Buy (Less). Give More.

March 27, 2007 at 5:53 pm (Sarah's Posts)

Sorry for my absence… I’ll be back and posting soon.

In the meantime, I came across this website that emphasizes how consumerism/corporate greenwashing isn’t the answer to solving the world’s problems, even if it raises money.  They plug into a concept that we’ve kicked around before about whether encouraging consumption as a way to raise money is ethical.

http://www.buylesscrap.org/

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Google Acquires Public Health-Oriented Statistics Tool

March 22, 2007 at 11:37 am (Links, Michael's Posts)

The story: some Swedish folks, with the health of the globe in mind, designed a cool tool for gathering statistics so as to make the plight of the poor in the world more powerfully factual in hopes of raising awareness and building strength in the discourse. Google recently bought that tool.
Is this a good or a bad thing?
Good: increased exposure and power is imbued in the tool via association with the WebGiant Google.
Bad: corporatization and the subsequent dulling of the social justice side of the tool.
Another health blog, Public Health Matters, has posted an article that I read and found interesting.
A call for action may be in the works.

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More on Racial Disparity in the USA

March 21, 2007 at 12:26 pm (Michael's Posts)

Below is an article I found in the New York Times Health Section a couple weeks ago. My reading of it points to the deep and hidden racism in America. If doctors are singling out Black and Latino patients for alcohol abuse, it’s a sign of their internal biases about the habits of their patients. Especially in light of the statement that the article makes about the lack of evidence to support such an assumption. This is most disturbing in light of the fact that minority patients are screened less for biological illnesses.

One of the issues I take with the researcher’s stance is with their statement that the increased alcohol screening rate could be due to theincome level of the patients being screened. Of all the patients I see at County, very few of them drink much. Granted, many are diabetic and many are older. However, the poor folks I see who are in their late 40s and mid 50s and not diabetic are often not drinkers. To top it off, the few really serious alcoholics I’ve seen have been white. Now, my patient exposure has not been enormous, but I’ve been working in this clinic for 6 months and I’ve seen enough to start making a few assertions.

Like I said before, by working on racism and pointing it out and watching ourselves and our colleagues, we can raise the quality of health in our country.

Disparities: Singling Out Minorities for Alcohol Counseling

By ERIC NAGOURNEY
Published: March 6, 2007

At last researchers can point to an area of medicine in which African-American and Hispanic patients get more attention than white ones do.

Whether that is a good thing is another matter. The care in question is counseling from doctors about alcohol abuse. And given that there is no evidence that blacks and Hispanics drink more than whites, the researchers ask why they seem to be singled out for the advice.

“Our results raise questions about whether physicians apply preventive screening practices systematically, and whether they inaccurately tie race to problem drinking,” wrote the author of the study, Dr. Kenneth J. Mukamal of Harvard. The report appears in the March issue of Alcoholism: Clinical and Experimental Research.

As a general rule, numerous studies have found, minority patients are less well served than whites by the medical system. They receive less screening, for instance, for cancer and other illnesses.

The new study drew on information gathered in a federal survey of more than 15,000 people about their health. Among other questions, those surveyed were asked how much they drank and if they had been counseled by a doctor about alcohol.

The study found that blacks and Hispanics were about twice as likely as whites to report having been counseled about alcohol. But when it came to counseling about diet, the differences largely disappeared.

Part of the explanation, the study said, may lie in the fact that minorities tend to see doctors whose practices focus on low-income populations. So it might be less a matter of an individual doctor treating black and white patients differently than how minority communities over all are served.

In any case, the study says, given how effective alcohol counseling has been found to be, the answer is not to give less of it to minority patients but to give more of it to all patients.

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Entitlement and the Poor

March 15, 2007 at 10:59 am (Michael's Posts)

I was shadowing one of the very senior attendings in the department of medicine at Cook County Hosptial a week ago. His reputation is well-established as a thorn in the side of those who would rather turn a blind eye to the bureaucratic waste and BS that the poor who utilize the Big Public Hospital have to put up with. He fights for them in every way he can every day. Because of his fierce advocacy, he has been passed over for promotions that he absolutely deserves. He’s not popular with the higher-ups. But the work he’s been doing for the last 30 years is indispensable. Truly an inspiration.

As we were coming out of one patient’s room, Dr Schiff commented that he was a “Classic County patient. Never worked a day in his life. Just sitting around waiting for a handout.” Now listen for a minute to this guy’s story. And imagine that everyone we talked to had a similar one.

When Dr Schiff asked this man what he had done for work in his life (he was 81 and built like a horse except his heart was fluttering like a drunk butterfly), the man looked at him with a weary smile and said, “Everything.” He worked construction during the week, bartended at night, drove a cab on the weekends, did upkeep work for various churches, etc, etc. He put FIVE of his eight kids through college. In short, he lived a busy, stressful, and very productive life.

Dr Schiff was obviously kidding when he said what he did. And with a lot of bitterness in his voice. He made me realize consciously what I knew about the people I saw in the outpatient clinic: all of these people worked hard and they’re still poor.

This idea we Americans have about “Bootstraps” and the ability to pull oneself up by them is maybe partially true but is way more conditional than we’d like to think. It depends on what you have to fight against to get upward motion. It depends on if you even have bootstraps to pull on. Think about our 80 year old friend who, with the most dignity I can imagine, submits to the whims of an inefficient bureaucracy whose higher-ups could care less about him for his medical care. Think of his grandchildren whose lives he made better. How can we treat him the way we do?

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On Deconstructing the Discourse

March 9, 2007 at 9:54 am (AE Beacon's Posts)

“Can one divide human reality, as indeed human reality seems to be genuinely divided, into clearly different cultures, histories, traditions, societies, even races, and survive the consequences humanely? … For such divisions are generalities whose use historically and actually have been to press the importance of the distinction between some men and some other men, usually towards not especially admirable ends.”

-Edward Said in Orientalism  

 

The central mission of Global and International Health is to improve health conditions for people facing the highest burden of disease and suffering. This lot typically falls to those living in Africa, Asia and South America. However, is the discourse of this benevolent mission categorically reinforcing the social order it seeks to alleviate?

What is the utility of the phrase “developing country”? The original conception of developing versus developed countries was created as an economic method of stratifying nations by economic output. Despite having limited correlations to health status, this terminology has been subsequently adopted by health workers to define areas of supposed greater disease burden and suffering.

This transliteration fails to achieve several of its objectives. First, lumping countries into developing or developed ignores the spectrum of need between nations. Second, nation based classifications of health fail to accurately represent the internal needs of political groups such as immigrants or internally displaced persons and social groups such as religious and ethnic factions or women and children. Finally, some developing countries such as Cuba, despite having the resources and political structure that would otherwise suggest poor health, have managed to produce impressive health outcomes. Thus, the concept of developing country does not accurately evaluate how well a region or nation can deal with its health issues.

The segregation of developing and developed nations does succeed in accomplishing several things. First, it insists on the immaturity of developing countries. Inherent to this distinction is the idea that developed countries have achieved a universally attainable state of happiness and prosperity, a socio political nirvana if you will, through integrity, hard work and ingenuity. Implicitly, that developing countries have failed to reach this standard reflects more on their inadequacy than on divisive social and economic structures that keep them in poverty and disarray.

Second, this construct asserts that the methodologies of my society, capitalism and cultural exportation, are requisites of domestic success.  Despite the considerably dependence of my economy on cheap goods from elsewhere, we have maintained an equal opportunity rhetoric that doesn’t suffice to describe our domestic state let alone global economic and political involvement. Finally, the concept of “developing” demeans the intelligence, talent and efforts of (health) professionals abroad. Stripped of the comprehensive diagnostic testing equipment, auxiliary support staff and myriad pharmacological interventions would our physicians be more capable? I won’t posit an answer but only suggest that poor outcomes reflect more than the physician’s capability.

So what can we change? How can we (I) more accurately delineate differences in health outcomes without disparaging those in need?

Æ Beacon

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The Importance of Local Health Data (Plus a v. Brief Comment on Race and Health)

March 7, 2007 at 2:15 am (Michael's Posts)

Today I was reading a paper by Shah, Whitman, and Silva from the Sinai (Chicago) web archive of papers on Urban Health (archive found here) and I just had to share it. Very common sense but also very good to read it in study form. It’s short and not too dense.

The main point of the paper is that to properly understand what’s going on in the health of communities, we need to look not at provincial or city levels, but rather at community levels (zip codes/neighborhoods, not just counties). The blend of all neighborhoods’ data together in a city- or county-wide survey (much more common than neighborhood-based surveys) masks disparities. And if we want to address the needs of communities, we have to understand where those needs lie.

“As urban settings become increasingly diverse and certain populations are disproportionately affected by disease, variations in the health status of these smaller geographic areas may be substantial, and such variations must be considered if true advances in disease prevention and control are to be achieved.” (Shah, et al, 1)

In the study, it was found that very distinct health patterns in some indicators arose depending on the racial and socioeconomic makeup of one neighborhood versus another. For instance, two adjoining neighborhoods with different racial makeups had vastly different rates of tobacco use (39% compared to 20%).

“If data are examined in an aggregated fashion, contextual differences in the demographic and health profiles of specific communities will not be identified, leading to difficulties in identifying and mounting effective community- based public health and public policy programs.” (Shah et al, 5)

In other words, as an example, the two above neighborhoods have different needs when it comes to smoking cessation work and one would benefit more from such work. The argument naturally follows that it would pay to focus the work where it is most needed so as to make the best use of scarce resources.

Their methods are quite good but are also time and money intensive. This is a shortcoming. However, if a philanthropic body can be plied for funds, it may be well worth it to public (state-run and community-supported) health workers to organize such data collection.

When reading this comment on race and health, recall that Chicago, like many American cities but probably more so than its peers, is extremely racially segregated. That is to say, neighborhoods are divided along racial lines. The study also highlights the rift between black and white, underscoring that even the more affluent black neighborhood in the study had much more in common in terms of low health outcomes with the poor black neighborhood in the study than it had in common with the relatively affluent white neighborhood. I found this an interesting, though not surprising, conclusion and one that adds to my understanding of the continuing inequality based on race in this country of ours. This can assure us that if we dedicate ourselves to curing racism in America, while working to heal a social ill we are certainly simultaneously doing important health work.

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Overestimating the HIV burden in India

March 5, 2007 at 10:04 pm (Sarah's Posts)

Overestimating the HIV burden

I’m once again stealing someone else’s story to tell here because I think it is a fascinating one with a good reminder in it for all of us. Here’s the short version with the corresponding paper attached. For those of you who are geeks like me, take a look at how sexy their methods are. For the non-nerdy, the study itself has some interesting applications.

The folks who wrote this paper are convinced that the burden of HIV in India is highly overestimated. We’re talking a difference of 3-3.5 million people instead of the current estimates of 5.2 million. They are basing this on an intensive study taken on in Guntur District of India. The estimated surveillance in the area was about 4.38%, using data collected by the generally accepted sentinel surveillance method from public antenatal and STI clinics. Doing a very intense population-based survey, the folks writing this paper found that the rate was 1.79%. So, why the difference?

It turns out that the public hospitals where the current country-wide data is collected from contains a higher representation of people from lower standards of living who represent a greater part of the HIV burden. In addition, the second that a private doctor suspects HIV, he refers the patient to the public hospitals so that he doesn’t have to deal with it. So, the public hospitals are (in their view) representing a much larger portion of HIV cases than private hospitals, which wasn’t taken into account in the earlier data.

When I asked Dr. Dandona about the policy implications of this study, his one big comment was that HIV funding represents a disproportionably large part of healthcare funding in India and in the world already, even without these overestimates. I’m loathe to just step up and say that HIV funding needs to be cut because it is clearly a huge problem in India that is mostly being ignored and swept under the carpet. But, it is important to really look at the study methods that are being used when we’re looking at data like this that is used to prioritize health budgets.

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Book List

March 5, 2007 at 9:18 pm (Michael's Posts)

Hey all. Sorry about the hiatus. My internet access has been spotty and I’ve been preoccupied. But you’ll hear from me in a couple days in a more expanded format.
I’d like this post to be a little book list . Add books in your comments, second reccommendations, and/or rebut reccommendations. Really, just add your books, though. 🙂 And include a little description.
Mine tend to be a little social-science theory-heavy. I miss my social science major and I really love theory. The bent of my reading has been to improve the theoretical framework with which I will be approaching care for the vulnerable in society.

-Michel Foucault, The Birth of the Clinic
(regarding the overarching structure of medical view in western culture. As Foucault tends to be, this is thick stuff but once you get the hang of his lingo, it’s really amazing insights into how doctors think, how they ought to think, and how we ought to think about health in general. He takes a historical-philosophical approach)

-Kwame Ture (formerly Stokeley Carmichael), Black Power
(Read a while ago but really amazing ideas about how how Black Americans in particular need to think about power structures and social organization in order to bring about change. Helpful for me because it showed me better than a lot of commentaries on the black-white problem in the US where I can fit in and be helpful. Possibly ideas that apply to other minorities/vulnerable groups in the world but is probably limited to American Blacks.)

-Sydney Lewis, Hospital
(In the middle of reading this oral history of Cook County Hospital and it has raised some interesting issues, some of which are probably unique to the County but most of which I am pretty certain apply elsewhere, as well. An interesting look at the stories of people who try to provide quality care to poor people in the midst of a prosperous society.)

Hit this up!!!

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