Sunday, February 8, 2015

What Is Public Health Anyway?

Now that I am in my last semester of my MPH program, I am often asked what I plan to do when I graduate. For the immediate future, the answer is, "I don't know yet! I need to start applying to soon as I get my capstone project done!"

But along with this question is often an undercurrent of confusion - and sometimes an openly voiced question - of what exactly public health is? I mean, I'm not training to be a doctor or a nurse. What do public health practitioners actually do?

The answer's complicated.

Public health can mean nearly anything. If something has any tie to health, you can bet there are public health professionals working on it. Many public health professionals are also doctors and nurses. But many others, like me, are not.

In general, I explain public health this way. Traditional medical professionals are generally concerned with treating an individual once you get sick or engaging in proximal prevention at the individual level (when you walk through their doors, they can tell you to eat better foods or take a pill to keep your blood pressure down to prevent further issues). Public health, on the other hand, is typically concerned with preventing disease in the population at large (or in a group of folks) by affecting health further "upstream," ideally long before any symptoms related to disease emerge.

For example, whereas a doctor may refer you for a mammogram to catch breast cancer early, public health would investigate what is it that puts some groups of people at greater risk for breast cancer in the first place? And what is it that affects breast cancer outcomes beyond the biology of the disease?

For example, if a large group of individuals do not have insurance and therefore cannot access doctors, how does that change the outcomes for that group and others in similar situations? Further upstream still, if they do not have insurance, why? What circumstances are contributing to lower rates of insurance in certain communities compared to others? Also, are there any experiences in the population at large that can be changed to lower rates of breast cancer itself? For example, if eating certain foods might decrease risk, why is it that some groups eat those foods and others do not? What are the cultural norms around food? What is the availability and quality of produce in a neighborhood? What is the availability of disposable income and time for that group to invest in healthy eating? Or what types of chemicals are found in one location that are not found in another which might increase risk of cancer? How are these exposures unequally distributed across neighborhood, socioeconomic, racial, and other lines? Or what is it that leads to greater stress and thus greater risk for disease in one community compared to another?

And then public health might ask, now that we have answered these questions and know there are differences in experience for different groups, which lead to differences in disease outcomes (what we call "disparities"), what can we do to improve the average experiences and exposures of the populations who are not achieving optimal health?

The answers to that question can range from vaccination campaigns that broadly affect rates of infectious disease, to economic development initiatives that aim to improve overall conditions in a neighborhood, to policy changes that limit toxin-producing industries from concentrating in low income neighborhoods, to organizing communities to campaign for changes that matter to them. Public health interventions can be Medicaid expansion or quality improvement of the patient experience or violence prevention efforts or reducing stigma and increasing health care access for a particular group of people. Public health can mean creating school gardens to increase vegetable consumption or teaching sexual education to students to lower rates of STIs and unwanted pregnancies. Public health can involve educating the public about the benefits of breastfeeding or campaigning for a new farmer's market to increase access to fresh produce or removing lead from buildings frequented by children. It can mean encouraging exercise programs in schools or limiting advertisements of unhealthful products or requiring restaurant employees to wash their hands after using the restroom or campaigning for equitable housing rules. Public health can mean increasing employment opportunities or teaching stress management classes or passing stricter laws about elder care abuse or requiring safety precautions in factories or creating emergency preparedness plans.

And, get the idea.

Public health can be almost anything that aims to prevent injury or disease and to decrease health disparities between groups. Public health also often involves research in how to do all of these things well and how effective our efforts really are at preventing disease anyway.

Ultimately, decreasing health disparities is what I want to do when I graduate! Exactly what that will entail is TBD, but I'll be sure to keep you posted!

Friday, November 28, 2014

Music Therapy and A Song for the Holidays

For Thanksgiving this year, most of our good friends were out of town. Luckily, we were still able to have three amazing friends over for turkey and stuffing and all sorts of other Thanksgiving goodies. Two of them were brand new friends who moved here only two weeks ago!

There is something special and immediately bonding about chatting over a plate of comfort food on a special occasion. We look forward to many more meals over which we can get to know our new friends better while we continue to grow closer to longtime friends. The more the merrier!

One of our new friends shared that she trained in music therapy, so I took a moment today to read a little bit about how music therapy works. I am a newbie to all of this information, but from what I read, what many of us understand intuitively about music's ability to change our mood and even our whole day has also been proven empirically.

Music can affect both mind and body. Music therapy can change the speed of brain activity, relieve stress, lower blood pressure, and improve sleep. It can even help stroke patients in their movement recovery.

So in honor of our enjoyable Turkey Day and the start of the holiday season, I thought I would share one song that has touched me deeply, provoked emotion, and helped me relax this year.

Pentatonix competed on NBC's The Sing-Off. They, and all contestants on the show, sing a cappella, which means that their music is made with only their voices. That includes drum sounds and all - no accompanying instruments allowed! (Reminds me of my high school choir days!) After my favorite group, Afro Blue (see here and here and here), was voted off the show, I got behind Pentatonix, and they did not disappoint! I was constantly astounded by the innovative and rich sound that this group made with just five mouths. (To see them on the show, check out here and here and here. For some of their incredible a cappella work since, see hereherehere, and here.)!

And without further ado, below is the song I want to share today, Pentatonix' beautiful and touching rendition of a holiday classic, "Mary Did You Know?"

Wednesday, October 29, 2014

California Gold

I seem to be on a media kick with my blog posts lately. Here is another such post!

I have noticed on my Bart rides home that there is a new ad campaign in Berkeley encouraging residents to use their "green bins" to recycle food scraps, as well as soiled paper/cardboard. These can then be composted to enrich the soil, aka "California gold."

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Did you know that California produces about half of the nation's fruits and vegetables in our central valley region? For some items, such as artichokes and walnuts, it is as much as 99%! That's why we care about soil.

The ads are produced by Ready Set Recycle, a campaign in Alameda County to help people learn how to properly sort their refuse. They even offer prizes, like gift cards, gardening compost, and fresh  food boxes from local farmers, for engaging in certain activities that support learning to recycle.

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One tricky thing is that businesses in Alameda County can contract with private recycling companies, which may not follow the same rules as the curbside program. For example, where I work, a Starbucks coffee cup can be composted (green bin) and the lid can be recycled (blue bin). In other places, the lid may not be recyclable and would go to landfill.

So what does recycling and composting have to do with public health?

As it turns out, the environment affects our health! Things we do to and for the environment can have lasting impacts on our health. For example, according to the EPA, recycling can play a role in reducing GHC emissions, which are associated with chronic illnesses like asthma. For more information on waste disposal and public health, see here, here, and here.

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Does your town, county, or region offer large scale composting? How has it changed your thoughts about waste or the environment?

Saturday, October 25, 2014

Health Insurance Changes Behavior: Moral Hazard

This semester, I am a Graduate Student Instructor for the undergraduate course Public Health 150D, Introduction to Health Policy and Management. I am really enjoying working with the students and am having fun helping them learn about the U.S. health care system! Here is something they learn about in our class:

UC Berkeley requires students to have health insurance to enroll in the school. When many of my classmates started graduate school, they had previously been working in settings that did not provide benefits and had therefore gone without some health services for a period. Once they started school and had insurance through the university plan, they got very excited to use those services to the fullest!

New glasses? Check!
Teeth cleaning? Check!
Pap smear? Check!
Flu shot? Check!
Sore throat? Why not get it checked out? Can't hurt! Check!
Ski trip? I'll have to save up to go, but at least if I get hurt on the trip, I know I'm covered!

Did you know? This phenomenon actually has a technical name!

Moral Hazard in health care is the tendency to behave differently when you have health insurance than when you don't. It can include both engaging in riskier behaviors (because you know you have insurance if you get hurt) or using more services (because they are covered fully or in part by your insurance).

Furthermore, it turns out that the better our insurance coverage (lower deductibles, lower copays, lower coinsurance, etc.), the more services (and more expensive services) we are likely to use! (See publications on the RAND Health Experiment and other similar findings.)

The name "moral hazard" makes it sound like this is a series of bad or wrong choices. But that is misleading, in my opinion. Sure, insurance companies dislike it, and in some cases, moral hazard can involve over-use of unnecessary services. But for most of us who just want to take care of our health, it is actually quite logical to weigh the risks and count the costs when we make everyday decisions. If we can afford it, of course we want to get the services that might improve our health!

If you have never heard the term "moral hazard" before, you have just been introduced to one concept from PH150D: Introduction to Health Policy and Management. And now you know!

Monday, October 20, 2014

Disney's Anti-Bullying Campaign #ChooseKindness

October is Bullying Awareness Month.

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While watching one my favorite ABC shows online recently, I saw an interesting anti-bullying ad put out by Disney, involving many of their stars donning t-shirts with anti-bullying messages and encouraging us to use the hashtag #ChooseKindness. Since bullying is an issue I have addressed on this blog before (read here and here), I looked into it more. As it turns out, Disney is doing an entire campaign this month around the issue. (For details, see their "Be Inspired" website.)

What I found particularly interesting is that they are not only putting out advertisements around the issue; they are also incorporating anti-bullying themes within the scripts of their television shows. Here are some sample clips I found:

Show Name: "Austin & Ally"

Show Name: "Girl Meets World"

I know that public health professionals have varying views on Disney as a whole (for example, some take issue with Disney's employment practices and affiliation with "The Other NRA"), and I am in no way trying to endorse them as a perfect company. And then, of course, there is the general philosophy (and evidence) that TV-viewing is not a particularly healthful behavior. (For more on that, see here, here, and here.)

But given the reality that kids watch an average of 4 hours of television per day,  I did want to share this one cool instance of public health social messaging making its way into mainstream media. I am thankful they are attempting something worthwhile through this campaign.

Wednesday, October 15, 2014

The Great Shake Out on October 16

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People across the country will be participating in the Great Shake Out, a nationwide earthquake safety drill, on October 16 at 10:16 am.

What to Do When an Earthquake Starts

According to the Southern California Earthquake Center, the best thing to do when an earthquake starts is:

1. Drop to the ground (before the earthquake knocks you off your feet). Do not try to move!

2. Cover your head and neck with your arms, and duck under a sturdy table if nearby. They say that with modern building design, you are more likely to be injured by falling debris, such as lamps or books, than by a collapsed building, which is why a desk or table is helpful.

3. Hold onto your shelter (desk/table) and be prepared to move with it until shaking stops.

Earthquake Safety Myths

On its website, the Center also dispels some common myths about earthquake safety:

Myth #1: You should go to a door frame, because door frames are the strongest part of the house. 

Although images of earthquakes from 50 years ago may show standing door frames, the Southern California Earthquake Center says that door frames are not stronger than other parts of a building in modern building design. Furthermore, a doorframe will not protect you from falling debris off a shelf or cabinet, which is the greatest risk during an earthquake.

Myth #2: You should try to run outside.

Many earthquakes do not last long enough for you to get outside, and perhaps more importantly, they may knock you off your feet or cause falling debris to hit you on the way. Furthermore, you may be hit by bricks or shingles off buildings if standing near a structure outside. The Center suggests it is better to drop, cover, and hold on where you are.

Myth #3: It is better to stay next to a table than to get under it (as perpetuated by chain emails circulating about the "triangle of life.")

The Southern California Earthquake Center says that this myth is based on multiple false assumptions, including the false beliefs that falling buildings are your primary threat during an earthquake, that buildings that do fall crush all furniture, and that you will be able to anticipate how a building might collapse if it does. According to the Center, while collapsed buildings get a lot of attention in headlines, this is much less likely to happen with modern building design. On the other hand, falling debris, bookshelves, and other items are much more likely to harm you and should be your main concern. This is why they recommend getting under a desk, rather than next to it.

For more information on earthquake safety in a variety of situations, check out their website or this helpful two-page handout!

Are you planning to do anything for The Great Shake Out event?

Saturday, October 11, 2014

Jesus as a Community Organizer?

For my Health Policy Advocacy class a couple weeks ago, we read an essay called, "The Power Tactics of Jesus Christ," by Jay Haley. The essay analyzes the ministry of Jesus as a movement for social change. The article compares Jesus' tactics to community organizers (and even dictators) who amass large followings. The text purports to describe the power dynamics of Jesus' movement-building work, providing lessons about rallying the poor and oppressed for a cause, which we can use in our own efforts to advocate for just health or other policies.

From our class discussion, it seemed like this article may be one of the few encounters many of my friends and classmates have had with Jesus, and it paints a rather disturbing picture. The text speculates on Jesus' ulterior motives and ultimately construes him as a tyrannical schemer who was willing to do anything it took to get his message of social justice out.

I have been hesitating on whether or not to share my thoughts on the essay for weeks, because of course, it is a controversial one to say the least. And then there is the personal temptation to hide who I am and what I believe, because faith is sometimes frowned upon in public health discussions.

But over the last few weeks, I have realized that I can only be who I am. Many of my classmates know that I am a Christian, and yet, I rarely share on a deeper level what that even means. The truth is, it has changed everything about who I am and how I see the world. Everything. I hope that sharing a glimpse into my own experiences of who Jesus is might open the door for others to feel more freedom in being real about who they really are and what defines them at the deepest level. So here goes nothing!

One thing I have in common with Jay Haley, the author of the essay we read, is that I do believe Jesus paved the way for a radically different view of the poor, hurting, and oppressed, and this belief is a large part of the reason that I am back in school to make a career change. I desire to love others through a career in public health.

Yet ultimately, the way I came to love Jesus had very little to do with His view of the world and everything to do with His view of me.

The scriptures taken as a whole, both Old and New Testaments, paint Jesus' motives and primary purpose not as a political campaign or rebellion, nor as a human movement for justice, but as the love-motivated fulfillment of God's plan to save and redeem humanity from separation from God himself. 

The most radical thing Jesus has shown me is that as much as I desire to love others through my own work and service, I cannot earn God's approval or love through these things. For one, my own efforts involve mistakes and mixed motives, many so corrupt that I hide them even from myself at times; as much as I try to be a good person, I shudder to think of what would happen to my reputation and relationships if the full content of my thought life were broadcast to the world on a projector 24/7. I don't know anyone that would fare well under the light of such a deep evaluation. Many of us agree that the world is a messed up place, but the more I examine myself, the more I realize that I am a central part of the problem.

Why is this so radical?

The miracle is that God actually knows all of the intimate details of every thought I have ever had, every motive I have ever held, every action I have ever done, and He loves me deeply.

Like, imagine the most passionate love story you have ever read or seen, multiply that by a million, and that is how God feels about me and you. In fact, He has already demonstrated his unconditional love for me through Christ's death on the cross. Christ lived the life of perfect love that I should live (but am unable to do in my own power) and then willingly out of love for me died the death that I truly deserve. When Jesus died on the cross, the scriptures teach that he actually paid the penalty for every corrupt thing I have ever thought or done, past, present, and future.

This free gift of love, this exchange of Christ's perfect life for my messed up one, is what I believe Christ's ministry was ultimately about. I don't need to keep trying to earn God's love or to save myself. I already have his unconditional love and salvation as a free gift.

It is out of the security of this relationship with God, knowing that He already loves me more than I could ever imagine or earn, that I grow to love Him more and can then serve and love others.

I am not interested in public health based on feelings of guilt or trying to earn God's approval with my chosen field.

On the contrary, because I understand at a deep level what selfless love is, based on what Jesus has already done for me and based on His unshakable love for me, regardless of what I do, I am overwhelmed with gratitude and have begun to be changed from the inside out. God's demonstrated love and his Holy Spirit guiding me are ultimately what help me pursue a world of greater equity, improved health, and justice for all.

When I was very young, I remember a few kids on the playground seemed to know something about God, and I had no idea who He was, having never gone to church at that time. I asked God to please show me who He was, and somehow He prompted my family to start attending the closest church to our house. Twenty years later, I am still leaning into new questions and asking God to show Himself to me, to help me figure out why I am responding to Him in any given way on any given day. And He is working on my heart from the inside out, revealing new aspects of His love in every season.

This is who I am. This is what shapes me.

My encouragement to those who have first encountered Jesus (or re-encountered him) through "The Power Tactics of Jesus Christ," would be to actually turn to God and ask Him your tough questions. Cry out to Him! If you find the essay intriguing, ask God to reveal Himself to you in other ways. If you find the essay disturbing, tell Him why and ask Him to help you in the search for answers. If you find yourself indifferent to it all, ask God why you feel this way. Maybe He will answer.

One great place to start in getting a glimpse into the life of Jesus is the book of John, the fourth book in the New Testament. If you are wondering who Jesus is, try reading it with an open mind, and see if God speaks to your heart through it. What events, characteristics, and statements stand out to you? What troubles you? What encourages you? God is not afraid of your questions; He already knows what they are before you speak them aloud, and He understands them. He loves you.

To learn more about the gospel of Jesus Christ, check out this resource about God's Plan of Salvation.

Not sure which translation of the bible to read? I enjoy the NLT, NIV, or ESV translations for modern language translated closely to the historical texts or The Message for a modern paraphrase / interpretation. (Note that The Message is NOT a translation.) All of these are available to read for free on