Tag Archives: public health

Planned Parenthood Drops the Pro-Choice/Pro-Life Labels

And here is their video explaining why.

Thoughts?

I generally agree that using labels in an incredible complex and nuanced decision like terminating a pregnancy is for the most part unhelpful. However, I never much liked “pro-life” for those opposed to abortion rights anyway, and preferred to use the term “anti-choice,” for the reasons that many have articulated – that a woman’s life must be considered above that of a fetus, that choosing to terminate a pregnancy based on one’s personal circumstances is in fact being pro-life and thinking of a potential child’s future, that a fetus is not yet an actual life, that a woman has a right to decide what goes on in her own body. As with all things, the weight and emotions of descriptors sometimes get too heavy, and I do hope that this will encourage more in-depth conversation around abortion rights.

Additionally, Guttmacher recently release a series of infogrpahics covering the racial/ethnic disparities in accessing abortion care, income disparities, how women pay for abortions, and a cross-sectional look at abortion in the United States. Check them out:

U.S. Women who Have Abortions

 

How do Women Pay for Abortions?

How do Women Pay for Abortions?

 

Racial and Ethnic Disparities

Racial and Ethnic Disparities

 

Abortion Concentrated Among the Poor

Abortion Concentrated Among the Poor

 

Barriers to Abortion Access

Barriers to Abortion Access

 

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Filed under Feminism, Public Health, Reproductive and Sexual Health, Women's Health

The Staggering Incidence of Breast Cancer in the Bay Area

Check out this piece in Tuesday’s edition of my hometown paper, the San Francisco Chronicle, discussing research by the Public Health Institute on the bizarrely high incidence of breast cancer in Bay Area counties. It’s fascinating. Marin County has for years been considered a hotbed for this disease, without much explanation as to why, but now it seems that multiple Bay Area counties – with the exception of San Francisco County itself – are showing similar rates. No research was undertaken in this project to determine why, but getting a handle on which regions have the highest incidence rates is a good first step for further exploration.

This image shows the counties and regions in which invasive breast cancer is 10%-20% higher than in other parts of the state – two other regions were seen with similar incidence rates in Southern California:

Picture copyright of San Francisco Chronicle

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Filed under Epidemiology and Population Health, Public Health, Women's Health

Juvenile Detention Centers Miss Key Health Indicators for Girls

I listened to a great NPR report this afternoon by Jenny Gold about juvenile detention centers and how they’re missing some key indicators of the health status of girls that enter into the system. As someone specializing in adolescent girls’ health, I was pretty fascinated – it detailed the personal experiences of a few girls being seen in a New Mexico facility and also tried to address ways it could be rectified. Detention centers can actually be helpful entry points for girls and young women to be connected to healthcare resources (we’re talking mental and physical health, so everything from counseling to substance abuse help to medical attention if they are victims of assault or violence or have seen physicians only irregularly).

One of the biggest issues facing these girls was confidential disclosure of their health status and any social, emotional, and physical issues they were facing. Developing rapport with a provider at a detention facility can be difficult in and of itself, but the girls reported having to answer personal questions in an open-door location, often with men and boys – staff or other teens – present; unsurprisingly, this made it difficult for many girls to feel that they could answer questions of a personal nature (sexual behavior, drug and alcohol use, history of assault, abuse or violence) honestly and openly. What we do know about these girls – 41% have vaginal injury consistent with sexual assault, 8% have positive skin tests for tuberculosis, and 30% need glasses but don’t have them – shows that getting all of this information early on is essential for appropriate and timely care.

One proposed solution to this – getting as much information as possible from these girls about their health status and the best ways to then help them, treat them, and connect them with resources – was to have them fill out a survey themselves. Currently, girls are asked 35 questions by an intake nurse when they arrive, that cover things like current medications, alcohol or drug use in the last 24 hours, and whether they have a history of self-destructive behavior. The proposed survey in the New Mexico facility is 132 questions, and according to one facility employee the time that would take is just not feasible given the traffic and business of the facility. Researchers and providers implemented a pilot study of the survey for 30 girls at the detention facility.

Of course, I can’t comment on the actual level of frantic activity in the specific facility at hand, but I can say that having a questionnaire that catches health issues which can be immediately and effectively addressed can prevent a host of issues from getting worse as time goes on without treatment – potential injuries from abuse or assault, needing STI screenings for victims of rape or girls who are sexually active without access to contraceptives or regular gynecological care, and of course mental health resources and immediate connection with social workers or therapists for those girls in need. Either having the girls fill out the survey via computer themselves or having a nurse help them would also be enormously helpful in the long run. This can also be a great way to track the care progress of these girls over the years, as many go in and out of detention centers. For girls who have experienced assault or abuse or multiple infections and injuries, this can be an easy way to follow-up with them without having to go through essentially baseline assessments of their well-being every time they enter a facility.

Some of the sobering stats about the girls from this particular New Mexico facility from this report: Of the 30 girls who participated in the piloting of implementing this survey, 12 needed immediate medical care, and 23 were coded as needing medical care within 24 hours, based on the survey’s questions. Intakes without this survey missed essential things, like burns on one girl’s torso and chest.

Check out the whole report here. I have no doubt that detention centers are in dire need of additional resources and likely way more staff than they have, for more than just this particular issue of adolescent girls’ health, but if the issue is there being one nurse for multiple intakes, having the girls fill out the survey on a computer themselves – when they’re more likely to be honest than in discussion with a nurse anyway, seems like the best solution to these kind of initial entry screenings. Especially since poor physical health is an indicator of recidivism, increasing the likelihood of girls ending up back in a facility.

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Filed under Child Development and Child Health, Health Behavior, Health Education, Mental Health, Women's Health

Countries Facing a Critical Healthcare Worker Shortage

A fantastic interactive graphic by the Guardian highlights which countries are in the most dire straits. Check it out here, and hover over a country’s name to get the statistics.

Some of the facts I found most interesting:

The Democratic Republic of the Congo has one physician and five nurses per 10,000 people and the infant mortality rate is 199 deaths before age five per 1,000 births.

Tanzania has less than one physician and two nurses per 10,000 people and an infant mortality rate of 103.

Chad also has less than one physician and three nurses per 10,000 people, and an infant mortality rate of 209.

Highest infant mortality rate? Afghanistan.

Check it out.

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Filed under Epidemiology and Population Health, International, Public Health

How Public Health Works to Save Lives

I love infographics, as regular readers of this blog know. Today, the American Public Health Association came out with a great one showing the intersections of public health and how various initiatives, supported by policy, save lives and money. Prevention is key!

Courtesy of APHA

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Filed under Epidemiology and Population Health, Health Policy, Public Health

Scientific American: We Are Getting Fatter and Drunker

Scientific American released a couple of interesting interactive graphs and infographics showing the rise of poor health behaviors among Americans, focusing on the changes between 1995 – 2010. Pretty interesting findings – overall, Americans are drinking more heavily, binge drinking more frequently, and overeating more regularly – but we are also smoking less, overall.

Vermont was the worst state for heavy drinking in 2010 (Tennessee had the fewest heavy drinkers), Wisconsin was the worst for binge drinking (Tennessee again had the fewest!), West Virginia was the worst for tobacco use (Utah had the fewest smokers), Mississippi was the worst for obesity (Colorado had the lowest obesity rates), and Oregon did the best in terms of exercising and physical activity (Mississippi was the worst).

You can toggle between health behaviors divided by regions in this piece, and here is the infographic showing the trends:

Image via Scientific American

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Filed under Epidemiology and Population Health, Health Behavior, Health Education, Public Health

The Conundrum of Caving to the Food Industry in the Battle Against Obesity

I just wanted to bring your attention to an excellent piece by Kelly Brownell of the Rudd Center for Food Policy and Obesity at Yale, in which she addresses the perilous slippery slope of appeasing the food industry and how that specifically impacts our fight against obesity.

He points out that all the research of calories in versus calories out, increasing exercise, cutting sodium, sugar, and fat, the problems with cutting physical activity from the daily routine of children, the abundant prevalence of fast food, and the cost of healthy, organic alternatives has been well and good – but that we are purposely avoiding and not addressing one of the biggest challenges in combating the increasing waistlines in America. The total avoidance of tackling head-on the way food is marketed, made, sold, and how quickly even healthcare organizations in need of a little extra cash may take a sponsorship or donation from a group directly contributing to many of the health issues that organization is tackling.

I know we live in a capitalist society. I know that the element most prized in this economic system is a competitive market and that supporters think private enterprise should be able to do whatever it likes in terms marketing and aggressive behavior towards consumers and that the individual is supposed to be able to make an independent choice. I also think that’s ridiculous. To assume that someone’s behavior is not influenced by the massive inundation of public messages, no matter how smart they are, disproves years of communication and sociological research. I always find it amusing when major corporations or businesses decry critics who say that advertising is harmful and misleading, when in fact most corporations and businesses are counting exactly on that – that the constant (and often subliminal, or in the least, very sly) messages they’re strategically slinging at us all the time are working their magic and ensuring that people will take the bait. As a critic of many advertising practices, a supporter of progressive paternalism (known to those on the opposite side of the aisle as a nanny state), and someone who has worked with people trying to change a range if disordered eating behaviors and poor nutrition habits, I found her piece particularly compelling and in agreement with her claim that the food industry has had plenty of time to prove itself trustworthy.

I think this line really sums it up: “When the history of the world’s attempt to address obesity is written, the greatest failure may be collaboration with and appeasement of the food industry. I expect history will look back with dismay on the celebration of baby steps industry takes (such as public–private partnerships with health organizations, “healthy eating” campaigns, and corporate social responsibility initiatives) while it fights viciously against meaningful change (such as limits on marketing, taxes on products such as sugared beverages, and regulation of nutritional labeling).”

Check it out.

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Filed under Advertising, Health Education, Media, Public Health

Integrating Family Planning and HIV Services Benefits All

Some pretty great research is cropping up at the 2012 International AIDS Conference, and it’s hard to pick just one finding to reference, but I do love infographics and I do love family planning – so I found something that combines the two! Population Action International, a truly fantastic research and advocacy organization focused on women’s reproductive health access and care, and they make a great point about the advantages and importance of providing both family planning and HIV services at the same time and in the same place. They point out that mother-to-child HIV transmission can be reduced, stigma may decrease, and both time and money are save. Take a look:

Combining HIV and family planning services (courtesy of Population Action International).

Another issue at hand is that of the relationship between a provider and a patient or client. Family planning clinics have a better chance of establishing long-term relationships with women – particularly if women have multiple children – given that they also sometimes aid in pre- and post-natal care or help connect women to those services, which increases the likelihood of women who test HIV+ to getting the treatment they need. Again, all in one place!

Follow along at #AIDS2012 on Twitter to stay abreast of everything going on in D.C.

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Filed under Health Education, International, Public Health, Reproductive and Sexual Health, Women's Health

Maternal Health and the Status of Women

Both globally and domestically, maternal health and the standing of women are inextricably linked. If women do not have the means and access to give birth safely, with trained and educated midwives, physicians and nurses, with appropriate prenatal education and care, it is often indicative of the standing of women in their communities and countries overall. Women’s inequality is also linked to the soaring population growth in developing countries, which will pose a range of new challenges for the next few generations.

Some may point to the United States as an anomaly, citing women’s increasing economic and financial independence, education, and leadership roles in America, while in terms of maternal health rankings, we remain pathetically far down the line for our resources (49 other countries are safer places to give birth than the U.S. – despite us spending more money on healthcare than anywhere else). Of course, the recent and incessant attacks on allowing women to access credible, accurate, up-to-date and comprehensive sexual and reproductive health education and services makes this statistic not entirely…surprising, shall we say.

So, I found the incredibly detailed and visually impressive infographic by the National Post, pulled from spectacular data and research done by Save the Children to be particularly fascinating. What they did was combine information on the health, economic, and education status of women to create overall rankings of the best and worst countries for women, splitting the countries into categories of more developed, less developed, and least developed, and the countries were ranked in relation to the other countries in their category (the divisions were based on the 2008 United Nations Population Division’s World Population Prospects, which most recently no longer classified based on development standing). While these divisions and the rankings can certainly be contentious and may incite some disagreement (nothing unusual there, these kind of rankings usually are), I thought the results were interesting. Some highlights – Norway is first, Somalia is last. The United States was 19th, and Canada was 17th (Estonia fell in between us and the Great White North) in the most developed. Israel is first in the less developed category, and Bhutan is first in the least developed category. The full report with data from Save the Children is also available, if you want to learn more about the information combined to make this image. Take a look:

A Woman’s Place – Courtesy of the National Post

One thing that I thought was particularly great was that the researchers combined women’s health and children’s heath data to create rankings specific to being a mother, when that category is sometimes only assessed based on access to reproductive care.The specific rankings of maternal health highlights largely mimics the overall standing of women, as seen here – Norway is number one, again, and Niger falls into last place:

Mother’s Index, Courtesy of Save the Children

I think these images and graphs are particularly moving given one of the top health stories coming out of the New York Times today, which showed that a recent Johns Hopkins study indicated meeting the contraception needs of women in developing countries could reduce maternal mortality (and thereby increase the standing of women in many of the nations doing poorly in the above ranking) globally by a third. When looking at the countries in the infographic that have low rates of using modern contraception and the correlation between that and their ranking in terms of status of women, it’s not surprising what the JH researchers found. Many of the countries farther down in the rankings have rates below 50%, and for those countries filling the bottom 25 slots, none of them even reach a rate that is a third of the population in terms of contraceptive use – which of course in most cases has to do with availability, not choice. Wonderfully, the Gates Foundation yesterday announced that they would be donating $1 billion to increase the access to contraceptives in developing countries.

Also of note, and in relation to maternal and newborn health, is a new study recently published by Mailman researchers that showed PEPFAR funded programs in sub-Saharan Africa increased access to healthcare facilities for women (particularly important for this region, as 50% of maternal deaths occur there), thereby increasing the number of births occurring in these facilities – reducing the avoidable (and sometimes inevitable) complications from labor and delivery, decreasing the chance of infection and increasing treatment if contracted. This has clear implications for children as well (and why I think this study relates to the National Post infographic and the NY Times article), since newborns are also able to be assessed by trained healthcare workers and potentially life-threatening conditions averted – including HIV, if the newborns have HIV+ mothers and need early anti-retroviral treatment and a relationship with a healthcare worker and system. And it goes without saying that if a new mother is struggling with post-delivery healthcare issues, including abscesses and fistulas, or was dealing with a high-risk pre-labor condition like preeclampsia, the child will have an increasingly difficult early life, perhaps even a motherless one.

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Filed under Child Development and Child Health, Health Education, International, Politics, Public Health, Reproductive and Sexual Health, Women's Health

Physicians Won’t be the Ones to Help You Lose Weight

Surprise! Your doctor may not be the best person to get you to lose weight – and it seems that it’s largely because they are averse to talking about it at all. A recent article from NPR breaks down some of the troubling reasons behind why this relationship isn’t making real significant strides in this public health fight.

78 million Americans are obese. There are 164,000 primary care doctors that are able to treat them. That’s a daunting division as it is, but when you think about the average amount of time a physician sees a patient – maybe 20 minutes, it seems impossible to achieve the task of vastly reducing the prevalence of obesity. The kind of personalized information that is needed for each patient would take longer than 20 minutes to gather, and creating a personalized subsequent behavior change and nutrition plan takes even longer. Interestingly, the NPR pieces cites the American Association of Family Physicians in reporting that not even 50% of primary care providers calculate a patient’s BMI (there are a lot of problems with BMI as a measure, and they’ve been widely discussed – how they don’t take into account muscle mass, for example – but for some obese patients, they can be a reasonable crude measure of where the individual is in terms of major health risks and how to initiate a weight loss program). But physicians who know the history of a patient and have tracked their health for years are in the best position in terms of knowing how risky an individual’s weight is.

Of course that’s not all that needs to be considered – I actually don’t think it’s even the most pressing or pertinent issue as to why physicians aren’t able to tackle the obesity epidemic. As the NPR article says, the psychologist in charge of the University of South Carolina’s weight management center calls the topic of weight loss and obesity a “mine field.” There can be resistance in going to the doctor for any number of reasons – shame or embarrassment, frustration, avoidance or denial, and even the very real fear of what a physician might tell them. And, importantly, deep concern and worry about not having the means – financially, mentally, community or family-wise, to tackle what seems like insurmountable changes in lifestyle. On the other side, doctors claim that some patients react defensively if they suggest that weight loss needs to be in their future.

This is a complicated dance, and I can’t help but draw parallels in these kinds of responses to the relationship between eating disorder patients and their physicians, psychologists, and nutritionists. Weight is so inextricably tied to identity, personally and culturally, for so many people, that the mere suggestion of a necessary change – either gaining or losing weight – can feel like an assault on the person’s actual self. How do we best navigate this? These conversations, first of all, can’t be brief. They just can’t. They require a meaningful relationship between those negotiating solutions, and for the individual who is in a precarious health position – whether it be due to restricting and bingeing and purging, or due to inactivity and unbalanced diets and genetic factors – it requires the sense that the person ostensibly helping them knows them personally, what their fears and concerns are, is patient, and most of all, is able to be consistently present and supportive through the successes and inevitable failures of the journey. And those relationships can be mighty hard to come by.

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Filed under Disordered Eating, Health Education, Public Health