Alright, here's the abstract:
-Epidemiology and heart disease
-Heart disease -- more about what you do or where you do it?
-Fundamental causes
-Contextualizing risk factors
-"Stress is the new tobacco."
-A big bunch of links to several academic webpages and articles.
So I've discussed a bit about epidemiology and my interest in the social determinants of health (SDH). Traditionally, epidemiology focuses on individual behaviors as causal factors for non-infectious disease risk (non-infectious diseases such as diabetes, heart disease, cancer, etc. A case can be made that SDH plays a role in incidence of infectious diseases as well. I'll touch on that another time).
I'll use not only the most deadly non-infectious disease, but the number one killer in the U.S. as an example: heart disease.
Epidemiology focuses on population level risk factors for heart disease. As such, perhaps we should take a step back and contextualize individual behaviors within the broader picture of where and how people live. What factors have an effect on behaviors? Can there be earlier interventions for better preventive measures? What I'm talking about here is what puts people at "risk of risk," as Jo Phelan and Bruce Marmot called it.
What is the fundamental cause of heart disease? Bio-medically speaking, we can talk about artery blockages that reduce blood flow to the heart, starving tissues of oxygenated blood and eventually causing a cardiac event (heart attack or stroke). But what causes the blockages? Physicians consider many factors: Does the patient have a healthy diet? Is the patient obese? Does the patient take time to exercise daily? Does the patient smoke? What is the racial identity of the patient (this can make a difference, I'll explain further in a moment)? There are several measurements taken into account by physicians, and often times a regimen including better diet and exercise, smoking cessation, and medication are prescribed.
I'll contextualize these factors, and address each one individually. Studies have shown that those in poverty are less likely to have a healthy diet, a factor which is directly related to obesity. Those in poverty are less likely to exercise, and this often isn't a choice. In fact, there is evidence to support the idea that regardless of income level, living in a "poor area" has a negative impact on your health. Furthermore, we know that those living in poverty are far more likely to smoke, increasing risk of heart disease. Read more on the links between poverty and tobacco use here. Multiple studies have shown that there is a major link between poverty and race, and people who identify as African Americans and non-white Hispanic suffer the most. The links between race, poverty, and disease have been discussed and researched again and again and again. A simple perusing of the available research quickly demonstrates a clear link between socioeconomic status and heart disease. The ability to treat and recover from heart attacks is also directly related to socioeconomic status. The stresses involved in dealing with
our complex medical and insurance system has cost lives and hope in the
battle toward recovery, and that stress is increased for those of low socioeconomic status.
Then what about stress? There's a lot of talk out there about how stress is the "new tobacco." Stress responses were originally present in our bodies as a way to protect ourselves from danger. The old "fight or flight" response. The opposite of this is the perhaps less known "rest and digest." So the difference in our modern world is the lack of life-threatening saber tooth tiger attacks and the over-filled bag of deadlines and schedules. Fight or flight is supposed to be temporary, to subside once we've flown or fought. A sustained state of fight or flight cuts down our body's ability to rest and digest, to repair itself, to do the upkeep necessary to stay healthy. What that means is that sustained levels of stress cause cortisol buildup in the body, interfering with the rest and digest state, causing damage to our internal organs and processes. Modern day stress is a major contributor to heart disease. It's killing us.
So let me make my point in no uncertain terms: There is an undeniable link between health and socioeconomic status. Inequality is deepening, and the poor of our country are suffering and dying at increasing relative rates, while our medical technology and life-saving measures keep getting better. It is unethical and unacceptable. We see here that simple behaviors or biomedical measurements are important, but they aren't the smoking gun. To get a true understanding of health in our country, we must fully understand the effects of socioeconomic status.
Thursday, May 23, 2013
Friday, May 17, 2013
I love school... Where do I go from here?
School has been an amazing experience so far. I love the Evergreen State College. As I'm about to finish my junior year, it's time to really start thinking about grad schools.
I'm looking to get an MPH in epidemiology. I want to have an additional concentration on social causations of health outcomes and public policy implications -- things of this sort. I'd love to work in a state department of health or social services. Non-profit work, such as with Kaiser would be incredible as well.
Eventually, I'd like to pursue a PhD in epidemiology and teach at a collegiate level. I'd like an opportunity to lobby at some point too, assuming I'm not working for a public agency.
So where do I go from here? Here's my short list.
UW School of Public Health is highly rated. Check out their epidemiology dept here. This program is the closest to where I live. The next closest is Portland.
Drexel University in Philadelphia has a school of public health that is gaining traction on the ratings list. Their site is incredibly informative, and there are several programs that really interest me. There seems to be a major focus on policy and social health issues.
George Washington University in D.C. has some pretty intensive programs. Also, it's in D.C. Location is a major factor here, as so many powerful organizations are located or do so much work here at the federal seat of the country.
So that's what I'm looking at. I'd LOVE to hear from folks who have experience with any of these schools! Further suggestions are welcome too, of course.
Have a great weekend everyone!
I'm looking to get an MPH in epidemiology. I want to have an additional concentration on social causations of health outcomes and public policy implications -- things of this sort. I'd love to work in a state department of health or social services. Non-profit work, such as with Kaiser would be incredible as well.
Eventually, I'd like to pursue a PhD in epidemiology and teach at a collegiate level. I'd like an opportunity to lobby at some point too, assuming I'm not working for a public agency.
So where do I go from here? Here's my short list.
UW School of Public Health is highly rated. Check out their epidemiology dept here. This program is the closest to where I live. The next closest is Portland.
Drexel University in Philadelphia has a school of public health that is gaining traction on the ratings list. Their site is incredibly informative, and there are several programs that really interest me. There seems to be a major focus on policy and social health issues.
George Washington University in D.C. has some pretty intensive programs. Also, it's in D.C. Location is a major factor here, as so many powerful organizations are located or do so much work here at the federal seat of the country.
So that's what I'm looking at. I'd LOVE to hear from folks who have experience with any of these schools! Further suggestions are welcome too, of course.
Have a great weekend everyone!
The Social Determinants of Health
Pre-read summary:
-What are social determinants of health, and why should I care, you fascist?
-Another mention of Dr. Mukherjee.
-Not that kind of social network.
-Stressed out mommies make stressed out babies.
-This article by Dr. Bezruchka.
-More reasons for libertarians to think I'm a commie.
-Social context.
Now THIS is a big topic.
So earlier I mentioned this concept of the social determinants of health and made the contention that the social context of the world we live in plays a larger role in our health than other individual factors, such as availability and quality of health care or the number of cardiologists in your area. But what exactly does this mean? What in the hell are "social determinants of health?"
To help answer that question, let's look at Siddartha Mukherjee's (MD, by the way, so pay attention) question in his book:
"Epidemiologists typically measure the risk factors for chronic, noninfectious illnesses by studying the behavior of individuals. But recently, they have asked a very different question: what if the real locus of risk lies not in the behaviors of individual actors, but in social networks?"
This isn't about Facebook. What Dr. Mukherjee was referring to here was the idea that behaviors (positive and negative) are reinforced through social norms. That is, the group you hang out with has a large influence on your behavior. The example he goes onto refer to in the book is social networks of smokers and the proliferation of lung cancer within these circles.
Social groups play a large role in rates and incidences of noninfectious diseases. But it goes beyond the groups an individual associates with. Policy measures having to do with social inequality also play a big role. For instance, there is a growing body of evidence that suggests that environmental factors during first 1000 days of life can have life-long effects on a child. Psychosocial stress certainly has a negative impact in utero. Political measures that disallow or make difficult the ability for parents to care for their newborns just may have an irreversible impact on that child's life.
Let's see what Dr. Bezruchka has to say about this:
"The United States does not provide paid maternity leave nor paid prenatal leave, which may be important factors in affecting health outcomes."
Now, he didn't just pull that statement out of the ether. This quote comes from his article "The Hurrider I Go, the Behinder I Get." That one statement has seven citations to support it. This particular article describes (in great detail) how universal medical care and personal behavior are not limited in their ability to determine health outcomes when compared to social inequality and lack of health outcome orientation in political infrastructure.
Another argument addressed in Dr. Bezruchka's article is one I've only rarely heard, but bears scrutiny. Doesn't the fact that people of so many different ethnic and racial backgrounds skew the health outcome numbers for this country? Are unhealthy immigrants bringing our numbers down? It doesn't look like it. Can you believe that first generation Hispanic immigrants have lower infant mortality and longer life expectancy numbers than non-Hispanic whites in the U.S.? It's true. (Interestingly, studies of second-generation immigrants demonstrate a substantial lowering in those numbers).
So. Health outcomes are bigger than what medicine you take, which doctor you see, and how many gallons of soda you imbibe on a daily basis. To be sure, each of these things is important. But in order to the full picture of how important these things are, we need to contextualize them within the bigger framework of the social setting in which we all live. This contextualizing is what makes clear the importance of the social determinants of our health.
-What are social determinants of health, and why should I care, you fascist?
-Another mention of Dr. Mukherjee.
-Not that kind of social network.
-Stressed out mommies make stressed out babies.
-This article by Dr. Bezruchka.
-More reasons for libertarians to think I'm a commie.
-Social context.
Now THIS is a big topic.
So earlier I mentioned this concept of the social determinants of health and made the contention that the social context of the world we live in plays a larger role in our health than other individual factors, such as availability and quality of health care or the number of cardiologists in your area. But what exactly does this mean? What in the hell are "social determinants of health?"
To help answer that question, let's look at Siddartha Mukherjee's (MD, by the way, so pay attention) question in his book:
"Epidemiologists typically measure the risk factors for chronic, noninfectious illnesses by studying the behavior of individuals. But recently, they have asked a very different question: what if the real locus of risk lies not in the behaviors of individual actors, but in social networks?"
This isn't about Facebook. What Dr. Mukherjee was referring to here was the idea that behaviors (positive and negative) are reinforced through social norms. That is, the group you hang out with has a large influence on your behavior. The example he goes onto refer to in the book is social networks of smokers and the proliferation of lung cancer within these circles.
Social groups play a large role in rates and incidences of noninfectious diseases. But it goes beyond the groups an individual associates with. Policy measures having to do with social inequality also play a big role. For instance, there is a growing body of evidence that suggests that environmental factors during first 1000 days of life can have life-long effects on a child. Psychosocial stress certainly has a negative impact in utero. Political measures that disallow or make difficult the ability for parents to care for their newborns just may have an irreversible impact on that child's life.
Let's see what Dr. Bezruchka has to say about this:
"The United States does not provide paid maternity leave nor paid prenatal leave, which may be important factors in affecting health outcomes."
Now, he didn't just pull that statement out of the ether. This quote comes from his article "The Hurrider I Go, the Behinder I Get." That one statement has seven citations to support it. This particular article describes (in great detail) how universal medical care and personal behavior are not limited in their ability to determine health outcomes when compared to social inequality and lack of health outcome orientation in political infrastructure.
Another argument addressed in Dr. Bezruchka's article is one I've only rarely heard, but bears scrutiny. Doesn't the fact that people of so many different ethnic and racial backgrounds skew the health outcome numbers for this country? Are unhealthy immigrants bringing our numbers down? It doesn't look like it. Can you believe that first generation Hispanic immigrants have lower infant mortality and longer life expectancy numbers than non-Hispanic whites in the U.S.? It's true. (Interestingly, studies of second-generation immigrants demonstrate a substantial lowering in those numbers).
So. Health outcomes are bigger than what medicine you take, which doctor you see, and how many gallons of soda you imbibe on a daily basis. To be sure, each of these things is important. But in order to the full picture of how important these things are, we need to contextualize them within the bigger framework of the social setting in which we all live. This contextualizing is what makes clear the importance of the social determinants of our health.
Why epidemiology?
Quick summary:
Epi-whatever
I have a talent for making cool things boring.
Epidemiology has scientific power.
Siddhartha Mukherjee wrote a brilliant book about cancer. Read it.
WashYourHandsingTon
Libertarians might hate epidemiology.
So just what is epidemiology anyway?
Most people I've told about my wanting to go into epidemiology react in one of three ways. Most frequently people say "What the hell is epi-whatever?" I've been surprised by the number of people who take a stab at what epidemiologists do. "So that's like... some kind of skin doctor?" The least common reaction is "Epi is so cool." Well, okay.
Epidemiology is about tracking disease incidences over time and space. The idea is to quantify data having to do with when, where, and how diseases spread in the hopes of developing measures to slow, stop, and prevent diseases from occurring. There's research and data gathering. There's a lot of statistical analysis involved. I have a talent for making things sound boring.
The power of epidemiology is what fascinates me. The ability to use quantitative data to devise methods and policies to slow infections or incidences of disease or death is incredible. Epidemiology is a fantastic mix of mathematics, biology, and social sciences that can and has allowed for enormous strides in reducing the impact of some of the world's deadliest diseases. The reason for this is the epidemiological emphasis on prevention.
It should be known that prevention of disease has had a far greater global impact on human survival than has treatment. Siddhartha Mukherjee describes well the impact of preventive medicine in his brilliant book The Emperor of All Maladies:
"If one plotted the decline in deaths from tuberculosis, for instance, the decline predated the arrival of new antibiotics by several decades. Far more potently than any miracle medicine, relatively uncelebrated shifts in civic arrangements -- better nutrition, housing, and sanitation, improved sewage systems and ventilation -- had driven down TB mortality in Europe and America."
Think, too, of seat belt and helmet laws, food labeling (for trans fats and the like), vaccines for all children, and shifts in public policy to encourage balanced diets and regular exercise. Remember those ads in our state (Washington), "Wash-your-hands-ington!" Brought to you by the state Dept of Health... based on epidemiologic knowledge. Of course hygiene is basically common knowledge now, but we have epidemiology to thank for that knowledge in a broad sense. Epidemiological studies play an important role in public policy, and as the cornerstone of public health, have shaped many aspects of our modern lives, both overtly and covertly.
So you can see that the power of epidemiology lies not only in the analytical and scientific heft of the study, but in advocacy and social health issues as well. There are some who undoubtedly shift uncomfortably in their seats reading about this, feeling that no institution or field should hold such sway. The ethical and moral sway of public health policy is yet another captivating aspect of the field for me. I wonder what Drew Carey thinks of epidemiology?
Good luck and good health, everyone.
Epi-whatever
I have a talent for making cool things boring.
Epidemiology has scientific power.
Siddhartha Mukherjee wrote a brilliant book about cancer. Read it.
WashYourHandsingTon
Libertarians might hate epidemiology.
So just what is epidemiology anyway?
Most people I've told about my wanting to go into epidemiology react in one of three ways. Most frequently people say "What the hell is epi-whatever?" I've been surprised by the number of people who take a stab at what epidemiologists do. "So that's like... some kind of skin doctor?" The least common reaction is "Epi is so cool." Well, okay.
Epidemiology is about tracking disease incidences over time and space. The idea is to quantify data having to do with when, where, and how diseases spread in the hopes of developing measures to slow, stop, and prevent diseases from occurring. There's research and data gathering. There's a lot of statistical analysis involved. I have a talent for making things sound boring.
The power of epidemiology is what fascinates me. The ability to use quantitative data to devise methods and policies to slow infections or incidences of disease or death is incredible. Epidemiology is a fantastic mix of mathematics, biology, and social sciences that can and has allowed for enormous strides in reducing the impact of some of the world's deadliest diseases. The reason for this is the epidemiological emphasis on prevention.
It should be known that prevention of disease has had a far greater global impact on human survival than has treatment. Siddhartha Mukherjee describes well the impact of preventive medicine in his brilliant book The Emperor of All Maladies:
"If one plotted the decline in deaths from tuberculosis, for instance, the decline predated the arrival of new antibiotics by several decades. Far more potently than any miracle medicine, relatively uncelebrated shifts in civic arrangements -- better nutrition, housing, and sanitation, improved sewage systems and ventilation -- had driven down TB mortality in Europe and America."
Think, too, of seat belt and helmet laws, food labeling (for trans fats and the like), vaccines for all children, and shifts in public policy to encourage balanced diets and regular exercise. Remember those ads in our state (Washington), "Wash-your-hands-ington!" Brought to you by the state Dept of Health... based on epidemiologic knowledge. Of course hygiene is basically common knowledge now, but we have epidemiology to thank for that knowledge in a broad sense. Epidemiological studies play an important role in public policy, and as the cornerstone of public health, have shaped many aspects of our modern lives, both overtly and covertly.
So you can see that the power of epidemiology lies not only in the analytical and scientific heft of the study, but in advocacy and social health issues as well. There are some who undoubtedly shift uncomfortably in their seats reading about this, feeling that no institution or field should hold such sway. The ethical and moral sway of public health policy is yet another captivating aspect of the field for me. I wonder what Drew Carey thinks of epidemiology?
Good luck and good health, everyone.
Thursday, May 16, 2013
Just one more thing... what it's all about
By the way everyone, I really am writing this to reach out to other public health students. Epidemiology, biostatistics, medicine, chiropractic, etc etc, I think these can all fall under the wide umbrella of public health. Obviously, anyone with an opinion is encouraged to share it. I want to engage conversation and give reading/viewing recommendations to anyone who reads this, and I hope the reader(s) will provide me with the same.
I've never done this before, so I'll be working on improving content and keeping it interesting and topical. So check back often. Or don't (at your own peril).
Good night and good luck.
-Zach
I've never done this before, so I'll be working on improving content and keeping it interesting and topical. So check back often. Or don't (at your own peril).
Good night and good luck.
-Zach
Medicine is a social science.
I have a tendency to just write and write... so I'm going to start off with a summary here for those who don't care to slog through my inanities:
Medical outcomes have far-reaching social implications.
Paul Starr wrote an informative (but extremely dense) book about it.
Dr. Stephen Bezruchka can tell you what's up with the social determinants of health.
Don't call my writing inane.
I can hear the pre-meds now:
"Medicine is a social science? Bio and chem are not pansy-assed social sciences."
Now look, I know I'm only a student and I don't have much (anything) by way of field experience, but let me be more clear with my contention here. I'm not saying medicine is sociology or something. Medicine is a practice. It is a craft whose goal is to provide the best health outcomes for patients. The tools of the craft are the sciences we all know and love -- chemistry and biology and so on.
But the focus here is health. The health of people. People make up populations. Populations make up society. I know I'm not making any giant leaps here, and this may be a little over-simplified. But I think I'm making my point. Maybe I can clarify and expand on this later.
Actually, there's been a lot of emphasis on the social impact of medicine in the past few years. Instruction in the understanding of and interaction with varying socio-economic and cultural groups is far more common in medical schools these days. This hasn't always been the case. In fact, physicians used to play a much more powerful role in defining legal and societal norms. Some could argue they still do, and in a lot of ways that's true, but not to the same level as it was up until, say, the 1980s. The effects of medical patriarchy, for better or for worse, have had an enormous impact on American life in the last 100 years, intentionally or not. I could say a ton about this, but check out this Paul Starr book for more on medical patriarchy.
So, I'm going to assume you agree with everything you read on here, so you can see that medicine is indeed a social science. Well, yeah. I mean. It should be. It actually kind of isn't. Look, I don't know a lot about medicine. But we know that physicians diagnose and treat diseases prophylactically. In this country we have a health care model that emphasizes tertiary specialties like cardiology and radiology and oncology and neonatology. Of course these are brilliant folks doing amazing work. But I contend there should be more emphasis on prevention.This is where my interest in epidemiology begins.
More specifically, I'm interested in the social determinants of health. What has the greatest impact on the health of populations? Doctors? Their areas of specialization? Medical technology? Pharmacological wizardry? Quality/cost/availability of health care? Individual behavior? Surgeon General's warnings? Each of those is important, sure. But what carries the most weight when it comes to health outcomes?
Socio-economic status.
It's true. But don't take my word for it.
I'm gonna recommend everyone check out Dr. Stephen Bezruchka. Dr. Bezruchka is a lecturer and researcher at the University of Washington who has done phenomenal work in the fields of public health and the social determinants of health. I'll recommend his article "The Hurrider I Go, the Behinder I Get" to start with. Don't let the title fool you, it's actually an extraordinarily informative and brilliant article.
Alright. This is enough for now, I think.
Medical outcomes have far-reaching social implications.
Paul Starr wrote an informative (but extremely dense) book about it.
Dr. Stephen Bezruchka can tell you what's up with the social determinants of health.
Don't call my writing inane.
I can hear the pre-meds now:
"Medicine is a social science? Bio and chem are not pansy-assed social sciences."
Now look, I know I'm only a student and I don't have much (anything) by way of field experience, but let me be more clear with my contention here. I'm not saying medicine is sociology or something. Medicine is a practice. It is a craft whose goal is to provide the best health outcomes for patients. The tools of the craft are the sciences we all know and love -- chemistry and biology and so on.
But the focus here is health. The health of people. People make up populations. Populations make up society. I know I'm not making any giant leaps here, and this may be a little over-simplified. But I think I'm making my point. Maybe I can clarify and expand on this later.
Actually, there's been a lot of emphasis on the social impact of medicine in the past few years. Instruction in the understanding of and interaction with varying socio-economic and cultural groups is far more common in medical schools these days. This hasn't always been the case. In fact, physicians used to play a much more powerful role in defining legal and societal norms. Some could argue they still do, and in a lot of ways that's true, but not to the same level as it was up until, say, the 1980s. The effects of medical patriarchy, for better or for worse, have had an enormous impact on American life in the last 100 years, intentionally or not. I could say a ton about this, but check out this Paul Starr book for more on medical patriarchy.
So, I'm going to assume you agree with everything you read on here, so you can see that medicine is indeed a social science. Well, yeah. I mean. It should be. It actually kind of isn't. Look, I don't know a lot about medicine. But we know that physicians diagnose and treat diseases prophylactically. In this country we have a health care model that emphasizes tertiary specialties like cardiology and radiology and oncology and neonatology. Of course these are brilliant folks doing amazing work. But I contend there should be more emphasis on prevention.This is where my interest in epidemiology begins.
More specifically, I'm interested in the social determinants of health. What has the greatest impact on the health of populations? Doctors? Their areas of specialization? Medical technology? Pharmacological wizardry? Quality/cost/availability of health care? Individual behavior? Surgeon General's warnings? Each of those is important, sure. But what carries the most weight when it comes to health outcomes?
Socio-economic status.
It's true. But don't take my word for it.
I'm gonna recommend everyone check out Dr. Stephen Bezruchka. Dr. Bezruchka is a lecturer and researcher at the University of Washington who has done phenomenal work in the fields of public health and the social determinants of health. I'll recommend his article "The Hurrider I Go, the Behinder I Get" to start with. Don't let the title fool you, it's actually an extraordinarily informative and brilliant article.
Alright. This is enough for now, I think.
Is this a one off?
Hi there.
I'm a junior at the Evergreen State College in Olympia, WA. I'm studying public health and statistics in hopes of continuing on to grad school in the fall of 2014.
I decided I want to write about my experiences as a student, and what it means to be a student of public health today. I'll probably also make ridiculous comments and be super-opinionated and whatever.
I mean, I don't know. This is the Internet. I don't really have to follow any rules. I guess I'll probably just stream-of-consciousness this thing until my interweb bloggy voice develops. All the while, the reader (singular) can rest assured that I'll keep this quote from Robert A. Heinlein in mind as a guiding principle:
"Writing isn't necessarily something to be ashamed of, but do it in private and wash your hands afterward."
Or something like that.
I can hope that I'll contribute something useful (or at least readable) to the reader(s).
Good day.
I'm a junior at the Evergreen State College in Olympia, WA. I'm studying public health and statistics in hopes of continuing on to grad school in the fall of 2014.
I decided I want to write about my experiences as a student, and what it means to be a student of public health today. I'll probably also make ridiculous comments and be super-opinionated and whatever.
I mean, I don't know. This is the Internet. I don't really have to follow any rules. I guess I'll probably just stream-of-consciousness this thing until my interweb bloggy voice develops. All the while, the reader (singular) can rest assured that I'll keep this quote from Robert A. Heinlein in mind as a guiding principle:
"Writing isn't necessarily something to be ashamed of, but do it in private and wash your hands afterward."
Or something like that.
I can hope that I'll contribute something useful (or at least readable) to the reader(s).
Good day.
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