More links

1. Pneumococcal vaccine: Babies routinely get this vaccine, but older children, adults, and seniors need to keep it in mind too. This vaccine can protect those with underlying health conditions from getting pneumonia, a dangerous complication of influenza.
   

   "But because flu season lasts until May and more outbreaks are likely, some of those officials, including the top ranks at the CDC, have begun talking about the pneumonia vaccine, which they say could save thousands of lives a year and prevent debilitating effects of severe illness in many more."

2. Oh, that unhealthy Santa: Santa, the large jelly-bellied man who "visits" kids at Christmastime, sits around, gets pulled by reindeer, and eats cookies at every house he visits. What an unhealthy image for kids! This article suggests that Santa needs a carrot, not a cookie. And that's not even starting to talk about all the sick, snotty kids who sit on Santa's lap all day, every day this time of year. (Ew.)
   
   
3. Your tap water is legal, but is it healthy? This article discusses the outdated Safe Drinking Water Act, a 35-year-old law that covers a fraction of the thousands of potential chemicals and contaminants. And the effects of these contaminants may not be noticed until years after the exposure, making it difficult to pinpoint the source. The Environmental Protection Agency (E.P.A.) is looking into changing the standards:
   

   ".. Even the E.P.A., which has ultimate responsibility for the Safe Drinking Water Act, has concluded that millions of Americans have been exposed to drinking water that fails to meet a federal health benchmark.."

4. This very interesting blog post examines the latest health care reform proposal in the Senate for public health provisions. Examples include: focus on evidence-based medicine (we'll see how that goes over with the public - see the outcry about mammogram recommendations), emphasis on healthy communities and healthy lifestyles, authorizing the Epidemiology Laboratory Capacity program to increase surveillance capacity (yay!), addressing public health workforce shortages, and an emphasis on prevention.
   
   
5. Trust for America's Health has released a new report "which finds that the H1N1 flu outbreak has exposed serious underlying gaps in the nation's ability to respond to public health emergencies and that the economic crisis is straining an already fragile public health system." Surprise! The report scores states on their preparedness levels.
   
   
6. And finally, CSTE has released its 2009 Epidemiology Capacity Assessment report, which assesses states' capacity to perform essential public health services related to epidemiology and surveillance. Check it out!
   
   

Some recent links

1. This interesting article discuses evidence-based medicine and the recent mammogram recommendations (I know, they're still talking about it.) Take a look and see what you think.
2. As I've discussed before, climate change is expected to have a major impact on health and public health. This article is about its impact on mental health specifically. The point that makes the most sense is that climate change is expected to bring more natural disasters, bringing more life upheaval and therefore more stress and mental health issues.
3. Cancer death rates are declining, according to this article. Researchers who found this statistic examined colorectal cancer as an example, and found that the decline was mostly due to better screening. Here is the study from which the article draws, which is worth a read - interesting.
4. The CDC has reported that the death toll from H1N1 is at 10,000, but also suggests that the number of new cases could be trickling off. It says one in five Americans have had H1N1. Mike Osterholm says, in my opinion accurately, that this pandemic is not over:
   

   “So the C.D.C. says 50 million have been infected so far,” he said. “Another 50 million have been vaccinated. And maybe 20 million have got innate immunity because of their age. You do the math — that’s 120 million who are immune out of 320 million, so two-thirds of the population is still not immune. It’s amazing how many people are acting as if this is all wrapped up. The numbers could still go up dramatically.”

5. This article describes the dismal state of public health and its critical understaffed numbers. It's a great article.
   

   "If swine flu is a test of public health, we've already flunked. And we have only ourselves -- and the political leaders who have been disinvesting in public health since 1980 -- to blame."

6. Finally, a new report from the Institute of Medicine about the National Vaccine Plan seeks to elevate vaccines to a higher public health priority, increase funding, and other recommendations. This article explains the highlights of the report. The updated plan is expected to take effect in 2010. However, the development of this plan does not ensure its implementation:
   

   "Siegel has doubts that the proposed policy can be implemented and enforced. 'There are extremely difficult obstacles -- fear, noncompliance, media hype and poor government choices,' he said."

   
   

Today's links

First, the EPA set out new standards that airlines have to test and disinfect water on planes. Ew, you mean they weren't doing this before? Read here for the article, and read here for more from the EPA.

Second, and a biggie. The first doses of H1N1 vaccine are just now becoming available, and there is much excitement over it. According to this article, several states were offering the nasal spray to children, with shots beginning next week. Public health officials are battling myths and opposition to the vaccine, posing public relations troubles for CDC and state health departments.

Here is an article about immunizations and opposition to them.

Finally, a tongue-in-cheek article from the Huffington Post about Big Pharma and H1N1.

Enjoy!

Social determinants of health

It may be intuitive to those who are public health-minded, but one's environment influences one's health. Social determinants of health has a large body of literature, and this post will attempt to summarize it.

According to the WHO, the social determinants of health are "the conditions in which people are born, grow, live, work and age, including the health system." A person's circumstances heavily influences his or her health status as well as overall health inequities.

Recently, the NYTimes and the Robert Wood Johnson Foundation reported that "research suggests social circles influence public health behaviors." For example, one study cited in the article found that a person's risk of obesity increased by 10% when a friend gained weight. According to this pie chart, lifestyle can determine up to 51% of one's health. If that lifestyle is centered around unhealthy environments and behaviors, influenced by one's surroundings, we can improve health drastically by changing one's surroundings.

This image, from the Commission on Social Determinants of Health's final report, illustrates the relationship between determinants of health and health inequities. The report says, "the structural determinants and conditions of daily life constitute the social determinants of health and are responsible for a major part of health inequities between and within countries." This Commission called for three areas of action: to tackle the daily living conditions in which people are born, grow, live, work and age; to tackle the structural drivers of those conditions at global, national and local levels; and to carry out more research to measure the problem, evaluate action and increase awareness.


There are several reasons and theories of why socioeconomic status (SES) influences health so heavily. I won't detail them in this posting as there are many articles that do so quite well (try here and here). Included in the theories are reasons of income disparities, social capital, racial discrimination, access to medical care, social support, and more. Lifestyle and physical environment causes may explain many of these issues; these two factors point to broader cultural and social trends that construct a framework in which health may be 'doomed' to be poor.

There are numerous articles citing the lack of healthy eating options, sidewalks, and safe neighborhoods for poor communities. Driving in Atlanta, this situation is abuabundantly clear. The nice neighborhoods have great grocery stores, walkable sidewalks, and overall lovely atmospheres; in contrast, the poorer neighborhoods have small and dingy grocery stores, unwalkable streets, and rundown atmospheres. These poor environments are not conducive to healthy eating or physical activity, but perhaps more importantly they may make it difficult to have a happy and meaning life with high social capital and support, crucial to overall well-being.

In sum, there are a number of factors beyond genetic makeup and personal behaviors that determine health status. These factors are crucial for public health to address in order to improve the population's health.

A few links

Pistachio proposal could reduce food safety risks

Public health emergency funding takes hit

UN: Treaty expanded by 9 more dangerous chemicals

And last but certainly not least, "Do Everybody a Favor: Take a Sick Day." Seriously! If you're sick, don't come to work!

Chemical bath -- toxic chemicals in our products?

My last few posts have been about pregnancy and children...probably because I have a young niece in the family and another niece/nephew on the way. Babies on the brain! Regardless, there are a lot of moms out there who have been hearing information regarding possible carcinogens in their baby bath products. After a little bit of searching, sure enough I found a few articles and a nonprofit organization doing some real environmental research on cosmetics and bath products.

The Campaign for Safe Cosmetics did some laboratory testing on 48 baby bath products and found:

17 out of 28 products tested – 61 percent – contained both formaldehyde and 1,4-dioxane.
23 out of 28 products – 82 percent – contained formaldehyde at levels ranging from 54 to 610 parts per million (ppm).
32 out of 48 products – 67 percent – contained 1,4-dioxane at levels ranging from 0.27 to 35 ppm.

According to the site, 1,4-dioxane is a contaminant produced during manufacturing, the FDA does not require 1,4-dioxane to be listed as an ingredient on product labels. Without labeling, there is no way to know for certain how many products contain 1,4-dioxane—and no guaranteed way for consumers to avoid it. Most commonly, 1,4-dioxane is found in products that create suds, like shampoo, liquid soap and bubble bath.

For more information, visit their site.

In an effort for fair reporting and allowing the reader to hear both sides of the story, read about an article completely debunking the Campaign for Safe Cosmetics Report here: http://stats.org/stories/2009/baby_bath_cancer_mar13_09.html

I think it's important to have consumers and readers make their own decisions regarding their health. What is evident in both reports is that we are exposed to numerous chemicals in our bath and beauty products that we use every day. The chemicals may have health effects that are still currently unknown and it is up to epidemiologists and public health scientists to take into account all factors when making any conclusions. Whether the bath products of today will result in the cancer of tomorrow is yet to be determined. Overall, our environment has numerous possible carcinogens and we must attempt to limit our exposure to as many known carcinogens as possible. The epidemiology on this issue is still to be determined...

Can foreclosures cause public health problems?

What a cool article!
The gist of it: foreclosures = abandoned homes = neglected swimming pools = standing water = mosquitoes = increased incidence of West Nile Virus. What a connection to make.

Other possible public health problems that might result from foreclosures:
- Environmental toxin exposures as homes sit and are neglected.
- Mental health concerns stemming from homeowner stress. (A fact sheet about mental health & public health, another fact sheet, and an article.)
- Injuries from neighborhood kids playing around the foreclosed house.

Any other ideas?