Making the case for public schools, the highest-stakes poker game around

Recently I posted a link on my Facebook page to a Slate blog piece by Allison Benedikt: If you send your kid to private school, you are a bad person. It drew some negative feedback as well as a very positive response. Benedikt, who is a parent, provocatively suggests if you do this, you are “not bad like murderer bad—but bad like ruining-one-of-our-nation’s-most-essential-institutions-in-order-to-get-what’s-best-for-your-kid bad. So, pretty bad.”

Benedikt then goes on to argue that people who abandon public K-12 education undermine the foundations that make for a healthier, more democratic society. In defense of her seemingly provocative view, she claims that the bad things she did with bad kids during her public school days taught her more about life than reading Walt Whitman. In the end, she pleads with the middle-class moms and dads of the country reading her piece to go to bat for public schools in the most visceral way.

There’s a big public health story here too, but first, let me give some personal background and why this resonated profoundly with me.

How I endured then cherished my public school experience

I have friends who send/have sent their kids to private schools, and I do not think they are bad. But having attended K-12 public schools my formative years, I am very biased to Benedikt’s point of view. It’s my tribe, those public school grads. You might call me a bulldog on this point. My mother was a public school teacher as well, so I know the exhausting and harsh down sides from the perspective of such educators.

The most important things I learned about life are the ones I clawed together in that often chaotic petri dish, and at times it was chaos too. While I think many aspects of U.S. public schools truly stink, mainly the large mega schools and school systems that reward jocks and criminally fail to prevent abusive bullying of all stripes, I cannot deny the value of socializing in this publicly-funded mosh pit provides.

A seen from my graduating class of 1983 from University City Senior High School--yes I'm in there, bad hair and all.

A snapshot from my graduating class of 1983 from University City Senior High School; yes I’m in there, bad hair and all.

The system I attended til 1983 in University City,  next to St. Louis, was good (in some ways), but very divided in terms of who was on the fast track to say a great music college and who was on the fast track to say joining the armed forces. Both paths seem good to me now, and I was among those without a clear path. People came from respectable professional families (the ones whose parents were high-earning types like doctors) and from those living on the margins. The realities of race, and in my mind class, were omnipresent. During my years in that system, grades 3-12, the student population was roughly 70% black, 25% white, and 5% all other (Latino, Asian, Middle Eastern).

There were great teachers, and awful ones. There were clicks, stoners, nerds, punks, jocks, super achievers, motorheads (people I respected the most), future criminals, future drop-outs, future business people, musicians, and hip hop artists. Violence lurked in many places, too. I saw three extremely violent and criminal assaults (two on campus, one off) during a several-year stint. I experienced more than my fair share of racial harassment, and I was hospitalized after being cold cocked on a school setting—a crime I partially brought on myself, but also with racial undertones. But hey, who says high school is supposed to be walk through the flowers?

A group shot from my 1983 graduating class; I am not seen in this one.

A group shot from my 1983 graduating class; I am not seen in this one.

In the end, I would not trade this for anything. All of this gave me the tools to deal with an increasingly diverse country, where skills at communicating cross-culturally matter in every professional setting, and in most personal interactions too. In a more fundamental way, I felt equipped to stand my ground and hold my own anywhere in the world, and really appreciate people on their own terms. It gave me a window to really get to know people.

Schools becoming less diverse and more segregated

Today, however, it is more likely students finishing their K-12 education will not have experienced something like what I did—a school that has true racial and cultural diversity without deep segregation at the district level. According to a 2009 report by the University of California at Los Angeles’ Civil Rights Project, schools in the United States are more segregated today than they have been in more than 40 years. Worse, millions of non-white students are trapped in so-called “dropout factory” (public) high schools, where large numbers do not graduate and remain unprepared for the challenges of an increasingly knowledge-based economy of technological haves and have-nots.

While our nation has come a long way since the Brown v. Board of Education Supreme Court case of 1954 made it illegal to segregate schools based on race, there are still many problems. A typical example is in Richmond, Va., where a recent news report found that 40 years after the U.S. Supreme Court rejected consolidation of public school districts to achieve racial integration in the Richmond area, one in every three black students in the Richmond-Petersburg region attends a school with a population that is at least 90 percent black and 75 percent poor.

So what right-minded parent, black or white or brown, would want their child in a school that is segregated and all but likely underfunded? It is a non-starter, really.

School Enrollment comparison

The U.S. Department of Education’s data show private school enrollment has dropped, mostly due to declining attendance at Catholic schools.

Public vs. private schools by the numbers

According to the U.S. Department of Education in 2008, the number of public schools in the United States outnumbered private schools (including religious schools) by about a 5-1 margin (65,990  vs. 13,864). In the past 15 years (1995-2009), private school enrollment actually dropped from 12% of all enrollment to less than 10%. The main reason is attributed to the drop in Catholic school enrollment.

Economic downturns also led to falling enrollment. Due to the increasing decline of the U.S. middle class and the concentration of all wealth in the hands of a few Americans, the disparities have even worsened. Between 2009 and 2011, the mean net worth of the wealthiest 7% of households rose 28%, while the mean net worth of households in the lower 93% slipped 4%, according to a Pew Research Center.

According to Jack Jennings, founder and former president of the Center on Education Policy, the real issue remains how well the nation will educate the 90% majority—the ones with increasingly less wealth—who are not privileged and have less resources and who comprise the majority of our public school student population. They will be the future soldiers, medical professionals, politicians, scientists, engineers, construction workers, and more. “If we want a bright future, we must focus national attention on making public schools as good as they can be,” Jenning says.

At last count, about 49 million kids were enrolled in K-12 education, or nearly or a sixth of the U.S. population. So the debate about where we educate these youngest citizens and our up-and-coming leaders is about as important issue as any we face as a nation, and as citizens of our communities and country.

Jessica Strauss, in a June 2013 New York Times piece on the country’s growing education divide, pointedly notes: “The truth is that there are two very different education stories in America. The children of the wealthiest 10% or so do receive some of the best education in the world, and the quality keeps getting better. For most everyone else, this is not the case. America’s average standing in global education rankings has tumbled not because everyone is falling, but because of the country’s deep, still-widening achievement gap between socioeconomic groups.”school_choice

Education, health, and ethnic diversity–fused at the hip

So where should kids get the tools they need to prepare them for their life challenges, a turbulent economy that is divided by knowledge and technology, and the diversity in a country that will be less than 50% white by 2043. Navigating the nation’s ethnic and linguistic diversity will be as critical for someone running a small business as it will be for a highly trained medical professional serving patients with different ways of dealing with health care.

Research over the past 20 years has generated countless studies consistently showing how a person’s health is driven largely by underlying factors, or the social determinants of health. In short, one’s education will predict a child’s future health as good as any other causal factor.

So as a nation, if we also want to promote opportunities for everyone to achieve good health, as well as good jobs, there must be a public policy imperative to ensure that the poor, underachieving, increasingly non-white public schools do not get short-changed. Does that mean more blog posts and rants chastising liberal middle-class parents and taunting them? Perhaps that’s one way to raise awareness, as Benedikt tried and I think succeeded.

But I’m less convinced parents of any race who want their kids to be learning Mandarin by age 8 and making high-def feature movies by grade 10 (like students do at the elite Annie Wright School of Tacoma, Wash.) will dare risk their child’s well-being for the larger social good. If parents are fortunate to be economically well off in that narrowing minority of “haves,” they will choose the high-price, high-quality schools like this leafy campus and pay tens of thousands of dollars for that rare privilege. Because I am not a parent, I can avoid this very hard decision, so I am very lucky.

Such advantage-bestowed kids will undoubtedly go on to be successful leaders. But I am less inclined to believe they will be the right leaders, who have a visceral sense of what’s best for all of us, though many of them will be the ones driving the agenda in many of the organizations that impact us the most.

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The crowded, congested, contested road: unsafe at nearly every speed

Seattle traffic

Seattle traffic is among the worst in the nation, and it can be downright deadly, according to those who track road-related fatalities.

Every day that I drive to work, I am literally putting my life on the line. I commute roughly 80 miles daily, round trip, from Seattle to Tacoma, navigating one of the most harrowing urban traffic corridors in the Untied States, on Interstate 5 and two state highways. (My story why I am commuting this way will be for another day, but there are good reasons.)

Routinely, erratic drivers dangerously pass me, putting our lives at risk, in order to gain a few extra minutes by speeding. I have seen many accidents, some fatal, on this route over the years, and I am glad that I have my will and living will in proper order in case a truck jack-knifes near me in the rain—and yes I’ve seen that happen twice before on the freeway system around Seattle.

Seattle Road Kill 2001-2009

How deadly are roads in the Puget Sound–take a look at the roadkill on this data map showing types of mortality by form of transportation for 2001-2009.

Judging by this map, we get a fair share of road kill in the metro area I call home.

The Centers for Disease Control and Prevention (CDC) put the number of road deaths annually in my home state at nearly 500 (2009). Nationally, in 2012, the United States reported that 34,080 people died in motor vehicle traffic crashes in 2012, a 5.3% jump over 2011. This ranks as 10th leading cause of death in the United States, if one pulls this form of death from all accidental deaths, in which it is grouped by the CDC epidemiologists.

So by all counts, getting in one’s car (or on one’s bike or in a bus or other form of transportation) and hitting the road can be deadly business in my country, especially given the proliferation of mobile-device users and drunk drivers.

In 2011, cell phone use in the good ole’ U.S.A. was a contributing factor in more than 3,300 deaths and for the previous year, in 387,000 motor vehicle injuries. These are very sobering numbers, and I actually expected there would be more given that I have seen far too many texters during peak travel times in vehicles moving 70 mph. Normally I move over a lane or lay on my horn to snap them out of it.

But this is nothing compared to the perils that passengers and drivers experience globally. According to the World Health Organization (WHO), road accidents claimed 1.2 million lives globally in 2011, ranking as the No. 10 cause of death, on a list that has some pretty nasty company, including respiratory infections (3.5 million), tuberculosis (1.3 million), and the big killer of children ages 0-5 years, diarrhea (2.5 million).

The Institute for Health Metrics produced this data table showing how road deaths globally compared to other causes of death (it's No. 10); go to: http://www.healthmetricsandevaluation.org/gbd/visualizations/gbd-heatmap

The Institute for Health Metrics produced this data table showing how road injury globally compares to other burdens of disease (it is No. 10); go to: http://www.healthmetricsandevaluation.org/gbd/visualizations/gbd-heatmap

A typical story that one sees with mind-numbing frequency overseas are bus collisions with motorcycles and motor scooters. This November 2012 story, 19-yr-olds crushed to death by bus, notes two aspiring young men were run over by an errant bus driver and dragged 40 feet in Chandigarh, India; the driver then fled the scene. Both of the men’s heads were crushed by the bus’s wheels.

I saw no less than three similar road maulings on the island of Java in 2009, when I visited Indonesia. That island, one of the most densely populated locations in the world, is overwhelmed with low-income and middle-income residents on  scooters competing for space with trucks and army of loosely and unregulated van taxis and buses.

Indonesians who use these highly efficient and inexpensive 100-125cc motor scooters are frequently killed on the island nation's infamously unsafe and crowded roads.

Indonesians who use these highly efficient and inexpensive 100-125cc motor scooters are frequently killed on the island nation’s infamously unsafe and crowded roads.

Road accidents alone in Indonesia account for more than 48,000 deaths annually, the 9th leading cause of death in the world’s largest Muslim nation.

The United States Department of State offers this stern warning to would-be American visitors to Indonesia–a country I really loved by the way: “Air, ferry, and road accidents resulting in fatalities, injuries, and significant damage are common. … While all forms of transportation are ostensibly regulated in Indonesia, oversight is spotty, equipment tends to be less well maintained than that operated in the United States, amenities do not typically meet Western standards, and rescue/emergency response is notably lacking.”

During my two-week visit in 2009 to the island nation, I rode about a dozen different buses and equally as many microbuses, not to mention the country’s crash-prone domestic air carriers once, their local train service (also unsafe at times), and the far less safe inter-island ferry services. I saw about a half dozen crashes from my bus window, most fatal and usually with motor cycle riders as victims, and from my hotel room I heard one multi-vehicle crash in the middle of the night that clearly claimed many lives. I learned the next day it was between a bus and truck. The bus was totaled.

Roads can really kill you overseas, and so can planes, boats, and trains too

Buses like these are cheap in Indonesia, but your life can be as some locals would say, insha-Allah, or at the mercy of God.

Buses like these are cheap in Indonesia, but your life can be as some locals would say, insha-Allah, or at the mercy of God.

The writer Carl Hoffman, author of the book The Lunatic Express: Discovering the World… via Its Most Dangerous Buses, Boats, Trains, and Planes, documents the horrendous conditions of ferries, public transportation, trains, planes, and other forms of transport. The book’s online promotion notes that it offers a “harrowing and insightful look at the world as it is, a planet full of hundreds of millions of people, mostly poor, on the move and seeking their fortunes.”

Anyone who has travelled in developing or “middle-income” countries (like, say, Chile or Turkey) knows their life is literally in the hands of drivers who may have no proper training, in busses with no proper maintenance or even reliable brakes. Worse, the drivers of buses and microbuses in countries from Uganda to India to Mexico may trust their fate to Allah, Saint Christopher, the Virgin Mary, or Krishna. Those who have travelled in such places know this to be true, by the many religious deities dangling at the front of public transportation by the drivers’ seats.

Worse, the drivers will often play chicken with their competitors by speeding into oncoming traffic at high speeds while passing other vehicles or simply to “have fun.” I swear I thought I would die on many occasions in: Mexico, Guatemala, Nepal, Peru, Uganda, Indonesia, Egypt, Turkey, Chile, Argentina, India, and other places that I’d rather forget just now.

accident or more by Birn

When is an accident really an accident, or when it is linked to larger systems issues? This analysis is provided by Anne-Emmanuelle Birn in her description of the social determinants of health (SDOH).

Three separate times, after I lived through the near mishap, I swore I would never, ever take a bus again in a developing nation. Yet I threw caution to the wind, as I needed to get around, and I could not afford to get around any other way. Not seeing the country I was visiting was not an option.

Is it really  “just an accident” or something more?

Anne-Emmanuelle Birn, international health professor at the University of Toronto, and co-author of the widely used global health tome called Textbook of International Health, points out the deeper connections that road-related deaths have to poverty and social inequity in undeveloped and middle-income countries. Birn writes that road traffic accidents are the second-leading cause of death for children between 5 and 14 years of age globally, and that poor and working classes are disproportionately affected in most countries. In high- income countries, most of those killed are drivers and passengers, whereas in low- and middle-income countries pedestrians, cyclists, and public transport passengers make up nine out of every 10 road-related deaths.

In Haiti, for instance, the word for local transport is molue (“moving morgue”) and in southern Nigeria locals say danfo (“flying coffins”).

Duncan Green, an Oxfam policy adviser and development blogger, recently wrote an article asking when road traffic injuries would finally be recognized as a priority by the international development community.

In fact a major report released in June 2013 by the Overseas Development Institute, the United Kingdom’s leading development think tank, notes that transportation is not recognized as a human right like access to water, yet it still is a fundamental factor for many to achieve basic human rights. Well-run transportation systems, for people and for goods and services, promote benefits, while unsafe and weak transportation systems harm the most vulnerable citizens.

Given the debate emerging now for future sustainable development post-2015, the deadline set for the Millennium Development Goals, road safety may finally find a way into the broader public health, development, and environment agenda, as a way to tackle this clearly documented major global killer. Perhaps the threat may finally be treated as the international epidemic that is is, globally or closer to home in the United Sates. For me, this includes the roads in the Puget Sound where I spend more than two hours daily to and from my public health job.

Do community health fairs really make any difference at all?

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.”

Rally to ban assault weapons lays out strategy for Washington State activists

I attended a rally today (Jan. 13, 2013) in Seattle that included a march through downtown to the Seattle Center. The event called for an immediate ban on assault weapons and better laws to require background checks on all weapons sales. The march was organized by the non-profit called Washington Ceasefire, a state-based group founded in 1983 and dedicated to reducing violence from guns in the United States. (See my photo essay below.)

The event attracted somewhat lukewarm media coverage as of this evening, with stories picked up by most of Seattle’s major broadcast media, including the major TV news stations. The event was competing with the story that mattered most to Seattle–the playoff game that saw the Seattle Seahawks fall in a heart-breaker to the Atlanta Falcons. Still, approximately 400-500 participants attended the rally that marched about a half mile from Westlake Center to the Seattle Center.

The event began with a speech by mayoral candidate and current City Councilman Tim Burgess, a former Seattle police officer who called for attendees to focus their advocacy on immediate actions that could be taken by the Washington State Legislature. No specific state-level legislation or bills were identified, and Burgess’ rallying cry noticeably did not call for any specific federal action, perhaps because such proposals are still being formulated by the Obama White House.

Nor were any of the state’s congressional members referenced in public remarks or acknowledged in any event promotional material I am aware of. (Note I left the rally before it ended.) To my knowledge, no member of the state’s congressional delegation officially participated in the speaking activities, nor did their staff. I found that omission intentional and noteworthy. I am sure many attending noticed this also.

Washington Ceasefire President Ralph Fascitelli specifically called on an outright ban on assault weapons and sensible gun legislation. The web site created to promote the event quoted the group’s executive director, Beth Flynn: “We want to send a clear message to our legislators that we want to ban semi-automatic assault weapons.”

It was refreshing to me, as a public health professional, to hear Councilman Burgess make reference to the public health threat posed by firearms in his remarks. I spotted at least one retired University of Washington School of Public Health faculty member in attendance and holding a sign, which was very encouraging. I also met other public health professionals in the audience. Again, nice to see.

A list of the dignitaries who were invited to speak can be found here. I spied Seattle Mayor Mike McGinn, Councilman Nick Lacata, Councilmember Jean GoddenState Rep. Reuven Carlyle (D-Seattle), and other civic and religious leaders on the Mural Amphitheater stage at the Seattle Center, where remarks were made.

Also noteworthy was the presence of gun-rights activists. I saw two men wearing handguns in their holsters at the Westlake Center. So, I took their photographs. No doubt groups opposed to firearms legislation were monitoring the event and were mixing with the crowd. I observed very peaceful exchanges between those for greater legislation and those opposed to it. I included a photograph of the two men who were armed below to highlight how they communicated their views–at least through a visible display of their guns for the TV cameras and for those seeking legislation to control firearms violence.

Photographs of the StandUp Washington rally, January 13, 2013 (click on each thumbnail for a larger image)

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.

Cheap energy poses a threat to Americans’ health

One of the most talked-about initiatives taking place in public health, with funding supports from the Centers for Disease Prevention and Control (CDC), is policy, system, and environmental change to address the rise of chronic disease in the United States, the country’s leading cause of death. According to the CDC, chronic diseases are responsible for seven out of 10 deaths of all Americans annually, and one half of all Americans have at least one chronic illness. Worse, three-quarter of the $2.5 trillion (yes trillion) dollars spent annually on health care in the United States goes to battling chronic diseases. The CDC’s grant funding is being disbursed to health departments to undertake a range of interventions. But none of these interventions is going after what some say is one of major sources for the rise of obesity and chronic disease—the cheap price of energy in the United States.

According to Ian Roberts of the London School of Hygiene and Tropical Medicine, the overall obesity rate is highest in the United States among all other nations because the price of gasoline is very low. “So where gasoline is really cheap, we over-consume it, it’s bad for the environment and actually because we should be using food energy for human movement – if we use gasoline for human movement, then we store the food energy and you know where we store it.” And there are other costs associated with being a fat nation, says Roberts. “So there’s obviously an increased demand on food supplies, but also there is an increased demand on everything. You know, bigger people need more energy to move them. Airplanes take more energy to get off the ground. It takes more of the shares that, you know, of the Earth’s resources to actually support all that extra weight.”

In the United States, the U.S. Energy Information Agency estimates we use 317 million BTUs per person a year. In this country, nearly half of all of our energy comes from petroleum and natural gas, and the country ranks seventh globally in terms of per capita energy use, trailing Canada and some smaller nations like Luxembourg and Trinidad and Tobago. However, the United States is  No. 2 (19% of global demand) in terms of global consumption of energy after China (20.3% of global demand), which just took the No. 1 slot.

Feeder pipelines gather crude oil produced at Prudhoe Bay, which is eventually shipped to the lower 48 for consumption on the West Coast.

A significant negative outcome can be seen in the widening waistlines of Americans. Charles Courtemanche of the Department of Economics at the University of North Carolina at Greensboro published a study in 2009  (A Silver Lining? The Connection Between Gasoline Prices and Obesity) that found increases in gas prices were associated with an uptick in walking or bicycling and public transportation use (and more people walking to bus and subway stops) and a drop in the how often people eat at restaurants, all impacting weight. Courtemanche estimates that:

– A $1 rise in the price of gasoline would reduce overweight and obesity by 7% and 10% in the U.S. The reduction in obesity would save approximately 11,000 lives and $11 billion per year, savings that would offset 10% of the increased expenditures on gasoline.

– An 8% of the recent rise in obesity from 1979 to 2004 can be attributed to the decline in real gasoline prices during the period.

According to Dr. Brian Schwartz, professor at the Johns Hopkins Bloomberg School of Public Health’s Department of Environmental Health Sciences and co-director of the School’s Program on Global Sustainability and Health, cheap energy also is responsible for creating our built environment, which is exacerbating our poor health trends. Schwartz argues that since World War II, the United States and other developed countries “have invested in large tracts of low density, non-compact, single use developments, which are highly reliant on the automobile and often lack public transit options.  This type of housing and transportation system is totally reliant on cheap and plentiful oil.”

The built environment of U.S. suburbs has been shaped by the relatively cheap price of petroleum paid by U.S. consumers at the pump.

Schwartz argues the average foodstuff in the United States requires about 10 units of fossil fuel-based energy input for each unit of food energy derived from the food, and that ratio jumps to 100 to 1 for many meats. Less energy would lead to declines in food calories too, as many kinds of food would become too expensive to produce and too expensive for consumers. What’s more, Schwartz suggest that this unsustainable suburban lifestyle would change dramatically after peak oil, that future and historic moment when global production of both oil and natural gas reaches its historic peak and begins to decline, setting off chain reactions impacting every facet of our life to what we eat, how we work, how goods and people move about, and how nations respond on a massive scale. (Go here for a summary of peak oil and its health impacts, as explained by Schwartz.)

Schwartz also notes that our entire health care delivery system, on top of our suburban-sprawl development pattern, food production systems, and supply chains, also is tied to unsustainably cheap energy in the form of cheap fossil fuel. “Large energy-inefficient health care facilities are staffed by health care workers living in distant suburbs who require large quantities of paper, plastic, and electronics to do their work. Systems for provision of care will need to be completely redesigned to adapt to the new reality of more expensive energy.”

Portland, Ore., that oh-so progressive Northwest city that has become a beacon of contemporary planning that tries to vaguely resemble what they do in Netherlands or Denmark, for instance, already has assembled a Peak Oil Task Force, back in 2006. The group prepared a report and drafted a resolution, passed by the City Council in 2007. That resolution sets out an ambitious goal to “reduce oil and natural gas use in Portland by 50 percent in 25 years and take related actions to implement recommendations of the Peak Oil Task Force.” It may be no surprise Portland was recently ranked the No. 1 biking community in the United States.

What continues to baffle me is how unengaged or willfully silent the United States’ professional public health system is to the connection between cheap energy and health, notably obesity. I just did a keyword search today (Sept. 3, 2012) on the word “obesity” for the upcoming American Public Health Association (APHA) Annual Meeting and Exposition to be held in San Francisco in October 2012. There were 797 hits for the word–many for papers being presented on the topic. When I typed in the word “oil” I yielded 33 hits, some on the Deep Horizon oil spill and its impacts and others on shale gas development, such as a paper being presented by Dr. Roxana Witter of the University of Colorado called “Comprehending health implications of natural gas development through public health research.” But I saw no papers on any linkage between the so-called “obesygenic environment” and energy prices tagged under the word “oil” in the searchable database of presentations and papers. I did a search for the word “energy” and got 82 hits, but most related to topics like high-energy drinks, not on oil, gas, or energy policy issues impacting human health.

Seattle like other cities is entirely dependent on relatively cheap petroleum, and as a consequence suffers from some of the worst traffic congestion of any metro area in the country, as well as a sprawl development in the city and throughout surrounding King County.

I dream of the day when public health professionals will organize their advocacy less around what kids eat at school and talk more about what our state and national lawmakers are doing to create meaningful tax policy that prices energy–making it more expensive while using revenues to promote renewable energy sources–to create larger downstream impacts. To completely cede this issue to supporters of cheap energy and the status quo and to deny that there are serious public health implications by doing so is to turn one’s back on best available evidence and the duties those in the field have to promote healthy outcomes for the U.S. population.  I did try to raise this issue in one of my classes at the University of Washington School of Public Health, and was met with unusual silence. I hope one day perhaps UW faculty in the economics department, school of business, and schools of public health and public affairs get together one day to pursue research examing negative health impacts of national energy policy.

A tale of two farmers-food markets and what it means

I love fresh food markets. I had a fruit, vegetable, and fish market near me growing up, the old Market in the Loop, in University City, Mo. To this day I remain a loyal supporter of local food and local businesses that sell fresh fruit and vegetables. Today, these markets are very much at the center of the national health discussion on nutrition, healthy food, obesity, and politics. So I decided to examine this issue using two examples in Seattle–one where I shop and the other where I mostly people watch and occasionally will buy some food. (Please go below for my photo essay of both venues.)

For  the last decade, the public health community increasingly has been focussing on how to increase fruit and vegetable consumption by Americans, improve Americans’ nutritional intake, and address the complex systems that are making this country the fattest on earth. Research has shown that Americans still do not consume the recommended amounts of fruits and vegetables, and government research is showing that lower-income consumers eat fewer fruits and vegetables than higher-income consumers do.

According to research by public health experts, communities that lack full-service grocery stores and neighborhood food markets have less access to fresh fruits and vegetables. Since 2009, the CDC, in its list of strategies to reduce obesity, has called for making healthier food choices available in “public service areas.” Specifically, the CDC says local governments can make healthier foods accessible through policy choices and offering vouchers that can be redeemed for healthy food choices. This is happening nationally at farmers markets, where technology to read food stamps, or EBT, cards (known today as Supplemental Nutrition Assistance Program, or SNAP), is being made available to merchants so they can serve lower-income consumers.

The Food Research Action Center (FRAC) has called for increasing participation in SNAP; improving those benefit levels so lower-income persons can afford adequate diets, including healthier foods; promoting fruit and vegetable purchases with SNAP benefits, which is taking place; and boosting the access to healthy and affordable foods in “underserved communities.” To that end, the CDC is making available more than $100 million (chump change, really, when you compare that to funding made available to corporate farms through the U.S. Farm Bill) to promote policy, systems, and environmental change through Community Transformation Grants (CTG).  This is designed to “to reduce chronic diseases such as heart disease, cancer, stroke, and diabetes” — all major health issues that are also bankrupting our health care system and treasury.

A 2010 White House report on childhood obesity notes that in the last three decades, prices for fruits and vegetables rose twice as fast as the price of carbonated drinks, and a bump in the cost of fruits and vegetables relative to less healthy foods can reduce consumers’ desire to buy fruits and veggies, leading to unhealthy Americans. Pricing is of course a key issue impacting purchasing decision of lower-income consumers, among other factors. U.S. Department of Agriculture (USDA) research found that a 10% discount in the price of fruits and vegetables would increase the amount purchased by 6-7%.

So, yes, price matters a lot, along with access. Where I live (Seattle), the Farmers Market Alliance claims “the vast majority” of the fruits, vegetables, herbs, and berries are the same price or less expensive at farmers markets, especially with organics, than at conventional grocery stores (QFC, Fred Meyer, Safeway, etc.). The organization further claims that the quality and variety of its produce exceeds the quality sold at the chain grocery stores. The farmers market movement is truly national in scope, and a network of nonprofits like the Philadelphia based Food Trust is partnering with local farmers to promote farmers markets in underserved areas.

The Atlantic in May 2011 published an article noting that farmers markets were less expensive than supermarkets and provided better food. The article challenges the criticism that farmers markets catered to mostly wealthy white snobs who drive Subarus and Prius’s, and it argues that no formal research supports “this widely accepted contention, and the few studies that have been conducted call its veracity into question.” Of course the movement to support “local food production” and farmers markets has both national and local critics, including conservative bloggers, who call it a trendy cause. Some have blasted the use of electronic EBT card readers as a wasteful expense ($1,200 to purchase, $50 to lease).

The closest market to my home, about one mile away, called the Ballard Farmers Market, most definitely is more expensive than grocery stores and independently owned produce and grocery stores where I also shop in Seattle. Its clientele, based on my many trips there, is decidedly and stereotypically upscale, white or Asian (I’d say 90% white, 5% Asian, 5% other), and professional. I haven’t conducted a poll to actually verify this, but this corner of Seattle is not that diverse, and it is close to a neighborhood where homes fetch $600,000 and where condominiums are sprouting on many major intersections. No, I can’t afford to buy anything there, with the exception of a good bargain, like beets today ($3 a bushel of three). I have bought a few apples and heads of lettuce and other veggies in the past, but not much else — not salmon, not herbs, nothing. For my part, I grow some of my own food, pick some (like berries or tree fruit that abounds in Seattle), and wish I caught salmon like I did in Alaska.

I don’t begrudge the vendors there for selling produce at a higher price point, which shuts out low-income persons like me. (I may have a few university degrees, but I am by all measures very low-income now.) As one food blogger and jam-making blogger from San Francisco notes: “People selling at the markets have priced their products according to a wide range of criteria. First, many of the farmers who sell at markets are smaller operations than those who sell to grocery stores. Maybe they have 10 acres of land compared to 60 or 100 or 200 acres and rely almost exclusively on markets for income.”

I try to support my favorite produce store in Seattle, called McPherson’s Fruit and Produce, in Seattle’s Beacon Hill neighborhood. First, their selection is usually excellent–fresh but not organic food in season. I find their produce is fresher than most grocery stores. Their vegetables and fruits are always cheaper than any grocery store I visit, including stores with hefty supply chain advantages like Costco. They cater to a full spectrum of clients, and that clientele is more low-income and more ethnically diverse than what is found in Ballard. (Beacon Hill is much more diverse ethnically.) I’m as likely to see Hispanic, African American, immigrant, and Asian-American shoppers as I am those who look like me (white). However, McPherson’s is located about seven miles by car from my home, while the Ballard Farmer’s Market is a mile away, making it impossible for me to bike to Beacon Hill, and there are some serious hill and traffic issues. So I drive there, but usually combining outings and errands with a stop. I have been shopping at McPherson’s for years, during my previous and current stays in Seattle. I do not know if their model can be replicated in other cities–unique private owners, a great location on well-travelled road, proximity to distributors, an ability to attract shoppers with and without cars.

Perhaps instead of throwing all of our support into the farmers market craze, more can be done to help smaller businesses and producers. This would require the proverbial “upstream intervention.” For instance, our government tells people to eat five servings of fruits and vegetables a day, but is not providing the supports through federal legislation to make that possible. The White House Task Force on Childhood Obesity notes that by 2020, the country needs to boost the availability of fruits and vegetables by 70%, or 450 pounds per person a year (that’s an enormous pile of food by the way). It is not doing that now because of our dated, bloated Farm Bill.

Such upstream actions, to grow the intake of healthy food consumption, in a policy sense, have the biggest bang for the buck, compared to downstream actions. Many wise and smart persons who follow food and nutrition issues have long said that the pork-laden, decades-old Farm Bill needs to be overhauled to create true change. New York Times food blogger Mark Bittman notes “agricultural subsidies have helped bring us high-fructose corn syrup, factory farming, fast food, a two-soda-a-day habit and its accompanying obesity, the near-demise of family farms, monoculture and a host of other ills.” The farm bill, up for renewal in 2012, offers an agriculture subsidy worth $30 billion, $5 billion of which is direct payments to farmers. Conservative groups like the Heritage Foundation even blast this.

Bittman suggests that a revised Farm Bill–which I believe no one involved in policy-making believes can occur in the current political climate–should support farmers who at the moment now grow unsubsidized fruits, vegetables, and beans, while giving incentives to “monoculture commodity farmers to convert some of their operations to these more desirable foods.” This is food that would make us healthier compared to factory raised meat fed on subsidized grain, which is what our current system promotes. Bittman also calls for incentives to help medium-sized farms, those big enough to supply local supermarkets but small enough to care what and how they grow, compete better with corporate agribusiness.

Personally, I would love to see both farmers markets and McPherson’s in most neighborhoods in most cities. Right now, I’m going to stick with shopping primarily at McPherson’s, despite the inconvenience. And I’ll keep growing a garden where ever I live, too.