Monday, October 14, 2013

Safety Done Pretty Well

(Special thanks to Sarah Riddle for bringing this to my attention.)

Like many in Boston, when I lived in that fair city, I had a love/hate relationship with the public transit system-- the Massachusetts Bay Transit Authority, or MBTA.  The heat lamps by the Silver Line bus shelters?  A nice touch.  The fact that Green Line doors get stuck and passengers are asked to move to the left side of the train to offset the weight?  Absurd in 2013.  So I was heartened to see this solid effort from the MBTA on transit safety and "distracted riding."  I love it when Boston displays Good Public Health.

Admittedly, the dancing is pretty awful.  The song could be better.  And I'm not certain what exactly the safety bounce entails.  This is no Dumb Ways to Die.  But the video raises the issue of rider safety and invites the public in with a goofy song.  And given Boston's high transit ridership (5th in the country), I liked that the video incorporated 3 languages and at least tried to incorporate faces reflective of Boston's demographics.

If you're taking notes, MBTA.  Here are some other videos to work on: accessibility, noise pollution (cough, Boylston Street station), and sanitation.

Monday, September 30, 2013

ObamaCare Done Right

The Affordable Care Act made funny, clear, and Olivia-Pope-y.  This is how you explain things.  

Budget Constraints

(At the top where we belong.  
Photo Credit: Marie Castelli via

Every Sunday when we were little, my father gave my brother and me two coins each.  We were supposed to put one in the offering box at Sunday School and keep the other as allowance, which we could then pool together to buy snacks while we waited for the adults to be done with church.  Yet much to Peter’s chagrin, I’d often get caught up in Christianly love and happily give both of my coins to Jesus — which meant that not only could he not eat my chips, but I had to dip into his share. 

Much like my brother and me, you, insurance companies, and our government all have limited resources and competing demands.  One of us may even run out of cash on Oct. 17th.  Our constraints make the study of healthcare quality a health policy priority.  Since we can’t spend money on everything, we need to make sure that we are only spending our limited funds on quality items, like Jesus, seaweed chips*, and good healthcare. 

How does one measure healthcare quality?  In the classic quality paradigm, one can measure factors related to structure (e.g. staffing structure), process (e.g. physician hand washing), and outcome (e.g. patient mortality).  Things get thorny and fun when you start debating which which measures better reflect quality.  Patient satisfaction, for example, seems like a pretty good indicator.  As a society, we probably want to spend resources on healthcare that makes patients satisfied.  But patient satisfaction is also complicated by other factors that need to be teased out, like how friendly a doctor is and how nice the hospital food is.  Sometimes, the sickest patients are the most satisfied.  A 2012 study by Dr. Joshua Fenton et al, for example, found that having high patient satisfaction was significantly associated with higher health spending, more hospital admissions, and higher mortality.  This doesn’t mean that the most satisfied patients get the worst care, or we should invest our ObamaCare Bucks on stocking hospitals with duck fat fries (we so should).  It certainly doesn’t mean that patient satisfaction is bogus.  Instead, the study reflects the complexity of the issue and demonstrates how all that health policy wrangling over performance measures in the news are worthy debates.  Quality measures are a lot sexier than you realize.  They involves your money and your healthcare. Deciding the measures and how to hold providers accountable aren’t easy matters—that’s why there’s ruckus.  But it’s necessary ruckus, ‘cause we don’t have racks on racks on racks. 

*If you asked 9-year-old-me what I missed most about Taiwan, I would have said potato chips and hot dogs.  They just taste better.

Substance Abuse Done Right?

(Concerting with MGMT)
Last month, Christine hooked me up with tickets to a music festival.  I loved the acts that we saw, even those we saw standing outside the venue gate with rain above, mud below, and sticky skin pressed all around us.  But the experience made me realize that I have now entered the stage in my life* where I look at concertgoers and think: a) we need to get you more clothes and b) this place is in dire need of public health interventions. 

Apparently, I was not the only one.  Though I was mostly thinking of dousing the pavilion with Purell, the New York Times reported last week that the TomorrowWorld festival had teamed up with DanceSafe, a charity that educates concertgoers on the safer use of drugs.  The article highlights interesting parallels between drug and sex education (e.g. the differing perspectives between the US and Europe, the tension between abstinence and proper use, etc), though of course, the analogy is limited.  The legality and associated mortality of the two issues differ drastically.  The article writes:
But Missi Wooldridge, the president of the DanceSafe board, said providing festival participants with information about Ecstasy and other party drugs can save lives, just as promoting condom use can prevent the transmission of AIDS. Nightlife should be viewed as a public health issue, as it is in some European countries.

What do you think?  Is nightlife a public health issue?  Are concerts the best venue for such interventions?  I am not wholly decided, but I am intrigued.  

*Who am I kidding, I have always been at this stage.

Monday, July 15, 2013

Local Politics Done Right

(Yes, this is basically a clip show.  But it's 97 degrees outside and we could all use a little P&R.) 

(Photo credit:
Parks & Recreation is my favorite show on television.  Writer/creator Mike Schur is my hero and this episode should be required viewing in every health policy program.  Set in fictional Pawnee, Indiana ("the 9th most obese city in the US"), the hilarious show has some surprisingly real public health moments, especially when it exemplifies the tension between population health and individual freedom as well as those between eating and abstaining from Paunch Burgers.  In today's post, we break down, on a scale of 0 to Public Health, which character is the most public health of them all.

Ron Swanson:  0

If this scale could tip negative, Swanson's steady diet of bacon, distaste for child labor laws, and distrust of the medical establishment, would send his score far below 0.  Despite being the Director of the Parks & Recreation department, Swanson practices what he preaches, and that is anti-government intervention.  It's true, Ron, people were much tougher back then, but there were also more dead babies.

(Also scoring 0s: Jerry Gergich, Jean-Ralphio Saperstein, and Pawnee Animal Control.  Councilman Jamm doesn't deserve to be scored.)

Donna Meaglepp

Donna is a tough one.  Sure, her tweets are great, she knows Ginuwine, and subscribes to the Treat Yo' Self philosophy.  But all that cunning and self interest neither promote nor deter population health.  She does, however, invest in local business while also working toward public interest, and is one of the department's few competent employees.  For her embodiment of successful public-private partnerships, we give her a little credit.

Tom Haverfordpp

See also, Donna Meagle.

Andy Dwyer & April Ludgateppp

No one commits like Andy.  Whatever he lacks in his knowledge of the healthcare system, he makes up for with a steady devotion to the Department and the public's well-being.  Sure, he could not be more detrimental to his own well-being, but he is a faithful public servant striving for the public good.

April is the perfect yin to Andy's yang.  He cares, she does not.  She's shrewd, he's not.  But when she puts her mind to it, April is a savvy policy maker in the making and has an eye for the big picture- a must have in public health.

Ann Perkinspppp

Technically the only character who works for the Department of Health, Ann Perkins scores high for trying, though often unsuccessfully, to mount public health campaigns in the city, including sex education for city employees, water fountain sanitation, and curbing candy consumption.  In her personal life, though, Ann is a noted jogging and salad hater (though who can blame her).

Chris Traegerpppp

With a resting heart rate of 23 beats per minute, Chris Traeger is the healthiest person in Pawnee and an indefatigable promoter of well-being.  Unrelentingly upbeat, unfortunately, Chris's downfall is his perfection: others find his diet and exercise un-relatable and gives public health a bad name.

Ben Wyattpppp

He has a cute butt, a sensible lifestyle, and the political savvy to put progressives in office.  In essence, Ben is the anti-Ron Swanson.  But like Chris, Ben's downfall is in his inability to make public health promotion seem fun.  Most notably, his horrendous Low-Cal Calzone Zone idea.

Leslie Knope: 11,004p  (yes, out of 5)

Leslie's worth is in her work: through her tenures at the Parks Department and on the City Council, Leslie has created green spaces, reduced obesity rates, and contained the city's animal control problems.  But that doesn't mean she's a model of individual health herself:  Leslie puts sugar in spaghetti sauce, has a waffle addiction, and could be in better shape.  But through her imperfections, she embodies the give and take required of good public health practice.

Monday, July 8, 2013

Anniversary Edition: What We Talk About When We Talk Public Health II

(Just how many face masks do I have?)
My big brother and I were coloring in our playroom, back when we were young enough to have one, when he read the crayon box and exclaimed, “These are non-toxic!”  “Non-toxic!?” I asked. “That means you won’t die when you eat it,” he explained with a laugh. I laughed with him.

Soon after, I declared to my father my intentions to eat a crayon, thus sparking one of the first and most frustrating arguments I ever had with him.

“But they’re non-toxic,” I whined.

“You can’t eat everything that’s non-toxic.”

“But I won’t die.”

Exasperated, my father pointed to our round, mahogany dining table. 

“This is non-toxic, too, but that doesn’t mean you can eat it.”

My eyes widened as my little brain processed this new possibility.  I imagined clamping my jaw onto the side of the big table. Whoa- you can eat tables?

When I talk about public health with other people, I often think I know what my father must have felt like talking in circles with me.  Like my father, I often find my perfect logic and apt examples coming up short as I try to argue helmets, nutrition labels, and ObamaCare with people not in this field.  I love thinking, talking, and doing public health, but it frustrates me when people don’t see the world the same way I do.  It makes me want to walk away from tough conversations. 

Recently, I was at the annual conference for health services research folks like (and much smarter than) me.  It was there last year that I got the idea for this blog.  I attended a presentation there called “Minimizing Churning and Coverage Gaps Between Medicaid and Subsidized Qualified Health Plans,” given by one of my role models from Harvard.  As you can tell by the title, it was very specific and a bit technical.  But even in that context, Professor Kathy Swartz broke through the wonkiness.  The details of the talk don’t matter for us, except that rather than talking about insurance enrollment periods in the hypothetical, Kathy explained the end of the year as a time when “low income people are thinking about the expenses of the upcoming holidays, of paying for heating and  buying Christmas presents for their children.” 

That little vignette helped me understand that issue.  I’ve thought a lot about it in the last two weeks.  I hope to do the same for you here.  This blog is where I come to make constructive use of my frustrations, to have the conversations I want to walk away from., and to highlight good examples.  This is where I convince you that eating crayons is so not public health.