Soda Tax and Other Crap Initiatives Public Health is Committed To

http://publichealth.columbia.edu/degree-programs/columbia-mph/integration-science-and-practice

Glad to see Mailman is making the rigorous study of pointless crap even more central to its curriculum. Highlighting soda tax as an exemplary case study does not bode well for the promise of making a positive impact on public health through an MPH education. Worst case scenario: an obese person who drinks a two liter of soda every day. The soda can’t possibly be in the top 10 list of behaviors and factors most impacting that person’s health. Soda tax, calorie postings, salt regulations – give me a break. Sick days aren’t protected for many people, minimum wage is a joke, 3% of Americans are in jail or on probation and ¾ of those people are there for non-violent crimes (http://www.nytimes.com/2011/06/17/opinion/17carter.html?hp), states spend as much or more on prisons than education, poor air quality, increasing frequency of natural disasters that cities are towns aren’t prepared for, rising income inequality and a shrinking social safety net – these are the huge things reducing public health. Look at the example analysis questions for the soda tax:

• How do you weigh the value of individual choice against the public good of preventing obesity?
• Will the economic impact of this plan be equitable?
• What is the evidence that such a tax would change consumer behavior?

The answer – it doesn’t even matter because taxing soda is such a limited and trivial tactic. Addressing the big issues: health insurance that covers the services and prescriptions a person needs, drug policy and sentencing, labor laws, education policy, and effecting change in state and federal legislation are all topics that demand issue-specific knowledge. I for one would like to see Mailman enshrine that into its curriculum rather than expanding the study of crap initiatives like soda tax. Spending class time studying soda tax might not seem like such a big problem, but I see the profession as a whole getting distracted by trivial initiatives rather acting as a strong voice addressing these destructive societal problems in a meaningful way. Reorienting the profession will probably begin with reorienting the education of public health professionals.

EFA - Ecological Fallacy Alert

http://www.nytimes.com/2011/02/01/health/01mind.html

The ecological fallacy is my Favorite public health concept. This New York Times article dispensing advice to Super Bowl fans illustrates it perfectly.

At its simplest, the ecological fallacy is when population level data is interpreted at the individual level. Here, the researchers take a city's mortality data post-Super Bowl and interpret it to mean that increasing stress coupled with high-rates of fatty-food intake common amongst Super Bowl fans means that a loss causes heart attacks etc when the city's team loses. Unfortunately, their study as it is cannot respond to their hypothesis. Their data does not tie those that died to the Super Bowl. There is no reason to know that those experiencing post-Super Bowl deaths had watched the game, had an emotional tie to the game, or even had any knowledge of the game.

That is fine. It could be important to know that mortality rates spike post-Super Bowl loss, but there is no grounding (yet) to say that any of these interventions will have an effect. This study relied on one city and one four year difference. Did something happen in LA around the beginning of January in 1980 or 1984 that could effect mortality rates? Is LA 1980 and 1984 the same as the rest of the country in 2011? We need more cities with additional win/losses to compare. That can't overcome the ecological fallacy of city data being used to issue individual fans' care plans, but we can at least have a surer more tested evidence base for recommendations.

I get that this article is a joke, but ecological fallacies just aren't funny. When you read a study authored by MD's, you must remember they likely haven't taken Epidemiology 101.

New York Flies

Departing a bit from the original intention of this blog, I have some thoughts on flies. Our apartment is filled with houseflies. The apartment is perfectly clean - no, really. Food is never left out, dishes are washed promptly, the trash is covered and taken out regularly, the rabbit's house is cleaned daily, surfaces are clean. It's just New York. It's filled with flies. They can't all fit outside on this little island. Even my classes at Columbia always seem to have flies buzzing around in the classroom. It's a mystery why they are here, and really, the why of it is a second order concern. The first order of business is to get rid of them. I am unfortunately not blessed with quick hands so swatting them isn't very effective for me. I googled 'how to kill flies' and found a clever idea for building a fly trap out of syrup, water, a glass jar, and a screwdriver. You put some syrup in a glass jar, add some water, and poke a fly-size hole in the lid. The idea is that the flies are attracted to the smell, go inside, and either get stuck to the syrup or can't find their way back out of the hole. My flies love this device but won't go inside of it.

So. I stare at the fly on my kitchen cabinet door. He rubs his little fly hands together. He lowers his little sucker thing and tastes my kitchen cabinet door. He washes his head with his little fly hands. And he stares at me. And stares. He is transfixed. I raise my fly-swatter Newsweek. He crouches. I don't move. He stands back up. We stare again. And keep staring. I move my Newsweek towards him but doesn't move. He knows I am going to get him. It's like Anais Nin's snake and mouse in The Eye's Journey, "It's fixed terror, it's incapacity to run away as soon as the snake began to gaze upon it with its unblinking stare. The snake knew it would not struggle but wait transfixed with terror. So the snake lingered and delayed the moment of devouring the mouse, enjoying the certainty."

I learned a lot about fly behavior because of my slow reflexes. You have to position yourself in a comfortable position for swatting the resting fly. Let him get used to you being there. Move the swatter in and around a little to get him used to it. Wait until they are doing something else so they can't fly away as fast once you begin your swat. Wait until they are washing they little fly hands or sucking on the surface. Then, swat! I got at least 25 in this manner and I am incredibly slow. I took piano lessons as a child and grew up playing the saxophone and oboe so you would think I'd be able to flick my wrist fast enough to get a fly, but no. I always had to play the slower songs.

The flies always want to have a handwashing session after buzzing around for a while. So it pays to watch one fly around until he lands. There are always ones that have a strong preference for the ceiling. Just forget about them. Flies only live for two weeks anyway. Just get the ones you can and don't look at the ceiling for two weeks. These fly attack sessions have to go in bursts. After ten or fifteen minutes they will stop engaging with you. Let them calm down and then come back. Also they love to walk around the bodies of their fallen comrades. Try to make a little pile of fly bodies as you swat them and you'll get even more.

Kabala Government Hospital Article

I ran across an article in a Freetown newspaper describing the Kabala Government Hospital. This hospital was constructed by the World Bank. It currently has no doctors, water, electricity, or waste disposal system and is the main source of medical care for the district. The one thing it does have: untrained volunteers!

http://www.news.sl/drwebsite/publish/article_200513270.shtml

http://www.thepatrioticvanguard.com/spip.php?article4486

An article written by a recent Salone immigrant to the US. Reveals very commonly held attitudes towards the west, brutal patriarchy women live under, shows how easy it is for anyone to understand more progressive viewpoints while still maintaining regressive and oppressive attitudes.

Tacugama Chimpanzee Sanctuary

Lakka Beach