Treating the gun violence epidemic: A Call to Action

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IMG_4801-1 (2)

Yesterday, marked the three-year anniversary of weekly demonstrations led by a group called We the People for Sensible Gun Laws.  The group meets every Monday in front of the White House, holding signs displaying the names of victims of gun violence and demanding sensible gun laws.

In honor of the group’s third anniversary, the District’s Congresswoman Eleanor Holmes- Norton and Mayor Muriel Bowser joined the rally.

“You would think that after the Charleston nine …, you would think after the Louisiana shooting, where a deeply troubled man got a gun, you could at least get the background checks,” lamented Congresswoman Norton. “I am here to tell you that although the background check bill has been introduced in the House it hasn't even been introduced in the Senate.”

Then her tone changed. She reminded the crowd that laws change in response to committed activism.

“What that really tells us is that the kind of dedication you are showing is what our side needs to show. If 90% of American people are for the background check law, there is no good reason why we shouldn’t have that law. We know the gun violence we could have prevented.”

Sadly we know too well. There have been 204 mass shootings — and 204 days — in 2015 so far.

***Note: 204 refers only to mass shootings – defined as an event that results in the shooting of four or more people.   The numbers are significantly higher when accounting for total gun violence in this country since January 2015.***

The Congresswoman’s words were reenergizing. Changing American culture, perception and tolerance is a marathon. As we gear up for the next election cycle, the public health community needs to demand candidates who recognize a leading cause of death among young people (second only to car accidents) for what it truly is: an epidemic.

Gun violence is one of the biggest public health threats facing the United States today. IMG_4793

After each shooting, President Obama reminds us that the biggest “frustration” of his presidency is his failure to enact common sense gun legislation in this country.

We must send a message to the 2016 candidates that failing to address systemic gun violence is not a frustration, it is a crisis. And it is preventable. This past April, the Annals of Internal Medicine published Firearm-Related Injury and Death in the United States: A Call to Action From 8 Health Professional Organizations and the American Bar Association. The public health community must rally to champion this call to action in order to let our candidates know that it’s time to end "frustration” over gun violence.

Posted in Health reform, National Healthcare; Tagged: , , .


Addressing disparities in global health – it’s about time, but we still have important questions to consider

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disparities1Those working in global health and development are used to hearing about inequalities and disparities in health outcomes. We know that poor or disadvantaged populations around the world are more likely to have poorer health outcomes across almost all measures of health. It is promising to see large donors such as the Ford Foundation recognizing this and shifting their funding to focus on addressing global inequality.

But many questions remain about the best way to achieve the health outcomes we seek. For example, are some interventions having positive outcomes while exacerbating existing disparities within a population? Is this necessarily a bad thing? What if specifically focusing on disparities can sometimes slow overall progress to achieve a public health goal? Read More

Posted in Global Health, Tobacco; Tagged: , , , .


The Abortion Drone: An Innovative Use of Technology to Advance Women’s Health

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This post was co-authored by Rebecca Reingold and Sandra Majestic.

Image courtesy of CBC News

Image courtesy of CBC News

Last month, sexual and reproductive rights activists found a new use for drone technology. The Dutch NGO Women on Waves, in collaboration with other women’s rights organizations, coordinated the first “Abortion Drone”. The unmanned aerial vehicle flew packets of abortion pills from the German town of Frankfurt an der Oder to the Polish town of Slubice.

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Posted in Human Rights; Tagged: , , , , , , , .


Can Biohacking Solve the Global Insulin Shortage?

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Image courtesy of: http://www.mfprac.com/06disease/endocrine/dm/insulin2.png

Image courtesy of: http://www.mfprac.com/06disease/endocrine/dm/insulin2.png

For many diabetics, access to insulin can mean the difference between life and death. However, this vital product is often exorbitantly expensive, particularly for those living in low- and middle-income countries. As a result, many needlessly suffer and die from a manageable disease. One study estimates that the global prevalence of diabetes will rise from 171 million in 2000 to 366 million by 2030—4.4% of the world’s population. While not all diabetics are insulin-dependent, this will mark a vastly larger population of patients in need of the drug.

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Posted in Global Health; Tagged: , , , .


One year later: did the Ice Bucket Challenge actually work?

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140819-ice-bucket-challenge-1949_899e03e1c58b45b56812f96bc79680a6One year ago, the Ice Bucket Challenge was on its way to becoming one of the world’s most successfully awareness campaigns, instantly going viral on all social media platforms all over the world. Throughout the 2014 summer, more than 17 million people participated in the challenge, whose goal was to grow ALS awareness and support. However, the success was also met with much skepticism; were people truly reaching into their pockets and donating to the cause or simply having a laugh with their Facebook and Instagram friends?

Well, according to a recent Huffington Post article, the global #IceBucketChallenge raised an estimated $220 million in donations. In the U.S. alone, 2.5 million people donated $115 million to the ALS Association, making the event one of the largest episodes of giving outside of a disaster or emergency. Read More

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How would obesity policy differ if we didn’t blame the individual?

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This week in the New York Times, Aaron E. Carroll questioned why paying people for quitting smoking and losing weight is unpalatable to many Americans, even though significant evidence shows that financial incentives improve health outcomes. Carroll concludes that financial incentives tend to be least palatable for behaviors we know are harmful to begin with, as “[p]aying people to quit using harmful drugs or smoking can seem too close to rewarding people for adopting such habits in the first place.”obesity word cloud

Carroll’s piece got me thinking. If we didn’t see obesity largely as the result of individual irresponsibility, what would obesity policy look like?

Obesity and individual blame

As a society, we tend to cast obesity as the result of individual irresponsibility: laziness, lack of willpower, poor dietary choices, and questionable parenting. While people no doubt have some personal responsibility for their health, research on the determinants of smoking, exercising, and eating behavior reveals “that these are not simply free and independent choices by individuals, but rather are influenced by powerful environmental factors.”

In their recent piece in The Lancet, Roberto and colleagues discuss a series of environmental factors “exploiting biological, physiological, social, and economic vulnerabilities of people in ways that undermine their ability to act in their long-term self-interest.” Yet, our inherent prejudice against people who are overweight and obese essentially ignores these powerful environmental factors, like highly-appetizing processed foods packed with sugar, fat, salt, and calories, which make it harder for the body to regulate intake and weight. Similarly, we tend to disregard important biological barriers to losing excess weight, including changes in metabolism and hunger during weight loss attempts.

Obesity policy based on scientific evidence, rather than blame and stigma

Our tendency to blame obesity on the individual not only causes stigma and discrimination, it deprives society of comprehensive population level policies and laws we need to prevent and treat this chronic health condition.

As Carroll’s piece suggests, if we neutralized blame and stigmatization, we would likely see more research and policies utilizing financial incentives for healthy eating and weight loss among the overweight and obese. Such incentives would no longer be seen as rewarding slothful and gluttonous behavior, but as evidence-based, cost-effective means of achieving sustainable health outcomes.

Perhaps we would also see more public funding and insurance coverage for the full range of treatments for overweight and obesity, including nutritional counselling, prescription weight-loss medications, and weight-loss surgery. If we remove blame and stigmatization, we remove the basis for the argument that public funds should be reserved for the treatment of more “deserving” patients. As Ben Brooks writes, since neither obesity nor overweight “has the terrifying arbitrariness of cancer, nor the abruptness of a sudden heart attack – neither seems to warrant the same commitment to prevention.

Most importantly, perhaps, we would see more regulatory focus on the powerful environmental and social factors that undermine individual decision-making. Effective policies like taxes on sugar-sweetened beverages, portion size limits, and legislatively mandated restrictions on the salt content of processed foods would be commonplace. Most of us would reject industry claims of “personal responsibility” and the intrusive “nanny state,” which are deployed to undermine strong public health regulations. Policy-makers, no longer hamstrung by these industry tactics, would reject the its calls for self-regulation, voluntary schemes, and consumer education information as the answer to the obesity epidemic. Instead, compulsory regulations focused on manufacturers and society-level issues like marketing and availability would rule the day, complimented by genuinely informative labeling and nutrition information.

Today, non-communicable diseases (NCDs) are by far the leading cause of death in the world. Many NCDs are caused by tobacco use, alcohol consumption, and unhealthy diets, which, driven by the industries promoting them, evoke notions of individual irresponsibility and blame. As we make policies and laws to address NCDs and their risk factors, we should recognize that societal perceptions of disease influence research, funding, policies, and regulation. Our tendency towards individual blame not only causes stigma and discrimination—it deprives us of effective policies and laws to prevent, treat, and support people with serious chronic health conditions.


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The Right to Health, Europe, and Greece

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This hospital in Greece was closed due to austerity measures. Courtesy of The Independent (UK), February 21, 2014.

This hospital in Greece was closed due to austerity measures. Courtesy of The Independent (UK), February 21, 2014.

Following capital controls and the partial shutdown of the financial system after Greek’s default last week on a loan payment to the IMF, food and medicine are becoming scarce. The threat to health from austerity  are far from new with the latest phase of Greek’s economic disaster, however. A 2014 study in the Lancet “found evidence of rising infant mortality rates, soaring levels of HIV infection among drug users, the return of malaria, and a spike in the suicide count,” along with 800,000 people without access to health care, as reported in the UK’s Independent newspaper. This echoed an earlier study on the effects of austerity in Greece and elsewhere. Last night, the PBS NewsHour reported on the 50% increase in suicides among Greeks during much of the period of austerity and the devastating budget cuts for Greece's hospitals just this year – from $735 million during the first four months of 2014 to only $50 million for the country's 132 hospitals during the first four months of this year.

I will not address here the issue of Greek responsibility, from tax avoidance to poor policy choices leading to its heavy debt burden. For now, one point only: whether Greeks begins to recover their health – I mean human health – depends on the European Union. Require more austerity, and after Sunday’s referendum and the Greek people’s rejection of more of the same, and the economic collapse could only worsen, and with it, people’s health. More could – and almost surely would – die.

Germany, France, and other European countries will make choices in the coming days that will either lead to more or less ill health for the people of Greece. If they choose the path of ill health, then the countries of Europe, generally among the most concerned about human rights, will be violating their human rights obligations.

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Posted in Global Health, Human Rights; Tagged: , , , , , , , .


The Worst Global Sickness

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Nicholas Kristof newsletter South Sudan 7-5-15

This family in South Sudan has survived by eating water lilies and grass. They recently lost one of their children to a government attack. Courtesy of Nicholas Kristof (also pictured) and the New York Times (Nicholas Kristof newsletter, July 4, 2015).


A family survives, if barely, "by eating water lilies and grasses in the marshes." Still, they are better off than former neighbors who have been burned alive in their huts. You can join the thousands trying to escape the worst of it, those soldiers who are burning their homes and shooting their children, but you too will have to contend with crocodiles.

Not too far away, in the adjacent land, bombs are falling, but their target is not clear. One of two possibilities: either the “Air Force was trying to bomb the village of grass huts, or the girl’s high school next to it.” In that land of falling bombs, do not get sick – or hungry. For you will find bombs, but not much food or medicine; the government is keeping them out.

Welcome, I daresay, to the Sudans and these dual catastrophes – which, as explained below, can be stopped. The family that had to survive by eating that which is not food for human beings, who escaped from an area where government soldiers set fire to people’s homes with families inside, was in South Sudan. Since December 2013, a brutal civil war there as pitted the world’s youngest country’s President Salva Kiir against his former vice president, Riek Machar. The fighting has assumed a deep ethnic dimension; President Kiir is a Dinka, his former vice president, a Nuer. Those government soldiers, they were slaughtering Nuer – likely in revenge for earlier atrocities by the rebel forces against Dinka civilians. Alas, even before the fighting, the people of South Sudan were abandoned by their government as it quickly morphed into an authoritarian kleptocracy. The United Nations recently issued a report on the massive scale of atrocities both sides have committed, which you can access here. Read More

Posted in Global Health, Human Rights; Tagged: , , , , , , , , .


Ahoy Matey – Time for the 4th of July Festivities to Begin!

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This weekend is the IMG_2312Fourth of July holiday in the United States and, admittedly, my favorite holiday of the year. Growing up it was a holiday spent with cousins at the parade, going tubing and water-skiing and completing the day with fireworks over the lake, which we would watch from the dock while eating s’mores. Idyllic. Today, things are pretty much the same, with the addition of a few political candidates roaming around trying to make connections before the upcoming caucuses, and a trip to Farmers Beach on the boat to take in the scene. What does this have to do with public health, and especially, global health? Well besides the obvious of delicious high caloric food, (ir)rational use of chilled beverages and fireworks safety, one thing that does scare me about the 4th of July holiday is boat safety and drowning.  Read More

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Glossip v. Gross: When it comes to the death penalty, the Supreme Court remains divided

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Image courtesy of the New York Times

Image courtesy of the New York Times

The U.S. Supreme Court ended its term yesterday, handing down a decision that upholds the use of a controversial drug for lethal injection in executions. In recent years, the limited availability of substances used in lethal injection protocols – due to changes in the domestic production of these substances as well as tighter regulations in the European Union on the export of these substances – has posed a serious challenge for executing states in the U.S.

In Glossip v. Gross, the Supreme Court considered a challenge brought by a group of death-row inmates to the three-drug protocol that Oklahoma uses to execute prisoners. The inmates argued that the use of the first drug in the three-drug protocol, midazolam, violates the Constitution because it can't reliably render the inmate unconscious. If an inmate isn't unconscious when the second and third drugs are administered, the third drug will cause him to suffer serious pain, but no one will know because the second drug will prevent him from moving at all. Midazolam played a part in a handful of long and apparently painful executions just last year.

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Posted in Human Rights; Tagged: , , .

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