Blue Zones

       I recently finished reading the book, The Blue Zones: 9 Lessons For Living Longer from the people who've lived the longest. Blue zones are defined as pockets in the world where people live measurably longer lives and have a higher rate of centenarians- people who live until 100 years of age. The story is told by the Author and describes his experiences visiting each of the 5 blue zones in the world: Sardinia, Italy; Loma Linda, California; Okinawa, Japan; Nicoya, Costa Rica; and Ikaria, Greece. The stories he told were absolutely mind-blowing. At the end of each chapter, the lessons of that blue zone were listed. How were these people living so long?
        Although each blue zone had there own unique characteristics and practices, there were a few common themes. First, all of the zones place high emphasis on the importance of spending time with friends and family. All of the communities are very close, they help each other out, and there is a sense of comfort and safety within their community. Next, mostly all zones consumed limited amounts of meat or were vegetarians. They grew just about all of their food in gardens, which means they barely ever ate processed foods- it was all organic and had to be prepared. Third, they all lived very active lifestyles. Although some did exercise by biking and weight lifting, their main forms of physical activity was walking and performing their daily tasks such as gardening. It was stressed that moderate-level exercise is all that is necessary and this should come from just making your daily life more active, not going to the gym for 1 hour everyday and then remaining sedentary for the rest of the day. The last thing they all seemed to have in common, which was called a different thing in each zone, was having a strong sense of purpose in life/ a reason to wake up in the morning.
     The quality of these people's lives were very high. They suffered from much lower rates of morbidity and mortality, and they were genuinely happy. However, already, the rates of centenarians are expected to decline with more urbanization in these areas. Kids are not growing up the same as their parents and grandparents that made it to this old age. Do you think it is even possible to adopt a lifestyle similar to those in the blue zones? Or is it impossible because of how our lives and environments are structured? Instead of living active lifestyles and eating highly plant-based diets, we are overwhelmed with technology that makes us lazy and convenience foods that are necessary for our busy work weeks.

                                                          

Linking Theory to Practice

There was a discussion question raised in this week’s class regarding how we can link the theories that we are exposed to from our education and linking it to practice as Public Health professionals. We can often get wrapped up in our studies so much so they we may often forget why we are doing what we’re doing, but it is great to contemplate the purpose of all we are being exposed to. I like to think of it as training, we are in specified programs with specific course requirements to go out into the field that we each desire and utilize what we have learned. As such, it is important for us as students to take the initiative in asking ourselves “how can I use this when I am out in the field?”; whatever ‘field’ that may be, whether it be as researchers, community health workers, doctors etc.

So in reflecting on my research interests and linking to practice, I found this great article on linking CBT (Cognitive- Behavioral Techniques) to improve breastfeeding rates in a marginalized community in Pakistan (Rahman et al., 2012). Here, the researchers aimed to integrate CBT into the maternal counselling programs that were carried out by the community health workers (CHW). After conducting qualitative research, Rahman et al, (2012) were able to identify the cultural behaviors and practices that shaped breastfeeding attitudes and used this data to design a counselling program using cognitive-behavioral techniques. The CBTs included integrating organized dialogue between the health worker and the mother into the counselling practices; dialogues were based on various elements such as establishing a CHW and patient relationship, brainstorming sessions for problem solving and reflection, as well as timed session visits based on infant’s age. After assessing the CHW’s feedback on the intervention after implementation, it was found that the program was useful and had a positive influence on increasing the exclusive breastfeeding rate within the community (Rahman et al., 2012).

Articles such as this made me realize the importance for public health workers and researchers to critically analyze the theories that we are exposed to in order to be able to utilize them and translate them into the work that we do. Behaviors and attitudes are what shapes the health outcomes in any population, whether it be towards breastfeeding practices or deciding on a health policy for a given country. By understanding the theories behind behavior change or psychology as a whole, we can positively influence how communities, government workers, and other healthcare professionals see intervention programs and utilize them to their full advantage.

Reference

Rahman, A., Haq, Z., Sikander, S., Ahmad, I., Ahmad, M., & Hafeez, A. (2012). Using cognitive-behavioural techniques to improve exclusive breastfeeding in a low-literacy disadvantaged population. Maternal & Child Nutrition, 8(1), 57–71. https://doi.org/10.1111/j.1740-8709.2011.00362.x

Child Mortality

Usually during the springtime, while walking pass the memorial mall, someone will accost me with images of dead fetuses, and a plug for pro-life.  I usually smugly reply what is life and how is that life supported.  Then I go on to ask, whether they support welfare, which usually ends up being NO, because it’s a handout. If then say well if you believe in the sanctity of life then you should also believe in supporting that life financially once it is born. Regardless of your believe, while we sit and debate pro-life or pro-choice, there are children in the US and around the globe dying from lack of nutrition and adequate health care where health and nutrition interventions for both mother and child could have saved a life and reduced the traumatic burden that sometimes leads to psychosis.

In areas hardest hit by infant mortality you have TNC like corporations that will market formula to new mothers. In developing countries, infants who are not breast fed have seven-fold and five-fold risk of death from diarrhea and pneumonia respectively.  They are not getting the necessary immunity from their mothers. Risk factors of child mortality: unhygienic and unsafe conditions, ingestion of unsafe water, inadequate availability of water for hygiene, lack of access to sanitation, 88% of death from diarrhea. Clinical cause of infant mortality around the globe range from Neonatal disorders, diarrhea, pneumonia, malaria, AIDS, measles and other.  Some of these diseases are preventable as there are vaccines, however Neoliberalism and TRIPS have created a political and health structure, Biopolitics, that those in need are not seen as a viable economic profit market, therefore not as valuable. Usually children don’t just die of one disease but multiple or co-morbidity. One co-morbidity that is heavily overlooked is malnutrition and hunger which is prevalent in low-income and middle-income countries.

Child mortality is concentrated in regions such as south Asia specifically, and sub-Saharan Africa. The  top 6 countries with a large proportion of child death in order from greatest to least is India, Nigeria, China, Pakistan, DR Congo, and Ethiopia.  If you look at these countries you would also see that in the last 2-3 decades these counties have been faced with political uprising and unrest as well as occupational environmental exposures.

Health and nutrition interventions should be in place for both mother and child that incorporate some form of education that will lessen the impact of the disease burden. Health and nutrition of the mother is important as if the mother is not healthy then the child in-utero will lack the necessary nutrients to develop appropriately and may not survive, or survive but with DALYS, that place an economic burden on an already strapped economy. I consider the least of these and most vulnerable and where we should put aside profit and politics is with children.   

Too Much of a Good Thing: Combatting Globalization of Overused Cesarean Sections

Last week in class we discussed globalization and how ideas and practices are so easily passed around the world.  One global health issue that has been able to do so is the growing rate of birth by Cesarean section.  Bringing this procedure to parts of the world that did not have it before has helped to reduce infant and maternal mortality from medically complicated births.  However, this is only up to a point. The procedure is often viewed casually here, as it occurs in about 1 of 3 births, but in less industrialized settings it can be very dangerous to do such a major surgery in an already critical moment.  Even in the developed world, the procedure has likely become overused for various reasons.  Due to stress on hospitals to see many women, a C-section may be seen as a method to quickly and efficiently move through patients.  Some women also see it as an easier or more ideal method of giving birth.   In countries, increased access to hospitals has caused the C-section rate to skyrocket, in Mexico up to about 50%.  These women face a burden of a long recovery and the need to have C-sections for their subsequent births.  The consequences go beyond this to the biological level; their child may face trouble with their immune system due to the lack of microbiome exposure that occurs during the normal labor and birth process, leading to higher risk of asthma, allergies, celiac disease, obesity, and more.

What can be done to reverse this trend?  The WHO has identified two points to address. First, population data needs to be continuously studied to determine an appropriate C-section rate.  Currently, they have set a global number at 10% of births, because once the rate goes higher than this no decrease in maternal or infant mortality is seen.  While this may be a good place to start, I think more population-specific study is necessary as well; for example, in a country with higher weights of overweight and obesity, such as the US, the optimum number of women to receive C-sections to yield the most benefit may actually be higher than 10%.  Still, I think this is a great place to start to understand the state of the problem.  Secondly, they have developed a classification system called the Robson scale that is simple enough to be implemented in all health care systems to determine what groups of women should have/are getting C-sections (see link below for more detail).  Getting data specific to birth history and complications is important to identify where we could target to reduce the C-section rate, as opposed to women who actually would benefit from the procedure.

As globalized as this life-saving surgery has become, we must now begin to globalize a more nuanced view of both its power to help and its potential to harm.  Rather than striving for a specific rate of Cesarean sections, our number one global health goal should be to make sure that this procedure is getting to the women who need it and not being forced upon women who don’t.  The rate targets are simply a crude tool to help us get there.  Gaining a better understanding of when and why this procedure is necessary will temper its use to the healthiest level possible in a given population.

Reference:

Human Reproduction Program. 2015. WHO Statement on Cesarean Section Rates. Available from: http://apps.who.int/iris/bitstream/10665/161442/1/WHO_RHR_15.02_eng.pdf?ua=1

First Black President

            This morning, my boyfriend and I read the news, and like every morning there was yet another article about Hillary Clinton & Donald Trump (election season!). As we talked about the possibility of having a woman for president for the first time in history I said out loud "Wow, we could have our First Black President and First Woman President back to back! What a time in history." And then it kind of hit me. Obama becoming the first black president was a big deal. But then, why was it such a big deal? Why is someone having a different color of skin becoming the first fill-in-the-blank-here such a big deal? I was not diminishing the accomplishment like you may be thinking. I was wondering, why does race even matter to begin with? Of course, I was thinking idealistically. In an ideal world race wouldn't matter. But this is not an ideal world and race does so unfortunately matter. I realized slowly that such great suppression of the black race in this country, that spread globally, really happened just yesterday – it was not that long ago in history. The same with women's rights. I am just hoping as time and history go on, that slowly this accomplishments, first black president, and accomplishments like it won't be such a big deal because they will simply be commonplace.

            As I was reading "Representations That Frame Health and Development Policy" from Global health: Why cultural perceptions, social representations, and biopolitics matter (Nichter, 2008) for our readings next week, I found the words I was lacking to convey this morning: "The questions of how and why [groups at risk] are exposed are often left unasked - and this can be highly problematic. Simply identifying a group as being at risk from an illness is an invitation for others to think that this is due to an inherent genetic or behavioral group trait. This impression all too often plays into a pre-existing negative stereotypes" (112). He later goes on to explain that we (researchers, students, health professionals) should consider rewording our questions from What risk factors does a person have to disease X? to What protective factors within a group prevent a problem from being worse than it is or from developing? He also describes how representations of "groups at risk" need to be seen in light of environments of risk if the group is not to be stigmatized. Race of course has implications nationally and globally. Although this book was written before 2000, I haven't seen this type of wording before. I wonder if we rephrased our research questions and took "at risk" groups on from a different angle, if we could begin, or increase, the reduction of racism and negative health and negative stereotypes.

Nichter, M. (2008). Global health: Why cultural perceptions, social representations, and biopolitics matter. University of Arizona Press.

The Obesity Pandemic and How to Fix It

We have discussed the spectrum of malnutrition.  Obesity and undernutrition are, ironically enough, both concerns of the world.  Obesity has become a pandemic in all honestly.  One issue we face with obesity is viewing it as a disease. I do not believe this is accurate.  Obesity should be categorized more as state of being than a disease.  This being said, it is definitely a risk factor for other diseases.  I was required to read an article called Fat Britain.  This article went into detail about how the “Americanized” United Kingdom is becoming obese.  I think part of addressing obesity is looking at the nutrition of the people it is affecting.  It is become apparent that countries with the “Western diet” are more often the obese countries.  A Western diet includes lots of animal-source protein and fatty oils.  I am not suggesting we eliminate these types of food completely.  That is both largely unrealistic and people would rebel.  Look at what happened when large soda pop beverages were threatened in New York!  People went ballistic when a soda tax was suggested and it was an ineffective solution.  I suggest that we concern ourselves more with better educating people to indulge in moderation.  You can have potato chips, but not with every meal.  Another factor to consider is the biology behind obesity.  My mother had gestational diabetes when she was pregnant with me.  Because of this, my body is more inclined to store fat.  That is only part of the obesity equation, but it is part I feel is too often overlooked.  Living in the age of technology is also contributing to obesity because of the sedentary lifestyle it allows us.  What do you think would be the best way to get this health education to people?  Should there be more restrictions on “junk” food?  I would love to see your opinions!

·          Cohen, Roger. "Fat Britain." The New York Times (2014).

Globalization and Gender Inequality

Although some claim that globalization has a global long term positive health and social influences by increasing growth rates, employment and financial autonomy, it has been shown that this “trickle down” theory is not correct. Money and wealth are definitely appropriate and beneficial to those on the top of the socioeconomic gradient. However, the assumption that such financial and social benefits will trickle down to the needy is not a real fact.

 Despite that both genders in the low socioeconomic gradient are negatively affected by globalization, women seem to be more at risk. Women are considered as “shock absorbers” of the economy in the developing countries. Although our readings last week addressed lower wage, dead end jobs, food insecurity and other financial, health and social factors as negative influences of globalization on women, I want to target the psychological aspect.

Being from one of the developing countries, I personally encountered the taste of inequality when I was declined my right to be honored as a top student in the high school due to not being among regular school students. Homeschooling was treated as an option for criminals, elders or FEMALES! The Egyptian community, till now, has abasement thinking to homeschooling females. When I started working and become affiliated with the department of Pediatric Dentistry and Dental Public Health, I suffered again the gender inequality problem. Despite being highly educated, some of my colleagues and professors treated me in a way of being a person with half efficiency, only, due to being a working wife and a mother. It took me a couple of years of extreme hard work and stress to prove them wrong.

Although, in the era of globalization, women can have more opportunities, they are usually under threat not only from a financial aspect but also from a psychological one. They are usually under-estimated, ignored and under continuous psychological stress which eventually destroy their health, families, communities and that will, consequently, have serious global implications. Such culture that lead to the social construction of reality in a majority of developing countries that females are low standard citizens should be addressed. In my opinion, It is considered as a severe sort of structural violence and social injustice towards females. Building successful communities and achieving progress in every aspect is mainly based on females who should gain not only their financial rights but also their psychological ones!

Double Burden of Malnutrition

Double Burden of Malnutrition

This week’s discussion led me to reflect on how globalization has had an impact on maternal nutrition in developing countries. In my search, I came across many articles discussing the concept of Double Burden of Malnutrition (DBMN) which is defined by the World Bank as both under and overnutrition being present in the same population; often “across the life course” (Shrimpton & Rokx, 2013). A very interesting phenomena that is often attributed to the rise of globalization (Winichagoon, 2013). Many countries such as Cambodia, Democratic Republic, Bangladesh, and Vietnam, have now been having to deal with undernutrition in infancy and obesity in later years in the life course of an individual (Haddad, Cameron, & Barnett, 2014; Shafique et al., 2007; Shrimpton & Rokx, 2013).

One study in particular by Winichagoon (2013) studied DBMN with regards to maternal and child nutrition in Thailand by examining both food and nutrition data from national surveys between 1960 and 2009. They found that although progress was made in maternal and child undernutrition, many primary concerns still exist post globalization including nutrient deficiencies and anemia. The alarming result was the rise in not only obesity, but various diseases among women and children over the course of almost 50 years (Winichagoon, 2013). I admire one of the author’s recommendations that he refers to in the paper in that intervention programs with regards to maternal and child nutrition need to be based on findings studied over a longer period of time in order to communicate its importance in developing countries. It is through these measurable results that DBMN may be seen as a prevailing issue and appropriate nutrition programs can be implemented in the right outlets and at multiple life stages of those in the impacted communities.

However, how can we address this effect of globalization in a sustainable way in order to leverage its benefits such as developing infrastructure, increase healthcare access, food security, and trade yet at the same time, eliminate the DBMN risk?

A guided ‘framework’ that I found to be most appropriate in approaching DBMN that also touched on a lot of the points we have been discussing in class, was brought up by Pinstrup-Andersen & Babinard (2001). Here, the researchers discuss the importance of needing to manage the degree in which globalization is infiltrated through policy implementation, standards that are customized by region, and having the national institutions be the driver of these decisions. On this incremental basis, things such as food safety standards and food security can be looked at through a microscope when implementing factors of globalization such as trade agreements in order to minimize its impact on the nutrition status of both parties involved. Two primary questions when approaching policy reformation and standard creations should be examined:

            (1)   Whose standards will be used as a norm? Having customization food safety standards is important in order to outweigh high or low food prices that often come as a result

            (2)   Is there a trade-off between food safety and food security? In the evolution of an increase in trading amongst countries, high food safety standards in a more wealthier area may impact the food security of the smaller community farmer (Pinstrup-Andersen & Babinard, 2001).

It is through these open discussions that globalization can be optimally used for its many benefits to global public health initiatives as well becoming the driving force towards progress for the human race- a progress that is built on the foundation of health and opportunity for all. Perhaps its not the black and white argument of globalization being 'bad' or 'good', but the need to think of it as an intrinsic process as part our evolution. 

Would love to hear any comments or thoughts! 

References 

Pinstrup-Andersen, P., & Babinard, J. (2001). GLOBALIZATION AND HUMAN NUTRITION: OPPORTUNITIES AND RISKS FOR THE POOR IN DEVELOPING COUNTRIES. African Journal of Food, Agriculture, Nutrition and Development, 1(1), 9–18.

Shafique, S., Akhter, N., Stallkamp, G., Pee, S. de, Panagides, D., & Bloem, M. W. (2007). Trends of under- and overweight among rural and urban poor women indicate the double burden of malnutrition in Bangladesh. International Journal of Epidemiology, 36(2), 449–457. http://doi.org/10.1093/ije/dyl306

Shrimpton R, Rokx C. World Bank Health, Nutrition and Population (HNP) Discussion Paper. Washington, DC; 2013. The double burden of malnutrition: a review of global evidence.

Winichagoon, P. (2013). Thailand nutrition in transition: situation and challenges of maternal and child nutrition. Asia Pacific Journal of Clinical Nutrition, 22(1), 6–15.

Biopolitics

From the Article by S. Craddock: The philosopher Giorgio Agamben’s depiction of “bare life” as life that can be killed but not sacrificed because it has no political relevance, in the age of modern biopolitics, where sovereign forces such as governments and corporations possess as part of their powers the “right to decide on the value or the non-value of life as such.”

That observation as one may call it, really cut at my heart.  AIDS is not a new pandemic, yet the pharmaceutical companies have not made headway in terms of finding a vaccine to intervene in this global tragedy. Could this be because AIDS is no longer a trending topic in the developing world, and celebrities such as Magic Johnson has shown that we could like a healthy and productive life with the disease? But the reality is that the resources that Magic Johnson has at his disposal is not available to those in poor hard-hit countries. AIDS is prevalent in low-income areas and developing countries with little vaccine purchasing power. Less than 1% of the $70 billion spent annually on health product research is earmarked for AIDS vaccine research. The developing countries do not have the resources to develop their own vaccines or research. The developed countries with pharmaceuticals companies that are corporate-dominated, medical capitalism, does not see a value in developing a vaccine, because the market that desperately needs it does not have the capital by which to make a profit. This to me seems morally bankrupt and corrupt, however because of governmental structures that have been set up such that economic considerations are weighed above the loss of life. This creates a structural violence paradigm that gives corporations the right to decide how valuable the life of poor and hard-hit countries are, and if the people are worth saving. Public private partnerships have been trying to work through this contradiction, focusing on vaccines for HIV sub-types in hard-hit areas. However, I fear that we have ceded or moral  authority to corporate profits that obfuscate the sanctity of life and thus we will see that this not only affects developing countries, but as in the case of the epi pen debacle, it will be widespread and catastrophic, affecting all aspect of life and health. 

The Ubiquity of Stress

Because of my research group’s interest in stress, I chose to write this week’s blog post about stress, stressors, and the stress response. The American Psychological Association (APA) defines stress as “any uncomfortable emotional experience accompanied by predictable biochemical, physiological, and behavior changes. Last week in another class we learned about this topic, and one thing I found to be very interesting, is that stressors- any stimulus that may lead to lead- do not produce the same response in everyone. Two people could both be given a 10 page paper to write, or two families could be struggling taking care of a family member with an illness, and each will be affected differently, if at all, by the stressors.

In light of this class, I was thinking about how, around the world, people are exposed to so many different types of stressors. In America, are primary stressors that lead to stress may be, our job, doing housework, paying the bills, and helping a loved one deal with a chronic disease. In developing countries, these things are negligible compared to what they are suffering through. According to The World Health report 2008, globalization is putting the social cohesion of many countries under stress and health systems are not performing as well as they should. The development of good health systems are crucial for these populations because they are living in poverty, which has been linked to poorer health, they are vulnerable to many communicable diseases which are preventable and curable in developed nations, and they are at a higher risk for outbreaks. The biggest thing I see as a barrier here, is that these populations are under heightened continued stress because they have no control over these stressors.

We know that chronic stress can result in a number of health problems including anxiety, insomnia, high blood pressure, and a weakened immune system. It can also contribute to the development of major illnesses such as heart disease, depression, and obesity. It is clear that stress is a major problem in all parts of the world, but I am wondering if there are different stress responses for different types of stressors, whether it’s a big exam or a family member fighting AIDS. Also, what if person 1 who is well-off was put into a developing country scenario of person 2 and vice versa? Would person 1 be overwhelmed with stress, and person 2 be resilient? Are there ways to help people in developing countries deal with stress to limit the chance of worsening a disease? Or is this impossible because they have little to no control over the situations at hand?

References:

http://www.apa.org/helpcenter/understanding-chronic-stress.aspx

http://www.who.int/whr/previous/en/