medicine | ChangingMedia

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.

May 13

Started from the Bottom

By Leanne Demery | Health | One Comment

For the past nine months I’ve had the pleasure of working with kids through a nutrition education program called Food as Medicine at a local Baltimore middle school. Twice a week, once after school and once in the 6^th grade classroom, volunteers help students think critically about the food they eat and teach them how it affects their body. We’ve had such success in the first year the kids are planning to get a salad bar for the school and have already made a commercial promoting healthy choices (soon to be released on YouTube, it’s a rap to the tune of Drake’s “Started from the Bottom“).

As an AmeriCorps VISTA, you live in poverty and fight poverty through program development and capacity-building. If you know me, you know that I hate using the words “poor” or “poverty” because they create a one-dimensional view in peoples’ minds. Being “poor” doesn’t only mean that you don’t have enough money; it means a much more fundamental lack of resources and opportunity. Yes, the middle school I work at in Waverly is Title I, meaning that about 76 percent of students are low-income and 98 percent of them receive free lunches. But it is the lack of access to society’s institutions and opportunities that creates the true detriment to their health and to their success later in life.

School budgets are determined by enrollment, with schools receiving about $5,000 for each child and a little bit more for special education and advanced students. That is the school’s entire budget that goes to food, toilet paper, teacher’s salaries, projectors and everything else. That leaves little extra for programming or even what many people consider basics. So this school of 6^th – 8^th grade students cannot afford languages, arts, P.E., health or science education. Aside from our program, the students have no other opportunity for after-school clubs or sports.

Ten years ago, all these students were zoned to Roland Park Middle School, which is one of the best in Baltimore but then were re-zoned to Waverly which didn’t even have a building for these kids to go to. The School Board promised the community a school equal to the quality of Roland Park, but instead gave them an old community center that was scheduled to be shut down and no funding to build it up. The community worked very hard for donations and to get the building suitable for children. Now the building looks nice, but the kids are left with no gym, equipment, playground or drinking water. Want to wash that apple you brought to school for snack? You can, but you will get lead all over it.

So it’s no surprise that these kids don’t know how much sugar is in soda or cereal or even chocolate milk. They don’t know that whole milk, Cheetos and fries have a whole bunch of fat in them. They didn’t know that you can die from strokes, heart attacks and diabetes which all are diseases mostly dependent on diet. Thanks to our program, students can identify what are healthy fats, that hydrogenated oils are bad for you and that too much sugar can cause diabetes. They know why vegetables are healthy and not just that they should eat them. Most importantly, they are more willing to try new foods. Before, students only ate things because they tasted good (and they still do) but now they know how to make healthy choices on their own because we told them how to read food labels and what nutrients are essential, and opened their eyes to all the dirty secrets of processed foods.

Luckily, things are looking up for the Waverly community. They worked very hard to get a brand new $30 million building — the first new school building for Baltimore in 15 years. Next year they will actually have a gym, science labs and enough room to fit 900 kids — more than double the enrollment now. With a building that has safe drinking water they can actually get a salad bar and wash their fruit. They will have an actual kitchen that doesn’t just re-heat food but will be equipped with real cooking utensils. They will have a real gym and a real playground to run around in. With more than double the possibility for funding, they will be able to hire science, health and P.E. teachers and finally will have the resources and opportunities to excel in life.

A picture of the after school club, self-named “The Healthy Society,” cooking with Chef Ty from Bon Appetit.