When it comes to public health innovations, Senegal rarely come to mind as a role model. But as the The Economist recently reported, the country is an outlier on the continent (and indeed much of the world) in treating sex work as a public health matter. Continue reading
Never before have so many humans enjoyed longer and healthier lives. Across the world, even in some of the poorest countries, deaths from most infectious diseases are declining precipitously, while every region is seeing increased longevity. The data are resoundingly clear:
According to the Bloomberg Global Health Index, which includes such factors as life expectancy, access to health care, and malnutrition, these are the world’s healthiest countries:
The top ten nations were:
The United States is facing an opioid and heroin epidemic that is killing and harming record numbers of people; more people died of overdoses in 2014 than in any other year on record.
One of the latest and most troubling images of this problem was a widely circulated photo of a couple passed out in their car with their four year old left watching from the back city. The City of East Liverpool, Ohio saw fit to share the photo on its Facebook profile to “show the other side of this horrible drug”. Continue reading
It is no surprise that wealthier countries, like wealthier people, tend to live longer. But how strong is this correlation? In a video released by The Gapminder Foundation, Swedish academic and professor Hans Rosling uses detailed but digestible visual data to explore the link between a nation’s wealth –namely its gross domestic product, or GDP — and the average longevity of its people.
To check out the two minute video, click here. (Sorry, I cannot embed it.)
Ultimately, the findings do indeed confirm that rich societies live longer. But what the data also show is that those countries in the middle range of GDP — e.g. the developing world — display a broad range in life expectancy, from low to surprisingly high. This illustrates the discrepancy in how states invest their growing wealth, and whether the fruits of their development are going to their people.
Video courtesy of Aeon.
Utilizing USDA data, Vox.com has produced acolorful graph that charts the vast changes in the average American’s diet since 1972. (Note that it shows the total supply of these items divided by the number of Americans, rather than exact consumption levels. However, this nonetheless gives a good sense of how eating patterns are changing over time, especially insofar as supply both reflects and often influences demand.)
Here is some analysis from the article:
[Y]ou might notice there are a lot of olive-green bars toward the bottom. We’re all eating a lot more fresh fruits and vegetables than we used to. That’s in part a story about changing tastes, but it’s also about economics — globalization and trade deals like NAFTA have given Americans more access to a wealth of fruits such as limes and avocados. And it appears those foods have replaced preserved or processed produce — many of the foods whose availability has shrunk are those maroon bars that represent canned, frozen, or dried produce.
While we’re eating a lot more fresh fruits and veggies than before, we’re not getting healthier all around. High-fructose corn syrup consumption has skyrocketed. Back in 1972 — right around the time that it was first introduced — we had 1.2 pounds per capita of the syrup available to us. Today, it’s 46.2 pounds … and that’s in fact down substantially from a high of 63 pounds in 1999.
Of course, don’t let the numbers fool you on a few of these — some of the massive growth came because of very small numbers. For example, it’s not that we’re eating piles and piles of lima beans today; rather, it’s that we were eating only 0.0005 pounds in 1989 versus 0.007 pounds in 2012 — a huge percentage gain in growth from an initially very small number.
What are your thoughts and reactions?
Drug addicts and substance abusers would hardly come to mind as rational or reasonable individuals. Yet an interesting new study discussed in the New York Times sheds light on the very complex nature of addiction, one that challenges the popular caricature of drug abusers as voracious consumers enslaved at all costs to a particular high.
Dr. Hart recruited addicts by advertising in The Village Voice, offering them a chance to make $950 while smoking crack made from pharmaceutical-grade cocaine. Most of the respondents, like the addicts he knew growing up in Miami, were black men from low-income neighborhoods. To participate, they had to live in a hospital ward for several weeks during the experiment.
At the start of each day, as researchers watched behind a one-way mirror, a nurse would place a certain amount of crack in a pipe — the dose varied daily — and light it. While smoking, the participant was blindfolded so he couldn’t see the size of that day’s dose.
Then, after that sample of crack to start the day, each participant would be offered more opportunities during the day to smoke the same dose of crack. But each time the offer was made, the participants could also opt for a different reward that they could collect when they eventually left the hospital. Sometimes the reward was $5 in cash, and sometimes it was a $5 voucher for merchandise at a store.
When the dose of crack was fairly high, the subject would typically choose to keep smoking crack during the day. But when the dose was smaller, he was more likely to pass it up for the $5 in cash or voucher.
“They didn’t fit the caricature of the drug addict who can’t stop once he gets a taste,” Dr. Hart said. “When they were given an alternative to crack, they made rational economic decisions.”
When methamphetamine replaced crack as the great drug scourge in the United States, Dr. Hart brought meth addicts into his laboratory for similar experiments — and the results showed similarly rational decisions. He also found that when he raised the alternative reward to $20, every single addict, of meth and crack alike, chose the cash. They knew they wouldn’t receive it until the experiment ended weeks later, but they were still willing to pass up an immediate high.
So if biological and psychological addiction aren’t as potent as it seems to be…what accounts for all the addicts? As with most social and public health issues, the origins are multidimensional:
“There seemed to be at least as many — if not more — cases in which illicit drugs played little or no role than were there situations in which their pharmacological effects seemed to matter,” writes Dr. Hart, now 46. Crack and meth may be especially troublesome in some poor neighborhoods and rural areas, but not because the drugs themselves are so potent.
“If you’re living in a poor neighborhood deprived of options, there’s a certain rationality to keep taking a drug that will give you some temporary pleasure,” Dr. Hart said in an interview, arguing that the caricature of enslaved crack addicts comes from a misinterpretation of the famous rat experiments.
“The key factor is the environment, whether you’re talking about humans or rats,” Dr. Hart said. “The rats that keep pressing the lever for cocaine are the ones who are stressed out because they’ve been raised in solitary conditions and have no other options. But when you enrich their environment, and give them access to sweets and let them play with other rats, they stop pressing the lever.”
So once again, we find evidence that negative material conditions — poverty and inequality — play a major role in yet another social ill. It seems so deceptively easy: reduce poverty and improve social environment (usually through the former), and everything else falls into place for the most part. In that case…
…why do we keep focusing so much on specific drugs? One reason is convenience: It’s much simpler for politicians and journalists to focus on the evils of a drug than to grapple with the underlying social problems. But Dr. Hart also puts some of the blame on scientists.
“Eighty to 90 percent of people are not negatively affected by drugs, but in the scientific literature nearly 100 percent of the reports are negative,” Dr. Hart said. “There’s a skewed focus on pathology. We scientists know that we get more money if we keep telling Congress that we’re solving this terrible problem. We’ve played a less than honorable role in the war on drugs.”
Indeed, there are too many entrenched interests that have a lot to gain from the ever-more costly crusade on drugs — from the private prison industry, to moralizing religious fundamentalists, among others. As studies like these continue to mount, and as the social and economic liabilities of this hamfisted approach build up as well, I can only hope we take a more humane and sensible approach to what is ultimately a socioeconomic and public health problem.
Let’s start with an easy one – sterile syringe access programs. We know from decades of research and implementation the world over that these programs prevent the spread of HIV/AIDS and hepatitis C among people who inject drugs. And yet our federal government still prohibits the use of federal HIV prevention funding for syringe access programs, citing erroneous drug war rhetoric about “encouraging drug use.” While we could consider all of the data from around the world, in the case of syringe access, we have plenty of evidence from locally funded programs here in the U.S. that have proven this scare-mongering to be untrue. Syringe access programs prevent the spread of HIV/AIDS and do not encourage or increase rates of drug use. Period. This has been proven from Bangkok to Bakersfield – so why is Washington dragging its feet?
Next up is another proven method of preventing HIV and other diseases. Safe injection facilities (SIFs) are places where people who inject drugs can do so under medical supervision. These facilities reduce overdose deaths and the spread of diseases such as HIV/AIDS and hepatitis C, and also to draw hard-to-reach users into treatment and rehabilitation. While the idea of facilitating intravenous drug use might raise eyebrows as syringe access once did, the results are incontrovertible. More than 90 facilities are serving clients — and saving lives — as we speak, in countries including Canada, Australia, the Netherlands, Spain and Switzerland. It’s time we started raising our eyebrows at a government willing to ignore the evidence in favor of drug war rhetoric.
This next innovative idea saves lives and is successfully treating opiate addiction in a number of European countries including Denmark, Germany, Switzerland and the U.K: heroin-assisted treatment. This treatment involves strictly regulated and controlled prescription of pharmaceutical heroin to help severely dependent heroin users who have not succeeded with other treatment options. The programs have been shown to significantly improve participants’ health, their housing and employment situations, and to dramatically decrease criminal behavior. Impressive results like these should have this idea on the tip of every legislator’s tongue.
And, finally, the success story that has dramatic implications for drug policy the world over: decriminalization. Ten years ago Portugal shifted its method of dealing with drug use and misuse from a punitive approach to a health-centered one by rapidly expanding access to treatment and decriminalizing drugs – all of them. Rates of overdose and HIV infection have dropped precipitously and none of the hysterical predictions of Lisbon becoming a drug tourism capital have materialized. In fact, following the introduction of decriminalization, Portugal has maintained drug use rates well below the European average – and far lower than the United States. Most importantly, youth drug use rates have dropped – a goal we can all agree on. It’s a bold experiment – but didn’t the U.S. used to be a place known for its bold experiments?
In light of forty years of failure, would it hurt to at least try some of these options, perhaps beginning at the local or state level? How much more money and life must be wasted in these fruitless efforts?