Video @UNICEF: 2016 world’s warmest?

Per a video from BBC News 2016 is set to be the warmest year on record.  With an observed global temperature rise of 1.2 degrees Celsius, we are rapidly nearing the threshold of 1.5-degree change considered most advantageous to stave off considerable threat.  This figure was agreed upon by representatives of 195 countries at the Paris climate conference in December 2015.  It stands as the first -ever universal, legally binding global climate deal.

Such a deal has come too late for those who live in regions of the world devastated by drought, such as Ethiopia.

Ethiopia is no stranger to the devastation wreaked by drought.  Drought in the early-to-mid 1980s sparked a famine that killed a million people.  Even if, like me, you weren’t alive at the time, you are probably familiar with widely publicized images of skeletal babies, such as in this BBC newscast (Warning: Graphic images).  The disturbing images spurred the first Live Aid concert in 1985.

The present drought in Ethiopia is linked to a super El Niño, exacerbated by rising ocean temperatures.

According to the World Meteorological Organization, the current El Niño is one of the strongest events recorded, which is pushing people already suffering from the effects of climate change deeper into poverty and making them more vulnerable.

Since the drought began in earnest in 2014, Ethiopia’s economy has tanked.  Eighty percent of Ethiopia’s agricultural produce relies on a rainy season that remains elusive.  This is devastating for a country where 85% of people rely on agriculture to make a living.  Ten million Ethiopians will need international aid to survive this drought – on top of 8 million already receiving aid from safety net programs – to the tune of 1.4 billion dollars.

The United States under the Obama administration has been the single largest donor to this cause, totaling $774 million along with $381 million from the Ethiopian government itself.  This type of aid isn’t guaranteed to continue as President-elect Trump’s comments about climate change are scientifically unsound at best.

Besides calling man-made climate warming a hoax invented by China (which China refutes), in the above video, Trump says he is a “huge believer in clean water…crystal, clean water.”  This begs the question water for who?  And where?

An Op-ed piece published in the New York times connects one of Trump’s least talked about points (climate change) with one of his most (immigration):

When you visit the Pentagon, ask the generals about climate change. Here’s what they’ll tell you: A majority of immigrants flooding Europe today are not coming from Syria or Iraq. Three-quarters are from arid zones in central Africa, where the combination of climate change and runaway population growth are making small-scale farming unsustainable.

Will Trump withdraw the US from the Paris climate deal?  If we take him by his word, it’s a possibility:

Any regulation that’s outdated, unnecessary, bad for workers or contrary to the national interest will be scrapped and scrapped completely.  We’re going to do all this while taking proper regard for rational environmental concerns.

As we hover mere tenths of a degree away from potential catastrophe, I ask that Mr. Trump and all present and future leaders consider the global interest ahead of job growth.

 

The right to die

The results of the recent U.S. elections have thrown many Americans for a loop.  While we work to unpack a lot of feelings about a Trump presidency, I thought it might be better to talk about another result from last Tuesday.  Colorado became the sixth state to pass a bill that allows terminally ill patients to seek life-ending medication.  Supported by 65% of the constituency, the measure applies to individuals with 6 months to live or less who can self-administer the lethal dose.

The measure requires that people “make two oral requests, separated by at least fifteen days, and a valid written request to his or her attending physician.” It also requires that people be capable of taking the medication unassisted, and stipulates that patients can rescind a request for life-ending medication at any time during the process.

Oregon – along with Washington, Vermont, Montana, California, and most recently Colorado – has had an aid-in-dying measure since 1997.  Winner of a Grand Jury Prize at the 2011 Sundance Film Festival, How to Die in Oregon, an HBO documentary tells the stories of people impacted by this law.  To date, 1,327 prescriptions have been filled with 859 deaths.  The most commonly cited reasons for requesting the prescription include loss of autonomy, decreasing ability to participate in activities that made life enjoyable, and loss of dignity.

So-called aid-in-dying and Death with Dignity measures are highly controversial, perhaps due in part to Dr. Jack Kevorkian’s unabashed commitment to “physician-assisted suicide.”

Forms of assisted suicide are legal in the Netherlands, France, Germany, Switzerland, and Belgium.  While the laws in France, Germany, and Switzerland are more passive, the Netherlands and Belgium are anything but.  Passed in 2002, Belgium law allows doctors to prescribe life-ending drugs to individuals suffering “intractable and unbearable pain.”  This includes pain caused by mental illness.  The Economist produced a documentary about a 24-year-old Belgian woman on her journey to euthanasia due to severe and chronic depression.  In February 2014, Belgium became the first country to allow minors to request euthanasia with parental consent.  To qualify, children must give informed consent, be terminally ill, and beyond all hope of medical intervention.  The first case of physician-assisted suicide of a minor occurred earlier this year.

Of course, euthanasia is fraught with controversy.  The act alone conflicts with the ethical and professional codes of the medical profession:

A physician’s assistance in suicide can indeed be construed as helping the patient: helping in the sense of being an ally in the patient’s quest to fulfill personal goals, or helping by buttressing individual autonomy. However, there are also features of such action that can be qualified as harmful: harmful by sowing confusion in trainees about the conceptual core of traditional clinical methods, or harmful by eroding respect for absolute moral values such as “do not kill.”

Others argue that the Hippocratic Oath is irrelevant including its oft misquoted tenet: “First do no harm.”  In the case of physician-assisted suicide, isn’t harm avoided by allowing patients autonomy and freedom from painful, protracted deaths?  Patients with Amyotrophic lateral sclerosis (ALS), called Lou Gehrig’s disease, remain cognizant while the rest of their body shuts down.  Though progression differs from person-to-person, an individual with ALS can expect to lose mobility, use of hands and arms, the ability to chew and swallow, and finally the ability to breathe without assistance.

The vast majority of deaths in ALS are the result of respiratory failure, a process that progresses slowly over months. Medications can relieve discomfort, anxiety and fear caused by respiratory insufficiency.

Given this prognosis, it is plain to see why an increasing number of ALS patients in Oregon are seeking a death with dignity.  Do you think physician-assisted suicide has a place in public health discourse?

Big Soda muddies science, politics

The American Beverage Association’s Let’s Clear It Up site is a one-stop shop for all your burning beverage, marketing, and health questions:

MYTH

High Fructose Corn Syrup (HFCS) causes obesity and diabetes.

FACT

Actually, the American Medical Association has concluded that HFCS, a common liquid sweetener made from corn, is not a unique contributor to either obesity or type 2 diabetes. In fact, HFCS is so similar to sucrose (table sugar) that your body can’t tell the difference between the two, and processes both in the same way.

Despite its name, HFCS it is not high in fructose and, just like sucrose, it is a combination of two simple sugars – glucose and fructose.

Source: American Medical Association

While the argument that Let’s Clear It Up makes is valid – HFCS is indeed not a unique contributor to either obesity or type 2 diabetes – over-consumption of HFCS and sugar does contribute to both.  The issue with the above “fact” is that it seeks to obfuscate the argument by citing the American Medical Association.

Dr. Sandra Fryhofer is the source in question.   Past Chair of the American Medical Associations Council on Science and Public Health, Fryhofer has also served as President of the American College of Physicians and as a committee member with the Centers for Disease Control and the Institute of Medicine.  She’s also a spokesperson for Coca-Cola.

MYTH: In the above video, Fryhofer claims that HFCS is simply half glucose – brain fuel – and half fructose – found in fruits, honey, and root vegetables.  Sometimes, she concedes there is a smidge more fructose in HFCS than in sugar, 55% vs. 50%, but hardly worth reporting.

FACT: A study published in Nutrition found that fructose in beverages sweetened with HFCS can reach 65% of total sugar with an average of 59%.  Per the third National Health and Examination Survey (NHANES) adults and children consume a lot of fructose.  Mean consumption of fructose stood at 54.7 g/day or 10.2% of total calories.  Adolescents consumed the most fructose at 12.1-15% of daily calories.  Sugar-sweetened beverages were the largest, single source (30%) of fructose in the diet.  Consuming a diet high in fructose can contribute to insulin resistance and obesity.

As reported by Dr. Yoni Freedhoff’s Weighty Matters blog, Dr. Fryhofer’s affiliation with Coca-Cola runs counter to the American Medical Association’s Conflict of Interest Policy:

To ensure that the Trustee or Member is not placed in the difficult position of serving organizations with conflicting overall goals and objectives, a Trustee or Member shall disclose his or her participation in other organizations. If the overall goals and objectives of the AMA and the other organization do not conflict, participation is permitted. If a conflict exists, the Trustee or Member shall choose between the conflicting organizations, and shall resign from one of the positions.

Rather than violate the policy, a recent study found that Fryhofer isn’t alone in her patent endorsement of the beverage industry within the ranks of public health.

The study, published by Boston University researchers, found that the American Beverage Association sponsored 96 public health organizations between 2011 and 2015.  Organizations that received funding from PepsiCo and Coca-Cola include the American Center Society, American Diabetes Association, Centers for Disease Control, and National Institutes of Health.  The Academy of Nutrition and Dietetics and the American Academy of Pediatrics did not renew contracts with the American Beverage Association after 2015.

Along with paying organizations that support public health initiatives, the American Beverage Association uses its vast monetary and political sway to trump public health bills, including those that propose restrictions on purchases made within the Supplemental Nutrition Assistance Program, voluntary guidelines for marketing to children, and soda taxes.  A Center for Science in the Public Interest analysis found that the American Beverage Association spent $106 million since 2009 in opposition of local, state, and federal public health initiatives.

When the city of Philadelphia proposed a soda tax in 2010, the American Beverage Association offered to donate $10 million to Pew Charitable Trusts on one condition: drop the proposal.  Philadelphia chose not to comply, the tax is in effect, and a lawsuit against the tax was filed by the American Beverage Association.

Tomorrow, 4 cities in California and Colorado will vote on measures to introduce 1 to 2 cent soda taxes.  Shy of 100,000, these voters are contending against a barrage of the American Beverage Association’s best offense.  In San Francisco alone, $9.5 million worth of air time has been dedicated to opposition of the tax.  In neighboring Oakland, California, those in favor of the tax have spent $23,000, around 3% of what the American Beverage Association has spent in the same community.

The American Beverage Association also hires dietitians to tweet false statistics and retweet articles in support of bans on soda tax.  Tweets include #partner, #advisor, and @cartchoice but do not specifically disclose the partnership.  @Cartchoice refers to the American Beverage Association’s blog Your Cart Your Choice where many tweeters are also contributors.  Ninjas for Health, “a network of innovators who have big ideas for keeping health out of the hospital,” maintain public lists of twitter accounts sponsored by Coca-Cola.  You can read them here, here, and here.

See anyone you know?

CIT: a solution for police interaction with the mentally ill

Eight hundred and ninety-six people have been killed by police in the United States since January 1st.  I have had to update the total each morning as I wrote this post.  That boils down to 88.6 people per month.  Were this rate to continue, we’ll fall just short of 2015’s total of 1,146 fatal police shootings.  How does the U.S. compare to other countries?  England and Wales have experienced 55 fatal police shooting in the last 24 years.  Fifty-nine people were killed in the U.S. in the first 24 days of 2015.  Iceland, ranked 15th globally for gun ownership per capita, had one fatal police shooting in 2013, the first since it gained independence in 1944.

In the U.S., hardly a day goes by without a fatal police shooting.  The stories that make the nightly news and overwhelm our Facebook and Twitter feeds depict white cops shooting black men.  These shootings have fanned the flame of civil unrest in cities like Ferguson, Missouri and led to the formation of the Black Lives Matter movement.  In a recent article, Harvard economist Roland G. Fryer Jr. found no evidence of racial bias in police shootings.  Highlights of the study, culled from thousands of reports from 10 police departments in California, Texas, and Florida, found that while minorities are much more likely to be targeted by police and subject to unwarranted stops, frisks, and physical restraints, race was not a motivating factor in fatal shootings.

These findings echo an analysis based on data from the U.S. and Australia.  Researchers found that 1 of every 291 stops or arrests ends in injury or death, but minorities and whites face the same risk.  Both studies got at least one aspect correct.  White people are killed by police officers in large numbers.  Per the Guardian’s definitive record of police shootings, The Counted, 584 of those 1,146 killed in 2015 were white.  One hundred and five were unarmed.  Comparatively, 306 were Black, 79 unarmed.

Those numbers are comparable until adjusted for population.  Per the 2010 U.S. Census, there are approximately 200 million white people compared to 40 million Black.  Do the math and you will find that Black people are about 2.5 times more likely to be killed by police than white people.  Stories in the Washington Post and Vox corroborate and further debunk the source article’s claims:

For one, the study is looking at a very limited pool of police departments in terms of shootings: 10 jurisdictions in three states in the first data set, and just Houston in the second data set. The study even acknowledges that there are questions about whether the data is nationally representative.

Worse, the data runs into a big problem with selection bias. For police shootings, the researchers looked at data that police departments gave up willingly. A few, including New York City, didn’t hand over their shooting data to the researchers. It’s possible the police departments that refused did so because their data would confirm racial biases. We just don’t know.

This all leads to today’s video, a twist on the all-too-common theme.  This is the story of Charles Kinsey, a Black behavioral therapist, who was shot while attempting to deescalate a situation involving an autistic client.

If you question why police guns were trained on Charles Kinsey while he worked, you must also ask why they were pointed at a young, autistic man in distress.  The answer is as simple as it is maddening.  Despite what the media reports, the mentally ill and disabled are likely the population most subject to police shootings.

In the case of Charles Kinsey, the bullet that struck his leg was meant for his autistic charge.  Police responded to a 911 call that placed Kinsey and Arnaldo Eluid Rios in the road.  The caller cautioned the police about a possible weapon, what turned out to be a toy truck, in Rio’s possession.  When police arrived, Kinsey assumed the position while he attempted to convince Rios to lie on the ground.  Despite Kinsey’s pleas for the police not to shoot as he worked to deescalate the situation, an officer fired.  A statement by the officer’s lawyer affirms his intent:

This was not an accidental discharge.  This was a very real perceived threat to the officer — and it simply missed the mark. He had a fear the Mr. Kinsey was going to be killed.

While this story gained national attention, at its heart, the fatal police shootings of people with mental illness or a disability are far too common and under-reported.  Depending on the source, one-quarter to one-half of all police shootings involve a mentally ill or disabled victim.

The vast majority were armed, but in most cases, the police officers who shot them were not responding to reports of a crime. More often, the police officers were called by relatives, neighbors or other bystanders worried that a mentally fragile person was behaving erratically, reports show. More than 50 people were explicitly suicidal.

After the widespread closure of state-funded mental health facilities and an inadequate infrastructure to treat veterans with PTSD and traumatic brain injuries, police have become front-line mental health workers with little to no training.  A recent study by the Police Executive Research Forum found that cops-in-training receive 60 hours of gun handling instruction, compared to 8 hours of training to respond to the needs of the mentally ill or crisis deescalation.

A late-breaking policy statement adopted at the recent American Public Health Association’s Annual Meeting speaks directly to this conflict and asks public health workers and government agencies to work together to reverse the frightening trend:

LB-16-02 Addressing law enforcement violence — In the context of violent and sometimes lethal encounters between law enforcement, people of color and people in marginalized communities, calls for a public health strategy for preventing law enforcement violence that has four main elements: decriminalization; robust police accountability measures; increased investment in racial and economic equity policies; and community-based alternatives for addressing harms and preventing violence and crime. Urges the U.S. Council of State and Territorial Epidemiologists to work with fellow public health experts to create surveillance protocols for law enforcement-related injuries and deaths. Calls on Congress to fund research on the health consequences of police violence, and encourages federal, state and local officials and law enforcement agencies to engage review of those law enforcement agencies’ policies and practices and eliminate those that lead to disproportionate violence against specific populations. Calls on government to reverse the militarization of police and on officials at all levels to fund community-based violence prevention programs.

One such violence prevention program is Crisis Intervention Training (CIT).  CIT is a program that brings law enforcement, mental health providers, hospital emergency departments, and individuals with mental illness and their families to improve responses to those in crisis.  After an investigation by the U.S. Department of Justice found that Portland (Oregon) Police Bureau had used excessive, occasionally lethal force, when dealing with the mentally ill, officers enrolled in CIT.

“It’s really about a culture shift,” said Lt. Tashia Hager, who heads the unit that coordinates the department’s mental health response.  In the past, she said, officers were taught, “If you do this, I’m going to do that.” Now they are encouraged to question whether “that” is really necessary.

To check out CIT at work, watch this video about the Memphis Police Department that pioneered CIT.

UK pardons homosexuals: Too little, too late?

The British Parliament announced last week that it would posthumously pardon individuals convicted of homosexual offences that are now deemed legal.  Known throughout history as sodomy, buggery, or the abominable crime, Britain punished individuals who engaged in sexual acts not key in reproduction – or involving an animal – by imprisonment or death.  Homosexual acts in England and Wales were decriminalized between consenting adults over 21 in 1967, as well as in Scotland and Northern Ireland in 1980 and 1982, respectively .

Homosexuality, as well as a wide spectrum of other sexual and gender expressions, have been a part of countless cultures for thousands of years. Several African languages  have pre-colonial terms to describe homosexual activities and relationships. Even prehistoric rock paintings  in Zimbabwe depict two men engaging in anal sex. In China, same-sex relationships were tolerated and prevalent among scholars and those of a higher class to denote power and wealth .  Known as “two-spirit” or “berdache,” native people of the Americas were intersex, androgynous, and homosexual individuals who were accepted as part of society.  In some instances, these individuals were married, served as caretakers to family members, and held rank as spiritual leaders and teachers . In some cultures, homosexual relationships were viewed as a mechanism to pass power between generations.

This inclusive worldview, expressed in various ways around the globe, changed dramatically when Europeans set foot on distant shores.  Along with Christianity and communicable diseases, British imperialism left homophobia in its wake (only 22 countries have not at one time in their history been under the sovereignty of the British Empire ).  Compared to other European colonizers, former British colonies are significantly more likely to have current laws against homosexual activities .  A report found that 70% of countries that were once in British possession still criminalize homosexual acts, even when controlling for such factors as religiosity, modernity, and wealth.

Homophobia has led many countries to severely persecute its citizens who engage in same-sex sexual activity.  In the Gambia, acts of homosexuality and HIV infection can be grounds for life imprisonment .  Nigeria’s anti-gay laws make promotion of homosexuality a punishable offense with a sentence of 10 years’ imprisonment.  This law is also used to punish public health workers and people who fail to inform on acquaintances and neighbors.

uganda-anti-gay

In Jamaica, mounting violence against homosexuals and LGBT organizations have led to the gruesome murders of activists.  In the United States, anti-sodomy laws have been used to routinely deny civil liberties such as the right to marry, raise children, and job security.  Today, in 9 U.S. states, discussion of homosexuality in schools is explicitly banned in sex education unless described as a route for sexually transmitted infections.

In addition to perpetuating human rights violations and encouraging discrimination and violence, deeply entrenched homophobia impedes HIV prevention efforts, further marginalizing one of the groups at highest risk for infection:  MSM, or men who have sex with men.

The term “MSM” has been used in public health literature to describe this sexual minority in the hopes of reducing stigma related to HIV infection and men who engage in homosexual behaviors.

Men who have sex with men (MSM) is a term introduced in 1992 to attempt to capture a range of male–male sexual behaviours and avoid characterisation of the men engaging in these behaviours by sexual orientation (homosexual, bisexual, heterosexual, or gay) or gender identity (male, female, transgender, queer).1 MSM includes gay-identified men, heterosexually identified men who have sex with men, bisexual men, male sex workers who can have any orientation, men engaging in these behaviours in all male settings, such as prisons, and the rich and wide array of traditional identities and terms for these men across cultures and subcultures .

In the United States, MSM, along with men who identify as gay or bisexual, account for 55% of those living with HIV, though they only represent 2% of the total population.  Among the age group 13-24, men who have sex with men, make up nearly the total (92%) of new HIV infections.

usa-msm

A six-part series published in the Lancet finds that prevalence of HIV in MSM is growing around the globe, though data concerning this population is lacking across the board.  A joint report by WHO, UNAIDS, UNFPA, and UNDP  found that MSM sexual health needs in Eastern Europe and Central Asia are summarily ignored:

The current response to HIV among MSM communities and transgender people in the region is largely failing to provide a basis for Universal Access (UA) among this key population. The issue is either essentially ignored due to lack of sufficient data and analysis, or marginalized with little resource allocation within national HIV programmes. The list of barriers to prevention, care, treatment and support programmes includes, but is not limited to, human rights violations, stigma and discrimination, lack of effective national policies and sufficient government support, inadequate funding, lack of sustainability and continuity of project activities, as well as the lack of biological and behavioral research in the region to better “know your epidemic”.

An article published in the Psychology and AIDS Exchange Newsletter reports that discrimination, stress, and homophobia experienced by homosexuals is a driving force in behaviors that contribute to HIV transmission.  Homophobia has otherwise been implicated with risk-seeking behaviors such as substance abuse, sexual promiscuity, self-harm, and suicide.  Often rejected by family and community, MSM have trouble establishing monogamous relationships, which could decrease transmission .

In countries where homosexual relationships are punishable by imprisonment or even death, MSM are even harder to reach.

Punitive legal and social environments hinder the ability of gay men and other men who have sex with men to organize and participate meaningfully in the design and implementation of programmes to provide HIV-related services. This poses a concern for the HIV response—studies have demonstrated that the involvement of gay men and other men who have sex with men and transgender people in peer outreach and other community-level behavioural interventions can reduce HIV risk behaviours by up to 25%.

As the UK prepares to expunge the records of individuals, many of whom are deceased, is it perhaps a better use of time to address this issue impacting the living?