Racism is a public health crisis

Way back when I was a graduate student in Los Angeles, I interned for a while at a regional planning agency in downtown Los Angeles.  Some of my fellow interns were undergraduates, and one of them was an African-American.

Of all the interns, he was the only one who always showed up well-attired.  While the rest of us made it clear through our outfits that we were students, he came dressed as if he were a full-time employee.  I thought that maybe that was his thing.

Only decades later, it dawned on me that maybe he was well-dressed in order to make sure that many of us with our implicit biases would not mistake him for being a hooded mugger from whom we had to escape at least by crossing over to the other side of the road.  If that were the case, what a terrible burden that he had to deal with every single day!

Now, it is not that I have not been mugged.  Once, three guys surrounded me one late evening and I had to empty out the few dollars that I had.  I was now in a bind: I had no money to pay as fare for the transit bus, and it was quite a distance to walk to my crummy graduate student apartment.

A bus pulled up.  I told the driver that I had just been mugged, and that I had no money.  He waved me in.

Mugging was real.  But, to then suspect that every black young man is a mugger is where the racism kicks in.  And therefore people walking away from young black men is an explicit demonstration of that racism.  

Through his professional attire, my fellow-intern was perhaps signaling to those with explicit or implicit bias that he is simply one of us.

Racism is one damn public health crisis. 

As this commentary in The Conversation puts it, "Treating racism like the disease that the CDC says it is suggests boosting our investment in public health funding would be money well spent."

That's exactly what my county government resolved two days ago, following up on the CDC statement.  The resolution also makes an important public admission:

WHEREAS, the racist history of Oregon in particular, including the presence of the Black exclusion clause in the State’s constitution, has had lasting negative consequences for Black, Indigenous and People of Color (“BIPOC”) communities of the State and Lane County;

A terrible history that we have here in a "liberal" state.

If you thought that this was a unanimous resolution, then you don't know Oregon.   There are plenty of people, even my own neighborhood, who are racists.  It is not without reason that then-candidate tRump came to Eugene in May 2016!  Remember this post in which I described one effect of his visit?

So, yes, the county resolution was not unanimous.  There was one who voted no--Commissioner Jay Bozevich.

“If we’re already doing all of the work that is called for in this,” he said at the April 21 meeting, “I see this as almost an unnecessary piece of virtue signaling.” 

He added that he did support the definition of racism put forth by staff. 

As the report reminds us, "Lane County’s resolution comes weeks after the Centers for Disease Control and Prevention’s April 8 statement that racism is a serious public health threat."

The CDC's statement was possible only because of the outcome of the elections last November.  Thankfully!

The former fellow-intern perhaps has a son or two who could be in their mid-20s now.  I would certainly want them to have all the rights and privileges that people like Bozevich take for granted.

Coronavirus and civic duty

During the H1N1 scare, when I was visiting India, one of the relatives simply pooh-poohed the global worries by declaring that the virus is not new and that it has always been there.  Having learnt my lessons well, I decided that I would not argue with fools like him.  I smiled.  He then launched into a rant about how the controversy was manufactured by the pharmaceuticals industry.

More than a decade later, as I recall those interactions, I am now amazed at how much conspiracy theories have always been there even in medical contexts.  With every real threat, there are always nutcases that spout crazy theories.  Now it is COVID19.  The most recent Presidential Medal of Freedom honoree said this: “The coronavirus is the common cold, folks”.  He continued on: “It looks like the coronavirus is being weaponized as yet another element to bring down Donald Trump”.

As public health experts warn that the spread of the coronavirus is inevitable and urge Americans to take precautions, the pro-Trump media world has presented the subject as more fodder for partisan debate.

And then there are the rest of us who don't care about crazy conspiracies, but instead focus on the science and the evidence.  We understand the importance of this: "Getting ready for the possibility of major disruptions is not only smart; it’s also our civic duty."

It is a civic duty.  Indeed.

We should prepare, not because we may feel personally at risk, but so that we can help lessen the risk for everyone. We should prepare not because we are facing a doomsday scenario out of our control, but because we can alter every aspect of this risk we face as a society.
That’s right, you should prepare because your neighbors need you to prepare—especially your elderly neighbors, your neighbors who work at hospitals, your neighbors with chronic illnesses, and your neighbors who may not have the means or the time to prepare because of lack of resources or time.

I might be healthy enough that the virus might just about make me sneeze a few times.  But, I could also be spreading the virus through the sneeze. Or by carrying it in my fingers.  We need to play our part to flatten the curve of how it spreads:

Epidemiologists often talk about two important numbers: R0 or how infectious a disease might be, expressed as the number of people that are infected by each person who’s been infected; and the case fatality ratio (CFR): the number of people who die as a result of being infected. For example, an R0 of two means each infected person infects two people on average, while a number less than one means the disease is likely dying out in the population.

The CFR is out of my individual control--that is the task of the government machinery and hospitals and various organizations.  But, I can personally address the R0.

The infectiousness of a virus, for example, depends on how much we encounter one another; how well we quarantine individuals who are ill; how often we wash our hands; whether those treating the ill have proper protective equipment; how healthy we are to begin with—and such factors are all under our control. After active measures were implemented, the R0 for the 2003 SARS epidemic, for example, went from around three, meaning each person infected three others, to 0.04. It was our response to SARS in 2003 that made sure the disease died out from earth, with less than a thousand victims globally.

So, what are the estimates of R0 in the case of COVID19?  It is a wide range at this point, as epidemiologists try to make sense of the data.

Meanwhile, an epidemiologist cautions: “things are going to get shut down. And this virus is probably going to be with us for some time to come. It might become endemic, like measles.”

Who you gonna believe?  This President and the likes of his Presidential Medal of Freedom honoree on Faux News, or public health experts?  Oh, of course, if you are reading this, it means you are not one of the 63 million here in the US.  Good for you for being a responsible citizen!

Tick, tick, tick

A few weeks ago, a student emailed me an update about her health condition.  She now had an official word on it: "what is called chronic, or stage 2 Lyme disease, which means the disease is very aggressive."

Lyme disease.  Here in the urban parts of Oregon?

In the space of two generations, the natural landscape in many American states has been slowly transformed from a place of refuge and peace to one of peril and menace. Blacklegged ticks that transmit Lyme disease and other illnesses inhabit half of US counties, where they infect some 300,000 people yearly in grassy meadows, urban parks, backyards and many other places.

Oh shit!

As we conquer old bugs, new bugs creep into our lives.

The prevailing view of Lyme disease as an epidemic without urgency means that it has long been starved for funding. In 2016, U.S. health agencies spent less than $30 million to fight Lyme disease while giving $184 million to fight the mosquito-borne Zika virus. The hasty allocation was driven by valid concern for Zika’s potential to cause birth defects. But as people developed immunity to the usually harmless infection, the epidemic quickly petered out, with U.S. cases dropping from 224 in 2016 to seven in 2017.
Bites from blacklegged ticks offer no such immunity, and this plague will not soon retreat. Rather, ticks are moving to new and warmer places and delivering more illnesses

Yep, whether it is Lyme or Zika, as always, we panic about "threats" coming from outside our borders, even as we yawn over the much nastier ones that are home-grown.

Only the lonely!

A few weeks ago, a student came to get my advice.  I know what you are thinking; what's wrong with the student to ask me, right?

I never really tell students what they ought to do.  Instead, I often ask them whether they had seriously considered options other than the one for which they want my feedback.  I even tell them that my job is to make sure they have looked at their options from multiple perspectives, so that they can then decide for themselves.

Years ago, one student said that she wished for a Hogwart School kind of a situation.  If you recall, (btw, Harry Potter is now 20 years old!) students are assigned to the houses based on what the magic hat senses.  This student said it will be awesome if such a hat existed that will then tell her what she should do.  "What about free will?" I asked her with a smile.

So, when the student asked me for advice, I engaged with her quite a bit.  And one of the questions that I asked her was about how she spends time outside of classes, and about friends.  "Most people value the time they spent in college for the experiences they had," I told her.  "It is not classes and teachers that people cherish later on.  It is all about experiences with people, especially the healthy experiences."

I am not sure what kind of an impact my words had on that student.  I have done my part.

Students have gazillion "friends" in their social media lives, but, are they meaningfully engaging with their peers in the real  world?  I hope they are; else, it is recipe for loneliness, which is one of the increasing health problems.  Which is why the UK has even appointed a minister for  loneliness!

As this essay puts it:

Loneliness is the leprosy of the 21st century, eating away at its victims and repelling those who encounter it.

Ouch!

It may be that affluence is making things worse. We prize space, privacy and independence, and the richer we get the more of these we can afford, yet their corollary is being alone. Our economy works better if people move around to find work, yet mobility stretches and breaks the bonds of family and community. Phillips told me that “capitalism and a mobile labour market make connections between people very precarious and difficult. In so far as people feel that what they’ve got to do is get on, they are, as it were, encouraged to sacrifice relationship and intimacy.” 
But if money can’t shield you from loneliness, poverty can exacerbate it.

I am with this opinion author who cautions against overblowing the loneliness situation.  And I am also in agreement with the author's concluding lines:

In places like the United States and Britain, it’s the poor, unemployed, displaced and migrant populations that stand to suffer most from loneliness and isolation. Their lives are unstable, and so are their relationships. When they get lonely, they are the least able to get adequate social or medical support.
I don’t believe we have a loneliness epidemic. But millions of people are suffering from social disconnection. Whether or not they have a minister for loneliness, they deserve more attention and help than we’re offering today.

I hope the young, including that student, are making healthy choices.

Thank you for smoking!

Nope, this is not about the cigarette industry.

It is about people who smoke without actually smoking.  Yep, without lighting up a cigarette, people smoke about two packs every single day.  Adults, children. Everybody.

On Tuesday, levels of the most dangerous air particles, called PM 2.5, reached more than 700 micrograms per cubic meter in parts of the city, according to data from the United States Embassy. Experts say that prolonged exposure to such high concentrations of PM 2.5 is equivalent to smoking more than two packs of cigarettes a day.

The smog in Delhi is so intense that breathing that air throughout the day is the equivalent of smoking more than two packs of cigarettes!

While in many contexts I metaphorically write about puking, kids and adults are literally throwing up because of this atrocious conditions:

Manish Sisodia, the deputy chief minister of Delhi State, said he was driving to a meeting Wednesday morning when he passed a school bus and saw two children throwing up out of the window. “That was shocking for me,” he said. “I immediately told my officers to pass the order to close all the schools.”

Schools closed for a week.  But, what are the kids going to do?  Their homes don't filter out all the crap.  Further, they will end up playing outside.

The situation prompted the state’s chief minister, Arvind Kejriwal, to say on Twitter: “Delhi has become a gas chamber. Every year this happens during this part of year."

A gas chamber!

Pollution kills. It kills way more than the notorious tobacco industry can ever kill.  “Pollution has not received nearly as much attention as climate change, or Aids or malaria – it is the most underrated health problem in the world."

Pollution kills at least nine million people and costs trillions of dollars every year, according to the most comprehensive global analysis to date, which warns the crisis “threatens the continuing survival of human societies”.
...
The vast majority of the pollution deaths occur in poorer nations and in some, such as India, Chad and Madagascar, pollution causes a quarter of all deaths. The international researchers said this burden is a hugely expensive drag on developing economies. 

People, especially those in India, need to ask themselves whether such a "development" of a country is worth all the physical and emotional toll.

Swine flu and global public health

The worldwide attention paid to swine flu is great, from a public health perspective.  If only we could equally effectively rally our country and the rest of the world about the many infectious diseases that ail millions of poor everyday.

In early September, in a few villages in Orissa, which is a state in India, about 40 people died and more than 200 were admitted to hospitals.  It was not because of the swine flu, which has so far claimed about 300 lives in that country.  The deaths in Orissa were because of diarrhea.

Diarrhea is a gastrointestinal infection that typically spreads through contaminated water or food.  A bad infection results in severe loss of fluids and even death, which was what happened in Orissa.  According to the World Health Organization, the deaths of nearly two million children every year in the less developed countries has one single culprit—diarrhea.   

The fact that many of the severe diarrheal deaths can be traced back to contaminated water should not come as a surprise given that more than 2 billion people, most of them in sub-Saharan Africa and South Asia, lack access to clean water and sanitation facilities.  Not having such facilities means a slew of other waterborne diseases such as cholera, typhoid, and hepatitis.   

The irony is that in such contexts, it is practically impossible to implement the typical swine flu prevention advice—to frequently wash hands.

When I was in India this past summer, as reports of swine flu came to dominate the news and conversations, I sincerely suggested to my parents that they should frequently wash their hands, and time it by humming the “happy birthday” song. 

As the words slipped out of my mouth, I knew it was a stupid and incongruous advice because of the water shortage in the city.  Apartment complexes were paying hefty amounts to private operators who supplied water by transporting them in special water-tankers.  When that was the condition for middle-class households, I cannot imagine the less affluent spending their precious money to wash hands in order to battle an invisible enemy.    Clean water is a super-luxury for the poor. 

I do not mean to minimize the risks of a global pandemic, particularly if the swine flu virus were to mutate into a highly virulent form.  But, I do want to point out that the global focus on the swine flu, which we have rightfully managed to accomplish, should remind us that being a good citizen of the world also means that we ought to pay attention to the priorities of the rest of the world—in particular, the sufferings of the poor, who are almost always voiceless in the international arena.

Unfortunately, our track record has not been one that we can proudly hold up when it comes to supporting public health programs for the world’s poor.  Even a couple of years ago, Congress and the White House bickered over allocating $25 billion for public health programs in Africa.  Soon after that, in what comes across as quite a surreal contrast, the same people quickly committed all of us taxpayers to a couple of trillions of dollars—that  we do not have—in order to bailout various economic institutions here in the US.  Well, the $25 billion for Africa that we fought over sure does seem like chump change these days! 

As the economist Jeffrey Sachs has pointed out “we’ve just been making choices to ignore the poor rather than calculations based on real resources available. We made a choice to let millions of people die and not honor our commitments.”

Changes in our attitude towards war and peace will certainly win over a few hearts and minds around the world.  But, we can easily and dramatically increase that number if only we spent even a fraction of our military expenditures on public health programs around the world that will immediately improve the everyday lives of millions of poor.  Here lies an opportunity for the “soft power” that Secretary Hillary Clinton often talks about.  Above all, it is the right thing to do.

Cover your nose and mouth when you sneeze. Why?