Wednesday, April 16, 2014
Inquirer Daily News

POSTED: Friday, April 11, 2014, 6:30 AM
Filed Under: Kids
New York Mets second baseman Daniel Murphy missed opening day to be with his wife when she gave birth. Some critics said she should have had a C-section so he could make the game. Bad idea. (AP photo)

Last week the blogosphere was set on fire when former NFL quarterback and current WFAN commentator Boomer Esiason commented on the paternity leave of New York Mets' second baseman Daniel Murphy, who missed two games, including opening day, to be with his wife while she delivered their baby. “Quite frankly,” Esiason said, “I would've said, 'C-section before the season starts. I need to be at opening day.’”

The response was quick and harsh, with much of the attention focused on the rights of any father, including a major league baseball player, to take time off to be with his family during the birth of a baby. Unfortunately, less attention has focused on the suggestion that it was okay for a woman to have a voluntary Cesarean delivery, scheduled for convenience. This is an important part of the conversation – research shows that early deliveries pose serious risks for both mother and baby.

An early elective delivery is a birth that takes place before the 39th week of pregnancy without a medical reason. Even for deliveries during the 37th and 38th weeks, healthcare providers are very careful to balance any risks of bringing the pregnancy to term against the risks of an early delivery. The last weeks can be very, very challenging. But they are critical for a baby’s development Parents who would do anything for their child, including spending thousands of dollars on the right toys to stimulate her growing brain and demanding that family members never smoke around their baby, often have no idea that when they (or a sports commentator) push for an early scheduled C-section, the decision could seriously impact the development of the child’s brain, lungs, and liver.

POSTED: Wednesday, April 9, 2014, 6:30 AM
Filed Under: History | Jonathan Purtle
In mid-17th century London, Bills of Mortality - the precursor to the modern death certificate - were simply lists of the dead. (University of London-Institute of Historical Research)

Why do we die? The question is existential, scientific, and spiritual at the very least. It’s also bureaucratic.  Like voter registration cards and driver’s licenses, death certificates relegate the cause of our physical demise to a discrete category that becomes a single data point in a sea of statistical information. And they are vitally important to the public’s health.

In Final Forms,” an excellent article in the April 7 issue of The New Yorker, Kathryn Schulz tells the story of the death certificate: its history, its public health significance, its shortcomings.

Schulz traces the origins of the modern death certificate back to 1512. In London, Bills of Mortality were first issued to track the number of people who died from the plague, in addition to the number succumbing to non-plague causes. The Bills included no information about individual decedents, such as their name or what exactly killed them (other than the plague), and were only issued sporadically after the terror of the Black Death subsided.  Things changed, however, in 1629 when King James I mandated that the Bills be issued on a regular basis, capture every death, and its cause. Years later, an actuarially-oriented haberdasher named John Gaunt reviewed 20 years worth of Bills and teased out 81 distinct causes of death across the four categories: chronic diseases, epidemic disease, conditions that killed children, and injuries.

POSTED: Monday, April 7, 2014, 12:00 PM
Filed Under: Addiction

Dramatic increases in overdose rates now terrorize rural and suburban neighborhoods. Inner cities have long dealt with the quiet desperations of addiction, but now these new communities also are overrun. This clashes with our stereotypes of misuse and addiction.

My point isn't to criticize very real and merited terror over prescription drug and heroin epidemics. It is to ask: what can we learn from this about our attitudes toward addiction and those who suffer from it? Specifically:

  • Why are physicians inadequately prepared for medicating pain and screening for addiction? While pain and addiction are widespread, causing extraordinary human, health and economic harm, formal physician training short-shrifts both. Yet primary care and hospital emergency department physicians may have the most influence and leverage to initiate interventions. We need that influence and leverage to reach most of 1 in 7 Americans suffering from addiction. Another third engage in such risky substance use that contact with health care providers or law enforcement may result.
  • Given rising public concern as fatal drug overdoses have more than tripled since 1990, why is there such policymaker resistance in Pennsylvania to making naloxone more available? In the hands of first responders, clinics and even families, this safe, easy-to-administer drug (brand name Narcan) can prevent drug and alcohol poisoning (that's what overdose is) from killing. There is similar Pennsylvania resistance to allowing "good Samaritans" to call for medical help without fear of being investigated themselves. To see how much the inaction in Pennsylvania contrasts with progress in New Jersey, explore the Law Atlas, a compilation of laws affecting public health, including Good Samaritans and legal issues surrounding naloxone for overdose prevention. public health laws . Yet New Jersey has a lower drug overdose mortality rate than Pennsylvania (see page 12 for state-by-state comparisons).
  • Why isn't there more concern about what happens to overdose victims who survive and need to overcome stigma and discrimination, e.g., housing, employment, that create barriers to long-term recovery?

There is a common thread through all three questions: despite scientific certainty that addiction is a chronic disease, perhaps best compared to diabetes, 19th and 20th century imagery of immorality and criminality, of dissolute drunks and shooting galleries, still hold sway. The powerful, disparaging mindset that addiction is behavioral, that "addicts" should resist or simply throw off the shackles of the disease still dominates otherwise modern minds. This keeps us from acting compassionately and decisively.

POSTED: Sunday, April 6, 2014, 6:30 AM
Dr. Bernard Rollin, a Colorado State University professor and leading scholar in animal rights and animal consciousness. (William A. Cotton)

There are few issues in the public sector today that affect us all in the way that industrial animal agriculture does. We all eat, and almost all of the food we consume is produced by this system. Not only aren’t most of us aware of the nature of the system that provides us with our food sources (for most Americans, it is as if food appears magically on our plates every day), but most of us certainly aren’t aware of the impact that the system has on the public’s health. From the pesticides that impact us and our environment, to the concentrated animal feeding operations (CAFO) that house many of the animals we eat, to the overuse of antibiotics throughout agriculture, our health and environment is ever at risk.

On Tuesday, renowned philosopher and ethicist Dr. Bernard Rollin from Colorado State University will be giving a lecture at the Academy of Natural Sciences on the history, ethics and public health impact of industrial animal agriculture. Dr. Rollin's free public lecture, which begins at 6 p.m., is entitled "This Ain't Agriculture: How Industrial Agriculture Hurts Animals and the Public's Health." The talk will examine the impact of industrial animal agriculture on animals, humans, and the environment, and proposes ways to improve this system and make it more sustainable. The event is co-sponsored by the Program for Public Health Ethics & History at the Drexel University School of Public Health (I am director of this program), the Center for Science, Technology and Society at Drexel, and the Academy of Natural Sciences.

Dr. Rollin is an expert in this area and has worked closely with both government and corporate interests with the goal of improving the current agricultural system. His 1982 book, Animal Rights and Human Morality, now in its third edition, is a classic in the field, and he has authored over 500 papers and 17 books, the most recent of which is the autobiographical Putting the Horse Before Descartes: My Life's Work on Behalf of Animals. Most recently, he served on the Pew National Commission on Industrial Farm Animal Production, which in 2008 released a series of landmark reports on the public health, environmental, social and animal welfare issues implicated in industrial animal agriculture.

POSTED: Wednesday, April 2, 2014, 6:30 AM
The Plague marched across Europe in the mid-1300s; death followed quickly.

On television, forensic scientists can solve the mystery of someone’s death in an hour. In reality, uncovering the facts can take a lot longer. As an anthropologist leading the investigation of some skeletons dug up in England last year put it: their discovery “solves a 660-year-old mystery.” DNA tests on the skeletons revealed that they didn’t die of bubonic plague; they died of pneumonic plague.

Workers extending the London railway line unearthed 25 skeletons. They were victims of the Black Death that ravaged the world from 1348 to 1350, killing at least 75 million people. Scientists examining the bones confirmed not just the cause of death but details about the lives of those who died. Their bones reveal lives marred by violence and characterized by heavy work and malnutrition. The Black Death carried them away quickly. Untreated, it can kill in a few days. With no understanding of the cause of the disease, 14th-century Europeans often blamed Jews and foreigners for the disastrous epidemic that transformed life around the globe.

Bubonic plague is spread by fleas from infected rodents and is now easily cured by antibiotics. If the infection reaches the lungs and becomes pneumonic plague, however, it can be transmitted from person to person via infected droplets in cough. Victims must be treated promptly; mortality rates from this form of the disease are high. There is a third form of plague, septicemic plague, also spread by fleas.

POSTED: Friday, March 28, 2014, 6:30 AM
Filed Under: Janet Golden | Statistics

The Robert Wood Johnson Foundation describes its ambitious annual attempt to rate the health of counties in every state based on analysis of voluminous data as an effort to prod communities to make things better, although the rankings have a lot to do with conditions over which they have limited control: high income and level of education, for example, are strongly linked to health (Chester County is second out of 67 Pennsylvania counties; Philadelphia is 67th).

The just-released 2014 report has two sets of rankings. Health Outcomes are based on measures of life expectancy and quality of life. Health Factors – what lead to those outcomes – are based on four broad categories: health behaviors (30 percent) such as tobacco use, diet and exercise, alcohol and drug use, and sexual activity; clinical care (20 percent), which includes both access to and quality of care; social and economic factors (40 percent) like education, employment, income, family and social support, and community safety; and, physical environment (10 percent), which incorporates air and water quality, housing and transit.

To really appreciate the ratings, dig into the underlying data on teen births, adult obesity, access to dental care, diabetes and mammography screening, unemployment, and deaths from injuries, among other things. All these factors, and the resulting health of the population, add up to an excellent summary of the elements constituting public health and how we measure it.

POSTED: Wednesday, March 26, 2014, 6:30 AM
Filed Under: Food | History | Janet Golden | Nutrition
Ahhh, the quest for the perfect weight loss diet—the one that lets you eat and shed pounds. With so many Americans obese or overweight, the marketplace is full of diet books and over-the-counter drugs. There’s the Paleo diet —eat meat like a cave man! And the Mediterranean diet —eat vegetables like a peasant! And the grapefruit diet —eat like a Florida farmer!

There used to be more daring choices. Like the tapeworm egg diet. That’s right, a program that told you to swallow tapeworm eggs and lose weight.

In the early 20th century, marketers began selling this program to what were then called “fleshy people” under brand names like “Lard-B-Gone.” Sanitized tapeworm eggs delivered what they promised. You got rid of pounds without exercise, dieting, surgery, or dangerous drugs like arsenic pills, which were once a popular means of weight loss because they allegedly cut the appetite. With the tapeworm diet you swallowed the eggs and the tapeworm did all the work—consuming your meal while living in your digestive tract. Meanwhile, the tapeworm produced and shed millions of eggs in your intestine and grew up to 20 feet long.

POSTED: Friday, March 21, 2014, 6:30 AM
Thursday's discussion at the sold-out symposium will continue online Friday morning.
First in a series of posts about what is being done to address trauma and toxic stress in the city.

Four years ago, on a train from Philadelphia to Washington, Sandra Bloom told me about the Adverse Childhood Experiences (ACE) Study. I hadn’t heard of it, and was astounded to learn about strong connections it found between exposure to trauma and toxic stress in childhood, and experiencing behavioral, social, emotional, and health problems as an adult. I told almost everyone I knew. I circulated the study’s publications among my public health peers. Hardly any of them had heard of it in 2011, when I wrote the first of several related posts.

On Thursday, I sat with more than 350 Philadelphians at WHHY's studios as the study was discussed at a sold-out symposium entitled “Children and Toxic Stress: A Public Health Response for Philadelphia’s Children and Families.” Awareness about the ACE Study (first findgs were published in 1998) and its implications has spread rapidly over the past few years. And Philadelphia, in the words of Arthur Evans, commissioner of the city's Department of Behavioral Health and Intellectual disAbility Services, has been the “epicenter” of knowledge dissemination. “Philadelphia is the only city where only a few hands pop up when I ask how many people have not heard of the ACE Study,” said Martha Davis, a new program officer at the Robert Wood Johnson Foundation who until recently headed the local Institute for Safe Families. A brief video of her remarks on building resilience is here.

About this blog

What is public health — and why does it matter?

Through prevention, education, and intervention, public health practitioners - epidemiologists, health policy experts, municipal workers, environmental health scientists - work to keep us healthy.

It’s not always easy. Michael Yudell, Jonathan Purtle, and other contributors tell you why.

Michael Yudell, PhD, MPH Associate Professor, Drexel University School of Public Health
Jonathan Purtle, MPH Doctoral candidate and Research Associate, Center for Nonviolence and Social Justice, Drexel University
Janet Golden, PhD Professor of history, Rutgers University-Camden
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