By Jonathan Purtle

What does the United States have in common with South Sudan and Somalia? Not much, except for being the only other United Nations member state that has not ratified the Convention on the Rights of the Child (CRC).

Entered into force in 1990, the CRC is a human rights document that guarantees a set of civil, political, economic, social, health, and cultural rights to children. Some specific rights include not being subjected to abuse, having guaranteed access to health care and quality education, and enjoying the freedom to access information, express one’s thoughts, and establish an identity. The United States was instrumental in helping draft the treaty during Ronald Reagan’s presidency  and signed it in 1995 (a purely symbolic act), but the Senate has yet to ratify it. The CRC is a legally binding document.  If the United States were to ratify it, the federal government would need to ensure that the rights enumerated in the treaty were  satisfied for all children in the U.S., or face sanctions from the United Nations.

For many years, Article 37 of the CRC was the United States’ excuse for not ratifying it. Article 37 prohibits the execution of children and life sentences for children without the possibility of parole. Recent Supreme Court decisions, however, allow the U.S. to clear the Article 37 hurdle. In 2005, in Roper v. Simmons, the court found that executing children was a form of cruel and unusual punishment.  In 2010, the decision in Graham v. Florida outlawed sentencing children to life in prison without the possibility of parole for crimes other than homicide. In June 2012, in Miller v. Alabama, the court extended this protection to children convicted of homicide.

By Jonathan Purtle

Injuries are the leading cause of death among people age 44 and younger in the United States. The Centers for Disease Control and Prevention’s (CDC) Center for Injury Prevention and Control is the federal entity charged with reducing this burden. Visit the Center’s website and you’ll find guidance on how to prevent pretty much every type of injury imaginable—such as those resulting from motor vehicle accidents, dog bites, fireworks, and playgrounds just to name a few. 

When it comes to preventing injuries caused by nail guns, which are responsible for an estimated 37,000 emergency department visits annually, the CDC is “Nailing Down the Need for Nail Gun Safety.” But when it comes to real guns, which were responsible for an estimated 73,883 injuries and 31,672 deaths in 2012, you won’t find a bullet of guidance about preventing firearm-related injuries on the CDC website. Seem strange?

By Jonathan Purtle

Last Friday, the United States Department of Agriculture (USDA) announced new standards to regulate the nutritional content of food sold in schools. The standards come in response to a bipartisan request from Congress for something to be done about childhood obesity in the U.S.— an issue of public health priority, and national security, which has been getting worse for the past 30 years. In 1980, about six percent of the nation’s school-aged children were obese. In 2010, 18 percent were obese (an additional 15 percent were overweight, so fully one-third were carrying around too many pounds for their height).

Why might school food environments be a place to intervene? As noted in an issue brief recently published by the Robert Wood Johnson Foundation, food consumed at school accounts for between 35 and 50 percent of a kid’s diet. About 40 percent of students buy, and eat, at least one snack at a school daily; 68 percent purchase and guzzle at least one sugary drink.

A few years back, Congress passed the Healthy Hunger-Free Kids Act of 2010. Among other things, the legislation requires the USDA to develop nutritional standards for all food sold in schools — not just that which is dished out on the plates of federally-supported school meals. In the world of public health, these foods are referred as “competitive foods” and include that which is offered a la carte in the cafeteria (e.g., Domino's Pizza), at school stores (Snickers), and in vending machines (Pepsi). (All of these were available at my schools in Radnor Township in the 1990s). Parents can still send their kids to school with whatever they see fit (or unfit) to eat. Birthdays party sweets and bake sales will not be subject to regulation.

By Jonathan Purtle

Earlier this month, Pennsylvania State Sen. Daylin Leach (D., Montgomery-Delaware) announced plans to introduce a bill that would legalize marijuana —  not just for medical purposes, as New Jersey recently did, but also for recreational use.  The substance would be regulated by the state in a way similar to alcohol and tobacco.  As Leach describes on his website, the bill is founded on the idea that marijuana is no more harmful, and less addictive (this is debatable), than both these substances and that the financial costs of keeping marijuana illegal are enormous. Citing data from the White House Office of National Drug Control Policy, Leach points out that 24,685 marijuana arrests were made in Pennsylvania in 2006 — translating into $325 million in criminal justice costs.

Leach’s proposal follows referendums in Colorado and Washington that recently gave those states the green light for recreational marijuana use.  And while  the Pennsylvania bill will likely go up in smoke — Gov.  Corbett has vowed to veto the bill if it reaches his desk — it seems high time to explore the potential pros and cons of legalizing marijuana from a public health perspective.   

First the cons.

By Jonathan Purtle

In a box in my basement — amongst a broken TI-83 calculator, Discman, and other college-era artifacts — is a poster entitled “Forever 27.” Once ubiquitous in dorm rooms, the poster depicts Jimi Hendrix, Janice Joplin, Jim Morrison, and Kurt Cobain in a Daliesque purgatory at the age when all of them died after bouts with substance abuse: 27 years old. In addition to being a tribute to rock legends, the poster embodies the popular belief that fame and fortune lead to excess consumption, which occasionally leads to an early, but glamorous, demise.

While there is probably some truth to this logic, a study published last month in the open-access medical journal BMJ Open suggests that something far earlier in their lives — exposures to extreme stress during critical periods of childhood development — may be behind a substantial portion of rock stars’ premature mortality.

These kinds of stressors are known to trauma researchers as ACEs. The name comes from the Adverse Childhood Experiences study, a large research project started in the 1990s that discovered a strong, graded relationship between childhood trauma and stress  and the leading causes of adult death in the United States. The research spawned many other studies, and we have written about several on this blog.   The original research  designated each type of trauma or stressor — growing up with an alcoholic parent, for example, or being physically abused or neglected — as an ACE.  Among the ACE study’s findings, adults who'd experienced one ACE as children were twice as likely to have become addicted to illicit drugs at some point in their lives than people who'd experienced zero ACEs. Those with three ACEs were over three times as likely; a person with five or more ACEs was nearly eight times as likely to have become addicted. A similar relationship was identified between ACEs and alcohol abuse.  

The recently published research on early deaths among rock stars is part of a larger study of 1,489 pop stars who achieved fame between 1956 and 2006 (Elvis Presley to Amy Winehouse). The authors investigated 137 cases of musician mortality in that group. Using biographic information from a variety of sources, they determined each star’s ACE score — it's based on a standard set of 10 questions — and whether their death was “substance abuse or risk related.”

By Michael Yudell and Jonathan Purtle

Approximately 3.9 million babies will fondly recall 2012 as the year they were born in the United States. The year will hold a special place in their hearts for an estimated 78.5 years—the average life expectancy at birth in the U.S. Their chances of living beyond that estimate, and their quality of life as they age, will be greatly influenced by the issues that we write about on this blog—the issues which fall within the purview of public health.  Here are some of the top public health issues that we, and perhaps a cohort of 3.9 million, will think of when we reflect back on 2012. 

Fracking: While not an animal in the Chinese zodiac, 2012 was the year of the guinea pig in Pennsylvania.  As The Public’s Health’s expert panelist Bernard Goldstein described, Pennsylvania has volunteered to serve as the proverbial guinea pig of the Marcellus Shale natural gas extraction experiment.  Limited regulatory oversight, tax incentives, and an absence of research have allowed for the practice of hydraulic fracking to generate quick state revenue while its health consequences remain “inconclusive.” Like a guinea pig in a scientific experiment, however, Pennsylvania is taking on extraordinary risk for short-term gains.   Neighboring states, which are exercising more caution in their fracking decisions, are likely to benefit from the knowledge that results from Pennsylvania’s fracking experiment. 

Violence: An estimated 16,000 people died from interpersonal violence in the U.S. in 2012—most of them youth.  While coordinated efforts to prevent the community violence which plagues many U.S. cities are lacking, the tragic mass shootings in Aurora, Colorado and Newtown, Connecticut have catapulted the issue of violence to the forefront of political agenda. What real change will come from this sudden burst of attention? Time will tell.  To be sure, discussions about tradeoffs between public safety and individual liberty and the role of collective responsibility for identifying and addressing mental illness will be central to any meaningful action.

Don Sapatkin is the bicycle-commuting Inquirer public health reporter who edits The Public’s Health blog.

By Don Sapatkin

The Robert Wood Johnson Foundation on Wednesday posted an interesting interview with Michael Yudell and Jonathan Purtle, the experts behind The Public’s Health.

By Jonathan Purtle

Emotions rise high when election season rolls around every four ears. Could the culmination of this excitement and passion for political participation result in excess motor vehicle fatalities when Election Day finally arrives? A 2008 study published in the Journal of the American Medical Association suggests so.

Using data from the Fatality Analysis Reporting System, the researchers tested how the number of fatal motor vehicle crashes on election Tuesdays in eight years when presidents were on the ballot compared with the number of fatal motor vehicle crashes on the Tuesdays before and after Election Day. Only fatal crashes occurring during local polling hours, between 8 a.m. and 7:59 p.m., were included in the analysis.

On the election Tuesdays between 1976 (Jimmy Carter) and 2004 (George W. Bush), 1,265 people died in motor vehicle accidents while the polls were open — an average of 158 deaths per day, 13 per hour.  The average for the two control Tuesdays was 134 deaths per day, 11 per hour. In other words, based on this comparison the risk of dying in a motor vehicle accident was 18 percent higher on Election Day than it was on the Tuesdays on either side. The researchers found that this increase in risk remained relatively consistent regardless of the age or sex of those involved in the accident, the location where it occurred – and, yes, whether a Democrat or a Republican won the presidency.

By Jonathan Purtle

Jobs jobs jobs. Both parties' national conventions were abuzz with talk of plans to address unemployment — 8.1 percent nationally in August, the government reported Friday (and certainly higher locally, where preliminary July rates were 9.1 percent for the Philadelphia metro area and 11.6 percent in the city). The importance of revitalizing the economy undoubtedly resonates with most Americans, for obvious reasons. Here's another: A vast body of public health research indicates that losing your job can mean losing your health.

And while creating new jobs, and well-paying ones at that, may solve unemployment, a new study published in the journal Social Science & Medicine raises questions about the potentially lingering health effects of the nation’s economic downturn.

In the fall of 2009, near the height of the great recession, researchers at Yale conducted the random door-to-door survey of households in New Haven, Conn. Seventy three percent of those approached completed the survey, yielding a study sample of over 1,200 people. Of them, 14.5 percent reported being unemployed and looking for work, 18.4 percent working part-time.