Harassment and stress: addressing a threat to population health

PHS 795 Student Laura Bunke draws connections from current events to principles of population health. In response to an article commenting on France’s consideration of enacting fines for catcalling and other forms of sexual harassment, she writes:

After Trump’s campaign and election and the Harvey Weinstein, many women have been speaking up about sexual harassment. It feels that this has been a head line in some way for the past 6 months with more women coming forward and speaking out. The #MeToo and, #BalanceTonPorc (#Expose Your Pig). in France, this past two weeks has highlighted how many women are affected and show people that it happens to so many they personally know. The outcry has been criticized by some saying women don’t owe any one their story or that this is better handled in court. I think we are at a turning point and the fact that social media gave so many women a chance to identify and speak out is healthy and helpful to the cause.

There are several articles surrounding this topic in the US, but I picked this one from France because they are actually taken action to change the culture. This article states that there are proposals under ‘discussions to fine men for aggressive catcalling or lecherous behavior toward women in public, to extend the statute of limitations in cases of sexual assault involving minors and to create a new age ceiling under which minors cannot legally consent to a sexual relationship.’

If our countries took sexual harassment more seriously and changed the culture of how women are treated, I believe the mental and physical health of half of our population would be better. We talked in class about how internalized stress can affect a person’s health in so many ways. We thought of this mostly with racial and SES disparities, but I think we could apply it to gender disparities as well. Many women carry the burden of remembering an unwanted sexual advance and having their guard up to defend themselves from another. How did we let this be our culture for so long? And now that we are here, how do we change our policies, laws, and conversations to protect women and change the actions of men?

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STDs are on the rise: why, and what to do…

A PHS 795 student draws our attention to recent findings that 2016 saw the highest number of STDs ever reported in the U.S.  See: http://www.cnn.com/2017/09/26/health/std-highest-ever-reported-cdc/index.html

They write:

This news article about the recent increase in cases of Gonorrhea, Syphilis, and Chlamydia in the United States relates to our lecture from Professor Higgins. Syphilis, a disease that was at such low levels in the mid 1900’s that it was basically eliminated, had 28,000 new cases in recent times. The author of the article cites funding cuts, ineffective sex education, and the lack of symptoms in most cases as factors that have led to the increase in new cases. As Professor Higgins stated, frequently, public health approaches to STDs and other risks associated with sexual contact don’t reflect one of the main reasons that people engage in sexual intercourse. Building on the idea that sex related public health initiatives must take into account context to increase effectiveness, public health initiatives focused on STD prevention must take into account that STDs carry a social stigma in many places that prevents people from seeking care. The author references the movement to reduce HIV infection as a STD related initiative that navigated the social stigma more effectively than the current movement to prevent Gonorrhea, Syphilis, and Chlamydia. My question is: what are ways in which the movement to reduce HIV infection gained traction? How did it overcome challenges? And, can we use some of those methods to reduce the rates of other STDs?

Lessons from a hospital infection cluster outbreak…

PHS 795 student Kelsey Baubie came across an article that touches home on a couple of fronts. First, this particular series of serratia infections happened right here at UW — the article highlights the role of Pop Health graduate Dr. Nasia Safdar in helping solve this case. Second, the sad cause of the outbreak touches on a number of issues we discuss in class, including our upcoming lecture by Dr. Randy Brown on the opioid addiction.

https://www.statnews.com/2017/09/14/blood-infection-medical-mystery/

Kelsey writes:

There are a handful of population health science concepts in this article: random sampling procedures, an epidemic, a cluster, and single-source origin. The addition of opioids being involved also makes it relevant for many of us who are interested in this national crisis or will be working with opioids in the future; we can also use this to talk about the social contexts with which this crisis has been painted. The UW serratia cases are a clear example of an epidemic in that cases are higher than expected. The layperson may think “epidemic” means something widespread which affects a lot of people, but the actual definition is that cases are simply higher than one would expect. Have you experienced any opioid control measures in your work? What do you think should be focused on in order to better control the flow of these highly addictive substances? Looking at it from a social justice lens, have you seen a difference in how the opioid crisis has been couched versus the crack epidemic in the 1990s?

UW News — Autism Prevalence and Socioeconomic Status: What’s the Connection?

http://news.wisc.edu/autism-prevalence-and-socioeconomic-status-whats-the-connection/

By Gabrielle Waclawik (PHS 795 student):

As Durkin points out in her study, we have seen an increase in prevalence of Autism Spectrum Disorder (ASD) over the years. Many reasons likely exist for this including advances in screening techniques, changes in medical training and education, and even increase in coverage in the popular mainstream media. Moreover, the DSM-V criteria switched in 2013, although after Durkin’s study period, to recognize Autism Spectrum disorder (with varying severity) to include what was previously diagnosed separately as Autistic Disorder, Asperger’s Disorder, and Pervasive Developmental Disorder (Not Otherwise Specified). Despite all of these changes, Durkin states that the “findings collectively support the idea that children living in poorer or less well-educated areas are being diagnosed with ASD at lower rates because they have less access to health care providers who could make the diagnosis and provide needed support.”

While the Durkin calls for better access to screening and health care providers in lower SES areas, the most interesting and timely point for me comes towards the end of the article. Durkin states “if we are under-identifying ASD in certain socioeconomic groups — as seems likely — we need to be prepared to provide services at a higher level to more people. We need to find cost-effective interventions and supports and make sure they are distributed equitably and in a way that reaches everybody who needs them.” While this is likely only referring to childhood and early intervention programs and services, we must not forget that as many of these children age, they too likely continue to require services as adults. I say this is timely, because Dane County is currently undergoing a drastic long-term care reform as it transitions from a regionally structured individualized approach to a more standardized statewide insurance model, which includes medical care, that will take effect in 2018.

I recently attended an informational meeting on the Dane County long-term care transformation, since the change will directly affect my older brother who has severe Autism and medical needs that require 24/7 supervision and care. Throughout the meeting, it was difficult to ignore many of the current caregiver’s and advocate’s echoes of frustrations and complaints about the current transition, as they are fearful the new structure could jeopardize supportive services by combining them with medical care in contracts run by insurance companies. And trust me, I can tell you firsthand how any change or interruption of routine can be devastating for a someone with severe autism. However, the Dane County waitlist currently holds about 600 people unable to receive any covered support services. Under the new “family care” model, all of those people will gain coverage.

As 2018 is quickly approaching, we will see how the changes unfold. I have no doubt it will be an extremely unsteady transition, as every change is for my brother. We will see how the state budget and coverage for such long-term care services upholds over the coming years, and if waitlists will continue to be a part of the past. As Durkin points out, as we increase access to screening and health care, we will continue to see a rise in prevalence of ASD. And we will need to be ready to meet the increasing demand for these support services.

 

Contraception and population health: changing the narrative

Following up on a lecture on the determinants of contraceptive use by Prof. Jenny Higgins, Pop Health 795 student Katherine Brow comments on a recent executive order from the Trump administration affecting requirements for employer health plans to pay for contraception.  She writes:

During Dr. Higgins’ lecture today, I could not stop thinking about how relevant her discussion on changing attitudes regarding contraception use is to current legislation and policies being pushed by our current administration. On October 6, the Trump administration rolled back the Obama-era requirement that employer-health plans cover birth control methods at no additional cost to their women employees, on the basis that this requirement infringes on the employer’s rights to religious freedom. Although its predicted that many companies will continue to provide coverage for birth control, this new rule creates a huge loophole for any employer who doesn’t wish to provide coverage and thus many women will be forced to pay out of pocket for their prescriptions.

What I find to be the most devastating ramification of this new rule is the affirmation by our government that access to contraception and the basic tools for sexual and reproductive health is not considered to be an inalienable human right. It makes access to contraception and basic control over reproduction even more of a privilege – this policy won’t affect affluent women who can still afford insurance that covers contraception, but rather those who depend on their employer to provide coverage. The same administration is also launching attacks on organizations like Planned Parenthood that provide care to disadvantaged individuals who don’t have the insurance to cover birth control. After this new rule rolled out, the response on social media condemning this action was overwhelmingly based on the fact that many women go on birth control for a slew of reasons: including management of irregular, painful, or heavy menstruation, control of premenstrual symptoms and acne, prevention of bone thinning and anemia, among many others. These are all extremely legitimate reasons for a person to go on birth control but what stood out to me is that the majority of people didn’t talk about one of the major (if not THE major) reason women choose to go on birth control: to prevent unwanted pregnancy. Since the beginning of the reproductive rights movement, advocates have had to market the pill and other methods as being a medically relevant good in order to overcome the enormous stigma against positive female sexuality.

So, this leads me to my biggest question following Dr. Higgins’ lecture: how can we shift the overall narrative of contraception as a medical good to a sexual good when we are still fighting for the social and legal legitimacy of birth control? How can we assure the sexual acceptability of contraction for all women when it’s still a privilege simply to have access to quality birth control? As Dr. Higgins discussed in lecture, we can start this cultural shift within our own personal relationships with family members, clients, or patients, which can give a lot of hope in times where significant change seems futile. And going along with the general theme of this class; we do have evidence-based research and measures of the sexual acceptability of contraception – we just have to continue our work and empower others so that change is possible.

 

Environmental justice and population health

A number of lectures have focused on the role of socioeconomic status on population health. Although our course has not focused on the “chemical environment” (e.g., air and water pollution), the concentration of health challenges in neighborhoods has been a recurring theme. PHS 795 Student Laurel Myers calls our attention to an interesting resource to help explore the relationship of health determinants to geographic location. She writes:

As we reflect on the effects of neighborhoods on health and happiness, I would like to highlight an important component of those outcomes: environmental justice. I am sure that many of us are already familiar with this concept, even if we don’t have a name for it. 

 The term “environmental justice” arose in the 1980’s and can be defined as “the unequal distribution of social and environmental costs between different human groups, classes, ethnicities but also in relation to gender and age.” Examples include increased pollution or decreased access to safe exercise spaces. Impoverished communities do not often have time or resources to fight the battles necessary to combat new factories that spew chemicals or to advocate for more sidewalks or green space. 

The EJ Atlas not only details the issue, but provides and interactive map where you can see violations of environmental justice worldwide: https://ejatlas.org/about

For those interested in exploring this issue more, Majora Carter explains environmental justice well in her talk “Greening the Ghetto” (https://www.ted.com/talks/majora_carter_s_tale_of_urban_renewal). I challenge you to consider what environmental injustices might exist here in Madison, or in your home communities.

Student offers thoughts on retirement income and health…

PHS 795 Student Zeeshan Yacoob writes in response to lectures examining the SES gradient of health:

One of the articles we are required to read for class talks about SES and the increasing retirement age. After reading this article I began to realize how this policy negatively impacts the poor while benefiting the rich. Therefore, I did a bit of searching to educate myself on the topic of raising the retirement age and the options that exist which is how I found the following article: http://host.madison.com/business/investment/markets-and-stocks/core-ways-to-fix-social-security—-which/article_3f879e25-5269-5c84-acdc-535a3c001754.html.

I personally believe that it is neither ethical nor does it make sense that our current maximum taxable income is set at $127,200. I feel as though it would make a lot more sense to eliminate the tax on income for individuals making less than $20,000 (or less than whatever the bottom 10% of the population makes) and also to eliminate the maximum taxable earnings cap. This in turn would not only allow us to finance social security for many more years to come but we would also be able to do it without raising the retirement age. Furthermore, it would also make our society are more just one and go towards eliminating the health disparities that exist. Also, who knows, it might even allow us to pay for universal healthcare, thus improving our abysmal Infant Mortality Rate.

A closer look at neighborhood data

By PHS 795 Student Grace Shea:

This project, called “The Equality of Opportunity Project,” was started by a Harvard grad and economist, Raj Chetty, who was interested in studying the effects of socio-ecological factors on a person’s long-term trajectory. This website shows much of the research that has been done by him and his staff using “Big Data” to analyze some of the financial and health outcomes associated with one’s neighborhood. This project was also featured on one of the Freakonomics Radio podcasts sessions, which you can find on the website. Primarily, I think this website can serve as a huge resource for many in the Public Health field because they provide all of their data to the public including lecture videos from a similar class that Dr. Chetty taught. The lectures are available via Youtube with links on the website.

http://www.equality-of-opportunity.org/neighborhoods/

In this link, you can scroll to the Local Area Rankings for Commuting Zones (Counties is also an option). The list provided shows the commuting (primarily urban) centers where your adult income is estimated based on where you live as a child if you are in the bottom 25th percentile for family income. Essentially, this data attempts to predict the causal effects of where you live if you are in a low-income family. Capture

If you look at the list provided, Seattle is at the top of the list. To understand this list, let’s use Seattle as an example. If a child were to grow up in the Seattle metro area instead of an average place, he/she would make about 12% more at age 26. The average level of household income at age 26 is $26,000, so this 12% gain translates to $3,120 of additional income.

If you look a bit further down, Madison is on that list. All kids in Madison have a 7.4% chance of making more as adults with boys at 10.4% and girls at 3.9%. My question to the class is why do we think we see such a significant gender gap for adult income for children in Madison. Additionally, do we think that a 7.4% increase in income is meaningful for predicting their long-term outcomes? How does this compare to the bottom of the list where in Fayetteville, NC, children have a -17.8% chance of making more money as an adult than their family’s current income? Can we use this data to predict where future public health efforts will be needed?

The effect of conflict on the mental health of children and adolescents

As we have been studying the cumulative effects of environmental stressors on population health, PHS Student Zeeshan Yacoob brings our attention to an article about the effects of the Israeli-Palestinian conflict on mental health through the experience of an 11-year-old boy. Zeeshan writes:

Zeeshan writes:

This article is about an 11-year-old Palestinian boy who suffers from PTSD after witnessing his brother die. After reading this article I began to wonder how these children will grow up and what type of society they will establish in the future. Furthermore, I also began to wonder about all of the health conditions they would have to face even if their situation would change overnight (for example if they were taken in as refugees to the U.S.). I’m sure that many of these children due to their stress will suffer from conditions like hypertension, cardiovascular disease and depression. As a result, their productivity as a society will decrease and also the societies educational attainment will also undoubtedly decrease. All in all, not only do I feel frustration and anger for the situation that these children have been exposed too but I also worry what their health future will look like not only for themselves but also for the next generation after them.

Zeeshan also points us to a systematic review on the effects of conflict on mental health of children in the Middle East:

https://www.ncbi.nlm.nih.gov/pubmed/?term=%22A+systematic+review+on+the+mental+health+of+children+and+adolescents+in+areas+of+armed+conflict+in+the+Middle+East%22

Image result for salwa massadPopulation Health graduate, Salwa Massad, PhD has done significant work in this area. She is currently a research manager in the World Health Organization’s Palestinian National Institute of Public Health and adjunct faculty at Columbia. Here is a link to a presentation of her brave and powerful work on the health of children living in chronic war zones:

http://health.oregonstate.edu/seminars/salwa-massad

Questions of non-binary gender and population health

PHS 795 Student Rissa Lane writes:

This article was published in CNN on Wednesday, September 20th, and refers to The Global Early Adolescent Study: An Exploration of the Factors that Shape Adolescence, an article published in the Journal of Adolescent Health volume for October 2017 and came from researchers from Johns Hopkins Bloomberg School of Public Health and the World Health Organization. The study draws connections between binary gender roles imposed on people from a very young age and the health implications that result. The article suggests that gender role expectations are the result of bias from group to group and the norms that exist in a community, because gender roles exist in nearly every culture across the globe, but the expectations for each gender are not necessarily synonymous across different populations. This study is particularly relevant to the content covered in this course as we have started to look at health of populations and social-ecological determinants of health. Typically, controls are imposed on study participants to regulate the effects of varying income, education level, age, and gender on the representation of results of evaluation. With this study, it becomes evident that the binary gender system may actually have health implications in and of itself.

http://www.cnn.com/2017/09/20/health/geas-gender-stereotypes-study/index.html