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YTH Live 2020

By ERIN MCKELLE

There are many public health conferences that focus on young people, or that center around youth issues, but very few that actually include the young people’s voices that we are claiming to uplift as public health professionals.

There are also very few conferences that emphasize innovation in healthcare, that are pointed towards solutions rather than discussing problems at length without clear ways of solving them.

These core issues are at the heart of the annual YTH Live conference. Each year (we’re on our twelfth!), we showcase the boldest technologies in health and cutting-edge research in all facets of youth health and wellness. We also have attendees that range from IT professionals to high school students, with over 25% of last year’s attendees and speakers being young people themselves.

YTH’s Communications Coordinator Erin McKelle has first-hand experience of this. “I first attended YTH Live when I was a senior in high school. It was the first conference I ever spoke at and all of my fears about being the only young person in the room were quickly put to rest, once I saw that YTH plans a youth conference that actually centers around youth voices,” she says. “I’m proud to now be working for the organization years later, after serving on the Youth Advisory Board, paying the mission of youth empowerment forward to the next generation of youth leaders.”

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We Can Stop America’s Surge in Opioid-Dependent Babies

By STUART H. SMITH

Imagine a massive public health crisis in the United States that affects tens of thousands of people. Now imagine that the government had a simple tool at its disposal that could prevent this kind of physical and psychological trauma. You might think that I’m writing about America’s deadly outbreak of gun violence, which has made headlines this summer from Dayton to El Paso.

But actually I’m talking about a different crisis that affects even more people – all of them children — and which could be sharply reduced with one simple step that lacks the bitter political animus of the gun debate. The issue at hand involves babies born to mothers who used opioids during pregnancy – babies who tend to develop a condition called Neonatal Abstinence Syndrome, or NAS.

Experts say that state and federal governments have grossly underestimated the number of NAS babies currently born in the United States, as the addiction crisis triggered by Big Pharma’s greed in pushing painkillers refuses to fade. They say an accurate accounting would find a minimum of 250,000 children — and possibly two or three times that every year born with NAS. These kids will face chronic symptoms such as trembling and seizures, gastrointestinal problems, and an inability to sleep. Their numbers are more than eight times higher than the last official estimate from the government.

For more than a year now, I’ve been working with a team of attorneyscalled the Opioid Justice Team who are fighting for any settlement of the massive court fight pitting more than 2,000 localities against Big Pharma to include a medical monitoring fund for the estimated hundreds of thousands of kids born with NAS syndrome. But our team has also been pushing for radical measures that would prevent many of these unfortunate cases.

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Standing Rock Two Years Later: Public Health Lessons and the Physician’s Responsibility

By PHUOC LE MD 

A close look at disease and suffering would lead most of us to the same conclusion: our natural environment is inextricably linked to our health. When the Army Corps of Engineers approved the construction of the Dakota Access Pipeline (DAPL) in July 2016, thousands of water protectors from across the world gathered in protest. Through staunch, organized resistance, indigenous activists and their non-indigenous allies refuted the proposed pipeline, which now shuttles over 500,000 barrels of oil per day through the Standing Rock Sioux’s sole water supply and most coveted burial grounds.

In December 2016, I joined the thousands at Standing Rock to briefly bear witness to their commitment to protecting the health and well-being of future generations. Eager to assist, I provided medical care to these heroes, many of whom had given up their jobs, quit school, or come out of retirement in solidarity with the water protectors. Their determination and strength became even more inspirational when a blizzard brought -40° F in its wake, trapping everyone inside the camp for several days.

Photo Courtesy of Phuoc Le, MD

After battling corporate juggernauts, state governments, and fossil fuel lobbyists for months, the Standing Rock Sioux Tribe and their allies neared victory when the Obama administration denied a permit required for the pipeline’s completion. Just a couple of months later, however, President Trump authorized its advancement and on February 23rd, 2017, the U.S. National Guard evicted the final Standing Rock protestors from the Oceti Sakowin camp. Last week marks the two-year anniversary of that eviction.

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Everyone Has a Part to Play in Ending Vaccine Hesitancy

Felicia D. Goodrum Sterling

Heidi L. Pottinger

By FELICIA D. GOODRUM STERLING, PhD and HEIDI L. POTTINGER, DrPH, MPH, MA

The measles outbreak in Washington state this week has brought new attention to the anti-vaccine movement.  In fact, the World Health Organization recently identified “vaccine hesitancy” as one of top threats to global health. In the US, the number of unvaccinated children has quadrupled since 2001, enabling the resurgence of infectious diseases long-since controlled.  In fact, the WHO claims a staggering 1.5 million deaths could be prevented worldwide by improved vaccination rates.

Amidst the media and public health outcry, a mystery persists:  Why has vaccine hesitancy continued, despite years of vigorous debunking of shoddy science?  The answer may lie in a deeply-rooted distrust of doctors and science.

One of the authors of this article, Dr. Pottinger, surveyed hundreds of Arizona parents, from schools with exemption rates greater than 10%, about their perceptions on vaccines. Pottinger and colleagues found the vast majority of the parents surveyed who delayed or chose not to vaccinate their children did so because of true personal beliefs and not convenience.  Specifically, they tended to distrust physicians and information about vaccines or held misperceptions about health and disease, including the idea that immunity by natural infection is more effective or that vaccine-preventable diseases are not severe.

These beliefs, stoked by a fraudulent 2010 study, have proven almost impossible to shake—despite the fact that the debunked study, based on 12 children, was retracted due to serious ethical violations and scientific misrepresentation; authors cherry-picked and fabricated data, and the first author had undisclosed business interests in the vaccine industry.

The failure of many interventions to dispel misinformation demonstrates the power of a complex interaction of confirmation bias, cognitive dissonance, distrust in data sources, and personal experiences and narratives.  Taking them on requires that the healthcare community effectively spread the following messages.

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Hotlines Aren’t Enough to Help People at Risk of Suicide

By CARA ANGELOTTA MDCara Angelotta, suicide prevention, health policy

Contrary to popular belief, the risk of suicide does not increase around the holidays. But, according to the Centers for Disease Control and Prevention, annual suicide rates in the U.S. have risen nearly 30 percent since 1999.

Much of the media coverage following the high-profile suicides of Kate Spade and Anthony Bourdain has followed recommended best practices to reduce risk of suicide contagion or “copycat” suicides by including warning signs a person may be at risk of suicide due to depression and contact information for the national hotline for suicide prevention. This overly simplistic approach implies that we can prevent all suicides by reaching out to loved ones in emotional distress and advertising the existence of mental health treatment.

As a psychiatrist who treats individuals hospitalized for acute suicide risk, I am concerned that much of the media coverage has belied the complexity of suicide. While we do not yet fully understand why suicide rates are rising, we do know that suicide is a complex public health problem that will require a multifaceted approach to reduce deaths. Increased awareness of depression as a treatable medical illness is an important but insufficient response to the suicide epidemic.

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Advice to Vivek Murthy: Be Nonpartisan, Use Common Sense and Move Americans

Vivek Murthy

In defiance of dire predictions, children haven’t been sent to workhouses and women haven’t been chained to utensils after the GOP gained strength in the House and the Senate. And Vivek Murthy, the unabashed Obamaphile, was finally confirmed Surgeon General.

To be honest, I always thought the controversy surrounding Murthy’s nomination because of his stance on gun control was rather daft. Stopping doctors from pontificating over guns, such as the Docs versus Glocks legislation, is like banning me from trying to convert Pope Francis to Hinduism. The legislation is a parody not just for its own sake but because what it seeks to prevent is parody as well.

Murthy’s first challenge is to raise the position of the Surgeon General from that tokenism of a career UN bureaucrat to something vaguely useful. Which means Murthy must resist the call of banality, the banality of ideology and the ideology of making all of mankind’s imperfections public health problems.

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What Is It With Gun Rights Proponents?

Art Caplan 2Why are they so afraid of public health types who want to do something about the carnage caused by guns in America?

Vik Khanna is the latest man with a gun to write squealing in terror  before the kale crunching, fitbit wearing hordes of public health types who he is somehow sure are out to disarm him and, even more hilariously, have any chance of doing so.

Vik, buddy, no one and especially the roughly 28 folks in public health not completely distracted by their lack of funding and inability to secure tenure is capable of doing anything that will pry your gun from your warm-blooded grip. There is no political movement to take away anyone’s guns. The NRA is the mightiest lobbying outfit in these United States and the best Mike Bloomberg or Bill Gates are going to be able to do is to get the anti-gun lobby a few more op-eds and soundbites.

Vik stop being afraid of your critics. You hold all the bullets er … cards. Time to think harder. Do public health folks have anything to offer that might reduce the mayhem while letting you hunt deer or shoot partridge or blast targets or whatever it is you and your son like to do with your guns?

Well yes in fact there are some things from the minds of the unarmed weenies of public health worth your consideration and that of your open-carry pals.

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Why Public Health Needs a New Gun Doctrine

The Future Looks Like a Girl With a Gun Resized

I am a public health professional, educated at the vaunted Johns Hopkins University Bloomberg School of Hygiene and Public Health. I like guns, and I believe the Second Amendment clearly secures the rights of individuals to own firearms.

You read that correctly. I am a public health professional.

And I like guns.

This make me a heretic in American public health, where embracing firearms and the rights of gun owners is a gross violation of orthodoxy.

As a society, our focus on guns and not gun users derives from the shock of mass killings, such as those in Newtown, CT, Aurora, CO, Virginia Tech, and Norway, which has some of the strictest gun control laws on the planet. Mass killings, however tragic, get distorted by saturation media hysterics and 24-hour political grandstanding. What gun opponents refuse to discuss is the precipitous fall in violent crime and deaths by firearms over the past 20 years, and how it coincides with an equally dramatic increase of guns in circulation in the US.

While that isn’t cause and effect, the association is certainly curious.

In 2013, the Institute of Medicine, at the behest of the Centers for Disease Control, produced a report on firearms violence that has been ignored by the mainstream media. The upshot: defensive use of firearms occurs much more frequently than is recognized, “can be an important crime deterrent,” and unauthorized  possession (read: by someone other than the lawful owner) of a firearm is a crucial driver of firearms violence.

That report went away for political reasons. Translation. Nobody wanted to talk about it because it raised more questions than it answered.

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An Outbreak of Outbreaks

Screen Shot 2014-06-12 at 1.31.43 PM

Lately, stories about outbreaks seem to be spreading faster than the diseases themselves. An outbreak of measles in Ohio is just part of an 18-year high of U.S. cases. Meanwhile, polio continues to circulate in Pakistan, Afghanistan, and Nigeria, while spreading to other countries, like Cameroon, Equatorial Guinea, and Syria, leading the World Health Organization to declare a “Public Health Emergency of International Concern” last month.

The Role of Globalization

As recent threats of H5N1, H1N1, and MERS attest, the increasingly global nature of infectious diseases presents serious risks. Foreign tourists, Americans returning home from international travel, immigrants, and refugees can all expose countries to disease.

With modern transportation shuttling people and products to nearly any part of the world in a matter of hours, the volume of these comings and goings is unprecedented. In 2008, approximately 360 million travelers entered the United States, which also takes in about 50,000 refugees annually.

It should be unsurprising, then, that the Ohio measles outbreak started when unvaccinated Amish missionaries visited the Philippines, then returned home. Infected persons spread the disease to others within their largely unvaccinated communities. The last naturally occurring U.S. outbreak of polio occurred in similar fashion: An outbreak in the Netherlands spread to Canada in 1978, then to the United States the following year, all among unvaccinated Amish populations across four states.

Compared to the United States, nations experiencing social unrest and political conflict face even more serious obstacles to preventing infectious disease.

Strife can interrupt routine vaccination campaigns, as is largely happening with polio. For example, the largest numbers of polio cases last year were in Somalia and Pakistan. Refugees and other displaced populations without health care access can create fertile settings for disease spread, especially if they’re not protected by vaccination. Health workers involved in vaccination campaigns can become targets of violence. And in some areas—Nigeria, for example—religious leaders haveconvinced their followers that the polio vaccine is a biological weaponpromulgated by the West.

For the most part, the United States doesn’t face these barriers. In America, vaccination is more of a choice. Unfortunately, some Americans are putting themselves, their families, and their communities at risk by choosing not to get vaccinated. If those who opt out of vaccination travel to areas where diseases are more common or come in contact with individuals arriving from such areas, they’ll be at risk of becoming ill from otherwise preventable diseases.Continue reading…

Harvard MOOC: Patient Safety and Quality with Ashish Jha

Ashish Jha

Last year, about 43 million people around the globe were injured from the hospital care that was intended to help them; as a result, many died and millions suffered long-term disability.  These seem like dramatic numbers – could they possibly be true?

If anything, they are almost surely an underestimate.  These findings come from a paper we published last year funded and done in collaboration with the World Health Organization.  We focused on a select group of “adverse events” and used conservative assumptions to model not only how often they occur, but also with what consequence to patients around the world.

Our WHO-funded study doesn’t stand alone; others have estimated that harm from unsafe medical care is far greater than previously thought.  A paper published last year in the Journal of Patient Safety estimated that medical errors might be the third leading cause of deaths among Americans, after heart disease and cancer.

While I find that number hard to believe, what is undoubtedly true is this:  adverse events – injuries that happen due to medical care – are a major cause of morbidity and mortality, and these problems are global.  In every country where people have looked (U.S., Canada, Australia, England, nations of the Middle East, Latin America, etc.), the story is the same.

Patient safety is a big problem – a major source of suffering, disability, and death for the world’s population.The problem of inadequate health care, the global nature of this challenging problem, and the common set of causes that underlie it, motivated us to put together PH555X.

It’s a HarvardX online MOOC (Massive Open Online Course) with a simple focus: health care quality and safety with a global perspective.

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