Roger Gollub, a model for leadership in public health

Dr. Roger Gollub and his beloved golden retriever, Sophie, at the famous Balto  statue in downtown Anchorage.

Dr. Roger Gollub and his beloved golden retriever, Sophie, at the famous Balto statue in downtown Anchorage.

Five years ago today, on a cold Alaska night, I was awoken by a strange phone call left on my answering machine saying something had happened to my Anchorage friend, Dr. Roger Gollub. Confused, I called the emergency room at the Maniilaq Health Center in Kotzebue, a remote bush city in the Northwest Arctic Borough, 26 miles north of the Arctic Circle on the Chukchi Sea. Roger had flown there a day earlier on assignment—I was with him the night before. I could not believe what I heard. The medical personnel told me, with great difficulty, that one of county’s finest pediatricians and public health caregivers had died from injuries sustained on a trail just outside of town that night.

Dr. Roger Gollub, a career pediatrician with the U.S.  Public Health Service’s Indian Health Service, never returned home from his short visit to care for patients in this mostly Native community. He, along with a coworker, were mushing on a shared-use trail in subzero weather, under Alaska’s majestic starry skies, when they were run over by a snowmachine. The driver had a criminal background and was under the influence of drugs and booze. It was about a senseless a crime as I could have ever imagined, and more brutal because of the injuries Roger and his coworker sustained. (Note, Roger’s colleague survived, but only after heroic procedures and months of recovery, all costing more than any non-wealthy person can afford.)

After a bitter scream of disbelief upon hearing the news, I caught myself and thought, what would Roger do. I then spring into action for the next 24 turbulent hours, and the years beyond. In fact, my response to Roger’s tragic passing continues to this day. I would never have gone back to graduate school and earned my MPH in 2012 had I not been inspired by Roger’s amazing life’s work. He remains the finest man I have ever known.

Roger Gollub's good friend and champion in so many uncountable ways, Gunnar Knapp, stands by spot where Roger was taken. Thanks, Gunnar, for sharing this with all of us who cared about Roger.

Roger Gollub’s good friend and champion in so many uncountable ways, Gunnar Knapp, stands by the spot where Roger was taken on Nov. 19, 2008. Thanks, Gunnar, for sharing this with all of us who cared about Roger.

Roger had just retired from a distinguished career, which included an epidemiological residence with the U.S. Centers for Disease Control and path-breaking work with Native American and Alaskan Native communities (details here). He was still working under contract serving his many patients, and thinking about an active life ahead, including research, time with his wife and two daughters, projects with the Anchorage Amateur Radio Club, and travels he long delayed. Roger’s death forever changed my life, but also in a good way. From that time on I vowed to work even harder at showing the type of leadership that Roger demonstrated throughout his life.

Though he was only 5’6”, Roger towered above his peers as a professional, and particularly as an exemplary caregiver who understood his young Native American and Alaskan Native patients and their families. He was named physician of the year by the national health agency he dedicated his life too. He had legions of fans across the U.S. Public Health Service who held him in the highest of regards.

At Roger Gollub's "Celebration of Life," hundreds of well-wishers offered condolences and happy memories of one of Alaska's finest doctors ever (December 2008).

At Roger Gollub’s “Celebration of Life,” hundreds of well-wishers offered condolences and happy memories of one of Alaska’s finest doctors ever (December 2008).

I saw hardened, even stoic and cantankerous men who knew him through his ham radio activities openly weep when trying to make sense of his death. (Roger was an advanced ham, who knew Morse code, and who brought amazing life into the local club.) I saw more than 500 mostly Alaskan Natives give him the highest honors normally bestowed only to revered elders. I heard dozens of stories describing how Roger helped and even saved their very sick children, all while preventing costly medical waste within a sometimes-inefficient bureaucratic health delivery system. That alone is amazing, and Roger never expressed cynicism about that system that often thwarted him and his seasoned colleagues.

This letter, published in the Anchorage Daily News shortly after his death, captured a sentiment that lit up the blog coverage of his passing, with comments pouring in nationwide: “I am sure I’m not the only one who feels a great loss with the recent passing of Dr. Roger Gollub. He was truly a man with a servant’s heart and had a tremendous impact on my family. As a pediatrician at the Alaska Native Medical Center, he has shown pure dedication to the Native community and loved each and every patient. He had a place in my heart and my children’s. Once, my daughter had to see another doctor while he was on vacation, and cried for her doctor to come back. The world will never see another with the same compassion, dedication, intellect, integrity and valor as he. I was privileged to know this man for six years and he will never be forgotten in my children’s heart and mine. Linda Tomaganuk Anchorage.”

On the darkest of days, Roger still managed to smile. He always took phone calls from worried parents–at home, in his car, on his walks, wherever. How many doctors take house calls, or personal calls, ever? That was Roger. That was the kind of leader he was. He breathed it. He lived it.

Roger demonstrated to me examples of the leadership that I admire most:

Emotional Intelligence: Roger demonstrated this trait that most researchers say is the best predictor of leadership. He never appeared flustered. His coworkers described his ability to bring chaotic situations under control, in hospital wards or during infectious disease outbreaks, with a calm, deliberative, thorough, and positive manner. It proved contagious, and he earned trust and credibility among his peers.

Understanding of and Respect from his Peers: Abraham Lincoln, America’s greatest politician, was infamous for his empathy and his ability to understand his friends and opponents, which helped him articulate decisions and policy choices that always seemed perfectly suited for the difficult challenges ahead. He knew where the audience was, and where he needed them to go. Roger was celebrated in the Indian Health Service for his true commitment to community based participatory research, for which he earned the deepest respect from his Native American medical professionals. Mention Roger to anyone who has worked in this community, and you will quickly learn of Roger’s deep and genuine appreciation for the community he served during his lifetime. I met a former career pediatrician in the Indian Health Service last spring and mentioned Roger’s name, and was greeted by the most contagious grin I had seen in months. One University of Washington School of Public Health faculty member, who specializes in the field of community based participatory research and who knew Roger in New Mexico, said unequivocally, “Roger was the real deal.”

Leading by Example: Dorris Kearns Goodwin’s portrayal of Lincoln’s wartime cabinet, his famous “team of rivals,” highlights Lincoln’s eventual winning over of Democrat Edward Stanton. Before the Civil War, the former Ohio attorney had ridiculed and mocked the then lesser-known Illinois lawyer as a “long-armed ape” during a legal case during which Stanton shunned Lincoln’s work. Lincoln did not hold a grudge, and he then sought out Stanton to run the War Department during the Civil War, because he had the right qualities to master a complex organization. Stanton later become Lincoln’s strongest ally. Lincoln’s ability to put aside personal grudges and genuinely collaborate even with his political rivals was not an act. It was genuine.

Roger treated everyone he interacted with, even those who did not return the courtesy, with respect. I never once heard him utter a bitter word or even cynical comments, even when I expected them. I have met few people who have demonstrated this trait. Roger had a work ethic paralleled by few. He put in 12-hour days and longer, never compromised his duties as a father or husband, and excelled at nearly anything he tried to do—medicine, engineering, ham radio communications, running, parenting, research, epidemiology, research. Roger adopted practices seeing patients that saved taxpayers tens of thousands of dollars, which his peers steadfastly noted at his funeral. He never sought glory, though during his life he was gaining a national reputation he could never even imagine.

That tiny little guy you see in the front row, in the middle, is team captain Roger Gollub (University City Senior High School Track Team, 1973).

The small guy in the front row, in the middle, is team captain Roger Gollub (University City Senior High School Track Team, 1973).

Roger  particularly demonstrated this talent at University City High School, where he ran track and cross country. I attended the same high school, though ten years after Roger. Roger was the smallest man on an interracial track team, which was comprised of very large young men who towered over Roger. Racial tensions were real here, but so were the strong bonds. I know this school, and I can assure you this is a serious alpha dog environment and not for the faint of heart, particularly among young, competitive men. Roger’s peers voted him captain of the track team, because he pushed the bar farther and competed harder and ran faster than all of them. In short, he inspired them to do better. He never asked for that title. He earned it. He made his team a genuine competitor at the state level. Roger carried that excellence to Yale where he competed for the Yale track team as well. (Roger’s own running hero was Olympian Edwin Moses.)

Moral Vision and Visionary: Roger’s values were nurtured in his Jewish, middle-class upbringing in a diverse community, University City, Mo., which we both called home. (I lived next door to Roger, but only briefly overlapped when I was younger, as he was 10 years older.) It was an often-hard place to learn about racial differences, but also a great place to dream big about pursing a path that made a difference. Roger knew exactly who he was and what he wanted. He graduated class valedictorian in 1973, and never forgot his roots. His vision was, as his friends said, a mix of Mighty Mouse heroism mixed with the Star Trek prime directive to do no harm–and yes, these describe his actions and values as a doctor working cross-culturally.

At Roger Gollub's celebration of life, his family assembled assorted "tools of the trade" he used to care for sick kids, and of course the famous lobster hat.

At Roger Gollub’s celebration of life, his family assembled assorted “tools of the trade” he used to care for sick kids, and of course the famous lobster hat.

I never once saw Roger lose faith in others or in the inherent goodness of people. His service to patients, the core mission of the U.S. Public Health Service, and purposes far bigger than himself can be seen in every personal and professional choice he ever made. He demonstrated and articulated a clear, humane vision for health care, community, family, race relations, and society that he blazed intensely everyday, inspiring dozens if not hundreds by his example.

Don’t be fooled by that doctor you see in this picture with a goofy grin, and a lobster hat and Elmo toys. That was a master professional’s slight of hand to get nervous kids comfortable and the most conniving of change agent’s subversive and effective strategy to reform a health care system that has long forgotten how to put compassion ahead of egos and profits.

I have yet to meet anyone in the field of public health and public service who embodied all of the leadership traits Roger seemed to have in spades. Sometimes we just get dealt the right hand and can say, damn, I was lucky I had a chance to work with or know such a gifted, natural leader. Thanks, Roger!

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The politicization of public health (and everything else too)

maherobama

Click on the photo to open a link to the video clip of Maher’s commentary.

Some might say TV host Bill Maher is so political that he cannot be trusted. I disagree.

On March 8, on his TV show, Maher delivered a very provocative commentary that everyone in the field of health promotion, public health, and public policy should watch. Maher rightly asked, “Since when in America did everything have to be so political?” It was a smart piece of punditry, because he correctly showed how efforts to promote public health, nutrition, and healthy eating had become as politicized as the debate over regulating the proliferation of firearms.

Showing pictures of First Lady Michelle Obama, a champion of a national nutrition and exercise campaign called Let’s Move, Maher opined, “If seeing this nice lady on TV saying she likes the movies, or nutrition, or exercise fills you with rage, get help.”

Maher further correctly noted, “Big portions, conservative; knowing where your food came from, liberal.” In short, Maher said what few in the public health profession are saying or have the courage to say—that a deep schism exists in the public space that taints and will continue to taint all efforts to tackle some of this country’s biggest health problems.

These include the obesity epidemic and the threat posed to our healthcare system and our national health by chronic disease.

Ever a political lightning rod who is ready to fan conservative flames, former half-term Alaska Gov. Sarah Palin used her speaking appearance  at the 40th annual Conservative Political Action Committee (CPAC) conference on March 16, to lambaste New York City Mayor Michael Bloomberg’s efforts to tackle obesity by limiting the size of sugary-sweetened beverages. Bloomberg’s New York City law to limit the serving size of such drinks to just 16 ounces was  overturned by a New York State Judge on March 11.

This perfectly framedAP file photo from March 16 shows Palin's eager embrace of red-meat politics that seeks to prevent small measures to address the proliferation of obesity in the United States.

This perfectly framed AP file photo from March 16 shows half-term former Alaska Gov. Sarah Palin’s eager embrace of red-meat politics that seeks to prevent small measures to address the proliferation of obesity in the United States.

Completely ignoring the obesity crisis that is afflicting her own former state and the country, where two-thirds of all residents are obese or overweight, Palin slurped soda from a 7-11 Big Gulp. The theatrics, all perfectly inline with Palin’s anti-government theology, again proved Maher’s point about the politicization of even micro efforts by some local elected officials to address the public health threats facing the country. (Side note, Palin briefly was governor when I lived in Alaska, and I saw her at health promotion events like community runs–an action that she likely would brand as “liberal” today.)

Whenever I would engage Puget Sound area public health officials during my two years of study at the University of Washington School of Public Health (2010-’12), I always asked, how can you prevent the public perception that efforts to promote healthy activity and nutrition are not perceived by conservative voters and Republican elected officials as part of a liberal, activist agenda. I never got a good answer, mainly because I do not believe those officials had an answer. I did not draw any great wisdom from my faculty or UW SPH peers either.

Some wonkish types have tried to investigate this issue in “philosophical terms,” along traditional axes of egalitarianism/choice minded conservatism against regulation-minded “big government” liberalism. One 2005 article on responsibility in health care choices argued, “Holding individuals accountable for their choices in the context of health care is, however, controversial.” There may be some truth to this, but I discount the “core political values” explanation as a way of understanding the politicization of public health initiatives.

Perhaps the biggest fight  in the U.S. political system today is over tax policy and the future of major social/medical programs—Social Security, Medicare, Medicaid—that provide the true underpinning to the public wellness of our country. This is, at its core, is vicious political battle that will shape the public health of the country unlike any action taken by any regulatory or health agency of the U.S. government.

Regulation to promote health has been at the heart of the public health enterprise ever since the field emerged as a profession in the United States in the late 1800s. According to the Centers for Disease Control and Prevention, many of the most successful public health achievements of the 20th century  (food safety, motor vehicle safety, identifying tobacco as a health hazard, etc.) were “upstream” interventions that, by definition, were regulatory in nature and thus purely political.

However, public health, by being a public enterprise, is by definition a creature of the political process, and thus influenced through the power of the purse to curtail its authority and stymie its reach. Public health departments today, for instance, are managed by publicly accountable officials. A local public health department board of health, like King County’s, includes a broad range of elected officials and a few medical professionals.

The nation’s leading de facto public health official, the U.S. Surgeon General (Dr. Regina Benjamin), today remains a mostly toothless position that has little if no sway over the public policy debate concerning the nation’s public health, according to New York Times health blogger Mark Bittman. He writes, “… there is no official and identifiable spokesperson for the nation’s public health, and the obfuscation and confusion sown by Big Food, along with its outright lies and lobbying might, has created a situation in which no one in power will speak the truth: that our diet is making us sick, causing millions of premature deaths each year and driving health care costs through the roof.”

I personally believe that the position of Surgeon General remains that of a paper tiger because those who have power, members of Congress and the Executive Branch, do no wish to allow an advocate for public health to embarrass them with pesky things like facts and science that call for action.

Dr. C. Everett Koop, former U.S. Surgeon General and effective communicator and advocate for public health.

Dr. C. Everett Koop, former U.S. Surgeon General and effective communicator and advocate for public health.

The most effective Surgeon General in living memory who recently passed away in February, the late Dr. C. Everett Koop, proved unpredictable. Though a staunch conservative appointed by President Ronald Reagan, Dr. Koop staked out very controversial political positions on moral and medical grounds, in defiance of his boss, Reagan.

His notable actions still stand out today for their audacity to challenge powerful interests and their embrace of morality as a tactical advocacy tool:

  • Koop’s office produced the plainly worded, 36-page “Surgeon General’s Report on Acquired Immune Deficiency Syndrome,” which clinically detailed HIV transmission, making clear it was not spread by casual contact and affirming that, “We are fighting a disease, not people.” Koop promoted sex education and condom use, enraging conservative critics.
  • Koop also took on the all-powerful tobacco industry and lawmakers who received its many contributions with his pronouncements that smoking killed and should be banned. He famously called purveyors of cigarettes the “merchants of death.” (When is the last time anyone has heard a medical leader embrace such powerful language for a public health cause?)

Though Koop reportedly claimed morality never “clouded his judgment,” he remained an effective advocate on the bully pulpit by literally shaming those in power. “My whole career had been dedicated to prolonging lives,” he said, “especially the lives of people who were weak and powerless, the disenfranchised who needed an advocate: newborns who needed surgery, handicapped children, unborn children . . .people with AIDS.”

I keep waiting for someone, anyone besides billionaire Mayor Bloomberg, to enter the political discourse on behalf of public health and use straight language that cuts through the hype. The problem is, they cannot teach you leadership when you enter the fields of public health or politics. It is something you either are capable of, or simply lack. Right now, it is lacking.

Come a rain storm, put those running shoes on your feet

The dark and extremely gloomy days of Seattle are now settling in. For runners in this region who work normal day shifts, this signals the dark days of running that last up to five to six months, depending on what time of day one runs and how much free time one has. I find it more gloomy than Anchorage, where I lived and ran six years. I never minded running in the dark there, because the snow and clouds created very powerful ambient light that made running at night very pleasurable. But here, it is dark as a coal mine, and damp. People’s vitamin D levels are unhealthily low, and there seems to be widespread manifestations of seasonal affective disorder (SAD).

First, let’s talk about why this is such a depressing time of year and can be such a bummer place to be.

The absence of natural sunlight impacts the body’s production of two key hormones that impact the body’s sleep-wake cycles, energy, and mood: melatonin and serotonin. Research indicates that melatonin is generated in greater quantities because of longer periods of darkness. Increasing the production of melatonin leads to sleepiness and lethargy. Serotonin, whose production rises with more exposure to sunlight, falls during these shorter days. Low amounts of serotonin are also associated with depression.

Another byproduct of the darkness is a decrease in the production of vitamin D, naturally created by the body. Though researchers have not fully determined whether low vitamin D contributes to symptoms of depression or whether depression itself contributes to lower vitamin D levels, higher levels of Vitamin D are associated with decreased risks of depression. But alas, anyone living in  Canada, and the northern tier of the Lower 48 here in North America all require vitamin D supplements too to make up for the absence of sunlight come fall. Vitamin D also is critical in many key functions: enhancing the absorption of minerals in the gastrointestinal tract and kidney and thus into the blood, and it may protect against tuberculosis, gum inflammation, MS, and some cancers—at least according to my handy nutrition textbook: Understanding Normal and Clinical Nutrition. (I really love this tome – nicely written, well illustrated.) My response is to take vitamin supplements, but that is not enough.

So here I am in dark and rainy Seattle, deprived of naturally produced vitamin D, at higher risk of SAD. This is exacerbated by Seattle’s culture that seems to promote the absence of smiles and eye contact with strangers. What is a person to do?

Running is a perfect antidote to the blues that accompany the shorter days of autumn.

Easy, go running. While hitting my local running grounds (Greenlake), I heard some walkers recently comment, “This is when the real runners come out.” The observation was referring to the near absence of mobs of fair-weather walkers and runners whose numbers thin by nearly 80% the moment the rains fall and that stygian Seattle glooms settles around mid-October. Paradoxically, running is the perfect antidote to anything resembling SAD or depression or everyday stress. I have done this since I was 15, and I continue running rain or shine, but particularly when it rains.

One of the earliest blockbuster books on the health benefits of running, the Joy of Running, by Dr. Thaddeus Kostrubala, came out way back in1976. In it, Kostrubala was among the first of the self-improvement health gurus to promote using an aerobic activity, running, to help treat mental illnesses such as depression. More recently, in September 2011, the UK-based Telegraph published a typical story that is the grist for many running magazines, Running outdoors can improve mental health. The story touted how running outdoors “can both raise your spirits and give you a real buzz.” Of course there are all sorts of web sites that list evidence-based findings that point to the health benefits of running–stress relief, blood circulation to the brain, chemical releases, sharpened cognitive functions, getting outdoors, and more.

Running in the dark does not mean you can’t have fun.

There are also numerous, peer-reviewed scientific papers that highlight the mental health benefits of running, particularly in response to depression. I stumbled on one such paper doing a quick keyword search on the database PubMed, by D.I. Galper, et al., in the January 2006 edition of the journal Medicine and Science in Sports and Exercise, called “Inverse association between physical inactivity and mental health in men and women.” That study looked at the associations between measures of physical activity and mental health in a large group of more than 5,400 men and women. Galper and his colleagues found that cardio-respiratory fitness and habitual physical activity were associated with lower depressive symptoms and greater emotional well-being.

Of course I and other dark and rainy weather runners did not need this study to confirm what our bodies are telling us every time we get out of our homes and get wet while splashing outdoors. I realize that not everyone has the time to get out after busy days. They may have classes, second jobs, kids, or all of the above. But even in the rain, in the blackness of a fall day, a run or even a walk is sure to improve one’s mental outlook, boost one’s mood, and stimulate the body’s chemistry. Here’s to the days and months ahead of soggy shoes, headlamps, and hopefully a few hellos from water-logged runners. You’re a fine crew.

On becoming a public health zombie

Mark Twain, my favorite writer, in Life on the Mississippi, wrote of the transformation that occurred when he,  the majestic pilot of the paddleboat, no longer saw the magic and wonderment in the beautiful world outside the pilot’s cabin:

The Mark Twain riverboat in Twain’s hometown of Hannibal, Mo.

But as I have said, a day came when I began to cease from noting the glories and the charms which the moon and the sun and the twilight wrought upon the river’s face; another day came when I ceased altogether to note them … . No, the romance and the beauty were all gone from the river. All the value any feature of it had for me now was the amount of usefulness it could furnish toward compassing the safe piloting of a steamboat. Since those days, I have pitied doctors from my heart. What does the lovely flush in a beauty’s cheek mean to a doctor but a ‘break’ that ripples above some deadly disease. Are not all her visible charms sown thick with what are to him the signs and symbols of hidden decay? Does he ever see her beauty at all, or doesn’t he simply view her professionally, and comment upon her unwholesome condition all to himself? And doesn’t he sometimes wonder whether he has gained most or lost most by learning his trade?

And it is with these words, etched in my head, that I began to realize that I had become a zombie. To be precise, I had become a fully credentialed (MPH) public health zombie.

When I attend big festival type events, I no longer experience pure fun and enjoy the carnival atmosphere in a pure form. I look at how healthy or, rather, how unhealthy the food sold is. Is it loaded with transfat and sodium? Is it industrially raised meat with potential risks of carrying e-coli?

Fairgoers at the 2009 Alaska State Fair in Palmer, Ak., load up on deep fried everything.

Instead of people watching for pleasure, I will study the crowd through a public health lens. And are those attending a celebration, like Seattle’s annual Fremont Fair, smoking and drinking excessively? (And they were at the Fremont Fair in June this year – I guessed nearly one in five attendees smoked, and I counted at least four outdoor beer gardens, with people imbibing booze as early as noon on a summer day.)

Did people drive to this event, or did they use a healthy form of active transportation like biking, walking, or perhaps a bus?

Bikes aplenty were found at the Fremont Fair on June 16, 2012, in Seattle.

And what about that “electric” cigarette stand run by “Vapor Pro”– a definite concern of public health officials trying to battle the peddlers of nicotine to young and old people alike.

Electric smokes were being sold at the Fremont Fair on June 16, 2012 — should they be allowed?

I also recently visited a middle school in Snohomish County, and was looking at the school entirely as an environment where public health interventions were or were not working. Were kids walking and biking to school? No, they had to bus. The school was located off a busy highway, and there were no sidewalks anywhere near the school. I could go on and on and on. The visit actually was driving me nuts because of all the built environment issues I was seeing that was preventing the kids from being more active than they could be.

For its part, the CDC has, to my delight, decided to poke fun at its earnest seriousness protecting the public’s health by launching a “zombie preparedness” campaign to prepare for a “zombie apocalypse.” The was a surprisingly successful tongue-in-cheek awareness campaign on how to prepare for disasters. It received a lot of coverage. Was this a sudden dash of entrepreneurial social media savvy by the organization dedicated to protecting the health of the nation that tens of millions of Americans know little or next to nothing about?

As much as I hate seeing people eat incredibly unhealthy food, and smoke cigarettes in any form, and get drunk on beers in the midday sun, and drive their cars everywhere, I wish I could now just turn off my own “public health zombie.”  Now I often ponder if I have succumbed to Twain’s curse of the riverboat pilot, contemplating what I have gained against what I have lost by learning this trade.  The good news is, I have my next Halloween costume already planned: a zombie public health inspector.

Health interventions, the positive face of geopolitical engagement

On June 14, Tom Paulson’s insightful blog, Humanosphere, put the spotlight on U.S. military initiatives underway in Africa as part of a grander strategic focus the U.S. Government is placing on Africa, through the U.S. Africa Command called Africom. He raised concerns about the dual efforts of the U.S. Government. On one hand, it was expanding its covert operations, purportedly to root out so-called terrorism networks and promote and training activities in Africa by building bases stretching from Djibouti to Ouagadougou, Burkina Faso, while at the same time trying to stomp out malaria, which kills about 600,000 Africans a year. According to a U.S. Department of Defense (U.S. DOD) press release, “Africom incorporates malaria prevention into much of its theater engagement, distributing mosquito nets and teaching new diagnostic techniques during training events throughout Africa.”

I think few could argue with the humanitarian goals of this type of health intervention, at least with some basic metrics. But in reality, health-related assistance usually has a broader function. Combining “hard” and “soft” power  is nothing new to geopolitics or the U.S. Government and its diplomatic, development, and military branches. The two often go hand in hand. Closer to home for most Americans, but still far away in the U.S. Arctic in communities along coastal Alaska, the U.S. Coast Guard has spent four years expanding its training activities and capacities in the Arctic to prepare for offshore oil drilling by Shell Oil Co. Production is scheduled to begin in the summer of 2012 in the U.S. portions of the Beaufort Sea, just north of one of America’s largest oilfield, Prudhoe Bay. Oil would then be shipped down the aging and half-empty Trans-Alaska Pipeline System (TAPS).

The Prudhoe Bay oildfield is one of United States richest oil producing areas, but its production is declining leading to offshore development.

The Coast Guard preceded its Arctic ramp-up with a much heralded health and logistics outreach, called Operation Arctic Crossroads, starting in 2009, to Alaska’s western coastal communities, such as Barrow and Kivalina. These were welcomed by the mostly Native residents and received high marks from nearly all quarters in Alaska. The Coast Guard is perhaps one of the most celebrated institutions in Alaska because of its humanitarian work saving countless lives and vessels, year after year, and because of the stellar reputation it has earned, demonstrated by its outstanding safety and rescue record. (I am a huge fan of the Coast Guard, if you cannot tell, having reported on their helicopter rescues numerous times as a reporter in Sitka, Ak., in 1993.) But the Coast Guard also has noted these outreach events in Alaska have been ultimately tied to the much larger issue of energy security and defense. The U.S. DOD reported “the Arctic has economic, energy and environmental implications for national security. Coast Guard missions there are increasing because Shell Oil Co. has permits to drill in Alaska’s Chukchi and Beaufort seas beginning this summer.” The U.S. DOD further notes, “Shell will move 33 ships and 500 people to Alaska’s North Slope, and will helicopter some 250 people a week to drilling platforms.”

Deadhorse is the main landing area for the North Slope oil and gas production facilities in Alaska.

The coast of the Beaufort Sea holds significant oil reserves that Shell Oil Co. will begin tapping in the summer of 2012.

All told, Shell spent some $2.2 billion for offshore leases alone, not to mention millions in legal wrangling, government relations, PR, advocacy in Alaska and in DC, and much more since the mid-2000s. The New York Times estimates Shell spent $4 billion in its quest for one of the biggest oil prizes in North America outside of the Athabascan oil sands of Alberta and shale oil finds in North Dakota. (Shell also is drilling for natural gas in the Chukchi Sea this summer also.) The issues framing a stronger U.S. commitment in the Arctic are natural gas and oil resources and a so-called “race for resources,” as it has been described by some, which concerns rights to those resources on the Arctic Ocean seabed floor.

The U.S. Energy Information Agency claims that nearly a quarter of untapped oil and natural gas resources are in the Arctic basin, which explains the significant interest by the major multinational oil exploration companies in the shallow Arctic waters off Alaska’s North Slope. Companies like Shell and ConocoPhillips and others have been staking out their claims for years by buying controversial offshore drilling leases that have been sharply contested in protracted legal fights with environmental groups and Native Alaskan residents of the North Slope Borough (the Inupiat). The Inupiat residents,  who, while mostly supporting onshore development, are concerned about the threat an oil spill or blowout in pristine Arctic waters, similar to BP’s spill in the Gulf of Mexico in 2010. Some Inupiat resident say that would harm their subsistence hunting of migratory bowhead whales, which have been hunted and eaten by these historic Arctic residents for thousands of years.

A whaling ship rests in the Arctic summer sun in Barrow, on the coast of the Beaufort Sea.

What is clear is that interventions premised on health care will likely be part of a larger strategic framework of  nations as powerful as the United States. Those actions, no matter how well-intentioned to improve health care from Kivalina to Kenya, must be understood in a much larger context of any nation’s political and economic interests. This is particularly true regarding access to and the development of natural resources, wherever those resources may be.

I would eat salmon every day if I could afford it

To celebrate the completion of my public health studies at the University of Washington School of Public Health, I celebrated on June 2, the way I always do at the end of long journeys or the start of new chapters—I had a salmon barbecue with good friends. This time I added Alaskan ling cod to the menu.

Copper River sockeye and Alaska ling cod — oh yeah, very very good!

I love salmon. The fish I bought, Copper River sockeye, was very fresh, and the ling cod was amazingly delicious (have to eat more of this). In the past, I have always marked major milestones of my life with salmon. This includes moving, changing my name, celebrations with friends, and other good reasons to cheer. My last night in Alaska, in August 2010, also involved salmon. Times I have left Seattle for journeys abroad have included salmon. In many ways I am following historic traditions of the tribes of coastal British Columbia and their potlatch celebrations.

Salmon has long held a special place in the traditions of West Coast Native peoples, from the Salish all the way up to the Alaska among nearly all Native groups in the Great Land (what Alaskans call their home state). Salmon provided food to support both the health and culture of many tribal bands.

Dipnet caught Kenai River sockeye, July 2010.

Rich in vitamins A and D and omega-3 fatty acids, which reduce the risk of heart disease and stroke, wild salmon is extremely healthy food. Its intake has traditionally been much higher among many Natives because of their subsistence lifestyle. In Alaska, the Yup’ik people, of the Yukon-Kuskokwin region (including the Yukon River), often eat 20 times more fish oil than other people, and they appear to be protected from ill health effects of junk food and obesity with such a diet. However, epidemiologists still assess risk with salmon intake because of potential mercury contamination.

In Alaska, epidemiologists recommend people eat fish at least twice a week, and they say wild Alaska salmon of any species can be eaten in unlimited amounts by women and children, but other species should be eaten less, because of mercury and other toxic contaminants that could be found in fish.

As a former Alaskan, I was spoiled by an abundance of fresh fish.

Alaskan residents are still allowed to dipnet and catch fish as subsistence users in the Kenai River and other areas depending on the runs. During my years there, I would dipnet on the Kenai River for sockeye.

Dipnetting on the Kenai River, 2008.

Rudy Owens and fresh caught Kenai River sockeye, 2010.

The fish I caught would last me through the spring. Here in Seattle, I spent $18 a pound for Copper River salmon. As a just graduated MPH student, that is beyond my budget. My classmate and I once joked when a nutrition professor asked if students ate fish twice a week. Maybe the professor forgot to check what the tuition price was as the University of Washington. Lentils and rice still keep me going. I forever dream of salmon now.

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.