Health care reform — another chimera?

Note: I wrote this Saturday, August 15th. When I got the papers Monday morning, front page articles splashed the news that President Obama might be willing to support a health reform plan without a public plan. It’s a huge change, but one that might make the legislation more palatable — or not. Saturday, it seemed that the whole thing was unraveling. So I wrote…

A lot of people all over the country are talking about what kind of health reform package we will have. I am an optimist on most things. When it comes to health reform, my optimism is shaded with deep concern. The igniting of extreme passions (illustrated by the appearance of guns at health reform rallies), especially on the part of anti-health care reformers, is causing me to worry that, yet again, health care reform will be just another chimera, a vision and dream deferred. Each time health care reform seems breathtakingly close, fear-mongering drowns out rational voices. I spent a few hours in the Atlanta airport last week and found myself speaking back to Lou Dobbs (on CNN) as he authoritatively spoke one mistruth after another about health reform. There was no one answering him but me — mostly under my breath.

The problems with our health care non-system have been catalogued — more than 47 million Americans uninsured, great disparities between those who are minority and those who are not, access problems, waste, geographic mal-distribution of health care, uneven quality of care, and health outcomes that, for many indicators, are worse in the US than in other countries. As Gawande, Berwick, Fisher and McClellan wrote in the New York Times August 13th, “So we are trying to decide if we are willing to change-willing to ensure that everyone can have coverage.” In 2009, we should conclude that we are willing to ensure that all Americans can have health care coverage.

There are many good analyses of the current bills. The bills have many common themes — guaranteed issue, administrative simplification, some but not all cover preventive services, transparent purchasing marketplace, minimum benefit package, individual mandates in some but not all plans, health care delivery reforms, workforce reform (includes public health), and allowable services dependent in part on comparative effectiveness. There’s a lot more, but these are some of the common elements. There’s no discussion of tort reform, but that needs to be fixed.

John Oberlander, PhD, Associate Professor of Health Policy and Management at our school, is one of the most astute commentators about health reform. Here are some links to his recent articles.

There’s no perfect system, but we can do better. We should do better.

Welcome back students!

I look forward to meeting our new students and talking with those who are returning. I love the fact that the sounds of students have begun to replace the sounds of silence in our atrium. Wishing you all a great year!

Happy Monday, Barbara

• Learning from Failure in Health Care ReformPicking the Right Poison — Options for Funding Health Care Reform, N Engl J Med 360:2045, May 14, 2009 Perspective

• Great Expectations — The Obama Administration and Health Care Reform
  N Engl J Med 360:321, January 22, 2009 Perspective

• Health Care and the Recession, N Engl J Med 360:e5, January 22, 2009 Perspective

• The Partisan Divide — The McCain and Obama Plans for U.S. Health Care Reform, N Engl J Med 359:781, August 21, 2008 Perspective

• Health of the Nation — Coverage for All Americans,N Engl J Med 359:777, August 21, 2008 Perspective

• Presidential Politics and the Resurgence of Health Care Reform, N Engl J Med 357:2101, November 22, 2007 Perspective

Been away — a few quick thoughts

Travel seems to go in batches. I’m nearing the end of three almost back-to-back trips — California, Texas and Georgia. The deans from schools of public health met in California a couple weeks ago. In the four years I have been attending the meetings, turnover in deans is dramatic, so dramatic, that I am becoming a senior dean! And the number of schools continues to rise each year — now, we are 40. States increasingly see schools of public health as valuable. I worry that if we don’t step up the training pace, we will all be competing for a very finite number of students and faculty, especially minority students and faculty. I really value discussions with fellow deans. We share many common challenges and struggles — like the 2009 budget crisis. No matter how bad the budget crisis may seem here at times, it’s much worse many other places. I’m grateful that North Carolina has been so supportive of its universities.

Reading on the road

The Kindle, an electronic reader, is really great for traveling on the road. The fact that it can be loaded with books and magazines is great for an over-packer like me. (By the time I have packed work and workout clothes, I’m always right at the carry-on limit.) I read Fool’s Gold by Gillian Tett on the California trip. It’s a fascinating look at the banking crisis and how we got into the mess that helped to fuel a global economic crisis. One cautionary note is the focus on banking innovations that few could understand-perhaps something for people in public health and medicine to ponder. Innovation is important, but not innovation merely for the sake of innovation.

For several years, I rarely read anything that wasn’t non-fiction, but I’ve gotten back into some fiction, including a fascinating mystery series by Josephine Winspear that has a very public health theme running through it-infectious disease deaths to disproportionately poorer people in the aftermath of World War I, suffering of soldiers that is forgotten as people move on after war and attention to the emotional toll of war. I’ve now read all the books in the Maisie Dobbs series and was captivated. Usually, on a long plane ride, I intersperse a stack of journal articles with a few more light reads-my own reward system. There’s a lot to read these days. No general journal is covering health reform more consistently and thoroughly than the New England Journal of Medicine.

New grants and articles to and by School’s faculty

Check out our home page to view the slides with news about new grants to our faculty and articles published by faculty, many with student co-authors. They’ve really done great in landing new grants to address significant research questions.

UNC Wellness Super Sprint Triathlon

Congratulations to Charlotte Nuñez-Wolff and Viktor Bovberg (and anyone else in the School) who completed the UNC Wellness Triathlon Sunday, Aug. 9, a hot, muggy summer day. The race website described the course this way: after a 5 lap swim, athletes transition to a rolling 9 mile bike course and rolling 5K run. Let me tell you, it’s more than a rolling run, speaking as someone whose house is on the route, and my street is quite a hill on the way to the finish line.

Some of this text is graphic and may be disturbing.

Visit to North Carolina CAFOs (Concentrated Animal Feeding Operations)

Last Thursday, we visited Duplin County, NC to learn about Industrial Farm Animal Production (IFAP) (thanks to volunteer pilots Bob Epting, lawyer and former member of the NC Environmental Management Commission, and Dennis Howard). The group also included Steve Wing (associate professor, Epidemiology), Jim Merchant, (former dean College of Iowa School of Public Health and environmental scientist) Brenda Motsinger, director of special projects, SPH. We also were joined by Rick Dove, lawyer and Riverkeeper (Neuseriver.org) through the Waterkeeper Alliance (WKA). I came away sad, angry and shocked by what we saw and motivated to act.

The Pew Commission on Industrial Farm Animal Production said:

“Over the last 50 years, the method of producing food animals in the United States has changed from the extensive system of small and medium-sized farms owned by a single family to a system of large, intensive operations where the animals are housed in large numbers in enclosed structures that resemble industrial buildings more than they do a traditional barn. That change has happened primarily out of view of consumers but has come at a cost to the environment and a negative impact on public health, rural communities, and the health and well-being of the animals themselves.”

Flying over Duplin County

We flew over Duplin County. As far as the eye could see, there were hog lagoons and low slung buildings that house thousands of hogs and chickens. From the air, we could see how hog waste is sprayed onto fields, how the effluent runs into ditches that run into creeks that lead to rivers, including the Neuse, and pollutes all it touches. We saw how close the spray would come to neighboring houses and could imagine how the wind would blow that disgusting liquid onto yards and even into houses. It felt like we had traveled back in time to the 19^th or early 20^th century, before modern means of waste disposal were used. Think of CAFOs as factories, like what Upton Sinclair wrote about in The Jungle. These aren’t the bucolic farms of yesterday. Animals are raised strictly as products, crammed together in inhumane conditions, raised only to be slaughtered. There’s nothing noble about CAFOs. The Farm-Aid website has some fabulous aerial photos of Duplin County CAFOs and hog lagoons.

Ten million hogs in North Carolina are raised “industrial style.” Most all of these hogs are located in the environmentally sensitive area of North Carolina’s Coastal Plain (area East of I-95).  Each and every day, those 10 million hogs produce “fecal waste” equivalent to what is produced by all the citizens in the following states combined: North Carolina, California, New York, Pennsylvania, Texas, New Hampshire and North Dakota (100 million people). This ten to one ratio is verified by the research of Dr. Mark Sobsey (UNC, Chapel Hill). (From the Neuseriver.org website)

After we landed, we were met by Devon Hall, co-founder of REACH (Rural Empowerment Association for Community Help), a community support organization in Warsaw, North Carolina. Devon drove us around the county, pointing out the proximity of CAFOs to homes, showing us polluted wetlands, taking us to the home of a woman who lives across from a CAFO and whose well is now contaminated. We stopped along the way to take pictures of the contents of a “dead box.” A dead box is one of many dumping grounds for carcasses of dead animals. Earlier that day, I’d never even heard of a dead box, and now it is forever etched into my memory.

Meeting with community members

We were hosted by Devon Hall and community members to a generous lunch of fresh country foods (The banana pudding looked fabulous.) and watched a presentation by Riverkeepers Rick Dove and Larry Baldwin. Then, we heard from community members, all of them Black. They told us how they’d been harmed by the hog and poultry industries–how they’d lost their homes, farms, jobs and/or health, how their dogs who drank the contaminated run-off water from CAFOs had died, how they’d been intimidated but still had not given up or given in. They talked of not being able to go outside, because of the smell and not being able to hang clothes to dry on the line outside, because when the spray came on, the effluent would contaminate their sheets. They did not speak of themselves as heroes. They are heroes.

Anti-CAFO, not anti-farm

No one with whom I spoke is against farms (some of them are or had been farmers) or against eating meat. (In fact, I appeared to be the only vegetarian in the midst.) They objected to CAFOs, because they depend on inhumane treatment of animals and threaten the environment, the public’s health and the integrity of rural communities.  Industrial farming even exploits farmers who used to own the land and everything on it but leveraged their futures to multi-national corporations that have made them indentured servants in many cases.

I am very concerned about CAFOs. Animal waste carries pathogens. Hogs produce a lot of waste. Because animals are raised in extremely tight quarters in ways that compromise their health and development, pathogens spread faster. (Hogs may be implicated in the current H1N1 epidemic, but the data are not yet complete.) Animal waste is sprayed on fields as fertilizer and contaminates air, fields, water and whatever is in its path. People living in communities around these operations are sickened by their exposures. Their children get more asthma. This is a public health problem. It is also a social justice problem, because CAFOs are most often located in communities that are poor, cannot complain and often can’t leave. One of the men who spoke offered this caution with regard to ill health, environmental degradation and other consequences of CAFOs: “It may be in my neighborhood today, but it might be in yours tomorrow.”

Science counts

What we do matters. On the flight back, Bob Epting said to Jim Merchant and me: the numbers matter, and the science matters. He reminded us that our research provides critical pieces of the evidence about the relationship between IFAP and the environment and human health. Unbiased, well-designed research results contribute to policy making and could help in reaching the tipping point about a problem too few people care about. The RIVERKEEPTERS(TM) cited Mark Sobsey’s (PhD, Kenan Professor of Environmental Sciences and Engineering (ESE)) research about fecal contamination in water. Everyone talked about the importance of Steve Wing’s research that addresses the connection between exposures to hog wastes and human health–a critical connection. Mike Aitken (chair, ESE) is leading a new project to remove nitrogen and recover energy from hog waste. A study by David Richardson (associate professor Epidemiology) may help to sort out the relationship between exposure and asthma episodes and managing disease and linking data. Alice Ammerman and Marci Campbell (professors of Nutrition) and colleagues have been working in Duplin County for many years through the Health Promotion and Disease Prevention Center at UNC.

I don’t yet know how our School can be most helpful, but I am going to figure it out–with a lot of input.

Below is a picture of Rick Dove and Larry Baldwin, two Riverkeepers who traveled with us.

Postscript - a message from Bob Epting

Bob Epting wrote us after the visit. His words are eloquent.

I am always struck, coming home from Duplin County, with the idea that we fly over it and see how it encompasses everything, and is inescapable, but then, we can come home.

The human beings who fed us last Thursday cannot simply fly away from the stench, or from the hog mess running off into the streams and seeping into the wells, fouling the air and water vital to their existence. They cannot anymore fly away from it than they can sell their polluted homes and move away. Nor should they have to. The political and financial powers that control their physical circumstances, and despoil their peace and happiness, fully control their options.

And yet they gather, and bring in friends, and others interested in their plight, and they make manifest, as they did for us, their faith and their courage.

I am encouraged…by the determination of the human spirit reflected in that meeting hall, by their strength and dignity.

I believe that we are put here, in this moment, to see whether we have the will, and reciprocal courage, to hear them, to recognize their suffering as ours to share, and to repeat their stories over and over again, speaking truth to the powers within the circles we are able to share…Truly, what we have seen should leave no doubt that we are a part of, not apart from, the natural universe, and that our highest duty ought to be to protect and engender an appreciation of our place and interdependence within the ecosystem.

At least this is how I have come to understand Public Health.

That’s an excellent way to describe public health!

For more information:

• Environmental Injustice in North Carolina’s Hog Industry by Steve Wing, Dana Cole and Gary Grant

• Putting Meat on the Table: Industrial Farm Animal Production In America: A Report of the Pew Commission on Industrial Farm Animal Production

• Farm-Aid’s facts about factory farms
  

July 4, 2009

Chapel Hill was very quiet over the weekend. Everywhere I went, people said things like “Everyone is away this weekend.” I kept feeling the need to say, “Well, not everyone is away!” Watching part of the DC Capitol celebration on TV, a place we have been several times, I thought what a strange, unsettling year it has been. In general, the American people have confidence in this new President. And there have been some positive economic indicators, but there sure aren’t any sustained positive signals.

We are preparing to implement permanent budget cuts at UNC and in our School, on top of the temporary cuts we already have sustained. Many of us now spend most of our time in budget discussions. Trying to cut 10% or more without damaging the core functions of the School is really a challenge. Although no one wants to pay more taxes, cutting spending alone is not going to solve our problems. It seems like time to raise taxes, including on foods like sugary soft drinks, and get on with it. See Governor Perdue’s cogent message.

The End of Overeating

That’s the title of the provocative new book (Rodale Press, 2009, NYC) by David Kessler, MD, former head of the FDA. I read the book over the weekend. Kessler makes a compelling, well-documented case that the food industry has engineered foods so that we want to overeat. His premise is that the industry has figured out how to make foods that are highly palatable and available. He points out through interviews and data that we now face “the taco chip challenge every day-the challenge of controlled eating in the face of constant food availability.” (p.128)  40 years ago, this wasn’t a daily challenge; now it is. By engineering the balance of fats, sugars and salt, the industry makes foods we crave, foods that may taste luscious but are dripping in empty calories and low nutritive value, are readily available, associated with positive emotions and in portions that are more than we need for weight maintenance, let alone weight loss. Over the years, as our faculty members Barry Popkin, PhD, Carla Smith Chamblee Distinguished Professor, nutrition, Penny Gordon-Larsen, PhD, associate professor, nutrition and others have shown, we have been eating more sugary drinks, larger portions and getting less exercise. It is a perfect storm to create the overweight and obesity epidemic that now envelops us.

I don’t want to demonize an industry. Many food companies have become more conscious of the obesity problem, and they have made changes. Kessler says we need a social consensus about the problem. He said we especially need to change our thinking about “big food.” We must work together on interventions for individuals, communities and policy changes that incentivize positive choices. Our School is perfectly positioned to lead the way.

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

Speaking without a net

Last week, I gave a talk titled Why does public health matter to us all? at Carolina Meadows, a retirement community in the Chapel Hill area where my parents live. It is a wonderful community, the kind there are too few of in this country. The support, services and people are fabulous. Although I’d committed to give the talk months ago, it was only about six weeks ago that I learned the room did not permit either slides or video. As an academic, I have become undoubtedly far too dependent upon these tools. And we have a wonderful School video I’d really wanted to show. Once it became obvious that I’d have to create a new presentation, I adapted, with some mental resistance. As I assembled the facts about why public health matters to us all, I became more enthusiastic about the assignment and more appreciative of how important it is to create messages before the slides. It is too easy to become dependent on slides, and sometimes the key points get lost in the dramatic presentation of the slides themselves. There have been many commentaries focused on why powerpoint can be deadly, and they’re right, up to a point.

Here are just a few of the reasons why public health matters to us all…

• When one person is infected with an infectious disease, it can put us all at risk. As the latest flu virus A(H1N1) shows us so clearly, diseases don’t stop at borders. We are more vulnerable than ever before to diseases that can be transmitted around the world.

• Lack of access to medical care due to lack of insurance or poor insurance is a national crisis and a local crisis. We have more uninsured people in North Carolina than many other states. In 2006-2007, 22 percent of North Carolinians were uninsured and didn’t have a usual source of health care. The number has increased.

• Lack of coverage hurts us all. Many uninsured people delay needed care and end up sicker, with bills shifted to others. In North Carolina, people with health insurance pay more for their health insurance premiums  – on average, an additional $438 per individual and $1,130 per family — to help pay for the cost of uncompensated care for the uninsured.

• The World Health Organization estimates that globally, more than 1.6 billion adults are overweight and 400 million are obese. They estimate that by 2015, there will be 2.3 billion overweight adults. This is a global epidemic that affects us all. Over 180 million people worldwide have diabetes; this number is expected to double by 2030.

• 36% of North Carolinians are overweight and 30 percent are obese. We have the eleventh highest obesity prevalence in the United States.

• 30% of our high school students are overweight or obese, and only 44 percent of our high school students meet adequate physical activity levels. Diabetes costs North Carolina $5.3 billion annually due to medical expenses, lost productivity and indirect costs.

And these are only some of the reasons why public health matters. Lack of safe water and sanitation, high-quality maternal and infant health care, and effective violence prevention and so many other issues plague our state, nation and world. Our School conducts research, teaches about and provides service in all these areas and many more.

The Carolina Meadows audience was astute, well-informed and very interested in public health. I appreciated the invitation. And once I got over needing to create a new presentation, it was a good reminder that sometimes one should fly without a net and go without slides!

Nicholas Kristof article

On Sunday in the New York Times, Nicholas Kristof had a very poignant article in which he described becoming pregnant as one of the most dangerous things a woman in Africa could do. In Sierra Leone, 1 woman in 10 dies in childbirth. We can do better. He closed with the line, “…women can be saved in childbirth — but only if their lives become a priority.”  I so appreciate Kristof’s observations on the world. He can awaken millions of people to this problem. Our School works on many aspects of this issue, including family planning. A  new WHO Collaborating Centre in global reproductive health, led by Herbert B. Peterson, MD, professor and chair of the maternal and child health department and a professor of obstetrics and gynecology at the UNC School of Medicine, will develop evidence-based guidelines for family planning and reproduction.

To Twitter or not to Twitter

I really want to use the new social media effectively. But I am trying to grapple with longer days, shrinking budgets and growing needs. There’s a lot of evidence that people in their 20s and 30s use Twitter and that for many of our students, Facebook is the way to communicate. But I am trying to figure out how to do it all and have it all. For the first time, I cannot answer all my e-mails and return all calls every day. So I find myself wondering, how many friends can I handle? I’d appreciate advice from readers.

Administrative review-onward

I was going to talk about the outcome of my administrative review, a process all senior leaders at UNC undergo in the fourth year of five-year terms. However, it’s late, and I risk trying my readers’ patience. So, next week, expect a few comments. Bottom line: I am pleased to have been reappointed. It is an incredibly difficult job, but it is the job I want to do. I love this School and University.

Happy Monday! Barbara