible. I’m moving to Africa and the world is mine for the taking! According to Joel Stein’s The Me Generation such narcissism and self-confidence is beneficial since it causes myself and others born between 1980 and 2000 to think that we can change the world for the better. At the same time, such traits are becoming a barrier to the success of the Affordable Care Act.

The Department of Health and Human Service recently announced a video contest, pioneered by the non-profit The Young Invincibles, that will give up to $30,000 in prizes to winners who convince the millennials to sign up for health insurance. A little bit of peer education – smart idea. Getting people ages 18-30 is an integral part of making Obamacare work and keeping critics at bay. Having healthy people to pay for insurance (or medical care of the poor) is a sacrifice that all other countries with national health care consider a no-brainer. And it should be. Getting young healthy people to pay for insurance means keeping insurance costs lower for everyone else (ideally).

Most critics have already been complaining about higher premiums costs under the ACA. But all premium increases (whether it’s an increase to an already existing plan or a comparison of the new plans in the exchanges) will have to be approved and out-of-pocket costs will be capped, eventually (unfortunately this requirement will also be delayed another year). Another consideration is that all health insurance plans will have to have minimum benefits so even if you’re paying more, you may be receiving more too. Slowly but surely states are releasing estimates of health insurance rates from the exchanges, and depending where you live it could be more or less. Plus people up to 400% of Federal Poverty Level will be receiving subsidies for health insurance.

So if you’re young and invincible and will very soon need to start thinking about purchasing health insurance, the government has given over $67 million to organizations that will help people navigate the exchanges. United Way and Planned Parenthood are two of the most popular organization to receive grants while University of South Florida Association of Community Health Centers and United Way of Metropolitan Tarrant County (Texas) were among those to receive the highest amounts. Or if you want to start taking things into your own hands (feeding into those self-reliant stereotypes) these pointers from Kaiser Health News will serve you well. And if you’re still hesitant about even considering health insurance, this article from New York Magazine describing how vulnerable we truly are might change your mind.

Aug 08
0

Let Us Eat Lettuce

By | Health, The Global Is Local | One Comment

Don’t forget to bust some silos! And let us know how you’re doing it!

And now…. Lettuce!

So, as you may have guessed, the title of this piece has both a global and a local angle, as is the norm for this column. First, of course, is the global (or at least hemispheric) — the recent cyclospora outbreak plaguing Texas, Nebraska and Iowa predominantly, but scattered other cases as well. The outbreak seems to be tied to lettuce served in some chain restaurants, although that assessment is so far limited to the cases in Nebraska and Iowa. The source of this lettuce is a company in Mexico, and highlights the impact that a global food chain can have far from the growing site.

In the meantime, we have moved past lettuce season at the local Farmer’s Markets in Baltimore, not because there is no longer lettuce available, but because so many other things are! I still buy lettuce every week (since I keep forgetting to reseed my own after the last batch got fried to a toasty, lettucy crisp in that one week of terrible heat), but it doesn’t excite me in the same way it did in May. It’s the same as the leaves on the trees, isn’t it?

May: “Oh wow, stop the car, everybody pause, look, a leaf-colored thing!”

July: “If there weren’t so many leaves, it might not be so humid. When is Fall starting?”

Anyway, lettuce is still great, but there are also fresh peaches, tomatoes, beets, string beans, and corn, so you’ll have to excuse me if lettuce is no longer as exciting. Still love it, less excited. Don’t be mad, lettuce.

Image Credit: Wikimedia Commons

The FDA and the CDC are in the midst of working out the route of transmission of this outbreak, but it’s more than likely that this episode is now in the past for those who were infected (although several dozen needed to be hospitalized). If they are lucky, they may be able to trace it back to a single worker in the facility in question, but again, this is already moving toward Old News, and by the time that information comes out, even the folks infected with the parasite will have begun to put the experience behind them. Probably.

Cyclospora causes a pretty unpleasant condition with symptoms that include the full range of gastrointestinal ickiness, as well as some flu-like fatigue and aches. Washing pre-bagged greens goes a long way toward preventing infection, though.

My thoughts about the global food/local food issues this story raises fall into a couple categories.

1. Local vegetables may sometimes be more expensive, but they also support your neighbor, so that’s good.

2. Scale is important in this issue. The scale of global food producers demands an amazing amount of labor and process, and that means that despite careful systemic controls, there are simply more cooks in the kitchen, so to speak, and any one of thousands of workers could potentially introduce a parasite into the process. Local, small scale farms may not be able to address the needs of a national or international restaurant chain (in the current model of doing things, anyway. Check out Big City Farms for an example of small scale local ‘industrial’ farming that supplies restaurants, or Farm Alliance for a farmer’s collective model), but the owners are often the workers, drivers, and bookkeepers, or share the responsibilities with a very small group of coworkers. This doesn’t prevent the possibility of infection, but it does mean that one or two people can know just about everything about the entire product cycle, from dirt to dinner table.

3. The global food chain is an essential component to almost all of us, especially in intensely urban or suburban regions. On the East coast, it’s pretty challenging to grow, hunt, and wildcraft all the food you need for your family, and if you do, it’s not an option for everyone. In fact, sub/urban resources would tap out very fast if more than a fraction of a percent of the population followed such practices. A safer, more accountable global food chain is something that society is struggling with right now. Perhaps this is due to cost?

4. Cost. You know that cheap, fast, good tri-chotomy? It can’t be all three, and maybe can’t even be two out of three. Maybe global food has been cheap, and gets to us fast, but continued examples of preventable food-borne illness should cause us to question if it is still good. If global food is to continue to fill the vital role it holds at the moment, it will need to continue to be fast (lettuce doesn’t have a long shelf life, and Mexico to Maryland is a long trip). We want it to be good (I have no desire to have two months of diarrhea for the sake of some inexpensive arugula). Maybe it’s time to consider that it should not be quite so cheap. The cost of transport has gone up significantly in the past decade, and we don’t pay full price for that increase. Corners get cut elsewhere to maintain profits, and bam, Red Lobster is on the news.

5. (Last one, I promise) Finding a balance in this context should be a food system that is healthy, economically viable, and safe. Local producers should be given incentives that would allow them to play a greater role in their local food economy, and international producers should be rewarded for delivering goods that are safe and nutritious.

No problem, right? Any ideas?

Aug 06
0

Introducing: Evergreen Health Co-Op!

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In less than two months, health insurance exchanges around the country will be helping people to enroll in health insurance. In Maryland, you can get all your questions answered at Maryland Health Connection, our online exchange. Or you can sign up for Evergreen Health Co-Op, Maryland’s first non-profit health consumer oriented and operated plan.

One of the best things about Co-ops, besides the intent of offering affordable and comprehensive health insurance is that they will be partly managed by members. Evergreen will open positions to members on its board of directors which will make costs and operations transparent to the customers. It’s the first time that the American people will have a say in how their health insurance is run. Currently there are 24 states that have state-run co-ops, all of which have been given grants from the government.

Although Evergreen is a brand new organization, most of their insight comes from the current president and former officer of the Healthy Howard Health Plan which gives low-cost health insurance to residents of Howard County who aren’t eligible for Medicaid. The program also focuses on social determinants of health such as education, housing and employment.

It’s a common misconception that Medicaid serves all low-income individuals. But it doesn’t. It serves people with children, with disabilities or the elderly. If you’re a low-income childless adult, where do you turn? For the residents of Howard County they have their awesome comprehensive plan. For other Maryland residents they can turn to the Primary Adult Care (PAC) program which basically will hook you up with a primary care doctor but nothing else, and only if you make less than $2,000 a month. Otherwise you could turn to The Access Partnership (for people living near Johns Hopkins Hospital), the Maryland General Financial Assistance or a free health clinic such as Shepard’s Clinic. Starting January 2014, PAC will be no more, but what will happen to free health clinics?

Some clinics such as the Esperanza Center, which primarily serves the immigrant population, will continue as normal. Others may have to reconsider their purpose completely. Maybe we will see more health resource centers that focus on improving the social determinants of health. And others still might begin charging insurance companies for their services. It’s almost scary to think that free health care may become extinct but we shouldn’t have to have these non-profits filling in the gaps in the first place… right?

IMAGE CREDIT. [www.bernardhealth.com].