Author Archives: Zoe Anderson

Pakistan Floods- Connection to McKibben

I found a really disturbing and interesting article about the 2010 Pakistan floods. It reminded me a lot of what McKibben was talking about in Eaarth, especially in the first chapter. Notice how the article mentions the floods affects on infrastructure, politics, international relations (foreign aid and U.S’s regional strategy to combat the Taliban and Al Quaeda) and military issues, disease, food shortage, economics (severe inflation), and
political instability.

Imagine what will happen when the number of climate-related storms, floods, and droughts continues to increase around the world? What role will the U.S play?

Smart-Growth Policy Splits Environmentalists

In class and in our reading we’ve been learning about the divide between the environmental justice movement and the environmental movement. This article talks about another split in the environmental movement; between those who support investing in a “smart-growth policy” in urban areas and those who don’t. Developing environmentally friendly “green” building projects (parks, housing) seems like a good idea, but the Sierra Club has been experiencing a lot of opposition. Many club members are against the new focus on urban environment and “see efforts to promote density as colluding with developers.”

Do you think this represents an outdated vision of environmentalism? Is incorporating urban development into the environmental movement a good thing? (Do you agree with Arreguin, that the club should “look at the bigger picture of how (we) can be more sustainable”?)

And finally, is it possible to bring these movements together despite the apparent conflicting ideals and differences?

Canada Declares BPA, a Chemical in Plastics, to be Toxic

I thought I’d share this article about a chemical widely found in plastics that is thought to be toxic (at least by the Canadians). I came across this article for biology because we’ve been learning about hormones and the chemical in the article, bisphenol A or BPA, is thought to act as an endocrine disrupter. But I also thought it related to our class, especially in how different governments have reacted and the role that industry has played.

Just food for thought…

  • How large a role should the federal government play in protecting the health of their citizens? (vs. states, health agencies, etc.)                                                                                                                                                                                                     “In the United States, about half a dozen states have banned BPA in children’s products. The federal government has taken no action, saying there is no proof of harm in humans. But health and regulatory agencies have concerns about BPA and have commissioned more studies.”
  • How is it that Britain and the U.S found it to not be toxic, while Canada, France, and Germany did (based on the same scientific evidence?)                                                                                                                                                                          What does this show about these countries interests? (Note the line: “Canada’s move, which was strenuously fought by the chemical industry….”)
    What makes Canada so different?
  • Do you think the American Chemistry Association’s argument, that Canada’s announcement will “unnecessary confuse and alarm the public”, is legitimate?
  • Why do some health issues get more media attention than others?
    “The compound was formally listed as being toxic to both the environment and human health in an official notice published online by the government without fanfare, a noticeable contrast to the earlier baby bottle announcement, which was made by two cabinet ministers.”
  • Does BPA’s high prevalence in products add or take away from an argument against it?

Also, I noticed that even though the federal government has not declared BPA to be a toxic substance, water bottle companies like Nalgene are still now making “BPA free” bottles…..

Understanding Social Determinants of Health

Understanding the Social Determinants of Health: Breaking the Link between Poverty and Health

Brown graduates working with Project Health (program where college students work in local health clinics) based in Providence, Rhode Island. Samantha Murder (Program Manager) and Hanna Nichols (National Talent and Technology Coordinator)

Cycle of Poverty

  • MONEY is needed for healthy food, healthy housing, childcare (so you can go to work), education and school, clothing (job interviews), health care, utilities, medicine
  • in order to get money you need a JOB
  • in order to have a job, you need EDUCATION

Need education and a good job for money, but need money for education and chance for a job! Not a linear path and a difficult cycle to enter.

Project Health works to provide resources and knowledge.

Social Determinants of Health- “economic and social conditions under which people live which determine their health”

  • The Big Five: Food, housing, energy, education, and employment/insufficient income.
  • Shaped by the distribution of money, power, and resources (influenced by policy choices)
  • Social determinants are mostly responsible for health inequities

What do we mean by Poor?

Mentioned that the federal poverty line has been used a lot throughout the symposium as a measure of poverty. They stressed that people are struggling for money well above the federal poverty line. The federal poverty line for a family of 4 is $22,050, but, in suburban Illinois for instance, a family needs at least $58,000 for necessities (study done by NCCP -see budget calculator)

FOOD

Food insecurity greatly increases likelihood for poor health (ex. low birth weight for mothers)

Compared nationally, Vermont is doing well, subsidized lunches and breakfasts at school are critical (50% of kids in Essex county use this) Essex also has high levels of low birth weight.

What’s out there? Resources to combat food insecurity

ENERGY

Heat or eat?

Energy insecure households- 22% increased chance of being hospitalized since birth

What’s out there?

  • LIHEAP (covers a large amount of monthly winter heating bill, if you can’t meet cutoff your utilities will be shut off- difficult to pay back. Grants are getting smaller)
  • local neighborhood funds
  • Special protections for disabilities
  • Payment plans (utilites prefer some money)

HOUSING

Related to health. Household mold (makes you 2.2 times more likely to experience asthma!), cockroaches, cold, lead poisoning, unsafe housing conditions, stress from not being able to pay rent contribute to asthma and low nutrition, hospitalizations, poor health

Housing is considered not affordable when it costs more than 30% of income.

Housing in context- Vermont. Top 10 occupations in Vermont include retail salespeople, cashiers, janitors and cleaners- none of whom have a salary high enough to pay for housing. Not a livable salary! Poverty is “not just about getting a job”

What’s out there

  • public subsidized housing (projects)
  • private subsidized housing (contracted out)
  • housing choice voucher Program (Section 8)- pay up to 30% of income and government pays rest- HARD TO GET, 5 to 8 year wait for voucher in Rhode Island
  • shelters
  • transitional housing
  • rental assistance
  • legal action- something unsafe in house- legal pressure on landlord (less expensive than moving)

EDUCATION

They highly suggested the film “Waiting for Superman”! (check out the trailer)

What’s out there

  • GED classes
  • ESOL classes (English is 2nd language)
  • Adult basic education
  • Computer literacy
  • Child enrichment
  • Head start and early head start (includes literacy classes for parents, checkup for kids, losing seats right now)

INSUFFICIENT INCOME/ EMPLOYMENT

Related to obesity and other health issues. Not knowing what will happen raises stress and sickness- lack of locus of control.

People below the poverty line live an average of 9.6 health adjusted years less than Americans above the poverty line!

What’s out there

  • Child care subsidies
  • Food stamps

PROJECT HEALTH

Founder noticed underlying health problems involved with evictions

Doctors could do nothing for patients suffering from unemployment, poor housing.

Student in project health connect families to resources/volunteers. For example, they often connect families to food pantries or call utilities to arrange payment plans.

HOW THEY WORK

  • guided referrals
  • resource knowledge
  • identification of barriers
  • creative solutions
  • education
  • advocacy
  • connections

Conversations about food security and housing are important to both doctors and patients, but those conversations weren’t happening. Health services often don’t have the time or the knowledge to refer people, which is where Project Health steps in. Project Health also works to collect data that can be used in advocacy movements and campaigns.

Located in 6 cities, with 600 volunteers, and has helped over 5,000 families.

If you’re interested, check them out here!

The New Biopolitics of Race and Health

“The New Biopolitics of Race and Health” by Dorothy Roberts of Northwestern University School of Law

Disparity and Health Inequities- Introduction

In Chicago

  • 1/3 of blacks would not have died if rates of black and white deaths were equal
  • black women are 2X more likely to die of breast cancer than white women (even though whites are more likely to get it)
  • black women are not more susceptible, white women just had more access to new technologies from 1996-2004

Globally

  • 50% of black woman wouldn’t have died of breast cancer if rates were equal
  • Rates of child mortality (before the age of 5) is 6/1000 in high-income countries, 88/1000 in developing countries, 120/1000 in poor countries
  • In the U.S, there were  83,570 excess black deaths (the number of deaths that could be prevented in the U.S if the black-white mortality gap were eliminated)

New Biopolitics of Race

  • Different approaches to the WHY behind health inequalities
  • One explanation is to treat race as a biological category, which attributes disparate health outcomes to racial differences
  • Roberts says this approach is denying the impact of race on society and reinforces racial inequality
  • Human Genome Project showed no evidence of racial divisions (Bill Clinton, Francis Collins, Craig Ventor all noted this at the conclusion of the project)
  • For some reason, the results of the Human Genome Project are now being geared towards research involving the differences of race (on a genetic level) and health. Nicholas Wade of the New York Times said researchers are now being “forced to confront a treacherous issue: the genetic differences between human races”. Roberts says this is ridiculous, and that none of the results of the project suggest this line of research.
  • Somehow, she says, the reasoning is that the 0.1% genetic difference in people’s genomes accounts for race which accounts for unequal health outcomes. Roberts says this argument is ridiculous.

Research

  • Flawed studies about genetic differences, race, and health have gained lots of media attention
  1. Study done that supposedly proved that genetics were the cause of blacks having more preterm babies. The researchers said the experiment was independent of social constraints, but they only controlled a few things. Without proof, or any scientific backing, they leapt to the conclusion and created a theory that genetics were the cause of the difference in the number of preterm babies between black and whites. This highly flawed study made it to a New York Times headline.
  • Millions of dollars are being invested into genetics and race research (especially from the U.S and U.K). Roberts mentioned this article

Drugs

If genes are the cause of health inequities, there are 3 ways to address this

  1. nothing we can do, blame nature
  2. gene therapy
  3. drugs

This last option has gained a lot of attention. Roberts described the history of  BiDil, which is a heart disease prevention drug that is specifically made for blacks. The drug is actually just two generic drugs put together, and was originally patented for anyone. The FDA only patented the drug once it was specifically marketed for blacks. The FDA said this was a “step towards personalized medicine”. The original goal of the Human Genome Project was to provide personalized medicine, but the FDA is now using race as a proxy for genetic difference, while waiting for legitimate drug treatment differences based on people’s individualized genotypes. Dr. Steve Nissen, of the FDA, said himself, “We’re using self-identified race as a surrogate for genetic markers”. Roberts says this is unfounded and inappropriate. Obviously, the FDA is using race and health concerns for it’s own commercial advantage.

New Race Based Genomics – where is this new ideology being implemented (already mentioned drugs and research)
  • race as a category in biomedical and human gentic varation research
  • race specific pharmaceuticals
  • genetic ancestry testing
  • DNA forensic and biobanks
  • reproduction-assisting technologies (eggs and sperm grouped by race)

What “They’re” Saying

This new theory says that racial differences are real at the molecular level, but constructed at the social level. Treating race as an ideology, rather than a scientific truth, is what causes social tensions (the example of political correctness). People are starting to believe that social justice is actually working against improving health through genetics!

What Dorothy Roberts is Saying

  • Why would we ever divide cell lines by race? The idea that we should divide people by race as a biological category is engrained. But we are seperated by society, not by genetics. “Race is a political category, not a biological one”.
  • Inequity is a product of the social and political situation, and is not a “natural” difference.  Inequity is unjust and calls for social change, not solutions involving individual choice (like race-based drugs).
  • Social justice is a way of achieving better health, and genetics and social justice should not be pitted against each other.
  • “A More just World would be a Healthier One”

Corporate Captilism vs. Intrinsic Nature of Race

What is causing this change in thinking? Roberts’ says it is a combination of both corporate capitilism (whatever sells, example of BiDil) and the perputuating defintion of racial order. Ever since race was invented, the idea that some people are naturally inferior has persisted. The very function of race was to create political division.  The evidence of  natural divisions is now manifesting in genetics. This sort of manifestation has been happening for years (ex. Tuskiki experiments in the 1970’s) and just because it’s said to be based in science doesn’t mean it is unbiased or justified. The two components are working together to spread this ideology, one has “a hand in the pharmaceutical industry” and one is based on “the usefulness of race in America”.

Zoe and Dorrie

Targeting the Youth

This Saturday, I attended the workshop on AIDS in Africa that was lead by Lisa Adams, who is an assistant professor at Dartmouth College, and coordinator of Dartmouth’s Global Health Initiative.

As a group of about 10, we discussed how to spread knowledge and information about HIV/AIDS to younger generations and address problems facing health-care providers in Africa.

-Lisa introduced herself and gave us a brief background of the progress of AIDS relief in Africa. Because of the work of programs  initiated during the Clinton and Bush administration (i.e, PEPFAR, CHAI), most areas of Africa have access to necessary drugs and care. The problem has become more of a social one, and the focus has now moved to the prevention of AIDS as well as the treatment.

-Lisa emphasized the importance of teaching youth AIDS prevention and awareness. WHAT AGE, she asks, should this education begin? As a group we discussed…

  • starting when kids leave for home for a boarding school (very common in Africa)- around age 12.  (free from parental disapproval, with peers)
  • maybe starting at an even younger age, because so many have been exposed to the disease with deaths in their areas.
  • When do we first learn of AIDS? Around 6th grade for most American schools.
  • We finally decided that the age range of 12-19 seemed best.

Then she asked us to discuss WHO should be involved in teaching kids? As a group we came up with the following list..

  • via School teachers, have AIDS education incorporated into the standard curriculum (especially at the boarding schools). We thought it would be especially important that this be part of the regular school day and not an afterschool activity
  • community health workers going to schools
  • parents (if they support it)
  • community/ religious leaders (depends on religion and community values)
  • peers/friends (we discussed the possibility of training older kids to be peer educators for younger grades. Peers are probably more effective than parents in transmitting information)
  • siblings
  • health care workers (ex. when visiting the doctor)
  • coaches (we talked about this program called Grassroot Soccer, which mixes soccer training and concepts with HIV/AIDS education)
  • media- pampthlets, billboards (very succesful strategy in Ghana- see pics)
  • HIV+ person

We spent most of our time talking about the power of both peers and mentors. At a certain point, kids stop listening to their parents, and for many of them, something that a peer (especially an older one) or a coach says is much more respected. We also mentioned the importance of having someone confidential to talk to, and whether the person teaching the kids should be taught by someone close to them (a sibling, parent) or a stranger, but from the community (older peer), or a complete stranger (health workers).  One girl, who had actually seen an AIDS information session given to kids in Jamaica, said that the kids were not as willing to listen to a stranger.

Content of the AIDS/HIV awareness education

We all agreed that it had be a uniform message, given without bias or judgement, and that, in most cases, some sort of training should be required. (Who provides training? We didn’t discuss that…). Lisa talked about the ABC’s, Abstinence, Be faithful, and Condoms. When PEPFAR was initiated, a certain percentage of the funds had to go towards Abstinence information. One girl, who had traveled to Russia and worked with prostitutes, STD’s, and drug use there, said that a large part of PEPFAR proved to be a waste of money in the area she was in because of this stipulation (it wasn’t that effective to lecture sex workers on being abstinent). We discussed putting more focus on teaching abstinence as a way to delay having sex, rather than 100% avoiding it. We also thought that the ABC’s method should be modified depending on who the audience is (when talking to older teens, put more emphasis on prevention techniques than “Being Faithful” which is more appropriate for married couples).

Factors affecting HIV/AIDS education and prevention

  • Religion- some prohibit the use of birth control
  • Culture- often taboo to discuss sex and AIDS in areas of Africa, especially to children
  • Stigma- people with HIV face prejudice (we discussed how an HIV+ person would be treated on Middlebury campus)
  • Opportunity Costs- even though treatment is free in most areas, costs of transportation, lab tests, etc. sometimes make treatment impossible

Disclosing Status: At what age do you tell HIV+ kids (who had it passed on through their mother’s  of their status? In general, we thought the younger the kid, the better. Then they could have more time to accept their situation and learn about the consequences of spreading the disease. But, in many areas of Africa, parents do not tell their children until pretty late. Many kids take treatment drugs, but are never told what they are taking them for. Parents are often racked with guilt and fear about telling the child, and they put it off until the kid is already sexual active or thinking seriously about it. This is one of the biggest problems facing health care officials. Do they have the authority to inform kids without full parental consent? How do they convince parents/relatives of the importance of informing the kid as soon as possible? In the ideal situation, we thought it would be best if the medical worker talks with the parent privately (in an effort to convince them that sooner is better) and then both the parent and health care worker, together, inform the child. Still, this is a very messy issue in Africa, and one that is causing considerable tension between health care workers and parents/members of the communities.  Uninformed HIV+ kids are becoming a large part of the continuing spread of the disease.

Lisa wrapped up by reminding us of the multifaceted and complex issue that is AIDS/HIV awareness and prevention in Africa. She reminded us, too, that many of the issues are no longer medical ones, but cultural ones. These, she said, are the hardest to fix.

Zoe