So what the heck is public health?

I have spent two years studying public health at one of the United States’ most respected schools of public health. I have read hundreds of articles, countless books, and more data than I can possibly quantify. Perhaps it is a good time to ask, just what the heck is public health, and how is it communicated. Do people understand what public health experts say, and how well do public health people communicate what we do?

An oft-repeated definition of public health by C.E.A. Winslow (1920) describes it as “the science and art of preventing disease, prolonging life, and promoting physical health and efficiency through organized community efforts for the sanitation of the environment, the control of community infections, the education of the individual in principles of personal hygiene, the organization of medical and nursing services for the early diagnosis and preventive treatment of disease, and the development of the social machinery which will ensure to every individual in the community a standard of living adequate for the maintenance of health.”

Well, phew. That was exhausting.

Here’s another, this time from an Institute of Medicine report, from 1988. In the IOM’s words, public health is “fulfilling society’s interest in assuring conditions in which people can be healthy.” This implies a population focus, namely interventions that aim to prevent disease and promote health that affect everyone.

However, the world of public health, when it attempts to explain itself to the wider public, often resorts to graphs that, despite being conceptually rich and research based, appear downright confusing and at times bizarre, at least to outsiders I fear. I remember one lecturer I heard in January 2012 say, “Public health people love boxes and arrows.” To that add circles, diagrams, squiggly lines, and a range of other symbols. Does this help public health, or simply make the general public confused about what public health is? Or, should we continue to stick with what we, in the field, have come to believe are best communications practices?

To those who have very little experience with public health, I present three images of population health, public health interventions, and the social determinants of health. The first diagram is of factors influencing population health.

Population health model

Public health wheel of interventions

A model explaining the social determinants of health

Running, an evolutionary high humans share with our canine companions

NPR science reporter Christopher Joyce this month profiled the research of University of Arizona anthropologist David Raichlen and his hypothesis that humans are, basically, adapted to run. Well, they are not so much as adapted, but literally “wired to run.”

Kikkan Randall, Holly Brooks, and Cedar Bourgeois blast off at the start of the July 4, 2010, Mt. Marathon mountain race in Seward, Ak.

Raichlen’s lab’s research focusses on: evolutionary biomechanics, linking physical activity to physiology and neurobiology in humans and other critters, and studying energetics and activity levels in human hunter-gatherers and other critters. Raichlen’s team is trying to link these elements to paint a picture of how aerobic activity levels impacted our evolution.

The story quotes Raichlen, who says: “Wired to run, meaning that our brains are probably, have been sort of rewired from an evolutionary sense to encourage these running and high aerobic-activity behaviors.” The theory by some anthropologists assumes that early humans learned to run long distances in order to chase down and exhaust prey, like antelopes. The evolutionary payoff for this difficult activity would be survival in the form of all kinds of goodies – nutritious and healthy food, particularly protein, not to mention clothing and bones for tools.

However, Raichlen believes there was another reward: the so-called “runner’s high.” This high is the release of naturally produced body chemicals cannabinoids, similar to the chemicals in marijuana.

This treadmill-running-pooch photo is found on the Neuman K-9 Academy, Inc. web site at: http://www.mndogtraining.com/article_treadmill.html

I find this term misused and applied to different sensations, which some say is “euphoria,” but I mainly link to the relaxed feeling that follows runs. As a lifelong runner, I can personally testify to what I believe to be the “runner’s high,” and the sensation running provides to my mental mood, overall body feeling, and attitude. And the absence of running, in my case and in those of my many running friends, definitely induces withdrawal symptoms, irritability, and poor moods and worse performance in other activities.

Raichlen and his researchers designed a test to determine if other distance-running mammals also produced those drugs. He did that by putting ferrets and dogs on treadmills and taking samples of their blood. Turns out that dogs, who are also are built for distance, produced the drug and the ferrets did not (ferrets are not built for distance).

The team’s paper was published in the Journal of Experimental Biology in December 2011, which of course is locked behind a firewall that the general public cannot access without paying a hefty fee, a frustrating feature of the marketplace of publicly-funded science and the monopolies that control the publication of peer-reviewed journals (but I digress).

Doing the traditional “show off your stuff” run at the Alaska Kennel Club Show, February 2008.

I also find it, again, interesting how dogs and humans share this trait and seem amazingly co-adapted to share this wonderful activity of running. I personally have never been able to tell if humans or canines enjoy running more than the other. I just know that humans and dogs usually have that same wonderful expression of contentment when they finish their outings. It is the look of bliss, and if Raichlen is right, it is an evolutionary advantage.

World Health Assembly to consider polio emergency declaration

Polio, once one of the world’s most feared infectious diseases, still stubbornly persists, notably in countries with high poverty rates, structural issues that create poor sanitation, and unrest. For decades, global health leaders have waged a campaign to eliminate the virus, and have largely contained it, but the final push has stalled. It is considered endemic in Afghanistan, Pakistan, and Nigeria — having previously been considered endemic in India — but it continues to jump borders, such as to Chad this year. As a result of the resurgence of Polio in 2011, the World Health Assembly as of mid-May was considering adopting a resolution declaring polio eradication a programmatic emergency for global public health.

The Global Polio Eradication Initiative drew up an ambitious plan to revitalize the stalled campaign in 2010.

Last week, the United Nations Secretary-General Ban Ki-moon said the time was now to wipe out polio, asking for another $2 billion in commitments, to save up to $40 billion by 2035. Remember, this is money that if not going to polio, could be going to other pressing global health issues, like malnutrition, which the United Nations, as of 2010, claimed accounted for more than one-third of the nearly 9 million deaths worldwide of kids five and under. The tragic part is, low-cost prevention and treatment measures, according to the UN, could have saved most of these lost lives.

The global campaign to eliminate polio was first launched in 1988. It has been the single-most expensive medical campaign focussed on a single human illness in the history of humanity.

A major funder of polio eradication efforts, the Bill and Melinda Gates Foundation, as of 2009 had pumped nearly $1 billion of their foundation’s money into what is known as a “vertical” intervention strategy, targeting a single disease, not a “horizontal” strategy, which goes after root causes of health issues like social inequality, poverty, and poor primary care infrastructure.

This debate is particularly sensitive with polio, given Bill Gates’ personal trips to Nigeria to convince the country’s leaders to spend their meager health resources on polio eradication, when they face many daunting challenges with a very poor basic health care system. About 800,000 Nigerian children under five die annually, the second highest rate of any nation in the world, according to UNICEFʼs 2009 count.

The campaign that eradicated smallpox in 1979 also offers telling lessons for the polio eradication effort. International aid was $100 million. Recipient nations spent $200 million of their own funds—a scenario many say will repeat with the current polio strategy. The World Health Organization (WHO) reports that in many African nations like Nigeria, government spending on health is less than 5 percent of all outlays. It is unlikely countries like Nigeria can pay for polio eradication and other efforts like reducing child mortality from malnutrition.

Having travelled widely in India in 1989, I vividly recall seeing the victims of polio in many communities. No one wants to see polio’s return. But are the resources this effort demands, particularly for meeting Millennium Development Goals, worth the concerted effort?

Every day can be bike to (fill in the blank) day

Here in the United States, promoters of biking and various groups attempt to rally public awareness around the health, environmental, cost, and multiple other benefits of biking by having “bike to work month” and “bike to work day.” This is important, because these activities can turn the attention of a chaotic media landscape for a brief moment on the incredible versatility and value of biking.

The down side is, once the day, week, or month passes, the next worthwhile cause takes the spotlight, and the public’s attention quickly turns away from biking, and without sustained interest, meaningful policy work and political momentum fizzles. Luckily, I live in a Seattle that at least has a critical mass of cyclists and some more “advanced” infrastructure to help keep cyclists somewhat safe from the perils of sharing roads with vehicles. To Seattle’s credit, it is getting ready to update its bicycle master plan. (For anyone who is from Seattle and who has not taken the survey, please do so.) And nationally, many advocates are working hard to sustain a national movement one community at a time.

As a highlight of “bike to work day” on May 18 in Seattle, a portion of the Ballard neighborhood was closed to vehicle traffic. Bikers were able to lock their bikes to makeshift bike locks. This is a scene we seldom see in this country because too few businesses and governments support and pay for basic infrastructure to make cycling more doable — such as having secure areas to lock bikes and accommodate them. (This is not the case in every community, and cycling advocates throughout the country are working to ensure new developments accommodate bikes with the right bike racks.)

Celebrating Bike to Work Day in Seattle’s Ballard neighborhood, May 18, 2012.

I remembered my travels to Germany. Even back in the 1980s, I found hundreds of bikes locked outside, in large bike parking areas, that were used during every month of the year, including winter months. I long for the day when bike racks are common in front of every building, and every rack is occupied by a locked bike.

A sea of bikes in in Heidelberg, Germany, December 1985 — winter did not scare these cyclists, and they had a place to park their bikes.

The journey ends at the UW School of Public Health

On May 11, 2012, faculty and students gathered at the Center for Urban Horticulture to celebrate accomplishments achieved during the academic year. Such events are important, I think, particularly when those honored truly deserve the accolades of their peers. To my delight, three graduate students who I know and respect greatly won top honors from their respective departments and programs, and even the entire school: Valerie Pacino, Bridget Igoe, and Mateo Banegas. It was awesome to see this kind of recognition of people who I am confident will be leaders in whatever place in health care, policy, science, or research they find themselves. It is so fun to get to meet people who you know will be making their mark in the world.

As for me, I am just delighted to be at the end of the long, expensive, and interesting journey. At times exhausting, and at times fascinating, graduate programs no matter what the field or the school have their ebbs and flows. The best part of course is when you reach the end and look back on all you have done. To celebrate the final class of my program (Community Oriented Public Health Practice), one of my classmates surprised us all by preparing mimosas before noon, while we did a very thorough review of management and organizational behavior theory (and I really enjoyed this block, taught by Professor William Dowling). I still have a couple of presentations to make, and of course get that all elusive great job doing what I love to do, but all in due time.

Rudy Owens, final day of coursework at the UW School of Public Health, turning to the heavens in thanks at Seattle’s Discovery Park (May 17, 2012).

Walking and why it is the secret to longevity and happiness

This week, a physical education columnist with the New York Times named Gretchen Reynolds was all over the radio. In 48 hours I heard her interviewed by Terry Gross of Fresh Air  and then interviewed by the BBC World Service. She has published a book with a catchy title called The First Twenty Minutes. It appears to be catching fire.

I liked a lot of the things she was saying, and how she communicated. Reynolds is a communicator attempting to take peer-reviewed journal articles, which to nonscientists are impenetrable with graphs and meaningless numbers and confusing P values and unconnected to their lives, and make them fit into the larger problems this country faces with the obesity and overweight epidemic. I applaud her for calling attention to this problem that is bankrupting our medical system and leaving tens of millions of Americans unable to live more productive, happier lives.

I caught most of her interview with Gross, and while upbeat, I found some of the discussion on the health benefits of activities like standing up often while sitting to be out of touch with larger systemic issues causing the health crisis that led to two-thirds of this country to become obese or overweight.  Encouraging people to do minor things is not asking anything resembling sacrifice or commitment, which is what is required both in a personal sense and a larger policy sense. It is as if we have completely dumbed down all of our messaging to the lowest denominator. But then again, Reynolds is someone making a living as a writer and health expert — and selling a popular message as a product is critical to success.

Instead of the media talking to experts about whether 30 minutes of exercise is  good enough to keep us healthy, media should be talking about the primary reasons why people aren’t exercising—the overconsumption of TV and screen use, the built environment that promotes the utter dominance of the internal combustion engine, and the failure of each individual to take ownership for their health from the food they eat to how much they move their bodies. (And, yes, I know it is more complicated than this, especially for many minorities and lower-income Americans, but these factors matter a lot).

I was delighted, however, that Reynolds praised the health benefits of walking. She rightly called walking the single best exercise that exists on the planet and what humans are built for. She is right. It reduces your risk for heart disease and diabetes, and it apparently increases memory capacity in mammals (makes sense, blood flow stimulates oxygen and chemicals produced by the body to be delivered to the brain). As for me, there is no better exercise in the world than walking. A walk anywhere, anytime, in any weather, beats sitting on my butt and not walking at all. I feel healthy, happy, and more level-headed after a walk. I just wish more Americans could embrace walking and voted to support measures that promote walking – sidewalks in neighborhoods, parks and trails – and support politicians who want to change how we deal with public transportation funding in this country. Even one of the biggest promoters of lopsided transportation priorities, the car- and petroleum-friendly federal government, notes that a tiny sliver (0.7%) of federal transportation funds are spent on improving pedestrian facilities.

Maybe we need what Scotland has, the right to roam about in a responsible way (yeah Scotland).

Walking the Coastal Trail in Anchorage on a lovely summer night.

My favorite place to walk in Anchorage Alaska, along Westchester Lagoon.

Cats behind bars — more proof of how pets bring out our best

For years, corrections officials have been incorporating animal training programs into the various penal facilities that exist around the country. Many animals have been used, especially dogs.

The Seattle Times, in its May 3, 2012, edition is running a story called “Cats bringing out the soft side of inmates,”on the success of a program in a Vancouver, WA-area prison that is teaming cats with prisoners, in order to teach the incarcerated prisoners greater compassion, as well as modify their behavior and thus reduce risks, violence, and costs.

It appears to be working since its launch in January 2012.  The story describes how two inmates are paid 35 cents an hour to care for a 6-year-old cat with “a testy disposition.” The project is taking place at the Larch Corrections Center, which is described as a minimum-custody prison. In the words of one of the prisoners working with the cats: “This gives you a softer side; it makes you feel like you have a kid at home. When I’ve been out during the day I remember I’ve got my daughter at home waiting for me.”

The story notes that prisoners at the Washington Corrections Center for Women, in Gig Harbor, WA, have trained dogs for owners with special needs for three decades, and since the 1980s, dog-training programs have spread to much of the state prisons.

Mrs. Chippy, the cat on the ill-fated Antarctic expedition of the Endurance, and one of the most beloved members of the entire crew by the extremely hardened men who loved her.

So, once again, there is evidence of the mutually beneficial relationship that humans have with pets, and how human health and behavior can be positively impacted by the interaction with animals.

This does not involve costly technology, or coercive techniques, or anything that is radically new or not even known to researchers and people with good judgment and basic common sense. It does involve leadership and the willingness of those who run such institutions to try out something new.

Here is to the cats in at the Larch Corrections Center. Good work, and keep on purring.