Can we please stop fixating on weight loss as the solution to the obesity epidemic?

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Image courtesy of metro.co.uk

Image courtesy of metro.co.uk

Last Friday, I felt very uneasy when I came across an article in the Washington Post about the obesity epidemic, in which a doctor declared that “exercise alone won’t make you lose weight”. Aseem Malhotra, a cardiologist, writes that despite an ever-growing fitness industry, obesity continues to surge around the world. Focusing solely on the premise that “exercise – no matter how many gym memberships you buy or how often you wear your Fitbit – won’t make you lose weight” he claims that caloric intake (and the types of calories we consume) is what’s fueling the obesity epidemic.

Even if the research he refers to is valid, these statements distort the bigger picture. Such simple yet categorical claims about an incredibly complex health issue distracts from the reason we need to exercise in the first place: to reduce risk factors for chronic disease. Weight can be one of them, but isolating it is misleading and can exacerbate the body-shaming and weight stigmatization that is already endemic in our society. Especially when the message comes from a member of the medical profession – a powerful and authoritative voice whose message carries a lot more weight (no pun intended).

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


The O’Neill Institute Reads: “Poor Economics”

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Poor Economics CoverThis week, my colleagues and I at the O’Neill Institute launched our informal book club. As a group of self-described health law and policy nerds, our team rabidly consumes literature from our intellectual domains. But, as researchers, the things that we have to read often outweigh the things that we’d like to read. Too many intriguing works seem to have a permanent place at the periphery, but never quite make it to the top of our lists.

Our book club, therefore, was intended as a catalyst to get through our long respective wish lists of books. But again, as researchers, it’s difficult to limit our thoughts between the four walls of our institute, so we decided to launch a parallel “The O’Neill Institute Reads” series on our blog. The various members of our group will provide periodic reflections on what we’re reading, and this post launches this dialogue.

Coordinated by Law Fellow, Dan Hougendobler (no small task), and through a relatively democratic process, we selected Abhijit V. Banerjee and Esther Duflo’s Poor Economics (Public Affairs, 2011) as our first book selection. The tagline on front cover of the paperback edition pronounces that it is, “a radical rethinking of the way to fight global poverty.” The authors clarify that their work is a study (or series of studies) of the world’s most poor – the 13% of the world (~ 865 million people) that live on less than $0.99 per day (the book is a bit dated as the standard for the most poor has since been raised to $1.25 per day).

As we are only two chapters in, it would probably be imprudent for me to give it a definitive thumbs up or thumbs down, but so far, I like what I’ve read.  Read More

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An end to salmonella on produce? A look at FDA’s Food Safety Challenge

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Listeria monocytogenes, SEM, Color Enhanced

Listeria monocytogenes, SEM, Color Enhanced

I recently read an article in Forbes that asked, “Are [foodborne] outbreaks actually increasing, or are we just more aware of them?”

I work in food safety. I often feel panicked before I feed my children. But I thought that might just be a hazard of working in this field.

So, are foodborne outbreaks actually increasing? That’s not really clear. Advances in diagnostic technology, including the ability to sequence the genome of a particular pathogen, and epidemiological improvements in reporting have greatly contributed to public recording of outbreaks. Couple that with the nationalized reality of the food supply in the United States. As the reach of any single distributor continues to expand, the scope, scale and impact of pathogens in our food supply is felt more broadly.

While pregnant I was told no deli meats, sushi or unpasteurized cheese. The fear was listeria monocytogenes, a bacterium known to cause miscarriage in pregnant women and severe illness or even death in the young, old and immunocompromised. Avoiding the riskier foods was easy. I did however eat lots of hummus, spinach and ice cream, three of the sixteen foods recalled just in the last two months because of listeria contamination.

It feels like each day there is more salmonella in peanut butter, campylobacter in poultry and shigella in food generally. Read More

Posted in FDA; Tagged: , , , .


In celebration of our mothers: key supporters of our health and wellbeing

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Mothers dayMy mother was fiercely supportive and protective of the people she loved and the causes she believed in. Her strength as a woman, her dedication as a mother, and her death in a car accident when I was a teenager, inspired me to become an advocate for the health and wellbeing of others. Here at the O’Neill Institute, I promote the use of law as a tool to prevent avoidable death, disease, and injury. If my work can help prevent even one death, it would be a wonderful way for me to honor my mum.

Women and mothers play a very important role in supporting the health of children, families, and communities. This Mother’s Day, I want to reflect on how communities can better support women in this vital work.

Women and mothers are major contributors to health

Women and mothers are major contributors to health, both as primary caregivers in families and as health care providers in formal and informal health care settings. Mothers are usually primarily responsible for infant and childhood nutrition, which is a key determinant of health in childhood and beyond. Mothers who can provide a supportive environment in early life help children achieve optimal physical and emotional development.

In many countries, women comprise over 75% of the health sector workforce. Although women still tend to occupy lower-status health occupations, they are indispensable contributors to the delivery of health care throughout the world. Read More

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How to Follow the 2015 World Health Assembly

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Image source: World Health Organization

Image source: World Health Organization

Author's Note: Since this was published, the World Health Organization has announced that, for the first time in its history, the deliberations of the Plenary, Committee A and Committee B will be webcast and available to the general public. Live webcasts can be viewed here.

In 10 days, delegates from World Health Organization member states will gather to discuss the most pressing global health issues facing the planet.

Sadly, the World Health Assembly is not noted for its accessibility. [See author's note.Despite prominent calls to webcast the event, there is no indication that this year’s event will be streamed, making keeping up-to-date remotely more challenging. This post outlines some of the websites and online tools that can help you to keep tabs on global health’s most important annual meeting.

World Health Assembly Website


The most obvious place to start is with the WHO itself. The Organization maintains a website that contains the agenda and copies of all of the documents to be discussed. Once the WHA begins, it will also include news releases, selected videos, and an embedded WHO Twitter feed. Read More

Posted in Global Health; Tagged: , , .


Global Health: Progress or Peril? Hints from South Africa

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A "foreign" boy, donning a hat with the South African flag, in a camp established in Durban to protect non-South Africans in the wake of xenophobic violence. Photo courtesy of BBC.

A "foreign" boy, donning a hat with the South African flag, in a camp established in Durban to protect non-South Africans in the wake of xenophobic violence. Photo courtesy of The Guardian.

Why is it that even as global health indicators continue to improve significantly, there seems from civil society, from so many people, from communities around the world, expressions of disquiet, of continued urgency, even of outrage, a sense that we are headed in the wrong direction?

There are many answers to this question. We see new health threats, like climate change and antibiotic resistance and new epidemics, as well as the growth of non-communicable diseases. In some countries and among some populations, little has improved. Aggregate numbers mask inequalities, long-standing and newly emerging, such as the persistence of smoking among poorer populations in wealthier countries, even as overall levels fall. In some countries, these inequities grow. Among some populations – such as white women in the United States – life expectancy has been falling. Even with improvements, the scale of both unnecessary death and the global health equity gap remains vast.

There are fears that progress could be reversed, in part because of such threats as climate change and the new blend of natural and manmade disasters. And fear of the future raises other concerns. Will new medicines be priced out of reach? Will the promise of personalized medicine be a realized only for the economically well-off?

There is a pervasive distrust in the powers that be, that powerful interests are interested in just that – power – and the needs of the vast majority of the people will remain subservient to these interests, with the health and well-being of people in poorer countries and poorer communities around the world not part of those interests.

This has been on my mind, though, because of something else, another sort of manmade disaster, which made me think of the centrality of social determinants of health, and how perhaps fear about lack of progress or even deterioration of some of these determinants contributes to this anxiety over health.

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


Violence and Vulnerability: From Colombia to Baltimore

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From: www.aap.com

From: www.aap.com

This week, Baltimore made headlines as riots erupted following the funeral of Freddie Gray. The riots have put a spotlight on the cruel reality lived by low-income communities in Baltimore, not to mention the level of “incomprehensible” violence that is part of everyday life for many Baltimoreans. For those of us in Washington, D.C., it is difficult to wrap our heads around the idea that a city that has been ranked #36 in the world’s most violent cities could only be a one-hour car drive away—that’s 40 miles from the capital of the United States. 36 is one spot above Juárez, Mexico, and one below Medellin, Colombia.

Many seek answers to how Baltimore can best address the problems that have been plaguing it for so long. In her policy speech on Wednesday, Hillary Clinton called for the reform of the criminal justice system “to end the era of mass incarceration” of African-Americans. She also made a call to make mental health a priority—an issue that Clinton has declared as one of her areas of focus in her campaign for presidency. Realizing the connection between mental health and violence is not a new discovery, or at least it should not be treated as such.

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


A growing HIV epidemic that could have been prevented right in our own back yard?

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M~ SUN1106_downtown_eastside_54On March 26th, the Governor of Indiana, Mike Pence, declared a public health emergency in the rural southeast Scott County due to a severe outbreak of HIV. According to the Indiana State Department of Health (ISDH), out of the 4,200 people that live in this community, 142 have been diagnosed with HIV since December—this in a county that hadn’t recorded more than five cases in any prior year, with no reported cases in many of those years. 85 percent of those newly diagnosed HIV patients in Scott County are co-infected with the hepatitis C virus (HCV).

An investigation between the ISDH and the Centers for Disease Control and Prevention (CDC) linked the cause of the outbreak to the intravenous injection of oxymorphone, an oral painkiller sold under the brand name Opana. Abuse of the prescription opioid has been a common problem in southern Indiana for years and many other communities across the US. Scott County is one of the poorest and least healthy counties in Indiana and has struggled with injection drug abuse for years. Now the drug use in the area has spawned a second epidemic of a different kind: HIV and HCV.

Last Friday, CDC released a report showing that numbers are only set to rise. Among 112 persons interviewed thus far, 108 (96%) injected drugs; all reported dissolving and injecting tablets of the prescription-type opioid and using shared drug preparation and injection equipment. Those interviewed reported an average of nine syringe-sharing partners, sex partners, or other social contacts who might be at risk for HIV infection. The reported daily numbers of injections ranged from four to 15, with the reported number of injection partners ranging from one to six per injection event. Read More

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Sexually Transmitted Ebola: Another Reason to Stigmatize Survivors?

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Image courtesy of NYT

Image courtesy of NYT

As Ebola retreats in West Africa, medical investigators are focused on two women who died of the disease recently. Ruth Tugbah, a 44-year-old food seller with no known risk factors, developed Ebola in Monrovia, Liberia and died in late March. She was the first person to test positive for Ebola more than two weeks after the last known case in the country had been discharged from the hospital. In Freetown, Sierra Leone, a woman who was nine months pregnant and had no known risk factors died of Ebola around the same time. Read More

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


The global burden of low back pain – more than just an irritation

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Is this really a public health issue? Am I just tired of writing about Ebola and traditional non-communicable diseases that I’ve decided to make low back pain, something that we’ve all experienced, into a public health problem?

Maybe. Then again, did you know that low back pain is the leading cause of activity limitation and work absence throughout much of the world? In the US, it is the most common cause of job-related disability and a leading contributor to missed work days – approximately 149 million work days are lost every year because of low back pain, with total costs estimated to be US$100-200 billion a year. Low back pain is also the most frequently reported pain condition among adult Americans.

In a recent global burden of disease study (that is, a study looking at the burden of all disease in the world), low back pain ranked sixth in terms of overall burden of disease – right below stroke and HIV/AIDS, and above 291 other conditions surveyed, including road injury, depression, diabetes, TB, and all mental health conditions and cancers.

To get technical just for a moment, the burden of disease is measured by disability-adjusted life years (DALYs), which are calculated by combining years of life lost (YLL) due to premature mortality, and years lived with disability (YLD). Because nobody dies from low back pain, when you look just at the YLD, it actually ranks number one – ie the greatest contributor to disability in the entire world. Read More

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

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