Posts tagged “public health”
Today, in Nature:
Even though high-profile programmes have distributed millions of stoves to households in south Asia, Africa and Latin America, it is hard to find signs that the stoves are being widely used. There is a vast gap between reported accomplishments and what researchers see when they step into people’s homes.
The crux of the problem is that simply supplying the stoves does not establish demand for them.
Efforts could be redirected to providing people with the energy they most aspire to: not a stove designed by someone in the developed world to cook cleaner, but the actual stoves used in the developed world, which run on electricity or hydrocarbons such as liquefied petroleum gas (LPG).
This is not an absurd goal. The International Energy Agency (IEA) estimates that bringing electricity and clean-cooking facilities to every person on Earth by 2030 will cost US$49 billion a year. Although that is a considerable sum, the agency points to major commitments by Indonesia, Ghana and Nigeria to aggressively switch large portions of their population to cooking with LPG.
Where will all this new energy come from? It will require some additional consumption of fossil fuels, and that will increase the emissions of carbon dioxide into the atmosphere. But the extra pollution would be minimal at the global scale: the IEA estimates that it would boost CO2 emissions by just 0.7% above its base scenario.
Powerful opinion piece by Michael E. Mann in the NYT:
If scientists choose not to engage in the public debate, we leave a vacuum that will be filled by those whose agenda is one of short-term self-interest. There is a great cost to society if scientists fail to participate in the larger conversation — if we do not do all we can to ensure that the policy debate is informed by an honest assessment of the risks. In fact, it would be an abrogation of our responsibility to society if we remained quiet in the face of such a grave threat.
This is hardly a radical position. Our Department of Homeland Security has urged citizens to report anything dangerous they witness: “If you see something, say something.” We scientists are citizens, too, and, in climate change, we see a clear and present danger. The public is beginning to see the danger, too — Midwestern farmers struggling with drought, more damaging wildfires out West, and withering record summer heat across the country — while wondering about possible linkages between rapid Arctic warming and strange weather patterns, like the recent outbreak of Arctic air across much of the United States.
How will history judge us if we watch the threat unfold before our eyes, but fail to communicate the urgency of acting to avert potential disaster? How would I explain to the future children of my 8-year-old daughter that their grandfather saw the threat, but didn’t speak up in time?
Those are the stakes.
It’s been a long time, blog. Blame India and Nepal. Both of which are seemingly under-represented in the below map. View the map in your full browser window here; I had to yank the embedded code because it was causing all kinds of issues.
For the past three years, the Global Health program at the Council on Foreign Relations has been tracking relevant reports to produce an interactive map plotting global outbreaks of diseases that are easily prevented by inexpensive and effective vaccines. The diseases include measles, mumps, whooping cough, polio, and rubella.
“These outbreaks illustrate a worrying trend and raise the sense of alarm regarding failures in and public resistance to vaccine efforts,” says CFR senior fellow for global health Laurie Garrett. “Small decreases in vaccine coverage are known to lead to dramatic increases in outbreaks of vaccine-preventable diseases,” she explains.
C. Everett Koop — public health hero, activist, and the man who brought power and sway to the office of the Surgeon General — died at 96 today. Among his largest achievements were (1) speaking candidly about AIDS from a bully pulpit, from which he advocated condom use, prevention, and early sex education, despite his conservative Presbyterian beliefs; and (2) bringing the harms of smoking to the forefront nationally by comparing the habit to heroin and condemning it as “the greatest killer and producer of premature deaths” in the United States.
From the NYT:
As much as anyone, it was Dr. Koop who took the lead in trying to wean Americans off smoking, and he did so in imposing fashion. At a sturdy 6-foot-1, with his bushy gray biblical beard, Dr. Koop would appear before television cameras in the gold-braided dark-blue uniform of a vice admiral — the surgeon general’s official uniform, which he revived — and sternly warn of the terrible consequences of smoking.
“Smoking kills 300,000 Americans a year,” he said in one talk. “Smokers are 10 times more likely to develop lung cancer than nonsmokers, two times more likely to develop heart disease. Smoking a pack a day takes six years off a person’s life.”
When Dr. Koop took office, 33 percent of Americans smoked; when he left, the percentage had dropped to 26. By 1987, 40 states had restricted smoking in public places, 33 had prohibited it on public conveyances and 17 had banned it in offices and other work sites. More than 800 local antismoking ordinances had been passed, and the federal government had restricted smoking in 6,800 federal buildings. Antismoking campaigns by private groups like the American Lung Association and the American Heart Association had accelerated.
The New Yorker looked backed into their archives and pulled a nice profile written upon his retirement that highlights his work on AIDS.
In his frequent interviews with the press and in his reports to the public Dr. Koop insisted on using words that are considered taboo in much of the country—“condom,” “penis,” “rectal intercourse”—not to shock but, rather, to dispel the dark mystery that cloaked the AIDS epidemic. To Dr. Koop, there was nothing immoral about medical wisdom. By using those banned words, the Surgeon General accelerated the ongoing sexual education of America. He also alienated many of his supporters on the right: they accused him in the bitterest terms of abandoning his fundamentalist Christian convictions and promoting illicit sexual behavior. “I’m not the nation’s chaplain general—I’m the surgeon general,” Dr. Koop would counter. Meanwhile, liberals, including those on Capitol Hill who in 1981 had vehemently opposed his nomination, because of his impassioned stand against abortion and his reputation for moral fervor (Dr. Kook, they tagged him), took to hailing him as a new folk hero. But throughout this political firestorm Dr. Koop insisted that he was the same man: the same reverence for human life that had impelled him, as a distinguished surgeon at Philadelphia’s Children’s Hospital, to operate on horribly deformed infants no other doctors would go near now drove him to take bold measures against the spread of AIDS. Explicit safe-sex education for the general public, and care and protection for those stricken with the disease—these were the twin pillars of Dr. Koop’s public-health strategy.
Everyone in the US owes Koop their gratitude, especially those of us in public health. His writings and speeches are collected at NIH’s National Library of Medicine. Highly recommended.
The deans of the top schools of public health around the US speak out against covert action under the guise of health-promoting campaigns:
In the first years of the Peace Corps, its director, Sargent Shriver, discovered that the Central Intelligence Agency (CIA) was infiltrating his efforts and programs for covert purposes. Mr. Shriver forcefully expressed the unacceptability of this to the President. His action, and the repeated vigilance and actions of future directors, has preserved the Peace Corps as a vehicle of service for our country’s most idealistic citizens. It also protects our Peace Corps volunteers from unwarranted suspicion, and provides opportunities for the Peace Corps to operate in areas of great need that otherwise would be closed off to them.
In September, as a result of a CIA sham vaccination campaign used to hunt for Osama Bin Laden in Pakistan, Save the Children was forced by the Government of Pakistan (GoP) to withdraw all foreign national staff. This action was apparently the result of CIA having used the cover of a fictional vaccination campaign to gather information about the whereabouts of Osama Bin Laden. In fact, Save the Children never employed the Pakistani physician serving the CIA, yet in the eyes of the GoP he was associated with the organization. This past month, seven or more United Nations health workers who were vaccinating Pakistani children against polio were gunned down in unforgivable acts of terrorism. While political and security agendas may by necessity induce collateral damage, we as a society set boundaries on these damages, and we believe this sham vaccination campaign exceeded those boundaries.
This is important. Support global health and sign the petition.
The health benefits of coffee [joe, java, brown sludge, nectar of the gods, liquid happiness] have been widely unproven in the peer-reviewed scientific testing. Studies have flip-flopped on the impact of coffee consumption on various health endpoints more than Mitt on… everything.
A recent systematic review and dose-response meta-analysis in Circulation, a journal of the American Heart Association (AHA), found that moderate coffee consumption — of around 2 US cups per day (between 295 - 590 mL) — was health protective and decreased the risk of heart failure by 11%. This flies in the face of the current statement on coffee by AHA, based on a single study, which states that coffee may increase the risk of heart failure. The previous study failed to control for potential characteristics of the evaluated population that may also contribute to heart failure.
The systematic review looked across the medical literature beginning in 1966 and found 5 valid studies that followed a cohort of people over time. These studies, when combined, included 6522 heart failure events among 140,220 participants. Four of the studies were conducted in Sweden; one was conducted in Finland. The relationship between coffee consumption and heart failure did not vary by sex, history of myocardial infarction, or diabetes.
There are some shortcomings to the study, of course. The 5 studies included in the analysis relied on self-reported coffee consumption. The type of coffee consumed — that is, the strength of the coffee, whether it was caffeinated or blasphemous decaffeinated, and the brewing method — were not noted in the original studies.
All that said, the review convincingly argues that moderate coffee intake is healthful and heart-protective.
I’m off to sound my barbaric yawp over the roofs of the world with mug o’joe in hand.
* in moderation
The New England Journal of Medicine - among the most preeminent medical journals - is 200 years old this year. In recognition of that two century milestone, they’ve put together a number of special (and accessible) articles available here.
In “The Burden of Disease and the Changing Task of Medicine,” authors David Jones, Scott Podolsky, and Jeremy Greene outline shifting patterns of disease and their effect on the role of medicine in society.
The article contains numerous anecdotes, some unbelievable, about diseases and disease states that were common 100 years ago. Some sound familiar; others, not so much. I find the article particularly interesting when it starts to delve into how we define and prioritize diseases, and how that ties into inequities in well-being:
A population’s disease status can also be gauged by lists of common diagnoses at clinics or hospitals, but no single measure definitively characterizes a population’s burden of disease. Choosing among metrics is as much about values and priorities as about science, and it directly affects health policy. Whereas advocates of clinical and research funding for cardiovascular disease might use mortality data to support their claims, mental health advocates can cite morbidity measures in seeking greater resources. Data on causes of childhood mortality would justify certain priorities; analyses of health care spending would justify others. An ideal, sophisticated health policy would integrate all measures to form a holistic map of the burden of disease, but in practice competing interests use different representations of disease burden to recommend particular policies.
And, later in the article:
The persistence of health inequalities challenges our scientific knowledge and political will. Can we explain them and alleviate them? Genetic variations don’t explain why mortality rates double as you cross Boston Harbor from Back Bay to Charlestown or walk up Fifth Avenue from midtown Manhattan into Harlem. Nor do they explain why Asian-American women in Bergen County, New Jersey, live 50% longer than Native American men in South Dakota. Although we know something about the relationships among poverty, stress, allostatic load, and the hypothalamic - pituitary - adrenal axis, doctors and epidemiologists need more precise models that sketch in the steps between social exposure, disease, and death. … Disparities in health and disease are outcomes that are contingent on the ways society structures the lives and risks of individuals.
In many respects, our medical systems are best suited to diseases of the past, not those of the present or future. We must continue to adapt health systems and health policy as the burden of disease evolves. But we must also do more. Diseases can never be reduced to molecular pathways, mere technical problems requiring treatments or cures. Disease is a complex domain of human experience, involving explanation, expectation, and meaning. Doctors must acknowledge this complexity and formulate theories, practices, and systems that fully address the breadth and subtlety of disease.
The article hints at the relationship between public health, health policy, and medicine, but doesn’t delve fully into how those relationships have evolved over the 200 year history of the Journal. It would be interesting to learn more along that vein - how medicine has informed policy and influenced public health measures, etc. Overall, though, an interesting, enlightening read.