public health

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U.S. Health Care Is Less Private, More ‘Socialist’ Than You Might Think

The extent of the government's role in health care has become a key issue in the Democratic presidential primary. Here, candidates Hillary Clinton and Bernie Sanders are seen in a debate on Jan. 17 in Charleston, S.C. (Mic Smith/AP)

The extent of the government’s role in health care has become a key issue in the Democratic presidential primary. Here, candidates Hillary Clinton and Bernie Sanders are seen in a debate on Jan. 17. (Mic Smith/AP)

By Richard Knox

Readers, a pop quiz:

The proportion of U.S. health care paid by tax funds is (a) less than 30 percent, (b) about half or (c) more than 60 percent.

If you picked “more than 60 percent,” you’re right — but you’re also pretty unusual.

“Many perceive that the U.S. health care financing system is predominantly private, in contrast to the universal tax-funded health care systems in nations such as Canada, France or the United Kingdom,” David Himmelstein and Steffie Woolhandler write in a new analysis of U.S. health spending in the American Journal of Public Health.

They find that 64.3 percent of U.S. health expenditures are government-financed. And they project the tax-supported proportion will rise to 67.1 percent over the coming decade as the baby boom generation ages and retires — nearly as high as Canada’s 70 percent.

“We are actually paying for a national health program, we’re just not getting it,” Woolhandler says.

tax dollars for U.S. health spending

Now, Himmelstein and Woolhandler have an agenda. For decades, they’ve been perhaps the leading researchers promoting the kind of single-payer health system that Socialist and Democratic presidential candidate Bernie Sanders has put on the debate agenda. One recent poll suggests more than half of Americans (and 30 percent of Republicans) support the idea.

But even if you disagree with the Himmelstein-Woolhandler ideology, their research is generally regarded as sound, and their method is straightforward.

They added up what federal and state governments spend on health through Medicare, Medicaid, the Veterans Health Administration, government employees’ health care premiums, tax subsidies and other programs. They argue that accounting by government agencies (the Center for Medicare and Medicaid) undercounts the real tax burden because it leaves out major pieces of the pie — such as government employees’ care ($156 billion a year) and tax subsidies for private, employer-sponsored coverage (nearly $300 billion).

And whatever you think about Medicare-for-all, it’s a good idea to see the present U.S. health care system for what it is — an increasingly government-funded financing scheme. Continue reading

Rare Common Ground: Gun Dealers And Public Health Workers Unite To Cut Suicides

(Image taken, with permission, from a New Hampshire Firearm Safety Coalition poster)

(Image taken, with permission, from a New Hampshire Firearm Safety Coalition poster)

By Richard Knox

The elegantly dressed woman looked out of place at Riley’s Sport Shop, the largest gun dealer in New Hampshire. Owner Ralph Demicco was behind the counter. He noticed she didn’t make eye contact.

“I’d like to buy a gun,” she said. “Could I see that one?”

Demicco sensed something was amiss. “Should you really be buying a gun?” he asked.

She immediately broke into tears. “I took her into the backroom,” Demicco recalls. “She confided that she’d been released from the state mental hospital in Concord that morning. She said she told her doctor she wasn’t ready to go and if he discharged her she was going to take her life. Apparently he didn’t put any stock in that.”

Demicco asked the name of her psychiatrist, then told her to go home and wait for the doctor to call. Then he called the doctor, who intervened. It was a suicide that didn’t happen.

The incident stuck with Demicco. But it wasn’t until later that he realized that gun dealers could take more concerted action to prevent gun suicides — by far the nation’s leading cause of firearm fatalities. That came after a Dartmouth Medical School injury prevention researcher alerted him that three different customers had killed themselves in a single week within hours or days of buying their guns at Riley’s.

The partnership is a rare instance of common cause between gun enthusiasts and public health proponents, amid increasingly polarized public views.

“That was stunning,” Demicco says. He started meeting with the Dartmouth researcher and other gun retailers and health workers. They decided to create a group called the New Hampshire Firearms Safety Coalition. Their idea is catching on — in Massachusetts, Vermont, Maryland, New York, Virginia, Tennessee, Texas, Colorado, Utah, Nevada and California, according to Elaine Frank, chair of the New Hampshire coalition.

Frank is the Dartmouth injury-prevention specialist who alerted Demicco to the problem. Early on in the coalition’s work, a public health worker came to a meeting after talking to gun shop owners around the state. She expressed surprise they were so positive.

One of the gun dealers in the group said, “I could be insulted by that,” Frank recalls. “He said, ‘Why would you think we’d be less interested in suicide prevention than you are?’ It was absolutely an ‘aha!’ moment.”

The partnership is a rare instance of common cause between gun enthusiasts and public health proponents, amid increasingly polarized public views on how to reduce the nation’s death toll from firearms. It’s not embraced by all gun proponents; some fear it’s a stalking horse for more gun controls.

But it’s a real-life example of what President Obama and others are calling for: a public health approach to the nation’s gun violence crisis.

“The concept of collaboration, which is often lost, is very much alive in this area of suicide prevention,” says Bill Brassard, spokesman for the National Sport Shooting Foundation, which represents gun dealers.

A prominent gun control advocate at the Harvard H.T. Chan School of Public Health agrees. “What you want to do are the things that are easiest to do — the low-hanging fruit — and show we can work together,” says David Hemenway, author of “Private Guns, Public Health.” “It takes a long time to build trust. But this is happening.”

The payoff could be large — potentially bigger than gun control measures proposed to stem homicides.  Continue reading

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Bad Odors And Brain Fog: 5 Things Nobody Tells You About Quitting Cigarettes

On a break from his midday hosting duties, WBUR's Jack Lepiarz lights up outside the station. (Robin Lubbock/WBUR)

On a break from his hosting duties, WBUR’s Jack Lepiarz lights up outside the station. (Robin Lubbock/WBUR)

WBUR’s Jack Lepiarz is no wimp. He not only braves live air multiple times a day as the station’s midday anchor, he also performs around the country as a circus whip-master, and even recently attempted to break the Guinness world record for whip strokes per minute.

But Jack has yet to defeat the most insidious physical and psychological challenge many of us ever face: his smoking habit.

He has plenty of company: Almost 1 in 5 Americans smoke, the CDC says. He writes here about some of the unexpected obstacles involved, in hopes of helping other would-be quitters and their supporters. And he’ll document his fight periodically this year. Please stay tuned. — Carey

I’m about to try again. This weekend will mark my fourth attempt to quit smoking over the last 10 weeks or so. At age 27, I’ve been smoking for a little more than seven years, with multiple attempts to quit every year since three months after I started. When they tell you that nicotine is as addictive as heroin, they’re not kidding.

I’m at the point where I’ve started and stopped so many times that I know what I’m getting into, but every time, I seem to notice a new symptom or side effect of nicotine withdrawal. Almost always, I’m surprised. We hear about cigarette cravings, irritability and other symptoms of withdrawal — but the process of quitting also carries with it some other, lesser known symptoms.

1. The Mental Fog

By far my least favorite side effect, and one that I find the hardest to explain. You know that feeling you have right after you wake up? Half present, half in another world? This is your brain — not on drugs. I’ve described it as similar to going a day without coffee — except worse. (Believe me, I’ve tried.) Or being in a state of constantly having just had two beers. You can’t focus, you can’t sit still, you can’t formulate any thoughts that last in your brain for more than 30 seconds.

Except for how much you want a cigarette.

2. The Smell

This is one that sneaks up on you. Most people know that smoking dulls your sense of taste and smell, but it’s such a gradual process when you start smoking that you don’t notice it. For me, it rarely takes more than 36 hours to get those senses back strongly — and never in a good way.

The first time I really noticed it was last winter, when after a day of not smoking I drank a soda and nearly spat it out. I never knew it was that sweet.

The smell aspect hit me when I tried to quit on a hot, humid day in July. Long story short, we all need to wear more deodorant. Also brush our teeth more. Also, cities just smell awful in general. Also, yes, I recognize the irony of a smoker complaining about bad smells. You notice just how bad cigarettes smell, too.

3. The Constant Hunger Continue reading

Analysis: Controversy Over CDC’s Proposed Opioid Prescribing Guidelines

OxyContin pills are arranged at a pharmacy in Montpelier, Vt. in this 2013 file photo. Opioid drugs include OxyContin. (Toby Talbot/AP)

OxyContin pills are arranged at a pharmacy in Montpelier, Vt. in this 2013 file photo. Opioid drugs include OxyContin. (Toby Talbot/AP)

Updated at 3 p.m.

By Judy Foreman

The U.S. Centers for Disease Control and Prevention recently came out with controversial proposed guidelines for opioid prescribing through a process that critics say may harm pain patients and is based on relatively low-grade evidence.

One of those critics is Cindy Steinberg, national director of policy and advocacy for the U.S. Pain Foundation, a patient advocacy group which receives funding from opioid manufacturers. Steinberg said in an interview and in emails that she’s worried the guidelines may negatively impact patients suffering with severe pain. “I am concerned that if these guidelines go forward as they are now written, they will lead to further restrictions on access to opioids for people with unremitting pain who truly need them and take them responsibly,” she said.

Dr. Jane Ballantyne, president of the non-profit Physicians for Responsible Opioid Prescribing (PROP), which is part of a larger group involved in the guidelines process, said in a telephone interview that the worry about limited access to opioids for chronic pain patients is a “very legitimate fear.” But, she added: “We don’t want to reduce access for people already dependent on opioids. The guidelines are designed to not have so many people dependent on opioids in the future…”

Ballantyne said that the new guidelines are similar to previous guidelines with two key exceptions: lower dose limitations and the recommendation that, for acute pain not related to major surgery or trauma, opioids should be prescribed for only three days.

The month-long period for public comment on the proposed guidelines will be over Jan. 13.

A major concern of some critics is the lack of solid evidence backing up the guidelines, which give recommendations on prescribing practices; they include when to start opioids, how to establish treatment goals, how to discuss risks and benefits, recommended limitations on drug doses, duration of treatment and other issues. Continue reading

Harvard Researchers: Make Police Killings A Matter Of Public Health

In this Oct. 20, 2014, frame from dash-cam video provided by the Chicago Police Department, Laquan McDonald, right, walks down the street moments before being shot by officer Jason Van Dyke in Chicago. Van Dyke has now been charged with murder. (Chicago Police Department via AP)

In this Oct. 20, 2014, frame from dash-cam video provided by the Chicago Police Department, Laquan McDonald, right, walks down the street moments before being shot by officer Jason Van Dyke in Chicago. Van Dyke has now been charged with murder. (Chicago Police Department via AP)

By Richard Knox

Every week, it seems, a new police killing enters the news stream, sparking outrage, breeding cynicism, fraying still further the social compact between police and communities.

The issue reached a new peak just this week, when the Justice Department announced a probe of the Chicago Police Department, the nation’s second-largest, to determine if there has been “systematic misconduct.” The investigation comes in the wake of social unrest and the recent firing of the police commissioner, after two police killings there.

In fact, police killings happen in America far more often than once a week.

The best available data come from news organizations, such as a website launched earlier this year, ironically enough, by the British newspaper The Guardian. They show that U.S. civilians die at the hands of police nearly three times a day. So far this year, 1,055 Americans have been killed by police, by The Guardian count. The Washington Post has tallied up 913 people “shot dead by police this year.”

About 120 law enforcement officers were killed in the line of duty last year, according to the National Law Enforcement Officers Memorial Fund.

Run through the Guardian’s website of civilian police-related deaths, called “The Counted,” and you’ll see that many of these everyday police killings involve suspects who were armed and menacing. The 14 people killed in the past week include the San Bernardino shooters and others who reportedly were threatening police officers. These are not the kind of cases that generate Black Lives Matter protests, although they shouldn’t necessarily be classified as justifiable use-of-force without careful investigation, either.

“No act of Congress is needed,” they write. “No police departments need to be involved. Public health agencies can do the job.”

The typical investigation focuses on the circumstances and actions in a specific case. But larger forces may be driving the phenomenon as well, forces that don’t get identified in case-by-case investigations. And that’s just the point of a new proposal, out Tuesday, that makes a strong case for collecting data on law enforcement-related deaths a matter of public health.

The authors, from the Harvard School of Public Health, assert that these killings — both by and of police — should be “notifiable” to public health agencies, just like homicides, suicides, many infectious disease deaths, work-related fatalities and injuries, and death by poisoning, fire and spinal cord injuries. That means they should as a matter of law be reported to health departments; currently police-related deaths are reportedly voluntarily (or not).

The Harvard researchers write, in the journal PLoS/Medicine, that death and injury due to police encounters are “a matter of public health, not just criminal justice, as is the occupational health of law-enforcement officials.”

“Deaths are part of our bailiwick,” lead author Nancy Krieger says.

She argues that only by compiling data on a national basis (but with details specific to local jurisdictions) can public health scientists identify time trends, racial-ethnic and geographical disparities, and other relevant indicators. And only then can they put these events in context with, say, the racial makeup of communities and police forces.

Such data now are fragmentary and delayed. Using what’s available, the researchers charted arrest-related deaths in eight U.S. cities at the top of The Guardian’s rankings, along with some recent hotspots such as Ferguson, Missouri.

“We show enormous variability over time among the eight cities,” Krieger says.

Take, for instance, the critical issue of black-white differences in who dies as the result of a police encounter. Continue reading

You Hate Leaf Blowers, Your Neighbor Uses Them: How One Town Seeks Middle Ground

(GBaile/Wikimedia Commons)

(CBaile/Wikimedia Commons)

About five years ago, Jamie Banks noticed that the whine of gas-powered leaf blowers around her home in Lincoln, Massachusetts, had grown from an occasional burst of nearby noise to a frequent, high-decibel din that could last for hours, several days a week.

She would wake up to the engine roar, she says, step outside and observe landscape workers wielding four or five blowers, raising a 30-foot-high miasma of dust that commuters would skirt as they walked to the nearby train station in the town center.

“At my home it had become a 360-degrees surround-sound situation,” she said. “It was ubiquitous.” And it was all year round, Banks added, the machines used not just for leaves but to clear parking lots and driveways, gutters and planting beds. Even to blast snow off roofs.

A health care researcher with a Ph.D, Banks began looking into the health effects of the fine dust, exhaust pollution and noise caused by leaf blowers, and found causes for concern — including a clear recommendation against using gas-powered leaf blowers and lawn equipment from the American Lung Association.

In 2012, Banks teamed up with Robin Wilkerson, a Lincoln garden designer who worried not just about the noise and dust and carbon footprint of leaf blowers, but also about their impact on the land.

“People were scouring their land of valuable organic matter,” Willkerson said, and then often replacing it with dyed mulch from Louisiana. “It just seemed like lunacy.”

Something needed to be done, they both decided.

At this point in the story, which has played out in many towns and cities around the country, a big fight ensues. Residents who hate the blowers try to get the machines banned. Landscapers, landlords and homeowners who use the blowers fight back. The neighbor-vs.-neighbor battles often grow heated, as they have recently in the big Boston suburbs of Newton and Brookline.

And often, the attempts to regulate lose. Some California towns banned leaf blowers back when they were new in the 1990s, but blower use has been growing enormously, and relatively few towns have blocked them or successfully enforced limits.

In New England, where leaf-peeping season is now routinely followed by leaf-blowing season, no town has passed an outright ban, though a few have imposed restrictions.

First-World Problems

First-world problems, you might say. And you might be correct. Lincoln, a gorgeous New England hamlet of old stone walls along winding, wooded lanes, is one of the richest towns in the U.S., with median annual household incomes topping $100,000. The leaf blower issue naturally tends to arise in affluent suburbs where people can afford landscapers and increasingly seek a manicured look.

But it can surface just about anywhere there are trees and blowers, and it doesn’t seem trivial if it’s happening where you live or (try to) work.

No less a literary personage than James Fallows of The Atlantic, who has become very vocally active against leaf blowers, argues that the issue speaks to big concepts about collective versus private life. A trenchant New Yorker article on the mother of all leaf blower regulation fights in California found that it became “a referendum on what it means to be a neighbor.”

As Banks and Wilkerson learned more about the battles over bans around the country, they decided to pursue a more positive path in Lincoln.

They started in 2012 by forming a citizen group, Quiet Lincoln, to spread word about the issue. The next year, in 2013, they asked their fellow citizens at Lincoln’s Town Meeting to approve a study panel. And thus, the Lincoln Leaf Blower Study Committee was formed.

No landscaping companies joined, but the panel did include members from the Department of Public Works, which uses blowers, and the Rural Land Foundation — which owns a small collection of stores and offices in the town known as the “mall,” and employs landscapers to maintain it — along with residents.

The committee surveyed the town to get a sense of people’s feeling about leaf blowers, and found that 46 percent of respondents were bothered by the noise and 37 percent by the dust and air pollution.

“We recognized the importance of education if we were to get town support around this issue,” Banks said. “This is a problem that affects some individuals and not others, so it’s very hard to get broad-based support.” Continue reading

Exploring The Link Between Chronic Pain And Suicide

By Judy Foreman

This week’s grim report about rising suicide and overall death rates among white, middle-aged Americans contains a slim silver lining. Here it is:

The new analysis by two Princeton economists, Anne Case and Angus Deaton, suggests that chronic pain — and the opioids used to treat it — may be a key driver of the rising deaths. While the “noisy” opioid epidemic has garnered near-daily headlines across the country for several years now, the equally horrible but silent epidemic of chronic pain has not yet broken through into the nation’s consciousness. Maybe things are beginning to change.

Many people still don’t realize it, but 100 million American adults live with chronic pain, many of them with pain so bad it wrecks their work, their families, their mental health and their lives.

There are no hard data on how many people with chronic pain die by suicide every year. But there are inferences. The suicide rate among people with chronic pain is known to be roughly twice that for people without chronic pain.

(jennifer durban/Flickr)

(jennifer durban/Flickr)

Since there are 41,149 suicides every year in the U.S., according to the National Center for Health Statistics,  it’s possible that roughly half of these suicides are driven by pain. Not proven fact, but plausible hypothesis. This would suggest that perhaps up to 20,000 Americans a year with chronic pain kill themselves, which would be more than the government’s tally of 16,235 deaths from prescription opioids every year.  According to a CDC spokeswoman:

In 2013, there were 8,257 deaths that involved heroin and 16,235 deaths that involved prescription opioids. These categories are not mutually exclusive: if a decedent had both a prescription opioid as well as heroin listed on their death certificate, their death is counted in both the heroin as well as the prescription opioid death categories.

The truth, of course, is devilishly difficult to figure out with any certainty. Many people in severe, chronic pain have, and should have, opioids available. But unless they leave a suicide note it’s virtually impossible to tell if they overdose on purpose or accidentally. That’s in stark contrast to a pain patient who ends his or her life using a gun. That’s clearly a suicide, with or without a note.

In the course of researching my 2014 book on chronic pain, I heard many grisly stories. One Salt Lake City truck driver I interviewed would be dead today if his wife hadn’t walked in on him with a gun in his mouth. He had been in severe headache pain and after many visits to the ER, was repeatedly dismissed as a drug seeker, even without a medical workup. (Eventually, he was diagnosed with two brain aneurysms, bulging weak spots in a blood vessel). Continue reading

Beyond Medicine: The Road From Health Insurance To Health

By Katherine Gergen Barnett, M.D., and Lauren Taylor, MPH, M.Div

Now that as many as 6.4 million low- and middle-income Americans across 34 states have health insurance as a result of the Affordable Care Act, it’s worth asking this question: When does health insurance turn into actual health?

It’s a legitimate question because the impact of health insurance on health has been shown to be less impressive than we might wish. At least one study out of Massachusetts, for instance, has demonstrated reductions in mortality associated with insurance status, while other studies out of Oregon show only modest reductions in mental health disease burden. So how much health have we really gained nationwide from the ACA’s insurance expansion? It remains to be seen.

In the meantime, it may be time to turn our collective attention to a slightly different question: Where else in Americans’ lives might we find more substantive ways to improve health?

The Blue Cross Blue Shield of Massachusetts Foundation recently released a report which might help answer some of these questions. Researchers, led by Elizabeth H. Bradley, Ph.D., of the Yale School of Public Health, reviewed available literature on the health improvements and cost reductions associated with interventions beyond the scope of traditional medical care. The authors point to the strong evidence that increased investment in selected social services — housing support, nutritional assistance, case management for low-income families, children with asthma and seniors — as well as various models of partnership between health care and social services can offer substantial health benefits and reduce health care costs for targeted populations.

 In other words, the research demonstrates that when these interventions are targeted at high-cost, high-need patients, the results can make a huge difference in people’s lives, and also save the system money.

As a longtime primary care physician working in an urban hospital, my patients (often underserved families) confirm this empirical evidence. Here’s just one example:

The mother of a family has been coming to me for years. Her body and medical chart are riddled with multiple diagnoses: high blood pressure, chronic pain, anxiety, depression, high sugars and obesity, for which she takes numerous medications. Her life was chaotic — homeless with two young girls, a constant state of fighting in shelters, hyper vigilance for her girls’ safety and a state of depression that was only getting darker. Her girls also started getting their care through me and though they were more resilient in this state of constant flux and stress, their own lives were slowly falling apart in the long shadows of their mother’s mental illness. As a physician, it was hard to know where to start to get this family back to better health. As a mother myself and a public health advocate, I knew I had to start with the mother and her primary concerns.

And so in every visit we addressed her housing issues — filling out form after form, making calls and writing letters — alongside her other medical issues. Last year, she came in elated. She finally had secured housing. The next several visits were a flurry of pictures — new bedrooms and her smiling girls. But far beyond the pictures, there was a transformation. My patient started seeing a therapist again, taking her psychiatric medications, exercising and taking better care of her body. Her daughters also came to see me in the months that followed and it was if they were plants in the sun, finally growing back into their girlhoods. The oldest was just starting to dream about college. And though I am not naïve enough to think that their secure housing will make their health consistently good, it shifted the landscape entirely. Enough that they were able to start taking care of their lives and each other.

Continue reading

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Vomiting Up Brunch? Your Angry Tweet May Save Others From Food Poisoning

When you're in this position, you likely don't want to call health officials and report food poisoning. (Irina Souiki/Flickr)

When you’re in this position, you likely don’t want to call health officials and report food poisoning. (Irina Souiki/Flickr)

By Chelsea Rice

One of the last warm Saturdays in September, my boyfriend and I planned to celebrate his birthday at a Cambridge restaurant that friends had praised as their favorite brunch spot. The food tasted great: We shared a plate of oysters to start, and he enjoyed eggs Benedict for his main course while I opted for a breakfast take on the classic BLT sandwich, mainly because it was served on a croissant, a buttery weakness of mine.

But upon arrival back home…our brunch backfired.

I ran out to pick up the birthday cake. When I returned, I found the birthday boy almost paralyzed by stomach pain, feverish and violently ill. While he spent the rest of his birthday in a migratory pattern between the bathroom and bedroom, I waited to see if I would get sick and searched online to learn how to report the food poisoning.

Turns out that here in the Boston environs, residents call a special number at the Boston Public Health Commission. It connects with a public health nurse who asks questions about symptoms, what you ate over the past few days, and where you ate it. On that memorable day, I shouted this option into the bathroom at my sick partner, but he was so nauseous he could barely talk to me. Reliving what he had eaten in the past 48 hours was the last thing he wanted to do.

As a health journalist, I know it’s important to report food poisoning — one in six Americans gets it every year. But as a consumer, filing a public health report can be an intimidating and impersonal process for a very personal — and vulnerable — experience.

We told all our friends and canceled the rest of the festivities, vowing never to return to the scene of the crime, but I still wondered: Were we selfish? Could we have helped others with our story? Have other diners had a similar experience at that restaurant?

According to the restaurant’s worst reviews on Yelp, the list is long. (I’m not naming it to give it the benefit of the doubt — maybe it was having an off day? — but the picture is grim.) The worst reviews include bugs in the plates, under-cooked proteins and foreign objects that broke a tooth. There are even a few that reported diners getting sick after eating there. And those are just the brave few who posted. I was alarmed that this restaurant still had a line and a reservations list with complaints like that. There’s no way a health department could ignore claims like these, I thought, if they were written up in an official report.

Little did I know, there’s a new bridge between social media and public health that is finally crossing that divide.

In 2011, a research group out of Boston Children’s Hospital published a study using extracted, keyword-related Yelp reviews, showing that the ingredients people described in their reviews about food-borne illness matched up with relevant ingredients that the CDC reported were involved in food-borne outbreaks for that time.

An excerpt from HealthMap's tool to track tweets related to foodborne illness (Courtesy of HealthMap)

An excerpt from HealthMap’s tool to track tweets related to foodborne illness (Courtesy of HealthMap)

Now, that team is taking their work to help cities across the country address and more accurately monitor food-borne illness with HealthMap Foodborne Illness, part of a larger social media disease-tracking initiative based at Boston Children’s.

“When someone talks about diarrhea on Twitter they are really looking for people to care, and that’s really what it’s all about.”

– Dr. John Brownstein

Dr. Elaine Nsoesie and Dr. John Brownstein, who co-founded the project, are working with New York City, Chicago, St. Louis and other major cities to customize their foodborne disease tracking tool for each city’s needs.

“It’s hard to make people come to you,” said Brownstein. “People aren’t engaged necessarily in public health.” But if you can tap in to their online voices, he said, “you can actually get a huge amount of information that would not come from another vehicle.”

In Chicago, the city’s public health department monitors Twitter in a social media tracking initiative that HealthMap customized for them called FoodborneChicago. The tool filters tweets that are geocoded to a specified area through a system that recognizes key words related to food poisoning. Think “sick,” “food,” “vomiting,” “diarrhea,” “poisoning” and various combinations like “restaurant made me sick” or “vomiting after that lunch.”

A public health official can monitor the filtered tweets live, and sort them into “relevant” (ambulance icon), “questionable” (question mark) and “irrelevant” (trash can), as in the image above. Continue reading

WHO Says Processed Meat Causes Cancer, So Should We Stop Eating It Altogether?

Is this the end of bacon, hot dogs and corned beef on rye? (Didriks/Flickr)

Is this the end of bacon, hot dogs and corned beef on rye? (Didriks/Flickr)

Is this the end of bacon, hot dogs and corned beef on rye?

How should consumers react to news from the World Health Organization that these and other processed meats can cause cancer, and that red meat, including beef, pork, veal and lamb, are “probably carcinogenic to humans” too? Should we abstain completely now that the WHO’s International Agency for Research on Cancer (IARC) put processed meat in the same cancer-risk category as tobacco and asbestos?

Here’s the bottom line risk, from the IARC news release: “The experts concluded that each 50 gram portion of processed meat eaten daily increases the risk of colorectal cancer by 18%.”

Processed meats have previously been inked to a range of illnesses, from heart disease to diabetes and cancer. But even with this big news from the WHO, many nutrition and public health experts said that reducing consumption of such meats is key, not eliminating them altogether.

Frank Hu, a professor of nutrition and epidemiology at the Harvard School of Public Health, says there’s no need for everyone to suddenly become vegetarian or vegan. But, he said in an interview, he hopes the WHO announcement will spark real dietary change.

He made three points:

1. The WHO Announcement Is Big 

“I think the WHO announcement is very significant from a public health point of view because processed red meats have already been linked to type 2 diabetes, cardiovascular disease and other chronic disease, and this provides convincing evidence that consuming processed meats, like bacon, sausage, hot dogs, is linked to an increased risk of colorectal cancer in particular. Cutting back on red meat and processed meat reduces risk of diabetes and cardiovascular disease, but also reduces the risk of cancer. Improving your diet can actually be beneficial for reducing your cancer risk.”

2. You Don’t Need To Quit

“I’m not a vegetarian. This doesn’t mean everyone should become a vegetarian or vegan. Processed red meat should be consumed as little as possible — once or twice a week should not be a major problem. For unprocessed red meat, consumption should be moderate, but that’s hard to quantify; maybe every other day. We’re not talking about banning hot dogs, sausages or bacon, but we should change our dietary pattern from a meat-based diet to a more plant-based diet. That’s not really a new message. This message will hopefully raise more awareness. Hopefully it will motivate people to change their eating patterns.”

3. Change The Food Environment

“Certainly the risk accumulates as the amount increases, and if you can stay away from it completely that would be good. But occasional consumption of processed red meat isn’t going to create significant health problems … There are so many chemicals and ingredients in processed red meats — preservatives, nitrates, high sodium, saturated fats — it’s difficult to pinpoint exactly which chemicals cause cancer. From a public health point of view, it’s not necessary to know which chemicals are precisely responsible for the increased risk. Here the message is similar to tobacco, even though we may not know precisely which chemical cause the cancer, we can take actions to reduce the cancer risk by cutting back … It’s also important for the government to improve the food environment. There’s so much junk food in the food system.” Continue reading