Repression in Iran

I really hate what’s happening in Iran – the Ahmadinejad regime repressing dissent and claiming victory without producing evidence to back their claims. For awhile, there was such energy in the streets. People of all ages, but especially young people, courageously protested. Tweets sprung up all over the world. Then, slowly the iron fist seemed to come down upon the crowd and upon the media and stilled much of the dissent. The spark may be rekindling. I hope so.

I’ve spent hours talking with Iranian people who have so much pain. One spoke of a relative who was arrested last week without cause, someone who’d spent most of his life in the U.S. and was in Iran to visit relatives. The family cannot get any information and don’t know if he’s dead or alive. This is both surreal and all too real. I’m speaking out, because we should not remain silent in the face of such repression. Nor should we take military action. My heart goes out to the Iranian people, wherever they are in the world.

Students in action

For the 1.6 billion people in the world without a sustainable source of household water, there’s no insurance policy for water. Our students are educating, working with communities and bringing water to communities. Check out the photo album from health behavior and health education students Emily Werder and Anna Gieselman. They’re working on water projects with UNICEF in Bangladesh this summer to complete practicum projects for their MPH degrees. Notice the water pumps, people carrying jugs and jars of water, often over long distances in blisteringly hot weather. These are people who lack the basics we take for granted every day when we reach for the faucet, grab a water bottle for the gym or make coffee.

Nine of our students are in India this summer through the Deshpande Foundation for which we’re so grateful. Four of our master’s students in environmental sciences and engineering, Nick DeFelice, Oluwaseyi Ibidapo, Jill Johnston and Patsy Polston, are installing sanitation systems and teaching people in two rural Indian villages how to use them. Here’s the exciting first installment of their reports.

Yasmin Cole-Lewis, Daniel Cothran, Jessica Feingold and Jessica Izquierdo (master’s students in health behavior and health education) and Rajeev Colaco (doctoral candidate in maternal and child health) aim to increase young men’s understanding of gender dynamics and women’s health so that men will be positive influences on women access to  health services.

These students are going to make a world of difference in these villages. Our students are working across North Carolina and around the world this summer learning while doing and making the world a better place in the process.

Last week at the CDC

I spent a couple days at the Centers for Disease Control’s (CDC) meeting of the Task Force on Community Preventive Services. The Task Force reviews evidence in various areas critical for public health and makes recommendations on the basis of comprehensive evidence reviews. We should use evidence for decision making about what to do in public health as well as in medicine. Using ineffective strategies when effective ones are available is poor practice in either case.At the last meeting, we reviewed several topics, including the use of technology-based interventions for obesity prevention and maintenance of weight loss, comprehensive risk reduction and abstinence education interventions to prevent adolescent pregnancy, HIV, and other sexually-transmitted infections, using population levels of alcohol consumption as an indicator of excessive alcohol consumption and vaccination programs in schools to increase vaccination coverage in children and adolescents. Being on the Task Force helps me stay current with the literature in a lot of different areas.  I am glad that the Obama administration seems to understand the importance of evidence in resource allocation and decision making.

Nicholas D. Kristof, a voice for public health in the New York Times

Kristof has been a hero of mine for some time. In fact, he is one of the best writers anywhere about public health issues. In his blog, Kristof wrote that “My Sunday column was inspired by ‘Food, Inc.,’ the new documentary playing in theaters nationwide. I argue that at the same time we examine our health care system, we should also take a look at our agribusiness system, which — I argue — tends to promote an unhealthy diet.” He talked about the latest E. coli outbreak which caused a recall of Nestle cookie dough. Who’d think of cookie dough as a breeding ground for E. coli! One of our faculty members, Professor Mark Sobsey, is trying to develop a better test for E. coli.

Will there be health care reform?

As I have said before, I am old enough to have been through these debates multiple times. This time, though, there is encouraging news from recent polls. Voters want change. Not only do they seem to be willing to pay more, but they appear to support a public insurance option — that means an option not as the only option. See Paul Krugman’s Op Ed in today’s New York Times. With nearly 50 million Americans uninsured and millions more under-insured, the time for waiting is long past. But the details will help to decide whether key people can overcome their differences and come together in compromise for the common good.

There’s a lot of talk about a “Public” Health Plan or a “Public-Health Plan.” The use of “public health,” in this case, is essentially a health plan for the public as opposed to how we think about public health in terms of the public’s health. Nuances aside, what really will make it a public health plan is if it guarantees access for all Americans, incentivizes prevention, encourages wise, evidence-based decision-making about health care, manages quality and provides reasonable payments to health care providers. Here are a couple links to different points of view, for and against a public option — in the interest of encouraging civil discourse on difficult topics.

Lancet on public health

The Lancet editors published a new manifesto for the CDC June 6^th, with advice for the new CDC director Dr. Tom Frieden. He’s known especially for his work to remove transfats from NYC restaurants, a bold, significant move. It’s a good call to action. I especially like the editors’ statement that

“traditional public health will need to move from a focus on disease interruption and biomedical interventions to catalyzing social change and providing support for behavior change-from chronic diseases and obesity to HIV/AIDS. Other long-term priorities include revitalizing the discipline of public health…The agency should continue to have a big role in global health…”(p.1919).

These are good suggestions that I will return to in the next few weeks. Behavior change requires a lot of attention and some new ways of thinking.

Belated Happy Father’s Day to all fathers

I really appreciate my own father who was one of the earliest effective communicators in the fight against smoking — and still an astute thinker.

Leave a reply - I’d like to hear from you!

How to be 21^st century

This past weekend, I spent four hours in my office sorting through the papers that had accumulated over the last two months. I whittled it down a lot but kept thinking, “I shouldn’t  accumulate this much paper.”

I’d like to hear from people who’ve made the transition successfully in spite of getting 100+ email messages each day, many of them with attachments. Oh yeah, and how to do it in organizations with incredibly small storage limits.

Send me your thoughts!

A landmark week for public health

The ground shifted last week. Congress voted to grant the FDA authority to regulate tobacco (HR 1256). And we have a new Commissioner of the FDA, Margaret Hamburg, who wrote in last week’s New England Journal of Medicine about the FDA as a public health agency!

Tobacco products are comprised of many toxic additives (599) which the FDA now will regulate. So, who cares whether the FDA regulates tobacco? We all should. In the future, there won’t be candy-flavored cigarettes and there’ll be fewer ads featuring sexy young smokers (Durham Herald-Sun, 6/13). Cigarette packages will have larger warning labels. All these changes will help to reduce teenage smoking. “Each day in the United States, approximately 3,600 young people between the ages of 12 and 17 years initiate cigarette smoking, and an estimated 1,100 young people become daily cigarette smokers” – CDC Fact Sheet Youth and Tobacco Use: Current Estimates. Many of them will seal their fates as they start smoking.

In this country alone, about 400,000 people still die of smoking-related illnesses every year. Over $100 billion is attributed to the health care costs associated with smoking—every year. We simply cannot afford this product. Tobacco has played an important role in North Carolina history, and I empathize with the plight of tobacco farmers. Today, with the health consequences of tobacco use known for more than 40 years, we should regard the profits associated with use of tobacco toxic assets.

For another point of view, see “Washington’s Marlboro Men” in the Wall Street Journal (WSJ). The editorial argues that by not regulating menthol, an additive favored by Black smokers, Congress could. The result, they say is “largely an exercise in political and financial self-interest masquerading as public virtue.” I don’t agree, but the WSJ has a good point about menthol.

Happy Monday!

Budget quandaries and quagmires

I’m a bit less prompt about posting early in the week. Put it down partly to the huge investment of time that I and others are devoting to managing budget cuts. The fact that we must plan for the worst, a little less bad and slightly less bad scenarios is incredibly time-consuming. As Chancellor Holden Thorp has written, these are very challenging times, and the impact of the Great Recession will leave UNC with many fewer resources for our core missions. We are not playing Monopoly. Our decisions have real impact for real people — people with names, faces, lives and families. No one here takes it lightly.

Last Friday, with no advance notice, we learned that one of our important service contracts will not be renewed, leaving us rental space we don’t need and cannot afford and people who no longer have a means of being paid. UNC provides critical services to the state across the system, and especially, across the professional schools. Across UNC-Chapel Hill, we care for patients with AIDS in prisons, educate teachers, provide telephone hotlines for vulnerable populations, train child care workers, offer continuing education in vital areas to our public health workforce, provide mental health services and a lot more (Read about some of our School’s service activities at NCIPH-North Carolina Institute for Public Health or Carolina Public Health magazine) . When our contracts are obliterated, we have no other way to meet North Carolinians’ needs. Yet, the legislature is in a real bind. There is not enough money to balance the budget unless revenue is increased. Follow continuing legislative deliberations at www.ncleg.net.

The future of academic medicine

I enjoyed speaking last week to the HORA (Health Organizational Research Association) meeting that Health Policy and Management hosted. It gave me a chance to read some key articles on academic medicine and to think about the important role our academic medical centers play in the health of populations. The original mission of these organizations was to improve the health of societies, a mission that is sometimes subsumed to other critical functions, such as discovery - important but only part of the mix. Public health and academic medicine should do even more together.

• Academic Health Centers: Leading Change in the 21^st Century (PDF)
• The Future of Academic Medicine Five Scenarios to 2025 (PDF)
• The Problem with Academic Medicine: Engineering Our Way into and out of the Mess (Abstract) (PDF download)
• A Single Mission for Academic Medicine: Improving Health (PDF)
• A Time for Transformative Leadership in Academic Health Sciences (PDF)

I have learned a lot from Paul Levy’s blog which my sister, Sara Rimer, the New York Times writer, showed me. He’s CEO of Beth Israel Deaconess Medical Center in Boston and talks about quandaries and developments in leading a hospital with a lot more as well. I was thrilled that he advocated to save the Boston Globe. I’m a shameless newspaperphile!

This is a book I’m going to buy and read

From TED Blog:

“The Worldchanging book, “A user’s guide to the 21st century“, is published today. Our friends at Worldchanging.com in Seattle have been for a few years now publishing an insightful and inspiring collective blog disseminating information about sustainability and social change and describing pragmatically what’s possible, what new technologies are coming along, what solutions to the world’s global and local most pressing problems people and organizations are putting in place.

“Alex Steffen writes in his editor’s introduction (Alex spoke at TEDGlobal last year). As we face a planetary crisis, ‘we also find ourselves in a moment of innovation unlike any that has come before… We live in an era when the number of people working to make the world better is exploding’.”

Is it true that the number of people working to make the world better is exploding? I really like that idea and hope it is true! What do you think?

Happy Monday! Barbara

Interesting reading

I don’t know about you, but for the first time in my life, I absolutely cannot keep up—with the hundreds of emails every day, the journals that seem to appear before I have read the last one, the books I want to read and so much more. I’m still wondering why I added a subscription to the Wall Street Journal (WSJ) to the other two papers we get every morning—New York Times (NYT) and the Chapel Hill Herald/Durham Herald Sun. WSJ does give me another viewpoint, one I might not ordinarily get. I use the local papers to learn about the local scene and to get perspectives on UNC that I might miss otherwise. And I check to see that our School and faculty are being covered. I’m a hard copy newspaper reader. I like print, and I like it in my hands. I have no problem reading books on the Kindle, but I like to go out for the paper in the morning, and have a physical paper not a virtual one. That may make me an anachronism, but so be it! My sister is a reporter so I am very sympathetic to newspapers. By the way, she had an interesting article on texting while eating in the NYT last week.

I liked Nicholas Kristof’s NYT column today. Of course, I like Kristof. He travels to some of the world’s roughest spots and had what appear to be great tips for traveling safely. Check them out. He criticized universities for being “far too parochial, rarely exposing students to worlds beyond their borders.” That is definitely not true for us.

Excellent article on digital surveillance in recent New England Journal of Medicine.

Doing more with less

We are grappling with potentially very large permanent budget cuts and trying to figure how we can do more with less, especially since our School (like most UNC schools) had little discretionary budget to start with. I only wish we could put as much time into planning strategy as we are into planning budget cut scenarios. At this point, we do not know where we will end up, only that it is not where we are now. North Carolina has been good to us in the past. We’ll all do the best we can.

Quintiles’ new building

Several of us heard Dennis Gillings, CBE, Governor Perdue, Durham’s Mayor Bill Bell and others celebrate Quintiles Transnational’s new building. It is a beautiful space. I enjoyed interacting with SPH alumni and others who spoke highly of the School. The growth of companies like Quintiles, even during poor economic times, demonstrates one aspect of the growing importance of public health professionals. In the pharmaceutical and medical device industry, our graduates in biostatistics, epidemiology and health policy (among others) have an opportunity to shape the kinds of medical treatments available to people around the world. Congratulations Quintiles.

Happy Monday. Barbara