Progressive public health

The US House of Representatives is scheduled to vote on one of the many required, but in this case crucial, steps to beginning an overhaul of the chaotic situation of American health care. By all accounts the vote is close, which is really pathetic. What is being proposed in the US is a baby step in absolute terms, although it is huge in terms relative to the historically backwards and reactionary character medical care in the US. I hope it passes, since not passing it would leave tens of millions without insurance of any kind and most of the rest of us insecure about the coverage we have.…

The Reveres consider themselves progressives (check the masthead), a word used for people who believe government has a role to play to make the world better, but also tend to be social libertarians. Many scientists and doctors are progressive in that sense. But it's a mighty big tent, and apparently covers some folks whose politics I agree with on many issues but can still be very far from what progressives also call the "reality based community." Very far. Far, as in "they can't see it from where they are." Literally: Atlanta Progressive News has parted ways with long-serving senior staff…

Illinois is not a state I know well, despite having spent five terrifying days and nights in 1968 being chased around its major city by its (then) rabid constabulary and almost losing my life in the process. It was decades before I could bring myself to return there, but when I did I found a vibrant, electric city with some of the greatest food anywhere. Some things hadn't changed that much, though, and Chicago and Illinois politics have remained, well, "different." Think Rod Blagojevich. Well, don't. He's not the Governor any more. After Blago's impeachment, his estranged Lieutenant Governor…

I don't know if the rest of the world laughs at the US, but I feel quite sure they at least shake their collective heads when they hear how we lack one of the most important non-pharmaceutical measures against pandemic flu: paid sick leave. Of course only those countries with a policy of paid sick leave would be shaking their heads. It turns out, though, that's just about everybody: The United States is one of only five countries in the world without a national policy on paid sick leave, Dodd said. "We're in the company - and I say this respectfully of these countries - of Lesotho, Liberia,…

It's being described as a "dramatic settlement" that will set a pattern for the nation. Let's hope so, because the agreement reached yesterday by the California Nurses Association/National Nurses Organizing Committee (CNA/NNOC) and hospital player Catholic Healthcare West (CHW) sounds like just what the doctor ordered. It covers 32 CHW facilities in California and Nevada, where CNA/NNOC represents 13,000 registered nurses. Some details: A centerpiece of the agreement is the creation of a new system-wide emergency task force, comprised of CNA/NNOC RNs and hospital representatives following…

Of the three main modes of infection for flu -- transmission by large droplets, transmission by tiny suspended aerosols, transmission via inanimate objects (also called fomites) -- it is the last that is the least certain but garners the most attention in the form of hand hygiene, disinfectants and now, fear of magazines and toys in emergency department waiting rooms and acute-care clinics in Canada. Here's the lede from an article in the Montreal-Gazette: All magazines and toys should be removed from emergency department waiting rooms and acute-care clinics to reduce exposure to human swine…

I don't know what's going to happen with swine flu. I do know that if there is a nasty flu season we'll all get through it better if we help each other, not run from each other. It's national independence day in the US, so I thought this clip of the crowd singing the National Anthem (hat tip, Paul Rosenberg at Open Left) at Boston's Fenway Park (home field of the Boston Red Sox baseball team) was appropriate. It was Disability Awareness Day and to recognize it the anthem was being sung by a handicapped youngster. When he got nervous, the entire ball park came to his rescue:

WHO today declared we an influenza pandemic is underway (aka, phase 6), which is not news to anyone. This beast has been barreling long for at least 3 or 4 weeks and the reluctance to call it what it was was related to resistance from some of WHO's member states (the UK, China and Japan have been often fingered as the chief culprits). The apparent lack of cases in Europe didn't fool most experts. The EU was using a testing protocol designed to minimize the case count. It was refreshing not to have the US party to these kinds of shenanigans, but of course we had no opportunity: it started here…

You learn a lot when you move from investigator to subject. I just heard about Drive-by Tylenol for day-care and school age kids. This is the practice of stuffing a couple of Tylenol down the little tyke's throat to bring down a fever just before entering the daycare center. The objective is to get 4 or 5 hours of work in before being called to school because your child has a fever. The underground lore about it includes not using any flavored Tylenol preps with red dye in them so that when the child urps up everthing after lunch there will be no tell-tale pink color savvy teachers will…

Laurie Garrett of the Council on Foreign Relations and a well-known authority on emerging infectious diseases was on PBS's Newshour last night and she made a very important but little appreciated point. Mexico has made a major national sacrifice for global public health by shutting down its country and interrupting transmission of disease. The cost to Mexico has already been enormous it will continue to pay in other ways. The reputation of the government has suffered because of the way it handled this -- the lack of transparency, the initial slow footedness (which of course it denies), its…

One of the things we are told is not the responsibility of government but an "individual responsibility" is not working sick or sending our kids to school when they are sick. I pointed out that the ability to do this may depend on others, particularly employers. Employers also have a responsibility, not just employees. The US has some of the worst sick leave and child care policies among industrialized nations. It is nothing short of a scandal. And now these non-policies have the potential to have major public health consequences. The US labor movement is querying its workers about this. Here…

The White House briefing today had Obama written all over it. It's themes were Obama, it's tone of quiet, serious confidence were Obama. The sense of total command of the situation was Obama. There was the Obama-ese call for "personal responsibility." Government can't do everything. There are things we each have to take personal responsibility for. Fine. I don't disagree. But I think there are some things missing from this frame. One is that it isn't a binary choice, government or the individual. We all live in a set of overlapping communities: work, home, neighborhood, civic organizations,…

My public health colleague DemFromCT continues his public health interview series on the front page of DailyKos today, talking to Dr. Georges Benjamin, Executive Director of the American Public Health Association (APHA). Dem clearly likes Dr. Benjamin, which is not a surprise. He is a very likable person. I have been a member of APHA (on and off; I keep forgetting to renew) for over 40 years, have served on one of its top policy boards and been a member of its Governing Council. But in recent years I have had little to do with APHA, and Dem's interview today illustrates one of the reasons.…

One of the nastiest things about the years after the Republicans took control of the Congress in 1994 and Bush the White House in 2001 was the increase in inequality in the US. The rich not only got richer and the poor, poorer, but rich got more comfortable and led better lives. The idea that they got rich because all they did was work is nonsense. They had plenty of time to spend their money and relax. Moreover the prosperity in the economy didn't accrue to everyone. It was the folks at the top that benefitted. We all know that the rising tide only lifted the yachts, but we sometimes forget…

On Sunday DailyKos frontpager, DemFromCT (who is also a founder of the FluWiki and a pulmonary specialist) finished up his two part interview with us. It's cross-posted here below the fold. If anyone doubted we were academics, the display of watching us argue with ourselves would have but those doubts to rest. Scientists cherish the hope that we will make difficult things simple, but often we wind up making simple things difficult. We see complications in everything, even the simple question of what is public health infrastructure. Witness: Q. Last week I asked you about public health…

On Sunday my friend and colleague from Fluwiki, DemFromCT, did me the honor of interviewing me on the front page of DailyKos. That's a pretty tall platform, being the most visited blog in the known universe (and beyond), so it's best to be absolutely clear when saying things there. I"m not sure I quite met that standard, but I'll let you judge for yourself, as I am cross-posting the interview below the fold. But this also gives me an opportunity to clarify one point that drew some justified comment. Here's something I said in the interview: In the past I downplayed individual prepping for a…

The Holiday Season is upon us so we won't post daily on the Public Health Conversation series. But you can join in at any time, in two ways. Effect Measure and The Pump Handle, the two blog sites hosting the discussion, have comment threads for each post. You can make a comment at any time on any post. If you want to see all the posts on this topic, just click the Progressive public health category on the left sidebar on Effect Measure. We will put an appropriate tag on The Pump Handle posts as well. If you have produced a more polished piece, send it by email to The Pump Handle. We will be…

A couple of ideas are floating around in the comment threads as part of an initial conversation about public health. I'm not surprised they seem to be on different topics and have the feel of talking past each other. We are not used to discussing basic assumptions and have an immediate tendency to talk about what we know, what interests us particularly, what bothers us most or what is our particular preoccupation. Many of those things turn out to be really important for public health and there are plenty of reasons for talking about them. Annie, for example, is frustrated with other medical…

I'm (more than) pleased to say the public health conversation is starting. I assume it was already going on but not where we could all hear what others were saying. So let me continue by responding to a point raised at The Pump Handle (TPH) that was also the subject of offline discussion from someone who read the post. Liz and Catherine (at TPH) made special reference to this comment from me: "If I am an ordinary person, I don't want to have to think about public health. I want it to work well but in the background, like the water system." Each had a slightly different take on it, as did my…

Yesterday Flu Wiki founding editor and DailyKos frontpager DemFromCT reviewed three recent report cards on public health, one each by the American Public Health Association (APHA), The Trust for America's Health (TFAH) and the American College Of Emergency Physicians (ACEP). It was a great a service in two ways. The first is to remind us that "health reform" is hollow without making sure the public health infrastructure is sound. And second, he reviewed these reports so the rest of us don't have to. Believe me, that's a service in my eyes. My patience gets pretty short when I see these tomes…