Monday, December 15, 2014

Public Health and the Holidays: The Stories...

Yes, I am enough of a nerd, and a Christmas fan, that any and all blog posts between now and Christmas will be about...guess what, Christmas.  Apologies to those who don't do Christmas.
As I once again become immersed in the traditional Christmas stories, I'm struck by how public health concepts arise in some of them.

First, A Christmas Carol.  In the part of the story about the Ghost of Christmas Yet to Come, there is talk of Tiny Tim dying because his father, Bob Cratchit, can't afford what this ill, crippled little child needs to survive.  Unaffordable care...sound familiar?!? This is, unfortunately, often characteristic of health care in America.  The reality?  People without insurance can't pay for a routine checkup at the doctor, for an emergency surgery, for antibiotics at the pharmacy. People who are eligible for insurance can't pay their deductibles or copays, or can't pay for coverage for their families.  New cancer drugs and Hepatitis medications are so outlandishly expensive that no one can afford them.  The consequences?  Yes, some deaths--directly and/or indirectly related to unaffordable care.  Less dramatic but equally important...patients who skip the blood pressure medicine because they can't pay for it, patients who wait to get breast lumps checked because there's no money for appointments and tests, patients who don't get diabetes labs done regularly because of costs.  The solution?  At the end of Dickens' story, Scrooge becomes nice, and starts caring about poor people.  It would certainly help if our country and our health care system would mimic Scrooge, if we would start caring more about our most vulnerable and if we would make some drastic changes.  Medical care that's affordable without breaking the bank.  Policy, systems, and environmental changes like soda taxes to reduce childhood obesity.  A simpler, gentler, kinder insurance system.  Coverage for everyone.  Some government price controls to keep medications affordable.

The second story on my mind is a lesser known one, but one that also has public health implications.
The Christmas Truce of 1914 refers to what was supposedly a truce between British and German enemy soldiers during World War 1.  For at least a brief period of time around Christmas Eve and Christmas, they stopped fighting, got along, and even celebrated together.  There are different versions of exactly what happened, I admit to being a sucker for the idea that they joined together in signing Silent Night.  Public health implications...around the holidays, even briefly, could people show some goodwill and peace towards others and just get along?  Thinking about this, it's ironic in a good way that after months of bickering, the Senate finally confirmed Dr Vivek Murthy as Surgeon General today, just before the winter holidays begin.  Democrat-Republican truce?!? I wish.  Seriously, though, a few cease fires around the holidays in war-torn regions, among rival gangs...could make a public health difference.  Maybe only a small one, but a difference nonetheless.

And that, my friends, is how public health meets the Christmas stories.

Wednesday, December 10, 2014

Public Health and the Holidays: Voices

For the past two years, I've managed to blog about connections between public health and the winter holidays.  I can't resist doing it again this year.

At the moment I'm sitting by my Christmas tree, listening to a CD in which the voices--bass, tenor, alto, and soprano--all meld together.  Perfectly.  Whether they're doing unison or harmony, it sounds like they're one strong, powerful voice.

I wish we heard many voices joined together as one strong, powerful voice more often in the worlds of public health and health policy.

Recently, as politics has heated up in Washington, there has been renewed bickering over the ACA.  Every day there is news about some related issue, particularly since the enrollment period is happening now.  To be honest, the ACA-bickering doesn't even sound remotely like a song.  It sounds like a catfight to this public health professional's ears!

And I am really tired of it.  I'm frustrated and discouraged that our country (citizens and politicians) can't and won't join together, singing with one strong, powerful voice, that we believe everyone deserves access to affordable, covered, comprehensive health care.  Why can't we come together around this?

Other nations have single payer systems, and some people that I respect talk about this as a solution for the US...but seriously, we're so, so far from singing this song at the national level.  We can't even sing together as one voice about increasing access to coverage via the ACA, let alone going beyond it.  Even though there's a law in place that was long ago deemed constitutional, certain politicians still try to sing out above the others about repeal.

As  I listen to my Christmas music, to the voices blending so smoothly together, it makes me hope that more in our country will join the song for affordable, covered, comprehensive health care for everyone, and that people will sing together as one strong, powerful voice.

Saturday, December 6, 2014


Illness provides perfect fodder for a health-related blog.  Well, at least when I'm feeling well enough to blog, and when I'm recovering enough that I'm at least somewhat inspired.  Which--finally, after a long week, is today.

This particular brand of illness has involved coughing, and this version of cough has meant using gadgets to take certain medicines pretty regularly--every four hours.  There are two gadgets that have been very much part of my life this past week, an inhaler and a nebulizer.  The inhaler is no big deal.  The nebulizer is more complicated.  For those that have never experienced it, it is a machine that turns liquid medicine into an aerosol form and pushes it, as you breathe through tubing and a a mouthpiece, deep into your lungs.  Don't get me wrong, it's wonderful when you can feel the med magically  opening tight bronchi.  To use a neb, though, requires breathing while it's plugged into an outlet.  For 10-15 minutes each time.  

As I've been sitting and breathing in neb meds several times a day, I have been antsy, wondering how much longer til all the med will have been inhaled and I can get up and do things.  I've perfected the art of multitasking, breathing in meds while scanning Facebook and deleting emails. I've had to remind my impatient self that this inconvenience would only affect my schedule for a few days, maybe a week...and that things like meds, special feedings, and medical procedures affect lots of other peoples' schedules and lives day in and day out.  This experience gives me a new appreciation for people, especially families, who fit regular meds/feedings/procedures into daily life. There are many who do it, for things far more serious than bouts of coughing.  I'm in awe of those who manage it every day, because it takes planning, organization, and lots of patience--more than I have.

The other thing going through my mind has been the power and impact of viruses.  I remember learning in school--and teaching my students--that they were teeny tiny organisms, much smaller than bacteria.  Yet they can have  such powerful effects!  Colds, GI bugs, and much more serious viruses like influenza and HIV.  And antibiotics don't work...a Zpack (zithromax) won't cure a cold, and there's no magic bullet for Influenza.  You can treat some symptoms, but just have to wait.  It's your body versus the virus.  Now that I'm feeling almost well enough to contemplate this, it amazes me just how much havoc viruses can wreck....and how our bodies somehow marshall the powers to figh them.  

Sunday, November 30, 2014

A Health Policy Holiday Wish List...

I know that it's not officially December yet, but I also know that a whole bunch of kids--and some adults (guilty as charged, I confess!) are starting already to make their holiday wish lists.  Kids thumb through toy catalogs, adults surf's  just part of the winter holidays. This got me thinking, what would a health policy holiday wish list look like?  Here's my first attempt:

1.  CHIP (Children's Health Insurance Program) Funding extended:  OK, so this would actually be a 2015 gift, but it's a big ticket item--so it never hurts to ask for it early.  CHIP covers children and families who can't afford private insurance but whose income is too high for Medicaid. Right now, funding will expire in October of 2015, unless Congress acts.  Extended funding is crucial to ensure continued coverage and access to care for these families. Some legislators have introduced bills, and ideally in the new year these would be passed with bipartisan support.

2.  A confirmed, actual Surgeon General:  It seems the Republicans and Democrats in Congress just can't agree to confirm Obama's nominee, Dr.Vivek Murthy. Briefly, the NRA doesn't like Dr. Murthy's strong gun control stance, and hence the Republicans don't much like Dr. Murthy as a Surgeon General candidate.  There's a perfectly good Acting Surgeon General in office (Boris Lushniak), but it's not the same symbolically to the American public as having an actual Surgeon General.  A Surgeon General is important for multiple reasons, one being as a public health messenger to people.  Thus, it would be very nice if Congress would quit playing games and confirm someone...Vivek Murthy, Boris Lushniak, or another qualified candidate--soon.  It shouldn't be this complicated.

3.  A successful appeal to the Florida law that keeps MDs from asking about guns in the home:  not exactly sure what the timeline is on this, so it is probably another 2015 item...but a successful appeal by the medical societies involved would be a victory for health care providers everywhere who take comprehensive medical and social histories and provide patient education and guidance in response to information learned.  And it would be health policy grounded in evidence-based medicine and public health, rather than in politics.

This list could certainly be expanded, but these are three biggies that are at the top of my health policy holiday wish list.

Sunday, November 23, 2014

The Thankful List 2014...

I have been neglecting this blog recently. Actually, I think this is the longest I've ever gone without blogging. There are good reasons--ranging from vacation/conference to choir rehearsals.  But now I'm back to blogging.  With Thanksgiving a few days away, it seems appropriate to once again (yes, I did this last year) make a health/health care/health policy thankful list:

1.  Politicians who aren't afraid to stick their necks out on health issues:  I'm thinking of Sen. Sanders and his colleagues who are digging deep into the mysteries of sharp increases in generic drug prices, but certainly there are others out there who truly care about health and health care policy, and are willing to lead the way.  There are even a few who put health and health care before partisanship.  It would be nice if there were more, but we should be thankful for those who do exist.

2.  Writers who inspire and provoke us on matters of health:  Nicholas Kristof, Atul Gawande, Elisabeth Rosenthal, Eric Topol, etc.  When their words flow across the page, they wake up our brains and serve as an impetus for ideas and activism and change.  Again, it would be nice if there were more writers who truly understood health/health care/health policy, but there are definitely enough for whom we can and should be thankful.

3.  Advocates whose words, whether spoken/written/Tweeted, make a difference by swaying politicians or leaders, raising awareness, or igniting passion.  All of us have the ability to be health/health care/health policy advocates, so we can include ourselves and our friends and colleagues in this category.  A special level of thankfulness goes to those advocates who always speak out loudly and consistently, who can rabble-rouse when the rest of us cannot.

4. Doctors and hospitals and insurers that put patients before profits.  Truly caring for and about patients, charging reasonable and transparent prices, maintaining broad provider networks. 

and my personal list item:

5.  Mentors, teachers, and role models:  I've had so many over the years it's hard to count.  The lessons they've taught me guide the professional and volunteer work, and the advocacy, I do every day.  I'm so lucky--and so thankful.