Public Health

You are currently browsing articles tagged Public Health.

Employers Pushing Healthier Living

August 8, 2011 in Employee Benefits, Health Insurance | 3 comments

“This isn’t about big brother telling people what to do,” says John Rice, GE’s vice-chairman, “but helping them make better choices.”

The Economist reviews large employers efforts to improve employee health and thus decrease their own health care costs.  Some of these efforts include:

  • Prohibiting smoking on company premises
  • Handing our healthy recipes
  • Building on-site gym
  • Bonuses for healthier living

Take these examples from Fortune 500 companies:
“At IBM, employees receive a $150 bonus for exercising, eating nutritious meals and so on. One such bonus is designed not just for an employee but for his entire family. According to IBM’s own data, caring for a diabetic child is six times costlier than caring for a healthy one.”

Kevin Volpp, the director of the Centre for Health Incentives at the University of Pennsylvania, found that GE’s anti-smoking incentives prompted 9.4% of smokers to remain smoke-free after 18 months. Without incentives, only 3.6% of those who tried to quit succeeded. A review published in Health Affairs last year found that firms saved $3.27 for every dollar they spent on health programmes.”

Is this a good thing? Health insurance should account for random health risks. Health risks due to individual employee behavioral choices, however, should be internalized by the individual. Since the premium prices are basically the same (free) for most employees in large firms, they have a smaller incentive to maintain a healthy behavior than would be the case if employers used individual underwriting in pricing policies. Thus, efforts to give bonuses for healthier behavior by employees and their families is, in essence, an effort to increase net premiums for those who do not engage in healthy behaviors. With health care costs consuming a larger and larger portion of employer’s budgets, these efforts to control costs will be increasingly important over time.

Tags: , , , ,

Drinking in College is “Largely Positive”?

May 24, 2011 in Public Health | 3 comments

According to Marshall Poe, drinking in college has more positives than negatives.

“Rowdy drinking is not the problem. It is an essential, ineradicable, and largely positive element of American college culture. The problem is students who cannot or will not engage in rowdy drinking safely, for they often harm themselves and others.”

How is drinking a positive?  According to Poe, it fosters community at the University of Iowa and many other American universities.

“For most students and alumni, rowdy drinking is considered essential to becoming a Hawkeye. …It may well constitute some of the glue that holds said package together. At Iowa and in American colleges throughout the nation, getting tight and acting silly with your classmates is a rite of passage. It is self-imposed hazing writ large. Like any initiation ritual, it comes at a price…In the vast majority of cases, however, that price is low: hangovers, poor grades, and fines. If you make it through — and almost everyone does — then you will have become a different person and be welcomed into a vast, eternal community. You will have earned the right to reminisce about your eventful days in Iowa City, to warn your children with a wink not to do the things you did, and to bask in the glory of being a Hawkeye.”

Drinking in college is certainly a risky behavior.  Public health offical should examine their efforts to stop college drinking in two parts: 1) what is the net impact of college drinking, and 2) will public health officials/college administrators be able to stop it.  On the first count, public health officials generally only focus on the cot of drinking and not the benefits (i.e., hedonistic pleasure, comradery).  On the second count, it seems like health efforts will only have a marginal effect on drinking.

Instead of demonizing college drinking, let’s focus on helping those who truly have a drinking problem, and let college kids who drink (relatively) responsibly have their fun.

Tags: , , , ,

Japan’s Nuclear Fallout: The Health Impact

March 15, 2011 in Current Events | No comments

The before-and-after pictures of the tsunami in Japan are heart-wrenching.  And things look to be getting worse.  From the New York Times:

“With hydrogen gas bubbling up from chemical reactions set off by the hot fuel rods, the storage pond produced a fire and powerful explosion on Tuesday morning that blew a 26-foot-wide hole in the side of reactor No. 4 at the Fukushima Daiichi nuclear power plant. There were also concerns about the storage ponds at reactors 5 and 6.”

What is the health impact of the potential nuclear disaster?  According to the Kaiser Family Foundation:

“The most immediate risk from high levels of radiation exposure is thyroid cancer, and the Japanese government is planning to distribute potassium iodide pills to help lessen the risk. In worst-case scenarios in which nearby residents are exposed to very high levels of radioactive fallout, they can develop other cancers years later. However, a complete meltdown of the reactors “would not necessarily mean medical doom, experts said. It depends on the amount and type of radioactive materials,” according to the article, which compares the current situation to previous nuclear reactor disasters at the Chernobyl plant in the Ukraine and the Three Mile Island plant in Pennsylvania (3/15). According to CNN, two U.S.-based companies have received hundreds of orders for potassium iodide since the earthquake (Smith, 3/15).”

This is just another reminder that medical care is only one component of health.  Your behavior (e.g., exercise, smoking), your genetics, and your environment (e.g., environmental pollutants like radiation) are also key contributers to health.  Let’s hope the environmental health influencers improve in Japan and the nuclear reactor is controlled quickly.

To donate to the relief effort:

Tags: , ,

End of the War on Drugs?

May 11, 2010 in Current Events | 1 comment

According to Businessweek:

President Barack Obama’s plan to fight drug abuse and trafficking proposes spending $15.5 billion next year and shifting the emphasis from fighting a war on drugs to treating the problem as a national health issue, the administration’s top drug-policy adviser said in an interview.

“It’s a disease, it’s diagnosable and it’s certainly something that can be treated — but it’s not a war,” said Gil Kerlikowske, director of the White House Office of National Drug Control Policy.

Just because the President increased spending on drug treatment, however, does not mean that the war is over.  In fact, President Obama plans to increase spending on domestic law enforcement by “1.9 percent to $3.9 billion under the plan, with $579 million going to the Organized Crime Drug Enforcement Task Force.”  Plus, the U.S. still supports Colombian efforts to destroy cocaine growing plants in South America.  Drugs are still illegal and penalties for drug use–although moving gradually towards decriminalization in many states such as California–have not changed on the federal level.

Despite the rhetoric, the War on Drugs continues.

Tags: ,

The Intensive and Extensive Margins of Teenage Sex

March 12, 2009 in Contagious Disease, Public Policy | No comments

HIV is a huge health issue around the world and especially in sub-Saharan Africa.  Many American NGOs have promoted abstinence programs as a way to prevent the spread of HIV/AIDS.  However, most evidence finds that this approach has been ineffective.

An NBER working paper by Dupas (2009) adds more support that abstinence programs do not work.  In the paper, the author used a

“…randomized fi…eld experiment involving 328 primary schools to compare the effects of providing abstinence-only versus detailed HIV risk information on teenage sexual behavior. Half of the schools, randomly selected, received teacher training on the national HIV/AIDS curriculum, which focuses on abstinence until marriage, but does not discuss risk reduction strategies (such as condom use or selection of safer partners). In 71 schools, randomly selected after stratifying by teacher training status, an information campaign provided teenagers with information on the prevalence of HIV disaggregated by age and gender group (the relative risks information campaign).”

The authors finds that the abstinence program had no effect on pregnancy rates.  However, the “risk reduction” educational program decreased the probability a girl had started childbearing within a year by 28%.  The decreased pregnancy rates were not, however, due to less frequent sexual activity.  Instead, teenage girls switched their sexual partners from older partners to teenage boys in their age cohort.

This leads to the finding that teenage girls are having the same amount of sex, teenage boys are having more sex, but pregnancies are decreasing.  Why is this?

The author explains that when teenage girls have sex with teenage boys, “…teenage girls report higher rates of condom use, presumably in order to avoid pregnancy with resource-constrained teenagers.”  It is also possible that teenage girls can more easily convince boys of their same age to wear a condom whereas it may be more difficult to convince older men to use a condom.

Thus, we see that these “relative risk” educational programs do not decrease sexual activity on the extensive margin (teenage girls are having the same amount of sex), but do decrease risky behaviors on the intensive margin (more condom use when teenage girls have sex with people of their same age).

Tags: , , ,

Flushed

November 21, 2008 in Books, Health Care in Developing Nations | 1 comment

I just finished reading an interesting book on plumbing.  I can just see that I lost half my readers with that last sentence.  How can plumbing be interesting?

It turns out that if you are interested in health, you must be interested in plumbing.  Disposing of human waste is one of the biggest health problems, especially for individuals living in cramped urban areas.  In Flushed: How the plumber Saved Civilization, W. Hodding Carter takes the reader on an enjoyable, not-too-serious journey through wonderful world of plumbing.  This book is not written by an expert, but what is lacking in in-depth reporting is made up for with personal experiences and lighthearted commentary.  Mr. Carter gives the reader interesting historical information, technical details on sewage, and describes his tourist trips to visit plumbing systems of the past and present from around the world.  Even included are Mr. Carter’s own attempts at fixing the plumbing system in his house and his eventual purchase of a toilet with a heated seat [I am told by my brother that this is popular in Japan].

One of the most interesting anecdotes relates Mr. Carter’s trip to India to visit Sulabh International.  India lacks the wastewater treatment infrastructure to keep its waterways clean.

“As a result, India’s produce teems with bacteria and infectious diseases.  The country has an infant mortality rate of sixty deaths in a thousand births and two million Indian children die every year of diseases due in part to poor sewage disposal.  

Sewage is the scourge of India”

Sulabh International is an NGO who’s goal is to improve the sanitation and human waste disposal across India.  The NGO has developed a flush toilet which uses little water and where human waste is organically compounded to later be used for fertilizer.

After you have a glass of wine with dinner and hear nature’s call, be thankful for modern plumbing.

Tags: , ,

Flu Surveillance

November 13, 2008 in HC Statistics, Healthcare IT, Information, Vaccinations | No comments

Google searches as a public health resource:

Google.org has released Flu Trends, an online reporting tool for flu-related search activity. It’s long been theorized that Google’s search data would be useful to predict epidemics. This is the first time they’ve released a tool like this to the public. As they say on the main page:

We have found a close relationship between how many people search for flu-related topics and how many people actually have flu symptoms. Of course, not every person who searches for “flu” is actually sick, but a pattern emerges when all the flu-related search queries from each state and region are added together. We compared our query counts with data from a surveillance system managed by the U.S. Centers for Disease Control and Prevention (CDC) and discovered that some search queries tend to be popular exactly when flu season is happening. By counting how often we see these search queries, we can estimate how much flu is circulating in various regions of the United States.

This tool comes to us via Google.org’s Predict & Prevent initiative. You can download the data for your own analysis.

[Update, 14 May 2009: Google is refining their Flu Trends data by asking people questions about their flu searches.]

Tags: , ,

Poor housing market increases incidence of West Nile

August 7, 2008 in Contagious Disease, Economics - General | Permalink

California has been one of the states that have been hardest hit by the “housing crisis.” According to the May 2008 Case/Shiller Index, home prices in San Diego and Los Angeles Counties have fallen 23% and 25% respectively over the past year. Foreclosures are rising and many houses are now left empty.

The Economist reports (“Meet the new neighbors“) that the housing crisis is spawning a rise in the West Nile virus in California. When homes with pools are left unattended, this creates a breeding ground for West Nile mosquitoes. Public health officials have reported that the West Nile virus has reached record levels in southern California.

Looks like the housing crisis may create a public health crisis as well.

Tags: , , ,

Violence as a Public Health Issue

May 4, 2008 in Current Events, Public Policy | Permalink

Can we think of issues related to violent crime as basically similar to that of a contagious disease?  This is the question an article in the N.Y. Times Magazine (“Blocking the Transmission of Violence“) attempts to answer.

Violence may spread like an epidemic; murders lead to revenge killings, which lead to more revenge killings.  Stopping the “transmission” of violence at its source is the goal of Gary Slutkin and his CeaseFire organization.  “CeaseFire tries to deal with these quarrels on the front end. [Interrupters'] job is to suss out smoldering disputes and to intervene before matters get out of hand.”

This is a radical approach, but will it work?

Tags: ,