Denmark, a place I could call home

I love Denmark, reportedly the world’s “happiest country.” I could live there. I could die there. In fact, for years I had truly hoped to marry a Danish woman and become part of the extended Danish family.

Well, not all of these happened. I clearly have not died, and I have not married a Danish woman, though I have known many amazing Danish women who impress me by their linguistic abilities, intelligence, dry sense of humor, warmth, and worldliness. They have good schools in Denmark, and Danes have some other quality I cannot fully explain that always has charmed me. They also are very humble despite, overall, being extremely capable (take for example the promotion of wind energy). They also like cozy, or “hygge,” which can mean enjoying each other’s company over an after-dinner coffee and sitting in a living room without any hurry to dash off anywhere. I felt it there, particularly with my friends in Copenhagen and Aarhus.

I was very fortunate to have spent about a month in the summer of 2000 living in Aarhus, the second largest city of Denmark, on the Jutland. It is a lovely city, with a world-class university, a great transportation system, great white sand beaches north of the city, and generally very friendly residents. (I just discovered they have published a plan to turn Aarhus into a world-class biking city, with a strong local investment in public spending and planning.) My host, a wonderful Danish pediatrician I had met in Greenland in 1999, took me to some very out of the way places and gave me a place to call home base while I worked on photography projects that summer in Greenland and on the European continent. After 12 long years, I am finally publishing some of those photos here. Hej hej.


What Denmark can teach Snohomish County and other Puget Sound areas

For my current class on management in my public health program at the University of Washington, we are examining the Snohomish County Health District’s strategic plan. Snohomish, just north of Seattle, has nearly 720,000 people. The two top killers in the county are chronic diseases (cancer and heart disease).  The county’s health profile largely mirrors the rest of the nation’s—residents are suffering from obesity and being overweight, they rely heavily on personal vehicle use to travel, and their built environment has been created mostly to facilitate personal vehicle use. (There were 449 vehicular deaths in the county from 2002-08; deaths from unintentional injuries rank as 4th leading killer in the county.)

In short, the county is premised on sprawl development, which encouraged real-estate speculation, all collapsing with a bang when the housing bubble burst in 2008. Such sprawl, subsidized by taxpayer funded infrastructure (i.e., roads to serve the automobile) and extremely cheaply priced energy (gasoline), of course is one of the major factors leading to this nation’s ever-worsening health indicators, such as a rise in type 2 diabetes and bulging waist lines.

By comparison, Denmark, where I visited for more than a month in 2000, has a robust public health system and a healthier population than the United States’, and it spends about half per capita on health care than the extremely inefficient U.S. system. The country has strict land use and planning regulations, and nationally and locally they have a heavily subsidized public transportation system that enables residents to commute to work and their homes by bike, bus, and light rail.

I lived in Riis Skov, just north of Aarhus, the country’s second largest city. Aarhus, even back in 2000, had an incredibly well-designed multi-modal transportation system that encouraged “active transportation” (biking, walking). Today, one can find free bikes in the city.  The downtown area, site of the historic cathedral and main square, by the port, was pedestrian only. Bike paths in all directions from the city were designated in blue painted paths on the streets and with bike charettes or with clear white lines. People rode their low-tech, three-speed bikes everywhere, even in the rain (many did not use bike helmets, interestingly).

Multimodal planning in Aarhus, Denmark--making it safe for bikes in the city center

Here in Seattle, where I live, we have nowhere near as safe or robust a multi-modal transportation system. There are no blue-painted bike lanes. We have bike lanes painted onto dangerous busy streets, and we lack the sophistication in planning that Aarhus had achieved years before Seattle could build a light rail. We have a lot to learn from our Danish friends. Go Aarhus, go Denmark!

Rails and trails--how residents commute to and from Aarhus, Denmark

My $85 used bike — best investment I have made in years

Here she is, my  $85, Chinese-manufactured, used mountain bike. OK, I have replaced the rear wheel, chain, and rear derailleur, but that happens with all bikes. I bought it before I began my MPH program in 2010, so I would not have to worry about my wheels being stolen (who wants an $85 bike?) while I was in class or in my apartment, where I had to lock it outside. Since its purchase, I guess we have cycled more than 4,200 miles (mainly to and from the University of Washington campus, and around Seattle). She is my testimony to the marriage of health, policy, convenience, and common sense (all very American ideas in my book). In public health, I think it is critical practitioners practice what they preach, and this is testimony to that.

More than 4,000 miles for less than the price of an iPhone

We are passed all the time on the Burke Gilman bike trail, but that is OK. I am still getting the benefits of a ride, 10 miles every weekday, when class is in session. There are simply few things in life that produce so many positive effects for such little money and with practically no environmental impacts. Here is why biking makes great sense, particularly in cities in the USA, and a few reasons why we have to do better, particularly with infrastructure and investments to make it safer.

Safety: We know that there are fewer accidents to pedestrians and bicyclists when there are safe areas for them to travel. Studies have shown that changes to our cities that make it safer to bike and walk help improve our health.

But in Seattle and elsewhere in the U.S., walking and cycling are much more dangerous, on a per-trip and per-mile basis. Compared to other countries such as Germany and Netherlands, where biking and walking are encouraged by changes in transportation designs, travel by biking and walking were six and eight times greater than the U.S., mainly because of real dangers. What’s more, in the U.S. a pedestrian is 23 times more likely to be killed than car occupants, and bikers 12 times more likely. On a per-kilometer/per-trip basis, U.S. walkers were three times more likely to get killed than German walkers, and six times more likely than Dutch pedestrians. Biking is healthy, but without infrastructure and numbers, we are greatly exposed. One reason German and Dutch cities are safer for walkers and bikers is because they provide safe and attractive corridors and crossings for them. We fail to do that in this country, even in “bike friendly” United States. We must do better, at the local and national policy levels.

Health: Biking literally makes you skinnier and it is great for your health. The U.S. Surgeon General recommends that adults engage in 30 or more minutes of physical activity a day – and barely half of all Americans engage in more than 30 minutes of exercise 5 days a week. Currently, more than a two-thirds of all Americans, according to the Centers for Disease Control and Prevention, are obese or overweight. Medical expenses associated with health issues related to obesity , according to the CDC, accounted for nearly 10 percent of total U.S. medical expenditures, totaling over $80 billion dollars annually. By contrast, in European countries, those with the highest rates of walking and cycling have much lower rates of obesity, diabetes, and hypertension. Type 2 diabetes alone is estimated to cost the U.S. $180 billion annually. In short, making it easier to bike makes health sense and fiscal sense. Including here in Seattle.

Car Trips Can Be Reduced: In the United States, more than 40 percent of all car trips were less than 2 miles, and 28 percent were less than 1 mile – and we know that biking can easily cover such distances. Americans need to get on their bikes for short trips, even in winter cities. It’s doable. Winter cities in Europe are filled with bikers. Addressing the safety barrier is a hurdle we have to overcome with designated bike corridors, to help encourage exercise levels needed to help reduce prevalence of some chronic diseases.

Two Great Reasons: New bicycle commuters can expect to lose 13 pounds their first year of bicycle commuting. [Bicycling Magazine]. If that wasn’t enough, we know that biking is cheaper than driving, a fact that make sense as we are seeing a spike in oil prices because of instability in the Mideast and North Africa.

Good Ideas: The Centers for Disease Control and Prevention has developed transportation policy proposals that could improve health. The CDC’s recommendations call for “healthy community design elements”—transportation networks, street designs, land use policies—that can mitigate adverse impacts from air and noise pollution and reduce injuries.  The proposals also call for policies that protect pedestrians and bicyclists, which in turn can have a profound positive impact on health. These include designing streets to reduce vehicle speeds and pedestrian and bike injuries and correcting hazards in infrastructure to make it safer for walkers and bicyclists.

I do not know if I will reach 5,000 miles with my cheapo bike, but think of the low-cost impact this kind of tool could have if just 1 percent of all Americans who did not own a bike found one on Craigslist, purchased it, and started to transform themselves and their neighborhoods. It is practically revolutionary as an idea, and good for the economy too.

Suggested Sources:

Pucher J, Dijkstra L. Promoting safe walking and cycling to improve public health: lessons from the Netherlands and Germany. American Journal of Public Health. 2003; 93:1509 –1516.

Making Healthy Places: Designing and Building for Health, Well-Being, and Sustainability. Eds.  Dannenberg, A., Frumkin, H., Jackson, R. Washington, DC: Island Press, 2011.

Centers for Disease Prevention and Control. CDC recommendations for improving health through transportation policy. 2010;

The power of perseverance, as told by Michael Caine

One of the qualities I respect the most in successful people is grit. Another term to describe that wonderful trait is “stickwithitness.” By many measurements this characteristic, more than intelligence, may be a greater indicator of a person’s long-term success.

The other night I was discussing with a friend a characteristic I admire about Confucian cultures–the inner discipline, which is valued culturally. That inner self-control and single-mindedness are things that I see as attributes to address weaknesses all of us have. That can be eating bad food like too much chocolate (my vice, I admit), or not sticking with a healthy eating regime that can be so easy when we are busy or stressed, or watching too much TV–all things that can lead us to have less desirable health outcomes.

I do not think that “stickwithitness” is Confucian or the property of any culture, outright. It is frequently associated with people who many of us admire. That can be the musician who trains and trains, or great persons who have that indomitable will to overcome great odds, like an Abe Lincoln rising from poverty to the presidency.

Charlie Brown–he never ever ever ever gave up, just like Michael Caine, and just like folks we admire for sticking with it.

This is a story I heard last fall during an interview with one of my favorite actors, Michael Caine. It is such a happy story, I am going to risk getting in trouble with NPR by reprinting Michael’s full statement here about how he met his best and lifelong friend (you have to read below). And guess what folks–they did live happily ever after, and how often do you hear stories like that? Michael was sure of what he wanted. He did not give up.

“Mr. CAINE: Oh my God, yeah. That was the greatest day of my life and, you know, like all great days of your life, you don’t realize it. What happened was is I had my best friend – his name was Paul. We were both single and we were out, obviously, six days in the discotheques, right, girls, dancing and everything. I said to Paul, I said we’ll do something we’ve not done before. We’ll stay in and we’ll watching television.

And a commercial came on for coffee and this girl was in it with these maracas. And I fell in love with this girl instantly – absolutely instantly. And then I got all excited. And I said, oh, I said, we’re going to Brazil tomorrow to find her. And then I went – I said, well, let’s go out and have a drink. So, I went down to discotheque and we’re sitting there, Paul and me, and a guy came in we knew.

He said, no girls tonight? I said, no. I said, I’m love with a girl I saw on the television. I’m going to Brazil to find her tomorrow.

So he said, I’ve been watching television all evening. He said, I didn’t see any beautiful girls on television. I said, she wasn’t in a show. I said, she was in a commercial for coffee. He said, we make that commercial. I said, well, I’m going to Brazil to find that girl. He says, shes not in Brazil, Michael. She lives in the Fulham(ph) Road in London. And she’s not, shes not Brazilian, she’s Indian. Her name’s Shakira Baksh. He gave me her number and I called her.

And I called every night for two weeks and she wouldn’t go out with me. And on the 10th or 11th – whatever it was – time I found her, evening, one after another, keep getting refused, I said to myself if she doesn’t come out with me tonight, I’m never phoning her again. And she said that night she would come. I’ve had the happiest 40 years of my life with this lady. And if she’d have said no that night, that would’ve been the end of it.

But anyway, it wasn’t and it’s been fantastic.”

Being SMART about feel-good social media sensations

Like many people, I have very mixed feelings about the media phenomenon that is the super viral video known as Kony 2012. It has a sexy opening line: “Nothing is more powerful than an idea”–something that is a two-edged sword.  This can be terribly awful if applied by those promoting “evil agendas” (explained below). The video is produced by a group called Invisible Children, itself a major recipient of corporate giving (JP Chase Morgan Bank is a huge supporter of this group, according to the company’s web site). This itself gives one pause.

The moment I saw it, I was screaming out loud: “manipulative,” “scam,” “cliche,” “heroic white saviors,” “powerless Africans with only one name,” “exploitative.” I actually have followed this story for more than a decade, and I have been to northern Uganda in 1997, where the Lord’s Resistance Army wrought havoc on innocent Ugandans. This is a long, complex story involving several African nations, ethnic groups, geopolitics, and more. This video, while bringing a horrible human rights offender to the attention of the public, disregarded many historic realities that I found deeply troubling as a former journalist. For instance, the main villain, Joseph Kony, is no longer in Uganda committing crimes; he reportedly was last seen in the Democratic Republic of Congo.

So what are we to do when we see how emotionally manipulative media products can gain one instant notoriety and fame, itself a goal of many scraping to make it in media production, photography, and storytelling.  (Recall “performance artist,” but definitely not a journalist, Mike Daisy and the factually inaccurate story he pushed about Apple’s suppliers in China that compromised his career and brought disgrace to the radio show This American Life.)

I can never disassociate the message from the person. Remember Leni Riefenstahl and her hypnotically seductive Triumph of the Will, a  scary masterpiece of fascist propaganda released in 1935 (when concentration camps were not quite operationalized) that helped the cause of one of the greatest murdering madmen of human history, Adolf Hitler? Riefenstahl latter downplayed her Nazi sympathies and attempted to justify her work as merely the output of an artist doing a job, without moral consideration for the outcome. And she was a brilliant photographer and filmmaker, who even after being associated with a genocidal regime, revitalized her career with images of Sudan (The Last of the Nuba) that many would think of today as “progressive” in its orientation. (See the stunning photo below.)

Leni Riefenstahl’s photos of the Nuba, seen here, are brilliant images in their own right, but should they be viewed as distinct from her ties to a genocidal regime from her more youthful days?

I just stumbled on a promotional page for a group called International League of Conservation Photographers. I immediately smelled the conflict between huge egos involved in their media/photographic work and their worthwhile “cause.” The video creates an image of heroic warriors, backed by their own orchestral score. Or, are they just talented photographers trying to make a living too as photographers. What do you all think?

I am always going to suspect self-promotion if I do not see a clearly defined goal that accompanies the promotion. This organization states what many would believe to be a worthy goal: “The ILCP seeks to empower conservation photographers by creating an organizational structure that allows them to focus on the creative aspects of their work while at the same time finding venues that allow their images to make a significant contribution to the understanding and caring of the environment.” But is this truly a clear roadmap?

In public health, they teach us that the best interventions have SMART objectives because they provide the clearest guidelines for developing measurable, achievable actions. SMART stands for:
-Time Bound

Whether SMART objectives actually lead to change, or themselves become watered down by their clever wording, is another topic. But in general, I believe this is a relevant way for looking at groups who promote social change. Is what they are offering SMART, or is something more akin to Triumph of the Will, dressed in clever social media marketing. That really is the job of the viewer, but also those who can also use social media to call attention to Triumph of the Will’s and Kony 2012’s viral step-children.

Photographing leprosy in the Philippines

In 2003, I visited two leprosy clinics in the Philippines, run by the Philippine Leprosy Mission. One is located near the capital, Manilla, the other operates outside of the second largest city, Cebu City.

Leprosy is not considered a major global health priority, relative to much more serious infectious diseases, such as tuberculosis and HIV/AIDS, or mosquito-borne malaria. Still the World Health Organization (WHO) estimates that more than 200,000 persons, mostly in Africa and Asia, are infected. It’s a bacterial disease, and has been reported well before the time of Christ. The disease mainly affects the skin, the peripheral nerves, mucosa of the upper respiratory tract, and also the eyes. Leprosy is curable and treatment provided in the early stages averts lifelong disability. If it is not caught, it can cause progressive and permanent damage to the skin, nerves, limbs, and eyes. That is the leprosy in the popular imagination. It is the disease that causes deep fear because it is misunderstood.

My photographs were shared with the American Leprosy Mission, which supports these two missions. These were the final product of my trip. The project grew out of a relationship I developed with a Seattle-area physician, working to raise funds to help permanently eliminate the disease, in conjunction with the American Leprosy Mission and supporters in the Philippines.

The two photographs shown here were taken at the Eversly Childs Sanitarium, near Cebu City, on the island of Cebu. The facility is home to patients suffering from leprosy, and their children, like the young girls laughing below. Patients served by the Philippines Leprosy Mission are engaged in a variety of activities, including trades that help them earn a living, including this man. This was not my greatest work, and wish I had spent more time getting to meet the residents. This was parachute documentary work, and it shows. However, I think the photos presented residents as themselves, living their lives to their fullest. While outside support is critical to this mission, the place is ably run by Filipino professionals. I remember these smiling young ladies the most. Wonderful people.

More research on why humans bond with dogs

The latest viral news story this week, about a black lab that stood guard over its dead canine companion on a busy Los Angeles road, once again highlighted the virtues of dogs that forever fascinate many Americans. The dog’s loyalty won over millions of news watchers, who saw videos and pictures of the sad scene of a dead dog and its frightened companion not budging from the scene.

Would a human do that? Or would we just drive off? We would like to think our good Samaritan instincts would prevail, but we know that with a dog, that type of devotion is unquestionable. And so our love of dogs increases even more when such stories surface. But remember, dogs have been domesticated by us for 10,000 years, and there is solid evidence the reasons are symbiotic, if not more.

I found another peer-reviewed article this week, “Understanding dog–human companionship,” written by Michael J. Dotson and Eva M. Hyatt, and published in 2008 in the United States Journal of Business Research ( volume 61, pages 457 – 466). (Sorry folks this is “behind the firewall,” but you can likely find it if you have access to university databases.) The article reports on a survey of  749 dog owners and the owners’ interactions with their dogs. The researchers found seven underlying dimensions defining our relations with dogs: symbiotic relationship, dog-oriented self concept, anthropomorphism, activity/youth, boundaries, specialty purchases, and willingness to adapt. I was less interested in the findings, and more interested in the background research uncovered.

How important are pets, and dogs in particular to people in this country? The article noted that approximately 70 million homes in 2002 reported having at least one pet as a member of the household. One author quoted, Brickel (1986), suggests that animals provide “one highly reliable association in a person’s life … more consistent and reliable than human–human.” Maybe that is why television viewers were so moved by that loyal black lab; we see something in dogs we fail to get from each other.

According to Dotson and Hyatt, it also turns out women serve as the primary caregivers for dogs in 73 percent of U.S. pet-owning households (US Pet Ownership and Demographic Sourcebook, 2002), and thus will score higher on all measured dimensions of dog companionship. Younger people also score stronger measurements of attachment to dogs, likely because of their ability to provide more time to the relationship. The paper further notes that researchers’ perceptions of the significant, distinctive role that pets play in people’s lives indicates we must recognize this relationship as one that “augments relationships with other humans.”

The researchers also point to findings that show that dogs create interactions among previously unacquainted people (old trick — get a puppy and make new friends) and help to establish trust among  newly acquainted people (you always will talk to a dog owner won’t you — a nice icebreaker for all people of all races, ages, and genders).

All of this makes me sad thinking of my short-lived relationship with AK, a lovely mutt who I could not keep in my apartment in 2010. He tore up the place, and I could not bear to leave him alone in a crate during the day, so I returned him to his owners hoping he would find a nice outdoor home. My status as a non-dog owner will change once I finish this program at the University of Washington School of Public Health.

AK resting (so calm)
AK and Rudy, September 2010