cultivating & crashing

an organic collection of notes, observations, and thoughts

Tag: public health

CSEB

Last week I attended the Canadian Society for Epidemiology and Biostatistics Student Conference, the first conference I traveled to present at. Sandro Galea gave a great keynote speech.

  • population health vs. personalized health
  • mismatch of funds spent and health of populations
  • article in Fortune, “Can genes really predict your health?”
    • our health has deteriorated, but our genes haven’t changed, so why all the fuss (and funding) about them?
  • population estimates do NOT allow us to predict individual event inference (a point about personalized medicine)
  • no lone ranger, no silver bullet. obesity is associated with a HUGE causal web, not one isolated factor
  • book written with Katherine Keyes

slides I was interested in

  • health determinants vs. health expenditures
  • social causes of death vs. others (poverty causes same no. as injury)
  • what percentage of your intelligence depends on genes?
    • it depends on your environment
  • need with grapple with health equity vs. efficiency trade-off
    • people of high SES benefit most from changes
  • embrace intellectual and moral challenges of our time: how to change the socio-economic context that influences health?

metaphors

  • goalie is medicine. for every one goalie, ten players that are not goalies are needed to move the ball up the field. OTHERWISE WE LOSE.
  • goldfish in a bowl: can exercise, have safe sex, and eat not too much food, but if the water isn’t changed, it will still die.

I liked this talk because it confirmed everything I believe about the social nature of how society functions. our health is mostly determined by our social environment, and it’s those social factors that are at the crux of making sure populations are healthy. poverty stunts, sickens, and kills people. we must create societies that take care of the least privileged, the most vulnerable. otherwise, rich people will enjoy the advances of health while their neighbours rot in misery.


We had a session in which we spoke to a group of people who work in different epidemiology/public health positions.

National Collaboration Centre (NCC)

  • different centres in different provinces
  • internships
  • funded by Public Health Agency of Canada

data management and data cleaning are 90% of the work that must be done in data analysis. get experience working with horrible data sets.

Public Health Ontario epidemiologists – mailing list, great resources

make yourself stand out in an interview, educate yourself well about the place/department. also, want to be flexible, be a generalist with enough knowledge about a lot of things, not in-depth for one topic (advice is diametrically opposed to that for someone who wants to continue in academia).

working in government

  • BUREAUCRACY. the right thing to do takes 10 years, but it happens! sometimes even in just 2 years.
  • important impact on populations

Kue Young

  • FYI: WHO makes up data where none exists, read the fine print and footnotes of everything you use
  • Global Health Observatory data is cool, check it out
  • beware the reification of stats due to pretty charts and maps (ie they become true because they are visualized)
  • data don’t exist in a social vacuum

Intervention and agency

Yesterday I attended this seminar by Lise Gauvin on two public health interventions that have taken place in Montreal: Wixx, an initiative promoting physical activities targeting tweens in Quebec, and BIXI, a bike-sharing program. The talk was great, and not only because I’m really interested in this kind of work. One thing that struck me was how Nuffield intervention ladder demonstrates that effectiveness of public health initiatives are inversely proportional to the amount of control they exert on the individual or group. People should not drink sugary drinks, and the most effective intervention would be to ban their sale. Yet that would trigger riots more vehement than those protesting police murders of unarmed people. Wixx and BIXI are examples of interventions that have wide reach and create behavioural changes and are also well received by the public, showing that a balance can be struck between intervention and acceptability.

Profile on Lise Gauvin and her work

Decline in herd immunity in the US

Much in line with the article I posted yesterday about how scientific fact can be easily disregarded comes this one about the decline of herd immunity in the United States due to a high rate of parents ditching vaccinations.

This is what the postmodern world looks like: one in which science and its hard-earned truth is merely one of many viable stories that can be subscribed to. It is not the end-all, and is not respected as such. So maybe I’m a modernist, after all.

Food, health, environment

The Economist just came out with this great article about a study that just came out in the New England Journal of Medicine. The article illustrates how an improvement in environment (specifically connected to availability of fresh food) translated into a lower rate of chronic diet-based disease in a group of low-income women. I would say more but I have to go read about the deportation of young Slovakian women to death camps in WWII.

Environment + health, and academia

Went to the opening of this at the CCA. It was great, as things at the CCA usually are. Also, I think urban planners have a really great perspective on things. I’m beginning to like university more as time goes on and I start talking to people who are engaging their curiosity and their ingenuity in questions about justice, health, and dealing with reality. The originality and creativity I sometimes am privy to makes me want to go farther, dig deeper, and drink more beer with more people who are passionate about their ideas and projects.

And profs are a part of this, too. All of my professors this semester are vibrant, intelligent people who I’m lucky to be taught by and speak with. These days the Academy is looking more and more interesting to me as a place in which to make my work a home. A happy realization.

Insite

A few days ago, the Canadian Supreme Court ruled unanimously to grant an exemption to Insite, Vancouver’s safe injection site. The CPHA is happy.

Goldberger

Just finished reading a book about Joseph Goldberger, an American public health hero of the early twentieth century. He discovered the nature and cure to pellagra—a major disease in the States at the time and one that had evaded understanding for two centuries in America and Europe. He was a physician and researcher, but in the end realized that all of his medical breakthroughs were not what ailed pellagrins; it was the economic, political, and social circumstances creating poverty that led to deadly malnutrition. Time and time again, he came upon the stark realization that it was not medicine that was the limiting element in treating the scourge of the South, but the vested interests in maximized profits of cotton production in the region. As Golberger would explain, “pellagra is only ignorance; pellagra is only poverty.” In his lifetime and in his work, Goldberger experienced the shift between what characterized public health a century ago, namely infectious disease, and the chronic, lifestyle-based concerns that are at the heart of public health in developed countries today. He also happened upon the crucial junction between health and society, which is the most difficult obstacle to address. Public health implies a distinct socialist tendency, something the States is allergic to, and something that must be strenuously worked for in our globalized, capitalistic economies. (On a tangent, given the difficulty posed in sustaining Canada’s nationalized health system, some hard questions need to be asked, and answered with equal candour. Or maybe it just boils down to values, or what is adaptive to our monkey selves—dammit!)

“All knowledge is sterile not translated into service.”

Naturally, I liked the story of his life, and the simple strategy by which he became a hero: start with principles of honesty and concern for the public good, then do your homework, be precise, and work tirelessly. On the other hand, it’s important to note how Goldberg sacrificed his family life, including the happiness of his wife and children, to attain what he achieved in the name of science, and of the thousands of lives he saved. Une décision à prendre.

Why public health

I read this article when it came out last month and I still can’t get over it. Today I read it to my mom, who was even more shocked. This is why global public health is needed.

Public health brainstorming

Wondering what topics I’d be interested in getting into. Obesity (nutrition, exercise), breastfeeding, food, mental health? (How about the epidemiology of obesity or chronic preventable non-infectious diseases?) Do I want to be involved with a certain group, such as children or immigrants? What sort of programs can actually effect change in health behaviours and which are a waste of time and resources?

Should I be volunteering at a hospital? At a Baby-Friendly CLSC? Should I ask the people at the Social Studies of Medicine this?

Details on SSOM grad programs

Volunteer opportunity cuddling premature infants at the MUHC

Dalla Lana programs at UofT

After snooping around a bit, this last link at least gives me an idea of what fields of interest I could investigate to find out what I’m interested in.

Part of the problem I’m having is that I have no idea where it is I’m looking to get to, and thus have little clue what path to take. What job do I want? Do I want to be a practitioner or researcher? Do I want to work for the government?

All I know is I like the idea of spending 3-4 hours cuddling premies every week.

Update: I should go talk to Career Counselling at school and check out where Richard Lessard has been, too.

And only a bit unrelated, a tool for finding out what’s in season locally