Paradigm Shifted

be the change you wish to see in the world

Archive for the 'public health' Category


poked and prodded

Posted by deepali on April 24, 2008

Right now, things are a little nuts around here.  I’m trying to get my health forms completed for my Fulbright, and it’s really a frustrating process.  I’ve had blood drawn twice, gotten a physical, gotten a gyn exam, gotten PPD, and now we’re going to look at my immunizations. No more needles! I’ve learned a few things though -

Test results freak me out. I don’t know why, but I get very anxious when I’m looking at them (even though I don’t expect anything but normal).  There were a few abnormal, but they’re up to interpretation.

I can’t stand the sight of my own blood.  I’m ok with wounds.  But I can’t watch my own blood filling up the vial.  It’s not scary or gross, it’s just surreal.

The health care industry is confusing.  If I didn’t already work in the field, I would be quite baffled.  What does “family history” really mean?  What’s the difference between an HPV test and a Pap test? How often should you update your immunizations? What does the “normal range” indicate?

Straight men should not do pap smears.  That is all I have to say about that.

I should be all done with this madness by Monday, at least until next January or so, when I have to get the immunization updates!

Posted in music, public health | No Comments »

doing good from the comfort of your own home: cambodia edition

Posted by deepali on April 2, 2008

As I’ve mentioned before, I recently took a vacation. While the purpose of the trip was to visit friends and family and take a break from school and work, I also managed to include an educational component (yes, I’m a geek). Specifically, I got a crash course on the state of education in Cambodia.

A lot of people couldn’t pick out Cambodia on a map. If you’re older than 30, your knowledge of Cambodia might be limited to the Vietnam War. You might also be familiar with the Khmer Rouge. You might not know that our incursions into Cambodia during the former had a great deal to the do with the rise of the latter.

The Khmer Rouge period has had a deleterious impact on Cambodian society today. Not only is the population very young, it is also not well educated. This is due to both genocide and emigration, but also due to the selective targeting of the intellectual components of society. In addition, infrastructure was heavily damaged during the Khmer Rouge period, and many parts of the countryside still contain landmines.

Add these together, and providing education across the countryside becomes difficult. In addition, poverty (and the increasing price of food) means parents are unable to afford to send their children to school, which then makes them vulnerable to trafficking. Young girls are sent over the border to work the sex trade in Thailand.

In the midst of this, I met some engaged and ambitious people working to improve this situation. Both work for NGOs in Cambodia - Schools for Children of Cambodia is local, though its board of directors is from the UK. This Life Cambodia is also local, founded by an Aussie expat.

This Life Cambodia is currently providing fundraising and technical assistance to Self Help Community Center in Puok District. I had the opportunity to visit SHCC and see the project firsthand. Puok District is well off the grid, which means they receive no electricity or piped water. As such, they run on generators (which grows expensive as fuel prices soar) and store water in their homes. This, of course, puts community members at risk of a number of easily preventable diseases. It also means that the things we take for granted (prenatal care, refrigeration, school) don’t exist.

To combat these issues, SHCC is building a school. It is a massive undertaking, but one in which the community is fully vested. When the school is complete, it will have 3 classrooms, a library, and a computer room. It will also run on solar panels (which will also help power the community) , 2 fishing ponds (for the sustainable production of fish), and various organic gardens. The hope is that the school will be self-sufficient.

The proposed costs for this project are around $12000. This includes construction of the school, the land lease/purchase costs, and materials (ie, books, farm products). 100% of donations received through This Life Cambodia will go towards this project (unless otherwise specified).

For my personal finance visitors, it’s conceivable that $12000 is less than your total non-mortgage, non-school debt. If you’re like most people in debt, some of that probably came from poor decisions and frivolous purchases. And for that same amount, about 200 children can be provided an opportunity that will literally be life-changing. Education (even at only the primary level) reduces child and maternal mortality, and it reduces risk of gender-based violence and trafficking.

Here is where you come in. Chances are, you’ve got a plan to reduce that debt. It probably includes being frugal, saving, and spending wisely. So consider adding another dimension to your debt reduction plan - philanthropy. What goes around, comes around, yes? Even a small donation of $5 or $10 will go a long way for SHCC… and will barely make a dent in your own budget.

And for those of you not in debt, well, we can all benefit from a little good karma.

(pictures of the school site)

Posted in budget, human rights, personal growth, poverty, public health, school, travel | 2 Comments »

implications of the beef recall

Posted by deepali on February 27, 2008

In case you aren’t aware, we are currently in the midst of the largest beef recall in history. Officials say you shouldn’t be concerned about health hazards. Most of the beef has already been consumed, and the recall is purely on principle.

Well, that’s true and false.

Since most of the meat has already been consumed, and there hasn’t been an epidemic of GI illness, it’s not likely that there will be one related to this incident. But, that doesn’t mean this is an isolated case, and from what we already know about USDA and the meat industry, I’m quite sure it isn’t.

Here’s the beef (so to speak) -

USDA has very little power over the meat industry. Despite a superficial appearance as a regulatory agency, USDA’s rules are mostly voluntary. The beef trust has very handily, over the past 100 years, ensured itself not only a virtual monopoly, but also virtual free reign. You think the government can protect your food? Think again. The meat industry is pretty much self-regulating, and it is not in their best interests to care about your health (and in relation, the health of meat animals).

Part of this has to do with powerful special interest lobbying in meat-packing states. Those of you in Iowa, Colorado, Kansas, Nebraska, and Texas can thank your representatives to Congress for that one. USDA has effectively been hamstrung, and lacks the budget to truly regulate this industry. There are just not enough inspectors for them to be able to do a thorough job; and if the meat industry has its way, there will never be.

So why this recall? Well, despite mad cow disease being extremely rare, some of us are scared enough to worry. In addition, the past wave of pathogenic contamination (in meat and produce) has also raised issues of food safety. And of course, the War on Terror has highlighted all the weak spots in our food production chain.

So, when video footage (shot by animal rights groups - the only people who seem to care about our health) showed clear violations of safety standards, the government had an incentive (and a cause) to step in. In addition, what makes this case unique is that most of the beef winds up in school lunches as part of the federal plan. This gives USDA greater power than usual.

Think about that for a minute. Meat that is part of the national school lunch plan is usually poor quality. We’ve always known that, and know we have even more evidence - sick cows (called downers) are beaten and abused to the end of the assembly line. This is what your kids are eating. When did we get to the point where we’ve decided that feeding our children bad food is ok?

This case has highlighted other deficiencies in our system. Mad cow disease is rare, but we actually don’t have a good handle on prevalence. Why? Because the beef industry refuses to allow mass testing of their meat animals. We slaughter 35 million cattle a year. Less than 1 million of them are tested for mad cow disease.

Cows are also fed antibiotics to aid in growth; presumably this would fight off infection as well. But as we see a rise in antibiotic resistance in microbes, you can bet that’s being fueled by antibiotic use in cows. You can also bet that the pathogens that cows pick up aren’t being killed by the growth additives.

And finally - meat slaughter is not humane. It can be, but not in a slaughter plant. Cows that are already stressed by factory farm living are then herded into a slaughter house where they are stunned before being killed. Of course, some of the cows are not quite knocked out when slaughter begins. Stress releases hormones into the blood stream that settle in muscle and fat. This stress hormone-laden muscle and fat is your hamburger. Not only are you at risk for pathogens, but you’re also being loaded with stress (and growth hormone).

So it’s not just about a few cases of tainted meat, or one factory that mishandles slaughter. It’s about a systemic failure to put the health of people first. It’s about an easy way to make a profit. And the problem will only get worse until we start seeing fundamental shifts in the way we view our food.

Posted in corporate america, food, public health | 2 Comments »

how to survive the coming apocalypse

Posted by deepali on January 31, 2008

So you’ve got a budget plan. Check. A food behavior modification plan. Check. An exercise plan. Check. A career plan. Check. You’re all set, right? Just hit auto-pilot and sail through life.

But wait. What about a survival plan?

That’s right. There’s one you forgot, and it’s probably going to be the most important plan you’ll ever make. Because what good is your 401K going to do you while zombies are munching on your brain? And while a good exercise plan should help you outrun the escaped lions from the zoo, you can only run so far. As for your career plan, well, when the meteorite hits, ideally it’ll take out your boss (thereby allowing you to assume his position), but statistically speaking, the chances of that are pretty slim (most likely, the meteorite will take you out too).

Ok. Let’s get a little realistic. Zombies, meteorites, and zoo break-ins are serious business, but more the stuff of action-packed science fiction movies. But while the jungle survivalist plan might not be of too much relevance to you, a good emergency plan should be. Because depending on where you live, floods, earthquakes, power outages, and the like are not uncommon events. And 9/11 showed us that terrorism isn’t just for the movies either.

So while you’re assessing your finances and weight and career aspirations, assess your chances of survival as well. Every family should have a good emergency plan, either for sheltering in place (ideal) or regrouping in the case of evacuation. Emergencies come in different forms, but under the all-hazards model, response follows the same guiding principles.

Here are a few simple and practical steps to develop this plan:

1. Arrange a family meeting. Your household should meet to discuss steps you would take during an emergency. Everyone needs to be a part of the plan, and everyone should be made to feel as though their concerns are being addressed.

2. Make an emergency kit. The preparedness folks at CDC (as well as DHS and elsewhere) suggest a few items for this kit, including bottled water, canned food items (and a can opener), a flashlight, battery-powered radio, first aid kid, plastic bags and towelettes, basic tools, cash, and pet needs. Additional items should be added per need (ie, medications). And while it was a topic of amusement, I’d also suggest duct tape and plastic sheeting to reinforce shelter.

3. Create a phone tree. You can decide how inclusive this should be, but ideally, immediate family members, select neighbors, and other key people should be included. Those living outside your immediate area of residence should also be on there. In the case of an emergency, each person contacts the person before and after them to check in. In addition, programming an ICE (In Case of Emergency) contact into your cell phone is useful too.

4. Set meeting points and times. Usually in an emergency, the best plan of action is to shelter in place; evacuation is a last resort. Workplaces and schools have emergency plans of their own, so there is no need to rush to school to retrieve your child. However, some mechanism should be in place for contact. Discuss with school administrators to see how they’ve included this in their plans. In the need for evacuation (for which you will be advised), there is a possibility of separation. In this situation, predetermined meeting places and times should be set (with accompanying materials such as phone cards and maps).

5. Learn about local plans. Your community should have plan as well, whether it’s your neighborhood, city or county. In addition, local hospitals and clinics have plans in place and you should make yourself familiar with those. Know where to turn for both information and medical care.

6. Don’t forget your pet. If you shelter in place, your emergency kit should include items for your pet. In the cause of evacuation, determine where you might leave your pet. Familiarize yourself with animal hospitals or kennels in neighboring areas.

7. Keep alert. Emergencies don’t just happen at home. When traveling, take a quick stroll around the hotel and check out emergency exits. Leave schedules or phone numbers with loved ones.

Planning for an emergency is not time-consuming or labor-intensive, but it is important and should take priority. The important factor to remember is that everyone should be on the same page about the plan.

Posted in goals, public health, terrorism | 1 Comment »

advice to a meat-eater from a vegetarian

Posted by deepali on January 26, 2008

As I’ve mentioned before, I’m vegetarian. After a lifetime of eating meat, I chose to stop about 2 years ago. It was a gradual process that started with giving up beef about 10 years ago and slowly spread to other types of meat, until it ended with fish. I still eat eggs and dairy, though I try to go with organic and free-range, and I’m always willing to try out vegan options.

While I will fully admit that I do not condone the meat-eating lifestyle, I do not condemn it either. I don’t have a problem with people eating meat, but I do have a problem with our meat industry.

I will also confess that I am not strict about my vegetarianism - a handful of times out of the year, I do eat meat. I’ve observed a few things in these moments, and thought I’d share with the regular meat-eating crowd.

Meat has never been a main course.

In anthropological food language, meat is a fringe food, like oil and fat. The bulk of the diet for most of human kind has been produce - leaves, fruits, seeds. 10, 000 years ago, when we discovered agriculture, we added grains and dairy to our diet. But both prior to and after that moment, meat never took center-stage. It was either too energy-consumptive (ie, hunting down game) or not cost-effective (eggs are a more sustainable source of protein than the chicken).

We eat too much protein.

Americans worry about their protein intake. They shouldn’t bother. We get far more protein than we need in our diet - the real problems are refined foods, such as sugars, and too much fat.

Cheap meat is bad meat.

For years, meat was a delicacy. The fast food industry changed that for us, and now meat is relatively cheap. But with that drop in price also came a drop in quality. Factory-farmed meat is, in a word, terrible. There is a considerable difference in taste and healthfulness between free-range and organic meat vs industrial meat.

Excess meat consumption leads to health risks.

Our rates of obesity and heart disease have increased. This is partly a result of more meat consumption, and partly a result of other aspects of our diet (processed foods). It’s also a result of lowered exercise levels. In China, which is currently undergoing the nutrition transition, we are seeing the increased rates of disease first hand. As Neal Barnard put it: “If beef is your idea of ‘real food for real people’ you’d better live real close to a real good hospital.”

Industrial animal production is cruel.

It’s no secret that animals suffer in the process (and in particularly horrific ways). What we are less aware of is who else suffers. For one, workers in meat processing facilities tend to be illegal immigrants working at far below minimum wage with little to no benefits (including health care). They also suffer one of the highest rates of occupational injury. Two, communities in which concentrated animal feeding operations (CAFOs) are located tend to suffer from economic decline and poor health. Three, this industry is little regulated and is now the largest source of industrial pollution (beating out petrochemicals). Manure from CAFOs run into our drinking water and infects us with pathogens, many of which are displaying antibiotic resistance.

We are eating ourselves to famine.

A billion people in the world do not have enough to eat. It takes seven times as much as farmland and energy to produce a cow, than to produce wheat. We make meat cheaper for ourselves, at the expense of those who go without any type of food.

There is no transparency.

You don’t know that McDonalds receives huge subsidies to train workers that never get trained. You don’t know that IBP lies on its inspection reports. You don’t know that USDA doesn’t really have a clue what happens in this industry. You don’t know that industrial animal production is unnatural, every step of the way, which has a profound effect on your health. You don’t know that your tax dollars (and your spending dollars) are fueling the cycle.

So what’s a meat-eater to do?

I’m not going to advocate giving it up altogether - that’s a personal choice that we all have to make ourselves. But consider this - studies have shown that organic diets lessen allergies, vegan diets prevent diabetes, and small farms support local economies (and pollute much less). If you ate less meat than you do currently, you’d be happier and healthier, and arguably, skinnier.

The Meatless Monday campaign is based on this idea. Healthy People 2010 is aiming to cut saturated fat consumption by 15% and the largest source of saturated fat in our diet is meat. 15% is about 1 in 7, or 1 day a week.

And those days you do eat meat, consider spending a little more for quality. It’s one thing to get a cheap cut to make broth, it’s another to actually claim that store-brand chicken thighs are actually any good. Organic and free-range are better, and better for you. Even better still is locally raised on a small independent farm. These are people who take pride in their product, resulting in a better item for your consumption.

At the end of the day, your life is your life, and only you can take responsibility for it. But many of us stumble through life without awareness of our actions and their repercussions. We fail to think about what we’re eating, where it came from, how it got to our plates. As a vegetarian, if there is one thing I’d wish for a meat-eater to do, it’s to consume with mindfulness.

Posted in corporate america, food, public health | 19 Comments »

credit cards vs personal responsibility: thoughts from the injury prevention paradigm

Posted by deepali on January 19, 2008

The credit vs no credit debate is endless. Those opposed to credit cards point to predatory lending practices, while those on the side of credit cards claim that personal responsibility is key. So who’s right? Well, both are.

Let me use an example from my field. Until recently, injury was unrecognized as an essential component of public health. Of course, we realized that injuries were a leading cause of morbidity and mortality, but we’ve always held the widespread belief that they are merely “accidents” over which we have no control. It’s only been in the past few years that we’ve come to realize that there are specific risk and causative factors (and thus areas for intervention) for injury and injury events.

In 1970, William Haddon developed the Haddon matrix, which identified various factors in the three stages of an event (before, during, and after). These factors included personal, vector, environmental, and social.

When we first started address this problem of intentional and unintentional injuries, we focused on addressing behavior (personal). People’s knowledge, values, and beliefs played a role in the types of decisions they’d made, so injury prevention specialists attempted to intervene at that point. But we quickly realized that this was both cost-inefficient and ineffective.

Yes, people should make the right decision. But in practice, we make poor decisions all the time. Sometimes, we do so deliberately. But most of the time, it’s because we lack the proper tools to make the correct decision.

Generally speaking, a driver should slow down when entering a school zone. But more often then we’d like, that person does not. We could focus an educational campaign on teaching that person why they should slow down; we could even teach the children at that school to be careful while crossing the street. We call this an active intervention - one that requires action on the part of the individual. We undertake these types of interventions all the time, with varying degrees of success.

More effectively, we can also undertake passive interventions. Instead of relying on people to make the correct decision, we alter the environment such that they have little other choice. Hence we install medians, speed bumps, traffic cameras, and the like, to ensure that drivers have all the means at hand to make the safe choice.

The same can be applied to personal finance. Yes, we should all use credit responsibly. Unfortunately, too few of us are given the tool to be responsible, and for the most part, we’re actually given the tools to be irresponsible.

Few of us receive any sort of education on credit cards and debt management, or even simple budgeting. But almost all of us are bombarded with the idea that living beyond our means is ok. Even worse, the credit card companies prey upon our initial ignorance, providing ever easier ways to drown ourselves in debt.

We will, if given the right opportunities, make the right choices, even when it comes to finances. But if making the wrong choices is easier, then it’s no wonder so many people choose that road. So while education and personal responsibility should provide a cornerstone in changing behavior, there needs to be a passive intervention as well.

Simply put, credit card companies should change their ways. Or rather, the regulatory environment should change, thereby resulting in incentives for credit card companies to change. Consumer protection laws should be enacted, and the worst of credit card practices should be abandoned.

Of course, there is a fine line between protection and paternalism; we walk it all the time in public health. But the practices that were initially decried as infringing too much on our personal freedoms are also those that have saved the most lives - seat belts, child seats, speed limits. They’ve also not had an effect on the profitability of the auto industry, nor have they resulted in increased costs. And if anything, they’ve allowed for better decision-making.

Posted in budget, corporate america, public health | 2 Comments »