Health Archives - Page 3 of 8

Jul 26

Summer: Sun, Humidity, and Hurricanes

By Adam Conway | Health, The Global Is Local | No Comments

Remember Sandy? She (or he) was barreling down on us not so long ago. There were recommendations to stockpile water for three to five days, BGE was pre-emptively cutting tree limbs that threatened wires, and I’m sure there was a run on Old Bay and Natty Boh in the supermarkets.

Hurricane Sandy Storm Track as of October 26th, 2012

Image credit: USGS

The reason Sandy is now just a memory of a disaster that could have been (for most of us in Baltimore City, anyway) is that things turned out very differently than they could have. The storm turned away from us and instead focused it’s attention on our neighbors to the north.

What I heard most often in the days afterwards were variations on “We were so lucky!” Homes and lives were destroyed in New York and New Jersey. Entire hospitals were evacuated. Billions of dollars in damages are still being assessed, repaired, and replaced. Part of the extent of the damage has to do with the sheer density of the regions affected, of course, but Fells Point and Canton aren’t exactly ghost towns, and the Inner Harbor is far from a dilapidated dump that can be written off for the insurance money.

“Lucky” might be a bit of an overstatement, though. It’s certainly good that we didn’t get a direct hit, of course, but there are massive atmospheric forces at work that dictate the speed, direction, and overall countenance of storms.

Last October, I was wondering a couple of things as Sandy traipsed along the coast.

1. Why is everyone in such a tizzy? Doesn’t this happen all the time? We’re right near the coast!

2. What is Natty Boh?

The answer to number two became clear before long, although it has yet to make a substantial impression on me. Cheap beer that isn’t terrible is good to have available, though, so I don’t have any objections.

Number one, regarding tizzies, has only started to make sense in the (almost) year since then. First, Baltimoreans like to have strong reactions to weather, whether it’s complaints about the heat, driving like a fleet of grannies in a quarter inch of snow, or stockpiling for the apocalypse when a big storm approaches. Second, like I said earlier, there are some macro factors that affect the behavior of hurricanes. Atlantic hurricanes that move up the East coast typically follow a consistent, if broad, path that dog-legs North and East as it passes the mid-Atlantic region. This is why there has not yet been a direct hit on the city, despite the storm surge from Isabel that I still hear about sometimes. So although that general pattern was still predicted (see image above), that dog-leg would mostly be over land, and pass right over us, which would be unusual. Needless to say, Sandy decided to follow protocol and headed North and East instead.

Changes in the behavior of the Gulf Stream have the potential for throwing many of our normal prediction models for a loop. Along with hypothesized frigid temperatures in Europe, there are many questions about how future storms will behave, and whether past prediction models are adequate to assess risk in various places. Due to the effects of a little “theory” about global warming, the 100 or 500 year storms are now storms of our time, not of the distant future or past, and their behavior is becoming less predictable. Even a hurricane such as Sandy – large, strong, but not record breaking by most measures — had a storm surge that would have put much of the downtown area underwater including City Hall, the police headquarters, and of course most of Fells Point, Federal Hill, Canton, and Locust Point, among others.

If those aren’t compelling reasons for some serious consideration about how we invest in infrastructure, housing, and tourist destinations in places like the Inner Harbor, I don’t know what would be.

Jul 22

Obamacare Mash-up Model

By Leanne Demery | Health | No Comments

If an alien came to America today and asked you to describe our health care system, could you?

I certainly doubt you would be able to fit it into one sentence. It’s a smorgasbord of private insurance, government programs (Medicare and Medicaid), non-profits and a lot of things in between. Lucky for some other countries, they don’t have this problem. And two in particular, Germany and Britain, are seen by experts as two of the best models for health care.

The Bismarck Model

For 130 years the Germans have been using this model of health care. Adopted by the French and many other countries, including the U.S. to some extent, this system uses insurance or “sickness funds” to pay for medical care. Employers and employees contribute to the funds through payroll and the government sets budgets and prices. This model works really well for a lot of countries despite the doctors who often exercise their right to strike and protest for higher wages.

The Beveridge Model

This is the epitome of the single-payer system. The government, through taxes, is the sole payer of medical care in Britain and other countries such as Spain and Cuba who’ve adopted the model. The government keeps costs low and patients never see a bill.

The Obamacare Model?

The other week I had the privilege of seeing Wes Moore speak (author of The Other Wes Moore, a true story about two boys from Baltimore with the same name who grew up to have very different lives — a must read). He said one of the smartest things I’ve heard in a while. His definition of a good politician was someone who sees what’s already working and helps to make it work bigger and better. To me, I think that is what the Obama administration tried to do when it came to health care reform.

For example — and Obama has said this many times — they looked at Mayo Clinic and Kaiser Permeante for inspiration on the Accountable Care Organizations that have been popping up in Medicaid. In these organizations, multi-disciplinary groups of health care providers are accountable for the quality and cost of care to the patient. This could be a shift from the old fee-for-service model of payment and is one of the few cost-control initiatives in the affordable care act.

On a less popular note, what had been working (or more like had created a market so big that it couldn’t be shut down, cough, cough Blue Cross Blue Shield) were private insurance and employer-based insurance. Since the turn of the 20^th century this is what has been “working” and is most popular in the country, for better or for worse.

In this way and many others, Obamacare tried to improve on our current mash-up health care system. But will Obamacare be known as a model for health care? It certainly is the first reform and health care system that advocates for the market-based approach. Even though the Affordable Care Act itself isn’t popular, most of the provisions on their own are.

IMAGE CREDIT. [www.transatlanticacademy.org].

Jul 12

Congestion Cycle of Doom

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

…..But first, a look back at Silos in the ChangeEngine world:

Thanks to everyone who has provided feedback, either in the comments section of Silos or Silos II, The Power of the Triple-S, in person, or as Michelle and Rodney did, in full fledged posts on ChangeEngine. Excellent discussions have been taking place, and I want to encourage that to continue. Challenge yourself and your colleagues:

What is the box you are in, for better or worse, and how can seeking partnerships or experience outside those parameters benefit your organization AND the community you live in?

Good luck, and keep us all posted! Link back to Silo Breakers as you post about your efforts, use a hashtag (I’ll defer to Hasdai on how to do that), and talk to friends and strangers… (Ed: Thanks Adam. It’s @ChangEngine #breakoutchallenge on Twitter, facebook.com/ChangingMedia, or email hasdai@changingmediagroup.com).

——-

Okay, this week, we touch upon the issues raised in posts about bicycling this past Spring (B’More Bike Friendly, Bikemore in Baltimore, and I Bike, You Bike, We Bike!) but with a wider lens. Although the previous posts brought up the local ramifications of taking cars off the roads, getting more of our community off the couch and out of the drivers seat, and so forth, today we will take a further step back to look at the transportation trends across the country and the world.

As was noted in the recent post by Stu Sirota, Our Trillion Dollar Dirty Little Secret, transportation funding in the United States is hyper-focused on roads and bridges. It’s not an unreasonable priority. The road infrastructure throughout the nation is vast, adding up to just over 2.5 million miles of pavement (not including the quadrillions of acres that make up parking lots and such things). We rely on roads and bridges for transport and economic vitality.

Image credit: Wikimedia Commons

The trouble is that those pesky roads share some unfortunate traits with us — they get stiff in the winter, squishy in the summer, and show the effects of age sooner than they feel like they should (“I swear it was only yesterday that 695 and I were at the prom together, young and fresh, and now look at us, full of potholes and cracks!”). The context in which this massive infrastructure was built was far different, and the maintenance costs increase over time. The current political climate has not been productive for passing thoughtful, long-term legislation of any sort, and future transportation bills may face the same problems.

As Sirota points out in his piece, the network of roads and associated development that have grown out of the national highway building efforts of previous decades have initially eased and then subsequently caused congestion and a need for expansion and development.

Shifts in our expectations about transportation, urbanization, work and play are undergoing a generational shift, however, which may reverse or at least force a reassessment of earlier priorities. New industries and young workers have a greater interest in working and living in urban areas, rather than suburban software parks for instance.

OK, so great, good for U.S.; we’re progressive as hell and living the green dream, right? Well, no, of course not. America will continue to rack up miles on our cars, build roads while others crumble, and generally remain a servant of the internal combustion engine. But things will improve, of course — better gas mileage, improved bike/car education, and pro-environmental youth will vote with their dollars more and more as they join the labor force.

Other places in the world however, are on a different trajectory:

Image credit: European Environment Agency

The developing world has long epitomized a biking culture for decades, and although many people now own Motos (mopeds, scooters, or other low-powered motorbikes) and aspire to own their own car, bikes still fill the streets. India and China in particular are projected to experience a massive increase in car ownership in the coming decades, fueled (ha) in part by their own domestic auto industries.

Image Credit: Wikimedia Commons

This trend is going to have a massive impact on vehicle emissions in coming years, but with any luck, the exploding population of car owners will be the proud owners of smaller, more fuel-efficient cars than were typical in the United States — imagine millions upon millions of Cadillac Eldorados cruising the Chinese landscape. At the same time, heavy industry in these countries will likely benefit from a greening culture as well as more efficient technologies, decreasing environmental impact.

This ebb and flow of transportation and urban fashions both here and around the world will have profound and lasting effects on our lives, our economy, our health, and our city. Baltimoreans have a particular responsibility to share innovations, be good ambassadors when traveling or hosting international guests, and break out of our regional and national silos when we engage in the online community.

Baltimore shares many characteristics with cities in the developing world — substantial industry presence, high poverty and disease burden, and vibrant pockets of entrepreneurship and innovation. We must share our lessons learned, reach out to inspire others, learn from disparate cultures with similar characteristics, and change the world.

Jul 09

Obamacare’s Delayed But Not a Disaster

By Leanne Demery | Health | No Comments

It’s been a rough week for Obamacare. Last Tuesday the White House announced it would delay the employer mandate of the Affordable Care Act until 2015, giving businesses with 50 or more employees an extra year to figure out how to provide health insurance. Because of this the law has been under major scrutiny since many critics believe this is proof of failure. Though this delay is definitely a huge setback for morale, there could be some good that comes out of it.

But first, the cons.

Besides all the remarks about how Obamacare is now a disaster and will never work, the delay will probably make the law more expensive next year. Those who don’t receive health insurance from their employer will now have to turn to the exchanges to find it. Plus these people are more likely to be lower-income workers meaning that many of them will be eligible for subsidies (incomes up to 400 percent of the Federal Poverty Level) which cost the government (and us) a lot more. And it gets a little worse than that too. When you apply for an exchange, the government is no longer requiring proof of income to qualify for the subsidies (I guess just try to keep that on the down-low). Paying for subsidies is one of the biggest expenses for Obamacare. And to help pay for them, businesses were going to help out, not just by providing insurance, but from fees for not following the employer mandate.

And there’s more. The national health insurance exchanges are falling behind schedule which are supposed to be ready by October 1^st. The law requires at least two insurance companies for the exchange and at least one that’s not-for-profit. This is supposed to create more competition in order to lower premiums. So far, only the Blues (Blue Cross Blue Shield) have applied for the national exchange. But they already dominate the country without much competition.

Okay, deep breath — now the pros. I like to find the light in any negative situation.

First, this delay is a relief to many businesses and mostly those who are right on that 50 employee border. A lot of businesses revealed plans to cut workers or workers’ hours to offset costs of buying more insurance. Now they have extra time to figure out how to make the law work efficiently for them. Yes, you can argue that the Obama administration is once again being swayed by big business, but like it or not, businesses are made up of people too.

Second, the employer mandate doesn’t really affect that many people (relatively speaking). Most large businesses already provide health insurance (about 95 percent of them in fact) — it’s pretty much the backbone of the American health insurance system. And of the companies that do not provide insurance, about 10,000 out of six million, they employ only 1 percent of American workers.

Third, delaying a somewhat significant part of the law shows that there is room to adapt and reflect on what is working and what does not. Taking a year to reconsider and revise the employer mandate, in my opinion, leaves room to consider other options that may work better — reconsidering a livable wage (to make health insurance more affordable)? Reconsidering a public option? Reconsidering more comprehensive plans for medical cost control? Hey, a girl can dream.

All-in-all, the employer mandate delay is an eye sore for the image of Obamacare. Is it a complete disaster and train wreck? I don’t think so. If you look at it this way, the main goal of Obamacare is to expand coverage and non-insured employees at large companies will still be able to purchase insurance through the exchanges. Cost control was never a priority but maybe now the Obama administration will see that it should be.

IMAGE CREDIT. [www.golocalworcester.com].

Jun 27

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

By Adam Conway | 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?

Jun 24

Burkina Bound

By Leanne Demery | Health | No Comments

I was bitten by the travel bug a long time ago, but ever since I found out I’ll be leaving for Burkina Faso in October with the Peace Corps, I haven’t really been able to hide my excitement. So I wanted to dedicate this post to my future home.

Burkina Faso is a landlocked country in West Africa about the size of Colorado. Despite all the turmoil that affects nearby countries, Burkina Faso is relatively peaceful as they don’t have any coveted natural resources. They grow peanuts and mangoes rather than raw minerals or oil fields. The country has been described as poor even by African standards. A low blow, but nonetheless true — the United Nations ranks it 181 out of 187 on the Human Development Index.

But what the Burkinabe people lack in resources they make up for in personality. It is known as one of the friendliest countries in the world and I hear they live up to their country’s name, meaning “The Land of the Upright People.” They also take fashion, arts and music very seriously. Ouagadougou (pronounced wah-gah-doo-goo, and so much fun to say), the country’s capital, is home to the African equivalent of the Cannes film festival and many other famous music festivals. They also have one of the world’s best soccer teams.

Plus, Burkina Faso actually has somewhat of a structured health care system. In the years following its independence from the French in 1960 their system was managed by the government, but with no support from the local level, meaning there wasn’t really outreach to Burkinabe who still today rely on traditional or folk medicine. Then, about 25 years ago at the African Ministers of Health conference, the Burkina government decided it was time to provide more primary care services to its people. They started the Bamako Initiative which allocated more medical resources and money to the community level and pushed for a bigger emphasis on primary care.

Today, the health care system is organized into three institutional tiers. The first is the Ministry of Health, which has three national hospitals throughout the country and manages all health care policies and public health programs. The second tier is made up regional directors who enforce the policies set by the ministry and provide assistance to the third tier – the local health districts, which contain emergency care centers, dispensaries and clinics. I’ll be working in one of these local clinics as a Peace Corps volunteer. Each health district has a health team that manages the resources and makes sure minimum services are available. The health team is hired by the government but they have to share managerial power with a committee elected by the community. This sharing of power makes the administrative doings of the clinics more transparent, so clinic staff become more accountable and will better allocate funding.

Even though Burkinabe are expected to live until only about 52, I think there’s something very attractive about their health care system. What I love most about the Burkina health care system is that they include the community in the management of the local health districts. If we had something like this with our hospitals, there wouldn’t be all this sneakiness about billing and service fees.

We could also use more community health educators in our hospitals, clinics and doctor’s offices. Somebody could counsel you about insurance (much of what Health Leads does) or talk you more thoroughly about diabetes, high blood pressure, smoking cessation or whatever else instead of getting a little pamphlet about it. If I come in with diabetes, and someone from my community who also has the disease comes in to talk to me about managing it and encourages me to be proactive about my health– that gives so much more motivation than a doctor suggesting you do such and such.

If our clinics and hospitals got this kind input and support from the community level, we would see a lot more people using preventative care and get a lot more out a visit to the doctor.

IMAGE CREDIT. [Wikimedia Commons].

Jun 14

Silos

By Adam Conway | Health, Silo-Breakers, The Global Is Local | 3 Comments

Specialization- the process by which we have achieved space flight, agriculture, engineering, science, industry, efficiency, and ninjas.

Although specialization can lead to excellence, it can have unintended consequences or stem from conditions of disparity.

A meandering anecdote now follows: My wife and I took her grandfather to the Museum of Industry a few weeks ago. As a lifelong tinkerer, woodcrafter, history buff, and political activist, it was in many ways an ideal activity for his 91^st birthday visit here in Baltimore. If you haven’t been there, I recommend it. The quality of the overall experience was very impressive, including a complimentary docent tour with admission. It was through the docent that we learned about the specialization that took place among the industry workers in Baltimore circa 1900.

Many of the examples of specialization were impressive — for instance, oyster shuckers could move at an amazing pace, as could all the other piece-workers responsible for prepping, canning, and labeling the products moving through the factories. This led to safe, affordable food that could be distributed for hundreds of miles to the significant benefit of the nation and the industries that operated the workshops and factories.

On the other hand, the labor that powered these engines of industry were often entire families, including children. In addition, some of the hardest work was the only work that African Americans could get hired for. Injury and death in turn of the century factories was a fact of life. Also, although useful, mastery of oyster-shuckery has limited transferability, and mobility to other, safer or more lucrative occupations was very difficult.

So, despite the wonderful things that specialization can and does produce, it can be caused by (and reinforce) racism and poverty.

A phrase that gets used a lot in social science, among other disciplines, is silos. The word evokes a stark image in my mind, isolated towers full of a single kind of stuff. Efficient? Yes, of course. But who wants just one kind of stuff? Diversity is essential for a complete experience. Despite my hereditary love of bread, I am certainly not about to limit my diet to strictly bread. [OK, add some cheese, and then maybe….]

Silos are perhaps an effective analogy for the partitioned experiences we have in our day-to-day lives as well. We have our professional personality, colleagues, and activities, and our private versions of the same. Little self-silos if you like. Groups of social contacts broken up by shared experiences and backgrounds — the group you exercise with, the group you party with, the group we have children’s playgroups with.

I’ve been thinking about silos and the efficacy of innovation for a couple weeks. I attended an event recently which brought together social entrepreneurs to problem-solve some issues that a half a dozen organizations brought to the table over a few hours. As is often my experience in Baltimore, there were people from very different backgrounds, different ages, men and women, all with a passion- via their own silo — to effect positive change in their city and the world.

Breaking down the walls of their own pet projects to contribute their energy toward projects outside their silos gave each participant a sense of the universe of other silos outside their own. At the end, however, one bold woman pointed out that the full diversity of the city was not well represented. The targets of many socially beneficial projects in Baltimore are the residents and environments in poor, predominantly African American neighborhoods, and yet members of these communities are very often neglected when the invitations go out. Not by intention, but as a result of the natural process of silos. Specialization, remember, tends to focus similar energy and resources into a self-contained cluster. The organizers, by the way, acknowledged the challenge and committed to a conscious effort toward broadening the population of participants.

I would like to suggest a similar challenge for each of us this week:

First, identify your silos. Where are you most comfortable? Who do you hang out with most often? How do you work toward your ideals?

Next pick one of those silos and break out of it for a day. Remember, you’re reading this because you have at least a passing interest in innovative, transformative social change. Switching brands of jelly does NOT count, even if it was made by a local organic producer. Bring someone into a new social circle; allow their views to inform the activity, conversation, and menu. Get outside your comfort zone, talk to someone you disagree with, and finally, share your experience with others on digital and interpersonal social networks.

Jun 11

Domo Arigato Mr. Abe

By Leanne Demery | Health | 2 Comments

If France can brag that they have the healthiest health care system, Japan can brag that they have the healthiest people. At a life expectancy of 82 years, the Japanese live the longest and have four full years of life on us Americans. Some people may think it’s because of their diet full of fish and low on fried foods but it could be that the Japanese have their hands-on government to thank.

First of all, even if the traditional Japanese diet is lower in fat and sugar than a lot of countries around the world, the Japanese government doesn’t care. They will still make you take nutrition classes if your waistline is over a certain amount of inches because of the Waistline Law. To Americans this may seem strange because the United States has more than three times the amount of obese people. Bloomberg and public health officers are green with envy — they can’t even ban large sodas.

In addition to the government’s heavy hand in public health, they also control most of private health matters. Every two years the Ministry of Health sets the prices for all health care services. Hospital stays cost roughly $10 a night whereas it runs in the thousands for a U.S. patient. Doctors may get paid way less, but they also don’t have to pay for medical school and their malpractice insurance for the whole year is less than what doctors here pay in a month.

Although the Japanese government severely controls prices, the patients have all the freedom of choice. They don’t need a referral to see a specialist and they can see any doctor they please — there’s no in or out of network for insurance. And the Japanese are taking advantage of this freedom too. They see a doctor about three times more than Americans do.

Good for them, as the Japanese will always have health insurance and it doesn’t cost that much either. That’s because all health insurance companies in Japan are not-for-profit and if the company comes in the black one year, they subtract it from your premiums the next. Most Japanese people get health insurance through their employer, which helps pays for the already low-cost premium, or through the government.

So how does our reformed health system compare? Well, soon all Americans will have the opportunity to have health insurance. Though people are grumbling about a rumored increase in insurance premiums, all insurance companies must run them by the government first. And a lot of the speculations of high cost premiums don’t take into account the subsidies for people up to 400% of the Federal Poverty Level (roughly $45,000/yr). For a more realistic estimate of what insurance will cost in the exchanges, Washington D.C. recently released proposed rates. But as far as the other highlights of Japan’s health care system, particularly public health measures and cost control, it’s not looking too good. It would help if states would consider expanding Medicaid to include people making up to 133% the poverty level but so far only 23 states have taken that step.

Perhaps we don’t want our government policing our waistlines, but when it comes to providing a low-cost, equitable healthcare system for all, Japan is, quite literally, years ahead of us.

IMAGE CREDIT. [Ko Sasaki for The New York Times].

May 31

The Gluten Wars

By Adam Conway | Health, The Global Is Local | 5 Comments

My apologies in advance for the personal biases expressed in the following post, but not very big apologies.

Change takes place on so many different time scales that it truly boggles the mind: Geologic history is too slow to comprehend, and the speed of light is similarly beyond our everyday understanding. In any case, what we are really interested in is ourselves and those around us.

For the most part, this moment in history allows us to surf along on a sea of issues, each with their human connection, each one changing as social pressure influences and reacts to it. This is the story of one of these trends, and how it has influenced me, my family, the country, and the feedback loop that has changed the trend itself.

My parents started a bakery shortly after moving to Vermont in the mid-1970s, and their business has been cooking ever since, although with far greater attention to product quality than profit. Their small operation has not changed a great deal, growing slowly and shifting with their interests rather than with market pressures. They were the first organic bakery in the state, and probably one of the first in the country. (Check out some pictures and their story here, as long as you’re not already hungry!)

They have watched as the American consumer has gone from disdain to grudging acceptance, then cautious enthusiasm, then passion, and in the past decade, spastic cycling through rapid adoptions and rejections of the product they have spent a lifetime carefully crafting.

Their reaction? Mostly they try to ignore these market gyrations and just do what they want to, baking European-style sourdough loaves in their massive French hearth oven, working all the time, and raising a family of bread-loving children.

However, the changes taking place in public attitude over the past ten years have been something of a shock, and my folks and other artisan bakers have certainly had to acknowledge South Beach, Dr. Atkins, and all that followed in the low-carb frenzy that was intended to drop American pounds. The effect of the frenzy, by the way: Americans did not, overall, benefit substantially from their fear of carbohydrates, although the publishing industry certainly has enjoyed the ongoing attention to the issue (just shy of 6,000 titles come up on an Amazon search). My family’s business suffered a bit, but for the most part, it did not seem as though the followers of Dr. Atkins were the same ones who were ordering crusty, sourdough Whole Wheat loaves from our small organic bakery in Vermont.

This has continued to be the case over the past ten or fifteen years as the popularity of strict low-carb diets has waned somewhat, and I believe that this has been due to the separation between two segments of their customer base. On the one hand, there are what I will call Mainstream Eaters, brought up (like my father) on Wonderbread and Skippy, sticking to the traditional (i.e. large chain) grocery stores, and eating a diet that owes much to the cultural norms of the 1940s-1950s. On the other hand are my parents’ customer base, who I will call the Spelt Enthusiasts, a term I lovingly bestow on the many earnest, kind, birkenstock-wearing, kale-eating, home-made-granola eating hippies and their children (of which I am one, of course) who have come to my parents for decades seeking whole grain breads, made by hand using traditional methods. (Spelt, for the uninitiated, is an ancient variety of wheat which has experienced relatively little hybridization and has a somewhat nutty flavor.)

The separation between these two groups has narrowed in recent years, moving in the general direction of the Spelt Enthusiasts as a greater foodie culture has spread throughout the country. The narrowing of this gap has had an enormous impact on our economic and food systems in the U.S., (and arguably the world) as there is now a far greater interest in organic, local, artisan, hand-crafted food and beverages. This trend has given a degree of market power to local producers that has been absent for generations- perhaps since the Industrial Revolution.

Although I would hesitate to describe this as ‘unprecedented,’ as I am not a historian, it isn’t a stretch to refer to this market transformation as amazing. Despite the awesome power of industrial farming, baking, brewing, cooking, packaging, and shipping technologies, individuals using essentially the same ingredients and techniques as their great great grandparents are launching successful bakeries, restaurants, breweries, and cheese making operations all over the country.

Time to circle back to the title of this piece. The challenge my family faces is the latest iteration of popular science writing, which had previously focused on folk neuroscience and psychology- issues that passed bakers by other than our passive consideration while listening to the radio and rolling baguettes. The cold, hard pen (or keyboard) of scientific terminology and rationale has turned to the issue of diet. The demon of this recent dietary focus is, of course, gluten – the web of proteins that allows bread to rise from a cold, dense piece of dough into a transcendent, glowing, golden loaf crying out for a slice of cheese and tomato. We should be concerned about blind trust in scientifically justified behavioral recommendations with very limited scientific basis.

As Alissa Quart points out in her 2012 NYT piece,

…bogus science gives vague, undisciplined thinking the look of seriousness and truth.

Regardless of your opinion on the issue, there are some facts that most agree upon.
1. Celiac Disease affects .7 percent of the population, many of whom are undiagnosed. The most effective strategy for those with Celiac Disease is to avoid gluten altogether.
2. Allergies to wheat may affect as much as 3 percent of the population.
3. Less clear, but still generally agreed is that a slightly larger group has gluten sensitivities, but not full blown Celiac. This number may be as much as 6 percent of the population, with a very wide range of severity, from profound to scarcely noticeable.

What I feel is missing:

1. Many people do not know what gluten is or where it comes from. Look at the products now proclaiming their gluten free status. Hummus? Juice? Cheese? There is a massive amount of money to be made on gluten-free products right now, and companies are taking advantage of uninformed consumers. How much of this is being driven by profit? It makes an honest assessment of health impacts very challenging.

2. A sense of perspective. Like most effective diets, giving up gluten involves a far greater amount of attention paid to what you ate eating. There is a need for balance, more fruit, vegetables, and legumes, while moderating the intake of animal proteins. If following such a diet makes you feel better, it could be the gluten, or it could be the effect of giving what is on your plate some truly conscious thought.

Celiac Disease is an extremely challenging condition, requiring sacrifice and discipline in order to stay healthy. Those who suffer from it are torn about the recent spike in gluten-free diets, appreciating the diversity of options now available, but frustrated by those who have simply jumped blindly onto the bandwagon.

3. Fads. There is nothing like a fad to push a business operating with high overhead and a reliance on a stable market into a situation that threatens the owners and employees.

People who love eating good food should take the time to be certain that giving it up is a wise health choice. Eating good food is one of the most easily accessible and most important ways to affect the health of individuals and their families.

Fads end eventually, and the artisans responsible for providing high quality bread can only remain in operation after the gluten bubble bursts if conscientious consumers continue to support them. Thanks to the changing attitudes about food and farming practices, these craftsmen and women are likely to be your friends and neighbors, not line workers at an industrial food factory 5,000 miles away.

Additional image credits to Chuck and Carla Conway, with assistance by archivist Sophie Conway

Pottery class starts next month, by the way! Sign up soon to get muddy and make pots!

May 27

A La Sante!

By Leanne Demery | Health | No Comments

It’s no secret that j’aime la France. It’s in my blood. And you know who else loves the French? The French. Besides their wine, cheese and “c’est la vie” attitude, one of their biggest bragging points is their health care system. In 2000 when the World Health Organization ranked health systems, France came out on top. The curious thing is that if you take a closer look, our red, white and blue cousins have health care very similar to ours yet spend about half of what we do.

So how do they do it? The French have coverage in two ways. The first is through the government’s Sécurité Sociale. Each working person pays an income tax to finance universal coverage. If you’re not working, pas de problème, there are taxes on tobacco, alcohol and pharmaceuticals that also help pay for universal coverage. De plus, co-pays were most recently added to the pot. The Sécurité Sociale pays for 70 percent of fees and the customer pays the remaining 30 percent if you’re referred by or seeing a primary care physician. This may sound high to an American, but fees are set each year by the government and they are also made known to the patient so prices stay low even though doctors are paid by fee-for-service. In every doctor’s office and hospital the cost of every service provided is presented in clear view.

Even though 100 percent of the population is covered through Sécurité Sociale, more than 92 percent of the population also buys supplemental insurance. This can help pay for that extra 30 percent and give you coverage for some bonus services. This insurance can be private, but providers are not allowed to compete by lowering health premiums. Instead they can offer different benefits and ways to cover the 30 percent. Supplemental insurance is also provided by employers with about half of the cost split by an employer and employee.

Like ours, France’s health care system is not simple, but everyone has coverage. Even illegal immigrants — after they’ve been in country for three months — receive health insurance. And people can go to any doctor they please, unlike in the U.S. where you must stay within your insurers network. And coverage is cheap too. People pay small co-pays at doctor’s visits but to make it even fairer people with chronic illnesses, low-income people and pregnant mothers get free services.

The most magnifique component of France’s health care system is the little plastic health insurance card. The “carte vitale” or “life card” contain all the information needed for a doctor to not only adequately asses the patient but asses how the patient will pay. All medical records have been digital since the 1990s and tell the doctor every note, exam and service the patient has had. The processing of services is also done digitally by the “carte vitale.” The doctor inputs the services and this alerts the government and the supplemental insurance of payment which must be given to the doctor within three days. It’s fast and cuts down enormously on medical errors, unknowns and administrative costs.

En bref, when it comes to health care, the French get more bang for their buck. They have more freedom of choice, better quality, lower costs and more efficiency. Many French people still complain about the rising costs and doctors complain about their low salaries (a general practitioner in France will make about a third of what one in the U.S. makes). Both countries rely heavily on employer-based insurance, pay doctors by fee-for-service and both countries demand choice. But WHO ranked France’s system number one for many reasons — low infant mortality rates, higher life expectancies, low medical errors and low deaths in preventable illnesses. The French decided that health care for all is more important than free markets and excessive salaries, and it paid off. I think we can learn a thing or two from that.

IMAGE CREDIT. [my.aup.edu].