Lessons from Tropical Storm Harvey

Lessons from Tropical Storm Harvey

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Over the past several days, it’s been hard to miss the stories and images of people and animals affected by widespread flooding in southeast Texas. Tropical storm Harvey has battered the region before moving east toward Louisiana, another state that has been hit hard by extreme weather patterns – including Hurricane Katrina, which FEMA called “the single most catastrophic natural disaster in US history.”

As a public health physician, I’ve been closely following the emergency relief response in Texas. I’ve been encouraged by the outpouring of concern, compassion, and support for humans and animals alike – although there is still much to be done.

In a previous blog, I wrote about how large-scale disasters and emergencies underscore our shared vulnerabilities – despite our differences as humans or our differences with animals. And, as we saw after Hurricane Katrina, foreseen and unforeseen disasters also offer an opportunity to address these shared vulnerabilities and prevent future suffering by remedying systemic problems. For example, after Hurricane Katrina, when some people refused to leave their homes because of concern for their animals, Congress rightly passed the Pets Evacuation and Transportation Standards (PETS) Act, providing temporary shelter for companion animals and their families during a disaster. Gradually, through a combination of their own volition and legal mandates, more shelters are taking in people with animals. It is becoming clearer and clearer that the problems we face aren’t a question of “us or them.” True, sustainable solutions include attention to the needs of all people and animals.

Nonetheless, Harvey has already resulted in tremendous suffering and death. What can we learn from this disaster – both to prevent future catastrophes of this scale and to create healthier, more resilient communities?

Here are a few ideas:

  • We’re all in this together, and we are stronger together. It’s wonderful to see the surge of empathy, courage, and fortitude in response to the widespread flooding in Texas. Why don’t we practice these qualities every day? Instead of focusing on what divides us – and allowing politicians to deepen existing biases and prejudices – why not find and focus on that which unites us, including our potential for vulnerability and resilience?
  • The risk for disease and disorder isn’t static. Vulnerability to illness and suffering is determined by how we care for the natural world and design the built environment around us. The flooding in Texas has placed many people at risk for physical and mental illnesses, including injuries, infectious diseases, exacerbations of chronic diseases like asthma and diabetes, anxiety, depression, and posttraumatic stress. Investing in sound infrastructure matters. This issue, like other city, state, and federal planning efforts, influences the risk for large-scale disasters and corresponding health risks.
  • Some individuals are more vulnerable than others. For example, some people are more likely to be victims of disasters since they live in environments with inferior infrastructure, with compromised access to lifesaving resources.  In a similar vein, I find myself thinking not only of the companion animals caught in the Texas floods, but also of the animals on farms, in zoos, and in laboratories who are trapped by the floods. Not only do these animals suffer but their predicament also creates more misery for humans because of the potential for increased disease exposure and transmission. These are all human-created problems that are worsened for animals and people during large-scale disasters. We need to acknowledge the inextricable link between human and animal wellbeing and inspire action accordingly. Rather than merely finding proximate and piecemeal solutions, we need to address the root causes of problems. Those of us with any privilege are particularly well positioned to address the core causes of suffering – before and after emergencies.
  • We have to be real about the world we’re living in. We aren’t connected only to each other but also to the earth that is our only home, no matter where we live in the world. Coming to terms with the effects of climate change and environmental degradation and taking responsibility for it is key. Younger generations appear to understand this dilemma but it will be too late if we wait for them to fix our mistakes. Our everyday choices are wreaking havoc on the climate and the environment we depend on for our health and wellbeing. Changes in rainfall associated with global warming influence weather patterns including hurricanes and flooding. Medical and public health organizations cite risks associated with extreme temperatures and weather patterns, including poor air, water, and food quality, and a corresponding rise in instability, violence, and chronic and infectious diseases, among other dangers. As I’ve written before, each of us can make changes in our everyday lives to stem the risks associated with climate change and environmental degradation.
  • I don’t know if we are running out of time but I do know that every wasted moment matters. If we can prevent one more tragedy, we should. We need to do everything we can to create healthier, more resilient communities and protect them from further disaster – whether those disasters are slow or sudden.

Let’s make our moments matter in the best ways possible.

Five Ways to Help Stop Attacks on Women and Girls

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Last week, after the suicide bombing at Manchester Arena, several reporters commented on how it represented an attack on girls and women. As a doctor involved in the response to sexual and gender-based violence, I was interested to hear what these journalists had to say. They made valid and important points – from how the attack occurred at a concert by Ariana Grande, who has taken a strong stand against sexism and the objectification of women while embracing sex positivity, to how terrorists and their supporters aim to limit girls’ and women’s freedom and opportunities.

The attacks were a reminder of the ubiquity of malice against girls and women. Oppression and misogyny aren’t confined to only some areas of the globe. As we saw in our recent presidential election, even here in the US, we still have a long way to go. Nick Kristof provided another reminder in one of his recent editorials which described the plight of an 11-year-old Florida girl pushed to marry a 20-year-old church member who had raped her. In the same article, Kristof laid out surprising statistics on “child marriage” in the US, similar to other areas of the world.

Clearly, we aren’t where we need to be.

Though it’s often easier to point fingers at others, it’s important to examine how those of us with privilege can influence the lives of other women and girls. Those of us in positions of power and influence need to be leaders in all areas of society – from medicine to business to government. As First Lady, Michelle Obama rightly and repeatedly returned to this important theme.

Right now, there are many opportunities to help women and girls, including those living in the US. Here are some acutely evolving areas of policy that matter:

  1. Health Care: Currently, there is an effort to repeal and replace the Affordable Care Act with the American Health Care Act, which would result in a major loss for women – from access to preventive services, including contraceptive and reproductive health services, to restrictions on health services for women who have been raped, abused, pregnant, or depressed. Instead of focusing on repeal and replacement, we should work to improve the Affordable Care Act for everyone.
  2. Education: The current administration aims to cut the Education Department’s funding by $9 billion – particularly with cuts to career and technical education. Almost $1 billion would go toward charter-school and voucher initiatives while shifting money away from public education. Proposed changes will disproportionately hurt vulnerable kids, working families often led by women, and teachers, about three-quarters of whom are women. Rather than shifting funds away from public education under the guise of “choice,” we should support our teachers while maintaining accountability.
  3. The Basics: Proposed changes in housing, supplemental nutrition, and tax policy will disproportionately harm individuals living in poverty, particularly women who often bear the greatest burden of poverty. If we can’t guarantee basic needs for women and their children, where do we even begin to improve the lives of girls and boys?
  4. Business: We still don’t have a federal living wage or a legal requirement that women receive equal pay for equal work. Nearly two-thirds of minimum wage workers are women, who often support families in single and combined parent households. These disparities aren’t coincidental. Some states and employers are already taking steps toward establishing a living wage, but we still have a long way to go.
  5. Politics: Though women represent at least half of the American population, relatively few hold public office. That means that issues that matter to women – from health care and economics to animal welfare and war and peace – don’t get the attention they deserve. And proposed solutions don’t benefit from women’s wealth of experience.

So, here’s the good news. Since the 2017 presidential election, more women are exploring political careers. Across the US, women are finding support from nonprofit organizations, political consultants, and other women. And women aren’t just running for office – they are winning.

So where are there opportunities for us to stand up and speak out for other women? Everywhere. Whether you’re considering running for office, supporting another woman who is interested in running, becoming or continuing as a local activist, or calling your local, state, or federal representatives, you can make a difference for women and girls. (Here I’d add that men and boys can certainly help out, and many good ones often do!) And, together, we can set an example for the rest of the world.

 

 

 

 

 

 

On & After Earth Day, Do Good & Do No Harm

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Today is Earth Day – a great day to think about the only home we have. This year’s campaign focuses on empowering people with the knowledge to inspire greater environmental protection. Forty-seven years after its launch, more than one billion people participate in Earth Day activities. The first Earth Day was launched after ecologist Rachel Carson published Silent Spring – The New York Times bestseller that highlighted how the public’s health is affected by our treatment of the environment and other beings.

In medicine, we’re taught to “do good or to do no harm,” a pledge that originated in the Ancient Greek physician Hippocrates’ Of the Epidemics. But Hippocrates spoke of much more than the mere obligations of doctors. Like Rachel Carson did two millennia later, he wrote extensively on how changes in seasons, water, air, and soil can influence health and illness.

Today Rachel Carson’s and Hippocrates’ messages are more critical than ever.

Our modern lives are racing by. We pay more attention to screens than we do to the world around us. All the while, our environment is rapidly changing – from global warming and water scarcity to air pollution and soil erosion to the modern, man-made sixth extinction. We rarely think about how these changes affect our everyday health. But they do – almost like a boomerang that comes back to hit us where we stand.

Climate change impacts our physical, social, and mental health. For example, changes in rainfall affect the availability of water as well as the chance for extreme weather patterns like droughts, hurricanes, and flooding, which can all cause chaos and illness. Climate change can also drive diseases like malaria, bird flu, and Ebola. Likewise, water scarcity can lead to disease and even violence. Air pollution kills more people than do car accidents, HIV/AIDS, or diabetes, and soil erosion can result in shortages of healthy crops. It can also increase the amount of dust carried by the wind and the risk for transmitting infectious diseases such as anthrax and tuberculosis.

Like us, other animals suffer from air pollution, soil erosion, water scarcity, and climate change. And as Rachel Carson showed, when other animals aren’t healthy, it’s a sign that humans aren’t either.

But we can stop the boomerang. Our everyday decisions impact the climate, air, and water we depend on. So many environmental insults are preventable and perhaps even reversible with changes in lifestyle that avoid harm to other people, animals, and the natural world around us.

One important example is shifting from a meat-based diet to a plant-based diet since the meat and dairy industry is responsible for more than 50 percent of greenhouse gas production. Using animals to produce food is also responsible for consumptive water use, soil erosion, and air pollution – as well as heart disease, diabetes, and certain forms of cancer.

Another important example is ending our obsession with oil and gas, which are also huge contributors to climate change and air pollution. And here are even more ideas.

Though each of us can make a difference with our individual purchases, it’s similarly important that we lobby for policies that do good and do no harm. That’s especially important today when there are increasing threats to established environmental protections.

Our choices matter. From protecting our water sources (drops of life) to choosing the right fuel for our bodies and the earth, we can set a better path. And as Hippocrates pointed out thousands of years ago, in doing so we can also help stave off disease – from cancer to bird flu.

 

 

Health Care Reform: What We Need to Be Healthy As Individuals and As a Society

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Last week, long-term attempts to repeal the Affordable Care Act, enacted under the Obama Administration, failed. House Republican leaders, facing opposition from Republicans and Democrats, pulled legislation to replace the Affordable Care Act with the American Health Care Act. If successful, the repeal and replacement would have left an estimated 24 million people without health insurance coverage within a decade.  The replacement bill would have also reduced access to Medicaid, increased premium costs for many Americans in upcoming years, and restricted access to some women’s health services.

Most Americans opposed the replacement bill.

Like many Americans, I was relieved the new bill didn’t replace the Affordable Care Act – especially for patients desperate for health services. In the course of my medical career, I’ve had the privilege of providing health care for people across the sociopolitical and economic spectrum. I’ve learned that despite our differences, we’re all vulnerable – susceptible to disease and disorder. Merely being alive leaves us with wounds and scars. Nonetheless, due to many factors outside our control – including economic and health care policies – some are more vulnerable than others. These disparities have become clearer and clearer to me over the years as I’ve witnessed many of my patients struggle with working hard for little pay, homelessness, and unimaginably difficult decisions like choosing between food, medications, and heating.

In recent years, with the passage of the Affordable Care Act (sometimes referred to as Obamacare), access to health insurance has expanded, especially for some of the most vulnerable individuals. Before it was implemented, the percentage of people who were uninsured or underinsured was increasing and the pool of doctors to care for them was shrinking. Overall, the Affordable Care Act has increased access to affordable health insurance and preventive and treatment services and helped slow the rate of increase in national health care spending for the first time in years.

While we were moving and between jobs, my husband and I signed up for health insurance through the Affordable Care Act, and it was easy and affordable (more affordable than COBRA). Nonetheless, problems with the Affordable Care Act remain and there is at least bipartisan agreement that improvements should be made – though there are differences of opinions about what those changes should entail.

At this point, it’s worth considering which principles should guide further health care reform. Based on the evidence and experiences around the globe, here are a few ideas:

1) Policies should reflect key moral values like equity, compassion, and respect for dignity.

Many countries around the world place these values, as well as community and solidarity, at the core of their health care policies.

In practice, this approach takes many forms – from universal coverage to a multi-tiered system with a clear safety net for people who cannot afford health insurance. In remarkably different ways, several capitalist democracies across the globe deliver health care for everyone.

Along these lines, in the United States, some are calling for a “Medicare for All” approach in order to increase access to health care.

Though these approaches all differ in their details, they all put patients ahead of inanimate corporations – from drug companies to hospital conglomerates to insurance firms – by increasing transparency, capping or negotiating lower drug prices, limiting hospital costs, and more.

2) Health care should be evidence-based, high value, and cost-conscious.

Though spending growth has slowed in the U.S. and most other countries in recent years, the country’s health care spending exceeds that of other high-income countries.  We spend more public dollars on health care than most other high-income countries – even without a publicly financed universal health system. Much of this can be explained by spending on technologies that aren’t clinically indicated – interventions that don’t necessarily improve quality of life or extend life.

U.S. health care organizations are beginning to move in a better direction – toward more high value, cost-conscious care. The Affordable Care Act has hastened some of these positive changes.

3) We need to invest in prevention.

Many health care costs in the U.S. and across the globe are attributable to chronic diseases such as diabetes and heart disease. These diseases and their complications are expensive to treat, but they are preventable.

On the flipside, prevention – especially primary prevention (preventing illness before it occurs) – is cheaper over the long haul. Prevention also helps us live longer and better. The Affordable Care Act established funds for prevention, though some of those investments – which would have battled smoking, lead poisoning, heart disease, diabetes, stroke, and falls among elderly adults and promoted breastfeeding and immunization programs – have since been repealed.

4) Social and economic policies should prevent – not promote – disease.

Right now, many social and economic policies aren’t aligned with prevention goals. Nutrition policy is but one example. For example, agricultural policies currently provide subsidies for meat and dairy production, which end up as commodities that are high in cholesterol and saturated fat and promote illnesses like heart disease, diabetes, and obesity in children and adults.

In another area of social policy, Housing First and supportive housing policies – which provide housing and health care management to individuals who need it regardless of factors like drug use – help reduce costs associated with mental and medical illness.

Overall, studies show that investing in social services – from basic necessities like adequate nutrition and shelter to education and childcare – can help improve lives and lower the cost of health care.

Almost all of us, at some point in our lives, will need some type of health care. Instead of arguing about whether it is a right or privilege, we should focus on what we need to be healthy – as individuals and as a society. In the process, we might discover how our vulnerability unites rather than divides us.

 

 

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