Archive for November, 2008

Health for All: Alma Ata is Alive and Well in Venezuela: Social Medicine V3N4

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We have just published a new edition of Social Medicine / Medicina Social which is available in English at www.socialmedicine.info and in Spanish at www.medicinasocial.info.  In this issue guest editors Joan E. Paluzzi and Fernando Arribas García offers a unique, detailed look at the health reforms currently taking place in Venezuela.

Health for All
Alma Ata is Alive and Well in Venezuela

Mothers & their children at a graduation celebration for children who have exclusively breastfed for at least 6 months (San Rafael, Venezuela)

Editorials

Health for All: Alma Ata is Alive and Well in Venezuela:Joan Elizabeth Paluzzi, Fernando Arribas García (PDF)

“Misión Barrio Adentro is one of the many widespread social sector programs (Missions) developed within the framework of the ongoing Bolivarian Revolution and initiated following the election of President Hugo Chávez in 1998. Barrio Adentro can be translated “inside the neighborhood”, a concept which establishes the ‘street credentials’ of the Venezuelan reform as a legitimate exemplar of an engaged model for social medicine in the 21st century.”

Venezuelan Health Reforms

National Training Program for Comprehensive Community Physicians, Venezuela: Eugenio Radamés Borroto Cruz, Ramón Syr Salas Perea (PDF)

“Cuban experience with community oriented medical education and global health cooperation was drawn upon to develop curriculum and provide faculty for the new National Training Program for Comprehensive Community Physicians, begun in 2005 in cooperation with six Venezuelan universities. The program differs from previous Venezuelan medical education models by adopting a stated goal of training physicians for public service, recruiting students who had no previous opportunity for university-level education, and concentrating the weight of their training on a service- and community-based model of education, relying on practicing physician-tutors.”

Neoliberal Policies and their Impact on Public Health Education: Observations on the Venezuelan Experience: Oscar Feo (PDF)

“In Venezuela, like other countries of the American continent, public health schools had been transformed from institutions under the direction of the Ministry of Health to a model in which training took place under market conditions. Education in public health became a private good for individual consumption, and schools, lacking official funding, survived by offering courses in a market that did not necessarily respond to a country’s health needs. The conclusion discusses the currrent Venezuelan experience in which the State has resumed control of the training of specialists in public health, making it more democratic, and adoptng an educational model centered around practice and whose purpose is the mass training of leadership teams to bolster the National Public Health System.”

Venezuela’s Barrio Adentro: participatory democracy, south-south cooperation and health care for all: Carles Muntaner, Francisco Armada, Haejoo Chung, Mata Rosicar, Leslie Williams-Brennan, Joan Benach (PDF)

“The need of the population for better access to health services became exceedingly evident in Caracas during 2002 through demands made by organized community groups, corroborated by social studies conducted by the city council of the municipality of Libertador. To meet these requirements, the city council designed a plan to provide basic health care through “Casas por la Salud y la Vida” (Houses of Health and Life) in certain metropolitan areas (“marginal neighborhoods”) that were lacking any type of public services. In January 2003, the government of the municipality invited local doctors to participate in the new program. The response was minimal and justifications given included concerns about personal safety and lack of the infrastructure needed to practice medicine. Based on the humanitarian support provided by Cuba during the Vargas tragedy, Caracas Mayor Freddy Bernal, with the support of President Chávez, agreed on a pilot project with the Cuban government. In April 2003, 58 Cuban doctors specializing in integral general medicine (a form of family medicine) were established in several peripheral neighborhoods (barrios) of Caracas, to provide primary health care. “

Venezuela’s Misión Barrio Adentro “Inside the Neighborhood”: Joan Elizabeth Paluzzi (Slideshow)

Adentro Barrio Adentro: An American Medical Student in Venezuela: Rebecca Trotzky Sirr (PDF)

“I decided I had to see it for myself. Had Barrio Adentro been successfully implemented so quickly in such a large and diverse geographic setting? Surely there would be important lessons learned for health care providers across the globe. What worked well? What should be done differently? Applying for a Fulbright grant to study medicine in Venezuela was like sending a message in a bottle to my future self: “Dear Jaded Future-Self, do not give up your dreams of social justice in medicine. Check out the health care system transformations in South America. Love, Idealistic Former-Self.” I wanted to gain direct exposure to the Barrio Adentro program, interview Cuban physicians, and understand the perspective of Venezuelan physicians who often saw Barrio Adentro as a threat to professional organized medicine.”

Themes and Debates

Social Determinants of Health: Perspective of the ALAMES Social Determinants Working Group: Oliva López Arellano, José Carlos Escudero, Luz Dary Camona. (PDF)

“On the basis of these reflections and our perspective we would like to highlight a series of problems in the Commission’s Report which we feel should be further discussed: […]

  • The report is silent about problems which produce destruction, mass death, and enormous suffering in populations: imperial wars, genocide, and the manipulations of transnational pharmaceutical and food companies, among others.
  • The report does not discuss the limitations onthe reduction of social and health inequalities imposed by capitalism in general and by specific capitalist formations. In other words, there is no discussion about the contradiction posed by adopting a “politically correct” concern over poverty, which proposes to reduce social and health differences, while at the same time, ferociously defending the market economy.
  • In summary, the Commission’s report amply fulfils its purpose of gathering evidence on health and socioeconomic inequalities, and of stressing the importance of socioeconomicdeterminants. But it falls short of advancing an understanding of the origin of these problems, what Benach and Muntaner have called “the causes of the causes of the causes.”

News & Events

Global Health Watch 2 (PDF)

posted by Matt Anderson

More on Free and Low-Cost Health Care in New York City

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La Casita de la Salud, the student-run free clinic of New York Medical College

La Casita de la Salud, the free clinic of New York Medical College

Since our last posting (on 10/8/2008) about free and low-cost health care, we have learned of the following additional resources:

A 2003 article in the Village Voice entitled Free and Low Cost Health Care describes various options available in the City.  One of the key issues for many people is dental care and the Voice article suggests the NYU College of Dentistry Clinic.  Similar clinics exist at other dental schools and generally charge less than private practice.  The New York City Department of Health also has dental clinics for people up to age 21.

There are several additional free medical student clinics which we did not mention in our prior posting. The following list (hopefully complete) is taken from the Cornell site:

The NYU site has a rather extensive list of free and low cost services in New York.  The Cornell Site has a shorter list, but it is still worth looking at.

Finally, New Yorkers may want to look at the website of the  Mayor’s Office of Citywide Health Insurance Access to learn if they might be qualify for either public or private insurance.

Free and low cost services are vitally important to the many people who are denied coverage by the current US healthcare system.  But it is equally important that our society provide care to all who need it, obviating the need for free clinics.

For addtional posts about this topic, click here.  We would be happy to post additional resources.

Posted by: Matt Anderson, MD

Residency Program in Social Medicine: Orientation Month 2008

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US Incarceration Rates Stratified by Race

Each October our Residency Program in Social Medicine does something rather unusual.  We take our interns off the hospital wards to participate in “Orientation Month.”  For four weeks they learn about social medicine and the Bronx, the place in which they are practicing medicine.  They are introduced to the philosophy, theoretical framework, and practice of Social Medicine through a curriculum of didactic and experiential learning. The month emphasizes a biopsychosocial perspective that integrates patients, their communities, and the medical system into a holistic view of health problems. At the conclusion of the month residents present a synopsis of the clinical problem they have studied and  develop a proposal to address its social determinants.

This year the overall theme of the Orientation month was The Impact of Violence on Clinical Practice. We explored this through three cases: one involved a patient who had been incarcerated, the second a case of domestic violence and the third an immigrant. These cases were tightly integrated into a series of activities that included visits to prisons (Riker’s Island and Sing Sing), community organizations, community centers (e.g. the Bronx Community Pride Center), local businesses (such as botanicas) and Bronx institutions such as the Botanical Gardens and the Bronx Museum.  The interns also learned practical skills such as how to perform a medical evaluation of an ayslum seeker and how to do community organizing (a workshop taught by Steve Max of the Midwest Academy).

On Tuesday, November 18th the interns presented their work as part of our regularly scheduled Social Medicine Rounds.  A standing room only crowd listened as they shared what they had learned and made a a variety of project proposals. Their presentation can be downloaded as a Powerpoint. While the Powerpoint does not capture the richness of their actual presentation, it suggests the themes they explored and learned about.

Posted by Matt Anderson, MD

The ACLU, the Madonna & Breastfeeding in New York

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Legal in New York State since 1984

Legal in New York State since 1984

Several years ago, a young mother of our acquaintance was visiting the Cloisters, the gorgeous annex of the Metropolitan Museum of Art dedicated to the Medieval period and located at the northern tip of Manhattan.  She sat down in the garden (shown at this link) to breastfeed her son.  She was soon approached by a very serious-appearing guard wearing a blue blazer who informed her that breastfeeding was not allowed in public.  She protested that they were surrounded by images of Madonnas feeding Christ.  She offered to cover over the baby’s head.  But to no avail.  The guard told her that rules were rules.

Well, the guard was wrong.

In 2006, the New York Civil Liberties Union (the New York affiliate of the ACLU) threatened  to sue Toys ‘R Us (mentioned in an earlier breastfeeding posting) for prohibiting a mother from breastfeeding in a store. Donna Lieberman, the New York Civil Liberties Union executive director noted:“It’s ironic that a store that caters to children would prohibit a mother from doing what is best for her child.  One would think that Toys “R” Us would have moved past the puritanical notions that this incident reflects.” Toys ‘R Us responded that it simply asked the mother to go into one of the approved breastfeeding rooms of the store.

However, the NYCLU had lobbied successfully for a 1984 New York State law that – in the words of La Leche League – “exempted the breastfeeding of infants from their criminal statutes.” (Think of it!)  The New York State law states that mothers have the right to breastfeed in any public place they have a right to be and need not go into special breast-feeding rooms.  [The specifics of this law and a review of US breastfeeding legislation can be found on the La Leche League website. ]

The NYCLU has now produced materials for women outlining their rights with respect to breastfeeding. These rights cover being in the hospital,  in pubic and at work.  Here is their summary:

AT THE HOSPITAL
YOU HAVE THE RIGHT:

  • To be with your baby at any time after you give birth.
  • To start breastfeeding, so long as it’s safe for you and your baby.
  • To get information about breastfeeding so that you can decide what you want to do.
  • To have someone show you how to feed your baby.
  • To get advice about the health benefits of breast milk for your baby, how to eat and stay healthy while you are breastfeeding, common problems nursing moms face, and how to collect and store your breast milk.
  • To get information about how to feed your baby with formula if you can’t breastfeed or decide not to.

IN PUBLIC
YOU HAVE THE RIGHT:

  • To breastfeed your baby in any public or private place where you have a right to be.
  • This includes stores, day care centers, doctors’ offices, restaurants, parks, movie theaters and many other places.
  • No one can tell you to leave any of these places because you are breastfeeding, and no one can tell you to breastfeed in a bathroom, a basement or a private room.

AT WORK
YOU HAVE THE RIGHT:

  • To pump breast milk for three years after you give birth.
  • To use your paid break or meal time, or take reasonable unpaid break times, to pump breast milk.
  • To ask for a private place to pump breast milk close to where you work. Your employer must try to find you one.
  • Your employer cannot discriminate against you for choosing to breastfeed your baby or for pumping milk at work.

Interested women can order a breast-feeding rights card at this link.

Commentary

This is an wonderful example of health activism on the part of lawyers.  It grows out of the Reproductive Rights Project of the NYCLU. But clearly we have a long way to go before breastfeeding is seen as the norm and bottle feeding the exception.  What would Mary have said!

Correction: An earlier version of this posting incorrectly identified the activities described herein as originating from the American Civil Liberties Union and the ACLU’s Women’s Rights Project.  In fact, the initiatives described in this post come from the Reproductive Rights Project of the the New York Civil Liberties Union, the local affiliate of the American Civil Liberties Union. We apologize for any confusion.

Posted by Matt Anderson, MD

Feast and Famine: Obesity, Diabetes and Hunger in New York City

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Drew Gardens

On Wednesday, November 19th, the Public Health Association of New York (PHANYC) wil sponsor a symposium at Lehman College in the Bronx entitled: Feast and Famine: Obesity, Diabetes and Hunger in New York City.  The event, which is cosponsored by the MPH program at Lehman, will take place between 6 and 8PM at the Faculty Dining room of the Music Building at Lehman College.  For directions, click here.

The program will include presentations by a diverse group of Bronx community activists.  Among these are:

Sister Mary Alice of the Part of the Solution Soup Kitchen on Webster Avenue.  POTS started in 1982 with three people making soup in a Bronx store front. “At that time, the original founders were told that POTS was the 35th emergency food provider in New York City . Twenty-four years later, there are over 170 providers in the Bronx alone.”

Lorraine Montenegro and Christian Estrada of United Bronx Parents, Inc will also discuss hunger in the Bronx.  UBP runs a variety of programs including La Escuelita, which includes a homeless hot meals program and an emergency food pantry.

Someone from the local Health  Department will discuss Bronx Farmers’ Markets.

Jennifer Plewka of the Phipps Development Corporation will discuss community gardens.  Phipps is a large non-profit which develops, owns and manages affordable housing.  Phipps also runs a community development corporation which created Drew Gardens in the West Farms section of the Bronx.  Details on the garden are available from the Bronx River Alliance at this link.

Marian Feinberg of For A Better Bronx (FABB) will discuss several initiatives to support alternative food sources including community gardens, farmers’ markets and indoor food growing.

David Sappire of the Council on the Environment will discuss the Learn It, Grow It, Eat It program in the Morrisania section of the South Bronx.  You can see this program in action in a video clip from an August 2008 WCBS TV news report.

A representative of Bronx Health Reach will discuss their Bodegas Outreach Initiative which encourages bodega owners to low-fat snacks, 1% milk, and a variety of fruit.

Many of these programs work in collaboration with local academic medical centers including Montefiore Medical Center, Albert Einstein College of Medicine, and the Institute for Family Health.

For more information or to RSVP, please contact PHANYC at info@phanyc.org.

Posted by Matt Anderson
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Spirit of 1848 Presentations at the American Public Health Association 2008

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Berlin Revolution, March 1848

Berlin Revolution, March 1848

The Spirit of 1848 (www.Spiritof1848.org) is a network of progressives dedicated to “politics, passion and public health.” They are perhaps best known for their very active listserve and their well-attended sessions at the American Public Health Association.  They recently circulated a report about the Spirit of 1848 sessions at the October 2008  APHA conference in San Diego.  The report offers an exciting picture of critical and activist scholarship in public health.

If you are curious where the name “Spirit of 1848” comes from, see the explanation on their website.  It’s probably worth noting that the term “social medicine” was coined in the year 1848 independently by Rudolf Virchow in Berlin and Jules Guerin in Paris.

What follows is taken from their report.  It will shortly be available on their website.

The Spirit of 1848 at APHA 2008

In brief, we grew out of the work in the late 1980s of the National Health Commission of the National Rainbow Coalition, we cohered as the Spirit of 1848 network in 1994 and began organizing APHA sessions as an affiliate group to APHA that year. In 1997 we were approved as an official Caucus of APHA, enabling us to sponsor our own sessions during the annual APHA meetings.

  • We have 4 sub-committees:
    • politics of public health data,
    • progressive pedagogy & curricula,
    • history (with the sub-committee serving as liaison to the Sigerist Circle, an organization of progressive historians of public health & medicine), and
    • e-networking, which handles our listserve and website.
  • To ensure accountability, all projects carried out in the name of the Spirit of 1848 are approved by the Spirit of 1848 Coordinating Committee. The Coordinating Committee communicates regularly (by email) and its chair (and other members, as necessary) deals with all paperwork related to organizing & sponsoring sessions at APHA and maintaining our Caucus status. The subcommittees also communicate regularly by email in relation to their specific projects (e.g., organizing APHA sessions).

Below is a brief summary of the highlights of each session, in chronological order.

1) SOCIAL HISTORY OF PUBLIC HEALTH
Our provocative session was attended by ≈ 100 people (about the same as the ≈ 120 in both 2006 and 2005 and more than ≈ 70 in 2007 and ≈ 45 in 2004).

HISTORY, BORDERS, IMMIGRATION, AND PUBLIC HEALTH: FROM 1848 TO 2008 – 160 YEARS OF DEBATE
MON, OCT 27 ***10:30 AM-12 NOON (SESSION 3159.0) *** SD CONV. CENTER (SDDC) RM 7A
10:30 AM — Introduction: Border conflicts and negotiations: a hidden history of public health. Luis Alberto Avilés, PhD & Kirby Randolph, PhD, but presented by Anne-Emanuelle Birn, MA, ScD
10:35 AM — Commercial and social disturbance and restrictions at the U.S.-Mexico border (1819-1924): an improvement to the public’s health? Ana Maria Carrillo, PhD
11:00 AM — Medicalizing borders and immigrant bodies: immigration & public health policy in the 20th century. Natalia Molina, PhD
11:25 AM — “Medical Borders”: a historical perspective. Rakefet Zalashik, PhD (discussant)
11:40 AM — Question & answer period

Anne-Emanuelle Birn opened up the session by commenting on how immigration has always been a critical issue in public health and that focusing on issues of US-Mexican politics, immigration, and public health was especially timely, given the theme of the APHA conference (“Public Health Without Borders”) and its location in San Diego, CA.

Ana Maria Carrillo gave a fascinating presentation, focusing on how Mexico actively engaged with the US over sanitary codes and other aspects of public health and immigration policy during the late 19th and early 20th century. Among the many points raised, one was that whereas the US government (at the federal and state level) repeatedly represented Mexico as a threat to the US, many of Mexico’s epidemics in the early 20th century (e.g., typhus, plague) were imported from the US. Additionally, Mexico was not simply reactive to the US, but instead instigated negotiation over sanitary codes, including via its joining of the American Public Health Association in 1892, so as to have a larger say in US public health policies.

Natalia Molina then covered more recent US-Mexican immigration/border public health issues. Building on her central thesis that immigration and public health policies are profoundly intertwined, she discussed the role of public health in medicalizing borders, with regard to both legal and also symbolic citizenship and inclusion. The three examples she focused on pertained to: (1) Railroad workers in Los Angeles in the early 20th c.; (2) the Bracero program (1942-1964), designed to bring in Mexican laborers to work in the US; and (3) contemporary patient deportations by hospitals of undocumented persons unable to pay for long-term care. As per the prior presentation, a common theme was how Mexicans were depicted by US authorities as a threat, with complete disregard for how Mexicans were badly treated in the US. For example, in the case of the railroad workers, when an outbreak of typhus occurred in the highly congested railroad worker camps, built without adequate sanitary facilities and populated by workers receiving less than a living wage, the US public health authorities waged a campaign premised on the idea that Mexican were “dirty” and needed to be taught hygiene; by contrast, as documented by a letter that Molina cited, the Mexicans argued that what they needed was better housing, better sanitation, and better pay.

The discussant, Rakefet Zalashik, reiterated themes pertaining to the medicalizing of borders, as contrasted to the statement that “disease has no borders.” Among the topics addressed during the lively Q&A period included whether it was appropriate to discuss all of the patient transfers as “deportations,” since some involved actions of only private hospitals or even the Mexican consulate, but not the US government, to which Molina replied that she used the term “medical deportation” to make clear that these events occurred in the context of US immigration policy. Another theme concerned the context-specific racializing of immigration and public health threats, with depictions of Mexicans on the West Coast often different from those of the Japanese, and with concerns about immigration of white “ethnic” groups being more of an East Coast phenomenon than one of the West Coast.

During the Q&A period, questions focused on the use of the language of “medical deportations” (which Molina argued was appropriate, so as to situate health policies in context, especially in relation to immigration policies) and also how issues of “race” and immigration played out differently for diverse groups in the US, e.g., the emphasis in California on persons of Mexican, Japanese, and Chinese origins, with all “whites” lumped into one group, whereas on the US East Coast during this same time period, different “white ethnic” groups were considered separately.

2) POLITICS OF PUBLIC HEALTH DATA
Our thought-provoking session was attended by ≈ 250 people (up from the ≈ 220 in 2007 and 2005, all better than the ≈ 140 in 2006).

ANALYZING HEALTH INEQUITIES: WHAT’S NEW IN THE 160 YEARS SINCE 1848? – APPLYING NEW METHODS TO LONGSTANDING PROBLEMS OF SOCIAL INJUSTICE
MON, OCT 27 ***2:30 PM-4:00 PM (SESSION 3359.0) *** SD CONV. CENTER (SDCC) RM 2
2:30 PM — Introduction to the Politics of Public Health Data session. Catherine Cubbin, PhD
2:35 PM — Using 21st c technologies to analyze the impact of racism on health: the implicit association test (IAT), web-based surveys, and explicit measures of racial discrimination. Nancy Krieger, PhD, Dana Carney PhD, and Mahzarin Banaji, PhD
2:55 PM — Utilizing the CT Health Equity Index, GIS, and community engagement to address health inequities. Baker Salsbury, MPH, MSW, MHSA
3:15 PM — Biological embedding of social factors: epigenetic processes and health inequalities. Darlene Francis, PhD
3:35 PM — Discussant. Vickie Mays, PhD, MSPH
3:45 PM — Question & answer period

Catherine Cubbin opened up the session, introducing the speakers and also the theme of the session – our need to use whatever are the best available methodologies to move forward the work on social justice & public health.

Nancy Krieger presented preliminary research results on novel use of the implicit association test (IAT) to measure experiences of racial discrimination (noting that the IAT has previously been used mainly to study prejudice). In both a community-based sample and a web-based sample of US-born black American adults, the explicit measure of racial discrimination revealed the usual person/group discrimination discrepancy phenomenon (higher reports of discrimination against group than against self), but no such discrepancy was evident using the IAT. Noting that the web-based sample had a much higher education level and better health status than the US black population on average, preliminary findings indicated that among those with less than a college education, both the explicit and implicit measures were significantly associated with hypertension. The implication is that use of both types of measures can advance understanding of how racial discrimination harms health, a hypothe
sis that is now being tested in a large-scale community-based study that Krieger and colleagues currently have underway.

Baker Salsbury presented on the Connecticut Health Equity Index, a public health tool meant to raise accountability at the neighborhood and local level regarding the monitoring of health inequities and efforts to address them, especially by state and local health departments. Developed by the Connecticut Association of Directors of Health, Inc. (CADH), which consists of health directors who represent Connecticut’s 169 towns, including both health departments and districts, the tool draws on public health surveillance data, census data, and myriad other sources of data providing information on social and economic conditions at the census tract level. Using GIS to help map the results, it employs data on a core set of social determinants of health, organized into 9 domains, with 27 components and 71 core indicators, as well as data on diverse health outcomes. Preliminary work conducted in 20 census tracts in two cities in Connecticut has shown expected associations with diverse health outcomes, spanning from mental health emergency room treatment and Hepatitis C infection to cancer incidence rates and age-adjusted mortality rates. Next steps are to test the tool in 800 Connecticut census tracts, with a goal of developing a tool that can be used nationally by communities and local health departments. For more information about the tool, contact Sharon Mierzwa, at CADH (email: smierzwa@cadh.org; phone: 860-727-0974). And see also: http://www.cadh.org/AboutCADH/CurrentProjectsOverview/HealthEquityIndex/tabid/79/Default.aspx

Darlene Francis spoke about why epigenetic processes – that is, processes that regulate gene expression – matter for understanding health inequities. Noting that her work explicitly challenges the dogma that always places genes first, and context second, in shaping phenotype, she offered instead empirical evidence, based on elegant studies of mice, that vulnerable experiences can affect gene expression, thereby affecting phenotype – with the implication being that social and developmental experiences can affect biological vulnerability. As one of the several examples she presented, she discussed one experiment with two different strains of mice – in shorthand, one bred to be “cool, calm, collected” and “smart,” the other much more “anxious” and “less smart.” Noting that fetuses in each breed of mouse would be differently exposed to stress hormones in utero (given that their mothers were likewise either “calm/smart” versus “anxious/less smart”), in her experiment she transplanted the mouse fetuses from one strain to the other, thereby altering their pre-birth exposures, and she also did post-birth swaps, exchanging the different types of pups (those whose full gestation was in their original mother and those who were transplanted to the womb of a mother of the other breed), with some kept with the mother from whom they were born and others places with mothers from the two different breeds. A key finding was the mice whose strain predisposed them to be “anxious/less smart” who were transplanted into the wombs of the “calm/smart” breed mothers and raised by them performed just as well as the mice bred to be “calm/smart” on open-field tests regarding their ability to explore in new environments, thereby demonstrating how context shaping gene expression produces the phenotype (despite these mice being “genetically predisposed” to be “anxious/less-smart”). The net implication is that DNA does NOT equal “destiny” and that epigenetic processes – involving regulation of DNA, not altering changes in the DNA sequence – are likely critical for understanding health inequities.

Vickie Mays, as discussant, emphasized how all three projects worked across disciplines, took risks, and produced data that can give us new insights into causes of health inequities and how to address them. In relation to the Health Equity Index, she underscored the importance of combining data on, say, transportation access with data on where shopping markets are located, noting that in the neighborhood where her mother lived in Chicago, the bus stop was so far away from the shopping market (on the other side of the large parking lot built to accommodate the cars of the shoppers) that it made using the bus for shopping very difficult. Emphasizing the importance of animal studies for investigating topics that cannot be studied on people, she praised Francis’ work for how it powerfully challenged the dominant nature/nurture assumptions by bringing attention to the critical role of gene regulation – and showing how parents’ context can affect health of the next generation through epigenetic mechanisms, not just genetic inheritance. Noting her own research on how the pain experienced as a consequence of racial discrimination and social isolation registers in the brain as the same as that produced by physical pain, she said that use of the IAT was one example of how researchers can use new methods to get at exposure to racial discrimination and its consequences, especially in an era of reduced overt bias. Noting the need to consider the psychological and health costs of people’s reliance on stereotypes, she likewise urged that attention be paid to how IAT results may differ by not only education level but also for persons from more individualistic vs more collective societies. The overall message was that we can use 21st technologies to better understand the mechanisms – at many different levels, from societal to gene regulation – that produce health inequities, and that we need to take risks and ask bold questions to move along the work and make a difference.

During the Q&A, questions focused on whether the IAT can be used to look at voter behavior (yes, it has been, but also key is what happens to the voters, in terms of access to voting, voter exclusion, problems with voting machines, etc), whether the Health Equity Index is intended for national use (yes, but first it needs to be tested in a wider range of census tracts, with the next iteration including 800 census tracts), and whether there is any evidence that damage brought about by epigenetic processes can be reversed (sometimes, depending on the degree of damage and also the rapidity, in early life, that conditions are changed, but some good news is that new evidence indicates the social brain is harder to perturb than has previously been thought, such that there is more resilience and plasticity to give grounds for hope).

3) INTEGRATIVE

This session, celebrating 160 years of the Spirit of 1848, was attended by ≈ 150 people, just about all of whom avidly filled in our ever-present sign-in books. We note that this session was held at the same time slot as the APHA “Town Hall Meeting on Health System Reform,” which, with its emphasis on the current election and post-election planning, was a major draw. (NB: the attendance was very good for an APHA session, albeit understandably less than the ≈ 550 who attended our integrative session last year, which was focused on how to use the new film series “Unnatural Causes: Is Inequality Making Us Sick?”).

160 YEARS OF THE SPIRIT OF 1848: CRITICAL REFLECTIONS, CELEBRATION AND INSPIRATION
MON, OCT 27 ***4:30 PM-6:00 PM (SESSION 3433.0) *** SD CONV. CENTER (SDCC) RM 6C/F
4:30 PM — Introduction: Anne-Emanuelle Birn, MA, ScD
4:35 PM — American Indian, Alaska Native, and Native Hawaiian Caucus; Occupational Health and Safety Section and Labor Caucus; Public Health Nursing Section; International Health Section; Lesbian, Gay, Bisexual, and Transgender Caucus; Black Caucus of Health Workers; School Health Education and Services Section; Socialist Caucus
5:08 PM — Reflecting on the events of 1848: Kirby Randolph, PhD
5:13 PM — Peace Caucus; Family Violence Prevention Forum; Trade and Health Forum; Medical Care Section; Sigerist Circle; Social Work Section; Women’s Caucus; Latino Caucus
5:45 PM — Looking forward, building on the Spirit of 1848: Nancy Krieger, PhD
5:50 PM — EVERYONE: sing “Step by Step,” led by Andrea-Kidd Taylor, DrPH

The full-line up, with names of presenters, is as follows, and the program for and photographs of the event and presenters are available at our website (http://www.Spiritof1848.org), as are several of their slide presentations. We also thank the Spirit of 1848 members who helped out with the event: Pam Waterman, for technical assistance with the music & slides, Catherine Cubbin for keeping the presenters moving along, and Suzanne Christopher and Vanessa Watts for ushering.

Presentation
Musical prelude “Step by Step” and “Ella’s Song”
Spirit of 1848: AE Birn — Introduction
American Indian, Alaska Native, and Native Hawaiian Caucus: Dean Seneca
Occupational Health and Safety Section and Labor Caucus: Peter Dooley
Public Health Nursing Section: Noncenba Lubanga
International Health Section: Samir Banoob
Lesbian, Gay, Bisexual, and Transgender (LGBT) Caucus: Seth Welles
Black Caucus of Health Workers: Jill Dingle
School Health Education and Services: Bill Cissell
Socialist Caucus: Martha Livingston
Spirit of 1848: Kirby Randolph/Lisa Moore – History
Peace Caucus: Kathleen Fagan
Family Violence Prevention Forum: Peggy Goodman
Trade and Health Forum: Susanna Bohme
Medical Care Section: Gordy Schiff
Sigerist Circle: Ted Brown
Social Work Section: Kim Jaffee
Women’s Caucus: Heather Brandt
Latino Caucus: Henry Montes
Spirit of 1848: Nancy Krieger – Closing
Andrea Kidd-Taylor lead everyone in “Step by Step”

Included in the session program are the music and lyric of the song we all sang at the end: “Step by Step,” based on the preamble of the 1863 constitution of the American Mineworkers Association, with the music arranged and adapted in 1948 by Waldemar Hill and Pete Seeger:

Step by step the longest march
Can be won, can be won.
Many stones can form an arch,
Singly none, singly none.
And by union what we will
Can be accomplished still.
Drops of water turn a mill,
Singly none, singly none.

The wide range of presentations – which used song, visual images, and reflected on both the broader social and historical context and the specific work of each APHA caucus, section, and forum that participated – asked all present to think critically about the past 160 years in terms of the struggles and accomplishments we can recognize and celebrate, the setbacks endured and the suffering they have caused and, ultimately, the work we need to do now, in our generation, in our own times, to advance the agenda of social justice and public health.

4) PROGRESSIVE PEDAGOGY

This engaging session was attended by ≈ 100 people (twice the ≈ 50 in 2006, but down from the ≈ 250 in 2007, which drew in many who wanted to know how to teach the content of “Unnatural Causes”).

TEACHING CRITICAL HISTORY OF PUBLIC HEALTH AND HEALTH POLICY: PROGRESSIVE PEDAGOGY IN ACTION
TUES, OCT 28 *** 8:30 AM-10:00 AM (SESSION 4063.0)*** SD CONV. CENTER (SDCC) RM 2
8:30 AM — Introduction. Lisa Dorothy Moore, DrPH and Suzanne Christopher, PhD
8:35 AM — A role for exhibitions: “Making a Difference in Global Health.” Manon Parry, MA MSc
8:50 AM — Literacy, access to information, and social power – 1848 and 2008. Sherry Spence, MD
9:05 AM — Necessity of teaching the history of public health from a critical perspective. John P. Elia, PhD
9:20 AM — University of Toronto’s history of international health course. Anne-Emanuelle Birn, MA, ScD
9:35 AM — Question & answer period

Lisa Moore introduced the session with comments on how the lack of critical teaching about public health history in most US schools of public health was the impetus for the session, since a knowledge of history is part of what enables us not only to better understand the past and how we got to where we are today but also to see ourselves as historical actors who create history in the present by what we do. She also announced that all syllabi discussed in the session will be available at the Spirit of 1848 website, at: http://www.Spiritof1848.org.

Manon Parry described the exhibition the National Library of Medicine launched in April 2008, titled “Against the Odds: Making a Difference in Global Health.” Geared especially to a younger audience and to overcome the widespread views that “global health is about them, not us (in the US),” that “the US provides answers, as opposed to solutions coming from elsewhere,” and that “the problems are so overwhelming that nothing can be done,” the exhibition focuses on “missing stories” about the impact of poverty on health and well-being, the connection between health and human rights, the shared values that promote a decent quality of life, the link of the US to the rest of the world, and concrete examples of individuals, organizations, communities, and societies that have made a difference. Using historical and contemporary examples, the themes of the exhibit pertain to: clean water; nutritious food; access to affordable health care; protection from violence; and safe housing. Other “missing stories” addressed pertain to discrimination and HIV/AIDs, to the spending on monies on conflict and war, rather than health needs. The exhibition goals are to: (1) broaden perception of the causes of illness, i.e., not just viruses but poverty, hunger, and other social determinants of health; (2) challenge assumptions about who is at most risk, looking at inequities within as well as between countries; (3) encourage collaboration based on shared values, e.g., human rights; and (4) encourage people to get involved, especially youth activism. Each week, a new question is placed on a comment board at the end of the exhibition, asking “What’s Your Perspective” and, suggesting the exhibit is meeting its goals, when the question on the board asked “can one person make a difference,” one reply from a student concisely stated: “Hell yeah!” The traveling version of the exhibit is intended to be shown at schools of public health, with the only cost being that of covering its shipment by fed-ex, and the encouraging news is that it is already booked up through summer 2010. If you are interested in having your school host the exhibit, contact Manon Parry at: parrym@mail.nlm.nih.gov; to see more about the exhibit on-line, visit: http://apps.nlm.nih.gov/againsttheodds/index.cfm

Sherry Spence then gave a presentation looking at health literacy and the dissemination of public health information in historical context, with attention to the implications of literacy and health literacy for power relations and health inequities. Examples pertained to the invention and dissemination of use of the printing press in Europe during the Renaissance and Reformation, the rise of slave literacy in the US in the mid-19th century, and the current use of the internet and the importance of e-health literacy. Common themes were the link between literacy and power and the need to build capacity for health literacy, including e-literacy. For more discussion of these issues, and also the 50-page bibliography informing the presentation, see: http://sandbox.wikispaces.com/health-literacy-community

John Elias next presented on a new course at San Francisco State University on the critical history of public health in the United States. Geared to undergraduates, the course’s impetus was the lack of any public health courses focused on history, coupled with the lack of any courses in the history of science department that were focused on either medicine or public health. Approximately 75% of the enrolled students were from public health, the other 25% from history, with one discovery being the utility of pairing up students from these two different disciplines, since the public health students could teach the history students about health, and the history students could teach the public health students about both history and analyzing primary as well as secondary source materials. Key to the course was its inclusion of critical, revisionist history, with an emphasis on the intersections between class, race/ethnicity, gender, and sexuality. Each session includes a 30-35 mini-lecture; other components include: (a) students working in groups to critique, from a critical intersectional standpoint, a particular article, with each student writing a 3-4 page analysis that s/he shares with the other students in the group, as the basis for a joint critique developed by the full group; and (b) engaging the students in critiques of different films, regarding what they cover and what they omit, e.g., a film on the “History of Sex in America in the 20th century,” which, when discussing Margaret Sanger, made no mention of her support for eugenics. There is also a mid-term exam and a final 8-10 page paper. Two aspects of student resistance, both the result of prior educational experiences, that needed to be addressed were: (1) their expectation of being “fed” education rather than be engaged in critical education, and (2) their questioning of the legitimacy of studying history from a historical perspective; by going through the course, students came to appreciate the value of a critical stance.

Anne-Emanuelle Birn described the graduated level course she teaches, a seminar on the History of International Health at the University of Toronto. This course looks at the ideologies, institutions and practices of the field of international health, from its imperial origins to the present-day, including in relation to colonialism, class, racism, and gender. Focusing on the political, scientific, and social underpinnings of the principles and activities of the international health field and its embedded cultural values as well as both its continuities and discontinuities, the course relies on both primary sources (e.g., printed documents, whether text, correspondence, or poems, and also photographs and films) and secondary sources (e.g., scholarly research, both books and articles). Each session uses films and documentaries and draws especially on the visual resources available at the National Library of Medicine (with Anne-Emanuelle also acknowledging the work of Elizabeth Fee, who was present in the audience, for her essential work in making more visible and available critical work on the history of public health). The two assignments are: (1) from the perspective of a late 19th or early 20th century medical officer, justify the importance of a particular international health activity or policy, and (2) write a 2050 paper, analyzing early 21st century work in international health, so as to learn how to contextualize the on-going work in one’s own era. Examples of themes of particular sessions are: (a) Colonial vs International vs Global Health: what’s the difference?; (b) Mind, Body, Race, and the Building of Empire; (c) Missionaries and Health; (d) Industry, Research, and “Tropical” Medicine; and (e) Sex, Sickness, and Security: Metropole and Outpost. Examples of two contrasting films, whose use sparks lots of conversation among the students, are an mid-20th century American Medical Association film titled “MD International” (1958), featuring then Vice-President Richard Nixon extolling US efforts to help others abroad, versus a very different, sponsored by the World Health Organization, on “Health for All” (1978), made after the Alma Ata conference, and showing footage of, among other things, a Frelimo rally in Mozambique, making clear how the fight for national liberation was essential for health, with health campaigns to fight disease, conducted in the midst of armed struggle, portrayed as part of a strategy to ensure people would be strong enough to build their nation – and with contemporary students amazed that WHO would ever have included such material in a film, noting how in the current era, prevailing ideologies and power relations have precluded such a critical stance.

Suzanne Christopher then opened up the session for Q&A, noting how the presentations had made vividly clear how many “missing stories” there were and why a critical historical perspective is needed. From the floor, Elizabeth Fee underscored the many resources that are available at the National Library of Medicine, including not only films but also syllabi of courses taught world-wide about the history of public health and medicine, and noted that the NLH is currently producing a DVD-series to make the films more widely available. For these and related resources, see:
— for films: http://www.celebratingresearch.org/libraries/nlm/healthfilms.shtml
— for syllabi: http://www.nlm.nih.gov/hmd/collections/digital/syllabi/index.html
An additional resource mentioned by Walter Lear is the US Left Health Historical Center, based in the Institute of Social Medicine and Community Health (in Philadelphia) which he directs and whose website is in construction. The Center has available archival documents (e.g., pamphlets, photographs, political pins) and scholarly publications and also produces a news letter; for further information, contact Walter Lear at: ISMCH, 206 N. 35th St, Philadelphia, PA 19104 (phone: 215-386-5327; email: wjlear@critpath.org). Other issues raised during the Q&A period included how to ensure these sorts of courses are taught, or materials are at least included in required introductory courses, given how many other requirements students face, and also how to ensure that whatever is included as session in other courses is presented in a critical way (e.g., simply including photographs of the Broad Street pump and mentioning John Snow is not adequate for critical history of epidemiology) and how to address the problem that most students need remedial education in general history so as to put the public health history in context – with the only way to address this being that there is no short cut around the fact that students do have to read to gain this context …

5) STUDENT POSTER SESSION
Our 7th “STUDENT POSTER SESSION: SOCIAL JUSTICE AND PUBLIC HEALTH” (session 4099.0, Tues, Oct 28, 12:30 to 1:30 pm) had 6 posters accepted (of which 1 had to withdraw). There was a good turn out, with lots of good discussion with the student presenters about their work. The five posters displayed were as follows:
STUDENT POSTER SESSION: SOCIAL JUSTICE & PUBLIC HEALTH
TUES, NOV 7 *** 12:30 -1:30 PM (SESSION 4099.0)*** BOSTON CONV. CNTR (BCEC) HALLS A/B1
Board 1 — Invisible Places, Invisible People: Facing health disparities in urban North Carolina K. Wu, MPH Candidate; J. Kadis, MPH Candidate; C. Katz, MPH Candidate; K. MacGuire, MPH Candidate; A. Agyemang, MPH Candidate
Board 2 — Other side of the tracks: Understanding the historical, social and environmental context of health in an African American community in eastern North Carolina S. Barber, MPH Candidate; J. Tzeng, MPH Candidate; A. George, MPH Candidate; J. Thompson, MPH Candidate.
Board 3 — Interdisciplinary approaches: A student-initiated course on Critical Race Theory J. J. García, MPH.
Board 4 — Goods Movement 101: A training model for community engagement and education J. Lucky, MPH; A. Logan; A. M. Hricko, MPH; I. Ramirez; C. Truax; A. J. Groopman, MHS.
Board 5 — A gender analysis of cervical cancer R. M. Lee

Of note, for all the students involved, their poster presentation at the Spirit of 1848 session was the first time they had ever presented a poster at a scientific conference, and for virtually all it was their first time attending an American Public Health Association annual meeting. They really appreciated the opportunity to gain the experience of presenting their work and meeting so many different people in so many diverse aspects of public health, and likewise felt affirmed in their focus on issues of social justice and public health. All of which suggests our session is meeting its objective, in helping bring forward the next generation to do the work at hand!

6) Other:

We co-sponsored & helped organize the P. Ellen Parsons Memorial Session, on “Health Access & The Elections: What Happened, What Didn’t” (Session 4242.0, Tues, Nov 7, 2:30 to 4:00 pm), obviously held before the elections (and we are now very happy to send our reportback in the aftermath of the Obama victory!). The primary sponsor was the Medical Care Section; other co-sponsors were the Women’s Caucus and the Socialist Caucus. It was attended by ≈ 100 people (up from ≈ 75 people the year before, and much higher than the ≈ 35 in 2006).

  • Ellen Shaffer opened the session by reviewing and contrasting the Obama and McCain health plans and their limitations, noting that HR676 in Congress still was putting forth support for a universal single-payer health system and that people in public health need to keep alive support this alternative and sorely needed approach to resolving the problems of the US medical care system.
  • Claudia Fegan, the past president of the Physicians for a National Health Program (see: http://www.pnhp.org), then made the case for why a single-payer universal health system is necessary, including a review of all the US state-level plans that have promised to provide universal coverage but have not succeeded, given their approach of only incremental reform (leading her to quote Moms Mabley: “if you always do what you always did, you always get what you always got …”).
  • Susan Wood, an advisor to the Hilary Clinton and now the Obama campaign, then spoke to how each candidate’s plan did or did not address women’s health needs, noting that the Obama plan opened the door to people “voting with their feet” for single-payer via signing up for a group insurance plan modeled after Medicare and the Federal employees benefit plan, whereas the McCain approach was to have people cut loose from employer-based plans and opt for individual plans, even though evidence indicates women fare much worse under individual-plans, where they are more underinsured than men and everyone is much less able to negotiate, as an individual, for better plans. Her sense is that the Obama plan was cautious so as not re-ignite the fears caused by the “Harry & Louise”-type ads that sunk the prior Clinton attempt at health care reform, and said that advocates need to ensure that the Obama plan, if he is elected, is the floor, not the ceiling.
  • Larry Adelman then spoke about the efforts of the film series “Unnatural Causes” (see: http://www.unnaturalcauses.org/) to get across the message that action is needed on the social determinants of health. So far, there have been over 10,000 screenings and they have more than 350 outreach partners, far more than expected, and remain engaged in a Health Equity Campaign whose goals are to educate the broader public about the root causes of health inequities, to inject the issue of social determinants of health into public debate, and to highlight the health consequences of economic policy. Four key message frames are: (1) focus on the social determinants of health equity (e.g., it takes more than individual choice to deal with toxic dumps, ensure a living wage, or have available affordable quality housing); (2) make health equity an “us” issue (vis a vis the social gradient and rising health care costs); (3) America’s health is America’s choice (demonstrating that health inequities are neither natural or inevitable, cf studies by Singh et al showing how health inequities have widened since 1980, and the 2008 PlosMed study by Krieger showing how health inequities in fact shrank between 1965 and 1980 and thereafter widened, with the progress in shrinking the inequities paralleling the implementation of the War on Poverty, the Civil Rights Act, the creation of OSHA and EPA, etc.); and (4) Common sense: invest now for better health or pay even more later to repair the damage.
  • Linda Rae Murray, as discussant, then spoke to the importance of not staying stuck in an overly complicated policy-wonk mode but instead appealing to people’s sense of fairness, framing health care as a human right, and making clear the current system does not work and incremental efforts at reform have made little or no difference. She also emphasized that one reason that efforts over the past 100 years have failed is that creating a system that fairly provides universal health coverage is a way of redistributing wealth, which goes against capitalist ideology, such that it requires taking this ideology head-on, noting that especially in this time of economic crisis, many people would agree that the “invisible hand of the market” is not an “all-knowing god.” Arguing that we can point to how every other industrialized capitalist country has managed to ensure universal medical coverage, she further noted that this is only one piece, since good health is only possible in a just society, meaning that we need to bring in allies to address the broader social determinants of health.

During the Q&A, a key theme was that health advocates cannot afford to repeat past mistakes, e.g., diluting proposals in order to be “allowed at the table” or directing work only towards policy makers; it is vital to work with the people & public more generally, since they are the source of power and do want universal health coverage and better health.

Finally, the Spirit of 1848 co-sponsored the Occupational Health and Safety health activist dance on the Monday night of APHA.

Posted by Matt Anderson, MD

Should Women Pay More for Health Insurance?

5 Comments

According to a recent New York Times article, “Women Buying Health Policies Pay a Penalty,” women are paying up to 50% more than men for private health insurance on the individual market. This discrepancy, which the industry attributes to the cost of maternal care and higher consumption of medical services by women, demonstrates yet another negative impact of for-profit insurance companies on the US health care system.   Some, including John McCain, may disagree about whether health care is a human right, but necessary medical care, especially in the case of emergencies or in prevention of chronic disease, cannot be considered a commodity, if we truly value the public’s health.

For individuals or employers seeking to purchase health insurance plans, the forces of the free market have not shaped a rational or efficient system in the United States. Even health plans that do not cover maternal care end up costing women more than men of similar age and health status, making it clear that the driving force for higher costs is utilization. Young women, for whom the cost discrepancy is greatest, may consume more health care services than young men, but this necessary care, such as family planning services or pap smear testing for cervical cancer, would be encouraged by a well functioning health care system.   Preventive medicine improves health and avoids more expensive interventions – like treatment of cervical cancer or maternal care for an unwanted pregnancy – later in life. However, most individuals change health plans multiple times in their adult life (20% per year in the employer based market), making the upfront costs of prevention, which may ultimately benefit a competitor, an unfavorable investment for a for-profit insurance company.

Beyond costs, when health care becomes a commodity, public health loses. Financial barriers to recommended care, such as high premiums for young women likely to access preventive care (or cost sharing for mammography or pharmaceutical benefits), achieve the goal of reducing health care utilization, and therefore costs for the insurance company, but this can be harmful for the health of a population. Financial barriers compel individuals to go without both necessary and unnecessary care, and have been shown to have deleterious effects especially among the poor and elderly. We need a health care system that controls cost by encouraging prevention, promoting evidence based medicine, and eliminating private insurers’ profits from the balance sheet. But we cannot skimp on care.  We need a system that truly values each individual’s right to high quality health care and right to their highest attainable status of health and wellness. Left up to the markets, we get a system that penalizes women for accessing necessary care, which is both unjust and unwise.

posted by Aaron Fox

UN Special Rapporteur on the Right to Health: Looking Back and Moving Forward

1 Comment
UN Special Rapporteur Anand Grover

UN Special Rapporteur Anand Grover

The International Federation of Health and Human Rights Organizations has just published a brief synopsis of a symposium entitled: The UN Special Rapporteur on the Right to the Highest Attainable Standard of Health:
Looking Back and Moving Forward
. The symposium, attended by over 100 people, was held from September 25-27th at the British Medical Association offices in London.  In August the first UN Special Rapporteur, Paul Hunt stepped down after two terms in office.  He has been replaced by Anand Grover, an Indian (see announcement by UNAIDS).

The 11 page symposium report offers a concise snapshot of the current status of the human rights approach to health.  In summarizing Paul Hunt’s six-year tenure as Special Rapporteur, the report noted he and his team had “left an impressive body of reports offering detailed analyses on elements of the right to health.”  [These reports are available on the websites of IFHHRO (www.ifhhro.org) and the Human Rights Centre (www2.essex.ac.uk/human_rights_centre/rth)]

The symposium was organized around 11 working groups and five plenaries.  Each of the working groups considered a particular aspect of the Rapporteur’s work during the past 6 years and then made specific recommendations for the future.  Here, for example, is the report of the working group 5 on sexual and reproductive rights:

Working Group 5: Sexual and Reproductive Health Rights, including Maternal Mortality

In a 2004 report, the Special Rapporteur paid particular attention to the issue of sexual and reproductive health and rights. His 2006 report to the UN General Assembly focused on the reduction of maternal mortality, which is intrinsically related to sexual and reproductive health rights. In this working group, Ariel Frisancho (CARE Peru) and Luz Melo (UNFPA) presented their recommendations for donors with regards to sexual and reproductive health and rights. Further, Claudia Trautvetter of the German development agency GTZ highlighted the work of her organisation on the topic.

One of Paul Hunt’s achievements is that the issue of maternal mortality is now framed as a grave violation of human rights and also of the right to health. There are many international organisations that support work on these issues and civil society groups have been effective in targeting and lobbying for sexual and reproductive rights. However, it is not clear yet if the interventions are making a difference. Another challenge is that talking about sexual and reproductive health rights is still difficult in many countries, as it is a sensitive issue. Cultural sensitivity is thus very important. After the presentations and discussions, the working group listed some suggestions for the new Special Rapporteur.

Those readers interested in the current “state of the art” with respect to the human rights approach should consider consulting the report and following the work of the new Rapporteur.

Posted by Matt Anderson, MD

Resources on Community-based Participatory Research from CCPH

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North East Pennsylvania CCPH

North East Pennsylvania CCPH

Sarena D. Seifer, a Senior Consultant at Community-Campus Partnerships for Health passed on to us the attached list of resources for Community-Based Participatory Research (see below). They are also available at www.ccph.info.

Community-Campus Partnerships for Health (CCPH) was set up in 1996 to promote “health (broadly defined) through partnerships between communities and higher educational institutions.” Currently it consists of a network of 1800 communities and campuses involved in “service-learning, community-based participatory research, broad-based coalitions and other partnership strategies.”

Community–based participatory research (as defined by the WT Kellogg Foundation) is a “collaborative approach to research that equitably involves all partners in the research process and recognizes the unique strengths that each brings. CBPR begins with a research topic of importance to the community, has the aim of combining knowledge with action and achieving social change to improve health outcomes and eliminate health disparities.”

Many see CBPR as an antidote the exploitative relationships that some academic centers have had with local communities. The Agency for Healthcare Research and Quality reviewed CBPR in 2004 and their report can be accessed here. Here is CCPH’s list of CBPR resources:

CBPR RESOURCES WEBSITE
Resources on the site include:
• Principles, policies, reports, presentations and curricula
• Opportunities for funding, training and technical assistance
• Links to related organizations and initiatives

DEVELOPING & SUSTAINING CBPR PARTNERSHIPS: A SKILL-BUILDING CURRICULUM
This evidence-based curriculum is intended as a tool for partnerships that are using or planning to use a CBPR approach to improving health. Each of 7 units includes:
• Learning objectives
• In-depth content information about the topic(s) being presented
• Examples & interactive exercises
• Citations & suggested resources

INSTITUTIONAL REVIEW BOARDS & CBPR
This 6-part call series covered such topics as “Supplementing IRBs with a Community Advisory Board,” and “Creating an Independent Community IRB: When is it Right for You?” Download audio files & handouts at http://depts.washington.edu/ccph/irbcalls2.html
Sign up for the CBPR & Research Ethics Electronic Discussion Group at http://mailman.mcw.edu/mailman/listinfo/ccph-ethics

CBPR RESOURCES BY & FOR COMMUNITY PARTNERS
The Community Partner Peer Mentoring & Advocacy Website is designed as a resource for community members and community groups in their work with academic partners.

CBPR ELECTRONIC DISCUSSION GROUP
Stay on top of the latest CBPR news and funding opportunities! Co-sponsored by CCPH and the Wellesley Institute, the listserv has over 3,500 subscribers, including community organizations, colleges & universities, funding agencies and policy makers. Sign up at http://mailman.mcw.edu/mailman/listinfo/cbpr

CCPH CONSULTANCY NETWORK
Looking for a CBPR expert to give a presentation, lead a workshop, conduct an evaluation or provide phone or on-site consultation? The CCPH Consultancy Network is here to help! Learn more at  http://depts.washington.edu/ccph/mentor.html

CCPH’s 11th conference, “Creating the Future We Want to Be: Transformation Through Partnerships,” will take place from April 29-May 2, 2009 in Milwaukee, WI. Learn more at http://depts.washington.edu/ccph/conf09-overview.html

Posted by Matt Anderson, MD




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