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Among The Nairobi Dead: Harvard Humanitarian, Expectant Mother

The violent siege and hostage crisis at a shopping mall in Nairobi, Kenya, is reported to be over after a four-day standoff between the Kenyan government and the Somali Islamic extremist group al-Shabaab.

In its wake, more than 170 people were injured and 62 were killed.

This undated photo shows Ross Langdon and his partner Elif Yavuz in Australia. Regional Associates, an architecture and research consultancy, identified the two as the victims of the terrorist attack on Kenya’s shopping mall on Saturday. (AAP Image/AP)

This undated photo shows Ross Langdon and his partner Elif Yavuz in Australia. Regional Associates, an architecture and research consultancy, identified the two as the victims of the terrorist attack on Kenya’s shopping mall on Saturday. (AAP Image/AP)

Among the deceased is Elif Yavuz, 33, a native of the Netherlands and a 2013 graduate from the Harvard School of Public Health. She was visiting Nairobi to deliver her first child, due in early October. Her husband was also killed in the attacks.

While working towards her degree, Yavuz conducted extensive research on malaria in eastern Africa and was heavily involved in public health advocacy. She accepted a job with the Clinton Health Access Initiative after graduating.

The Dean of the Faculty at HSPH, Dr. Julio Frenk, released a statement to the Harvard community yesterday:

I am extremely saddened to let you know that Elif Yavuz, ScD, a 2013 graduate of our Department of Global Health and Population, was among the victims of this weekend’s senseless violence at a shopping mall in Nairobi, Kenya. As an HSPH doctoral student, Elif completed her dissertation research on malaria in eastern Africa. Elif was Dutch, and had lived and worked abroad for many years, both in Africa and in Asia. She was currently working with the Applied Analytics Team at the Clinton Health Access Initiative and preparing her thesis for publication.
Elif and her partner, who was also a victim in the attack, were expecting their first child in early October. Continue reading

Stud Study: Sperm Quality Better In Athletes, Worse In Heavy TV-Watchers

sperm

Guys, anybody need a boost off the couch in the wake of the Super Bowl? Here you go: A new study from researchers at the Harvard School of Public Health suggests that turning off your TV and getting back into playing sports rather than just watching them could be good for your sperm quality.

The study, just out online in the British Journal of Sports Medicine, surveyed 189 college-age men at the University of Rochester about their exercise and TV habits, along with health-related questions about diet, smoking and stress. It also analyzed their semen quality.

Lead author Audrey Gaskins, a Harvard doctoral student, sums up the results: “Men who were in the top category of physical activity, which translated into 15 hours or more per week, had 73 percent higher sperm counts than those who exercised for less than five hours a week.”

“Then we looked at TV-watching and found that the men who watched the most TV — more than 20 hours per week — had 44% lower sperm counts compared to men who watched almost no TV. Our results show that modifiable lifestyle factors — physical activity and TV watching — could have a big impact on sperm count.”

Research over the last several years has suggested that semen quality has been declining in most Western countries. Gaskins says the new study’s motivation was to determine whether sedentary lifestyles might explain that decline. It controlled for several other factors that might have been at work, including stress levels, smoking and diet. Continue reading

All 100 Million Mexicans Have Health Coverage, While To The North…

(Smooth_O on Wikimedia Commons)

The parallel is unmistakable. Before the reforms that brought in health coverage for all, Mexico had 52 million residents who were not covered. We here in the big rich neighbor to the north have about the same number of people — roughly 48 million in a recent count — who lack health insurance. Mexico has shown over the last decade that it is possible to cover everyone. We — well, you know.

Just out in the medical journal The Lancet is a sweeping look at how Mexico brought in universal coverage, and the health benefits the country reaped, including significant drops in the death rates among babies and children and mothers. A Lancet editorial concludes that Mexico has demonstrated that universal coverage, “as well as being ethically the right thing to do, is the smart thing to do.”

I’m afraid my first question to the Lancet paper’s lead author came out a little plaintive:  Why? Why could Mexico do it, reach universal coverage, while America seemingly can’t? Felicia Knaul is the director of the Harvard Global Equity Initiative and a senior economist for the Mexican Health Foundation. Her reply, by phone from Mexico City:

‘This country chose to believe in the fact that people’s access to health should not be defined by where they work’

“First let me just say, i think the United States is moving forward in the right direction and we just have to keep that forward movement going, in all sorts of senses. I can tell you why Mexico did it; I can’t tell you why the United States didn’t until now.

This country chose to believe in the fact that people’s access to health care should not be defined by where they work but rather by their need for health care. Number two, in addition to this being a right, a social entitlement, it was good for human development, for social development, for economic development, to make sure people were not going bankrupt and suffering impoverishment and catastrophe from trying to figure out how to manage the cost of health care.”

Was it, I asked, a convergence of historical forces? Continue reading

Harvard Health Care Blog Debut: How To Use Hospital Rankings


Click on your bookmarks tab, please, everyone. Announcing a new blog that looks very worth following: An Ounce of Evidence, featuring Dr. Ashish Jha, The C. Boyden Gray Associate Professor of Health Policy and Management at the Harvard School of Public Health.

In his first package, Dr. Jha not only analyzes the recent harvest of hospital rankings from U.S. News and World Report, Consumer Reports and The Leapfrog Group. He also offers guest posts from some of the the rankers themselves, discussing what they do and why.

Dr. Ashish Jha (HSPH)

As health policy goes, the blog is shockingly readable (yes, that’s a left-handed compliment if ever there was one) and uses car-shopping as a helpful analogy. For example:

If you’re lucky enough to find a hospital that gets rated highly by all three organizations, I’d take that in a heartbeat. It’s like finding a car that drives well, looks stylish, is reliable, and safe! No brainer. Unfortunately, those hospitals are rare. In Boston, Massachusetts General Hospital was ranked the #1 hospital in the country by U.S. News. It got an “A” from Leapfrog. It was near the bottom of Massachusetts hospitals in the CR rating, receiving a score of just 45 out of 100.

It can be easy to decide if the safety, or the style, or the performance of a car is most important to you. Unfortunately, choosing what’s most important in health care can make us ask difficult and seemingly unreasonable questions. Is my primary goal to survive my hospitalization, avoid infections and medication errors, or have a reasonably good experience? Every individual has to decide what matters most. If a low mortality rate is most important, U.S. News is your best bet. If you care most about patient safety, then Leapfrog is the way to go. Consumer Reports emphasizes infections, unnecessary radiation and patient experience. If those matter most, CR is your best bet.

My personal list ranks mortality as most important (by far), followed by safety, with patient experience an important but distant third. Others will make different choices.

So why, I asked, is Dr. Jha, a prominent researcher and practicing physician, adding a blog to his very full plate? He explained: Continue reading

Study Raises Major Questions About Nicotine Patches And Gum

A friend of mine has been chewing nicotine gum for about a decade now. I used to joke that we should buy stock in the makers of Nicorette, but it stopped being funny when he backslid into smoking a few weeks ago. I’d thought the gum was supposed to help wean you. Instead, in him, it seems to have maintained an addiction that eventually reverted back from gum to butts.

A new Harvard/UMass study seems to bear out his experience, and raises major questions about nicotine replacement. It found hundreds of smokers who had just quit and followed them over several years; relapse rates were the same whether the quitters used nicotine replacement — gum or patches — or not.

The evidence looks fairly strong in the medical literature that nicotine replacement does help people quit. So does this study mean, I wondered, that the replacement methods help people quit but do not prevent relapse? Harvard researcher Hillel Alpert responded: “The evidence for NRT helping people is for short-term quitting and not long-term abstinence; and it does not necessarily capture the experience in the real world, as our study demonstrates.”

The study’s press release:

Nicotine replacement therapies may not be effective in helping people quit smoking

Boston, MA – Nicotine replacement therapies (NRTs) designed to help people stop smoking, specifically nicotine patches and nicotine gum, do not appear to be effective in helping smokers quit long-term, even when combined with smoking cessation counseling, according to a new study by researchers at Harvard School of Public Health (HSPH) and the University of Massachusetts Boston. Continue reading

A Behind-The-Ledger Look At Partners HealthCare’s Billions

Partners HealthCare's capital spending

Partners HealthCare, the state’s biggest and richest hospital system, fills me with confusion and cognitive dissonance.

Partners does angels’ work: all the cutting-edge research and top-flight tech at Mass. General, Brigham and Women’s and other hospitals. But when it comes to health care costs, Partners is seen as one of the prime culprits behind the high prices that are driving up our health insurance premiums and bedeviling our economy.

(An editor-friend prompted, “So it seems to you that Partners epitomizes almost everything that’s right and everything that’s wrong with the American health care system?” “Damn, you’re good,” I said.)

I went to see Peter Markell, chief financial officer of Partners HealthCare, about a fascinating set of Partners financial slides that were until recently knocking around the Internet. Peter provided updates on the data, and explanations. The first slide, above, shows the Partners system’s capital spending total for 2009-2013: a staggering $3.2 billion. That’s a scale that virtually none of the state’s other hospitals can even dream about.

‘People want to walk into a place that makes them feel good.’ (‘Good, yes,’ I thought. ‘But $687-million-good?’)

Peter described a dynamic process in which Partners holds its operating margin — its excess of revenue over expenses — at roughly 2%, then chooses the best from among a superabundance of staffers’ ideas for spending its capital budget.

That sounds like the best of choices, but others question whether the hospital system is making the right choice writ large, by spending so hugely. Professor Nancy Kane of the Harvard School of Public Health says she sees these Partners’ slides’ message as “Whatever we want to spend, we should be able to spend, regardless of the cost or affordability to taxpayers and Massachusetts small business premium payers.”

The big picture Continue reading

Ask Deval Patrick Your Health Reform Question


The Harvard School of Public Health is making an offer we cannot refuse: Send in your health care reform question for Gov. Deval Patrick and he could answer it during a Webcast tomorrow afternoon. You can also send a question for any of these local luminaries on the discussion panel:

John Auerbach, Commissioner, Massachusetts Department of Public Health
Hurmon Hamilton, President, Greater Boston Interfaith Organization
Nancy Kane, Professor of Management, Harvard School of Public Health
John McDonough, Director, Center for Public Health Leadership, Harvard School of Public Health; former Executive Director of Health Care for All

They’re all slated to speak on the next phase of health care reform — costs and quality — at a forum at the school of public health’s aptly named “Forum,” which aims to bring scientific experts and political decision makers together on urgent health topics. It is scheduled to be Webcast tomorrow at 4 p.m. here. I just asked WBUR’s Martha Bebinger, my revered health care policy sage, what our question should be, and we came up with this:

What is your best indication that a shift to global payments will actually save money, and how soon do you think those savings can actually be realized?

Okay, just sent it in to theforum@hsph.harvard.edu. Readers, if you send in a question, feel free to cut and paste it as a comment here as well. Just wondering what you’re most wondering!

Election’s Effects On Health Care Reform: New Harvard Public Health Forum Webcast


What comes next? After today’s election, that is, for health care reform? Experts will try to answer that question in a Harvard Webcast this Friday at 1:30.

We don’t normally post calendar events, but this one marks the “soft launch” of a high-profile new Harvard institution that aims to become a forum on some of the most burning topics in public health.

In fact, it’s called “The Forum at Harvard School of Public Health,” and you can learn more about it here. In brief, it’s meant to be “an exchange focused on health issues and controversies of current concern to decision-makers around the world.”

Says the forum’s director, Robin Herman: The Harvard School of Public Health has built a state-of-the-art broadcast facility for webcasts and videoconferences in its main building and plans to have live (and on-demand) webcasts around compelling health issues that require immediate decision-making.

The next Forum event will be its “official ceremonial launch” and is scheduled for Dec. 9 with philanthropist Ted Turner in conversation with Dean Julio Frenk on how to meet UN development goals for global health.

Warm Neighbors Make for Better Heart Health

row-house

matturick via Flickr

Are your neighbors good for your health?

After winter storms, our neighbor, Chuck, gets out his snowblower and clears the sidewalk for the whole street. Every time I see him do that, I feel a surge of pleasure at his kindness somewhere deep in my heart. Or maybe my arteries. Something cardiovascular, anyway.

A new study out of the Harvard School of Public Health documents the “Chuck” effect on women, only they call it “social cohesion.” As the Harvard Gazette reports, women in neighborhoods where people are isolated have much higher rates of coronary artery calcification, a marker for heart disease.

According to the researchers, social cohesion, defined as strong, trusting relationships between neighbors, can improve people’s health by lowering stress and depression, fostering the sharing and reinforcing of healthy behaviors, and strengthening a neighborhood’s effectiveness in advocating for improvements in local services.

Do you have a neighbor who’s good for your health? Share your story — give them the glory they deserve!