health Archives - ChangingMedia

Jan 24

The “I Have A Bike” Speech

By Adam Conway | 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.

Jan 10

Resolve Yourself to Good. And Kale.

By Adam Conway | 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.

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!

Nov 14

Typhoons Are Not Someone Else’s Problem

By Adam Conway | 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?

Oct 31

Vaccination Nation

By Adam Conway | 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.

Oct 28

Overwhelmed by the Terrors of Tomorrow

By Lindsey Davis | The Good Plan | No Comments

Earlier this week, my acupuncturist asked if I could ever imagine living in a pain free world, without the chronic head or back aches that brought me to her in the first place. A conversation on the doomsday mentality followed. I discussed how I could never disillusion myself into thinking I could one day have a pain-free life, but rather I do what I felt most people do, live with a mindset that accepts things they way they are, and then responds in kind. Why, and how could we live with fruitless hope?

The conversation made me think about how our society has trained itself to create a market around the doomsday mentality. I feel like I less frequently read about inventions for a world of equality than I do about inventions in response to fear.

Several months after Hurricane Sandy, after the articles on recovery efforts and rising insurance costs, there were the articles on building new resilient cities — floating schools, and planning for the sinking of coastlines throughout the next century. After the BP oil spill there were articles on a world without seafood, and this past week, an article on an art exhibit entitled ‘Ghostfood,’ made my skin crawl, as it proposed the provision of oxygen tubes, allowing people to experience the taste of chocolate, since one day it is forecast that all chocolate will be gone.

I’m torn by these premonitions. While preparing for the generations to come is a responsibility of our time and a socially responsible application of our acquired knowledge, I wonder how much of this projection of a destitute and deprived future is taking us away from our ability to revel in the present and solve the problems at hand. Is it possible to enjoy where we are right now, and what we do right now, tearing ourselves away from the future mentality of destruction without being seemingly irresponsible? Fighting against segregation and immediate issues such as the 1% vs 99% is one thing, as it affects our ability to respond and evolve, but is there more detriment to a productive emotional state if we insist on focusing on the coast-less chocolate-less, water world of our future?

If sending people into space for $250,000 should take precedent over ensuring the children in the Delta (or Baltimore City, for that matter), are educated. If we should be growing petri-dish-produced hamburger instead of taking a more active response to the poachers poisoning watering holes in Africa. If we’re living in a world where we do nothing but proselytize the proposed resolution to destruction, are we overlooking our ability to prevent, or heartily postpone this destruction in the first place?

Focusing more on the now, having contests deisgning higher seawalls or hurricane proof homes should take precedence over what the world wiould be like without fat belly tuna. Teaching urban farming may be a better option than theorizing on which place is going to be the new New York City when the current one has gone the route of Atlantis.

Imagine the difference if we could see the change created by our actions, if the knowledge we had was applied in a way that helped people more immediately, allowing us to believe the world would get better. If we could see the ramifications of our actions in our own lifetimes, instead of the solutions that exist hundreds of years away. What if people saw good and felt change, would that shift the way we care about the places we live and the world around us? I argue that it would. Running community meetings where people can see change does worlds more than the mentality of residents in the communities repeatedly positioned as guinea pigs, studied by a semester-long workshop of college students and presented with a report that then sits on the shelf. Seeing change may allow us to change our mindsets; allowing us to picture a pain free world because we see change for the good, instead of the repeated and infinite promise that generations from now, people will thank us.

IMAGE CREDIT. “Apocalypse” by Ignacy Gierdziejewski, Wikimedia Commons.

Oct 18

The Architecture of Our Psychological Health

By Adam Conway | 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.

Sep 19

Obamacare? Isn’t That Socialized Medicine?

By Adam Conway | 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

A Guide to Shopping for Health Exchange Insurance Plans

By Leanne Demery | 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 1^st.

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 15

On Risk, Tears, and Monkey Bars

By Lindsey Davis | The Good Plan | No Comments

Jamal was one of my closest friends in first grade. I don’t remember much about him, and have no idea where he is today, but most distinctly I remember the way Jamal interacted with the playground. The lower school playground was a good one. Built of wooden towers, its intended use was for people to stay within the Lincoln log-esque structure and climb to the top through a series of interior stairs, safely enclosed by four walls. Most of us abided by these rules, but not Jamal. I remember going to the third story of the playground structure, and looking up at the clouds while he threw one leg over the open sidewall, then the other, climbing down the outside of the tower to the second-story window below. Nothing under his feet, tips of his sneakers stuck into the structural holes intended for bolts, not for toes.

Jamal never got in trouble for his creative use of the playground equipment, but I remember thinking how he could have fallen and gotten seriously hurt. Playground equipment, designed to let children play and move without serious risk of injury, has never hit its stride of standardization. How safe is too safe? How much risk should we let children take? In a world where child leashes and swimmies are still seen on regular occasion, how do we balance risk taking with the seemingly ever-present safety net? While I have no children of my own, I do feel like the toddlers I see at the climbing gym are developing very differently than the five-year olds I witness buckled into an extended-age stroller.

I would imagine most of us conjure up similar images of a playground from our youth — a slide, monkey bars, swings, some sort of not-so-rickety bridge, and perhaps a metal jungle gym. I would bet all of us, at some point or another, misused this equipment: standing on swings, climbing on top of the monkey bars, or attempting to climb up the fireman’s pole rather than slide down as intended. These self-imposed challenges allowed us to overcome the standardized actions. We went up the slide instead of down, trying to make the soles of our shoes stick to the hot metal slope. We got our swings to go so high the chains refused to stay straight, tempted by gravity to buckle inwards. In the mind of an academic or sociologist, these actions demonstrate the need for a greater challenge. Dissatisfied with what is provided for us, we think about new ways to use our surroundings to provide unprecedented stimulation.

These actions aren’t limited to children. We witness envelope pushing in the teenagers skateboarding on steps or the parkour crews bouncing off walls and running across windowsills. Our environment presents us with the building blocks, we add the imagination to create interaction. In the urban environment and on the school playground, some manufacturers are changing things, in essence, to standardize creativity and risk. Playgrounds with small climbing walls or zip lines are popping up next to cargo nets. These features aren’t just for aesthetics, they’re meant to encourage increased physicality for kids — building upper body strength and helping hand/eye coordination. Urban planners and entrepreneurs provide similar opportunities — chess boards on sidewalks or built skate parks, interactive light installations or pop-up swingsets on promenades. These interventions encourage our imagination and allow us to change our behavior. The observation can even extend to bike paths; as greenways are created, we’re more apt to interact differently with our environment in a controlled fashion, rather than bicycle down a pedestrian promenade.

We can equate the benefits of risk taking to how adults react when a child falls. There is often a second, after a fall or a break, where a child isn’t sure what happened. They fall off a bike or get hit by a ball, and there’s a moment of silence where they collect themselves, and take inventory of what’s around them. The worst thing adults can do, my relatives profess, is to gasp. This harsh intake of air conveys worry, sending the message that the child might be hurt, and therefore, the child feels something is wrong and starts to cry. Several years ago I witnessed the opposite while ice skating on the Rideau Canal in Ottowa. Growing up with the world’s largest skating rink, kids were falling all over the place and no tears were shed. Falling was a standard risk of the physical challenge. During that key moment of silence, the adult wouldn’t miss a beat, “come on, get up, lets go.” There was no time to cry. This shift in normalcy from gasping and coddling to quick reassurance and continuation, I imagine, makes a huge difference in the willingness of a child to do more activities which might cause them to fall. It’s worth extending this attentive-parent worry to kids who don’t often have present supervision. Are those who fall and don’t risk hearing a nearby gasp of a worried parent more likely to play harder, go faster, and walk away from a fall with less perceived pain? I’d argue yes. when nobody is there to take care of you, there’s really no choice but to get up and keep throwing the ball.

In the daily grind where our senses are often dulled by a routine, these new and shiny installations are essentially new building blocks, challenging our minds to stretch more than usual — seeing our own piece of the world differently. Playgrounds are spaces where kids can learn from others in addition to pushing their own limits. Installing elements that encourage risk taking and help them conquer fear in a controlled environment are lessons many of us, I would imagine, wish we had the opportunity to learn ourselves.

Aug 22

We Just Keep Doing Dumb Stuff

By Adam Conway | 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.