Serious health care reform is needed in the US. Despite spending more than any other OECD nation on health care expenditures, we are also the only democracy with any sort of substantial uninsured population–over 40 million in 2002. While we pride ourselves in intellectual capacity, we’re the last of the industrialized nations to realize that voluntary pooling of risk in a competitive, capitalistic market is absolutely unsustainable. Insurers will skip high risk “uninsurables” in order to avoid large expenditures–leaving the uninsured to find their care at emergency rooms and the government footing the bill with the highest risk populations.

It’s time to move up with the rest of the world. Health care reform is necessary.

[Image from artbymags via Flickr.]

However, two UCLA experts are much braver than us. They just released a new statement blaming American values for the current health care crisis. It’s a short and quick read.

Now, I can blame my obsessive-compulsive irrationality on something scientifically sound. Trials done at the University of Southamptom found that items with a copper surface had 95% fewer micro-organisms than their stainless steel counterparts. Sure, this is good news for hospitals with a much cheaper and effective way of reducing the exposures to potential infection, but this is much better news for my own neuroticism.

A press release of the study can be read here.

The supporters of the bill say that decriminalization would improve the safety and health of sex workers by allowing them to come forward to the police with complaints of rape or assault without fear. The opponents say the measure would increase crime and allow the already problematic human trafficking in San Francisco to explode.

While I won’t get into the details of the bill or my own personal opinion, it certainly shows the moral dilemmas one might face in public health. Does your moral stance against prostitution outweigh your moral stance against abuse and assault? Do the sex workers “deserve” to get assaulted if they are doing something illegal? Are you more interested in the health of the population or the perpetuation of your personal morals?

What I found most intriguing is the Swedish model of prostution enforcemet. In 1999, Sweden passed the “Sex Purchase Law”, which effectively makes the sale of sex legal but the purchase of sex illegal. This allows the sex worker to come forward, report crimes, receive proper medical attention, and more accurately portrays the sex workers as a victim. Originally mocked, the law has seen a recent surge of interest. It’s hard to gauge the effectiveness of the law as the drop in prostitution may just be the result of pushing it underground.

It’d be interesting to do a formal study about the health of the sex workers, sexual health of the general Swedish population, and rate of prostitution. If anybody knows of one, I’d like to know about it.

[Image by gwalton1 via Flickr.]

AIDS has already killed more Americans than the combined total of combat deaths in World War I, World War II, Korea, and Vietnam. Despite treatment advances, the deaths keep coming. In 2006, the most recent year with good records, we lost 14,627 of our fellow citizens to this terrible disease.

And the scary part is: he is not wrong. In fact, it has gotten so bad in the US that if African-Americans were there own country, they would rank 16th in the world in the number of people living with AIDS according to a new article. This administration has tried and given plenty to countries abroad while ignoring the huge HIV problem at home. As Pollack says, “Our next President will inherit a badly deteriorated public health system.”

In general terms of HIV prevention, we are in bad shape. The article by Pollack is definitely worth a read. He also has an article in The New Republic which is more technical and verbose but equally engaging. Particularly this part:

… in 1985, President Reagan made his first speech on AIDS. Health authorities proposed that he say the following: “As far as our best scientists have been able to determine, AIDS virus is not spread through casual or routine contact.” These words were redacted by a young White House aide, future Chief Justice John Roberts. This story stings, not just because Roberts was wrong, but because the public health community was so casually over-ruled by a well-placed young lawyer who knew nothing about AIDS.

Since the beginning of public health as a governmental institution, politicians, lawyers, advisers and those with little to no medical knowledge have had overwhelming powers in determining law.

If HIV prevention, or any public health issue, is going to be seriously addressed, there needs to be serious reform within the government–here’s to hoping for something new in the coming election.

[Image mine.]

TUESDAY, Sept. 2 (HealthDay News) — Suicides among U.S. children appear to be on the rise after a 15-year decline, and the trend may owe, in part, to fewer teens being prescribed antidepressants, a new study suggests.

This has occurred after the 2003 “black box“ing of a certain group of antidepresseants, selective serotonin reuptake inhibitors or SSRIs. It also occurs after the return of many troops from Afganistan and Iraq. Our economy has also been in the middle of the mental recession that isn’t. And, of course, also after the rise of social networking sites like MySpace and Facebook. Though those may not be the reasons for the rise, it has been cited as possible in the study.

In the end, the study is relatively inconclusive in terms of cause of how to address the problem, but I think it reflects the increasing scope of public health. Just last decade we learned we had to worry about an increasingly large, older population as life expectancy increased, and now we are learning we also have to worry about an increasingly large death rate in our young populations.

For more information on suicide, visit the NIHM website here. If you are in a crisis or feel that you need immediate help, call 1 800 273 TALK (8255). People are on the line to help you immediately.

[Photo is used by CC. Credit goes to daveelmore of Flickr.]

More than 100,000 people live in New York City with HIV and thousands more are unaware they carry the disease. There are more AIDS cases in NYC than in Los Angeles, San Francisco, Miami and Washington DC combined. There is also a large disparity; the brunt of the burden — 80% — is taken on by African-American and Latino populations. HIV is spreading in New York at three times the national average

That’s the bad news. However, it is even worse than we thought. In a story by the NYTimes, a new formula developed by the CDC estimates that 4,762 New Yorkers contracted HIV in 2006.

Because this was a new method of estimating, it is difficult to tell the direction of the trend. What is evident, however, is the social and geographical disparities. Though the rate of white males contracting HIV in New York is 4 times greater than the national average, the raw numbers show almost 80% of new infections are from black and Latinos. to combat AIDS has never worked for us domestically and why he believes it would ever work for other nations is beyond me. The simple fact of the matter is that certain issues of public health cannot be looked at on a international or even national scale. Certainly, the numbers show that HIV is one of those things. Even within the city, the data obviously shows points of particular interest — where educational programs, advertisements, awareness campaigns, etc — would be most effective and which demographics to target. What we need is legislation and funding free of strings and constraints and local nonprofits to run targeted and concentrated campaigns.

[Image is mine and under CC license.]

28 August 2008 | GENEVA — A child born in a Glasgow, Scotland suburb can expect a life 28 years shorter than another living only 13 kilometres [8 miles] away. A girl in Lesotho is likely to live 42 years less than another in Japan. In Sweden, the risk of a woman dying during pregnancy and childbirth is 1 in 17 400; in Afghanistan, the odds are 1 in 8. Biology does not explain any of this. Instead, the differences between – and within – countries result from the social environment where people are born, live, grow, work and age.

That is a quote from a recent press release by the World Health Organization.

It’s been stated in the public health profession that posing social issues such as these — povert, war, etc — in a public health perspective has serious perils but I don’t think these facts can or should be ignored.

How is it that within 8 miles of the same country there can be a 28 year disparity in life expectancy? How is it that the disparity between countries can be so high? These are obviously not biological factors as the disparities within countries — even within cities — can be even greater than the disparity between countries.

These are questions that must be more thoroughly investigated and answered not just for the sake of the world’s poorest but also for the benefit of the world’s richest countries. The investigation this press releases was based on was a three year long investigation by academics, heads of states, ministers of health, etc and largely focuses on the social determinants of health.

After reading mounds of academic journals, I’m relieved to have gone through this report. It’s for the layman and the focus on SDOH instead of epidemiological sources is evidence of a new trend in public health research geared not only towards individuals and institutions but the entire social context of populations and how they affect health.

The study refers to status gradients that are universal — poor people die sooner than medium income people who die sooner than rich people regardless of the wealth of the nation as a whole. This may make sense economically but the universality of status gradients is further extended in other facets of life — education, working conditions, social status, occupational prestige, etc. Ultimately, issues that are most often funded are issues that affect rich countries. Thankfully, this is an issue that affects rich countries but resulting research findings and paradigms may be applied to poor countries as well.

The report is a good read but if I’d recommend at least reading the press release. Just the facts alone are interesting enough to make you want to read the whole thing.

[Image is mine and under CC License. Some rights reserved.]