Health

The politicization of public health (and everything else too)

Rudy Owens1 Comment
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.

Do community health fairs really make any difference at all?

Rudy Owens2 Comments

As a frequent community event and festival attendee in Seattle and many other communities, I have always wondered how effective these events have been in achieving their goals of promoting health and wellness. In the public health world, we call these “health fairs,” and they are fairly ubiquitous nationally and accepted with de rigueur. But do they really work?

Somewhat new to the field of public health, I am more familiar with trade shows, which I have been attending for many years. These much more ubiquitous activities provide a common space where companies, governments, and a mass market meet to hopefully find audiences and make sales. They do not seem to be going out of fashion. One show I attended, the biennial Oil and Gas Expo in Calgary, one of the continent’s largest energy shows, draws 20,000 attendees from around the world and sells out every hotel room during its June run. The massive trade fair also attracts some of the world’s largest and most influential companies. So clearly where money is to be made, “the show must go on.”

The super-sized Oil and Gas Expo in Calgary is a perfect example of how important trade fairs are in the private sector.
The super-sized Oil and Gas Expo in Calgary is a perfect example of how important trade fairs are in the private sector.

But what of health fairs that cater to smaller subpopulations, and sell messages, behavior change, and health awareness that can be even unwanted by the audience? I recall distinctly that one of my public health professors at the UW School of Public Health, who shall remain nameless, said s/he had never seen any evidence this public health activity had any measurable outcomes, yet they proliferated as a best practice.

Champions of the health fair model

One fan of community health fairs is Dr. Kevin Pho, an internal medicine specialist who also runs a blog that attempts to reach out to a mass audience. On his blog, KevinMD.com, he gives space to another blogger, who does not give his name and thus we do not know if he is a true MD. But Dr. Pho claims he is, and by endorsing his colleague, he publishes a passionate defense of health fairs as a way of extending medical care without medical hierarchy: “Meeting in this context fosters rapprochement between patient and doctor. The once hierarchical encounter is no more. In this habitat, doctor and patient are in fellowship.” The mystery doctor, who we cannot fully validate, claims that health fairs:

  • Are an excellent way to engage underserved communities in caring for their health.
  • Offer a unique opportunity to engage patients in the community with which they self-identify, particularly when they are in the “precontemplation” phase of action.
  • Are a great opportunity to field patient questions–he claims to have fielded many questions about Bill Clinton’s post-bypass surgery veganism.
  • Uncover and provide the platform to correct misconceptions, in a nonconfrontational setting that can lead to positive discussions.
  • Can grow a doctor’s practice.
  • Are fun.

    At the 2013 Tet Fest at the Seatte Center, a health clinic table was set up amid other tables hawking cell phone plans and new bank accounts.
    At the 2013 Tet Fest at the Seatte Center, a health clinic table was set up amid other tables hawking cell phone plans and new bank accounts.

The Centers for Disease Control and Prevention (CDC) publishes how-to guides how to organize events that engage target communities, such as this guide focusing on injury prevention for kids. Seattle, where I live, is virtually awash in corporate medical events that also involve local partners, like the Seattle Housing Authority and social service providers like Neighborhood House.

These event focus on many of the many minority populations in King County, such as the Latino community, which was engaged at the annual Fiestas Patrias event held in September at the Seattle Center. This particular fair focussed on HIV testing, behavioral health, dental care, long-term care, cancer, chronic disease, and culturally appropriate care for the Spanish-speaking community.

I was recently at the annual Tet celebration at the Seattle Center the weekend of Feb. 16-17, 2013, and not to my surprise saw a table promoting health-fair-styled information for the nearly entirely Vietnamese-American audience in attendance. I did not have the ability to know if anyone attending bothered with that booth or were more interested in the photo booth, the deep fried tofu and Vietnamese coffee, or stage shows.

A booth offering Tet pictures appeared to be more popular than the health clinic table at the Tet Fest in Seattle in February 2013.
A booth offering Tet pictures appeared to be more popular than the health clinic table at the Tet Fest in Seattle in February 2013.

What do we know from recent research?

One non-profit, called Unite for Sight, published an article that reported that there was inconclusive evidence about the benefits of health fairs and community screenings. The medical literature has often viewed them with great skepticism. “Health fairs are neither regulated nor routinely certified in the United States, and complete data on their numbers and content are not available.” The article further noted that tests at fairs may be more harmful than helpful because the may unnecessarily alarm participants with bad results, or provide false reassurance that results shown are normal.The article cites a 1985 study that found “rates of false alarm of healthy people and false reassurance of those at risk may be high for some tests, and the benefits of detecting new disease are easily overestimated.”

A more recent 2011 study on blood pressure screenings at community health fairs, published in the Journal of Community Nursing, looked at outreach on hypertension. The article reported “nurse-operated health fairs, crafted to identify those with high BP readings, are promising as a simple and effective means in motivating individuals to seek follow-up care.”

Another study from 2003, Reconsidering Community-Based Health Promotion: Promise, Performance, and Potential, published in the American Journal of Public Health, found that “evidence from health promotion programs employing a community-based framework suggests that achieving behavioral and health change across an entire community is a challenging goal that many programs have failed to attain.” The authors, Cheryl Merzel and Joanna D’Afflitt, write that “interventions themselves probably are too limited in scope and intensity to produce large effects across a community. Many programs focus primarily on individuals, with most people receiving mass education alone, and interventions and messages are not sufficiently tailored to reach various population subgroups.”

How well do health tables compete with the private sector like banks, as seen at Seattle's 2013 Tet Fest.
How well do health tables compete with the private sector like banks, as seen at Seattle’s 2013 Tet Fest.

The article, however, reported that community interventions have been found to work for, say, HIV. They call this the “prevention paradox,” or the fact that prevention measures that bring big benefits to the community have little benefit to individuals. Thus, most community-based chronic disease prevention programs have  reportedly found it hard to get individuals to change their behavior, but HIV-related programs have reportedly worked.

Merzel and D’Affliti suggest that HIV programs may be more successful than other health fair promotion events because they go after small and homogenous groups. This is harder to do with large, diverse groups. So “getting identifiable social groups to change specific behaviors with discrete levels of individual risk may be more achievable than developing multiple interventions designed to motivate numerous subgroups of varying risk found within a broad geographically defined community.”

Are Swedes more beautiful, or do they just have a better public health system?

Rudy Owens2 Comments

I have always thought about what makes some people look better than others — at the individual, ethnic, and national level. Having travelled on six continents, I have been able to test ideas and stereotypes—including my own—through personal observations.

Is "Jenny," who I saw on a YouTube video teaching yoga-type exercises, good looking because she is Swedish, and if so, what does that mean?
Is “Jenny,” who I saw on a YouTube video teaching yoga-type exercises, good looking because she is Swedish, and if so, what does that mean?

This all came back to me last night while I was surfing YouTube for a video on ski waxing, where I, yes, got distracted by what looked like a very healthy and attractive woman doing yoga. Instead of it being a yoga tutorial, it was a video published by two young Swedish women that is mostly a product of personal vanity and that natural desire to express one’s self. I believe their names are Jenny and Andrea, and they appear to have a preoccupation with their admittedly very good looks. I cannot fault them for that.

Yes, these two are very physically attractive. But I again thought about why? Why are many Swedish and other Scandinavian women I have met so attractive?

First, I do not ascribe to the idea of “national beauty” or the national ranking systems that have little scientific validity. Social and popular media are obsessed with the idea that Swedish women are among the world’s most beautiful. A dubious online source called Traveller’s Digest claims Sweden tops their list of countries with the hottest looking women. (The country’s men also rank No. 1). Such rankings amount to Internet silliness.

I traveled to Sweden in 1990 for about a week, staying with friends I met in India (Eva and Eva — yes the real names). I found many people I met there to be healthy and attractive, but not to an extreme. I did find an excessive amount of out of control binge drinking in the social circles my generous hosts ran with, particularly among college-age and slightly older Swedes. In fact, globally, I have found few places that matched the excessive drinking I saw all over Sweden.

I also have seen Swedes globally, and in general many do appear more fit and healthier than the typical American, who rightly has earned a reputation as being overweight and thus unhealthy, and therefore unattractive in the eyes of many. Such data is borne out by national health statistics, as America is the fattest country on the planet, and because of that, my country does not have the reputation as Sweden does for the hottest men and hottest women, I think.

One of the most ubiquitous stereotypes of nationalities is that of "hot" Swedish women--perpetuated by photos like this one.
One of the most ubiquitous stereotypes of nationalities is that of “hot” Swedish women–perpetuated by photos like this one.

Globally, Sweden does very well in terms of health rankings and public health investments. Sweden scores highly in terms of life expectancy from birth, ranking No. 16 among all countries (81.8 years). Its Nordic neighbor, Norway, ranks 25th (80.32 years). The United States fares worse than both, and Jordan, and New Zealand, and, well, 50 other countries, at 78.5 years. By comparison the much poorer Cuba, with a vastly lower standard of living (less than 20% of the United States per capita), ranks No. 60, with a life expectancy of 77.9 years.

In 2010, according to the World Bank, Sweden spent 9.6% of its GDP on public and private health, including preventive and curative services, family planning activities, nutrition activities, and emergency aid designated for health but not water and sanitation. Norway spent nearly the same amount, or 9.5%, while the United States was staggeringly inefficient, spending 17.9% of its GDP, and the trend is getting worse.

The socialist and undemocratic Cuba, which invests heavily in public health for its population, spent a mere 10.6% of its GDP, but had nearly the same life expectancy per person as its mighty northern neighbor, America. So even though the United States spends nearly twice as much as these three countries, it does not have results to show for it.stats for four countries income health obesity

Such discrepancies are frequently cited highlighting how grossly inefficient U.S. health care is compared to countries with strong government-backed and financed health systems.

But do such investments have anything to do with physical appearance, and thus beauty?

Well, expanding waist lines and bulging bottoms, which nearly most people globally do not view as physically attractive, seem to indicate that Americans are likely to be less attractive than Cubans, Norwegians, and those stereotypically “hot” Swedes.

The International Obesity Task Force estimates that, globally, 1 billion adults are overweight (BMI 25-29.9 kg/m2) and 475 million are obese. In the United States, two-thirds of all residents are obese or overweight. The United States is the world’s heaviest country per person–a dismal and frighteningly scary statistic for our healthcare system and for future incidence of many of our top killers (cancer, heart disease, as well as diabetes, though further down the list).

So why, say, is Sweden doing better than many countries and the United States.

For starters, everyone in Sweden has equal access to health care services under a decentralized, taxpayer system. The Swedish Institute reports that every city council “must work to promote good health for the entire population.” Again, this is a vastly different value system than the United States’, where taxes are viewed with increasing hostility by the political right and where individuals are still, for the most part, considered responsible for their health.

This photo published by the Swedish Institute highlights a view of health, from youth to old age, and by most measures, Swedes are healthier and live longer than Americans.
This photo published by the Swedish Institute highlights a view of health, from youth to old age, and by most measures, Swedes are healthier and live longer than Americans.

In Sweden the responsibility for health and medical care is a shared responsibility of the central government, county councils, and municipalities. The country’s Health and Medical Service Act regulates the roles of county councils and municipalities, and it gives local governments freedom in this area, while the central government sets principles and guidelines for health and medical care.

What’s more, Sweden’s maternal mortality, another key public health indicator, is among the world’s lowest: 2.74 in 1,000 babies and less than than 1 woman out of 100,000 die in birth. “Swedish maternal care is often highlighted as a success story in international contexts,” boasts the Swedish Institute. By comparison, the United States infant mortality rate is 6 per 1,000 (bested by Cuba’s 4.73 per 1,000).

So in the end, you have a country that invests more in its people and in the health of its people, who likely have a good chance of being active and also avoiding stigma associated with excessive weight. It’s not so much that Swedish women, like Jenny in the exercise video, is anything extraordinary, though she is very attractive because she is healthy. She is, perhaps without her full awareness, the recipient of extensive investments in her education, her health from cradle to grave, and a social contract that values the well-being of the population.

The International Obesity Task Force published this map of obesity rates globally; some data likely is missing for African nations.
The International Obesity Task Force published this map of obesity rates globally; some data likely is missing for African nations.

And how do we react when we see Swedes, on YouTube or traveling abroad, or in business or education settings? We react positively.

An August 2012 story published in Psychology Today (“I’m Successful Because I’m Beautiful”– How we Discriminate in Favor of Attractive People) highlighted some frequently cited studies on how specific physical traits are rewarded.

The article quotes Dr. Gordon Patzer, who reportedly conducted three decades of research on the topic and found that human beings are “hard-wired” to respond more favorably to those who are attractive: “Good-looking men and women are generally regarded to be more talented, kind, honest, and intelligent than their less attractive counterparts.”

Still, obesity is afflicting even the Nordic countries, which has universal health care and strong safety nets. A 2010 study by Kirsti Matlerud and Kjersti Ulrisken in the journal Patient Education and Counseling (“Norwegians fear fatness more than anything else”–A qualitative study of normative newspaper message on obesity and health) looked at how newspapers in that affluent country sent messages on body weight. They found in a public survey, when people were asked what health problems they would like the health authorities to give priority to, obesity ranked highest, and then followed by care for the elderly, cancer, psychiatry, and cardiovascular disease. They also reported a general attitude of fatness being associated with being lazy and irresponsible.

So yes, they do care about their looks in Nordic nations and discriminate against overweight persons, much the way we do in the United States. They just do a better job of ensuring their population stays healthier. Jenny and Andrea have reaped the benefits and get the added benefits of being viewed as  attractive and being seen more favorably than those who have not had a national health system ensuring its population has the best possible chance of being healthy.

How research on gun violence is muffled, and who refuses to shut up

Rudy Owens1 Comment

On the first day in the new year, I read one of what will become thousands of similar stories that will be published this year in the United States about how firearms were involved in completely senseless and preventable violence.

To understand why we have so many shootings, one may wish to buy this book: Armed America: Portraits of Gun Owners in Their Homes by Kyle Cassidy. Go to http://www.armedamerica.org/. The cover photo provides a shockingly good insight into the national crisis over gun related violence.
To understand why the United States has so many shootings, one may wish to buy this book, Armed America: Portraits of Gun Owners in Their Homes, by Kyle Cassidy. Go to http://www.armedamerica.org/. This book cover photo offers one perspective on the national crisis over the nation’s gun-related violence.

In this particular instance, a 54-year-old woman reportedly shot a  24-year-old man in the thigh over a dispute that he was shooting fireworks at her property in rural Lake Stevens, Wash. No, I am not making this up.

While no one died in this New Year’s eve confrontation, the story barely received three paragraphs of news coverage, as it lacked the dramatic horror that the media exploit when mass homicides occur involving often-legally purchased weapons. There were no dead children or mentally deranged men in military gear loaded with weaponry. Were this story to occur in Canada, or say Japan, it would have received much different coverage.

While we may assume this seemingly “bland” shooting will be counted in national data, that is not guaranteed. It likely could be ignored.

In response to uncertainty over national data, Slate Magazine, on Jan. 1, 2013,  published a story called How Many People Have Been Killed by Guns Since Newtown?. The article alleges guns statistics are “surprisingly hard to come by.” Slate claims it will track the toll of gun related killings with an an anonymous publisher with the Twitter feed @GunsDeath to create an interactive tracking feature. The articles asks readers  who know about gun deaths in their community that are not counted on its interactive map  to tweet @GunDeaths with a citation, and it will be added to the feed.

brady center stat count
The Brady Center keeps a daily tab on gun violence–go to the right corner of the center’s home page for the shooting count, based on CDC data.

The Brady Center, the best known nonprofit that is working to pass legislative fixes to issues such as the sale of semi-automatic weapons and closing loopholes that allow for guns sales without background checks, uses data from the Centers for Disease Control (CDC) (2008-09 estimates). It then makes an estimate of the number of killings a day that may not correspond to the most recent trends. The source data is captured by the CDC National Center for Injury Prevention and Control, reported and accessible through the web-based Injury Statistics Query and Reporting System.

A lesson in how to silence public health researchers, and yes it is about the money

Slate’s professed shock at the lack of poor tracking of gun-related fatalities should actually surprise no one who has monitored the muzzling of research on gun-related violence since the 1990s by the National Rifle Association (NRA), the gun industry’s lobby, and its allies in Congress.

According to a newly published article by Dr. Arthur L. Kellermann and Dr. Frederick P. Rivara (both of whom have MPH degrees), in the Dec. 21, 2012, edition of the Journal of the American Medical Association, gun research at research universities that is funded by the federal government has been systematically quieted by pro-gun forces since a ban was enacted on the CDC in 1996, mainly through budget language. Pulling funding, in effect, silenced the nation’s public health agency on a critical public health issue.

The budget language, which remains in effect today, stated “none of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control.” While it is not clear why individual CDC officials or even highly paid medical and public health professionals have not more publicly risked their professional standing to challenge this language, the authors of the study note, “Extramural support for firearm injury prevention research quickly dried up. Even today, 17 years after this legislative action, the CDC’s website lacks specific links to information about preventing firearm-related violence.”

Rivara and Kellermann further state that the language restricting such research was expanded after a 2009 study that was federally funded, this time by the National Institute on Alcohol Abuse and Alcoholism, if a gun increases or reduces the risk of firearm assault. Congress, in 2011, during the Obama administration and amid the Tea Party insurgency of 2010, “extended the restrictive language it had previously applied to the CDC to all Department of Health and Human Services agencies, including the National Institutes of Health.”

The two authors highlight other efforts taking place national to stifle medical professionals from speaking out, such as Florida’s law (HB 155), which put health care practitioners at risk of penalties, including the loss of their licenses, “‘if they discuss or record information about firearm safety that a medical board later determines was not ‘relevant’ or was ‘unnecessarily harassing.'”

How silencing plays out at research universities, quietly and likely without intent

This blog has reported that the silence within the research community can be found at major public health research programs, such as the University of Washington School of Public Health, which  I attended from 2010 to 2012. I was unable to find any faculty actively teaching future public health leaders–my classmates–about firearms safety research or gun violence in the school’s public health curricula.

It should be noted Dr. Rivara is an adjunct faculty member of the UW School of Public Health, and Dr. Kellermann and he are also graduates of the same school (for their MPH degrees). Dr. Kellerman was in fact my graduation commencement speaker, and proved to be a passionate scientist and advocate to all of us. However, my review of courses did not reveal any classes focussing on gun violence as a public health issue; this does not mean Dr. Rivara and other faculty did not cover this topic in their classes. (It should also be noted that a keyword search for “guns” on the UW SPH web site today, Jan. 2, 2013, yielded only three pages, one focussing on Dr. Rivara and another focussing on Dr. Kellerman.)

During my studies there, I repeatedly raised this anomaly to my professors and during seminars in front of as many faculty as possible–often to the point of becoming an annoyance to those who had heard me ask the same questions repeatedly. But short of actually sitting in on faculty strategy sessions or having any survey data, it is impossible for me to know the reasons why my former school choose not to include this topic in its curricula. There were and remain classes on issues that do receive federal funding: tobacco cessation, obesity and nutrition, maternal and child health, and much more. All are worthy topics, but these were the winners, guns was a loser.

My guess remains it was purely a matter of funding, or lack of funding, and the intense internal pressure on junior faculty to pursue research dollars highly coveted by all departments that were not tied to this pariah topic. Thus the silencing of research continued, without any alarm bells raised from a larger community of researchers, who should be the most active and who should have been leaders, locally and nationally. That is how it works.

Dr. Rivara’s primary role is as a faculty member at the UW School of Medicine, Department of Pediatrics. To his credit, he has shown continued national leadership on gun violence. He and Dr. Kellerman deserve great praise for their lifelong service and work on this topic. Hopefully their article also will shame and embarrass their distinguished academic peers–locally and nationally–into either creating endowed teaching positions or a campaign drive to fund research that can shed light on this national public health crisis that has seized the nation’s attention since the massacre of 20 children and six faculty in a public school in Newtown, Conn. in December. MPH students also can lobby for change too, despite the hazards of confronting faculty who grade and often employ them as assistants.

Given that many faculty at these institutions can earn salaries well above $200,000 annually, some may be reluctant to jeopardize their professional careers or positions in the name of public-minded research on a topic that is at the center of one of the nation’s greatest moral debates since the Civil Rights movement and perhaps since the violent ending of slavery during the Civil War.

Gun researchers who have not been silenced by budget threats

Researchers not blocked by the ban on the CDC and NIH have shown that a prized policy goal of the NRA and gun makers, expanding “standing your ground laws,” have lead to more homicides.Researchers have found that states with a stand your ground law record more homicides than states without such laws.

Data from the study by Hoestra and Cheng, as published on the NPR.org web site (Jan. 2, 2013).
Data from the study by Hoekstra and Cheng, as published on the NPR.org web site (Jan. 2, 2013).

Two economics researchers at Texas A&M University, Mark Hoekstra and Cheng Cheng, found that the laws “do not deter burglary, robbery, or aggravated assault. In contrast, they lead to a statistically significant 8 percent net increase in the number of reported murders and non-negligent manslaughters.” The findings run counter to the argument of the primary proponent of such legislation, the NRA.

On average, there are about 500-700 more homicides a year among the 23 states with stand your ground laws because of these laws: “One possibility for the increase in homicide is that perhaps [in cases where] there would have been a fistfight … now, because of stand your ground laws, it’s possible that those escalate into something much more violent and lethal,” says Hoekstra.

The Newtown massacre and musings on guns, morality, and public health

Rudy OwensLeave a comment

The brutal massacre of 20 young children and six public school employees in Newtown, Conn., on Dec. 14, brought to mind one of the greatest speeches in U.S. history, President Abraham Lincoln’s Second Inaugural Address. On March 4, 1865, well into the fifth year of the bloodiest U.S. conflict, to resolve the criminal institution of slavery, Lincoln evoked unusually strong biblical and moral language that he normally avoided.

This FaceBook Post generated comments that said, this is why this country is so great and also why it is is so “f’d up” (https://www.facebook.com/photo.php?fbid=314047015290064&set=o.113895238664965&type=1&theater)
This facebook post generated comments that said, this is why this country is so great and also why it is so “f’d up” (https://www.facebook.com/photo.php?fbid=314047015290064&set=o.113895238664965&type=1&theater)

He first stated that the continuing expansion of slavery was the goal of the South. “All knew that [slavery] was, somehow, the cause of the war. To strengthen, perpetuate, and extend this interest was the object for which the insurgents would rend the Union … .” Then Lincoln, in language well understood by his countrymen, further noted the sins and injustice of slavery had brought the wrath of an Old Testament God upon the nation: “Fondly do we hope–fervently do we pray–that this mighty scourge of war may speedily pass away. Yet, if God wills that it continue, until all the wealth piled by the bondsman’s two hundred and fifty years of unrequited toil shall be sunk, and until every drop of blood drawn with the lash, shall be paid by another drawn with the sword, as was said three thousand years ago, so still it must be said the judgments of the Lord, are true and righteous altogether.”

A moral issue?

In short, Lincoln held his country morally accountable for that “peculiar institution.” He used moral language, much the way Dr. Martin Luther King, Jr., a century later, used similar language to address the injustices of discrimination and racism in the Jim Crow South and throughout the country. Such language by elected officials, however, has been mostly absent from the national debate over firearms violence that is involved in the death of more than 11,000 U.S. residents annually (homicides alone).

But the debate over the regulation or expansion of guns and automatic weaponry on the open market may have turned a page with Newtown shooter Adam Lanza’s killing spree. He used at least three guns (Glock 10 mm and a Sig Sauer 9 mm handguns and a Bushmaster .223-caliber) that were first obtained legally. He stole all of them from his well-to-do mother after killing her.

This Bushmaster .223, as of Dec. 16, was being advertised for sale on the Internet.
This Bushmaster .223, as of Dec. 16, was being advertised for sale on the Internet.

The availability of such lethal weaponry is far from an aberration. The Bushmaster .223 can easily be purchased now. Here’s one ad I found on Dec. 16; the weapon is described as intended for military combat.

In response to this mass murder of mostly kids, Peter Drier, professor of politics and chair of the Urban & Environmental Policy Department at Occidental College, posted a piece on Dec. 15, on the Alternet web site titled “The NRA’s Wayne LaPierre Has Blood on His Hands: The Brady Campaign to Prevent Gun Violence has a 62-page list of mass shootings in America since 2005. It is Wayne LaPierre’s resume.” Drier asserts that “the long list of killings is due in large measure to the political influence of the [National Rifle Association] NRA—and the campaign finance system that allows the gun lobby to exercise so much power.” In short, the NRA, the gun industry it lobbies for,  the NRA’s alleged 4 million members, and officials in elected office are all morally accountable for downstream effects of firearms proliferation.

Who is morally accountable for mass gun shootings like Newtown's? Just the shooter or weapons industry promoters like NRA CEO Wayne LaPierre,
Who is morally accountable for mass gun shootings like Newtown’s? Just the shooter or weapons industry promoters like NRA CEO Wayne LaPierre.

The NRA’s influence

The NRA, of course, alleges that the Second Amendment to the Bill of Rights gives individual Americans the right to possess guns, even combat weapons designed for the mass killing of people. The NRA also, in my opinion, falsely alleges that regulating gun sales and ownership is an attack on our constitutional freedoms–even our “civil rights.” Such language is devoid of both logic and rationality, and absent any moral foundation. I continue to find “literalist” interpretations of the U.S. Constitution, which also legitimized slavery for decades, as irrelevant to the complexities of a public health crisis that weapons-related violence has become in this country.

But, the NRA is more than a gun lobby. Its annual budget exceeds more than $250 million. It donates generously to political campaigns. It runs a non-profit foundation that boasts having raised $160 million. It runs a multimedia operation to promote its extremist views. It is, at the state level, aggressively promoting gun rights such as “stand your ground” laws. In the U.S. Senate, John Thune (R-S.D.) introduced a measure that would force all states that issue concealed carry permits to recognize the permits from other states. More importantly, the NRA promotes both the culture of weapons proliferation and a social media ecosystem that enables extremist views to proliferate, both inside its ecosystem and in the blogosphere, where many NRA talking points pepper the comments section of news stories on gun violence.

Using a public health lens to debate gun violence

In addition to embracing moral language, the national debate should also use a public health lens and the widely available data at all times to bury the completely false NRA propaganda that “guns don’t kill people, people kill people.” For example, the Harvard School of Public Health’s Injury Injury Control Research Center examined peer-reviewed research and reported three main findings that point to the association between gun proliferation and homicides, including in the United States:

1. Where there are more guns there is more homicide.
2. Across high-income nations, more guns = more homicide.
3. Across states, more guns = more homicide.

A public health approach involves looking at the data, having a population focus (rather than focusing on the motives of a mentally disturbed killer), examining the policies and systems that enable guns to continue impacting the public’s health, and focusing on forces that develop dangerous personal behaviors—even the embracing of ideas that promote harmful activities such as owning guns. The conservative-leaning Seattle Times, which has not called for any legislative action to address firearms violence this past week (following two mass killings), pulled together some data from public sources on Dec. 15, regarding mass murders involving firearms (my comments in italics):

  • Shooting sprees are not rare in the United States.
  • Eleven of the 20 worst mass shootings in the past 50 years took place in the United States.
  • Of the 12 deadliest shootings in the United States, six have happened from 2007 onward.
  • America is an unusually violent country. But we’re not as violent as we used to be. (See the graph below.)
  • The South is the most violent region in the United States.
  • Gun ownership in the United States is declining overall. (However, we have more than 300 million guns in the U.S.–a staggering figure.)
  • States with stricter gun-control laws have fewer deaths from gun-related violence.
  • Gun control, in general, has not been politically popular. (This fact  overlooks how campaign funding impacts local and national races.)
  • But particular policies to control guns often are.
  • Shootings don’t tend to substantially affect views on gun control.
Duke University sociology professor Kieran Healy complied OECD data on violence in developed countries (excluding Estonia and Mexico) and concluded “America is a violent country.” Such data points to both a pathology toward violence and how aassults in the U.S. end up with lethal consequences (his data does not distinguish cause of death from say guns to knives.) Go to: http://www.kieranhealy.org/blog/archives/2012/07/20/america-is-a-violent-country/
Duke University sociology professor Kieran Healy compiled OECD data on violence in developed countries (excluding Estonia and Mexico) and concluded “America is a violent country.” Such data points to both a pathology toward violence and how assaults in the U.S. end up with lethal consequences (his data do not distinguish cause of death from say guns to knives). Go to: http://www.kieranhealy.org/blog/archives/2012/07/20/america-is-a-violent-country/

A 2003 study by EG Richardson and D Hemenway  (called “Homicide, suicide, and unintentional firearm fatality: comparing the United States with other high-income countries, 2003”) found that he United States has “far higher rates of firearm deaths-firearm homicides, firearm suicides, and unintentional firearm deaths compared with other high-income countries” and that the “United States is an outlier in terms of our overall homicide rate.”

Referencing this study, the Brady Campaign concludes that “the United States has more firearms per capita than the other countries, more handguns per capita, and has the most permissive gun control laws of all the countries.” The Brady Campaign further notes that “of the 23 countries studied, 80% of all firearm deaths occurred in the United States; 86% of women killed by firearms were U.S. women, and 87% of all children aged 0 to 14 killed by firearms were U.S. children.”

More blood from the sword … for the lash?

What remains to be seen is if the preponderance of data and the moral outrage that may have been generated by the Newtown shootings will create change.

President Obama, the day of the shootings, held a press conference and said, “We’re going to have to come together and take meaningful action to prevent more tragedies like this, regardless of the politics.” Gun control advocate and billionaire New York City Mayor Michael Bloomberg dismissed such talk immediately:  “Not enough,” Bloomberg said. “We have heard all the rhetoric before. What we have not seen is leadership — not from the White House and not from Congress. That must end today.” To date Obama has not used his office to promote any national legislation or even national dialogue on gun policy.

One thing is certain: there will be more mass murders in the United States involving legally obtained and legally sold firearms. And I am left paraphrasing Lincoln and wondering: how much more blood from such gun-related killings will have to be spilled to atone for our nation’s continued shortcomings to control what other developed nations have managed to do, and do for decades?

Taking the pulse–do exercise programs get kids in shape?

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New York Times blogger Gretchen Reynolds, in her Oct. 3, 2012, piece, Do Exercise Programs Help Children Stay Fit?, profiled a recent British journal article that shows such weight-reducing and health-promoting efforts from the past two decades have flopped. (Scroll below to take a quick one-question pool on this very question.)

Citing the study published by Brad Metcalf and colleagues in the August 2012 edition of the journal BMJ (a journal accessible to all users), Reynolds reports that the authors found that “programs almost never increase overall daily physical activity. The youngsters run around during the intervention period, then remain stubbornly sedentary during the rest of the day.”

Two decades of interventions to help kids move more and weigh less may be failing.
Two decades of interventions to help kids move more and weigh less may be failing.

The British team of researchers from the Peninsula College of Medicine and Dentistry in England found 30 acceptable studies that met their criteria for examining if exercise interventions for kids work. The articles reviewed were published between January 1990 and March 2012. According to Reynolds, the programs simply failed to do what they were supposed to do: get young people to move more.

The article said their data covered 14,326 participants–6,153 with accelerometers that measured physical activity. The authors concluded that interventions “had only a small effect (approximately 4 minutes more walking or running per day) on children’s overall activity levels. This finding may explain, in part, why such interventions have had limited success in reducing the body mass index or body fat of children.”

An accompanying editorial  by Sally and Richard Greenhill notes that current United Kingdom guidelines state that all children and adolescents should have 60 minutes of moderate to vigorous exercise a day. And in the United Kingdom, only a third of boys and a fifth of boys are meeting those guidelines. In the United States matters are worse, and kids’ levels of inactivity now ranks as harried parents’ No. 1 concern, according to an August 22, 2012, USA Today story. Yet, parents appear to be a big part of the problem, too, along with ubiquitous and highly, highly, highly addictive technology. Nearly six out of 10 children spend less than four days a week playing outside because “parents find it more convenient to spend time in front of a television or computer.”

Times writer/blogger Reynolds quoted Frank Booth, a professor of physiology at the University of Missouri-Columbia, who worked on the meta-analsysis in the BMJ: “So if structured classes and programs are not getting children to move more, what, if anything, can be done to increase physical activity in the young? It’s a really difficult problem.”

Such a finding begs the question: Do interventions to promote physical activity work, or are they a waste of time and resources?

Maine’s Efforts: Cutting Edge or a Good Idea Needing a Makeover?

The Let's Go program in Maine is one of many in the United States trying to get kids to exercise for an hour daily.
The Let’s Go program in Maine is one of many in the United States trying to get kids to exercise for an hour daily.

One influential program, that combines exercise with nutrition and is being duplicated across the country, is the Let’s Go! 5-2-1-0 program from Maine. This stands for:

5 – fruits and veggies,
2 – hours or less of recreational screen time,
1 – hour or more of physical activity, and
0 – sugary drinks, more water, and low-fat milk [editorial note, I find the promotion of milk as a drink for kids questionable, given the inordinate influence of big agri-business on the U.S. Department of Agriculture and the availability of other fortified, non-dairy drinks].

Let’s Go! founders claim the program is successful and is grounded in three principles: 1) changing environments and policies; 2) consistent messaging across sectors–like “5-2-1-0”; and 3) approaches that use science and are recommended by the medical community.

Places as diverse as Kentucky and Hawaii are attempting to duplicate this program, despite apparently non-conclusive evidence of its efficacy.

Maine launched the program in response to the obesity epidemic (as of 2005, more than 60% of all adults in Maine reported being either overweight and 36% of kindergarten students, 26% of 6th-8th graders, and 29% of 9th-12th grade youth were reported being overweight or at-risk for overweight).

According to the program’s own evaluation of its efficacy tackling issues such as weight, the prevalence of overweight and obesity among children decreased from 33% in 2006 to just 31% in 2009 and was not statistically significant. However, among females, between 3 and 5 years, a smaller proportion were overweight and obese in 2009 compared to 2006 (25% vs. 31%). In short, this confirmed the findings from the BMJ study.

But what do you think?

Bloomberg spends millions on candidates supporting firearms legislation

Rudy OwensLeave a comment
Democratic U.S. Rep. Joe Baca, of California’s 43rd Congressional District, lost in a race for the redrawn 35th Congressional District to fellow Democrat, state Sen. Gloria Negrete McLeod, thanks mostly to funding by Mayor Michael Bloomberg’s super PAC focussing on gun control issues.

During the November general elections, few candidates running for national office chose to stake out policy positions advocating for legislation attempting to address the proliferation of firearms and the public health risks they pose to the country. But a few did, and their sugar daddy, New York City Mayor Michael Bloomberg, chose to invest some of his small fortune in a handful of political races that put the long-smothered issue into the national spotlight.

One six-term congressional veteran, U.S. Rep. Joe Baca from southern California, lost thanks to campaign spending by the Independence USA PAC, created by Bloomberg late in the fall campaign. According to a Nov. 23, 2012, story on the race by National Public Radio (NPR), Bloomberg’s PAC was looking for “the right race and the right set of circumstances.”

According to the NPR Story, the first thing Bloomberg’s new super PAC wanted was a clear contrast between the candidates on an issue of real concern, such as guns, and Baca, a Blue Dog Democrat, previously had gotten high ratings from the National Rifle Association (NRA). Columnist Dan Bernstein, with The Press-Enterprise newspaper in the “Inland Empire” area east of Los Angeles, said, “There’s probably one man in America, in this campaign, who cared about gun control. And it’s Mayor Bloomberg.”

For reasons still not clear to me, NPR’s report focussed on how super PACs can defeat local candidates, but ignored the bigger issue of why Bloomberg joined the fray–to address the issue of gun violence in the country. NPR continues to be a media outlet that fails to report national statistics on firearms violence, namely easily accessible public health data on murders and suicides linked to guns.

Mayor Michael Bloomberg of New York City is a billionaire who has staked out policy interventions to promote public health, targeting obesity/nutrition and firearms.

Bloomberg’s super PAC made late entry in key races

When Bloomberg made his announcement on Oct. 17, 2012, he stated, “It’s critically important that we have elected officials in Washington, Albany, and around the nation who are willing to work across party lines to achieve real results. I’ve always believed in the need for more independent leadership, and this new effort will support candidates and causes that will help protect Americans from the scourge of gun violence, improve our schools, and advance our freedoms.”

Bloomberg’s decision had an immediate and symbolic impact. The Press Enterprise newspaper noted that Baca lost his re-election bid to a come-from-behind finish by state Sen. Gloria Negrete McLeod, D-Chino, thanks mostly to a last-minute cash infusion from Bloomberg’s PAC. Baca also reportedly blamed Bloomberg’s spending for his loss in the race for the redrawn 35th Congressional District.

Bloomberg’s super PAC came late in the race. The Washington Post only reported the PAC’s existence the day Bloomberg made it public, and all just three weeks before the Nov. 6, general elections. A New York Times blog had initially reported that Bloomberg’s top issues were abortion and gun control before the super PAC was made public.

Bloomberg’s actions were entirely consistent with his statement following the horrific mass murder in Aurora, Colo., on July 20, 2012, when a gunman wounded 59 civilians and killed 12 others at a theater. Bloomberg, after the shooting and the media spectacle that ensued, lambasted Republican presidential candidate Mitt Romney and Democratic President Barack Obama for failing to mention the issue of how unrestricted firearms was a major factor in such mass murders of U.S. citizens.

“Soothing words are nice,” said Bloomberg, “But maybe it’s time the two people who want to be president of the United States stand up and tell us what they’re going to do about it, because this is obviously a problem across the country.” Both candidates failed to discuss any serious policy approach to stemming gun-related violence in the United States, notably during the three presidential debates.

As this blog has reported before, the Centers for Disease Control and Prevention (CDC) reports that the number of firearm homicides in 2010 in the United States was 11,493, while the role of firearms in suicides was nearly twice that rate, or 18,735 persons. All told firearms were linked to 30,228 deaths annually at last count–a fact that Democrats have decided to avoid as they put together their national coalition that includes many center and right of center candidates in the U.S. House of Representatives the U.S. Senate.

Bloomberg’s super PAC picked Pennsylvania race winner

Bloomberg’s PAC also supported Pennsylvania Attorney General Democratic candidate, Kathleen Kane. An ad paid by the super PAC said: “Kathleen Kane: close the [Florida] loophole and keep guns out of the wrong hands. Track stolen guns to choke of supply to criminals. Background checks for all gun sales.” (See the ad here.)

Independence USA, Michael Bloomberg’s new super PAC, ran this issue ad supporting candidate Kathleen Kane prior to the Nov. 6, 2012 election.

Kane, in a rare move for a Democrat running for a state or higher office, publicly came out in favor of legislation favoring firearms control. She said she wanted to close the so-called “Florida loophole,” which lets someone denied a concealed-carry gun permit in Pennsylvania to get one in another state and then transfer that permit to Pennsylvania. Kane went on to win her race handily.

While Kane is a rarity, few if no politicians have the pockets of Bloomberg, an independent who can spend $10 million to $15 million of his own fortune on an issue that has seen no legitimate political discourse at the state or federal level for years, thanks mainly to the work of the NRA, the gun industry lobby.

All told, Bloomberg’s spending was directed at seven races nationally, of which his picks won four races, costing the billionaire roughly $8 million. Public health advocates who champion addressing firearms violence in the country likely will be following how Bloomberg’s super PAC will continue to wade into strategic races and confront the silence over firearms violence, which has become the acceptable new normal in political discourse by both major parties.

Leadership likely will remain with big city mayors, who as managers overseeing jurisdictions that carry out day to day criminal justice activities, see all facets of firearms violence most closely. The Brady Center also will continue to lobby for legislative changes to address the proliferation of firearms in the United States, as well.

The Brady Center featured this image on its web site to advocate for firearms policy reform here: http://bradycenter.com/advocates/women.

Latino voters’ strong support of healthcare reform overlooked in electoral analysis

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A week has passed since President Barack Obama handily defeated Republican challenger Mitt Romney in the Electoral College count  (332-206) for the office of the presidency. While Obama grabbed approximately 61 million votes compared to Romney’s roughly 58 million, he trounced him among Latino voters. And their decisive backing of the incumbent Democrat by a margin of 71% to 27% can be credited greatly to Latinos’ strong support of the administration’s signature health care/health insurance reform known as the Affordability Care Act (ACA).

Latinos’ support for healthcare reform dates back to the 2008 election, captured so joyously in this pro-Obama video that calls out Obama’s “plan de salud.” (I love this video, and want to hire this band for my first run for office if I ever do that.)

The Pew Center calculated the wide margin by which President Barack Obama defeated challenger Mitt Romney among Latino voters.

In November 2011, exactly a year before the 2012 general election, Univision/Latino Decisions polled 1,000 Latinos (ME +/- 3.1%) and asked them how they viewed the role of government in ensuring that everyone had access to healthcare, or whether people should be responsible for their own health insurance. The question served, in short, as a proxy on how this block of potential voters viewed the national debate on healthcare. At the time, the ACA was vehemently opposed by the GOP, healthcare and business interest groups, nearly half of the country’s GOP governors, the GOP majority of the U.S. House of Representatives, and most importantly future Republican Party standard bearer Mitt Romney.

In that poll, those favoring government-led healthcare numbered 59% compared to those favoring individual insurance at 29%. Half of those polled answered that they believed Democrats were closer to their position on healthcare compared to Republicans, at a paltry 18%.

At that time, 12 months prior to the general election, the top issue among potential Latino voters was the economy, overwhelmingly, at 40%, but the No. 4 issue was healthcare, at 16%.

On election night on Nov. 6, and in the days following the election, the blogosphere and pundits of all stripes prognosticated on how poorly the Republican Party courted the crucial and incredibly diverse Latino electorate. The group includes those self-identifying as whites and non-whites, Mexican and Central Americans, Cubans, South Americans, Dominicans, and others. The group harbors great economic diversity as well.

ABC News’ Nov. 7 coverage was typical: “Mitt Romney and the Republican Party’s tremendous difficulty appealing to Latino voters dealt a significant blow to their chances of winning in 2012.” Many of the experts suggested that Romney’s campaign miscalculated during the primary when he swung hard right and said he would support “self-deportation.” Such statements, go the conventional wisdom, explain why most of the Latino’s 10% share of the national voting electorate favored Obama. (Numerous media outlets reported that it was the first time since 1996 that a Democratic challenger had won such a high percentage of the Hispanic vote; President Bill Clinton in 1996 grabbed 72% of the Hispanic vote.)

Healthcare issue ignored in the Latino election narrative

Was Mitt Romney “done in” by Latinos or “done in” by vehemently opposing healthcare reform overwhelmingly supported by Latino voters?

Of course this simplistic analysis doesn’t fully explain why Latinos would trust Obama, when his administration was on record as deporting 1.5 times (yes 1.5 times) more immigrants per month than the previous administration of George W. Bush. As of July 2012, according to the Washington Post, the Obama administration had deported 1.4 million immigrants, allegedly targeting dangerous criminals. While Obama’s team mounted a legal challenge to Arizona’s harsh anti-immigrant law and provided a limited amnesty program to offer limited but not permanent amnesty to nearly 800,000 young immigrant residents in July 2012, his administration’s anti-immigrant actions also clearly alarmed many Latino residents and voters.

So why did they fall so completely and totally for  Obama and Vice President Joe Biden over Romney and his running mate Paul Ryan? Clearly, healthcare mattered, and it mattered more than the media has acknowledged. The election was also a very clear referendum on national healthcare reform that Romney and Ryan pledged to dismantle if they won.

In a September 2012 speech to the U.S. Hispanic Chamber of Commerce, Romney stated his agenda clearly: “Obamacare is the wrong way to go … . I will repeal and replace Obamacare with reforms that increase choice, slow down the runaway growth of insurance costs, and open the door to more new jobs.”

Such messages completely flew in the face of what Latino voters wanted – a government-led, national healthcare plan. On Nov. 6, Latino Decisions’ election eve poll of 5,600 voters reported virtually unchanged numbers among Latino voters from the poll a year earlier.

The respected polling organization again found healthcare to be the No. 4 issue among the diverse Latino electorate, behind the economy, education, and immigration. The poll virtually repeated numbers found a year earlier, showing 61% of respondents favored leaving healthcare reform in place.

Latino Decisions’ Matt Barreto reportedly told USA Today that from the beginning of the Romney campaign “the most obvious miscue” between Romney and Latino voters was his continued attack on the ACA.

What remains puzzling is why so many media organizations completely ignore that Latino voters, like the majority of the voting public, supported the administration in a clear national referendum on healthcare reform that the GOP, GOP surrogates, many parts of the all-powerful healthcare industry, special and business interest groups opposed with nearly obsessive and feral passion.

The matter is settled, both by the highest court in the land and now by the ballot box. The opponents of the ACA — the market-oriented, limited healthcare reform that was passed by Congress — lost, and they lost decisively. Latinos voters, who so clearly supported the legislation, made that clear as a bell on election night in completely rejecting the GOP, its anti-healthcare reform message, and the former Massachusetts governor.

Two milestones put the Oglala Sioux back on the global stage

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This 2002 file photo by the Denver Post shows alcohol being sold in Whiteclay, Neb., adjacent to the Pine Ridge Reservation.

October was a huge month for the Oglala Sioux Tribe of South Dakota. The Lakotan band made the national spotlight, perhaps in ways not seen since the historic and bloody siege at Wounded Knee in 1973.

On Oct. 1, 2012, the tribe lost a $500 million lawsuit it filed against a group of multinational beer manufacturers and four stores in neighboring Nebraska that the tribe claimed were liable for bootlegging and the widespread destruction of alcoholism that has plagued the Pine Ridge Reservation for decades. The 3.5 million-acre reservation, about the size of Connecticut, is officially dry. However, 5 million 12-ounce beers were sold in 2010 at the Nebraskan stores immediately adjacent to Pine Ridge. That means about 13,000 cans a day were purchased for consumption at a reservation with just 45,000 residents—a simply staggering figure.

The litigation represents a legal and public health strategy that seeks to hold the companies and retailers/distributors culpable for downstream effects of the health hazard for a legal drug, in this case, alcohol. It also demonstrates the tribe’s proven ability to use symbolic and media tactics that capture global interest, in order to highlight glaring, historic, and shocking injustices that are not tolerated elsewhere in the United States. I actually first heard about this story not from U.S. news sources, but while listening to the BBC World Service in February this year.

Oglala Sioux tribal attorney Tom White holds a press conference after filing the tribe’s lawsuit in Lincoln, Neb.

The second major but not disconnected story last month was the death on Oct. 22, 2012, of famous Oglala Sioux activist Russell Means, a major figure in the American Indian Movement (AIM). The so-called “radical” group galvanized Native Americans and many tribes in the early 1970s by first occupying Alcatraz Island in 1969. The New York Times, in a fit of what can best be called sanctimonious arrogance and historic ignorance, was dismissive of Means’ lasting significance to Native activism of the 20th and 21st century.

The obituary/editorial referenced Mean’s alleged proclivity to guns and brawls. However, the editorial noted Means galvanized global attention of the plight of Native Americans during the  siege at Wounded Knee, at the height of the Vietnam War and amidst President Nixon’s growing Watergate scandal. The Gray Lady begrudgingly states in its judgmental obituary: “Pine Ridge and other reservations have not escaped plagues of poverty and alcohol. Governmental neglect remains a scandal.” Today, Shannon County, S.D., where the reservation is located, is the nation’s third poorest, where more than half of all residents live in poverty.

Oglala Sioux tribal member Russell Means died on Oct. 22, 2012.

By comparison, the Oglala Sioux Tribe, which itself was divided violently before and after the 71-day siege at Wounded Knee, immediately proclaimed Means’ birthday (June 26) as Russell Means Day on the Pine Ridge Reservation. The tribe acknowledges his contributions to helping improve his impoverished tribe’s status. A web site paying tribute to Means’ lasting role to Native Americans called him the most important Native American since Sitting Bull and Crazy Horse.

Means seemed to capture the Oglala’s Sioux defiance and resilience. National Geographic’s August 2012 profile of that resilience  highlighted 60-year-old activist Alex White Plume.  He summed up the injustices brought upon his people by the federal government and others. The tribe is one of seven Sioux bands whose once far-ranging ancestral lands of the Northern Plains and Inner Mountain West were literally taken by the expanding U.S. nation in the mid- and late 1800s. “They tried extermination, they tried assimilation, they broke every single treaty they ever made with us. They took away our horses. They outlawed our language. Our ceremonies were forbidden.”

The most egregious crime was the U.S. Calvary’s massacre in 1890 at Wounded Knee of 146 Sioux members, of whom 44 were women and 18 children. The mass murder was a fearful reaction to the Ghost Dance that was sweeping the Sioux people, a deeply spiritual religious revival that promised a rebirth and paradise on earth. Another 200 Native Americans were killed in related incidents shortly after.

Nearly a century later, starting in February 1973, the AIM movement again focused the attention of the globe on the impoverished Pine Ridge Reservation in what became known as the siege at Wounded Knee.

About 200 AIM members occupied the site of the Wounded Knee massacre. They protested broken treaties and the corrupt tribal governance of then tribal head Dick Wilson. At the time, the tribal government ran its own private militia called Guardians of the Oglala Nation, or GOONS, who were made infamous in the 1992 film Thunder Heart, which was based loosely on the Pine Ridge incidents. The GOONS, National Guard troops, and FBI agents surrounded the activists.

During the siege, 130,000 rounds were fired, two FBA agents were killed, and 1,200 arrests had been made. Ian Frazier, who writes about the incident in his 2000 travelogue and profile of the Oglala Sioux called On the Rez, interviewed Le War Lance, a participant in the siege. Le claims to have snuck in out of the siege 18 times and to have observed the presence of U.S. military forces (82nd Airborne), armored personnel carriers, and helicopter and reconnaissance flights. (A summary of the FBI’s files is here.)

The problems at Pine Ridge did not end with the siege. AIM activists and their sympathizers note that between March 1, 1973, and March 1, 1976, the murder rate on the Pine Ridge Reservation was more than 17 times the national average. Activists attempting to free Leonard Peltier, who was sentenced to life in prison for the killing of two FBI agents during the siege, have counted 61 unsolved homicides during that time. Some of those killings are now being re-investigated.

While AIM may not have created lasting change on the Pine Ridge Reservation, it did demonstrate what Frazier called a real flair “for the defiant gesture in the face of authority.” Frazier says that, along with AIM’s strong historic self-identity, made it both conservative and radical all at once. That same flair and sense of historic injustice is clearly visible in the unsuccessful lawsuit that was brought in February 2012 by the Oglala Sioux in Nebraska’s U.S. district court.

The suit alleged that one in four children born on the reservation has fetal alcohol syndrome or fetal alcohol spectrum disorder. The tribe’s average life expectancy ranges from 45 and 52 years, shorter than anywhere else in the Northern Hemisphere outside for Haiti. By comparison, the average life expectancy in the United States is 77.5 years. The suit sought rewards to cover cost of health care, social services, law enforcement, and child rehabilitation that it claims are caused by chronic alcoholism on the reservation. “The devastating and horrible effects of alcohol on the (Oglala Sioux Tribe) and the Lakota people cannot be overstated,” the lawsuit stated.

In terms of negative health outcomes, Native Americans and Alaskan Natives (AI/AN) fare much poorer than their fellow countrymen by all standard public health measures. The Centers for Disease Control and Prevention (CDC) notes that “rural and urban AI/AN alike experience greater poverty, lower levels of education, and poorer housing conditions than does the general U.S. population.” And, of course, such conditions lead to a range of health issues, including the alcoholism and the despair prevalent on the Pine Ridge Reservation.

The CDC, while trying to present unfiltered data, bizarrely and disparagingly states, “Geographic isolation, economic factors, and suspicion toward traditional spiritual beliefs are some of the reasons why health among AI/ANs is poorer than other groups.” Remarkably, the CDC summary of health data, at least in this source, does not account for the systemic and historic racism, political persecution, coordinated and clearly documented efforts to destroy Native American cultures and languages, and economic exploitation as potential contributors to current health disparities. While the top two killers of AI/NA are heart disease and cancer (both greatly influenced by the social determinants of health), the No. 3 killer is “unintentional injuries,” which can include car accidents, and the No. 8 killer is suicides. For those not familiar with the social determinants of health, these two types of deaths are easier to link to the deep socioeconomic disparities experienced throughout Indian country.

Today, Pine Ridge is the only reservation in South Dakota that bans alcohol. The booze is supplied by nearby Whiteclay, Neb., population 12. For its part, the state of Nebraska split hairs and postured it could do nothing to ban alcohol sales that tribal leaders alleged were tantamount to genocide. The Denver Post reported that Nebraska’s  Attorney General, Jon Bruning, said he “despised” Whiteclay’s beer sellers, “but feared shutting down Whiteclay would cause patrons to travel to other Nebraska towns.” Such statements almost defy logic and demonstrate that state’s leaders still willfully ignore staggering data  that show the state has a legal and moral obligation to solve a public health crisis originating inside its state borders.

The major beer makers singled out by the lawsuit were Anheuser-Busch, Molson Coors Brewing Company, MIllerCoors LLC, and Pabst Brewing Company. Given the historic settlement by 46 states attorney generals against tobacco manufacturers in 1998, it is all but certain that these titans of American suds have mapped out a legal strategy to stem all future efforts to hold them liable for downstream impacts of alcohol consumption. Fetal alcohol syndrome and DUI-related fatalities are two of the more well-known and symbolically rich health impacts of alcohol that capture the media’s interest and harness the public’s collective disgust with the harmful impacts of the drug.

Tribal leaders are now discussing whether to legalize the sale of alcohol on the reservation. A previous effort failed in 2004. Though the tribe lost, the lawsuit may spark future public-health framed legal challenges to the sellers and manufacturers of alcoholic beverages. It should be noted that trial attorneys repeatedly failed over 50 years to hold tobacco companies liable for the deaths and illnesses of former cigarette smokers. That does not mean other tribes and trial attorneys will not continue to explore legal challenges to the commercial reality of alcohol “on the rez.”

As for the continuing omnipresence of alcohol on the Pine Ridge Reservation, or any of the other more than 560 reservations in the United States, that is nearly certain. The socioeconomic conditions that have made reservations fertile ground for America’s No. 1 drug of choice remain unchanged. As the most famous contemporary Native American writer, Sherman Alexie, writes, “Well, I mean, I’m an alcoholic, that’s what, you know, my family is filled with alcoholics. My tribe is filled with alcoholics. The whole race is filled with alcoholics. For those Indians who try to pretend it’s a stereotype, they’re in deep, deep denial.“

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

Rudy Owens1 Comment

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.