John Pospisil's blogshttp://www.justmeans.com/editorials/health/210.htmlSat, 18 May 2013 19:52:47 GMThttp://www.justmeans.com en hourly 1http://www.justmeans.com/The-Modern-World-of-Sustainable-Finance/49221.htmlSun, 14 Aug 2011 04:34:19 GMTJohn Pospisil The world is full of buzzwords and catchphrases. Sometimes these are counter-intuitive. "Sustainability" brings to mind vision of socially meaningful behavior with long-term goals in mind. In recent years, the word "finance" likely summons memories of a worldwide recession, Greece and Ireland teetering on the brink of total failure and the United Kingdom adopting austerity measures. Specifically in the USA, "finance" can make a person think of bank fraud, a mortgage crisis, TARP, a high rate of Read Full Article ]]> The world is full of buzzwords and catchphrases. Sometimes these are counter-intuitive. "Sustainability" brings to mind vision of socially meaningful behavior with long-term goals in mind. In recent years, the word "finance" likely summons memories of a worldwide recession, Greece and Ireland teetering on the brink of total failure and the United Kingdom adopting austerity measures. Specifically in the USA, "finance" can make a person think of bank fraud, a mortgage crisis, TARP, a high rate of unemployment in the USA and the emerging threat of a second recession. Corporate Social Responsibility (CSR) can seem like an unattainable, unrealistic goal.What is sustainable finance? The operating definition used in a study by Strandberg Consulting is that sustainable finance is "the provision of financial capital and risk management products and services in ways that promote or do not harm economic prosperity, the ecology and community well-being." Rather than being perceived as epicenters of greed and the root cause of economic difficulties in industrial and post-industrial countries, financial asset companies and even the financial markets themselves can have a direct role in sustainable finance.Corporate Social Responsibility, however, can be part of an overall successful, profit-driven business strategy. Although non-governmental organizations and non-profit companies are certainly involved in sustainable financial projects, it does not mean that a company necessarily abandons the concept of profit or only uses resource to contribute to improvement in environmental or social factors.So, what activities can institutions such as banks and other lenders practice to demonstrate a commitment to sustainable finance, while maintaining their proper relationship with shareholders? After all, organizations such as Bank of America, Citibank are in the business of making money and delivering dividends and value to owners. (Disclaimer: the author's former home mortgage was held by Bank of America and coverage of Bank of America here in no way endorses or indicates dissatisfaction with that experience.) Citibank created a $40 million fund to finance rooftop photovoltaic arrays for residences.Who wins? Homeowners, Citibank and SolarCity (whose motto is "turning sunshine into savings"), the company that installs the arrays. Bank of America received recognition at the2011 Financial Times/International Financial Corporation Sustainable Finance Awards. Between 2007 and 2010, BoA dedicated $8.4 billion (out of a planned $20 billion environmental commitment fund) to lending, services and internal activities oriented towards thwarting global climate change.There is a concerted financial effort on the part of BoA in the areas of solar power, wind power, financing research in biofuel and biomass and carbon market services. Clearly, Bank of America expects a positive return on investment, but these activities should be noted as prosocial banking behavior.What are the hallmarks of for-profit companies in terms of corporate social responsibility? Incorporation of CSR into mission statements, adopting innovative measures to finance conservation, long-term financial planning, promoting programs designed for the long-term benefit of employees - including reasonable wages, and integration of sustainable financing into other areas of company interest.My next article will examine a specific project dedicated to environmental conservation with an eye towards the financial programs supporting it.Image courtesy ofThe United States Federal Government athttp://www.ssa.gov/history/wallst.html]]>http://www.justmeans.com/Women-s-Health--Tsunamis--Natural-Disasters--Resilience-and-Coping-Revisited---A-Little-Help-is-Good/48703.htmlTue, 26 Apr 2011 21:08:14 GMTJohn Pospisil A few weeks ago, I posted an article that largely agreed with a researcher's findings that people are naturally resilient and many coping interventions are minimally useful or potentially harmful. A reader responded, and I promised to go back and look at my sources. This article summarizes some positive aspects of coping interventions following natural disasters.Psychosocial support and professional care can be a strong, effective intervention after disasters. In the case of natural disasters, s Read Full Article ]]> A few weeks ago, I posted an article that largely agreed with a researcher's findings that people are naturally resilient and many coping interventions are minimally useful or potentially harmful. A reader responded, and I promised to go back and look at my sources. This article summarizes some positive aspects of coping interventions following natural disasters.Psychosocial support and professional care can be a strong, effective intervention after disasters. In the case of natural disasters, such as the Orissa cyclone of 1999 and the 2004 tsunami that affected many areas including India, psychological support after the event was crucial in recovery and constitutes a meaningful public health intervention in the final stage of disaster response.Cyclone 05B, the Orissa supercyclone, struck many areas in the North Indian basin. It made landfall in India on October 29, 1999. Approximately 16,000 human deaths were directly attributed to the cyclone. Of course, millions were affected in ways ranging from homes destroyed, critical livestock killed and the sanitation and supply problems as aftermath of such events. One positive (and resilient) event to come from the disaster was a training program to assist in providing psychosocial support to survivors of natural disasters. Individuals were taught how to provide support, but also how to train others as well. For better or worse, that program was useful in 2004, when the so-named Indonesian Tsunami struck many places, including India. The presence of trained workers skilled in rebuilding social support allowed for scientific testing of the hypothesis regarding the usefulness of support programs as public health interventions.What does effective psychosocial care in disasters involve? The treatment paradigm revolves around not labeling emotional reactions as mental diseases. Rather than focusing on the potential for depression, anxiety and post-traumatic stress syndrome, a strong treatment program views such emotional reactions as normal responses to the worst-case abnormal events possible.Humans are social beings, and accordingly a focus on social relations after disaster is important. A primary aspect is reliance on community, especially trained community workers skilled in providing emotional support and helping survivors who may have lost many important connections re-establish social connections that are accessible and available. The next most important aspect, according to Dr. Susan Becker, is providing skills to mitigate the potential for adverse, long-term psychological damage. Relaxation techniques might sound impossible to somebody mired in loss and destruction, but they apparently work and are recommended.How does one know this works? Dr. Susan Becker's peer-reviewed article in the American Journal of Public Health (April 2009, Vol. 99, No. 4) compared a control group of 100 Indian women who did not receive psychosocial care after the 2004 tsunami with 100 women who did receive such care. All women were recruited volunteers. Women were chosen as opposed to a cohort consisting of both men and women as previous research indicates that women are approximately three times as likely to report more depression, anxiety and post-traumatic stress responses in response to negative life events than men. This does not mean men are unaffected. For any public health intervention, one has to target individuals most likely to be affected by a given condition whether that is influenza or psychological responses.The intervention by mental health teams lasted three months. Based on self-report scores on a valid and reliable scale (the Impact of Events scale), women who received the psychosocial treatment showed statistically meaningful less emotional distress than women who did not receive such trained support. Subscale measures included hypervigilance, avoidant behavior and intrusive thoughts relative to the disaster, and women receiving treatment had lower scores on the respective subscales than their control group counterparts.Research shows that up to one-third of individuals can show negative psychological symptoms up to one year after a disastrous event. While there may be equivocal research surrounding long-term coping, it is clear that whether through their own means or with skilled assistance, people have the capability to recover from disasters. By itself, that is both impressive and admirable.Image courtesy of U.S. National Oceanic and Atmospheric Administration]]>http://www.justmeans.com/Modern-Drug-Marketing--An-Unsustainable-Model/48518.htmlWed, 20 Apr 2011 18:24:03 GMTJohn Pospisil Cymbalta. Abilify. Lunesta, Chantix and that drug for "when the time might be right." As a consumer and especially as a psychologist, it unsettles me when I see television ads exhorting potential clients to ask a doctor about a specific drug. Even if I do not believe general practitioners or specialists know best, I do not believe consumers should ask for specific drugs. To me, without any science behind my opinion, that seems like patients are being turned into marketing agents for pharmaceutic Read Full Article ]]> Cymbalta. Abilify. Lunesta, Chantix and that drug for "when the time might be right." As a consumer and especially as a psychologist, it unsettles me when I see television ads exhorting potential clients to ask a doctor about a specific drug. Even if I do not believe general practitioners or specialists know best, I do not believe consumers should ask for specific drugs. To me, without any science behind my opinion, that seems like patients are being turned into marketing agents for pharmaceutical companies. The next observation is based solely on my television viewing habits: it seems the number of diseases treatable by drugs, even if used off-label, has grown.According to an article published in the American Journal of Public Health, my unscientific beliefs may really have a scientific basis. Howard Brody, MD, PhD and his colleague, Donald W. Light, PhD identified several trends and cite examples supporting the idea that physicians are pressured to prescribe drugs to a larger population than they were originally intended to treat. As an experimental psychologist, it especially disturbed me to read that 60% of prescriptions for antipsychotics - not trivial drugs with potentially severe and permanent side effect - are for off-label use. Meaning, they are being prescribed for conditions they were not originally meant to treat. The article claims that in 75% of those cases, there was not strong evidence of a positive effect to warrant exposing patients to harm.The authors do cite drug demand being driven by marketing towards consumers as a factor. They also cite "disease-mongering", or reducing the threshold for an existing condition to being diagnosed as a disease as a contributing factor as well. They call the process "the inverse benefit law." According to Brody and Light, the way to look at the "law" is that the more heavily a drug is marketed, the greater chance of harm to the patient rather than good occurs.As thrilled as I was to discover I was not merely paranoid, I had to look up the inverse benefit law. There is dissenting opinion. Not dissenting, exactly, but more complications. Naturally, in the form of how regulatory bodies handle the entire process. Specifically, the dynamic between marketing and the benefit-to-harm ratio may also be affected by a combination of regulation of the pharmaceutical companies and the difference in knowledge about drugs between the manufacturers on one hand and the doctors and their patients on the other.This implies that the effect of the "inverse benefit law" is modified by a combination of regulation designed to prevent abusive marketing and exaggerated claims about product efficacy and safety with increased public awareness of the problem in the first place. This is a classic modern model of a public health approach to solving health problems, for better or worse.If there really is a health problem associated with fabrication of disease states, convincing both the public and physicians to use drugs in unsafe ways, then it constitutes a menace to the public health. Personally, I am quite aware of the financial and scientific difficulties with drug development, clinical trials and getting drugs approved for use and sale. I know a large number of people involved in drug development, and I truly believe not a one of them sets out to create a drug that will be misused or do more harm than good. To me, it is another example of a process that has become so complex with tension created at so many points it may be impossible to ever control.Image provided by a U.S. Army soldier or employee.]]>http://www.justmeans.com/Mental-Resilience---How-People-Overcome-Tsunamis--Meltdowns-and-other-Disasters/47813.htmlSun, 03 Apr 2011 18:42:12 GMTJohn Pospisil The world is full of people suffering. Tsunamis, earthquakes, epidemics and other natural disasters are obvious stressors. Acts of war and terrorism can be traumatic for the perpetrators, victims, medical personnel and bystanders. On a family level, divorce, loss of a spouse, disease, loss of a child and even loss of a pet can be overbearing.Stress by itself can make one sick. Hans Selye was one of the first to report that as awful as these events are, it is actually the number of minor stressor Read Full Article ]]> The world is full of people suffering. Tsunamis, earthquakes, epidemics and other natural disasters are obvious stressors. Acts of war and terrorism can be traumatic for the perpetrators, victims, medical personnel and bystanders. On a family level, divorce, loss of a spouse, disease, loss of a child and even loss of a pet can be overbearing.Stress by itself can make one sick. Hans Selye was one of the first to report that as awful as these events are, it is actually the number of minor stressors (how often you lose your keys and cell phone when you need to go to work immediately) that correlate most highly with rates of illness.Conventional thinking mandates that "survivors" of traumatic events are inherently at risk of stress-related illness, including mental illnesses such as post-traumatic stress syndrome, anxiety and depressive disorders. Grief and trauma counseling are industries, and it's practitioners are called in after events almost as a knee-jerk reflex. Public policy in some cases dictates that such professionals arrive at disaster and other catastrophic scenes as soon as possible to speed "the healing process."But is it necessary? Or even a good idea? In other words, is this belief about the inherent frailty of humans scientifically valid?George Bonanno, a leading researcher at Columbia University who studies grief, bereavement and resilience, thinks not. Quite the opposite, Bonanno's research indicates that the grief counselors and near-mandatory traumatic crisis interventions can do more harm than good. Published in "Weighing the Costs of Disaster: Consequences, Risks and Resilience in Individuals, Families and Communities", there is evidence across multiple studies that psychological resilience is common. This is not meant to ignore the negative consequences people can experience following traumatic incidents. Post-traumatic stress syndrome, depression, substance abuse as a maladaptive coping strategy and damaged social relationships do happen. The more psychological and social resources available reduce the likelihood, severity and duration of adverse consequences such that only a minority of individuals are extremely affected. In other words, the majority of people are inherently resilient and thus resistant through potentially traumatic events.Some individuals even show little or no grief after significant losses. Bonanno's work shows that these people are not cold sociopaths, but are essentially "immunized" by virtue of their psychological resilience. So, if resiliency can provide resistance, can people be trained in becoming resilient? Given that awful things do happen to everybody at some point in time, resilience training might be a wonderful psychological and physical investment. The U.S. Army believes there is a significant payoff in assessing positive coping traits and teaching resilience skills to it's soldiers. Among other events, war veterans are at greater risk of homelessness than other members of society. The organization launched a five-year, $125 million program involving 800,000 troops. Soldiers participate in psychological assessments and each months 150 participate in a University of Pennsylvania program to learn how to teach resiliency to others. The long-term hope is that a significant database will exist that can be tapped by civilian researchers to better understand factors that cultivate and impede the development of psychological resilience.Bonanno, however, remains skeptical. Given that most intervention programs either do no good or actually do harm, what will the Army program accomplish? Will resilience improve across the board, or would otherwise normal, healthy, resilient soldiers be rendered more susceptible to negative outcomes? Will this become $125 million well-spent, or $125 million worth of harm? Without even meaningful pilot data, there is no current scientifically valid answer.Image courtesy of U.S. National Oceanic and Atmospheric Administration]]>http://www.justmeans.com/Human-Trafficking-as-a-Public-Health-Crisis-Part-3---What-One-Person-Can-Accomplish/47698.htmlFri, 25 Mar 2011 19:38:13 GMTJohn Pospisil What can one person accomplish? Dr. Paula Heron is a a postdoctoral fellow at the University of Kentucky. Born in Zimbabwe, she's lived most of her life in South Africa. Ten years ago, Ms. Heron came to the US to complete her Ph.D. in neuroscience and has remained here. She decided to combine her triathlon experience with a passionate stand against human trafficking. The following is a verbatim record of my interview with Dr. Heron. For her, it began with a movie...1.. What is Tri4Freedom and wh Read Full Article ]]> What can one person accomplish? Dr. Paula Heron is a a postdoctoral fellow at the University of Kentucky. Born in Zimbabwe, she's lived most of her life in South Africa. Ten years ago, Ms. Heron came to the US to complete her Ph.D. in neuroscience and has remained here. She decided to combine her triathlon experience with a passionate stand against human trafficking. The following is a verbatim record of my interview with Dr. Heron. For her, it began with a movie...1.. What is Tri4Freedom and when did you start it?"Tri4freedom is something I conceptualized less than a year ago with the intention of using the sport of triathlon as a platform to raise public awareness about human trafficking. The success and effectiveness of this mission hinges upon the support and commitment of fellow triathletes and community at large willing to take a stand against human trafficking."2. What motivated you to take such an interest in human trafficking?"Initially my own awareness about human trafficking stemmed from a movie about a young woman from an eastern European country who thought she was coming to the United States to pursue a dream job as a model but once she arrived she was forced into sex slavery. What struck me was the relative ease with which this travesty was committed by the trafficker and the finality of what had occurred from the victim's perspective. The excitement associated with arriving in a new country - something I can well relate to - is abruptly replaced with an indescribable fear. This I find terrifying and the realization that human slavery occurs within our communities and areas we deem safe to live, haunts me."3. How surprised are people to learn the extent of human trafficking, both in sheer numbers and global extent?"I have found that the majority of people I speak to either have no idea what human trafficking is or they have heard of it but fail to recognize how prevalent it is in the United States. Most people see it as a third-world issue. People's responses have varied greatly when they hear that human trafficking occurs in their own cities. Some people prefer to continue ignoring the issue, while some are alarmed and take a genuine interest in what they can do to help the situation."4. It's literally an ancient crime. In terms of modern solutions, do you feel governments willfully ignore human trafficking or is it just so difficult to solve that it slips below the radar?"Governments are certainly aware of the issue. Many states have anti- human trafficking laws; however law enforcement alone is not sufficient to combat the problem. The Not For Sale Campaign, a non-profit organization committed to the fight against human trafficking, maintains that abolishing slavery can only be achieved by creating a community task force. I think the fact that human trafficking occurs unnoticed to the general public has contributed to its escalation into the 32 billion dollar industry it is now. If people knew the extent of human trafficking it should prompt public outrage which would force governments into finding effective ways to combat it."5. How doe Tri4Freedom help the problem?"As an individual deeply disturbed by the issue of human trafficking I created tri4freedom in an attempt to merge my passion for triathlon with my desire to see an end to human slavery. Firstly, Tri4freedom can raise substantial awareness about human trafficking within the triathlon community, including spectators of major races such as Ironman. Secondly, Tri4freedom aims to support The Not for Sale Campaign by raising funds and highlighting the efforts this organization is doing to combat the issue."6. Why the link between triathlon and the cause?"Triathlon by definition is comprised of three sports presenting a challenge that only the most dedicated and zealous individuals find appealing. Not surprisingly, demographics have indicated that the majority of triathletes are highly successful and educated professionals. For this reason I am hopeful that tri4freedom will spark enthusiasm from fellow triathletes who are entrepreneurs, lawyers, healthcare workers, teachers and community leaders. Collectively triathletes are in professional positions most likely to have an influential impact on finding effective solutions to combat human trafficking."7. How much support are you receiving through the Tri4Freedom website? Domestically, internationally?"The support I have received so far has stemmed from letters I have written requesting sponsorship or from individuals that know me. The purpose of the website is to provide interested people with information and resources to help in the fight against slavery. As I promote my site more in the coming months I hope to achieve greater support from the general public and fellow triathletes."8. Who are some of the "good actors" organizations that either partner w/Tri 4 Freedom or provide support in some way?"First and foremost the Not For Sale Campaign has demonstrated continuous support for Tri4freedom, which is raising funds for their Free2play initiative. In collaboration with this organization, we are working on promoting fair trade athletic apparel and increasing media awareness about Tri4freedom's contribution to their efforts in abolishing human slavery.Local businesses have been very supportive. Most notably, Green's Toyota of Lexington has provided financial assistance to help promote the Tri4freedom event in June. This event would not have been possible without the support of SpindleTop Hall who kindly offered to host the event and help with local promotion. Ad-Venture Promotions, and In His Image Designs have also shown enthusiastic support for Tri4freedom. HFP racing has been very supportive in helping promote Tri4freedom at two of their race weekends this summer which will reach almost 1500 athletes. Newton Running has generously donated a free pair of their running shoes for me to wear during my 27 hour triathlon."9. What is this 27-hour event you are planning this summer?June 18th-19th I will do a solo triathlon lasting 27 hours, which I named "Free2tri" after Free2play, which is the sole recipient of all funds we raise. 27 hours has significance- 27 million people are currently enslaved around the world. The event will be hosted by Spindletop Hall and will begin at 6am starting with a 2.5 hour swim, followed by a bike ride until sunset and ending with an overnight run until 9am the following morning. In collaboration with Not For Sale and our sponsors, planning is underway to encourage public attendance and donation incentives. As the date approaches we will release updates on the website. The purpose of "Free2tri" is to showcase Tri4freedom in the hopes of gaining athlete support, to raise funds for the Not For Sale Campaign and most importantly to highlight the widespread travesty of human trafficking.10. How can individuals help draw attention to and combat the problem of human trafficking?Talk about it. Get angry. Acknowledge that human trafficking exists and accept the reality that an end to human trafficking is going to require a change in behavior. For example one way to help is by only purchasing fair trade products. This ensures that employee's lives are enhanced. The current reality is that fair trade is expensive because there is no overwhelming consumer demand to drive the price down. We need to demand that companies and their supply chains adhere to a slave-free workforce. The success of this approach has been demonstrated in the chocolate industry where a few companies have been pressured by the public to make their chocolate fair trade.People could further this issue by being vigilant in identifying potential victims of human trafficking and contacting local authorities or dialing the National Human Trafficking hotline 1888-3737-888. There are numerous resources available on the web that describes human trafficking cases and how the public can help. I good place to start is http://www.notforsalecampaign.org and my site http://www.tri4freedom.com Image courtesy of Paula Heron at Tri4Freedom.com]]>http://www.justmeans.com/Human-Trafficking-as-a-Public-Health-Crisis--Part-2/47497.htmlWed, 23 Mar 2011 21:24:31 GMTJohn Pospisil This is the second part of a three-part series focusing on human trafficking from a public health perspective.Malaria affects over six million people per year. Worldwide, more than two million individuals are infected with tuberculosis. Each year, there are about two - three million new people who are newly infected with HIV. Each disease is considered a public health problem and is preventable. The World Health Organization estimates that up to four million people are direct victims (captives) Read Full Article ]]> This is the second part of a three-part series focusing on human trafficking from a public health perspective.Malaria affects over six million people per year. Worldwide, more than two million individuals are infected with tuberculosis. Each year, there are about two - three million new people who are newly infected with HIV. Each disease is considered a public health problem and is preventable. The World Health Organization estimates that up to four million people are direct victims (captives) or indirect victims (for example, affected by disease or family member loss) of human trafficking. If 16,000 US citizens died from an epidemic, there might reasonably be national outrage. However, 14,500 - 17,500 individuals, including children, are estimated to be illegally brought into the United States per year for the purposes forced labor, among other crimes. It is even more difficult to estimate how many people once within US borders are moved between states and communities without leaving the country. Worldwide, hundreds of thousands of men, women and children are direct victims.The standard governmental model for handling criminal behavior includes punishment for offenders, protection for victims and despite best intentions, preventive measures come last. Human trafficking is a complex social and economic problem, much like the war on drugs. Similarly, it cannot be stopped by single, law-enforcement focused approach. Criminal law tends to address events after they have occurred rather than through encouraging attitudinal and behavioral change. To abate human trafficking, it might be time to change tactics to put a premium on prevention.Even if one does not view human trafficking as a public health problem, there are aspects of the model that fit well in this fight. Public health is a unique field among the health professions. There is a focus on populations rather than individuals and prevention rather than cure. It is a scientific, evidence-based endeavor with a firm link to government and politics. Additionally, outcomes of violence prevention initiatives benefit from a public health model, so it seems reasonable to extend this methodology to human trafficking.Following the model proposed by the Center for Disease Control for preventing violence, there are four steps that must be fulfilled. The root cause of trafficking must be understood. This means a scientific analysis that evaluates individual risk factors, social relationships that increase personal risk, the role of the local environment and community and finally sociocultural standards.Public health campaigns must bring the problem to a level of social consciousness. According to the report "U.S. Awareness of Human Trafficking: Executive Summary of Survey Findings", most Americans are quite unaware that the United States is affected. Individuals, communities and non-governmental organizations can, if motivated, provide government officials with feedback about what efforts work well for the local population, what resources are necessary and generally guide lawmakers on how government can effectively intervene rather than government blindly and unwisely throwing resources at the problem.Finally, at the level of personal responsibility, each person should be able to see how even small actions can help ameliorate the issue of human trafficking. Just in the same way that people learn how diligent hand-washing and how to properly "cover and cough" can help prevent the spread of colds and the flu, small efforts can make a difference. The next posting in this series examines one person's efforts to raise awareness about the problem of human trafficking and how to combat it.Image courtesy of Antonu]]>http://www.justmeans.com/Human-Trafficking-as-a-Public-Health-Crisis/47439.htmlMon, 21 Mar 2011 22:04:19 GMTJohn Pospisil Jonathan Todres, Associate Professor of Law at Georgia State University, has a unique perspective on human trafficking. Whether this complex crime is a public health problem or not, Todres views it as a treatable disease using the public health model of prevention first. His paper, Moving Upstream: The Merits of a Public Health Law Approach to Human Trafficking presents the argument that governments could attack the problem of human trafficking similarly to health hazards such as smoking, commun Read Full Article ]]> Jonathan Todres, Associate Professor of Law at Georgia State University, has a unique perspective on human trafficking. Whether this complex crime is a public health problem or not, Todres views it as a treatable disease using the public health model of prevention first. His paper, Moving Upstream: The Merits of a Public Health Law Approach to Human Trafficking presents the argument that governments could attack the problem of human trafficking similarly to health hazards such as smoking, community violence and highway fatalities. While such a preventive, public health approach is insufficient by itself, this represents a method uniquely different from standard criminal law model currently in place in many countries. This is the first of a three-part series on the health consequences of human trafficking, along with government and non-governmental efforts to prevent the problem.Forced labor. Sexual exploitation and forced prostitution. Debt bondage. Anything that constitutes the unlawful motion of men, women and children into slavery-like practices and conditions can constitute human trafficking. It is a global phenomenon, including within the United States, but does occur more frequently in underdeveloped countries and states where human rights are not as protected. The Institute of Medicine defines health as a complete state of physical, mental and social well-being, and human trafficking clearly does not mesh with that vision. Aside from gross repugnance, what are some of the public health concerns such a violation raises?Individuals in forced labor situations often are channeled into poorly-regulated work environments. Agriculture, mining, manufacturing and construction industries using such workers may be overcrowded, have improper indoor environments, present harm to workers by exposure to toxic and carcinogenic materials and be generally unsanitary. These conditions are precisely what allow for the development and spread of diseases such as malaria, tuberculosis, and cholera depending on the location. This clearly constitutes an environmental health problem.Sexually-transmitted diseases (STDs) are a recognized public health problem. Not surprisingly, individuals involuntarily made participants in involved in exploitative work environments are at greater risk of contracting and spreading HIV and other STDs. This can occur within local populations, but can spread across international borders as humans are transported from one area to another. Finally, the World Health Organization provides data showing that human trafficking has a specific population-based effect with prevalence considerably greater than other diseases, even in industrialized countries. Infectious diseases and diseases more specific to sanitation such as cholera that are more prevalent in underdeveloped countries are of minimal concern in the United States. For example, less than 5000 cases of tuberculosis were reported in the United States in 2007. In contrast, approximately 15,500 individuals are estimated to have been smuggled into the United States in 2007. From an epidemiological perspective, this constitutes a public health crisis. The victims of human trafficking directly suffer illness, injury, violence, and mental disorders such as post-traumatic stress syndrome as result of the conditions in which they are forced to work and live. Combined with risks inherent even in transporting smuggled humans across borders, and one sees a total condition in which not only are victims directly harmed, but populations in proximity - even if uninvolved - are placed at risk as well. His paper, Moving Upstream: The Merits of a Public Health Law Approach to Human Trafficking can be downloaded free of charge from The Social Science Research Network Electronic Paper Collection at http://ssrn.com/abstract=1742953.Image courtesy of Antonu]]>http://www.justmeans.com/Public-Health-Indicators-in-Libya-Higher-than-Expected--but-Revolt-Disrupts-Services/45930.htmlSat, 26 Feb 2011 22:12:33 GMTJohn Pospisil Doctors Without Borders/Mdecins Sans Frontires (MSF) finally has an eight-person team inside Libya, and reached three medical in facilities Benghazi. MSF issued a press release on their website indicating that the original team of six, along with medical and surgical supplies, was blocked at the Tunisian - Libyan border.While it is currently unclear what the long-term health care needs in Libya will be after the revolt, there is an immediate crisis caused by a shortage of medical supplies and a Read Full Article ]]> Doctors Without Borders/Mdecins Sans Frontires (MSF) finally has an eight-person team inside Libya, and reached three medical in facilities Benghazi. MSF issued a press release on their website indicating that the original team of six, along with medical and surgical supplies, was blocked at the Tunisian - Libyan border.While it is currently unclear what the long-term health care needs in Libya will be after the revolt, there is an immediate crisis caused by a shortage of medical supplies and a large number of individuals wounded during protests. Revolution and war clearly disrupt health services, and the aftermath can leave the health care system of a country shattered and overwhelmed. Especially in failed states such as Afghanistan and Somalia where services are poor, conflict takes a bad situation and worsens it. Discounting loss of facilities, personnel and supplies, intervening public health workers are likely to find the post-revolt situation somewhat better in Libya than one might expect.The World Health Organization (WHO) classifies Libyan Arab Jamahiriya is classified as being in the Eastern Mediterranean region. This is a particularly volatile area notably containing but not limited to Palestine, Pakistan, Afghanistan, Lebanon, Iraq, The Islamic Republic of Iran, Somalia and Sudan. This is a region where polio eradication is still a challenge. Wealth from oil deposits in conjunction with renewed commercial ties to the Unites States at the end of 2003 (President Bush offered to reinstate ties with Libya after the latter ceased work on its nuclear, chemical and biological weapons programs allowed Libya to develop a relatively strong health care infrastructure.By most available measures, the average citizen in Libya in 2008 was in a much better social and economic condition than those in other Eastern Mediterranean countries. The average Libyan earned approximately four times the regional average per year, had a greater life expectancy at birth, a lesser chance of dying prior to the age of five and reduced risk of death due to communicable diseases. There was significantly more medical staff per capita, especially nurses. The government provides free health care for citizens, and immunization rates are high. While one often thinks government-provided health care means total government control, there has recently been an increased emphasis on supporting private clinics and hospitals. Primary care is emphasized over specialty practices.The country is also on the developed side of the epidemiological shift: people are at greater risk from noncommunicable diseases such as cardiovascular disease, diabetes, and cancer than communicable diseases. As is often the case with lifestyle diseases, there has been a concomitant rise in risk factors such as obesity and smoking. Even traffic accidents represent a major burden of disease, with four - five deaths daily among a population of 5.5 million. Surprisingly, slightly less than 3% of the Libyan Gross Domestic Product is spent on national health care. In contrast, the United States federal government spent approximately 17.6% of Gross Domestic Product on health care. That is just over $8000 per person and the rate of spending is only predicted to increase. Photo credit: CIA World Factbook]]>http://www.justmeans.com/New-Premiums-Reduce-Participation-in-Children-s-Health-Insurance-Plan/45839.htmlFri, 25 Feb 2011 19:01:00 GMTJohn Pospisil New premiums were blamed when families took more than 3000 children out of the Children's Health Insurance program in Kentucky. The same occurred in Arizona, when families meant to be helped by the state insurance program were unable or unwilling to pay the relatively small premium for coverage. Over 1000 children were removed from the insurance program in Arizona. The Patient Protection and Affordable Care Act, also known as "health reform", "Obamacare" or any number of names depending on one's Read Full Article ]]> New premiums were blamed when families took more than 3000 children out of the Children's Health Insurance program in Kentucky. The same occurred in Arizona, when families meant to be helped by the state insurance program were unable or unwilling to pay the relatively small premium for coverage. Over 1000 children were removed from the insurance program in Arizona. The Patient Protection and Affordable Care Act, also known as "health reform", "Obamacare" or any number of names depending on one's political leanings, is one of the most complex pieces of legislative work in decades. The American health care system is currently one of the most regulated industries in the country, for better or worse. All parties seem to agree that some level of reform is due, but there are very basic questions for which are provided no substantial answers. For example, what will it cost each citizen, and what will the government pay directly? Will a revamped American system mirror Canadian, European or an Australian model? Who will be helped and who is left out?Fear of change in part stems from fear of the unknown. The Children's Health Insurance Program (CHIP) can be looked at as a proving ground for aspects of national health care policy. One study published in the December 2007 issue of Health Services Research isolated aspects of price and enrollment on what was then known as SCHIP.SCHIP enrollment data was collected in Arizona from July 2001 to December 2005 and in Kentucky from November 2001 to August 2004. New premiums were introduced for certain income groups in Arizona in 2004 and Kentucky in 2003. In Arizona, this meant a fee of $10 per month for one child and $15 per month for two or more children for families with incomes at or below 150 percent of the Federal Poverty Level (FPL). Kentucky families with incomes between 151 and 200 percent of the FPL were hit with a new premium of $20 per month per family. Advanced statistical models were used to analyze the data. Hazard analysis is a technique separating events into categories of severity and likelihood of occurring. This method let researchers understand why individuals left or remained in the SCHIP programs and if they left, where they went. Time series analysis looks for trends and internal structure in the data and was used to examine changes in worker caseload as premiums changed. The effect in both states indicated that the new premiums caused an increase in program dropout and a drop in the number of children re-enrolled. In short, the new premiums caused the SCHIP program to be less effective at providing health insurance coverage. Any national health care policy is so complex that a small shift in one variable will affect others in ways impossible to imagine - think of The Law of Unintended Consequences. However, insurance premiums are known to perform at least two functions: reduce public costs and reduce the number of public participants. That is a good starting point as the country renews the national health care debate.Photo Credit: Analoguni]]>http://www.justmeans.com/Regenerative-Medicine-Technique-Speeds-Healing-of-Burn-Wounds/45647.htmlWed, 23 Feb 2011 22:50:05 GMTJohn Pospisil A new medical technique can dramatically improve healing time for severe burn wounds. The device looks more like a gadget from Doctor Who than one from a surgery room. And the stem cells that form the tissue for healing the patient come from the patient.People with serious injuries such as partial-thickness burns covering significant portions of their bodies are told two things on the way to the hospital: the good news is if the burns were worse, they might die. The bad news is that recovering f Read Full Article ]]> A new medical technique can dramatically improve healing time for severe burn wounds. The device looks more like a gadget from Doctor Who than one from a surgery room. And the stem cells that form the tissue for healing the patient come from the patient.People with serious injuries such as partial-thickness burns covering significant portions of their bodies are told two things on the way to the hospital: the good news is if the burns were worse, they might die. The bad news is that recovering from substantial partial-thickness burns can be one of the most painful and expensive medical experiences they will likely face. The standard treatment involves surgical and mechanical debridement, skin grafts, a rigorous hygiene schedule, and even with prescription narcotics there is significant pain. Thirty days out-of-work or more is common.While the process of spraying skin cells was invented in Argentina approximately twenty years ago, a significant leap in quality improvement was made by Dr. Fiona Wood in Australia. She and her team reduced the time required to culture the volume of new cells sufficient to cover large wounds from 21 days to 5 days. Growing large sheets of skin for grafting is not a new idea either. Time is a significant factor in burn recovery. The longer it takes for new skin to be cultured and grafted to the patient, the more opportunity there is for infections to develop. Lethal Infections can develop beneath newly-grafted skin as well.A joint research effort by the USA and the UK funded a team led by Professor Joerg C. Gerlach and others at the Department of Surgery at the University of Pittsburgh's McGowan Institute for Regenerative Medicine. Instead of relying on hand-pumped delivery systems, they took after professional painters and engineered the device that lets them spray skin cells onto a patient the way anybody would paint a fence: gently. The hand-pumped delivery devices worked more like pressure washers, and could damage the skin.The technique sounds deceptively simple. A sample of healthy skin is taken from the patient; stem cells are isolated from the sample and combined with water. The burned areas are sprayed with the mix. Normally, partial-thickness burns can take weeks or months to heal. This new method lasts approximately ninety minutes from cell-harvesting to cell-spraying, and burned areas can improve significantly in as little as three days. Cell growth is promoted by a treated bandage placed over the newly-sprayed skin. The bandage is coated with a mix of nutrients and antibiotics to sustain the growing cells and prevent infection while healing begins. There is one misconception surrounding Professor Gerlach's technique. Individuals are not totally healed in three days. The burn wound may resemble a dry wound needing no bandages after three or four days. For a burn patient, that is a hugely significant benefit.The next therapeutic wave is likely to come from tissue engineering. Synthetic cells combining organic material with a matrix of nanofibers, tissue grown outside a patient to later be transplanted, and methods and materials of speeding up healthy cell growth are all open fields. As early as 2005, transplanting insulin-producing pancreatic cells seemed to offer a cure for type 1 diabetes. An altered HIV virus has been used to attack breast cancer cells in mice. The future can only get better.Photo credit: US Gov]]>