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.
Friday, June 17, 2011
Sunday, February 6, 2011
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.
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.
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